Enquête épidémiologique sur la santé buccodentaire d'enfants âgés de 4 ans scolarisés en école maternelle

Comparative study of the dental health of 4-year-old children in north-eastern France between 2001 and 2018

PURPOSE

To analyse the evolution of the oral health of 4-year-old children in nursery school between 2001 and 2018 as well as the early predictor and associated risk factors, in different school areas.

METHODS

We compared (1) the prevalence of ECC (4 ≥ dmft ≥ 1) and S-ECC (dmft ≥ 5) of 4-year-old children and (2) data obtained by a structured questionnaire completed by their parents from two studies performed in 2001 and 2018. Data were analysed using the Chi2 test and odds ratio (OR).

RESULTS

A total of 322 children and of 425 children randomly selected among Moselle's public nursery schools in north-eastern France were, respectively, included in the study in 2001 and 2018. The prevalence of ECC was respectively 40.70% and 21.65% in 2001 and 2018 (p < 0.001; OR = 2.48; 95% CI = 1.78-3.47). We also observed a decrease of S-ECC prevalence (10.56% in 2001 vs 5.90% in 2018, p < 0.05, OR = 1.89; 95% CI = 1.07-3.38). The intake of cariogenic food (sweet drink, biscuits, candies, milk, baby bottle) decreased but the knowledge of parents concerning cariogenic food did not improve. The proportion of parents helping their child has not changed in 17 years (82.33% vs 86.52%, p > 0.1) but tooth brushing was initiated earlier in 2018 than in 2001 (p < 0.01). Prescription of systemic fluoride decreased (39.14% vs 3.62%; p < 0.001).

CONCLUSION

The identification of the food consumption habits and the knowledge of parents concerning oral health should enable strengthening of preventive measures and the initiation of an oral health education programme for children and their family.

Relevance of Sociocultural Inequalities and Parents' Origins in Relation to the Oral Health of Preschoolers in Lanzarote, Spain

Approaching inequalities to achieve health equity requires joint action. Early childhood caries affects disadvantaged population groups. The objective of this study was to determine the relevance of sociocultural inequalities and parental origin with respect to oral health in preschool children in Lanzarote. A transversal epidemiological study was carried out. Sociocultural data and information about parental origin were collected via a questionnaire. The decayed and filled teeth (dft), decayed teeth (dt), filled teeth (ft), restorative index (RI), plaque index (PI) and gingival index (GI) were obtained via an investigator's examination. Statistical analysis of the data indicated that children of semi-skilled manual workers (28.15%) had the highest prevalence of caries (46.9%). Additionally 43.7 of the mothers had second grade and first cycle studies. When relating the medium and high level of education, there were statistically significant differences in relation to the cod index (p = 0.046). When the origin was foreign (48.4%), preschoolers presented 10.7% more active or untreated caries than Spaniards (p = 0.038). Low socioeconomic cultural level and foreign origin is associated with a more deficient state of oral health in preschoolers. Oral health programs are needed to minimize social inequalities.

Comparison of Childhood Caries Levels between Children of Pediatric Dentists and Children of General Dentists: A Cross-Sectional Study

Caries development in children is a prevalent childhood disease. Factors affecting chronic teeth lesions include nutrition, parental involvement, and executing proper dental health attitude. Professional dentists are perceived as role models for the oral health and hygiene of their families. The purposes of the research were 1. To compare caries rates in the children of pediatric dentists and children of general dentists. 2. To compare children’s nutrition habits between pediatric dentists and general dentists. 3. To compare children’s oral health and hygiene between pediatric dentists and general dentists. 4. To compare children’s usage of fluoride-containing products between pediatric dentists and general dentists. A cross-sectional study was conducted by distributing self-reporting questionnaires to pediatric dentists and general dentists via the social media “snowball” platform. The following themes were surveyed: nutrition habits and oral hygiene of the children. The sample consisted of 176 participants. Children of pediatric dentists were found to have fewer cases of caries than children of general dentists (p = 0.018). Nutrition habits did not differ between the two groups. In addition, pediatric dentists reported that their children use more fluoridated toothpaste in comparison with general dentists. Professional training of pediatric dentists contributed to shaping the oral hygiene attitude of their children.

What are health professionals' perceptions and attitudes regarding children with early childhood caries and their families? A qualitative research protocol to assess oral health stigma in the medical setting

INTRODUCTION

Dental caries is one of the most common non-communicable diseases in children. The disease management of caries relies on both a preventive individual approach (fluoridation, risk evaluation) and the surgical treatment of established carious lesions. Similar to other non-communicable diseases (obesity, mental diseases, etc), health professionals' negative perceptions of patients have been shown to affect the quality of disease management. Regarding dental caries in children, some data have indicated the presence of discriminating beliefs and behaviours towards these children and their families in the medical setting. However, oral health stigma related to dental care remains a largely unexplored issue.

METHODS AND ANALYSIS

This study presents an exploratory research protocol focusing on the perceptions and attitudes of health professionals towards children with early childhood caries (ECC) and their parents. Semistructured interviews will be conducted among medical and dental health professionals, and verbatim quotations obtained from audio transcriptions will be analysed to identify health professionals' perceptions of ECC and the influence of these perceptions on clinical care for these children.

ETHICS AND DISSEMINATION

The research ethics committee of the Department of Family Medicine at University Lyon 1 approved this protocol. The results will be published in peer-reviewed journals and presented at scientific meetings.

TRIAL REGISTRATION NUMBER

NCT05284279.

Early predictors of childhood caries among 4-year-old children: a population-based study in north-eastern France

BACKGROUND

Untreated early childhood caries (ECC) can trigger a number of negative consequences, including pain, chewing difficulties, insufficient physical development and low academic performance. Therefore, ECC impacts the oral health-related to quality of life. That is why it is important to assess the ECC prevalence and to determine the associated risk factors.

AIM

The aim of this study was to investigate the relationship between early predictor factors and dental caries among 4-year-old French children, considering the socioeconomic factors, dietary and oral hygiene practices, the access and the follow-up by paediatric dentist.

DESIGN

The study was a cross-sectional observation. A random sample of 4-year-old children was selected among 596 Moselle's public nursery schools in north-eastern France. Data were gathered from clinical dental examinations and a structured questionnaire completed by parents.

RESULTS

In total, 425 subjects with completed questionnaires and clinical examinations were included. The prevalence of ECC and S-ECC (Severe-ECC), including only cavitated lesions, d3mft, were 15.8% and 5.9%, respectively. Multivariable logistic regression modelling identified four main factors associated with a high risk of ECC that were sweet intake (adjusted odds ratio OR_adjusted = 3.43, 95% CI = 1.57-7.53), brushing habits (OR_adjusted = 2.25, 95% CI = 1.23-4.21), childcare arrangement (OR_adjusted = 2.27, 95% CI = 1.23-4.21) and maternal educational level (OR_adjusted = 1.87, 95% CI = 1.06-3.31). These four factors have a cumulative effect. Only 4% of children presented teeth restoration.

CONCLUSIONS

This study highlighted the impact of the family environment on the oral health status of the preschool children. The identification of the risk factors should allow to strengthen preventive measures and initiate oral health education program for children and their family.

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.

[Social inequalities in oral health and early childhood caries: How can they be effectively prevented? A scoping review of disease predictors]

BACKGROUND

Early childhood caries represent a major public health problem. In addition to their individual impact, the massive social inequalities in oral health that are at the roots and result from the disease have largely underestimated consequences for the child, his family and the community. In response to the question of "how and where to act?", this scoping review identifies the individual characteristics associated with the disease on which it would be possible to act, using appropriate prevention strategies.

METHODS

This scoping review is aimed at describing and analyzing available data in the literature on the different factors associated with early childhood caries.

RESULTS

The predictors of early childhood caries are represented by mediating (knowledge, attitudes and parents' oral health practices) and moderating (psychosocial parameters, parental health literacy and alcohol consumption) factors. Twenty-eight articles fulfilled the selection criteria, twenty of which studied mediators related to early childhood caries, and fourteen of which dealt with moderators. The lower the parents' level of knowledge and literacy in oral health, the higher a child's dmft index. Additional studies are needed to assess the role of psychosocial parameters.

CONCLUSION

Parents' knowledge and oral health literacy are the key predictors to be preferentially targeted in view of reducing social inequalities in health through actions undertaken on a local scale. The prevention of early childhood caries necessitates a combination of generic and targeted interventions.

Breastfeeding and early childhood caries. Review of the literature, recommendations, and prevention

CONTEXT

Early childhood caries is a chronic disease that affects a child's general state of health. The question of a link between primary tooth caries and breastfeeding has been addressed for many years, with contradictory results. The concomitant decay of primary teeth, effective establishment, or not, of oral hygiene, and alimentary diversification away from breastfeeding are all confounding factors in this topic. The aim of our study was to analyze the links between breastfeeding and the appearance of caries, as described in the scientific literature and in the recommendations of specialist societies.

METHODS

A review of publications written in English and French was carried out, searching for the terms early childhood caries, decay and breastfeeding, focusing on literature reviews and meta-analyses dating from the past 10 years. The PubMed database of the US National Library of Medicine National Institutes of Health (NBCI) was used. Furthermore, a review of specialist dental and pediatric societies was conducted.

RESULTS

Breastfeeding until the age of 1 year is not associated with an increased risk of dental caries, and may even provide protection compared with feeding with formula milk. By contrast, infants who are breastfed beyond the age of 12 months demonstrate an increased risk of caries. However, the results derive from heterogeneous studies that do not always take into account contradictory factors such as eating habits of the mother or infant (feeding during the night, number of meals per day, eating sweet foods etc.), dental hygiene, or the sociocultural context. Moreover, the most recent recommendations of pediatric and dental societies advise breastfeeding until the age of 2 years, suggesting that this be accompanied by toothbrushing and better nutrition by reducing the frequency and consumption of sugary foods, aimed at helping parents choose prolonged breastfeeding.

CONCLUSION

Extended breastfeeding is a protective factor for childhood caries under 1 year of age. Beyond 1 year, it is difficult to conclude between protection and aggravation of caries because of the multiplicity of confounding factors such as dietary patterns, which vary depending on countries and families, and problems of oral hygiene. In practical terms, when breastfeeding continues beyond 1 year, consultation with a dentist is necessary for examination and preventive advice regarding dietary practices (especially sugar intake), oral hygiene, or supplementary fluoride.

[Therapeutic education in pediatric dentistry: analysis of obstacles and levers to the development of programmes in France in 2016]

OBJECTIVE

Over recent years, therapeutic patient education has become part of dental medicine. Management of early childhood caries, known to be a very common chronic disease, has evolved to include an educational dimension. The objective of this study was to identify the levers and barriers to the development of formalized therapeutic education programmes and alternatives.

METHODS

A comprehensive exploratory qualitative study was conducted between November 2015 and June 2016 on a targeted sample of 15 people aware of the problem of TPE in dentistry.

RESULTS

The study showed that TPE training in dentistry is underdeveloped, despite its numerous benefits: change of the healthcare professional's approach, implementation of structured educational programmes, development of research, etc. There are many obstacles to the development of TPE programmes: insufficient resources, rigid legislation or lack of knowledge of TPE practices. The dental profession is an obstacle itself because of its lack of understanding and variable degrees of integration the medical community. There are multiple levers, but the main ones are changing attitudes of the profession and the provision of resources to develop TPE. Although alternatives to TPE programmes exist (accompanying measures, short educational strategies, connected health), they cannot replace TPE.

CONCLUSION

More educational strategies must be developed in the field of dentistry. However, the framework of TPE must be adapted to the profession to ensure good uptake.

[An illustrated guide to dental screening: a school survey]

AIM

Marked social inequalities in oral health are observed right from early childhood. A mandatory complete health check-up, including dental screening, is organized at school for 6-year-old children. School healthcare professionals are not well trained in dental health. The aim of this study was to assess the relevance of an illustrated guide as a simple and rapid dental screening training tool in order to ensure effective, standardized and reproducible screening.

METHODS

A cross-sectional study was conducted in the context of the dental examination performed as part of the health check-up. Two examiners (Doctor E1 and Nurse E2) were trained in dental screening by means of the illustrated guide. This reference guide, comprising pictures and legends, presents the main oral pathology observed in children.

RESULTS

109 consent forms for oral screening were delivered, and 102 children agreed to participate (93.57%). The sensitivity of detection of tooth decay by examiners E1 and E2 was 81.48% with a specificity of 96%. No correlation was observed between the child's age (+/- 6 years) and correct detection rates.

CONCLUSIONS

The illustrated guide is an appropriate and rapid tool for dental screening that can improve the quality of dental check-up and increase the number of children detected.

The healthcare system and the provision of oral healthcare in EU Member States: France

The French oral health system is based on the provision of dental treatment and is organised around a fee-per-item model. The system is funded by a complex mix of public and complementary health insurance schemes. The system is successful in that it provides access to affordable dental treatment to the majority of the French population. However, France had the highest health expenditure as a share of gross domestic product (GDP) of all European Union countries in 2008 and rising oral health inequalities may be exacerbated by the manner in which oral health care is provided and funded. In addition, there is no organised national strategy for the prevention of oral diseases or for oral health promotion.

[A therapeutic education tool in paediatric dentistry]

Therapeutic education for children is developing in the treatment of dental caries. The Elmy pathway, a pedagogical game aiming to improve children's oral health skills, has been designed. The qualitative assessment of this tool seems to confirm its benefit for use in therapeutic education sessions.

Social vulnerability in paediatric dentistry: an overview of ethical considerations of therapeutic patient education

Dental caries is a multifactorial condition that remains a major public health issue in high income countries. The prevalence of dental caries in children has markedly declined in most countries over the past 30 years. However, the disease continues to affect a vulnerable population defined as a high-risk group. As many public health policies are inefficient in dealing with this underprivileged group, it is necessary to find other strategies to decrease the incidence and the burden of dental caries. Defining dental caries as a chronic disease enables us to develop the concept of 'therapeutic patient education.' It is meant to train patients to self-manage or adapt treatment to their particular chronic disease and to cope with new processes and skills. The purpose of this paper is to propose a new approach to dental caries, in particular to early childhood caries. That should decrease the gravity and prevalence of the disease in this specific population. As a result, this new approach could increase the quality of life of many children both in terms of function and aesthetics.

Pattern and severity of early childhood caries in Southern Italy: a preschool-based cross-sectional study

BACKGROUND

This survey was intended to investigate prevalence and severity of early childhood caries (ECC) in a sample of children in Southern Italy and to identify factors that may be related to this condition.

METHODS

The study was designed as a cross-sectional survey. The study population (children aged 36-71 months) attending thirteen kindergartens was randomly selected through a two-stage cluster sampling procedure. Parents/guardians of all eligible children were invited to participate filling out a structured self-administered questionnaire, and after having returned the informed consent form an oral examination of the child was performed at school. The questionnaire included information on: socio-demographics about parents/guardians and child, pregnancy and newborn characteristics, oral hygiene habits of child, eating habits particularly on consumption of sweets, access to dental services, and infant feeding practices. The WHO caries diagnostic criteria for deciduous decayed, missing and filled teeth (dmft) and surfaces (dmfs) were used to record ECC and severe-ECC (S-ECC). Univariate and multiple logistic regression analyses were conducted to evaluate statistical associations of social demographics, infant feeding practices, oral hygiene habits, and access to dental services to ECC, S-ECC, dmft and dmfs.

RESULTS

515 children participated in the study. 19% had experienced ECC, and 2.7% severe-ECC (S-ECC), with a mean dmft and dmfs scores of 0.51 and 0.99, respectively. Mean dmft was 2.68 in ECC subjects, and 6.86 in S-ECC subjects. Statistical analysis showed that prevalence of ECC significantly increased with age (OR = 1.95; 95% CI = 1.3-2.91) and duration of breastfeeding (OR = 1.26; 95% CI = 1.01-1.57), whereas it was significantly lower in children of more educated mothers (OR = 0.64; 95% CI = 0.42-0.96), and higher in those who had been visited by a dentist in the previous year (OR = 3.29; 95% CI = 1.72-6.33).

CONCLUSIONS

Results of our study demonstrate that even in Western countries ECC and S-ECC represent a significant burden in preschool children, particularly in those disadvantaged, and that most of the known modifiable associated factors regarding feeding practices and oral hygiene are still very spread in the population.

Dental caries and oral health practice among 12 year old school children from low socio-economic status background in Zimbabwe

Introduction

Dental caries is one of the most prevalent chronic diseases affecting children in Sub-Saharan Africa. Previous studies show a higher prevalence of dental caries in children from low socio-economic status backgrounds. The purpose of this study was to determine the prevalence of dental caries among 12 year old children in urban and rural areas of Zimbabwe and establish preliminary baseline data.

Methods

A descriptive cross-sectional study was conducted among 12 year old children at primary schools in Harare and Bikita district. A Pre-tested questionnaire was administered to elicit information from the participants on tooth cleaning, dietary habits and dental experience. Dental caries status was assessed using the DMFT index following World Health Organization (WHO) guidelines.

Results

Our results showed a high prevalence of dental caries in both urban (59.5%) and rural (40.8%) children. The mean DMFT in urban and rural areas was 1.29 and 0.66, respectively. Furthermore, our data showed a general lack of knowledge on oral health issues by the participants.

Conclusion

There is high prevalence of dental caries among 12 years old school children in both urban and rural areas of Zimbabwe. This calls for early preventive strategies and treatment services. We recommend incorporation of oral health education in the elementary school curricula.

Parental influence and the development of dental caries in children aged 0-6 years: a systematic review of the literature

OBJECTIVE

A well established body of research documents the role of individual factors, such as biology and diet, in the aetiology of early childhood caries (ECC). Recently empirical attention has shifted to the relationships between broader ecological influences (e.g., education, ethnicity and income) and ECC; however, how such determinants interplay in the aetiology of ECC remains unclear. An intermediary mechanism that warrants greater empirical attention is parental influences. This oversight is interesting given the primacy of the parent in governing the child's proximate environment and the likelihood of the child endorsing adaptive or maladaptive health attitudes, beliefs and behaviours. The objective of this paper was to conduct a systematic review of the evidence for parental influences on the development of caries in children aged 0-6 years.

DATA

All studies testing associations between dental caries and socio-demographic factors, feeding practices, parent attributes, behaviours, oral health, attitudes, knowledge and beliefs in children aged 0-6 years, published between 2006 and 2011.

SOURCE

Medline, ISI, Cochrane, Scopus, Global Health and CINAHL databases.

STUDY SELECTION

Fifty-five studies were included from an initial identification of 1805 studies.

CONCLUSIONS

To date, most research has focused on the association between caries and socio-demographic and feeding factors with few studies exploring parents' attributes, attitudes, knowledge and beliefs, and none exploring possible pathways between the multiple layers of influences potentially accounting for how determinants of ECC operate and traverse individual, familial, community, and socio-cultural contexts. Collaboration between Psychologists and Dentists may accelerate the identification and understanding of mechanisms that underlie risk associated with ECC.

Addressing children's oral health inequalities: caries experience before and after the implementation of an oral health promotion program

OBJECTIVE

(1) To evaluate the dental status of 5-year-old children in Clermont-Ferrand (France) in 2009; (2) To measure changes in children's dental status between 2003 and 2009; and (3) To estimate the impact of an Oral Health Promotion (OHP) program implemented in nine schools since 2005.

MATERIALS AND METHODS

All 5-year-olds attending public schools in deprived areas (n = 15) and six randomly selected other schools in Clermont-Ferrand were invited to participate. Dental status was recorded using d(3)mft, as in 2003. Parents responded to questions about their child's oral hygiene and provided socio-demographic information.

RESULTS

Of children invited, 478 (77%) were examined. Mean dmft was 1.18 (SD 2.61); 27.6% had at least one tooth affected. Caries experience varied significantly with deprivation status, oral hygiene and household SES indicators. The only difference observed between 2003 and 2009 was an increase in the 'f' component (p < 0.001). Dental status had slightly deteriorated in areas characterized in 2003 by low caries levels (p=0.07). In deprived areas, mean dmft increased in schools without the OHP program (p = 0.04). Changes between 2003 and 2009 were studied at school level using Multiple Factorial Analysis; it tended to improve in four schools, which had the OHP program. Household indicators of SES changed little. Oral hygiene levels varied differently from one school to another.

CONCLUSIONS

Caries experience was high, with large inequalities between children. No major differences were observed between 2003 and 2009. The OHP program has done little to reduce disparities in oral health, even if dental status improved in four schools.