Maternal health and lifestyle, and caries experience in preschool children. A longitudinal study from pregnancy to age 5 yr

The Global Prevalence and Severity of Dental Caries among Racially Minoritized Children: A Systematic Review and Meta-Analysis

Racially minoritized children often bear a greater burden of dental caries, but the overall magnitude of racial gaps in oral health and their underlying factors are unknown. A systematic review and meta-analysis were conducted to fill these knowledge gaps. We compared racially minoritized (E) children aged 5-11 years (P) with same-age privileged groups (C) to determine the magnitude and correlates of racial inequities in dental caries (O) in observational studies (S). Using the PICOS selection criteria, a targeted search was performed from inception to December 1, 2021, in nine major electronic databases and an online web search for additional grey literature. The primary outcome measures were caries severity, as assessed by mean decayed, missing, and filled teeth (dmft) among children and untreated dental caries prevalence (d > 0%). The meta-analysis used the random-effects model to calculate standardized mean differences (SMD) and 95% confidence intervals (95% CI). Subgroup analysis, tests for heterogeneity (I2, Galbraith plot), leave-one-out sensitivity analysis, cumulative analysis, and publication bias (Egger's test and funnel plots) tests were carried out. The New Castle Ottawa scale was used to assess risk of bias. This review was registered with PROSPERO, CRD42021282771. A total of 75 publications were included in the descriptive analysis. The SMD of dmft score was higher by 2.30 (95% CI: 0.45, 4.15), and the prevalence of untreated dental caries was 23% (95% CI: 16, 31) higher among racially minoritized children, compared to privileged groups. Cumulative analysis showed worsening caries outcomes for racially marginalized children over time and larger inequities in dmft among high-income countries. Our study highlights the high caries burden among minoritized children globally by estimating overall trends and comparing against factors including time, country, and world income. The large magnitude of these inequities, combined with empirical evidence on the oral health impacts of racism and other forms of oppression, reinforce that oral health equity can only be achieved with social and political changes at a global level.

Prevention of caries and obesity in children with immigrant background in Norway- a study protocol for a cluster randomized controlled trial

BACKGROUND

Immigrants are known to experience greater socioeconomic stress and poorer well-being and to suffer more from lifestyle- and diet-related disorders than native populations. There is also evidence that children of immigrant parents are at greater risk of diverse health problems than their host country cohorts. The aim of this study is to apply and evaluate the efficacy of an early life intervention program among parents/children with immigrant background to prevent childhood caries and obesity, thereby improving the children's general health, oral health, and quality of life.

METHODS

This is a study protocol for a cluster randomized controlled intervention follow-up study. In phase I of the study, the primary care health centers in the municipality of Bergen, Norway were randomly allocated to intervention or control groups. The intervention was carried out using the motivational interviewing technique and the common risk factor approach. The intervention group received guidance on diet/oral hygiene and the control group received standard care information. Parental knowledge and children at age 3 and 5 years old will be assessed in a prospective phase II follow-up study compared to native Norwegian controls. The primary outcome will be evaluation of change on parental oral health related knowledge and attitudes. The secondary outcome will assess the impact of the intervention on children's caries -, body mass index- and oral health related quality of life.

DISCUSSION

Collaboration between dental public health and primary health care personnel on the common risk approach motivational intervention offers opportunities to address key dietary behaviors that may prevent obesity and dental caries. Providing sustainable preventive measures decreases the burden of diseases and consequently reduces health inequalities, particularly among at-risk children.

TRIAL REGISTRATION

The study is registered as a clinical trial (ClinicalTrials.gov Identifier: NCT05758454: 7 March 2023). Ethical approval has already been granted by the Regional Ethical Committee (REK) (2015/ 27,639 /REK vest) and Sikt - Norwegian Agency for Shared Services in Education and Research (Reference number 778825).

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prepregnancy BMI, gestational weight gain and offspring caries experience: Avon longitudinal study of parents and children

Pre-existing maternal overweight/obesity and pregnancy weight gain are associated with adverse birth outcomes such as low birth weight and prematurity, which may increase the risk of developmental tooth defects and early childhood caries. We sought to investigate the association between prepregnancy BMI, gestational weight gain (GWG) and the risk of early childhood caries. Data from 1,429 mother-offspring participants of the 1991/1992 Avon Longitudinal Study of Parents and Children were analyzed. The exposures were prepregnancy BMI (under/normal weight vs. overweight/obese), and gestational weight gain (GWG) based on the Institute of Medicine’s recommended levels. The main outcome measured was offspring caries experience determined by clinical oral examinations at three time points. Log binomial regression estimated risk ratios and 95% confidence intervals. Seventy six percent (76%) of the mothers were under/normal weight prepregnancy, 39% and 26% respectively gained less and more than the recommended weight for their prepregnancy BMI during pregnancy. Being overweight/obese prepregnancy was associated with unadjusted RR (95% CI) of offspring caries of 1.16 (0.90, 1.51) at 31-months, 1.20 (0.96, 1.49) at 43-months and 1.09 (0.91, 1.30) at 61-months. GWG less than recommended was associated with higher unadjusted offspring caries experience of 1.13 (0.86, 1.48), 1.17 (0.92, 1.48) and 1.04 (0.87, 1.25) at 31-months, 43-months and 61-months respectively. There was insufficient evidence to indicate an association between prepregnancy BMI and gestational weight gain on offspring caries experience risk.

The prevalence and socio-behavioural and clinical covariates of oral health related quality of life in Ugandan mothers with and without HIV-1

Background

There is limited evidence regarding oral health related quality of life of HIV positive populations in sub-Saharan Africa. Focusing HIV positive- and HIV negative Ugandan mothers, this study assessed the influence of HIV status on oral health related quality of life in terms of oral impacts on daily performances, whilst adjusting for clinical- and socio-behavioural factors. We also examined whether any association of clinical and socio-behavioural factors with oral impacts on daily performances vary according to mothers’ HIV status.

Methods

This cross-sectional study used data from a trial (n = 164) and a comparison group (n = 181). The trial comprised of mothers with HIV-1 participating in the ANRS 121741-PROMISE-PEP-trial (NCT00640263) conducted between 2009 and 2013 and from the ANRS 12341-PROMISE-PEP-M&S follow-up study conducted in 2017. The comparison group comprised of HIV negative mothers recruited in 2017. Interviews and clinical oral examinations were performed. The oral health related quality of life was assessed using the oral impacts on daily performances frequency scale. Caries experience and gingival bleeding were assessed using the World Health Organization’s Decayed, Missed and Filled teeth indices and community periodontal index. Logistic and negative binomial regression analyses were performed.

Results

29% of HIV-1 positive and 32% among the comparison reported any oral impact on daily performance. In adjusted logistic regression analysis, HIV status was not significantly associated with oral impacts on daily performances. Mother’s self-reported oral health, caries experience, gingival bleeding and oral health related quality of life of their children were independently associated with oral impacts on daily performances. Corresponding prevalence ratios and 95% confidence intervals were: 0.3 (0.2–0.6), 1.8 (1.0–3.2), 1.1 (1.0–1.1), and 2.1 (1.1–4.3). No significant interaction between HIV status and covariates were observed.

Conclusions

Oral health related quality of life was substantially impaired in Ugandan mothers but did not discriminate between HIV positive and negative participants. Mothers with impaired oral health related quality of life were more likely to have dental caries and children with impaired oral health related quality of life. HIV positive and negative mothers in Uganda deserve special attention regarding their oral disease and quality of life status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01844-3.

Early childhood caries risk assessment in 1-year-olds evaluated at 6-years of age

OBJECTIVES

The aim was to identify caries risk factors in 1-year-olds predicting dentine caries in 6-year-olds.

MATERIALS AND METHODS

Caries risk assessment was performed in 804 one-year-olds. Their parents answered a questionnaire, regarding family factors, general health, food habits and oral hygiene. Clinical examinations and caries risk assessments at 1, 3 and 6 years of age were performed. Simple and multiple regression analyses were used for identification of caries-associated factors.

RESULTS

Caries risk was found in 5% of the 1-year-olds, and 12% of the 3-year-olds. Dentine caries was found in 3% of the 3-year-olds and in 16% of the 6-year-olds. Caries risk assessment was associated with caries at 6 years of age (OR = 5.1, p < .001). Multiple logistic regression analysis found the following variables associated with caries at 6 years of age: Caries in sibling (OR = 2.1, p = .012), Beverage other than water (OR = 2.1, p < .001), Night meal (OR = 1.9, p = .002), Presence of mutans streptococci (MS) (OR = 1.6, p = .033) and Male gender (OR = 1.5, p = .053). An overall caries risk assessment was more reliable than any single caries risk factor.

CONCLUSIONS

Caries risk assessment for 1-year-olds in a region with low caries prevalence has limited accuracy to predict dental caries at 6 years of age. Caries risk often changes over time and should be reassessed on a regularly basis. The presence of MS in 1-year-olds did not increase the prognostic accuracy at 6 years of age.

Systematic review suggests a relationship between moderate to late preterm birth and early childhood caries

AIM

The aim was to examine the association between moderate to late preterm birth and the prevalence of early childhood caries.

METHODS

We searched the PubMed, Scopus, Cochrane Trials Register databases up to February 28, 2020. Two independent reviewers screened the papers for relevance, extracted data and assessed the risk of bias. A random-effects meta-analysis was performed to pool the prevalence of early childhood caries by gestational age.

RESULTS

The authors identified 14 studies covering 210,691 children. They were published from 2007-2020 and included birth cohorts, cross-sectional, register-based and case-control studies. We assessed eight of them as having low or moderate risk of bias. The median caries prevalence was 48.8% among children born moderate to late preterm compared to 20.5% for those born full term. The pooled overall odds ratio was 1.48 (95% confidence interval 1.16-1.89; P < .001). The certainty of this finding was low due to heterogeneity and inconsistencies across the studies.

CONCLUSION

This systematic review and meta-analysis displayed a significantly higher prevalence of early childhood caries in children born moderate to late preterm compared to full term children. The finding suggests that the gestational age should be collected as a risk factor in the paediatric dental records.

U-shaped association between maternal age at delivery and dental caries in offspring

OBJECTIVE

To determine the association between maternal age at delivery and caries in offspring.

MATERIALS AND METHODS

This registry-based cohort study included all children born between 2000 and 2003 and who were residing in Stockholm County, Sweden, at 7 years of age. Between 2007 and 2010, the cohort (n = 65,259) was examined to determine caries experience (deft scores) at 7 years of age. Age of mother at childbirth was retrieved from the patient histories. Data were analysed using linear regressions.

RESULTS

The lowest mean deft occurred in children born to mothers aged 25-34 years. The final model - adjusted for sex, income, educational level, migration background, family situation, smoking, obesity, small for gestational age, and number of siblings - found that young mothers and older mothers were significant risk indicators for caries experience at 7 years of age.

CONCLUSIONS

The present study found a U-shaped relationship between maternal age at childbirth and caries experience in the offspring at age 7 years. The offspring of mothers under 25 or over 34 years of age are at greater risk of having more teeth with caries experience.

The Prevalence of Dental Caries in Primary Dentition in 3- to 5-Year-Old Preschool Children in Northern China

Objectives

To investigate the prevalence and factors promoting caries in primary dentition of 3-5-year-old children in Northeast China.

Materials and Methods

Data of 1,229 children aged 3 to 5 years were randomly selected. The caries prevalence and other indicators were assessed, and the results analyzed by SPSS. A questionnaire was also given to the children's guardians to ascertain the potential risk factors associated with caries.

Results

The decayed, missing, and filled teeth (dmft) index in children aged 3, 4, and 5 years old was 3.17, 5.13, and 6.07, respectively, while the caries prevalence rate was 62.16%, 75.89%, and 87.28% accordingly. The incidence of caries among rural children was higher than that in urban areas. Regarding oral health awareness, it was found that parents in urban areas had more accurate perceptions of oral health problems. It was also noted that the children's brushing habits were worrying. Family economic and medical resources are not the main causes of serious dental caries in rural areas.

Conclusions

The oral health status of children aged 3-5 years is not optimistic. Many parents have a low awareness of oral health. Strengthening the promotion of oral health knowledge is an effective way to change the situation.

Nutrient Intake during Pregnancy and Post-Partum: ECLIPSES Study

Pregnancy and post-partum are critical periods in which nutritional intake is essential to maternal and child health. Our aim was to describe dietary intake during pregnancy and post-partum and assess its adequacy. A longitudinal study was conducted on 793 pregnant women. Data about maternal characteristics, health, diet and lifestyle were assessed. Energy and nutritional intake were compared to the Recommended Dietary Allowances (RDA). The results showed that the intake of energy (82.6%), protein (80.6%) and carbohydrate (99.5%) was adequate (above 80% of RDA) during pregnancy, as were vitamins C, B2 and B12; but vitamin D, iron and folate intake were a long way from RDA (below 35%). Similar results were observed for the post-partum period although fiber, and vitamins E and C decreased compared to intake during pregnancy. In conclusion, although nutritional requirements increase during gestation, pregnant women did not increase their energy and nutritional intake during pregnancy and postpartum and they had a high risk of deficient intake of vitamin D, iron and folates during pregnancy, and therefore, of developing an unfavorable nutritional status, contrary to health recommendations. These findings underscore the necessity of intensive nutrition programs during and after pregnancy.

Dental anxiety in 18-year-old Norwegians in 1996 and 2016

Objective: To estimate the prevalence of dental anxiety, and to explore factors that may increase the risk of reporting dental anxiety among 18-year-old Norwegians in 2016. A further objective was to report changes in dental anxiety since 1996.Material and methods: An anonymous survey from a strategic sample of upper secondary students (n = 351) in 2016 with high response rate (93%) was compared with the results of an investigation of a similar population conducted in 1996.Results: The prevalence of dental anxiety and dental distrust was reduced from 1996 to 2016. Dental Fear Survey (DFS) from 19 to 8% (p < .001), and Dental Belief Survey (DBS) from 15 to 6% (p < .001). Geer Fear Scale (GFS) which measure phobic anxiety did not show a similar reduction (17 versus 15%, p = .37). Phobic anxiety, avoidance behaviour, self-reported poor oral health and previous experiences of pain were all associated with dental anxiety.Conclusion: The prevalence of dental anxiety was reduced from 1996 to 2016, but 8% still report dental anxiety. Proper pain management and use of behavioural management techniques still needs to be highlighted to prevent development of dental anxiety, avoidance behaviour and poor oral health.

A cross-sectional study to assess the prevalence of early childhood caries and associated risk factors in preschool children in district Mandi, Himachal Pradesh

AIM

The aim of this cross-sectional study is to investigate the prevalence and related risk factors of early childhood caries (ECC) in preschool children of district Mandi, Himachal Pradesh, India.

MATERIALS AND METHODS

A total sample of 2859 children aged between 2 and 6 years were selected from various parts of district Mandi. The status of dental caries and decayed missing and filled teeth (DMFT) score was recorded.

RESULTS

ECC increased significantly with age. Boys had significantly higher caries prevalence and mean DMFT score as compared to girls. Children who belonged to low socioeconomic group showed higher caries prevalence and mean DMFT score. Children aged 3-6 years who brushed their teeth twice daily had the least prevalence of dental caries as well as DMFT score when compared to children with one time and no brushing.

CONCLUSION

The early identification of poor oral hygiene and improper feeding habits should be considered in preventive health promotion in low socioeconomic communities of district Mandi, Himachal Pradesh.

Genetic and Early-Life Environmental Influences on Dental Caries Risk: A Twin Study

OBJECTIVES

To explore the relative contributions of genetic and environmental influences on dental caries risk and to investigate fetal and developmental risk factors for dental caries.

METHODS

We recruited children from 250 twin pregnancies midgestation and collected demographic, health, and phenotypic data at recruitment, 24 and 36 weeks' gestational age, birth and 18 months, and 6 years of age. 25-hydroxyvitamin D was quantified in mothers at 28 weeks' gestation and in infants at birth. Dental caries and enamel defects were measured at six years of age. We compared concordance for the presence of any caries and advanced caries in monozygotic and dizygotic twin pairs. To investigate environmental risk factors for caries, we fitted multiple logistic regression models using generalized estimating equations to adjust for twin correlation.

RESULTS

A total of 345 twins underwent dental assessment, with 111 (32.2%) showing signs of any caries and 83 (24.1%) having advanced caries. There was no evidence of higher concordance in monozygotic twins compared with dizygotic twins, with a difference of 0.05 (95% confidence interval -0.14 to 0.25; P = .30) and 0.00 (95% confidence interval -0.26 to 0.26; P = .50) for any caries and advanced caries, respectively, suggesting that environmental factors, rather than genetics, are the predominant determinant of caries risk. After adjusting for potential confounders, lack of community water fluoridation, hypomineralized second primary molars, dichorionic placenta, and maternal obesity were associated with caries.

CONCLUSIONS

Environmental rather than genetic factors drive dental caries risk and arise as early as prenatal life.

Risk Factors for Early Childhood Caries: A Systematic Review and Meta-Analysis of Case Control and Cohort Studies

Purpose: The purpose of this study was to perform a systematic review to assess current evidence for association between various risk factors and the prevalence or incidence of early childhood caries (ECC). Methods: Two reviewers searched various databases until January 2019. The Newcastle-Ottawa scale was used to perform risk of bias assessment. The included studies were categorized according to the World Bank classification. Data were summarized in a meta-analysis using fixed and random effects inverse-generic meta-analyses. Results: A total of 7,034 records involving 89 studies that evaluated 1,352,097 individuals were included; 23 were high, 46 were moderate, and 20 were of low quality. A total of 123 risk factors were found. Meta-analysis revealed that the strongest risk factors found in the high-income countries were presence of dentinal caries (dmft greater than zero; odds ratio [OR] equals 4.21 [2.18 to 8.16]) and high levels of mutans streptococci (OR equals 3.83 [1.81 to 8.09]). In upper-middle-income countries, presence of enamel defects (OR equals 14.62 [6.10 to 35.03]) was found to be the strongest risk factor. Conclusion: The strongest risk factors associated with early childhood caries was the presence of enamel defects, presence of dentinal caries and high levels of mutans streptococci.

Predicting Caries in Medical Settings: Risk Factors in Diverse Infant Groups

Expanded partnership with the medical community is a promising strategy for reducing disparities in dental caries among young children. However, no validated caries risk instrument exists for use in primary health care settings. To help resolve this gap, a 52-item caries risk questionnaire was developed and targeted to primary caregivers (PCGs) to test in a 3-y prospective study. To begin to understand the validity of the questionnaire items, the purpose of this study was to compare responses to the questionnaire based on key demographic characteristics known to be associated with disparities in caries experience (e.g., race/ethnicity and insurance status). A total of 1,323 one-year-old children were recruited primarily through 3 medical research networks. Baseline questionnaire responses were analyzed via logistic regression. The sample was 49% female. Its racial/ethnic makeup was as follows: 13% Hispanic, 37% White, 37% Black, and 13% other or multiracial. Sixty-one percent were enrolled in Medicaid, and 95% resided in urban communities. Mothers represented 94% of PCGs. There were significant differences ( P < 0.05) in baseline responses based on Medicaid status and race/ethnicity. As compared with those not enrolled in Medicaid, children in the Medicaid group were significantly more likely (after adjusting for race/ethnicity) to 1) go to sleep while nursing or drinking something other than water, 2) eat sugary snacks between meals, 3) consume sugary drinks between meals, 4) receive topical fluoride from a health professional, 5) visit the dentist, and 6) not have an employed adult in the household. PCGs of children enrolled in Medicaid were significantly more likely to be the mother, have bleeding gums, eat sugary snacks between meals, consume sugary drinks between meals, eat or drink something other than water before going to bed, and not get regular dental checkups. In conclusion, there are significant differences in caries risk questionnaire responses based on Medicaid status and race/ethnicity that provide construct and criterion validity to the developed caries risk tool (ClinicalTrials.gov NCT01707797).

Influence of mode of delivery, family and nursing determinants on early childhood caries development: a prospective cohort study

INTRODUCTION

Conflicting results exist regarding mode of delivery and caries. We investigated the influence of the mode of delivery and selected family- and nursing factors during the first 2 years of life on the prevalence of dental caries at 5 years.

MATERIALS AND METHODS

551 infants were invited to a prospective medical study with focus on growth and overweight prevention. The parents of 346 infants (179 boys and 167 girls) accepted this invitation and at the age of 2-years, 336 of them agreed to dental check-ups and salivary samplings. At the ages of three and five years, 302 (90%) and 292 children (87%) could be re-examined with respect to caries by one of two calibrated examiners. All stages of caries lesions were scored on tooth and surface level. Background maternal and nursing data were collected semiannually through validated questionnaires and interviews.

RESULTS

The caries prevalence (initial + cavitated lesions) was 5.6% at 3 years of age and 18.9% at 5 years. The 5-year-olds delivered with caesarian section displayed a significantly elevated risk of having caries (relative risk [RR] 2.2; 95% confidence interval (CI) 1.4-3.6; p < .05). Parental smoking and siblings with caries were the most influential family determinants (p < .05) while drinking juice to meals at 2 years of age (p < .05) was most outstanding among the nursing factors (p < .05).

CONCLUSIONS

In this cohort, the mode of delivery (caesarian section) had a significant impact on the risk of early childhood caries (ECC) but also other family and infant nursing determinants were related to the development of the disease.

Socioeconomic Determinants, Maternal Health, and Caries in Young Children

Introduction

Maternal health during pregnancy plays a part in child health, and several conditions have been associated with adverse child outcomes.

Objectives

To determine the socioeconomic determinants and maternal health factors associated with dental caries in young children.

Methods

This cross-sectional study is part of a register-based cohort study including all children who were born from 2000 to 2003 and were residing in Stockholm County, Sweden, at age 3 y (n = 73,658). The study followed the cohort until individuals were 7 y old. The final study cohort comprised all children examined at 3 and 7 y (n = 65,259). Data on socioeconomic conditions, maternal health, and maternal health behavior were extracted from Swedish national registries. The multivariate analyses used 2 outcomes: caries experience at age 3 and 7 y (deft > 0 [decayed, extracted, and filled teeth]).

Results

The results of this study show that socioeconomic and maternal health behaviors during pregnancy are important determinants of oral health in their preschool offspring. When all significant risk factors were present, the cumulative probability of being diagnosed with dental caries at age 7 y was 75%.

Conclusion

This study also showed that maternal obesity and smoking during pregnancy were predictors of dental caries in preschool children. Strategies must be developed for increasing maternal motivation and self-efficacy and providing mothers with knowledge and caries-preventive tools.

Knowledge Transfer Statement

The results of this study inform clinicians about the importance of including a more detailed history regarding maternal health and maternal health behaviors during pregnancy to assess caries risk in preschool children. Education, income, and other socioeconomic factors are difficult to modify in the short term. Therefore, strategies must be developed to increase parental motivation and self-efficacy to give parents the determination, knowledge, and tools for prevention.

Oral, systemic and socioeconomic factors associated with preterm birth

BACKGROUND

The rates of preterm births have been increasing worldwide. Complications related to preterm births are associated with increased costs of care, and have a direct impact on the health system of the countries. Therefore, it is important to address factors associated with preterm birth in order to provide prevention strategies.

OBJECTIVE

This case-control study investigated oral, systemic, and socioeconomic factors associated with preterm birth in postpartum women. Participants were 279 postpartum women that gave birth to a singleton live-born infant. Cases were women giving birth before 37 completed weeks of gestation (preterm birth). Controls were women giving birth at term (≥37weeks). Data were collected through questionnaires, medical records and intra-oral clinical examinations, which included dental caries registration according to World Health Organization criteria and oral biofilm evaluation through visible plaque index.

RESULTS

Ninety-one women had preterm birth (cases) and 188 women had birth at term (controls), ratio 1:2. Caries lesions were present in 62.3% of the cases and in 62.5% of the controls. The univariate analysis showed no association between dental caries and preterm birth (Odds Ratio=1.08, p=0.90). The multivariate analysis showed that maternal educational level (Odds Ratio=2.56, p=0.01) and arterial hypertension (Odds Ratio=2.32, p=0.01) were associated with prematurity.

CONCLUSION

This study demonstrated that dental caries is frequent in postpartum women, but it does not appear to be associated with preterm birth. Meanwhile, maternal education level and arterial hypertension were associated with prematurity in this population.

Streptococcus mutans in Mother-Child Dyads and Early Childhood Caries: Examining Factors Underlying Bacterial Colonization

This study investigated the association between colonization of mother-child dyads with Streptococcus mutans (SM) and early childhood caries (ECC), with consideration of the mediator and confounders, using a theoretical model. Four hundred mothers and their children from São Luís, Brazil, were included in the study. A diagram based on directed acyclic graphs was elaborated to analyze the association between SM colonization of the mother, mediated by child SM, and ECC. Other maternal (socioeconomic, waist circumference, sugar consumption, DMFT index, and visible plaque) and child factors (sugar consumption, visible plaque, and child age) composed the theoretical model. A total effect model (maternal SM on ECC) and a direct effect model, adjusted by the mediation effect of child SM (maternal SM via child SM) on ECC, were analyzed. The outcome of interest in this study was ECC (number of teeth with caries experience, dmft), which was analyzed as a discrete variable by Poisson regression. The Paramed test was used to analyze mediation. The following variables were associated with ECC in the total effect model: maternal SM, maternal waist circumference ≥80 cm, DMFT, maternal visible plaque, child age ≥4 years, and increased sugar consumption of the child (>3 times/day). In the direct effect model, high maternal SM levels remained associated with ECC, while moderate and high colonization of the child with SM was also associated with ECC. Child SM colonization just partially mediated the effect of maternal SM on ECC (33%). Thus, factors other than the mechanism of bacterial colonization should be considered in mother-child dyads, including eating habits, oral hygiene practices, and a family history of caries.

Comparison of the Effectiveness of a Mobile Phone-based Education Program in Educating Mothers as Oral Health Providers in Two Regions of Saudi Arabia

Aims and Objectives:

The penetration of mobile phone devices is widespread across the Kingdom of Saudi Arabia. Recently, there has been evidence of the success of phone-based applications in the provision of preventive oral health care to children and their parents. The aim of this study was to compare the effectiveness of a mobile phone-based application in educating mothers of children aged below 6 years of age in preventive dental care.

Materials and Methods:

A mobile phone-based application (iTeethey™) was developed for iPhone and Android and made freely available on Google Play and App Store. The application was then distributed to 3879 mothers of children below 6 years of age (1989 in Riyadh Region and 1890 in Najran region). The mothers were subjected to a standardized knowledge attitude and practice of oral hygiene questionnaire before being asked to download the application. A total of 1055 mothers who downloaded the application completed 3-month recall process.

Results:

Significant improvement in the knowledge of the mothers was reported after the use of the application from both regions. The mothers from Najran showed significantly greater improvement in knowledge when compared to the mothers from Riyadh region. The application was also more effective in mothers with more than one child when compared to first-time mothers.

Conclusion:

Within the limitations of this study, we can state that the mobile phone application used in this study significantly improves the knowledge of mothers toward their child's oral health.

Risk factors for dental caries in children with developmental disabilities

The aim of the present study was to investigate risk factors for dental caries in children with developmental disabilities who were treated at a clinical reference service for patients with special needs in Belo Horizonte, MG, Brazil. This is a retrospective cohort study that evaluated 401 dental charts of individuals without dental caries or restorations in their first dental appointment. The dependent variable was the time of occurrence of new dental caries or restorations and was measured in months. Gender, age, International Code of Diseases (ICD), mother´s education, sugar consumption, use of fluoride toothpaste, oral hygiene, mouth breathing, reports of xerostomia, gingival status, use of psychotropic or asthma drugs, and history of asthma were covariates. The Cox proportional hazards regression model was used to estimate the raw and adjusted hazard ratios and their respective 95% confidence intervals. The average time that individuals remained free of dental caries/restoration was equal to 107.46 months (95%CI 95.41 to 119.51), with a median of caries-free children up to 94 months. For each point increase in the scale of sucrose consumption, the increase in caries risk was 1.07 (95%CI 1.01 to 1.15). Sucrose consumption was the only risk factor for dental caries found in this group of individuals with developmental disabilities.

Dentin caries risk indicators in 1-year-olds. A two year follow-up study

BACKGROUND

Early childhood caries (ECC) risk factors are suspected to vary between regions with different caries prevalence.

AIM

Identify ECC risk factors for 1-year-olds predicting dentin caries at 3 years of age in a region with low caries prevalence.

DESIGN

Caries risk was assessed by dental hygienist or dental assistant in 779 one-year-olds. The oral mutans streptococci (MS) score was performed from a tooth surface or (in pre-dentate children) from oral mucosa. A parental questionnaire with questions regarding family factors (siblings with or without caries), general health, food habits (night meals, breastfeeding, other beverage than water), oral hygiene habits and emerged teeth were answered by parents of the 1-year-olds. Dentin caries was assessed when the children were 3-year-olds. Simple and multiple logistic regression analyses were used for identification of caries-associated factors.

RESULTS

An increased caries risk was assessed in 4.4% of the 1-year-olds. Dentin caries was found in 2.6% of the 3-year-olds. Caries risk at 1 year was associated with caries at 3 years (OR = 6.5, p = .002). Multiple regression analysis found the variables Beverages other than water (OR = 7.1, p < 0.001), Caries in sibling (OR = 4.8, p = .002), High level of MS (score 2-3) (OR = 3.4, p = .03) and Night meal (OR = 3.0, p = .03) to be associated with caries. The single variables Beverage other than water between meals and Caries in sibling were more reliable than Caries risk assessed performed by dental personnel.

CONCLUSIONS

Behavioural, family and microbial factors are important when assessing caries risk among 1-year-olds in a region with low caries experience.

Caretaker's caries experience and its association with early childhood caries and children's oral health-related quality of life: A prospective two-generation study

OBJECTIVES

The first objective of this study is to examine the association between caretakers' caries experience and caries experience of their children. Second, to investigate whether children's and caretaker's caries experience is associated with oral health-related quality of life (OHRQoL) of children and their families.

METHODS

This study is based on the prenatal recruitment interviews and the 5-year follow-up of 417 caretaker-children pairs from the Ugandan site of the PROMISE-EBF trial conducted in Mbale, Eastern Uganda. Face-to-face interviews were conducted with caretakers at the household level. Caries experience of caretakers (DMFT >0) and children (dmft >0) were assessed in accordance with the criteria of the World Health Organization. OHRQoL was assessed using an abbreviated version of the Early Childhood Oral Health Impact Scale (ECOHIS).

RESULTS

Adjusted negative binomial regression analysis revealed that caretaker's caries experience was positively associated with early childhood caries of their offspring (IRR 2.0, 95% confidence interval (CI) 1.3-3.0). Children's caries experience (IRR 1.8, 95% CI 1.2-3.0), but not caries experience of caretakers, was associated with worse OHRQoL of children and their families. Caretakers who perceived good child oral health were less likely to report OHRQoL impacts (IRR 0.20, 95% CI 0.12-0.35).

CONCLUSION

Improving caretaker's caries experience and her perception of child's oral health status could improve children's caries experience and the OHRQoL of children and family. Such knowledge is important and should inform public oral health programs for young children.

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.

Adverse birth outcomes and childhood caries: a cohort study

OBJECTIVES

To examine the association between adverse birth outcomes and dental caries in primary teeth.

METHODS

This study included children in Khon Kaen, Thailand, who participated in the Prospective Cohort Study of Thai Children. Preterm was defined as a birth at <37 weeks gestation, low birthweight (LBW) as birthweight <2500 g, and small-for-gestational age (SGA) as birthweight <10th percentile of expected weight for gestational age. Two calibrated dentists measured dental caries in primary teeth when the children were 3-4 years old using decayed, missing and filled surfaces (dmfs) index following the World Health Organization criteria. We used negative binomial regression with generalize linear models to estimate relative risks (RRs) and their 95% confidence intervals (CIs), adjusted for confounding factors. Of 758 children with gestational age data and 833 with birthweight data, the 544 (follow-up rate of 71.8% in preterm and 65.3% in LBW) who had dental data available were included in the analysis.

RESULTS

Dental caries was observed in 480 children (88.2%), with a mean dmfs of 14.3 (standard deviation 12.8). The adjusted RR for dental caries was 0.61 (95% CI 0.43, 0.85) for preterm, 0.89 (95% CI 0.67, 1.21) for LBW, and 0.96 (95% CI 0.74, 1.26) for SGA.

CONCLUSIONS

There was an inverse association between preterm and childhood caries. LBW and SGA were not associated with dental caries in this population.

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.

Factors associated with the development of early childhood caries among Brazilian preschoolers

The aim of this study was to assess the prevalence of early childhood caries (ECC) in children and investigate the influence of sociodemographic variables, quality of oral hygiene and child-related aspects. A cross-sectional study was carried out with 593 children aged three to five years. Data were collected through clinical examinations and interviews with parents. Interviews with parents of the children were conducted to acquire information on sociodemographic aspects, breastfeeding, bottle feeding and harmful oral habits. Statistical analysis involved the chi-square test and the Poisson regression. The prevalence of ECC was 53.6%. The occurrence of ECC was greater among children with unsatisfactory oral hygiene (PR: 2.95; 95% CI: 2.42-3.60) and those from a family with a lower monthly household income (PR: 1.62; 95% CI: 1.24-2.10). In conclusion, unsatisfactory oral hygiene and monthly income exerted an influence on the occurrence of ECC among preschoolers.

Avaliação da participação de mães em um programa de prevenção e controle de cáries e doenças periodontais para lactentes

OBJETIVO: Avaliar o conhecimento sobre saúde bucal de mães participantes de um programa educativo-preventivo para lactentes. MÉTODOS: Estudo de coorte com 112 mães e seus bebês de 0 a 18 meses, cadastrados no projeto "Promoção de Saúde Bucal na Primeira Infância", da Universidade Federal do Maranhão. Inicialmente, entrevistas semiestruturadas que contemplavam o nível de conhecimento das mães sobre a saúde bucal dos bebês foram realizadas. Também foi examinada a cavidade bucal dos bebês a fim de detectar o nível de placa bacteriana, sangramento gengival e presença de cárie. Em seguida, palestras educativo-preventivas foram ministradas e, após um ano de acompanhamento, novas entrevistas foram realizadas, bem como o exame clínico. Para analisar os dados, foram utilizados os testes de qui-quadrado e exato de Fisher com nível de significância de 5%. RESULTADOS: Antes das palestras educativas, 93% das mães executavam a higiene bucal de seus bebês e 57,3% a realizavam nos períodos diurno e noturno. Após as palestras, todas responderam executar os cuidados (p=0,02), sendo 74,7% nos períodos diurno e noturno (p=0,01). Não houve diferença quanto ao consumo de alimentos cariogênicos nos questionários inicial e final. Notou-se que, inicialmente, 5,6% das faces dentais apresentaram cárie; 29,7%, placa bacteriana; e 11,9%, sangramento gengival. Após as palestras, apenas 0,4% das faces dentais apresentaram cárie (p<0,0001); 2,4%, placa bacteriana (p<0,0001); e 10,6%, sangramento gengival (p<0,0001). CONCLUSÕES: A aquisição de conhecimentos é fundamental para melhorar as condições de saúde.