Early childhood caries: a positive beginning

The Role of Feeding Practices as a Determinant of the pufa Index in Children with Early Childhood Caries

OBJECTIVE

To evaluate the prevalence and severity of untreated dental caries among young children (aged <6 years) with early childhood caries (ECC) using the pufa index and to examine the relationship between caries and feeding practices.

STUDY DESIGN

A cross-sectional study of children with ECC was undertaken in two stages: a questionnaire survey based on interviews and an intraoral examination using the defs and pufa indices.

RESULTS

The overall prevalence of untreated dental caries in our sample of 238 ECC-affected children was 72.3%. The abscess component (code a) was the most common condition. There was an increase in the ECC patterns and the severity of untreated dental caries with increasing age for all teeth groups. ECC and untreated caries lesions for the various teeth groups and study sites varied inversely with current feeding status. The majority of the children had posterior ECC, and the fewest were affected by ulceration (code u) as a consequence of untreated dental caries. Except for the posterior caries pattern, all other caries patterns and pufa components (code u alone, p<0.05) had a significantly higher prevalence among children with nocturnal feeding practices (p<0.001). Binary logistic regression analyses revealed that older age (p<0.05) and nocturnal feeding practices (p<0.001) were significantly associated with pufa scores>0.

CONCLUSION

These data provide valuable evidence of the effect of nocturnal feeding as an important determinant of the increased prevalence of untreated caries lesions among children with ECC.

Early childhood caries in preschool children of Kosovo - a serious public health problem

Background

Even though it has been widely studied, early childhood caries (ECC) remains a serious public health problem, especially in countries where there is no national program of oral health assessment and no genuine primary oral health care, such as in Kosovo. The purpose of this study was to assess the prevalence of ECC and analyze caries risk factors.

Methods

The subjects were 1,008 preschool children, selected by stratified random cluster sampling, in the municipality of Prishtina, capital of Kosovo. Data were collected through clinical examination and interviews. Dmft data were recorded according to WHO criteria. Bacterial examination (CRT bacteria test) and plaque test of Greene-Vermillion were used.

Results

The mean dmft of preschool children was found to be 5.8. The prevalence of ECC was 17.36%, with a mean dmft of 11 ± 3.6. Streptococcus mutans prevalence in ECC children was 98%. A significant correlation between dmft and S mutans counts (≥10⁵ CFU/mL saliva) was demonstrated. A correlation was also found between daily sweets consumption and dmft in children with ECC (P < 0.001). Comparing the dmft of ECC children and duration of bottle feeding showed a statistical correlation (P < 0.001). The mean plaque test was 1.52. None of the examined children had ever used fluoride.

Conclusion

The prevalence of ECC was high among preschool children in the municipality of Kosovo. We recommend increasing parents' knowledge of proper feeding habits and oral health practices, and increasing preschool children's accessibility to dental services.

Diet and caries-associated bacteria in severe early childhood caries

Frequent consumption of cariogenic foods and bacterial infection are risk factors for early childhood caries (ECC). This study hypothesized that a short diet survey focused on frequency of foods, categorized by putative cariogenicity, would differentiate severe ECC (S-ECC) from caries-free children. Children's diets were obtained by survey and plaque bacteria detected by PCR from 72 S-ECC and 38 caries-free children. S-ECC children had higher scores for between-meal juice (p < 0.01), solid-retentive foods (p < 0.001), eating frequency (p < 0.005), and estimated food cariogenicity (p < 0.0001) than caries-free children. S-ECC children with lesion recurrence ate fewer putative caries-protective foods than children without new lesions. Streptococcus mutans (p < 0.005), Streptococcus sobrinus (p < 0.005), and Bifidobacteria (p < 0.0001) were associated with S-ECC, and S. mutans with S. sobrinus was associated with lesion recurrence (p < 0.05). S. mutans-positive children had higher food cariogenicity scores. Food frequency, putative cariogenicity, and S. mutans were associated with S-ECC individually and in combination.

Relationship between parental locus of control and caries experience in preschool children - cross-sectional survey

Background

Due to high prevalence and serious impacts, childhood caries represents a public health issue. Behavioural risk factors such as locus of health control have been implicated in the development of the disease; however their association with childhood caries has not been thoroughly studied. The aim of this cross-sectional survey was to assess the relationship between parental locus of health control and caries experience and untreated caries of their preschool children in a representative sample in Czech Republic, adjusting for relevant sociodemographic characteristics.

Methods

A representative sample of 285 preschool children and their parents was recruited. Study data included children's dental status recorded in nurseries and parental questionnaires with 13 attitudinal items regarding locus of control (LoC) in caries prevention. The association between parental locus of control and children's caries experience and level of untreated caries was analysed using logistic regression, adjusting for the effect of key sociodemographic variables.

Results

There was a statistically highly significant linear trend between increased parental LoC and higher probability of the children to be free from untreated caries, independent from the effect of sociodemographic variables of children and parents. A similar highly statistically significant trend, although not entirely linear, and independent from sociodemographic variables was observed with respect to the chance of the children to be free from caries experience with increasing strength of parental LoC. After full adjustment, children in the strongest parental LoC quintile were 2.81 (1.23–6.42, p< 0.05) times more likely to be free from untreated caries in comparison to the weakest parental LoC quintile and 2.32 (1.02–5.25, p< 0.05) times more likely to be free from caries experience in comparison to the weakest parental LoC quintile.

Conclusion

The findings support the hypothesis that higher internal parental LoC is associated with better control of both untreated caries and caries experience in their preschool children and highlight that a more internal LoC within the family is advantageous in the prevention of dental caries.

Early Childhood Caries among a Bedouin community residing in the eastern outskirts of Jerusalem

Background

ECC is commonly prevalent among underprivileged populations. The Jahalin Bedouin are a severely deprived, previously nomadic tribe, dwelling on the eastern outskirts of Jerusalem. The aim of this study was to assess ECC prevalence and potentially associated variables.

Methods

102 children aged 12–36 months were visually examined for caries, mothers' anterior dentition was visually subjectively appraised, demographic and health behavior data were collected by interview.

Results

Among children, 17.6% demonstrated ECC, among mothers, 37.3% revealed "fairly bad" anterior teeth. Among children drinking bottles there was about twice the level of ECC (20.3%) than those breast-fed (13.2%). ECC was found only among children aged more than one year (p < 0.001); more prevalent ECC (55.6%) was found among large (10–13 children) families than among smaller families (1–5 children: 13.5%, 6–9 children: 15.6%) (p = 0.009); ECC was more prevalent among children of less educated mothers (p = 0.037); ECC was more prevalent among mothers with "fairly poor" anterior dentition (p = 0.04). Oral hygiene practices were poor.

Conclusion

ECC levels in this community were not very high but neither low. This changing population might be on the verge of a wider dental disease "epidemic". Public health efforts clearly need to be invested towards the oral health and general welfare of this community.

A randomized trial of the effectiveness of home visits in preventing early childhood caries

OBJECTIVES

Assess the effectiveness of home visits for advising mothers about breast feeding and weaning on early childhood caries (ECC) at the age of 12 months.

METHODS

A randomized field trial was conducted in mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo (intervention group = 200; controls = 300). The intervention group received the advice 10 days after the child's birth, monthly up to 6 months, at 8, 10 and 12 months, based on the 'Ten Steps for Healthy Feeding', a Brazilian national health policy for primary care, based on WHO guidelines. Both groups had research assessment at 6 and 12 months, with dental caries investigated in this last assessment; 122 children were lost in the 1-year follow-up; 378 were assessed for caries: two predentulous children were excluded from the analysis. Mann-Whitney U was used to test if the average number of decayed surfaces (DS; white spots and cavities) differed between the intervention and control groups, and logistic regression to estimate the effects of the intervention on the odds of ECC. Chi-square test was used to test for differences between the intervention and control groups in the distribution of feeding behaviours tackled by the dietary intervention.

RESULTS

10.2% of the children in the intervention group and 18.3% of the controls had caries. The odds of caries was 48% lower for the intervention group, adjusted for number of teeth (OR = 0.52, 95% CI = 0.27-0.97). Mean DS were lower for the intervention group (0.37) when compared with the control group (0.63), (Mann-Whitney U, P = 0.03). The intervention group had significantly longer duration of exclusive breast feeding (P = 0.000), later introduction of sugar (P = 0.005), and smaller probability of ever having eaten biscuits (P = 0.000), honey (P = 0.003), soft drinks (P = 0.02), fromage-frais (P = 0.001), chocolate and sweets (P = 0.001).

CONCLUSIONS

ECC is a public health problem in that population. The home visits for dietary advice appear to help reducing dental caries in infants. Greater efforts are needed to tackle cariogenic dietary behaviours even further, as a relevant proportion of children of the intervention group were shown to present with dental caries. Further studies should examine the effect of the intervention in the longer term.

Breast-feeding and early childhood caries: an assessment among Brazilian infants

OBJECTIVES

The purpose of the present study was to evaluate early childhood caries among 12-36-month-old children from families living in poor socio-economic conditions in the city of Recife, Brazil, its association with the type and duration of feeding (e.g. natural, sugared, bottle and glass), as well as the relationship between a supplementary diet and the occurrence of this type of caries.

METHODS

The present study consisted of a visual clinical examination of teeth that had been previously cleaned with gauze. This was carried out under natural light in a waiting room. Four calibrated examiners performed the examination and the kappa test value was 8.0. The parents or guardians were interviewed for the following information: name, address, age, type of feeding, number of sugary meals, sugar intake and habitual diet. Some 468 children were included in this study. Their ages ranged from 12 to 36 months. The sample was comprised of 222 (47.4%) males and 246 females (52.6%).

RESULTS

Of the 468 children included in this study, 133 (28.4%) had caries. Only 59 (12.6%) of the children examined had been breast-fed, 20 (33.9%) of whom presented with caries. Three hundred and twenty-seven (69.9%) subjects had been bottle-fed with sugared milk, 86 (26%) of whom had caries. Two hundred and eight children had five or more sugary meals per day, 70 (33.6%) of whom had caries. No statistically significant relationship was seen between breast-feeding and the prevalence of tooth decay.

CONCLUSIONS

The results of the present study show that the prevalence of early childhood caries in 12-36-month-old children from poor backgrounds in Recife is in accordance with the rate found in other Brazilian cities and is extremely high compared with that of the world population as a whole. Early childhood caries was not clearly related to the type of feeding in this sample. The prevalence of early childhood caries increased with age, and the number of sugary snacks between meals and a cariogenic diet were strongly related to early childhood caries. The lack of fluoridated water and high rates of early childhood caries in lead the authors to suggest that fluoride dentifrice should be introduced at 12 months of age as a fluoride supplement and an important aid in the prevention of childhood caries. Additional studies in different cultures and societies need to be undertaken before a definitive conclusion can be drawn.

A systematic review of clinical diagnostic criteria of early childhood caries

OBJECTIVE

This paper reviews case definitions and clinical diagnostic criteria of early childhood caries (ECC) and severe ECC (S-ECC) in children aged 1 to 5 years old. The acronym S-ECC as used in this paper refers to nursing caries, baby bottle tooth decay, rampant caries, labial caries, maxillary anterior caries, and other terms used to refer to severe dental caries in preschool children.

METHODS

A search was carried out for articles published in peer-reviewed journals and indexed in MEDLINE using the following terms: nursing caries, baby bottle tooth decay, early childhood caries, rampant caries in preschool children, labial caries, maxillary anterior caries, and nursing bottle caries. MEDLINE's MeSH terms "dental caries" and "deciduous teeth" were used to search for other relevant studies. Reports were selected if they included children 1 to 5 years of age and described diagnostic criteria or case definitions of S-ECC. Three previous reviews were searched for other relevant reports. One unpublished report was included in this review and data from NHANES III were analyzed to provide information on caries patterns in preschool children in the United States. The first author read all the abstracts from the MEDLINE search and tagged relevant reports for photocopying. He also abstracted all the information from the reports. The first author calibrated the second author, who independently read all included and excluded reports. Disagreements were resolved by consensus.

RESULTS

Out of 126 studies, 32 were excluded and 94 (93 published and 1 unpublished) were included in this review. Eighty-one of the 94 published studies were cross-sectional surveys or clinical studies, 7 were case-control clinical studies, 2 studies were controlled clinical trials, and 4 were cohort or field trials. About two-thirds of the included studies did not report on calibration of examiners. Information on reliability of examiners was reported by 19 of the 94 studies. The included studies varied widely in the name used to identify S-ECC, case definitions, and diagnostic criteria. "Cavitation" was the most common criterion used to define dental caries. Several studies measured early or noncavitated carious lesions. Twenty-seven studies used the presence of 1 dmf maxillary incisor to classify a child with S-ECC. Another 23 and 9 studies defined S-ECC by the presence of 2+ or 3+ dmf maxillary incisors, respectively. Dental caries in preschool children clusters in pits and fissures and on smooth tooth surfaces of primary molars and maxillary incisors.

CONCLUSIONS

This review found a wide variation in the case definitions and diagnostic criteria used to diagnose ECC or define S-ECC. Dental caries in the maxillary incisors is one of several patterns of dental caries that may occur in primary teeth of preschool children. A consensus is needed on case definitions and diagnostic criteria that can assist researchers to test preventive interventions and study the etiology and epidemiology of ECC.