Oral conditions and trouble sleeping among preschool children

Roles of Streptococcus mutans-Candida albicans interaction in early childhood caries: a literature review

As one of the most common oral diseases in kids, early childhood caries affects the health of children throughout the world. Clinical investigations show the copresence of Candida albicans and Streptococcus mutans in ECC lesions, and mechanistic studies reveal co-existence of C. albicans and S. mutans affects both of their cariogenicity. Clearly a comprehensive understanding of the interkingdom interaction between these two microorganisms has important implications for ECC treatment and prevention. To this end, this review summarizes advances in our understanding of the virulence of both C. albicans and S. mutans. More importantly, the synergistic and antagonistic interactions between these two microbes are discussed.

Parental report of dental pain and discomfort in preschool children is associated with sleep disorders: a cross-sectional study in Brazilian families

PURPOSE

To evaluate the prevalence of sleep disorders in Brazilian preschool children and its associations with parental report of dental pain and discomfort.

METHODS

This cross-sectional study involved 604 Brazilian preschoolers (4-5 years old). Sleep disorders (SD) and the parental report of dental pain and discomfort (DPD) were evaluated using the Brazilian versions of the Sleep Disturbance Scale for Children (SDSC) and the Dental Discomfort Questionnaire (DDQ-B), respectively. Bivariate and multivariate Poisson regression analyses with robust variance were performed to analyze the association between SDSC and DP.

RESULTS

Prevalence of SD ranged from 7 to 21%. 7.9% of the children had DPD indicating the need for more invasive dental procedures (DDQ-B ≥ 5). Significant associations were found between DPD and the following SDSC domains: sleep hyperhidrosis (p = 0.024; PR_a = 1.38; 95% CI: 1.04-1.83), disorders of initiating and maintaining sleep (p < 0.001; PR_a = 1.41; 95% CI: 1.15-1.73), parasomnias (p < 0.001; PR_a = 1.82; 95% CI: 1.39-2.37), and sleep-wake transition disorders (p = 0.018; PR_a = 1.28; 95% CI: 1.04-1.58). Children with higher prevalence of DPD presented 20% higher prevalence of SD than children lower prevalence of DPD (p = 0.039; PR_a = 1.20; 95% CI: 1.01-1.44).

CONCLUSION

Preschool children with higher prevalence of DPD are more likely to have SD, such as hyperhidrosis, disorders of initiating and maintaining sleep, parasomnias, and sleep-wake transition.

Salivary microbiome diversity in Chinese children with various caries states

OBJECTIVE

This study aimed to explore oral microbiome diversity among children with various caries status based on dmft scores.

METHODS

A total of 320 children aged 3-5 years were recruited, with 66 healthy children and 254 children affected by dental caries. According to dmft scores, these children with dental caries were classified as "mild group" (dmft score 1-3), "moderate group" (dmft score 4-6), and "severe group" (dmft score 7-14). Healthy children with dmft score of 0 served as control group. Illumina MiSeq sequencing was employed to analyze all salivary samples collected from these children.

RESULTS

The salivary microbial diversity among four groups was similar (p > 0.05). A total of five bacterial genera were highly abundant in the control group including Bergeyella, Acidimicrobiales, Acidimicrobiia, Halomonas, and Blautia (p < 0.05). For mild group, there were nine bacterial genera identified to be predominant: Porphyromonadaceae, Porphyromonas, Enterobacteriales, Enterobacteriaceae, Weissella, Leuconostocaceae, Alphaproteobacteria, Stenotrophomonas, and Rhizobiales (p < 0.05). Only one genus, Aggregatibacter was predominant in moderate group (p < 0.05). There were six bacterial genera (Alistipes, Lachnoclostridium, Escherichia-Shigella, Romboutsia, Sphingomonadales, and Denitratisoma) enriched in severe group (p < 0.05).

CONCLUSION

Oral microbial profile was different in children with various caries status based on dmft scores.

CLINICAL RELEVANCE

The results might be beneficial to deeply understand microbiological diversity of early childhood caries (ECC) at various stages and inform effective strategies for ECC prevention.

Prediction Models of Early Childhood Caries Based on Machine Learning Algorithms

In this study, we developed machine learning-based prediction models for early childhood caries and compared their performances with the traditional regression model. We analyzed the data of 4195 children aged 1-5 years from the Korea National Health and Nutrition Examination Survey data (2007-2018). Moreover, we developed prediction models using the XGBoost (version 1.3.1), random forest, and LightGBM (version 3.1.1) algorithms in addition to logistic regression. Two different methods were applied for variable selection, including a regression-based backward elimination and a random forest-based permutation importance classifier. We compared the area under the receiver operating characteristic (AUROC) values and misclassification rates of the different models and observed that all four prediction models had AUROC values ranging between 0.774 and 0.785. Furthermore, no significant difference was observed between the AUROC values of the four models. Based on the results, we can confirm that both traditional logistic regression and ML-based models can show favorable performance and can be used to predict early childhood caries, identify ECC high-risk groups, and implement active preventive treatments. However, further research is essential to improving the performance of the prediction model using recent methods, such as deep learning.

A Machine Learning Approach to Uncovering Hidden Utilization Patterns of Early Childhood Dental Care Among Medicaid-Insured Children

Background: Early childhood dental care (ECDC) is a significant public health opportunity since dental caries is largely preventable and a prime target for reducing healthcare expenditures. This study aims to discover underlying patterns in ECDC utilization among Ohio Medicaid-insured children, which have significant implications for public health prevention, innovative service delivery models, and targeted cost-saving interventions.

Methods: Using 9 years of longitudinal Medicaid data of 24,223 publicly insured child members of an accountable care organization (ACO), Partners for Kids in Ohio, we applied unsupervised machine learning to cluster patients based on their cumulative dental cost curves in early childhood (24–60 months). Clinical validity, analytical validity, and reproducibility were assessed.

Results: The clustering revealed five novel subpopulations: (1) early-onset of decay by age (0.5% of the population, as early as 28 months), (2) middle-onset of decay (3.0%, as early as 35 months), (3) late-onset of decay (5.8%, as early as 44 months), (4) regular preventive care (67.7%), and (5) zero utilization (23.0%). Patients with early-onset of decay incurred the highest dental cost [median annual cost (MAC) = $9,499, InterQuartile Range (IQR): $7,052–$11,216], while patients with regular preventive care incurred the lowest dental cost (MAC = $191, IQR: $99–$336). We also found a plausible correlation of early-onset of decay with complex medical conditions diagnosed at 0–24 months. Almost one-third of patients with early-onset of decay had complex medical conditions diagnosed at 0–24 months. Patients with early-onset of decay also incurred the highest medical cost (MAC = $7,513, IQR: $4,527–$12,546) at 0–24 months.

Conclusion: Among Ohio Medicaid-insured children, five subpopulations with distinctive clinical, cost, and utilization patterns were discovered and validated through a data-driven approach. This novel discovery promotes innovative prevention strategies that differentiate Medicaid subpopulations, and allows for the development of cost-effective interventions that target high-risk patients. Furthermore, an integrated medical-dental care delivery model promises to reduce costs further while improving patient outcomes.

Association between Sleep Disturbances and Emotional/Behavioral Problems in Chinese and Japanese Preschoolers

Objectives: Sleep disturbances are often associated with emotional/behavioral problems in young children, but whether the association differs among Asian countries remains unknown. This study aimed to investigate the association between sleep disturbances and emotional/behavioral problems in Chinese and Japanese preschoolers and to explore potential differences.Methods: Participants were 1,020 Chinese preschoolers from 10 cities and 438 Japanese preschoolers from 1 city aged 4 to 5 years. Parents filled out the Children's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ).Results: Chinese children with sleep disturbances (defined as total CSHQ score >41) demonstrated more peer problems than children without, while there was no such difference in Japanese preschoolers. Domains of sleep disturbances associated with emotional/behavioral problems in Chinese children were sleep disordered breathing and daytime sleepiness, yet in Japanese children were sleep anxiety and night wakings. Children with a higher score of sleep anxiety showed more emotional problems in Japan, but fewer conduct problems in China.Conclusions: Sleep disturbances were associated with emotional/behavioral problems in preschoolers with differences between China and Japan, indicating subcultural differences in preschoolers' sleep within Asian countries.Abbreviations: CSHQ: Children's Sleep Habits Questionnaire; SDQ: Strengths and Difficulties Questionnaire; ANCOVA: analysis of covariance; SD: standard deviation; CI: confidence interval.

Diet and lifestyle habits associated with caries in deciduous teeth among 3- to 5-year-old preschool children in Jiangxi province, China

Background

The purpose of this study was to investigate the status of caries in deciduous teeth and the effect of diet and lifestyle habits on dental caries among 3- to 5-year-old preschool children in Jiangxi Province, China.

Methods

In total, 2880 cases involving preschool children were selected by stratified cluster sampling. The dental examination methods and criteria followed the WHO guidelines. SPSS 19.0 was used for the statistical analysis. Chi square tests were used to compare the caries prevalence among children with different social characteristics. Non-parametric tests were used to compare the decayed, missing and filled teeth (dmft) index values. Univariate and multivariate regression analyses were used to study the effect of diet and lifestyle habits on dental caries.

Results

The caries prevalence among the 2880 cases of 3- to 5-year-old preschool children in Jiangxi Province, China was 49.13%. There was no gender difference in this rate (P > 0.05). The caries prevalence increased with age (P < 0.05). The prevalence of caries in the rural areas was higher than that in the urban areas (P < 0.05). The deciduous central incisors and deciduous molars had a higher caries prevalence than the other deciduous teeth. According to the multivariate logistic regression analysis, the caries risk increased with living in a rural area, exclusive breastfeeding, greater frequency of daily snacking, high frequency of snacking before sleep and beginning to brush teeth at a late age; the caries risk decreased when parents helped their children brush their teeth.

Conclusion

The caries prevalence among 3- to 5-year-old preschool children in Jiangxi was lower than the level throughout the country and lower than the rate in other developing countries. The children’s diet and lifestyle habits were closely related to dental caries. Parents and children should be more aware of oral health, and parents should help their children develop healthy lifestyle behaviours.

World traumatic dental injury prevalence and incidence, a meta-analysis-One billion living people have had traumatic dental injuries

Traumatic dental injuries (TDIs) account for a considerable proportion of bodily injuries. Nevertheless, global TDI frequency is unknown, probably because TDI diagnosis is not standardized. This study estimated world TDI frequency. A literature search (publication years 1996-2016) was aimed at covering as many countries, communities, ethnic groups as possible, thus achieving high generalizability. In particular, non-specific keywords, no language restrictions, and large databanks were used. Observational studies reporting proportions of individuals with at least one TDI (prevalence) and who developed TDI (incidence rate) were considered. Prevalence rates to permanent dentition, primary dentition and in 12-year-olds, incidence rate to any tooth for any age, male-to-female prevalence ratio (PR) in 12-year-olds, with 95% confidence intervals (95 CIs), were extracted/calculated. Study quality, Z-score distribution, funnel plot symmetry analysis, between-study heterogeneity, sensitivity, and subgroup analyses were performed. Selected primary studies were 102 (permanent dentition; 268 755 individuals; median age, 13.8 years), 46 (primary dentition; 59 436 individuals; median age, 3.4 years), 42 (12-year-olds; 33 829 individuals), 11 (incidence rate; 233 480 person-years; median age, 7.8 years), and 31 (PR; 16 003 males, 16 006 females). World TDI frequency resulted as follows: permanent dentition prevalence 15.2% (95 CI, 13.0%-17.4%); primary dentition prevalence 22.7% (95 CI, 17.3%-28.7%); 12-year-olds prevalence 18.1% (95 CI, 15.3%-21.0%); incidence rate, 2.82 (95 CI, 2.28%-3.42%) per 100 person-years; PR, 1.43 (95 CI, 1.34%-1.52%). Differences between WHO Regions were found. This study shows that more than one billion living people have had TDI. TDI is a neglected condition which could rank fifth if it was included in the list of the world's most frequent acute/chronic diseases and injuries.