Caries and background factors in Norwegian and immigrant 5-year-old children

Long-term effects of a community-based oral health intervention for young children in the Netherlands: A 5-year follow-up

OBJECTIVES

The aim of this study was to assess whether referral of parents of 6 months old children by a well-child care (WCC) clinic medical practitioner for an early first dental visit combined with the Non Operative Caries Treatment and Prevention (NOCTP) approach in dental practices was effective to maintain oral health in children.

METHODS

The study was conducted as a quasi-experimental comparative pre-post trial with a baseline measurement before the intervention. In total 1347 children were allocated at the age of 6 months and 306 children (intervention group: n = 166; care as usual (CAU) group: n = 140) underwent an oral examination at 5 years of age and their parents completed a questionnaire. Nonparametric tests and Hurdle models were used to determine differences in caries experience between the intervention and CAU groups.

RESULTS

Children in the intervention group had significantly lower caries experience (d1,2,3mfs) than children in the CAU group (Median = 2 vs. 5, r = .15, p < .01). Children in the intervention group had significantly fewer inactive caries lesions compared with children in the CAU group (Median = 2 vs. 3, r = .18, p < .001). No differences were found for dentin caries experience and also no differences for active caries lesions.

CONCLUSIONS

Referral of parents of newborns for a preventive first dental visit by a WCC medical practitioner combined with NOCTP in dental practices may offer a new opportunity to reduce enamel caries lesions in young children.

Relevance of Sociocultural Inequalities and Parents' Origins in Relation to the Oral Health of Preschoolers in Lanzarote, Spain

Approaching inequalities to achieve health equity requires joint action. Early childhood caries affects disadvantaged population groups. The objective of this study was to determine the relevance of sociocultural inequalities and parental origin with respect to oral health in preschool children in Lanzarote. A transversal epidemiological study was carried out. Sociocultural data and information about parental origin were collected via a questionnaire. The decayed and filled teeth (dft), decayed teeth (dt), filled teeth (ft), restorative index (RI), plaque index (PI) and gingival index (GI) were obtained via an investigator's examination. Statistical analysis of the data indicated that children of semi-skilled manual workers (28.15%) had the highest prevalence of caries (46.9%). Additionally 43.7 of the mothers had second grade and first cycle studies. When relating the medium and high level of education, there were statistically significant differences in relation to the cod index (p = 0.046). When the origin was foreign (48.4%), preschoolers presented 10.7% more active or untreated caries than Spaniards (p = 0.038). Low socioeconomic cultural level and foreign origin is associated with a more deficient state of oral health in preschoolers. Oral health programs are needed to minimize social inequalities.

Oral health history in children referred to a child advocacy center in Norway

BACKGROUND

Some suspected child victims of physical or sexual abuse undergo dental forensic examinations at child advocacy centers (CACs) in Norway. Their oral health history has not previously been studied.

OBJECTIVE

This study aimed to compare oral health history of CAC children to matched children. Additionally, the oral health history of children exposed to sexual abuse was compared to children exposed to physical abuse.

PARTICIPANTS AND SETTING

The CAC cohort included 100 children, 3-16 years. The matched cohort, with no known history of abuse, included 63 children.

METHODS

The retrospective study analyzed registered data in the children's dental records.

RESULTS

CAC children were more likely than matched children to have caries experience in both primary and permanent teeth, with incidence rate ratio (IRR) 1.50 (95 % CI 1.01-2.25) and 1.92 (1.11-3.30). "Was Not Brought" to dental appointments was more than twice as likely, IRR 2.25 (1.31-3.86), in the CAC cohort. There were no significant differences in reports to the Child Protection Services or dental traumas. Suspected victims of sexual abuse had more caries, IRR 4.28 (2.36-7.77), and fillings, IRR 4.83 (2.55-9.16), in permanent teeth compared to suspected victims of physical abuse.

CONCLUSIONS

CAC children were more likely to have caries experience and not show up for dental appointments than the matched children. Sexual abuse suspected had four times more caries experience than physical abuse suspected. This study supports the need for addressing oral health in risk evaluations concerning child abuse, and provides valuable information to dental professionals and prosecuting authorities.

Effect of Mozart's music on the learning of toothbrushing behavior in children with high and low dental anxiety levels

OBJECTIVES

The aim of this study was to evaluate the effectiveness of Mozart's music on the learning of toothbrushing behavior in children with high and low dental anxiety levels.

MATERIALS AND METHODS

A randomized, controlled, single-blinded, and observational study was conducted with 60 children, aged 8-12, who were recruited to high dental anxiety level (HDAL) and low dental anxiety level (LDAL) groups. Both groups were divided into two equal subgroups (with or without Mozart's music). In the Mozart's music subgroups, children were exposed to Mozart's Sonata for 7 min and toothbrushing training was given accompanied by music. The training was instructed to the second subgroup without listening to Mozart's music. The periodontal measurements were repeated after 15 days. Three-factor variance analysis was used to analyze the data.

RESULTS

There was a statistically significant decrease in plaque index (PI) and gingival index (GI) scores in the follow-up visits for all groups (p < 0.05). A statistically significant decrease was found in PI values between groups with or without music in those with HDAL (p < 0.001). However, no statistically significant differences were found between groups with or without music in those with LDAL (p = 0.07).

CONCLUSIONS

Listening to Mozart's music before toothbrushing training had a significant effect on plaque removal in children with high dental anxiety, while Mozart's music did not have a positive effect in the group with low dental anxiety.

CLINICAL RELEVANCE

The use of Mozart's music may be beneficial in oral hygiene education for children with high dental anxiety levels.

Acculturation and 4-year caries increment among children of foreign-born mothers in Sweden: a register-based cohort study

Background

To study the association of maternal age upon arrival and length of residence in Sweden with the 4-year caries increment in their children between ages 3 and 7 years in relation to the human development index (HDI) of the maternal country of origin.

Method

This registry-based cohort study included all children born in 2000–2003 who resided in Stockholm County, Sweden, at age 3 years and who were followed up at age 7 (n = 63,931). Negative binomial regressions were used to analyze different models adjusted for sociodemographic factors.

Results

Children of foreign-born mothers, regardless of the HDI of the maternal country of origin, had a higher risk of caries increment between ages 3 and 7 years than children of Swedish-born mothers. Furthermore, children of mothers who had arrived from a low or medium HDI country had a lower caries increment if their mothers arrived before age 7 compared with after age 7. Nearly half (44%) of the children whose mothers arrived in Sweden at age ≥ 20 years from a low HDI country had a caries increment compared to 22% of the children whose mothers had arrived in Sweden before 7 years of age. Furthermore, children whose mothers were born in a low HDI country and had resided in Sweden ≤ 19 years had approximately 1.5 times higher risk of caries increment compared to children of mothers who had resided in Sweden for more than 20 years.

Conclusions

Caries increment in the children of foreign-born mothers was associated with the age of their mother when she arrived in Sweden and was lower when the mother had arrived before age 7 years. This indicates an intergenerational effect that carries over to the children and is greater the longer the mother has participated in Swedish dental healthcare.

Oral Health Status among Migrants from Middle- and Low-Income Countries to Europe: A Systematic Review

Introduction. Economic inequality, political instability and globalization have contributed to the constant growth of the migration phenomenon in recent years. In particular, a total of 4.2 million people migrated to Europe during 2019 and most of them settled in Germany, France and Italy. Objectives. The objective of this study was to conduct a systematic review of studies analyzing the oral health condition among migrants from middle- and low-income countries to Europe and assessing the eventual association between their sociodemographic and socioeconomic characteristics and oral health status. Materials and Methods. A systematic review was conducted in PubMed, Cochrane Library, Scopus and Science Direct databases. After titles, abstracts and full-text examination, only 27 articles were selected on the basis of inclusion criteria and consequently included for quality assessments and data extraction. Results. Most of the studies reported a higher prevalence of caries experience, a poorer periodontal health and more difficulties in accessing dentalcare services among migrant groups compared with the non-migrant population. Inequalities were mostly associated with ethnic background, economic condition and social grade. Conclusion. Our review demonstrates the lack of dental health among migrants, underlining that their cultural beliefs and their social and economic living conditions could influence their oral health.

Long-term effects of a lay health advisor intervention on immigrant children's dental caries and maternal preventive behaviour: A randomized controlled trial

OBJECTIVES

An oral health disparity exists between native and immigrant children in Taiwan. This study evaluated the long-term effectiveness of a lay health advisor (LHA) intervention on immigrant children's dental caries and maternal preventive behaviours.

METHODS

Fifty-one immigrant mother-child pairs were randomly assigned to LHA intervention (n = 23) and control (n = 28) groups. Mothers in the LHA group received a four-chapter one-on-one lesson plan, which included dental caries-related knowledge, brushing techniques, caries prevention and free preventive services, from the LHA over 4 weeks. Mothers in the control group received only a health brochure. Baseline and 1-week, 2-month, and 8-month follow-up information was collected using dental examinations and questionnaires.

RESULTS

The mean ages of the children in the LHA and control groups were 4.0 ± 1.4 and 4.2 ± 1.5, respectively. The decayed, missing due to caries, filled teeth (dmft) index in the LHA and control groups was 4.8 ± 6.0 and 5.4 ± 5.4, respectively, at baseline. At the 8-month postintervention follow-up, the number of filled teeth (ft) in the LHA group was higher than that in the control group (β = 8.3, P = .033). The effect size (ES) demonstrated an upward trend at 1-week, 2-month and 8-month follow-ups in ft (ES = 0.21, 0.50 and 0.59, respectively) and a decrease in the number of decayed teeth (dt) (ES = 0.30, 0.43 and 0.57, respectively). The mothers in the LHA group were observed to be 10.9 times more likely than control mothers to assist their children in toothbrushing for 3 min at the 1-week follow-up (95% CI = 1.98-59.40, P = .006).

CONCLUSIONS

The LHA intervention strategy had positive effects on the immigrant children's new dt and ft and on maternal preventive behaviour, such as assisting their children in toothbrushing.

Stainless-steel crowns in children: Norwegian and Finnish dentists' knowledge, practice and challenges

BACKGROUND

Stainless-steel crowns (SSCs) are recommended for restorative treatment of young teeth severely affected by caries, fractures or dental developmental disorders (DDDs). However, despite recommendations and clinical evidence, SSCs are not widely used by general dentists, who favour extraction and more conventional restorations. The present study aimed to investigate the views of and use of SSCs among Norwegian and Finnish dentists.

METHODS

The present study was a cross-sectional survey among Norwegian and Finnish dentists. An electronic questionnaire was sent to Norwegian and Finnish dentists asking whether they used SSCs and on which indications. In addition, the questionnaire assessed reasons for non-use and dentists' perceptions regarding advantages and challenges in the use of SSCs, as well as the need for additional training. Distributions of background characteristics, use of and views on SSCs were calculated, and statistical significance of the associations between respondents' background and their answers were evaluated.

RESULTS

Of the 574 Norwegian and 765 Finnish respondents, only 12.0% and 12.9% reported to use SSCs, respectively. The most frequently reported barrier reported by those who did not use SSCs was lack of practical training. The most frequent challenge reported by those using SSCs was difficulties in crown adjustment followed by aesthetic issues, and the most frequently reported advantage was that SSCs maintain the function and occlusion. The majority of respondents reported a need for more information and practical training in the use of SSCs, with hands-on course as their most frequently preferred education type.

CONCLUSION

Although the value of SSCs for restoring young molars is recognized by Norwegian and Finnish dentists, SSCs are rarely used by general dentists. The majority of the respondents reported lack of training and materials and was interested in receiving more information and education.

Facilitators and barriers to home-based toothbrushing practices by parents of young children to reduce tooth decay: a systematic review

OBJECTIVES

Parental supervised toothbrushing (PSB) is a collection of behaviours recommended by national guidance to improve oral health. This systematic review aimed to identify the barriers and facilitators to PSB.

MATERIALS AND METHODS

Studies investigating parental involvement in home-based toothbrushing in children under 8 years old and the impact on tooth decay were included. Electronic databases, references and unpublished literature databases were searched. The Theoretical Domains Framework (TDF) was used to code barriers/facilitators to PSB.

RESULTS

Of the 10,176 articles retrieved, 68 articles were included. Barriers and facilitators were found across all 12 TDF domains. Barriers included an inadequate toothbrushing environment and resources, knowledge of what PSB entails and child behaviour management. Facilitators were increased oral health knowledge, the adaption of the social environment to facilitate PSB and positive attitudes towards oral health. When only high-quality articles were synthesized, knowledge was not a common barrier/facilitator.

CONCLUSIONS

There are a comprehensive range of barriers/facilitators to PSB acting across all domains and at multiple levels of influence. This review identifies the most popular domains, thus informing the focus for supporting resources to supplement oral health conversations.

CLINICAL RELEVANCE

PSB is a complex behaviour. Practitioners need to understand and be able to explore the wide range of potential barriers and have practical suggestions to enable PSB. This review provides pragmatic examples of different barriers and facilitators and emphasises the importance of listening to parents and exploring their story to identify the barriers and solutions that are relevant to each family.

Common social determinants for overweight and obesity, and dental caries among adolescents in Northern Norway: a cross-sectional study from the Tromsø Study Fit Futures cohort

BACKGROUND

Non-communicable general and oral health conditions share common risk factors. Studies investigating common social determinants as risk factors for overweight/obesity and dental caries among the same adolescents are scarce and inconclusive.

METHODS

This cross-sectional study included data from 464 girls and 494 boys from the population-based Tromsø study Fit Futures, which included first-year students attending upper secondary school in 2010-2011 from two municipalities in Northern Norway (1038 participants in total, 93% participation rate). Multivariable binary logistic regression analyses stratified by sex were used to investigate the association between socioeconomic position indicators (adolescent's own study program, parents' education and employment status) and overweight/obesity indicated by body weight and waist circumference, untreated dental caries in dentine, and when these conditions were considered simultaneously.

RESULTS

Boys enrolled in the general studies and sports programs (versus vocational) had lower odds of being overweight/obese (POR 0.42, 95% CI 0.20-0.86 and POR 0.24, 95% CI 0.08-0.73, respectively), of having high waist circumference (POR 0.39, 95% CI 0.21-0.75 and POR 0.25, 95% CI 0.10-0.64, respectively), dental caries (POR 0.57, 95% CI 0.32-0.99 and POR 0.47, 95% CI 0.22-0.98, respectively), and being simultaneously overweight/obese, having high waist circumference and dental caries (POR 0.24, 95% CI 0.07-0.81 and POR 0.11, 95% CI 0.01-0.98, respectively). Girls enrolled in the general studies program (versus vocational) had lower odds of having dental caries (POR 0.50, 95% CI 0.30-0.84).

CONCLUSIONS

Adolescent's own study program was identified to be a common social determinant for overweight/obesity and dental caries among boys. These results support the broader concept of social determinants as common risk factors for general and oral health conditions, and call for common health promotion strategies addressing these common social determinants among adolescents. However, there is a need for more studies to investigate and better understand the influence of social determinants on health conditions among adolescents.

[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.

[How to measure the migration status of the child and young population? Studies on health and inequalities in health in Europe]

OBJECTIVE

To analyse how the migration status of the child and young population is measured in the scientific literature on health and social inequalities in health in Europe.

METHOD

A systematic search of the literature published in Spanish, English and French between 2007 and 2017 in PubMed and Social Sciences Citation Index was carried out. The included studies analysed health and social inequalities in health of a population under 18 years old according to its migration origin in Europe. The variables used to measure the migration status were described.

RESULTS

50 articles were included. Twenty studies analysed perinatal health, eleven mental health, nine dental health, and ten studies other variables. The main variables to define migration status were the country of birth (32 studies), either of the child, the mother, or one of the parents, and sometimes in a complementary way. Less frequent was the use of nationality (15 studies), of the child, or of the parents, especially the mother. Migration status is referred to in very different ways, not always comparable and sometimes the variable used is not clearly explained.

CONCLUSIONS

There is a great diversity of ways to measure migration status in the child and young population. A better definition and consensus is needed to improve the temporal and geographical comparability of knowledge in this area, which will help to design public policies aimed at reducing social inequalities in health from childhood.

Recall intervals in children are individualized and extended

Objective: The aim of this study was to follow attendance patterns longitudinally by exploring length of intervals between routine dental examinations in children at the ages of 5 and 12 years, and study associations between length of recall intervals and caries prevalence, controlled for gender, parent's background and parent's education. Materials and methods: The study included 2960 children in one Norwegian county monitored from 5 to 12 years of age. Data were collected at clinical examinations, from dental records and by parental questionnaires. Length of recall intervals was dichotomized into short (shorter than 18 months) and long (18 months and longer). Data were analysed and tested using Chi-square statistics, correlation coefficient and multivariate regression. The study was ethically approved. Results: Recall intervals were individualized and varied from 4 to 30 months. The most frequent used recall intervals were 12, 18, 20 and 24 months. A majority of children at both ages were given long recall intervals. Multivariate logistic regression showed that the probability of having short interval was higher in children having caries experience than in caries-free children at both 5 years (OR 12.6 CI 9.9-16.0) and 12 years (OR 2.7 CI 2.3-3.1). At 5 years of age, length of recall intervals was associated with parents' background (OR 1.8 CI 1.4-2.4) and parents' education (OR 1.3 CI 1.0-1.5). Conclusions: The results showed that routine intervals were individualized and extended, indicating that more resources were spent on children with the highest need of dental care, aiming at reducing health inequalities.

Socio-economic inequality in oral health in childhood to young adulthood, despite full dental coverage

The aim of this cross‐sectional study was to assess differences in caries experience according to socio‐economic status (SES) in a health‐care system with full coverage of dental costs for children up to the age of 18 yr. In 2011 and 2014, by performing hurdle negative binomial models, we obtained data on 3,022 children and young adults aged 5, 8, 11, 14, 17, 20, and 23 yr, living in four cities in the Netherlands. At all ages between 5 and 23 yr, the percentages of children with caries‐free dentitions were lower and mean caries experience were higher in low‐SES than in high‐SES participants. In 5‐yr‐old children with dmft > 0, mean caries experience was 3.6 in those with low SES and 2.3 in those with high SES. In 23‐yr‐old participants, these estimates were 6.8 and 4.4, respectively (P < 0.05). Low‐SES children have a greater risk of more caries experience than high‐SES children. Thus, in a system with full free paediatric dental coverage, socio‐economic inequality in caries experience still exists. Dental health professionals, well‐child care doctors and nurses, general practitioners, and elementary school teachers should collaborate to promote oral health at the community level, with specific targeting of low‐SES families. We further need policy measures to curtail, at community level, the increasing availability and consumption of highly processed, carbohydrate‐rich foods, with particular attention for low‐SES families.

Ethnic inequalities in child and adolescent health in the Scandinavian welfare states: The role of parental socioeconomic status - a systematic review

Aims: Adult non-Western immigrants in Scandinavia tend to be worse off in terms of health than native-born populations, which cannot be fully ascribed to their often lower socioeconomic status (SES). This review examines if differences in health status are also present between non-Western immigrant and majority children in Denmark, Norway and Sweden, and if SES explains the differences. Methods: Following PRISMA guidelines, relevant Scandinavian peer-reviewed quantitative publications since 1990 were identified through a systematic search of PubMed, EMBASE, Scopus, Web of Science and SveMed. Of 1197 identified publications, 27 remained relevant after applying inclusion criteria: 3 Danish, 6 Norwegian and 18 Swedish studies. Results: Non-western immigrant children had overall poorer outcomes compared with ethnic majority children in Denmark, Norway and Sweden in health issues covered by the included studies: diabetes, obesity, oral and mental health, and well-being. However, in diabetes, obesity and mental health, non-Western immigrant children from certain countries and regions, and descendants of non-Western immigrants had similar/more favourable outcomes than majority children. In mental health and well-being, ethnic inequalities were strongly associated with SES, while for diabetes, obesity and oral health, differences remained significant after adjusting for SES. Conclusions: Overall poorer health outcomes in non-Western immigrant compared with majority children in Scandinavia cannot be fully explained by SES. Evidence points to additional mechanisms at individual, household, societal or policy levels, including reasons for migration, culture and societal discrimination. Finally, methodological issues may influence study outcomes, e.g. heterogeneity of populations studied and socioeconomic variables included.

Decision Tree Approach to the Impact of Parents' Oral Health on Dental Caries Experience in Children: A Cross-Sectional Study

Decision tree (DT) analysis was applied in this cross-sectional study to investigate caries experience in children by using clinical and microbiological data obtained from parent–child pairs. Thirty pairs of parents and children were recruited from periodontal and pediatric dental clinics. All participants were clinically examined for caries and periodontitis by a calibrated examiner. Cariogenic and periodontopathic bacteria examinations were conducted. The Kendall rank correlation coefficient was used to measure the association between data variables obtained through clinical and microbiological examinations. A classificatory inductive decision tree was generated using the C4.5 algorithm with the top-down approach. The C4.5 DT analysis was applied to classify major influential factors for children dental caries experience. The DT identified parents’ periodontal health classification, decayed, missing, filled permanent teeth (DMFT) index, periodontopathic test (PerioCheck) result, and periodontal pocket depth as the classification factors for children caries experience. 13.3% of children were identified with a low decayed, missing, filled primary teeth (dmft) index (dmft < 3) whose parents had a periodontal pocket depth ≤3.7, PerioCheck score >1, DMFT index <13.5, and periodontal classification >2. The DT model for this study sample had an accuracy of 93.33%. Here, parental periodontal status and parents’ DMFT were the factors forming the DT for children’s caries experience.

Parents' willingness to invest in their children's oral health

OBJECTIVES

This study aimed to evaluate parents' Willingness to Invest (WTI) in their children's oral health in terms of money, visits to a dental practice, and brushing minutes. Objectives were to assess the association between parents' WTI and a) children's dental caries experience, b) children's oral hygiene behavior (OHB), and c) maternal education level and ethnic background.

METHODS

A sample of 630 five to six-year-old-children was recruited from pediatric dental centers in the Netherlands. Children's dmft scores were extracted from personal dental records. Parental questionnaires were used to collect data on parents' WTI, children's OHB, maternal education level and ethnicity.

RESULTS

On average, parents were willing to spend a maximum of €37 per month, 3.0 dental visits per year, and 4.5 brushing minutes per day to maintain good oral health for their child. The mean dmft was significantly higher in children whose parents were willing to pay more money and visit the dentist more often (P = 0.028 and P = 0.002, respectively), while the mean dmft was significantly lower in children of parents who were willing to invest more brushing minutes (P < 0.001). Parental WTI in terms of money and brushing minutes was higher in native and higher-educated parents, and was associated with more favorable OHB of children.

CONCLUSIONS

Parents' WTI in their children's oral health is related to children's dental caries status and reported OHB. Results suggest that children are better off when parents are willing to invest in self-care, rather than in money or dental visits.

Trends in socioeconomic inequalities in oral health among 15-year-old Danish adolescents during 1995-2013: A nationwide, register-based, repeated cross-sectional study

BACKGROUND

Scandinavian welfare states, despite having better population oral health than less egalitarian societies, are characterized by ubiquitous social gradients and large relative socioeconomic inequalities in oral health. However, trends in these inequalities among Scandinavian children and adolescents have not been studied in detail.

OBJECTIVES

To describe the associations between socioeconomic position (SEP) and oral health in adolescents and to investigate the trends in these associations between 1995 and 2013.

METHODS

Nationwide repeated cross-sectional studies (using individual-level data) were conducted on 15-year-olds in Denmark from 1995, 2003, and 2013 (N=154,750). Dental data were obtained from the national dental register of the Danish Health Authority (Sundhedsstyrelsens Centrale Odontologiske Register [SCOR]) and data on social variables from administrative registers at Statistics Denmark. SEP measures included previous year's parental education (highest attained educational level by either of the parents), income (equivalized household disposable income), and occupational social class (highest recorded occupational class between the parents). Covariates were immigration status, country of origin, number of children and persons in the family, and household type. The outcome was dental caries experience, represented by the decayed, missing, and filled surfaces (DMFS) index. Negative binomial regression models were used to examine the association between DMFS count and each of the explanatory variables separately while accounting for cluster-correlated family data. Furthermore, hierarchical multiple regressions of DMFS on SEP indicators-using the zero-inflated negative binomial (ZINB) distribution as the outcome distribution-were estimated while successively adjusting for the potential effects of the included covariates.

RESULTS

Caries prevalence declined from 71% in 1995 to 63% in 2003 and 45% in 2013. Separate assessment of each covariate showed statistically significant graded associations between each covariate and DMFS count at all time points. Similarly, in the ZINB models, in all 3 years, clear gradients were observed in terms of caries differentials in all three SEP categories, with statistically significant associations (Type 3 P values, <.0001) even after adjustment for all other covariates. For instance, in 2013, even among adolescents with positive caries experience, being of lower occupational social class was associated with up to 2.4-fold (95% confidence interval [CI]: 2.2-2.6) higher caries experience. Between 1995 and 2013, relative inequalities increased in all SEP categories, while absolute inequalities decreased in the education and occupation categories.

CONCLUSION

Considerable progress has been made in reducing dental caries rates among Danish adolescents; however, this progress has benefited the disadvantaged social groups less than the better-off groups.

Parental attitudes towards oral health and caries-risk in their children

OBJECTIVES

The aim of this study was to investigate whether parents can be matched with attitudes towards oral health by means of a short vignette sheet, developed based on the results of an earlier Q-methodological study. Furthermore, this study aims to explore how the attitudes associate with diet and oral hygiene habits and with clinical outcomes in children.

METHODS

A total of 170 parents of 6- to 9-year-old children completed a questionnaire including the vignette sheet and clinical scores (oral hygiene, caries) were retrieved from the follow-up measurement of a RCT on caries-preventive measures.

RESULTS

Of the 170 respondents, 159 (93.5%) could be matched to a single best matching attitude. Respondents identified "well" to "very well" with at least one of the attitudes and seemed to be able to differentiate well the extent to which they matched to the different attitudes. Parents scoring high on different attitudes were found to be associated with different lifestyle patterns and clinical outcomes.

CONCLUSIONS

It was concluded that using a self-assessed attitude tool, derived from the results of a Q-methodological study, it is possible to identify different groups of parents with different oral health-related risk factors. Of course, it is hardly likely that people are 100% only 1 type of parent; parents can be considered to be a mix of different typologies. However, information on the composition of that mix may be helpful for the dental professional to estimate risks and to deliver a more tailored prevention strategy in children.

Own brand label restorative materials-A false bargain?

OBJECTIVES

This study aims at evaluating and comparing mechanical, chemical, and cytotoxicological parameters of a commercial brand name composite material against two 'own brand label' (OBL) composites.

METHODS

Parameters included depth of cure, flexural strength, degree of conversion, polymerization shrinkage, filler particle morphology and elemental analyzes, Vickers hardness, surface roughness parameters after abrasion, monomer elution, and cytotoxicity.

RESULTS

The conventional composite outperformed the OBLS in terms of depth of cure (p<0.001), degree of cure at the first and last time intervals (p<0.001), hardness (p<0.001), and post-abrasion roughness (p<0.05). The polymerization volumetric shrinkage ranged from 2.86% to 4.13%, with the highest shrinkage seen among the OBLs. Both Monomer elution from the OBLs was statistically significantly higher (p<0.001). Statistically significantly higher cytotoxicity combined with altered morphology and loss of confluence was detected in the cells exposed to extracts from the OBLs.

CONCLUSIONS

The OBLs were in general outdone by the conventional composite.

CLINICAL SIGNIFICANCE

OBLs restorative materials have become pervasive in the dental market. Manufacturers often promise equal or better characteristics than existing brand-name composites, but at a lower price. Dentists are highly recommended to reconsider utilization of OBLs lacking sound scientific scrutiny, and our findings underscore this recommendation.

Ethnic Disparities in Dental Caries among Six-Year-Old Children in the Netherlands

The aim of this study was to investigate potential differences in caries prevalence of children from ethnic minority groups compared to native Dutch children and the influence of socio-economic status (SES) and parent-reported oral health behaviour on this association. The study had a cross-sectional design, embedded in a population-based prospective multi-ethnic cohort study. 4,306 children with information on caries experience, belonging to 7 different ethnic groups, participated in this study. The decayed, missing, and filled teeth (dmft) index was assessed at the age of 6 and categorized in two ways for analysis: children without caries (dmft = 0) versus any caries experience (dmft >0) and children without caries (dmft = 0) versus children with mild caries (dmft = 1-3) or severe caries (dmft >3). Compared to native Dutch children, children with a Surinamese-Hindustani, Surinamese-Creole, Turkish, Moroccan, and Cape Verdean background had significantly higher odds for dental caries. Especially the Surinamese-Hindustani, Turkish, and Moroccan group had significantly higher odds for severe dental caries. Household income and educational level of the mother explained up to 43% of the association between ethnicity and dental caries, whereas parent-reported oral health behaviour did not mediate the association. Alarming disparities in caries prevalence between different ethnic (minority) groups exist, which cannot be fully explained by social inequalities. Public health strategies can apply this new knowledge and specifically focus on the reduction of ethnic disparities in oral health. More research is needed to explain the high caries prevalence among different ethnic minority groups.

Health nurses' experiences and attitudes regarding collaboration with dental personnel

Background

Collaboration between primary care personnel and dental personnel to prevent early childhood caries has been established in several countries. The purpose of this study was, firstly, to describe health nurses’ experiences and attitudes regarding collaboration with dental personnel, and secondly, to identify characteristic of health nurses and health centres associated with the collaboration.

Methods

Health nurses working with children answered a questionnaire. In total, 163 of 296 health nurses (55 %) reported demographic information, referral routines, frequency of and reasons for referral of young children to dental personnel, contact with dental personnel and satisfaction with the collaboration. Data were analysed using multivariate logistic regression.

Results

The majority of health nurses (83 %) were familiar with referral routines and 31 % reported referring children to dental personnel monthly or more often. The most frequent reasons for referral were clinical caries (52 %), dental discolouration (38 %) and dental trauma (34 %). Few health nurses (18 %) had contact with dental personnel monthly or more often. Two-thirds of health nurses (71 %) reported being satisfied with the collaboration with dental personnel. Results of multivariate analysis showed that health nurses were more likely to refer children when the proportion of immigrant children under care in the health centres was high than when proportion of immigrant children was low (OR 6.4, CI 2.7–14.9). Health nurses working in small health centres were more likely to be satisfied with the collaboration than health nurses working in large health centres (OR 3.2, CI 1.4–7.0). Health nurses 45 years or older were more likely to possess knowledge of referral routines than younger health nurses (OR 2.7, CI 1.1–6.4).

Conclusions

The results indicated that the majority of health nurses possessed knowledge of collaboration routines and were satisfied with the collaboration. The proportion of immigrant children under care in the health centres, the size of the health centres and the age of health nurses were factors influencing the collaboration between primary care personnel and dental personnel.

Role of saliva proteinase 3 in dental caries

Salivary analysis can be used to assess the severity of caries. Of the known salivary proteins, a paucity of information exists concerning the role of proteinase 3 (PR3), a serine protease of the chymotrypsin family, in dental caries. Whole, unstimulated saliva was collected from children with varying degrees of active caries and tested using a Human Protease Array Kit and an enzyme-linked immunosorbent assay. A significantly decreased concentration of salivary PR3 was noted with increasing severity of dental caries (P<0.01); a positive correlation (r=0.87; P<0.01; Pearson's correlation analysis) was also observed between salivary pH and PR3 concentration. In an antibacterial test, a PR3 concentration of 250 ng·mL⁻¹ or higher significantly inhibited Streptococcus mutans UA159 growth after 12 h of incubation (P<0.05). These studies indicate that PR3 is a salivary factor associated with the severity of dental caries, as suggested by the negative relationship between salivary PR3 concentration and the severity of caries as well as the susceptibility of S. mutans to PR3.

Association between family factors and children's oral health behaviors--a cross-sectional comparative study of permanent resident and migrant children in large cities in China

OBJECTIVES

To examine the association of family factors on oral health behaviors of children and compare them between permanent residents and migrant children.

METHODS

A total of 3015 children in grades 4, 5, and 6 from 16 elementary schools and their parents in Beijing and Guangzhou, China, were selected through multistage stratified cluster random sampling. Questionnaires constructed for this study were self-completed by children and parents to collect information on children's oral health behaviors (COHB), parents' modeling behaviors (PMB), parents' direct controlling behaviors (PDCB), parents' indirect controlling behaviors (PICB), parents' oral health knowledge and attitudes (POHKA), and children's oral health knowledge and attitudes (COHKA). Correlation analysis and path analysis were used to explore the correlation between COHB and PMB, as well as the effects of family factors [socioeconomic status (SES), PMB, PDCB, PICB, and POHKA on COHB].

RESULTS

Considering all participants, the rates of behavioral similarities of parents and children were 63.8-86.1%, all showing statistical significance. For family factors included, PMB, SES, PICB, and POHKA demonstrated positive relationships with COHB with standardized coefficients of 0.200, 0.122, 0.040, and 0.059 in residents and 0.160, 0.121, 0.090, and 0.041 in migrants, respectively. Family SES was associated with COHB directly and indirectly to a similar degree. In migrants, the relationship between COHKA and COHB was greater than that between PMB and COHB. COHB scores were higher in younger children. In residents, the relationship between PMB and COHB was greater than that between COHKA and COHB. COHB scores were slightly higher in older children indirectly influenced by increases in COHKA.

CONCLUSIONS

Parents' behaviors shared relatively high similarities with COHB and family factors were associated with COHB greatly. The relationship between PMB and COHB was less than that between COHKA and COHB in migrants. The association between family factors and COHB in disadvantaged populations should be considered when designing children's health education programs.

Early childhood caries in Switzerland: a marker of social inequalities

BACKGROUND

Early childhood caries (ECC) is a marker of social inequalities worldwide because disadvantaged children are more likely to develop caries than their peers. This study aimed to define the ECC prevalence among children living in French-speaking Switzerland, where data on this topic were scarce, and to assess whether ECC was an early marker of social inequalities in this country.

METHODS

The study took place between 2010 and 2012 in the primary care facility of Lausanne Children's Hospital. We clinically screened 856 children from 36 to 71 months old for ECC, and their caregivers (parents or legal guardians) filled in a questionnaire including items on socioeconomic background (education, occupation, income, literacy and immigration status), dental care and dietary habits. Prevalence rates, prevalence ratios and logistic regressions were calculated.

RESULTS

The overall ECC prevalence was 24.8 %. ECC was less frequent among children from higher socioeconomic backgrounds than children from lower ones (prevalence ratios ≤ 0.58).

CONCLUSIONS

This study reported a worrying prevalence rate of ECC among children from 36 to 71 months old, living in French-speaking Switzerland. ECC appears to be a good marker of social inequalities as disadvantaged children, whether from Swiss or immigrant backgrounds, were more likely to have caries than their less disadvantaged peers. Specific preventive interventions regarding ECC are needed for all disadvantaged children, whether immigrants or Swiss.

Oral health behaviors and bacterial transmission from mother to child: an explorative study

Background

Health behaviors play a major role in the prevention of the most common oral diseases. To investigate health behaviors related to the potential transmission of oral bacteria from mother to child using novel multiple correspondence analysis (MCA).

Methods

Mothers (n = 313) with children under three years attending two municipal child health clinics in Finland completed a self-administered questionnaire on health knowledge and behaviors such as sharing a spoon with their child, kissing on the lips, and the mothers’ tooth brushing, smoking, age, and level of education. We used MCA to reveal the relationships between the mothers’ behaviors and background factors, along with unconditional, binary, multivariable logistic regression models, odds ratios (OR) and their 95 % confidence intervals (95 %CI).

Results

Of the mothers, 38 % kissed their child on the lips and 14 % shared a spoon with their child; 11 % believed that oral bacteria cannot be transmitted from mother to child. Two-thirds (68 %) of them reported tooth brushing twice daily, and 80 % were non-smokers. MCA revealed two diverging dimensions of the mothers’ behaviors: a ‘horizontal’ one showing clear evidence of relationships between tooth brushing, smoking, age and education, whereas the ‘vertical’ one revealed the mothers’ habits of kissing the child on the lips and sharing a spoon related to each other. Spoon sharing was related to the kissing on lips (OR 10.3), a higher level of education (OR 3.1), and, inversely, older age (OR 0.1), whereas kissing on lips behavior was inversely related to a higher level of education (OR 0.5).

Conclusion

The study revealed two diverging dimensions of the mothers’ health behaviors. More emphasis in health education ought to be put to how to avoid bacterial transmission from caregiver to child during feeding.

Maternal Dental Anxiety and its Effect on Caries Experience Among Children in Udaipur, India

CONTEXT

Dental caries is a common oral disease among children. There are various factors that influence caries development. Parents and family environment influence oral health behaviours among children. Dental Anxiety is a common hindrance in seeking dental treatment. Mothers' dental anxiety may act as a barrier to seek professional advice about their children's caries experience.

AIM

To evaluate dental anxiety among mothers and its possible relationship with caries experience in their children in Udaipur city, India.

SETTING AND DESIGN

The sample was selected from those attending Darshan Dental College and Hospital, Udaipur for dental treatment. The study period was from June 2014 to November 2014.

MATERIALS AND METHODS

A cross-sectional survey was designed. A total of 187 mother-child pairs were recruited for the study. The children's age ranged from 3-14 years. Modified Dental Anxiety Scale (MDAS), Hindi version, was used to evaluate dental anxiety among the mothers that categorizes the dental anxiety into five levels. Demographic detail such as age, educational level, and family income was also collected. The World Health Organization (WHO) criteria was utilized for the diagnosis of dental caries in children. DMFT (Decayed, missing and filled teeth) and DMFS (Decayed, missing and filled surfaces) scores were then calculated.

STATISTICAL ANALYSIS

Statistical Package for Social Sciences (SPSS) version 20.0 was used to interpret data. Maternal anxiety scores taken as mean MDAS were compared with various independent variables. Statistical tests were used to compare maternal anxiety and children's caries experience. A p value equal or less than 0.05 was considered as statistically significant.

RESULTS

Almost half (49.7%) of the mothers reported as being 'fairly anxious' or 'very anxious'. There was a significant (p=.001) difference in maternal dental anxiety level in relation to age of the children. Mothers of younger children reported higher anxiety scores. Similarly, mothers with lesser education and lesser family income reported higher anxiety scores. The mean decayed score in children of very anxious mothers and phobic mothers was significantly (p=.001) higher as compared to the children of the mothers with lower anxiety levels.

CONCLUSION

There was a strong positive association between maternal dental anxiety and children's dental caries experience.

Inequalities in dental caries experience among 6-year-old German children after the caries decline

OBJECTIVE

As in many other countries, caries decline in Germany has left pockets of persisting caries prevalence. This study aims to assess the benefit of a 10-year community-based prophylaxis program, focused on regular toothbrushing with fluoridated toothpastes or gels and involving institutions noted as having the highest caries levels.

MATERIALS AND METHODS

The caries data (d3mft/D3MFT) was extracted from the results of the compulsory school entry examinations in Greifswald/Germany (2003/2004-2012/2013) involving ∼280 6-7-year-olds each year. Data from schools that include children with the highest caries levels and coming from low-SES families were analyzed independently and used for comparisons. Additionally, caries trends from Greifswald were compared to data from representative national surveys (2004-2009).

RESULTS

Data from 2871 children were available for analysis. The baseline d3mft value (2003/2004) was 3.2±3.8; the d3-component corresponded to 70% of the index. The latest caries data (2012/2013) showed a strong reduction (43.8%) in caries prevalence (d3mft=1.8±2.5). Similarly, the SiC-Index declined significantly from 2003/2004 (7.9±2.3) to 2012/2013 (4.8±2.3; p<0.001). Nevertheless, in all analyzed years the d3mft values and the SiC-Index were significantly higher in the institutions that included children coming from lower-SES families (p<0.05). The amount of caries reduction between 2004 and 2009 corresponded to 38% in Greifswald as compared to 13% in Germany.

CONCLUSIONS

This strategy involving a combination of regular toothbrushing and fluoride application has achieved an overall substantial caries reduction, thereby indicating that caries-control strategies for heterogeneous risk groups can be highly successful as setting approach. However, activities targeting high risk groups still need to be strengthened.

Does early establishment of favorable oral health behavior influence caries experience at age 5 years?

OBJECTIVE

The purpose was to study associations between tooth brushing frequency, use of fluoride lozenges and consumption of sugary drinks at 1.5 years of age and having caries experience at 5 years of age.

METHODS

This study was based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and by the Public Dental Services. A total of 1095 children were followed from pregnancy to the age of 5 years. Questionnaires regarding oral health behavior were completed by the parents at 1.5 and 5 years of age. Clinical and radiographic examination of the children was performed at the age of 5 years.

RESULTS

In multiple logistic regression, having caries experience at 5 years of age was associated with; at 1.5 years of age having the teeth brushed less than twice daily (OR = 2.1, CI = 1.3-3.6) and being offered sugary drinks at least once a week (OR = 1.8, CI = 1.1-2.9) when controlled for family characteristics and oral health behavior at 5 years of age.

CONCLUSIONS

Tooth brushing frequency and consumption of sugary drinks in early childhood were related to caries development during pre-school age, independent of family characteristics and oral health behavior at 5 years of age. The results indicate that early established habits regarding tooth brushing and consumption of sugary drinks have long-term effects on caries development. Parents encountering difficulties in establishing favorable oral health behavior in children's first years of life should receive special attention from health personnel.

Comparação de métodos de regressão multivariada no estudo de determinantes da cárie dentária em crianças

Objetivos: comparar resultados com modelos multivariados hierarquizados e convencionais na investigação de determinantes da cárie dentária em crianças. Métodos: analisou-se dados de um inquérito em crianças assistidas pela Estratégia Saúde da Família do Recife, Pernambuco, conduzido em 2006. A variável dependente foi a prevalência de cárie (ceo-d≥1); As variáveis independentes foram ordenadas em blocos: socioeconómico, contexto de vida/familiar, cuidado em saúde bucal. Variáveis estatisticamente associadas a ceo-d ≥1 em análises univariadas, com um nível de significância dep≤0,20, foram incluídas nos modelos multivariados. No modelo hierarquizado, a ordem de inclusão das variáveis foi orientada por um modelo conceitual multidimensional. Variáveis associadas a um nível de p≤0,10 foram mantidas no modelo final. No modelo logístico convencional as variáveis significantes nas análises univariadas foram simultaneamente incluídas e ajustadas. Variáveis associadas ao ceo-d com p≤0,10 foram mantidas. Resultados: no modelo convencional foram fatores associados ao ceo-d≥1: alta densidade domiciliar, baixa escolaridade do cuidador; estudar em escolas públicas, procurar tratamento/emergência, ingerir doces. No modelo hierarquizado, além desses fatores, foram mantidos no modelo final a ocupação do pai e a escolaridade da mãe. Conclusões: a análise hierarquizada possibilitou identificar os determinantes distais, que exerceram influências sobre os de níveis inferiores e destes sobre o desfecho, permitindo uma discussão mais contextualizada do problema.

Oral health status and oral health knowledge, attitudes and behavior among rural children in Shaanxi, western China: a cross-sectional survey

BACKGROUND

The current oral health status and possible dental risk factors among children in rural Shaanxi Province, western China are unreported. This study aimed to describe the oral health status and to analyze the possible risk factors for the oral health status in this population.

METHODS

A multi-stage cluster sampling method was used to survey 12- to 15-year-olds and 4- to 6-year-olds in villages in Shaanxi Province. The structured questionnaires were provided to the 12- to 15-year-olds and to the caregivers of the 4- to 6-year-olds to collect information on the subjects' oral health knowledge, attitudes and behavior. A clinical examination was performed to assess dental caries and gingival bleeding (only 12- to 15-year-olds). SPSS 17.0 statistical software was used to analyze the data.

RESULTS

The decayed, missing, filled teeth (DMFT) index scores of 12- to 15-year-olds and 4-to 6-year-olds averaged 0.45 and 3.05, respectively. The caries prevalence was 23.9% in 12- to 15-year-olds and 67% in 4-to 6-year-olds. Additionally, 45.2% of the 12- to 15-year-olds had gingival bleeding and 62.8% had calculus. The oral health knowledge of the subjects was generally poor, whereas they held very positive attitudes toward oral health. A low number of participants reported that they brushed their teeth at least twice daily. Moreover, a statistically significant relationship was found between oral health knowledge scores, tooth brushing frequency and DMFT scores as well as gingival bleeding in the 12- to 15-year-olds. Frequency of sweets consumption was strongly related to dmft scores in the 4- to 6-year-olds.

CONCLUSION

The oral health status, oral health knowledge and behaviors among village children in Shaanxi Province are poor. Oral health education to improve oral health knowledge and to increase the frequency of tooth brushing should be undertaken in the rural schools in western China.

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.

Dental status of new caledonian children: is there a need for a new oral health promotion programme?

BACKGROUND

Before implementing a new oral health promotion program in the French overseas territory of Nouvelle Calédonie, the health authorities needed recent data about dental status of the New Caledonian child population.

OBJECTIVES

This study aimed to describe the dental status of 6, 9 and 12-yr-old New Caledonian children and to investigate the environmental and behavioural risk factors related to oral health.

METHODS

A randomly selected sample of 2734 children (744 6-yr-olds, 789 9-yr-olds, and 1201 12-yr-olds) was examined clinically by seven calibrated investigators and participants responded to a questionnaire. The main variables were objective criteria about dental status and subjective criteria about experience of dental care, dental fear, self-perception of oral health, cultural or ethnic identity and environmental and behavioural risk factors.

RESULTS

Overall, most of the children had infectious oral diseases: more than 50% had gingivitis, and 60% of 6- and 9 yr-olds had at least one deciduous or permanent tooth with untreated caries. The mean 12-yr-old number of decayed missing and filled teeth (DMFT) was 2.09±2.82. The number of carious lesions was related to the unfavourable lifestyle, deprived social status and no preventive dental care. Kanak, Polynesians and Caledonians (respectively 27%, 18% and 45% of the study sample) were more affected by caries than metropolitan French and Asian children. Children with many untreated carious lesions had negative perceptions of their oral health; they complained of chewing difficulty and had higher scores for dental anxiety.

CONCLUSION

This study highlights the need for new strategies aimed at improving oral health and at reducing inequalities in New Caledonia. An oral health promotion program would need to be developed in connection with other health programmes using the common risk factor approach within the context of the local environment.

Caries and background factors in Swedish 4-year-old children with special reference to immigrant status

OBJECTIVE

This study assesses the prevalence of caries and some background factors in 4-year-old children in the city of Umeå, northern Sweden, and compares this with data from earlier studies to reveal changes over time.

MATERIALS AND METHODS

Children from the catchment areas of three Public Dental Health Service clinics in Umeå (n = 224) born during the third quarter of 2008 were invited to undergo a clinical dental examination. Decayed surfaces (including both dentine and enamel, except for enamel lesions on buccal and lingual surfaces), missing and filled surfaces (dmfs) were recorded using the same methods and criteria as in a series of earlier studies performed between 1980-2007. Background data were collected in a case-history and a questionnaire. Results. The proportion of children with caries significantly decreased from 2007 (38%) to 2012 (22%) (p < 0.05). In addition, the distribution of dmfs differed significantly between these years (p < 0.05). More immigrant children had caries (42%) than non-immigrant children (15%) (p < 0.05). For children with caries, there were no significant changes in the distribution of dmfs between 1980-2012 (p > 0.05). An immigrant background was associated with a lower frequency of tooth brushing and a higher intake of ice cream, sweets and chocolate drinks (p < 0.05).

CONCLUSION

Although the proportion of children with caries declined between 2007-2012, this decline was limited to non-immigrant children. Since 1980 the distribution of dmfs remained unchanged among children with caries. More research on interventions for changing oral health behaviours is needed, specifically for immigrant children.

Dental erosion: a widespread condition nowadays? A cross-sectional study among a group of adolescents in Norway

OBJECTIVE

This study aimed to investigate the prevalence, distribution and severity of erosive wear in a group of 16-18-year-olds in the western part of Norway. A second aim was to describe possible associations between caries experience, socioeconomic background and origin of birth.

MATERIALS AND METHODS

Adolescents (n = 795) attending recall examinations at Public Dental Service (PDS) clinics were also examined for dental erosive wear on index surfaces, using the Visual Erosion Dental Examination scoring system (VEDE).

RESULTS

In total, 795 individuals were examined. Dental erosive wear was diagnosed in 59% of the population (44% erosive wear in enamel only, 14% combination of enamel and dentine lesions, 1% erosive wear in dentine only). The palatal surfaces of upper central incisors and occlusal surfaces of first lower molars were affected the most (33% and 48% of all surfaces, respectively). Cuppings on molars were registered in 66% of the individuals with erosive wear. Erosive wear was significantly more prevalent among men (63%) than women (55%) (p = 0.018).

CONCLUSIONS

There were no significant associations between dental erosive wear and caries experience, socioeconomic background or origin of birth.

Pattern and severity of early childhood caries in Southern Italy: a preschool-based cross-sectional study

BACKGROUND

This survey was intended to investigate prevalence and severity of early childhood caries (ECC) in a sample of children in Southern Italy and to identify factors that may be related to this condition.

METHODS

The study was designed as a cross-sectional survey. The study population (children aged 36-71 months) attending thirteen kindergartens was randomly selected through a two-stage cluster sampling procedure. Parents/guardians of all eligible children were invited to participate filling out a structured self-administered questionnaire, and after having returned the informed consent form an oral examination of the child was performed at school. The questionnaire included information on: socio-demographics about parents/guardians and child, pregnancy and newborn characteristics, oral hygiene habits of child, eating habits particularly on consumption of sweets, access to dental services, and infant feeding practices. The WHO caries diagnostic criteria for deciduous decayed, missing and filled teeth (dmft) and surfaces (dmfs) were used to record ECC and severe-ECC (S-ECC). Univariate and multiple logistic regression analyses were conducted to evaluate statistical associations of social demographics, infant feeding practices, oral hygiene habits, and access to dental services to ECC, S-ECC, dmft and dmfs.

RESULTS

515 children participated in the study. 19% had experienced ECC, and 2.7% severe-ECC (S-ECC), with a mean dmft and dmfs scores of 0.51 and 0.99, respectively. Mean dmft was 2.68 in ECC subjects, and 6.86 in S-ECC subjects. Statistical analysis showed that prevalence of ECC significantly increased with age (OR = 1.95; 95% CI = 1.3-2.91) and duration of breastfeeding (OR = 1.26; 95% CI = 1.01-1.57), whereas it was significantly lower in children of more educated mothers (OR = 0.64; 95% CI = 0.42-0.96), and higher in those who had been visited by a dentist in the previous year (OR = 3.29; 95% CI = 1.72-6.33).

CONCLUSIONS

Results of our study demonstrate that even in Western countries ECC and S-ECC represent a significant burden in preschool children, particularly in those disadvantaged, and that most of the known modifiable associated factors regarding feeding practices and oral hygiene are still very spread in the population.

Tooth brushing frequency and use of fluoride lozenges in children from 1.5 to 5 years of age: a longitudinal study

OBJECTIVES

The purpose of the analyses was to study development, stability and changes in oral health behaviour - tooth brushing frequency, use of fluoride lozenges and fluoridated toothpaste in children from 1.5 to 5 years of age - and to study associations between oral health behaviour and family characteristics.

METHODS

This study was based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and data from the Public Dental Services. A total of 771 children were followed from 1.5 to 5 years of age. Questionnaires regarding oral health behaviour in children were completed by the parents three times during preschool age.

RESULTS

More than half of the children (52%) had their teeth brushed twice daily at 1.5 years of age, increasing to 61% at 3 years and 76% at 5 years of age. At 1.5 years of age, 37% of the children used fluoride lozenges daily, increasing to 74% at 3 years and 75% at 5 years of age. The majority of the children who had started brushing twice daily and used fluoride lozenges daily at 1.5 years of age continued these behaviours until the age of 5 years. At 1.5 years of age, children who brushed twice daily were more likely to use fluoride lozenges daily than children who brushed less frequently (P = 0.03). Multiple logistic regression showed that the probability of a child having its teeth brushed twice daily continuously during preschool age was higher when both parents were of western origin [odds ratios (OR) 4.0, confidence intervals (CI) 1.3-11.9] than when one or both parents were of non-western origin. Children with one older sibling brushed more frequently (OR 1.4, CI 1.0-1.9) and used fluoride lozenges more often (OR 1.6, CI 1.1-2.2) during preschool age than children without older siblings.

CONCLUSIONS

Oral health behaviour established in early life was stable during preschool age. The results indicate that tooth brushing frequency and use of fluoride lozenges were not in accordance with the present recommendations based on the scientific literature. The teeth of Norwegian preschoolers were brushed less frequently than recommended, and more children than recommended were using fluoride lozenges.

Prevalence of caries among preschool-aged children in a central Anatolian population

Objective:

Early childhood caries (ECC) is a particularly destructive form of tooth decay that afflicts young children. The etiology and associated factors of ECC should be studied adequately to overcome this health hazard. The aim of this study was to determine caries prevalence and its consequences in toddlers in an Anatolian city, Kırıkkale.

Materials and Methods:

Examinations were performed in family medicine centers by three calibrated dentists during a period of 6 months. The status of dental caries was recorded according to the World Health Organization (WHO) criteria. We recorded the clinical indexes of decayed, missed, and filled teeth (DMFT and dmft; upper-case letters refer to permanent and lower-case letters to primary teeth), and decayed, missed, and filled surfaces (DMFS).

Results:

Totally 3171 toddlers were included (52% males and 48% females). The mean age was 25.8 ± 10.1 months. The prevalence of ECC in preschool children was 17.3%, while the mean df(t) was 0.63 ± 1.79. ECC increased significantly with age. Dental caries were mostly observed in primary maxillary central teeth. Occlusal and buccal surfaces were the most affected sites. The difference in distribution of caries between maxilla and mandibula was found to be statistically significant (P < 0.05).

Conclusions:

When compared to other data obtained from various epidemiologic studies, the toddlers living in Kırıkkale city center had a significant caries level. This observation had clearly suggested that early preventive measures should urgently be put into effect all over the city.

Dental treatment needs in vancouver inner-city elementary school-aged children

Aims. To examine the dental treatment needs of inner-city Vancouver elementary school-aged children and relate them to sociodemographic characteristics. Methods. A census sampling comprising 562 children from six out of eight eligible schools was chosen (response rate was 65.4%). Dental treatment needs were assessed based on criteria from the World Health Organization. Results. Every third child examined needed at least one restorative treatment. A higher proportion of children born outside Canada were in need of more extensive dental treatments such as pulp care and extractions compared to the children born in Canada. There were no statistically significant differences in dental treatment needs between age, gender, or income groups or between children with or without dental insurance (Chi Squared P > 0.05). The best significant predictors (Linear Multiple Regression, P > 0.05) of higher dental treatment needs were being born outside Canada, gender, time of last dental visit, and family income. Having dental insurance did not associate with needing less treatment. Conclusion. A high level of unmet dental treatment needs (32%) was found in inner-city Vancouver elementary school-aged children. Children born outside Canada, particularly the ones who recently arrived to Canada, needed more extensive dental treatments than children born in Canada.

Oral health behavior of parents as a predictor of oral health status of their children

Introduction. It is widely acknowledged that the behavior of parents affects their children's health. This study aimed to evaluate the relationship between oral health behavior of parents and oral health status and behavior of their children in a sample of preschool children in Iran. Method and Material. A random sample of over-five-year-old preschool children and their parents were enrolled in the study. Selection of schools was by clustering method. Parents were asked to fill a piloted questionnaire which included demographic characteristics, socioeconomic status, oral health behaviors of children and their parents. Oral health status of children was examined. The parent and their children oral health relationship were tested using regression and correlation analysis. Results. About 222 parents and children participated in the study. There was a significant relationship between history of having dental problems in parents and dmft index in their children (P = 0.01). There was a significant relationship between parental frequency of tooth brushing and child frequency of tooth brushing (P = 0.05); however, there was no significant relationship between parental frequency of dental visits and those of their children (P = 0.1). Conclusion. The study concluded that some important health behaviors in parents, such as tooth brushing habits are important determinants of these behaviors in their young children. So promoting parent knowledge and attitude could affect their children oral health behavior and status.