A Systematic Review and Meta-analysis of School Children's Caries Studies in Gulf Cooperation Council States

Secondary Smoking and Early Childhood Caries: A Systematic Review and Meta-Analysis

OBJECTIVE

This study aimed to systematically review the relationship between secondary smoking and early childhood caries (ECC) among preschool children.

METHOD

Two independent reviewers systematically searched English publications with keywords in PubMed, Web of Science, Medline, Scopus, and Embase to identify publications reporting on secondary smoking and ECC for children under 71 months. Observational studies, including cohort studies, case-control studies, and cross-sectional surveys, were included. The reviewers screened the titles and abstracts to remove duplicate records, reviews, and irrelevant studies. They performed meta-analyses to investigate the prevalence of ECC in children exposed to secondary smoking.

RESULTS

This study identified 1243 publications and included 16 publications. Twelve publications were cross-sectional studies. A meta-analysis of 11 of them revealed that children with secondary smoking exposure had an odds ratio of 1.77 in caries risk (P < .001), whereas one cross-sectional study found no increase in caries risk without data reporting. Two cohort studies with low and very low quality were combined into a meta-analysis, which found children from infancy with secondary smoking exposure had a relative risk of 1.45 in caries incidence (P < .001). Two case-control studies with moderate and low quality were combined into a meta-analysis, which found that children exposed to secondary smoking had an odds ratio of 4.46 in caries prevalence (P < .001).

CONCLUSION

The literature has reported that preschool children with secondary smoking exposure have a higher risk of caries; however, the number and quality of these studies are limited.

SEQUEL: Prevalence of dental caries in Saudi Arabia: A systematic review and Meta-analysis

This meta-analysis investigated the prevalence of dental caries throughout the Kingdom of Saudi Arabia (KSA) between 2011 and 2023 as a follow-up to a previously published review in 2013 by Khan et al. and aimed to provide an update on the current status of caries prevalence in the KSA. A literature search was conducted, and thirty-three articles were included in the final analysis. To determine the prevalence of caries in primary teeth, the 2- to 12-year-old Saudi population was included in the search, and an age range of 6-18 years was used for permanent teeth. The prevalence of caries in the primary and permanent dentition was analyzed separately. As the included studies for the primary and permanent teeth had insignificant heterogeneity, fixed-effect models and forest plots were used to evaluate caries prevalence in both dentitions. In the primary dentition, the mean decayed-missing-filled teeth (dmft) index was 4.14 (95 % confidence interval (CI): 3.11-5.18), with an average prevalence of 75.43 %. For the permanent teeth, the mean DMFT (uppercase used for permanent dentition) was 1.28 (95 % CI: 0.93-1.64), with an average prevalence of 67.7 %. The average dmft/DMFT scores decreased in both primary and permanent teeth compared to the previous meta-analysis by Khan et al., suggesting a beneficial effect of preventative measures on caries prevalence. Continuing these measures is necessary to maintain the downward trend of caries prevalence in the KSA.

Transforming Dental Care in Saudi Arabia: Challenges and Opportunities

This comprehensive review examines the dental healthcare system in Saudi Arabia, tracing its evolution, current status, and persisting challenges. The system has evolved significantly due to government initiatives and technological integration, yet it grapples with issues like professional shortages, financial constraints, and disparities in access. Despite improvements in accessibility, geographic and socio-economic disparities persist, and oral health promotion remains limited. The integration of technology faces resistance, and specialized care for people with disabilities requires targeted strategies. Cultural and social factors influence oral health, and the system's response to the COVID-19 pandemic showcases adaptability and patient-centered approaches. Addressing these challenges is crucial for ensuring equitable and effective oral health service delivery in Saudi Arabia.

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

Introduction

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

Method

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

Results

Dental caries prevalence data were extracted from 18 cross-sectional studies (n = 56,327 children). The pooled estimate for the caries prevalence among 5-7 years' children was 84% (95% CI: 0.81-0.87%; I2 = 91%) while among 12-15 years' children was 72% (95% CI: 0.63-0.79; I 2 = 96.2%). Discussion. In this systematic review, the summary estimate of the prevalence of dental caries among children of 5-7 years and 12-15 years were 84% and 72%, respectively. Further research is required to identify approaches for preventing and treating dental caries in schoolchildren.

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

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

Self-reported knowledge about dental caries at young age and variations between dental practitioners in the Ministry of Health in Bahrain

OBJECTIVES

To assess basic knowledge on dental caries and its prevention especially in young children and variation thereof between dental practitioners working for the Ministry of Health in Bahrain.

MATERIALS AND METHODS

Self-reported questionnaire was sent to all dentists and dental hygienists.

RESULTS

One hundred and thirty-four dental practitioners responded. The mean knowledge and practice scores for association between diet and dental caries was 64.9 ± 20.1. Females scored higher than males (p = 0.011) and dentists scored higher than dental hygienists (p = 0.009). A low mean score 45.5 ± 19.6 was observed in preventing dental caries in toddlers. Those >40 years of age and those with >15 years of experience have significantly higher scores than other groups (p = 0.009 and p = 0.001), respectively. Mean score for caring for children's teeth, which covered advice on fluoridated toothpaste, was 63.4 ± 20.9. Younger dentists had higher score than those >40 years of age (p = 0.003). Mean score for frequency of fluoride varnish application was 64.4 ± 15.8 with no significant variation between practitioners.

CONCLUSION

There is a need to reduce variations and update and improve dental practitioners' knowledge in regard to risks and prevention of caries at young age.

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

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

Enamel defects and caries prevalence in preterm children aged 5-10 years in Dubai

Background: Enamel defects (EDs) are commonly reported dental findings in preterm/low birthweight children. EDs potentially increase caries susceptibility.Aim: To assess the prevalence of EDs and dental caries in a group of preterm children (aged 5-10 years) in Dubai, United Arab Emirates (UAE).Methodology: A retrospective cohort study of medical records of 62 preterm children (mean age 8.1 ± 1.54) and 62 full-term children (mean age 8.1 ± 1.73) of both genders born in a UAE children's hospital were studied. These children were dentally assessed for EDs and caries by a calibrated examiner.Results: EDs were 4.34 times more prevalent among preterm children [odd ratio (OR) = 4.338, CI 95% [2.010-9.366]. The prevalence of EDs in the pre-term group was 58.15%, significantly higher (P < 0.01) than the full-term control group (24.2%). Birth weight, intubation and type of delivery were statistically significant factors contributing to EDs. In the primary dentition, the mean dmft was 4.61 ± 4.30, while in the permanent dentition DMFT was 0.38 ± 0.99. There was a statistically significant difference in permanent teeth caries experience amongst pre-term children compared to the full-term control as measured by DMFT (P = 0.008).Conclusion: EDs and dental caries in permanent dentition in the pre-term group were significantly higher than the full-term group.

General dental practitioners' approach to caries prevention in high-caries-risk children

AIMS

To evaluate the advice and preventive care provided by General Dental Practitioners (GDPs) to high-caries-risk children in Jordan.

METHODS

A cross-sectional study using an open-ended questionnaire. GDPs were presented with a high-caries-risk child scenario and asked regarding: (1) oral hygiene and dietary advice they would give; (2) preventive-care they would offer; (3) barriers they face in prevention delivery. Answers were compared to an evidence-based guideline. Data were input into SPSS-20 and analysed using descriptive statistics and frequencies. Chi-square test was used to compare results by age, gender, practice location and type.

RESULTS

One-hundred and sixty GDPs were approached and 128 agreed to participate (80%), of whom 87 (69%) were female. The average age was 31 years [range 22-50]. Sixty-nine percent practiced in the capital, Amman. Sixty-five percent gave advice on tooth-brushing frequency, but only 23% suggested brushing at bed-time and 24% recommended parental supervision. None provided advice on toothpaste fluoride content. Seventy-one percent advised reducing sugary-food amounts, but only 21% focused on frequency and 2% suggested using diet diaries. Most knew about fissure-sealants (77%) and fluoride-varnish (80%). Forty-two percent reported barriers to delivering preventive-care, including parental attitudes (36%), child cooperation (30%), financial reward (19%), and training (6%). Participants practicing outside of the capital were less likely to use fluoride-varnish [P = 0.002] and more likely to report barriers [P = 0.001].

CONCLUSIONS

Advice delivered by GDPs to high-caries-risk children in Jordan does not meet the standards of an evidence-based guideline. Future initiatives for oral-health-promotion should aim to address the barriers reported, especially outside the capital.

A single-centre investigator-blinded randomised parallel-group study protocol to investigate the influence of an acclimatisation appointment on children's behaviour during N2O/O2 sedation as measured by psychological, behavioural and real-time physiological parameters

AIMS AND OBJECTIVES

To describe a study protocol of a randomised control trial (RCT) assessing the effectiveness, in reducing dental anxiety, of an acclimatising nitrous oxide sedation (N₂O) session prior to actual dental treatment with N₂O.

MATERIALS AND METHODS

A single-centre investigator-blinded parallel-group RCT conducted in a postgraduate dental hospital in Dubai, United Arab Emirates (UAE). Anxious children requiring N₂O (aged 5-15 years) will be randomly assigned to; a study group: children who will have a preparatory N₂O trial experience or; a control group: children who will only have N₂O explained to them. Treatment with N₂O for both groups will start at the second visit. The following outcomes will be recorded: completion of dental treatment, anxiety scores at baseline and after treatment (using the Modified Child Dental Anxiety Scale faces), behaviour of the child (using Frankl Rating Behaviour Scale) and the acquisition of real-time physiological anxiety-related parameters (using E4^® electronic wrist devices).

RESULTS

The data will be analysed statistically.

DISCUSSION

There is a paucity of research regarding dental N₂O acclimatising appointments. This RCT will supplement existing literature.

CONCLUSIONS

This RCT will report whether prior acclimatising of a child to N₂O sedation is effective, or not, in improving dental treatment behaviour.

Regional caries data availability in Saudi Arabia: Impact of socioeconomic factors and research potential

Background and aims

Monitoring oral diseases is needed to allocate resources, plan health services and train dental workforce. Caries is one of the oral diseases most commonly included in oral health surveillance systems. The present study assessed (1) caries data availability in the administrative regions of Saudi Arabia and (2) factors associated with this availability.

Methods

We collected caries data in the period 2008-2018 in Saudi Arabia (outcome variable). The explanatory variables included region-level factors: (a) socio-economic indicators (percentage of individuals with university education, percentage of category A governorates, percentage of owned houses, households with computers, internet and smart phones) and, (b) oral health research potential indicators (number of Dental Public Health (DPH) specialists, Ministry of Health (MoH) dentist to population ratio and number of dental schools). ArcGIS was used for data visualization and logistic regression was used for analysis.

Results

Twenty-two studies provided caries data for 46.2% of the regions which were inhabited by 84.7% of the population. Region-level data availability was associated with the number of dental schools (OR = 1.63) with 61.5% of the regions correctly classified. More regions were correctly classified when population to MoH dentist ratio (76.9%) and the number of DPH specialists (92.3%) were included.

Conclusions

Caries data were available for half of the administrative regions in Saudi Arabia and data availability was associated with higher number of dental schools. The presence of DPH specialist provided the critical mass to collect caries data.

United Arab Emirates dentists' perceptions about the management of broken down first permanent molars and their enforced extraction in children: a questionnaire survey

PURPOSE

The broken down first permanent molar (BDFPM) is common in children. Enforced extractions of first permanent molars (EExFPMs) guidelines were published in the United Kingdom (UK) in 2014. We aimed to assess the knowledge and practice of dentists in the United Arab Emirates (UAE) of BDFPMs in children in light of the guidelines.

METHODS

A cross-sectional sample of UAE-based dentists treating children completed a self-administered questionnaire covering; knowledge and practice of the principle of EExFPMs; to whom dentists would refer in case of BDFPMs; knowledge of the ideal age for EExFPMs (8-10 years) and finally actual awareness of the EExFPMs guidelines. Chi-square tests (p < 0.05).

RESULTS

A total of 199 questionnaires were completed (total return rate was 66.33%). There was no agreement on how to deal with a scenario of BDFPMs. Over 85% majority believed in saving BDFPMs rather than extracting them but 89% would consult/refer to other specialists. Whilst 51% of the participants had never carried out EExFPMs in children, 69% were aware of the EExFPMs concept and 61% knew the ideal timing of a lower FPM extraction. More than 82% were unaware of the actual UK EExFPMs guidelines. Paediatric dentists would consider EExFPMs more than other groups (p = 0.007).

CONCLUSION

In the UAE dentist sample surveyed, there was a preference for preserving BDFPMs rather than extracting them in children, despite knowing when the ideal time for extraction was. Training background and specialty were influencing factors. There was a lack of awareness of the actual UK 2014 EExFPMs guidelines.

Efficacy of a Self-Designed Mobile Application to Improve Child Dental Health Knowledge among Parents

Objectives:

The objective of the study is to develop a mobile-based application and assess its efficacy in improving child dental health knowledge of parents.

Subjects and Methods:

A mobile-based application (Your child's smile) was developed and made available on application-store and play store. This application provided all essential information to parents on child dental health prepartum and from infancy to adolescence. To assess improvement in parent's knowledge two similar pretested questionnaires were incorporated within the application, one to be filled at initial registration and other after the parents had utilized the application. Responses were entered into MS excel sheet and analyzed using IBM SPSS statistics version 20.0.

Results:

Within the 15 days’ research period, the application was downloaded by 230 parents out of whom 110 answered only the 1^st and 120 both questionnaires. Out of the 120 who responded to both majority showed highly significant (P < 0.01) or significant (P < 0.05) improvement in their knowledge on tooth development, importance of deciduous teeth, importance of regular dental check-up, pit and fissure sealants, bedtime bottle use, and consequence of early loss of deciduous teeth. Confidence in child dental health knowledge was also evident in other areas with more parents opting for agreeing, strongly agree, or disagree options. A majority 75% of parents favored the use of mobile applications as an effective child dental health knowledge tool.

Conclusion:

Within the limitations of the study, we can conclude that mobile based applications are an effective tool for providing child oral health knowledge to parents and significant improvement in knowledge is evident after parents utilized the mobile-based application.