Caries experience among children born after a complicated pregnancy

Maternal smoking during pregnancy and early childhood dental caries in children: a systematic review and meta-analysis

BACKGROUND

Early childhood dental caries, or ECC, is a significant global oral health concern associated with various adverse outcomes. This systematic review and meta-analysis aimed to investigate the potential link between maternal smoking during pregnancy and the occurrence of dental caries in children.

METHOD

Through a comprehensive search of PubMed, Scopus, and Google Scholar databases for studies examining the correlation between maternal smoking during pregnancy and childhood caries, we identified 609 relevant articles up to October 2023. Studies were selected, and data extraction was based on the pre-established eligibility criteria and items. Meta-analysis was executed utilizing Comprehensive Meta-analysis (CMA) with a random effects model, ensuring a robust synthesis of the gathered evidence.

RESULT

7 cohorts and five cross-sectional studies, totaling 12 studies, were included in our analysis. The combined results from the studies revealed a significant association between maternal smoking during pregnancy and an increased risk of dental caries in children (OR = 1.78, 95% CI = 1.55-2.05, I2 = 68.53). Sensitivity analyses confirmed the reliability of our results. However, there were indications of publication bias, as suggested by the funnel plot and Egger's test (P = 0.011) concerning the connection between prenatal smoking and childhood caries.

CONCLUSION

This review underscores the association between maternal smoking during pregnancy and childhood dental caries. Nevertheless, confounding variables influence this link, necessitating more large-scale, longitudinal studies with adjusted factors. Additional randomized control trials are needed to validate these findings due to the observed heterogeneity. Future research should investigate the precise reasons behind this association. It is essential to raise awareness among pregnant women about the risks of smoking through educational programs.

Oral and craniofacial research in the Generation R study: an executive summary

OBJECTIVES

Oral conditions are of high prevalence and chronic character within the general population. Identifying the risk factors and determinants of oral disease is important, not only to reduce the burden of oral diseases, but also to improve (equal access to) oral health care systems, and to develop effective oral health promotion programs. Longitudinal population-based (birth-)cohort studies are very suitable to study risk factors on common oral diseases and have the potential to emphasize the importance of a healthy start for oral health. In this paper, we provide an overview of the comprehensive oral and craniofacial dataset that has been collected in the Generation R study: a population-based prospective birth cohort in the Netherlands that was designed to identify causes of health from fetal life until adulthood.

METHODS

Within the multidisciplinary context of the Generation R study, oral and craniofacial data has been collected from the age of 3 years onwards, and continued at the age of six, nine, and thirteen. Data collection is continuing in 17-year-old participants.

RESEARCH OUTCOMES

In total, the cohort population comprised 9749 children at birth, and 7405 eligible participants at the age of seventeen. Based on questionnaires, the dataset contains information on oral hygiene, dental visits, oral habits, oral health-related quality of life, orthodontic treatment, and obstructive sleep apnea. Based on direct measurements, the dataset contains information on dental caries, developmental defects of enamel, objective orthodontic treatment need, dental development, craniofacial characteristics, mandibular cortical thickness, and 3D facial measurements.

CONCLUSIONS

Several research lines have been set up using the oral and craniofacial data linked with the extensive data collection that exists within the Generation R study.

CLINICAL RELEVANCE

Being embedded in a multidisciplinary and longitudinal birth cohort study allows researchers to study several determinants of oral and craniofacial health, and to provide answers and insight into unknown etiologies and oral health problems in the general population.

The association of maternal smoking and other sociobehavioral factors with dental caries in toddlers: A cross-sectional study

Background

Severe early childhood caries (S-ECC) is a form of dental caries in toddlers, which can strongly affect general health and quality of life. Studies on factors that can contribute to the development of caries immediately after tooth eruption are sparse. The aim of this study was to assess the role of sociobehavioural factors and pre- and postnatal exposure to tobacco smoke in the aetiology of dental caries in children up to 3 years old.

Methods

A cross-sectional study was conducted between 2011 and 2017 to assess oral health and teething in urban children 0-4 years of age. The number of teeth and surfaces with white spot lesions (d_1,2), as well as decayed (d), missing (m), and filled (f) teeth classified according to ICDAS II was evaluated in a dental office setting. d_1,2dmft and d_1,2dmfs were calculated. Severe early childhood caries was diagnosed for d_1,2dmfs > 0. Parents completed a self-administered questionnaire on socioeconomic factors, maternal health, course of pregnancy, child's perinatal parameters, hygiene and dietary practices, as well as maternal smoking during and after pregnancy. Data on children aged 12-36 months were collected and analysed statistically using the t-test, Spearman rank correlations and Poisson regression. Significance level was set at 0.05.

Results

Dental caries was found in 46% of 496 children aged 12-36 months. Mean d_1,2dmft and d_1,2dmfs were 2.62 ± 3.88 and 4.46 ± 8.42, respectively. Tobacco smoking during and after pregnancy was reported by 8.9% and 24.8% of women, respectively. Spearman's rank correlation analysis confirmed a relationship between S-ECC and parental education, maternal smoking, bottle feeding, avoiding springy foods, number of meals, and the age of tooth brushing initiation. Pre- and postnatal exposure to tobacco smoke increased the risk of S-ECC especially in children in age 19-24 months. Maternal smoking was correlated with the level of education and dietary practices.

Conclusion

Our study confirmed that prenatal smoking is associated with increased risk of severe-early childhood caries (S-ECC) while the association with post-natal smoking is also evident, the increase in risk is not statistically clear. Both maternal smoking and the child's tooth decay are associated with poor parental education and other improper oral health behaviours. The positive impact of quitting smoking on the oral health in children should be part of anti-smoking advice.

The association between low birth weight and/or preterm birth and dental caries -A systematic review and meta-analysis

BACKGROUND

Studies on the association between adverse birth outcomes and dental caries in children have shown conflicting results, so the aim of this systematic review and meta-analysis was to investigate the association between adverse birth outcomes and dental caries in children.

METHODS

We systematically searched articles in four electronic databases (Web of Science, PubMed, Cochrane Library and Embase) published prior to August 2021. The odds ratio (OR) (or converted OR) and the corresponding 95% confidence intervals (95% CI) were processed. The certainty of evidence was assessed using GRADE's risk bias assessment tool. Random effects model was used for this meta-analysis.

RESULTS

A total of thirty-one observational studies met the inclusion criteria. The pooled estimates indicated that children exposed to low birth weight (LBW)/preterm birth (PTB) did not experience higher dental caries in primary teeth. Subgroup analyses showed that children with LBW (OR: 1.30, 95% CI: 1.03-1.63) were prone to have dental caries in primary teeth for cross-sectional studies, but no significant differences for prospective studies. PTB children experienced more primary caries in high-income countries (OR: 1.31, 95% CI: 1.00-1.70) than in low- and middle-income countries.

CONCLUSIONS

The current evidence did not suggest a significant association between LBW and dental caries in children for primary teeth. Children with PTB in high-income countries had a higher prevalence of primary dental caries. Further prospective studies should adjust for confounding factors (age, oral health and family finances) to determine the definitive association between LBW/PTB and dental caries.

Caries experience among children born after a complicated pregnancy

Objectives

Behavioural and lifestyle factors, as oral hygiene and diet, are well‐established risk factors in the pathogenesis of dental caries, though displaying large differences in susceptibility across individuals. Since enamel formation already starts in utero, pregnancy course and outcome may eventually play a role in enamel strength and caries susceptibility. Therefore, we studied the association between history of pregnancy complications and the caries experience in their six‐year‐old children. The pregnancy complications included small for gestational age (SGA), spontaneous preterm birth (sPTB), gestational hypertension (GH), pre‐eclampsia (PE), individually, and a combination of those, designated as placental syndrome.

Methods

This study was embedded in Generation R, a prospective longitudinal Dutch multiethnic pregnancy cohort study. Information about pregnancy complications was obtained from questionnaires completed by midwives and obstetricians with cross‐validation in medical records. These included SGA, sPTB, GH and PE. Caries experience was assessed with the decayed, missing and filled teeth (dmft) index at a mean age of six years. The association between dental caries experience and a history of pregnancy complications was studied by using hurdle negative binomial (HNB) models.

Results

We were able to assess the dmft index in 5323 six‐year‐old children (mean age 6.2 years, SD 0.5). We did not find an association between the different pregnancy complications and dental caries experience in childhood, whether for SGA, sPTB, GH, PE, or for the combined outcome placental syndrome (HNB estimates: OR 1.02, 95%CI 0.87 ‐ 1.19; RR 0.90, 95%CI 0.78 ‐ 1.04). Further adjustment of the models with different confounders did not alter the outcome.

Conclusions

Although it is expected that prenatal stress can be a risk factor for caries development later in life, our findings do not support this hypothesis. Therefore, we believe disparities in caries experience between children are probably not explained by early life events during a critical intrauterine period of development.