Associations of social and behavioural factors with early childhood caries in Xiamen city in China

PREVALENCE OF CARIES PATTERNS IN THE 21ST CENTURY PRESCHOOL CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVE

This systematic review aimed to describe and evaluate the caries patterns among the 21st century preschool children globally.

METHOD

Six electronic databases (Pubmed, Embase, Medline, Web of Science, EBSCOhost, and Scopus) were searched using predetermined terms. Dual independent screening of all retrieved abstracts was performed to identify studies conducted after year 2000 and the caries pattern among preschool children was investigated. Data regarding the prevalence of caries by tooth type and surface were extracted. Meta-analyses, subgroup analyses and meta-regression were carried out with the statistics software Stata using the random-effects model.

RESULTS

A total of 2642 records were screened, and 43 observational studies were finally included. Cavitated caries lesions were commonly found in the maxillary incisors and molars in both arches among preschool children. The highest caries prevalence was found in the maxillary central incisors (29.1%, 95%CI: 25.5%-32.7%) and the mandibular second molars (28.5%, 95%CI: 24.7%-32.3%), while the mandibular lateral incisors had the lowest prevalence (1.7%, 95%CI: 1.5%-2.0%). Occlusal surfaces of the mandibular molars were the most frequently affected by caries, whereas caries hardly affected the lingual surfaces of lower anterior teeth. Caries pattern on the left and right sides was symmetrical. The overall caries prevalence was significantly higher in the maxillary teeth. Caries prevalence was higher in the older children, whereas the caries pattern was not significantly different among children from countries with different human and economic development levels.

CONCLUSION

Cavitated carious lesions were more commonly observed in the maxillary incisors and molars in both arches. The prevalence of caries varies significantly with child's age and primary tooth type. However, preschool children exhibit a similar pattern of caries, regardless of the time, socioeconomic status or geographical location.

Social inequities in early childhood caries in Australia: A population-based study on statewide public dental services data

BACKGROUND

Social disadvantage leads to dental caries during childhood.

AIM

This study investigated whether dental caries occur earlier in children from households experiencing social disadvantage than those not experiencing social disadvantage.

DESIGN

The overall risk of, and relative time to, early childhood caries (ECC) according to sociodemographic characteristics in Victoria, Australia, was quantified. Records for 134 463 children in Victoria, Australia, from 2009 to 2019 were analysed. Time ratios (TR) and hazard ratios (HR) of carious lesion(s) in early childhood were estimated.

RESULTS

Compared with reference groups, Indigenous children had an adjusted TR of 0.80 (95% CI: 0.78, 0.82), children from households with languages other than English had an adjusted TR of 0.83 (95% CI: 0.82, 0.84), and dependants of concession cardholders had an adjusted TR of 0.81 (95% CI: 0.80, 0.81); therefore, 20%, 17% and 19% reduced times to the first carious lesion, respectively. The estimated HRs were 1.57 (95% CI: 1.49, 1.67) for Indigenous children, 1.46 (95% CI: 1.42, 1.50) for children from households with other languages and 1.57 (CI: 1.53, 1.60) for dependants of concession cardholders.

CONCLUSION

Preventive oral health interventions must be targeted early in children from households experiencing social disadvantage to avoid social inequities in ECC.

Association between early childhood caries and parental education and the link to the sustainable development goal 4: a scoping review

BACKGROUND

The goal of the United Nations Sustainable Development Goal (SDG) 4 is to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. The aim of this scoping review was to map the current evidence on the association between the prevalence of early childhood caries (ECC) and parental education; and to identify possible pathways by which parental education may protect against ECC.

METHODS

The two questions that guided this review were: what is the existing evidence on the association between maternal and paternal education and ECC; and what are the pathways by which parental education protects against ECC? The initial search was conducted in January 2023 in PubMed, Web of Science and Scopus. Articles published in English between January 2000 and October 2022 that reported on the association between parental education and ECC were screened, and the extracted data were compiled, summarized, and synthesized. Review papers and non-primary quantitative research papers were excluded from the full-text review. Open coding was applied to develop a conceptual framework.

RESULTS

In total, 49 studies were included: 42 cross-sectional, 3 case-control and 4 cohort studies. The majority (91.8%) reported on the associations between ECC and maternal (n = 33), paternal (n = 3), and parental (n = 9) level of education, and 13 (26.7%) reported on the association between parental education and the severity of ECC. Mothers with more than primary school education (n = 3), post-secondary/college/tertiary education (n = 23), and more than 4-12 years of education (n = 12) had children with lower risk for ECC. Two studies reporting on parental education found an association between maternal but not paternal education and ECC. The review suggests that achieving the SDG 4.1 may reduce the risk of ECC. Possible pathways by which maternal education protects from ECC were feeding practices, oral hygiene practices, and the use of dental services.

CONCLUSION

The study findings suggests that higher maternal educational level may reduce the risk for the consumption of cariogenic diet, poor oral hygiene practices and poor use of dental services for caries prevention. However, the association between paternal education and ECC was not consistently observed, with significant associations less frequently reported compared to maternal education. Future studies are needed to define the magnitude and modifiers of the impact of maternal education on the risk for ECC.

Prevalence and socio-behavioral determinants of early childhood caries in children 1-5- year- old in Iran

AIM

According to the World Health Organization (WHO), early childhood caries (ECC) is still considered a major global health problem despite the general improvement in oral health practice. This study aimed to assess ECC's prevalence, severity, and key social and behavioral determinants in Iranian children 1-5- years of age.

METHOD

This cross-sectional study recruited Iranian 1-5-year-olds with a three-stage stratified clustered sampling method. After providing consent, parents were interviewed using a validated questionnaire, including questions on child characteristics and behavioral factors. Each child underwent a dental examination by one of four trained and calibrated dentists. Associations between key covariates of interest and primary outcome measures were assessed by multivariable logistic regression modeling and multivariate generalized negative binomial regression modeling after weightings were applied. Statistical analysis was performed using SPSS V25 and Stata V14.2 software packages. A p-value ≤ 0.05 was considered significant.

RESULTS

The mean age of 909 participants was 41.1±1.2 months, 48.6% were male, and 38.1% lived in rural areas. The overall prevalence of ECC was 53.2% and mean dmft score was 2.7± 0.3. Key determinants associated with ECC included living rurally (p = 0.009, OR = 2.13), consuming sweet drinks, sugary snacks, or both [p-value = 0.02 (OR = 2.53), and p-value<0.001 (OR = 4.96), respectively], and visible plaque (p<0.001, OR = 3.41). Covariates associated with dmft scores included residing in rural regions (p = 0.02, IRR = 1.31), having both sugary snacks and sweet drinks (p = 0.02, IRR = 1.85) compared to those had none, and visible dental plaque (p<0.001, IRR = 2.06).

CONCLUSIONS

The prevalence of dental caries in children is high in Iran. The increase of ECC prevalence and severity from toddlers to preschoolers emphasizes on the critical importance of early interventions in toddlers. Improving access to care for rural children is essential along with the need to change dietary and self-care behaviors through multilevel efforts.

Analysis of Risk Factors Associated with Early Childhood Caries

Objective

To identify the main factors associated with early childhood caries by analyzing the risk factors of early childhood caries, thus providing a reference for developing prevention programs to reduce the risk of early childhood caries.

Methods

We selected a total of 221 children aged 3-4 years from two kindergartens in Tongzhou District, Beijing for this study. We conducted oral examination and the caries activity test (Cariostat) on children and their parents / primary caregivers, and the parents / primary caregivers additionally answered a questionnaire survey. Based on the results, we comprehensively evaluated the caries status of children and statistically analyzed the caries-related factors to identify the relevant risk factors.

Results

The mean age of children in the study children was 40.08 ± 2.65 months, with a caries prevalence rate of 54.97% and a mean caries value of 4.61. Early childhood caries was correlated with the intake frequency of sugary foods, intake of sugary foods before bedtime, frequency of tooth brushing, oral health knowledge of parents, caries susceptibility, and age of starting to brush teeth. Logistic regression analysis results showed that the intake frequency of sugary foods, oral health knowledge of parents, and caries susceptibility were the factors influencing early childhood caries, especially the intake frequency of sugary foods.

Conclusion

The intake frequency of sugary foods, intake of sugary foods before bedtime, frequency of brushing teeth, oral health knowledge of parents, caries susceptibility, and age of starting to brush teeth were associated with early childhood caries. Among these, the intake frequency of sugary foods, oral health knowledge of parents, and caries susceptibility, especially the intake frequency of sugary foods, were the influencing factors.

Comparison of Childhood Caries Levels between Children of Pediatric Dentists and Children of General Dentists: A Cross-Sectional Study

Caries development in children is a prevalent childhood disease. Factors affecting chronic teeth lesions include nutrition, parental involvement, and executing proper dental health attitude. Professional dentists are perceived as role models for the oral health and hygiene of their families. The purposes of the research were 1. To compare caries rates in the children of pediatric dentists and children of general dentists. 2. To compare children’s nutrition habits between pediatric dentists and general dentists. 3. To compare children’s oral health and hygiene between pediatric dentists and general dentists. 4. To compare children’s usage of fluoride-containing products between pediatric dentists and general dentists. A cross-sectional study was conducted by distributing self-reporting questionnaires to pediatric dentists and general dentists via the social media “snowball” platform. The following themes were surveyed: nutrition habits and oral hygiene of the children. The sample consisted of 176 participants. Children of pediatric dentists were found to have fewer cases of caries than children of general dentists (p = 0.018). Nutrition habits did not differ between the two groups. In addition, pediatric dentists reported that their children use more fluoridated toothpaste in comparison with general dentists. Professional training of pediatric dentists contributed to shaping the oral hygiene attitude of their children.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Which determinants should be considered to reduce social inequalities in paediatric dental care access? A cross-sectional study in France

Better access to dental care through systemic and educational strategies is needed to lessen the burden of disease due to severe early caries. Our study aims to describe family characteristics associated with severe early caries: parental knowledge, attitudes, practices in oral health and socio-demographic factors. For this cross-sectional study, 102 parents of children aged under 6 years with severe early caries and attending paediatric dentistry service in France completed a questionnaire during face-to-face interviews. Caries were diagnosed clinically by calibrated investigators, using the American Academy of Paediatric Dentistry criteria, and dental status was recorded using the decayed, missing, and filled teeth index. The majority of children were from underprivileged backgrounds and had poor oral health status, with a median dmft index of 10. Parents highlighted the difficulty of finding suitable dental care in private practices. Parents appeared to have good oral health knowledge and engaged in adapted behaviours but showed a low sense of self-efficacy. They perceived the severity of early caries as important but the susceptibility of their child as moderate. The study affirmed the importance of improving the accessibility of paediatric dental care and developing educational strategies to enhance the knowledge, skills, and oral health practices of families.

Discriminant validity of the CAST instrument compared to the dmf index in the deciduous dentition: a cross sectional study

This study aimed to assess the discriminant validity of the Caries Assessment Spectrum and Treatment (CAST) at different thresholds, compared with the Decayed, Missing, and Filled Teeth Index (dmf) instrument, to discriminate caries risk factors. A cross-sectional study was conducted including children aged 2-5 years from preschools in Southern Brazil. Parents answered a questionnaire, and children were clinically examined using the CAST instrument and, in the following weeks, using the dmf index. Two caries thresholds were adopted for CAST: caries in dentin (CAST4-7/CAST2,4-8) and enamel caries (CAST3-7/CAST2-8). Poisson regression was used in the analysis (p < 0.05). A total of 200 children were included. The prevalence of caries was 47.0% with dmf, 42.5% with CAST4-7, and 77.5% with CAST3-7. When the outcome was caries prevalence, CAST4-7 discriminated between sexes, household crowding, and dental pain, and CAST3-7 discriminated age and family income, while the dmf was associated with dental pain. When experience of caries was the outcome, all the criteria discriminated between sexes, age, family income, household overcrowding, visible dental plaque, and dental pain, while dmf and CAST2-8 also discriminated maternal schooling. The CAST discriminated caries risk factors similar to the dmf index when caries experience was the outcome. When prevalence was considered, CAST was able to discriminate for more individual characteristics than dmf.

Mapping Evidence on Early Childhood Caries Prevalence: Complexity of Worldwide Data Reporting

Objective

This review aims to identify variances and research gaps in the early childhood caries (ECC) prevalence within countries and the global community by mapping current evidence.

Materials and methods

We performed a literature search in PubMed/MEDLINE and Web of Science to identify English-language, peer-reviewed epidemiologic studies published from January 1999 to January 2019. Abstracts and full-text articles were dual-screened based on predefined eligibility criteria. We classified outcomes by children's age and countries based on economic status. Ranges of reported caries prevalence and median values by country and age were calculated and evidence-mapped.

Results

Out of 915 studies, 59 studies met the inclusion criteria. The most significant number of reports were from the USA, Brazil, and India. The ranges of prevalence (1-96%) among the studies were large. The calculated median caries prevalence values may better estimate countries' prevalence than the reported ranges. Early childhood caries prevalence's highest median values were found for South Korea studies (54%) for children <3-year-old and from Bosnia (81%) for children 3-6 years old. No apparent difference was found in the prevalence of ECC from developed and developing countries.

Conclusion

This mapping review reflects the ranges and median values of ECC worldwide. Overall, the reported prevalence of ECC in most countries is very high. No apparent difference was found in the prevalence of ECC from developed and developing countries. Reported ranges of ECC, as well as heterogeneity and methodological issues, hamper comparisons across studies globally.

Clinical significance

The global ECC prevalence ranges are extreme. Median data may provide a structure for future epidemiological studies to optimizing healthcare resources for caries interventions globally.

How to cite this article

Abdelrahaman M, Hsu K-L, Melo MA, et al. Mapping Evidence on Early Childhood Caries Prevalence: Complexity of Worldwide Data Reporting. Int J Clin Pediatr Dent 2021;14(1):1-7.

Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and meta-analysis

Background

Early childhood caries (ECC) is a type of dental caries in the teeth of infants and children that is represented as one of the most prevalent dental problems in this period. Various studies have reported different types of prevalence of dental caries in primary and permanent teeth in children worldwide. However, there has been no comprehensive study to summarize the results of these studies in general, so this study aimed to determine the prevalence of dental caries in primary and permanent teeth in children in different continents of the world during a systematic review and meta-analysis.

Methods

In this review study, articles were extracted by searching in the national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (ISI) between 1995 and December 2019. Random effects model was used for analysis and heterogeneity of studies was evaluated by using the I² index. Data were analyzed by using the Comprehensive Meta-Analysis (Version 2) software.

Findings

In this study, a total of 164 articles (81 articles on the prevalence of dental caries in primary teeth and 83 articles on the prevalence of dental caries in permanent teeth) were entered the meta-analysis. The prevalence of dental caries in primary teeth in children in the world with a sample size of 80,405 was 46.2% (95% CI: 41.6–50.8%), and the prevalence of dental caries in permanent teeth in children in the world with a sample size of 1,454,871 was 53.8% (95% CI: 50–57.5%). Regarding the heterogeneity on the basis of meta-regression analysis, there was a significant difference in the prevalence of dental caries in primary and permanent teeth in children in different continents of the world. With increasing the sample size and the year of study, dental caries in primary teeth increased and in permanent teeth decreased.

Conclusion

The results of this study showed that the prevalence of primary and permanent dental caries in children in the world was found to be high. Therefore, appropriate strategies should be implemented to improve the aforementioned situation and to troubleshoot and monitor at all levels by providing feedback to hospitals.

[Social inequalities in oral health and early childhood caries: How can they be effectively prevented? A scoping review of disease predictors]

BACKGROUND

Early childhood caries represent a major public health problem. In addition to their individual impact, the massive social inequalities in oral health that are at the roots and result from the disease have largely underestimated consequences for the child, his family and the community. In response to the question of "how and where to act?", this scoping review identifies the individual characteristics associated with the disease on which it would be possible to act, using appropriate prevention strategies.

METHODS

This scoping review is aimed at describing and analyzing available data in the literature on the different factors associated with early childhood caries.

RESULTS

The predictors of early childhood caries are represented by mediating (knowledge, attitudes and parents' oral health practices) and moderating (psychosocial parameters, parental health literacy and alcohol consumption) factors. Twenty-eight articles fulfilled the selection criteria, twenty of which studied mediators related to early childhood caries, and fourteen of which dealt with moderators. The lower the parents' level of knowledge and literacy in oral health, the higher a child's dmft index. Additional studies are needed to assess the role of psychosocial parameters.

CONCLUSION

Parents' knowledge and oral health literacy are the key predictors to be preferentially targeted in view of reducing social inequalities in health through actions undertaken on a local scale. The prevention of early childhood caries necessitates a combination of generic and targeted interventions.

Association between early childhood caries and poverty in low and middle income countries

Background

The aim of this study was to assess the relationship between early childhood caries (ECC) in 3–5-year-old children, seven indicators of poverty and the indicator of monetary poverty in low- and middle-income countries (LICs, MICs).

Methods

This ecologic study utilized 2007 to 2017 country-level data for LICs and MICs. Explanatory variables were seven indicators of poverty namely food, water, sanitation, health, shelter, access to information, education; and monetary poverty. The outcome variable was the percentage of 3–5-year-old children with ECC. A series of univariate general linear regression models were used to assess the relationship between the percentage of 3–5 year-old children with ECC and each of the seven indicators of poverty, and monetary poverty. This was followed by multivariable regression models to determined the combined effect of the seven indicators of poverty, as well as the combined effect of the seven indicators of poverty and monetary poverty. Adjusted R² measured models’ ability to explain the variation among LICs and MICs in the percentage of 3–5-year-old children with ECC.

Results

Significantly more people had food, sanitation, shelter, access to information, education and monetary poverty in LICs than in MICs. There was no difference in the prevalence of ECC in 3–5-year-old children between LICs and MICs. The combination of the seven indicators of poverty explained 15% of the variation in the percentage of 3–5-year-old children with ECC compared to 1% explained by monetary poverty. When the seven indicators of poverty and the indicator for monetary poverty were combined, the amount of variation explained by them was 10%. Only two of the poverty indicators had a direct relationship with the percentage of children with ECC; there was a higher percentage of ECC in countries with higher percentage of population living in slums (B = 0.35) and in those countries with higher percentage of the population living below poverty lines (B = 0.19). The other indicators had an inverse relationship.

Conclusion

The use of multiple indicators to measures of poverty explained greater amount of variation in the percentage of 3–5-year-olds with ECC in LICs and MICs than using only the indicator for monetary poverty.

Parenting and child behaviour as predictors of toothbrushing difficulties in young children

BACKGROUND

Oral disease is one of the most prevalent chronic health conditions affecting children. Twice-daily toothbrushing is recommended to promote good oral health; however, a large proportion of Australian families are not meeting this recommendation.

AIM

This study aimed to identify important barriers to regular toothbrushing for young children.

DESIGN

In this study, 239 parents of 0- to 4-year-old children completed an online survey that investigated child, family, and parent factors associated with child toothbrushing. Hierarchical linear regression was used to identify predictors of toothbrushing frequency in children and perceived difficulty of the task by parents.

RESULTS

We found that parent factors, specifically oral health knowledge, were the most significant predictors of toothbrushing frequency. Conversely, parent factors did not contribute significantly to the prediction of perceived difficulty of toothbrushing once family and child factors were taken into account. Oral health knowledge and use of routines were identified as the most important predictors of toothbrushing frequency, whereas resistant child behaviour and household organisation were found to be the most important predictors of perceived difficulty of regular toothbrushing.

CONCLUSIONS

The findings of the study have implications for behavioural interventions to support parents, as well as directions for future research.

The disparity in caries and sealants between migrant and native children in Shanghai: A cross-sectional study

OBJECTIVE

To investigate the disparity in dental caries between native and migrant children in Shanghai, China.

METHODS

Between 2013 and 2015, a random cluster sample of native and migrant children aged 5, 9, 12 and 15 years was collected from each district in Shanghai. Oral examination was performed following the World Health Organization (WHO) method, and findings were reported as decayed-missing-filled teeth of primary dentition (dmft) and permanent dentition (DMFT).

RESULTS

A total of 10 150 children were examined, and 33.6% of them were migrants. Migrant children had a higher prevalence of deciduous caries than native children (the 5-year-old age group, 67.8% vs 63.0%, P = 0.024; the 9-year-old age group, 75.9% vs 66.1%, P < 0.001), and higher dmft values were found in migrant children. But with respect to permanent teeth, no statistical differences were found between the two groups in caries prevalence or DMFT. After controlling for potential confounders by logistic regression, migrant children showed a higher risk of deciduous caries (odds ratio 1.42, 95% confidence interval 1.25-1.61, P < 0.001) but not of permanent caries. Migrant children exhibited relatively lower deciduous Restorative Care Index (RCI). However, 9- and 15-year-old migrant children had a higher permanent RCI than their native counterparts.

CONCLUSIONS

Dental caries prevalence in migrant children was higher in the deciduous teeth but not in the permanent teeth compared to that in their native counterparts. School-based dental public health services may contribute to reducing the disparity in dental health status between migrant and native children.

Effectiveness of preventive dental programs offered to mothers by non-dental professionals to control early childhood dental caries: a review

BACKGROUND

Early childhood caries is a common chronic childhood disease and maternal oral health is a risk factor. Improving the oral health behaviours of pregnant women/young mothers can positively influence the oral health of children and reduce their caries risk. Such preventative strategies have been undertaken by non-dental professionals producing mixed results encompassing various interventions across the perinatal period. However, no comprehensive review of these studies has been undertaken. The aim of this review was to assess the effectiveness of maternal oral health programs undertaken during the antenatal and/or postnatal period by non-dental health professionals to reduce early childhood caries.

METHODS

A systematic search of five databases was undertaken using key search terms. Studies were included if they (a) involved quantitative study designs with a control; (b) were published in English; (c) reported on interventions delivered by non-dental professionals (d) delivered the intervention to expectant mothers or mothers with young infants up to 24 months; (e) measured outcomes when the child was under 5 years; (f) measured changes in oral health outcomes of children clinically and oral health behaviours of mothers or children. No restrictions were placed on the study quality and setting.

RESULTS

Nine studies met the inclusion criteria and involved interventions delivered by diverse non-dental professionals across the antenatal (n = 1), postnatal (n = 6) and perinatal period (n = 2). Most studies were of low methodological quality (n = 6). The interventions focussed on oral health education (n = 8), dental referrals (n = 3) and oral health assessments (n = 1). Interventions conducted in either the postnatal or antenatal periods showed meaningful improvements in children's clinical and mother's behavioural oral health outcomes. The outcomes appear to be sustained when a suite of interventions were used along with referral reminders. There were mixed results from interventions across the perinatal period.

CONCLUSIONS

Non-dental professionals can promote maternal oral health by providing oral health education, risk assessment and referrals. Combining these interventions could provide a sustained improvement in oral health outcomes for children although current evidence is weak. More high-quality studies are needed to confirm these findings and determine whether the antenatal and/or postnatal period is best suited to deliver these interventions.

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

Objective

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

Methods

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

Results

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

Conclusions

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

Deciduous dental caries status and associated risk factors among preschool children in Xuhui District of Shanghai, China

BACKGROUND

This study aims to understand the deciduous dental caries status of preschool children in Xuhui District of Shanghai, China and to analyze the associated risk factors.

METHODS

In January of 2016, a cross-sectional investigation was conducted to examine the oral health of all the kindergarten children in Xuihui District of Shanghai, China. Meanwhile, a field questionnaire survey was conducted with the children's guardians to ascertain the potential risk factors associated with deciduous dental caries.

RESULTS

Among 11,153 children, the prevalence of deciduous dental caries was 47.02%, and the mean dmft score was 2.21. The first three predilection sites were maxillary central primary incisors, mandible second primary molars, and mandible first primary molars. There were statistically significant differences in caries prevalence and dmft among different age groups and different household registration (Hukou) types (P < 0.001). Multivariate Logistic regression suggested that the possible risk factors for deciduous caries included: older age, drinking sweetened beverages frequently, often or usually eating sweets before sleep compared to rarely/never eat them at this time, exclusive or predominant breastfeeding compared to exclusive or predominant artificial feeding and latter introduction of toothbrushing. On the other hand, Shanghai Hukou families, high educational level of guardians (high school or college education), regular parental support for children's toothbrushing, guardians' oral health knowledge, and a good perception about children's oral health conditions were shown as potential protective factors for deciduous dental caries.

CONCLUSIONS

The deciduous dental caries status of preschool children in Xuhui District of Shanghai was still serious. The caries prevalence in Xuhui, China, is associated with children's age, household registration type, oral health habits, feeding habits, guardians' education level, parental perception about children's oral health and knowledge about oral health.

Parental Factors Influencing the Development of Early Childhood Caries in Developing Nations: A Systematic Review

Background

Early childhood caries (ECC) is one of the most prevalent and chronic conditions of childhood. Various factors including biological and dietary factors along with an overlay of parental social factors have been found to be associated with the progression of ECC. The objective of this systematic review is to synthesize available literature and to identify parent-level proximal and distal risk factors associated with the development of ECC in developing nations.

Methods

Studies conducted in developing nations, published between 2005 and 2017 in English, that included children younger than 6 years and examined ECC were included. The outcome of interest were parental risk factors, which included parental knowledge, behavior, attitudes, sense of coherence (SOC), stress, socioeconomic status (SES), education, and breastfeeding duration. The studies were retrieved from MEDLINE, Ovid Medline, and PubMed.

Results

The search yielded 325 studies, of which 18 were considered eligible for inclusion in this review. Ten studies found maternal education, and seven studies found parental education to be significantly associated with ECC. SES was significantly associated with ECC in 13 studies in the form of annual household income and occupation level. Four studies observed the significant association between oral health knowledge and attitudes with ECC, whereas only two studies found maternal attitude to be associated with ECC. Breastfeeding duration was a significant risk factor in four studies. One study each found significant associations of SOC, parental distress, and secondary smoke with ECC.

Conclusion

To date, most of the researches done in developing countries have reported distal parental factors such as income and education being significant risk factors in caries development compared to proximal risk factors in low-income groups. Only a few studies analyzed the psychosocial and behavioral factors. Interventions could be designed to improve parental oral health knowledge and behaviors in these nations.

Free Sugars Consumption around Bedtime and Dental Caries in Children: A Systematic Review

This systematic review aimed to assess the association between food and drink consumption around bedtime-specifically, food and drinks containing free sugars-and the risk of dental caries in children. Five electronic databases were searched (PubMed, Ovid Medline, EMBASE, Web of Science, and Scopus) to identify studies that investigated any relationship between food and drink around bedtime and dental caries in 3- to 16-y-old children. The Agency for Healthcare Research and Quality domain guidelines were used to assess the quality of the individual studies, while GRADE guidelines assessed the quality of studies based on the body of evidence. From 1,270 retrieved titles, 777 remained after removal of duplicates. Of these, 72 were reviewed in full. Eighteen studies fulfilled the inclusion criteria and were included in the analysis: 13 cross-sectional, 4 cohort, and 1 case-control. Studies were categorized into 3 age groups: 3- to 5-y-old, 6- to 11-y-old, and 12- to 16-y-old children. Based on the Agency for Healthcare Research and Quality criteria, 6 of the 18 studies were rated as providing good-quality evidence; 8 were rated as fair; and 4 were categorized as being of poor quality. It was not possible to conduct a meta-analysis, because of the considerable variations in the type of bedtime exposure and outcome measures. The studies showed a consistent positive association across the 3 age groups, with all 7 studies on preschool children reporting significant positive associations. However, the quality of the body of evidence pertaining to the consumption of food and drinks at bedtime (specifically, food and drinks containing free sugars) and risk of caries was rated as "very low." The results suggest that restricting free sugars before and at bedtime may reduce the risk of caries, but studies with improved design are needed to confirm this. Knowledge Transfer Statement: This is the first systematic review of the evidence assessing the association between caries risk in children and the consumption of food or drinks at bedtime-specifically, foods and drinks containing free sugars. Although the data showed a consistent positive association, the quality of evidence was very low. This means that the current recommendation to restrict food and drinks containing free sugars before bedtime in children, while based on a sound physiologic premise, is supported only by very low-quality published evidence as measured by GRADE guidelines.

The Association between Cariogenic Factors and the Occurrence of Early Childhood Caries in Children from Salem District of India

INTRODUCTION

Various aetiological factors for Early Childhood Caries (ECC) have been suggested in literature, but the role of each factor has been disputed in various studies.

AIM

To evaluate the association between ECC and its related factors in children between three to six years of age, from rural, semi-urban and urban schools in the district of Salem (India).

MATERIALS AND METHODS

The study consisted of children between three to six years of age, selected randomly from schools in semi-urban, urban and rural schools at Salem. Questionnaire (comprising of the factors associated with ECC) and parental consent forms were sent to each of the parents of the school children. Filled questionnaires and parental consent forms were obtained from a total of 2771 children, out of which 1771 were boys and 1000 were girls. Clinical examination for ECC was carried out according to the WHO criteria, by a single examiner and an assistant to eliminate inter-examiner variability. Statistical analysis was carried out using the student's independent t-test and ANOVA (one way analysis of variance).

RESULTS

Out of a total of 2771 children examined, only 443 (315 boys and 128 girls) children were found to have ECC (16 %). Significant correlations were found between the occurrence of ECC and various factors like age of parents, number of siblings, on-demand breast feeding and bottle feeding habits and sweetened pacifier use. However, factors such as age and gender of the child, type of birth and duration of pregnancy, had no significant correlation with the occurrence of ECC.

CONCLUSION

The need for educating parents on the ill effects of improper breast feeding and bottle feeding habits is important.

Quantitative analysis of S. mutans, Lactobacillus and Bifidobacterium found in initial and mature plaques in Thai children with early childhood caries

AIMS

To quantify Streptococcus mutans, lactobacillus and bifidobacterium in initial and mature plaque collected from children with severe early childhood caries (S-ECC) and caries-free (CF) groups and to analyse the association between these bacteria and caries-related factors in each group.

STUDY DESIGN

A collection of 120 initial and overnight supra-gingival plaques were collected from Thai children aged 2-5 years-old (S-ECC = 60, CF = 60). Plaque, gingival indices and decayed, missing, filled tooth (dmft) scores were recorded. A questionnaire was used to assess the parents' attitudes and behaviour regarding the child's oral hygiene care and diet.

METHODS

After DNA extraction, quantitative real-time polymerase chain reaction (PCR) using fluorescent dye (SYBR green) was performed.

RESULTS

Levels of Streptococcus mutans, lactobacillus and bifidobacterium in both initial and mature plaques of S-ECC were significantly higher than those from the caries-free group (p < 0.05). The ratio of S. mutans, lactobacillus, and bifidobacterium to the total bacteria in S-ECC was significantly higher than in the caries-free group (p < 0.05). Levels of lactobacillus and bifidobacterium in both plaques significantly correlated with dmft scores and the plaque index, while S. mutans levels only correlated with dmft scores (p < 0.05). Factors that were significantly associated with caries were parents's education, duration of bottle feeding, especially during sleeping and the frequency of consuming cariogenic food between meals (p < 0.05).

CONCLUSION

Levels of S. mutans, lactobacillus, bifidobacterium and the ratio of these bacteria to total bacteria in both initial and mature plaques were significantly higher in children with S-ECC and related to dmft scores, oral hygiene and dietary habits.

A longitudinal study of early childhood caries incidence in Wenzhou preschool children

Background

Early childhood caries (ECC) is a serious public health problem in China. Few studies, however, have described the incidence of ECC in China. The purpose of this study was to assess the prevalence and incidence of ECC among preschool children in Wenzhou China.

Methods

Preschool children aged 3–4 years old were surveyed and followed up when they reached 5–6 years of age in the city of Wenzhou in southeast China. The rates of dental caries were determined with prevalence, and incidence density for risk of caries of a person (ID_p) and of a tooth surface (ID_s).

Results

The prevalence and decayed, missing, and filled primary teeth (dmft) score of 3–4, 4–5, and 5-6 years old children were 59.8% and 2.9, 71.8% and 4.2, and 76.4% and 4.6, respectively. The ID_p was 29.7 and 14.8 persons/100 person-year during the first and second year. The ID_s was 5.9 and 2.7 newly affected surfaces/100 surface-year, respectively. The percentage of molars with caries experience increased obviously; the percentage of maxillary central incisors and mandibular incisors with caries experience increased during the first follow-up, whereas it declined during the second follow-up; the others increased gradually.

Conclusions

The prevalence and incidence of dental caries in Wenzhou preschool children were very high with most of the carious teeth left untreated. The molars were the most affected teeth during the observation period.

Is severe early childhood caries predictive of caries and fluorosis in permanent teeth? Ten-year follow-up

Abstract Introduction Severe early childhood caries is defined as the presence of any sign of decay in children younger than three years. Objective This retrospective longitudinal observational study investigated caries and fluorosis in children with S-ECC from a city with fluoridated water. Material and method We included children under the age of three years who followed a maternal and child dental care program between the years of 1997 and 2003. The children were divided into 2 groups: group 1 (S-ECC) and group 2 (no caries). Guardians were contacted by telephone or mail. Caregivers completed questionnaire on socio-demographic and behavioral variables. The clinical dental examinations were performed in a dental clinic to assess caries experience and dental fluorosis. Multiple linear regression was used to determine factors associated with DMFT, and multivariate analysis by multiple logistic regression was used to determine the possible independent factors associated with the occurrence of fluorosis. Result The sample consisted of 126 patients aged 8-12 years, of whom 52.4% were male. The presence of S-ECC increased the DMFT by an average of 0.84 (p = 0.02). Both the frequency of tooth brushing and the use of standard toothpaste were protective factors from the development of caries in the permanent dentition (p <0.05). Parents who reported that their children refused to brush their teeth had 70% less chance of developing fluorosis (p = 0.02). Conclusion The presence of S-ECC was a risk factor for the development of caries in the permanent dentition, but not for the development of fluorosis.

Bayesian Analysis of the Association between Family-Level Factors and Siblings' Dental Caries

We conducted a Bayesian analysis of the association between family-level socioeconomic status and smoking and the prevalence of dental caries among siblings (children from infant to 14 y) among children living in rural and urban Northern Appalachia using data from the Center for Oral Health Research in Appalachia (COHRA). The observed proportion of siblings sharing caries was significantly different from predicted assuming siblings' caries status was independent. Using a Bayesian hierarchical model, we found the inclusion of a household factor significantly improved the goodness of fit. Other findings showed an inverse association between parental education and siblings' caries and a positive association between households with smokers and siblings' caries. Our study strengthens existing evidence suggesting that increased parental education and decreased parental cigarette smoking are associated with reduced childhood caries in the household. Our results also demonstrate the value of a Bayesian approach, which allows us to include household as a random effect, thereby providing more accurate estimates than obtained using generalized linear mixed models.

Measuring Potential of Preschool Facility Staff to Prevent Early Childhood Caries

The aim of this study was to investigate the possible potential of preschool staff through a newly designed questionnaire and evaluate their role in the prevention of early childhood caries (EEC) in Serbia where extremely high prevalence of this preventable disease was recorded.

We preformed a cross-sectional study of 268 preschool staff using specially prepared semi-structured questionnaire for measuring potential of secondary children’s caregivers to prevent EEC. The questionnaire was tested on a pilot sample and after that all collected data were analyzed trough construction of correlation matrix with the evaluation of the value of each question, reliability testing, factorial analysis and estimating of its validity using SPSS software.

The tested questionnaire had good internal consistency based on the Cronbach’s alpha coefficient value of 0.873 calculated directly and similar value (0.899) after applied Spearman-Brown “prediction” formula. Using exploratory factorial analysis and orthogonal rotation, we identified two domains that emerged with similar loadings (4.043 and 3.183). The first factor (domain) reflected attitudes of the study participants towards prevention of EEC, and the second factor (domain) showed behaviour of the study participants, which includes preventive actions against EEC.

The total score of the questionnaire was correlated positively with oral health knowledge (Spearman’s correlation coefficient 0.331, p=000) and inversely with the length of employment, where each additional year of employment decreased the total score of the questionnaire by 1.20.

These findings could partially explain an extremely high prevalence of EEC in young children and indicate that preschool teachers should be more engaged in health education activities and motivation programs.

Influence of Lifestyle Factors on Risk of Dental Caries among Children Living in Urban China

The prevalence of dental caries has been decreasing among kindergarten children in Shanghai, China, over recent years, although it still remains at an unacceptably high level. The purpose of this study was to identify which factors were important in providing oral health guidance and achieving further improvement in the oral health status of kindergarten children in urban China. A survey was conducted on dental caries in 128 Japanese and 368 Chinese kindergarten children and a questionnaire given to their parents/guardians on each child's lifestyle and dietary habits from birth to the present. Correlations between responses to each questionnaire item and the status of dental caries were statistically analyzed. The dft index score (p=0.0016), prevalence of dental caries (p=0.0002), and percentages of children with decayed (untreated caries-affected) teeth (p<0.0001) were significantly higher in the Chinese than in the Japanese children. Many differences were observed in lifestyle factors between the two groups. The percentage of parents failing to control the child's snacking habits between meals was higher in China, and weaning was significantly delayed in China compared with in Japan. These lifestyle factors were considered to be associated closely with the high risk of dental caries in Chinese kindergarten children. These findings indicate that oral health guidance for kindergarten children in Shanghai, China, should focus on control of dietary habits, including control of inter-meal snacking, and breastfeeding practices. The results of this study may help improve the status of dental caries among Chinese children.

Framing Young Childrens Oral Health: A Participatory Action Research Project

BACKGROUND AND OBJECTIVES

Despite the widespread acknowledgement of the importance of childhood oral health, little progress has been made in preventing early childhood caries. Limited information exists regarding specific daily-life and community-related factors that impede optimal oral hygiene, diet, care, and ultimately oral health for children. We sought to understand what parents of young children consider important and potentially modifiable factors and resources influencing their children's oral health, within the contexts of the family and the community.

METHODS

This qualitative study employed Photovoice among 10 English-speaking parents of infants and toddlers who were clients of an urban WIC clinic in North Carolina. The primary research question was: "What do you consider as important behaviors, as well as family and community resources to prevent cavities among young children?" Five group sessions were conducted and they were recorded, transcribed verbatim and analyzed using qualitative research methodology. Inductive analyses were based on analytical summaries, double-coding, and summary matrices and were done using Atlas.ti.7.5.9 software.

FINDINGS

Good oral health was associated with avoidance of problems or restorations for the participants. Financial constraints affected healthy food and beverage choices, as well as access to oral health care. Time constraints and occasional frustration related to children's oral hygiene emerged as additional barriers. Establishment of rules/routines and commitment to them was a successful strategy to promote their children's oral health, as well as modeling of older siblings, cooperation among caregivers and peer support. Community programs and organizations, social hubs including playgrounds, grocery stores and social media emerged as promising avenues for gaining support and sharing resources.

CONCLUSIONS

Low-income parents of young children are faced with daily life struggles that interfere with oral health and care. Financial constraints are pervasive, but parents identified several strategies involving home care and community agents that can be helpful. Future interventions aimed to improve children's oral health must take into consideration the role of families and the communities in which they live.

The early childhood oral health program: a qualitative study of the perceptions of child and family health nurses in South Western Sydney, Australia

Background

Early childhood caries affects nearly half the population of Australian children aged 5 years and has the potential to negatively impact their growth and development. To address this issue, an Early Childhood Oral Health (ECOH) program, facilitated by Child and Family Health Nurses (CFHNs), commenced in 2007 in New South Wales, Australia. This study builds on the previous evaluation of the program. It aims to explore the perceptions of CFHNs regarding the implementation of the ECOH program in South Western Sydney and the challenges and barriers related to its sustainability.

Methods

A descriptive qualitative design was used in this study. Two focus groups were conducted with 22 CFHNs who were sampled from two Community Health Centres in South Western Sydney, Australia. Data were transcribed verbatim and thematic analysis was undertaken.

Results

Most CFHNs acknowledged the importance of early childhood oral health promotion and were providing education, oral assessments and referrals during child health checks. Many stressed the need for collaboration with other health professionals to help broaden the scope of the program. Some barriers to implementing the program included confusion regarding the correct referral process, limited feedback from dental services and the lack of oral health awareness among parents.

Conclusion

The study findings suggest that the ECOH program is being sustained and effectively implemented into practice by CFHNs. Improvement in the referral and feedback process as well as enhancing parental knowledge of the importance of infant and child oral health could further strengthen the effectiveness of the program. Expanding oral health education opportunities into general practice is advocated, while regular on-line training for CFHNs is preferred. Future research should include strategies to reduce non-attendances, and an assessment of the impact on the prevalence of childhood caries of the ECOH program.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-016-0213-0) contains supplementary material, which is available to authorized users.

Dental caries status of students from migrant primary schools in Shanghai Pudong New Area

BACKGROUND

In China, there is a large migrant population. A significant proportion of children of the migrant population in China are not able to attend public schools due to the lack of local household registration (HuKou). They turn to privately-operated migrant schools, which are usually under-funded, have bad environmental facilities and are inadequately staffed compared to public schools. This study aims to describe the dental caries status of students from migrant primary schools in Shanghai Pudong New Area and factors that influence their caries status.

METHODS

Children (7-12 years old) from migrant primary schools in Shanghai Pudong New Area were randomly selected through a multi-stage cluster sampling method. Following the recommendation of the World Health Organization, caries experiences were recorded using the dmft index. A questionnaire to survey the children's socio-demographic characteristics and oral health-related behaviours was completed by the children's parents or guardians.

RESULTS

A total of 1385 children in migrant primary schools were invited, of which 1323 joined the survey (95.5 %). Among all the surveyed subjects, the prevalence rate of dental caries was 74.7 % (65.7 % for primary teeth and 28.1 % for permanent teeth). The mean (SD) dmft scores were 3.17 (3.12), 2.74 (3.02) for the primary teeth and 0.44 (0.84) for the permanent teeth, and 99.5 % of the carious teeth received no treatment.

CONCLUSIONS

Students from migrant primary schools in Shanghai Pudong New Area had bad conditions of dental caries and most of the carious teeth were left untreated. The caries experience was associated with tooth brushing habits, snacking habits, dental visit and gender.

Risk determinants associated with early childhood caries in Uygur children: a preschool-based cross-sectional study

Background

The prevalence of early childhood caries (ECC) varies with geographical region and population. The Uygur people, one of 55 officially recognized ethnic minorities in China, have a population of 10,069,346. We performed a preschool-based cross-sectional study of 670 Uygur children from the southern region of Xinjiang, China, to investigate the prevalence and severity of ECC and to identify factors related to the dental health condition of this population.

Methods

The study population of children ranging in age from 3 to 5 years was invited using a three-stage stratified sampling in Kashgar, the westernmost city in China. The “dmft” index was used to assess dental caries. The diagnosis of ECC or severe ECC was based on the oral health diagnostic criteria defined by the American Academy of Pediatric Dentistry. A questionnaire was completed by the children’s caregivers. The survey included questions concerning the children’s sociodemographic background; feeding and eating habits, particularly frequency of sweet beverage and food consumption; dental hygiene-related behaviors; the general oral health knowledge of caregivers; and the dental healthcare experience of caregivers and their children.

Results

A total of 670 Uygur children underwent complete dental caries examination. Most of the children (74.2%) had ECC, with a mean dmft ± SD of 3.95 ± 3.84. The prevalence of severe ECC was 40.1% (N =269), with a mean dmft of 7.72 ± 3.14. More than 99% of caries were untreated. Statistically significant correlations were found between higher ECC prevalence and increased age and lower socioeconomic background, while greater dental health knowledge of the caregiver and positive oral hygiene behaviors were found to be protective. Our findings confirm the multi-factorial etiology of ECC.

Conclusions

The prevalence of ECC among preschool-aged Uygur children in Kashgar was high, particularly among those from lower socioeconomic backgrounds. Caries prevalence was associated with oral hygiene behaviors of children and the general oral health knowledge of caregivers. These factors could be modified through public health strategies, including effective publicity concerning general dental health and practical health advice.

Electronic supplementary material

The online version of this article (doi:10.1186/1472-6831-14-136) contains supplementary material, which is available to authorized users.

Screening preschool children with toothache: validation of the Brazilian version of the Dental Discomfort Questionnaire

BACKGROUND

The Dental Discomfort Questionnaire (DDQ) is an observational instrument intended to measure dental discomfort and/or pain in children under 5 years of age. This study aimed to validate a previously cross-culturally adapted version of DDQ in a Brazilian children sample.

METHODS

Participants included 263 children (58.6% boys, mean age 43.5 months) that underwent a dental examination to assess dental caries, and their parent that filled out the cross-culturally adapted DDQ on their behalf. Exploratory factor analysis (principal component analysis form) and psychometric tests were done to assess instrument's dimensionality and reliability.

RESULTS

Exploratory factor analysis revealed a multidimensional instrument with 3 domains: 'eating and sleeping problems' (Cronbach's alpha 0.81), 'earache problems' (alpha 0.75), and 'problems with brushing teeth' (alpha 0.78). The assessment had excellent stability (weighted-kappa varying from 0.68 to 0.97). Based on the factor analysis, the model with all 7 items included only in the first domain (named DDQ-B) was further explored. The items and total median score of the DDQ-B were related to parent-reported toothache and the number of decayed teeth, demonstrating good construct and discriminant validities.

CONCLUSIONS

DDQ-B was proven a reliable pain assessment tool to screen this group of Brazilian children for caries-related toothache, with good psychometric properties.

Examining the accuracy of caregivers' assessments of young children's oral health status

BACKGROUND

Caregivers' perceptions of their young children's oral health status (OHS) are a strong determinant of whether the children visit a dentist. Our aims were to quantify the correlation between caregivers' assessments and their children's clinically determined restorative treatment needs, while investigating factors related to this association.

METHODS

One hundred eight caregivers assessed their children's OHS by answering a question on the self-reported National Health and Nutrition Examination Survey III instrument. Children underwent clinical oral examinations at one of two study sites of the Carolina Oral Health Literacy Project: a dental school-based clinic and a community-based health clinic. Examiners recorded the children's clinical treatment needs by using a modification of the caries severity index. The authors quantified concordance between the two measures with use of the Spearman rank correlation (ρ) and Kendall τ rank correlation, whereas they assessed differences in sociodemographic factors and oral health literacy (OHL) levels by using a homogeneity χ(2) test (P < .2 criterion).

RESULTS

The concordance between caregivers' assessments and clinically determined OHS was lower for younger children (< 2 years, ρ = 0.29 versus = 2 years, ρ = 0.63 [homogeneity P = .03]), a pattern that was evident in the community clinic but not in the university clinic. Caregivers' age, education and OHL did not influence the accuracy of self-reports.

CONCLUSIONS

For children younger than 2 years, caregivers' assessments correlated poorly with clinical needs, which routinely were underestimated. Practice Implications. These findings underscore the importance of preventive dental visits at a young age and the early establishment of a dental home.

Can child temperament be related to early childhood caries?

Beyond the biological risk factors of early childhood caries (ECC) is child temperament. This study aimed to investigate the relationship of ECC to different traits of child temperament, directly and indirectly through the nutritional and oral hygiene habits. Through a multi-stage sampling, 373 kindergarten children aged 18-36 months participated in this study. The primary caregivers filled in the Early Childhood Behaviour Questionnaire (ECBQ) and a checklist containing demographic data and the dietary and oral hygiene habits of the children. Children were examined for dental caries. The frequency of ECC was 41.14%. With 18 aspects of a child's temperament under consideration, attentional shifting, fear, frustration, low-intensity pleasure, sadness and shyness were significantly higher in the ECC group. Cuddliness, perceptual sensitivity, positive anticipation and soothability were significantly higher in caries-free children. Attentional shifting (p = 0.02), frustration (p = 0.02) and shyness (p = 0.03) were risk factors and cuddliness (p < 0.001) was a protecting factor for ECC. In the multiple regression model regarding nutritional and oral hygiene habits, easily soothable children were 0.69 times less likely to use sweetened liquids frequently [odds ratio (OR) 0.69, 95% confidence interval (CI) 0.49-0.97, p = 0.03], while sad children were 0.58 times less likely to brush (OR 0.58, 95% CI 0.36-0.94, p = 0.02). Considering temperament traits along with socioeconomic status, positive anticipation was the most significant determinant of ECC (OR 1.57, 95% CI 1.13-2.19, p = 0.007). However, considering temperament, socioeconomic measures and child habits among ECC risk factors, the most significant was the initiation of brushing habits (OR 5.41, 95% CI 2.81-12.98, p = 0.002).

The maternal socioeconomic status and the caries experience among 2-6 years old preschool children of lucknow city, India

AIM

The aim of the present study was to assess the maternal socioeconomic status and the caries experience among 2-6 years old preschool children of Lucknow city, India.

MATERIAL AND METHODS

A sample of 512 preschool going children were selected through a multistage cluster random sampling. Their mothers provided information regarding their demographic data. Their socioeconomic statuses were elicited by using the modified B.G.L. Prasad's classification for the year 2010. Their mothers' education, occupations and incomes were also recorded. The dental caries experience was recorded by using the dentition status and the treatment needs (WHO Basic Oral Health Survey 1997). The association between the socioeconomic status and the caries experience was obtained by using the Chi - square test. One way ANOVA was used for the multiple group comparisons.

RESULTS

The prevalence of nursing caries was 33.01%. The association between the presence of nursing caries and a lower status of the mother's education and occupation and socioeconomic position proved to be statistically significant (p<0.001).

CONCLUSION

Instilling positive attitudes in the parents, especially in the mothers, towards the prevention of nursing caries, would reduce its prevalence at this tender age of life.

Oral hygiene and dental caries in 5- to 6-year-old children in Ajman, United Arab Emirates

OBJECTIVE

To investigate the association between oral hygiene and dental caries in young children in the Emirate of Ajman, United Arab Emirates.

METHODS

A one-stage cluster sample was used to randomly select children. Clinical examinations were conducted by a single examiner. Parents completed questionnaires seeking information on child and family characteristics, dietary habits and oral hygiene practices.

RESULTS

The total number of children sampled was 1297. Dental examination and questionnaire data were obtained for 1036 (79.9%). Frequency of eating per day and snack consumption level were both significantly associated with plaque score. Children who brushed their teeth more often had lower plaque scores. The observed association between mean plaque score and mean decayed, missing, filled teeth suggests that children with high plaque scores are more likely to experience caries.

CONCLUSIONS

Brushing with fluoride toothpaste was under-utilized in Ajman. Tooth brushing therefore needs better promotion and reinforcement.

Impacto de um projeto de extensão universitária na formação profissional de egressos de uma universidade pública

INTRODUÇÃO: Dentre as competências necessárias à formação profissional em Odontologia no Brasil, está aquela destinada à atuação nos serviços de saúde. Nesse processo de formação, a participação em programas de extensão universitária amplia as possibilidades de aprendizado por permitir a vivência entre os ambientes acadêmico e comunitário. OBJETIVO: Determinar o impacto que as informações e ações desenvolvidas em um programa de extensão universitária exerceram na formação profissional de egressos de uma universidade pública. MATERIAL E MÉTODO: Foi realizado um estudo observacional transversal descritivo. A população do estudo foi composta por 268 cirurgiões-dentistas, que participaram do projeto de extensão universitária do curso de Odontologia da Universidade Federal do Piauí - Programa Preventivo para Gestantes e Bebês, no período de 1997 a 2011. Foi utilizado questionário enviado por e-mail como instrumento de coleta de dados, incluindo perguntas relativas à importância que o programa exerceu na qualificação profissional dos ex-estagiários. RESULTADO: O percentual de resposta foi de 52,6%, ou seja, 141 cirurgiões-dentistas responderam ao questionário. Os resultados apontaram que 98,6% dos sujeitos classificaram o Programa Preventivo para Gestantes e Bebês como ótimo; 91,5% declararam aplicar os conhecimentos adquiridos no projeto em sua rotina profissional; 28,4% implantaram programas semelhantes; 85,8% atendem gestantes em suas rotinas de trabalho e, destes, 19,8% relataram dificuldade nos atendimentos; 69,5% atendem bebês em suas rotinas de trabalho e, destes, 63,3% se sentem capacitados para executar procedimentos clínicos. CONCLUSÃO: As informações e ações desenvolvidas no Programa Preventivo para Gestantes e Bebês apresentaram impacto positivo na qualificação profissional de egressos, contribuindo para que os mesmos atuem com segurança nos atendimentos de gestantes e bebês.

Caregivers' oral health literacy and their young children's oral health-related quality-of-life

OBJECTIVES

To investigate the association of caregivers' oral health literacy (OHL) with their children's oral health related-quality of life (C-OHRQoL) and explore literacy as a modifier in the association between children's oral health status (COHS) and C-OHRQoL.

METHODS

This study relied upon data from structured interviews with 203 caregivers of children aged 3-5 from the Carolina Oral Health Literacy (COHL) Project. Data were collected for OHL using REALD-30, caregiver-reported COHS using the NHANES-item and C-OHRQoL using the Early Childhood Oral Health Impact Scale (ECOHIS). This study also measured oral health behaviors (OHBs) and socio-demographic characteristics and calculated overall/stratified summary estimates for OHL and C-OHRQoL. Spearman's rho and 95% confidence intervals (CI) were computed as measures of correlation of OHL and COHS with C-OHRQoL. To determine whether OHL modified the association between COHS and C-OHRQoL, this study compared literacy-specific summary and regression estimates.

RESULTS

Reported COHS was: excellent-50%, very good-28%, good-14%, fair-6%, poor-2%. The aggregate C-OHRQoL mean score was 2.0 (95% CI: 1.4, 2.6), and the mean OHL score 15.9 (95% CI: 15.2, 16.7). There was an inverse relationship between COHS and C-OHRQoL: ρ = -0.32 (95% CI: -0.45, -0.18). There was no important association between OHL and C-OHRQoL; however, deleterious OHBs were associated with worse C-OHRQoL. Literacy-specific linear and Poisson regression estimates of the association between COHS and C-OHRQoL departed from homogeneity (Wald χ(2) p < 0.2).

CONCLUSION

In this community-based sample of caregiver/child dyads, a strong correlation was found between OHS and C-OHRQoL. The association's magnitude and gradient were less pronounced among caregivers with low literacy.

Parental influence and the development of dental caries in children aged 0-6 years: a systematic review of the literature

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.

Efficacy of a non-drilling approach to manage non-cavitated dentin occlusal caries in primary molars: a 12-month randomized controlled clinical trial

BACKGROUND. Despite the efficacy of non-drilling approaches to manage non-cavitated dentin occlusal lesions (NCDOL) in permanent teeth, there is no data validating this type of therapy in the primary dentition. AIM. To compare the efficacy of a traditional fissure sealant in managing NCDOL in primary molars. DESIGN. This study is a randomized controlled clinical trial with a split-mouth design. Thirty schoolchildren with two NCDOL were selected and divided into two groups. The experimental group received a resin-based fissure sealant, whereas the control group was treated with a conventional composite resin. Treatment efficacy was evaluated after 1 year by means of clinical and radiographic examinations. RESULTS. The two treatment modalities were found to be similarly effective in managing DONCL in primary molars. CONCLUSION. For the management of non-cavitated dentin occlusal caries in primary teeth, the invasive approach can be replaced with non-drilling fissure sealing techniques.