Prevalence of dental caries in children and adolescents with type 1 diabetes: a systematic review and meta-analysis

Dental health status of children with diabetes in Riyadh, Saudi Arabia

Objective

The impact of diabetes on oral diseases remains debatable. We aimed to determine the prevalence of dental caries, gingival health status and knowledge, and oral hygiene level and practice in children with type 1 diabetes mellitus in Riyadh, Saudi Arabia.

Methods

The teeth of Sixty children with diabetes (33 males and 27 females; age 11.3 ± 2.2 [7-14] years) were examined for dental caries following the modified World Health Organization criteria. Data on age, sex, medical history, gingival health status and knowledge, and oral hygiene level and practice were collected from parents.

Results

In this study, 53 % of the children had dental caries with decayed, missing, and filled primary and permanent teeth scores of 5.6 ± 3.8 and 3.6 ± 3.2, respectively, with similar scores for male and female children. Children with and without caries had similar oral hygiene practices and oral health knowledge but differed in the rates of good or fair oral hygiene status (89.2 vs. 56.6 %; P = 0.024) and normal gingival health status or mild gingivitis (96.5 vs. 81.3 %; P = 0.010).

Conclusions

We found that the oral hygiene status and rate of gingivitis differed in children with type 1 diabetes mellitus with or without dental caries.

Systems mapping of multilevel factors contributing to dental caries in adolescents

Dental caries is a prevalent chronic disease among adolescents. Caries activity increases significantly during adolescence due to an increase in susceptible tooth surfaces, immature permanent tooth enamel, independence in pursuing self-care, and a tendency toward poor diet and oral hygiene. Dental caries in permanent teeth is more prevalent among adolescents in low-income families and racial/ethnic minority groups, and these disparities in adolescent dental caries experience have persisted for decades. Several conceptual and data-driven models have proposed unidirectional mechanisms that contribute to the extant disparities in adolescent dental caries experience. Our objective, using a literature review, is to provide an overview of risk factors contributing to adolescent dental caries. Specifically, we map the interactive relationships of multilevel factors that influence dental caries among adolescents. Such interactive multilevel relationships more closely reflect the complex nature of dental caries experience among the adolescent population. The methods that we use are two-fold: (1) a literature review using PubMed and Cochrane databases to find contributing factors; and (2) the system dynamics approach for mapping feedback mechanisms underlying adolescent dental caries through causal loop diagramming. The results of this study, based on the review of 138 articles, identified individual, family and community-level factors and their interactions contributing to dental caries experience in adolescents. Our results also provide hypotheses about the mechanisms underlying persistence of dental caries among adolescents.

Conclusions

Our findings may contribute to a deeper understanding of the multilevel and interconnected factors that shape the persistence of dental caries experience among adolescents.

Type 1 diabetes, glycemic traits, and risk of dental caries: a Mendelian randomization study

Background: Regarding past epidemiological studies, there has been disagreement over whether type 1 diabetes (T1DM) is one of the risk factors for dental caries. The purpose of this study was to determine the causative links between genetic susceptibility to T1DM, glycemic traits, and the risk of dental caries using Mendelian randomization (MR) approaches. Methods: Summary-level data were collected on genome-wide association studies (GWAS) of T1DM, fasting glucose (FG), glycated hemoglobin (HbA1c), fasting insulin (FI), and dental caries. MR was performed using the inverse-variance weighting (IVW) method, and sensitivity analyses were conducted using the MR-Egger method, weighted median, weighted mode, replication cohort, and multivariable MR conditioning on potential mediators. Results: The risk of dental caries increased as a result of genetic susceptibility to T1DM [odds ratio (OR) = 1.044; 95% confidence interval (CI) = 1.015-1.074; p = 0.003], with consistent findings in the replication cohort. The relationship between T1DM and dental caries was stable when adjusted for BMI, smoking, alcohol intake, and type 2 diabetes (T2DM) in multivariable MR. However, no significant correlations between the risk of dental caries and FG, HbA1c, or FI were found. Conclusion: These results indicate that T1DM has causal involvement in the genesis of dental caries. Therefore, periodic reinforcement of oral hygiene instructions must be added to the management and early multidisciplinary intervention of T1DM patients, especially among adolescents and teenagers, who are more susceptible to T1DM.

DMF scores in patients with diabetes mellitus: A systematic review and meta-analysis of observational studies

OBJECTIVE

The aim of this systematic review(SR) is to comprehensively and critically summarise and synthesise the available scientific evidence from observational studies that use the decayed-missed-filled(DMF) index to determine caries experiences among adult patients with diabetes mellitus  (DM) as compared to individuals without DM(non-DM).

DATA

Indices that present examinations of decayed-filled-surfaces(DFS), decayed-missed-filled-surfaces(DMFS), and decayed-missed-filled-teeth(DMFT) established from observational studies were considered.

SOURCES

MEDLINE-PubMed and Cochrane Central databases were searched through 1 February 2023 to identify studies that evaluate DMF indices for adult patients with DM compared to non-DM. The reference lists of the selected studies were reviewed to identify additional potentially relevant studies.

STUDY SELECTION

All studies were independently screened by two reviewers. Included papers were critically appraised using pre-designed forms, and the risk of bias was assessed. Data as means and standard deviations were extracted. A descriptive data presentation was used for all studies. If quantitative methods were feasible, then a meta-analysis was performed. It was decided 'a priori' to perform a sub-analysis on type of DM(I or II). The quality of the studies was assessed.

RESULTS

Initially 932 studies were found, and screening resulted in 13 eligible observational studies. The total number of subjects included in this SR is 21,220. A descriptive analysis of the comparisons demonstrated that eight studies provided data and demonstrated higher DFS (1/2), DMFS (2/3) and DMFT (5/8). This was confirmed by the meta-analysis difference of means(DiffM), which was 3.01([95%CI:1.47,4.54],p=0.0001) for DMFT and 10.30([95% CI:8.50,12.11],p<0.00001) for DMFS. Subgroup analysis showed that this difference is irrespective to the type of DM(DiffM=3.09;[95%CI:2.09,4.09],p<0.00001).

CONCLUSION

There is moderate certainty for a higher DMF index score in DM patients as compared to those without DM disease.

CLINICAL SIGNIFICANCE

This SR indicates a higher DMF index in DM patients. Oral disease prevention should be the focus of the dental care practitioner in this patient category.

Epigenetic changes underlie the association between diabetes mellitus and oral diseases

Patients with diabetes mellitus (DM) suffer from oral complications related to oral infections, periodontal diseases, and endodontic lesions. Emerging evidence has revealed the contribution of the epigenetic process as the underlying mechanism of DM complications. DNA methylation, histone modifications, and non-coding RNAs are epigenetic regulators that directly affect gene expression. The present review elaborated on the role of epigenetic dysregulation in the etiology of diabetes-related periodontal and endodontic diseases. The narrative review study was prepared using databases such as PubMed, Google Scholar, Science Direct, and Scopus. The formation of glycation products as a result of hyperglycemic condition increases oxidative stress, and elevates chronic inflammatory mediators that could in turn adversely change the cellular environment and alter the epigenetic status. This process contributes to the alteration of regulatory genes expression, leading to the development of diabetes-induced bone complications and impaired odontogenic capacity of pulp. Indeed, epigenetic mechanisms mediate the interaction between gene expression and DM cellular environment. Further investigations on epigenetic factors involved in DM oral complications may provide novel therapeutic targets.

Evaluation of oral health in different types of diabetes mellitus: A cross-sectional retrospective study

OBJECTIVE

It was aimed to compare the relationship between oral health and two types of diabetes mellitus (DM) using laboratory findings and oral health parameters.

MATERIAL AND METHOD

This retrospective study was conducted between 2021 and 2022. Type-I and Type-II diabetic patients who had laboratory findings and panoramic radiograph taken on the same day was included to the study. HbA1c, glucose, urea, LDL, HDL, AST, ALT, triglyceride, creatinine, positive and negative microalbuminuria levels on laboratory tests and, the number of root canal treated, missing, filled and decayed tooth on the panoramic radiograph were recorded. The obtained data were compared statistically to evaluate the association between diabetes type and oral health.

RESULTS

A total of 101 patients, 51.5 % (n = 52) with Type-I diabetes and 49.5 % (n = 49) with Type-II diabetes, were included. The number of males (53.8 %) in Type-I DM group and the number of females (67.3 %) in Type-II DM group were statistically higher. The mean age of Type-II diabetic patients was higher than Type-I diabetic patients (p < 0.05). While the average number of teeth with caries per patient in the Type-1 diabetes group was 5, the average number of tooth loss per patient in the Type 2 group was 9.

CONCLUSIONS

While Type-I diabetes could be a predisposing factor for dental caries, Type-II diabetes could be a predisposing factor for tooth loss.

MiniMed 780G™ in 2- to 6-Year-Old Children: Safety and Clinical Outcomes After the First 12 Weeks

Objective: The safety and impact of the advanced hybrid closed-loop (AHCL) system on glycemic outcome in 2- to 6-year-old children with type 1 diabetes and the diabetes distress of caregivers were evaluated. Research Design and Methods: This was an open-label prospective study (n = 35) with historical controls matched by treatment unit, diabetes duration, age, gender, and baseline treatment modality. The inclusion criteria were (1) type 1 diabetes diagnosis >6 months, (2) total daily dose of insulin ≥8 U/day, (3) HbA1c <10% (85 mmol/mol), and (4) capability to use insulin pump and continuous glucose monitoring. The MiniMed 780G™ AHCL in SmartGuard™ Mode was used for 12 weeks. Parental diabetes distress was evaluated with a validated Problem Areas In Diabetes-Parent, revised (PAID-PR) survey. Results: No events of diabetic ketoacidosis or severe hypoglycemia occurred. Between 0 and 12 weeks, HbA1c (mean change = -2.7 mmol/mol [standard deviation 5.7], P = 0.010), mean sensor glucose value (SG) (-0.8 mmol/L [1.0], P < 0.001), and time above range (TAR) (-8.6% [9.5], P < 0.001) decreased and time in range (TIR) (8.3% [9.3], P < 0.001) increased significantly, whereas no significant change in time below range (TBR) was observed. At the same time, PAID-PR score decreased from 37.5 (18.2) to 27.5 (14.8) (P = 0.006). Conclusions: MiniMed 780G™ AHCL is a safe system and 12-week use was associated with improvements in glycemic control in 2- to 6-year-old children with type 1 diabetes. In addition, AHCL is associated with a reduction in parental diabetes distress after 12-week use. ClinicalTrials.gov registration number: NCT04949022.

Clinical Performance of Diagnostic Methods in Third Molar Teeth with Early Occlusal Caries

The aim of this study was to compare the diagnostic performance of clinical visual examination (ICDAS II), digital periapical radiography (PR), near infrared light transillumination (NIR-LT), and laser fluorescence (LF) to microcomputed tomography (Micro-CT) which is the reference standard for the detection of non-cavitated occlusal enamel and dentin caries in third molar teeth. Potential participants were consecutively recruited. In this prospective study, 101 third molars of 101 patients were examined; the molars had non-cavitated occlusal caries which required extraction. ICDAS II, PR, NIR-LT and LF examinations were carried out by two blinded examiners. Reference standard was determined by micro-CT imaging seven days after extraction. Accuracy rate, sensitivity, specificity, predictive values and areas under receiver operating characteristic (ROC) curves (Az) were statistically analyzed. Nonparametric variables were subjected to the Kruskal−Wallis Test. Significance level was set as p < 0.05. NIR-LT had the highest sensitivity (99.67−99.67%) and accuracy (78.22−77.23%) for the determination of occlusal enamel caries according to examiners 1 and 2, respectively. LF method had the highest sensitivity (70.83−54.17%) and accuracy (66.34−59.41%) for determining occlusal dentin caries according to examiners 1 and 2, respectively. The ROC curve (Az) value ranged between 0.524 and 0.726 for the different methods tested. Most effective methods for the diagnosis of occlusal enamel and dentin caries were determined to be NIR-LT and LF pen methods, respectively. The present prospective clinical study showed that NIR-LT and LF-Pen were a reliable modality for the detection of occlusal enamel and dentin caries without ionizing radiation.

Association between metabolic control and oral health in children with type 1 diabetes mellitus

Background

Type 1 diabetes mellitus is the most common chronic disease and can be reflected in the oral cavity. The aim of this study was to analyze the impact of metabolic control on saliva, dental caries, dental plaque, gingival inflammation, and cariogenic bacteria in saliva.

Methods

A case–control epidemiologic study was performed on children with type 1 diabetes (ages 10–15 years) separated into two groups: 34 children with good metabolic control of glycated hemoglobin (HbA1c < 7.5%) and 46 children with poor metabolic control of glycated hemoglobin (HbA1c > 7.5%). Oral status was assessed using the Decay, Missing, and Filled Teeth index for permanent teeth (DMFT), plaque index and gingival index. The stimulated salivary flow rate was measured, and the colonies of Streptococcus mutans and Lactobacillus in saliva were determined. The observed children answered questions related to their frequency of brushing habits, dental visits and parents’ education. Mann–Whitney U Test, Chi-Square test and Fisher’s exact test were used in the statistical analyses. The significance level was set at p < 0.05.

Results

The children with diabetes with poor metabolic control had significantly higher values of the DMFT index, plaque index, and gingival index, more colonies, and a higher risk of Streptococcus mutans and Lactobacillus than the children with diabetes with good metabolic control (p < 0.001). The level of metabolic control of diabetes had no influence on salivary flow rates (p > 0.05). The majority of both groups with good and poor metabolic control brushed their teeth once per day, and they visited the dentist only when necessary (61.3%). However, the parents of children in both groups had medium to low levels of education, without any significant difference between groups (p > 0.05).

Conclusion

The results indicate that children with diabetes have a lower level of oral hygiene and are potentially to dental caries and periodontal diseases, mainly when their metabolic disorder is uncontrolled.

Dental caries and associated factors among diabetic and nondiabetic adult patients attending Bichena Primary Hospital’s Outpatient Department

Purpose

Dental caries is a significant public health issue affecting both the diabetic and nondiabetic populations. However, the problem and associated factors of dental caries among diabetics and nondiabetics patients are not well-known in Ethiopia. This study aims to compare the prevalence of dental caries and associated factors among diabetic and nondiabetic patients at the Outpatient Department of Bichena Primary Hospital in Northwest, Ethiopia.

Methods

Institutional based, comparative cross-sectional study was conducted from October 7 to December 6, 2019, among 200 diabetes and 400 nondiabetic adult patients. A consecutive sampling technique was implemented to recruit study participants. Data were collected by a pretested structured questionnaire and analysis was performed in Statistical Package for Social Science version 20. Bivariable and multivariable logistic regressions were employed and variables with a p-value &lt; 0.05 were declared statistically significant.

Results

A total of 582 patients were involved in the study with a response rate of 97.0%. The prevalence of dental caries was 67.9% [95% confidence interval (CI): 63.2%–72.8%] and 79.6% (95% CI: 74.0%–85.70%) in nondiabetic and diabetic group, respectively. Females gender [adjusted odds ratio (AOR) = 1.79, 95% CI: 1.15–2.77], poor oral hygiene (AOR = 2.95, 95% CI: 1.71–5.11), lack of regular teeth cleaning habits (AOR = 3.26, 95% CI: 2.13–4.97), feeling dry mouth (AOR = 2.31, 95% CI: 1.11–4.81), sugared tea drinking (AOR = 2.00, 95% CI: 1.18–3.38), inadequate oral health knowledge (AOR = 3.51, 95% CI: 2.19–5.62), and khat chewing (AOR = 2.14, 95% CI: 1.24–3.71) were significantly associated factors with high prevalence of dental caries.

Conclusion

The prevalence of caries was significantly higher among diabetics than nondiabetics. Oral health education with preventive measures such as improving teeth cleaning practice, reducing sugary foods and drinks intake, and improving oral hygiene practice of patients should be mainstreamed along with diabetic follow-up care.

Prevalence of Caries among School Children in Saudi Arabia: A Meta-Analysis

Introduction

Children's dental health has become the primary concern, because of the increase in the prevalence of caries amongst school children in Saudi Arabia. Therefore, a meta-analysis was conducted to assess the prevalence and severity of dental caries among school children in Saudi Arabia.

Method

A systematic search of Scopus, ISI Web of Science, EMBASE, Saudi digital library, Google Scholar, and MEDLINE via Ovid for cross-sectional studies with healthy participants between 5and –15 years. Two authors independently extracted the prevalence of caries. With 95% confidence intervals (CIs) using a random-effects model, we calculated caries prevalence.

Results

Dental caries prevalence data were extracted from 18 cross-sectional studies (n = 56,327 children). The pooled estimate for the caries prevalence among 5–7 years' children was 84% (95% CI: 0.81–0.87%; I² = 91%) while among 12–15 years' children was 72% (95% CI: 0.63–0.79; I² = 96.2%). Discussion. In this systematic review, the summary estimate of the prevalence of dental caries among children of 5–7 years and 12–15 years were 84% and 72%, respectively. Further research is required to identify approaches for preventing and treating dental caries in schoolchildren.

Caries-related salivary parameters and oral microbial flora in patients with type 1 diabetes: A meta-analysis

OBJECTIVES

This study aimed to conduct a meta-analysis by synthesising the outcomes of studies that investigated the relationship between type 1 diabetes (T1D) and salivary flow rate (SFR), salivary pH (SpH), salivary buffer capacity (SBC), streptococcus Mutans (SM), and lactobacillus (LB) counts.

MATERIAL AND METHODS

The PRISMA statement guide was followed for the meta-analysis. Electronic databases were searched, and study selection and data collection processes were performed. The risks of bias in individual studies and across studies were assessed. Mean differences (MD) and Odds Ratio (OR) were used to measure the effect estimates in the comparisons.

RESULTS

29 studies were included in the qualitative and quantitative syntheses. Significantly higher SFR (MD = -0.22, CI: -0.26, -0.18; p < 0.001) and SpH (MD = -0.59, CI: -0.81, -0.36; p < 0.001) were observed in the healthy individuals than T1D individuals. No significant difference was observed among groups in terms of SBC (MD = 0.10, CI: -0.46,0.66; p = 0.73). An increased odds ratio of SM counts were observed regarding the T1D (OR = 3.09, 95% CI: 1.16, 8.20; p = 0.02). No association was found between LB counts and T1D (OR = 2.15, 95% CI: 0.38, 11.98; p = 0.38).

CONCLUSIONS

Subjects with T1D have a significantly lesser SFR and SpH than healthy individuals. But no significant difference is available in terms of SBC. Lower SM counts were observed in individuals with T1D, while no association was observed regarding LB counts. The tendency to dental caries is more likely in subjects with T1D due to lower SFR, SpH, and higher SM.

Oral Cavity Status of Type 1 Diabetic Patients Who Underwent an Oral Hygiene Tuition

Diabetes mellitus is a civilization disease which affects increasing number of people. Diabetes essentially influences gingival disease, periodontal disease, saliva secretion disorders and its parameters. The aim of the study is both assessing the oral cavity status of that group of patients to clearly identify their treatment needs and the effectiveness of implementation of oral hygiene training. 57 patients with type 1 diabetes and 31 healthy declared their contribution to the research. The research was conducted within two visits. The evaluation was done during clinical examination: teeth condition, oral hygiene. During the end of the first visit patients received professional oral hygiene instructions. Analysis of the clinical research in both groups showed no differences for Decayed- Missing- Filled teeth index and Dental Treatment Index. The results demonstrated disparity between the groups for the decayed teeth component and filled teeth component (symptomatically higher values in the researched group). There was statistically significant difference in the modified Sulcus Bleeding Index values analysis between both groups. Conducting hygiene instructions influenced the decline of Approximal Plaque Index and Oral Hygiene Index in the treatment group. It is essential for dentists in cooperation with diabetologists to educate patients on the necessity to maintain oral hygiene procedures.

Pathogenesis and treatment of wound healing in patients with diabetes after tooth extraction

Diabetes mellitus is a common systematic chronic disease amongst dental patients. The elevated glucose microenvironment can prolong the healing of tooth extraction sockets. Therefore, the promotion of healing up tooth extraction sockets is of great clinical importance to the patients with diabetes mellitus. The current evidence indicates the mechanism of the recovery period of extraction sockets in hyperglycaemia conditions from physiological, inflammation, immune, endocrine and neural aspects. New advancements have been made in varied curative approaches and drugs in the management of wound healing of tooth extraction sockets in diabetes. However, most of the interventions are still in the stage of animal experiments, and whether it can be put into clinical application still needs further explorations. Specifically, our work showed topical administration of plasma-rich growth factor, advanced platelet-rich fibrin, leukocyte- and platelet-rich fibrin and hyaluronic acid as well as maxillary immediate complete denture is regarded as a promising approach for clinical management of diabetic patients requiring extractions. Overall, recent studies present a blueprint for new advances in novel and effective approaches for this worldwide health ailment and tooth extraction sockets healing.

Exploring the Interplay Between Oral Diseases, Microbiome, and Chronic Diseases Driven by Metabolic Dysfunction in Childhood

Oral childhood diseases, such as caries and gingivitis, have much more than a local impact on the dentition and tooth surrounding tissues, which can affect systemic conditions. While the mouth is frequently exposed to microbial stressors that can contribute to an inflammatory state in the entire body, chronic disorders can also interfere with oral health. Sharing common risk factors, a dynamic interplay can be driven between 1. dental caries, gingivitis, and type I diabetes mellitus, 2. early childhood caries and obesity, and 3. caries and cardiovascular diseases. Considering that there are ~2.2 billion children worldwide and that childhood provides unique opportunities for intervention targeting future health promotion, this review is of prime importance and aimed to explore the relationship between the oral microbiome and oral chronic diseases driven by metabolic dysfunction in childhood.

Efficacy, Pharmacokinetics, Biodistribution and Excretion of a Novel Acylated Long-Acting Insulin Analogue INS061 in Rats

Purpose

Long-acting insulin analogues are known to be a major player in the management of glucose levels in type I diabetic patients. However, highly frequent hypo- and hyperglycemic incidences of current long-acting insulins are the important factor to limit stable management of glucose level for clinical benefits. To further optimize the properties for steadily controlling glucose level, a novel long-acting insulin INS061 was designed and its efficacy, pharmacokinetics, biodistribution and excretion profiles were investigated in rats.

Methods

The glucose-lowering effects were evaluated in a streptozocin-induced diabetic rats compared to commercial insulins via subcutaneous administration. The pharmacokinetics, biodistribution, and excretion were examined by validated analytical methods including radioactivity assay and radioactivity assay after the precipitation with TCA and the separation by HPLC.

Results

INS061 exhibited favorable blood glucose lowering effects up to 24 h compared to Degludec. Pharmacokinetic study revealed that the concentration-time curves of INS061 between two administration routes were remarkably different. Following intravenous administration, INS061 was quickly distributed to various organs and tissues and slowly eliminated over time with urinary excretion being the major route for elimination, and the maximum plasma concentrations (Cmax) and systemic exposures (AUC) increased in a linear manner.

Conclusion

The present structural modifications of human insulin possessed a long-acting profile and glucose-lowering function along with favorable in vivo properties in rats, which establish a foundation for further preclinical and clinical evaluation.

Downregulation of Salivary Proteins, Protective against Dental Caries, in Type 1 Diabetes

Saliva, an essential oral secretion involved in protecting the oral cavity’s hard and soft tissues, is readily available and straightforward to collect. Recent studies have analyzed the salivary proteome in children and adolescents with extensive carious lesions to identify diagnostic and prognostic biomarkers. The current study aimed to investigate saliva’s diagnostic ability through proteomics to detect the potential differential expression of proteins specific for the occurrence of carious lesions. For this study, we performed bioinformatics and functional analysis of proteomic datasets, previously examined by our group, from samples of adolescents with regulated and unregulated type 1 diabetes, as they compare with healthy controls. Among the differentially expressed proteins relevant to caries pathology, alpha-amylase 2B, beta-defensin 4A, BPI fold containing family B member 2, protein S100-A7, mucin 5B, statherin, salivary proline-rich protein 2, and interleukin 36 gamma were significantly downregulated in poorly-controlled patients compared to healthy subjects. In addition, significant biological pathways (defense response to the bacterium, beta-defensin activity, proline-rich protein activity, oxygen binding, calcium binding, and glycosylation) were deregulated in this comparison, highlighting specific molecular characteristics in the cariogenic process. This analysis contributes to a better understanding of the mechanisms involved in caries vulnerability in adolescents with unregulated diabetes.

Prevalence of Dental Caries and Associated Factors in East Africa, 2000-2020: Systematic Review and Meta-Analysis

Background: Dental caries affects mastication, growth and development, and school attendance and has a long-term psychological effect on affected individuals. In developing countries, the prevalence of dental caries is increasing due to the growing consumption of sugary foods, poor tooth brushing habits, and a low level of awareness about dental caries. Even if there was a high prevalence of dental caries in sub-Saharan Africa, there is a paucity of data on the prevalence of dental caries in East Africa. Hence, this study aimed to determine the prevalence of dental caries and associated factors in East Africa. Methods: A systematic search of articles was conducted in MEDLINE, Scopus, and Google Scholar using all the synonyms of dental caries in published literature (until December 2020) in East Africa. Important data were extracted using a standardized data extraction form prepared in Excel. Stata software (version 14.0) was used to calculate the pooled prevalence of dental caries. Besides, subgroup analysis was done based on country and dentition type. Moreover, associated factors of dental caries were assessed and the overall effect was presented in the form of odds ratios. The quality of the included studies was evaluated using the Joanna Briggs Institute reviewers' manual. Results: The overall pooled prevalence of dental caries was found to be 45.7% (95% CI = 38.0-53.4). The pooled prevalence was high in Eritrea (65.2%, 95% CI = 49.2-81.1), followed by Sudan (57.8%, 95% CI = 36.0-79.7), and a low prevalence was found in Tanzania (30.7%, 95% CI = 21.5-39.9). Moreover, the subgroup analysis revealed a prevalence of 50% (95% CI = 38.4-62.1) in permanent dentition and 41.3% (95% CI = 33.5-49.2) in mixed dentition. The overall mean decayed, missed, and filled permanent (DMFT) and primary (dmft) teeth were 1.941 (95% CI = 1.561-2.322) and 2.237 (95% CI = 1.293-3.181), respectively. High DMFT scores were reported in Sudan (3.146, 95% CI = 1.050-5.242) and Uganda (2.876, 95% CI = 2.186-3.565). Being female (OR = 1.34, 95% CI = 1.24-1.46) and having poor tooth brushing habit (OR = 1.967, 95% CI = 1.67-2.33) were independent risk factors of dental caries. Conclusion: The overall prevalence of dental caries was comparatively high. Being female and poor oral health practice were independent risk factors of dental caries. The Ministry of Health of the member countries, along with dental associations of each country, ought to offer due attention to strengthen the oral health program in schools and primary health care centers and the implementation of school water fluoridation.

Oral health status and impact on the oral health-related quality of life of Egyptian children and early adolescents with type-1 diabetes: a case-control study

OBJECTIVES

The purpose of the present study is to (1) evaluate the oral health-related quality of life (OHRQoL) among a group of Egyptian children and early adolescents with type-1 diabetes mellitus (T₁DM) aged from 8 to 14 years and the impact of individual, environmental, oral health care and biological independent predictors (2) assess oral health status (OHS) in terms of oral hygiene, caries experience, untreated carious cavities and gingival condition.

MATERIALS AND METHODS

A case-control investigation conducted on eligible 444 participants who have been assigned into four groups (two case groups included 125 children and 97 early adolescents with T₁DM and two matched control groups). The OHRQoL was measured using a validated structured CPQ_8-10 for children and CPQ_11-14 short-form questionnaires for early adolescents. The questionnaire comprised of four parts that represented the study independent variables. Descriptive data were analysed using Mann-Whitney U test for the non-parametric data. Pearson's correlations have been calculated to inspect the interrelation between metabolic disease control and study of different OHS representatives. Log-linear Poisson model regression analyses performed to determine associations between the OHRQoL and independent predictors.

RESULTS

The prevalence of dental caries (DT ≥ 1) in children with diabetes was 49.6% (75.3%). The worse GI mean and median scores were recorded among early adolescents with T₁DM [mean (SD) = 2.24 ± 0.61; median (IQR) = 2.3(1)]. The social well-being of CPQ domains was a prominent concern that negatively affected children and early adolescents' life aspects. A strong correlation between OHRQoL and the level of HbA_1c in the two diabetic groups (r = 0.69 for children's group and 0.74 for the early adolescent group) was observed. The final model of log-linear Poisson regression analysis demonstrated that the odds ratio (OR) of poor OHRQoL among children and early adolescents with poor metabolic control was 1.30 [95% CI 1.18-1.47] and 1.22 [95% CI 1.11-1.38] times more than those with good metabolic control do.

CONCLUSIONS

The overall self-reported OHRQL appears to be adversely affected by T₁DM especially among children and early adolescents with poor metabolic control. Socioeconomic status and oral health care demonstrate a significant impact on the OHRQoL; however, the effect was obvious in the diabetic and non-diabetic groups.

CLINICAL RELEVANCE

1. In Egypt, the number of new cases rises progressively in a retrospective survey to figure out the prevalence of T1DM among children and adolescents. The available data is limited regarding the incidence and prevalence of dental caries and gingival condition among Egyptian children and early adolescents. 2. The present study is a premier study that assesses the OHRQoL and studies the impact of the individual, environmental, biological and oral health care variables. 3. This study highlights the urgent need for improving the oral health status of diabetic children and adolescents and the necessity for qualified oral health education programs for children and parents. There is an intense need to reinforce the role of preventive oral hygiene measures.