Dental caries: experience in relation to wasting and stunted growth among schoolboys in Abha, 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.

Does Dental Caries Increase Risk of Undernutrition in Children?

INTRODUCTION

A systematic review of the evidence on the impact of dental caries on malnutrition risk in children was conducted.

OBJECTIVES

To systematically review published evidence pertaining to the effect of dental caries severity and prevalence on risk of wasting or stunting in children.

METHODS

Four questions relating to caries of the permanent dentition, primary dentition, early childhood caries (ECC), and severe ECC as a risk factor for undernutrition were set. The target population was children aged 0 to 18 y from any country. Data sources included MEDLINE and Embase. All human epidemiological studies were included. Quality assessment excluded lowest-quality studies. Evidence synthesis by vote counting was depicted using harvest plots. A best available evidence approach was applied to narrative synthesis. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

RESULTS

Of the 2,690 studies identified, 447 were screened in duplicate; of these, 117 underwent quality assessment, resulting in 46 included studies, of which 38 were included in vote counting (3 quasi-experimental, 1 cohort, 1 case control, and 33 cross-sectional studies). For the permanent dentition, findings were mixed; the balance of data showed no association between caries prevalence (7/11 studies) or severity (8/17 studies) with wasting. For the primary dentition, the balance of data showed a positive association between caries prevalence (10/15 studies) and severity (12/15 studies) with wasting, as well as between-caries prevalence (4/5 studies) and severity (6/6 studies) with stunting. Considering ECC only did not alter this pattern of findings.

CONCLUSION

The balance of evidence suggests that dental caries in the primary dentition is associated with undernutrition. There is a need for well-designed trials on the impact of caries rehabilitation on growth trajectories of children from low- and middle-income countries and for prospective studies of the impact of caries severity on both stunting and wasting to confirm causality.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by policy makers when considering the importance of oral health in addressing the United Nations Sustainable Development Goal to end all forms of malnutrition. The findings suggest that dental caries in the primary dentition may impair children's healthy weight gain. The findings indicate that higher-quality data are required to confirm a causal relationship and thus inform funding bodies of the need for research, especially in low- and middle-income countries, to substantiate the current knowledge and inform clear and accurate policy statements.

Detection of Dental Caries' and Dermatoglyphics' Association with Relative Enamel Thickness Using CBCT Images in Saudi Subpopulation: A Novel Approach

Background

Dental caries is the localized destruction of dental hard tissues (enamel and dentine). Decayed, Missing, and Filled Teeth (DMFT) index is the most commonly used dental caries index. Thickness of the outermost part of the tooth called the enamel is determined by the rate of deposition of enamel proteins. Relative enamel thickness (RET) gives a measure of enamel thickness with respect to dentine. Dental caries is influenced by a genetically determined factor called dermatoglyphics (DG). As the genes responsible for RET and DG lie on the same chromosome and develop during the same time of intrauterine life, it is biologically plausible to correlate RET and DG.

Aims

This study consists of two primary aims: (1) to assess RET using cone beam computed tomography images and correlate it with caries and (2) to correlate RET with DG.

Materials and Methods

148 dental subjects were assessed for DMFT caries score and were categorized as Group 1 with DMFT = 0 and Group 2 with DMFT ≥ 1. Following this, their DG pattern was recorded digitally. The CBCT images of these subjects were assessed for RET, and the data were analyzed statistically.

Results

Mean RET in our sample population is 18.45 (SD 3.79) while mean DMFT is 5.34 (SD 5.13). Mean RET in Group 1 subjects was 19.82 (SD 4.05) while that in the Group 2 was 17.68 (SD 3.43). RET and DMFT showed a statistically significant negative correlation (p = 0.007). The “Single Loop” DG characteristic showed a statistically significant difference between males and females (p = 0.031). The “Simple Arch” type of DG was positively correlated with RET.

Conclusion

This is the first in vivo study to assess RET using CBCT images and correlate with DMFT and DG. RET is inversely related to DMFT while directly proportional to the “Simple arch” DG pattern. Males and females differed in their “Single Loop” DG characteristic.

Comparison of Fissure Sealant Chair Time and Patients' Preference Using Three Different Isolation Techniques

This randomized clinical trial aimed to evaluate the patient’s preference and chair time needed during pit and fissure sealant placement under three isolation techniques (Isolite system, rubber dam isolation, and cotton roll isolation). Participants, aged 6–15 years and requiring four sealants on the first or second permanent molars, attending the pediatric dental clinics at King Saud University in Saudi Arabia were enrolled according to the inclusion criteria. Each participant received sealants on three random first or second permanent molars using three isolation techniques. The time required for sealant placement was recorded for each technique. Following sealant placement, an interview-based questionnaire was administered to the participants to evaluate their preference regarding the isolation techniques. Forty-eight children (23 male and 25 female) with a mean age of 8.58 ± 1.93 years participated in this study. The mean chair times were 248.14, 255.89, and 243.29 s for the Isolite system, rubber dam isolation, and cotton roll isolation, respectively. Approximately 79% of participants considered cotton roll isolation to be the most comfortable, whereas approximately 71% were significantly less likely to use rubber dam isolation again. In conclusion, there were no significant differences in sealant placement time among the three isolation techniques. However, cotton roll isolation was the technique that was most preferred by the participants.

Dental caries and anthropometric measures in a sample of 5- to 9-year-old children in Dhaka, Bangladesh

AIM

This study aimed to assess associations between dental caries and anthropometric measures among a sample of children aged 5-9 years in Dhaka, Bangladesh.

METHODS

A cross-sectional observational study was conducted among 5- to 9-year-old children in Dhaka, Bangladesh. Data were collected from children and their parents attending the Dhaka Dental College Hospital and from three nearby primary schools. The outcome measures were as follows: age and sex adjusted height-z-scores (HAZ), weight-z-scores (WAZ) and BMI-z-scores (BAZ). Multiple linear regressions were used to assess the associations between caries and anthropometric measures, adjusted for maternal education, family income, study setting, birth weight and childhood diseases as potential confounders.

RESULTS

The final sample comprised 788 children, and the overall response rate was 96.7%. The majority (73.2%) had experience of dental caries. The mean dmft + DMFT score was 2.84 (95% CI 2.64, 3.03) and 35.8% experienced dental sepsis. Dental caries and sepsis were negatively associated with HAZ, WAZ and BAZ scores. After adjustment for potential confounders, children with severe levels of caries had lower HAZ scores (coefficient: -0.40; 95% CI -0.69, -0.10), lower WAZ scores (coefficient: -0.59; 95% CI -0.94, -0.24) and lower BAZ scores (coefficient: -0.50; 95% CI -0.87, -0.13) than those who were caries free. Children with moderate levels of caries also had lower WAZ scores (coefficient: -0.43; 95% CI -0.72, -0.15) and lower BAZ scores (coefficient: -0.43; 95% CI -0.72, -0.13) than caries-free children. Children with dental sepsis had lower HAZ (coefficient: -0.23; 95% CI -0.42, -0.03), WAZ (coefficient: -0.33; 95% CI -0.56, -0.10) and BAZ scores (coefficient: -0.29; 95% CI -0.53, -0.05) than dental sepsis-free children.

CONCLUSIONS

Dental caries was associated with lower height, weight and BMI among this sample of Bangladeshi children, even after adjusting for age and sex and a number of potential confounders.

Prevalence of dental caries among male students aged 15-17 years in southern Asir, Saudi Arabia

Background

Dental caries had been studied by several studies in Saudi Arabia among different age groups and at various places. According to World Health Organization (WHO), assessment of caries at 15 years of age is more meaningful. The objective of this survey was to assess the prevalence of dental caries among 15–17-year teenage students in Abha, Saudi Arabia. Results of the present study can be used as baseline data for future oral health interventions for the population.

Methods

A stratified cluster random sampling was followed in selecting the students. The clinical data was collected using dentition status component of WHO oral health assessment form 2013. Five investigators were trained and calibrated with 20 subjects for two successive days (Cronbach's Alpha = 0.91). Data was analyzed for descriptive statistics and Mann-Whitney U test was applied to compare the DMFT scores.

Results

Prevalence of dental caries among the study population was found to be 72.9%. The DMFT scores were found to be highest in the posteriors (90.7%). First permanent molar was the most common tooth affected by dental caries in all quadrants.

Conclusion

The present study revealed that there is a high prevalence of dental caries among students aged 15–17 years in Abha, Saudi Arabia. Caries prevalence was highest in mandibular posterior segments, however, it was lowest in mandibular anterior segments. There is an urgent need for both preventive and curative dental health services in the region. It is recommended that a coordinated school dental program may be initiated in the area.

Reducing Inequalities in Oral Health in the Africa and Middle East Region

Dentistry is facing many serious challenges and threats. Addressing them will require major changes in strategy. This work outlines the extent of dental disease in the Africa and Middle East Region (AMER) and suggests strategies to reduce inequalities in oral health. The main oral health challenges in the AMER relate to controlling the relentless increase in caries with age. A very conservative estimate of population caries levels suggests that a 5-fold increase in dental personnel would be required just to treat current levels of caries. Hence, we argue that current approaches to control caries in the AMER are both ineffective and unaffordable, and a new model to promote oral health is needed. Unless determinants of noncommunicable diseases are addressed and access to evidence-based minimal intervention dental care is improved, the burden of dental disease will persist. The new oral health promotion model calls for an integrated intersectoral common risk factor approach, namely, "oral health in all policies" (OHiAP). An OHiAP framework will initiate high-level policy initiatives and intersectoral partnerships. Oral health professionals have an important advocacy role in securing the fundamental changes in health strategy needed to control the growing, unjust, and unaffordable burden of oral disease.

Association between adult height and tooth loss in a representative sample of Koreans

OBJECTIVES

Evidence suggests that taller individuals have better health than that of shorter individuals. However, evidence for links to tooth loss is scarce. The aim of this study was to examine the association between adult height and tooth loss and to examine the roles of covariates in explaining the association in different birth cohorts in Korea.

METHODS

Using data from the Fourth and Fifth Korea National Health and Nutritional Examination Survey (KNHANES IV and V), the subjects were grouped into two birth cohorts based on their historical context: born from 1920 to 1945 and 1946 to 1962. The dependent variables were loss of 8 or more teeth and total tooth loss (edentulism), while the independent variable was the height quartile. Demographic factors (survey year, age, and gender), early childhood/adult socioeconomic status (SES) (father's education, own education, income, and place of residence), health behaviors (cigarette smoking, binge drinking, frequency of toothbrushing, and regular dental visit), and health problems (diabetes and hypertension) were included in a series of analytical models.

RESULTS

The survey year-, age-, and gender-adjusted prevalence ratios (PR) of the loss of 8 or more teeth for the shortest quartile were 1.23 (95% confidence intervals, CI: 1.13-1.35) for the 1920-1945 birth cohorts and 1.39 (95% CI: 1.20-1.62) for the 1946-1962 birth cohorts. The PRs for edentulousness were 1.64 (95% CI: 1.34-2.02) for the 1920-1945 birth cohorts and 2.26 (95% CI: 1.31-3.91) for the 1946-1962 birth cohorts. These associations were moderately attenuated after adjusting for own education but still significant in the fully adjusted models. After full adjustment for the covariates, those in the shortest height quartiles in the relatively young birth cohorts (1946-1962 birth cohorts) had a 1.93 (95% CI: 1.09-3.43) times greater prevalence of edentulism than that of their tallest counterparts.

CONCLUSIONS

Given that adult height reflects early-life conditions, independent associations between height and tooth loss support the view that early-life circumstances significantly influence oral health outcomes in later life.

Dental caries in Arab League countries: a systematic review and meta-analysis

OBJECTIVE

The aim of this review was to determine prevalence of dental caries in primary and permanent teeth in the 2-20-year-old population of the Arab league.

METHODS

A literature search was performed on Pubmed, Summon and Google Scholar using the key words 'Dental caries', 'dmft' and 'DMFT'. A total of 293 articles were found, of which 35 passed our inclusion criteria and were included in analysis. Tables were made separately for primary and permanent teeth; the age group for primary teeth was 2-12 years and for permanent teeth 6-20 years.

RESULTS

A meta-analysis was run by using data extracted from the studies included. Heterogeneity was tested by forest plot and chi-square test, and considerable heterogeneity was found. Mean decayed, missing and filled teeth (dmft) was 4.341 (95% CI 3.714, 4.969) and in permanent teeth (DMFT) was 2.469 (95% CI 2.019, 2.919) from a random effect model. Publication bias diagnostics suggested missing of four studies of primary teeth caries data and eight studies of permanent teeth caries data to obtain symmetry in the funnel plot.

CONCLUSION

The incidence of caries in primary teeth was found to be high compared with caries in permanent teeth in the Arab League. This study does not provide a comprehensive picture of caries prevalence in the Arab League because in many of these countries only a few studies were performed. Therefore, these data cannot provide a complete picture of the prevalence of caries in those countries. Additional studies are needed to better evaluate the prevalence of caries in children and young adults in Arab League countries.

A systematic review of population-based dental caries studies among children in Saudi Arabia

OBJECTIVE

Dental caries critically impacts the health and development of children. Understanding caries experience is an important task for Saudi Arabian policymakers to identify intervention targets and improve oral health. The purpose of this review is to analyze current data to assess the nationwide prevalence and severity of caries in children, to identify gaps in baseline information, and to determine areas for future research.

METHODS

A search of published and unpublished studies in PubMed, Google, and local Saudi medical and dental journals was conducted for the three keywords "dental," "caries," and "Saudi Arabia." The inclusion criteria required that the articles were population-based studies that assessed the prevalence of dental caries in healthy children attending regular schools using a cross-sectional study design of a random sample.

RESULTS/DISCUSSION

The review was comprised of one unpublished thesis and 27 published surveys of childhood caries in Saudi Arabia. The earliest study was published in 1988 and the most recent was published in 2010. There is a lack of representative data on the prevalence of dental caries among the whole Saudi Arabian population. The national prevalence of dental caries and its severity in children in Saudi Arabia was estimated to be approximately 80% for the primary dentition with a mean dmft of 5.0 and approximately 70% for children's permanent dentition with a mean DMFT score of 3.5. The current estimates indicate that the World Health Organization (WHO) 2000 goals are still unmet for Saudi Arabian children.

CONCLUSION

Childhood dental caries is a serious dental public health problem that warrants the immediate attention of the government and the dental profession officials in Saudi Arabia. Baseline data on oral health and a good understanding of dental caries determinants are necessary for setting appropriate oral health goals. Without the ability to describe the current situation, it is not possible to identify whether progress is being made toward these goals. A roadmap with a clear starting point, destination, and pathway is a desperately needed tool to improve the oral health of Saudi Arabian children.

Untreated severe dental decay: a neglected determinant of low Body Mass Index in 12-year-old Filipino children

Background

Dental decay is the most common childhood disease worldwide and most of the decay remains untreated. In the Philippines caries levels are among the highest in the South East Asian region. Elementary school children suffer from high prevalence of stunting and underweight.

The present study aimed to investigate the association between untreated dental decay and Body Mass Index (BMI) among 12-year-old Filipino children.

Methods

Data collection was part of the National Oral Health Survey, a representative cross-sectional study of 1951 11-13-year-old school children using a modified, stratified cluster sampling design based on population classifications of the Philippine National Statistics Office. Caries was scored according to WHO criteria (1997) and odontogenic infections using the PUFA index. Anthropometric measures were performed by trained nurses. Some socio-economic determinants were included as potential confounding factors.

Results

The overall prevalence of caries (DMFT + dmft > 0) was 82.3% (95%CI; 80.6%-84.0%). The overall prevalence of odontogenic infections due to caries (PUFA + pufa > 0) was 55.7% (95% CI; 53.5%-57.9%) The BMI of 27.1% (95%CI; 25.1%-29.1%) of children was below normal, 1% (95%CI; 0.5%-1.4%) had a BMI above normal. The regression coefficient between BMI and caries was highly significant (p < 0.001). Children with odontogenic infections (PUFA + pufa > 0) as compared to those without odontogenic infections had an increased risk of a below normal BMI (OR: 1.47; 95% CI: 1.19-1.80).

Conclusions

This is the first-ever representative survey showing a significant association between caries and BMI and particularly between odontogenic infections and below normal BMI. An expanded model of hypothesised associations is presented that includes progressed forms of dental decay as a significant, yet largely neglected determinant of poor child development.

Effects of Dental Caries on Nutritional Status Among First-Grade Primary School Children

The aim of this study was to explore association between caries prevalence and nutritional status among first-grade primary school children. A cross-sectional study of 212 students was conducted. All students were weighed and measured and then the body mass index (BMI) was calculated. Each student underwent dental examination and was interviewed. Overall, caries prevalence was 80.2% and the average decayed, missing, and filled surfaces (dmfs) were 12.4 ± 12.3. Although none of the students was in the underweight category, 45.8% were in low percentile (5th < BMI-for-age < 15th). Multiple logistic regression showed that each extra carious surface (dmfs) increased the odds of being at risk for underweight (5th < BMI-for-age < 15th) by 3.1% after adjusting for gender and dental visits. Our findings stressed that caries has significant implications on overall child health and health personnel should increase awareness of negative impacts and promote healthy nutritional choices for children.