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van Meijeren-van Lunteren AW, Liu X, Veenman FCH, Grgic O, Dhamo B, van der Tas JT, Prijatelj V, Roshchupkin GV, Rivadeneira F, Wolvius EB, Kragt L. Oral and craniofacial research in the Generation R study: an executive summary. Clin Oral Investig 2023:10.1007/s00784-023-05076-1. [PMID: 37301790 DOI: 10.1007/s00784-023-05076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/04/2023] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Agatha W van Meijeren-van Lunteren
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Xianjing Liu
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Francien C H Veenman
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Olja Grgic
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Brunilda Dhamo
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Justin T van der Tas
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Vid Prijatelj
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Gennady V Roshchupkin
- The Generation R Study Group, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Fernando Rivadeneira
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Eppo B Wolvius
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Lea Kragt
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
- The Generation R Study Group, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Alkhtib AO, Mohamed HG. Current knowledge about early childhood caries in the gulf cooperation council with worldwide reflection: Scoping review of the scientific literature (2010-2021). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001228. [PMID: 36962836 PMCID: PMC10021236 DOI: 10.1371/journal.pgph.0001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023]
Abstract
Early childhood caries (ECC) is one of the most prevalent chronic childhood diseases affecting the primary teeth of children younger than 6 years of age. The disease etiology is complex and includes social, biological, and dietary factors. This review aims to explore the knowledge of ECC prevalence globally and locally within the Gulf Cooperation Council (GCC) countries during the years 2010-2021. Another aim is to explore oral health promotion programs with more focus on the GCC region. A search was conducted in PubMed, Medline, Scopus, the Cochrane Collaboration database, and Google Scholar to identify relevant studies published between 2010 and 2021 using specific keywords. Studies that utilized both the World Health Organization criteria and International Caries Detection and Assessment System for dental caries assessment were included. The included studies indicated considerable variation in the reported prevalence of ECC. While developed countries show low prevalence, countries in the GCC and other Arab countries show a high prevalence of ECC. Many oral health promotion programs were identified globally including oral health education, nutritional programs, the use of fluoride and pit-and-fissure sealants, and inter-professional population-based oral health promotion and prevention programs such as school-based oral health programs, motivational interviewing, and anticipatory guidance. ECC remains a significant problem in many parts of the world including the GCC region. Oral health prevention programs have been established within the GCC region. Nevertheless, the GCC region has some unique characteristics that need to be investigated to contextualize the western model of the dynamics of ECC prevention and promotion programs locally.
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Hultquist AI, Brudin L, Bågesund M. Early childhood caries risk assessment in 1-year-olds evaluated at 6-years of age. Acta Odontol Scand 2021; 79:103-111. [PMID: 32697607 DOI: 10.1080/00016357.2020.1795247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim was to identify caries risk factors in 1-year-olds predicting dentine caries in 6-year-olds. MATERIALS AND METHODS Caries risk assessment was performed in 804 one-year-olds. Their parents answered a questionnaire, regarding family factors, general health, food habits and oral hygiene. Clinical examinations and caries risk assessments at 1, 3 and 6 years of age were performed. Simple and multiple regression analyses were used for identification of caries-associated factors. RESULTS Caries risk was found in 5% of the 1-year-olds, and 12% of the 3-year-olds. Dentine caries was found in 3% of the 3-year-olds and in 16% of the 6-year-olds. Caries risk assessment was associated with caries at 6 years of age (OR = 5.1, p < .001). Multiple logistic regression analysis found the following variables associated with caries at 6 years of age: Caries in sibling (OR = 2.1, p = .012), Beverage other than water (OR = 2.1, p < .001), Night meal (OR = 1.9, p = .002), Presence of mutans streptococci (MS) (OR = 1.6, p = .033) and Male gender (OR = 1.5, p = .053). An overall caries risk assessment was more reliable than any single caries risk factor. CONCLUSIONS Caries risk assessment for 1-year-olds in a region with low caries prevalence has limited accuracy to predict dental caries at 6 years of age. Caries risk often changes over time and should be reassessed on a regularly basis. The presence of MS in 1-year-olds did not increase the prognostic accuracy at 6 years of age.
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Affiliation(s)
- Ann Ingemansson Hultquist
- Västervik Public Dental Service, Kalmar County Council, Kalmar, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Region Kalmar Council, Kalmar, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Mats Bågesund
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Orthodontics and Pediatric Dentistry, Norrköping, Sweden
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Abdalla HE, Abuaffan AH, Kemoli AM. Molar incisor hypomineralization, prevalence, pattern and distribution in Sudanese children. BMC Oral Health 2021; 21:9. [PMID: 33407385 PMCID: PMC7789559 DOI: 10.1186/s12903-020-01383-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Molar incisor hypomineralization (MIH) has serious impact on oral health-related quality of life for a child, due to its effects on tooth structure, aesthetics and behavior of the child. The current study was designed to determine the prevalence, pattern and distribution of MIH in school children in Sudan. METHODS This was a descriptive cross-sectional study involving 568 children, aged 8-11 years from schools in Khartoum State. Following the collection of their socio-demographic data, the children were examined for hypomineralization on the 12 MIH-index teeth, the pattern and distribution of the MIH. The data collected was analyzed to obtain descriptive statistics. The results related to the socio-demography and other dental-related factors were tested using chi-square test and Spearman Rank Correlation, with the significant level set at p < 0.05. RESULTS The prevalence of MIH in the study population was 20.1%. The majority of the participants had both permanent first molars (PFMs) and permanent incisors affected (12.5%). However, in 7.6% of the cases only molars were affected. Even though more maxillary teeth were affected when compared to the mandibular teeth, there was no statistical significant difference between the occurrence of hypomineralization on mandibular and maxillary molars (p = 0.22). Maxillary incisors were significantly more affected by MIH when related to the mandibular ones (p = 0.00). Demarcated opacities were the commonest pattern of MIH defects (69.9%) in the experimental group. CONCLUSION The prevalence of MIH in Sudanese children was 20.1%. In both dental arches, the permanent molars and incisors were frequently affected, with the demarcated opacity type of MIH being the most common form of defect.
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Affiliation(s)
- Hanna E. Abdalla
- Department of Orthodontic, Paedodontic and Preventive Dentistry, Faculty of Dentistry, University of Khartoum, P.O. Box 102, Khartoum, Sudan
| | - Amal H. Abuaffan
- Department of Orthodontic, Paedodontic and Preventive Dentistry, Faculty of Dentistry, University of Khartoum, P.O. Box 102, Khartoum, Sudan
| | - Arthur Musakulu Kemoli
- Department of Paediatric Dentistry and Orthodontocs, University of Nairobi, P.O. Box 34848, Nairobi, 00100 Kenya
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van der Tas JT, Wolvius EB, Kragt L, Rivadeneira F, Moll HA, Steegers EAP, Schalekamp-Timmermans S. Caries experience among children born after a complicated pregnancy. Community Dent Oral Epidemiol 2020; 49:225-231. [PMID: 33219527 PMCID: PMC8246927 DOI: 10.1111/cdoe.12593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 01/27/2023]
Abstract
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.
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Affiliation(s)
- Justin T van der Tas
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eppo B Wolvius
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lea Kragt
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric A P Steegers
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sarah Schalekamp-Timmermans
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Structural and chemical enamel characteristics of hypomineralised second primary molars. Eur Arch Paediatr Dent 2020; 22:361-366. [DOI: 10.1007/s40368-020-00557-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/19/2020] [Indexed: 01/23/2023]
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Prevalence of Caries and Associated Risk Factors in a Representative Group of Preschool Children from an Urban Area with High Income in Milan Province, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103372. [PMID: 32408678 PMCID: PMC7277466 DOI: 10.3390/ijerph17103372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/03/2020] [Accepted: 05/08/2020] [Indexed: 12/12/2022]
Abstract
The present survey provides a quantitative assessment of caries prevalence, covering a group of 3–5 year-old children from an urban area generally with a high income in the province of Milan, and a comparison of the obtained results with the data presented by the W.H.O. A cross-sectional study was conducted in the period from March to September 2018 to investigate the prevalence of caries in a sample of 160 children (82 females and 78 males). The absence/presence of caries was defined as a dependent variable. Factors concerning lifestyle, diet, oral habits, oral hygiene, the presence and type of malocclusion and mouth breathing attitude were considered as risk factors. Data were analyzed by Chi-square (χ2) and regression tests using SPSS (version 25.0) software. In total, 84.38% of children (135 out of 160) showed no caries. A regression analysis demonstrated that children who had already received an early first dental visit were mostly those already affected by caries. Furthermore, children who had four meals daily or more were less exposed to the risk of developing caries compared to those who had only 1–3 meals daily. The caries prevalence of preschool children from urban areas with a high income in Milan province is relatively close to that considered acceptable by the W.H.O. in its proposed goals for the year 2020. Therefore, it can be concluded from the obtained results that there is a possibility for further improvement in preventing caries growth at its initial stage: it is necessary for the number of meals daily consumed by children to be controlled by parents, and conducting a dental visit early in childhood must not be neglected.
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Elger W, Illge C, Kiess W, Körner A, Kratzsch J, Schrock A, Hirsch C. Relationship between deciduous molar hypomineralisation and parameters of bone metabolism in preschool children. Int Dent J 2020; 70:303-307. [PMID: 32043580 DOI: 10.1111/idj.12550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/24/2019] [Accepted: 12/02/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The aetiology of deciduous molar hypomineralisation (DMH) is still largely unknown. AIM The aim of the study was to elucidate the occurrence of DMH as a function of the parameters of bone metabolism, as it is suspected that abnormalities in these parameters may affect the mineralisation of teeth. DESIGN In a prospective cohort study, 958 children aged 1-6 years were examined. The inclusion criteria were: a blood sample to determine the parameters of bone metabolism; and documentation of enamel mineralisation using the European Academy of Paediatric Dentistry (EAPD) criteria. Multivariable methods were applied to analyse the incidence of DMH relative to the concentrations of serum calcium, phosphate, vitamin D, vitamin B12 and alkaline phosphatase, taking into account the effects of age, gender and height. RESULTS The proportion of children diagnosed with DMH was 4.0% (38 of 958). A significant difference between DMH-affected and non-DMH-affected children was found only in the serum concentration of calcium (2.47 ± 0.08 mmol/l vs. 2.52 ± 0.10 mmol/l, respectively, P = 0.004). The risk of DMH significantly increased, by 1.63-fold (95% CI: 1.03-2.57), if the calcium level dropped by 0.1 mmol/l, regardless of age, gender or adjusted height. During the follow-up examination of 17 DMH-affected subjects, the calcium level remained consistently low 1 year later (t-test, P > 0.05). CONCLUSION Children with DMH showed consistently subclinically lower serum calcium levels. No associations were found for other parameters.
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Affiliation(s)
- Wieland Elger
- Department of Pediatric Dentistry, University of Leipzig, Leipzig, Germany.,LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Christina Illge
- Department of Pediatric Dentistry, University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), University of Leipzig, Leipzig, Germany
| | - Antje Körner
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), University of Leipzig, Leipzig, Germany
| | - Jürgen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Annett Schrock
- Department of Pediatric Dentistry, University of Leipzig, Leipzig, Germany
| | - Christian Hirsch
- Department of Pediatric Dentistry, University of Leipzig, Leipzig, Germany.,LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
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Alkhubaizi Q, Moule A, Al-Sane M, Sorkin JD. Oral health practices and knowledge among parents and hired caregivers. Eur Arch Paediatr Dent 2018; 19:403-410. [DOI: 10.1007/s40368-018-0372-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/12/2018] [Indexed: 11/28/2022]
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Silva MJ, Kilpatrick NM, Craig JM, Manton DJ, Leong P, Burgner D, Scurrah KJ. Etiology of Hypomineralized Second Primary Molars: A Prospective Twin Study. J Dent Res 2018; 98:77-83. [PMID: 30074848 DOI: 10.1177/0022034518792870] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The etiology of hypomineralized second primary molars (HSPM) is unclear, but genetic and environmental factors have been proposed. The aim of this study was to investigate the relative contribution of genes and environment to the etiology of HSPM and to identify potential environmental risk factors in a longitudinal twin cohort. Children from twin pregnancies ( N = 250) were recruited antenatally, and detailed demographic, health, and phenotypic data were collected at recruitment, 24- and 36-wk gestation, birth, and 18 mo of age. 25-Hydroxyvitamin D was quantified for mothers at 28-wk gestation and infants at birth. Dental examinations were conducted on the twins at 6 y of age to determine the presence, severity, and extent of HSPM per standardized criteria. To investigate associations of environmental risk factors with HSPM, multiple logistic regression models were fitted with generalized estimating equations to adjust for twin correlation. Within- and between-pair analyses were performed for unshared continuous variables: birthweight and birth 25-hydroxyvitamin D. Twin-twin concordance for monozygotic (MZ) and dizygotic (DZ) pairs was calculated and compared after adjusting for identified risk factors. A total of 344 twins underwent the 6-y-old dental assessment; HSPM occurred in 68 (19.8%). After adjusting for potential confounders, vitamin D levels at birth, infantile eczema, dizygosity, in vitro fertilization, socioeconomic position, and maternal smoking beyond the first trimester of pregnancy demonstrated the strongest associations with HSPM. Overall concordance for HSPM was 0.47 (95% CI, 0.32 to 0.62) with weak evidence ( P = 0.078) of higher concordance in MZ twins (0.63; 95% CI, 0.38 to 0.89) as compared with DZ twins (0.41; 95% CI, 0.24 to 0.58). After adjusting for known risk factors, there was no evidence ( P = 0.172) for an additive genetic influence. These findings suggest that shared and unshared environmental factors, such as maternal smoking later in pregnancy and infantile eczema, are important in the etiology of HSPM.
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Affiliation(s)
- M J Silva
- 1 Plastic Surgery Research, Murdoch Children's Research Institute, Parkville, Australia.,2 Department of Paediatrics, University of Melbourne, Australia
| | - N M Kilpatrick
- 1 Plastic Surgery Research, Murdoch Children's Research Institute, Parkville, Australia.,2 Department of Paediatrics, University of Melbourne, Australia
| | - J M Craig
- 3 Centre for Molecular and Medical Research, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia.,4 Environmental and Genetic Epidemiology Research, Murdoch Children's Research Institute, Parkville, Australia
| | - D J Manton
- 5 Melbourne Dental School, University of Melbourne, Australia
| | - P Leong
- 2 Department of Paediatrics, University of Melbourne, Australia.,4 Environmental and Genetic Epidemiology Research, Murdoch Children's Research Institute, Parkville, Australia
| | - D Burgner
- 2 Department of Paediatrics, University of Melbourne, Australia.,6 Department of Paediatrics, Monash University, Clayton, Australia.,7 Susceptibility to Paediatric Infection, Murdoch Children's Research Institute, Parkville, Australia.,8 Infectious Diseases, Royal Children's Hospital, Melbourne, Australia
| | - K J Scurrah
- 1 Plastic Surgery Research, Murdoch Children's Research Institute, Parkville, Australia.,9 Twins Research Australia, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Australia
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Neboda C, Anthonappa RP, King NM. Preliminary investigation of the variations in root canal morphology of hypomineralised second primary molars. Int J Paediatr Dent 2018; 28:310-318. [PMID: 29498121 DOI: 10.1111/ipd.12356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To investigate the root canal morphology of hypomineralised second primary molars(HSPM) using micro-CT(μCT) compared with non-hypomineralised second primary molars (non-HSPM). METHODOLOGY Ten HSPM and 10 non-HSPM were divided into Group 1(maxillary HSPM), Group 2 (mandibular HSPM), Group 3(maxillary non-HSPM), and Group 4 (mandibular non-HSPM). All teeth were scanned using μCT to assess the following parameters: (i) root canal configuration, (ii) pulp volumes, and (iii) the influence of the root canal system landmarks on access cavity outline forms and canal curvature. Two-way ANOVA was employed for descriptive analysis (P < 0.05). RESULTS At the furcation level, there was minimal variation in the number of canals. In the mesiobuccal root, Group 1 showed higher frequency of multiple canals in the middle (85.7%) and apical (85.7%) thirds compared with Group 3. In the mesial root, Group 4 demonstrated multiple canals at the furcation (60%) compared with Group 2(33.3%). In the distal root, Group 2 demonstrated a higher percentage of multiple canals at the apical level (100%) compared with Group 4. The mean pulp volumes of Group 2 and Group 4 were 54.1 mm3 (16.7) and 30 mm3 (5.12), respectively, which was statistically significant (P < 0.05). The canal curvature values did not differ significantly between HSPM and non-HSPM groups. CONCLUSIONS HSPM exhibited greater variations in their root canal configuration when compared to non-HSPM.
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Affiliation(s)
- Chaturi Neboda
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Robert P Anthonappa
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Nigel M King
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
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Decision Tree Approach to the Impact of Parents' Oral Health on Dental Caries Experience in Children: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040692. [PMID: 29642381 PMCID: PMC5923734 DOI: 10.3390/ijerph15040692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 03/21/2018] [Accepted: 04/03/2018] [Indexed: 01/20/2023]
Abstract
Decision tree (DT) analysis was applied in this cross-sectional study to investigate caries experience in children by using clinical and microbiological data obtained from parent–child pairs. Thirty pairs of parents and children were recruited from periodontal and pediatric dental clinics. All participants were clinically examined for caries and periodontitis by a calibrated examiner. Cariogenic and periodontopathic bacteria examinations were conducted. The Kendall rank correlation coefficient was used to measure the association between data variables obtained through clinical and microbiological examinations. A classificatory inductive decision tree was generated using the C4.5 algorithm with the top-down approach. The C4.5 DT analysis was applied to classify major influential factors for children dental caries experience. The DT identified parents’ periodontal health classification, decayed, missing, filled permanent teeth (DMFT) index, periodontopathic test (PerioCheck) result, and periodontal pocket depth as the classification factors for children caries experience. 13.3% of children were identified with a low decayed, missing, filled primary teeth (dmft) index (dmft < 3) whose parents had a periodontal pocket depth ≤3.7, PerioCheck score >1, DMFT index <13.5, and periodontal classification >2. The DT model for this study sample had an accuracy of 93.33%. Here, parental periodontal status and parents’ DMFT were the factors forming the DT for children’s caries experience.
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13
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van der Tas JT, Elfrink MEC, Heijboer AC, Rivadeneira F, Jaddoe VWV, Tiemeier H, Schoufour JD, Moll HA, Ongkosuwito EM, Wolvius EB, Voortman T. Foetal, neonatal and child vitamin D status and enamel hypomineralization. Community Dent Oral Epidemiol 2018; 46:343-351. [PMID: 29493792 PMCID: PMC6446811 DOI: 10.1111/cdoe.12372] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 01/21/2018] [Indexed: 02/05/2023]
Abstract
Objectives Recent literature suggested that higher vitamin D concentrations in childhood are associated with a lower prevalence of molar incisor hypomineralization (MIH). As tooth development already starts in utero, we aimed to study whether vitamin D status during foetal, postnatal and childhood periods is associated with the presence of hypomineralized second primary molars (HSPMs) and/or MIH at the age of six. Methods Our study was embedded in the Generation R Study, a population‐based, prospective cohort from foetal life onwards in Rotterdam, the Netherlands. HSPMs and MIH were scored from intraoral photographs of the children at their age of six. Serum 25(OH)D concentrations were measured at three points in time, which resulted in three different samples; mid‐gestational in mothers’ blood (n = 4750), in umbilical cord blood (n = 3406) and in children's blood at the age of 6 years (n = 3983). Results The children had a mean (±SD) age of 6.2 (±0.5) years at the moment of taking the intraoral photographs. After adjustment for confounders, no association was found between foetal 25(OH)D concentrations and the presence of HSPMs (OR 1.02 per 10 nmol/L higher 25(OH)D, 95% CI: 0.98‐1.07) or MIH (OR 1.05 per 10 nmol/L increase, 95% CI: 0.98‐1.12) in 6‐year‐olds. A higher 25(OH)D concentration in umbilical cord blood resulted in neither lower odds of having HSPM (OR 1.05, 95% CI: 0.98‐1.13) nor lower odds of having MIH (OR 0.95, 95% CI: 0.84‐1.07) by the age of six. Finally, we did not find higher 25(OH)D concentrations at the age of six to be associated with a significant change in the odds of having HSPM (OR 0.97, 95% CI: 0.92‐1.02) or MIH (OR 1.07, 95% CI: 0.98‐1.16). Conclusions 25(OH)D concentrations in prenatal, early postnatal and later postnatal life are not associated with the presence of HPSMs or with MIH at the age of six. Future observational research is required to replicate our findings. Furthermore, it is encouraged to focus on identifying other modifiable risk factors, because prevention of hypomineralization is possible only if the causes are known.
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Affiliation(s)
- Justin T van der Tas
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marlies E C Elfrink
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, Amsterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/psychology, Erasmus University Medical Center/Sophia, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Josje D Schoufour
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Edwin M Ongkosuwito
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eppo B Wolvius
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Trudy Voortman
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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14
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Degree of severity of molar incisor hypomineralization and its relation to dental caries. Sci Rep 2018; 8:1248. [PMID: 29352193 PMCID: PMC5775201 DOI: 10.1038/s41598-018-19821-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/09/2018] [Indexed: 11/19/2022] Open
Abstract
Molar incisor hypomineralization is a developmental defect of dental enamel associated with rapid caries progression. In order to discover whether molar incisor hypomineralization predisposes to dental caries, a cross-sectional cohort study was conducted in a sample of 414 children aged between eight and nine years. It was found that 24.2% of the children presented molar incisor hypomineralization. Of these, 72% had a mild form and 28% a severe form. Caries prevalence was greater among the children with severe form (60.7%) than in those with mild form (43.1%) or no molar incisor hypomineralization (45.5%). The caries indices were higher in out molar incisor hypomineralization (1.18) or with mild form (1.08). The tooth-surface caries ratio was significantly higher in surfaces with severe hypomineralization than in those with no hypomineralization or mild hypomineralization. A linear regression model showed that cariogenic food intake and the presence of severe molar incisor hypomineralization were significantly associated with DMFS. Consequently, an association was found to exist between dental caries and the presence of surfaces affected by severe molar incisor hypomineralization, which should be considered a risk factor within the multifactorial etiology of caries.
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15
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van der Tas JT, Kragt L, Elfrink MEC, Bertens LCM, Jaddoe VWV, Moll HA, Ongkosuwito EM, Wolvius EB. Social inequalities and dental caries in six-year-old children from the Netherlands. J Dent 2017; 62:18-24. [PMID: 28450065 DOI: 10.1016/j.jdent.2017.04.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The purpose of our study was to investigate the association of different socioeconomic and sociodemographic factors with dental caries in six-year-old children. Furthermore, we applied a district based approach to explore the distribution of dental caries among districts of low and high socioeconomic position (SEP). METHODS In our cross-sectional study 5189 six-year-olds were included. This study was embedded in a prospective population-based birth cohort study in Rotterdam, the Netherlands, the Generation R Study. Parental education level, parental employment status, net household income, single parenting, and teenage pregnancy were considered as indicators for SEP. Dental caries was scored on intraoral photographs by using the decayed, missing, and filled teeth (dmft) index. We compared children without caries (dmft=0) to children with mild caries (dmft=1-3) or severe caries (dmft >3). Multinomial logistic regression analyses and binary logistic regression analyses were performed to study the association between SEP and caries, and between district and caries, respectively. RESULTS Only maternal education level remained significantly associated with mild caries after adjusting for all other SEP-indicators. Paternal educational level, parental employment status, and household income additionally served as independent indicators of SEP in children with severe caries. Furthermore, living in more disadvantaged districts was significantly associated with higher odds of dental caries. CONCLUSION Dental caries is more prevalent among six-year-old children with a low SEP, which is also visible at the district level. Maternal educational level is the most important indicator of SEP in the association with caries. CLINICAL SIGNIFICANCE Our results should raise concerns about the existing social inequalities in dental caries and should encourage development of dental caries prevention strategies. New knowledge about the distribution of oral health inequalities between districts should be used to target the right audience for these strategies.
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Affiliation(s)
- Justin T van der Tas
- The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Lea Kragt
- The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Marlies E C Elfrink
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Vincent W V Jaddoe
- The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Epidemiology, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Paediatrics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Henriëtte A Moll
- The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Paediatrics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Edwin M Ongkosuwito
- The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Eppo B Wolvius
- The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
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16
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Costa FS, Silveira ER, Pinto GS, Nascimento GG, Thomson WM, Demarco FF. Developmental defects of enamel and dental caries in the primary dentition: A systematic review and meta-analysis. J Dent 2017; 60:1-7. [PMID: 28347809 DOI: 10.1016/j.jdent.2017.03.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES This systematic review and meta-analysis evaluated the association between developmental defects of enamel and dental caries in the primary dentition. SOURCES Electronic searches were performed in PubMed, Web of Knowledge, Scopus and Scielo for the identification of relevant studies. STUDY SELECTION Observational studies that examined the association between developmental defects of enamel and dental caries in the deciduous dentition were included. Additionally, meta-analysis, funnel plots and sensitivity analysis were employed to synthesize the available evidence. Multivariable meta-regression analysis was performed to explore heterogeneity among studies. DATA A total of 318 articles were identified in the electronic searches. Of those, 16 studies were included in the meta-analysis. Pooled estimates revealed that children with developmental defects of enamel had higher odds of having dental caries (OR 3.32; 95%CI 2.41-4.57), with high heterogeneity between studies (I2 80%). Methodological characteristic of the studies, such as where it was conducted, the examined teeth and the quality of the study explained about 30% of the variability. Concerning type of defect, children with hypoplasia and diffuse opacities had higher odds of having dental caries (OR 4.28; 95%CI 2.24-8.15; OR1.42; 95%CI 1.15-1.76, respectively). CONCLUSIONS This systematic review and meta-analysis demonstrates a clear association between developmental defects of enamel and dental caries in the primary dentition.
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Affiliation(s)
- Francine S Costa
- Postgraduate Program in Dentistry and Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Ethieli R Silveira
- Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.
| | - Gabriela S Pinto
- College in Dentistry, Faculdade Especializada na Área de Saúde do Rio Grande do Sul, Passo Fundo, Brazil.
| | - Gustavo G Nascimento
- Federal University of Pelotas and Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
| | | | - Flávio F Demarco
- Postgraduate Program in Dentistry and Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
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17
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Silva MJ, Kilpatrick N, Crombie F, Ghanim A, Manton D. What's new in molar incisor hypomineralization? ACTA ACUST UNITED AC 2017. [DOI: 10.12968/denu.2017.44.2.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mihiri J Silva
- Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Institute, Melbourne, Australia
| | - Nicky Kilpatrick
- Director, Cleft Services, Royal Children's Hospital, Senior Research Fellow, Murdoch Children's Research Institute, Melbourne, Australia
| | - Felicity Crombie
- PhD Lecturer, Oral Health CRC, Melbourne Dental School, The University of Melbourne, Parkville, Victoria, Australia
| | - Aghareed Ghanim
- PhD Clinical Senior Fellow, Oral Health CRC, Melbourne Dental School, The University of Melbourne, Parkville, Victoria, Australia
| | - David Manton
- Elsdon Storey Chair of Child Dental Health, Oral Health CRC, Melbourne Dental School, The University of Melbourne, Parkville, Victoria, Australia
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18
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Oyedele TA, Folayan MO, Oziegbe EO. Hypomineralised second primary molars: prevalence, pattern and associated co morbidities in 8- to 10-year-old children in Ile-Ife, Nigeria. BMC Oral Health 2016; 16:65. [PMID: 27259516 PMCID: PMC4893208 DOI: 10.1186/s12903-016-0225-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 05/26/2016] [Indexed: 11/29/2022] Open
Abstract
Background This study tries to determine the prevalence and co-morbidities associated with hypomineralised second primary molars (HSPM) in 8- to 10- year-old children in Ile-Ife, Nigeria; and the co-existence of HSPM and Molar Incisor Hypomineralisation (MIH) in the study population. Methods This was a cross sectional study involving 8- to 10- year-old children in schooling in suburban Nigeria. Information was collected on the child's age, sex and socioeconomic status. Intraoral examination was conducted to determine the presence of HSPM, MIH, caries and the oral hygiene status of study participants. The severity of HSPM was also determined. The prevalence of HSPM, the association between HSPM, sex and socioeconomic status of study participants, the difference in the prevalence of caries and poor oral hygiene in children with and without HSPM, and the prevalence of HSPM and MIH co-morbidity were determined. Results Twenty seven of the 469 children examined (5.8 %) had HSPM. The tooth prevalence of HSPM was 3.9 %. There was no significant sex (p = 0.06), age (p = 0.41), and socioeconomic status (p = 0.67) differences between children with HSPM and without HSPM. More children with HSPM had caries (p ≤ 0.001) and poor oral hygiene (p = 0.01). Children with HSPM have increased odds having dental caries (AOR: 6.34; CI: 2.78–14.46; p = <0.001) and reduced odds of having good oral hygiene (AOR: 0.32; CI: 0.13–0.78; p = 0.01) when compare with children without HSPM. Also 77.8 % of children with HSPM also had MIH. Conclusion The prevalence of HSPM in the study population is significantly high. The large number of children with HSPM and MIH also suggests that HSPM is a predisposing factor for MIH. The significantly higher proportion of children with HSPM who had caries and poor oral hygiene makes it imperative to institute screening programmes for HSPM/MIH in the study population.
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Affiliation(s)
- T A Oyedele
- Department of Surgery, Benjamin Carson, Snr, School of Medicine, Babcock University, Ilisan-Remo, Ogun State, Nigeria. .,Dental Department, Babcock University Teaching Hospial, Ilisan-Remo, Ogun State, Nigeria.
| | - M O Folayan
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Department of Child Dental Health, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - E O Oziegbe
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Department of Child Dental Health, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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19
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Mittal R, Chandak S, Chandwani M, Singh P, Pimpale J. Assessment of association between molar incisor hypomineralization and hypomineralized second primary molar. J Int Soc Prev Community Dent 2016; 6:34-9. [PMID: 27011930 PMCID: PMC4784061 DOI: 10.4103/2231-0762.175409] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The term molar incisor hypomineralization (MIH) has been described as a clinical entity of systemic origin affecting the enamel of one or all first permanent molars and also the incisors; less frequently the second primary molars have also been reported to develop hypomineralization of the enamel, along with MIH. Aim: To scrutinize the association between hypomineralized second primary molars (HSPMs) and MIH and their prevalence in schoolgoing pupils in Nagpur, Maharashtra, India and the associated severity of dental caries. Design: A sample of 1,109 pupils belonging to 3–12-year-old age group was included. The entire sample was then divided into Group I (3–5 years) and Group II (6–12 years). The scoring criteria proposed by the European Academy of Pediatric Dentistry for hypomineralization was used to score HSPM and MIH. The International Caries Detection and Assessment System II (ICDAS II) was used for appraising caries status in the hypomineralized molars. The examination was conducted by a single calibrated dentist in schools in daylight. The results, thus obtained, were statistically analyzed using Chi-square test and odds ratio. Result: Of the children examined, 10 in Group I (4.88%) had HSPM and 63 in Group II (7.11%) had MIH in at least one molar. In Group II, out of 63 subjects diagnosed with MIH, 30 subjects (48%) also had HSPM. Carious lesions with high severity were appreciated in hypomineralized molars. Conclusion: The prevalence of HSPM was 4.88% and of MIH was 7.11%. Approximately half of the affected first permanent molars were associated with HSPM. The likelihood of development of caries increased with the severity of hypomineralization defect.
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Affiliation(s)
- Rakesh Mittal
- Department of Pedodontics and Preventive Dentistry, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
| | - Shweta Chandak
- Department of Pedodontics and Preventive Dentistry, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
| | - Manisha Chandwani
- Department of Pedodontics and Preventive Dentistry, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
| | - Prabhat Singh
- Department of Pedodontics and Preventive Dentistry, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
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20
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van der Tas JT, Elfrink MEC, Vucic S, Heppe DHM, Veerkamp JSJ, Jaddoe VWV, Rivadeneira F, Hofman A, Moll HA, Wolvius EB. Association between Bone Mass and Dental Hypomineralization. J Dent Res 2016; 95:395-401. [PMID: 26747420 DOI: 10.1177/0022034515625470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to examine the association between the bone mass (bone mineral content [BMC]) and hypomineralized second primary molars (HSPMs)/molar incisor hypomineralization (MIH) in 6-y-old children. This cross-sectional study was embedded in the Generation R Study, a population-based prospective cohort study, starting from fetal life until adulthood in Rotterdam, Netherlands. The European Academy of Pediatric Dentistry criteria were used to score the intraoral photographs on the presence or absence of HSPMs and MIH. Bone mass was measured with a dual-energy x-ray absorptiometry (DXA) scan. Intraoral photographs and DXA scans were available in 6,510 6-y-old children. Binary logistic regression models were used to study the association between the bone mass and HSPMs/MIH. In total, 5,586 children had their second primary molars assessed and a DXA scan made; 507 children were diagnosed with HSPM. Of 2,370 children with data on their permanent first molars, 203 were diagnosed with MIH. In the fully adjusted model, children with lower BMC (corrected for bone area) were more likely to have HSPMs (odds ratio, 1.13; 95% confidence interval, 1.02 to 1.26 per 1-standard deviation decrease). A lower BMC (corrected for bone area) was not associated with MIH (odds ratio, 1.02; 95% confidence interval, 0.87 to 1.20 per 1-standard deviation decrease). We observed a negative association between BMC (corrected for bone area) and HSPMs. No association was found between BMC (corrected for bone area) and MIH. Future research should focus on investigating the mechanism underlying the negative association between the bone mass and HSPMs. Our study, in a large population of 6-y-old children, adds the finding that BMC (corrected for bone size) is associated with HSPMs but not with MIH in childhood.
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Affiliation(s)
- J T van der Tas
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus Medical Center, Rotterdam, Netherlands The Generation R Study Group, Erasmus Medical Center, Rotterdam, Netherlands
| | - M E C Elfrink
- Department of Cariology, Endodontology, and Pedodontology, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
| | - S Vucic
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus Medical Center, Rotterdam, Netherlands The Generation R Study Group, Erasmus Medical Center, Rotterdam, Netherlands
| | - D H M Heppe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, Netherlands Department of Paediatrics, Erasmus Medical Center, Rotterdam, Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - J S J Veerkamp
- Department of Cariology, Endodontology, and Pedodontology, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
| | - V W V Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, Netherlands Department of Paediatrics, Erasmus Medical Center, Rotterdam, Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - F Rivadeneira
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - A Hofman
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - H A Moll
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, Netherlands Department of Paediatrics, Erasmus Medical Center, Rotterdam, Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus Medical Center, Rotterdam, Netherlands The Generation R Study Group, Erasmus Medical Center, Rotterdam, Netherlands
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21
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Das B, Muthu MS, Farzan JM. Comparison of the chemical composition of normal enamel from exfoliated primary teeth and teeth affected with early childhood caries: an in vitro study. Int J Paediatr Dent 2016; 26:20-5. [PMID: 25604081 DOI: 10.1111/ipd.12153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to compare the chemical composition of enamel from teeth with early childhood caries (unaffected fragments) and from healthy primary teeth. DESIGN Forty exfoliated primary teeth (Group I) and 40 teeth affected with ECC (Group II) were collected. Unaffected enamel from the ECC group was sampled. Elemental analysis was carried out with energy-dispersive X-ray spectroscopy (EDS), following which the same tooth samples were subjected to amino acid analysis by high-performance liquid chromatography (HPLC). RESULTS Statistically significant differences were observed in the percentage of phosphorus (P) and the Ca/P ratios between the two groups in the elemental analysis. Amino acid analysis revealed no significant difference in the amino acid profile and the quantity of amino acid or protein content between the two groups. CONCLUSIONS This study showed significant differences in the P content and Ca/P ratio between the enamel from teeth with ECC and in that from healthy primary teeth. These findings indicate that differences in the composition of enamel could be a risk factor for ECC.
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Affiliation(s)
- Bhaskar Das
- Department of Pedodontics and Preventive Dentistry, Saveetha University, Chennai, India
| | - Murugan Satta Muthu
- Department of Pedodontics and Preventive Dentistry, Sri Ramachandra University, Chennai, India
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22
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Grund K, Goddon I, Schüler IM, Lehmann T, Heinrich-Weltzien R. Clinical consequences of untreated dental caries in German 5- and 8-year-olds. BMC Oral Health 2015; 15:140. [PMID: 26538196 PMCID: PMC4634920 DOI: 10.1186/s12903-015-0121-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background About half of all carious lesions in primary teeth of German 6- to 7-year-old children remain untreated, but no data regarding the clinical consequences of untreated dental caries are available. Therefore, this cross-sectional observational study aimed to assess the prevalence and experience of caries and odontogenic infections in the primary dentition of 5- and 8-year-old German children. Methods Dental examinations were performed in 5-year-old pre-school children (n = 496) and in 8-year-old primary school children (n = 608) living in the Westphalian Ennepe-Ruhr district. Schools and preschools were selected by sociodemographic criteria including size, area, ownership, socio-economic status. Caries was recorded according to WHO criteria (1997). The Lorenz curves were used to display the polarisation of dental caries. Caries pattern in 5-year-olds was categorized by Wyne’s (1997) definition of early childhood caries (ECC). Odontogenic infections as clinical consequence of untreated dental caries were assessed by the pufa index. The ‘untreated caries-pufa ratio’ was calculated, and the Spearman’s rank correlation coefficient (ρ) was used for evaluating the correlation between dmft and pufa scores. Categorical data were compared between groups using the chi-square test and continuous data were analysed by t-test. Results Caries prevalence and experience in the primary dentition was 26.2 %/0.9 ± 2.0 dmft in 5-year-olds and 48.8 %/2.1 ± 2.8 dmft in 8-year-olds. ECC type I (22 %) was the prevalent caries pattern in 5-year-olds. About 30 % of the tooth decay was treated (5y: 29.7 %/8y: 39.3 %). The Lorenz curves showed a strong caries polarisation on 20 % of the children. Pufa prevalence and experience was 4.4 %/0.1 ± 0.5 pufa in 5-year-olds and 16.6 %/0.3 ± 0.9 pufa in 8-year-olds. In 5-year-olds 14.2 % and in 8-year-olds 34.2 % of the d-component had progressed mainly to the pulp. A significant correlation between dmft and pufa scores exists in both age groups (5y: ρ = 0.399; 8y: ρ = 0.499). First deciduous molars were most frequently affected by odontogenic infections, presenting virtually all pufa scores (>95 %). Conclusions Prevalence and experience of odontogenic infections and the untreated caries-pufa ratio were increasing from the younger to the elder children. Dmft and pufa scores in primary teeth predict a higher caries risk in permanent teeth. The pufa index highlights relevant information for decision makers to develop effective oral health care programs for children at high risk for caries.
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Affiliation(s)
- Katrin Grund
- Department of Preventive and Paediatric Dentistry, Jena University Hospital, Bachstr. 18, D-07743, Jena, Germany.
| | - Inka Goddon
- Department of Social Services and Health, Health Services for Children and Adolescents Schwelm, Hauptstr. 92, D-58332, Schwelm, Germany.
| | - Ina M Schüler
- Department of Preventive and Paediatric Dentistry, Jena University Hospital, Bachstr. 18, D-07743, Jena, Germany.
| | - Thomas Lehmann
- Department of Medical Statistics and Epidemiology, Jena University Hospital, Bachstr. 18, D-07743, Jena, Germany.
| | - Roswitha Heinrich-Weltzien
- Department of Preventive and Paediatric Dentistry, Jena University Hospital, Bachstr. 18, D-07743, Jena, Germany.
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Ulusoy AT, Sen Tunc E, Bayrak Ş, Onder H. A Comparative Study of Oral Health Parameters in Molar Incisor Hypomineralization and High-Caries-Risk Children Aged 8-11 Years. Med Princ Pract 2015; 25:85-9. [PMID: 26466311 PMCID: PMC5588299 DOI: 10.1159/000440999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 09/10/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To compare oral health parameters: decayed missing filled teeth (dmft, DMFT), gingival index and plaque index in high-caries-risk children and children with molar incisor hypomineralization (MIH). SUBJECTS AND METHODS A study group of 81 children affected by MIH (49 girls, 32 boys) aged 8-11 years (mean 9.4 ± 1.1) was race-, age- and sex-matched with 81 high-caries-risk children not affected by MIH (controls). The MIH and control groups were divided into four subgroups according to age. The oral health parameters of both groups were recorded under clinical conditions. Mann-Whitney U and Kruskal-Wallis tests were used to compare the differences in the number of MIH-affected teeth between the groups. Other traits were evaluated with the ANOVA test, and Duncan's multiple comparison tests were used for comparing means. Linear and ordinal regression analyses were used to model the variables. RESULTS The mean age of the participants was 9.4 ± 1.1 years, and the mean number of affected teeth was 7.7 (range 3-12) in the MIH group. The number of affected teeth and severity of MIH did not change significantly with age and sex (p > 0.05). A comparison of the oral health parameters of MIH-affected and control children according to groups did not show any statistically significant differences between the groups for all parameters for all groups (p > 0.05) with the exception of DMFT values at 10 years of age (p < 0.05). In a comparison of the total scores without taking age into account, the children with MIH showed a significantly higher DMFT value than the children without MIH (p < 0.05), but there were no significant differences between the dmft, GI and PI values of the study groups (p > 0.05). CONCLUSION The children in the MIH group had higher DMFT than those without MIH. Hence, the presence of MIH could have a detrimental effect on oral health parameters, especially on DMFT values.
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Affiliation(s)
- Ayca Tuba Ulusoy
- Department of Pediatric Dentistry, Faculty of Dentistry, Eskişehir, Turkey
| | - Emine Sen Tunc
- Department of Pediatric Dentistry, Faculty of Dentistry, Eskişehir, Turkey
| | - Şule Bayrak
- Faculty of Dentistry, University of Osmangazi, Eskişehir, Turkey
| | - Hasan Onder
- Department of Animal Science Biometry and Genetics, Faculty of Agriculture, Ondokuz Mayis University, Samsun, Turkey
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Folayan MO, Kolawole KA, Oziegbe EO, Oyedele T, Oshomoji OV, Chukwumah NM, Onyejaka N. Prevalence, and early childhood caries risk indicators in preschool children in suburban Nigeria. BMC Oral Health 2015; 15:72. [PMID: 26123713 PMCID: PMC4486704 DOI: 10.1186/s12903-015-0058-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 06/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early Childhood Caries (ECC) is defined as the presence of caries lesion in an primary tooth in children below the age of 71 months. It is a significant public health problem with consequences for the growth and development of affected children. The objective of this study was to determine the prevalence and ECC risk indicators in a suburban population in Nigeria. METHODS The data of 497 children aged 6 months to 71 months who were recruited through a household survey conducted in Ile-Ife, Nigeria was analysed for prevalence of ECC and risk indicators. Information on children's ages, sex, socioeconomic status, tooth brushing habits, sugary snacks consumption, use of fluoridated toothpaste, birth rank, infant-feeding practices, breastfeeding practices, maternal age at childbirth, and maternal knowledge of oral health was obtained. Children's oral hygiene and caries status was also determined. Risk factors associated with ECC were determined using logistic regression analysis. RESULTS Thirty-three (6.6%) children had ECC. Four (0.8%) had severe ECC. The four risk indicators for ECC were the child's gender, mothers' knowledge of oral health, consumption of sugary snacks in between meals more than three times a day, and the child's oral hygiene status. Females (PR: -0.06; 95% CI: -0.01- -0.01; p = 0.02), and children with mothers who had good knowledge of oral health (PR: -0.06; 95% CI: -0.11--0.008; p = 0.02) were less likely to have ECC. Children who consumed sugary snacks in between meals three times a day or more (PR: 0.05; CI: 0.003 - 0.01; P = 0.04) and children with fair oral hygiene (PR: 0.05; 95% CI: 0.005-0.10; p = 0.03) were more likely to have ECC. CONCLUSIONS The prevalence of ECC in the study population was low. Promoting good oral hygiene practices and enhancing mothers' knowledge of oral health may help reduce further, the risk for ECC in the study population.
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Affiliation(s)
- Morenike O Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
- Oral Habit Study Group, Ile-Ife, Nigeria.
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
| | - Kikelomo A Kolawole
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
- Oral Habit Study Group, Ile-Ife, Nigeria.
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
| | - Elizabeth O Oziegbe
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
- Oral Habit Study Group, Ile-Ife, Nigeria.
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
| | - Titus Oyedele
- Oral Habit Study Group, Ile-Ife, Nigeria.
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
| | - Olusegun V Oshomoji
- Oral Habit Study Group, Ile-Ife, Nigeria.
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
| | - Nneka M Chukwumah
- Oral Habit Study Group, Ile-Ife, Nigeria.
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
| | - Nneka Onyejaka
- Oral Habit Study Group, Ile-Ife, Nigeria.
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
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Temilola OD, Folayan MO, Oyedele T. The prevalence and pattern of deciduous molar hypomineralization and molar-incisor hypomineralization in children from a suburban population in Nigeria. BMC Oral Health 2015; 15:73. [PMID: 26121979 PMCID: PMC4486434 DOI: 10.1186/s12903-015-0059-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/14/2015] [Indexed: 11/11/2022] Open
Abstract
Background Molar Incisor Hypoplasia (MIH) and Deciduous Molar Hypoplasia (DMH) have significant impact on the quality of life of affected individuals. The objective of the study was to determine the prevalence, pattern and clinical presentation of MIH and DMH in children resident in Ile-Ife, Nigeria, and their association with sex and socioeconomic status of the children. Methods Information on age, sex and socioeconomic status was collected from 563 children aged 3 to 5 years and 8 to 10 years using a structured questionnaire through a household survey. Clinical examination was conducted to assess for the presence of DMH and MIH. The prevalence of DMH and MIH were determined. Tests of association between sex, socioeconomic status, prevalence, and pattern of presentation of both DMH and MIH were conducted using Pearson’s Chi-squared test Fisher’s exact test. Result Fifteen (4.6 %) of the 327 children aged 3 to 5 years and 23 (9.7 %) of the 237 children aged 8 to 10 years had DMH and MIH respectively. There were no significant association between DMH, sex (p = 0.49) and socioeconomic status (p = 0.32). There were also no significant association between MIH, sex (p = 0.31) and socioeconomic status (p = 0.41). MIH/DMH co-morbidity was observed in eight (34.8 %) of the 23 children with MIH. The mandible and maxilla were affected equally. Antimere was not observed. Conclusion The prevalence of DMH and the prevalence of MIH in the study population were high. DMH and MIH were not associated with sex and socioeconomic status. There was no specific pattern identified in the presentation of DMH and MIH. The prevalence of DMH/MIH co-morbidity is also high. Patients with DMH should be screened for MIH.
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Affiliation(s)
| | | | - Titus Oyedele
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. .,Oral Habit Study Group, Ile-Ife, Nigeria.
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Elfrink MEC, Moll HA, Kiefte-de Jong JC, Jaddoe VWV, Hofman A, ten Cate JM, Veerkamp JSJ. Pre- and postnatal determinants of deciduous molar hypomineralisation in 6-year-old children. The generation R study. PLoS One 2014; 9:e91057. [PMID: 24988443 PMCID: PMC4079596 DOI: 10.1371/journal.pone.0091057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 02/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deciduous Molar Hypomineralisation (DMH) and Molar Incisor Hypomineralisation (MIH) are common developmental disturbances in pediatric dentistry. Their occurrence is related. The same determinants as suggested for MIH are expected for DMH, though somewhat earlier in life. Perinatal medical problems may influence the prevalence of DMH but this has not been studied sufficiently. OBJECTIVE This study aimed to identify possible determinants of DMH in a prospective cohort study among 6-year-old children. STUDY DESIGN This study was embedded in the Generation R Study, a population-based prospective cohort study from fetal life until young adulthood. The the data were used to identify the determinants of DMH. Clinical photographs of clean, moist teeth were taken with an intra-oral camera in 6690 children (mean age 6.2 years; 49.9% girls). Data on possible determinants that had occurred during pregnancy and/or the child's first year of life were on the basis of manual standardized measurements (like length and weight) and questionnaires. Multivariate analyse with backward and forward selection was performed. RESULTS A number of factors in the pre-, peri- and postnatal phase were found to be associated with DMH. After multivariate logistic regression analyses, Dutch ethnic background, low birth weight, maternal alcohol consumption during pregnancy, and fever episodes in the first year of the child's life were found to play a role in the development of DMH in 6-year-old children. CONCLUSION This study shows that Dutch ethnicity, low birth weight, alcohol consumption by the mother during pregnancy and any fever in the first year of the child's life are associated with DMH. Not only childhood factors but also prenatal lifestyle factors need to be taken into account when studying determinants for DMH.
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Affiliation(s)
- Marlies E. C. Elfrink
- Department of Cariology, Endodontology and Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Henriette A. Moll
- Department of Pediatrics, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jessica C. Kiefte-de Jong
- Department of Pediatrics, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
- The Generation R Study Group Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Vincent W. V. Jaddoe
- Department of Pediatrics, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
- The Generation R Study Group Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jacob M. ten Cate
- Department of Cariology, Endodontology and Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Jaap S. J. Veerkamp
- Department of Cariology, Endodontology and Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
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Boka V, Trikaliotis A, Kotsanos N, Karagiannis V. Dental caries and oral health-related factors in a sample of Greek preschool children. Eur Arch Paediatr Dent 2013; 14:363-8. [PMID: 24277257 DOI: 10.1007/s40368-013-0097-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 01/30/2013] [Indexed: 11/25/2022]
Abstract
AIM To assess the caries prevalence and some background factors in 3- to 5.5-year-old children in the municipality of Thessaloniki, Greece. METHODS One calibrated examiner examined the children of all municipal day care centres for dmfs, existence of visible dental plaque and presence of black stain. Examination was made on site using disposable dental mirrors. Questionnaires were given to parents for assessing socio-economic status, oral hygiene habits (brushing frequency, toothpaste use) and sucking/feeding at sleep habits (nursing bottle, its content and pacifier use). RESULTS Out of a total of 950 children, both clinical examination and questionnaire data were available for 804 children. The overall mean dmfs was 1.3 (SD = 3.8). The caries prevalence was 22.6 %, while the presence of black stain was evident in 2.4 % of the children. Intra-examiner agreement was estimated with Kendall's τ b = 0.99. A generalised linear model used to fit a Poisson regression for the analysis of count outcome data (dmfs) and logistic regression was used for binary outcome data (presence or absence of visible dental plaque). Statistically significant association was found between dmfs and the presence of visible dental plaque. The country of origin and education status of the parents were found to be significant factors for dmfs. The presence of black stain was negatively correlated with dmfs. CONCLUSIONS The mean dmfs was lower than earlier Greek data. Country of origin, education status of the parents and visible dental plaque seemed to be important caries risk factors, while the presence of black stain was a strong caries resistance predictor.
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Affiliation(s)
- V Boka
- Department of Paediatric Dentistry, School of Dentistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece,
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Salanitri S, Seow WK. Developmental enamel defects in the primary dentition: aetiology and clinical management. Aust Dent J 2013; 58:133-40; quiz 266. [PMID: 23713631 DOI: 10.1111/adj.12039] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2013] [Indexed: 11/30/2022]
Abstract
Developmental enamel defects, presenting as enamel hypoplasia or opacities are caused by damage or disruption to the developing enamel organ as a result of inherited and acquired systemic conditions. The high prevalence of these defects in the primary dentition demonstrates the vulnerability of the teeth to changes in the pre- and postnatal environment. The presence of enamel hypoplasia increases the risk of primary teeth to early childhood caries and tooth wear as the defective enamel is thinner, more plaque retentive and less resistant to dissolution in acid compared to normal enamel. The purpose of this paper was to critically review the aetiology and clinical complications of developmental enamel defects in the primary dentition and propose recommendations for the clinical management of affected teeth.
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Affiliation(s)
- S Salanitri
- Centre for Paediatric Dentistry, School of Dentistry, The University of Queensland, Brisbane, Queensland
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Inhibition of enamel mineral loss by fissure sealant: An in situ study. J Dent 2013; 41:42-50. [DOI: 10.1016/j.jdent.2012.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 09/22/2012] [Accepted: 09/28/2012] [Indexed: 11/21/2022] Open
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Leroy R, Declerck D. Impact of caries onset on number and distribution of new lesions in preschool children. Int J Paediatr Dent 2013; 23:39-47. [PMID: 22276749 DOI: 10.1111/j.1365-263x.2012.01222.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Caries in preschool children remains an important public health issue. AIM To determine (i) which teeth and tooth surfaces are most susceptible to dental caries by age 3, (ii) where do caries lesions develop during 2-year follow-up, and (iii) to evaluate the impact of caries onset on the distribution of new caries experience. DESIGN One thousand and fifty seven consecutively born children were recruited in Flanders (Belgium). Parents completed validated questionnaires on oral health-related behaviour and trained dentists examined the children at ages 3 and 5. RESULTS Children with visible caries experience at age 3 were significantly more vulnerable in developing additional caries during follow-up. In this group, new caries experience developed primarily in the occlusal and distal surfaces of the mandibular first molars and the occlusal surfaces of the maxillary second and first molars, whereas in the caries-free group, the occlusal surfaces of both mandibular and maxillary second molars ranked first. CONCLUSIONS This paper confirms the higher vulnerability for further caries development in those children with caries experience at age 3. Visible caries develops most frequently in the occlusal surfaces of the second molars: in high-risk children already by age 3 and in children who were caries free at baseline by age 5.
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Affiliation(s)
- Roos Leroy
- Department of Oral Health Sciences, KU Leuven, Belgium.
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Ghanim A, Mariño R, Morgan M, Bailey D, Manton D. An in vivo investigation of salivary properties, enamel hypomineralisation, and carious lesion severity in a group of Iraqi schoolchildren. Int J Paediatr Dent 2013; 23:2-12. [PMID: 22251406 DOI: 10.1111/j.1365-263x.2011.01215.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hypomineralised enamel is a prevalent, congenital defect vulnerable to deteriorate post-eruptively particularly in the presence of an unfavourable oral environment. AIMS To assess the influence of salivary characteristics on the clinical presentation of hypomineralisation lesions diagnosed in first permanent and second primary molars and to evaluate caries severity in relation to the defect's clinical presentation. DESIGN Recruitment consisted of 445 seven- to nine-year-old participants, of whom 152 were diagnosed as having molar hypomineralisation (MH); the remaining unaffected subjects (N = 293) were considered their controls for saliva analysis. Dental caries status was assessed in 300 subjects of saliva sub-sample, equally divided as MH-affected and non-affected children. The International Caries Detection and Assessment System was used for caries detection. Salivary flow rates, viscosity, pH, and buffering capacity were determined. RESULTS Molar hypomineralisation-affected children have significantly higher mean caries scores compared to the non-affected group. Dentinal carious lesions were ten times more frequent in teeth with post-eruptive breakdown (PEB) than with teeth with opacities only. Low salivary flow rates (LSFR), moderately viscous saliva, and low pH were significantly more common in the affected group. LSFR and moderate and highly acidic saliva were more likely associated with PEB. CONCLUSION Demarcated hypomineralised enamel is a dynamic defect highly influenced by individual characteristics of the oral environment.
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Affiliation(s)
- Aghareed Ghanim
- Oral Health Cooperative Research Centre, Melbourne Dental School, University of Melbourne, Parkville, Victoria, Australia
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Ghanim A, Manton D, Mariño R, Morgan M, Bailey D. Prevalence of demarcated hypomineralisation defects in second primary molars in Iraqi children. Int J Paediatr Dent 2013; 23:48-55. [PMID: 22276809 DOI: 10.1111/j.1365-263x.2012.01223.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Demarcated hypomineralization lesions are not uncommon in second primary molars. Data on the prevalence of hypomineralized second primary molars (HSPM) are scarce. AIM To investigate the prevalence of HSPM, assess the relationship between HSPM and first permanent molars previously diagnosed with demarcated lesions and to determine the severity of HSPM in relation to dental caries severity. DESIGN A cluster sample of 809, 7- to 9-year-old children was examined. The scoring criteria proposed by the European Academy of Paediatric Dentistry for hypomineralization in permanent dentition were adapted to score HSPMs. The International Caries Detection and Assessment System was used to assess caries status in the second primary molar of the children diagnosed with demarcated defects. The examination was carried out in schools by a calibrated dentist. RESULTS Of the children examined, 53 (6.6%) had hypomineralization defects in at least one second primary molar. Combinations of affected first permanent and second primary molars were reported in 21 (39.6%) of cases. Severe carious lesions were found mostly in teeth with enamel breakdown. CONCLUSIONS The prevalence of HSPM was 6.6%. Over one-third of affected second primary molars were associated with demarcated lesions in the first permanent molars. The chance of severe caries increased with the increase in the demarcated lesion severity.
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Affiliation(s)
- Aghareed Ghanim
- Oral Health CRC, Melbourne Dental School, The University of Melbourne, Parkville, Vic., Australia.
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Trends of oral health care and dental treatment needs in relation to molar incisor hypomineralisation defects: a study amongst a group of Iraqi schoolchildren. Eur Arch Paediatr Dent 2012; 13:171-8. [PMID: 22883355 DOI: 10.1007/bf03262866] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The dynamic properties of molar-incisor-hypomineralisation lesions (MIH) may impact negatively on personal daily oral care resulting in increased treatment needs. AIMS To describe and compare individual oral health care practices between MIH-affected and non-affected children, to evaluate and compare dental treatment needs between hypomineralised and non-hypomineralised first permanent molars, and to explore the role of reported fluoride exposure in the development of MIH. STUDY DESIGN A cluster sample of 7-9 year-old Iraqi schoolchildren (823 of 1000 eligible, response rate 82.3%) had their first permanent molars and incisors evaluated using the European Academy of Paediatric Dentistry evaluation criteria for MIH. Of these 153 were diagnosed with the defect and were referred to as MIH-affected children. METHODS Mothers of the participating children were asked to complete an oral health-questionnaire administered at schools. This included questions regarding child's history of dental visits, fluoride intake and the pattern of oral hygiene practices. Assessment of the dental treatment requirements for the first permanent molars was performed in a sample subset drawn from a larger data set of affected children (n=100) having their teeth assessed previously for dental caries status following the International Caries Detection and Assessment System. The sample subset consisted of 130 hypomineralised molars and 270 non-hypomineralised molars. RESULTS Of the total sample, approximately 71% of parents had taken their children to the dentist at some stage. For the total sample, tooth restoration or extraction was the most likely causes for seeking dental care at the first dental appointment (57.9%). Tap water was the main source of water consumed at home by the majority of children (77.8%). The prevalence of dental caries and tooth restorations was higher in hypomineralised affected molars (78.5%) than in the defect-free molars (33.7%). STATISTICS MIH-affected children reported significantly higher frequency of seeking dental care than their non-affected counterparts (82.4%, 68.2%; respectively). They were over three times (OR = 3.18) more likely to visit the dentist complaining of pain and were over six times (OR = 6.37) more likely to seek dental care due to tooth sensitivity than their non-affected peers. No significant differences were found between the study groups in terms of tooth brushing and toothpaste history with brushing frequency "once-a-day" was commonly reported in both groups (75.5%). Early exposure to fluoridated water appeared to have a protective effect for MIH (OR=0.38). Affected molars required more than twice the amount of restorative care than unaffected molars. CONCLUSIONS MIH did not seem to have an impact on the personal daily oral hygiene practices; however, MIH patients were commonly seeking dental consultation and needed care more often to improve their oral health.
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Ghanim AM, Morgan MV, Mariño RJ, Bailey DL, Manton DJ. Risk factors of hypomineralised second primary molars in a group of Iraqi schoolchildren. Eur Arch Paediatr Dent 2012; 13:111-8. [PMID: 22652207 DOI: 10.1007/bf03262856] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate risk factor/s involved in the development of hypomineralised second primary molars and to relate the location of the affected tooth in the dental arches with the timing of the illness/condition incidence. STUDY DESIGN A cluster sample of 1,000, Iraqi 7-9 year-old children were invited to have their second primary molars examined for demarcated hypomineralised lesions. METHODS Mothers of 823 children completed a questionnaire-based interview regarding pregnancy and childhood systemic health history. In the clinical examination, the buccal, occlusal and lingual/palatal surfaces of the second primary molar were evaluated for demarcated hypomineralisation lesions by visual examination. RESULTS A response rate of 82.3% was obtained. Of the children examined, 53 (6.6%) had hypomineralisation defects in at least one second primary molar and were considered as the hypomineralised second primary molar-affected group. Of the total affected teeth (n=83), maxillary molars were the teeth most frequently affected by hypomineralisation throughout all developmental stages (69.9%). Demarcated opacities were the most prevalent lesion type (71.0%). Ninety-four percent of subjects diagnosed with demarcated defects reported various medical conditions possibly associated with hypomineralisation compared with 44% for their non-affected counterparts. Peri-natal medical conditions (45.3%) were the most frequently reported followed by pre-natal and post-natal conditions (24.5%, 9.4%; respectively). STATISTICS Ill health during pregnancy, delivery complications, neonatal complications, acute childhood illness, birth weight and duration of breast feeding were significant potential risk factors (p<0.05). The greater the number of health events reported, the higher was the chance of developing the defect. Children who experienced neonatal complications and whose mothers reported pregnancy and birth problems were approximately six times more likely to have the defect than those whose mothers had delivery complications only (80% vs 14.6%) (p<0.001). Also of those children whose mothers did not report delivery complications, but were breastfed for less than six months, of low birth weight and had history of upper respiratory tract infection, the chance of hypomineralised defects was over four times more likely to happen than in those who did not suffer any of these problems (25.8% vs 6.7%) (p<0.01). No statistically significant association was revealed between the time of the illness/condition occurrence and the location of the tooth in the dental arches. CONCLUSIONS Children with hypomineralised second primary molars had experienced more medical conditions than their unaffected peers particularly during the peri-natal period. No single factor was identified as a potential cause, leaving the aetiology of the defect unclear.
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Affiliation(s)
- A M Ghanim
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
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Hooley M, Skouteris H, Boganin C, Satur J, Kilpatrick N. Parental influence and the development of dental caries in children aged 0-6 years: a systematic review of the literature. J Dent 2012; 40:873-85. [PMID: 22842202 DOI: 10.1016/j.jdent.2012.07.013] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 04/16/2012] [Accepted: 07/23/2012] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE A well established body of research documents the role of individual factors, such as biology and diet, in the aetiology of early childhood caries (ECC). Recently empirical attention has shifted to the relationships between broader ecological influences (e.g., education, ethnicity and income) and ECC; however, how such determinants interplay in the aetiology of ECC remains unclear. An intermediary mechanism that warrants greater empirical attention is parental influences. This oversight is interesting given the primacy of the parent in governing the child's proximate environment and the likelihood of the child endorsing adaptive or maladaptive health attitudes, beliefs and behaviours. The objective of this paper was to conduct a systematic review of the evidence for parental influences on the development of caries in children aged 0-6 years. DATA All studies testing associations between dental caries and socio-demographic factors, feeding practices, parent attributes, behaviours, oral health, attitudes, knowledge and beliefs in children aged 0-6 years, published between 2006 and 2011. SOURCE Medline, ISI, Cochrane, Scopus, Global Health and CINAHL databases. STUDY SELECTION Fifty-five studies were included from an initial identification of 1805 studies. CONCLUSIONS To date, most research has focused on the association between caries and socio-demographic and feeding factors with few studies exploring parents' attributes, attitudes, knowledge and beliefs, and none exploring possible pathways between the multiple layers of influences potentially accounting for how determinants of ECC operate and traverse individual, familial, community, and socio-cultural contexts. Collaboration between Psychologists and Dentists may accelerate the identification and understanding of mechanisms that underlie risk associated with ECC.
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Affiliation(s)
- Merrilyn Hooley
- School of Psychology, Deakin University, Melbourne, Australia.
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Alaluusua S. Defining developmental enamel defect-associated childhood caries: where are we now? J Dent Res 2012; 91:525-7. [PMID: 22529243 DOI: 10.1177/0022034512445634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- S Alaluusua
- Department of Pediatric and Preventive Dentistry, Institute of Dentistry, University of Helsinki, Helsinki, Finland.
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Elfrink M, ten Cate J, Jaddoe V, Hofman A, Moll H, Veerkamp J. Deciduous Molar Hypomineralization and Molar Incisor Hypomineralization. J Dent Res 2012; 91:551-5. [DOI: 10.1177/0022034512440450] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study was embedded in the Generation R Study, a population-based prospective cohort study from fetal life until young adulthood. This study focused on the relationship between Deciduous Molar Hypomineralization (DMH) and Molar Incisor Hypomineralization (MIH). First permanent molars develop during a period similar to that of second primary molars, with possible comparable risk factors for hypomineralization. Children with DMH have a greater risk of developing MIH. Clinical photographs of clean, moist teeth were taken with an intra-oral camera in 6,161 children (49.8% girls; mean age 74.3 mos, SD ± 5.8). First permanent molars and second primary molars were scored with respect to DMH or MIH. The prevalence of DMH and MIH was 9.0% and 8.7% at child level, and 4.0% and 5.4% at tooth level. The Odds Ratio for MIH based on DMH was 4.4 (95% CI, 3.1-6.4). The relationship between the occurrence of DMH and MIH suggests a shared cause and indicates that, clinically, DMH can be used as a predictor for MIH.
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Affiliation(s)
- M.E.C. Elfrink
- Department of Cariology, Endodontology and Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
- The Generation R Study Group Erasmus Medical Centre - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - J.M. ten Cate
- Department of Cariology, Endodontology and Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
| | - V.W.V. Jaddoe
- The Generation R Study Group Erasmus Medical Centre - Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Centre - Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Centre - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - A. Hofman
- Department of Epidemiology, Erasmus Medical Centre - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - H.A. Moll
- The Generation R Study Group Erasmus Medical Centre - Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Centre - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - J.S.J. Veerkamp
- Department of Cariology, Endodontology and Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
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Risk factors for caries incidence in a cohort of Flemish preschool children. Clin Oral Investig 2011; 16:805-12. [PMID: 21695390 DOI: 10.1007/s00784-011-0579-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 06/06/2011] [Indexed: 10/18/2022]
Abstract
The main objective of this study was to identify the risk factors for the incidence of visible caries experience in a cohort of preschool children living in Flanders. Data were collected from 1,057 children; validated questionnaires on oral health-related behaviour were completed by parents at birth (2003-2004), at age 3 (2007) and 5 years (2009). At ages 3 and 5, the children were examined by trained dentists. Logistic regression analyses were performed with the following as outcome variables: visible caries experience at age 3 and increment in visible caries experience between ages 3 and 5. At ages 3 and 5, enamel and/or dentinal caries experience was observed in 22% and 41% of the cohort, respectively. The multivariable logistic regression analyses revealed that the presence of visible plaque accumulation on at least one primary tooth was a significant risk factor for visible caries experience at age 3 and for an increment in caries experience between ages 3 and 5. Children with previous caries experience at age 3 had significantly higher odds for new caries lesions at age 5. Presence of visible plaque and previous caries experience are confirmed as significant risk factors for visible caries experience in preschool children. Interventions aimed at caries prevention should focus on very young children and on the control of plaque accumulation. The presence of visible plaque accumulation as a screening tool to identify young children at risk for future caries experience shows high potential.
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