Breastfeeding and Childhood Dental Caries: Results from a Socially Diverse Birth Cohort Study

Previous studies showed that prolonged breastfeeding increases the risk of caries. However, the observed associations were mainly based on non-European populations, and important confounding and mediating factors like socioeconomic position (SEP) and diet were often neglected. The aim of this study was to investigate the role of breastfeeding and bottle-feeding practices on dental caries during childhood while accounting for SEP, ethnic background, and sugar intake. This study was part of the Generation R Study, a prospective multiethnic cohort study conducted in Rotterdam, The Netherlands. In total, 4,146 children were included in the analyses. Information about feeding practices was derived from delivery reports and questionnaires during infancy. Caries was measured via intraoral photographs at the age of 6 years and defined as decayed, missing, and filled teeth (dmft). Negative binomial hurdle regression analyses were used to study the associations between several infant feeding practices and childhood caries. The prevalence of dental caries at the age of 6 years was 27.9% (n = 1,158). Prolonged breastfeeding (for >12 months) was associated with dental caries (OR 1.35, 95% CI 1.04-1.74) and the number of teeth affected by dental caries (RR 1.27, 95% CI 1.03-1.56). Furthermore, nocturnal bottle-feeding was associated with dental caries (OR 1.52, 95% CI 1.20-1.93). All associations were independent of family SEP, ethnic background, and sugar intake. Results from this Dutch cohort study confirmed the previously observed associations between prolonged breastfeeding and nocturnal bottle-feeding and the increased risk of childhood dental caries, even after proper adjustments for indicators of SEP, ethnic background, and sugar intake. Future studies are encouraged to elaborate further on possible explanations for the observed relationships. Healthcare professionals should be aware and advise caregivers about the potential risk of prolonged breastfeeding on caries development by applying the current recommendations on breastfeeding, oral hygiene, and feeding frequency.

Regenerative endodontic therapy: a follow-up of 47 anterior traumatised teeth

PURPOSE

To collect long-term survival data in anterior traumatised teeth on the outcome of Regenerative Endodontic Treatments (RET) with a network of dentists working in different clinics to overcome the problem of anecdotical evidence.

METHODS

The seven dentists from Paediatric REsearch Project (PREP) performed RET treatments following the same protocol in five different secondary dental care clinics in the Netherlands. Treatment resulting in pain, apical problems, sinus tracts, resorption or fracture were considered as failure of treatment.

RESULTS

47 teeth in 38 children were treated between January 2009 and September 2017 and had at least 6 month follow-up (mean 35 months). Apical closure was seen in 27 teeth (25 cases) and root length growth in 6 teeth (6 cases). Thickening of the root walls was seen in 20 teeth (20 cases) and obliteration of the root canal in 30 teeth (25 cases). Of 38 teeth with apical inflammation at the start of treatment, no radiographic sign of apical inflammation was visible at 3 months in 13 of 28 teeth; taking up to 42 months for radiographic signs of apical inflammation to be not visible. Nineteen of 35 teeth showed discoloration at the beginning of treatment. After 18 months two teeth showed signs of ankylosis, but were still functional. After 36 months one more tooth showed signs of new apical inflammation and 2 months later it was extracted.

CONCLUSIONS

With three failures in 47 treated teeth, RET seems to be a promising treatment for difficult to treat anterior traumatised teeth with an open apex.

Foetal, neonatal and child vitamin D status and enamel hypomineralization

Objectives

Recent literature suggested that higher vitamin D concentrations in childhood are associated with a lower prevalence of molar incisor hypomineralization (MIH). As tooth development already starts in utero, we aimed to study whether vitamin D status during foetal, postnatal and childhood periods is associated with the presence of hypomineralized second primary molars (HSPMs) and/or MIH at the age of six.

Methods

Our study was embedded in the Generation R Study, a population‐based, prospective cohort from foetal life onwards in Rotterdam, the Netherlands. HSPMs and MIH were scored from intraoral photographs of the children at their age of six. Serum 25(OH)D concentrations were measured at three points in time, which resulted in three different samples; mid‐gestational in mothers’ blood (n = 4750), in umbilical cord blood (n = 3406) and in children's blood at the age of 6 years (n = 3983).

Results

The children had a mean (±SD) age of 6.2 (±0.5) years at the moment of taking the intraoral photographs. After adjustment for confounders, no association was found between foetal 25(OH)D concentrations and the presence of HSPMs (OR 1.02 per 10 nmol/L higher 25(OH)D, 95% CI: 0.98‐1.07) or MIH (OR 1.05 per 10 nmol/L increase, 95% CI: 0.98‐1.12) in 6‐year‐olds. A higher 25(OH)D concentration in umbilical cord blood resulted in neither lower odds of having HSPM (OR 1.05, 95% CI: 0.98‐1.13) nor lower odds of having MIH (OR 0.95, 95% CI: 0.84‐1.07) by the age of six. Finally, we did not find higher 25(OH)D concentrations at the age of six to be associated with a significant change in the odds of having HSPM (OR 0.97, 95% CI: 0.92‐1.02) or MIH (OR 1.07, 95% CI: 0.98‐1.16).

Conclusions

25(OH)D concentrations in prenatal, early postnatal and later postnatal life are not associated with the presence of HPSMs or with MIH at the age of six. Future observational research is required to replicate our findings. Furthermore, it is encouraged to focus on identifying other modifiable risk factors, because prevention of hypomineralization is possible only if the causes are known.

Social inequalities and dental caries in six-year-old children from the Netherlands

OBJECTIVES

The purpose of our study was to investigate the association of different socioeconomic and sociodemographic factors with dental caries in six-year-old children. Furthermore, we applied a district based approach to explore the distribution of dental caries among districts of low and high socioeconomic position (SEP).

METHODS

In our cross-sectional study 5189 six-year-olds were included. This study was embedded in a prospective population-based birth cohort study in Rotterdam, the Netherlands, the Generation R Study. Parental education level, parental employment status, net household income, single parenting, and teenage pregnancy were considered as indicators for SEP. Dental caries was scored on intraoral photographs by using the decayed, missing, and filled teeth (dmft) index. We compared children without caries (dmft=0) to children with mild caries (dmft=1-3) or severe caries (dmft >3). Multinomial logistic regression analyses and binary logistic regression analyses were performed to study the association between SEP and caries, and between district and caries, respectively.

RESULTS

Only maternal education level remained significantly associated with mild caries after adjusting for all other SEP-indicators. Paternal educational level, parental employment status, and household income additionally served as independent indicators of SEP in children with severe caries. Furthermore, living in more disadvantaged districts was significantly associated with higher odds of dental caries.

CONCLUSION

Dental caries is more prevalent among six-year-old children with a low SEP, which is also visible at the district level. Maternal educational level is the most important indicator of SEP in the association with caries.

CLINICAL SIGNIFICANCE

Our results should raise concerns about the existing social inequalities in dental caries and should encourage development of dental caries prevention strategies. New knowledge about the distribution of oral health inequalities between districts should be used to target the right audience for these strategies.

Ethnic Disparities in Dental Caries among Six-Year-Old Children in the Netherlands

The aim of this study was to investigate potential differences in caries prevalence of children from ethnic minority groups compared to native Dutch children and the influence of socio-economic status (SES) and parent-reported oral health behaviour on this association. The study had a cross-sectional design, embedded in a population-based prospective multi-ethnic cohort study. 4,306 children with information on caries experience, belonging to 7 different ethnic groups, participated in this study. The decayed, missing, and filled teeth (dmft) index was assessed at the age of 6 and categorized in two ways for analysis: children without caries (dmft = 0) versus any caries experience (dmft >0) and children without caries (dmft = 0) versus children with mild caries (dmft = 1-3) or severe caries (dmft >3). Compared to native Dutch children, children with a Surinamese-Hindustani, Surinamese-Creole, Turkish, Moroccan, and Cape Verdean background had significantly higher odds for dental caries. Especially the Surinamese-Hindustani, Turkish, and Moroccan group had significantly higher odds for severe dental caries. Household income and educational level of the mother explained up to 43% of the association between ethnicity and dental caries, whereas parent-reported oral health behaviour did not mediate the association. Alarming disparities in caries prevalence between different ethnic (minority) groups exist, which cannot be fully explained by social inequalities. Public health strategies can apply this new knowledge and specifically focus on the reduction of ethnic disparities in oral health. More research is needed to explain the high caries prevalence among different ethnic minority groups.

Early Caries Predicts Low Oral Health-Related Quality of Life at a Later Age

Oral health-related quality of life (OHRQOL) is the perceived impact of one's own oral health on daily life. Oral diseases influence children's OHRQOL directly, but OHRQOL might also be related to oral health experiences from the past. We investigate the relation between dental caries at the age of 6 with OHRQOL assessed at the age of 10. This study was conducted within the Generation R Study, a population-based prospective cohort study. Caries experience was assessed with the decayed, missing, and filled teeth index (dmft) at a median age of 6.09 years (90% range: 5.73-6.80). OHRQOL was assessed with a short form of the Child Oral Health Impact Profile at the children's age of 9.79 years (9.49-10.44). In total, 2,833 children participated in this study, of whom 472 (16.6%) had mild caries (dmft 1-3) and 228 (8.0%) had severe caries (dmft >3). The higher the dmft score at the age of 6, the lower the OHRQOL at the age of 10 (p < 0.001). The children with severe caries at the age of 6 had significantly higher odds of being in the lowest OHRQOL quartile at the age of 10 (OR = 1.69; 95% CI: 1.17-2.45). Our study highlights the importance of oral health during childhood, because those who get a compromised start to oral health are much more likely to follow a trajectory which will lead to poor oral health (-related QOL) later. OHRQOL is not only related to current oral health experiences but also to oral health experiences from the past.

Association between Bone Mass and Dental Hypomineralization

The aim of this study was to examine the association between the bone mass (bone mineral content [BMC]) and hypomineralized second primary molars (HSPMs)/molar incisor hypomineralization (MIH) in 6-y-old children. This cross-sectional study was embedded in the Generation R Study, a population-based prospective cohort study, starting from fetal life until adulthood in Rotterdam, Netherlands. The European Academy of Pediatric Dentistry criteria were used to score the intraoral photographs on the presence or absence of HSPMs and MIH. Bone mass was measured with a dual-energy x-ray absorptiometry (DXA) scan. Intraoral photographs and DXA scans were available in 6,510 6-y-old children. Binary logistic regression models were used to study the association between the bone mass and HSPMs/MIH. In total, 5,586 children had their second primary molars assessed and a DXA scan made; 507 children were diagnosed with HSPM. Of 2,370 children with data on their permanent first molars, 203 were diagnosed with MIH. In the fully adjusted model, children with lower BMC (corrected for bone area) were more likely to have HSPMs (odds ratio, 1.13; 95% confidence interval, 1.02 to 1.26 per 1-standard deviation decrease). A lower BMC (corrected for bone area) was not associated with MIH (odds ratio, 1.02; 95% confidence interval, 0.87 to 1.20 per 1-standard deviation decrease). We observed a negative association between BMC (corrected for bone area) and HSPMs. No association was found between BMC (corrected for bone area) and MIH. Future research should focus on investigating the mechanism underlying the negative association between the bone mass and HSPMs. Our study, in a large population of 6-y-old children, adds the finding that BMC (corrected for bone size) is associated with HSPMs but not with MIH in childhood.

Is maternal use of medicines during pregnancy associated with deciduous molar hypomineralisation in the offspring? A prospective, population-based study

BACKGROUND

The effects of maternal use of medicines during pregnancy on tooth development has scarcely been studied; only negative effects of tetracycline on tooth germs are known (irreversible tooth discoloration and enamel hypoplasia).

OBJECTIVE

The aim of this study was to investigate whether antibacterials and anti-allergic and anti-asthma medicines, being the most frequently used medicines during pregnancy, are associated with deciduous molar hypomineralisation (DMH) and, if so, which specific medicines.

MATERIALS AND METHODS

To clarify this possible association, the participants of the Generation R Study, a population-based prospective cohort study from fetal life until young adulthood, were studied. Data on medicine use during pregnancy were retrieved from pharmacies. Clinical photographs of the second primary molars, which were scored for DMH, were taken with an intra-oral camera in 6,690 children (mean age 6.2 years, standard deviation [SD] ± 0.53; 49.9 % girls).

RESULTS

During pregnancy, 20.3 % of the mothers used antibacterials, 12.3 % anti-asthma medicines and 5.4 % anti-allergic medicines. The prevalence of DMH was 9.0 % in the study group. There was no association between the use of anti-asthma medicines, anti-allergic medicines (odds ratio [OR]: 0.97 [95 % CI 0.61-1.54]; OR: 1.04 [0.54-2.03]) or antibacterials (OR: 0.73 [0.49-1.09]) during pregnancy and DMH (all p-values >0.05). The study had sufficient power (80 %) to detect significant associations.

CONCLUSION

Maternal use of antibacterials, anti-allergic medicines or anti-asthma medicines during pregnancy is not associated with the development of DMH in the offspring.

Pre- and postnatal determinants of deciduous molar hypomineralisation in 6-year-old children. The generation R study

BACKGROUND

Deciduous Molar Hypomineralisation (DMH) and Molar Incisor Hypomineralisation (MIH) are common developmental disturbances in pediatric dentistry. Their occurrence is related. The same determinants as suggested for MIH are expected for DMH, though somewhat earlier in life. Perinatal medical problems may influence the prevalence of DMH but this has not been studied sufficiently.

OBJECTIVE

This study aimed to identify possible determinants of DMH in a prospective cohort study among 6-year-old children.

STUDY DESIGN

This study was embedded in the Generation R Study, a population-based prospective cohort study from fetal life until young adulthood. The the data were used to identify the determinants of DMH. Clinical photographs of clean, moist teeth were taken with an intra-oral camera in 6690 children (mean age 6.2 years; 49.9% girls). Data on possible determinants that had occurred during pregnancy and/or the child's first year of life were on the basis of manual standardized measurements (like length and weight) and questionnaires. Multivariate analyse with backward and forward selection was performed.

RESULTS

A number of factors in the pre-, peri- and postnatal phase were found to be associated with DMH. After multivariate logistic regression analyses, Dutch ethnic background, low birth weight, maternal alcohol consumption during pregnancy, and fever episodes in the first year of the child's life were found to play a role in the development of DMH in 6-year-old children.

CONCLUSION

This study shows that Dutch ethnicity, low birth weight, alcohol consumption by the mother during pregnancy and any fever in the first year of the child's life are associated with DMH. Not only childhood factors but also prenatal lifestyle factors need to be taken into account when studying determinants for DMH.

Caries pattern in primary molars in Dutch 5-year-old children

AIM

The aim of this study was to investigate the difference in caries prevalence based on quadrant dmfs data between first and second primary molars in 5-year-old Dutch children.

STUDY DESIGN

Cross-sectional observational study. METHODS AND STATISTICS: For this study 692 children, all insured by a "Health Insurance Fund", living in one of four selected cities in The Netherlands were asked to participate in the study. From the original cohort 435 children (49% girls) participated. Clinical examinations were performed and only carious lesions with involvement of the dentine were reported. Lesions on the occlusal, buccal, palatinal/lingual, mesial and distal surfaces as well as lesions in buccal and palatinal pits and fissures were reported separately. No radiographs were taken. Systematic differences in dmfs between first and second molars in the same quadrant of each primary dentition were tested with the Wilcoxon signed rank test.

RESULTS

Second primary molars, even after correction for caries in pits and buccal/palatinal fissures, had a statistically significant higher total dmfs than the first primary molars. The differences were mainly found on the occlusal surfaces. On proximal surfaces, the first primary molars had significant more caries than the second primary molars. The d-component constituted the major part of the caries index.

CONCLUSIONS

Second primary molars, corrected for decay in the pits and buccal/palatinal fissures of this molar, are more affected by caries than first primary molars and that the differences in caries prevalence are the largest on the occlusal surface. The specific site of the caries found suggests that developmental disturbances in second primary molars may attribute to their prevalence.

Factors increasing the caries risk of second primary molars in 5-year-old Dutch children

BACKGROUND

Caries is still a prevalent condition in 5-year-old children. At present, knowledge regarding some aetiological factors, like deciduous molar hypomineralization (DMH), is limited.

AIM

To investigate aetiological factors both directly and indirectly associated with caries in second primary molars.

DESIGN

Of 974 children invited to participate in the study, 386 children were examined clinically with visual detection of caries. Only carious lesions determined to have reached the dentine were recorded. Information about tooth brushing frequency, education level of the mother, and country of birth of mother and child, was collected by means of a multiple-choice questionnaire. Parents of 452 children filled in the questionnaire. Complete clinical and questionnaire data were available for 242 children. Statistical analysis of the effect of the independent variables was undertaken using the Pearson's chi-squared test.

RESULTS

Deciduous molar hypomineralization (P = 0.02) and the country of birth of the mother (P < 0.001) were positively associated with caries prevalence.

CONCLUSIONS

Deciduous molar hypomineralization and the country of birth of the mother play a role in the prevalence of dental caries. These aetiological factors associated with childhood dental caries need to be investigated further in longitudinal clinical trials.

Hypomineralized second primary molars: prevalence data in Dutch 5-year-olds

The aim of this cross-sectional observational study was to report on the prevalence of hypomineralizations in second primary molars in 5-year-old Dutch children. In the study 386 (45% girls) 5-year-old Dutch children, all insured by a Health Insurance Fund, participated. Scoring criteria for molar incisor hypomineralization molars were adapted to score second primary molars. The prevalence of hypomineralized second primary molars (HSPM) was 4.9% at child level and 3.6% at tooth level. Most HSPMs (87%) showed demarcated opacities, followed by posteruptive enamel loss (40%).