Dental caries and quality of life among preschool children: a hospital-based nested case-control study

School-based caries prevention using silver diamine fluoride: A pragmatic randomized trial in low-income rural children

Background

Dental caries is the world's most prevalent noncommunicable disease, disproportionately affecting children from low-income families and rural geographic areas.

Methods

The CariedAway 3.0 study was a cluster-randomized pragmatic non-inferiority trial comparing silver diamine fluoride (SDF) to sealants and atraumatic restorations (ART) for the prevention and control of dental caries. All participants also received fluoride varnish. Analysis consisted of mixed-effects logistic regression for caries prevalence and weighted least squares and mixed-effects negative binomial regression for caries incidence. A non-inferiority margin of 10% for the difference between groups was used. Dental caries was defined as an ICDAS score of four or greater.

Results

A total of 3345 children were enrolled across 35 schools; however there was a large proportion of children who were noncompliant and received external dental care over the course of the trial. In adjusted analyses of compliant participants (n=1083; 543 in the SDF group and 540 in the sealant and ART group), there was no difference in the weighted risk difference between treatment groups (B=0.003, 95% CI = -0.0001, 0.0008). The odds of caries prevalence was elevated in the SDF group in longitudinal analyses (OR = 1.35, 95% CI = 0.86, 2.11) but was not significant and was below the non-inferiority margin. There were no significant differences between groups for caries incidence in adjusted models (IRR = 1.19, 95% CI = 0.81, 1.74). Results for intent to treat analyses were similar to that of per-protocol.

Discussion

In this school-based clinical trial, the prevalence of dental caries in children treated with SDF and fluoride varnish was non-inferior compared to those treated with sealants, ART, and fluoride varnish, although the overall risk was slightly higher. Unfortunately, a high rate of dropout and participant noncompliance was observed, likely due to the impacts of COVID-19 on study procedures. As a result, observed effects may be unreliable beyond the short-term. Trial Registration: NCT03448107.

Association between early childhood caries and diet quality among Chinese children aged 2-5 years

Background

Early childhood caries (ECC) is a major oral problem affecting the health and wellbeing of children worldwide. Diet quality is a better predictor of ECC risk than single foods or specific nutrients. The purposes of this study were to assess the associations between ECC and diet quality among 2- to 5-year-old Chinese children.

Methods

A total of 150 eligible children were included in this study. The decayed, missing, or filled surface (dmfs) score was recorded for each child by dental examination. All participants were divided into three groups based on their age and dmfs score [the caries-free group, the ECC group, and the severe early childhood caries (S-ECC) group]. Parents were invited to complete a questionnaire on the general characteristics and oral health behaviors of the participants. The information of 24-h dietary intake from each child was captured via a mobile APP. The Chinese diet balance index for preschool children (DBI_C) indicators score, high bound score (HBS), low bound score (LBS), and diet quality distance (DQD) score were calculated to assess the diet quality of study subjects. The associations of ECC with HBS, LBS, DQD score, and DBI_C indicators score were analyzed by Mann-Whitney U test and multivariable logistic regression analysis.

Results

In this study, 21, 31, and 98 children were diagnosed with caries-free, ECC, and S-ECC, respectively. Statistical analysis revealed that the risk of ECC and S-ECC were significantly increased with the DQD score (OR = 1.283 and 1.287, respectively), but both were not associated with HBS and LBS (P > 0.05). In the meantime, the risk of ECC and S-ECC were significantly increased with the Grains score (OR = 1.623 and 1.777, respectively), and significantly decreased with the Food diversity score (OR = 0.271 and 0.315, respectively). Moreover, the risk of S-ECC also significantly decreased with the Vegetables score (OR = 0.137).

Conclusion

Both ECC and S-ECC were associated with a high degree of dietary imbalance and grains intake as well as a low degree of food diversity among Chinese children aged 2-5 years. In addition, S-ECC was also associated with a low degree of vegetable intake.

Early Childhood Caries in 4- to 5-Year-Old Children in Erzurum, Turkey

Introduction: Early childhood caries is tooth decay seen in children under 72 months old. It is associated with multiple predisposing factors and has a negative impact on quality of life. In this study, our aim was to assess the oral health conditions and prevalence of early childhood caries (ECC) in children in the city of Erzurum, Turkey. Materials and Methods: This cross-sectional epidemiological study was conducted in Atatürk University, Faculty of Dentistry, Pediatric Dentistry Department/Erzurum-Turkey, in the 2015-2016 academic year. A total of 1,156 children (588 girls and 568 boys), with mean age of 4.9 ± 0.3 years (min 4, max 5) were included in the study. Restorative index (RI), deft, significant caries index (SiC), SiC10, treatment needs, number of lost primary teeth per 100 children, care index, and prevalence of carious primary teeth were evaluated. Data were analyzed by Chi-square test and Mann-Whitney U test (p < 0.05). Results: A total of 73.3% prevalence of ECC was observed in preschool children with a mean deft score of 3.9±4 and an increase in ECC with age. RI was 2.2%, SiC was 8.5, SiC10 was 12.3, caries treatment needs was 93.5%, care index was 2.1%, and number of lost primary teeth per 100 children was 0.9 tooth. Conclusion: High level of ECC indicates the necessity of starting an oral health education program for mothers and dental screening of children, and the demand for improving oral and dental services.

Association between Dental Caries and Influenza Infection in Children: A Japanese Nationwide Population-Based Study

Dental caries is the most common chronic childhood disease. Recent studies have suggested that dental caries harbor respiratory infections in adults. We investigated the association between dental caries and influenza in children. In this study, 42,812 children aged 2.5 years, 38,540 children aged 5.5 years, and 34,124 children aged 10 years were included in the analysis from the Longitudinal Survey of Newborns in the 21st Century in Japan, which targeted all children born during a certain period in 2001. We used information on dental caries treated at hospitals and clinics in the past year as exposure and influenza as outcome during the observation periods (1.5–2.5, 4.5–5.5, and 9–10 years of age). We performed a log-binomial regression analysis, adjusting for potential confounders, and stratified analysis according to previous dental caries status. The presence of dental caries increased the incidence of influenza in all three target ages compared with the absence of dental caries. The incidence of influenza increased with the presence of current dental caries, regardless of the presence of past dental caries. These associations were observed irrespective of household income. Early detection and treatment of dental caries may reduce the risk of influenza in children.