Prevalence of early childhood caries and enamel defects in four and five-year old Qatari preschool children

Perceptions of mothers of preschool children towards oral health services - a qualitative study

BACKGROUND

Poor oral health, especially dental caries in early childhood is a major public health concern. Parental oral health knowledge, behavior, and perceptions are important elements in determining the child's oral health status. The aim of the study was to investigate the perceptions of mothers of preschool children in Qatar towards their children's oral health and their experiences with oral health services provided to children.

METHODS

The study is based on qualitative methods using focus groups. Purposive sampling was used to recruit mothers of preschool children at two kindergartens in the city of Doha, Qatar. The focus group consisted of a series of open-ended questions about the oral health of children and the opinion of mothers towards the current oral health services provided in the country. An inductive thematic content analysis at the statement level approach was used to analyze the qualitative data.

RESULTS

Twelve mothers between the ages of 20 and 41 years old from two kindergartens participated in two separate focus groups. The average number of children per mother was 5 with 45 months being the mean age of children. Several themes emerged from analyzing the data retrieved from the discussion with mothers. For oral health knowledge, mothers demonstrated a different level of oral health knowledge, from good to poor. As for experiences with health services, recognized the value of oral health services in Qatar but expressed difficulties in access to oral health services for their children with almost all having had some negative experiences. Regarding the anticipated role of mothers in the oral health of their children, mothers were very positive about their potential role in supporting their children's oral health. The mothers also gave recommendations to improve oral health services for young children.

CONCLUSION

Mothers showed positive attitudes towards the oral health of their children and they recognized the importance of a good oral health care system.

Oral health promotion: a qualitative study to explore perspectives of kindergarten nurses at Qatar

BACKGROUND

The oral health of preschool children remains a concern globally. Kindergarten and school nurses can improve oral health by reducing the incidence of Early Childhood Caries (ECC) among children. This study aimed to explore the perceptions of kindergarten nurses about a proposed oral health promotion program to be implemented in primary health centres and kindergartens.

METHODS

The qualitative research used in-depth interviews of 12 kindergarten nurses who were audio-recorded and transcribed verbatim. Qualitative data analysis software was used (NVivo9 MANUF). Four major themes emerged and were analysed to explore contextual patterns within the data.

RESULTS

The major themes included participants acknowledged the high prevalence of caries in children and identified several causes within the local context, including parental practices, poor dietary habits, the impact of cultural lack of oral health knowledge and limitations in the healthcare system. However, the study results' themes also revealed complex barriers and enablers regarding the implementation of the program highlighting interpersonal, structural, systemic, and social elements.

CONCLUSION

Kindergarten nurses maintained an affirmative attitude towards oral health promotion programs and were enthusiastic about initiating and supporting these programs. This qualitative study brought out critical socio-biological-cultural factors that influence the oral health promotion of preschool children.

Oral Health of 7- to 9-Year-Old Children Born Prematurely-A Case-Control Observational Study with Randomized Case Selection

Background: Along with the long-term sequelae of preterm birth for general health, oral health is potentially influenced by prematurity due to developmental and behavioral peculiarities. Objectives: This study aimed to compare oral health parameters in the mixed dentition of prematurely and full-term born children. Methods: Dental caries, developmental defects of enamel (DDE), and gingival inflammation were assessed in 7-to-9-year-old children (n = 38) born preterm (PT) compared to a matched control group born full-term (FT) in Germany. Dental caries was recorded using the International Caries Detection and Assessment System (ICDAS II) and DMFT/dmft-criteria. DDE was scored with modified DDE-Index and periodontal health by Periodontal Screening Index (PSI). Statistical analysis included McNemar's test and Poisson regression. The significance level was p ≤ 0.05. Results: Caries prevalence was 47.4% in PT and 57.9% in FT. In the primary dentition, FT children were significantly more affected than PT children (1.6 dmft vs. 2.7 dmft; p = 0.035). PT children with extremely low birthweight (ELBW) had the highest caries experience (3.2 dmft; 1.0 DMFT). Prevalence of DDE in primary teeth was significantly higher in PT (55.3%) than in FT children (28.9%; p = 0.008). PSI was 3.8 in PT and 3.3 in FT children, but significantly higher in PT children with ELBW (7.4; p = 0.125). Conclusions: PT children are at higher risk for DDE in primary teeth and compromised periodontal health than FT children. Children with ELBW are most susceptible for dental caries and gingivitis.

The Hall technique: knowledge, practice, and concerns of dentists in primary care settings in the State of Qatar-a questionnaire-based survey

PURPOSE

To assess the knowledge, practice, and concerns about the Hall Technique among pediatric dentists (PDs) and general dental practitioners (GDPs) working in primary care settings in the State of Qatar.

METHODS

A prospective questionnaire-based survey was distributed to all GDPs and PDs working at different Primary Health Care Corporation centers in Qatar between 1 November and 10 December 2023. Descriptive data analysis was carried out.

RESULTS

The response rate was 49% among GPDs and 100% among PDs. Approximately 85% of PDs and 48% of GDPs were familiar with the HT although only 58% of the PDs and 4% of the GDPs applied HT preformed metal crowns (HTPMCs) in their current primary care practice. Majority of both PDs and GDPs did not consider HTPMCs as the treatment of choice for restoring asymptomatic carious primary molars and preferred applying the HT for cavitated carious lesions over non-cavitated lesions. Regarding HT practices, 57.7% of PDs and 48% of GDPs always planned on taking a pre-operative radiograph before the procedure, while only 15.4% of PDs and 8% of GDPs would always consider using an orthodontic separator prior to placing an HTPMC. The main concerns among the respondents about the HT included sealing in caries (PDs 31%; GDPs 50%), high occlusion (PDs 57.7%; GDPs 53.3%), and gingival damage (27% PDs; 47% GDPs.) Endorsement by professional bodies and further research evidence were seen as ways to promote wider adoption of the HT.

CONCLUSION

The HT is recognised but not widely used among primary care dentists working in the State of Qatar. HTPMCs are often seen as secondary options for restoring carious primary molars with dentists still having a number of concerns regarding the HT.

Oral health knowledge, attitudes, and practices among female public health and nutrition university students in Qatar

Objectives

The present study aimed to determine oral health (OH) related knowledge, attitudes, and practices among Public Health (PH) and Nutrition (NU) students at Qatar University.

Method

A cross-sectional study was conducted using a pre-validated questionnaire comprising 36 items covering demographics, knowledge, attitudes and perception of oral health practices. Data were analyzed descriptively (means, standard deviations, proportions) and inferentially using statistical tests including t-tests for comparing means, and chi-square tests for examining associations between categorical variables.

Results

A total of 112 female undergraduate students participated, including 41 from PH and 71 from NU programs (response rate for both courses = 59.5%). The mean age was 21.8, while 23% were Qataris and 77% non-Qataris. Overall, students demonstrated good knowledge of OH (67.65%), with the PH group scoring higher (70.7%) than NU (65.35%). Knowledge regarding dental plaque was low for both groups (31.0%). Attitudes toward OH varied among participants. Most students reported practicing brushing with fluoridated toothpaste and demonstrated high knowledge regarding the association between poor OH and general health (95%).

Conclusion

Overall, PH and NU undergraduate students exhibited relatively good knowledge of OH, however, demonstrated a range of attitudes and practices, including suboptimal ones. Integration of OH education into the PH and NU curriculum is warranted, along with enhanced interprofessional education to promote self-awareness and improve patient oral health outcomes.

Content of cariostatic trace elements (F, Cu, and Zn) in the commercially packaged and public tap waters of Qatar

Objectives

Drinking water containing optimal levels of cariostatic trace elements is an effective preventive approach against community-wide dental caries. This study aimed to (i) determine the concentrations of fluoride, copper, and zinc in commercially packaged and public tap water available in Qatar, (ii) assess the accuracy of the content of these cariostatic trace elements on commercial water brand labels, and (iii) check for seasonal fluctuations in the levels of these trace elements in commercial and public water samples.

Methods

Duplicate samples from 20 commercial and six public tap water sources were collected once in the summer and winter seasons. Water samples were evaluated for fluoride concentration using ion chromatography (IC), whereas copper and zinc concentrations were estimated using inductively coupled plasma mass spectrometry (ICP-MS).

Results

The fluoride content of all commercial and public water samples was below the 0.25 mg/L detection limit of the IC instrument. Commercial water brands had copper and zinc levels below the ICP-MS detection limits (1.22 μg/L for copper and 0.24 μg/L for zinc). Copper levels in the public water samples ranged from <1.22 μg/L to 11 μg/L. Zinc levels in the public water samples ranged from 5 μg/L to 40 μg/L. Thirteen commercial water brands labelled their fluoride content, with most showing labelled fluoride levels <0.1 mg/L, consistent with the results of this study. The difference in trace element content between the summer and winter water samples was not statistically significant (P > 0.05).

Conclusions

Lower optimal cariostatic trace element content in the drinking water in Qatar could be a reason for the exceptionally high prevalence of dental caries. The results of this study could lead to public health advocacy for supplementing drinking water in Qatar with cariostatic trace elements that could potentially lower the prevalence of dental caries.

Correlates of childhood caries: A study in Qatar

BACKGROUND

The prevalance of dental caries in children in Qatar is high, which necessitates preventive efforts.

AIM

To identify the sociodemographic and behavioural correlates of dental caries in the primary dentition of children 4- to 8-year-olds in Qatar.

DESIGN

Weighted data from the Qatar Child Oral Health Survey 2017 were analysed for caries prevalence (dmft>0) and experience (dmft). Sociodemographic and behavioural variables were also drawn from the survey.

RESULTS AND CONCLUSION

Among the 1154 children, caries prevalence was 69.3% (95%CI [63.4, 74.5]) and experience at 3.8 dmft (95%CI [3.3, 4.2]). The prevalence ratio (PR) 0.82 (0.72, 0.94) was lower among younger than in older children; those for non-Qatari nationality Arabic PR 0.91 (0.82, 1.00) and Other PR 0.75 (0.57, 0.99) than for Qatari nationality; those attending international kindergartens/schools PR 0.89 (0.80, 0.99) than independent schools; and whose parents had university-level education PR 0.85 (0.75,0.95) than did not. Caries prevalence was lower among those toothbrushing by age 3 years PR 0.88 (0.80,0.99) than later; children with low/intermediate sugar exposures PR 0.85 (0.74,0.97) and 0.89 (0.79,1.00) than those with high exposures; children with a dental check-up PR 0.68 (0.53,0.87) than those without; and children who drank bottled water with some fluoride PR 0.89 (0.80,0.99) than those who did not. Findings were similar for dmft. In conclusion caries prevalence varied but was high across sociodemographic correlates indicating vulnerablity. Interventions focusing on behaviours - such as toothbrushing, reducing sugar intake, check-up and encouraging intake of water with fluoride - are needed.

Barriers and enablers for oral health promotion programs amongst primary healthcare stakeholders in Qatar - a qualitative investigation

BACKGROUND

Oral health of preschool children remains a concern globally. Primary healthcare providers are in a vital position to support preventive oral care programmes. This study explored current practices, perception and barriers of primary health care professionals towards oral health promotion program of children in Qatar.

METHODS

The qualitative research used focus group discussions and interviewed a total of 108 participants that were audio recorded and transcribed verbatim. Four major themes emerged and were analysed to explore contextual patterns within the data.

RESULTS

Participants acknowledged the high prevalence of caries in children and identified the causes in the local context which included parental practices, poor dietary habits, impact of culture lack of oral health knowledge, limitations in the healthcare system, and negative role of the media. However, complex barriers were exposed, including lack of time and ownership, system coordination between organizations, and lack of policy.

CONCLUSION

Health professionals and bureaucrats involved in decision-making held a positive attitude towards oral health prevention programs and were enthusiastic to initiate and support these programs.

Evaluation of the Effects of Different Types of Resin Cement Systems on the Push-Out Bond Strength of the Fiber Post to Intracanal Dentin in Anterior Primary Teeth

Background

This study aimed to evaluate the effects of using three different resin cements on push-out bond strength (PBS) of fiber posts to root canal dentin of primary teeth.

Methods

Fifty primary canines were randomly divided into five experimental groups according to the type of the luting agent used for fiber post cementation after endodontic treatment and post space preparation as the following: Group 1: glass ionomer cement (GIC), Group 2: flowable resin composite, Group 3: etch and rinse (E&R) resin cement, Group 4: self-etch (SE) resin cement, Group 5: self-adhesive (SA) resin cement. The PBS values of the cemented fiber posts to root canals were measured. The data were statistically analyzed using a one-way analysis of variance, followed by Tukey's post hoc test.

Results

The highest mean PBS value was observed in Group 4 (SE resin cement), followed by Group 3 (E&R resin cement), and the lowest PBS value belonged to Group 1 (GIC), followed by Group 5 (p-values < 0.05). The mean PBS of Group 3 (E&R resin cement) was significantly higher than those of Groups 1 (GIC), 2 (flowable resin composite), and 5 (SA resin cement) (p-values < 0.05). However, no significant difference was found between the mean PBS of GIC and SA resin cement (p-value >0/05).

Conclusion

Using SE resin cement for fiber post cementation in primary anterior teeth showed the best results, followed by E&R resin cement. The lowest PBS was observed for GIC, followed by SA resin cement.

Child dental neglect and legal protections: a compendium of briefs from policy reviews in 26 countries and a special administrative region of China

Background

Child neglect is a public health, human rights, and social problem, with potentially devastating and costly consequences. The aim of this study was to: (1) summarize the oral health profile of children across the globe; (2) provide a brief overview of legal instruments that can offer children protection from dental neglect; and (3) discuss the effectiveness of these legal instruments.

Methods

We summarized and highlighted the caries profile and status of implementation of legislation on child dental neglect for 26 countries representing the World Health Organization regions: five countries in Africa (Nigeria, South Africa, Sudan, Tanzania, Zimbabwe), eight in the Americas (Argentina, Brazil, Canada, Chile, Mexico, Peru, Unites States of America, Uruguay), six in the Eastern Mediterranean (Egypt, Iran, Libya, Jordan, Qatar, Saudi Arabia), four in Europe (Italy, Latvia, Serbia, United Kingdom), two in South-East Asia (India and Indonesia) and one country (China) with its special administrative region (Hong Kong) in the Western Pacific.

Results

Twenty-five of the 26 countries have legal instruments to address child neglect. Only two (8.0%) of these 25 countries had specific legal instruments on child dental neglect. Although child neglect laws can be interpreted to establish a case of child dental neglect, the latter may be difficult to establish in countries where governments have not addressed barriers that limit children's access to oral healthcare. Where there are specific legal instruments to address child dental neglect, a supportive social ecosystem has also been built to facilitate children's access to oral healthcare. A supportive legal environment, however, does not seem to confer extra protection against risks for untreated dental caries.

Conclusions

The institution of specific country-level legislation on child dental neglect may not significantly reduce the national prevalence of untreated caries in children. It, however, increases the prospect for building a social ecosystem that may reduce the risk of untreated caries at the individual level. Social ecosystems to mitigate child dental neglect can be built when there is specific legislation against child dental neglect. It may be more effective to combine public health and human rights-based approaches, inclusive of an efficient criminal justice system to deal with child dental neglect.

Prenatal, neonatal and postnatal factors and the developmental defects of dental enamel

OBJECTIVE

To estimate the prevalence of developmental defects in dental enamel and its possible association with prenatal, neonatal and postnatal conditions in six-year-old schoolchildren in a southern Brazilian municipality.

METHODS

A cross-sectional study was conducted involving 655 six-year-old schoolchildren. Sociodemographic and health data were collected through interviews with mothers and children's oral examinations at schools. Multivariate analyses were performed using Poisson regression with robust estimator.

RESULTS

The prevalence of developmental defects of enamel was 44.0%. Demarcated opacities were the most prevalent, followed by diffuse opacities. Late pregnancy, maternal schooling less than eight years, female gender and child's white skin color were independently associated with the prevalence of demarcated opacities.

CONCLUSIONS

The prevalence of developmental defects in dental enamel was 44.0%. Late pregnancy, maternal schooling less than eight years, female gender and child's white skin color were associated with the prevalences.

Prevalence and Associated Factors of Malocclusion among Preschool Children in Huizhou, China: A Cross-Sectional Study

This survey examined the prevalence of malocclusion and its associated factors in 3- to 5-year-old children in Huizhou, China. Children were recruited from 21 kindergartens using a multistage sampling method. Two examiners performed oral examinations on the children, assessing occlusal traits, including primary molar and canine relationship, overjet, crossbite, overbite, anterior open bite, scissor bite, midline deviation, crowding, and spacing. Caries experience was recorded. Self-administered questionnaires were distributed to collect background information and oral health-related habits. Chi-square test, Mann-Whitney U test, and binary logistic regression were conducted. The study invited 1485 children and eventually recruited 1454 (52.9% boys; response rate: 97.9%). The prevalence of malocclusion was 68.3%, and deep overbite was found in 48.6% of the children. Children who had lip-biting habits had a higher prevalence of deep overbite than those who did not (OR = 2.36, p < 0.05). Children who had digit-sucking habits and dental caries in anterior maxillary teeth had a lower prevalence of deep overbite than those who did not (OR = 0.73 and 0.70, respectively, p < 0.05). In conclusion, over half of the children in Huizhou who participated in the study had malocclusion. Dental caries in anterior maxillary teeth, digit-sucking, and lip-biting were the associated factors of deep overbite.

Current knowledge about early childhood caries in the gulf cooperation council with worldwide reflection: Scoping review of the scientific literature (2010-2021)

Early childhood caries (ECC) is one of the most prevalent chronic childhood diseases affecting the primary teeth of children younger than 6 years of age. The disease etiology is complex and includes social, biological, and dietary factors. This review aims to explore the knowledge of ECC prevalence globally and locally within the Gulf Cooperation Council (GCC) countries during the years 2010-2021. Another aim is to explore oral health promotion programs with more focus on the GCC region. A search was conducted in PubMed, Medline, Scopus, the Cochrane Collaboration database, and Google Scholar to identify relevant studies published between 2010 and 2021 using specific keywords. Studies that utilized both the World Health Organization criteria and International Caries Detection and Assessment System for dental caries assessment were included. The included studies indicated considerable variation in the reported prevalence of ECC. While developed countries show low prevalence, countries in the GCC and other Arab countries show a high prevalence of ECC. Many oral health promotion programs were identified globally including oral health education, nutritional programs, the use of fluoride and pit-and-fissure sealants, and inter-professional population-based oral health promotion and prevention programs such as school-based oral health programs, motivational interviewing, and anticipatory guidance. ECC remains a significant problem in many parts of the world including the GCC region. Oral health prevention programs have been established within the GCC region. Nevertheless, the GCC region has some unique characteristics that need to be investigated to contextualize the western model of the dynamics of ECC prevention and promotion programs locally.

An Investigation of the Knowledge, Attitudes, and Practices of Physicians Regarding Child Oral Health at Primary Health Centers in Qatar: A Cross-Sectional Study

OBJECTIVES

 The aim of this study was to investigate physicians' knowledge, attitudes, and practices (KAP) in relation to oral health in children attending baby well clinics in primary health care centers (PHCC) in Qatar.

MATERIALS AND METHODS

 A cross-sectional design was adopted in which a piloted self-administered questionnaire was sent electronically to 417 physicians (pediatricians/family physicians) practicing in all PHCCs in Qatar. The questionnaire gathered information concerning demographic characteristics and KAP in relation to oral health in children. A score for each domain was given based on the percentage of correct answers.

STATISTICAL ANALYSIS

 Descriptive and analytical statistics were employed. For descriptive statistics, the frequency of distribution in relation to demographic data and responses to items of the questionnaire was presented. For analytical statistics, associations between independent variables (predictors) and KAP were assessed by employing univariate and multivariate logistic regressions. Predictors which were significantly associated in the unadjusted regression were entered into a final multivariate logistic regression to evaluate their effects after adjustment.

RESULTS

 The response rate was 24%. The overall mean scores of KAP were 61, 60, and 44.4%, respectively. Females were more likely to give positive answers than males (odds ratio [OR] = 12.3, 95% confidence interval [CI] 2.4-62.2, p = 0.02). Age groups 35 to 45 and >45 years had significantly more correct answers than <35 years age group (OR= 7.5, 95% CI = 1.1-56.6 and 9.2, 95% CI 1.2-44.6, respectively, p = 0.05). No significant associations were found between any of the independent variables with attitudes. With respect to practices, multivariate logistic regression revealed that specialty was significantly associated with practices. Pediatricians were more likely to adopt positive practices when compared with family medicine physicians (OR, 95% CI = 5.3 (1-25.6), p = 0.04).

CONCLUSION

 Although physicians demonstrated moderate levels of knowledge and attitudes, this did not reflect positively on their practices. The overall score of practices was considered poor (44.4%). Poor practices in our sample reflected an urgent need for actions and plans to improve this aspect and confirmed other findings which stated that acceptable levels of knowledge or attitudes do not necessarily translate into favorable practices.

Prevalence of early childhood caries in South Africa: a systematic review

BACKGROUND

The prevalence of Early Childhood Caries (ECC) in South Africa was last determined in 2002 in a national survey. Since then only few scattered studies were conducted across pocketed communities in the country. There appears to be an increasing trend in dental caries prevalence in South Africa. Since South Africa has one of the highest burden of HIV in the world, less focus was spent on Non-Communicable Diseases (NCDs), it was only when HIV patients developed NCD's did the government start evaluating NCDs. However, oral health is still not given enough attention within the health sphere. It is the hope of this systematic review to showcase the extent of dental caries amongst the future leaders of our country.

OBJECTIVES

The systematic review presents the prevalence and severity of early childhood caries between age groups and provinces in South Africa from 1975 to 2014.

DESIGN

A systematic review of prevalence was performed.

SETTINGS AND PARTICIPANTS

All studies performed on children under the age of six who lived in South Africa were eligible to be included.

PRIMARY AND SECONDARY OUTCOME MEASURES

The prevalence of ECC and the dmft scores were the primary and secondary outcome measures.

RESULTS

Twenty-one studies were included in the present review. The overall prevalence was 44.94% (95% confidence interval (C.I.) 39.73-50.15%) and the overall dmft score was 2.422 (95% C.I. 2.148-2.696).

CONCLUSIONS

The dmft score was the lowest in the Limpopo Province and highest in the Eastern Cape. ECC prevalence increased post-apartheid possibly on account of lifestyle changes due to the exodus from rural to urban and peri-urban areas. Registration The protocol of this systematic review was registered with PROSPERO, CRD42018112161, in November 2018.

Knowledge, Attitudes, and Practices of Parents on Early Childhood Caries in Qatar-A Questionnaire Study

OBJECTIVES

 The aims of the present study were to evaluate the level of knowledge, attitudes, and practices (KAP) toward early childhood caries (ECC) in a group of Qatari parents and to assess the association of sociodemographic factors on their KAP.

MATERIALS AND METHODS

 A cross-sectional study which was based on a piloted self-administered questionnaire was conveniently distributed to parents who attended the Pediatric Dentistry Section, Hamad Dental Center (HDC), Doha, Qatar. The questionnaire comprised four parts which asked about sociodemographic characteristics, knowledge, attitudes, and practices. A score for each domain was given based on the percentage of correct answers.

STATISTICAL ANALYSIS

 Descriptive and analytical statistics were employed. For descriptive statistics, frequency of distribution in relation to sociodemographic characteristics and responses to items of the questionnaire were presented. For analytical statistics, associations between independent variables and KAP were employed using Chi-squared tests.

RESULTS

 The overall mean scores of KAP were 60.8%, 65.6% and 72.7%, respectively. Females had significantly higher percentages of correct answers than males (p = 0.001). Only 20% of females had poor knowledge, while it was 40% in males. Parents with university or higher degrees had significantly higher percentage of good attitudes than parents with preparatory or less education (p = 0.05). Areas that necessitated improvement by parents included the following: the amount of toothpaste needed for brushing, signs of tooth demineralization, bacteria that causes tooth decay can be transmitted from mother to her child, and tooth decay can be transmitted by sharing utensils (i.e., spoons, forks).

CONCLUSIONS

 The overall KAP of parents toward ECC was relatively fair. However, certain socioeconomic factors (SEF) seemed to influence each domain, and areas of improvement are needed. Areas of improvement are needed in each domain. Mothers were significantly more knowledgeable than fathers regarding oral health issues of their children. Highly educated parents demonstrated better attitudes than the less educated. Continuous educational programs coordinated by health regulatory bodies should be introduced to improve parents' KAP regarding ECC risk factors and prevention.

The global prevalence of early childhood caries: A systematic review with meta-analysis using the WHO diagnostic criteria

AIM

To estimate the global prevalence of early childhood caries using the WHO criteria.

DESIGN

Systematic review of studies published from 1960 to 2019.

DATA SOURCES

PubMed, Google Scholar, SciELO, and LILACS. Eligibility criteria were articles using: dmft-WHO diagnostic criteria with calibrated examiners, probability sampling, and sample sizes.

STUDY SELECTION

Two reviewers searched, screened, and extracted information from the selected articles. All pooled analyses were based on random-effects models. The protocol is available on PROSPERO 2014 registration code CRD42014009578.

RESULTS

From 472 reports, 214 used WHO criteria and 125 fit the inclusion criteria. Sixty-four reports of 67 countries (published 1992-2019) had adequate data to be summarised in the meta-analysis. They covered 29 countries/59018 children. Global random-effects pooled prevalence was (percentage[95% CI]) 48[43, 53]. The prevalence by continent was Africa: 30[19, 45]; Americas: 48 [42, 54]; Asia: 52[43, 61]; Europe: 43[24, 66]; and Oceania: 82[73, 89]. Differences across countries explain 21.2% of the observed variance.

CONCLUSIONS

Early childhood caries is a global health problem, affecting almost half of preschool children. Results are reported from 29 of 195 countries. ECC prevalence varied widely, and there was more variance attributable to between-country differences rather than continent or change over time.

The silent epidemic of common oral diseases among the Arab population: An emerging health problem

Oral diseases are often ignored in public health policy within the Arab world, despite being a prevalent public health problem exerting a significant continuous increasing socioeconomic cost. This review paper explored the current status of the common oral diseases (dental caries, periodontal disease, oral cancer, and oro-facial trauma) in the Arab world through a literature search of the PubMed, Scopus, Google Scholar, and Google databases between 1998 and 2021. The literature available revealed sufficient evidence to support that oral diseases are highly prevalent in Arab nations. Collective, multi-sectorial action to reduce and eliminate oral diseases among the Arab population has become an urgent need.

Influence of tenofovir exposure in utero on primary dentition

Tenofovir disoxoproxil fumarate (TDF) is recommended for antiretroviral treatment for pregnant women living with HIV. As a comparative method to study bone density, we investigated the influence of in utero tenofovir exposure on the prevalence and distribution of developmental defects of enamel (DDE) in the primary dentition, as the mineralization process in teeth is higher and more complex and thus more vulnerable. HIV-exposed children with in utero exposition to tenofovir were included in this prospective observational single-center study. Dental status and enamel defects were assessed by an experienced dentist following a standardized protocol. Further information was collected using a standardized questionnaire, available in German and English. The prevalence of developmental defects in children with intrauterine tenofovir exposure was compared with literature data from a recent study of 377 healthy children in Germany and literature data from a study of 1221 healthy African children. Thirty-one children (mean age 2.1 ± 0.3 years; 41.9% female) were included. Median tenofovir exposure in utero was 28 weeks (mean ± 10.52 SD). Prevalence of developmental defects in the primary dentition in tenofovir-exposed children was similar compared to data of unexposed children (16.1% vs. 5.3%, p = 0.051 (compared to German cohort); 16.1% vs. 33.3%, p = 0.068 (compared to African cohort)).Conclusion: HIV-uninfected infants with in utero exposure to TDF showed no significant differences in the prevalence of DDE in comparison to cross-sectional data of HIV- and TDF-unexposed children; thus, the in utero exposure to TDF did not negatively influence the prevalence or distribution of DDE. What is Known: • There are no data available on the prevalence of developmental defects of enamel (DDE) in the primary dentition in intrauterine HIV- and tenofovir-exposed children. • Conclusions can be drawn from intrauterine milk tooth development to bone development and mineralization. What is New: • Prevalence of developmental defects in the primary dentition in tenofovir-exposed children was similar compared to data of unexposed children. • Preterm birth and hospitalization did not show a significant association on the prevalence of developmental defects in the primary dentition.

Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and meta-analysis

BACKGROUND

Early childhood caries (ECC) is a type of dental caries in the teeth of infants and children that is represented as one of the most prevalent dental problems in this period. Various studies have reported different types of prevalence of dental caries in primary and permanent teeth in children worldwide. However, there has been no comprehensive study to summarize the results of these studies in general, so this study aimed to determine the prevalence of dental caries in primary and permanent teeth in children in different continents of the world during a systematic review and meta-analysis.

METHODS

In this review study, articles were extracted by searching in the national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (ISI) between 1995 and December 2019. Random effects model was used for analysis and heterogeneity of studies was evaluated by using the I2 index. Data were analyzed by using the Comprehensive Meta-Analysis (Version 2) software.

FINDINGS

In this study, a total of 164 articles (81 articles on the prevalence of dental caries in primary teeth and 83 articles on the prevalence of dental caries in permanent teeth) were entered the meta-analysis. The prevalence of dental caries in primary teeth in children in the world with a sample size of 80,405 was 46.2% (95% CI: 41.6-50.8%), and the prevalence of dental caries in permanent teeth in children in the world with a sample size of 1,454,871 was 53.8% (95% CI: 50-57.5%). Regarding the heterogeneity on the basis of meta-regression analysis, there was a significant difference in the prevalence of dental caries in primary and permanent teeth in children in different continents of the world. With increasing the sample size and the year of study, dental caries in primary teeth increased and in permanent teeth decreased.

CONCLUSION

The results of this study showed that the prevalence of primary and permanent dental caries in children in the world was found to be high. Therefore, appropriate strategies should be implemented to improve the aforementioned situation and to troubleshoot and monitor at all levels by providing feedback to hospitals.

Knowledge, attitudes and practices of primary health care providers towards oral health of preschool children in Qatar

Objective

Health care providers can effectively participate in oral health promotion for children in primary care setting. Currently, there are no oral health promotion programs that involve primary health care professionals in Qatar. Hence, this study was undertaken to examine the knowledge, attitudes and practices of all health professionals who work in the Well baby Clinics in the primary health centers.

Method

A 23-item questionnaire was distributed across 20 primary health centers. The questionnaire sought information on the demographic data of health professionals, their knowledge of oral health and their practices and attitudes towards critical oral health issues. Data were examined by Pearson Chi-squared tests or Fisher’s Exact test (p = 0.05).

Results

The response rate of the health professionals was 67%. Only 35.7% of the 225 participants received some form of oral health training during their undergraduate programme. The participants would assess the dental problem of the child (p = 0.05) and discuss the importance of tooth brushing with the mother (p = 0.03). A significant number of respondents (p = 0.04) were unlikely to assess the children’s fluoride intake. There was a significant difference in the group of participants that would examine the child’s teeth (p = 0.1) and counsel the mothers on prevention of dental problems (p = 0.01). This group would also refer children to dentist at 12 months of age (p = 0.05).

Conclusions

Health professionals had a positive attitude towards the anticipatory guidance elements of oral health. However, the knowledge of healthcare professionals on childhood oral health is rather limited.

Success rate of proximal tooth-coloured direct restorations in primary teeth at 24 months: a meta-analysis

The aim was to determine the survival of tooth-coloured restorative materials in proximal restorations of primary teeth at 24 months of follow-up and the influence of the following variables: use of coating, use of cavity conditioner, use of rubber dam isolation, the cavity form, the dentist's experience and the methodological characteristics of the studies. We conducted a search until May 2019, obtaining 16 articles from which 30 independent studies were extracted, which were considered as units of analysis. Four outcome measures were extracted from each study: retention, marginal integrity, anatomic form, and absence of recurrent caries. Separate meta-analyses were carried for each outcome and multiple meta-regression model was applied. The outcomes with the highest mean success rates were absence of recurrent caries and anatomic form. The type of material significantly influenced success rates. The best materials were resin-based material plus total-etching adhesion and resin-modified glass ionomer cement (RMGIC), and the worst high viscosity glass ionomer cement (HVGIC). Atraumatic restorative treatment (ART) had a lower success rate than the conventional cavity form. RMGIC had the best clinical performance and HVGIC the worst. The form of the cavity, blinding and the experience of the operator were the variables that influenced success rates. Proximal primary molar restorations should be performed with RMGIC as it combines good mechanical performance of the resins together with the prevention of secondary caries of glass ionomers.

Pulpotomy versus pulpectomy in the treatment of vital pulp exposure in primary incisors. A systematic review and meta-analysis

Background: Early childhood caries is a serious public health problem. When caries extend to involve the pulp, various forms of pulp treatment are tried to stimulate tooth repair. Although pulpotomy is the treatment of choice for vital primary tooth pulp exposure but there is a trend among many dentists to perform pulpectomies  in vital primary incisors. This study aimed to assess the effect of pulpotomy and pulpectomy in treatment of carious vital pulp exposure in primary incisors.

Methods: We searched Pubmed and Cochrane library databases up to March, 2018, OpenGrey for grey literature and ClinicalTrials.gov for ongoing trials. Randomized controlled trials were included and assessed with Cochrane risk of bias tool . Primary outcomes were clinical failure and radiological failure. The effect sizes were calculated as risk ratios with 95%CI using the Mantel-Haenszel method.

Results: Four trials were identified for qualitative assessment, only three trials were included in meta-analysis after exclusion of one trial due to its high risk of bias. The pooled results of the longest follow up period for clinical failure showed no statistically significant difference between pulpotomy and pulpectomy. The relative risk (RR) was e 2.69, 95% CI 0.76 to 9.58 for clinical failure. For radiographic failure, the sensitivity analysis showed RR 0.45, 95% CI 0.25 to 0.83 with a higher risk for radiographic failure in pulpectomy. The evidence was limited by the small number of trials included in the meta-analysis.

Conclusions: Both pulpotomy and pulpectomy can be used successfully in the treatment of vital pulp exposure in primary incisors. Further high quality studies comparing between pulpotomy and pulpectomy in primary incisors with longer follow up period till exfoliation time are needed.

Structural equation modelling for associated factors with dental caries among 3-5-year-old children: a cross-sectional study

Background

The aim of the current study was to explore the factors influencing dental caries among 3–5-year-old children in Sichuan Province and the interrelationship between these factors using structural equation modelling (SEM).

Methods

A cross-sectional study was conducted among 2746 3–5-year-old children in Sichuan Province. Examination of caries was conducted on all children and a questionnaire was answered by the children’s caregiver. SEM alternative models were constructed to interpret the intricate relationships between socio-economic status (SES), caregiver’s oral health knowledge, attitudes, children’s oral health behaviours and children’s dental caries.

Result

The results showed that dental caries were significantly associated with dietary behaviours (β = 0.11, SE = 0.03, P = 0.001, BC 95% CI =0.05/0.18) and SES (β = − 0.17, SE = 0.03, P<0.001, BC 95% CI = -0.23/− 0.10) directly, While the indirect effect of SES on dmft is in an opposite direction (β = 0.08, SE = 0.02, BC 95% CI = 0.04/0.12).

Conclusion

We found that unhealthy dietary behaviours increased the prevalence of dental caries. However, oral health knowledge and attitude failed to affect dietary behaviour in this model. This result warns that oral health education should strengthen feeding-related knowledge. Meanwhile, it also reminds that it is easier known than done. Future oral health education should focus on exploring a more effective way for the public to turn knowledge into action.

Developmental defects of enamel in primary teeth: highly prevalent, unevenly distributed in the oral cavity and not associated with birth weight

AIM

Estimate the prevalence of developmental defects of enamel (DDE) in the primary dentition, describe the distribution among tooth groups and investigate the association with birth weight.

METHODS

A cross-sectional study was conducted with a sample of 827 children aged 2-5 years representative of the city of Canela in southern Brazil. Demographic characteristics (gender and age) and birth weight were collected from vaccination cards. The diagnosis of DDE was performed by six trained examiners following the criteria of the Federation Dentaire International. DDE were described both jointly and separately as opacity and hypoplasia. Statistical analysis involved the Chi square test, Mann-Whitney test and Poisson regression with robust variance.

RESULTS

The prevalence of DDE was 55.1% (95% CI 51.6-58.5%), with a mean of 3.0 ± 2.2 teeth affected. Opacity was the more frequent defect (50.4%), followed by hypoplasia (15.5%). Distribution of the defects was uneven, with opacity predominant on second molars and hypoplasia predominant on canines and second molars. Children with a low birth weight did not have a greater probability of opacity (PR: 1.13; 95% CI 0.91-1.41), hypoplasia (PR: 1.33; 95% CI 0.80-2.22) or DDE (PR: 1.11; 95% CI 0.91-1.37).

CONCLUSION

The prevalence of DDE was high, predominant on second molars and not associated with birth weight. These findings indicate directions for future examination/diagnosis protocols and specific orientations.

Parental attitudes about acquiring a dental home for preschool children: a new concept in the Arab state of Qatar

OBJECTIVE

The purpose of the study was to assess parental perceptions and acceptability of a dental home for their preschool children, a new concept in the state of Qatar.

METHODS

A cross-sectional prospective study was conducted at Hamad Medical Corporation, in the state of Qatar. Parents of infants and children <5 years of age were offered an interview survey.

RESULTS

A total of 309 questionnaires were completed (response rate =98%). More than 90% of the participants believed that oral health and dentition affected total-body well-being. Only 18% of parents stated that their children had excellent oral health. Interestingly, more than two-thirds of children had not had a routine dentist visit in the 12 months preceding the interview. Reasons for not having such visits included long appointment times (17.4%), the perception that dental care was expensive (15.5%), the notion that deciduous teeth did not need care (9%), the impression that insurance did not cover dental procedures (8%), unawareness of location of dental centers (4%), the child did not want to go (4%), the notion that children are difficult to handle during a dental procedure (3%), a combination of these factors (33.5%), and other factors (5%). When asked what factors would encourage them to enrol a dental home for their children, almost 20% mentioned speedy appointments followed by dentists specialized in pediatrics (14.3%), child-friendly atmosphere (12%), low cost (12%), close to home (5.7%), none (2.7%), others (2%), and all of the above (32.3%).

CONCLUSION

Counseling by primary-care physicians can increase dental home acceptability in the state of Qatar, especially that access to health care is easy in our community.

Pulpotomy versus pulpectomy in the treatment of vital pulp exposure in primary incisors. A systematic review and meta-analysis

Background: Early childhood caries is a serious public health problem. When caries extend to involve the pulp, various forms of pulp treatment are tried to stimulate tooth repair. Although pulpotomy is the treatment of choice for vital primary tooth pulp exposure but there is a trend among many dentists to perform pulpectomies  in vital primary incisors. This study aimed to assess the effect of pulpotomy and pulpecomy in treatment of carious vital pulp exposure in primary incisors. Methods: We searched Pubmed and Cochrane library databases up to March, 2018, OpenGrey for grey literature and ClinicalTrials.gov for ongoing trials. Randomized controlled trials were included and assessed with Cochrane risk of bias tool . Primary outcomes were clinical failure and radiological failure. The effect sizes were calculated as risk ratios with 95%CI using the Mantel-Haenszel method. Results: Four trials were identified for qualitative assessment, only three trials were included in meta-analysis after exclusion of one trial due to its high risk of bias. The pooled results of the longest follow up period for clinical failure showed no statistically significant difference between pulpotomy and pulpectomy. The relative risk (RR) was e 2.69, 95% CI 0.76 to 9.58 for clinical failure. For radiographic failure, the sensitivity analysis showed RR 0.45, 95% CI 0.25 to 0.83 with a higher risk for radiographic failure in pulpectomy. The evidence was limited by the small number of trials included in the meta-analysis. Conclusions: Both pulpotomy and pulpectomy can be used successfully in the treatment of vital pulp exposure in primary incisors. Further high quality studies comparing between pulpotomy and pulpectomy in primary incisors with longer follow up period till exfoliation time are needed.

A systematic review and meta-analysis of primary teeth caries studies in Gulf Cooperation Council States

OBJECTIVES

The aim of the study was to evaluate the prevalence and severity of dental caries in pre-school children in the Gulf Cooperation Council (GCC) area.

METHODS

A search of literature was conducted to identify articles of dental caries in primary dentitions published during the period from January 1st, 1992 to June 30th, 2016. PubMed, Google Scholar search, and hand searching of journals was conducted to identify relevant articles. The search strategy employed both dental subject headings and free-text terms.

RESULTS

Out of a total of 193 studies that fit the initial inclusion criteria, 159 studies were further excluded. Only 34 studies were included in the systematic review and meta-analyses. The overall mean dmft in the primary teeth was 5.14 with prevalence of 80.9% in the GCC area. A high level of heterogeneity in the selected studies was found as demonstrated by Q-value of 2538.501 (df = 21) and I2 value of 99.17%. However, the funnel plots showed symmetrical shape at the bottom in both dmft and prevalence studies indicating absence of publication bias, which was also confirmed by insignificant result of Egger's regression statistical test (Egger's test P = 0.179-0.358).

CONCLUSION

Caries in the primary dentition in the GCC States was high both in terms of mean dmft (5.14) and prevalence (80.95%).

Dental caries and their association with socioeconomic characteristics, oral hygiene practices and eating habits among preschool children in Abu Dhabi, United Arab Emirates - the NOPLAS project

Background

Dental caries are a global public health problem and influence the overall health of children. The risk factors for caries include biological, socio-behavioral and environmental factors. This cross-sectional study assessed dental caries and their associations with socioeconomic factors, oral hygiene practices and eating habits among Emirati and non-Emirati children in Abu Dhabi, United Arab Emirates (UAE).

Methods

The stratified sample comprised children aged 18 months to 4 years recruited from 7 nurseries. The World Health Organization (WHO) decayed, missing and filled teeth index (dmft) was used to analyze the dental status of the children. Parents completed a questionnaire regarding demographics, food consumption and oral habits. The study was approved by the Research Ethics Committee at Zayed University, UAE (ZU15_029_F).

Results

A total of 186 children with a mean age of 2.46 years, of which 46.2% were Emirati, participated. Overall, 41% of the children had dental caries. The mean dmft±SD was 1.70 ± 2.81 with a mean ± SD decayed component (dt) of 1.68 ± 2.80 and mean ± SD filled component (ft) of 0.02 ± 0.19. Emirati children showed higher mean dmft, Plaque Index and Significant Carries Index values than non-Emirati children (P < 0.000). Low maternal education, rural nursery location, infrequent tooth-brushing, frequent consumption of high-sugar food items and Emirati nationality were factors significantly associated with dental caries.

Conclusions

In this study, 4 out of 10 nursery children were found to have dental caries. Sociodemographic factors, dietary and oral health habits were associated with dental caries. Effective oral health interventions tailored to improve eating habits and the dental screening of children in this age group are imperative to mitigate these concerns.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0557-8) contains supplementary material, which is available to authorized users.

Early Childhood Caries: Epidemiology, Aetiology, and Prevention

Early childhood caries (ECC) is one of the most prevalent diseases in children worldwide. ECC is driven by a dysbiotic state of oral microorganisms mainly caused by a sugar-rich diet. Additionally, poor oral hygiene or insufficient dental plaque removal leads to the rapid progression of ECC. ECC leads not only to dental destruction and pain with children, but also affects the quality of life of the caregivers. Children with extensive ECC are at high risk to develop caries with the permanent dentition or will have other problems with speaking and/or eating. To prevent ECC, several strategies should be taken into account. Children should brush their teeth with toothpastes containing gentle ingredients, such as mild surfactants and agents showing antiadherent properties regarding oral microorganisms. Parents/caregivers have to help their children with brushing the teeth. Furthermore, remineralizing and nontoxic agents should be included into the toothpaste formulation. Two promising biomimetic agents for children's oral care are amorphous calcium phosphate [Ca_x(PO₄)_yn H₂O] and hydroxyapatite [Ca₅(PO₄)₃(OH)].

Dental Caries and Developmental Defects of Enamel in the Primary Dentition of Preterm Infants: Case-Control Observational Study

AIM

Assessment of dental health in the primary dentition of preterm infants (PTI) including investigation of mother- and infant-related risk factors in a case-control study design.

MATERIAL AND METHODS

One hundred twenty-eight infants aged 3-4 years were included. Sixty-four PTI (27 males) were randomly selected from the preterm registry of the Jena University Hospital. As a control group served 64 full-term infants (FTI) recruited from the Department of Paediatric Dentistry, matched for age and sex. Dental examinations were provided by one dentist under standard clinical conditions. Caries was scored using the International Caries Detection and Assessment System (ICDAS II) and the DMFT, gingival health using the Periodontal Screening Index, and developmental defects of enamel using the DDE index. Mother- and infant-related factors were collected via a questionnaire and from medical records.

RESULTS

The caries prevalence was 50.0% (ICDAS II >0) in PTI and 12.5% (ICDAS II >0) in FTI. The caries experience was higher in PTI (DMFT 1.0 ± 3.1) than in FTI (DMFT 0.3 ± 1.0). PTI had a higher risk of caries (OR 7.0), initial lesions (OR 6.2), DDE (OR 7.5), and gingivitis (OR 6.5) than FTI. The highest risk occurred in PTI with an extremely low birth weight (<1,000 g). A higher risk of DDE was present when mothers suffered from illness during pregnancy (OR 3.9). A higher risk of caries was revealed in infants with respiratory syndrome (OR 6.2) or when their mothers had a lower socioeconomic status (OR 6.3).

CONCLUSIONS

PTI had less healthy teeth than FTI and are at a higher risk for DDE, caries, and gingivitis. The poorer dental health in PTI is associated with a low birth weight, a low socioeconomic status, and mothers' illness during pregnancy.

Developmental defects of enamel and dental caries in the primary dentition: A systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis evaluated the association between developmental defects of enamel and dental caries in the primary dentition.

SOURCES

Electronic searches were performed in PubMed, Web of Knowledge, Scopus and Scielo for the identification of relevant studies.

STUDY SELECTION

Observational studies that examined the association between developmental defects of enamel and dental caries in the deciduous dentition were included. Additionally, meta-analysis, funnel plots and sensitivity analysis were employed to synthesize the available evidence. Multivariable meta-regression analysis was performed to explore heterogeneity among studies.

DATA

A total of 318 articles were identified in the electronic searches. Of those, 16 studies were included in the meta-analysis. Pooled estimates revealed that children with developmental defects of enamel had higher odds of having dental caries (OR 3.32; 95%CI 2.41-4.57), with high heterogeneity between studies (I2 80%). Methodological characteristic of the studies, such as where it was conducted, the examined teeth and the quality of the study explained about 30% of the variability. Concerning type of defect, children with hypoplasia and diffuse opacities had higher odds of having dental caries (OR 4.28; 95%CI 2.24-8.15; OR1.42; 95%CI 1.15-1.76, respectively).

CONCLUSIONS

This systematic review and meta-analysis demonstrates a clear association between developmental defects of enamel and dental caries in the primary dentition.