Impact of Prolonged Breastfeeding on Dental Caries: A Population-Based Birth Cohort Study

Longitudinal assessment of factors associated with dental caries on the first permanent molars: a prospective clinical study in Brazilian children

PURPOSE

The first molars are frequently the first permanent teeth to erupt in the oral cavity, and their premature loss can significantly affect a child's oral health. This study aimed to identify determinants of dental caries on the first permanent molars among schoolchildren.

METHODS

A longitudinal study was conducted with 122 mother-child pairs from the Brazilian city of Diamantina. The children were evaluated at three instants: first, between 1 and 3 years of age (T1), then, 3 years after the initial assessment (T2), and finally, 6 years after the initial assessment (T3). Socioeconomic data, child habits, visible plaque, and dental caries (assessed through International Caries Detection and Assessment System [ICDAS-II]) were collected at all three time points.

RESULTS

The incidence of dental caries in the first permanent molars was 70.5% and was associated with the presence of caries at T1 (RR = 1.41; 95% CI 1.08-1.84) and T2 (RR = 1.58; 95% CI 1.12-2.22). The following variables at both T1 and T2 were also significantly associated with caries incidence: a high number of income dependents (RR = 1.66; 95% CI 1.17-2.35) and low brushing frequency (RR = 1.77; 95% CI 1.27-2.46). Yet, the persistence of low brushing frequency from T2 to T3 (RR = 1.32; 95% CI 1.05-1.65) was also associated with the incidence of caries.

CONCLUSIONS

The incidence of dental caries in the first permanent molars was associated with prior caries experience, low toothbrushing frequency, and schoolchildren belonging to families with a high number of income dependents. These findings highlight the importance of early preventive interventions and socioeconomic considerations in addressing childhood dental caries.

Parental Knowledge of Breastfeeding and Nutrition: Influence on Oral Health and Self-Reported Early Childhood Caries in Preschool Children in Croatia

Aim: Parents' knowledge of oral health plays a key role in shaping their children's habits and preventing early childhood caries, particularly through breastfeeding and nutrition. This study aimed to assess parents' knowledge of how dietary habits affect both oral health and early childhood caries rates. Materials and methods: An online cross-sectional survey was conducted among 595 parents of children aged 3 to 6 years old using a self-structured questionnaire. Sociodemographic data, the children's characteristics, breastfeeding practices, daily diet, the perceived effects of diet on orofacial health, and self-reported dental caries were recorded. The data were analyzed using descriptive statistics, chi-square tests, and regression models. Results: One-third of the children had dental caries (200/595). The prevalence of caries was significantly higher among children from rural areas (40.5%) compared to those from urban areas (31.1%) (p = 0.021) and in low-income families (72.7%) compared to middle-income (35.4%) and high-income (25.1%) families (p = 0.002). Breastfeeding duration, bottle feeding, and night feeding were not significantly associated with the occurrence of caries. Only 11.1% of parents recognized the role of extended breastfeeding on a child's demand over one year in promoting the development of tooth decay. Better knowledge was observed among parents with university degrees, in healthcare workers, and in parents with lower incomes (p < 0.05). Conclusions: Dental caries was prevalent, especially among children from rural areas and low-income families. Although there is no direct correlation between the duration of breastfeeding and dental caries, parental awareness of the preventive benefits of breastfeeding remains low. Education for parents about breastfeeding and nutrition's impact on oral health can have a substantial effect on preventing ECC. Educational efforts aimed at specific audiences are necessary to boost knowledge and advance preventive strategies. This study must recognize its limitations due to its dependence on self-reported caries data. Subsequent research must include clinical dental evaluations to achieve findings that are both dependable and factual.

Dental caries in anterior teeth of babies can predict the occurrence of severe dental caries in posterior teeth: a 3-year cohort study

OBJECTIVE

To evaluate whether the presence of dental caries in the primary anterior teeth of 1- and 2-year-old babies can predict the occurrence of severe dental caries in the primary posterior teeth of these children after a 3-year follow-up.

METHODOLOGY

This cohort study was carried out with 99 children and their guardians who were assessed at the beginning of the study and reassessed after 3 years. Severe caries in posterior tooth at the 3-year follow-up is the dependent variable. Caries in anterior tooth at baseline is the main independent variable. Other independent variables are family income, mother's education, oral hygiene, night oral hygiene, sucrose consumption, and history of toothache. Descriptive analysis, chi-square test, and Poisson regression were performed.

RESULTS

The incidence of severe caries in posterior tooth was 3.33 times higher in children with caries in anterior tooth at baseline (95% CI 2.06-5.37). Children who belonged to lower-income families both at baseline and at follow-up (RR: 2.75; 95% CI 1.40-5.39), who did not perform night-time oral hygiene at baseline (RR: 1.76; 95% CI 1.10-2.80) and who had a frequency of sucrose consumption equal to or greater than twice a day, both at baseline and at follow-up (RR: 4.07; 95% CI 2.03-8.19) had a higher risk of developing severe dental caries in posterior deciduous teeth.

CONCLUSION

Children with dental caries in primary anterior teeth when they were babies have a higher incidence of severe caries in posterior teeth.

The Global Consortium of Oral Health Birth Cohort Studies-GLOBICS

This article highlights the transformative initiatives of the Global Consortium of Oral Health Birth Cohort Studies (GLOBICS) as a key response to the call for a global overhaul of the oral health agenda. Recognizing the critical role of birth cohort studies in public health, particularly in understanding the interplay between oral health, noncommunicable diseases (NCDs), and social inequalities, GLOBICS is spearheading efforts that are research driven and focused on translational pathways. GLOBICS is advancing an International Research Agenda with 8 key priorities aimed at addressing the most pressing questions in oral health research. These priorities shall guide pooled analyses from oral health birth cohort studies (OHBCS) spread across the globe, enabling the consortium to generate robust evidence answering core research questions. One of the major efforts of GLOBICS is data harmonization, which involves standardizing and integrating data from multiple sources to ensure consistency and comparability. This process is vital for generating reliable global insights and fostering collaborations with new research partners. GLOBICS also emphasizes the nurturing of the next generation of OHBCS researchers, ensuring that the field continues to grow and innovate. The consortium's commitment to disseminating and translating its findings is central to its mission. By supporting the development of clinical practice guidelines, policies, and public health information tailored to the specific contexts of its collaborators, GLOBICS is making strides toward tangible improvements in global oral health. This work is a testament to the power of collaborative research and an invitation for further contributions to this global effort.

Iranian early childhood dental caries: a comprehensive systematic review and meta-analysis of prevalence and associated risk factors

OBJECTIVES

Early childhood dental caries (ECC) is a prevalent dental condition affecting infants and young children, characterized by one or more carious lesions in primary teeth. ECC risk factors include malnutrition, genetic predisposition, specific dietary habits, lack of fluoride, and prolonged bottle feeding. A comprehensive prevalence estimate is crucial for understanding the extent of dental caries in the population. So, this study aimed to determine the prevalence of ECC and its associated risk factors in Iranian children.

METHODS

A comprehensive literature search was conducted in Scopus, Web of Science, PubMed, Google Scholar, ACECR Scientific Information Database ( www.ACECRScientific Information Database.ir ), and Magiran research databases. Eligible English and Persian studies published between 2006 and 2024 were reviewed and analyzed. The studies on ECC prevalence were identified and included in the meta-analysis. Random effect models were utilized to calculate the pooled prevalence, and meta-regression and sensitivity analyses were conducted to assess sources of heterogeneity in the systematic review of risk factors.

RESULTS

The meta-analysis encompassed thirty eligible studies, providing the prevalence of ECC in Iran, with an estimated prevalence of 61.7%. Meta-regression analysis indicated a non-statistically significant increase in ECC prevalence with age and a substantial slight decrease over time. Additionally, 68 Studies evaluated categories such as age, gender, sociodemographic factors, microbial flora, oral hygiene, breast/bottle feeding, and dietary. Significant ECC-related factors identified included parents' education and occupation, breastfeeding, and oral hygiene.

CONCLUSION

The overall prevalence of ECC in Iran was estimated at 61.7%, with notable heterogeneity. Most of the studies extensively evaluated sociodemographic factors as risk factors.

A Narrative Review on Advancing Pediatric Oral Health: Comprehensive Strategies for the Prevention and Management of Dental Challenges in Children

Oral health is fundamental to overall well-being, especially in childhood, when dental structures and lifelong habits are established. This review provides a comprehensive analysis of children's dental development, common oral health challenges, and evidence-based preventive strategies. Key topics include the mechanisms of tooth development, the eruption processes of primary and permanent dentition, and the management of developmental abnormalities. The prevalence, risk factors, and health impacts of dental caries in children are examined, underscoring the need for early intervention and targeted prevention. This review evaluates the effectiveness of preventive measures such as dental sealants, fluoride varnishes, and fluoride mouth rinses while highlighting the influence of dietary habits, toothbrush selection, and parental involvement on oral health outcomes. Additionally, it explores the synergistic benefits of combining preventive approaches, such as the concurrent use of dental sealants and fluoride applications, which have demonstrated superior caries prevention compared to either method alone. The effectiveness of these strategies is analyzed across different age groups, from early childhood to adolescence, with tailored recommendations for each developmental stage. Furthermore, the role of education, policy interventions, and community-based programs in addressing oral health disparities is discussed. By integrating developmental insights with epidemiological data and clinical evidence, this review provides a comprehensive framework for advancing pediatric dentistry, informing best practices, and enhancing preventive strategies to reduce the burden of oral diseases in diverse pediatric populations.

An International Research Agenda for Oral Health Birth Cohort Studies

The GLOBICS-Global Consortium of Oral Health Birth Cohort Studies (OHBCS)-is a long-lasting international collaborative research group among existing OHBCS, established in response to the Lancet Series on Oral Health, which pointed out the need to shift the global oral health agenda. This study aimed to identify priority research questions from OHBCS that can be leveraged to improve children's global oral health. A 2-phase online Delphi process sought consensus over research priorities for OHBCS. Participants were identified by mapping existing OHBCS. Fourteen research questions were grouped into 4 thematic areas. A 9-point Likert-type scale was applied. Consensus was achieved if the question had (1) at least 51% of participants scoring a research question as "high priority," (2) an interquartile range of <2.5, and (3) a standard deviation of <1.7 or 75% of responses falling between 2 points above and below the mean score. Forty-four of 114 participants completed the Delphi survey. The 8 research priorities identified included questions about the effect of childhood dental visits on oral health throughout life (n = 2), questions related to sugar consumption and dental caries in childhood and adolescence (n = 4), infant growth and dental diseases (n = 1), and whether socioeconomic inequalities in dental caries are mitigated by fluoride exposure (n = 1). Guided by expert insight, the priorities identified for future OHBCS research should leverage a life course perspective to address knowledge gaps in children's oral health and oral health equity.

Mouth breathing is associated with a higher prevalence of anterior dental caries in preschool children

This cross-sectional study aimed to investigate the association between anterior dental caries and the predominant type of breathing in preschoolers. The research involved a sample of 257 children aged between 3 and 5 years, who were enrolled in public daycare centers and preschools in the city of Diamantina, MG, Brazil. A questionnaire was applied to parents/guardians to collect sociodemographic data, habits, oral health, and a dietary diary used to calculate the Sucrose Consumption Index. The predominant type of breathing, whether nasal or through the mouth, was determined through direct observation. Dental caries was assessed using the International Caries Detection and Assessment System (ICDAS). Descriptive analyses and the Poisson regression were conducted to analyze the data. The results revealed a higher prevalence of anterior dental caries among children who predominantly breathed through the mouth (PR = 1.57; 95%CI: 1.01-2.46; p = 0.047), who exhibited a higher frequency of sucrose consumption (PR = 4.02; 95%CI: 2.03-7.95; p < 0.001), and had mothers with lower educational levels (PR = 1.53; 95%CI: 1.01-2.32; p = 0.043). Pacifier use was associated with a lower prevalence of anterior dental caries (PR = 0.57; 95%CI: 0.34-0.96; p = 0.035). In conclusion, this investigation demonstrated an association between carious lesions in the anterior teeth and predominantly mouth breathing in preschoolers.

Every bite counts to achieve oral health: a scoping review on diet and oral health preventive practices

OBJECTIVE

To examine the landscape of preventive strategies and interventions directed to achieve oral health equity, with particular emphasis on the interplay between dental caries prevention, individual behaviors, and population-level strategies across various demographic and geographic regions.

METHODS

This scoping review was guided by Peters et al.'s framework, which incorporates four key concepts aimed at reducing caries: education for individuals and healthcare providers, behavioral modifications, addressing broader social determinants of health, and extending oral health education programs beyond traditional dental settings. A systematic search was conducted across five databases, from 2011 to 2022.

RESULTS

This review identified 107 studies highlighting three main themes: behavioral practices (N = 33), which focused on reducing the prevalence of caries, improving oral hygiene practices, and enhancing overall oral health knowledge; educational interventions (N = 39), which explored strategies to integrate oral health with broader public health initiatives; and dietary interventions (N = 35), which emphasized the critical relationship between diet and oral health.

CONCLUSION

This SR highlights the critical need for comprehensive multilevel approaches that address the complex interplay between nutrition, oral health, and sociodemographic factors, while emphasizing the critical relationship between societal factors and individual health behaviors. Multifaceted interventions that include behavioral change, education, and dietary modifications are crucial for improving oral and overall health outcomes across diverse populations. Comprehensive strategies should prioritize medical-dental integration and data-driven approaches to effectively reduce oral health disparities for vulnerable populations, promoting long-term health equity.

A deep learning feature importance test framework for integrating informative high-dimensional biomarkers to improve disease outcome prediction

Many human diseases result from a complex interplay of behavioral, clinical, and molecular factors. Integrating low-dimensional behavioral and clinical features with high-dimensional molecular profiles can significantly improve disease outcome prediction and diagnosis. However, while some biomarkers are crucial, many lack informative value. To enhance prediction accuracy and understand disease mechanisms, it is essential to integrate relevant features and identify key biomarkers, separating meaningful data from noise and modeling complex associations. To address these challenges, we introduce the High-dimensional Feature Importance Test (HdFIT) framework for machine learning models. HdFIT includes a feature screening step for dimension reduction and leverages machine learning to model complex associations between biomarkers and disease outcomes. It robustly evaluates each feature's impact. Extensive Monte Carlo experiments and a real microbiome study demonstrate HdFIT's efficacy, especially when integrated with advanced models like deep neural networks. Our framework shows significant improvements in identifying crucial features and enhancing prediction accuracy, even in high-dimensional settings.

Breastfeeding Beyond Six Months: Evidence of Child Health Benefits

Breastfeeding is globally recognized as the optimal method of infant nutrition, offering health benefits for both the child and the mother, making it a public health priority. However, the potential advantages of breastfeeding extend well beyond initial months. Breast milk adapts to the evolving needs of the growing infant, and its immunological, microbiological, and biochemical properties have been associated with enhanced protection against infections and chronic diseases, improved growth and development, and lower rates of hospitalization and mortality. This review explores the evidence supporting the continuation of breastfeeding beyond six months. More meticulous studies employing consistent methodologies and addressing confounders are essential. This will enable a more accurate determination of the extent and mechanisms of the positive impact of prolonged breastfeeding and allow for the implementation of effective public health strategies.

Parental Knowledge and Its Impact on Nutrition and Oral Health Habits in Children: A Cognitive Investigation

Background: The correlation between the intake of certain nutrients and the development of oral pathologies has been demonstrated by several studies. The objective of this epidemiological investigation was to evaluate parents' knowledge and awareness of children's nutrition starting from the early stages of childhood. Methods: A questionnaire with 35 questions was handed over to 120 parents of infants aged 4 to 24 months. Among these, 20 questionnaires were excluded because they were incomplete; hence, the final sample analyzed consisted of 100 questionnaires. The outcome of this study revealed that the parents are well aware of many common topics, but their knowledge regarding specific prevention measures, i.e., the use of systemic fluoride as per the international guidelines, needs proper attention. Results: and Conclusions: After analyzing all the collected data, it is possible to conclude that prevention is the best investment to avoid the onset of the carious pathology, which can be possible through parental education, for example, by raising awareness among expectant mothers, through different actions in the territory. However, further research is needed as this study has some limitations and the convenience sample is hospital-based and not effectively representative of the whole population.

The prevalence of dental caries and its associated factors among preschool children in Huizhou, China: a cross-sectional study

Background

Dental caries among preschool children were prevalent worldwide and had a significant impact on children and their families. Understanding its prevalence and risk factors helps to optimize the delivery of oral health care to the target population and promote their oral health ultimately. This cross-sectional study aimed to examine the prevalence of dental caries and its associated factors among 3- to 5-year-old children in Huizhou, Guangdong Province, China.

Method

We recruited children from 21 kindergartens adopting multistage sampling method. Two examiners performed oral examination. They assessed children's dental caries experience following the World Health Organization criteria. Children's dental caries activity, malocclusion, tonsil size and pH value of saliva were evaluated. Parental questionnaires collected child's sociodemographic background and oral-health-related behaviors. Data were analyzed by univariate analysis and logistic regression using SPSS.

Results

This study invited 1,485 children and recruited 1,348 (53.2% boys) (response rate: 90.8%). Dental caries prevalence rate was 58.2% for 3-, 70.7% for 4-, 80.5% for 5-year-old and 72.9% for all recruited children. The mean dmft score (±SD) was 3.38 (±4.26) for 3-, 4.75 (±4.96) for 4-, 5.81 (±5.71) for 5-year-old and 4.99 (±5.02) for all children. Age, family status (singleton or not), monthly family income, mother and father's education level, tonsil grading score, spacing in dentition, Cariostat score (reflecting the caries activity), dental plaque index, duration of breastfeeding, dental visit experience, tooth brushing habits and sugary snacking before sleeping were statistically related to the prevalence of dental caries (p < 0.050) in univariate analysis. These factors were further analyzed in the regression model. The results of the final model indicated dental caries were associated with age (p < 0.001), Cariostat score (p < 0.001), spacing (p < 0.001), tonsil grading score (p = 0.013), singleton or not (p = 0.002), sugary snacking habit before bed (p < 0.001) and breast-feeding duration (p = 0.050).

Conclusion

Dental caries was prevalent among 3-to 5-year-old preschool children in Huizhou, China. Children's age, caries activity, tonsil size, malocclusion, family background, sugary snacking habit and breast-feeding habit were related to the prevalence of dental caries. More emphasis should be placed on prevention targeting the risk factors from early life.

Prevalence of dental carries and its association with breastfeeding duration among young children in Addis Ababa, Ethiopia

BACKGROUND

Breastfeeding is a crucial feeding practices that significantly contributes to the healthy development of children. However, the effect of breastfeeding duration on caries risk is unclear, as different studies have found different results. This study aims to assess the prevalence of dental caries and its association with breastfeeding duration among young children aged 12-36 months in selected health facilities of Addis Ababa, Ethiopia.

METHODS

A cross-sectional study among 380 children aged 12-36 months from 11 health centers in Addis Ababa was conducted. Questionnaires and dental examinations were used to collect data. Dental caries was measured by the deft (decayed-extracted-filled teeth) index. Binary logistic regression was used to assess the association between dental caries and duration of breastfeeding, after adjusting for the confounders.

RESULTS

The prevalence of dental caries was 53.4% (95% CI: 48.3, 58.5%), with 13.7% having high caries and 39.7% having low caries. Breastfeeding duration was not significantly associated with dental carries, after adjusting for confounders. However, sugar intake, older age, mothers' unemployment, and not being in marital union are risk factors for dental caries development.

CONCLUSIONS

Promotion of healthy diet, especially limiting intake of sugar and sweets, and integration of oral health into primary health care programs are recommended. Further research using longitudinal design or meta-analysis is recommended to establish more concise evidence on the association between breastfeeding duration and dental caries.

A longitudinal study on the impact of breastfeeding with or without formula milk on dental caries

Concerns exist about prolonged breastfeeding increasing dental caries risk, but evidence is mixed. This 2-year cohort study followed 486 toddlers, to examine the association between breastfeeding duration and caries at age 3. Caregivers reported feeding practices and potential confounders every 6 months. "Full breastfeeding" was defined as feeding breastmilk without formula milk regardless of other foods/liquids, whereas "any breastfeeding" was feeding breastmilk with/without formula milk. A calibrated dentist performed dental examinations. We used multivariable log-binomial and negative binomial regressions to estimate relative risks (RRs) and 95% confidence intervals (CIs) for caries prevalence and severity, adjusted for confounders. At 3-year-old, 60.3% of children exhibited caries (mean decayed-and-filled-teeth, dft: 3.3). Notably, full breastfeeding for 6-17 months reduced caries prevalence (RR = 0.84, 95%CI 0.73-0.98 for 6-11 months; RR = 0.78, 95%CI 0.63-0.96 for 12-17 months). Conversely, any breastfeeding ≥ 18 months significantly increased caries risk (RR = 1.45, 95%CI 1.31-1.60). Full breastfeeding ≥ 6 months or any breastfeeding 6-17 months was associated with lower dft scores in children. Our findings suggest a complex relationship between breastfeeding duration and caries. Full breastfeeding for moderate durations (6-17 months) offers protective benefits, while any breastfeeding ≥ 18 months increases risk in this population.

Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis

Early childhood caries (ECC) is a growing public health concern worldwide. Although numerous systematic reviews have been published regarding the association between breastfeeding and early childhood caries (ECC), the results remain inconclusive and equivocal. This systematic review synthesises the evidence on the association between breastfeeding and ECC. Five electronic databases and backward citation chasing were performed from inception until May 2023. A total of 31 studies (22 cohort studies and 9 case-control studies) were included in this review. The meta-analysis of the case-control studies showed statistically significant fewer dental caries in children who were breastfed for < 6 months compared to those who were breastfed for ≥6 months (OR = 0.53, 95% CI 0.41-0.67, p < 0.001). There was a statistically significant difference in dental caries between children who were breastfed for <12 months and those who were breastfed for ≥12 months (RR = 0.65, 95% CI 0.50-0.86, p < 0.002). Similarly, there was a statistically significant difference in dental caries in children who were breastfed for < 18 months compared to those who were breastfed for ≥18 months (RR = 0.41, 95% CI 0.18-0.92, p = 0.030). Nocturnal breastfeeding increases the risk of ECC compared with no nocturnal breastfeeding (RR = 2.35, 95% CI 1.42-3.89, p < 0.001). The findings suggest breastfeeding for more than 12 months and nocturnal breastfeeding increase the risk of ECC.

Breastfeeding, consumption of ultraprocessed foods, and dental caries at 4 years of age: A birth cohort study

BACKGROUND

Cohort studies have demonstrated an association between prolonged and/or frequent breastfeeding and early childhood caries (ECC).

AIM

To investigate the association between prolonged breastfeeding and ECC at 48 months, while considering the interaction between prolonged breastfeeding and ultraprocessed foods (UPF).

DESIGN

Data from a birth cohort study conducted in southern Brazil were used (n = 3645). Poisson regression was used to evaluate the influence of breastfeeding and UPF consumption on the prevalence and experience of caries. To measure the interaction on the additive scale between breastfeeding and UPF consumption on the prevalence and experience of ECC, the relative excess risk due to interaction (RERI) was calculated.

RESULTS

Prolonged breastfeeding was associated with higher prevalence (PR = 1.82; CI:1.59-2.08) and experience (RR = 2.47; CI:1.97-3.10) of ECC. Greater prevalence (PR = 1.16; CI: 1.04-1.30) and experience of ECC (RR = 1.22; CI: 1.00-1.48) were found in children who had high consumption of UPFs. Negative RERIs were observed for the prevalence and experience of ECC (-0.25 and -0.001).

CONCLUSION

High UPF consumption and prolonged breastfeeding were associated with ECC. No interaction, however, was observed, showing that the two exposures have independent effects. To prevent ECC, policies and programs are needed to support breastfeeding until the age of 2 years and to limit the consumption of UPF.

[Knowledge, attitudes and practices in oral health of breastfeeding women]

The benefits of breastfeeding on the health of infants and mothers are no longer in doubt. On the other hand, the advantages in terms of maxillofacial development and the risks of prolonged breastfeeding on oral health are much less discussed. An exploratory qualitative study, carried out within the pediatric dentistry functional unit of the dental care service of the Lille University Hospital Center in 2022, aimed to analyze the knowledge, attitudes and practices in oral health of breastfeeding women. This article will discuss the gaps in prevention as well as the obstacles and levers to improving care.

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.

Family income modifies the association between frequent sugar intake and dental caries

AIM

The aim of this cross-sectional study was to investigate whether family income modifies associations between dental caries and sex, age, mother's education, type of preschool, sugar intake, and toothbrushing.

BACKGROUND

Dental caries is a multifactorial dyanamic disease primarily mediated by biofilm and sugar.

DESIGN

A randomly selected sample of 308 Brazilian preschool children aged 1-3 years underwent a clinical oral examination for the assessment of moderate/extensive dental caries using codes 3-6 of the International Caries Detection and Assessment System. Mothers were asked to fill out a form addressing the child's demographic and socioeconomic characteristics as well as the frequency of sugar intake. Statistical analysis involved descriptive statistics, the chi-squared test, and Poisson regression models.

RESULTS

The prevalence of moderate/extensive dental caries was 42.5%. The adjusted model revealed that within low-income families (<2 times the monthly minimum wage), the prevalence of dental caries was higher among children with a high frequency of sugar intake (≥ twice per day) than in those with a low frequency of sugar intake (< twice a day) (RR = 1.79; CI: 1.38-2.33). In families with higher income (≥2 times the monthly wage), no significant association between sugar intake and dental caries was, however, found.

CONCLUSIONS

In conclusion, monthly family income can modify the association between the high frequency of sugar intake and dental caries.

Integration of Breastfeeding Consultation and Practices in the Scope of Pediatric Dentistry: Collaboration with Lactation Specialists

Background

In recent years, breastfeeding has been largely promoted due to health benefits for the children and the mothers and social, economic, and environmental advantages. World Health Organization (WHO) recommends breastfeeding for at least 2 years and to be continued for as long as this is desired by the mother-child dyad.Despite its advantages, including protection against caries in the 1st year of life, prevention of malocclusions, and development of more normal breathing patterns, there is a great controversy in the literature regarding breastfeeding involvement in elevated risk for early childhood caries (ECC).Breastfeeding and oral health are strongly related. Breastfeeding can influence oral health and development, but oral findings, such as tethered tissues and natal/neonatal teeth, may negatively affect lactation.

Conclusion

A healthy collaboration between the oral health care provider and the lactation specialist is important in order to identify those oral findings and prevent breastfeeding implications, but also in order to facilitate uneventful breastfeeding by emphasizing oral health care prevention strategies.

Clinical significance

Information on the advantages of certain lactation aspects and the potential risks for ECC is important for the pediatric dentist to be able to form an individualized treatment/prevention plan that will benefit and promote the oral and general health of young patients.

How to cite this article

Papadopoulou P, Boka V, Arapostathis K. Integration of Breastfeeding Consultation and Practices in the Scope of Pediatric Dentistry: Collaboration with Lactation Specialists. Int J Clin Pediatr Dent 2023;16(S-3):S306-S310.

Early-life sugar consumption and breastfeeding practices: a multicenter initiative in Latin America

The aim of this multicenter study was to explore the early-life sugar consumption and dietary practices in Latin America as well as to investigate the association between breastfeeding duration and the age at which foods and beverages with added sugars are introduced. A cross-sectional study was conducted with 805 1- to 3-year-old children from 10 Latin American countries, as a complementary study to the Research Observatory for Dental Caries of the Latin American Region (OICAL). A Food Frequency Questionnaire previously tested in different countries was applied to children's mothers and data on breastfeeding and age at introduction of sugary foods and beverages was collected. Statistical analysis included the Kruskal-Wallis test and Poisson regression with robust variance, with the calculation of crude and adjusted mean ratios (MR) and 95% of confidence intervals (CI). The average age at introduction of sugary foods and beverages was 10.1 months (95%CI 9.7-10.4) and 9.6 (95%CI 9.2-9.9) months, respectively, with a significant variation between countries (p < 0.001). The average daily frequency of sugary foods-beverages was 3.3 times per day (95%CI 3.1-3.5) and varied significantly between countries (p = 0.004). Breastfeeding duration of over six months was associated with an increase in the age of introduction of sweet drinks (16%; MR 1.16; 95%CI 1.05-1.28) and foods (21%; MR 1.21; 95%CI 1.10-1.33). In conclusion, most children from vulnerable settings in Latin America start consuming sugary products in the first year of life and a high frequency of consumption was reported through early childhood. Additionally, breastfeeding contributes to a delay in the introduction of sugary products.

Prolonged breastfeeding and dental caries in preschool children

PURPOSE

To explore breastfeeding from 6 to 18 months of age and to study the association between breastfeeding and caries prevalence at 5 years of age.

METHODS

The study included 1088 children from one Norwegian county and was based on the Norwegian Mother, Father and Child Cohort Study (MoBa). The children had clinical dental examination at 5 years of age, and parents answered a questionnaire, which included information on breastfeeding, oral health behaviour and child characteristic. Multivariate logistic regressions were performed. The study was ethically approved.

RESULTS

Of the studied children, 77% were breastfed at 6 months of age and 16% were still breastfed at 18 months of age. Few children (6%) were breastfed during night at 18 months of age, while 11% received sugary drink during night. No association was found between breastfeeding up to 18 months of age and caries prevalence at 5 years of age (p > .05). Children who at 18 months of age had their teeth brushed less than twice daily (OR 2.4, CI 1.5-3.9), consumed sugary drink once a week or more often (OR 1.7, CI 1.1-2.7) and had non-Western parents (OR 3.4, CI 1.5-8.1) were more likely to have caries experience at 5 years of age than other children.

CONCLUSION

Breastfeeding up to 18 months of age was not associated with caries development during preschool age.

Impact of breastfeeding and other early-life factors on the development of the oral microbiome

The oral cavity is home to the second most diverse microbiome in the human body. This community contributes to both oral and systemic health. Acquisition and development of the oral microbiome is a dynamic process that occurs over early life; however, data regarding longitudinal assembly of the infant oral microbiome is scarce. While numerous factors have been associated with the composition of the infant oral microbiome, early feeding practices (breastfeeding and the introduction of solids) appear to be the strongest determinants of the infant oral microbiome. In the present review, we draw together data on the maternal, infant, and environmental factors linked to the composition of the infant oral microbiome, with a focus on early nutrition. Given evidence that breastfeeding powerfully shapes the infant oral microbiome, the review explores potential mechanisms through which human milk components, including microbes, metabolites, oligosaccharides, and antimicrobial proteins, may interact with and shape the infant oral microbiome. Infancy is a unique period for the oral microbiome. By enhancing our understanding of oral microbiome assembly in early life, we may better support both oral and systemic health throughout the lifespan.

Prevalence and correlates of dental caries among 2-5 years children with special reference to breastfeeding in Kamrup District, Assam

Background

Dental caries among children is one of the most common health-related issues worldwide.

Aim

To find out the prevalence of dental caries among 2-5 years old children in Kamrup district of Assam with reference to breastfeeding and associated variables.

Materials and Methods

In this community-based cross-sectional study, 1439 children were examined from 15 wards of Kamrup Metro and four randomly chosen blocks of Kamrup Rural. Children were examined to assess the mean decayed/filled primary teeth (dmft) index, and a self-administered validated questionnaire was given to the mothers to collect data on the practice of breastfeeding initiation, its duration, and dental hygiene habits.

Results

Dental caries prevalence was found to be higher in urban areas (54.6%) than rural areas (45.4%). The frequency of using toothpaste was highest among the tooth-cleaning materials. A significant difference in caries prevalence was observed among the children, those who brushed twice a day, and those who did not brush (P = 0.039). The difference was significant in the mean dmft of children from the upper socioeconomic class (P = 0.023) compared with the other classes. A significant difference was also observed between breastfeeding duration (P = 0.010), exclusive and nonexclusive breastfeeding, time of initiation of breastfeeding within 12 h (P < 0.001), and alternative feeding with caries prevalence (P < 0.001).

Conclusions

Dental caries were higher in urban localities and upper socioeconomic classes. Breastfeeding initiation and duration may play an important role in the causation of dental caries. No significant association was found between colostrum, prelacteal feeding, and caries prevalence.

The impact of infant feeding and oral hygiene habits on early childhood caries: A cross-sectional study

Background and Aim

The aim of this study is to evaluate the relationship between the Early Childhood Caries (ECC)/severe-ECC (S-ECC) and prolonged breast-feeding (BF), bottle-feeding, and oral hygiene habits in 0-year-old to 5-year-old Turkish children.

Patients and Methods

Dental examinations were performed on 255 patients to determine the prevalence of the ECC and the S-ECC as per the definition of the American Academy of Pediatric Dentistry. To predict the progress rate of caries, noncavitated and cavitated lesion scores were assessed by using the International caries detection and assessment system II criteria. Information on infant feeding practices, oral hygiene habits, maternal characteristics, and demographic features were gathered by means of a questionnaire. The results were statistically evaluated.

Results

There were no associations between BF duration, night-time BF, bottle-feeding, and the ECC. And there were also no associations between BF duration, night-time BF, bottle-feeding, and the S-ECC. Cavitated lesions were more common in children breastfed at night for 18-23 months compared to 12-17 months (P = 0.031). Sweetened bottle was an impact factor on caries experience (P = 0.042). A significant correlation was found for dmft, S-ECC, and the cavitated lesions regarding sugar consumption (P = .001, P = .002, and P = .001, respectively). Early introduction to tooth-brushing and regular dental visits were significantly effective in reducing the ECC (P < .001 and P < .001, respectively).

Conclusion

BF and bottle-feeding practices were not associated with the ECC/S-ECC. Sweetened bottles and sugary foods are strong risk factors for the ECC/S-ECC.

Knowledge, perceptions, and behavior regarding children's oral health among Syrian pediatricians: a cross-sectional study

BACKGROUND

Oral health has a direct impact on health-related quality of life (HRQoL). Hence, general health and oral health cannot be separated. Pediatricians play a pivotal role in providing primary care for infants and are the first to interact with them since birth. Therefore, the aim of this study was to evaluate the knowledge, perceptions, and behavior of Syrian pediatricians regarding children's oral health.

METHODS

This was a cross-sectional study. The questionnaire consisted of six main sections and required answers regarding demographic characteristics, knowledge, behavior, perceptions, and training received in oral health. The association between categorical variables was tested with Pearson's chi-square tests and Fishers exact tests using SPSS ver. 23.

RESULTS

The response rate was 43.12% (229/531). Most of the participants (64.02%) got a poor level of knowledge and no significant association was found between knowledge level and years of experience (p = 0.270). The majority of the participants (99.13%) perceived that diet, bacteria, and sugar exposure time are the etiological factors of dental caries. The overwhelming majority of the participants (98.25%) acknowledged the need for further oral health training during residency.

CONCLUSIONS

Most pediatricians reported a poor level of knowledge. It is recommended to update the postgraduate and residency curriculum to equip pediatricians with adequate knowledge regarding children's oral health.

Parents' Knowledge and Attitudes toward Preschool's Oral Health and Early Childhood Caries

Aim

The present cross-sectional study was done to evaluate the attitudes and knowledge of caregivers toward oral health and early childhood caries (ECC) in preschool children in the Jazan population.

Materials and methods

The present cross-sectional study was carried out on 105 study subjects, including parents of children, using a self-administered structured questionnaire. The demographic variables and information regarding the awareness and knowledge of caregivers were recorded. The data gathered were analyzed using statistical analysis using IBM Statistical Package for the Social Sciences (SPSS) version 20.0 software.

Result

Among 105 children, 66.7% were male, showing male predominance regarding ECC. Among parents, 52.4% were with a bachelor's degree. Most parents lack awareness in regard to dental caries affecting their children. Parents lack knowledge regarding various preventive and treatment options available.

Conclusion

The study revealed that caregivers had very less knowledge and clinical practice concern with the oral well-being of preschool kids. The study's results reveal that promotion programs in relation to oral health are required to cover the gaps of knowledge among mothers of kids related to the care of oral health in their young kids.

Clinical significance

Different health-concerned behaviors are being affected by awareness and knowledge, and the health of the oral cavity is not an exemption. It has been postulated that diseases of the oral cavity are affected by social factors. Thus, this study was conducted to find the connection between the knowledge of parents regarding their oral health and the status of the health of their children's oral cavities.

How to cite this article

K Saheb SA, Najmuddin M, Nakhran AM, et al. Parents' Knowledge and Attitudes toward Preschool's Oral Health and Early Childhood Caries. Int J Clin Pediatr Dent 2023;16(2):371-375.

Impact of breastfeeding and bottle-feeding comparison on children between 2- and 6-year-old caries development

BACKGROUND

Caries is a multifactorial degenerative disease, and it is the most common chronic disease during childhood. Few studies have assessed the effects of breastfeeding and bottle feeding on children's dental caries, also taking into account the duration of both options. We investigated whether the infant feeding duration and feeding methods (breast, bottle or both) are risk factors for dental caries in childhood.

METHODS

Our study included 210 children from 2 to 6 years old and it was carried out in the Department of Pediatric Dentistry of Borgo Cavalli (Treviso, Italy). The average number of decayed, missing, and filled primary tooth surfaces (DMFT) were investigated by analyzing the medical histories. Data collection was conducted from September 2021 to July 2022. Data analysis was performed using the statistical program R (R Foundation for Statistical Computing, Vienna, Austria). First, an analysis was performed to verify the database using a graph. We used the negative Poisson and Binomial count model for the data. Next, the verification of which covariables were significant was performed, finally the conclusions were obtained.

RESULTS

By dividing the population according to the type of feeding, we saw that most of the children participating in the study had between 3 and 7 cavities. By analyzing the length of feeding, we saw that the average duration was between 10 and 20 months. Due to the P values, we concluded that the total duration of feeding variable was not significant in explaining the event of interest and, therefore, only the variable type of feeding (artificial and natural) was significant because the P value was below the 5% significance level. Finally, we concluded that natural type breastfeeding increases the average amount of caries by 1.29 times, or 29% more than artificial feeding.

CONCLUSIONS

Compared to bottle-feeding, breastfeeding increases the risk of caries at an early age; however, there is no correlation between duration and occurrence of caries. Meanwhile, considering health benefits, dental professionals should not discourage breastfeeding; as a matter of fact, promoting breastfeeding has many benefits for infants and mothers, provided that it is associated with proper oral hygiene.

Prolonged breastfeeding, sugar consumption and dental caries at 2 years of age: A birth cohort study

OBJECTIVES

Previous cohort studies have found a positive association between prolonged breastfeeding (≥12 months) on dental caries, but few of them analysed the mediated effect of sugar consumption on this association. This study investigated whether prolonged breastfeeding is a risk factor for caries at 2-year follow-up assessment (21-27 months of age) and whether this effect is mediated by sugar consumption.

METHODS

A birth cohort study was performed in the Brazilian Amazon (n = 800). Dental caries was assessed using the dmf-t index. Prolonged breastfeeding was the main exposure. Data on baseline covariables and sugar consumption at follow-up visits were analysed. We estimated the OR for total causal effect (TCE) and natural indirect effect (NIE) of prolonged breastfeeding on dental caries using the G-formula.

RESULTS

The prevalence of caries was 22.8% (95% CI: 19.8%-25.8%). Children who were breastfed for 12-23 months (TCE = 1.13, 95% CI: 1.05-1.20) and for ≥24 months (TCE = 1.27, 95% CI: 1.14-1.40) presented a higher risk of caries at age of 2 years than those breastfed <12 months. However, this risk was slightly mediated by a decreased frequency of sugar consumption at age of 2 years only for breastfeeding from 12 to 23 months (NIE; OR = 0.95, 95% CI: 0.91-0.97).

CONCLUSIONS

In this study, the effect of prolonged breastfeeding on the increased risk of dental caries was slightly mediated by sugar consumption. Early feeding practices for caries prevention and promoting breastfeeding while avoiding sugar consumption should be targeted in the first 2 years of life.

Clinical characteristics of children and guardians possessing CBP-positive Streptococcus mutans strains: a cross-sectional study

Streptococcus mutans is a major etiological agent for dental caries. We previously demonstrated that S. mutans strains expressing collagen-binding proteins (CBPs) were related to the pathogenesis of systemic diseases. However, their acquisition and colonization remain unknown. Here, we investigated the detection rates of CBP-positive S. mutans strains in children and their guardians to clarify the background for the acquisition and colonization in children. Saliva samples were collected from children and their mothers, and detection of S. mutans and collagen-binding genes (cnm, cbm) was performed by PCR after DNA extraction. The oral status of each child was examined, and their mothers were asked to complete a questionnaire. The isolation rate of Cnm-positive S. mutans was significantly higher in mothers than in children. Notably, the possession rates of CBP-positive strains in children were significantly higher in children whose mothers had CBP-positive strains than in children whose mothers did not have these strains. Furthermore, children with CBP-positive strains had a significantly shorter breastfeeding period than children without these strains. The present results suggest that nutritional feeding habits in infancy are one of the factors involved in the acquisition and colonization of CBP-positive S. mutans strains.

Prevalence of Dental Caries in Children in Mymensingh and Its Associated Risk Factors: A Cross-Sectional Study

Background: Children suffer from various oral and periodontal diseases. Dental caries is one of the most prevalent oral diseases among children in the world. This study was conducted to identify the prevalence and risk factors of dental caries in children in Mymensingh, Bangladesh. Methods: A cross-sectional study was conducted on 362 pediatric patients who attended the Dental Unit of Mymensingh Medical College from March to September 2019. The sample size was calculated using a statistical formula and the children were selected using a systematic random sampling technique. Children and their guardians were interviewed and data were recorded using a structured questionnaire. Risk factors were analyzed using multivariate logistic regression. Results: The overall prevalence of dental caries was 82.7%. The prevalence of caries was significantly higher in aged children (8–10 years) and also in rural, low-income, and illiterate families. Seven significant risk factors were identified that included residence in the rural area (OR: 7.31 [1.73–30.83]), a parental income of BDT ≤ 20,000 per month (OR: 4.75 [1.49–15.05]), reduced duration (≤1 min) of teeth cleaning (OR: 18.54 [2.05–168.17]), teeth cleaning before breakfast (OR: 93.30 [10.95–795.32]), the spoon-feeding method (OR: 12.57 [2.09–75.61]), long-term (37–48 months) breastfeeding (OR: 212.53 [8.69–5195.25]), and family oral problem (OR: 8.20 [2.57–26.16]). Conclusions: The prevalence of dental caries among the children in Mymensingh is very high and was associated with residence in rural areas, parental income, reduced duration of teeth cleaning, teeth cleaning before breakfast, the spoon-feeding method, long-term breastfeeding, and family oral problems.

Expert consensus on early childhood caries management

Early childhood caries (ECC) is a significant chronic disease of childhood and a rising public health burden worldwide. ECC may cause a higher risk of new caries lesions in both primary and permanent dentition, affecting lifelong oral health. The occurrence of ECC has been closely related to the core microbiome change in the oral cavity, which may be influenced by diet habits, oral health management, fluoride use, and dental manipulations. So, it is essential to improve parental oral health and awareness of health care, to establish a dental home at the early stage of childhood, and make an individualized caries management plan. Dental interventions according to the minimally invasive concept should be carried out to treat dental caries. This expert consensus mainly discusses the etiology of ECC, caries-risk assessment of children, prevention and treatment plan of ECC, aiming to achieve lifelong oral health.

Technical Report: Breastfeeding and the Use of Human Milk

Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding or the provision of human milk a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention and The Joint Commission monitor breastfeeding practices in United States hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding. Efforts to improve breastfeeding rates must acknowledge existing disparities and the impact of racism in promoting equity in breastfeeding education, support, and services.

Impact of Dietary Patterns on Plaque Acidogenicity and Dental Caries in Early Childhood: A Retrospective Analysis in Japan

This study aimed to assess the relationship of dietary patterns, such as frequency, timing, and cariogenicity of food/beverage consumption, with plaque acidogenicity and early childhood caries (ECC) in Japan. A total of 118 children aged 1–4 years who had visited the pediatric dental clinic were enrolled. We retrospectively reviewed their records to collect data including age, sex, medical history, medication, caries status, and plaque acidogenicity level at the first dental visit. The plaque acidogenicity level was measured using Cariostat^®. Dietary data were collected from 3-day dietary records, and the dietary cariogenicity score was calculated from these data. Children with ECC or high plaque acidogenicity consumed between-meal sugars more frequently than did their counterparts (p = 0.002 and p = 0.006, respectively). Children with ECC or high plaque acidogenicity drank juices between meals more frequently than at mealtimes (p = 0.02). Frequent consumption of between-meal sugars was associated with higher plaque acidogenicity and ECC, and frequent breast/bottle feeding was associated with ECC. No differences were found in the dietary cariogenicity scores between these groups. Therefore, the frequency and timing of sugar consumption, might affect plaque acidogenicity and ECC, and reducing the frequency of sugar intake could prevent ECC.

Scoping Review of Oral Health-Related Birth Cohort Studies: Toward a Global Consortium

The multidisciplinary nature and long duration of birth cohort studies allow investigation of the relationship between general and oral health and indicate the most appropriate stages in life to intervene. To date, the worldwide distribution of oral health-related birth cohort studies (OHRBCSs) has not been mapped, and a synthesis of information on methodological characteristics and outcomes is not available. We mapped published literature on OHRBCSs, describing their oral health-related data and methodological aspects. A 3-step search strategy was adopted to identify published studies using PubMed, Embase, Web of Science, and OVID databases. Studies with baseline data collection during pregnancy or within the first year of life or linked future oral health data to exposures during either of these 2 life stages were included. Studies examining only mothers' oral health and specific populations were excluded. In total, 1,721 articles were suitable for initial screening of titles and abstracts, and 528 articles were included in the review, identifying 120 unique OHRBCSs from 34 countries in all continents. The review comprised literature from the mid-1940s to the 21st century. Fifty-four percent of the OHRBCSs started from 2000 onward, and 75% of the cohorts were from high-income and only 2 from low-income countries. The participation rate between the baseline and the last oral health follow-up varied between 7% and 93%. Ten cohorts that included interventions were mostly from 2000 and with fewer than 1,000 participants. Seven data-linkage cohorts focused mostly on upstream characteristics and biological aspects. The most frequent clinical assessment was dental caries, widely presented as decayed, missing, and filled teeth (DMFT/dmft). Periodontal conditions were primarily applied as isolated outcomes or as part of a classification system. Socioeconomic classification, ethnicity, and country- or language-specific assessment tools varied across countries. Harmonizing definitions will allow combining data from different studies, adding considerable strength to data analyses; this will be facilitated by forming a global consortium.

Combination effect of diurnal exposure to sucrose and nocturnal exposure to lactose on enamel demineralization

We have hypothesized that the association between human milk and caries in breastfeeding children could be explained by the combination of a diurnal cariogenic diet with the nocturnal lactose fermentation, conditions simulated in this experimental study. Cariogenic biofilm was formed on bovine enamel slabs, which were exposed 8x/day for 3 min to a 10% sucrose solution, simulating a highly cariogenic diurnal diet, or 50 mM NaCl solution (control). Simulating the nocturnal retention of milk in mouth, biofilms were transferred to culture medium containing 0.7% lactose for 2 h, or only to culture medium (control). Four groups were designed (n=12): Ctrl, no exposure to diurnal sucrose or nocturnal lactose; Lac, only nocturnal exposure to lactose (2 h); Suc, only diurnal exposure to sucrose (8x/day); and Suc→Lac, diurnal exposure to sucrose (8x/day) followed by nocturnal exposure to lactose (2 h). The medium was changed 3x/day, at the beginning of the day, and after diurnal and nocturnal exposures. Calcium in the medium was determined as chemical indicator of partial demineralizations occurred during the diurnal and the nocturnal treatments; the medium pH was also determined. After 96 h of growth, biofilms were harvested to evaluate CFU, biomass, and extracellular polysaccharides, soluble and insoluble. The percentage of enamel surface hardness loss (%SHL) was evaluated as cumulative demineralization. Data were analyzed by one-way ANOVA, Tukey's test (α=5%). Highest %SHL (p<0.05) was found for Suc→Lac (40.6%) group when compared to Suc (32.1%), Lac (7.7%), and Ctrl (3.8%). Calcium released during the diurnal and nocturnal treatments were respectively: Suc→Lac=Suc>Lac=Ctrl and Suc→Lac=Lac>Suc=Ctrl (p<0.05). Regarding Ctr group, calcium released from nocturnal lactose fermentation by Suc→Lac group was 4-fold greater than that provoked by Lac group. The findings were supported by the pH of the media. The data suggest that the biofilm formed under diurnal exposure to sucrose enhances the cariogenicity of nocturnal exposure to lactose.

Oral health status and knowledge of only and non-only children in China

Objectives To evaluate the oral health status and knowledge of only children (OC) and non-only children (NOC), and to explore potential reasons for the differences.Materials and methods This cross-sectional sampling survey included 3,731 children between the ages of 12 and 15 years. The oral health of the subjects was examined, according to the Basic Methods of Oral Health Survey (fifth edition) recommended by the World Health Organisation, and their eating habits, oral health knowledge and oral habits were recorded. EpiData software was used to input data, and SPSS version 19.0 software was used for analysis and comparison.Results The incidence of dental caries and the decayed, missing and filled teeth index (DMFT) in OC (53.2% and 1.53, respectively) were significantly lower than those in NOC (56.2% and 1.86, respectively) (P <0.05). These values were highest in female NOC (63.7%). Gingival bleeding in NOC (78.9%) was significantly higher than that in OC (74.1%) and the difference was statistically significant (P <0.05). The pit and fissure sealant rate of the OC (17.9%) was better than that of the NOC (11.0%), and the difference was statistically significant (P <0.05). There were no significant differences in the oral health attitudes between the two groups, while the scores of the OC were higher than that of the NOC on eight questions of oral health knowledge and awareness, with statistically significant differences for five of the questions (P <0.05). In terms of oral behavioural habits and related factors, the OC scored better than the NOC.Conclusions Our results show that the oral health status of NOC, especially female children, is worrying. When formulating health-related policies, it is necessary to consider these inequalities in adolescents and to provide more resources to the relatively vulnerable adolescents.

Recommendations from paediatric dentistry associations of the Americas on breastfeeding and sugar consumption and oral hygiene in infants for the prevention of dental caries: A bibliometric review

BACKGROUND

The Internet provides a plethora of information on health issues related to children's oral health.

AIM

Identify online recommendations of paediatric dentistry associations of the Americas (PDAAs) regarding breastfeeding practices, weaning, sugar introduction and initiating oral hygiene.

DESIGN

Websites of PDAAs were accessed to record recommendations/questions (Q) relevant to early childhood that specifically covered issues about exclusive breastfeeding-Q1, indications of bottle feeding-Q2, when and how to start weaning-Q3 and Q4, respectively, association of breast milk and dental caries-Q5, when to start oral hygiene and how to introduce it-Q6 and Q7, respectively, and guidance on the introduction of sugar-Q8. Similarity/dissimilarity frequencies between the associations (Euclidean distances) were calculated.

RESULTS

From 35 countries on the two American continents, 21 associations were affiliated with the International Association of Paediatric Dentistry and/or the Latin American Pediatric Dentistry Association, whereas eight did not have websites. Higher (P < .05) dissimilarities for Q6 (68.2%), Q7 (72.7%), and Q8 (62.1%) were observed. Results were similar for Q1 and Q5 (P > .05). No association mentioned Q2, Q3 or Q4 responses, whereas Q7 was the most frequently discussed issue.

CONCLUSION

Not all of the investigated issues are mentioned on websites of PDAAs, potentially stymieing efforts by both the layperson and health professional to gather information.

Feeding Practices and Early Childhood Caries in Korean Preschool Children

Objectives

This study aimed to investigate the association between feeding practices and early childhood caries using representative Korean national survey data.

Methods

Data of 2772 children (aged 1-3 years) from the fourth to seventh Korean National Health and Nutrition Examination Surveys (2007-2018) were analysed. Data on decayed-filled teeth (dft) were obtained, and early childhood caries was determined as dft ≥1. Chi-squared test was performed to examine the experiencing of dental caries by participant characteristics, whilst analysis of variance was performed to compare the difference in dft values amongst the 3 groups (breast-feeding, mixed-feeding, and formula-feeding groups). Logistic regression analysis was performed to evaluate the association between feeding practice and early childhood caries.

Results

Comparison of the mean dft values amongst the 3 groups showed the highest value in the breast-feeding group. Multiple logistic regression analysis results showed that the likelihood of experiencing dental caries was significantly lower in the mixed-feeding group than in the breast-feeding group, whereas no significant difference was seen between the formula-feeding and breast-feeding groups. The likelihood of early childhood caries was higher in the group that introduced weaning food at ≥6 months than that at 4- to 6-month age, whilst the introduction of cow's milk and use of nutritional supplements had no significant association with the likelihood of early childhood caries.

Conclusions

Breast-feeding and delayed introduction of weaning food were associated with a higher likelihood of early childhood caries.

Impact of Dietary Trajectories on Obesity and Dental Caries in Preschool Children: Findings from the Healthy Smiles Healthy Kids Study

This study examines the impact of longitudinal dietary trajectories on obesity and early childhood caries (ECC) in preschool children in Australia. Mother–infant dyads from the Healthy Smiles Healthy Kids study were interviewed at 4 and 8 months, and 1, 2, and 3 years of age. Children underwent anthropometric and oral health assessments between 3 and 4 years of age. Multivariable logistic regression and negative binomial regression analysis were performed for the prevalence of overweight and obesity, and the number of tooth surfaces with dental caries, respectively. The intake of core, discretionary, and sugary foods showed distinct quadratic (n = 3) trajectories with age. The prevalence of overweight or obesity was 10% (n = 72) and that of early childhood caries (ECC) was 33% (mean decayed, missing, and filled tooth surfaces (dmfs) score: 1.96). Children with the highest trajectories of discretionary foods intake were more likely to be overweight or obese (adjusted OR: 2.51, 95 %CI: 1.16–5.42). Continued breastfeeding beyond 12 months was associated with higher dmfs scores (adjusted IRR: 2.17, 95 %CI: 1.27–3.73). Highest socioeconomic disadvantage was the most significant determinant for overweight or obesity (adjusted OR: 2.86, 95 %CI: 1.11–7.34) and ECC (adjusted IRR: 2.71, 95 %CI: 1.48–4.97). Targeted health promotion interventions should be designed to prevent the incidence of two highly prevalent conditions in preschool children.

Cariogenic Potential of Human and Bovine Milk on Enamel Demineralization

The higher cariogenicity of human milk when compared with bovine milk is still a debatable subject. Therefore, we evaluated the effect of human or bovine milk exposure on biofilm composition and enamel demineralization using a validated cariogenic biofilm model. Streptococcus mutans UA159 biofilms (n = 8) were grown on human saliva-coated bovine enamel slabs of known surface hardness. The biofilms were exposed 8×/day to 0.9% NaCl (negative control), human milk, bovine milk, 7.0% lactose (active human milk control), 4.5% lactose (active bovine milk control), or 10% sucrose (positive control). The culture medium was changed twice daily, and the pH was analyzed as an indicator of biofilm acidogenicity. After 120 h of growth, biofilms were harvested to evaluate viable cells, and soluble and insoluble extracellular polysaccharides (EPS). Enamel demineralization was assessed by the percentage of surface hardness loss (%SHL). Data were analyzed by one-way ANOVA/Tukey's test (α = 5%). In terms of %SHL, negative control (7.7 ± 3.1), human milk control (13.3 ± 7.5), bovine milk control (15.3 ± 8.2), human milk (7.5 ± 5.0), and bovine milk (8.7 ± 6.3) did not differ among them (p > 0.05) but differed (p < 0.05) from sucrose (55.1 ± 5.4). The findings of enamel demineralization (%SHL) were statistically supported by the data of biofilm acidogenicity, bacterial counts and EPS biofilm composition. This experimental study suggests that human and bovine milk have low cariogenic potential to provoke caries lesions in enamel.

Methods for prevention of early childhood caries: Overview of systematic reviews

Early childhood caries (ECC) is a global problem, disproportionately affecting disadvantaged populations. The aim of this study was to evaluate systematically the available scientific evidence on the effectiveness of methods for ECC prevention. Six electronic databases were searched. Two independent reviewers selected the publications and analysed the quality of the included systematic reviews. Thirteen studies were included. Overall, eight reviews were classified with methodological quality critically low using the AMSTAR 2, whereas five reviews achieved a high risk of bias using the ROBIS tool. The methods identified that were positively related to the prevention of ECC were as follows: preventive dental programmes for pregnant women; advice on diet and feeding; prenatal oral health care; integration of maternal and children's oral health promotion into nursing practice; maternal oral health programmes undertaken by non-dental health professionals; dental health education in combination with the use of fluoride for children; early preventive dental visits; and the use of fluoride varnish and toothpastes with more than 1000 ppm of fluoride. The currently available evidence supporting the effectiveness of methods for prevention of ECC, although suggesting some methods of greater potential, is still lacking due to the methodological quality of the systematic reviews and the included primary studies.

Impact of Breastfeeding and Cosleeping on Early Childhood Caries: A Cross-Sectional Study

The type and duration of breastfeeding can be key factors in the development of early childhood caries (ECC). The association between nighttime feeding and ECC was investigated. Specifically, whether cosleeping is a potential mediator of children's oral health was investigated, considering many of the etiological factors of caries. In this cross-sectional study, 212 children (aged 2-4 years) from Madrid (Spain) who breastfed at night were examined to assess the mean decayed/filled primary teeth (dft) index, and a questionnaire was administered to the mothers to collect data on the practice of breastfeeding and cosleeping and its duration, the number of nighttime feeding sessions, sugar content in the diet, dental hygiene habits, and age at first dental visit. The dft index was lower in the group that breastfed for less than 18 months (p = 0.02). In addition, there were significant differences in the dft index in the group breastfeeding for more than 18 months between those who coslept for 18 months or more and those who coslept for less than 18 months (p < 0.05), as well as between those who coslept for 18 months or more and those who did not cosleep (p < 0.01). In conclusion, breastfeeding at night from 18 months onwards is considered a risk factor for ECC.

Risk Factors of Early Childhood Caries Among Preschool Children in Eastern Saudi Arabia

This study aimed to determine the risk factors of early childhood caries (ECC) among preschool children from eastern Saudi Arabia. In this cross-sectional study, 241 carers and their children from 10 daycares were recruited and asked to complete a questionnaire aimed at assessing their sociodemographic profile and oral health-related behaviors. This was followed by a dental examination of the children by two calibrated dentists. Caries status was recorded using the dmft index. Chi-square and logistic regression tests were used to analyze the data (p < 0.05). The mean dmft of the children was 4.39 (SD ± 4.25). According to logistic regression analysis, children who were bottle-fed between 7 and 12 months (Adjusted Odds Ratio (AOR): 0.110) or breastfed between 13 and 18 months (AOR: 0.028) were less likely to have ECC than those with a prolonged feeding duration (>18 months). Also, those with smoking carers (AOR: 0.176) were less likely to have ECC than those with nonsmoking carers. On the other hand, children who had working carers, mainly mothers, in the education sector (AOR: 11.105), were more likely to have ECC (p < 0.05). The risk factors associated with the presence of ECC among preschool children in eastern Saudi Arabia include the mother's occupation and the carer's smoking status, as well as feeding practices (particularly bottle feeding). These factors can be modified by encouraging carers to completely wean their children (particularly from the bottle) by 18 months of age and advising working mothers to perform tooth brushing for their children in the morning before they go to work and in the evening before the children go to bed.

Untreated dental caries and visible plaque of mothers are not determinant for the incidence of caries in dentin among children: evidence from a 3-year prospective cohort study

OBJECTIVES

To evaluate whether characteristics related to mother's oral health, trajectory of family income, and maternal education are associated with the incidence of caries in dentin in preschool children.

MATERIALS AND METHODS

One hundred fifty-eight mothers and their children were evaluated at baseline and re-evaluated after 3 years. Sociodemographic variables, dental caries, and biofilm of the mothers and children and daily sugar intake of the children were evaluated. Poisson regression was used to evaluate what factor represents risk for the incidence of caries in dentin at four to 6 years of age.

RESULTS

The risk of the incidence of caries in dentin was 54% higher in children whose mothers had a low level of education at both baseline and follow-up. Children from families with an income lower at baseline and follow-up (RR 2.49; 95% CI 1.62-3.83) and those whose families experienced a reduction in income in this period (RR 2.05; 95% CI 1.29-3.26) had a greater risk of the incidence of caries in dentin. Moreover, children who increased their daily sugar intake (RR 1.67; 95% CI 1.09-2.52), those that maintained high sugar intake (RR 1.81; 95% CI 1.14-2.87), and those with cavitated caries at baseline (RR 1.53; 95% CI 1.19-1.97) had a greater risk of the incidence of caries in dentin.

CONCLUSIONS

Low mother's education, a lower family income, a reduction in family income, a high frequency of daily sugar intake, and a history of cavitated caries were risk factors for the incidence of caries in dentin.

CLINICAL RELEVANCE

The results could help in the targeting of improved prevention and control strategies for dental caries.