Dental caries clusters among adolescents

Individual caries increments during adolescence in seven Norwegian cohorts born 1996-2002

BACKGROUND

Caries increment during adolescence, including enamel caries, is rarely explored in detail. This study assessed the caries increment during the period from 12 to 18 years. The specific objectives were to examine time trends, increment variability between individuals, and whether baseline caries experience at 12 years or sex had an impact on the caries increment.

METHODS

The sample included seven birth cohorts (1996-2002; n = 23,135) from a general adolescent population in Trøndelag County, Norway. Data was based on dental records from the Public Dental Service. Two caries increment thresholds were examined at the tooth level: the enamel caries increment (ΔD1-2T), and the caries increment at the dentin level, including missing and filled teeth (ΔD3-5MFT). Zero-inflated Poisson models were used to account for the skewed distribution with a high proportion of zero caries increment (31.1% with ΔD1-2T = 0 and 33.4% with ΔD3-5MFT=0).

RESULTS

The mean caries increments for the seven cohorts were ΔD1-2T = 3.14 (95% CI: 3.09-3.19) and ΔD3-5MFT = 2.51 (95% CI: 2.47-2.55). A modest temporal trend of decreasing caries increment across cohorts was observed at both thresholds: ΔD1-2T = -0.31 (95% CI: ±0.13) and ΔD3-5MFT = -0.43 (95% CI: ±0.11). However, this decrease was small compared to the variation in caries increments between individuals. Females had slightly lower mean caries increment than males, but there was no effect of sex on the change across cohorts. Adolescents with high baseline caries experience at 12 years had higher mean caries increments compared to the intermediate or low baseline caries experience groups, and a reduction across cohorts was only seen in the two latter groups.

CONCLUSIONS

While there was a modest reduction in caries increment across cohorts, this reduction was small compared to the variation in caries increments between individuals. The change across cohorts was the same in females and males. Baseline caries experience at 12 years was a strong predictor of caries increment and the reduction across cohorts was only seen among those with lower baseline caries experience, incdicating an increased dental health disparity among Norwegian adolescents.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT05935813, Release Date: 28/06/2023.

Caries trajectories from childhood to adolescence: Analysis of data from a nationwide school dental service

OBJECTIVES

The aim of the study was to assess patterns of longitudinal changes in caries status among school-going children in Singapore.

METHODS

Dental records for a single cohort of students who received dental examinations in six standard examination years between 2009 and 2017 were analysed (n = 24 699). Group-based trajectory modelling with a zero-inflated Poisson distribution was carried out to determine dental caries trajectories in the permanent dentition. Associations between sociodemographic factors and trajectory group membership were assessed using multinomial logistic regression.

RESULTS

The predicted population distribution across the four caries trajectory groups identified was 65.0% ('none'), 16.8% ('low'), 14.8% ('medium') and 3.4% ('high'). The 'none' trajectory group had a decayed, missing and filled teeth (DMFT) score of 0 throughout the 8 years. Higher baseline DMFT counts and nonlinear increases in DMFT scores were noted for the 'low', 'medium' and 'high' trajectory groups. The correlation coefficient between DMFT counts in years 6 and 8 was 0.91, as compared to 0.77 between baseline and year 1. Factors associated with the 'high' caries trajectory include lower socio-economic status, female gender, Chinese race (compared to the Indian race), enrolment in primary schools in the Eastern and Western regions of Singapore, and enrolment in public secondary schools.

CONCLUSIONS

Under a nationwide school dental service, four trajectory patterns of caries counts in the permanent dentition were identified over 8 years. Among students in the 'low', 'medium' and 'high' trajectory groups, greater caries increment was noted during the transition from primary to secondary school. The correlation between DMFT counts in successive examinations was stronger in older than younger ages.

Association between underlying dentin shadows (ICDAS 4) and OHRQoL among adolescents from southern Brazil

This study aimed to assess the association between underlying dentin shadows (UDS) and oral health-related quality of life (OHRQoL) among 15-19-year-old adolescents from southern Brazil. This population-based cross-sectional study included a representative sample of 1,197 15-19-year-old adolescents attending 31 public and private schools from Santa Maria, Brazil. The Oral Health Impact Profile-14 (OHIP-14) was used to evaluate the OHRQoL, and clinical examinations were performed by two calibrated examiners (intra/interexaminer kappa values for caries examination ≥ 0.80) to diagnose UDS (ICDAS code 4 caries lesions). Sociodemographic information and clinical characteristics (overall caries experience, traumatic dental injury, malocclusion, and gingivitis) were also collected as adjusting variables. Multilevel Poisson regression models were used to assess the association between UDS and OHRQoL. Rate ratios (RR) and 95% confidence intervals (CI) were estimated. The UDS prevalence was 8.8% (n = 106 adolescents). In the adjusted models, adolescents with UDS had poorer OHRQoL than those without UDS, and the strength of the association was dependent on the number of lesions per individual. Individuals with 1-2 UDS had a mean OHIP-14 score 8% higher (RR = 1.08; 95%CI: 1.01-1.17) than adolescents without UDS, while those with 3-4 UDS had a mean score 35% higher (RR = 1.35; 95%CI: 1.12-1.63). This negative association was related to physical disability, psychological disability, social disability, and handicap domains. This study showed that UDS was associated negatively with OHRQoL among 15-19-year-old adolescents from southern Brazil. The negative effect of UDS on OHRQoL emphasizes the importance of addressing issues regarding OHRQoL even in the posterior teeth of adolescents.

Secular trends of dental caries and association with nutritional status: a retrospective analysis of 16,199 Chinese students from three successive national surveys from 2010 to 2019

Introduction

The prevalence of dental caries (DC) among students in developing countries has increased at an alarming rate, and nutritional status has been shown to be associated with DC in children and adolescents with inconsistent conclusions. We aimed to understand the trends of DC prevalence in students aged 7, 9, 12, and 14 years and to explore the relationship between DC prevalence and nutritional status.

Methods

We recruited 16,199 students aged 7, 9, 12, and 14 years in China by multi-stage, stratified, random sampling methods from 2010 to 2019. Permanent caries were measured using the Decay, Loss, and Filling (DMF) index and prevalence rate. Deciduous caries were measured using the decay, loss, and filling (dmf) index and prevalence rate. Nutritional status was assessed using body mass index (BMI) and hemoglobin levels. Logistic regression analysis was used to assess the association between nutritional status and the DC prevalence in children and adolescents, incorporating information concerning family-related factors.

Results

The results indicated that DC prevalence increased from 39.75% in 2010 to 53.21% in 2019 in Henan province, with deciduous teeth and permanent teeth being 45.96 and 27.18%, respectively, in 2019. The total caries rate decreased with age (p < 0.05), and the caries rate of girls was higher than that of boys in 2019 (55.75% vs. 50.67%) (p < 0.001). The prevalence of dental caries among primary and secondary school students in areas with medium economic aggregate was the highest, followed by cities with the best economic development level, and cities with low economic levels have a lower prevalence of dental caries. The dental caries prevalence was negatively correlated with body mass index. In the fully adjusted model, underweight children had a higher caries prevalence (OR = 1.10, 95%CI: 0.86-1.41). Children with anemia had a higher prevalence of dental caries (OR = 1.18, 95%CI: 0.98-1.42).

Conclusion

The DC prevalence of students in Henan Province was high, with a tendency to increase. Females, young individuals, and those with a higher economic level showed a positive correlation with the prevalence of caries. In the process of economic development, particular attention should be paid to early childhood caries prevention. Nutritional status should be taken seriously among children and adolescents, and the oral health system should be improved to keep pace with economic development.

Adolescents' views on oral health care and promotion in Norway: everyday practices, recommendations, and future visions

Introduction

In this study, we aimed to understand adolescents' perspectives on oral health care and promotion. Our research was conducted in the context of Norway's oral health care system, where societal factors like income and education influence health disparities. Despite free public dental care for all residents younger than 19 years, challenges persist in promoting oral health among adolescents, a group whose oral health behavior and literacy remain largely unexplored.

Materials and methods

A thematic analysis of an anonymized dataset from 80 adolescents aged 12-20 years was conducted.

Results

Five central themes were recognized: (1) Feeling fresh vs. feeling indifferent: A broad spectrum of attitudes; (2) Bridging gaps, building habits: Collaborative efforts in oral care; (3) "Create good experiences at the dentist so people come back again"; (4) Requested qualities in oral health promoting solutions; (5) Reminder tools for everyday use. Taken together, these themes highlight adolescents' oral health practices and resources, recommendations for dental clinics, and visions for future oral health promotion.

Discussion

Based on the results, the discussion highlights a need for tailored oral health promotion and ideas to reach adolescents in meaningful and effective ways. Reflections on the theme of social inequalities are provided.

Oral Hygiene Study in Late Adolescence

The objective of this study is to determine prevalent behaviors and knowledge of oral hygiene on the late adolescents. Only individuals in the late stage of adolescence, specifically between the ages of 18 and 24, that were students from the "Ovidius" University of Constanta were chosen. The involvement was optional. A printed questionnaire was provided for them to complete. A total of 50 participants took part in this study, consisting of 26% (n=13) males and 74% (n=37) females. When asked about their toothbrush preference, 50% (n=25) individuals indicated using just manual toothbrushes. Out of all individuals who have utilized orthodontic appliances, 70.8% (n=17) reported that the dentist recommended for them to receive professional dental hygiene care while undergoing treatment. 78.0% (n=39) individuals reported participating in oral hygiene meetings and would be interested for additional information regarding the topic. It is essential to provide youngsters with early instruction about the importance of oral hygiene in order to develop long-lasting healthy habits.

Caries clusters at lesion-severity thresholds: A Sierra Leone case study

OBJECTIVES

Despite being almost entirely preventable, globally, dental caries is extremely prevalent. Moreover, dental caries will continue to present an even larger challenge for lower income countries, particularly those in the African context, as they transition to a more Western diet. Hence, epidemiological data providing insight into disease patterns and trends is critical to inform public health action. The purpose of this study was to examine dental caries clusters by caries detection threshold among 15-year-old adolescents in Sierra Leone, using data from the latest national survey, and to explore associated sociodemographic factors.

METHODS

This paper presents a secondary analysis of oral health data on 490 15-year-olds from the Sierra Leone national oral health survey of schoolchildren. Hierarchical cluster analysis of dental caries experience was conducted across all surfaces at four decay detection thresholds using the International Caries Detection and Assessment System (ICDAS) (clinical: ICDAS 2-6, cavitated: ICDAS 3-6, obvious: ICDAS 4-6 and extensive obvious: ICDAS 5-6 decay) across the four regions of Sierra Leone. Ordered logistic regression was used to estimate the association of sociodemographic factors with generated clusters relating to clinical and obvious decay experience. These are of both clinical and epidemiological relevance.

RESULTS

A 3-cluster decay pattern representing a 'low' to 'high' decay experience distribution was observed under each decay detection threshold across surfaces. For clinical decay (including visual enamel caries), 28.8% had low, 55.1% medium and 15.9% high caries status. In the adjusted model, the only significant risk factor across obvious and clinical decay thresholds was region, with adolescents outside the Western region more likely to experience decay.

CONCLUSION

This study suggests that adolescents in Sierra Leone fall into three distinct caries clusters: low, medium to high decay experience distribution, regardless of decay threshold. It reinforces the importance of recognizing dental caries detection thresholds and the use of contemporary epidemiological methodology. This suggests that adolescents outside the Western region are likely to have higher caries experience. The data also provides insight to the nature of adolescents in each cluster and should help to inform policy and planning of the integration of oral health into primary care and school systems.

Systems mapping of multilevel factors contributing to dental caries in adolescents

Dental caries is a prevalent chronic disease among adolescents. Caries activity increases significantly during adolescence due to an increase in susceptible tooth surfaces, immature permanent tooth enamel, independence in pursuing self-care, and a tendency toward poor diet and oral hygiene. Dental caries in permanent teeth is more prevalent among adolescents in low-income families and racial/ethnic minority groups, and these disparities in adolescent dental caries experience have persisted for decades. Several conceptual and data-driven models have proposed unidirectional mechanisms that contribute to the extant disparities in adolescent dental caries experience. Our objective, using a literature review, is to provide an overview of risk factors contributing to adolescent dental caries. Specifically, we map the interactive relationships of multilevel factors that influence dental caries among adolescents. Such interactive multilevel relationships more closely reflect the complex nature of dental caries experience among the adolescent population. The methods that we use are two-fold: (1) a literature review using PubMed and Cochrane databases to find contributing factors; and (2) the system dynamics approach for mapping feedback mechanisms underlying adolescent dental caries through causal loop diagramming. The results of this study, based on the review of 138 articles, identified individual, family and community-level factors and their interactions contributing to dental caries experience in adolescents. Our results also provide hypotheses about the mechanisms underlying persistence of dental caries among adolescents.

Conclusions

Our findings may contribute to a deeper understanding of the multilevel and interconnected factors that shape the persistence of dental caries experience among adolescents.

The role of income and frequency of dental visits in the relationship between dental sealant use and resin fillings after extended coverage: a retrospective cohort study

BACKGROUND

Prevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between implementing the sealant program and resin fillings restoration and to explore the role of income and frequency of dental visits in this relationship.

METHODS

This retrospective cohort study used the cohort database from the National Health Information Database of the National Health Insurance Service. The study population comprised 494,731 children born in 2007. A logistic regression model for the experience of resin fillings and a linear regression model for weighted utilization of them were used to identify the independent effects of dental sealants, income, and frequency of dental visits. All analyses were conducted using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA).

RESULTS

The ratio based on income level was almost proportional in all groups except the medical aid group, which had a rate as high as that of the wealthier group. Children without sealants were 1.05 times more likely to have resin fillings than others after adjusting for income level and frequency of visiting dental clinics in the final model. However, an opposite relationship between sealant experiences and resin fillings was observed in the previous model without dental visits. The gap in the weighted resin filling scores according to socioeconomic variables showed a similar tendency.

CONCLUSIONS

Income and frequency of dental visits might be confounding factors for the relationship between dental sealant and resin fillings. It is necessary to consider the complex relationship between socioeconomic indicators and service use while studying oral health inequality.

Trajectories of Dental Caries From Childhood to Young Adulthood: Unsupervised Machine Learning Approach

Objective

To determine the dental caries trajectories over the life course (from age 9 to 23) using an unsupervised machine learning approach.

Methods

This is a longitudinal study of caries trajectories over a life course using data from 1,382 individuals from the Iowa Fluoride Study birth cohort. The trajectory analysis of caries in the permanent dentition at ages 9, 13, 17 and 23 was performed using the unsupervised machine learning algorithm known as K-means for Longitudinal Data (KmL), a k-means based clustering algorithm implemented in R specifically designed for analyzing longitudinal data. The trajectory grouping was performed by assessing the distances of the individual trajectories from the centroid and the prediction of the "best" partition was performed based on the Calinsky & Harabatz criterion. The number of cluster partitions assessed was 2 to 6. The number of re-runs with different starting conditions for each number of clusters was 20.

Results

The trajectory analysis identified three trajectory groups with 70.5%, 21.1%, and 8.4% of participants in the low, medium, and high caries trajectory groups, respectively. The mean D2+MFS counts of the low caries trajectory groups at ages 9, 13, 17, and 23 were 0.23, 0.37, 1.10, and 1.56, respectively. The mean D2+MFS counts of the medium caries trajectory groups at ages 9, 13, 17, and 23 were 0.92, 2.09, 6.24, and 9.55, respectively. The mean D2+MFS counts of the high caries trajectory groups at ages 9, 13, 17, and 23 were 1.49, 4.80, 12.91, and 22.52, respectively. There were steeper increases in the D2+MFS scores of the three trajectory groups between age 13 and 17, with less steep but also strongly positive slopes from age 17 to 23, suggesting that the period from age 13 to 17 is the highest risk period.

Conclusion

There was an increase in the trajectory slopes after age 13 which might be due to changes in risk factors. The next step in this study will be to identify those factors that predict trajectory group membership by modeling their relationships using supervised machine learning techniques.

Preventive dental care utilization and dental caries for Medicaid-enrolled adolescents in Oregon

OBJECTIVES

This study aimed to evaluate the relationship between preventive dental care utilization and untreated dental caries for Medicaid-enrolled adolescents and to determine if the relationship is moderated by chronic conditions (CC).

METHODS

This analysis was based on 2015-2016 Medicaid claims files and survey data collected from adolescents ages 12-18 years enrolled in Oregon Medicaid, who received a dental screening between December 2015 and December 2016 (n = 240). To assess the relationship between preventive dental care utilization and untreated dental caries (defined as decayed tooth surfaces), prevalence ratios (PR) and 95% confidence intervals (CI) were generated using log-linear regression models. We also tested for an interaction between preventive dental care utilization and CC.

RESULTS

About 60.4% of adolescents utilized preventive dental care, 21.7% had CC, and 29.6% had ≥1 decayed tooth surfaces. There were no significant differences in untreated dental caries between adolescents who did and did not utilize preventive dental care (PR: 0.73, 95% CI: 0.33-1.60; p = 0.43). There was not a significant interaction between preventive dental care utilization and CC (p = 0.65). Preventive dental care utilization was not significantly associated with untreated dental caries for adolescents with CC (PR: 0.51, 95% CI: 0.10-2.65; p = 0.42) nor among adolescents without CC (PR: 0.79, 95% CI: 0.33-1.91; p = 0.61).

CONCLUSIONS

Preventive dental care was not shown to be associated with lower untreated dental caries for Medicaid-enrolled adolescents or those with CC. Future work that is adequately powered should continue to elucidate this relationship in Medicaid enrollees.

Subgroup detection-based dental caries status and inequalities trend exploration: A nationwide, 10-year-repeated cross-sectional study

Background

The goal of this study was to identify potentially important factors for the dental health though heterogeneous effects of risk factors within Chinese adolescent populations with different characteristics by analyzing the repeated cross-sectional data collected in the 3rd (2005) and 4th (2015) National Oral Health Survey.

Methods

We studied the relationships between the decayed, missing and filled permanent teeth (DMFT) score, which was a discrete value, with the caries risk factors (region, census type, gender, only child or not, parents' education level, tooth bushing, dentist visit history, knowledge score, sugar intake, and pit-and-fissure sealants status), though the Poisson mixture regression model, which could identify subgroups among the full population and estimate the heterogeneous effects of risk factors simultaneously. We performed a series of tests and trend analysis based on the model fitting results to explore the primary causes for the dental caries issue clearly and intuitively.

Results

A total of 39,049 teenagers aged 12 years were involved in the analysis. The Poisson mixture regression model clustered all individuals into three subgroups, where the mean values (standard deviations) of DMFT were 0.18 (0.56), 1.31 (1.49), and 2.91 (1.89), respectively. Model fitting results indicated that the heterogeneous effects of the involved risk factors were significant. In addition, we also found significant differences in the distributions and trends of DMFT within different categories of selected risk factors (region, census type, gender and dentist visiting history) from the projection analysis results. The estimated and projected proportions showed that the proportion of high caries risk population in the southwestern region increased by 31.8%, and will become even more severe as it will be the major component of high caries risk population in 2025.

Conclusions

We found that the trends for the developments and changes of dental caries within populations with different characteristics were inequality. The regional difference is the primary factor for diversified changes in DMFT. The findings in this study provide support for intervention and prevention policies for the deterioration of dental caries risk within different adolescent populations.

Primary Caregiver Retention and Perceptions of Retention Strategies in a 36-Month Prospective Childhood Caries Study

Introduction/Objectives:

This paper reports on participant retention from an ongoing prospective, multi-site cohort caries risk study involving parent/infant pairs. The objectives were to: (1) compare the retention rates at each intermediate contact (every 4 months) and dental visit (every 18 months) across the 3 clinical sites, (2) assess primary caregivers’ perceptions at the end of the study about the retention efforts used in this longitudinal study, and (3) determine whether primary caregiver baseline demographic characteristics and child’s baseline caries experience were associated with retention.

Methods:

1325 primary caregiver-child pairs recruited at the child’s first birthday were followed for 36 months at 3 sites. Dental visits occurred at children’s ages of approximately 12, 30, and 48 months. Telephone/email intermediate contacts with the primary caregiver occurred 6 times between dental visits. The outcome variable was the retention rates at each dental visit and each intermediate contact. Primary caregivers’ perceptions of intermediate contacts were evaluated. Retention rates were compared by maternal age, race, ethnicity, Medicaid status, yearly household income, baseline caries experience (defined as decayed, missing due to caries, or filled tooth surfaces) at 12 months, and the number of teeth erupted.

Results:

1325 primary caregiver/infant pairs were enrolled and completed the first in-person dental visit, 1062 pairs (80%) completed the second visit and 985 (74%) completed the third. Most primary caregivers were female (94%), with a mean age of 29 years and 667 (50%) self-identified as White, 544 (41%) as Black, and 146 (11%) as Hispanic. The percentages of successful intermediate contacts were 95% at 4 months decreasing to 82% at 34 months. Almost all 964 (98%) of 985 primary caregivers reported at the last visit that they were comfortable/very comfortable with 4-month intermediate contacts. The multivariable analysis showed that primary caregivers who were older (OR = 1.07; 95% CI, 1.04-1.09) and White (OR = 1.52; 95% CI, 1.12-2.06) were more likely to complete the study.

Conclusions:

Retention strategies were focused on frequent routine contact and increasing monetary incentives. Those strategies may have resulted in retention exceeding the proposed goals. At the end of the study, primary caregivers were comfortable with the 4-month intermediate contacts.

Trend on dental caries status and its risk indicators in children aged 12 years in China: a multilevel analysis based on the repeated national cross-sectional surveys in 2005 and 2015

Background

This study aimed to explore the trend and risk indicators for dental caries of children aged 12 years in China based on national oral health survey data in 2005 and 2015.

Methods

Research data were from the two latest national oral health surveys conducted in mainland China, including 30 and 31 provinces, autonomous regions, and municipalities in 2005 and 2015, respectively. Children aged 12 years were clinically examined for dental caries and dental fluorosis according to the World Health Organization criteria. Sociodemographic characteristics and oral health-related behaviours were collected using questionnaires. Multilevel zero-inflated negative binomial regression model was used to investigate the association between dental caries severity and dental fluorosis, sociodemographic characteristics, and oral health-related behaviours.

Results

The final analyses included 12,350 and 27,818 children surveyed in 2005 and 2015, respectively. The standardized prevalence of dental caries increased from 27.05% (95% confidence interval [CI], 24.25-28.85) in 2005 to 37.92% (95% CI, 34.94-40.90) in 2015, and the respective standardized mean decayed, missing, filled teeth (DMFT) index scores increased from 0.50 (standard deviation [SD], 1.04) to 0.83 (SD, 1.45) (P < 0.001). Fujian province had the highest increase in dental caries, followed by Liaoning, Heilongjiang, Hainan, and Yunnan. Results revealed that children who were girls, more frequently experienced dental pain, and had more recent dental visits, had significantly higher DMFT scores after adjusting for the survey year and other variables (all P < 0.05).

Conclusions

Dental caries of 12-year-old children in China deteriorated from 2005 to 2015, particularly in the northeast and southwest regions. Dental caries was associated with sex, dental pain, and dental service utilization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12262-x.

Analysis of the correlation between malocclusion, bad oral habits, and the caries rate in adolescents

BACKGROUND

Malocclusion deformity and caries are common oral diseases in adolescents. In order to explore the correlation between malocclusion deformity and caries prevalence in adolescents, this study analyzed the influence of factors such as poor oral habits on caries in adolescents.

METHODS

In this study, 1,093 adolescents aged 11 to 14 enrolled in 2-3 schools in Zhangjiakou area from September 2020 to June 2021 were selected as the research subjects. The basic data of these adolescents were collected by questionnaires. Malocclusion and caries were examined by on-site inspection. Their bad oral habits were also investigated. After data collection, the chi-square test, logistic regression, the Mann-Whitney U test, and the Kruskal-Wallis H test were used for multivariate analysis.

RESULTS

The results showed that the incidence of malocclusion was 72.66% and the caries rate was 68.8% among adolescents aged 11-14 in this area. The 4 bad oral habits of biting, mandibular protrusion, lateral chewing, and mouth breathing were the influencing factors of malocclusion in adolescents. Bad oral habits, malocclusion, and frequent consumption of sugary beverages were independent risk factors for caries in adolescents, and significantly positively correlated with the caries rate.

CONCLUSIONS

Malocclusion and the four bad oral habits were independent risk factors of caries in adolescents.

Childhood Factors and Dental Caries in the Permanent Dentition: Findings of an 8-Year Study Under a Nationwide School Dental Service

OBJECTIVE

This study, using a retrospective analysis of nationwide dental records of school-going children over 8 years, aims to identify childhood factors associated with dental caries incidence in the permanent dentition up to adolescence.

METHODS

Students studying in primary and secondary schools in Singapore are eligible for free basic dental care under the nationwide School Dental Service (SDS). All available dental records, general health records, and sociodemographic data from 2009 to 2017 were extracted as anonymised records, for a full cohort of 29,617 students that were enrolled in Primary 1 in 2009. Multiple logistic regression and modified Poisson regression were applied to identify risk factors for caries incidence in the permanent dentition over 8 years.

RESULTS

Caries occurred in the permanent dentition of 9389 (31.7%) students in the 8 years. Risk of caries incidence in the permanent dentition was associated with baseline caries in the primary (risk ratio [RR]: 1.88; 95% CI: 1.81, 1.95) and permanent (RR: 1.54; 95% CI: 1.47, 1.61) dentition, tooth hypoplasia (RR: 1.58; 95% CI: 1.49, 1.68), and poor baseline oral hygiene (RR: 1.07; 95% CI: 1.03, 1.12). Sociodemographic predictors of caries incidence include a lower socioeconomic status, Chinese ethnicity, female gender, and enrolment in nonmainstream schools or schools in the Eastern and Western regions of Singapore.

CONCLUSIONS

Both clinical and sociodemographic factors in childhood are associated with caries incidence in the permanent dentition and can be used for structuring dental service provision and identifying caries-susceptible individuals and groups for early prevention and intervention.

Relationship between the Normative Need for Orthodontic Treatment and Oral Health in Mexican Adolescents Aged 13-15 Years Old

This cross-sectional study aimed to establish a relationship between the Normative Need for Orthodontic Treatment (NNOT) and oral health among Mexican adolescents aged 13–15 years old. A convenience sample of 424 subjects in Mexico City participated in the study. The dependent variable used was NNOT, which was determined via the dental health component (grades 4 and 5) of the Index of Orthodontic Treatment Need (IOTN). The variables for oral health were as follows: caries experience, oral hygiene, self-reported temporomandibular joint pain, and self-reported bruxism. Logistic regression models were fitted to determine the association between NNOT and oral health. The prevalence of NNOT was 66.0% (280/424), and the crowding was the most prevalent occlusal anomaly with 36.1% (n = 135). Multivariate models showed that subjects with NNOT were more than twice as likely to present poor hygiene (OR = 2.56; p = 0.001) as subjects presenting crowding (>4 mm) (OR = 1.99; p = 0.004) and increased overjet (>6 mm) (OR = 1.74; p = 0.046). Those schoolchildren who presented anterior guidance were 72% less likely to present NNOT (OR = 0.28; p < 0.001). In conclusion, the risk of presenting NNOT in Mexican adolescents is high, with a prevalence of over 50% of which the most prevalent occlusal anomaly was crowding. On the other hand, poor oral hygiene was associated with crowding and increased overjet.

Impact of Lifestyle Variables on Oral Diseases and Oral Health-Related Quality of Life in Children of Milan (Italy)

A large part of the Italian population doesn’t receive adequate information and support on how to maintain oral health. In this observational, cross-sectional, pilot study, we investigated how some lifestyle-related variables affect oral diseases and oral health-related quality of life (OHRQoL) of children attending public-school summer services in Milan. A survey that included questions on children’s oral disease, OHRQoL and lifestyle-related factors (feeding habits, oral hygiene protective behaviors, dental coaching and socio-economic and educational status), was administered to the children’s caregivers. Data from 296 surveys were analyzed to assess the protective/negative effect of each variable on oral disease and OHRQoL. With respect to disease, the “never” consumption of fruit juice, the use of fluoride toothpaste, higher educational qualification and ISEE (equivalent family income) of those who filled out the form, resulted protective factors. Regarding OHRQoL, the “never” assumption/use of tea bottle, sugared pacifier and fruit juice as well as the use of fluoride toothpaste, a higher educational qualification and ISEE of those who filled out the form, resulted to have protective effects. In conclusion, protective behaviors and socio-economic status affect oral disease and OHRQoL in children of Milan.

Child Caries Management: A Randomized Controlled Trial in Dental Practice

This multicenter 3-arm, parallel-group, patient-randomized controlled trial compared clinical effectiveness of 3 treatment strategies over 3 y for managing dental caries in primary teeth in UK primary dental care. Participants aged 3 to 7 y with at least 1 primary molar with dentinal carious lesion were randomized across 3 arms (1:1:1 via centrally administered system with variable-length random permuted blocks): C+P, conventional carious lesion management (complete carious tooth tissue removal and restoration placement) with prevention; B+P, biological management (sealing in carious tooth tissue restoratively) with prevention; and PA, prevention alone (diet, plaque removal, fluorides, and fissure sealants). Parents, children, and dentists were not blind to allocated arm. Co–primary outcomes were 1) the proportion of participants with at least 1 episode of dental pain and/or infection and 2) the number of episodes of dental pain and/or infection during follow-up (minimum, 23 mo). In sum, 1,144 participants were randomized (C+P, n = 386; B+P, n = 381; PA, n = 377) by 72 general dental practitioners, of whom 1,058 (C+P, n = 352; B+P, n = 352; PA, n = 354) attended at least 1 study visit and were included in the primary analysis. The median follow-up was 33.8 mo (interquartile range, 23.8 to 36.7). Proportions of participants with at least 1 episode of dental pain and/or infection were as follows: C+P, 42%; B+P, 40%; PA, 45%. There was no evidence of a difference in incidence of dental pain and/or infection when B+P (adjusted risk difference [97.5% CI]: −2% [−10% to 6%]) or PA (4% [−4% to 12%]) was compared with C+P. The mean (SD) number of episodes of dental pain and/or infection were as follows: C+P, 0.62 (0.95); B+P, 0.58 (0.87); and PA, 0.72 (0.98). Superiority could not be concluded for number of episodes between B+P (adjusted incident rate ratio (97.5% CI): 0.95 [0.75 to 1.21]) or PA (1.18 [0.94 to 1.48]) and C+P. In conclusion, there was no evidence of a difference among the 3 treatment approaches for incidence or number of episodes of dental pain and/or infection experienced by these participants with high caries risk and established disease (trial registration: ISRCTN77044005).

Family characteristics on self-reported toothache among Indonesian children aged 12–14 years

Objective

Toothache was reported as a reason for school absenteeism, sleeping difficulties, loss of appetite, and seeking dental treatment among children. These represented some impacts of dental problems on health, quality of life, and socioeconomic problems. The aims of this study were to describe the prevalence of toothache among 12–14-year-old children in Indonesia and their family characteristics and to analyze the associations of family characteristics on the toothache.

Methods

We analyzed the data from the Indonesian Family Life Survey 5 in 2014–2015. A total of 2,377 children aged 12–14 years were included in this survey. This age is the early stage of eruption of all permanent teeth. Children were asked about their experience on toothache in the last 4 weeks as a dependent variable. The independent variables were the family socioeconomic characteristics including father's and mother's highest educational level, family income, and the number of children in the family. A logistic regression was applied to analyze the relationship of family characteristics with toothache experience of children.

Results

Toothache experience was reported from 13.9% of the respondents. Descriptive statistics showed that higher percentages of toothache were experienced by male children and children from family with lower parental education and economic position as well as from bigger family. However, logistic regression showed that only the number of children in the family had a statistically positive association with self-reported toothache of the children. Children living in the family with more than four children were more likely reported toothache than living in the family with one or two children (P=0.012; odds ratio [OR]=1.53). Children living with more siblings may experience less attention from their parents on oral health hygiene. Poor oral health habits could result in dental pain.

Conclusions

Descriptive statistics showed that a higher percentage of toothache was experienced by children from lower socioeconomic families, although the only significant association was the number of children in the family.

Inequalities in oral health among adolescents in Gangneung, South Korea

Background

This study aims to evaluate inequality in oral health among adolescents and to explain the mechanisms of such inequalities in Gangneung, South Korea.

Methods

One thousand two hundred sixty-seven students in their first year from four vocational and three general schools participated in the baseline survey of 2011, and 84.7% of them were surveyed again in 2013. Oral examinations by the same dentist and a self-administered questionnaire were repeated during both waves. Outcome measure for oral health was the existence of untreated dental caries (DT). As socioeconomic position (SEP) indicators, school type (general vs. vocational), father’s and mother’s education, perceived economic status, and Family Affluence Scale (FAS) were measured. Variables measuring oral health related behaviours included tooth brushing frequency, frequency of eating snacks and drinking sodas, smoking, and annual visits to dental clinics. Chi-square tests and panel logistic regression were adopted to examine the associations between dental caries and SEP indicators by STATA version 15.1.

Results

Having a less educated father and attending a vocational school were significant predictors for untreated caries after controlling for SEP indicators. However, students from general schools, higher SEP by father’s education, perceived economic status, or FAS, or having non-smoking experience or annual visits to dental clinics were more likely to stay caries-free.

Conclusions

There were socioeconomic inequalities in oral health on an adolescent panel. Given that oral health status during adolescents can persist throughout the course of a person’s life, intervention to tackle such inequalities and school environments are required.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0533-3) contains supplementary material, which is available to authorized users.

Association between malocclusion and dental caries in adolescents: a systematic review and meta-analysis

AIM

To evaluate the scientific evidence regarding the association between malocclusion and dental caries in adolescents.

METHODS

Searches were conducted of six electronic databases, complemented by manual searching of the reference lists of the selected articles and grey literature. Two independent reviewers performed the selection of the articles, data extraction and the evaluation of the risks of bias through an assessment of methodological quality. Meta-analysis was performed considering the mean decayed, missing and filled teeth (DMFT) index for caries and the Dental Aesthetic Index (DAI) for malocclusion. Heterogeneity was tested using the I² statistic and a random effect model was employed. Summary effect measures were calculated as differences in means.

RESULTS

The initial search retrieved 2644 studies, only 15 of which were selected for full-text analysis. Four cross-sectional studies were included in the qualitative systematic review. Only one of these studies found no association between malocclusion and dental caries. The meta-analysis of three studies demonstrated that a lower DAI value was significantly associated with a lower mean DMFT index, except for the comparison of DAI 26-30 vs. 31-35.

CONCLUSIONS

Based on the studies analysed, the scientific evidence indicates an association between malocclusion and dental caries.

Examining caries aetiology in adolescence with structural equation modelling

OBJECTIVES

This analysis examines the aetiology of caries development in adolescents using structural equation modelling to identify behavioural mediators of the relationship between socioeconomic status (SES) and caries incidence, and to investigate the role of sex on caries-preventive behaviour and caries.

METHODS

This analysis was based on data from the Iowa Fluoride Study, a longitudinal study of a birth cohort. We hypothesized that socioeconomic status earlier in life has a direct effect on caries development and an indirect effect from improved behavioural variables-dental visit attendance, toothbrushing frequency and percentage of beverage intake consisting of sugar-sweetened beverages-and that sex also plays a role in behavioural variables, as well as caries. A structural equation model was developed based on these hypotheses, and direct and indirect standardized path coefficients were calculated, as well as their standard errors.

RESULTS

Based on our proposed model, SES at birth significantly influences SES during adolescence, but not adolescent behaviours. The effect of SES during adolescence on caries in the permanent dentition is mediated by adolescent behaviours. Female participants have worse caries than male participants, despite lower self-reported percentages of sugar-sweetened beverage intake and more frequent brushing and dental attendance.

CONCLUSIONS

This analysis models the relationships among known causal factors for caries and suggests that the role of SES in caries may not be as important as previously thought and different behaviours that affect oral health between males and females as well as differences in caries between the sexes could begin during adolescence. These findings could help improve caries prevention programmes for adolescents.