Prediction of dental caries development in 1-year-old children

Prevention of caries and obesity in children with immigrant background in Norway- a study protocol for a cluster randomized controlled trial

BACKGROUND

Immigrants are known to experience greater socioeconomic stress and poorer well-being and to suffer more from lifestyle- and diet-related disorders than native populations. There is also evidence that children of immigrant parents are at greater risk of diverse health problems than their host country cohorts. The aim of this study is to apply and evaluate the efficacy of an early life intervention program among parents/children with immigrant background to prevent childhood caries and obesity, thereby improving the children's general health, oral health, and quality of life.

METHODS

This is a study protocol for a cluster randomized controlled intervention follow-up study. In phase I of the study, the primary care health centers in the municipality of Bergen, Norway were randomly allocated to intervention or control groups. The intervention was carried out using the motivational interviewing technique and the common risk factor approach. The intervention group received guidance on diet/oral hygiene and the control group received standard care information. Parental knowledge and children at age 3 and 5 years old will be assessed in a prospective phase II follow-up study compared to native Norwegian controls. The primary outcome will be evaluation of change on parental oral health related knowledge and attitudes. The secondary outcome will assess the impact of the intervention on children's caries -, body mass index- and oral health related quality of life.

DISCUSSION

Collaboration between dental public health and primary health care personnel on the common risk approach motivational intervention offers opportunities to address key dietary behaviors that may prevent obesity and dental caries. Providing sustainable preventive measures decreases the burden of diseases and consequently reduces health inequalities, particularly among at-risk children.

TRIAL REGISTRATION

The study is registered as a clinical trial (ClinicalTrials.gov Identifier: NCT05758454: 7 March 2023). Ethical approval has already been granted by the Regional Ethical Committee (REK) (2015/ 27,639 /REK vest) and Sikt - Norwegian Agency for Shared Services in Education and Research (Reference number 778825).

Evaluation of Children Caries Risk Factors: A Narrative Review of Nutritional Aspects, Oral Hygiene Habits, and Bacterial Alterations

Dental caries is one of the most common diseases—both in adults and children—that occurs due to the demineralization of enamel and dentine by the organic acids formed from bacteria present in dental plaques through anaerobic metabolism of dietary sugars. The aim of this article is to provide a guideline to assess the risk of caries by looking for the main factors involved. Literature research was performed for studies that analyzed the factors most involved in the development of child caries, such as poor oral hygiene, bad eating habits (or food disorders), and an alteration of the oral bacterial flora—with an increase of Streptococci spp., Lactobacilli spp., Candida albicans, Cryptococcus neoformans, and Candida sake. It is therefore essential to assess the risk of caries in children, based on the assessment of risk factors, in order to be able to establish preventive and/or therapeutic approaches that will reduce or stop the development of dental caries. The use of fluoride products, products made from casein phosphopeptide-amorphous calcium phosphate, substituted zinc biomimetic hydroxyapatite products, or products containing self-assembling oligopeptide SAP-P₁₁-4 are useful. In terms of the clinical approach, a communicative approach should be added to learn about the eating habits and the oral hygiene habits of the child and parents; in addition, the use of a simple method to frame the factors involved, and subsequently establish the risk of carious lesions in the child, allows the reduction of the DMFT (Decayed Missing Filled Teeth) or ICDAS (International Caries Detection and Assessment System) index on large scales.

Development of dental caries and risk factors between 1 and 7 years of age in areas of high risk for dental caries in Stockholm, Sweden

Purpose

To explore caries predictors at age 1 year and caries development at ages 5 and 7 years in two groups of children following different fluoride-based preventive programs.

Methods

We conducted a prospective cluster-randomized controlled intervention trial with two parallel arms comparing two prevention programs: one program included fluoride varnish applications every 6 months, the other did not; otherwise, the programs were the same. Participants were 1- and 3-year-old children enrolled at 23 dental clinics in high-risk areas in Stockholm, Sweden. The baseline examination included structured interviews. Caries data were extracted from dental records. The primary outcome measures were ICDAS 1–6 > 0 at baseline (age 1 year) and defs > 0 at ages 2, 3, 5, and 7 years. The secondary outcome measure at age 7 was DFS > 0.

Results

Continuous caries development occurred: defs > 0 in 23% at 5 years and in 42% at 7 years. We found no difference in caries development between children who had or had not received fluoride varnish as toddlers. At age 1-year, significant predictors for dental caries in later preschool years were immigrant background, family income, and sweets consumption. Fluoride toothpaste > once a day at 1 year had an OR < 1 for defs > 0 at 5- and 7 years.

Conclusions

For toddlers, fluoride varnish does not seem to be an adequate prevention tool. Brushing with fluoride toothpaste from 1 year of age could not arrest caries development. Immigrant background was the strongest predictor. A new toolbox as well as collaborative upstream actions for reducing free-sugar intake are needed.

Early childhood caries risk assessment in 1-year-olds evaluated at 6-years of age

OBJECTIVES

The aim was to identify caries risk factors in 1-year-olds predicting dentine caries in 6-year-olds.

MATERIALS AND METHODS

Caries risk assessment was performed in 804 one-year-olds. Their parents answered a questionnaire, regarding family factors, general health, food habits and oral hygiene. Clinical examinations and caries risk assessments at 1, 3 and 6 years of age were performed. Simple and multiple regression analyses were used for identification of caries-associated factors.

RESULTS

Caries risk was found in 5% of the 1-year-olds, and 12% of the 3-year-olds. Dentine caries was found in 3% of the 3-year-olds and in 16% of the 6-year-olds. Caries risk assessment was associated with caries at 6 years of age (OR = 5.1, p < .001). Multiple logistic regression analysis found the following variables associated with caries at 6 years of age: Caries in sibling (OR = 2.1, p = .012), Beverage other than water (OR = 2.1, p < .001), Night meal (OR = 1.9, p = .002), Presence of mutans streptococci (MS) (OR = 1.6, p = .033) and Male gender (OR = 1.5, p = .053). An overall caries risk assessment was more reliable than any single caries risk factor.

CONCLUSIONS

Caries risk assessment for 1-year-olds in a region with low caries prevalence has limited accuracy to predict dental caries at 6 years of age. Caries risk often changes over time and should be reassessed on a regularly basis. The presence of MS in 1-year-olds did not increase the prognostic accuracy at 6 years of age.

Structural equation model for parental influence on children's oral health practice and status

BACKGROUND

Children's oral health status (OHS) can be influenced by their oral health practices and many parental factors. This study aimed to investigate pathways from parental factors to oral health practices and status of children in Hong Kong.

METHODS

Using a combination of random and purposive sampling of Hong Kong households, 432 families with children aged 5-7 participated in a cross-sectional survey. Data on socioeconomic status, smoking, and oral health knowledge, attitudes, and practices, as well as OHS of parents and parents' knowledge of and attitudes towards their children's oral health, were collected through a questionnaire. Tooth status, periodontal status, and oral hygiene data were also collected through clinical examination. Correlations of oral health behaviors (OHB) and OHS within families were assessed by confirmatory factor analysis. A conceptual model of the parental influences on children's oral health practices and status was tested by a structural equation model (SEM). Chi-square test, chi-square/df, nonnormed fit index, comparative fit index, and root mean square error of approximation were used to assess the model fit.

RESULTS

Fit indexes for confirmatory factor analysis and SEM showed good fit. Positive correlations of OHB and OHS were found within the families that ranged from 0.74 to 0.98 for OHB and 0.30 to 0.43 for OHS. SEM showed better socioeconomic status of mothers led to better oral health knowledge and attitude (γ = 0.75, P < 0.001) and also towards their children's better oral health knowledge and attitude (γ = 0.44, P < 0.01). Parents' attitudes towards their children's oral health (β = 0.40, P = 0.04) and mothers' OHB (β = 0.60, P < 0.001) were positively associated with OHB of children. Positive OHB of children (β = - 0.48, P < 0.01) in turn led to better oral health.

CONCLUSIONS

Correlations of OHB and OHS between mothers and children were stronger than those of fathers. Children's OHS was directly affected by their mothers' OHB, which in turn were affected by parents' oral health knowledge, attitudes, and practices.

Daily life habits associated with eveningness lead to a higher prevalence of dental caries in children

Background/purpose

Circadian rhythm is an endogenous daily variation observed in most physiological functions including salivary secretion. Irregular lifestyle causes many diseases such as obesity and sleep disorders. The aim of this study is to examine the effects of the timings of sleep and meal on the prevalence of dental caries.

Materials and methods

Study was conducted at university hospital in Japan. We asked 230 children (1–16 years old) to record the following life habits for 8 days: waking time, bedtime, mealtimes, snacking frequency, and tooth brushing frequency. We analyzed sleep habits from all data and compared dental caries and life habits using data from subjects with primary (2–7 years old) or permanent (11–16 years old) dentition period.

Results

The number of dental caries assessed using the decay or filled teeth (dft) index correlated with bedtime, supper time, regularity of supper time, and snacking frequency in subjects with primary dentition. Multiple regression analysis revealed that bedtime and snacking frequency were mutually independent risk factors for dental caries. No correlations were found between the prevalence of dental caries and other measurement items. The number of caries correlated with the regularity of supper time and age in subjects with permanent dentition.

Conclusion

Children with daily life habits associated with eveningness have a higher prevalence of dental caries.

Effectiveness of an oral health intervention program for children with congenital heart defects

Background

Children with congenital heart defects (CHD) are reported to have poorer oral health compared with healthy children. The aim of the present study was to evaluate the effectiveness of an intensive oral health care program among children with CHD followed from infancy to the age of 5 years, by comparing their oral health status at 5 years with a control group of children with CHD who had not received the program.

Methods

In this longitudinal study, children in western Norway with a need for lifelong follow-up due to congenital heart defects were invited to participate (n = 119). Children born in 2008–2011 were offered an oral health intervention program from infancy to the age of 5 years. The outcome measures for evaluating the intervention were dental caries prevalence, dental erosion, plaque index and gingival bleeding index. The data of the intervention group were compared with cross sectional oral health data of 5 year old controls with CHD born 2005–2007 (already published).

Results

Early oral health intervention did not affect the prevalence of caries (25.3% versus 25.4%) or dental erosion (22.2% versus 19.7%) of children with CHD assessed at 5 years. Children in the intervention group were less likely than those in the control group to present with both dental plaque and gingival bleeding at age 5 years. In spite of no difference in caries prevalence between the groups, caries affected children (d_1-5mft) in the intervention group had fewer teeth affected by caries than children in the control group (p = 0.06). The care index was reported to be higher in the intervention group compared with the control group, implying that fewer children in the intervention group suffered from untreated dentine caries. Parents in the intervention group were more likely to brush their children’s teeth twice a day than parents of children in the control group.

Conclusion

The oral health promotive program did not influence the prevalence of caries nor dental erosion. However, the findings indicated better oral hygiene, reduced gingival bleeding and less untreated dentine caries in the intervention compared with the control group.

Trial registration

ClinicalTrials.gov NCT03311438. Registration date: October 17th 2017, retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0495-5) contains supplementary material, which is available to authorized users.

Dental treatment and caries prevention preceding treatment under general anaesthesia in healthy children and adolescents: a retrospective cohort study

AIM

This was to examine healthy children and adolescents treated under general anaesthesia (GA) and a matched control group not receiving GA to compare treatment and preventive care received prior to GA treatment.

METHODS

This retrospective cohort study included 71 healthy subjects and 213 age- and gender-matched control subjects. The treatment group had been consecutively referred from the Public Dental Health Service (PDS) in Stockholm to the Department of Paediatric Dentistry, Eastman Institute, Stockholm during 2006-2007. Data was extracted from the patient records at the PDS, including variables such as number of dental visits, treatment/prophylaxis prior to GA, number of missed and cancelled appointments, and number of decayed teeth.

RESULTS

On average, the treatment group had significantly more decayed teeth (p < 0.001) than the control group. Furthermore, the treatment group had significantly more restorations (p < 0.01), had visited the dentist significantly more often (p < 0.001), and had undergone significantly more behaviour management treatment and preventive treatment (p < 0.001). In the treatment group 65% of the children and adolescents, had received no behaviour management treatment and 48%, no preventive treatment.

CONCLUSIONS

In the Stockholm PDS, over half of the children and adolescents referred by general dentists to paediatric specialists had no behaviour management treatment and nearly half, no preventive treatment, despite receiving significantly more operative treatment compared with matched controls. General dentists should target high caries-risk patients for additional behaviour management and preventive care to reduce the need for treatment under GA.

Identification of Caries Risk Determinants in Toddlers: Results of the GUSTO Birth Cohort Study

The aim of this study was to identify risk determinants leading to early childhood caries (ECC) and visible plaque (VP) in toddlers. Data for mother-child pairs participating in the Growing Up in Singapore towards Healthy Outcomes (GUSTO) birth cohort were collected from pregnancy to toddlerhood. Oral examinations were performed in 543 children during their clinic visit at 24 months to detect ECC and VP. Following logistic regression, ECC and VP were jointly regressed as primary and secondary outcomes, respectively, using the bivariate probit model. The ECC prevalence was 17.8% at 2 years of age, with 7.3% of children having a VP score >1. ECC was associated with nighttime breastfeeding (3 weeks) and biological factors, including Indian ethnicity (lower ECC rate), higher maternal childbearing age and existing health conditions, maternal plasma folate <6 ng/mL, child BMI, and the plaque index, while VP was associated with psychobehavioral factors, including the frequency of dental visits, brushing frequency, lower parental perceived importance of baby teeth, and weaning onto solids. Interestingly, although a higher frequency of dental visits and toothbrushing were associated with lower plaque accumulation, they were associated with increased ECC risk, suggesting that these established caries-risk factors may be a consequence rather than the cause of ECC. In conclusion, Indian toddlers may be less susceptible to ECC, compared to Chinese and Malay toddlers. The study also highlights a problem-driven utilization pattern of dental services (care sought for treatment) in Singapore, in contrast to the prevention-driven approach (care sought to prevent disease) in Western countries.

Dentin caries risk indicators in 1-year-olds. A two year follow-up study

BACKGROUND

Early childhood caries (ECC) risk factors are suspected to vary between regions with different caries prevalence.

AIM

Identify ECC risk factors for 1-year-olds predicting dentin caries at 3 years of age in a region with low caries prevalence.

DESIGN

Caries risk was assessed by dental hygienist or dental assistant in 779 one-year-olds. The oral mutans streptococci (MS) score was performed from a tooth surface or (in pre-dentate children) from oral mucosa. A parental questionnaire with questions regarding family factors (siblings with or without caries), general health, food habits (night meals, breastfeeding, other beverage than water), oral hygiene habits and emerged teeth were answered by parents of the 1-year-olds. Dentin caries was assessed when the children were 3-year-olds. Simple and multiple logistic regression analyses were used for identification of caries-associated factors.

RESULTS

An increased caries risk was assessed in 4.4% of the 1-year-olds. Dentin caries was found in 2.6% of the 3-year-olds. Caries risk at 1 year was associated with caries at 3 years (OR = 6.5, p = .002). Multiple regression analysis found the variables Beverages other than water (OR = 7.1, p < 0.001), Caries in sibling (OR = 4.8, p = .002), High level of MS (score 2-3) (OR = 3.4, p = .03) and Night meal (OR = 3.0, p = .03) to be associated with caries. The single variables Beverage other than water between meals and Caries in sibling were more reliable than Caries risk assessed performed by dental personnel.

CONCLUSIONS

Behavioural, family and microbial factors are important when assessing caries risk among 1-year-olds in a region with low caries experience.

Effectiveness of Early Preventive Intervention with Semiannual Fluoride Varnish Application in Toddlers Living in High-Risk Areas: A Stratified Cluster-Randomized Controlled Trial

This study evaluated whether toddlers in an extended preventive program of semiannual fluoride varnish applications from 1 year of age had a lower incidence of caries than those undergoing a standard program. A cohort of 1-year-old children (n = 3,403) living in multicultural areas of low socioeconomic standing in Stockholm participated in a cluster-randomized controlled field trial with two parallel arms. The children attended 23 dental clinics. Using the ICDAS II criteria, the examiners recorded caries at baseline and after 1 and 2 years. The children in the reference group received a standardized oral health program once yearly between 1 and 3 years of age. The children in the test group received the same standard program supplemented with topical applications of fluoride varnish every 6 months. We compared the test group and the reference group for the prevalence and increment of caries. At baseline, 5% of the children had already developed caries (ICDAS II 1-6). We reexamined the children after 1 year (n = 2,675) and after 2 years (n = 2,536). Neither prevalence nor caries increment differed between the groups. At 3 years of age, 12% of the children had developed moderate and severe carious lesions (ICDAS II 3-6), with a mean increment of 0.5 (SD 2.4) in the test group and 0.6 (SD 2.2) in the reference group. In conclusion, semiannual professional applications of fluoride varnish, as a supplement to a standard oral health program, failed to reduce caries development in toddlers from high-risk communities.

Diagnostic accuracy of different caries risk assessment methods. A systematic review

OBJECTIVES

To evaluate the accuracy of different methods used to identify individuals with increased risk of developing dental coronal caries.

DATA

Studies on following methods were included: previous caries experience, tests using microbiota, buffering capacity, salivary flow rate, oral hygiene, dietary habits and sociodemographic variables. QUADAS-2 was used to assess risk of bias. Sensitivity, specificity, predictive values, and likelihood ratios (LR) were calculated. Quality of evidence based on ≥3 studies of a method was rated according to GRADE.

SOURCES

PubMed, Cochrane Library, Web of Science and reference lists of included publications were searched up to January 2015.

STUDY SELECTION

From 5776 identified articles, 18 were included. Assessment of study quality identified methodological limitations concerning study design, test technology and reporting. No study presented low risk of bias in all domains. Three or more studies were found only for previous caries experience and salivary mutans streptococci and quality of evidence for these methods was low. Evidence regarding other methods was lacking. For previous caries experience, sensitivity ranged between 0.21 and 0.94 and specificity between 0.20 and 1. Tests using salivary mutans streptococci resulted in low sensitivity and high specificity. For children with primary teeth at baseline, pooled LR for a positive test was 3 for previous caries experience and 4 for salivary mutans streptococci, given a threshold ≥10(5) CFU/ml.

CONCLUSIONS

Evidence on the validity of analysed methods used for caries risk assessment is limited. As methodological quality was low, there is a need to improve study design.

CLINICAL SIGNIFICANCE

Low validity for the analysed methods may lead to patients with increased risk not being identified, whereas some are falsely identified as being at risk. As caries risk assessment guides individualized decisions on interventions and intervals for patient recall, improved performance based on best evidence is greatly needed.

Multicenter study on caries risk assessment in Japanese adult patients

OBJECTIVES

This study was conducted to identify significant risk factors for the onset and the accumulation of new caries in adult patients undergoing regular preventive therapy.

METHODS

The data of 732 patients from nine Japanese general dental practices were retrospectively analyzed. Classification and regression tree (CART) analysis was applied to develop a caries prediction model using the following patient parameters: age, number of teeth with caries experience (DMFT), levels of mutans streptococci (SM) and lactobacilli (LB), saliva flow rate and buffer capacity, and compliance with a preventive program. Poisson regression analysis was conducted to identify factors affecting caries accumulation within three years.

RESULTS

CART analysis identified patients at high risk for primary caries with an odds ratio of 3.08 (95%CI, 1.55-5.79; p=0.0018) according to SM levels and compliance; and those for secondary caries with an odds ratio of 3.69 (95%CI, 2.29-5.91; p<0.0001) according to LB and SM levels. Poisson regression analyses showed that accumulation of primary caries was affected by compliance (p<0.001), SM (p<0.001) and LB (p=0.013). Accumulation of secondary caries was affected by DMFT (p<0.001), SM (p<0.001) and LB (p<0.001).

CONCLUSIONS

CART is an important tool in identifying the risk of caries development in individual adult patients. Cariogenic bacteria are important factors for both the onset and accumulation of primary and secondary caries.

CLINICAL SIGNIFICANCE

Participation in a regular preventive program limits the onset and the accumulation of primary caries in adult patients.

Risk factors for early colonization of mutans streptococci - a multiple logistic regression analysis in Swedish 1-year-olds

BACKGROUND

Mutans streptococci (MS) are closely related to the development of dental caries and are usually established in the oral cavity during early childhood. The aim of the study was to identify factors associated with the presence of MS in Swedish 1-year-olds.

METHODS

Parents completed a questionnaire on different caries-associated factors and an oral bacterial sample was collected from 1,050 (526 boys, 524 girls) 1-year-olds. Multiple logistic regression analyses were performed to identify risk factors for colonization with MS.

RESULTS

MS were found in 27% of the 1-year-olds with teeth. High or very high MS scores (2-3) were found in 72 (7%) of the children. MS score was correlated to the number of erupted teeth (p < 0.001). No difference due to gender was found. Multiple logistic regression analysis showed that presence of bacteria was associated with: caries in a sibling, other beverages than water between meals, and more than 8 erupted teeth. High or very high MS scores (2-3) were associated with other beverages than water between meals, and more than 8 erupted teeth.

CONCLUSIONS

Number of teeth present, diet and family aspects were factors associated with presence of MS in 1-year-olds. To develop high or very high MS scores, the number of erupted teeth and dietary habits are important.

Rural dentistry: Is it an imagination or obligation in community dental health education?

During the past two decades, epidemiologic studies in less developed or developing countries have clearly reported that caries prevalence shows the distinctive patterns over the word, even though it is declining in many developed countries. Due to huge rural districts where arrival is problematic and ineffective dental and preventive care centers in most suburban districts, there has been significant difference between the different parts of the communities to provide dental care service, and unfortunately the sole preventive measure has been limited with the advising of using the tooth brush and paste. The problems are usually arisen not only from the inadequacy of trained personnel but also from the absence of an effective economic and pragmatic system which aims to effectively dispense the dental service to all over the country. For this reason, the basic aim of dental care should be to carry out the many dental services in a multidisciplinary manner within the first appointment and to serve the people at their own homes and/or districts. Clearly, the needed multidisciplinary dental care system can lead to a new educational doctrine for rural dental practice. This versatile and practical training program based on specific perceived needs of a specific population(s) could need a new educational program. So, various preventive and/or restorative procedures included by this new doctrine could be named as "rural dentistry." In this review, with the examples from the many in vivo studies carried out under rural conditions over the world, the probable practices in this specific dental doctrine have generally been exemplified.

Mother and youth access (MAYA) maternal chlorhexidine, counselling and paediatric fluoride varnish randomized clinical trial to prevent early childhood caries

BACKGROUND

Mexican-American children have a higher caries prevalence than the U.S. average. The Mothers and Youth Access (MAYA) study was a randomized clinical trial initiated to address this problem.

AIM

Comparison of the efficacy of two prevention interventions in reducing early childhood caries (ECC).

DESIGN

All 361 randomized mother-child dyads received oral health counselling. Beginning at 4 months postpartum, intervention mothers received chlorhexidine (CHX) mouthrinse for 3 months beginning 4 months postpartum and children received fluoride varnish (FV) every 6 months from age 12-36 months. Control group children received FV if precavitated lesions developed. Salivary mutans streptococci (MS) and lactobacilli were assessed.

RESULTS

No significant difference in children's 36-month caries incidence between groups; 34% in each group developed caries [(d(2+) fs) > 0]. About half of control group developed precavitated lesions and received therapeutic FV. Maternal MS levels declined during CHX use, but increased when discontinued.

CONCLUSIONS

Maternal postpartum CHX regimen, oral health counselling and preventive child FV applications were not more efficacious than maternal counselling with child therapeutic FV for precavitated lesions for ECC prevention. FV for young children with brief maternal CHX use and oral health counselling may need to be combined with additional or longer-term therapies to significantly reduce ECC in high-risk populations.

Maternal health and lifestyle, and caries experience in preschool children. A longitudinal study from pregnancy to age 5 yr

In this study, associations were explored between maternal health and lifestyle during pregnancy and in early motherhood, and preschool children's caries experience. The study was based on the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and on data from the Public Dental Services. A total of 1348 children were followed from pregnancy to age 5 yr. A clinical dental examination was performed at age 5 yr. Questionnaires were completed by the mothers during pregnancy and in the first 18 months of their child's life, and as part of the dental examination. Results from the multivariate logistic regression analysis showed that having an obese mother (OR = 2.3, 95% CI: 1.3-4.1), a mother who consumed a diet containing more fat (OR = 1.6, 95% CI: 1.1-2.5) or sugar (OR = 1.5, 95% CI: 1.1-2.3) than recommended, a mother with low education (OR = 1.5, 95% CI: 1.1-2.3) or one or both parents of non-western origin (OR = 5.4, 95% CI: 2.8-10.6) were statistically significant risk indicators for caries experience at age 5 yr. In conclusion, maternal weight and intake of sugar and fat in pregnancy were associated with caries experience in preschool children. These characteristics may enable early referral to the dental services and preventive care to be delivered.

Risk factors for early childhood caries in disadvantaged populations

Early childhood caries is a significant international public health problem. The aim of this paper was to review the current evidence of the risk factors for dental caries in disadvantaged children under 6 years of age. Medline, Cochrane, and PubMed database searches were conducted. Systematic reviews were used where available, or meta-analyses; randomized, controlled trials; and cohort, case-control, and cross-sectional studies (in that order). Studies were restricted to those published in English from 1990 to October 2010. Early childhood caries has a complex etiology with biological, behavioral, and sociodemographic influences. Evidence suggests that young children are most likely to develop caries if Streptococcus mutans is acquired at an early age, although this is influenced by other factors, such as oral hygiene, fluoride, diet, dental visit patterns, socioeconomic status, ethnicity, and health literacy. Etiological pathways should be taken into consideration when designing interventions to prevent dental caries in disadvantaged preschool children.

Risk assessment of dental caries by using Classification and Regression Trees

OBJECTIVES

Being able to predict an individual's risks of dental caries would offer a potentially huge natural step forward toward better oral heath. As things stand, preventive treatment against caries is mostly carried out without risk assessment because there is no proven way to analyse an individual's risk factors. The purpose of this study was to try to identify those patients with high and low risk of caries by using Classification and Regression Trees (CART).

METHODS

In this historical cohort study, data from 442 patients in a general practice who met the inclusion criteria were analysed. CART was applied to the data to seek a model for predicting caries by using the following parameters according to each patient: age, number of carious teeth, numbers of cariogenic bacteria, the secretion rate and buffer capacity of saliva, and compliance with a prevention programme. The risks of caries were presented by odds ratios. Multiple logistic regression analysis was performed to confirm the results obtained by CART.

RESULTS

CART identified high and low risk patients for primary caries with relative odds ratios of 0.41 (95%CI: 0.22-0.77, p = 0.0055) and 2.88 (95%CI: 1.49-5.59, p = 0.0018) according the numbers of cariogenic bacteria. High and low risk patients for secondary caries were also identified with the odds ratios of 0.07 (95%CI: 0.01-0.55, p = 0.00109) and 7.00 (95%CI: 3.50-13.98, p < 0.0001) according the numbers of bacteria and existing caries.

CONCLUSIONS

Cariogenic bacteria play a leading role in the incidence of caries. CART proved effective in identifying an individual patient's risk of caries.

Patterns of soft drink consumption and primary tooth extractions in Queensland children

BACKGROUND

The authors examined the association of patterns of soft drink consumption and primary tooth extractions in Queensland children aged 12 years or less.

METHODS

Data were gathered through the Child Health Surveys conducted by Queensland Health in 2003 and 2008. The analysis allowed for various demographic characteristics using logistic regression analysis.

RESULTS

The data in both surveys showed an increased risk of tooth extraction in children who had a greater frequency and amount of soft drink consumption, and those that consumed soft drink between meals. In 2008, the percentage of children that had soft drink daily or several times a week had decreased, with an increase in those that never had soft drink.

CONCLUSIONS

To reduce the risk of primary tooth extraction due to decay, this paper recommends the continuing moderation of soft drink consumption frequency and the consumption of soft drinks with, rather than between, meals.

Identification of caries risk factors in toddlers

The purpose of this study was to identify risk factors to predict caries progression in toddlers in primary-healthcare settings for the cost-effective targeting of preventive and referral strategies. We examined 329 children (26 ± 6 mos old) twice, one year apart, in Indiana, USA. A 107-item structured interview was used to collect information from the primary caregiver and child on factors/beliefs/perceptions/behaviors that could affect caries development, transmission of bacteria, medical-dental health, and access to care. Bacterial levels, gingivitis, dental plaque, and caries experience were assessed. Multiple-variable logistic regression models of caries progression toward cavitation included family caries experience, transmission-related behaviors, dietary factors, health beliefs, and lower income, but differed in selected predictors/predictive power by race/ethnicity. Addition of clinical variables did not significantly improve the prediction.

Family characteristics and caries experience in preschool children. A longitudinal study from pregnancy to 5 years of age

OBJECTIVE

The purpose of the study was to explore associations between family status, family income, family size, mother's age at child birth, mother's education and parents' national background and caries experience in 5-year-old children.

METHOD

This study is based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and the Public Dental Services. A total of 1348 children were followed from pregnancy to the age of 5 years. Questionnaires were completed by mothers twice during pregnancy and when the children were 3 and 5 years of age. Clinical and radiographic examination of the children was performed at the age of 5 years.

RESULTS

Caries experience in the 5-year-old children was low; 89% had no caries experience (d(3-5) mft = 0). In multiple logistic regression having one or both parents of non-western origin (OR 3.4, CI 1.6-7.3), having had a change in family status from pregnancy to 5 years of age (OR 2.0, CI 1.1-3.4) and having mother with low education (OR 1.9, CI 1.3-2.8) were statistically significant risk indicators for having caries experience at the age of five.

CONCLUSION

Family characteristics in pregnancy and early life were associated with caries experience in 5-year-old children. Primary care personnel meeting young children with one or several of these characteristics should consider referring the child to dental personnel to enable early initiation of health-promoting activities.

Sociodemographic variation of caries risk factors in toddlers and caregivers

Objectives. Dental caries is the most common chronic childhood disease, with numerous identified risk factors. Risk factor differences could indicate the need to target caregiver/patient education/preventive care intervention strategies based on population and/or individual characteristics. The purpose of this study was to evaluate caries risk factors differences by race/ethnicity, income, and education. Methods. We enrolled 396 caregiver-toddler pairs and administered a 105-item questionnaire addressing demographics, access to care, oral bacteria transmission, caregiver's/toddler's dental and medical health practices, caregiver's dental beliefs, and caregiver's/toddler's snacking/drinking habits. Logistic regressions and ANOVAs were used to evaluate the associations of questionnaire responses with caregiver's race/ethnicity, income, and education. Results. Caregivers self-identified as Non-Hispanic African-American (44%), Non-Hispanic White (36%), Hispanic (19%), and "other" (1%). Differences related to race/ethnicity, income, and education were found in all risk factor categories. Conclusions. Planning of caregiver/patient education/preventive care intervention strategies should be undertaken with these caries risk factor differences kept in mind.

Mutans streptococci colonization associates with the occupation of caretaker, a practise-based study

BACKGROUND

The early mutans streptococci (MS) bacteria colonization is connected to early childhood caries. The aim of this study is to examine associations between the MS-colonization and background factors in young children, in order to enhance the oral health program in a low caries prevalence community.

SUBJECTS AND DESIGN

An age cohort of 512 children was screened for MS in the oral biofilm at the age of 18 months. The caretakers were, using a structured form, interviewed of demographical factors and habits connected to oral health: antibiotic treatments, child's appetite, frequency of night feeding, use of sugary products or drinks, and maternal xylitol use. The associations were evaluated with logistic regression analysis.

RESULTS

Mutans streptococci colonization was significantly associated with both the occupation of the caretaker and the non-Finnish background.

CONCLUSION

The early MS-colonization, in preschool children, strongly associates with the socioeconomic status of the family.

Improved ability of biological and previous caries multimarkers to predict caries disease as revealed by multivariate PLS modelling

BACKGROUND

Dental caries is a chronic disease with plaque bacteria, diet and saliva modifying disease activity. Here we have used the PLS method to evaluate a multiplicity of such biological variables (n = 88) for ability to predict caries in a cross-sectional (baseline caries) and prospective (2-year caries development) setting.

METHODS

Multivariate PLS modelling was used to associate the many biological variables with caries recorded in thirty 14-year-old children by measuring the numbers of incipient and manifest caries lesions at all surfaces.

RESULTS

A wide but shallow gliding scale of one fifth caries promoting or protecting, and four fifths non-influential, variables occurred. The influential markers behaved in the order of plaque bacteria > diet > saliva, with previously known plaque bacteria/diet markers and a set of new protective diet markers. A differential variable patterning appeared for new versus progressing lesions. The influential biological multimarkers (n = 18) predicted baseline caries better (ROC area 0.96) than five markers (0.92) and a single lactobacilli marker (0.7) with sensitivity/specificity of 1.87, 1.78 and 1.13 at 1/3 of the subjects diagnosed sick, respectively. Moreover, biological multimarkers (n = 18) explained 2-year caries increment slightly better than reported before but predicted it poorly (ROC area 0.76). By contrast, multimarkers based on previous caries predicted alone (ROC area 0.88), or together with biological multimarkers (0.94), increment well with a sensitivity/specificity of 1.74 at 1/3 of the subjects diagnosed sick.

CONCLUSION

Multimarkers behave better than single-to-five markers but future multimarker strategies will require systematic searches for improved saliva and plaque bacteria markers.

Caries and background factors in Norwegian and immigrant 5-year-old children

OBJECTIVES

The purpose of this study was to assess the caries status of 5-year-olds in a low caries area, and study associations between dental caries and parent-related factors: parents' education, national origin, oral health behaviours and attitudes.

METHODS

The material consisted of 523 children and was a stratified random sample. Clinical and radiographic examination was performed in 2007. Enamel and dentine caries were recorded at surface level. Parents filled in questionnaires regarding socioeconomic status, their own oral health behaviours and attitudes.

RESULTS

Most participants (66%) had no caries experience and 16% had enamel caries only. Dentine caries experience was present in 18% of the children, and 5% had dentine caries experience in five or more teeth. Surfaces with enamel caries constituted half of all surfaces with caries experience. In multiple logistic regression, statistically significant risk indicators for the child having dentine caries experience at the age of five were: having one or both parents of non-western origin (OR = 4.8), both parents (OR = 3.0) or one parent (OR = 2.1) with low education, parental laxness about the child's tooth brushing (OR = 2.8), parents' brushing their own teeth less than twice a day (OR = 2.2) and having parents with frequent sugar intakes (OR = 1.8).

CONCLUSION

Caries prevalence in 5-year-olds was strongly associated with parent-related factors signifying that information on parents' socioeconomic status, dental behaviours and attitudes should be considered when planning dental services for young children. Our results suggest that the real high risk group is non-western children whose parents have low education.

Validation of an age-modified caries risk assessment program (Cariogram) in preschool children

OBJECTIVES

(i) To validate caries risk profiles assessed with a computer program against actual caries development in preschool children, (ii) to study the possible impact of a preventive program on the risk profiles, and (iii) to compare the individual risk profiles longitudinally.

MATERIAL AND METHODS

Caries risk was assessed in 125 two-year-old children invited to participate in a 2-year caries-preventive trial with xylitol tablets. At 7 years of age, 103 were available for follow-up, 48 from the former intervention group and 55 from the control group. At baseline and after 5 years, 7 variables associated with caries were collected through clinical examinations and questionnaires, and scored and computed with a risk assessment program (Cariogram).

RESULTS

Children assessed as having a "low chance (0-20%) of avoiding caries" had significantly higher caries at 7 years of age compared to children with a lower risk in the control group (p<0.05) but not in the intervention group. Overall predictive accuracy and precision, however, were moderate in both groups. Less than half of the children remained in the same risk category at both ages, despite a largely unchanged consumption pattern of sugar. The majority of the children who changed category displayed a lowered risk at 7 years. The intervention program seemed to impair the predictive abilities of Cariogram.

CONCLUSION

A modified Cariogram applied on preschool children was not particularly useful in identifying high caries risk patients in a low-caries community.

Risk indicators and risk predictors of dental caries in schoolchildren

The purpose of this study was to identify risk indicators of high caries level at baseline (HCLB) based on cross-sectional data and predictors of high caries increment (HCI) based on a 7-year-follow-up examination in 6-8-year-old schoolchildren. Two hundred and six schoolchildren were examined in 1997 and in 2004 by the same two calibrated dentists, in Piracicaba, Brazil. At baseline, dental caries, presence of sealants, fluorosis, and oral hygiene status were recorded. The children's parents completed a questionnaire concerning socioeconomic level, fluoride use, dental service utilization, dietary and oral hygiene habits. HCLB and HCI were defined considering the upper quartile of the total caries experience distribution (dmfs+DMFS) and caries increment distribution, respectively. Logistic regression models were adjusted estimating the Odds Ratio (OR), 95% confidence intervals and p-values. Having white spot lesions (OR=5.25) was found to be a risk indicator of HCLB. Schoolchildren with dental fluorosis (OR=0.17) or those who brushed the teeth more than two times a day (OR=0.37) presented less probability of HCLB. The predictors of HCI were: dmfs>0 (OR=2.68) and mothers' educational level up to 8 years of schooling (OR=2.87). Clinical and socioeconomic variables were found to be risk indicators and/or predictors of dental caries in schoolchildren.

Strategies for caries risk assessment in children and adolescents at public dental clinics in a Swedish county

BACKGROUND

Since caries prevalence has decreased and become polarized, high-risk preventive strategies have been widely adopted. The underlying factors leading to assessment and management of caries risk are poorly understood.

AIM

The aim of this study was to identify the factors forming the basis for dentist's caries risk assessment in dental care for children and adolescents.

DESIGN

From all 3372 children in a Swedish county identified as at high risk for developing caries, a sample of dental records from 432 children, aged 3-19 years, were randomly selected to be analysed in the study. Information about medical and social history, dental status, dietary habits, oral hygiene, and salivary data was obtained from the records.

RESULTS

The results show that the only data registered in the majority of the dental records were dental status from the clinical examination and bitewing radiographs. In approximately half of the dental records, medical history and data concerning oral hygiene were registered. Dental history and dietary habits were noted in approximately 25% of the dental records, whereas other risk factors/indicators were occasionally registered.

CONCLUSIONS

Dentists mainly base their caries risk assessments on past caries experience, a reliable risk indicator for assessing the risk of being affected by caries again. In children with no experience of caries, knowledge of other risk factors/indicators needs to be available to perform a caries risk assessment. In this study, documentation of such knowledge was strongly limited.

[[Streptococcus mutans Acquisition and Dental Caries Development in First-Born Children].]

OBJECTIVE: To evaluate the moment of streptococcus mutans (SM) acquisition, caries development and their associate variables along 23 months, in first-born children of low socioeconomic status families, starting at 7 months of age. METHOD: The sample was chosen based on highly SM-colonized mothers, including all members of 14 families living in the same houses. The study included 14 mothers, 14 fathers and 14 first-borns and 8 relatives (mostly grandparents). Initial clinical examinations and radiographs determined the caries indices and periodontal conditions of the adults. SM count in all adults was made in the first 2 visits. The children were examined for SM count, number of teeth and number of carious lesions, in 4 visits. RESULTS: SM prevalence was high in the adults, being absent in only one of the parents. SM was found in 1, 2, 3 and 10 children in the first, second, third and fourth visits. Dental caries was detected in only 3 children in the last visit (at 30 months), who presented significantly higher SM scores than the children without caries in the same visit. CONCLUSION: A low income social condition and mothers highly colonized by SM do not mean necessarily early SM colonization and high caries activity in children with oral homecare. Caries development is significantly associated with high SM scores in the children.

Salivary glucosyltransferase B as a possible marker for caries activity

Bacteria-derived glucosyltransferases (Gtf) (EC 2.4.1.5), through synthesizing glucan polymers from sucrose and starch hydrolysates, play an essential role in the etiology and pathogenesis of caries. We attempted to correlate the levels of Gtf in whole saliva with the prevalence of carious lesions in young children. We examined saliva from children who were either free of overt carious lesions, or had severe early childhood caries (mean dmfs = 18.72 +/- 9.0 SD), for Gtf by direct enzyme assay. The levels of GtfB, GtfC and GtfD from Streptococcus mutans in the saliva using monoclonal/specific antibodies in an enzyme-linked immunosorbent assay were determined. Multiple logistic regression analyses with model selection showed that GtfB levels correlated with dmfs values of the subjects (p = 0.006). There was no correlation between total Gtf activity as measured by direct enzyme assay and dmfs values. There was a strong correlation between mutans streptococci populations in saliva and caries activity. Collectively, these data show that GtfB levels in saliva correlate strongly with presence of clinical caries and with number of carious lesions in young children. It is also possible to measure different Gtfs, separately, in whole saliva. These observations may have important clinical implications, may lead to development of a chair side caries activity test and support the importance of GtfB in the pathogenesis of dental caries.

Progression of dental caries and tooth loss between the third and fourth decades of life: a birth cohort study

The majority of what is known of the experience of dental caries among adults is from cross-sectional studies, and there are surprisingly few population-level longitudinal studies of dental caries among adults. Dental examinations were conducted at age 26 and again at age 32 among participants in a longstanding prospective study of a birth cohort born in Dunedin (New Zealand) in 1972/1973. Some 901 individuals (88.8%) were dentally examined at both ages. The mean number of remaining teeth and tooth surfaces fell between 26 and 32, reflecting ongoing tooth loss. The overall prevalence of caries rose from 94.9 to 96.8%, while there were greater increases in the proportion with caries-associated tooth loss (from 10.8 to 22.8%). Caries experience was greatest in the molar teeth and upper premolars, and was lowest in the lower anterior teeth. The mean crude caries increment (CCI) was 5.0 surfaces (SD 6.6); 681 (75.5%) experienced 1+ CCI, and the mean CCI among those individuals was 6.6 surfaces (SD 6.9). Substantial dental caries and tooth loss experience occur as people move from the third into the fourth decade of life.

Predictors of Dental Caries Development in 1.5-Year-Old High-Risk Children in the Japanese Public Health Service

OBJECTIVES

The purpose of this study was to construct prediction models for 1.5-year-old children who were at risk for the development of caries.

METHODS

The participants were 5,107 Japanese children who resided in 21 municipalities in the Shizuoka prefecture and received oral health examinations at both 1.5 and 3 years old. General practitioners in the respective municipalities conducted the examination and the evaluation of plaque deposit. At the examination at 1.5 years old, the guardians were asked to complete a questionnaire concerning the child care environment and the health habits of the children and themselves. They were divided into four groups based on the population of the concerned municipality. Approximately 30 percent of the subjects in each group were found to be in the high-risk category (deltadft > or = 1 during both examinations). A stepwise multivariate logistic regression analysis in each group was performed using high-risk subjects as the dependent variable and 28 independent variables from the examination at 1.5 years old and the questionnaire.

RESULTS

A significant model could be constructed for each group using eight to 14 independent variables, respectively. The variables common to more than three groups are related to the child's characteristics, especially sugar consumption, feeding, and caries experiences. The predictive ability of the models had a sensitivity of 58.0 to 64.0 percent and a specificity of 64.1 to 70.5 percent. Because the negative predictive value was 77.4 to 80.5 percent, these models might be considered to be in the permissible range.

CONCLUSIONS

The models could not predict caries risk but may be able to predict those cases who will not develop caries.

Carbonated soft drinks and dental caries in the primary dentition

We analyzed fluid intake data among children aged 2-10 years from a 24-hour dietary recall interview in the NHANES III (1988-94) to investigate the effect of high consumption of carbonated soft drinks on caries in the primary dentition. We used cluster analysis to determine fluid consumption patterns. Four distinct fluid consumption patterns were identified: high carbonated soft drinks, high juice, high milk, and high water. About 13% of children had a high carbonated soft drink consumption pattern; they also had a significantly higher dental caries experience in the primary dentition than did children with other fluid consumption patterns. A fluid intake pattern comprised mainly of milk, water, or juice was less likely to be associated with dental caries. Findings of this study suggest that high consumption of carbonated soft drinks by young children is a risk indicator for dental caries in the primary dentition and should be discouraged.

Assessment of Dental Caries Predictors in a Seven-year Longitudinal Study

OBJECTIVE

To identify, in a group of 6-8-year-old schoolchildren, risk factors for dental caries increment in permanent dentition.

METHODS

Two hundred and six children from three different schools in Piracicaba, Brazil, were examined at baseline and after 7 years by the same two calibrated dentists. Data on dental caries (dmfs, DMFS, presence of initial lesions), fluorosis, oral hygiene and presence of sealant were collected at the clinical examination that was performed in an outdoor setting, under natural light, using a dental mirror and probe following the WHO recommendations. Information on socioeconomic level, fluoride usage, dental service utilization, dietary and oral hygiene habits was also obtained at baseline in a semi-structured questionnaire sent to the parents. The dependent variable was the 7-year DMFS increment. A univariate analysis was performed to test the association of independent variables in caries increment. Then a logistic regression model was used to estimate the adjusted Odds Ratio for caries increment.

RESULTS

Clinical (dmfs, DMFS) and non-clinical variables (daily toothbrushing, use of preventive topical methods, parents' educational level) were entered in the multiple logistic regression analysis. The prediction model included the clinical and socioeconomic variables, DMFS, dmfs and mother's educational level. The best caries predictor was the dmfs variable.

CONCLUSION

Caries experience and mother's educational level were predictors of caries increment in permanent dentition.

Enquête épidémiologique sur la santé buccodentaire d'enfants âgés de 4 ans scolarisés en école maternelle

The departmental service of maternal and infantile protection (PMI) of Moselle (Lorraine region), together with the Paediatric Dentistry Department from Nancy University, organized a study of the dental health of 4-year-old children.

AIMS OF THE STUDY

To assess the children dental health; to evaluate parental knowledge of dental health; to identify the factors associated with caries amongst children.

MATERIAL AND METHODS

The study was a cross sectional observation. A random sample of 4-year-old children was selected among 11 586 children in nursery schools. The study was based on a clinical examination performed by a dentist and a structured questionnaire completed by parents.

RESULTS

The overall proportion of children affected by caries was 37.5%. The mean dmft score was 1.51 (sd = 2.82) and 11.6% of the children had caries which affected their upper incisors, a sign of early childhood caries. Only 6.2% had received dental treatment on at least 1 occasion. There was a clear disparity in dental health: 1 child out of 3 suffered from caries but 1 out of 2 children in priority education districts was affected, compared with only 1 out of 4 children coming from a rural area. The questionnaires completed by parents showed a lack of knowledge of dental health and inadequate use of current prevention facilities. The multivariate logistic regression analysis showed that the variables that were significantly associated with caries in 4 year-old children were the mother's education, the low social background, the level of consumption of drinks containing sugar by both children and parents, the consumption of fluoride, and the level of knowledge about fluoride.

CONCLUSION

Preventive measures must be developed in close relationship between pediatricians and dentists. Initial training of health care professionals has to be reinforced. Health care professionals in paediatrics are far more likely to meet mothers and young children than are dentists.

The effect of a needs-related caries preventive program in children and young adults - results after 20 years

The risk for caries development in children varies significantly for different age groups, individuals, teeth, and surfaces. Thus from a cost-effectiveness point of view, caries preventive measures must be integrated and based on predicted risk from age group down to individual tooth surfaces. Based on this philosophy and experiences from continuously ongoing research on evaluating and reevaluating separate and integrated caries preventive measures, as well as methods for prediction of caries risk, a needs-related caries preventive program was introduced for all 0-19-year-olds in the county of Värmland, Sweden, in 1979. The goals for the subjects following the program from birth to the age of 19 years were: 1. To have no approximal restorations. 2. To have no occlusal amalgam restorations. 3. To have no approximal loss of periodontal attachment. 4. To motivate and encourage individuals to assume responsibility for their own oral health. The effect of the program is evaluated once every year on almost 100% of all 3-19-year-olds in a computer-aided epidemiologic program from 1979. Most of the individualized preventive program was carried out by dental hygienists or prophy dental assistants at clinics in the elementary schools. During the 20-year period the percentage of caries-free 3-year-olds increased from 51% to 97%. In 1999 as many as 86% of the 12-year-olds were caries free. Caries incidence was reduced more than 90% in all age groups. More than 90% did not develop any new caries lesions in 1999. As a consequence, caries prevalence was dramatically reduced. In 12- and 19-year-olds, the mean number of Decayed and Filled Surfaces (DFS) per individual was reduced from 6 to 0.3 and from 23 to 2 respectively. In 19-year-olds the mean number of approximal DFS was <1, and only 0.5 had to be filled. The mean number of occlusal DFS was <1. Since 1995 we have not been allowed to use amalgam in 1-19-year-olds in Sweden. As an effect of our high quality plaque program, approximal attachment loss was prevented, and by efficient education in self-care based on self-diagnosis, needs-related self-care habits were established. Thus it can be concluded that nearly 100% of our goals had been achieved.

Effect of mixed mutans streptococci colonization on caries development

OBJECTIVE

To evaluate the clinical importance of mixed mutans streptococci colonization in predicting caries in preschool children.

METHODS

Caries prevalence was examined twice, with a 6-month interval, in 410 preschool children aged 3-4 years at baseline. A commercial strip method was used to evaluate the mutans streptococci score in plaque collected from eight selected interdental spaces and in saliva. Mutans streptococci typing polymerase chain reaction (PCR) assays (Streptococcus sobrinus and Streptococcus mutans, including serotypes c, e, and f) were performed using colonies on the strips as template.

RESULTS

Twenty variables were examined in a univariate analysis to predict caries development: questionnaire variables, results of clinical examination, mutans streptococci scores, and PCR detection of S. sobrinus and S. mutans (including serotypes c, e, and f). Sixteen variables showed statistically significant associations (P < 0.04) in the univariate analysis. However, when entered into a logistic regression, only five variables remained significant (P < 0.05): caries experience at baseline; mixed colonization of S. sobrinus and S. mutans including S. mutans serotypes; high plaque mutans streptococci score; habitual use of sweet drinks; and nonuse of fluoride toothpaste.

CONCLUSION

'Mixed mutans streptococci colonization' is a novel measure correlated with caries development in their primary dentition.

Clinical outcomes of risk-based caries prevention in preschool-aged children

OBJECTIVE

The aim of this study was to evaluate outcomes in young children of risk-based management of dental caries in comparison with routine prevention.

METHODS

The study was carried out in two municipal health centers in Central Finland. The risk-based prevention group consisted of 299 children from Vanha Korpilahti, and the routine prevention group of 226 children from Saarijärvi. The children were 2 yr old at baseline, and they were followed up for 3 yr. All children received regular annual oral health care. In the risk-based prevention group, the presence of mutans streptococci (MS) in plaque (Dentocult-SM strip mutans -test, Orion Diagnostica, Espoo, Finland) and incipient caries lesions were the screening criteria. Additional prevention was targeted at MS-positive subjects twice a year, consisting of health education and application of fluoride varnish. For those who had incipient lesions, 'the high-risk category', additional prevention was given four times a year and this included also chlorhexidine varnish treatments.

RESULTS

The screening and the preventive measures were successfully carried out by specially trained dental assistants. The proportion of children with cavitated caries or fillings was significantly lower in the risk-based than in the routine prevention group. The treatment effect was strongest within the high-risk category: two subjects had to be treated with intensive care for 3 yr to avoid restorative treatment of dental caries by the age of 5 yr in one subject (number needed to treat (NNT) = 2.0; 95% CI 1.4-3.8). The accuracy of screening was evaluated in the routine prevention group and found acceptable.

CONCLUSIONS

The results indicate that in young children, risk-based management of caries seems practical, and prevention of caries can be targeted efficiently to individuals at risk.

Caries risk analysis: considering caries as an individual time-dependent process

AIM

To estimate the probability that a tooth does not develop a cavitated lesion (= end-stage caries) within time periods of interest. Additionally it was of interest to assess the heterogeneity between patients, in relation to the time periods required for their teeth to develop a cavitated lesion.

DESIGN

A prospective study using patient data of a clinical pedodontic course.

SAMPLE AND METHODS

Forty-one patients who had been followed for at least 3 years were selected. Before initiation of therapy, affiliation to a specific risk group was checked. Nine individuals who had belonged to a high-risk group on test were excluded. Of 1968 teeth, 1378 were eligible for data evaluation. The statistical techniques applied originate from time-to-event analysis methods, including a parametric frailty approach providing estimates of the relative caries risk for each individual to develop a cavitated lesion.

RESULTS

In the selected group of patients the probability that a tooth remained free of a cavitated lesion within five years ranged from 0.89 to 0.95 applying a 95% confidence interval. In the present sample the true caries risk of the patients to develop a cavitated lesion varied considerably although such variation was not expected from the individual examinations at baseline.

CONCLUSION

The frailty model accounts sufficiently for the heterogeneity of each patient. The applied time-to-event methods facilitated reliable estimation of both the probability that a tooth remains free of a cavitated lesion within a certain time and the relative caries risk of an individual to develop a cavitated lesion.

Plaque minerals in the prediction of caries activity

BACKGROUND/AIMS

Attempts to identify subjects who will develop caries lesions in future years have been only moderately successful, suggesting that one or more important risk factors are being overlooked. The aim of this study was to validate the use of plaque calcium, phosphate and fluoride concentrations as significant risk factors in caries.

METHODS

DMFS and DMFT rates were measured three times over 2 years in a group of rural Chinese schoolchildren initially aged 12 years and not living in a high-fluoride area. At the baseline and year 1 examinations, dental plaque was accumulated for 3 days and, after collection, was analysed for Ca, P and F. Plaque scores, dental health behaviour and parents' occupation data were also recorded.

RESULTS

The mean DMFS increment over 2 years was 1.14 with a range of -2 to +9. Regression analysis taking all factors into account identified only plaque Ca concentration, baseline DMFS score and toothbrushing frequency as significant factors in identifying high-risk individuals. Plaque Ca also showed predictive ability on its own. For example, when high caries was defined as 3+ new DMFS and a Ca cut-off value of 200 nmol/mg dry wt was selected, sensitivity was 0.84 and specificity 0.38. However, with this cut-off value the percentage predicted to have high caries risk was unrealistically high at 66%. As in several other studies, baseline caries score was a useful predictor of future caries.

CONCLUSION

Low plaque Ca concentration showed a modest ability to predict future caries, and since it is implicated directly in the chain of events leading to caries, its use in caries prediction should be considered further. Plaque P and F showed no predictive ability in this study.

The dental home: a primary care oral health concept

BACKGROUND

The pediatrics community has promoted the concept of a medical home to improve families' care utilization. The authors describe the medical home and propose a dental home concept to improve families' access to dental care.

DESCRIPTION

The dental home is a locus for preventive oral health supervision and emergency care. It can be a repository for records and the focus for making specialty referrals. When culture and ethnicity are barriers to care, the dental home offers a site adapted to care delivery and is sensitive to family values.

CLINICAL IMPLICATIONS

The dental home can provide access to preventive and emergency services for children. Establishment of the home early in the child's life can expose a child to prevention and early intervention before problems occur, reduce anxiety and facilitate referral.

Study of the factors associated with dental caries in children who receive early dental care

The present study investigated the factors associated with the development of dental caries in preschool children who receive regular dental care and follow-up. The research was carried out at the Baby Clinic, Londrina State University, and comprised two hundred preschool children, whose ages ranged from 24 to 48 months, as well as their mothers, who had already taken part in a dental program at the Baby Clinic during, at least, the previous twelve months. Regarding oral hygiene habits, there was no significant difference between the preschool children who presented with caries and those who did not present with caries. However, the presence of visible bacterial plaque on the upper incisors was strongly associated with the presence of dental caries. Other factors associated with the presence of caries were: period of formal education of the father or of both parents equal or inferior to 8 years, high sugar consumption and bottle-feeding during sleep. In the studied population, the dietary pattern is still the main cause of carious lesions. In addition, the presence of visible bacterial plaque on the labial surface of the upper incisors must be considered as an important clinical sign, often associated with inadequate patterns of diet and oral hygiene.

Dietary effects on dental diseases

Dental caries is a highly prevalent chronic disease and its consequences cause a lot of pain and suffering. Sugars, particularly sucrose, are the most important dietary aetiological cause of caries. Both the frequency of consumption and total amount of sugars is important in the aetiology of caries. The evidence establishing sugars as an aetiological factor in dental caries is overwhelming. The foundation of this lies in the multiplicity of studies rather than the power of any one. That statement by the British Nutrition Foundation's Task Force on Oral Health, Diet and Other Factors, sums up the relationship between sugars and caries in Europe. There is no evidence that sugars naturally incorporated in the cellular structure of foods (intrinsic sugars) or lactose in milk or milk products (milk sugars) have adverse effects on health. Foods rich in starch, without the addition of sugars, play a small role in coronal dental caries. The intake of extrinsic sugars beyond four times a day leads to an increase risk of dental caries. The current dose-response relationship between caries and extrinsic sugars suggests that the sugars levels above 60 g/person/day for teenagers and adults increases the rate of caries. For pre-school and young children the intakes should be proportional to those for teenagers; about 30 g/person/day for pre-school children. Fluoride, particularly in toothpastes, is a very important preventive agent against dental caries. Toothbrushing without fluorides has little effect on caries. As additional fluoride to that currently available in toothpaste does not appear to be benefiting the teeth of the majority of people, the main strategy to further reduce the levels of caries, is reducing the frequency of sugars intakes in the diet. Dental erosion rates are considered to be increasing. The aetiology is acids in foods and drinks and to a much lesser extent from regurgitation.

Identification of adult populations at high risk for dental caries using a computerized database and patient records: a pilot project

OBJECTIVES

The purpose of this study is to test the usefulness of dental insurance claims history, supplemented with radiographic caries diagnoses, as a means of identifying caries-active and caries-inactive working adults, as determined by bacterial levels. Computerized identification of at-risk groups may facilitate subject selection for clinical trials designed to test caries-preventive strategies.

METHODS

Two groups of subjects were initially selected from an insurance database based upon their dental service utilization during a one-year period: a "low restorative" group of individuals defined as persons who had received no restorative treatment, and a "high restorative" group comprised of individuals who had received at least three multisurfaced restorations. A chart review confirmed a diagnosis of caries in the high restorative group and an absence of caries in the low restorative group. Subjects were then approached for saliva collection. The low and high restorative groups were compared for salivary mutans streptococci and lactobacilli levels, stimulated flow rate, and buffer capacity (n = 48).

RESULTS

The high and low restorative groups differed in mutans streptococci levels, but not on other measures.

CONCLUSIONS

A group of subjects who had recently received multisurfaced restorations that were placed for reasons of caries had significantly higher levels of mutans streptococci and potential for continued caries activity when compared to a group of subjects who had received no restorations and were caries free.

Prevention of dental disease. The role of the pediatrician

Evidence increasingly suggests that to be successful in preventing dental disease, we must begin preventive interventions within the first year of life. Pediatricians are well positioned to begin this process with early assessment of oral health and provision of anticipatory guidance, including ensuring that patients establish a dental home in addition to their medical home. This article provides information that will enable pediatricians to assess caries risk and provide practical and effective advice to parents about preventing dental disease, including oral hygiene, diet, and fluoride recommendations.

Infant oral health and oral habits

Many oral diseases and conditions, including dental caries (cavities) and malocclusions, have their origins early in life. Prudent anticipatory guidance by the medical and dental professions can help prevent many of the more common oral health problems. This article provides information on the rationale for early dental examination and instructions for pediatric and family practitioners in scheduling and conducting an early oral intervention appointment. In addition, feeding practices, non-nutritive sucking, mouth breathing, and bruxing are discussed, including their effects on orofacial growth and development.