Examining caries aetiology in adolescence with structural equation modelling

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.

Structural Relationships between Asthma and Dental Caries in Children: A Birth Cohort Study in Southern Brazil

INTRODUCTION

There is an inconclusive causal association between asthma symptoms and dental caries in the primary dentition. This study aimed to investigate, using SEM (structural equation modeling), a possible causal relation between asthma and dental caries in the primary dentition.

METHODS

Using data from the 2004 Pelotas Birth Cohort Study, a sub-sample of 1,303 individuals was selected. Dental caries was clinically evaluated at 5 years old based on decayed, missing, and filled tooth (dmft) index criteria. Asthma-related symptoms (wheezing and shortness of breath) at 1- and 4-year-olds composed a latent variable and were the main exposures to caries occurrence. SEM was used to identify possible direct, indirect, and mediated effects of asthma in primary dentition dental caries.

RESULTS

The general prevalence of caries at age 5 was 1.95 (SD: 3.56). When comparing the dmft values for children with asthma symptoms and those without, they presented similar values in both periods where asthma symptoms were evaluated (1- and 4-year-old). SEM analysis showed that asthma was neither directly nor indirectly related to dental caries.

CONCLUSION

Asthma, using a latent variable constructed based on asthma symptoms, showed no causal effect on dental caries occurrence in the primary dentition.

Factors associated with a cariogenic diet among adolescents: a structural equation modeling approach

OBJECTIVE

To investigate the factors directly and indirectly associated with a cariogenic diet among southern Brazilian adolescents.

MATERIALS AND METHODS

This cross-sectional study included 15-19-year-old students attending high schools in Santa Maria, southern Brazil. The participants completed a questionnaire on sociodemographic and behavioral variables. The Oral Health Impact Profile-14 was applied to collect data on oral health-related quality of life (OHRQoL). Clinical examination was used to assess the dental caries status (decayed, missing, and filled teeth index). A cariogenic diet was considered a latent variable measured by the self-perception of a healthy diet and the frequency of consumption of sugary foods and drinks. Structural equation modeling was used to analyze the direct and indirect pathways to a cariogenic diet.

RESULTS

A total of 1197 adolescents were included. Low toothbrushing frequency (standardized coefficient (SC), 0.10; p < 0.05), cigarette smoking (SC, 0.15; p < 0.01), and alcoholic beverages (SC, 0.14; p < 0.01) were directly linked to a cariogenic diet, which, in turn, was directly linked to untreated dental caries (SC, 0.18; p < 0.01) and poor OHRQoL (SC, 0.16; p < 0.01). In addition, household income (via toothbrushing frequency) and age (via alcoholic beverages) were indirectly linked to a cariogenic diet.

CONCLUSION

A cariogenic diet was consistently associated with a range of unhealthy behaviors during adolescence as well as poor household income.

CLINICAL RELEVANCE

Health promotion strategies to restrict sugar consumption and encourage healthier lifestyles should be aware of the synergism observed among unhealthy behaviors during adolescence.

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.

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.

Dental caries spectrum profile in Brazilian public school children and adolescents

Dental caries remains a major public health problem, with a higher prevalence among in adolescence. The present study aimed to assess the dental caries spectrum profile in children and adolescents in Brazilian public schools. A cross-sectional study was performed in two public schools in Brazil to examine the permanent teeth of children and adolescents. The dental caries were assessed by applying the Caries Assessment Spectrum and Treatment (CAST) instrument, and the results were distributed as per disease status (healthy/codes 0-2; pre-morbidity/code 3; morbidity/code 4-5; severe morbidity/codes 6-7; mortality/code 8) and by severity as per the CAST-F1 formula (no severity, mild, moderate, and severe). The CAST data were described by age groups (8-9 y, 10-11 y, 12-13 y, 14-15 y, 16-17 y, and 18-19 y). The Kruskal-Wallis test was used to investigate differences in CAST prevalence and severity among the groups (p < 0.05). Total 598 students were enrolled. Most of the subjects were male (53.34%) and belonged to the age group of 12-13 y (34.95%). The variables CAST 0/1 (p = 0.024), CAST (p = 0.024), and CAST-F1 (p = 0.029) showed significant differences among age groups, and the post hoc test showed the differences in these variables as per the age groups of 14-15 y and 16-17 y (CAST 0/1, p = 0.047; CAST, p = 0.047; CAST-F1, p = 0.033). The dental caries spectrum increased from 8 to 19 y with a peak in the prevalence and severity in the middle of adolescence.

Implementation fidelity of school oral health programs at a District in South Africa

BACKGROUND

It is important that components contributing to success of a program are well understood to ensure better outcomes and strengthen interventions. Hence the purpose of the study was to assess the level of fidelity achieved by school oral health programs in our study district and to determine elements of fidelity that predict the risk of dental decay.

METHODS

A cross-sectional study design was utilised. A multistage sampling technique was employed to randomly select 10 schools, two grades in each school were selected and all pupils in the selected grades were included in an oral health examination. Ten oral hygienists were observed and interviewed as they carried out the activities of the program and records were reviewed. Data collection tools included an oral health examination form, and an implementation fidelity checklist.

RESULTS

The average level of fidelity obtained was 40% and it was shown to be inversely correlated with levels of decay, as decay was predicted to decrease with increasing levels of fidelity. The fidelity elements that were found to directly predict the outcome of decay included duration (IRR, 0.49; p = 0.02) coverage (IRR, 0.54; p = 008), content (IRR, 1.36; p = 0.03) and age (IRR, 2.14; p = 0.00). Moderating factors of fidelity which indirectly influenced the outcome of decay included facilitation strategy, duration and age. These were predicted to reduce the risk of decay by 92%, 83% and 48% respectively.

CONCLUSION

The school oral health programs exhibited high levels of pupil coverage, however, the content of the programs offered was low (28%). Coverage was high in the context of lack of dental assistance and time. Multi-sectoral participation is therefore necessary to re-organise the program for improving implementation fidelity and bringing about quality implementation.

Carious lesion severity and demarcated hypomineralized lesions of tooth enamel in schoolchildren from Melbourne, Australia

BACKGROUND

Developmental hypomineralized lesions of enamel (DHL) may represent a significant caries-risk factor. The aim of this study was to determine the association between carious lesion severity and DHL in 6- to 12-year-old schoolchildren from Melbourne, Australia.

METHODS

The sample was derived from randomly selected schools in inner Melbourne. A full dental examination was performed at the school. Socio-demographic data, caries experience (DMFT/dmft/ICDAS II) and the consequences of untreated carious lesions (PUFA/pufa) were measured. DHL, molar incisor hypomineralization (MIH) and hypomineralized second primary molar (HSPM) presence were assessed using the European Academy of Paediatric Dentistry (EAPD) criteria.

RESULTS

Of the children examined (n = 327), 26.9% had DHL. The prevalence of MIH and HSPM was 14.7% and 8%, respectively. Almost 20% of children had severe carious lesions (ICDAS 5 & 6) in at least one permanent or primary tooth. Ordinal regression analyses indicated that DHL (OR = 2.17; 95% CI: 1.35-3.49) and being born overseas (OR = 2.59, 95% CI: 1.66-4.06) increased the likelihood of severe carious lesions.

CONCLUSIONS

One of four children had DHL. DHL-affected children had an increased likelihood of presenting untreated severe carious lesions compared with DHL-free children.