Early Childhood Caries: Epidemiology, Aetiology, and Prevention

Early Childhood Caries, Masticatory Function, Child Early Cognitive, and Psychomotor Development: A Narrative Review

Dental caries is known as a global public health issue that has been affecting general health apart from its painful nature. Hence, it is undeniable that caries affecting young children or known as early childhood caries, also have an effect on children's general health. One of the interesting findings about caries is that it can also affect child growth and development, specifically on their cognitive and psychomotor ability. Untreated caries are linked to cognitive development through both neural and vascular pathways, with masticatory function as the key. Meanwhile, its effect on psychomotor development might be related to nutritional intake, which might slightly decline on those with caries. This review is aimed to describe the current findings of caries effect on early child development, from masticatory disturbance to further impacts on cognitive and psychomotor development. The overall conclusion of this review is that untreated severe caries in children are potentially associated negatively with their growth and development.

A global survey of national oral health policies and its coverage for young children

Background

There is no accessible information on countries with oral health policies. The purpose of this study was to identify World Dental Federation (FDI) member countries with oral health policies and their scope and extent of coverage of oral health care for young children.

Methods

This international survey recruited chief dental officers, oral health advisors to national ministries of health, and other key informants of the 158 FDI member countries between December 2020 and December 2021. The survey tool was administered online to the study participants. Key questions explored the following outcome measures: countries with oral health policies; the thrusts of the oral health policies; policy thrusts targeting young children; and dental care plans as a component of a universal health care plan. Descriptive statistics were conducted to determine the number of countries with any of the study outcome measures and coverage per country.

Results

Sixty (38%) of the 158 FDI member-countries responded to the survey. Forty-eight (55.2%) of the 60 countries had a national oral health policy document or position statement on oral health; 54 (62.1%) countries had plans on universal health care, and 42 (48.3%) included dental care within their universal health care plan. The most common policy thrusts addressing the oral health needs of children were the promotion of oral hygiene (71.7%), provision of fluoride products for children (53.3%), collaboration with primary care providers (35%), and prenatal oral health education (50%). There were differences in the scope of oral health care coverage and the coverage for young children between continents as well as between countries. Europe had many countries with children-friendly oral health policy coverage.

Conclusions

About half of the surveyed countries had a national oral health policy. There were variations in the scope of oral health care coverage, particularly for young children, both between continents and among individual countries. These findings underscore the importance of understanding the landscape of oral health policies globally. Such insights can help inform targeted interventions to enhance oral health policies, thereby contributing to improved oral health outcomes on a global level.

Knowledge, Attitudes, and Practices Towards ECC Prevention in Thai Medical Personnel

OBJECTIVE

This study aimed to identify the knowledge, attitudes, and practices related to the prevention of early childhood caries (ECC) amongst medical personnel in well-baby clinics (WBC).

METHODS

Participants were 152 health care professionals, including public health officers, nurses, and physicians, working in WBC in Chonburi Province, Thailand. Participants completed a 6-part online questionnaire asking about demographic data, knowledge and attitudes related to ECC, ECC prevention practices, collaboration, referral systems, and suggestions for improving collaboration between dental and medical personnel in WBC.

RESULTS

Whilst most participants had high levels of knowledge about oral care instructions, tooth brushing frequency, and cariogenic foods and beverages, they knew less about recommendations for timing of the first dental visit, fluoride concentration in toothpaste, and the time for exfoliation of primary teeth. There were significant differences in the proportions of correct answers to questions related to the first dental visit and bottle feeding and in total knowledge scores between physicians and other health care professionals. Most participants demonstrated a positive attitude towards ECC prevention. More than 70% of participants always advise parents on oral hygiene and nutrition related to ECC prevention, but only 29% always refer patients to see dental personnel. Attitudes, collaboration, and referral systems were significantly associated with ECC prevention practices, but not knowledge.

CONCLUSIONS

This study demonstrates that attitudes, collaboration, and referral systems are key contributors to ECC prevention amongst Thai medical personnel. In addition to training programmes, consistent interprofessional policy and referral systems should be formulated, especially in primary care settings.

Caries Etiology and Preventive Measures

Caries is a widespread disease in both children and adults. Caries is caused by the conversion of fermentable carbohydrates by plaque bacteria into acids on the tooth surface. Thus, it is important to focus on sugar reduction and plaque control. For efficient plaque removal/control, state-of-the-art toothpastes contain various active ingredients such as antimicrobial agents (e.g., chlorhexidine, stannous salts, and zinc salts), abrasives (e.g., calcium carbonate, calcium phosphates, and hydrated silica), surfactants (e.g., sodium lauryl sulfate and sodium methyl cocoyl taurate), and natural compounds (e.g., polyphenols and xylitol). Agents with pH-buffering and calcium-releasing properties (e.g., calcium carbonate and calcium phosphates) and biomimetic actives (e.g., hydroxyapatite) reverse the effects of the acids. Additionally, modern toothbrushes (i.e., electric toothbrushes) as well as dental floss and interdental brushes significantly help remove plaque from dental surfaces including interproximal surfaces. In conclusion, modern concepts in caries prevention should focus not only on tooth remineralization alone but also on the control of all the key factors involved in caries development.

Preventive behaviour and attitudes towards early childhood caries amongst mothers of toddlers in Bangladesh

BACKGROUND

Our aim was to analyse mothers of toddlers' preventive behaviour towards ECC in Bangladesh.

METHODS

We conducted a cross-sectional survey of mothers and their 6-24-month-old children visiting vaccination centres in Trishal, Bangladesh in 2021. A cluster-sampling method was applied to select 10 immunization centres and all mothers who attended the centres with a 6-24-month-old child were recruited. Mothers' preventive behaviour and attitude towards oral health was determined using a reliable instrument. Clinical examinations were conducted to assess the presence of dental plaque on the labial surfaces of the upper central incisors and the ICDASII index criteria were utilized to detect ECC. The associations between preventive behaviours and the plaque score and caries status of the children were determined using multivariable logistic regression analysis after adjusting for confounding variables (mother's age and educational status).

RESULTS

The prevalence of ECC among the children was 25.8%. ECC experience was significantly associated with low educational level (p = 0.02) and older age (p = 0.01) of mothers. Of the mothers, 75.2% reported to brush their teeth twice daily and about half of them (48.8%) cleaned their children's teeth daily; and 5.8% with fluoridated toothpaste. The multivariate logistic regression analysis showed that caries preventive behaviour of mothers (AOR = 2.63, 95% CI1.41-4.91) and the plaque score of the child (AOR = 14.69, 95% CI7.45-28.9) were significant risk indicators for ECC in the study population.

CONCLUSIONS

The prevalence of ECC was high among the Bangladeshi toddlers and factors such as the mothers' preventive behaviour and presence of plaque were associated with the occurrence.

Anti-Cariogenic Effects of S. cerevisiae and S. boulardii in S. mutans-C. albicans Cross-Kingdom In Vitro Models

Despite the well-documented health benefits of the probiotic Saccharomyces, its application in oral health has not been comprehensively assessed. Dental caries is a transmissible disease initiated by acid production of cariogenic bacteria and yeast, such as Streptococcus mutans and Candida albicans, on tooth enamel and followed by subsequent enamel demineralization. Here, we investigated the effect of two Saccharomyces strains (Saccharomyces boulardii and Saccharomyces cerevisiae) on S. mutans-C. albicans cross-kingdom interactions using a cariogenic planktonic model. Viable cells, pH changes, and gene expression were measured. S. cerevisiae and S. boulardii inhibited the growth of C. albicans in dual- and multi-species conditions at 4, 6, and 20 h. Saccharomyces also inhibited C. albicans hyphal formation. Furthermore, Saccharomyces reduced the acidity of the culture medium, which usually plummeted below pH 5 when S. mutans and C. albicans were present in the model. The presence of Saccharomyces maintained the culture medium above 6 even after overnight incubation, demonstrating a protective potential against dental enamel demineralization. S. boulardii significantly down-regulated S. mutans atpD and eno gene expression. Overall, our results shed light on a new promising candidate, Saccharomyces, for dental caries prevention due to its potential to create a less cariogenic environment marked by a neutral pH and reduced growth of C. albicans.

Risk of Early Childhood Caries Estimated by Maternal Dental Caries during Pregnancy: A Retrospective Cohort Study

OBJECTIVE

 Public policy promoting prenatal dental care to provide long-term prevention of early childhood caries (ECC) in offspring would require evidence regarding the ECC risk associated with maternal dental caries during pregnancy. This study evaluated that association using a design capable of assessing temporal relationships and considered a directed acyclic graph to guide the adjustment of pertinent confounders.

MATERIALS AND METHODS

 This retrospective cohort study analyzed data from 158 mother-child dyads attending care at Prachathipat Hospital, Pathum Thani, Thailand. Maternal dental caries data at their first visits to prenatal oral care from February 2012 to May 2017 were traced forwardly to match the oral health data of offspring who visited the hospital from May 2013 to March 2018.

RESULTS

 Univariable and multivariable fractional logit regression models along with the calculation of average marginal effects revealed that children born to two categories of mothers with 1 to 5 and ≥6 carious teeth during pregnancy would averagely develop 4.5 to 5 and 7.9 to 8.8 more carious teeth per 100 teeth than dental caries would occur in offspring of caries-free mothers.

CONCLUSION

 This evidence identified the role of maternal dental caries during pregnancy as a significant clinical risk indicator for ECC and supported the provision of prenatal dental care for mothers to prevent ECC in offspring.

Doses of fluoride toothpaste for children up to 24 months

AIM

The aim of this study was to test the dose of fluoride toothpaste by parents for their children aged up to 24 months.

METHODS

Parents who use fluoride toothpastes for their children were asked to dose two commercially available toothpastes (A and B) with 1000 ppm fluoride each for their children as they would normally do at home. The toothpaste amounts were weighed, and as reference, the weight of an 'optimal' grain of rice-size amount of each toothpaste was used.

RESULTS

61 parents dosed a mean of 0.263 ± 0.172 g toothpaste A and 0.281 ± 0.145 g toothpaste B. The parents' mean doses were 5.9 times higher for toothpaste A and 7.2 times higher for toothpaste B than an 'optimal' grain of rice-size amount (the reference dose as recommended). The difference between parent's and reference dose was statistically significant (p < 0.001). Moreover, 39.3% of parents were not aware about conditions of use and warnings that have to be printed on the package of fluoride toothpastes.

CONCLUSION

In this study, parents significantly overdosed the toothpaste for their children. To avoid fluoride intake from toothpaste, parents can choose fluoride-free alternatives for the oral care of their infants and toddlers.

Clinical performance of sealants under different humidity control conditions: a split-mouth 1-year randomized trial

PURPOSE

Sealants are an effective method of prevention and treatment for early caries lesions. This study analyzed the 1-year clinical performance of resin-based and ionomeric sealants applied to permanent teeth under different humidity conditions.

METHODS

The investigation was a triple-blind randomized clinical trial (RCT) with a four arms split-mouth design, divided according to the sealant protocol: (1) Resin-based sealant applied with rubber dam isolation, (2) Resin-based sealant applied with cotton rolls isolation, (3) Ionomeric sealant applied with rubber dam isolation and (4) Ionomeric sealant applied with cotton rolls isolation. Fifty-eight patients started the study (232 teeth), and 47 (188 teeth) remained until the 1-year recall. The modified USPHS criteria were used in the analyzes to investigate surface texture, retention and the presence of secondary caries lesions around the sealants; in the following periods: baseline, after 3, 6, 9, and 12 months by two calibrated examiners. Data were analyzed by the Mann-Whitney and Friedman tests.

RESULTS

There was no difference between the types of sealants (p > 0.05). The type of humidity control influenced the superficial texture (p = 0.0012) and the retention of sealants (p = 0.0023). The sealant displacement was greater under cotton rolls isolation. Only one active caries lesion in enamel was found in the 9th month.

CONCLUSION

It may be concluded that sealants effectively prevented caries, even when they were partially or totally lost, regardless of the material. The rubber dam isolation with a rubber dam promoted lower surface roughness and improved the retention rates. International Clinical Trials Registry Platform: #1111-1215-2832 (07/26/2018).

Clinical validation of near-infrared imaging for early detection of proximal caries in primary molars

OBJECTIVES

The aim of this study was to validate the near-infrared imaging (NIRI) in comparison with visual inspection (VI) for early detection of proximal caries in primary molars.

METHODS

VI and intraoral scans were performed on 126 patients aged 3-12 years with at least one non-cavitied and non-restored proximal tooth surface, who were scheduled for bite wing radiography (BWR) as part of their standard care. Teeth with signs of proximal cavities, restorations or residual caries were excluded in this study. BWR, a gold standard to diagnose proximal caries in primary molars, was used to validate the findings of NIRI and VI. The accuracy, sensitivity, specificity and the area under the curve (AUC) of NIRI and VI were calculated.

RESULTS

The accuracy, sensitivity and specificity of NIRI were 82.89%, 74.10% and 90.97%, while those of VI were 71.64%, 43.88% and 97.14%, respectively. NIRI showed higher accuracy and sensitivity, and lower specificity (P < 0.001). The AUC of NIRI was higher than that of VI (0.826 vs 0.706; P < 0.05).

CONCLUSIONS

NIRI showed higher sensitivity and lower specificity compared with VI when detecting proximal caries in primary molars. Therefore, it is recommended to use NIRI in combination with BWR to improve the detection rate of proximal caries in primary molars.

CLINICAL SIGNIFICANCE

In children, there is a high incidence of proximal caries in primary molars, which require high technical sensitivity for detection. NIRI shows high sensitivity in detecting proximal caries, which may improve their detection rate in primary molars.

THE CLINICAL TRIAL REGISTRATION NUMBER

ChiCTR2300070916.

Antibacterial effectiveness of different zinc salts on Streptococcus mutans and Streptococcus sobrinus: An in-vitro study

Objectives

This in-vitro study aimed to evaluate the antibacterial effects of four zinc salts namely zinc chloride, zinc sulfate, zinc citrate and zinc acetate against Streptococcus mutans (S. mutans) and Streptococcus sobrinus (S. sobrinus).

Methods

Antibacterial susceptibility assay, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were undertaken to evaluate the inhibitory activities of different zinc salts against the tested bacteria. A scanning electron microscope (SEM) was used to evaluate the morphological changes of bacterial cells following exposure to zinc salts. Kruskal-Wallis and Mann-Whitney tests were used to compare the inhibitory effect of the different zinc salts.

Results

All zinc salts tested against S. mutans and S. sobrinus had a statistically and significantly smaller inhibition zone when compared to chlorhexidine, (P < 0.001). However, zinc chloride had the largest inhibition zone (20 mm ± 5.5) against S. sobrinus, which was comparable to chlorhexidine (22 mm ± 4) (P > 0.05). Zinc chloride, zinc sulfate and zinc acetate demonstrated higher MIC and MBC values against S. mutans compared to S. sobrinus. However, zinc citrate revealed the highest MIC and MBC values of 1 mg/mL and > 8 mg/mL for S. sobrinus and > 8 mg/mL for S. mutans, respectively.

Conclusion

Different zinc salts have displayed inhibitory growth effects against the common oral bacteria at very low concentrations except for zinc citrate which showed no inhibitory effect against these bacteria in vitro.

Maternal factors associated with early childhood caries among 3-5-year-old children with low socio-economic status in Trishal, Bangladesh

Introduction

Early Childhood Caries (ECC) is more prevalent in nations where a larger portion of the population resides below the poverty line. This study aimed to evaluate the connections between maternal awareness, attitudes, practices related to oral health, and the occurrence of ECC among children aged 3-5 years in Bangladesh, a low-middle income country with high level of poverty.

Methods

This cross-sectional study recruited mother-child pairs with a focus on children aged 3-5 years from low socioeconomic backgrounds in Trishal, Bangladesh. Data collected included maternal oral health knowledge, attitudes, and behaviors. Clinical examinations were conducted to check for dental plaque on the upper central incisors' labial surfaces. ECC was identified using the ICDAS II index criteria. Associations between maternal oral health knowledge, attitudes, behaviors, and children's plaque score and caries status were analyzed using multivariable logistic regression, and adjusting for confounding variables (child's age, gender, mother's age, education, and number of children).

Results

Among 532 mother-child pairs, 491 (93.2%) mothers were unaware of the role of fluoride in preventing caries, while 516 (97%) recognized the importance of using fluoridated toothpaste during brushing. Additionally, 520 (97.7%) mothers reported not knowing how to brush their child's teeth, and 87 (16.4%) brushed their children's teeth twice daily. Visible dental plaque was observed in 420 (78.9%) children, and 321 (60.3%) had ECC. Higher plaque score increased the odds of ECC in the study population (AOR: 5.617, 95% CI: 3.511-8.987).

Conclusions

Mothers of preschool children with low socioeconomic status were poorly aware of caries preventive behaviors and had suboptimal oral health practices for their children. The plaque score was the only oral health factor that seems to increase the risk for ECC among children with low socio-economic status in Bangladesh. It is imperative to prioritize support and interventions aimed at improving oral hygiene practices to reduce ECC risk in this population.

The composition of the dental pellicle: an updated literature review

Background

The dental pellicle is a thin layer of up to several hundred nm in thickness, covering the tooth surface. It is known to protect the teeth from acid attacks through its selective permeability and it is involved in the remineralization process of the teeth. It functions also as binding site and source of nutrients for bacteria and conditioning biofilm (foundation) for dental plaque formation.

Methods

For this updated literature review, the PubMed database was searched for the dental pellicle and its composition.

Results

The dental pellicle has been analyzed in the past years with various state-of-the art analytic techniques such as high-resolution microscopic techniques (e.g., scanning electron microscopy, atomic force microscopy), spectrophotometry, mass spectrometry, affinity chromatography, enzyme-linked immunosorbent assays (ELISA), and blotting-techniques (e.g., western blot). It consists of several different amino acids, proteins, and proteolytic protein fragments. Some studies also investigated other compounds of the pellicle, mainly fatty acids, and carbohydrates.

Conclusions

The dental pellicle is composed mainly of different proteins, but also fatty acids, and carbohydrates. Analysis with state-of-the-art analytical techniques have uncovered mainly acidic proline-rich proteins, amylase, cystatin, immunoglobulins, lysozyme, and mucins as main proteins of the dental pellicle. The pellicle has protective properties for the teeth. Further research is necessary to gain more knowledge about the role of the pellicle in the tooth remineralization process.

The prevalence of early childhood caries and treatment needs among children attending Anganwadi centers in Goa state: A cross-sectional survey

CONTEXT

The prevalence of early childhood caries (ECC) is widespread, as reported in studies conducted in various states across India. Many children residing in the rural areas attend Anganwadi centers for preprimary education, nourishment, and health care.

AIM

The aim of the study was to determine the prevalence of ECC among children attending Anganwadi centers in the state of Goa and their treatment needs.

SETTINGS AND DESIGN

The study was approved by the Institutional Ethical Committee of Goa Dental College and Hospital. The study was carried out in Anganwadi centers spanning the various districts and talukas of Goa state.

MATERIALS AND METHODS

The decayed, missing, and filled teeth (dmft) index was recorded in 3-5-year-old children along with treatment needs as per the modified WHO pro forma.

STATISTICAL ANALYSIS

Statistical software (STATA) for data science by StataCorp LLC (version 17), descriptive statistics, and Chi-square test.

RESULTS

A total of 386 children were examined, out of which 47% had ECC. The prevalence of ECC was highest in Canacona and the least in Tiswadi talukas. The severity and occurrence of ECC were found to the proportional to age. With regard to treatment needs, 8.55% needed restoration of at least one surface, 10.88% needed restoration of 2 or more surfaces, 5.44% required a crown, 11.4% needed pulpal treatment, and 6.74% needed extractions. Within the dmft component, the percentage of decayed teeth was 46.89%, followed by filled (0.52%) and missing (0.52%) teeth.

CONCLUSION

The prevalence and severity of ECC in children attending Anganwadi centers in Goa were found to be large and proportional with increasing age.

Comparative efficacy of topical povidone-iodine and chlorhexidine gel on dental plaque regrowth in toddlers: A randomized controlled trial

OBJECTIVES

This study aimed to compare and evaluate the efficacy of topical use of povidone-iodine (PVP-I) solution and chlorhexidine (CHX) gel on dental plaque regrowth after 3 and 7 days in toddlers aged 24-36 months.

MATERIALS AND METHODS

A randomized controlled trial that included 45 healthy toddlers aged 24-36 months, who were randomly assigned to three groups. The first group received a placebo (distilled water (DW)) (negative control). The second group received topical CHX gel (0.2% w/v) (positive control). The third group received topical PVP-I solution (10% w/v). Plaque accumulation was measured at the baseline (t0 ), after 3 days (t1 ) and after 7 days (t2 ) using the Turesky-modified Quigley-Hein plaque index (TMQHPI). Oral hygiene practices were prohibited during the trial period. The trial ID is ACTRN12623000567628.

RESULTS

In the DW group, the mean of the TMQHPI score was 1.89 ± 0.67 at t0 and decreased to 1.45 ± 0.66 at t1 (p = .028). Similarly, in the CHX group, the mean of the TMQHPI score was 1.83 ± 1.06 at t0 and decreased to 1.02 ± 0.99 at t1 (p = .033). Regarding the PVP-I group, the mean of the TMQHPI score went from 1.84 ± 0.85 to 1.01 ± 0.61 at t1 and then increased to 1.57 ± 0.74 at t2 . Those changes were statistically significant (p = .001) and (p = .002), respectively. No statistically significant difference was noted between TMQHPI scores at t0 (p = .789). Regarding t1 and t2 , no statistically significant difference was found between the three groups (p > .05).

CONCLUSION

CHX and PVP-I efficacy lasted only for 3 days, and PVP-I was not superior to CHX in terms of plaque control in toddlers. However, further studies are needed to determine the long-term efficacy of these antiplaque agents in toddlers.

The Efficacy of Apple Cider Vinegar at Different pH Values as an Antimicrobial Agent: An In Vitro Study

AIMS AND BACKGROUND

This study evaluates the antimicrobial activities of commercially available 5% apple cider vinegar (ACV) against Enterococcus faecalis, Streptococcus mutans, and Lactobacillus casei. Materials and methods: Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were conducted using the broth microdilution method. Sodium hypochlorite (NaOCl) of 5.25% was used as a positive control, and comparisons were also made with acetic acid (AA) as the main ingredient in ACV. The three test bacteria treated with the most effective ACV dilution were visualized under a transmission electron microscope (TEM) for structural changes.

RESULTS

Minimal inhibitory concentration was determined at 0.625% of the concentration of ACV against S. mutans and E. faecalis and 1.25% of the concentration of ACV against L. casei with two-fold serial dilutions. A concentration of 5 × 10-1% with 10-fold serial dilutions was found to be the MIC value for all three bacteria. No significant differences were found when compared with the positive control (NaOCl) (p = 0.182, p = 0.171, and p = 0.234), respectively, for two-fold serial dilutions and (p = 1.000, p = 0.658, and p = 0.110), respectively for 10-fold serial dilutions. MBC was observed to be 5% ACV for both E. faecalis and S. mutans. However, positive microbial growth was observed on the agar plate when cultured with L. casei. An independent sample t-test showed no significant differences (p > 0.05) in the antimicrobial activities between 5% ACV and 5% pure AA. TEM revealed cell wall and cytoplasmic membrane disruptions on all three bacteria at MIC value.

CONCLUSION

Apple cider vinegar has antimicrobial activities against Enterococcus faecalis, Streptococcus mutans, and Lactobacillus casei at their respective MIC values.

CLINICAL SIGNIFICANCE

Apple cider vinegar can be an alternative antimicrobial dental pulp disinfectant to sodium hypochlorite. Apple cider vinegar can be used safely, especially in children's dental pulp therapy and deep caries management, when adequate tooth isolation is not readily achievable. Thus, adverse reactions commonly associated with other frequently used chemical disinfectants can be avoided.

Meta-analysis of prevalence and filling rate of dental caries in preschool children in China

OBJECTIVES

This study aims to understand the prevalence and treatment status of dental caries in preschool children aged 3-5 years in China among the past five years.

METHODS

Databases including CNKI, WanFang data, VIP, MEDLINE, EMBASE were systematically searched for the epidemiological literature of dental caries in preschool children in China from 2017 to 2022 for Meta-analysis. Subgroup analysis was carried out by sex, age, geographical region, ethnology, and residence.

RESULTS

The Meta-analysis enrolled 27 literatures, including 72 788 preschool children; of which, 38 344 children had dental caries. The merged prevalence of dental caries in preschool children was 59.3% (95%CI: 54.6%-63.9%), and the merged filling rate of caries was 5.7% (95%CI: 2.5%-8.8%). In the subgroup analysis, the merged prevalence rates of caries in children aged 3, 4, and 5 years were 46.9% (95%CI: 42.5%-51.4%), 59.0% (95%CI: 55.1%-62.8%), and 67.3% (95%CI: 62.5%-72.2%), respectively, and the difference was significant. In addition, significant differences were found among different regions. The merged prevalence of dental caries in preschool children was the highest in northwest China (68.6%, 95%CI: 55.5%-81.8%) and the lowest in central China (49.1%, 95%CI: 47.3%-51.0%). The merged prevalence of dental caries was not significantly different among preschool children of different genders, ethnicities, and residence.

CONCLUSIONS

The prevalence of dental caries in preschool children aged 3-5 years in China is high and continuously increases. The oral health of preschool children should be comprehensively strengthened, and a three-level strategy should be implemented to prevent diseases.

Development and acceptability of behavioral interventions promoting mothers' brushing of pre-school children's teeth: The preparation phase of the multi-phase optimization strategy framework

BACKGROUND

Early childhood caries can be prevented through regular parental-supported toothbrushing, indicating the importance of behavior modification interventions targeting parents. Mobile oral health (m-oral health) interventions are gaining increased popularity although their production is not always based on solid theoretical frameworks and evidence about the efficacy of individual intervention components is not available. The Multiphase Optimization Strategy (MOST) offers a framework to develop complex m-oral health interventions and assessing the efficacy of individual components.

AIM

This study describes the development and assesses the acceptability of 3 intervention components using MOST to promote mothers' brushing of their preschool children's teeth.

METHODS

The Theory of Planned Behavior guided the development of 3 components: motivational interviewing (MI), storytelling videos (STVs), and oral health promotion messages (OHPMs). A researcher received training to conduct MI. Twenty-four OHPMs were developed, and 14 STVs scripts were developed based on the "And, But, Therefore" framework. A feasibility pilot study was conducted to determine the optimization objective and assess mothers' preferences regarding the frequency and timing of receiving the intervention components. The mothers participated in a semi-structured interview to assess the acceptability of the components using 7 open-ended questions based on the framework of acceptability and thematic analysis was used to analyze the qualitative data. The mothers also responded to questions assessing the perceived and experienced acceptability of the components using close-ended questions. Descriptive statistics were presented as means and standard deviations for continuous variables and median and interquartile range for categorical variables.

RESULTS

Sixteen mothers were included. The mothers expressed positive affective attitude towards the interventions. They felt the components served as "good reminders" to brush their children's teeth. However, "time" was a burden for the mothers. 80% of the mothers preferred receiving the OHPMs and STVs once per week, from 8 pm to 2 am (50%), and 60% indicated they can set 15-30 min to receiving the interventions.

CONCLUSION

The 3 components were acceptable to the mothers. The OHPMs and STVs will be sent to the mothers once per week, between 8 pm to 2 am. The MI and follow-up phone calls will be limited to 15 min.

Biomineral-binding liposomes with dual antibacterial effects for preventing and treating dental caries

Dental caries is a chronic oral disease that results from the demineralization of dental hard tissues caused by the long-term interaction of various pathogenic factors in the human oral cavity. Although magnolol (Mag) and fluconazole (FLC) have shown promising antibacterial activity against Candida albicans (C. albicans) and Streptococcus mutans (S. mutans), their clinical application is limited due to hydrophobicity. In this study, we constructed biomineral-binding liposomes co-loaded with Mag and FLC (PPi-Mag/FLC-LPs) to overcome the hydrophobicity and achieve a dual antibacterial activity in the acidic microenvironment of caries. PPi-Mag/FLC-LPs were characterized by laser particle size analysis, transmission electron microscopy, and high-performance liquid chromatography (HPLC). The ability of PPi-Mag/FLC-LPs to bind hydroxyapatite was assessed in vitro using fluorescence microscopy and HPLC, while the antibacterial activity was examined by measuring drug effects on the acidogenicity, acid resistance, biofilm formation and survival of C. albicans and S. mutans. The pharmacodynamics of PPi-Mag/FLC-LPs was also evaluated in vivo in a rat model of dental caries. Mag and FLC were released rapidly from PPi-Mag/FLC-LPs in a pH-sensitive manner, and they bound effectively to hydroxyapatite, leading to a better antibacterial effect on C. albicans and S. mutans compared to free drugs or liposomes loaded with a single drug. PPi-Mag/FLC-LPs improved the medicinal properties of Mag and FLC and provided a rapid, pH-sensitive release of both drugs in vitro. PPi-Mag/FLC-LPs displayed good antibacterial activity in vivo, showing promise as a dual-drug delivery system for the prevention and treatment of caries.

A Comparison of Antimicrobial Efficacy of Silver-based Preventive Restorations (Silver Nitrate, Silver Diamine Fluoride, and Silver Nanoparticles) against Streptococcus mutans Monospecies Biofilm Model

Aim

The ability of the Streptococcus mutans (S. mutans) to form biofilms is not only crucial in the initiation of early childhood caries (ECC) but is also a challenge to its treatment. The current management protocols focus on remineralization and use of antimicrobial formulations which penetrate biofilms, control their formation, and decrease the incidence of caries in children. The paradigm shift toward preventive protocols and increasing antibiotic resistance rekindled the use of silver as a promising antibacterial agent. To gain further insight into the therapeutic potential, aim of the present study was to compare the antibacterial efficacy of silver-based preventive restorations [silver nitrate (AgNO3), silver diamine fluoride (SDF), and silver nanoparticles (AgNPs)] against S. mutans species.

Materials and methods

Using an ex vivo monospecies biofilm model of S. mutans; the antimicrobial efficacy of three treatment groups (SDF, AgNO3, and AgNPs) was evaluated.

Results

There was a significant difference between the negative control and three treatment groups (SDF, AgNO3, and AgNPs). The results showed that the mean diameter of inhibition zones obtained in biofilms treated with AgNPs was 40.3 ± 0.25 mm which was greater than both SDF (37.7 ± 0.18 mm) and AgNO3 (36.26 ± 0.18 mm).

Conclusion

The study concluded that the number of viable bacteria was significantly reduced by all three medicaments (p < 0.05). However, AgNPs showed the highest antimicrobial activity in comparison to SDF and AgNO3 against S. mutans biofilm.

Clinical significance

The present study thus supports that AgNPs are a promising preventive anticaries agent due to their better antibacterial activity in comparison to other silver-based preventive restorations and can be effectively used as an alternative to SDF or AgNO3 for the noninvasive treatment of ECC in the young.

How to cite this article

Sharma P, Dhawan P, Rajpal SK, et al. A Comparison of Antimicrobial Efficacy of Silver-based Preventive Restorations (Silver Nitrate, Silver Diamine Fluoride, and Silver Nanoparticles) against Streptococcus mutans Monospecies Biofilm Model. Int J Clin Pediatr Dent 2023;16(S-1):S13-S19.

Comparative Evaluation of Fluoride Release from Four Commercially Available Pediatric Dental Restorative Materials

Objectives

The aim of this study was to evaluate the fluoride-releasing abilities of commercially available restorative materials such as-Activa™ BioActive-restorative™ material, Zirconomer (Shofu Inc), Beautifil® II (Shofu Inc), GC Gold Label 9 high strength posterior restorative glass ionomer cement (GIC Corp).

Materials and methods

A total of 40 disk specimens (10 of each material) were placed into distilled/deionized (DI) water and the fluoride release was measured for 30 days. Fluoride ion measurement was performed at the end of the 1st, 3rd, 7th, 15th, and 30th day under normal atmospheric conditions by fluoride ion selective electrode (F-ISE) (Orion 9609 BNWP, Ionplus SureFlow fluoride electrode, Thermo Scientific, United States of America) coupled to a benchtop analyzer (Hachsen Ion+).

Results

All the materials included in the study exhibited fluoride release. Although there were differences in the amounts of fluoride released between Activa™, Zirconomer, and GC Gold Label 9 the mean difference between these three groups was not found to be statistically significant. Beautifil® II showed low amounts of fluoride released at all time intervals.

Conclusion

Among the above-compared materials Activa™ and Zirconomer exhibit both improved mechanical properties as well as they have fluoride-releasing ability so can be preferred over conventional glass ionomer restorations.

How to cite this article

Dhumal RS, Chauhan RS, Patil V, et al. Comparative Evaluation of Fluoride Release from Four Commercially Available Pediatric Dental Restorative Materials. Int J Clin Pediatr Dent 2023;16(S-1):S6-S12.

Improving Oral Health with Fluoride-Free Calcium-Phosphate-Based Biomimetic Toothpastes: An Update of the Clinical Evidence

As the demand for clinically effective fluoride-free oral care products for consumers increases, it is important to document which types of toothpastes have been shown in clinical studies to be effective in improving oral health. In this review, we included different indications, i.e., caries prevention, improving periodontal health, reducing dentin hypersensitivity, protecting against dental erosion, and safely improving tooth whitening in defining what constitutes improvement in oral health. While there are several professional and consumer fluoride-containing formulations fortified with calcium-phosphate-based ingredients, this review focuses on fluoride-free toothpastes containing biomimetic calcium-phosphate-based molecules as the primary active ingredients. Several databases were searched, and only clinical trials in human subjects were included; in vitro and animal studies were excluded. There were 62 oral health clinical trials on biomimetic hydroxyapatite (HAP), 57 on casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), 26 on calcium sodium phosphosilicate (CSPS, or so called Bioglass), and 2 on β-tricalcium phosphate (β-TCP). HAP formulations were tested the most in clinical trials for benefits in preventing caries, dentin hypersensitivity, improving periodontal health, and tooth whitening. Based on the current clinical evidence to date, fluoride-free HAP toothpaste formulations are the most versatile of the calcium phosphate active ingredients in toothpastes for improving oral health.

The effectiveness of motivational interviewing on the oral health of leukemic children and oral health care knowledge, attitude and practice of their mothers: a hospital-based intervention

BACKGROUND

Some studies suggest a higher effectiveness of motivational interviewing compared to common oral health instruction in healthy individuals. As regards to higher prevalence of dental diseases like early childhood caries, oral mucositis, and gingivitis are reported for leukemic children, the present study aims to compare the effectiveness of educating mothers through MI with the common instruction (CI) for the oral health of children with leukemia under six years old.

METHOD

This quasi-experimental study was designed in Tehran University of Medical Sciences, School of Dentistry and conducted on 61 mothers with leukemic children under age six hospitalized in Mahak Hospital and Rehabilitation Complex which is a Pediatric Cancer Research and Hospital Center, in 2021. Mother and child pairs were allocated to MI or CI (using pamphlets) groups. Data was collected using a questionnaire of mothers' knowledge, attitude, motivation, and practice concerning oral health care in leukemic children. The children underwent clinical examination to assess plaque index before and three months after the intervention. The data were analyzed using SPSS version 25 (IBM, Armonk, NY, USA) by ANCOVA test.

RESULTS

The preschoolers mean ages were 4.23 ± 1.41 and 4.32 ± 1.33 (ranged from 2 to 6 years old) in the MI and CI group, respectively. There were 16 girls (53.3%) and 14 boys (46.7%) in the MI group, and 15 girls (48.4%) and 16 boys (51.6%) in the CI group. Significant differences were observed in the amount of plaque index between the MI group and the CI group (0.20 ± 0.04, p-value < 0.001). A significant increase was observed in the mean of changes in scores of knowledge, attitude, motivation, mother's practice concerning child's oral health, mother's practice concerning personal oral health in the MI group (p-value < 0.001).

CONCLUSIONS

Considering that instruction using MI showed to be effective in improving oral health adherence in mothers and reducing plaque in children with Leukemia, it may be recommended as a promising method to promote the oral health of such susceptible children in places that they are constantly present for treatment.

TRIAL REGISTRATION

The study was registered in the Iranian Registry of Clinical Trials (IRCT) on 11.03.2021 (code: IRCT20131102015238N5).

Digital Application for Promoting Evidence-Based Children's Oral Health to Control Early Childhood Caries: Randomized Control Trial on Parental Acceptance and Efficacy

BACKGROUND

Early childhood caries (ECC) remains a major global health problem. Various measures to prevent it have been implemented in the past, including those using digital applications.

AIM

To evaluate the acceptance and efficacy of a digital application (FU-APP) based on evidence-based caries control recommendations for parents of children aged 6-72 months.

METHODS

Part 1, prospective questionnaire-based survey to test FU-APP (usage, acceptance, content information, usefulness, and satisfaction) filled out by parents (n = 22); Part 2, two-armed (test n = 20; control n = 23) care-based, randomized controlled trial, where the test arm received instructions verbally and via FU-APP, and the control arm received them only verbally. At baseline and follow-up (4 weeks), intraoral clinical indices (plaque index-API and caries-dmft) were recorded.

RESULTS

FU-APP was considered by parents to be a suitable tool for gaining knowledge about oral health practices for their children (all criteria >86%). No differences in the dmft levels were expected. However, API was significantly better at the follow-up in the test-arm (p = 0.01), with no differences in the control-arm (p = 0.72).

CONCLUSION

A digital application can serve as an innovative tool to promote evidence-based oral hygiene recommendations among parents of children to control ECC. Its long-term usability and functionality should be tested.

The Impact of Anemia-Related Early Childhood Caries on Parents' and Children's Quality of Life

Background and Objectives: Today, oral diseases are well-known for their effects, not only on daily life but also on quality of life (QoL). Dental caries, especially early childhood caries (ECC), are considered a public health concern as regards their impact on the life quality of children and parents from multiple aspects. The present research was conducted to assess the effect of anemia on oral-health-related quality of life (OHRQoL) in terms of children and parents. Materials and Methods: The current study was performed in two independent stages. In the first stage, the Turkish version of the Early Childhood Oral Health Impact Scale (ECOHIS), and in the second stage, the Turkish version of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) were used to measure the effect of anemia-related dental caries among children and parents. SPSS and Jamovi software were used for all calculations, graphs and comparisons. Results: A total of 204 participants (child-parent pairs) were incorporated in the present study. A considerable number of children (81.5%) reported occasional or more frequent oral/dental pain. Secondly, the subscale scores were determined for child symptoms (2.25 ± 0.067), child function (6.8 ± 0.22), child psychology (3.87 ± 0.128), self-image and social interaction (1.74 ± 0.063), parental distress (3.82 ± 0.143), and family function (3.5 ± 0.121). Additionally, more than half of the parents (56.3%) responded "fair" for the health of their children's teeth, lips, jaws and mouth. Similarly, the child's overall well-being was stated as being affected "a lot" by the condition of their child's teeth, lips, jaws or mouth by half of the parents (49.5%). Conclusions: Anemia-related dental caries has a highly negative impact on the quality of life of children and parents according to both of the questionnaires. Therefore, children with high scores should be prioritized for preventive procedures and timely dental treatments.

Food Security Status, WIC Participation, and Early Childhood Caries in a Nationally Representative Sample of Children

BACKGROUND

Despite the potential role of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in mitigating the adverse effects of food insecurity on oral health, to our knowledge, no study has examined whether WIC participation could modify the association between food insecurity with caries in young children.

OBJECTIVE

Our aim was to investigate the impact of WIC participation in modifying the association between food insecurity and early childhood caries.

DESIGN

This was a cross-sectional study.

PARTICIPANTS/SETTING

Using 2011-2018 National Health and Nutrition Examination Survey data, children aged 2 through 5 years; with household income ≤185% of the Federal Poverty Level; and with data on WIC participation, food security, and dental examinations were included (n = 1,921).

STUDY EXPOSURES

Food-security status and WIC participation were the study exposures.

MAIN OUTCOME MEASURES

Total and untreated dental caries were the main outcome measures.

STATISTICAL ANALYSES

Logistic regression examined associations of food security (household-level and child-level) and WIC participation with odds of caries. Interactions between food security and WIC participation were examined using multiplicative interaction terms.

RESULTS

Marginal child food security was significantly related to higher odds of total caries in income-eligible WIC nonparticipants (odds ratio 1.92; 95% CI 1.07 to 3.46); however, this relationship was not observed in WIC participants. Furthermore, food insecurity was significantly associated with greater odds of untreated caries only among income-eligible WIC nonparticipants (odds ratio 1.79; 95% CI 1.12 to 2.85).

CONCLUSIONS

In this sample of preschool-aged children, the relationship of food insecurity with caries differed by WIC participation status. Findings suggest that WIC participation could improve the oral health of income-eligible children with lower levels of food security.

Promoting early childhood oral health and preventing early childhood caries on Instagram

Introduction

Early childhood caries (ECC) is prevalent worldwide. Oral health promotion effectively utilizes key messages to educate parents/caregivers and the public on how to prevent ECC. Instagram is one of the biggest social media platforms, and could be used to promote early childhood oral health. The purpose of this study was to determine if and how young children's oral health is promoted and supported on Instagram.

Methods

This study used inductive content analysis to categorize, quantify, and interpret pictorial and textual data derived from Instagram posts containing the most commonly used ECC-related hashtags in their captions (determined by an extensive search through Instagram's search bar).

Results

A total of 1,071 images and 3,228 comments were analyzed based on 13 hashtags. The most common types of images were those of people (57.5%) and graphics/memes (37.8%). Most people were older children (32.5%) or adults (20.3%), and were White (19.6%) or Asian (18.5%). A majority of images had people posing (79.1%) in dental clinics (81.3%). Most graphics/memes were instructional/informational (76.3%). A total of 173 posts had substantial discussions that were positive/constructive in nature. The majority of discussions had at least one comment providing advice, tips, or explanations (79.8%), or had users requesting further information (73.4%).

Conclusion

As more people engage with social media, health professionals should consider the potential for Instagram as a tool to promote early childhood oral health and to prevent ECC. Our study shows that many different users are providing and consuming content related to ECC. Targeted messaging, monitoring of content, and professional guidance could be beneficial to those seeking oral health information on this platform.

The Incidence of Dental Caries in Children with Down Syndrome: A Systematic Review and Meta-Analysis

Scientific evidence regarding the incidence of dental caries in Down syndrome (DS) patients is limited and sometimes presents divergent opinions among authors, making it difficult to reach definitive conclusions. We aimed to evaluate the caries incidence in the DS pediatric population and compare it against healthy controls. The search was performed using 4 universal databases: Cochrane, B-on, Biomed, and PubMed. The selected articles were synthesized and subsequently evaluated according to an adaptation of the Quality Assessment Checklist for Prevalence Studies risk of bias tool, and analysis charts were performed by the Risk of Bias visualization tool (ROBVIS). Statistics and graphs were performed by Open Meta Analyst and JASP software. The confounding effect on caries incidence of the following factors was evaluated through meta-regression: age, Male/Female (M/F) ratio, DMFT, dmft, and study geographic location. Overall, the incidence of caries in the DS population was 49.9%, whereas in the control population was 63.4%. The M/F ratio, DMFT, and dmft significantly affected the incidence of DS individuals (p-value < 0.05). The evidence regarding the lower pooled incidence of caries in individuals with DS regarding controls is limited by the few scientific reports available and cross-section designs. Therefore, further studies are needed to confirm these results.

Antimicrobial Photodynamic Effect of Cross-Kingdom Microorganisms with Toluidine Blue O and Potassium Iodide

Streptococcus mutans (S. mutans) and Candida albicans (C. albicans) are prominent microbes associated with rapid and aggressive caries. In the present study, we investigated the antimicrobial efficacy, cytotoxicity, and mechanism of toluidine blue O (TBO)-mediated antimicrobial photodynamic therapy (aPDT) and potassium iodide (KI). The dependence of KI concentration, TBO concentration and light dose on the antimicrobial effect of aPDT plus KI was determined. The cytotoxicity of TBO-mediated aPDT plus KI was analyzed by cell counting kit-8 (CCK-8) assay. A singlet oxygen (1O2) probe test, time-resolved 1O2 detection, and a 1O2 quencher experiment were performed to evaluate the role of 1O2 during aPDT plus KI. The generation of iodine and hydrogen peroxide (H2O2) were analyzed by an iodine starch test and Amplex red assay. The anti-biofilm effect of TBO-mediated aPDT plus KI was also evaluated by counting forming unit (CFU) assay. KI could potentiate TBO-mediated aPDT against S. mutans and C. albicans in planktonic and biofilm states, which was safe for human dental pulp cells. 1O2 measurement showed that KI could quench 1O2 signals, implicating that 1O2 may act as a principal mediator to oxidize excess iodide ions to form iodine and H2O2. KI could highly potentiate TBO-mediated aPDT in eradicating S. mutans and C. albicans due to the synergistic effect of molecular iodine and H2O2.

Hydroxyapatite as Remineralization Agent for Children's Dental Care

Children are prone to develop dental caries. This is supported by epidemiological data confirming early childhood caries (ECC) as a highly prevalent disease affecting more than every second child worldwide. ECC is known to result from an imbalance between re- and demineralization where demineralization dominates due to frequent acid production by cariogenic bacteria present in oral biofilms. The application of oral care formulations containing remineralizing agents helps to prevent dental caries. As young children are sensitive and usually swallow (intended or unintended) a majority of toothpaste or other oral care products during daily dental care, all ingredients, especially the actives, should be non-toxic. Biomimetic hydroxyapatite [HAP; Ca5(PO4)3(OH)] is known to have favorable remineralizing properties combined with an excellent biocompatibility, i.e., it is safe if accidently swallowed. Several clinical trials as well as in situ and in vitro studies have shown that HAP remineralizes enamel and dentin. Remineralization occurs due to deposition of HAP particles on tooth surfaces forming mineral-mineral bridges with enamel crystals, but also indirectly through calcium and phosphate ions release as well as HAP's buffering properties in acidic environments (i.e., in plaque). HAP induces a homogenous remineralization throughout the subsurface enamel lesions. This review summarizes the current evidence showing HAP as an effective remineralizing agent in oral care products for children. Additional studies showing also further beneficial effects of HAP such as the reduction of biofilm formation and the relief of hypersensitivity in children with molar incisor hypomineralization (MIH). It can be concluded that HAP is an effective and safe remineralizing agent for child dental care.

Evaluation of Parents' Awareness about the Effect of Prolonged Exposure to Milk or Sugary Liquids during Bedtime in the Development of Rampant Caries in Preschoolchildren and Infants

Background

Nursing caries (NC) is a specific type of dental rampant caries with an infectious and transmissible potential that usually affect preschool children or infants that are still in the nursing phase. Prolonged exposure to milk or sugary liquids or other cariogenic substance during bedtime has shown to be the most common cause of rampant caries in preschoolchildren and infants which contributes to lowering of both functional and cosmetic appearance.

Aim and objective

This study aims to evaluate parents' awareness about the effect of prolonged exposure to milk or sugary liquids during bedtime in the development of rampant caries (NC) in preschool children and infants in Riyadh, Saudi Arabia.

Materials and methods

The research design is an observational quantitative cross-sectional with a sample size of 303 participants. The targeted subjects were Saudi parents' males and females, older than 20 and living in Riyadh, Saudi Arabia, and those under 20 years old, non-Saudi without children, and not living in Riyadh were excluded.

Results

A sample of 303 parents was analyzed. Comparison between NC knowledge and gender showed that a higher percentage of mothers (71.0%) knew that bottle-feeding during bedtime can increase the incidence of caries compared to the fathers (51.9%), p value 0.003. The relation between NC awareness and previously heard about NC showed that those who heard about NC before knew more about bottle feeding during bedtime can cause NC, p value < 0.001. Most of the parents (88.7%) who previously heard about NC also knew that oral hygiene follow-up is important in preschool children, p value < 0.001. A significant difference in knowledge existed between those who heard about NC and those who are not in terms of the proper time to follow-up with a child's oral hygiene (p value < 0.001), and the proper time to visit a dentist (p value 0.012).

Conclusion

Our study showed that the parents are significantly aware of the incidence of NC during childhood (90.4%). In addition to the significant awareness among the parents who have previously heard about NC. However, (61.7%) of the parents acknowledged the most common leading cause of early childhood caries.

How to cite this article

Fatani B, Fatani OA, Kalantan R. Evaluation of Parents' Awareness about the Effect of Prolonged Exposure to Milk or Sugary Liquids during Bedtime in the Development of Rampant Cariesin Preschoolchildren and Infants. Int J Clin Pediatr Dent 2022;15(2):227-232.

An ecological study on the association between early childhood caries and intimate partner violence in 20 low- and middle-income countries: 2007-2017

Background: Women are the worst affected by intimate partner violence (IPV), and this impacts negatively on the health of the children they care for. This study aimed to determine the associations between IPV and the prevalence of early childhood caries (ECC) in 3-5-year-olds. Methods: This was an ecological study using IPV (physical, sexual, emotional) data extracted from the Demographic Health Survey of 20 low- and middle-income countries and ECC data for 3-5-year-olds of the same countries for the period 2007-2017. Linear regression analysis was used to assess the relationship between the percentage of 3-5-year-olds with ECC (outcome variable) and IPV indicators (physical, sexual, emotional). The model was adjusted for the country's gross national income and the percentage of women with secondary or higher education. Partial eta squared (ηp ²), regression coefficients, confidence intervals and p-values were calculated. Results: Data on ECC in 3-5-year-olds and IPV were available for six low-income-countries, 10 lower-middle-income-countries and four upper-middle-income-countries. The most prevalent form of IPV was physical violence (10.09%). The Democratic Republic of Congo had the highest prevalence of physical violence (45.8%), sexual violence (25.4%), and ECC (80.0%). The strongest association was between the prevalence of ECC and emotional violence (ηp ²=0.01), followed by physical violence (ηp ²=0.005), and sexual violence (ηp ²=0.003). For every 1% higher prevalence of emotional violence, there was 0.28% higher prevalence of ECC, and for every 1% higher percentage of physical violence, there was 0.21% higher prevalence of ECC. On the contrary, for every 1% higher prevalence of sexual violence, there was 0.35% lower prevalence of ECC prevalence. Conclusions: Emotional and sexual violence where the two types of IPV associated with the prevalence of ECC. The associations were minor and the directions of their effects were difference. These findings need to be studied further.

An ecological study on the association between early childhood caries and intimate partner violence in 20 low- and middle-income countries: 2007-2017

Background: Women are the worst affected by intimate partner violence (IPV), and this impacts negatively on the health of the children they care for. This study aimed to determine the associations between IPV and the prevalence of early childhood caries (ECC) in 3-5-year-olds. Methods: This was an ecological study using IPV (physical, sexual, emotional) data extracted from the Demographic Health Survey of 20 low- and middle-income countries and ECC data for 3-5-year-olds of the same countries for the period 2007-2017. Linear regression analysis was used to assess the relationship between the percentage of 3-5-year-olds with ECC (outcome variable) and IPV indicators (physical, sexual, emotional). The model was adjusted for the country's gross national income and the percentage of women with secondary or higher education. Partial eta squared (ηp 2), regression coefficients, confidence intervals and p-values were calculated. Results: Data on ECC in 3-5-year-olds and IPV were available for six low-income-countries, 10 lower-middle-income-countries and four upper-middle-income-countries. The most prevalent form of IPV was physical violence (10.09%). The Democratic Republic of Congo had the highest prevalence of physical violence (45.8%), sexual violence (25.4%), and ECC (80.0%). The strongest association was between the prevalence of ECC and emotional violence (ηp 2=0.01), followed by physical violence (ηp 2=0.005), and sexual violence (ηp 2=0.003). For every 1% higher prevalence of emotional violence, there was 0.28% higher prevalence of ECC, and for every 1% higher percentage of physical violence, there was 0.21% higher prevalence of ECC. On the contrary, for every 1% higher prevalence of sexual violence, there was 0.35% lower prevalence of ECC prevalence. Conclusions: Emotional and sexual violence where the two types of IPV associated with the prevalence of ECC. The associations were minor and the directions of their effects were difference. These findings need to be studied further.

Diversity of site-specific microbes of occlusal and proximal lesions in severe- early childhood caries (S-ECC)

Background

Severe-early childhood caries (S-ECC) a global problem of significant concern, commonly manifest on the occlusal, and proximal surfaces of affected teeth. Despite the major ecological differences between these two niches the compositional differences, if any, in the microbiota of such lesions is unknown.

Methods

Deep-dentine caries samples from asymptomatic primary molars of children with S-ECC (n 19) belonging to caries-code 5/6, (ICDAS classification) were evaluated. Employing two primer pools, we amplified and compared the bacterial 16S rRNA gene sequences of the seven hypervariable regions (V2—V4 and V6—V9) using NGS-based assay.

Results

Bray-Curtisevaluation indicated that occlusal lesions (OL) had a more homogeneous community than the proximal lesions (PL) with significant compositional differences at the species level (p = 0.01; R- 0.513). Together, the occlusal and proximal niches harbored 263 species, of which 202 (76.8%) species were common to both , while 49 (18.6%) and 12 (4.6%) disparate species were exclusively isolated from the proximal and occlusal niches, respectively. The most commonl genera at both niches included Streptococcus, Prevotella, and Lactobacillus. S. mutans was predominant in PL (p ≤ 0.05), and Atopobium parvulum (p = 0.01) was predominant in OL.

Conclusions

Distinct differences exist between the caries microbiota of occlusal and proximal caries in S-ECC.

The main criteria of dental morbidity in children under seven years of age living in regions with different fluoride content in drinking water

Relevance. Early caries is one of the most prevalent childhood diseases worldwide. Up to 32% of three-year-olds have tooth decay, the prevalence of caries in 6-7-year-old children in different cities of Russia increases to 65%, while 55.7% of children have caries of permanent teeth. In order to improve the quality of dental care, it is necessary to receive information about the prevalence and intensity of dental diseases, taking into account medical geography. Purpose – to assess caries and fluorosis incidence rate in primary teeth, to determine the hygiene index and the level of dental care for children under seven years old living in regions with different fluoride concentrations in drinking water.Materials and methods. The study conducted dental examinations of 150 children living in the South-Eastern Administrative District of Moscow aged 1 to 6 years and of 200 children living in Krasnogorsk aged 1 to 6 years. The study included the patients based on the developed inclusion criteria and informed voluntary parent consent. We entered the data into the registration card, which noted the dental formula, the prevalence and intensity of caries, the hygiene index according to Fedorov-Volodkina, the level of dental care according to P.A. Leus (1987).Results. Children living in an area with a low fluoride concentration in drinking water show the first signs of caries by the first year of age, then there is a significant increase, observed in the group of 3and 6-year-olds. The prevalence of caries in 1-year-old children living in an endemic focus of fluorosis is almost two times lower than in children living in an area with a reduced content of fluorides in drinking water, in 3-4-year-old children – 1.5 times lower, and in 5-6-year-old children 2 times lower. Along with this, 16-year-old children living in the focus of endemic fluorosis, Krasnogorsk, Moscow region, revealed fluorosis of primary teeth with a prevalence of 27%.Conclusions. The results indicates the need to increase the frequency and quality of patient education and increase the level of dental care.

Comparing oral health systems for children in six European countries to identify lessons learned for universal oral health coverage: A study protocol

Background: Oral diseases have the highest global prevalence rate among all diseases, with dental caries being one of the most common conditions in childhood. A low political priority coupled with a failure to incorporate oral health within broader health systems has contributed to its neglect in previous decades. In response, calls are emerging for the inclusion of oral health within the universal healthcare domain (UHC). This protocol outlines the methodology for a cross-country comparative analysis of publicly funded oral health systems for children across six European countries, reporting on oral health status in line with the indicators for UHC. Methods: This study will follow Yin's multiple case study approach and employ two strands of data collection, analysis, and triangulation: a systematic documentary analysis and semi-structured interviews with elite participants local to each country. The countries chosen for comparison and providing a representative sample of European dental systems are Denmark, Hungary, the Republic of Ireland, Germany, Scotland, and Spain. A systematic search of five electronic databases and four additional electronic resources will be undertaken, in addition to grey literature and other publicly available sources, with the outcomes verified and further informed by local experts. The WHO Universal Health Coverage Cube will be used to guide data collection and analysis. Conclusions: This research will provide policy makers with an in-depth analysis and comparison of publicly funded oral health systems for children in Europe, including consideration of effective preventive strategies, oral health system reform, and indicators of universal oral health coverage. It is anticipated that the outcomes may help in positioning oral health on governmental health agendas and support its integration into wider health systems' reform in an accessible and affordable manner.

Influence of childhood asthma on dental caries: A longitudinal study

OBJECTIVES

The study investigated the influence of childhood asthma on dental caries development and caries risk factors among children with asthma in Slovenia.

MATERIAL AND METHODS

The study population consisted of 2-17 years old children (n = 138), who had used anti-asthmatic medicines for at least 1 year. Controls were their non-asthmatic siblings (n = 140). International Caries Detection and Assessment System-II was used to assess caries status. After 3 years, 106 baseline participants (53 asthmatic and 53 siblings) were reexamined. Questionnaires completed by parents and data from the patients' medical records provided information on demographics, child's medical history, medication usage, and oral health behaviors. Additional 308 asthmatic children were examined to assess caries risk factors among children with asthma.

RESULTS

Asthmatic children had significantly higher mean d12 fs and D12 MFS (p ≤ 0.05), and fewer caries-free individuals (p ≤ 0.01). In asthmatic children, 3 years mean increment in D12 MFS was significantly higher (p ≤ 0.05). Furthermore, progression over 3 years from sound tooth surfaces to decayed cavitated and filled lesions in primary and permanent teeth were present in significantly higher (p ≤ 0.05) percentage, and likewise transition from decayed cavitated lesions to missing tooth surfaces because of caries in primary teeth, and from filled to filled non-cavitated and cavitated lesions in permanent teeth. Lower caries experience in asthmatic children was associated with lower doses of inhaled glucocorticoid use, leucotriene antagonist use, and daily milk and cheese consumption.

CONCLUSIONS

Asthmatic children who had used anti-asthmatic medicines had higher caries experience and higher caries progression over 3 years in both primary and permanent dentitions. Besides anti-asthmatic medicines, other factors were associated with higher caries experience in asthmatic children.

Silver diamine fluoride with delayed restoration reduces tooth discoloration

Introduction

Methods

Results

Conclusion

The use of hydroxyapatite toothpaste to prevent dental caries

Dissolution of hydroxyapatite from the tooth structure at low pH can lead to the irreversible destruction of enamel and dentin, which if left untreated can result in pain and tooth loss. Hydroxyapatite toothpastes contain hydroxyapatite particles in micro- or nanocrystalline form that have been shown to deposit and restore demineralized enamel surfaces. As such, they are currently being explored as a fluoride-free anti-caries agent. This narrative review article aims to summarize the recent findings of the research investigating the remineralization potential of HAP toothpaste in vitro, in situ and in vivo, as well as some other applications in dentistry.

36 Months' Clinical Performance of Primary Incisors Restorations Depending on the Type of Restorative Technique Used: A Randomized Controlled Trial

Background: Depending on the stage of the disease and the child’s age, different types of interventions can be used to treat early childhood caries. As a result, there is not enough clinical evidence to show that one kind of restoration is better than another. The objective of this longitudinal study was to compare the results of 36 months of clinical performance of primary incisors restorations using an incremental layering technique with the ceram.x^® SphereTECTM nanoceramic composite (Dentsply) or a full coverage technique with transparent strip crowns (Frasaco GmbH) with the same composite in children with or without biological caries risk factors. Methods: 80 patients (females 42/52.5%) were included in the study. A total of 160 restorations were performed. Restorations were evaluated at baseline and at 6, 12, 24, and 36 months, according to modified Ryge criteria. Conclusion: Restorations with both techniques were clinically highly successful and showed similar clinical performance at postoperatively regardless of the presence of biological factors of caries risk.

Metagenomic Analysis Reveals Neisseria bacilliformis Variation in the Early Childhood Caries Plaque Microbiome

The progression of early childhood caries (ECC) is caused by microbial colonized in dental plaque. However, the association framework both from 16s genus down to high resolution metagenomic strain level and from composition to genome function analysis on caries lacks. 16S rRNA sequence revealed the composition of 3-6 years dental caries (ECC, n = 29), and severe dental caries (SECC, n = 36) children are significantly different from caries-free controls (CF, n = 31). Especially, genus Neisseria is enriched in caries (P < 0.05). Metagenomics sequence of 3 ECCs, 3 SECCs, and 3 CFs reveals Neisseria bacilliformis ATCC BAA-1200 in genus Neisseria is also significantly enriched in caries (P < 0.05). Then, we recovered high-quality metagenomic assembly genomes (MAG), named bin 86, which have 99% identity with Neisseria bacilliformis ATCC BAA-1200 genome. Function analysis of Neisseria bacilliformis ATCC BAA-1200 genome shows its metabolism power of sugar and adhesion, colonization, acid production, and acid tolerance ability, which suggested Neisseria bacilliformis ATCC BAA-1200 may serve as a biomarker for childhood caries.

Biomimetic hydroxyapatite and caries prevention: a systematic review and meta-analysis

Dental caries is still one of the most prevalent diseases worldwide. Research has shown that fluoride has a role in caries prevention. For many reasons there are concerns about young children using fluoride-containing oral care products. Consequently, there is a need to identify effective fluoride-free products. A large body of literature now exists on the use of biomimetic hydroxyapatite (HAP) as an active ingredient in oral care products to combat caries.

AIM

To conduct a systematic review of the clinical evidence of the effects of HAP-based fluoride-free oral care products in caries reduction and conduct a meta-analysis of available randomized clinical trials (RCTs).

METHODS

Using the PICO question "In individuals of all ages (P), do fluoride-free oral care products containing HAP as the anti-caries agent (I), compared to products with fluoride or without caries control products (C), reduce the risk of dental caries (O)?" Ovid MEDLINE (PubMed), Scopus, EMBASE, and Web of Science databases were searched using the following keywords: apatite, hydroxyapatite, caries, dental decay, dentin(e), enamel, toothpaste, dentifrice, mouthwash, gels, biofilm, (dental) plaque, ero(de, ded, sion), (de, re)mineral(ise, ized, ised, ization, isation). Reviews, tooth whitening, tooth sensitivity, and in vitro studies were excluded. PRISMA was used for the search and GRADE was used to assess quality. Clinical trials were subjected to the Cochrane Risk of Bias assessment followed by meta-analysis.

RESULTS

291 studies were retrieved; 22 were suitable for systematic review, 5 were clinical caries trials and 4 were RCTs. A meta-analysis of 3 RCTs was possible showing HAP provided 17% protection against caries. The other 17 trials had simpler proxy outcomes for anticaries effects. Some trials showed non-inferior performance of HAP products compared to those with fluoride.

CONCLUSION

There is good evidence that hydroxyapatite in oral care products in the absence of fluoride effectively reduces caries.

Effects of Fluoride and Calcium Phosphate-Based Varnishes in Children at High Risk of Tooth Decay: A Randomized Clinical Trial

BACKGROUND

The aim of this study was to investigate the effect of the application of two varnishes-MI Varnish (5% sodium fluoride with CPP-ACP) and Clinpro White Varnish (5% sodium fluoride with fTCP)-applied every three months in children with high caries risk for 12 months on plaque indexes, salivary pH, salivary lactic acid and chemical elements concentrations.

METHODS

We included 58 children aged 4-12 years, assigned to control (placebo), Clinpro and MI groups. Baseline and three-month saliva samples were taken. We assessed changes in pH, lactic acid concentrations and chemical elements in saliva.

RESULTS

At 12 months, all groups showed a nonsignificant increase in pH levels and a reduction in lactic acid, which was greatest in the placebo group. There was a significant reduction in ²⁴Mg (p = <0.001), ³¹P (p = 0.033) and ⁶⁶Zn (p = 0.005) levels in the placebo group (p ≤ 0.05), but not in the other elements studied: ²³Na, ²⁷Al, ³⁹K, ⁴⁴Ca, ⁵²Cr, ⁵⁵Mn, ⁵⁷Fe, ⁵⁹Co, ⁶³Cu, ⁷⁵As, ¹¹¹Cd, ¹³⁷Ba, ²⁰⁸Pb and ¹⁹F.

CONCLUSIONS

Neither pH, lactic acid concentrations or most salivary chemical elements were useful in defining patients at high risk of caries or in monitoring the effect of MI Varnish and Clinpro White Varnish after three-month application for 12 months. However, the appearance of new cavities was stopped, and the hygiene index improved, probably due to hygienic and dietary measures and the use of fluoridated toothpaste.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN13681286.

Association between Dermatoglyphics and Early Childhood Caries among Preschool Children: A Pilot Study

Context

Primary teeth and dermal ridges form around the same time in utero. Hereditary and intrauterine factors affecting the formation of primary teeth may affect dermal ridge formation also.

Aims

This pilot study was conducted to see the association between dermatoglyphics and dental caries among preschool children.

Settings and Design

Cross sectional, case-control design.

Materials and Methods

One hundred, healthy preschool children aged 3-6 years attending private kindergarten participated. They were divided equally into caries active and caries free group based on the oral examination. The fingerprint patterns were collected for all the fingers of both hands of children and categorized as loop, whorl or arch for each finger of the right and left hand.

Statistical Analysis Used

Statistical analysis was performed using the Chi-square test and Independent t-test to compare the dermatoglyphics patterns between the caries-free group and the caries active group for each variable.

Results

(1) Dental caries susceptibility of an individual decreases with an increase in the incidence of loop pattern, followed by whorl pattern and arch pattern; (2) Left hand loop was found statistically significant (P = 0.03); (3) Presence of loop pattern in left hand thumb predicts significantly lower risk of caries, whereas the presence of arch pattern in left hand thumb predicts significantly high risk of early childhood caries (P = 0.01).

Conclusions

The caries free status of a preschool child increased with the presence of loop on the left thumb.

Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia

OBJECTIVES

To critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.

DESIGN AND SETTING

The evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.

PARTICIPANTS

Data were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.

COST MEASURES

Data included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.

OUTCOME MEASURES

Utility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.

RESULTS

Compared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only 'cost-effective' in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was 'cost-effective' in all scenarios except at 3 months scenario.

CONCLUSIONS

The midwives' only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives' and dentists' combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.

TRIAL REGISTRATION NUMBER

ACTRN12612001271897; Post-results.

An ecological study on the association between early childhood caries and intimate partner violence in 20 low- and middle-income countries: 2007-2017

Background: Women are the worst affected by intimate partner violence (IPV), and this impacts negatively on the health of the children they care for. This study aimed to determine the relationship between IPV and the prevalence of early childhood caries (ECC) in 3-5-year-olds. Methods: This was an ecological study using IPV (physical, sexual, emotional) data extracted from the Demographic Health Survey of 20 low- and middle-income countries and ECC data for 3-5-year-olds of the same countries for the period 2007-2017. Linear regression analysis was used to assess the relationship between the percentage of 3-5-year-olds with ECC (outcome variable) and IPV indicators (physical, sexual, emotional). The model was adjusted for the country’s gross national income and the percentage of women with secondary or higher education. Partial eta squared (ηp2), regression coefficients, confidence intervals and p-values were calculated. Results: Data on ECC in 3-5-year-olds and IPV were available for six low-income-countries, 10 lower-middle-income-countries and four upper-middle-income-countries. The most prevalent form of IPV was physical violence (10.09%). The Democratic Republic of Congo had the highest prevalence of physical violence (45.8%), sexual violence (25.4%), and ECC (80.0%). The strongest association was between the prevalence of ECC and emotional violence (ηp2=0.01), followed by physical violence (ηp2=0.005), and sexual violence (ηp2=0.003). For every 1% higher prevalence of emotional violence, there was 0.28% higher prevalence of ECC, and for every 1% higher percentage of physical violence, there was 0.21% higher prevalence of ECC. On the contrary, for every 1% higher prevalence of sexual violence, there was 0.35% lower prevalence of ECC prevalence. Conclusions: The association between IPV and the prevalence of ECC in 3-5-year-olds is minor, with the strongest direct association effect being with emotional violence; and there was an inverse association between sexual violence and the prevalence of ECC. These findings need to be studied further.

An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries

Background

Universal health care (UHC) may assist families whose children are most prone to early childhood caries (ECC) in accessing dental treatment and prevention. The purpose of this study was to determine the association between UHC, health expenditure and the global prevalence of ECC.

Methods

Health expenditure as percentage of gross domestic product, UHC service coverage index, and the percentage of 3–5-year-old children with ECC were compared among countries with various income levels using one-way analysis of variance (ANOVA). Three linear regression models were developed, and each was adjusted for the country income level with the prevalence of ECC in 3–5-year-old children being the dependent variable. In model 1, UHC service coverage index was the independent variable whereas in model 2, the independent variable was the health expenditure as percentage of GDP. Model 3 included both independent variables together. Regression coefficients (B), 95% confidence intervals (CIs), P values, and partial eta squared (ƞ²) as measure of effect size were calculated.

Results

Linear regression including both independent factors revealed that health expenditure as percentage of GDP (P < 0.0001) was significantly associated with the percentage of ECC in 3–5-year-old children while UHC service coverage index was not significantly associated with the prevalence of ECC (P = 0.05). Every 1% increase in GDP allocated to health expenditure was associated with a 3.7% lower percentage of children with ECC (B = − 3.71, 95% CI: − 5.51, − 1.91). UHC service coverage index was not associated with the percentage of children with ECC (B = 0.61, 95% CI: − 0.01, 1.23). The impact of health expenditure on the prevalence of ECC was stronger than that of UHC coverage on the prevalence of ECC (ƞ² = 0.18 vs. 0.05).

Conclusions

Higher expenditure on health care may be associated with lower prevalence of ECC and may be a more viable approach to reducing early childhood oral health disparities than UHC alone. The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01500-8.

Caries Preventive Effects of Theobromine Containing Toothpaste on Early Childhood Caries: Preliminary Results

Objective

Enamel remineralizing effects of theobromine have received much attention from the clinicians. The aim of this study was to investigate the caries preventive effect of theobromine containing toothpaste on children with early childhood caries (ECC).

Material and Methods

Salivary pH, buffering capacity and frequency of Streptococcus mutans (SM) levels were measured. Each child was assigned either fluoridated or theobromine containing toothpaste. The changes were analyzed using Laser Fluorescence system. Statistical analyses were performed.

Results

We included 13 children (mean age 4.25) with 145 teeth in the fluoridated toothpaste (Colgate Kids toothpaste) group; 13 children (mean age 4.46) with 115 teeth in theobromine containing toothpaste (Theodent^TMKids toothpaste) group. Both toothpastes demonstrated enamel remineralization and were effective in increasing the buffering capacity and pH (p < 0.05). A statistically significant decrease in S. mutans levels was found in both toothpaste groups (p<0.05).

Conclusion

Both toothpaste group showed a statistically significant amount of enamel remineralization. Since theobromine had the added benefits of increasing the salivary pH and decreasing the S.mutans levels, theobromine containing toothpastes can be considered effective agents in remineralizing white spot lesions and can be used in prevention of early enamel lesions.

Microbial population shift and metabolic characterization of silver diamine fluoride treatment failure on dental caries

The objective of this pilot study was to describe the microbial profiles present in the plaque and saliva of children who continued to develop new carious lesions following treatment with silver diamine fluoride ("nonresponders") compared to caries active, caries-free, and children immediately receiving SDF treatment for untreated caries in order to identify potential microbial differences that may relate to a re-incidence of caries. Saliva and plaque samples from infected and contralateral sites were obtained from twenty children who were either caries free, had active carious lesions, were caries active and received SDF treatment immediately before sampling, or had previously received SDF treatment and developed new caries. In total, 8,057,899 Illumina-generated sequence reads from 60 samples were obtained. Reads were processed using the Quantitative Insights Into Microbial Ecology pipeline. Group differences were assessed using Analysis of Variance Models and Tukey Honest Significant Differences. To identify significant taxa between treatment groups, Linear discriminant analysis Effect Size (LefSe) and Analysis of Differential Abundance Taking Sample Variation Into Account were used. Differential abundant analysis indicated that members of the Lachnospiraceae family were significantly enriched in non-responders and the genus Tannerella and species Granulicatella adiances were also highly abundant in this group. LefSe analysis between non-responders and SDF-treated groups revealed that genera Leptotrichia and Granulicatella were enriched in non-responders. We observed the highest abundance of phosphotransferase system and lowest abundance of lipopolysaccharide synthesis in non-responders. The microbiome in dental biofilms is responsible for initiation and progression of dental caries. SDF has been shown to be effective in arresting the progression carious lesions, in part due to its antimicrobial properties. Findings suggest that the differential abundance of select microbiota and specific pathway functioning in individuals that present with recurrent decay after SDF treatment may contribute to a potential failure of silver diamine fluoride to arrest dental caries. However, the short duration of sample collection following SDF application and the small sample size emphasize the need for further data and additional analysis.

The Burden of Early Childhood Caries in Children under 5 Years Old in the European Union and Associated Risk Factors: An Ecological Study

The associations among early childhood caries (ECC), socioeconomic status, and sugar consumption are of the utmost importance, due to their potential policy implications. The purpose of this study was to identify trends in ECC burden in children under 5 years old among European Union (EU) member states over time and to evaluate the relationship with its risk factors. Global Burden of Disease 2019 data were analyzed to estimate the burden of ECC over time, specifically incidence, prevalence, and years lived with disability (YLDs) for children under 5 years old. Four ecological variables with a potential effect on YLDs for ECC were used to investigate the association between 2014 and 2017. The YLDs rate was consistently higher among Eastern EU countries over time. Univariate models showed a positive significant association between at-risk-of-poverty rate and YLDs rate, while GDP per capita and urbanization were inversely associated with YLDs rate. In the multivariate analysis, sugar consumption, GDP per capita and urbanization showed significant association with YLDs rate. After stratification by region, association remained significant only in the Eastern EU countries between GDP, urbanization, and YLDs rate, while sugar consumption and at-risk-of-poverty rate had no significant impact on YLDs rates. This study found increasing ECC burden in the EU. The complexity of the problem indicates the need for innovative and personalized policy approaches to tackle the disease.