The dental health of three-year-old children in Greater Glasgow, Scotland

Fluoride Varnish in Nursery Schools: A Randomised Controlled Trial – Protecting Teeth @3

Studies suggest that fluoride varnish (FV) application can reduce dental caries in child populations. The multiple-component national child oral health improvement programme in Scotland (Childsmile) includes nursery-based universal supervised toothbrushing and deprivation-targeted FV applications, together with community and dental practice prevention interventions. This trial, a double-blind, two-arm randomised control trial, aimed to assess the effectiveness and cost-effectiveness of the nursery-based FV applications plus treatment-as-usual (TAU) Childsmile programme interventions, compared to TAU Childsmile interventions alone, in children not targeted to receive nursery FV as part of the programme. Participating children in the first year of nursery (aged three), with or without existing caries, were randomised to either FV or TAU and followed up for 24 months until the first year of primary school. Treatments were administered at six-monthly intervals. The primary endpoint was “worsening of d3mft” from baseline to 24 months. Secondary endpoints were worsening of d3mfs, d3t, mt, and ft. Individual record-linkage captured wider programme activities and tertiary endpoints. A total of 1,284 children were randomised, leading to 1,150 evaluable children (n = 577 FV, n = 573 TAU, 10% dropouts). Mean age was 3.5 years, 50% were female (n = 576), 17% had caries at baseline (n = 195), all balanced between the groups. Most children received three/four treatments. Overall, 26.9% (n = 155) had worsened d3mft in the FV group, and 31.6% (n = 181) in the TAU group, with an odds ratio (OR) of 0.80 (0.62–1.03), p = 0.078. The results for worsening of the secondary endpoints were: d3mfs 0.79 (0.61–1.01) p = 0.063, d3t 0.75 (0.57–0.99) p = 0.043, mt 1.34 (0.75–2.39) p = 0.319, and ft 0.77 (0.53–1.14) p = 0.191. We calculated a number needed to treat of 21 and a cost of GBP 686 to prevent a single worsening of d3mft. There was a modest non-significant reduction in the worsening of d3mft in the nursery FV group compared to TAU, suggesting that this intervention is unlikely to represent an effective or cost-effective addition to the population oral health improvement programme.

Socioeconomic and ethnic status of two- and three-year-olds undergoing dental extractions under general anaesthesia in Wolverhampton, 2011-2016

Introduction Socioeconomic and ethnic status have in the past been implicated as possible causes of dental caries. Aims To assess the role that relative social depravation and ethnicity has on dental caries in two- and three-year-olds undergoing DGA in Wolverhampton. Design and methods Retrospective analysis of hospital records of 213 patients over a six-year period (2011-2016). A three-way analysis of variance (ANOVA) and chi-square tests were used to test statistical significance. Results The most significant factor between ethnicity, year and sex, was ethnicity (P = 0.026), with the greatest difference between mean number of teeth extracted per treatment visit for Other Whites (mean = 6.3) compared with White British (mean = 4.0) (difference P = 0.012). The association between the difference in extracted quadrant and year of treatment was significant (P = 0.011), with the greatest frequency of extractions involving three and four quadrants in the later years of 2015 and 2016. Seventy percent of children treated were living in the 20% most deprived areas (deciles one and two) compared with children living in more affluent areas (deciles three to ten) (P <0.001). Conclusion An important public health issue is highlighted which needs to be addressed, both at a national level and locally, through early oral health education for mothers from relatively deprived areas; particularly those of Other White ethnicity.

Oral Health Disparities in Children: A Canary in the Coalmine?

Despite being largely preventable, oral diseases are still a major public health problem in child populations in many parts of the world. Increasingly, however, oral diseases disproportionately affect socially disadvantaged groups in society. It is unjust and unfair that children and families from disadvantaged backgrounds experience high levels of oral diseases. This article analyzes oral diseases through a health disparities lens. Action to combat oral health disparities requires a radical multifaceted strategy that addresses the shared underlying root causes of oral diseases, the social determinants of health inequality.

Ethnic disparities in the oral health of three- to four-year-old children in East London

AIM

To report ethnic differences related to caries experience among three- to four-year-old children living in three of the most deprived boroughs in the UK in Inner North East London: Tower Hamlets, Hackney and Newham.

METHODS

This cross-sectional survey used a cluster sampling study design following the British Association for the Study of Community Dentistry protocol. Twenty nurseries from each borough were randomly selected and all three- to four-year-old children in selected nurseries were invited to participate (n = 2,434). Calibrated dentists examined children. Demographic information was obtained from schools.

RESULTS

One thousand, two hundred and eighty-five children were examined in 60 nurseries (response rate = 52.8%). Twenty-four percent of three- to four-year-old children had caries experience (mean dmft = 0.92). Few children (2.1%) had filled teeth. Children living in Hackney had significantly lower dmft scores (mean = 0.63) than children living in Newham (mean = 1.06) and Tower Hamlets (mean = 1.06). White European (mean = 1.91), Bangladeshi (mean = 1.05) and Pakistani (mean = 1.11) children had a significantly higher number of untreated carious teeth than White British children (mean = 0.56).

CONCLUSION

Preschool children from a White Eastern European, Bangladeshi and Pakistani background are likely to experience significantly poorer oral health than their White British counterparts. These findings have profound implications for commissioning dental services and oral health promotion.

Elimination of 'the Glasgow effect' in levels of dental caries in Scotland's five-year-old children: 10 cross-sectional surveys (1994-2012)

BACKGROUND

Socioeconomic inequalities in health within Glasgow, Scotland, are among the widest in the world. This is largely attributed to socio-economic conditions. The 'Glasgow Effect' labels the finding that the high prevalence of some diseases cannot be fully explained by a conventional area-based socio-economic metric. This study aimed to investigate whether differences in dental caries between Glasgow's resident children and those in the Rest of Scotland could be explained by this metric and whether differences were of fixed magnitude, over time.

METHODS

Scotland's National Dental Inspection Programme (NDIP) cross-sectional data for five-year-old children in years: 1994, 1996, 1998, 2000, 2003, 2004, 2006, 2008, 2010, and 2012 (n = 92,564) were utilised. Endpoints were calculated from the mean decayed, missing and filled teeth score (d3mft) and percentage with obvious decay experience. Socioeconomic status was measured by DepCat, a Scottish area-based index. The Glasgow Effect was estimated by the odds-ratio (OR) of decay for Glasgow versus the Rest of Scotland adjusted by age, gender and DepCat. Inequalities were also assessed by the Significant Caries Index (SIC), SIC 10, and Scottish Caries Inequality Metric (SCIM 10).

RESULTS

Decay levels for deprived Glasgow children have reduced to be similar to those in the Rest of Scotland. In 1993, OR for d3mft > 0 for those living in the Glasgow area was 1.34(1.10, 1.64), p = 0.005. This reduced below unity in 2012, OR = 0.85(0.77, 0.93), p < 0.001. There were downward trends (p < 0.001) in absolute inequality measured by SIC and SIC 10 in each of the geographic areas. The SCIM 10 demonstrated further reductions in inequality across the population. The downward trends for all the inequality measures were larger for Glasgow than the Rest of Scotland.

CONCLUSIONS

Over the interval, Glasgow has eliminated the earlier extra health inequalities. When comparing 'like for like' by socioeconomic status there is now no higher level of dental caries in the Greater Glasgow area.

Salivary antimicrobial proteins associate with age-related changes in streptococcal composition in dental plaque

Secretion of antimicrobial proteins (AMPs) and salivary antibodies can modify biofilm formation at host body surfaces. In adolescents, associations have been reported between dental caries and salivary AMPs. AMPs demonstrate direct antimicrobial effects at high concentrations, and at lower more physiological concentrations they mediate changes in host cell defenses, which may alter the local environment and indirectly shape local biofilm formation. The expression of salivary AMPs in preschool children, at an age when the oral bacteria are known to change, has not been investigated. We sought to investigate salivary AMP expression in the context of previously well-documented changes in the oral cavities of this age group including salivary immunoglobulin A (IgA), oral bacteria and dental caries. Dental plaque and saliva were collected from 57 children aged 12-24 months at baseline, of whom 23 children were followed-up at 3 years of age. At each time, saliva was assessed for LL37, human neutrophil peptides 1-3, calprotectin, lactoferrin, salivary IgA, total plaque bacteria and Streptococcus mutans. Over time, concentrations of AMPs, S. mutans and bacteria-specific salivary IgA increased. Caries experience was also recorded when children were 3 years old. Concentrations of AMPs were highest in the saliva of 3-year-old children with the greatest burden of S. mutans. These data suggest that salivary AMPs are variable over time and between individuals, and are linked with bacterial colonization. At follow up, the majority of children remained caries free. Larger longitudinal studies are required to confirm whether salivary AMP levels are predictive of caries and whether their modulation offers therapeutic benefit.

Socio-behavioural factors and early childhood caries: a cross-sectional study of preschool children in central Trinidad

Background

Early childhood caries (ECC) is a public health problem due to its impact on children’s health, development and well being. Little is known about early childhood oral health in the West Indies or the influence of social and behavioural factors on the prevalence and severity of early childhood caries in this preschool population. The aims of this study were to describe the prevalence and severity of ECC in preschool children in a region of central Trinidad and to explore its relationship with social and behavioural factors.

Method

A cross-sectional survey was undertaken on children aged 3-5 years-old from a random sample of preschools in central Trinidad. Oral health examinations were conducted for children for whom parental consent was given, using WHO criteria (visual diagnosis / cavitation at d3). A self-reported questionnaire was distributed to all parents and caregivers. Variables included socio-demographics, oral health knowledge, attitudes and behaviours, visible caries experience and treatment need.

Results

251 children were examined, 50.2% were male with a mean age of 3.7 years (SD 0.67) and 71% were of Indian ethnicity. The prevalence of ECC was 29.1% and the prevalence of severe early childhood caries (S-ECC) was 17.5%. 29.9% of children had some treatment need, with 12% in need of urgent care or referral. Poisson generalized linear mixed model analysis found a higher rate of visible caries experience for children who ate sweet snacks more than twice a day (p < 0.001), had poorer parental dental health ratings (p < 0.0001), a previous dental visit (p < 0.0001) and difficulty finding dental care (p < 0.001).

Conclusion

The prevalence and severity of ECC in central Trinidad was related to oral health behaviours and access to dental care. Oral health promotion should include more supportive and practical advice for parents and caregivers of preschool children along with improved access to dental care to enable primary prevention and management of ECC.

Reductions in dental decay in 3-year old children in Greater Glasgow and Clyde: repeated population inspection studies over four years

BACKGROUND

Dental decay remains one of the world's most prevalent diseases in childhood. It is unfortunate that the proportion of children suffering from oral disease is so high, given that dental decay is almost entirely preventable. The objective of this study was to examine dental inspection data from three-year old children to assess the extent to which the dental health in Greater Glasgow and Clyde had improved during the initial years of the Childsmile intervention programme.

METHODS

Dental inspections of three-year old children in Greater Glasgow and Clyde were undertaken in the academic years of 2006/7 and 2007/8 (the baseline years), and again in 2008/9 and 2009/10 (after the intervention had begun). A standardised protocol suitable for the age group was used. The number of decayed, missing and filled teeth was calculated (ie d3mft). If d3mft was > 0 then a child was said to have 'obvious decay experience' into the dentine. Additional results examined the effect of socioeconomic status using the Scottish Index of Multiple Deprivation (SIMD).

RESULTS

We inspected 10022 children (19% of the population). The weighted percentage of children with decay experience was 26% in 2006/7, 25% (2007/8), reducing to 18% (2007/8) and 17% (2009/10). When compared to the first baseline year of 2006/7, the OR was 0.91 for 2007/8 (0.79-1.06, p = 0.221), 0.63 for 2008/9 (0.55-0.72, p < 0.001), and 0.50 for 2009/10 (0.43-0.58, p < 0.001). The weighted mean d3mft was 1.1 in 2006/7, 1.0 in 2007/8 (p = 0.869), 0.6 in 2008/9 (p < 0.001) and 0.4 in 2009/10 (p < 0.001). Reductions in decay were seen in all socioeconomic groups.

CONCLUSIONS

This study demonstrates that it is possible to impact upon the prevalence and morbidity of dental decay across the socioeconomic spectrum in a population. The dental health of young children in the Greater Glasgow and Clyde area has improved in recent years.

Effects of Streptococcus mutans on Dendritic Cell Activation and Function

Despite existing preventive and therapeutic measures, caries remains a ubiquitous infectious disease. Vaccine studies suggest that an adaptive immune response, culminating in effective antibody production, may reduce an individual’s susceptibility to caries. However, the efficacy of the immune response elicited by mutans streptococci in the oral cavity remains controversial. A greater understanding of the early stages of the adaptive immune response to cariogenic bacteria may potentially assist therapeutic targeting and design. We therefore sought to characterize dendritic cell (DC) activation and antigen presentation following Streptococcus mutans exposure. We found that S. mutans up-regulated DC expression of co-stimulatory molecules and MHCII in vitro and that DCs effectively processed and presented exogenously administered antigen. These DCs effectively initiated T-cell proliferation, but this was abrogated by live bacteria. The in vitro DC activation effects were not mirrored in vivo, where DCs in draining lymph nodes did not mature following oral exposure to S. mutans. Analysis of these data provides a model for studying antigen uptake from the oral cavity and evidence that, in vitro, S. mutans activates dendritic cells, a critical event for initiating adaptive immunity.