Incidence of early childhood caries: A systematic review and meta-analysis

Household, dietary, and clinical characteristics of childhood caries and overweight progression-A prospective cohort study

BACKGROUND

Childhood caries and obesity are complex chronic diseases with negative health outcomes.

AIM

This study sought a risk profile for childhood caries and overweight.

DESIGN

Children were recruited into a longitudinal prospective cohort study. Caries and overweight characteristics were obtained at baseline, 6, 12, and 18 months. Sequential data modeling steps determined a disease risk profile.

RESULTS

At baseline, 50% of the children (n = 194, 3.0 to 6.9 years) had caries; 24% were overweight, of whom 50% had caries. Correlation analysis separated child characteristics from household circumstances. Principal component modeling separated child snacking from meal-eating patterns, and household smoking from parent education variables. Baseline caries and overweight were not associated, but they grouped together in the modeling of composite features. Forty-five percent of children showed caries progression, 29% overweight progression, and 10% progression of both diseases. The strongest predictors of progression were disease presence, household-based characteristics, and sugary drinks. Children with caries and overweight progression shared multiple child- and household-based features.

CONCLUSION

Individually, caries and overweight were not associated. Children with progression of both conditions shared a profile and multiple risk characteristics suggesting these findings could be useful in assessing the risk for the most extreme cases of caries and overweight.

Barriers and enablers for oral health promotion programs amongst primary healthcare stakeholders in Qatar - a qualitative investigation

BACKGROUND

Oral health of preschool children remains a concern globally. Primary healthcare providers are in a vital position to support preventive oral care programmes. This study explored current practices, perception and barriers of primary health care professionals towards oral health promotion program of children in Qatar.

METHODS

The qualitative research used focus group discussions and interviewed a total of 108 participants that were audio recorded and transcribed verbatim. Four major themes emerged and were analysed to explore contextual patterns within the data.

RESULTS

Participants acknowledged the high prevalence of caries in children and identified the causes in the local context which included parental practices, poor dietary habits, impact of culture lack of oral health knowledge, limitations in the healthcare system, and negative role of the media. However, complex barriers were exposed, including lack of time and ownership, system coordination between organizations, and lack of policy.

CONCLUSION

Health professionals and bureaucrats involved in decision-making held a positive attitude towards oral health prevention programs and were enthusiastic to initiate and support these programs.

The global prevalence of early childhood caries: A systematic review with meta-analysis using the WHO diagnostic criteria

AIM

To estimate the global prevalence of early childhood caries using the WHO criteria.

DESIGN

Systematic review of studies published from 1960 to 2019.

DATA SOURCES

PubMed, Google Scholar, SciELO, and LILACS. Eligibility criteria were articles using: dmft-WHO diagnostic criteria with calibrated examiners, probability sampling, and sample sizes.

STUDY SELECTION

Two reviewers searched, screened, and extracted information from the selected articles. All pooled analyses were based on random-effects models. The protocol is available on PROSPERO 2014 registration code CRD42014009578.

RESULTS

From 472 reports, 214 used WHO criteria and 125 fit the inclusion criteria. Sixty-four reports of 67 countries (published 1992-2019) had adequate data to be summarised in the meta-analysis. They covered 29 countries/59018 children. Global random-effects pooled prevalence was (percentage[95% CI]) 48[43, 53]. The prevalence by continent was Africa: 30[19, 45]; Americas: 48 [42, 54]; Asia: 52[43, 61]; Europe: 43[24, 66]; and Oceania: 82[73, 89]. Differences across countries explain 21.2% of the observed variance.

CONCLUSIONS

Early childhood caries is a global health problem, affecting almost half of preschool children. Results are reported from 29 of 195 countries. ECC prevalence varied widely, and there was more variance attributable to between-country differences rather than continent or change over time.

Impact of oral hygiene training to Anganwadi and Accredited Social Health Activist workers on oral health of young children in tribal regions of Rajasthan State, India

CONTEXT

Early childhood caries is one of the most widespread diseases affecting children in urban and rural India. Community health workers can bring about a quantum of change in improving the oral health in children.

AIMS

The aim of the study was to assess the impact of oral health training imparted to Anganwadi and accredited social health activist (ASHA) workers on improving the oral hygiene of 148 children aged 1-6 years.

SETTINGS AND DESIGN

The preintervention followed by oral health training and postintervention assessment were done at three Anganwadi and ASHA centers of Rajasthan.

METHODOLOGY

The preintervention data included Decayed, Missing, and Filled Teeth/decayed, extracted, and filled teeth, oral hygiene indices (Oral Hygiene Index-Simplified [OHI-S] and Oral Hygiene Index Simplified-Modified [OHIS-M]), plaque index, and caries activity using Oratest. The oral health training consisted of PowerPoint presentations, video presentations, live demonstrations on brushing technique, rinsing, plaque disclosure, and flossing technique. They were enlightened on deleterious oral habits, emergency protocol on trauma, etc. The postintervention data included outcome measures consisting of oral hygiene indices (OHI-S and OHIS-M), plaque index, and Oratest after 2 months to evaluate the impact of training.

STATISTICAL ANALYSIS USED

The data were analyzed using Chi-square test, Fisher's exact test, independent t-test, paired t-test, and one-way analysis of variance test.

RESULTS

There was a significant improvement in toothbrushing practices and rinsing (P < 0.05). There was a significant difference in debris index, calculus index, OHI-S/OHIS-M, plaque index, and Oratest after intervention (P < 0.05).

CONCLUSION

Empowering Anganwadi and ASHA workers can be a feasible approach in India, where oral health is not a priority in primary health care as yet.

Meta-Analysis of In-Vitro Bonding of Glass-Ionomer Restorative Materials to Primary Teeth

Restoration of primary teeth is among the main clinical applications of glass-ionomer cements (GIC). The aim of the study was to review and summarize existing evidence of in vitro bond strength of glass-ionomer (GI) restoratives to enamel and dentin of primary teeth. A literature search was performed in PubMed/Medline, Scopus, Web of Science, Cochrane, and Google Scholar databases to identify studies published until April 2021. The search strategy was: (“glass”) and (“ionomer”) and (“primary” or “deciduous”) and (“bond” or “tensile” or “shear”). Two researchers independently retrieved articles that reported on the bond strength of GIC to primary dentin and/or enamel. The meta-analysis was performed to compare the bond strength values of conventional (C) GIC and resin-modified (RM) GIC to different substrates. From 831 potentially eligible articles, 30 were selected for the full-text examination, and 7 were included in the analysis. Studies were rated at high (3), medium (3), and low (1) risk of bias. RM-GIC showed higher bond strength to primary enamel and dentin compared to the C-GIC. Meta-analysis of in vitro studies, evaluating bonding properties of GI restoratives to primary teeth, suggests the superior performance of RM-GIC. However, there is a lack of studies that examine the properties of novel GI formulations.

Factors Affecting Future Caries Occurrence Among Preschoolers in Northern Guangdong: A Longitudinal Study

Purpose

This study aimed to investigate the new development of caries among preschoolers in northern Guangdong and to assess caries-related factors to distinguish groups with different caries risk levels.

Methods

Baseline data were recorded for participants from September to November 2019, and participants were reexamined from September to November 2020. A longitudinal observation of 11,973 preschoolers was conducted. The simplified debris index (DI-S) and decayed-missing-filled tooth (dmft) index values were obtained for each participant.

Results

Factors associated with whether caries would occur in the future and one-year increase in dmft (Δdmft) included baseline dmft, baseline DI-S, and baseline age. The risk ratio (RR) of caries occurrence and the number of teeth with new-onset caries were 4.482 (95% confidence interval, 4.056-4.957) and 2.945 (2.742-3.165) in the participants with baseline dmft ≥3, which were higher than those with baseline dmft =1 or 2. In the baseline caries-free group, whether caries would occur in the future was related to the baseline DI-S (95% confidence interval, 0.022-0.062). The caries incidence of maxillary central incisors (27.9%) was the highest among teeth of preschoolers without caries at baseline, whereas the caries incidence of mandibular first deciduous molars (42.7%) was the highest among teeth of preschoolers with caries at baseline.

Conclusion

Baseline dmft is a good predictor of future caries. Children with baseline caries-free status, baseline dmft >0, and baseline dmft ≥3 should be treated with preventive interventions of different intensities and frequencies. The occurrence of future caries in baseline caries-free participants is related to oral hygiene status. Measures to prevent caries on smooth surfaces, such as topical fluoridation, should be applied to all preschoolers. Preschoolers with caries at baseline may be given priority for pit and fissure sealing.

Assessment and correction of the daily diet in the treatment of severe early childhood caries

Relevance. The high prevalence and intensity of early childhood caries (ECC) require a detailed analysis of the influence of the nutritional status on the course of the carious process and possible ways to treat severe caries and control certain markers of calcium and phosphorus metabolism. Purpose – to identify correlation between the nutrient composition of the diet, calcium and phosphorus metabolism markers and severe childhood caries. Materials and methods. The study involved 46 children aged 12-36 months with severe ECC which had been treated under the general anesthesia. In all patients, the nutrient composition of the diet was studied and certain markers of calcium and phosphorus metabolism were determined. ECC comprehensive treatment plan with further evaluation of the effectiveness of the treatment was developed accordingly, based on the patients’ allocation to the main and comparison groups.Results. The dynamics of the content of excreted calcium in the main group of study participants indicates an increase in the consumed calcium entering the child's body with food. 24 months after the implementation of pathogenetic therapy, the increase in the intensity of caries in the main group was significantly reduced.Conclusions. The correlation analysis revealed a strong correlation between the frequency of consumption of the basic food products and caries intensity in the primary teeth. Patient-based ECC treatment protocols can reduce caries progression in primary dentition by 42.8 % in the long run.

Maternal knowledge on early childhood caries and barriers to seek dental treatment in Jordan

Purpose

To assess maternal knowledge, attitudes and beliefs of Early Childhood Caries (ECC) risk factors and to determine barriers in seeking dental treatment among children with ECC.

Methods

A total of 600 mothers of healthy children, aged 3–5 years, with ECC attending maternity and child health centres in Jordan completed a questionnaire using face-to-face interviews. ECC was diagnosed clinically by the chief investigator, based on the diagnostic criteria suggested by American Academy of Paediatric Dentistry (AAPD), and caries was recorded using dmft index.

Results

The majority of the children had poor oral health status (99.2%) with a dmft index of 6.04 (± 1.2). Less than third (25.7%) of the mothers believed that their child had poor oral health with more than half (53.3%) not being aware that their child had dental caries. Most of the mothers had poor knowledge, attitudes and beliefs regarding their children’s oral health (82%). Participants` oral health knowledge was significantly associated with mothers` level of education and profession (p < 0.05). In addition, there was delay in seeking dental treatment for their children by the majority (65.9%) of mothers. Maternal profession, family income and time needed to reach a nearby health centre were found to be significant barriers in seeking dental treatment (p < 0.05).

Conclusion

The majority of the mothers of children in Jordan with ECC had poor knowledge about their children’s oral health status. Moreover, seeking dental treatment was delayed by a large number of mothers of children with ECC.

Selected Behavioural Factors Affecting Oral Health in Schoolchildren: Results from the Health Behaviour in School-Aged Children (HBSC) Slovak Study

Oral diseases, particularly dental caries, affect as much as nine in 10 persons globally. Its development starts during childhood. Behavioural factors play an important role in its aetiology. The aim of the research was to analyse the prevalence of selected behavioural factors associated with dental caries in Slovak adolescents. Selected factors, such as toothbrushing less than once a day, consumption of sweets and sweetened soft drinks daily and their combination, were analysed using data from Health Behaviour in School-Aged Children surveys carried out in 2005/2006, 2009/2010, 2013/2014 and 2017/2018 in Slovakia. The target group consisted of 11- to 13-year-old schoolchildren. The results were analysed by sex and socioeconomic status. The consumption of sweets and sweetened soft drinks, despite declining, remains widespread (41.3% of boys and 39.6% of girls in 2017/2018). The absence of daily toothbrushing, similarly as a co-occurrence of factors, were more frequent in boys (10.6% and 5.0% in 2017/2018, respectively) than in girls (5.1% and 2.3% in 2017/2018, respectively). The absence of daily toothbrushing was associated with a lower socioeconomic situation. In conclusion, behavioural risk factors affecting oral health are widespread in Slovak adolescents. Despite the positive development of the epidemiological situation, effective interventions, as well as the improvement of oral hygiene in lower socioeconomic groups, are needed.

Outcome evaluation of the Dental Health Outreach Mobile Experience (HOME) Coach Program

BACKGROUND

The Ohio Department of Health identified dental care as the number one unmet health need for Ohio's children. The Dental Health Outreach Mobile Experience (HOME) Coach is a pediatric mobile dental unit that seeks to meet the dental needs of underserved children in the Columbus City Schools.

PURPOSE

The purpose was to conduct an outcome evaluation of the Dental HOME Coach Program and to compare the outcomes before (2010-2014) and after (2015-2019) the incorporation of the new Dental HOME Coach.

METHODS

Using a longitudinal outcome evaluation research design, the data were analyzed from 10 years of the Dental HOME Coach Program at the Ohio State University (OSU) College of Dentistry during the academic years ending in 2010-2019.

RESULTS

A total of 1063 dental students provided dental care to 26469 children in the Columbus City Schools. The top 3 performed procedures were sealants, prophylaxis, and resin composite fillings. Despite significant increases in the number of dental students providing oral health care, there were significant decreases in the number of amalgam fillings and stainless-steel crowns from before to after the incorporation of the new Dental HOME Coach.

CONCLUSION

The outcome evaluation revealed the Dental HOME Coach Program has been providing underserved children with oral health care that offers them a dental "home," giving dental students an array of hands-on learning experiences that include pediatric dentistry treatments performed under the supervision of OSU faculty members, and positively impacting the problems of access to oral health care for Ohio's families.

Knowledge, attitudes and practices of primary health care providers towards oral health of preschool children in Qatar

Objective

Health care providers can effectively participate in oral health promotion for children in primary care setting. Currently, there are no oral health promotion programs that involve primary health care professionals in Qatar. Hence, this study was undertaken to examine the knowledge, attitudes and practices of all health professionals who work in the Well baby Clinics in the primary health centers.

Method

A 23-item questionnaire was distributed across 20 primary health centers. The questionnaire sought information on the demographic data of health professionals, their knowledge of oral health and their practices and attitudes towards critical oral health issues. Data were examined by Pearson Chi-squared tests or Fisher’s Exact test (p = 0.05).

Results

The response rate of the health professionals was 67%. Only 35.7% of the 225 participants received some form of oral health training during their undergraduate programme. The participants would assess the dental problem of the child (p = 0.05) and discuss the importance of tooth brushing with the mother (p = 0.03). A significant number of respondents (p = 0.04) were unlikely to assess the children’s fluoride intake. There was a significant difference in the group of participants that would examine the child’s teeth (p = 0.1) and counsel the mothers on prevention of dental problems (p = 0.01). This group would also refer children to dentist at 12 months of age (p = 0.05).

Conclusions

Health professionals had a positive attitude towards the anticipatory guidance elements of oral health. However, the knowledge of healthcare professionals on childhood oral health is rather limited.

Evaluation of protective factors in caries free preschool children: a case-control study

BACKGROUND

Increasing the proportion of caries-free children following the WHO's global target has led to more desirable welfare and a higher level of quality of life for children. In the present study, we aimed to evaluate the factors contributing to a caries-free condition in preschool children as a basic action towards the global goals of children's oral health.

METHODS

This was a case-control study evaluating the protective factors contributing to dental caries free in 4-6-year-old children in Tehran/Iran in 2017. 500 preschool children and their mothers were selected from 22 randomly selected preschools and were enrolled in the study. The participants were divided into two case (caries-free) and control (with dental caries) groups. The data were collected using two data gathering tools; the child oral examination form and the mother's valid questionnaire. The latter included three domains; socio-demographic factors, behavioral oral health measures, and feeding practices and dietary habits. The criteria for caries detection were cavities in the enamel and dentine. A logistic regression model was applied to identify caries-free protective factors (P < 0.05).

RESULTS

Among 230 caries-free and 270 non-caries-free children who participated in the study, boys were more caries-free (P = 0.001). The protective factors against dental caries that were identified in the study were dental check-up as the cause of dental visit, being the first child in the family, the fewer sessions night feeding of the child's, family's house ownership, and parent's university education (P < 0.05).

CONCLUSIONS

Dental health can be achieved by considering protective factors like the regular dental check-up and socio-economic factors. Communities are invited to pay close attention to these important protective factors as far as they can increase the proportion of caries-free among preschool children especially in countries with developing oral health care systems.

The Predictive Potentiality of Salivary Microbiome for the Recurrence of Early Childhood Caries

The aim of this study was to investigate the variation of the salivary microbiota in the recurrence of early childhood caries (ECC), and to explore and verify the potential microbial indicators of ECC recurrence. Saliva samples from kindergarten children were tracked every 6 months for 1 year. Finally, in total 28 children and 84 samples were placed on the analysis phase: 7 children with ECC recurrence made up the ECC-recurrence (ER) group, 6 children without ECC recurrence constituted the non-ECC-recurrence (NER) group, and 15 children who kept ECC-free were set as the ECC-free (EF) group. DNA amplicons of the V3-V4 hypervariable region of the bacterial 16S rDNA were generated and sequencing was performed using Illumina MiSeq PE250 platform. No statistically significant differences of the Shannon indices were found in both cross-sectional and longitudinal comparisons. Furthermore, both principal coordinates analysis (PCoA) and heatmap plots demonstrated that the salivary microbial community structure might have potentiality to predict ECC recurrence at an early phase. The relative abundance of Fusobacterium, Prevotella, Leptotrichia, and Capnocytophaga differed significantly between the ER and NER groups at baseline. The values of area under the curve (AUC) of the four genera and their combined synthesis in the prediction for ECC recurrence were 0.857, 0.833, 0.786, 0.833, and 0.952, respectively. The relative abundance of Fusobacterium, Prevotella, Leptotrichia, and Capnocytophaga and their combination showed satisfactory accuracy in the prediction for ECC recurrence, indicating that salivary microbiome had predictive potentiality for recurrence of this disease. These findings might facilitate more effective strategy to be taken in the management of the recurrence of ECC.

Prevalence and Risk Factors for Dental Caries among Preschool Children: A Cross-sectional Study in Eastern India

INTRODUCTION

Dental caries is one of the major widespread health issues that continue to negatively affect the oral health of children globally.

AIM

To estimate the prevalence of dental caries and its risk factors among preschool children of Bhubaneswar, Odisha, India.

MATERIALS AND METHODS

The study was a community-based cross-sectional one among preschool children with (N = 425) participants recruited from the Anganwadi centers (AWCs) of Bhubaneswar, Odisha, India. By using a cross-sectional study design, dental caries was assessed using the World Health Organization (WHO) guidelines, and other socioeconomic and risk factors data were collected through parental interview using questionnaires. Caries was identified at both tooth and surface levels through visual dental examinations by trained and calibrated dentists. Logistic regression analyses were used to identify associations among variables and caries.

RESULTS

The proportion of preschool children suffering from dental caries was found to be 47.29%. The multivariable-adjusted model depicted that longer duration of breastfeeding was a significant predictor as follows: Those who had breastfed for more than 36 months [adjusted odds ratio (AOR): 5.41; 95% confidence interval (CI): 2.97-9.85; p = 0.001], 12 to 24 months (AOR: 2.1; 95% CI: 1.04-4.36; p = 0.037), followed by increase in age 61 to 72 months (AOR: 5.39; 95% CI: 2.72-10.67; p = 0.001), 49 to 60 months (AOR: 2.53; 95% CI: 1.41-4.52; p = 0.002), more than two children in the family (AOR: 2.70; 95% CI: 1.55-4.69; p = 0.001), and children who did not brush the teeth under the parent's supervision (AOR: 2.70; 95% CI: 1.55-4.69; p = 0.001).

CONCLUSION

The study highlights the need to increase awareness about the oral health and hygiene among parents of preschool children in India.How to cite this article: Chugh VK, Sahu KK, Chugh A. Prevalence and Risk Factors for Dental Caries among Preschool Children: A Cross-sectional Study in Eastern India. Int J Clin Pediatr Dent 2018;11(3):238-243.

Toxicological impact of waterpipe smoking and flavorings in the oral cavity and respiratory system

Waterpipe smoking (WS), an emerging trend has major health concerns. It is prevalent worldwide as a recreational activity both indoors and outdoors. The aim of this review was to assess the impact of waterpipe smoke on the oral and respiratory system (oral cavity and pulmonary tissues). A number of studies have shown that periodontal health status is compromised in waterpipe smokers when compared with nonsmokers. Some studies have associated WS with oral premalignant and malignant lesions; however, due to the poor quality of these studies, the presented outcomes should be interpreted with caution. Although cigarette smoking has been considered as a potential risk factor for dental caries; there are no studies in indexed literature that have shown an association to exist between dental caries and WS. Inhaled waterpipe smoke imposes oxidative stress and inflammatory responses and compromises the ventilatory capacity of the lungs and may lead to an increased risk of decline in lung function. WS may cause oral and pulmonary diseases, such as periodontal disease and chronic obstructive airway disease, respectively. The association between WS and development of dental caries and oral pre-cancer and their relationships with chronic airways disease requires investigations. This review discusses the current evidence of waterpipe smoke effects on the oral health and respiratory system based on basic and clinical science and provides future directions for research and regulatory science on how WS can affect the oral cavity and the respiratory/pulmonary system.

Infant and Child Oral Health Risk Status Correlated to Behavioral Habits of Parents or Caregivers: A Survey in Central Italy

AIM

The aim of this survey was to evaluate the knowledge and awareness of parents and caregivers about potential oral health risk factors for their children in their first months of life (3-30 months).

MATERIALS AND METHODS

The participation to the survey was proposed to all parents or caregivers of children attending the public consulting service in Latina for mandatory vaccinations during the period of June to August 2014. A self-administered questionnaire was completed to obtain information regarding demographic variables, infant feeding practice, maternal oral health during and after pregnancy, children's oral hygiene habits and risk behaviors (e.g., sharing cutlery, tasting of baby food, nightly using of baby bottles with sugared beverages, or sugared pacifier), and knowledge about caries and its transmission. The analysis of the data was performed using SPSS 14.0 for Windows (SPSS Inc., Chicago, IL, USA). The variance analysis and chi-square test were used to investigate the relationship between the variables.

RESULTS

Overall, the parents of 304 children consented to fill the questionnaire. Data analysis showed that about 50% of respondents considered dental caries an infectious disease, however, 53.6% was not aware of the potential vertical transmissibility of cariogenic bacteria through contaminated saliva. It is a common trend in the early stages of weaning to taste the baby food (53%) and sharing cutlery (38.5%). With regard to children oral health care, parents reported no toothbrushing for 53.1% of the children in their first 3 years of life. The relationship between the two variables concerning caries transmissibility and tools sharing carried out on through Pearson chi-square test identified P = 0.32.

CONCLUSIONS

From this survey, the need for parental oral health promoting program emerged to control children oral health risk status.