Comparison of two indices of caries patterns in 3-6 year old Brazilian children from areas with different fluoridation histories

Effectiveness of water fluoridation in an upper-middle-income country: A systematic review and meta-analysis

AIM

To summarize the information on the effectiveness of community water fluoridation (CWF) on the reduction of dental caries in the context of the wide use of fluoridated toothpaste in Brazil.

DESIGN

A systematic review was conducted regarding the effect of CWF based on studies with Brazilian population groups using the following electronic databases: MEDLINE/PubMed, LILACS, SciELO, and SCOPUS. The literature search was conducted up to August 2019. Studies that compared caries experience in at least two areas, one fluoridated and the other non-fluoridated, by mean dmft/DMFT (decayed, missing, and filled teeth) index or caries prevalence (caries vs. caries-free) were included. Considering the beginning of widespread use of fluoride dentifrice and the time for producing dental caries decline, studies published before 1995 were excluded. Descriptive analysis and meta-analyses were carried out. The effect size was measured by mean difference for dmft and DMFT ± SD and odds ratios on a logarithmic scale for caries prevalence.

RESULTS

Of the 574 studies retrieved, 16 and 10 were included in the qualitative and quantitative analysis, respectively. Fluoridated areas exhibited lower mean dmft/DMFT than non-fluoridated areas did. The mean difference in the dmft between non-fluoridated and fluoridated areas was -2.28 (95% CI -3.26; -1.30) for children aged 5-8 years and -1.12 (95% CI -1.93; -0.32) for those aged 3-12 years; the mean difference in the DMFT was -0.61 (95% CI -0.80; -0.42) for the children aged between 7 and 12 years. The caries prevalence was 1.4 times and 57% lower, respectively, at primary and permanent dentition in fluoridated areas. Heterogeneity was observed in all age groups, ranging from 77.6% to 98.2%.

CONCLUSION

Community water fluoridation remains effective in preventing dental caries in children younger than 13 years, even with the widespread use of fluoridated toothpaste.

Declínio da cárie em um município da região noroeste do Estado de São Paulo, Brasil, no período de 1998 a 2004

O objetivo do estudo foi analisar os índices CPOD, ceod, SiC Index e a porcentagem de crianças livres de cárie, em escolares de 5 a 12 anos da rede pública do Município de Bilac, São Paulo, Brasil, em estudos realizados nos anos de 1998, 2000, 2002 e 2004. Utilizou-se a mesma metodologia (OMS-1997) em todos os levantamentos. O teste estatístico kappa foi calculado a cada estudo, obtendo-se o valor de concordância interexaminadores mínimo de 0,86 e máximo de 0,89, e intra-examinador mínimo de 0,91. O índice ceod diminuiu pouco nos anos de 1998 e 2004. Houve uma redução contínua do índice CPOD aos 12 anos, passando de 5,28 em 1998 para 4,11 em 2000, 3,47 em 2002 e 2,62 em 2004, e o fenômeno da polarização. Na proporção inversa, a porcentagem de crianças com 5 anos livres de cárie aumentou de 37,9% em 1998 para 40% em 2000 e 2002, e 45,3% em 2004. Conclui-se que está ocorrendo a redução da cárie dentária na faixa etária de 12 anos entre escolares do ensino público do município.

[An epidemiological profile of dental caries in 12-year-old children residing in cities with and without fluoridated water supply in the central western area of the State of São Paulo, Brazil]

This study aimed to analyze the epidemiological profile of dental caries in the central western region of the State of São Paulo, Brazil, focusing on 12-year-old children by gender, comparing the DMFT index in fluoridated and non-fluoridated cities. The study used data from the Epidemiological Surveys in the State of São Paulo, 1998, pertaining to the 10th Regional Health Directorate, including 8 cities. The sample consisted of 485 schoolchildren, both boys and girls, distributed by city. In Pederneiras (a medium-sized city with a fluoridated water supply), DMFT was 7.06, higher than the Brazilian national mean for 1986. Boys showed a higher prevalence of dental caries than girls, showing a new trend for dental caries in the region. There was no statistically significant difference between DMFT in municipalities of the same size, regardless of the presence or absence of fluoride in the water supply, thus suggesting a "convergence" phenomenon, possibly due to the intake of other sources of fluoride and the presence of a "halo" effect. Prevalence of caries in the region was "high", with a DMFT of 4.82, thus failing to reach the goals set for the year 2000.

Caries patterns and their relationship to infant feeding and socio-economic status in 2-4-year-old Chinese children

AIMS

To describe the prevalence, severity and patterns of caries in 2-4-year-old children and to evaluate the association between caries experience of the children and their feeding patterns and socio-economic background in terms of mothers' education and family income.

DESIGN

Cross-sectional survey.

SETTING

Suburban area of Hanchuan in Hubei province, China.

PARTICIPANTS

A sample of 426 children (250 boys and 176 girls).

METHODS

Dental-examinations were undertaken in kindergartens using World Health Organization diagnostic criteria for dental caries. Mothers completed a short questionnaire.

OUTCOME MEASURES

Prevalence of caries; rampant caries; caries in incisors; caries in incisors and/or canines and molars; mean number of decayed, missing and filled teeth/surfaces (dmft/s).

RESULTS

36% of the children had caries, 7% had rampant caries. The more extensive pattern of caries involving primary molars as well as incisors and/or canines was seen in 12% of children. Children who had been wholly bottle-fed had five times the risk of having rampant caries compared to children who were breast-fed.

CONCLUSIONS

The results indicated that infant feeding practice might be a key risk factor for the development of caries at an early age in this country as elsewhere.

A systematic review of clinical diagnostic criteria of early childhood caries

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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