The bidirectional relationship between weight, height and dental caries among preschool children in China

Study on the association between malnutrition, early childhood caries and caries activity among children aged 3-5 years

BACKGROUND

This study aims to investigate the association between malnutrition and early childhood caries (ECC) and caries activity among children aged 3-5 years, in order to provide a theoretical basis for preventing and blocking ECC and improving malnutrition.

METHODS

Children aged 3-5 years from six kindergartens in Zhao Xian, China were enrolled in this study. The decayed, missing, filled teeth (dmft) of all children were examined and recorded. The Cariostat method was used to detect dental caries activity, collect anthropometric data and measure haemoglobin concentration. Parents were asked to complete a questionnaire on the general characteristics and oral health behaviour of the participants. The "Growth Standards for Chinese Children Under 7 Years Old" was used to assess the nutritional status of all participating children. Wilcoxon rank sum test and multivariate logistic regression analysis were used to analyse and evaluate the relationship between ECC, caries activity and malnutrition.

RESULTS

A total of 635 children who met the criteria were included in this study. After adjusting for confounding factors, logistic regression showed that the risk of ECC was significantly increased in underweight children compared with normal children (OR = 5.43, P < 0. 05); compared with normal children, the risk of ECC decreased in overweight and obese children (OR = 0.31, P < 0.001); underweight children had higher caries severity than normal weight children, and the difference was statistically significant (OR = 2.69, P < 0. 05); stunted children had higher caries severity than normal weight children and the difference was statistically significant (OR = 2.28, P < 0.05); underweight was positively associated with caries activity and the association was statistically significant (OR = 2.33, P < 0. 05); stunting was positively associated with caries activity and the association was statistically significant (OR = 2.1, P < 0.05); overweight and obesity were negatively associated with caries activity and the association was statistically significant (OR = 0.61, P < 0.05).

CONCLUSIONS

The risk of ECC among children aged 3-5 years was positively associated with undernutrition and negatively associated with overnutrition. The severity of ECC among children aged 3-5 years was positively associated with undernutrition. The caries activity among children aged 3-5 years was positively associated with undernutrition and negatively associated with overnutrition.

Oral processing behavior and dental caries; an insight into a new relationship

INTRODUCTION

Previous evidence suggests an individual variation in the preferred oral processing behavior. Individuals can be classified as firm processing(FPL) or soft processing likers(SPL). FPL(crunchers and chewers) prefer using their teeth while SPL(smooshers and suckers) prefer using the tongue and the palate when processing different food items. Variation in the preferred oral processing behavior has been associated with differences in food texture preference and eating time. Time is one of the factors directly related to the development of dental caries(tooth decay). Oral retention and eating times are associated with greater caries experience. This study aims to explore if a relationship exists between the preferred oral processing behavior and the individual's caries experience.

MATERIALS AND METHODS

This was a cross-sectional, dental center-based study conducted at Jordan University of Science and Technology. Five hundred participants consented to fill out the preferred oral processing behavior(POPB) questionnaire. Anthropometric measurements (including weight, height, and waist circumference) were recorded. A single trained and calibrated dentist registered each participant's caries experience and plaque levels using the DMFS index and plaque index of Silness and Loe.

RESULTS

A total of 351(70.2%) and 149(29.8%) participants were typed as FPL and SPL, respectively. SPL demonstrated higher levels of dental caries experience compared to FPL. The mean DMFS score for SPL was 28.8(±25.43) while for FPL was 18.71(± 18.34). This difference remained significant after adjustment for confounders(P<0.001). SPL exhibited a significantly higher mean score for the "M" component(P <0.001) while no significant difference in the mean score of the "D"(P = 0.076) and "F"(P = 0.272) components was observed when compared to FPL.

CONCLUSION

The current findings provide new insight into a possible relationship between the preferred oral processing behavior and an individual's caries experience. A relationship in which the preferred oral processing behavior can potentially affect and/or be affected by the dental caries experience.

A Review on Maternal Parenting, Child's Growth Stunting, and Oral Health

Stunting has gained global attention as one of the most critical problems in public health. As the first and dominant figure in a child's life, the mother is responsible for determining the proper parenting behaviors to apply to maintain the child's physical health. Stunting is often associated with early childhood caries (ECC) and molar incisor hypomineralization, which can be manifested into each other through various mechanisms. Therefore, it is crucial to explore how far maternal parenting behaviors affect stunting and oral health. This study aims to determine which maternal parenting behaviors can affect stunting and oral health. A systematic search was used through PubMed and Google Scholar to search for published articles between 2011 and 2021. The articles analyze maternal parenting behaviors with stunting and poor oral health. Final analysis was used on 21 articles containing 18 cross-sectional studies, 2 cohort studies, and 1 randomized controlled trial. The result implied that the high prevalence of stunting and ECC is the combined result of prolonged breastfeeding practices (7 articles), poor complementary feeding practice (6 articles), high consumption of sugar (5 articles), and poor oral hygiene practices (5 articles). Maternal parenting styles in the aspect of fulfilling nutrition and maintaining oral health affect the occurrence of stunting and ECC in children.

Early Childhood Caries and Nutritional Status of Children: A Review

BACKGROUND

Early childhood caries (ECC) is a serious public health issue affecting children around the world. Severe symptoms and complications commonly found with ECC are adverse effects on health and growth retardation triggered by sensitivity, pain, and abscesses associated with decayed teeth, premature tooth loss, and insufficient food intake due to difficulty in chewing and keeping food in the mouth.

OBJECTIVE

This article aims to provide an overview of the most recent and current evidence on the association between ECC and nutritional status with an aim to stimulate further research and to identify the impact of nutritional status on ECC and vice versa.

METHODS

PubMed, Web of Science, and Google Scholar databases were used to search the studies conducted between 2016 and 2022. The included studies were searched using some keyword combinations and saved in Mendeley Desktop for review and referencing. All books, policy briefs, thesis/dissertations, and non-peer-reviewed articles were excluded, and 47 studies were selected for this narrative review.

RESULTS

Many studies have identified long-term, frequent, and nocturnal bottle-feeding and breastfeeding as well as frequent consumption of sugary food and beverages as high-risk factors for ECC. Adverse nutritional status assessed by anthropometric measures, vitamin D status, and iron-deficiency anemia have been studied as risk factors for ECC.

CONCLUSIONS

Most of the prevailing studies are either case-control or cross-sectional studies, which are unable to provide strong evidence to prove the direction of causality. Thus, further prospective studies are needed to clarify the association between ECC and the nutritional status of children.

Growth Stunting Prevention in Indonesia: Dentist Knowledge and Perception

OBJECTIVE

 Dentists in Indonesia as health workers have a role to play in improving the quality of life of others; thus, dentists' participation in growth stunting prevention is essential. It is also supported by the fact that growth stunting correlates with dental and oral health. Therefore, a dentist's knowledge and perception of growth stunting and its prevention affect the success of a dentist's role in the community.This study aimed to explore the knowledge and perceptions of growth stunting and its prevention in dentists in Bandung.

MATERIALS AND METHODS

 A descriptive study was conducted on general dental practitioners and dental specialists in Bandung. The number of participants gathered were 76 general dental practitioners and 30 dental specialists, which, if added all together, are 106 dentists as the study participants. Data was collected using a knowledge-based questionnaire containing three dimensions: knowledge about nutrition, growth and development, and health behavior. In addition, a perception questionnaire contains statements categorized into four dimensions: awareness, adoption, implementation, and maintenance. The questionnaire was distributed online using Google Form. A descriptive analysis was then done on the collected data.

RESULTS

 Analysis of the findings showed that 80.19% of the participants have good knowledge of growth stunting and its prevention, 16.98% moderate, and 2.83% have poor knowledge. As for the perception category, the number of participants with positive perceptions is 53.77%, while the number of participants with negative perceptions is 46.23%.

CONCLUSION

 Most dentists in the city of Bandung have an excellent knowledge of growth stunting and its prevention and positively perceive growth stunting and its prevention.

Research on Nutrition, Dental Caries Status Using Novel Methods, and Related Factors to Preschool Children in Rural Areas of Vietnam

The study aims to examine correlations between nutrition status with different factors and dental caries of preschool children in rural areas of Vietnam. A big data based on a total of 690 children (356 boys and 334 girls), aged 2-5 years, living in Van Xuan commune, were thoroughly analyzed. Oral examinations were performed by dentists with the assistance of nursery teachers and the research team. Caries was diagnosed using criteria established by the International Caries Detection and Assessment System (ICDAS). The examined children and their parents responded to questions pertaining to dental hygiene practices. The nutrition status of preschool children was determined by the World Health Organization (WHO) standards in 2006. There are factors which have effects on the malnutrition status of children in the research. The prevalence of dental caries also contributed importantly to assess children's development. In this study, the stunting groups have a higher ratio of caries compared to the others. Children's morphology and nutritional status are associated with dental caries among the preschool children in Van Xuan commune, Vinh Tuong district, Vinh Phuc province.

Prepregnancy BMI, gestational weight gain and offspring caries experience: Avon longitudinal study of parents and children

Pre-existing maternal overweight/obesity and pregnancy weight gain are associated with adverse birth outcomes such as low birth weight and prematurity, which may increase the risk of developmental tooth defects and early childhood caries. We sought to investigate the association between prepregnancy BMI, gestational weight gain (GWG) and the risk of early childhood caries. Data from 1,429 mother-offspring participants of the 1991/1992 Avon Longitudinal Study of Parents and Children were analyzed. The exposures were prepregnancy BMI (under/normal weight vs. overweight/obese), and gestational weight gain (GWG) based on the Institute of Medicine’s recommended levels. The main outcome measured was offspring caries experience determined by clinical oral examinations at three time points. Log binomial regression estimated risk ratios and 95% confidence intervals. Seventy six percent (76%) of the mothers were under/normal weight prepregnancy, 39% and 26% respectively gained less and more than the recommended weight for their prepregnancy BMI during pregnancy. Being overweight/obese prepregnancy was associated with unadjusted RR (95% CI) of offspring caries of 1.16 (0.90, 1.51) at 31-months, 1.20 (0.96, 1.49) at 43-months and 1.09 (0.91, 1.30) at 61-months. GWG less than recommended was associated with higher unadjusted offspring caries experience of 1.13 (0.86, 1.48), 1.17 (0.92, 1.48) and 1.04 (0.87, 1.25) at 31-months, 43-months and 61-months respectively. There was insufficient evidence to indicate an association between prepregnancy BMI and gestational weight gain on offspring caries experience risk.

Association Between Early Childhood Caries and Obesity among Preschool Children

PURPOSE

Early childhood caries (ECC) and childhood obesity are among the most prevalent health conditions affecting children. ECC is associated with obesity through the common risk factor of sugar consumption. The present study aimed to assess the association between ECC and obesity in preschool children.

MATERIALS AND METHODS

A cross-sectional study was conducted among 1250 preschool children (698 girls, 552 boys; mean age: 4.3 [1.1] years). The children's body mass index was determined (BMI: weight/height in kg/m2). The World Health Organization criteria were used for the diagnosis of caries. Multivariable logistic regression was used to analyse the relationship between ECC prevalence and childhood obesity.

RESULTS

ECC was detected in 929 (74.3%) children. The mean dmft and dmfs was 5.91 (1.13) and 8.92 (2.07), respectively. The multiple regression model showed a statistically significant association between ECC prevalence and obesity with an adjusted odds ratio (OR) of 2.59 (95% CI: 1.88 - 3.57; P = 0.001). The logistic regression model showed that in children with a monthly family income > $2666, sugar consumption, preterm low birth-weight/full-term low birth-weight (PTLBW/FTLBW), and toothbrushing frequency ≤ 1 time/day were statistically significantly associated with ECC prevalence.

CONCLUSION

ECC was positively associated with obesity.

Early Childhood Caries in Obese Children: The Status and Associated Factors in the Suburban Areas in Hanoi, Vietnam

Obesity and early childhood caries are two prominent health problems affecting the majority of children worldwide. Thus, early childhood caries in obese children must be studied. This study was conducted to investigate the status of early childhood caries in obese children in Hanoi, Vietnam, and its associated factors. A cross-sectional study was conducted on 234 obese children, 234 normal children (non-obese) aged 36 to 71 months, and their mothers at some kindergartens in Hanoi. Study subjects were randomly selected with similarities in age, gender, and study location. Decayed tooth of children was detected by clinical examination and Diagnodent Kavo 2190 machine of Germany. In addition, a questionnaire for their mothers was used to find out related factors. We found that, in the Obese Group, the rate of early childhood caries (ECC), severe-early childhood caries (S-ECC), dmft index (the number of decayed teeth, teeth lost due to cavities, filled decayed teeth or filled cavity), and dmfs index (the number of surfaces of the teeth decay, surfaces of teeth were lost due to cavities, surfaces of filled decayed teeth) were 82.91%, 59.83%, 6.84 ± 4.92, and 9.10 ± 7.48, respectively. In the Normal Group, these rates were smaller than in the Obese Group, but the difference was not statistically significant. Regarding related factors, the hobby of drinking soft drinks, the habits and frequency of drinking milk at night and eating sweet marshmallows were associated with ECC in the Obese Group with p < 0.05. In conclusion, the higher rates of ECC were seen in obese children, with eating hobbies and habits being the related factors. Therefore, it is necessary to have appropriate policies and effective communication strategies to minimize ECC in the future.

Dental Caries Severity and Nutritional Status of Nigerian Preschool Children

INTRODUCTION

Malnutrition in children is one of the most prevalent global health challenges, and malnourished children have a higher risk of death from childhood diseases. Early childhood caries (ECC) is the most common chronic disease of childhood. Complications from ECC such as pain, loss of tooth/teeth, and infection can undermine a child's nutrition and growth.

AIM

This study aims to evaluate the severity of decay, missing, and filled tooth (dmft) by nutritional status using the z scores of the anthropometric measurements: height for age (HFA), weight for age (WFA), weight for height (WFH), and body mass index for age (BMIA) among children with ECC in Nigeria.

STUDY DESIGN

This is a cross-sectional study conducted in 5 local government areas (LGAs) in Lagos State, Nigeria. A multistage sampling technique was used.

RESULTS

A total of 273 cases of ECC were included in the analyses (mean age 4.19 ± 0.96 y). Overall, the mean dmft was 3.04 ± 2.28, and most (96%) were accounted for by untreated decay. The distribution of dmft within the different z score categories of BMIA (<-3 = severely wasted, -2 to -3 = wasted, -2 to +2 = normal, +2 to +3 = overweight and >+3 = obese) showed the highest dmft scores among the combined severely wasted and wasted groups, lowest among children with normal z scores, and intermediate in the overweight and obese groups. There was a significant negative correlation between BMIA z score, WFH z score, and dmft (r = -0.181, P < 0.05 and r = -0.143, P < 0.05, respectively). However, the correlations between HFA z score, WFA z score, and dmft were positive but not significant (r = 0.048, P = 0.44 and r = 0.022, P = 0.77, respectively).

CONCLUSION

Our study showed an increased severity of dental caries among severely wasted or wasted children with ECC compared to those of normal or overweight.

KNOWLEDGE TRANSFER STATEMENT

The results from this study will raise awareness among clinicians and policy makers on the need for a primary prevention program for early childhood caries in countries with high burden of malnutrition and limited resources. Also, it will help draw the attention of clinicians to the caries status of malnourished children that can be managed to improve the nutritional outcomes.

Psychometric evaluation of the Thai version of the Early Childhood Oral Health Impact Scale (Th-ECOHIS): a cross sectional validation study

Background

Early childhood caries (ECC) is prevalent in Thailand, but no appropriate tool has been available to measure its impact on children’s quality of life. This study translated the Early Childhood Oral Health Impact Scale (ECOHIS), a widely used proxy-reported questionnaire developed in the United States for measuring the oral health-related quality of life of preschool children and their families, into Thai (Th-ECOHIS). The scale’s psychometric properties were investigated in Thai caregivers and their children.

Methods

Cultural adaptation for the scale development within the Thai context was processed using forward–backward translation by experts. A face and content validation was conducted among 20 Thai caregivers to attain the final Th-ECOHIS. Psychometric testing was done on 3-year-old child-caregiver pairs in Bangkok using the interviewer-administered mode. Children’s oral health was determined by caries experience (decayed, missing and filled primary teeth, dmft) and treatment need. The caregivers answered the Th-ECOHIS and global questions regarding their perception of the children’s oral health. Across-items reliability was assessed by internal consistency using the Cronbach’s alpha coefficient. Test-retest reliability was managed at a 2-week interval in 10% of the sample using the intraclass correlation coefficient calculated by two-way analysis of variance. The discriminant validity was tested by the relationship between the severity of dental caries, treatment need and Th-ECOHIS scores, using the Kruskal-Wallis test.

Results

A total of 214 child-caregiver pairs participated. Twenty-two percent had ECC (dmft 1–3) and 17.3% had severe ECC (dmft 4 or higher) with mean (SD) dmft 1.63 (2.92). All items in the original ECOHIS were retained in the Thai version. The test-retest reliability of Th-ECOHIS was 0.87; internal consistency was 0.85; the total Th-ECOHIS scores were significantly correlated with the global rating of oral health question (r = 0.604). Th-ECOHIS scores in both child and family impact sections and the total were significantly associated with the severity of caries (p <  0.001) and treatment need (p <  0.001).

Conclusions

Th-ECOHIS demonstrated good reliability and validity. It could be used on caregivers to assess the impacts of ECC on quality of life of Thai pre-school children and compared to other countries.

Stunting Malnutrition Associated with Severe Tooth Decay in Cambodian Toddlers

Background: The persistently high prevalence of undernutrition in Cambodia, in particular stunting or chronic malnutrition, calls for innovative investigation into the risk factors that affect children’s growth during critical phases of development. Methods: Secondary data analysis was performed on a subgroup of children who were present at two time points within the Cambodian Health and Nutrition Monitoring Study (CAHENMS) and who were less than 24 months of age at the nominated baseline. Data consisted of parent interviews on sociodemographic characteristics and feeding practices, and clinical measures for anthropometric measures and dental status. Logistic regression modelling was used to examine the associations between severe dental caries (tooth decay)—as indicated by the Significant Caries Index—and the presence of new cases of stunting malnutrition at follow-up. Results: There were 1595 children who met the inclusion criteria and 1307 (81.9%) were followed after one year. At baseline, 14.4% of the children had severe dental caries, 25.6% presented with stunted growth. 17.6% of the children transitioned from healthy status to a low height-for-age over the observation period. Children with severe dental caries had nearly double the risk (OR = 1.8; CI 1.0–3.0) of making that transition. Conclusion: Severe caries experience was associated with poorer childhood growth and, as such, could be an underinvestigated contributor to stunting.

Associations between Child Snack and Beverage Consumption, Severe Dental Caries, and Malnutrition in Nepal

The global nutrition transition and increased consumption of sugar-sweetened beverages and ultra-processed snacks have contributed to increasing rates of child obesity and dental caries in developing countries. In Nepal, where child malnutrition rates are high, the relationship between malnutrition and dental caries is poorly understood. This cross-sectional study aims to assess this relationship among a convenience sample of 273 children age six months to less than 12 years in three communities in Nepal, using parent/caregiver interviews, child dental exams, and anthropometric measurements. Fisher’s exact test and independent t-tests examined associations between dietary practices and severe caries and between severe caries and malnutrition, respectively. Children consumed sugar-sweetened beverages and processed snacks frequently: 80% consumed tea with sugar, 60% consumed sweet snacks, and 65% consumed processed savory snacks daily. Overall, 74% of children had untreated tooth decay, and 21% exhibited stunting malnutrition, 14% were underweight, and 6% presented wasting. Significant associations were found between daily consumption of sweets and processed snacks with severe caries and between severe caries and poorer nutritional status. These findings underscore the need to incorporate nutrition and oral health promotion and dental treatment into maternal–child health services and schools and to strengthen policies to reduce children’s access to junk food.

Undernutrition is associated with change in severe dental caries

OBJECTIVES

To examine the association of baseline prevalence of thinness or stunting and the incidence of dental caries among preschool children in Liaoning Province, China.

METHODS

Children were recruited from 15 kindergartens in Liaoning Province. A total of 772 children were assessed at baseline and follow-up. The mean age of children at baseline was 50.82 months, and the median follow-up time was 10.12 months. Anthropometric measurement, dental caries, and questionnaire were assessed overtime, whereas only baseline questionnaire was used in the data analysis. z-Score for body mass index (BMI)-for-age, weight-for-age, and height-for-age were calculated using World Health Organisation (WHO) Child Growth Standards. Dental caries was assessed according to the fifth WHO Basic Methods for Oral Health Surveys. The presence of pulpal involvement, ulceration, fistula, and abscess (pufa) were used to indicate severe dental caries in deciduous teeth. A structured questionnaire mainly based on the fifth WHO Oral Health Surveys was used to collect sociodemographic and behavior data. Logistic regression was constructed to assess the association between change in severe dental caries and prevalence of thinness and stunting.

RESULTS

There was a positive association between prevalence of stunting and incidence of severe caries in the fully adjusted model [odds ratios 2.88; 95 percent confidence interval (CI): 1.01, 8.27]. Prevalence of thinness showed insignificant positive association with incidence of severe caries.

CONCLUSIONS

While undernutrition indicated by stunting appeared to be a risk factor for severe dental caries, it could also be a marker for other determinants of progress of dental caries including socioeconomic factors and lack of use of dental services.

The Socioeconomic Inequality in Increment of Caries and Growth among Chinese Children

BACKGROUND

This study aimed at assessing socioeconomic inequalities in the increment of dental caries and growth among preschool Chinese children, and to assess the best predictor of socioeconomic inequality for each of these conditions.

METHODS

This is a longitudinal population-based study. The sample data included preschool children living in three cities of the Liaoning Province, China. At baseline, 15 kindergartens with 1111 participants were included and dropped to 772 with a response rate of 70% at follow-up. Mean ages at baseline and follow-up were 50.82 and 60.55 months, respectively. Median follow-up time was 10.12 months. Data were collected through structured questionnaire, oral examination and anthropometric measurement. The questionnaire collected information on sex, age, family income, mother's education and children's dietary habits. The numbers of decayed, missing and filled teeth (DMFT) was used to indicate dental caries. Weight- and height-for-age z-scores were calculated using the WHO Growth Standard. Multilevel analysis was used to assess the association between baseline socioeconomic position and each of dental caries and child's growth.

RESULTS

Mother's education was negatively associated with increments of DMFT. Family income was not significantly associated with DMFT in the fully adjusted model. The association persisted after accounting for other socioeconomic and dietary factors. Higher income was positively related to an increase in the weight-for-age z-score. The relationship between income and changes in the height-for-age z-score was positive and significant in the second highest income group.

CONCLUSIONS

Mother's education appeared to be the strongest predictor of increments of dental caries. Only income was significantly associated with an increase in children's weight and height.

Associations of nutritional status, sugar and second-hand smoke exposure with dental caries among 3- to 6-year old Malaysian pre-schoolers: a cross-sectional study

BACKGROUND

Dental caries in primary teeth is a serious oral health concern among children. It can lead to detrimental impacts on a child's growth, development, and quality of life. Therefore, this cross-sectional study aimed to examine the prevalence of dental caries and its associations with nutritional status, sugar and second-hand smoke exposure among pre-schoolers.

METHODS

A total of 26 pre-schools in Seremban, Malaysia were randomly selected using the probability proportional to size sampling. Dental examination was performed by a dentist to record the number of decayed teeth (dt). Weight and height of the pre-schoolers were measured. The mother-administered questionnaire was used to gather information pertaining to the sociodemographic characteristics and second-hand smoke exposure. Total sugar exposure was calculated from a 3-day food record.

RESULTS

Among the 396 participating pre-schoolers, 63.4% of them had at least one untreated caries, with a mean ± SD dt score of 3.56 ± 4.57. Negative binomial regression analysis revealed that being a boy (adjusted mean ratio = 1.42, 95% CI = 0.005-0.698, p = 0.047), exposed to second-hand smoke (adjusted mean ratio = 1.67, 95% CI = 0.168-0.857, p = 0.004) and those who had more than 6 times of daily total sugar exposure (adjusted mean ratio = 1.93, 95% CI = 0.138-0.857, p = 0.013) were significantly associated with dental caries among pre-schoolers.

CONCLUSION

A high prevalence of dental caries was reported in this study. This study highlights the need to reduce exposure to second-hand smoke and practice healthy eating behaviours in reducing the risk of dental caries among pre-schoolers.

Severe dental caries is associated with incidence of thinness and overweight among preschool Chinese children

Objective: To examine the association of incidence and baseline prevalence of severe dental caries with incidences of thinness and overweight among pre-school Chinese children.Materials and methods: A longitudinal study design was used. A total of 772 children recruited from 15 kindergartens in Liaoning Province who completed baseline and follow-up assessments were included. The age range of children at baseline was 24.6-71.1 months. BMI-for-age z-score was calculated to estimate incidence of thinness and overweight. Severe dental caries was indicated by pulpal involvement, ulceration, fistula or abscess (pufa). Baseline prevalence of severe caries included children with pufa ≥1, incidence included those who changed from pufa = 0 to ≥1 at follow-up. Logistic regression was constructed to assess the association of baseline prevalence and incidence of severe caries with each of incidence thinness and overweight.Results: Children with incidence of severe caries had higher odds for incidence thinness (OR: 4.08; 95% CI: 1.08, 15.41). Baseline prevalence of severe caries was not significantly associated with incidence thinness. Participants with severe caries at baseline had higher odds for incidence overweight (OR: 2.33; 95% CI: 1.17, 4.63). The relationship between incidence of severe caries and incidence overweight was insignificant.Conclusions: The findings suggest a U-shaped relationship between severe dental caries and both ends of anthropometric measures among pre-school Chinese children. The findings highlight the importance of integrating oral and general health promotion policies. Primary health care providers are encouraged to incorporate dental screening, counselling and referral for treatment for severe caries to promote appropriate growth and overall health of children.

Association between early childhood caries and poverty in low and middle income countries

Background

The aim of this study was to assess the relationship between early childhood caries (ECC) in 3–5-year-old children, seven indicators of poverty and the indicator of monetary poverty in low- and middle-income countries (LICs, MICs).

Methods

This ecologic study utilized 2007 to 2017 country-level data for LICs and MICs. Explanatory variables were seven indicators of poverty namely food, water, sanitation, health, shelter, access to information, education; and monetary poverty. The outcome variable was the percentage of 3–5-year-old children with ECC. A series of univariate general linear regression models were used to assess the relationship between the percentage of 3–5 year-old children with ECC and each of the seven indicators of poverty, and monetary poverty. This was followed by multivariable regression models to determined the combined effect of the seven indicators of poverty, as well as the combined effect of the seven indicators of poverty and monetary poverty. Adjusted R² measured models’ ability to explain the variation among LICs and MICs in the percentage of 3–5-year-old children with ECC.

Results

Significantly more people had food, sanitation, shelter, access to information, education and monetary poverty in LICs than in MICs. There was no difference in the prevalence of ECC in 3–5-year-old children between LICs and MICs. The combination of the seven indicators of poverty explained 15% of the variation in the percentage of 3–5-year-old children with ECC compared to 1% explained by monetary poverty. When the seven indicators of poverty and the indicator for monetary poverty were combined, the amount of variation explained by them was 10%. Only two of the poverty indicators had a direct relationship with the percentage of children with ECC; there was a higher percentage of ECC in countries with higher percentage of population living in slums (B = 0.35) and in those countries with higher percentage of the population living below poverty lines (B = 0.19). The other indicators had an inverse relationship.

Conclusion

The use of multiple indicators to measures of poverty explained greater amount of variation in the percentage of 3–5-year-olds with ECC in LICs and MICs than using only the indicator for monetary poverty.

Association between early childhood caries and malnutrition in a sub-urban population in Nigeria

Background

To determine the association between malnutrition and early childhood caries (ECC) in children resident in sub-urban, Nigeria.

Methods

This study was a subset of a larger cross-sectional study the data of which was generated through a household survey conducted in Ile-Ife, Nigeria. The study’s explanatory variable was malnutrition (underweight, overweight, wasting and stunting) and the outcome variable was ECC. Poisson regression analysis was used to determine the association between ECC and malnutrition. Variables (sex, frequency of sugar consumption, maternal knowledge of oral hygiene, oral hygiene status) associated with ECC in the primary study were adjusted for to obtain the adjusted prevalence ratio (APR).

Results

Of the 370 children, 20 (5.41%) were underweight, 20 (5.41%) were overweight, 67 (18.11%) were wasting, 120 (32.43%) were stunted and 18 (4.86%) had ECC. Factors associated with ECC were being stunted, underweight, overweight and fair oral hygiene. The prevalence of ECC was lower in children who were stunted (APR: 0.14; 95% CI: 0.03–0.69; p = 0.02), almost seven times higher in children who were overweight (APR: 6.88; 95% CI: 1.83–25.85; p < 0.001), and predictively absent in children who were underweight (APR: 0; 95% CI: 0–0; p < 0.001) when compared with children who had normal weight. Non-significant risk indicators for ECC included consuming sugar between meals three times a day or more, having low socioeconomic status and being female.

Conclusions

For this study population, the indicators of malnutrition – being stunted, underweight, overweight - and fair oral hygiene were risk indicators for ECC. The frequency of sugar consumption was not a significant risk indicator when malnutrition was included as an explanatory variable for ECC in the study population.