Oral health status of San Francisco public school kindergarteners 2000-2005

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.

Association of DLX3 gene polymorphism and dental caries susceptibility in Japanese children

OBJECTIVE

In this study, we investigated whether single nucleotide polymorphisms (SNPs) in DLX3 are associated with dental caries susceptibility in Japanese children.

DESIGN

Genomic DNA of 201 Japanese children was extracted from buccal epithelial cells. The subjects were divided into two groups: 'low level' group with <10,000 colony forming units (CFU) of Streptococcus mutans/mL saliva (level 0) and 'high level' group with ≥ 10,000 CFU/mL (more than level 1). Each group was further divided according to decayed, missing, filled teeth (dmft) into low caries experience (dmft ≤2) and high caries experience (dmft ≥ 3). Seven SNPs in DLX3 were genotyped using TaqMan1® SNP Genotyping Assay.

RESULTS

Statistical significant association was observed between DLX3 (rs2278163) and caries experience in 'high level Mutans streptococci' group.

CONCLUSION

These findings suggest that rs2278163 SNP of DLX3 might be associated with dental caries susceptibility in Japanese children. T and C alleles of rs2278163 SNP may potentially be involved in caries susceptibility and caries protection respectively.

Bilingual flipcharts help improve oral health-related knowledge and self-efficacy of Korean-American caregivers of preschoolers

OBJECTIVE

We have limited knowledge on ways to improve oral health-related behaviors for caregivers of minority preschoolers. Our objective was to evaluate the effectiveness of a bilingual educational flipchart.

METHODS

We piloted a bilingual flipchart with Korean-American caregivers of preschoolers (n=219) and administered pre-/post-intervention surveys. The paired t-test evaluated changes in knowledge and self-efficacy (for all caregivers and stratified by acculturation).

RESULTS

There were significant improvements in knowledge on the bacterial etiology of tooth decay (P=0.02), mother-to-child transmission of tooth decay (P=0.03), fluoride toothpaste safety (P<0.0001), and dental visit frequency (P<0.0001). Caregivers' self-efficacy to keep their child's teeth healthy also improved (P<0.0001). There were differences in knowledge measures based on caregivers' acculturation.

CONCLUSIONS

Bilingual educational materials help improve the oral health-related knowledge and self-efficacy of Korean-American caregivers of preschoolers. Larger confirmatory studies are needed and future work should evaluate clinical outcomes associated with improved knowledge and self-efficacy.

Shades of Decay: The Meanings of Tooth Discoloration and Deterioration to Mexican Immigrant Caregivers of Young Children

The objective of this article is to investigate parental understanding of tooth discoloration and decay and their related care seeking for young, Mexican-American children. The research design entailed semi-structured, face-to-face interviews conducted in Spanish with a convenience sample of 37 Mexican immigrant mothers of young children in a low-income urban neighborhood. Five major color terms - white, off-white, yellow, brown, and black - were used to describe tooth discoloration, the causes of which were mainly unrecognized or attributed to poor oral hygiene and exposure to sweet substances. Mothers also described three major levels of deterioration of the structural integrity of teeth due to caries, from stains to decayed portions to entirely rotten. A trend was observed between use of darker discoloration terms and extensive carious lesions. Teeth described as both dark in color and structurally damaged resulted in seeking of professional care. The paper concludes with the finding that Spanish terms used to describe tooth discoloration and carious lesions are broad and complex. Mexican immigrant mothers' interpretations of tooth discoloration and decay may differ from dental professionals' and result in late care seeking. Increased understanding between dental practitioners and caregivers is needed to create educational messages about the early signs of tooth decay.

Language and literacy relate to lack of children's dental sealant use

OBJECTIVES

This study aimed to determine the percent of California's third grade public school children lacking sealants by child and family factors and to measure social disparities for lacking sealants.

METHODS

The study analyzed data from the California Oral Health Needs Assessment (COHNA) 2004-2005, a complex stratified cluster sample of children (n = 10,450) from 182 randomly selected public elementary schools in California. The dependent variable was absence of sealants in first permanent molars. The independent variables included child race/ethnicity; socio-economic position (SEP) measured as child's participation in the free or reduced-price lunch program at the individual and school level; acculturation measured as language spoken at home and school level percent of English language learners; and parent functional health literacy measured as correctly following questionnaire instructions. Absolute differences and health disparity indices (i.e. Slope Index of Inequality, Relative Index of Inequality-mean, Absolute Concentration Index) were used to measure absolute and relative disparities.

RESULTS

The percent of children lacking sealants was high in all racial/ethnic groups; no child or school level SEP differences in lacking sealants were seen, but significant differences existed by acculturation (child and school level) and parental functional health literacy.

CONCLUSIONS

NonEnglish language and poor parental functional health literacy are potential barriers that need to be addressed to overcome disparities in sealant utilization.

Association between AMELX polymorphisms and dental caries in Koreans

OBJECTIVES

Dental caries is greatly influenced disease by environmental factors, but recently there are increasing evidences for a genetic component in caries susceptibility. AMELX is the gene coding amelogenin, which is the most important factor for normal enamel development. The aim of this study was to examine the relationship between dental caries and single nucleotide polymorphisms (SNPs) in AMELX.

SUBJECTS AND METHODS

For this study, we used DNA samples collected from 120 unrelated individuals older than 12 years of age. All of them were examined for their oral and dental status under the WHO recommended criteria, and clinical information such as DMFT and DMFS were evaluated. Individuals whose DMFT and DMFS index lower than 2 were designated 'very low caries experience' and higher than 3 were designated 'higher caries experience'. Genomic DNA was extracted from hair samples, and single nucleotide polymorphisms of AMELX were genotyped. Genotyping of three SNPs (rs17878486, rs5933871, rs5934997, intron) in AMELX gene was determined by direct sequencing and analyzed with SNPStats.

RESULTS

There were significant associations between rs5933871 and rs5934997 SNP and caries susceptibility in the water fluoridation group.

CONCLUSIONS

These results suggest that SNPs of AMELX might be associated with dental caries susceptibility in Korean population.

Urban Mexican-American mothers' beliefs about caries etiology in children

OBJECTIVES

Caries is a severe condition which disproportionately affects Latino children in the US. This study sought contextual understanding of urban, low-income Mexican-American mothers' beliefs, perceptions, knowledge and behavior surrounding causes of caries.

METHODS

In urban San José, CA, a qualitative study was conducted with a convenience sample of Mexican-American mothers of young children about their beliefs and knowledge about the causes of caries. Audio-taped in-depth interviews with open-ended questions, primarily in Spanish, were translated to English and then transcribed verbatim. Texts were independently read and thematically analyzed by two researchers.

RESULTS

Even while expressing uncertainty, all 48 mothers mentioned specific causes of caries, most frequently citing candy or juice consumption (85%), poor oral hygiene (65%) and use of the bottle (52%). Mothers rarely recognized cariogenic foods beyond candy, did not know or perform recommended oral hygiene routines, and demonstrated confusion and uncertainty about exactly how baby bottles are detrimental to teeth. Nearly half of these mothers also mentioned secondary cavity causes, such as genetics, lack of calcium, not going to the dentist or lack of fluoride. Mothers did not mention the role of bacteria. While mothers recognized that oral hygiene can counteract the detrimental effects of candy consumption, they did not recognize its beneficial effects in other contexts. Nor did they know about other preventive activities.

CONCLUSIONS

Mothers recognized the three major important factors causing caries: sugar consumption, poor oral hygiene and bottle use. However, their knowledge is limited in depth and specificity which restricts development of caries prevention behaviors. More comprehensive education is needed, including about caries prevention (oral hygiene) behaviors, which could lead to an increased sense of self-efficacy with respect to their children's oral health.

Tackling child neglect: a role for pediatricians

Child neglect, the most prevalent form of maltreatment, poses challenges for pediatricians. There often is uncertainty regarding what constitutes neglect and how best to address it. The complexity is compounded by the many ways neglect can manifest. This article first discusses why neglect is so important a concern and then provides definitional considerations and a description of forms of neglect. Next presented are principles for assessing and addressing neglect and suggestions for prevention and advocacy.