Understanding oral health disparities in children as a global public health issue: how dental health professionals can make a difference

Dental caries status and related factors among 12-year-old Somali school children in Hargeisa

OBJECTIVES

There is little data on the oral health conditions of Somali children. The aim was to assess the dental caries status and related risk factors of 12-aged children in primary schools in Hargeisa, Somaliland.

METHODS

A school-based survey was conducted in Hargeisa in December 2022. Using 2-stage cluster sampling, 405 children (12-aged) were randomly selected from 16 primary schools. Data collection involved WHO structured interviewer-administered questionnaire and clinical examinations. The DMFT index was measured according to WHO criteria, and accordingly, the mean for the significant caries index (SiC) was calculated. The association between the DMFT and the relevant variables was analysed using negative binomial regression in STATA.

RESULTS

The overall prevalence of dental caries was found to be 62.7%, with a mean DMFT of 1.7 and a SiC score of 3.7. Non-public school pupils showed significantly higher prevalence of dental caries and mean DMFT compared to public school counterparts (68.5% vs. 58.6%) and (1.91 vs. 1.48), respectively. Merely 14.7% of the participants utilized dental care services in the previous year. The multivariable analysis showed a significant positive association of the DMFT outcome with attending a non-public school (95% CI 1.16-2.12) and having many previous dental visits (95% CI 1.22-2.83). In the adjusted model, fathers of low education had children with better dental caries status (lower mean DMFT) than their well-educated counterparts. The mean DMFT was not significantly influenced by the factors sex, location, educational attainment (school class of the participants) and frequency of teeth cleaning.

CONCLUSION

Although the overall mean DMFT of school children in Hargeisa could be regarded low, the high levels of untreated caries especially in the one-third most affected are a cause for concern. Children enrolled in non-public schools formed the high-risk group. Preventive oral public health programs targeting Somali school children are recommended.

The Assessment of Resin-Based Composite Sealants' Effectiveness in Arresting Non-Cavitated Dentin Carious Lesions (ICDAS 3)-A 12 Month Follow-Up Preliminary Study

Background and Objectives: The therapeutic management of carious lesions remains a significant focus for researchers, given their persistently high prevalence despite being largely preventable. This study aimed to compare the effectiveness of a composite resin-based sealant material in halting extended non-cavitated dentin carious lesions when used therapeutically versus preventively on caries-free teeth over a period of twelve months. Materials and Methods: out of the 236 children examined, 45 were excluded from the study due to non-compliance with the inclusion criteria. Thus, the study included 191 children aged 10-12 years, and 764 molars in total. Results: among these molars, 171 were caries-free (ICDAS II code 0), forming the Control group, while 180 molars were classified with an ICDAS II score of 3, forming the Study group. All molars were sealed and evaluated at 6- and 12-month follow-up intervals. Both intervals revealed statistically significant differences (p < 0.05) in sealant retention and carious lesion development between sound (ICDAS code 0) and decayed (ICDAS code 3) teeth. Conclusions: the findings did not support the effectiveness of sealants in halting non-cavitated dentin carious lesions classified as ICDAS II with code 3 compared to their preventive application in sound teeth classified as ICDAS II with code 0.

PARENTAL EDUCATION, CARIES EXPERIENCE, PLAQUE ACCUMULATION, AND Mutans Streptococci COUNT MAY PREDICT THE INCREMENT OF EARLY CHILDHOOD CARIES IN PRESCHOOL CHILDREN OVER 24 MONTHS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

RISK PREDICTORS OF EARLY CHILDHOOD CARIES INCREMENT-A SYSTEMATIC REVIEW AND META-ANALYSIS. Lam PPY, Chua H, Ekambaram M, Lo ECM, Yiu CKY. J Evid Based Dent Pract. 2022 Sep;22(3):101732.

SOURCE OF FUNDING

Government TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Fluoride Varnish in Dentistry: A Bibliometric Analysis of the 100 Most-Cited Papers

A highly cited paper is a milestone and might impact research and clinical practice. The present study analyzed the 100 most-cited papers on fluoride varnishes in dentistry. A search was performed on July 20, 2022, on the Web of Science Core Collection. Two independent researchers extracted the following data: number and citation density; year and journal of publication; study design; main topic; authors; institutions; keywords; countries and continents. Scopus and Google Scholar were consulted to compare the number of citations. Bibliometric networks were generated in the VOSviewer. The number of citations ranged from 36 to 351, and thirteen papers were cited more than 100 times. The papers were published between 1977 and 2018, most of which were published after 2008 (48%). The most prevalent journal was Caries Research (17%). Intervention studies were the most common design (41%). The most discussed topics were dental caries prevention (48%) and dental remineralization (31%). Europe was the continent with the highest number of publications (46%), mainly from Sweden (14%), and Umea University had the most substantial number of studies (8%). Petersson L.G. was the author with more papers in the top 100 (6%). The most used keywords were "dental caries" (34%) and "fluoride varnish" (31%). It can be concluded that the top 100 cited papers on fluoride varnish primarily originated from Europe, with the majority consisting of intervention studies focusing on the utilization of fluoride varnish for the prevention of dental caries.

Trends in social inequalities in early childhood caries using population‐based clinical data

OBJECTIVE

To assess the longitudinal trends in social inequalities in early childhood caries (ECC) using collected population-based data.

METHODS

Clinical data on children were routinely collected from 2008 to 2019 in Victoria, Australia. ECC prevalence and severity (dmft) were quantified according to Indigenous status, culturally and linguistically diverse (CALD) status, concession cardholder status, geographic remoteness and area deprivation. The inverse probability weighting was used to quantify social inequalities in ECC. The weighted prevalence differences, and the ratio between the weighted prevalence of ECC and mean dmft and their 95% confidence interval, were then plotted.

RESULTS

Absolute inequalities in ECC prevalence increased for children by 7% for CALD status and cardholder status between 2008 and 2019. Likewise, absolute inequalities in ECC severity in this time period increased by 0.6 for CALD status and by 0.4 for cardholder status. Relative inequalities in ECC increased by CALD (ratio: 1.3 to 2.0), cardholder status (1.3 to 2.0) and area deprivation (1.1 to 1.3). Relative inequalities in severity increased by CALD (1.5 to 2.8), cardholder (1.4 to 2.5) or area deprivation (1.3 to 1.5). Although children with Indigenous status experienced inequalities in ECC prevalence and severity, these did not increase on the absolute (ECC: 0.1-0.1 Severity: 1.0-0.1) or relative scale (ECC ratio: 1.3-1.3 Severity ratio: 1.6-1.1).

CONCLUSIONS

Trends in inequalities in ECC were different according to sociodemographic measures. Oral health policies and interventions must be evaluated on the basis of reducing the prevalence of oral diseases and oral health inequalities between population sub-groups.

Comparative Evaluation of Ease of Dental Treatment and Clinical Efficiency of Midazolam vs Midazolam and Ketamine Combination for Sedation in Young Uncooperative Pediatric Patients: A Systematic Review

Aim

To assess and compare the effectiveness of midazolam vs midazolam and ketamine combination in the management of young uncooperative pediatric patients.

Materials and methods

The research question was developed by using population, intervention, comparison, outcome, and study design framework. The literature search was performed using three electronic databases: PubMed, Scopus, and EBSCOhost. The risk of bias of the studies was independently appraised using the Cochrane Handbook for Systematic Reviews of Interventions.

Results

Out of 98 preliminary records, five studies were selected for analysis. Three hundred forty-six uncooperative children were randomized through the five randomized controlled trials (RCTs), with a mean age of 5.8 years. Midazolam with ketamine was the most successful combination for delivering rapid and sufficient analgosedation in uncooperative children. The clinical efficiency of midazolam and ketamine combination had an overall success rate of 84% when compared to ketamine and midazolam alone. 50% of children in the midazolam and ketamine group demonstrated calm behavior, compared to 37% in the midazolam group. 44% of the children experienced modest intra and/or postoperative adverse effects that did not necessitate any special treatment.

Conclusion

Midazolam and ketamine combination is more efficient than midazolam alone with respect to ease of treatment and clinical efficiency.

How to cite this article

Rathi GV, Padawe D, Takate V, et al. Comparative Evaluation of Ease of Dental Treatment and Clinical Efficiency of Midazolam vs Midazolam and Ketamine Combination for Sedation in Young Uncooperative Pediatric Patients: A Systematic Review. Int J Clin Pediatr Dent 2022;15(6):680-686.

Individual, Family, and Socioeconomic Contributors to Dental Caries in Children from Low- and Middle-Income Countries

Introduction: Collective evidence on risk factors for dental caries remains elusive in low- and middle-income countries (LMICs). The objective was to conduct a systematic review and meta-analysis on risk factors for dental caries in deciduous or permanent teeth in LMICs. Methods: Studies were identified electronically through databases, including Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, and CINAHL, using “prevalence, dental caries, child, family, socioeconomic, and LMIC” as the keywords. A total of 11 studies fit the inclusion criteria. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale (NOS). The MedCalc software and Review Manager 5.4.1 were used. Results: From 11,115 participants, 38.7% (95% CI: 28.4−49.5%) had caries and 49.68% were female. Among those with caries, 69.74% consumed sugary drinks/sweets (95% CI: 47.84−87.73%) and 56.87% (95% CI: 35.39−77.08%) had good brushing habits. Sugary drinks had a two times higher likelihood of leading to caries (OR: 2.04, p < 0.001). Good oral hygiene reduced the risk of caries by 35% (OR: 0.65, p < 0.001). Concerning maternal education, only secondary education reduced the likelihood of caries (OR: 0.96), but primary education incurred 25% higher risks (OR: 1.25, p = 0.03). A 65% reduction was computed when caregivers helped children with tooth brushing (OR: 0.35, p = 0.04). Most families had a low socioeconomic status (SES) (35.9%, 95% CI: 16.73−57.79), which increased the odds of caries by 52% (OR: 1.52, p < 0.001); a high SES had a 3% higher chance of caries. In the entire sample, 44.44% (95% CI: 27.73−61.82%) of individuals had access to dental services or had visited a dental service provider. Conclusion: Our findings demonstrate that high sugar consumption, low maternal education, and low and high socioeconomic status (SES) increased the risk of dental caries in LMICs. Good brushing habits, higher maternal education, help with tooth brushing, and middle SES provided protection against caries across LMIC children. Limiting sugars, improving oral health education, incorporating national fluoride exposure programs, and accounting for sociodemographic limitations are essential for reducing the prevalence of dental caries in these settings.

Oral Health of Children and Adolescents in the United Arab Emirates: A Systematic Review of the Past Decade

Oral diseases are a universal public health problem with serious health and economic burdens. These diseases are a major concern in the pediatric population specifically. In the United Arab Emirates (UAE), among all the diseases that affect children, oral diseases, particularly early childhood caries, are the most common despite improvement in the provision of oral health services. Enhancing oral health status is one of the key public health goals in the country. This current systematic review aims to summarize the available data on oral health among children and adolescents in the UAE over the past decade (2011-2021). The review was conducted following a predefined protocol and in concordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO, EMBASE via Ovid, the Cochrane Library, and the Index Medicus for the Eastern Mediterranean Region (IMEMR) databases, and the gray literature were searched for original studies reporting on oral health in the pediatric population in the UAE, without applying any language restriction. Twenty-nine studies were included reporting on a total of 43,916 participants; they were mostly cross-sectional, and emirate-based; they were mostly limited by their setting and convenient sampling. Among the general pediatric population, results showed a high prevalence of dental caries across different emirates. Nevertheless, it was difficult to provide a predictable profile of caries, as risk factors were not well-explored and inconsistent across studies. Suboptimal oral hygiene practices were also prevalent, in addition to a low utilization of dental services. Furthermore, included studies showed a high level of oral problems in children with different disease (down syndrome, cerebral palsy, thalassemia, autism…) and special conditions (children in prison nurseries); yet, in general, treatment indices were lower than their healthy counterparts. This review suggests that dental caries is a major pediatric health problem in the UAE. Risk factors included higher consumption of snacks, being in public schools, lower maternal education level, and socioeconomic status. Nevertheless, risk factors were not well-explored and inconsistent across studies. Suboptimal oral hygiene practices and a low utilization of dental services were also identified, in addition to a high level of oral problems in children with different disease coupled with lower treatment indices in comparison with their healthy counterparts. This systematic review provides crucial information for planning and evaluating effective oral health programs, identifies gaps in the recent research in this field, and paves the way for preventive and interventional studies targeting oral health in pediatrics in the UAE. Immediate oral health promotion strategies are needed to address this public health problem early in its course by creating conditions that promote oral health, and increasing uptake of dental services. Intensifying research to draw temporal trends, understand the profile of childhood caries in the UAE, and explore cost-effective national community prevention programs are also needed.

Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions

Aim: Early childhood caries (ECC) has significant public health implications but has received inadequate global attention. There is limited information regarding the success of oral health policies implemented to address the challenges of ECC. This review aimed to summarize such policies to tackle ECC from different countries/regions. Method: Independent collaborators from 14 countries/regions (Australia, Brazil, Cambodia, China, Hong Kong, Egypt, India, Indonesia, Japan, Nigeria, Thailand, UK, USA, and Venezuela) collected the data. The ECC status, dental workforce, oral health policies on ECC prevention in different countries/regions were summarized by each country. Results: The findings indicated that ECC prevalence varied in different countries/regions. The lowest prevalence of ECC among 5-year-old children was found in Nigeria (7%), and the highest was found in Indonesia (90%). The existing dental workforce and resources are limited in most countries. The smallest dentist to population ratio was reported by Nigeria at 1:48,400, whereas the highest ratio was in Brazil (1:600). Out of 14, three (21%) countries namely India, Venezuela and Cambodia had no national oral health policies addressing ECC and four (29%) countries (Cambodia, China, India, Venezuela) had no publicly funded dental care program for 0-5-year-old children. Water fluoridation is available in four countries/regions (Australia, Brazil, Hong Kong, USA). Conclusion: ECC remains a global health challenge and dental workforce is limited. National/regional programs to tackle ECC are not yet prioritized in many countries/regions. Evidence to support demonstration projects is limited. Further research on the cost-effectiveness of interventions strategies is required for policymakers.

Systematic Review of Intervention Studies Aiming at Reducing Inequality in Dental Caries among Children

(1) Background: The objective is to systematically review the evidence on intervention programs aiming at reducing inequality in dental caries among children. (2) Methods: Two independent investigators searched MEDLINE, Cochrane library, and Ovid up to December 2020 to identify intervention studies assessing the impact on socioeconomic inequalities in dental caries among children. The interventions included any health promotion/preventive intervention aiming at reducing caries among children across different socioeconomic groups. Comparison groups included children with alternative or no intervention. Cochrane criteria were used to assess interventional studies for risk of bias. (3) Results: After removal of duplicate studies, 1235 articles were retained. Out of 43 relevant papers, 13 articles were identified and used in qualitative synthesis, and reported quantifiable outcomes. The included studies varied in measurements of interventions, sample size, age groups, and follow-up time. Five studies assessed oral health promotion or health-education, four assessed topical fluorides, and four assessed water fluoridation. Interventions targeting the whole population showed a consistent reduction of socioeconomic inequalities in dental caries among children. (4) Conclusion: The quality of included papers was moderate. High heterogeneity did not allow aggregation of the findings. The overall findings suggest that whole population interventions such as water fluoridation are more likely to reduce inequalities in children’s caries than target population and individual interventions.

Inhibitory effects of flavedo, albedo, fruits, and leaves of Citrus unshiu extracts on Streptococcus mutans

OBJECTVES

Citrus unshiu has been shown to exhibit antimicrobial effects against citrus diseases. In the present study, C. unshiu was divided into flavedo, albedo, fruits, and leaves; the inhibitory effects of these extracts on Streptococcus mutans, a major pathogen of dental caries, were investigated.

DESIGN

C. unshiu specimens were separated into flavedo, albedo, fruits, and leaves. First, pH values and polyphenol amounts in Citrus extracts were measured. In addition, Citrus extract was added to the bacterial suspensions of S. mutans MT8148, and inhibitory effects of C. unshiu extracts on MT8148 for antimicrobial activity, bacterial growth, and biofilm formation were analyzed. These assays were also performed using C. sinensis extracts.

RESULTS

Among these extracts, albedo exhibited a pH value closest to neutral, while the fruits exhibited the most acidic pH value; the pH values significantly differed between these extracts (P < 0.05). In addition, the amounts of polyphenols were significantly higher in albedo than in other extracts (P < 0.001). All extracts showed inhibitory effects on MT8148 for antimicrobial activity, bacterial growth and biofilm formation. These inhibitory effects were significantly stronger in flavedo, albedo, and fruits, compared with leaves (P < 0.05). Furthermore, extracts of Citrus sinensis also showed inhibitory effects on S. mutans, although these effects were weaker than the effects of C. unshiu.

CONCLUSION

These results suggest that extracts from C. unshiu fruits exhibit inhibitory effects on S. mutans, among which albedo may be especially useful for dental caries prevention due to its neutral pH and abundant polyphenols, in addition to its inhibitory effects.

Barriers and Facilitators to Promoting Oral Health Literacy and Patient Communication among Dental Providers in California

Studies demonstrate that dental providers value effective provider-patient communication but use few recommended communication techniques. This study explored perspectives of California dental providers and oral health literacy experts in the United States on use of communication techniques. We conducted a qualitative key informant interview study with 50 participants between November 2019 and March 2020, including 44 dental providers (dentists, hygienists, and assistants) in public or private practice in California and 6 oral health literacy (OHL) experts. We undertook thematic analysis of interview transcripts and descriptive statistics about interviewees from pre-surveys. Dental providers reported frequently speaking slowly, and using simple language and models/radiographs to communicate with patients, while infrequently using interpretation/translation, illustrations, teach-back, or motivational interviewing. Providers reported using only 6 of the 18 American Medical Association's (AMA) recommended communication techniques and only 3 of the 7 AMA's basic communication techniques. A majority of providers indicated using one of five oral health assessment and educational strategies. Key barriers to effective communication included limited time, financial incentives promoting treatment over prevention, lack of OHL training, limited plain-language patient education materials, and patients with low OHL knowledge. Dental organizations should prioritize supporting dental providers in effective patient communication practices. Standardizing OHL continuing education, creating an evidence-based OHL toolkit for dental teams, ensuring accessible interpretation/translation services, and incentivizing dental providers to deliver education could improve oral health literacy and outcomes.

Fluoride Use in Caries Prevention in the Primary Care Setting

Dental caries remains the most common chronic disease of childhood in the United States. Caries is a largely preventable condition, and fluoride has proven effectiveness in caries prevention. This clinical report aims to clarify the use of available fluoride modalities for caries prevention in the primary care setting and to assist pediatricians in using fluoride to achieve maximum protection against dental caries, while minimizing the likelihood of enamel fluorosis. Fluoride varnish application is now considered the standard of care in pediatric primary care. This report highlights administration, billing, and payment information regarding the fluoride varnish procedure.