Oral health survey of 5-12-year-old children of National Guard employees in Riyadh, Saudi Arabia

Prevalence of Caries among School Children in Saudi Arabia: A Meta-Analysis

Introduction

Children's dental health has become the primary concern, because of the increase in the prevalence of caries amongst school children in Saudi Arabia. Therefore, a meta-analysis was conducted to assess the prevalence and severity of dental caries among school children in Saudi Arabia.

Method

A systematic search of Scopus, ISI Web of Science, EMBASE, Saudi digital library, Google Scholar, and MEDLINE via Ovid for cross-sectional studies with healthy participants between 5and -15 years. Two authors independently extracted the prevalence of caries. With 95% confidence intervals (CIs) using a random-effects model, we calculated caries prevalence.

Results

Dental caries prevalence data were extracted from 18 cross-sectional studies (n = 56,327 children). The pooled estimate for the caries prevalence among 5-7 years' children was 84% (95% CI: 0.81-0.87%; I2 = 91%) while among 12-15 years' children was 72% (95% CI: 0.63-0.79; I 2 = 96.2%). Discussion. In this systematic review, the summary estimate of the prevalence of dental caries among children of 5-7 years and 12-15 years were 84% and 72%, respectively. Further research is required to identify approaches for preventing and treating dental caries in schoolchildren.

Evidence based recommendations to improve the children oral health in Saudi Arabia

Aim

Identify the existing evidence base with regards to interventions that address high levels of dental caries. A discussion of the applicability of the evidence to possible replication in Saudi Arabia is presented, alongside recommendations to help reduce dental caries rates in children in Saudi Arabia.

Methods

A comprehensive systematic review following PRISMA methods was conducted using three databases: MEDLINE via OVID; EMBASE via OVID and Cochrane Library. Studies were included according to inclusion criteria. AMSTAR2 was used to assess the quality of the included studies, while GRADE was used to assess the quality of evidence.

Results

Ten studies were included in this review. The quality of these were 'high' (in two review), moderate (in two studies), low (in one study) and to 'critically low' (5 reviews). The quality of the evidence presented by the reviews ranged from 'moderate' to 'very low'. The interventions methods included MI, one-to-one nutrition advice, educational interventions and dental screening. The applicability of the findings in relation to dental care in Saudi Arabia is discussed and summarized in a narrative.

Conclusion

No strong evidence that supported interventions to improve the child oral health in Saudi Arabia was found. None of the included reviews included studies conducted in Saudi Arabia or evaluated interventions among the local community. As for different culture values, norms, beliefs and attitude to those demographics explored in the reviews, it is unclear if interventions with improve oral health among Saudi children. Further research is needed to explore the efficacy of these interventions in a Saudi context.

Dental fluorosis prevalence in Saudi Arabia

Aim

In order to improve the understanding of dental fluorosis prevalence in Saudi Arabia and have a good idea of the quality of the studies that have been conducted, a systematic review was conducted to evaluate the prevalence of dental fluorosis among people who live in Saudi Arabia.

Methods

Online databases EMBASE and MEDLINE and the Cochrane Library were searched, without any restriction regarding age. In addition, there were no study design filters applied to the search engine. Study selection and data extraction were conducted in duplicate. Studies were included if they were conducted in Saudi Arabia on any population (adults and children) and collected dental fluorosis data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies. A narrative synthesis was conducted.

Results

Seven cross-sectional studies were identified. Areas of weakness in study design/conduct were low response rates, and identification and handling of confounding factors. Statistical pooling of data was not appropriate due to substantial heterogeneity, due in part to variation in sample size, variation of water fluoridation concentration, index used, targeted population and age group. Seven studies present dental fluorosis at any level. The proportion of dental fluorosis prevalence at any level ranged from 0.00 to 0.91. Six studies explored the prevalence of dental fluorosis of aesthetic-only level of concern. The proportion of dental fluorosis in this category ranged from 0.07 to 0.76.

Conclusion

The proportion of dental fluorosis at any level ranged from 0.00 to 0.91 and fluorosis at aesthetics level ranged from 0.07 to 0.76. However, current data does not provide a complete assessment of dental fluorosis across Saudi Arabia. Existing studies are limited in terms of the population covered. The included studies had methodological flaws.

Dental caries in Saudi Arabia: A systematic review

OBJECTIVES

In KSA, numerous studies are conducted to measure the prevalence of dental caries. However, the prevalence of dental caries varies in KSA. This systematic review aims to improve the understanding of the prevalence of dental caries among adults and children residing in KSA.

METHODS

Online databases of MEDLINE, EMBASE, and the Cochrane Library were searched. The Saudi Dental Journal was hand-searched. Study selection and data extraction were conducted in duplicate. The studies on dental caries in the Saudi population were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the selected studies. Finally, a narrative synthesis was conducted.

RESULTS

Forty-nine cross-sectional studies were identified. Areas of weakness in study design/conduct were low response rates, reliable outcome measurement, and identification and handling of confounding factors. Statistical pooling of data was not appropriate due to substantial heterogeneity, also in part to a variation in geographical location and the target population. Twenty-nine studies presented data for primary dentition. The proportion of dental caries among primary teeth ranged from 0.21 to 1.00. Eighteen studies presented data for permanent dentition. The proportion of dental caries across permanent teeth ranged from 0.05 to 0.99.

CONCLUSIONS

In general, the methodological quality of the included studies was poor. Dental caries proportion level ranged from 0.05 to 0.99 in permanent teeth, and 0.21 to 1.00 across primary teeth. The available data does not provide a complete assessment of dental caries across KSA. Existing studies are limited in terms of the populations studied for dental caries.

Varying Manpower Alters Dental Health in a Developing Health Care System

OBJECTIVES

This study assessed relationships between oral health care workforce and dental health in 12-year-olds in a developing health care system in Iran from 1992 to 2014 and compared these findings with the most recent corresponding findings in selected countries.

METHODS

Data regarding oral health care workers from 1962 to 2014 were extracted from the comprehensive human resource data bank of the Shahid Beheshti Research Institute of Dental Sciences. Data regarding decayed, missing, and filled permanent teeth (DMFT) of 12-year-olds, extracted from official statistics, described dental health. Comparisons with other countries utilised the database of the World Health Organization. Changes in the DMFT index with fluctuations in the number of oral health care workers were investigated using exploratory data analysis methods. Associations of DMFT with the density of the oral health care workforce were evaluated using a multiple linear regression model.

RESULTS

The trend in supply of dental workforce in Iran began to expand in the 1970s and, after a reduction in 2003 to 2007, reached a peak by 2014. Means of DMFT indices of 12-year-olds in Iran fluctuated between 1.50 and 2.40 from 1992 to 2014. The relationship between the dentist to population ratio and the DMFT index of 12-year-olds showed a downwards trend (r = -0.994; P < .001) until 1998 and afterwards an upwards trend (r = 0.887; P < .001). Globally, the DMFT index decreased in countries with a preventively-oriented oral health care workforce.

CONCLUSIONS

Increased numbers of dentists have no significant impact on improving dental health in 12-year-olds. To promote dental health, the system providing health services should implement a preventively-oriented approach when planning for the oral health workforce.

Gingival health and oral hygiene practices among high school children in Saudi Arabia

BACKGROUND

Gingivitis is a site-specific inflammatory condition initiated by dental biofilm accumulation. The accumulation of dental plaque on the gingival margin triggers inflammatory effects that can become chronic. In addition to its local effect, gingival inflammation has recently been suggested to have an impact on general health.

OBJECTIVE

Determine the prevalence of gingivitis and its relationship to oral hygiene practices in high school children in Saudi Arabia.

DESIGN

Cross-sectional.

SETTING

High schools from different regions in Saudi Arabia.

PATIENTS AND METHODS

Periodontal examinations were conducted on a randomly selected sample of high school children between the ages of 15 and 19 years. Gingival and plaque indices, probing depth, clinical attachment level, oral hygiene practices and sociodemographic characteristics were recorded. Data were analyzed using descriptive statistics, chi-square and the independent t test.

MAIN OUTCOME MEASURE

Prevalence of gingivitis as defined by mean gingival index.

SAMPLE SIZE

2435 high school students.

RESULTS

Twenty-one percent of the sample had slight gingivitis, 42.3% had moderate, and 1.8% had severe. Gender, toothbrushing, tongue brushing, plaque index, and the percentage of pocket depth (PD) ≥4 mm showed a significant relationship with the severity of gingivitis. Almost 39.3% of females had a healthy periodontal status when compared to males (30.7%). Thirty-five percent (35.5%) of students who brushed their teeth had a healthy periodontium compared to 26.9% who did not brush. The mean plaque index was significantly higher in students with severe gingivitis when compared to students with healthy periodontium (2.4 vs. 0.79, respectively).

CONCLUSION

Gingivitis prevalence was high compared with Western countries in a nationally representative sample of high school students in Saudi Arabia and was influenced by oral hygiene practices.

LIMITATIONS

The half-mouth study design may underestimate disease prevalence. Data on oral hygiene practices was self-reported and may thus have been affected by social desirability bias.

CONFLICT OF INTEREST

None.

A Narrative Review of the Prevalence of Periodontitis in Saudi Arabia: A Proposal for a National Oral Health Research Agenda for Vision 2030

Objective:

The objective of this narrative review is to summarize the current knowledge on the prevalence of periodontitis in the Kingdom of Saudi Arabia (KSA) and to make recommendations for monitoring and improving oral health in the KSA population.

Background:

Periodontitis is a significant health issue in the general population, so conducting routine public health surveillance for this condition is important in every country. KSA is currently implementing a strategic plan called Vision 2030 which aims to improve many of the country’s infrastructures, including healthcare.

Methods:

To conduct this narrative review, Google Scholar (GS) was used to search for peer-reviewed articles on the prevalence of periodontitis in KSA. No limits were placed on the year of publication, but only articles translated into English were considered. Search terms used included “Saudi Arabia”, “periodontitis”, “surveillance”, “prevalence”, “rates”, “oral health” and “dental”.

Results:

The earliest estimate identified was from 1992, in which the rate of lack of periodontal health was estimated to be 90% in KSA residents aged 25 and over. A more recent estimate reported rates around 50%, but used a different case definition. Studies on tobacco use, periodontal health and KSA established that how tobacco is used strongly influences periodontal status. Other dental studies in KSA focus on other topics. The Saudi Health Information Survey (SHIS) conducted in 2013 asked oral health questions, but did not seek to estimate the rates of periodontitis in KSA.

Conclusion:

The World Health Organization’s (WHO) recommendations suggest that KSA should conduct research to develop surveillance case definitions of periodontitis that will have specific utility in KSA, and can be standardized to compare KSA rates with the rates worldwide. The existing surveillance definitions and efforts in other countries have been considered less than optimal, so research is needed to inform KSA’s effort. Recommendations are made for a national oral health research agenda in KSA under Vision 2030.

A systematic review and meta-analysis of primary teeth caries studies in Gulf Cooperation Council States

OBJECTIVES

The aim of the study was to evaluate the prevalence and severity of dental caries in pre-school children in the Gulf Cooperation Council (GCC) area.

METHODS

A search of literature was conducted to identify articles of dental caries in primary dentitions published during the period from January 1st, 1992 to June 30th, 2016. PubMed, Google Scholar search, and hand searching of journals was conducted to identify relevant articles. The search strategy employed both dental subject headings and free-text terms.

RESULTS

Out of a total of 193 studies that fit the initial inclusion criteria, 159 studies were further excluded. Only 34 studies were included in the systematic review and meta-analyses. The overall mean dmft in the primary teeth was 5.14 with prevalence of 80.9% in the GCC area. A high level of heterogeneity in the selected studies was found as demonstrated by Q-value of 2538.501 (df = 21) and I2 value of 99.17%. However, the funnel plots showed symmetrical shape at the bottom in both dmft and prevalence studies indicating absence of publication bias, which was also confirmed by insignificant result of Egger's regression statistical test (Egger's test P = 0.179-0.358).

CONCLUSION

Caries in the primary dentition in the GCC States was high both in terms of mean dmft (5.14) and prevalence (80.95%).

Impact of oral hygiene on oral health-related quality of life of preschool children

OBJECTIVES

To assess the impact of oral hygiene of preschool children and parental attitude on children's oral health-related quality of life (OHRQoL).

METHODS

In this cross-sectional study, 396 children of Shiraz kindergartens were selected by a randomized cluster sampling. Children's oral hygiene was assessed using the Simplified Debris Index (DI-S) and a self-made questionnaire about oral hygiene habits. Children's OHRQoL was evaluated by the Farsi version of Early Childhood Oral Health Impact Scale (F-ECOHIS). The effect of oral hygiene determinants on OHRQoL was measured using Pearson and Spearman correlation, independent-sample t-test and anova.

RESULTS

Children's mean DI-S and F-ECOHIS scores were 1.19 (± 0.77) and 19.36 (±8.42), respectively. Only 75% of the children had their teeth brushed once a day or more, and in 28%, toothbrushing had started before 2 years of age. DI-S values (P < 0.001) and frequency of toothbrushing (P < 0.001) had a statistically significant impact on OHRQoL of the children. Children's OHRQoL was also significantly associated with parents' attitude towards the importance of brushing deciduous teeth (P = 0.002).

CONCLUSIONS

Oral health status of preschool children in Shiraz was less than optimal and had a significant impact on their OHRQoL. Therefore, improvement of children's OHRQoL could be achieved by improving their home dental care. Strategies promoting parental attitude about the importance of children's toothbrushing may significantly influence children's oral hygiene and are highly recommended.

Dental caries in Arab League countries: a systematic review and meta-analysis

OBJECTIVE

The aim of this review was to determine prevalence of dental caries in primary and permanent teeth in the 2-20-year-old population of the Arab league.

METHODS

A literature search was performed on Pubmed, Summon and Google Scholar using the key words 'Dental caries', 'dmft' and 'DMFT'. A total of 293 articles were found, of which 35 passed our inclusion criteria and were included in analysis. Tables were made separately for primary and permanent teeth; the age group for primary teeth was 2-12 years and for permanent teeth 6-20 years.

RESULTS

A meta-analysis was run by using data extracted from the studies included. Heterogeneity was tested by forest plot and chi-square test, and considerable heterogeneity was found. Mean decayed, missing and filled teeth (dmft) was 4.341 (95% CI 3.714, 4.969) and in permanent teeth (DMFT) was 2.469 (95% CI 2.019, 2.919) from a random effect model. Publication bias diagnostics suggested missing of four studies of primary teeth caries data and eight studies of permanent teeth caries data to obtain symmetry in the funnel plot.

CONCLUSION

The incidence of caries in primary teeth was found to be high compared with caries in permanent teeth in the Arab League. This study does not provide a comprehensive picture of caries prevalence in the Arab League because in many of these countries only a few studies were performed. Therefore, these data cannot provide a complete picture of the prevalence of caries in those countries. Additional studies are needed to better evaluate the prevalence of caries in children and young adults in Arab League countries.

Correlating dental caries with oral bacteria and the buffering capacity of saliva in children in Madinah, Saudi Arabia

Introduction:

Caries is associated with high counts of mutans streptococci (MS), lactobacillus (LB), and a low saliva buffering capacity (BC). No study using odds ratios (OR) has correlated caries and these factors and no similar study has been done in Saudi Arabia before. Objectives: To determine: The prevalence of caries, the number of colony forming units (CFUs) of MS and LB, the saliva buffering capacity (BC) and the relationship between these factors.

Materials and Methods:

This was an analytical cross sectional study on children from Madinah. Caries was recorded using dmft/DMFT (decayed, missing, filled teeth). The scores for MS and LB and the BC of saliva was calculated using the Caries Risk Test (CRT)^®.

Results:

A total of 316 students were examined; two-thirds (62%) were female and 25% were caries free. Saliva was collected from 235 participants and the majority had high MS and LB scores (66 and 71%, respectively) while 25% had a low saliva BC. The odds for those who had high LB and MS CFUs, were 9 and 4 times more at risk to developing dental caries and those with a low BC had significantly more caries (P = 0.03). The likelihood for those having severe caries and high counts of LB and MS was 25 (P < 0.01) and 6 (P = 0.042) times greater, respectively, compared to those with no or mild caries. Those with multiple risk factors were more likely to have caries compared to those with single or no risk factors present.

Conclusions:

The prevalence of caries was relatively high and many respondents had greater than 10⁵ CFUs/ml of MS and LB. Almost all with a low BC had severe caries. There was a strong correlation between high MS, high LB, and low BC and the high prevalence of caries; hence the combination of these factors could be confidently used to predict caries in this population.

Early Childhood Caries among a Bedouin community residing in the eastern outskirts of Jerusalem

Background

ECC is commonly prevalent among underprivileged populations. The Jahalin Bedouin are a severely deprived, previously nomadic tribe, dwelling on the eastern outskirts of Jerusalem. The aim of this study was to assess ECC prevalence and potentially associated variables.

Methods

102 children aged 12–36 months were visually examined for caries, mothers' anterior dentition was visually subjectively appraised, demographic and health behavior data were collected by interview.

Results

Among children, 17.6% demonstrated ECC, among mothers, 37.3% revealed "fairly bad" anterior teeth. Among children drinking bottles there was about twice the level of ECC (20.3%) than those breast-fed (13.2%). ECC was found only among children aged more than one year (p < 0.001); more prevalent ECC (55.6%) was found among large (10–13 children) families than among smaller families (1–5 children: 13.5%, 6–9 children: 15.6%) (p = 0.009); ECC was more prevalent among children of less educated mothers (p = 0.037); ECC was more prevalent among mothers with "fairly poor" anterior dentition (p = 0.04). Oral hygiene practices were poor.

Conclusion

ECC levels in this community were not very high but neither low. This changing population might be on the verge of a wider dental disease "epidemic". Public health efforts clearly need to be invested towards the oral health and general welfare of this community.

Factors associated with active white enamel lesions

OBJECTIVE

The aim of this study was to assess the factors associated with the presence of active white enamel lesions among public school students in the city of Natal, Brazil.

METHODS

A convenience sample of 300 boys and girls aged between 7 and 12 years was selected among the pupils attending public schools in the city of Natal. Only those children presenting with opaque and rough-surface white lesions in a region of biofilm accumulation on the vestibular surface of permanent upper incisors were included. The investigation took the form of a cross-sectional study. A chart containing individual data was used, and a clinical examination was performed to determine the oral health status of the children, including caries (DMF-s(1), DMF-s(2), DMFdmf, dmf and total number of teeth with caries) and oral hygiene status (Gingival Bleeding Index and Visible Plaque Index). Data underwent descriptive analysis and analysis of variance, and chi-square tests were used for the comparison of continuous and dichotomous variables between groups with one, two, or three or more white lesions.

RESULTS

On average, each child presented with 2.3 teeth affected by white lesions, relatively high indices of dental caries and poor oral hygiene, with an 85% rate of localized plaque on the surfaces of teeth with lesions. The presence of visible plaque was statistically significant between the three groups, based on the number of lesions (P = 0.006), indicating a positive association between the number of lesions and the presence of biofilm.

CONCLUSION

There is a strong association between the presence of dental biofilm, high indices of caries and active white enamel lesions. Full professional effort is needed in order to motivate children to carry out oral hygiene sufficient for the adequate control of dental biofilm.

Oral health, sociodemographic factors, dietary and oral hygiene practices in Jordanian children

OBJECTIVES

To investigate the association between oral health, in terms of dental caries and gingivitis, and sociodemographic factors, dental plaque, oral hygiene behaviours, infant feeding and dietary practices in 4-5-year-old Jordanian children.

METHODS

Two-stage random sampling procedure was used to select children enrolled in kindergartens in Amman, Jordan. Clinical examinations were carried out by one examiner. Mothers completed questionnaires relating to sociodemographic factors, oral hygiene behaviours, infant feeding and dietary practices of the children.

RESULTS

About 67% of the children had caries, 31% had dmft greater than 4 and 66% had gingivitis. Of the children who had been wholly breast-fed, 86% had been fed on demand. Mothers of children attending kindergartens with the lowest tuition fees were more likely to have breast-fed their children on demand and for more than 18 months (prolonged breast feeding) compared to those attending kindergartens with higher fees. Savory snacks were consumed by 82%, confectionery by 76% and teas with sugar by 42% of the children. Multivariate analysis showed age, dental plaque, sleeping beside the mother, use of comforters and selected dietary habits to have an independent effect on caries prevalence. Dental plaque and prolonged breast feeding exerted an independent effect on caries severity and gingivitis. The strongest association with gingivitis was dental plaque.

CONCLUSIONS

In Jordan as elsewhere health promotion strategies need to be targeted to mothers from less advantaged backgrounds. Messages about infant breast feeding should emphasise that the method is beneficial to the oral health of the children if appropriately used.

Presence and antibiotic resistance of Porphyromonas gingivalis, Prevotella intermedia, and Prevotella nigrescens in children

BACKGROUND/AIMS

Only limited information exists about the prevalence in children of pathogens associated with periodontitis. The aim of the present study was to determine by culture whether 8-11-year-old children carry Porphyromonas gingivalis, Prevotella intermedia, and/or P. nigrescens in samples from the gingiva and/or the buccal mucosa taken before, and after caries treatment and oral hygiene instruction. A second aim was to assess the proportion of subjects who had gram-negative anaerobes carrying the tet(Q) and erm(F) genes, suggesting antibiotic resistance to tetracycline or erythromycin.

METHOD

A total of 150 children provided gingival and buccal swab bacterial samples that were cultured for P. gingivalis, P. intermedia, and P. nigrescens. The species was verified using DNA-DNA hybridization with species-specific probes made from the variable region of the 16S rRNA sequences. Antibiotic-resistant genes, tet(Q) and erm(F), were identified using specific DNA-DNA hybridization with specific DNA probes.

RESULTS

A total of 116 isolates of black-pigmented bacteria were cultured from 47 (31%) of 150 children. Five isolates were identified as P. gingivalis, 29 as P. intermedia, 33 as P. nigrescens, and 49 as other species. In general, the bacteria were not culturable at more than one time period. We found that 55% of these 47 children harbored black pigmented bacteria that carried either one or both of the two antibiotic-resistant genes studied (tet(Q), and erm(F)).

CONCLUSION

The present study demonstrated that children not exposed to regular dental treatment carry bacteria outside the gingival sulcus that have been associated with periodontitis, and that standard treatment procedures may not clear the presence of the putative pathogens. In addition, antibiotic-resistant genes are common in identifiable gram-negative anaerobes, including putative pathogens.