Risk factors for caries incidence in a cohort of Flemish preschool children

Dental caries status and related factors among 5-year-old children in Shanghai

BACKGROUND

Dental caries in young children is a difficult global oral health problem. In the last decade, China has put a great deal of effort into reducing the prevalence of dental caries. This study, which is part of the China Population Chronic Disease and Nutrition Surveillance 2021, aimed to investigate the prevalence of dental caries among children aged 5 in Shanghai, China, and its associated factors.

METHODS

A total of 1281 children aged 5 years from 6 districts in Shanghai were selected by a stratified sampling method. The survey consisted of an oral health questionnaire and an oral health examination. The questionnaire included questions on oral health knowledge, attitudes, and behaviours. The oral health examination used WHO standards. After screening, the data were input and analysed. Chi-square tests and logistic regression analyses were used to study the relevant factors affecting dental caries.

RESULTS

The prevalence of dental caries among 1281 children was 51.0%, the dmft index score was 2.46, the Significant Caries Index (SiC) score was 6.39, and the SiC10 score was 10.35. Dental caries experience was related to the frequency of sweet drink consumption, the age of starting tooth brushing, eating habits after brushing, whether the children had received an oral examination provided by the government (p < 0.05), and the mother's education level but was not related to sex, the use of fluoride toothpaste, the frequency of brushing, whether the parents assisted brushing, or the frequency of flossing (p > 0.05). Logistic regression analysis showed that the region of residence, eating after brushing and the age of starting brushing were associated with dental caries.

CONCLUSIONS

Dental caries remained prevalent among 5-year-old children in Shanghai, China. Prevention strategies that target the associated factors including region of residence, eating after brushing, and the age of starting brushing should be considered.

RISK PREDICTORS OF EARLY CHILDHOOD CARIES INCREMENT-A SYSTEMATIC REVIEW AND META-ANALYSIS

This systematic review aimed to investigate the risk predictors of caries in primary teeth and evaluate their association with the increment of Early Childhood Caries (ECC) among preschool children. This systematic review included only cohort or case-control studies of at least 2 years duration, over 300 participants and with English full-text. Potentially eligible studies were retrieved from 4 electronic databases (Ovid Embase, Ovid MEDLINE; PubMed, Web of Science) from inception to March 1, 2021. Independent screening and data extraction by 2 reviewers to identify factors associated with ECC increment, including family and socioeconomic factors, dietary and oral health-related habits, and clinical parameters. A total of 18 studies from 163 potential reports were included, involving 1,159,226 preschool children. Lower parental education attainment was found associated with ECC increment (WMD:0.87; 95% CI 0.52, 1.21); whereas immigration status (WMD:-0.38; 95% CI -1.09, 0.34), gender (WMD:-0.02; 95% CI -0.28, 0.24), and dental service utilization (WMD:0.35; 95% CI -0.10, 0.79) were not significant factors for ECC increment. All included studies consistently suggested positive correlations between ECC increment and baseline caries experience, plaque level, cariogenic microorganisms, and prenatal and passive smoking, while mixed findings were detected between ECC increment with dietary and oral hygiene practices. Preschool children whose parents have low education level are more likely to have greater increment of ECC over 2 years. Existing caries lesions, increased dental plaque level, cariogenic microorganisms, prenatal or passive smoking were also consistently identified as risk factors for ECC in all reviewed studies. This systematic review highlights specific risk factors to target for the prevention of ECC and supports implementing more oral health promotion for preschool children with parents of lower educational attainment.

Risk Factors of Dental Caries in Preschool Children in Thailand: A Cross-Sectional Study

Dental caries remains prevalent in young children. This study determined dental caries prevalence and risk factors associated with caries experience in Thai preschool children. Five kindergartens in Samut Sakhon Province were evaluated. Preschool children (4- to 5-year-old children) were recruited. The participants’ parents completed a questionnaire regarding their children’s demographic and socio-economic backgrounds and their oral health-related behaviors. Dental caries status and oral hygiene were recorded using the decayed, missing, and filled teeth index (dmft) and visible plaque index (VPI), respectively. In total, 308 children completed the oral examination (93.9% response rate). The mean age of the children was 5.1 ± 0.5 years old. Among them, 249 children (80.8%) had dental caries (dmft > 0) and their mean dmft score (SD) was 8.2 (4.7). The children’s age, VPI, primary caregiver, age of starting tooth brushing, assisted tooth brushing, and mother’s education level were significantly associated with dental caries (X2test, p < 0.05). The multiple logistic regression analysis revealed that older children with a higher VPI score and whose mothers had lower education had a significantly higher risk of having dental caries (p < 0.05). Caries prevalence was high among the evaluated Thai preschool children. The child’s age, visible dental plaque, and mother’s educational level are significant risk factors for dental caries.

Mapping Evidence on Early Childhood Caries Prevalence: Complexity of Worldwide Data Reporting

Objective

This review aims to identify variances and research gaps in the early childhood caries (ECC) prevalence within countries and the global community by mapping current evidence.

Materials and methods

We performed a literature search in PubMed/MEDLINE and Web of Science to identify English-language, peer-reviewed epidemiologic studies published from January 1999 to January 2019. Abstracts and full-text articles were dual-screened based on predefined eligibility criteria. We classified outcomes by children's age and countries based on economic status. Ranges of reported caries prevalence and median values by country and age were calculated and evidence-mapped.

Results

Out of 915 studies, 59 studies met the inclusion criteria. The most significant number of reports were from the USA, Brazil, and India. The ranges of prevalence (1-96%) among the studies were large. The calculated median caries prevalence values may better estimate countries' prevalence than the reported ranges. Early childhood caries prevalence's highest median values were found for South Korea studies (54%) for children <3-year-old and from Bosnia (81%) for children 3-6 years old. No apparent difference was found in the prevalence of ECC from developed and developing countries.

Conclusion

This mapping review reflects the ranges and median values of ECC worldwide. Overall, the reported prevalence of ECC in most countries is very high. No apparent difference was found in the prevalence of ECC from developed and developing countries. Reported ranges of ECC, as well as heterogeneity and methodological issues, hamper comparisons across studies globally.

Clinical significance

The global ECC prevalence ranges are extreme. Median data may provide a structure for future epidemiological studies to optimizing healthcare resources for caries interventions globally.

How to cite this article

Abdelrahaman M, Hsu K-L, Melo MA, et al. Mapping Evidence on Early Childhood Caries Prevalence: Complexity of Worldwide Data Reporting. Int J Clin Pediatr Dent 2021;14(1):1-7.

Do enamel and dentine caries at 5 years of age predict caries development in newly erupted teeth? A prospective longitudinal study

Objective: To explore caries development in children from 5 to 12 years of age, and to study whether enamel caries and dentine caries at 5 years of age could predict caries prevalence at 12 years of age, controlled for child characteristics.Methods: The study included 3282 children examined at 5 and 12 years of age. Data were collected by clinical examination and questionnaire. Enamel and dentine caries were registered at surface level. Data were tested by t-test and analysed by bi- and multivariate logistic regression. The study was ethically approved.Results: In 5-year-olds, 15% of the children had dentine caries experience and 21% had enamel caries. In 12-year-olds, 32% had dentine caries experience and 47% had enamel caries. Children with dentine caries experience at 5 years of age had at 12 years of age developed more surfaces with enamel caries (mean 2.8, SD 4.2) and dentine caries experience (mean 1.8, SD 2.5) than other children (p < .05). Dentine caries experience at 12 years of age was associated with having only enamel caries (OR 1.6, CI 1.2-2.0) and dentine caries experience (OR 3.2, CI 2.6-3.9) at 5 years of age. Family status and parental education were related to caries development.Conclusion: Children with caries in primary teeth continued to be caries risk children during the mixed dentition period. In addition to dentine caries experience, enamel caries in primary teeth was a predictor for caries development in young permanent teeth and may be used to improve the caries risk assessment.

Plaque Fluoride Levels as a Predictor of Caries Development in Early Childhood with High Sugar Exposure - A Preliminary Study

Objective

This longitudinal study aimed to investigate if the plaque fluoride (PF) concentration can predict the early childhood caries onset. Design: As part of a larger study, 188 preschoolers were clinically evaluated for early childhood caries diagnosis, at baseline and after 1-year follow-up. After that, the final sample comprised: 1. children who had already caries at baseline (decayed, missing or filled surfaces, as well as white chalky white spot lesions adjacent to gingival margins) and developed at least one more cavitation after one year (n=16), and 2. children who never had or developed any caries lesions, including active white spots lesions (n=15). Before the clinical examinations, dental plaque was collected. PF concentration was determined with an ion-specific electrode. A chart was used to estimate the mean daily sugar exposure. The results were statistically analyzed by Spearman correlation and logistic regression analyses (α=0.05).

Results

After one year, a positive significant correlation between caries development and liquid sucrose, total sugar and total sucrose consumption increments was found (p<0.05). Moreover, the solid sugar, solid sucrose and total sugar exposure at baseline were positively correlated with the presence of dental plaque at follow-up (p<0.05). To top it all, children with PF concentrations ≤0.1 μg/mg at baseline were 10 times more likely to develop caries.

Conclusion

In conclusion, this study demonstrated for the first time in vivo that low PF concentration is a predictor of caries development in primary teeth.

Fissure Depth and Caries Incidence in First Permanent Molars: A Five-Year Follow-Up Study in Schoolchildren

This study aimed to evaluate the association between the fissure depth (tooth morphology) of permanent molars and dental caries incidence with a five-year follow-up period. In total, 110 Mexican schoolchildren aged seven years were recruited at baseline, of which 88 children completed the follow-up assessments. The fissure depths of the first permanent lower molars were recorded, and dental caries [decayed, missing, and filled deciduous surfaces (dmfs) and decayed, missing, and filled permanent surfaces (DMFS)] was evaluated annually. A generalized estimating equation model was constructed for evaluating the association between dental caries and fissure depth. The initial and final DMFS scores were 0.02 (±0.2) and 1.55 (±2.49), respectively. The generalized estimating equation model showed that children with deep molar fissures were more likely to develop caries lesions, (Odds Ratio OR = 3.15, p = 0.028) compared to children with shallow fissures. Moreover, dental caries in primary teeth (OR = 1.07, p = 0.005) was associated with the development of carious lesions in the permanent dentition. Fissure depth was a useful predictor of dental caries, according to this five-year follow-up study. The detection of deep occlusal fissures in the lower first permanent molars could contribute to the identification of children at high risk of dental caries. Tooth morphology may be used to identify children at a higher caries risk, particularly in settings with limited resources.

Risk factors of early childhood caries (ECC) among children in Beijing - a prospective cohort study

BACKGROUND

Early childhood caries (ECC) was a serious oral health concern with high prevalence and a low treatment rate in China, and few researches have focused on preschool children. This study aimed to explore the risk factors of ECC in Beijing, China.

METHODS

Totle of 712 children (mean age: 46.37 ± 5.44 months) participated in this prospective cohort study. Questionnaires and the levels of mutans streptococci in dental plaques and non-stimulated saliva, assessed using Dentocult SM strips, were collected at baseline, respectively. Two calibrated examiners checked for dental caries according to the WHO 1997 criteria at baseline and 1-year follow-up. Negative binomial regression was used for multivariate analysis of factors related to caries development.

RESULTS

For caries-free children at baseline, only plaque mutans streptococci (PMS) levels were associated with caries development (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.08-2.61, P = 0.02). Children with high PMS levels (scored 2 and 3) had higher caries incidence (46.2% vs. 33.8%) and more caries increment (1.87 ± 3.17 vs. 0.90 ± 1.89) than those with low levels (scored 0 and 1). Among all participants, PMS (OR = 1.69, 95% CI: 1.32-2.23, P < 0.001) and previous caries experience (OR = 2.80, 95% CI: 2.20-3.56, P < 0.001) were related to caries increment.

CONCLUSIONS

For caries-free children, the only significant risk factor for ECC was high PMS levels. For all participants, besides high PMS levels, previous caries experience was another significant risk factor for caries development.

TRIAL REGISTRATION

The study design, protocol, and informed consent forms were undertaken with the understanding of Declaration of Helsinki and were approved by the Human Research Ethics Committee of the School of Stomatology, Peking University, China (PKUSSIRB-2012042).

Systematic Review of Evidence Pertaining to Factors That Modify Risk of Early Childhood Caries

INTRODUCTION

A systematic review of evidence on the impact of modifiable risk factors on early childhood caries (ECC) was conducted to inform recommendations in a World Health Organization manual on ECC prevention.

OBJECTIVES

To systematically review published evidence pertaining to the effect of modifiable risk factors on ECC.

METHODS

Twelve questions relating to infant feeding, diet, oral hygiene, and fluoride were addressed, as prioritized by a World Health Organization expert panel. Questions pertaining to the use of fluoride toothpaste were excluded due to its proven efficacy. The target population was children aged <72 mo. Data sources included Medline, Embase, CINAHL, and PubMed, and all human epidemiologic studies were included. The highest level of evidence was used for evidence synthesis and, where possible, meta-analysis. The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement, with evidence assessed via the GRADE method.

RESULTS

Of the 13,831 papers identified, 627 were screened in duplicate; of these, 139 were included. The highest-level evidence indicated that breastfeeding ≤24 mo does not increase ECC risk but suggested that longer-duration breastfeeding increases risk (low-quality evidence). Low-quality evidence indicated increased risk associated with consumption of sugars in bottles. Only 1 study had data on the impact of sugars in complementary foods, which increased risk. Moderate-quality evidence showed a benefit of oral health education for caregivers (odds ratio, 0.39; 95% CI, 0.19 to 0.80, P = 0.009). Meta-analysis of data on the impact on ECC from living in a fluoridated area showed a significant effect (mean difference, -1.25; 95% CI, -1.24 to -0.36; P = 0.006). Limited moderate- and low-quality data indicated a benefit of fluoride exposure from salt and milk, respectively.

CONCLUSION

The best available evidence indicates that breastfeeding up to 2 y of age does not increase ECC risk. Providing access to fluoridated water and educating caregivers are justified approaches to ECC prevention. Limiting sugars in bottles and complementary foods should be part of this education.

KNOWLEDGE TRANSFER STATEMENT

This research is being used by the World Health Organization in developing a toolkit on the prevention and management of early childhood caries. The information will guide 1) governments in developing national oral health plans and 2) clinicians when providing preventive advice, including that regarding infant feeding practices. It will help ensure that advice is in line with current World Health Organization guidelines and the best available evidence.

Identification of caries risk in 2-year-olds

OBJECTIVE

The first aim was to describe presence of plaque, caries and oral health behaviours in 2-year-old children. The second aim was to measure increments in caries experience from 2 to 5 years of age and to study whether national background, visible plaque, caries and oral health behaviour at 2 years of age were associated with increments in caries experience.

METHODS

The study population consisted of 392 children, of whom 211 were monitored from 2 to 5 years of age. At age 2 years, parents completed a questionnaire about family background and oral health behaviour. The presence of plaque and caries at tooth level was obtained from dental records. Data were tested with chi-square statistics and Mann-Whitney U test. Negative binomial regression analysis was conducted to explore the association between caries increment between 2 and 5 years of age and national background, visible plaque, caries and oral health behaviour at 2 years of age.

RESULTS

Caries was found in 4.6% of 2-year-olds, and 4.6% had visible plaque. More than half of these children (57.9%) brushed twice daily, toothbrushing was introduced when the child was 7 months or older in 61.0% of the children, and 15.6% consumed sugary snacks daily. Non-Western children more often had caries, visible plaque and unfavourable oral health behaviour than Western children (P < .05). At age 5 years, 28.9% of the children had caries experience. Non-Western background, toothbrushing less than twice daily, not using fluoridated toothpaste, not using fluoride lozenges, consuming sugary drinks at night, consuming sugary snacks daily, presence of plaque and caries at 2 years of age were associated with caries increment between 2 and 5 years of age in bivariable analyses. The results from multivariable analysis showed that children who started toothbrushing late, children who brushed less than twice daily at 2 years of age and children of non-Western background had a higher probability of having caries increment from 2 to 5 years of age than other children.

CONCLUSIONS

A small proportion of 2-year-olds had caries, but these children had several decayed teeth. Substantial differences in oral health and oral health behaviour were found between Western and non-Western children. The preventive care delivered to the studied children failed to prevent caries increment from 2 to 5 years of age.

Association between dental caries experience and sense of coherence among adolescents and mothers

BACKGROUND

Sense of coherence (SOC) is associated with oral health.

AIM

Investigate associations between dental caries experience and SOC among mothers and adolescents.

DESIGN

A cross-sectional study was conducted with 1195 adolescents and their mothers. Data were collected through a questionnaire, the short version of the SOC and oral clinical examinations. The data were statistically analyzed using bivariate analysis, Poisson regression models with robust variance, and Spearman's correlation coefficient.

RESULTS

The prevalence of dental caries experience was 41.8%. A moderate correlation was found between the SOC of mothers and adolescents (r = 0.563; P < 0.001). A higher mother's SOC (PR: 0.44; 95% CI: 0.36-0.53) and adolescent's SOC (PR: 0.46; 95% CI: 0.39-0.55) were protective factors against dental caries experience in the adolescents. The prevalence of dental caries experience was higher among adolescents with visible plaque (Model 1-PR: 1.77; 95% CI: 1.53-2.04; Model 2-PR: 1.59; 95% CI: 1.37-1.84) and those whose families were in a lower economic class (Model 1-PR: 1.56; 95% CI: 1.35-1.80; Model 2-PR: 1.57; 95% CI: 1.36-1.81).

CONCLUSION

Dental caries in adolescents was associated with social determinants evaluated through the sense of coherence.

Natural history of dental caries in very young Australian children

BACKGROUND

Whilst the global burden of caries is increasing, the trajectory of decay in young children and the point at which prevention should occur has not been well established.

AIM

To identify the 'natural history' of dental caries in early childhood.

DESIGN

A birth cohort study was established with 467 mother/child dyads followed at 1, 6, 12, 18, and 36 months of age. Parent-completed surveys captured demographic, social, and behavioural data, and oral examinations provided clinical and data.

RESULTS

Eight per cent of children (95% confidence interval (CI): 5-12%) at 18 months and 23% (95% CI: 18-28%) at 36 months experienced decay. Interesting lesion behaviour was found between 18 and 36 months, with rapid development of new lesions on sound teeth (70% of teeth, 95% CI: 63-76%) and regression of many lesions from non-cavitated lesions to sound (23% of teeth, 95% CI: 17-30%). Significant associations were found between soft drink consumption and lesion progression.

CONCLUSIONS

Findings suggest optimal time periods for screening and prevention of a disease which significantly impacts multiple health and well-being outcomes across the life course.

Prenatal and familial factors of caries in first permanent molars in schoolchildren living in urban area of Łódź, Poland

The objective of the present work is to identify the set of prenatal and familial factors that contribute to dental caries of first permanent molars in preschool and young schoolchildren, which will make it possible to determine a high-risk group that should be considered for special preventive measures. This study contributes to the evidence for the multifactorial nature of dental caries. Material was collected during a 2009-2010 study conducted in randomly selected schools and kindergartens in the city of Łódź (Poland). Only children with first permanent molars present were considered for the analysis, which limited the database to 1131 children. Dental examinations were accompanied by a questionnaire completed by the parents, covering items pertaining to prenatal and familial determinants. The present study shows that there are significant differences in the prevalence of caries in first molars between children of different ages (5-13 lat) and that no such differences exist between boys and girls. The prenatal and familial factors conducive to caries include maternal education level (OR=0.55), mode of delivery (OR=0.63) and birth order (OR=0.63). Mothers' smoking habit is also associated with increased caries prevalence in children. Caries prevention should already begin during the prenatal period primarily in respect of mothers with lower educational attainment who are pregnant with a second or subsequent child.

Can insoluble polysaccharide concentration in dental plaque, sugar exposure and cariogenic microorganisms predict early childhood caries? A follow-up study

BACKGROUND

Insoluble polysaccharide (IP) has been associated with caries prevalence in young children. However, the power of IP to predict ECC needs to be demonstrated.

AIMS

To assess the relationships between early childhood caries (ECC) and extracellular insoluble polysaccharides (IP) in dental plaque, sugar exposure and cariogenic microorganisms.

DESIGN

Visible plaque on maxillary incisors was recorded, followed by caries diagnosis in 65 preschoolers (3-4 years) at baseline and after 1 year. Plaque was collected for mutans streptococci (MS), total microorganism (TM) and lactobacilli (LB) enumerations in selective media, as well as for IP analysis, which was later assessed by colorimetry. Sugar/sucrose exposure was assessed by a diet chart.

RESULTS

Positive correlations were found among the prevalence of caries and MS, TM, LB, solid sucrose and visible dental plaque. Additionally, children with IP concentrations in dental plaque higher than 2.36 μg/mg (odds ratio-OR=6.8), with visible plaque on maxillary incisors (OR=4.3), harbouring LB (OR=13) and exposed to solid sugar more than twice/day (OR=5) showed higher risk of developing caries (p<0.05).

CONCLUSION

Extracellular insoluble polysaccharides, solid sugar/sucrose, visible dental plaque and cariogenic microorganisms could predict caries development, partially explaining the ECC pattern.

Oral health and oral health-related behaviour in preschool children: evidence for a social gradient

This study aims to investigate the social gradient in the reported oral health-related behaviour and oral health status of preschool children. Participants were 1,057 children born between October 2003 and July 2004 in Flanders, Belgium. Oral health examinations were performed by trained dentists when the children were 3 and 5 years old (respectively, in 2007 and 2009); data on dietary habits, oral hygiene habits and dental attendance of the children were obtained through structured questionnaires completed by the parents. Maternal educational level, measured in four categories, was used as a proxy of socio-economic status. Logistic and ordinal regressions showed a social gradient for the oral health-related behaviours: a lower educational level of the mother was related to a higher consumption of sugared drinks between meals and to a lower brushing frequency and dental attendance of the child. Children from low-educated mothers also had seven times more chance to present with caries experience than children from mothers with a bachelor degree. Contrary to the expectations, there was a deviation from the gradient in 3-year-olds from the highest educational group showing an increased risk for caries experience (OR = 3.84, 95 % CI = 1.08-13.65). Conclusion. Already in very young children, a graded relationship is observed between socio-economic position, oral health and related behaviours. The results suggest that different approaches are required to promote oral health during early childhood depending on the mother's educational background. As children from the highest social group also have an increased caries risk, specific techniques may be needed.