Early childhood caries: analysis of psychosocial and biological factors in a high-risk population

Maternal depression in first 1000 days of life and early childhood caries prevalence at 48 months of age

OBJECTIVES

The aim of this study was to investigate the effect of maternal's depression trajectory in the first 1000 days of the child's life on the prevalence of early childhood dental caries (ECC), in a birth cohort.

MATERIALS AND METHODS

All infants born in Pelotas in 2015 were identified, and the mothers were invited to participate in the cohort. A total of 3645 children were included in the study. The outcome was ECC at 48 months of age assessed according to ICDAS. Maternal depression was collected using Edinburgh Postnatal Depression Scale (EPDS) antenatally, at 3, 12, and 24 months of age. Maternal depressive symptom trajectory variables were created using group-based trajectory models and adopting two cutoff points. Poisson regression model with robust variance was used to identify the total effect of maternal depressive symptom trajectories on ECC, adjusting by confounders.

RESULTS

A total of 29.2% of the mothers presented a high trajectory for screening of depression, and 18.8% presented a high trajectory of depression diagnosis. The prevalence of ECC was 26.7%. After adjusted analysis, maternal depression trajectories (screening and diagnosis) from pregnancy to 24 months increased the risk for ECC at 48 months of age (RR = 1.14; 95% CI 1.02-1.28 and RR = 1.19; 95% CI 1.05-1.35).

CONCLUSIONS

Children from mothers with high depression trajectory had higher risk of having dental caries at 48 months compared to children from mothers with low depression trajectory.

CLINICAL RELEVANCE

Strategies of early detection and treatment of maternal mental disorders during the Golden Period should be considered of high priority in health services since it could impact positively in children's life.

Association between Parental Stress and Early Childhood Caries Experience among Preschool Children in Maduravoyal, Chennai: A Cross-sectional Study

Background

In recent decades stress has emerged as a variable of significant interest in the examination of oral health.

Objective

To study the association between parental stress and early childhood caries experience among 3-5 years old children.

Methods

A cross-sectional study was conducted among 342 randomly selected mother-child dyads in Maduravoyal, Chennai. The mothers were stratified into four stress categories based on their parental stress scores from the Parental Stress Scale (Berry and Jones, 1995). The children were classified into three subgroups, no caries [dmft = 0], low caries [dmft = 1-2], and high caries [dmft≥3]. Chi-square test with Yates’ continuity correction and Spearman's rank correlation were used as statistical test methods.

Results

Among the mothers with no stress, 44.9% had children in the no caries group, compared to 21.6% in the low caries and 7.3% in the high caries group [p < 0.001]. And among the mothers with mild to moderate stress, 6.3% had children in the no caries group, compared to 5.4% in the low caries and 30% in the high caries group [p < 0.001]. A positive correlation between parental stress and early childhood caries experience was observed [rho = 0.461, p < 0.001].

Conclusion

A significant moderate positive correlation between parental stress and early childhood caries experience was observed. Stressful parents can be a probable risk factor for early childhood caries. Hence, providing prenatal counseling will be of added value to all expecting mothers.

How to cite this article

Mahapatra S, Chaly PE, Junaid M, et al. Association between Parental Stress and Early Childhood Caries Experience among Preschool Children in Maduravoyal, Chennai: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(S-2):S131-S134.

Impact of Intelligence Quotient (IQ) on Dental Caries amongst Socially Handicapped Orphan Children and Children Living with Their Parents

Objective

To evaluate the IQ and dental caries status of socially deprived orphan children and compare with children living with their parents.

Study design

For comparison, 100 children in age-group 7-11 years, were divided in two groups: 50 orphanage children (orphanage-group) and 50 school-going children living with their families were included (home group). Raven's colored progressive matrices test was used to record the intelligence quotient (IQ) and dental caries status of children was recorded using dmft Index.

Results

There was statistically significant difference between children with different levels of IQ for both the groups. However, the majority of children who belong to below average IQ score had higher dental caries.

Conclusion

Children with better IQ had less dental caries. There was no difference in IQ and DMFT/dmft score between both the genders. The overall DMFT/dmft was high in children living with their parents when compared to orphanage children.

How to cite this article

Agarwalla S. The Impact of Intelligence Quotient (IQ) on Dental Caries amongst Socially Handicapped Orphan Children and Children Living with Their Parents. Int J Clin Pediatr Dent 2022;15(S-2):S230-S233.

Early childhood caries: Are maternal psychosocial factors, decision-making ability, and caries status risk indicators for children in a sub-urban Nigerian population?

OBJECTIVE

Early childhood caries (ECC) is caries in children below the age of 72 months. The aim of the study was to determine the association of maternal psychosocial factors (general anxiety, dental anxiety, sense of coherence, parenting stress, fatalism, social support, depressive symptoms, and executive dysfunction), decision-making abilities, education, income and caries status with the prevalence and severity of ECC among children resident in Ile-Ife, Nigeria.

METHODS

A dataset of 1549 mother-child (6-71-months-old) dyads collected through examinations and a household survey, using validated psychometric tools to measure the psychosocial factors, were analyzed. The DMFT for the mothers and the dmft for the child were determined. The association between maternal psychosocial factors, education, income, and decision-making ability, the prevalence of maternal caries, and the prevalence of ECC was determined using logistic regression analysis.

RESULTS

The prevalence of maternal caries was 3.3%, and the mean (standard deviation-SD) DMFT was 0.10 (0.76). The ECC prevalence was 4.3%, and the mean (SD) dmft was 0.13 (0.92). There was no significant difference between the prevalence and severity of maternal caries and ECC by maternal age, education, income, or decision-making abilities. There was also no significant difference in maternal caries, ECC prevalence and ECC severity by maternal psychosocial factors. The only significant association was between the prevalence of caries in the mother and children: children whose mothers had caries were over six times more likely to have ECC than were children with mothers who had no caries (AOR: 6.67; 95% CI 3.23-13.79; p < 0.001).

CONCLUSION

The significant association between ECC and maternal caries prevalence suggests that prenatal oral health care for mothers may reduce the risk for ECC.

The association between the salivary cortisol level of mothers, children's temperament, and early childhood caries

BACKGROUND

Multiple factors can affect early childhood caries (ECC). Maternal stress and child's temperament, as predictors of child behavior, are among factors that may be associated with ECC.

OBJECTIVES

The aim of this study was to evaluate the association between the salivary cortisol level of mothers as an indicator of maternal stress, child's temperament, and ECC.

METHODS

Ninety preschool children, who were divided into three groups of ECC, severe ECC (S-ECC), and caries-free (CF), were included in this study, as well as their mothers with no history of anxiety disorders. The salivary cortisol levels of mothers were analyzed using ELISA assay. Children were examined for the evidence of caries, using the decayed-missing-filled teeth index, based on the World Health Organization standard criteria. Child temperament was also assessed, using Cloninger's Preschool Temperament and Character Inventory, consisting of seven significant factors (cooperativeness, harm avoidance, novelty seeking, reward dependence, persistence, self-directing, and self-transcendence).

RESULTS

The association between the salivary cortisol level of mothers and temperament of children with S-ECC was positive although it was not statistically significant (P > 0.05). Of seven temperament factors, only harm avoidance was significantly different between the CF and S-ECC groups (P = 0.016).

CONCLUSION

Maternal stress and child's temperament were not associated with ECC. Based on the present findings, children with less harm avoidance may be more prone to S-ECC.

Parental stress as a predictor of early childhood caries: a systematic review

AIM

The aim of this study was to systematically review the literature to answer the question: Are parental stress associated with early childhood caries (ECC)?

METHODS

Electronic databases including MEDLINE (via Pubmed), Scopus and SciELO were searched. Cross-sectional and case-control studies that investigate the association between parental stress and ECC were included. The Newcastle-Ottawa scale was used to assess the risk of bias of the included articles.

RESULTS

Out of 498 articles identified in initial research, 7 articles met the inclusion criteria; five were cross-sectional and two were control-case in design. A statistically significant correlation between ECC and total parental stress as well as a higher level of carious activity associated with total parental stress was reported in four studies. In two studies, no significant relationship between stress and ECC was found (P > 0.05) and in one study, parental stress was inversely associated with children's ECC status with better dental outcomes significantly associated with a higher level of parenting stress.

CONCLUSION

Despite the fact that the heterogenicity of the following data precluded conclusions to be drawn, it was obvious that parenting stress or some of its domains may influence the development of carious lesions in young children.

Midazolam and its effect on vital signs and behavior in children under conscious sedation in dentistry

Midazolam is a short acting sedative with small number of adverse effects. Administered orally, it is currently the most common form of conscious sedation in children. The objective of this paper is to describe effect of midazolam administered to children during dental treatment on their vital signs, and to monitor changes in children's behavior. We described values of vital signs and behavior in 418 sedations conducted in 272 children between 1-12 years of age. To achieve the following results, we used data from 272 all first-time sedations. After administration of midazolam arterial blood pressure and blood oxygen saturation decreased by values which were not clinically significant. The heart rate increased, with values staying within the limits of physiological range. The speed of onset of midazolam's clinical effects depends on age and dose. The lower age and dose correlated with the higher behavior score. The effectiveness of midazolam treatment is 97.8 %. Unwillingness of child to receive midazolam is predictor for disruptive behavior during sedation. 1.8 % of all sedation cases showed paradoxical reactions. The administration of midazolam in dose of 0.5 mg per 1 kg of child's body weight is safe and could be recommended for dental treatment in pediatric dentistry.

Maternal Mental Disorders before Delivery and the Risk of Dental Caries in Children

Prevention of childhood caries is an ongoing public health challenge, but the possibility of an association with maternal mental disorders has received limited attention. We estimated the extent to which maternal mental disorders are associated with an increased risk of hospitalization due to dental caries. We conducted a longitudinal cohort study of 790,758 infants born in Quebec, Canada between 2006 and 2016, with follow-up extending to 2018. We identified women with mental disorders before or during pregnancy and computed the incidence of dental caries in their children. We estimated HR and 95% CI for the association of maternal mental disorders with the risk of dental caries, adjusted for personal characteristics. Infants of women with mental disorders before or during pregnancy had a higher incidence of dental caries compared to children of women with no mental disorder (56.1 vs. 27.2 per 10,000 person-years). Maternal stress and anxiety disorders (HR = 1.73; 95% CI 1.60-1.86), depression (HR = 1.81; 95% CI 1.60-2.03), schizophrenia and delusional disorders (HR = 1.69; 95% CI 1.29-2.22), and personality disorders (HR = 1.89; 95% CI 1.70-2.11) were associated with the risk of dental caries. The associations were present throughout childhood, including after 7 years (HR = 1.65; 95% CI 1.38-1.96). Maternal mental disorders were associated with caries of the enamel, dentin, and cementum and caries that reached the dental pulp. Maternal mental disorders before or during pregnancy, especially stress and anxiety, depression, schizophrenia, and personality disorders, are associated with the risk of childhood caries. Women with a history of mental disorders may benefit from enhanced strategies for prevention of dental caries in their children.

[Social inequalities in oral health and early childhood caries: How can they be effectively prevented? A scoping review of disease predictors]

BACKGROUND

Early childhood caries represent a major public health problem. In addition to their individual impact, the massive social inequalities in oral health that are at the roots and result from the disease have largely underestimated consequences for the child, his family and the community. In response to the question of "how and where to act?", this scoping review identifies the individual characteristics associated with the disease on which it would be possible to act, using appropriate prevention strategies.

METHODS

This scoping review is aimed at describing and analyzing available data in the literature on the different factors associated with early childhood caries.

RESULTS

The predictors of early childhood caries are represented by mediating (knowledge, attitudes and parents' oral health practices) and moderating (psychosocial parameters, parental health literacy and alcohol consumption) factors. Twenty-eight articles fulfilled the selection criteria, twenty of which studied mediators related to early childhood caries, and fourteen of which dealt with moderators. The lower the parents' level of knowledge and literacy in oral health, the higher a child's dmft index. Additional studies are needed to assess the role of psychosocial parameters.

CONCLUSION

Parents' knowledge and oral health literacy are the key predictors to be preferentially targeted in view of reducing social inequalities in health through actions undertaken on a local scale. The prevention of early childhood caries necessitates a combination of generic and targeted interventions.

The association between postpartum depression and early childhood caries

Objective: To determine whether postnatal depression was associated with early childhood caries (ECC).Methods: This cross-sectional study was nested in a large cohort study named Born in Guangzhou Cohort Study (BIGCS). Mothers were invited to answer the Chinese version of Edinburgh Postpartum Depression Scale (EPDS) at 11-14 months postpartum. Children's ECC experience was assessed at 24-37 months old. Socio-demographic factors were collected by a self-completed questionnaire. Chi-square test was used for bivariate analysis, and binary logistic regression was used for multivariable analysis.Results: Totally 337 mother/children pairs were included into this study. Among them, 33 children had caries experience, accounting for 9.8% of the participants. Mothers with EPDS scores between 7 and 10 were associated with worse ECC experience of their children (adjusted OR = 2.948, 95% CI = 1.209-7.190), whereas mothers with EPDS scores higher than 10 were not associated with ECC experience of their children. Mother's education and the number of children living together were also associated with children's ECC experience (adjusted OR = 1.822, 95% CI = 1.013-3.275, and adjusted OR = 1.528, 95% CI = 1.086-2.150, respectively). Other factors such as maternal age at the time of conception, family income, mother's work status, duration of breastfeeding, and children's gender did not show effect on children's ECC experience.Conclusion: Postnatal depression could be associated with children's ECC experience. In this study, mothers with slightly depression symptoms were more likely to have adverse effects on their children's ECC experience.

Are maternal mental disorders associated with children's oral health? A systematic review

Maternal mental problems may lead to a negative effect on children's oral health (COH). The aim of this study was to systematically review the literature to answer the question: Are maternal mental disorders (MMD) associated with COH from zero to 12 years old? Electronic searches were performed in five databases with no language restriction. Cohort, case-control, and cross-sectional studies were included. A total of 1183 references were identified, and seven studies were included. In relation to MMD studies investigated: Common Mental Disorders (n = 2), Major Depressive Disorder (MDD) (n = 2), symptoms of depression (SD) (n = 3), Alcohol-related diagnosis (n = 1), and symptoms of anxiety (n = 2). As outcome, the studies investigated dental caries (n = 5), gingivitis and periodontal diseases (n = 1), sleep bruxism (SB) (n = 1), and malocclusion (n = 1). Positive association was found between MDD and OH (SB and dental caries). There was no MMD associated with malocclusion. Alcohol-related diagnosis showed a positive association with gingivitis and periodontal diseases and no association with dental caries; anxiety had a positive association with dental caries and no association with SB. The heterogeneity of the data precluded precise conclusions to be drawn, but MMD may have influence on COH.

[Prevalence of dental caries and associated factors among 10-12-year-old students in Chongqing]

OBJECTIVE

To investigate the caries status of the first permanent molars in urban and rural children aged 10-
12 in Chongqing and analyze the related factors in order to provide a theoretical basis for the prevention and treatment of children's caries and targeted suggestions for oral health education.

METHODS

A multi-stage, stratified, cluster, and random sampling method was used to extract 5 057 children from 18 schools in three districts and three counties in Chongqing for oral health examination and questionnaire survey from March to May 2018.

RESULTS

The total caries rate of the first permanent molar was 39.2%. The decayed-missing-filled tooth was 0.84±1.20. The rate of filling teeth was 3.4%. The rate of pit and fissure sealing was 6.1%. The prevalence of the first permanent molars was significantly different between men and women, between urban and rural areas, between only children and non-only children, and between ethnic minorities and Han nationality (P<0.001). The gap between the pit and fissure sealing was significantly different between urban and rural areas (P<
0.001). Multiple logistic regression analysis showed that many independent factors influence the occurrence of caries, including the frequency of brushing teeth every day, the frequency of eating desserts, the habit of eating dessert/drinking milk before going to bed, whether only-children or not, and parents' education background, among others.

CONCLUSIONS

The first permanent molars of children aged 10-12 in Chongqing have a high rate of caries but low rates of pit and fissure sealing and dental caries filling. The difference between urban and rural areas is large, children's oral health knowledge is scarce, and children have bad oral hygiene behaviors and eating habits. Children's oral health education must be strengthened, oral health preaching must be implemented in schools, the oral health knowledge of children in school must be improved, and urban-rural differences must be minimized.

A qualitative study of the multi-level influences on oral hygiene practices for young children in an Early Head Start program

BACKGROUND

Individual child-level risk factors for Early Childhood Caries (ECC) have been studied, but broader family- and community-level influences on child oral hygiene behaviors are less well understood. This study explored multiple levels of influence on oral hygiene behaviors for young children in Early Head Start (EHS) to inform a future behavioral intervention targeting children from low-income families.

METHODS

Twenty-four semi-structured interviews were conducted with mothers of children under 4 years old, enrolled in the home visitor (HV) component of one EHS program in Los Angeles, CA, who participated in the BEhavioral EConomics for Oral health iNnovation pilot study (BEECON) in 2016-7. Audio-recordings of interviews were translated if needed, and transcribed in English, and coding and analysis was facilitated by Dedoose qualitative software. This investigation used general thematic analysis guided by the Fisher-Owens child oral health conceptual framework to identify influences on oral hygiene behaviors for the young children.

RESULTS

Many mothers reported brushing their children's teeth twice/day, and concern that most children frequently resisted brushing. They identified children being sick or tired/asleep after outings as times when brushing was skipped. Several child-, family-, and community-level themes were identified as influences on child oral hygiene behaviors. At the child-level, the child's developmental stage and desire for independence was perceived as a negative influence. Family-level influences included the mother's own oral hygiene behaviors, other family role models, the mother's knowledge and attitudes about child oral health, and mothers' coping skills and strategies for overcoming challenges with brushing her child's teeth. Overall, mothers in the EHS-HV program were highly knowledgeable about ECC risk factors, including the roles of bacteria and sugar consumption, which motivated regular hygiene behavior. At the community-level, mothers discussed opportunities to connect with other EHS-HV families during parent meetings and playgroups that HV coordinated. A few mothers noted that EHS-HV playgroups included brushing children's teeth after snacking, which can be a potential positive influence on children's hygiene practices.

CONCLUSION

Child-, family- and community-level factors are important to consider to inform the development of tailored oral health preventive care programs for families in EHS-HV programs.

Prenatal Oral Health Care and Early Childhood Caries Prevention: A Systematic Review and Meta-Analysis

Despite the advancement of early childhood caries (ECC) prediction and treatment, ECC remains a significant public health burden in need of more effective preventive strategies. Pregnancy is an ideal period to promote ECC prevention given the profound influence of maternal oral health and behaviors on children's oral health. However, studies have shown debatable results with respect to the effectiveness of ECC prevention by means of prenatal intervention. Therefore, this study systematically reviewed the scientific evidence relating to the association between prenatal oral health care, ECC incidence, and Streptococcus mutans carriage in children. Five studies (3 randomized control trials, 1 prospective cohort study, and 1 nested case-control study) were included for qualitative assessment. Tested prenatal oral health care included providing fluoride supplements, oral examinations/cleanings, oral health education, dental treatment referrals, and xylitol gum chewing. Four studies that assessed ECC incidence reduction were included in meta-analysis using an unconditional generalized linear mixed effects model with random study effects and age as a covariate. The estimated odds ratio and 95% confidence intervals suggested a protective effect of prenatal oral health care against ECC onset before 4 years of age: 0.12 (0.02, 0.77) at 1 year of age, 0.18 (0.05, 0.63) at 2 years of age, 0.25 (0.09, 0.64) at 3 years of age, and 0.35 (0.12, 1.00) at 4 years of age. Children's S. mutans carriage was also significantly reduced in the intervention group. Future studies should consider testing strategies that restore an expectant mother's oral health to a disease-free state during pregnancy.

Psychosocial factors and oral health practices of preschool-aged children: a qualitative study with Hispanic mothers

OBJECTIVE

This qualitative study sought to gain an in-depth understanding of Hispanic mother's parenting experiences and perceptions about select psychosocial factors. How psychosocial factors influence mothers' engagement in recommended oral health-related behaviors for their preschool-aged children (3-5 years) was explored. Psychosocial resources and barriers explored included maternal knowledge about children's oral health, beliefs such as perceived self-efficacy and health locus of control, and parenting experience and stress.

DESIGN

Six focus groups and one individual interview with lower-income, Hispanic mothers of preschoolers (n = 36 total participants) were conducted in Spanish at a community health clinic on the California-Mexico border during summer 2010. A bilingual dentist led all sessions using a set of open-ended guiding questions. All sessions were audio-taped, translated and transcribed in English. Transcripts were coded and analyzed for common themes.

RESULT(S)

Six themes were identified around dental knowledge, the mothers' primary role in performing the child's oral hygiene among multiple caregiving priorities, parenting challenges, perceived self-efficacy, perceived future outlook for their child's oral health, and family influences. Mothers recognized the importance of caring for primary teeth. However, few were knowledgeable about preventive practices to promote young children's oral health, such as the recommended ages for brushing or first dental visit. Mothers that were more knowledgeable expressed feeling more efficacious about maintaining their child's oral hygiene. All mothers believed they were primarily responsible for their child's oral health, and most held positive future expectations for their child's oral health.

CONCLUSION

These findings provide insight into how Hispanic mothers of young children perceive their role as caregiver. Maternal knowledge and perceptions affect their ability to care for their child's oral health and should be accounted for in future interventions.

The role of parental anxiety, depression, and psychological stress level on the development of early-childhood caries in children

BACKGROUND

It is important to understand how the psychological status of parents affects oral health in children.

AIM

This study aimed to assess the level of depression, anxiety, and stress of parents whose children have early-childhood caries.

DESIGN

The study included 235 children and their parents who visited the Dental clinic at the School of Medicine of the University of Split between October 2016 and July 2017. The dental status of each child was recorded, while parents filled out the Depression Anxiety Stress Scale questionnaire and the questionnaire related to the demographic characteristics, questions related to child's habits of the tooth brushing, eating sweets.

RESULTS

Multiple regression analysis showed that the incidence of active caries in the children was statistically significantly related not only to the level of parent depression (β = -0.289; P = 0.040) but also the level of anxiety (β = 0.186; P = 0.038) and stress (β = -0.120; P = 0.036). The dmft index in the examined children was negatively significant associated with the parental level of depression (β = -0.305; P = 0.032).

CONCLUSION

Considering the results of our research it is essential to emphasize the need for better health education of parents.

Maternal Depression Increases Childhood Dental Caries: A Cohort Study in Brazil

Aim: To investigate the relationship between maternal depression and childhood caries in a cohort of adolescent mothers. Methods: This cross-sectional study nested in a cohort evaluated a sample of 538 mother/child dyads. When the children were 24-36 months of age, data regarding oral health from children and mothers were collected by clinical dental examination. A mother's major depressive disorder was assessed by using the Mini International Neuropsychiatric Interview (MINI [Plus]), at the current moment. Independent variables were obtained by using questionnaires. The outcome on dental caries experience was dichotomized by using 2 cut points: dmfs ≥1 and dmfs ≥3. Poisson regression analysis, using a hierarchical approach, was applied to assess the association between major depressive disorder in mothers with and those without caries experience and the outcome. Results: The prevalence of dental caries in children was 15.1% (n = 82). The mean dmfs index was 1.12 (SD = 3.72). The prevalence of major depressive disorder was 32.6% (n = 168). An interaction between caries status and depressive disorder was found, and after adjusted analysis, children from mothers with major depressive disorder with negative caries experience presented a higher caries prevalence (prevalence ratio 4.00, 95% confidence interval 1.29-12.41). Conclusion: Our findings suggest that maternal psychiatric disorders could have a negative impact on children's oral health.

Risk factors of early childhood caries among children in Beijing: a case-control study

Background

The prevalence of early childhood caries (ECC) among children in Beijing, China, has been increasing continuously though slowly. However, there is limited information about ECC in Beijing. The aim of this study was to identify risk factors of dental caries among preschool children in Beijing.

Methods

For this case-control study, using a convenience sampling method, 787 children aged 3 and 4 years old were recruited; 386 children with caries constituted the early childhood caries (ECC) group and 401children without caries formed the caries-free (CF) group. Dental caries was diagnosed at the tooth surface level by two calibrated examiners according to the WHO 1997 criteria. A structured questionnaire was filled in by the children’s main guardians. Mutans streptococci in non stimulated saliva and plaque were measured with the Dentocult SM Strip. Negative binomial regression was used for multivariate analysis.

Results

Analysis of the data showed that level of mutans streptococci in dental plaque and history of dental visit were significantly correlated with the prevalence of caries and the mean dmfs score.

Conclusions

High level of plaque mutans streptococci is a risk factor for ECC in preschool children in Beijing. And longitudinal studies are needed to identify the causal relationships between the levels of mutans streptococci in dental plaque and caries development.

Stress Physiology in Infancy and Early Childhood: Cortisol Flexibility, Attunement and Coordination

Research on stress physiology in infancy has assumed increasing importance due to its lifelong implications. In this review, we focus on measurement of hypothalamic-pituitary-adrenal (HPA) function, in particular, and on complementary autonomic processes. We suggest that the measure of HPA function has been overly exclusive, focusing on individual reactivity to single, pragmatically selected laboratory challenges. We advocate use of multiple, strategically chosen challenges and within-subject designs. By administering one challenge that typically does not provoke reactivity and another that does, it is possible to represent allostatic load in terms of "flexibility," the capacity to titrate response to challenge. We also recommend assessing infant reactivity in the context of the primary caregiver's physiological function. Infant-mother "attunement" is central to developmental psychology, permeating diverse developmental domains with varied consequences. A review of adrenocortical attunement suggests that attunement is a reliable process, manifest across varied populations. However, attunement appears stronger in the context of more highly stressful circumstances, such that administration of multiple, selected challenges may help evaluate the degree to which individuals titrate attunement to challenge and determine the correlates of this differential attunement. Finally, we advocate studying the "coordination" of HPA function with other aspects of stress physiology and variation in the degree of this coordination. The use of multiple stressors is important here because each stress system is differentially sensitive to different types of challenge. Therefore, use of single stressors in between-subject designs impedes full recognition of the role played by each system. Overall, we recommend measure of flexibility, attunement, and coordination in the context of multiple challenges to capture allostasis in environmental and physiological context. The simultaneous use of such inclusive and integrative metrics may yield more reliable findings than has hitherto been the case. The interrelation of these metrics can be understood in the context of the adaptive calibration model..

An exploration of the views of Australian mothers on promoting child oral health

BACKGROUND

An important role for parents and caregivers in the prevention of dental caries in children is the early establishment of health promoting behaviours. This study aimed to examine mothers' views on barriers and facilitators to promoting child and family oral health.

METHODS

Semi-structured interviews were undertaken with a purposive sample of mothers (n = 32) of young children. Inductive thematic analysis was conducted.

RESULTS

Parental knowledge and beliefs, past experiences and child behaviour emerged as major influences on children's oral health. Child temperament and parental time pressures were identified as barriers to good oral health with various strategies reported for dealing with uncooperative children at toothbrushing time. Parental oral health knowledge and beliefs emerged as positive influences on child oral health; however, while most mothers were aware of the common causes of dental caries, very few knew of other risk factors such as bedtime feeding. Parents' own oral health experiences were also seen to positively influence child oral health, regardless of whether these were positive or negative experiences.

CONCLUSIONS

Understanding parental oral health beliefs is essential to overcoming barriers and promoting enablers for good child oral health. Improving child oral health also requires consideration of child behaviour, family influences, and increasing awareness of lesser-known influencing factors.

Effectiveness of fluoride sealant in the prevention of carious lesions around orthodontic brackets: an OCT evaluation

Objective:

This article aimed to evaluate in vitro the efficiency of Pro Seal fluoride sealant application in the prevention of white spot lesions around orthodontic brackets.

Material and Methods:

Brackets were bonded to the buccal surface of bovine incisors, and five groups were formed (n = 15) according to the exposure of teeth to oral hygiene substances and the application of enamel sealant: G1 (control), only brushing was performed with 1.450 ppm fluoride; G2 (control) brushing associated with the use of mouthwash with 225 ppm fluoride; G3, only Pro Seal sealant application was performed with 1.000 ppm fluoride; G4 Pro Seal associated with brushing; G5 Pro Seal associated with brushing and mouthwash. Experimental groups alternated between pH cycling and the procedures described. All specimens were kept at a temperature of 37 °C throughout the entire experiment. Both brushing and immersion in solutions were performed within a time interval of one minute, followed by washing in deionized water three times a day for 28 days. Afterwards, an evaluation by Optical Coherence Tomography (OCT) of the spectral type was performed. In each group, a scanning exam of the white spot lesion area (around the sites where brackets were bonded) and depth measurement of carious lesions were performed. Analysis of variance (ANOVA) was applied to determine whether there were significant differences among groups. For post hoc analysis, Tukey test was used.

Results:

There was statistically significant difference between groups 1 and 2 (p = 0.003), 1 and 3 (p = 0.008), 1 and 4 (p = 0.000) and 1 and 5 (p = 0.000). The group in which only brushing was performed (Group 1) showed deeper enamel lesion.

Conclusion:

Pro Seal sealant alone or combined with brushing and/or brushing and the use of a mouthwash with fluoride was more effective in protecting enamel, in comparison to brushing alone.

Maternal Allostatic Load, Caretaking Behaviors, and Child Dental Caries Experience: A Cross-Sectional Evaluation of Linked Mother-Child Data From the Third National Health and Nutrition Examination Survey

OBJECTIVES

We evaluated the associations between chronic maternal stress measured by allostatic load (AL), maternal caretaking behaviors, and child dental caries experience. We also assessed the role of socioeconomic status in these associations.

METHODS

We used data from the Third National Health and Nutrition Examination Survey (1988-1994). We included children aged 2 to 6 years who linked to a maternal record (n = 716 maternal-child pairs). The main exposure was maternal AL index (0, 1, or ≥ 2). The primary outcome of interest was child dental caries experience (none or any). We evaluated the association between maternal AL and (1) maternal caretaking behaviors, and (2) child caries status and the role of socioeconomic status in these relationships.

RESULTS

Children of mothers with an AL index of at least 2 were significantly more likely to have not been breastfed and to have dental caries than were children of mothers with a normal AL before adjusting for measures of socioeconomic status.

CONCLUSIONS

Maternal chronic stress, indicated by elevation in markers of AL, has an important role in child caretaking behaviors and in children's oral health.

Challenges Faced in Engaging American Indian Mothers in an Early Childhood Caries Preventive Trial

Objective. This study explores the challenges faced by the research implementation team in engaging new mothers in a community oral health prevention intervention in an American Indian (AI) reservation community. Methods. Qualitative methods in the form of in-depth interviews were used in the study. Qualitative data were collected from research staff workers at a field site, who were involved in the implementation of a culturally tailored, randomized controlled trial of a behavioral intervention utilizing Motivational Interviewing (MI). Results. Several challenges were described by the field staff in engaging new mothers, including low priority placed on oral health, lack of knowledge, and distractions that reduced their ability to engage in learning about oral health of their child. Other difficulties faced in engaging the mothers and the AI community at large were distrust related to racial differences and physical and environmental barriers including poor road conditions, lack of transportation and communication, and remoteness of data collection sites. The field staff developed and applied many strategies, including conducting home visits, applying new communication strategies, and interacting with the community at various venues. Conclusion. Prevention interventions for ECC need to target AI mothers. Strategies developed by the field staff were successful for engaging mothers in the study.

The importance of family functioning, mental health and social and emotional well-being on child oral health

OBJECTIVE

To examine the strength of associations between child oral health and aspects of the home environment (child behaviour, parental psychological distress and family functioning) in a large sample of 1- to 12-year-old Australian children.

METHODS

The current study used data from the 2006 Victorian Child Health and Wellbeing Study. Data were obtained on 4590 primary carers. Measures of the family environment included the level of family functioning, parental psychological distress, child's emotion and behavioural problems and the family structure.

RESULTS

The odds of children having good oral health status were lower with increasing parental psychological distress and poor family functioning across all age groups, and lower with increasing child mental health or conduct problems among children aged 4 years or older. Socioeconomic factors were also related to child oral health status, but this was significant only among children aged 4-7 years, with the odds of children having good oral health status 68% higher in households with a yearly income ≥AUD$ 60 000 compared with households with income <$20 000 (P < 0.05).

CONCLUSION

In order to address inequities in the experience of poor oral health, solutions that encompass social, economic and psychosocial dimensions will be required. Integrating intervention strategies that promote oral, healthy family functioning and the mental health of parents and children into existing systems reaching vulnerable community members may improve child oral health outcomes and reduce the unequal distribution of oral disease across the social gradient.

Learning from caries-free children in a high-caries American Indian population

OBJECTIVE

We aimed to identify salutogenic patterns of parental knowledge, behaviors, attitudes, and beliefs that may support resistance to early childhood caries (ECC) among a high caries population of preschool American Indian (AI) children.

METHOD

Participants were 981 child-parent dyads living on a Southwestern reservation who completed baseline assessments for an ongoing randomized clinical trial. T-tests were used to assess differences between reported knowledge, behaviors, and beliefs of parents whose children were caries-free (10.7 percent) and those whose children had caries (89.3 percent). Chi-square analyses were used for categorical variables.

RESULTS

Although there were no socio-demographic differences, parents of caries-free children viewed oral health as more important and reported more oral health knowledge and adherence to caries-preventing behaviors for their children. Parents of caries-free children were more likely to have higher internal locus of control, to perceive their children as less susceptible to caries, and to perceive fewer barriers to prevention. These parents also had higher sense of coherence scores and reported lower levels of personal distress and community-related stress.

CONCLUSIONS

Effective interventions for ECC prevention in high-caries AI populations may benefit from approaches that support and model naturally salutogenic behaviors.

Factors Associated with Oral Health Status in American Indian Children

The literature reports psychosocial, environmental, and cultural factors related to Early Childhood Caries (ECC), but few studies have included American Indian/Alaska Native (AI/AN) populations. AI/AN children have the highest prevalence of ECC among any population group in the United States. This study examined socio-demographic characteristics of children and their parents/caregivers and psychosocial characteristics of parents/caregivers as risk factors for baseline oral health status of preschool children in the Navajo Nation, as part of a 3-year cluster randomized clinical trial to evaluate the effectiveness of trained community workers providing a fluoride varnish and oral health promotion intervention to. The study recruited 1,015 children at 52 Head Start Centers. Baseline ECC data were collected by calibrated dental hygienists for 981 of the children ages of 3-5 years, and a Basic Research Factors Questionnaire (BRFQ) was completed by their parents/caregivers. Bivariable analysis revealed that dmfs was higher in older children; in males; in children with male parents/caregivers; and when the parent/caregiver had less education and income, worse oral health behavior in caring for their children's teeth, and higher scores for external powerful others and external chance locus of control, greater perceived susceptibility and barriers, and lower scores for community risky behavior. In a multiple linear regression model, the variables that remained statistically significant were child's age and gender, and oral health behavior score of the parent/caregiver. Intervening to improve parent/caregiver oral health behavior in caring for the teeth of children potentially could in AI/AN children.

The role of family functioning in childhood dental caries

OBJECTIVES

This study investigated the relationship between family functioning and childhood dental caries. Further objectives were (i) to explore whether oral hygiene behaviours could account for a possible association between family functioning dimensions and childhood dental caries and (ii) to explore whether family functioning could mediate the relationship between sociodemographic factors and childhood dental caries.

METHODS

A random sample of 630 5- to 6-year-old children was recruited from six large paediatric dental centres in the Netherlands. Children's dmft scores were extracted from personal dental records. A parental questionnaire and the Gezinsvragenlijst (translation: Family Questionnaire) were used to collect data on sociodemographic characteristics, oral hygiene behaviours and family functioning. Family functioning was assessed on five dimensions: responsiveness, communication, organization, partner-relation and social network. Associations with dmft were analysed using multilevel modelling.

RESULTS

Bivariate analysis showed that children from normal functioning families on the dimensions responsiveness, communication, organization and social network had significantly lower dmft scores compared with children from dysfunctional families. Poorer family functioning on all dimensions was associated with an increased likelihood of engaging in less favourable oral hygiene behaviours. Children with lower educated mothers, immigrant children and children of higher birth order were more likely to come from poorer functioning families. In multivariate analysis, organization remained a significant predictor of dmft after adjusting for the other family functioning dimensions and the mother's education level, but it lost statistical significance after adjustment for oral hygiene behaviours.

CONCLUSION

A relationship between family functioning and childhood dental caries was found, which may have operated via oral hygiene behaviours. Family functioning modestly explained socioeconomic inequalities in child oral health. Organization appeared to be the most important dimension of family functioning that influenced children's caries experience.

The impact of dental treatment on the salivary cortisol levels of children with severe early childhood caries

AIM

To compare salivary cortisol levels of caries-free children with those of children with severe early childhood caries (S-ECC) before and 3 months after comprehensive dental treatment.

METHODS

Thirty children with S-ECC were matched with 30 caries-free children from middle income families with college-educated working mothers. Early-morning saliva samples were collected from the children using the passive drool method. Post-treatment saliva samples were collected 3 months after completion of treatment in the S-ECC group. Salivary cortisol levels were analysed using electrochemiluminescence immunoassay.

RESULTS

Salivary cortisol levels of caries-free children were significantly lower than both the pre-treatment and post-treatment levels of children with S-ECC (F = 26.221, p < 0.0001). The pre-treatment cortisol levels of children with S-ECC were significantly higher than the post-treatment levels (t = 2.588, p = 0.015). No significant differences in cortisol levels were observed between genders or between children treated over multiple visits under local analgesia and in a single visit under general anaesthesia.

CONCLUSION

Dental treatment significantly reduced the salivary cortisol levels of children with S-ECC, however, the post-treatment levels remained significantly higher than those of caries-free children.

A systematic review of risk factors during first year of life for early childhood caries

BACKGROUND

Early childhood caries (ECC) describes dental caries affecting children aged 0-71 months. Current research suggests ECC has important aetiological bases during the first year of life. Gaps in knowledge about disease progression prevent the effective and early identification of 'at risk' children.

AIM

To conduct a systematic review of research studies focusing on (a) acquisition and colonization of oral bacteria and ECC and (b) risk and/or protective factors in infants aged 0-12 months.

DESIGN

Ovid Medline and Embase databases (1996-2011) were searched for RCT, longitudinal, cross-sectional and qualitative studies. Two investigators undertook a quality assessment for risk of bias.

RESULTS

Inclusion criteria were met for (a) by four papers and for (b) by 13 papers; five papers were rated medium or high quality. Bacterial acquisition/colonization and modifying factor interrelationships were identified, but their role in the caries process was not clarified. Key risk indicators were infant feeding practices (nine papers), maternal circumstances and oral health (6) and infant-related oral health behaviours (4).

CONCLUSION

This review confirmed that factors occurring during the first year of life affect ECC experience. Despite heterogeneity, findings indicated maternal factors influence bacterial acquisition, whereas colonization was mediated by oral health behaviours and practices and feeding habits.

Salivary cortisol as a biomarker to explore the role of maternal stress in early childhood caries

Objective. To compare salivary cortisol levels of children with ECC and their mothers with those of caries free children from a similar sociodemographic cohort. Design. Sixty-four college-educated, working mothers from middle income families with no history of anxiety disorders and their first born children aged between 48 and 71 months were included in the study. Salivary cortisol levels were analyzed using electrochemiluminescence (ECL) immunoassay. Statistical Analyses. Significance of difference between the cortisol levels of children with ECC and control children and of their mothers was analyzed using the Student's t- test. The intraclass correlation coefficient was used to measure the significance of correlation of cortisol levels between the mother and the child with logistic regression to explore possible associations. Results. Mothers of children with ECC had significantly higher levels of salivary cortisol (P < 0.05) than mothers of caries free children. The salivary cortisol levels of children with ECC were significantly higher than caries free children (P < 0.0001). A significant correlation existed between the salivary cortisol level of the mother and that of the child (P < 0.0001). Conclusion. While salivary cortisol levels of the child seem to have a direct impact on the incidence of ECC, maternal stress seems to have an indirect effect.

Early childhood caries update: A review of causes, diagnoses, and treatments

Dental caries (decay) is an international public health challenge, especially amongst young children. Early childhood caries (ECC) is a serious public health problem in both developing and industrialized countries. ECC can begin early in life, progresses rapidly in those who are at high risk, and often goes untreated. Its consequences can affect the immediate and long-term quality of life of the child's family and can have significant social and economic consequences beyond the immediate family as well. ECC can be a particularly virulent form of caries, beginning soon after dental eruption, developing on smooth surfaces, progressing rapidly, and having a lasting detrimental impact on the dentition. Children experiencing caries as infants or toddlers have a much greater probability of subsequent caries in both the primary and permanent dentitions. The relationship between breastfeeding and ECC is likely to be complex and confounded by many biological variables, such as mutans streptococci, enamel hypoplasia, intake of sugars, as well as social variables, such as parental education and socioeconomic status, which may affect oral health. Unlike other infectious diseases, tooth decay is not self-limiting. Decayed teeth require professional treatment to remove infection and restore tooth function. In this review, we give detailed information about ECC, from its diagnosis to management.

Parental stress as a predictor of early childhood caries among preschool children in India

BACKGROUND.  The health and well-being of children are linked to their parents' physical, emotional and social health in addition to child-rearing practices. OBJECTIVES.  To investigate the association of parental stress as a risk indicator to early childhood caries (ECC) prevalence among preschool children of Moradabad, India. METHODS.  A case-control study was conducted among 800 preschool children [400 cases (caries active) and 400 controls (caries free)] aged 4-5 years along with their parents. Using the Parental Stress Index-Short Form (PSI/SF), we determined the stress of primary caregivers of young children. These children were clinically examined for dental caries using Dentition Status and Treatment needs. Student's t-test, Pearson's correlation and linear regression were used for statistical analysis. RESULTS.  An overall mean parenting stress index was found to be 193.48 ± 59.63. Significantly higher mean stress scores were obtained among cases than among controls. Parental stress was significantly correlated with dmft scores and it was found to be one of the best predictors of ECC. CONCLUSION.  This study provides data to suggest that parental stress has a pervasive impact on the children's oral health. The practitioners should be aware of this possible relationship and be prepared to provide appropriate intervention.

Early maternal psychosocial factors are predictors for adolescent caries

Few studies have investigated the role of early maternal enabling and psychosocial factors on subsequent adolescent caries experience. In this retrospective cohort study of 224 adolescents, we hypothesized that the causal pathway between early maternal enabling factors (education, cognitive abilities, psychological distress) and adolescent caries experience (DMFT) at age 14 yrs is mediated by maternal psychosocial factors (stress, coping, social support) and adolescent dental behavior/access. Maternal data on socio-demographic, medical, and psychosocial variables were measured when the child was 3, 8, and 14 yrs old. A structural equations model (SEM) evaluated the causal pathway, with latent variables for maternal enabling factors (MEF), stress, coping, and social support. Poor MEF was associated with increased stress and poorer coping when the child was 3 yrs old, which in turn affected adolescent dental visits and behavior. Greater social support at child's age 3 was directly associated with lower mean DMFT in adolescence. Maternal psychosocial factors measured when children are young are important mediators for adolescent mean DMFT, but these factors measured when children are adolescents are not. Better early and concurrent MEF, however, was associated directly/indirectly (through dental visits and insurance) with adolescent DMFT. Early maternal factors are important predictors for adolescent caries.

Family context and incidence of dental caries in preschool children living in areas covered by the Family Health Strategy in Salvador, Bahia State, Brazil

Psychosocial factors influence family care and can jeopardize child development. This study aimed to analyze the association between maternal common mental disorders and incidence of early dental caries in preschool-age children living in areas covered by the Family Health Strategy in Salvador, Bahia State, Brazil, in a cohort design. A total of 472 children were examined and their mothers were interviewed from 2007 to 2008. Incidence of at least one tooth with caries was 21.19%, while 7.84% of the children showed high risk of caries. The results after adjusting for the child's age and maternal schooling showed that maternal common mental disorders were associated with high caries risk in deciduous teeth (adjusted RR = 2.41, 95%CI: 1.05-5.56, among children with 6 or fewer home appliances in the household; adjusted RR = 3.44, 95%CI: 1.06-11.17, among those that brushed twice or less per day). Maternal mental problems were associated with the development of caries in preschoolers.

Environmental, maternal, and child factors which contribute to early childhood caries: a unifying conceptual model

OBJECTIVES

Although the general pathways connecting the external social environment and child risk factors of early childhood caries (ECC) have been previously identified, the maternal and other links to ECC are not well understood. The aim of this paper is to propose a unifying conceptual model that ties together the broad social environmental, maternal, and child factors that are commonly associated with ECC.

METHODS

The aetiological factors of ECC are first reviewed individually to demonstrate their connections with ECC risk followed by presentation of the unifying conceptual model.

RESULTS

In severe ECC cases, there is usually a background of social disadvantage associated with low socioeconomic status, ethnicity or immigrant status, and low maternal educational level. These factors are commonly associated with economic and familial stresses which may in turn result in maternal psychological distress. The distress may be compounded by difficult temperaments of the children and can lead to dysfunctional parenting behaviours that place a child at risk for ECC.

CONCLUSIONS

The proposed conceptual model provides a framework that connects the social, psychological, and behavioural mediating factors involved in ECC. It demonstrates that the causative pathways involved are best explored using a combination of quantitative and qualitative research.

The prevalence of Early Childhood Caries in 1-2 yrs olds in a semi-urban area of Sri Lanka

Background

ECC remains a problem in both developed and developing countries and ECC has been considered to be present in epidemic proportions in the developing countries. The aetiology and associated factors of ECC should be studied adequately to overcome this health hazard. The objective of this study is to determine the prevalence of ECC in 1 to 2 years old children in some selected MOH areas (semi-urban) in the district of Colombo, Sri Lanka.

Methods

This study was conducted as a cross sectional study. A total of 422 children aged 1-2 years were selected using systematic sampling technique in Maharagama, Piliyandala, Nugegoda and Boralesgamuwa MOH areas in Colombo district, Western province, Sri Lanka. The pre-test was done initially with 10 children aged 1 1/2 year olds.

Prior to the clinical examination of each child, a questionnaire consisting questions regarding tooth brushing, dietary habits, breast and bottle feeding, long term medications(Sweetened medications taken more than 3 months), attending a dental clinic during pregnancy of mother and socio-economical status of the family was administered to mothers of those children. Sterile dental mouth mirrors were used to detect ECC in children.

Results

The prevalence of ECC of the whole sample of 410 children aged 1-2 years was 32.19% and the mean dmft was 2.01 and the mean dmfs was 3.83. From the children who had ECC 95% were untreated. There were significant relationships between dmft and long term use of medications (p < 0.000), intake of sugar with milk (p = 0.013), sweet consumption (p = 0.013), employment of mothers (p < 0.000) and visiting a dental clinic during pregnancy (p < 0.000).

Conclusions

This study documents high prevalence and severity of ECC among 1-2 years old children in four selected MOH areas of Colombo district and caries in most of the children with ECC (95%) were untreated. Results reveal an urgent need to increase awareness among the public about ECC and institute preventive strategies.

Caregiver self-report of children's use of the sippy cup among children 1 to 4 years of age

PURPOSE

This research examined the prevalence of the use of the sippy cup, as compared to the baby bottle, among children 1 to 4 years of age.

METHOD

Using a population-based telephone surveillance survey in Ontario, caregivers of children 1 to 4 years of age were asked about their child's use of the sippy cup/baby bottle from the Rapid Risk Factor Surveillance System Module: Early Childhood Tooth Decay.

RESULTS

Most caregivers reported that children 1 to 4 years of age were currently using the sippy cup (69.7%), with the proportion increasing to 94.4% when including children with past use of the sippy cup. Younger children were significantly more likely to use the sippy cup, and 10.8% of children 4 years of age continued to use the baby bottle. Diluted fruit juice was the most frequently used liquid in the sippy cup (58.2%). Most of the caregivers did not report the use of the sippy cup at night.

CONCLUSION

Caregivers need education as to potential increases in exposure to sugared/acidic liquids through the use of the sippy cup. Future research is needed to understand the extensive and prolonged use of the sippy cup/baby bottle by young children.

Point-of-care salivary microbial tests for detection of cariogenic species--clinical relevance thereof--review

Dental caries is a highly prevalent multifactorial disease that can result in serious health impairment. It was shown that oral bacteria play a significant role in caries development. Point-of-care (POC) salivary microbial tests for detection of cariogenic species have been investigated as a potential tool for caries risk assessment. This review aims to evaluate clinical relevance of these tests in the light of recent scientific evidence. Methodology involved PubMed search using key words salivary microbial tests, cariogenic bacteria and caries risk prediction. Articles obtained by the search were cross-referenced to obtain further sources. Specificity and negative-predictive value of these tests are higher than their sensitivity and positive value. Predictive power of the POC salivary microbial tests as a single predictor is generally weak, although it increases when included in multifactorial models for caries prediction. Literature findings support the use of these tests for screening of at-risk individuals in a population of young preschool children without visible caries and for motivation of subjects on individual level. POC salivary microbial tests are simple and inexpensive and, therefore, may be advantageous from public health perspective.

In vitro evaluation of fluoride products in the development of carious lesions in deciduous teeth

The purpose of this study was to evaluate the effect of the application of fluoride products on the development of enamel caries in deciduous teeth. A total of 108 deciduous teeth were chosen for the study. Acid-resistant varnish was applied on the teeth, leaving only one area of 5 mm x 1 mm of dental enamel exposed. The teeth were allocated randomly to one of the following groups: 1) control - toothpaste without fluoride; 2) 1.23% fluoride gel; 3) Duraflur fluoride varnish; 4) Duraphat fluoride varnish; 5) Fluorniz fluoride varnish; 6) Fluorphat fluoride varnish; 7) varnish with Duofluorid; 8) 12% silver fluoride diamine (Cariestop); 9) children's fluoride toothpaste (500 ppm). The tested products were applied on the teeth according to the manufacturer's recommendations and the teeth were stored in a moist environment for 24 hours. Each group of teeth was then subjected to a pH cycling model for 14 days, after which the teeth were cut through the center for an analysis of the depth of the carious lesion by polarized light microscopy. Comparisons were made between the treatments and the control group. The mean lesion depth values were 318 microm +/- 39 (control), 213 microm +/- 27 (fluoride gel), 203 microm +/- 34 (Duraflur), 133 microm +/- 25 (Duraphat), 207 microm +/- 27 (Fluor-niz), 212 microm +/- 27 (Fluorphat), 210 +/- 28 (Duofluorid), 146 +/- 31 (Cariestop) and 228 +/- 24 (fluoride toothpaste). None of the products used here was able to completely prevent the formation of lesions. The highest cariostatic effect was achieved by fluoride varnish Duraphat and the lowest by the fluoride toothpaste.

Update on early childhood caries since the Surgeon General's Report

The 2000 Surgeon General's Report on Oral Health included a limited discussion of the condition known as early childhood caries. Because of its high prevalence, its impact on young children's quality of life and potential for increasing their risk of caries in the permanent dentition, early childhood caries is arguably one of the most serious and costly health conditions among young children. A necessary first step in preventing dental caries in preschool children is understanding and evaluating the child's caries risk factors. Previous caries experience and white spot lesions should automatically classify a preschool child as high risk for caries. Microbial factors, such as presence of visible plaque and tests that identify a child as having high levels of mutans streptococci, also predict caries in young children. Frequency of sugar consumption, enamel developmental defects, social factors such as socioeconomic status, psychosocial factors, and being an ethnic minority also have shown to be relevant in determining caries risk. On the basis of this knowledge of specific risk factors for an individual, different preventive strategies and different intensities of preventive therapies can be implemented. Caries preventive strategies in preschool children include fluoride therapy, such as supervised tooth brushing with a fluoridated dentifrice, systemic fluoride supplement to children who live in a nonfluoridated area and who are at risk for caries, and professional topical fluoride with fluoride varnish. There is emerging evidence that intensive patient counseling or motivational interviews with parents to change specific behaviors may reduce caries prevalence in their children. Findings regarding antimicrobial interventions, efforts to modify diets, and traditional dental health education are less consistent.