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

A systematic review of caries risk in children <6 years of age

BACKGROUND

For caries risk assessment (CRA) tools for young children to be evidence-based, it is important to systematically review the literature to identify factors associated with the onset of early childhood caries (ECC).

AIM

This updated systematic review aimed to identify current evidence on caries risk in young children.

DESIGN

A comprehensive and systematic literature search of relevant databases was conducted to update a previous systematic review and identify risk factors associated with ECC. Potential risk factors were identified based on strength of association using odds ratios, hazard ratios, relative risk, etc. GRADE was used for rating quality evidence through consensus.

RESULTS

Twenty-two studies met inclusion criteria for the search from mid-2017 to 2021. Twenty-five publications from the prior systematic review, from 1997 to mid-2017, were also included. Several socioeconomic, behavioral, and clinical variables were identified as ECC risk factors. Factors included the following: age, socioeconomic status, frequency of and supervised toothbrushing, fluoride exposure, breast- and bottle-feeding, feeding habits, absence of a dental home, past caries experience, active non-cavitated lesions, visible plaque, enamel defects, and microbiome.

CONCLUSION

This study provides updated evidence of risk factors for ECC that could be included in CRA tools.

Oral and systemic health in Singapore: Revisiting the past to define the future

OBJECTIVES

This study aimed to identify studies exploring oral and systemic conditions using Singapore data.

METHODS

Studies were searched using the databases PubMed, Embase and Web of Science, with no publication date or language restrictions. Studies analysing Singaporean data were included in this review.

RESULTS

Six domains were identified: pregnancy and gingivitis; tooth eruption, dental caries and early-life factors; Crohn's disease and oral microbiome; diabetes and periodontal diseases; number of teeth, chewing ability and cognitive status; and oral health and pneumonia. Using data from Singapore, oral-systemic studies have prompted reflections on the aetiopathogenesis of oral disorders, such as common causes connecting oral and systemic chronic conditions. Moreover, it is speculated whether oral conditions could be used as a marker to predict future systemic diseases or whether early-life factors could affect the development of oral and systemic immune responses.

CONCLUSIONS

While Singapore provides opportunities to explore challenges connected to healthy ageing, it also explores health development in many stages of life. Singapore has been prioritizing investigations on a healthier life, and new initiatives are paving the way for oral health research across the lifespan.

Perception of nurses applying silver diamine fluoride to children's teeth: A mixed methods study

BACKGROUND

No studies have evaluated the unique potential of nurse-led silver diamine fluoride (SDF) application for children to bridge the gap in interprofessional collaboration.

AIM

To investigate the attitudes, beliefs and perceptions of nurses regarding nurse-led SDF application at the well-child visit and identify possible barriers and make recommendations.

DESIGN

Mixed methods design involving a questionnaire and semi-structured individual interviews were conducted.

RESULTS

All eligible nurses (n = 110) completed the questionnaire, and 16 were interviewed. Questionnaire responses highlighted that nurses were not confident in providing oral health services (score: <3 of 5) beyond oral hygiene advice (score: ≥3.9 of 5) but believed that they should be providing these services for individuals with difficulty accessing care. Interviews reflected that most nurses viewed oral health care as an important part of paediatric health but were limited by knowledge, time and manpower. Most were willing to expand their job scope to include SDF application with formal education and training, competency assessments and approaches to counter time limitations.

CONCLUSION

Where nurses are already providing basic oral healthcare, nurse-led SDF application could be the next step. Findings suggest that systemic changes should include strategies to empower and motivate nurses to apply SDF at the well-child visit.

Detection of Streptococcus mutans and Streptococcus sobrinus and Their Association with Oral Microbiome Stressors in 6-18-month-old Infants

Aim

To determine the presence of Streptococcus mutans (S. mutans) and Streptococcus sobrinus (S. sobrinus) and their association with extrinsic and intrinsic variables in 6-18-month-old infants.

Methods

This was an analytical, cross-sectional study of 65 6-18-month-old infants who visited the Centers for Early Childhood in Buenos Aires City. Three groups were established according to the presence of teeth-group I (GI)-edentulous infants, group II (GII)-infants with 1-8 teeth, and group III (GIII)-infants with 9-16 teeth. Data on the variables, diet, use of artificial teats, and oral hygiene were gathered using a self-administered questionnaire. An oral examination was performed according to the International Caries Detection and Assessment System (ICDAS II) criterion. A saliva sample was taken by aspiration with a sterile plastic syringe. Cariogenic Streptococci (CS) were counted using the adherence test in modified gold broth (AT-MGB). Molecular detection and quantification were performed by quantitative polymerase chain reaction (qPCR) (gtfB, gtfT, and tuf).

Results

A total of 12% of infants received oral hygiene, 38% used bottles, 30% used pacifiers, and 55% had sugar intake. S. sobrinus and S. mutans were detected in 57.1 and 28.6% of the children with caries, respectively. Groups I, II, and III had CS counts of log 2, 3.4, and 3.7, respectively. S. sobrinus was detected in 26.7% of GI, 52.9% of GII, and 85.7% of GIII, while S. mutans was detected in 13.3%, 35.3%, and 57.7%, respectively.

Conclusion

The prevalence of S. sobrinus was higher than S. mutans in all groups. The presence of CS was significantly associated with sugar intake. No association was found between S. mutans and S. sobrinus and the presence of caries, hygiene habits, or use of artificial teats.

Clinical Significance

This study supports the role of diet in developing a cariogenic biofilm in children under 2 years of age.

How to cite this article

Cornejo CF, Soken LJ, Salgado PA, et al. Detection of Streptococcus mutans and Streptococcus sobrinus and Their Association with Oral Microbiome Stressors in 6-18-month-old Infants. Int J Clin Pediatr Dent 2023;16(1):68-73.

Early childhood caries, obesity and anthropometric measurements: Is there a relationship?

This brief research report explored the relationship among obesity, anthropometric measurements, and early childhood caries (ECC), in 3–5 years-old children. Three hundred and ninety-one Brazilian preschoolers were given anthropometric examinations for the assessment of general, peripheral, and central adiposity, by the following measures: body mass index (BMI), hip circumference, and waist circumference. Obesity status was determined by BMI according to WHO standards. Parent's age and BMI were assessed by questionnaire, and sucrose exposure was tracked by means of a food diary. For the assessment of ECC, dental examinations were performed according to modified WHO criteria. Also, the presence of dental biofilm in maxillary incisors was detected. A direct association between BMI and ECC was found in the bivariate analysis and the best possibility of logistic regression model showed that hip circumference (HC) values ≥62 centimeters (OR = 1.63; p = 0.033) jointly with the presence of dental biofilm (OR = 2.38; p = 0.000), children's ages ≥37 months (OR = 5.09; p = 0.012), and mothers younger than 35 years (OR = 1.96; p = 0.004) were significantly connected with ECC. In conclusion, peripheral adiposity (represented by HC) in young children was in fact associated with ECC. Thus, hip circumference might be a valuable tool for exploring the relationship between caries and obesity in the early years of life.

Dental caries and associated risk factors in 13- to 18-month-old infants receiving breast or formula milk feeding: A cross-sectional study

BACKGROUND

The association between breast milk feeding and dental caries risk in children remains controversial. Moreover, it is unclear whether risk factors for caries differ between breast milk-fed and formula milk-fed infants.

AIM

To investigate dental caries in 13- to 18-month-old infants receiving breast milk or formula milk feeding and associated risk factors.

DESIGN

One hundred and sixty-six 13- to 18-month-old infants were recruited from a tertiary hospital in Bangkok, Thailand. Information on feeding practices, demographics, and potential risk factors was collected using a caregiver questionnaire. Carious lesions were identified by visual and tactile examination. The Chi-squared test, Mann-Whitney U test, and logistic regression model were used for statistical analysis.

RESULTS

The prevalence of caries in breast milk- and formula milk-fed infants was 31.8% and 36.0%, respectively, with no statistically significant difference (p = .579). Among all children, having dental plaque deposition on more than one third of the crown (adjusted OR (aOR): 15.11%; 95% CI: 6.11-37.35) and sleeping while milk feeding (aOR: 2.20%; 95%CI: 1.01-4.77) were associated with dental caries. In subgroup analysis, however, sleeping while milk feeding increased caries risk in the formula milk-fed group only (aOR: 2.95%; 95%CI: 1.07-8.12).

CONCLUSIONS

The type of milk feeding was not associated with dental caries, whereas dental plaque and sleeping while milk feeding increased the odds of having dental caries in this population.

Prepregnancy BMI, gestational weight gain and offspring caries experience: Avon longitudinal study of parents and children

Pre-existing maternal overweight/obesity and pregnancy weight gain are associated with adverse birth outcomes such as low birth weight and prematurity, which may increase the risk of developmental tooth defects and early childhood caries. We sought to investigate the association between prepregnancy BMI, gestational weight gain (GWG) and the risk of early childhood caries. Data from 1,429 mother-offspring participants of the 1991/1992 Avon Longitudinal Study of Parents and Children were analyzed. The exposures were prepregnancy BMI (under/normal weight vs. overweight/obese), and gestational weight gain (GWG) based on the Institute of Medicine’s recommended levels. The main outcome measured was offspring caries experience determined by clinical oral examinations at three time points. Log binomial regression estimated risk ratios and 95% confidence intervals. Seventy six percent (76%) of the mothers were under/normal weight prepregnancy, 39% and 26% respectively gained less and more than the recommended weight for their prepregnancy BMI during pregnancy. Being overweight/obese prepregnancy was associated with unadjusted RR (95% CI) of offspring caries of 1.16 (0.90, 1.51) at 31-months, 1.20 (0.96, 1.49) at 43-months and 1.09 (0.91, 1.30) at 61-months. GWG less than recommended was associated with higher unadjusted offspring caries experience of 1.13 (0.86, 1.48), 1.17 (0.92, 1.48) and 1.04 (0.87, 1.25) at 31-months, 43-months and 61-months respectively. There was insufficient evidence to indicate an association between prepregnancy BMI and gestational weight gain on offspring caries experience risk.

Internalizing problems are associated with oral health-related quality of life in early childhood: Outcomes from an Asian multi-ethnic prospective birth cohort

Oral health status ideally warrants for a holistic biopsychosocial approach to health and wellness. Little is known about the impact of behavioral problems on oral health-related quality of life (OHRQoL) in children due to the paucity of studies in early childhood, particularly in Asian multi-ethnic populations. This study evaluated the relationship between early child's socioemotional factors and OHRQoL, as well as its association with orofacial pain (OFP) and early childhood caries (ECC) in the Asian GUSTO birth cohort. Mother-child dyads were postnatally assessed at 3 time points. The Child Behavior Checklist (CBCL) was used to assess the child's socioemotional and behavioral problems at age 4-4.5 years together with other validated questionnaires to evaluate maternal anxiety and depression. ECC detection was performed at age 5, and OHRQoL (primary) and OFP (secondary) outcomes were assessed at age 6 from a total of 555 mother-child dyads. After a univariate regression analysis was performed to identify potential predictors and confounders, a multivariate regression model was run with predisposing factors (CBCL internalization and externalization problems, OFP, ECC) and adjusted for confounders (maternal psychosocial states, maternal education) to determine associations with OHRQoL. Results showed an association between CBCL internalization scores and poorer OHRQoL (RR = 1.03, p = 0.033, 95% CI 1.01 to 1.05), although the limited risk ratio may not have a practical applicability in psychosocially healthy children, alike the majority of those evaluated in this cohort. The average OHRQoL overall score among children with OFP was 2.39 times more than those without OFP (OR = 2.39, p < 0.001, 95% CI 2.00 to 2.86). Thus, in early childhood, OFP, and to lesser extent internalizing behaviors, may negatively impact OHRQoL. This study therefore highlights the complex relationship between OHRQoL and its predisposing socioemotional and somatic pain factors, and demands further investigations in clinically relevant populations.

Dietary Patterns and Oral Health Behaviours Associated with Caries Development from 4 to 7 Years of Age

The association between modifiable risk factors and caries in children has been documented; however, most studies have been cross-sectional and have not considered the complexity of dietary factors and oral health habits. This study aimed to investigate the prospective association between dietary patterns and oral health behaviours at 4 years of age and the development of new decayed, missing, and filled teeth (d_3–6mft/D_3–6MFT) over a period of three years. Participants were children from the Generation XXI population-based birth cohort. At 4 years of age, diet patterns were assessed using a food frequency questionnaire, with three dietary patterns being identified. For the purpose of capturing the new development of caries between 4 and 7 years of age, two dental outcomes were defined in the mixed dentition: “dental caries development” and “severe dental caries development” in the mixed dentition. Bivariate analysis and multivariate logistic regression were used. From 4 to 7 years of age, 51.2% of the children had at least one new d_3–6mft/D_3–6MFT and 27.4% had more than two new d_3–6mft/D_3–6MFT. Children belonging to the “energy-dense foods” (OR = 2.19; 95% CI: 1.20–4.00) and “snacking” (OR = 2.19; 95% CI: 1.41–3.41) dietary patterns at 4 years old were associated with severe dental caries development three years later. Preventive strategies should be implemented in an attempt to reduce snacking and the consumption of energy-dense, micronutrient-poor foods to promote children’s oral health.

Pathways influencing dental caries increment among children: A cohort study

BACKGROUND

Dentists should assess pathways influencing the increment of dental caries among children to guide the prevention and treatment of the disease.

AIM

Evaluate the pathways that influence the increment of carious lesions in pre-school children.

DESIGN

This is a 2-year cohort study was conducted with a random sample of 639 pre-school children in southern Brazil. Caries experience, socioeconomic status (SES), social capital, and psychosocial characteristics were obtained at baseline. Increment of dental caries was assessed at 2 years follow-up in 467 children (cohort retention rate of 73.1%). Previously calibrated examiners assess the caries through the International Caries Detection and Assessment System (ICDAS). Structural equation modeling (SEM) was performed to test the pathways influencing dental caries increment.

RESULTS

Dental caries at baseline was heavily influenced by children's age (SC: 0.381, P < .01), tooth plaque (SC: 0.077, P = .02), parent's perception child oral health (SC: 0.295, P < .01), and household (SC: 0.148, P < .01). Increment of dental caries was directly affected by dental caries at baseline (Standardized Coefficients [SC]: 0.377, P < .01). Indirect paths were not significant.

CONCLUSIONS

Dental caries experience was the main factor of direct influence on the increment of caries, reinforcing the theory of risk accumulation over time.

Childhood Factors and Dental Caries in the Permanent Dentition: Findings of an 8-Year Study Under a Nationwide School Dental Service

OBJECTIVE

This study, using a retrospective analysis of nationwide dental records of school-going children over 8 years, aims to identify childhood factors associated with dental caries incidence in the permanent dentition up to adolescence.

METHODS

Students studying in primary and secondary schools in Singapore are eligible for free basic dental care under the nationwide School Dental Service (SDS). All available dental records, general health records, and sociodemographic data from 2009 to 2017 were extracted as anonymised records, for a full cohort of 29,617 students that were enrolled in Primary 1 in 2009. Multiple logistic regression and modified Poisson regression were applied to identify risk factors for caries incidence in the permanent dentition over 8 years.

RESULTS

Caries occurred in the permanent dentition of 9389 (31.7%) students in the 8 years. Risk of caries incidence in the permanent dentition was associated with baseline caries in the primary (risk ratio [RR]: 1.88; 95% CI: 1.81, 1.95) and permanent (RR: 1.54; 95% CI: 1.47, 1.61) dentition, tooth hypoplasia (RR: 1.58; 95% CI: 1.49, 1.68), and poor baseline oral hygiene (RR: 1.07; 95% CI: 1.03, 1.12). Sociodemographic predictors of caries incidence include a lower socioeconomic status, Chinese ethnicity, female gender, and enrolment in nonmainstream schools or schools in the Eastern and Western regions of Singapore.

CONCLUSIONS

Both clinical and sociodemographic factors in childhood are associated with caries incidence in the permanent dentition and can be used for structuring dental service provision and identifying caries-susceptible individuals and groups for early prevention and intervention.

Influence of a programme for prevention of early childhood caries on early orthodontic treatment needs

OBJECTIVES

The aim of this prospective birth cohort study was to evaluate the effect of the programme for prevention (PP) of early childhood caries and the resulting need for orthodontic treatment in 8-year-old German children.

MATERIAL AND METHODS

Children who had been enrolled in a caries-risk-related recall system with continuous dental care starting at the time of birth (prevention group, PG) were compared with children of the same birth cohort whose parents decided not to participate in the programme (control group, CG). All children (n = 289) participating in the last PP evaluation at the age of 5 years were invited again and examined by blinded clinicians. Dental caries was scored using the WHO diagnostic criteria expanded to d1-level without radiography. Impressions were taken of children with premature tooth loss to analyse space conditions.

RESULTS

Two hundred twenty-seven children (mean age 8.4 ± 0.6 years; 46.7% female) were examined. Children in the PG (n = 127) showed significantly lower caries prevalence and experience (3.1%, 0.4 ± 1.0 d3-4mft) than children in the CG (37.3%, 3.9 ± 3.5 d3-4mft). Orthodontic analysis found a higher prevalence of premature tooth extraction, followed by a greater extent of space loss in the CG (41.0%; 3.3 ± 4.4 mm) vs. PG (7.9%; 0.4 ± 1.9 mm) and an increase in early orthodontic treatment need (KIG P3, IOTN 5).

CONCLUSIONS

The PP was an effective approach for preventing caries-related premature tooth loss in children and conserving relevant arch length.

CLINICAL RELEVANCE

Children who received continuous dental care starting at the time of birth showed better oral health with less premature loss of deciduous teeth and lower need for orthodontic treatment at the age of 8 years.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00003438, https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003438.

U-shaped association between maternal age at delivery and dental caries in offspring

OBJECTIVE

To determine the association between maternal age at delivery and caries in offspring.

MATERIALS AND METHODS

This registry-based cohort study included all children born between 2000 and 2003 and who were residing in Stockholm County, Sweden, at 7 years of age. Between 2007 and 2010, the cohort (n = 65,259) was examined to determine caries experience (deft scores) at 7 years of age. Age of mother at childbirth was retrieved from the patient histories. Data were analysed using linear regressions.

RESULTS

The lowest mean deft occurred in children born to mothers aged 25-34 years. The final model - adjusted for sex, income, educational level, migration background, family situation, smoking, obesity, small for gestational age, and number of siblings - found that young mothers and older mothers were significant risk indicators for caries experience at 7 years of age.

CONCLUSIONS

The present study found a U-shaped relationship between maternal age at childbirth and caries experience in the offspring at age 7 years. The offspring of mothers under 25 or over 34 years of age are at greater risk of having more teeth with caries experience.

Caries Risk Prediction Models in a Medical Health Care Setting

Despite development of new technologies for caries control, tooth decay in primary teeth remains a major global health problem. Caries risk assessment (CRA) models for toddlers and preschoolers are rare. Among them, almost all models use dental factors (e.g., past caries experience) to predict future caries risk, with limited clinical/community applicability owing to relatively uncommon dental visits compared to frequent medical visits during the first year of life. The objective of this study was to construct and evaluate risk prediction models using information easily accessible to medical practitioners to forecast caries at 2 and 3 y of age. Data were obtained from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) mother-offspring cohort. Caries was diagnosed using modified International Caries Detection and Assessment System criteria. Risk prediction models were constructed using multivariable logistic regression coupled with receiver operating characteristic analyses. Imputation was performed using multiple imputation by chained equations to assess effect of missing data. Caries rates at ages 2 y (n = 535) and 3 y (n = 721) were 17.8% and 42.9%, respectively. Risk prediction models predicting overall caries risk at 2 and 3 y demonstrated area under the curve (AUC) (95% confidence interval) of 0.81 (0.75-0.87) and 0.79 (0.74-0.84), respectively, while those predicting moderate to extensive lesions showed 0.91 (0.85-0.97) and 0.79 (0.73-0.85), respectively. Postimputation results showed reduced AUC of 0.75 (0.74-0.81) and 0.71 (0.67-0.75) at years 2 and 3, respectively, for overall caries risk, while AUC was 0.84 (0.76-0.92) and 0.75 (0.70-0.80), respectively, for moderate to extensive caries. Addition of anterior caries significantly increased AUC in all year 3 models with or without imputation (all P < 0.05). Significant predictors/protectors were identified, including ethnicity, prenatal tobacco smoke exposure, history of allergies before 12 mo, history of chronic maternal illness, maternal brushing frequency, childbearing age, and so on. Integrating oral-general health care using medical CRA models may be promising in screening caries-susceptible infants/toddlers, especially when medical professionals are trained to "lift the lip" to identify anterior caries lesions.

Infant dietary patterns and early childhood caries in a multi-ethnic Asian cohort

Dental caries, although preventable, remains one of the most prevalent chronic disease worldwide. Most studies focused on the relationship between sugar intake and caries. However, examining multidimensional dietary patterns is becoming increasingly important. Here, we examined the relationship between dietary patterns from ages 6 to 12 months and early childhood caries (ECC) at age 2 to 3-years. Infant dietary data was collected from caregivers and dietary pattern trajectories from 6 to 12 months derived. Oral examinations were carried out by trained calibrated dentists at ages 2 and 3 years. Associations between dietary pattern and ECC were estimated using generalized estimating equation. We found a 3.9 fold lower prevalence of decayed surfaces among children with high Guidelines dietary pattern scores at 6-months (IRR 0.26; CI [0.12–0.53]; p-value < 0.001) and 100% reduction of decayed surfaces with increased intakes of Guidelines dietary pattern foods from 6 to 12-month (IRR 2.4 × 10⁻⁴; CI [4.2 × 10⁻⁷–0.13]; p-value = 0.01). Suggesting that following the Guideline dietary pattern, which corresponds most closely to current World Health Organization weaning guidelines, at 6 months and an increase in pattern score between 6 and 12 months were protective against ECC development compared to Predominantly breastmilk, Easy-to-prepare foods and Noodles (in soup) and seafood dietary patterns.

Fluoride Use in Health Care Settings: Association with Children's Caries Risk

Expanded partnership with the medical community is an important strategy for reducing dental caries disparities. The purpose of this study was to assess the relationship between fluoride (F) "in office" (drops/tablets and/or varnish), as prescribed or applied by a health care professional by age 1 y, and 1) caries development and 2) presence of other caries risk factors or mediators (e.g., socioeconomic status). Child-primary caregiver (PCG) pairs ( N = 1,325) were recruited in Indiana, Iowa, and North Carolina as part of a longitudinal cohort study to validate a caries risk tool for primary health care settings. PCGs completed a caries risk questionnaire, while children received caries examinations per the criteria of the International Caries Detection and Assessment System at ages 1, 2.5, and 4 y. Baseline responses regarding children's history of F in office were tested for association with other caries risk variables and caries experience at ages 2.5 and 4 y via generalized estimating equation models applied to logistic regression. The sample was 48% female, and many children (61%) were Medicaid enrolled. The prevalence of cavitated caries lesions increased from 7% at age 2.5 y to 25% by age 4 y. Children who received F in office were likely deemed at higher caries risk and indeed were significantly ( P < 0.01) more likely to develop cavitated caries lesions by ages 2.5 and 4 y, even after F application (odds ratios: 3.5 and 2.3, respectively). Factors significantly associated with receiving F included the following: child being Medicaid enrolled, not having an employed adult in the household, child and PCG often consuming sugary drinks and snacks, and PCG having recent caries experience. Increased F in office from a health care provider by age 1 y was associated with known caries risk factors. Most (69%) children had never been to the dentist, suggesting that risk factors could be alerting medical providers and/or parents, thereby affecting in-office F recommendations. Differences among states could also be related to state-specific F-varnish reimbursement policies (ClinicalTrials.gov NCT01707797).

The role of human milk and sucrose on cariogenicity of microcosm biofilms

This study investigated the effect of human milk, alone and associated with sucrose, in the cariogenicity of biofilms in a microcosm biofilm model and compared with the cariogenicity of sucrose and bovine milk. Microcosm biofilms were grown in enamel discs in 24-well plates. Six growth conditions were studied: DMM (chemically defined artificial saliva - negative control), DMM with 1% of sucrose (DMM+s) (positive control), human milk with DMM, human milk with DMM+s, bovine milk with DMM, and bovine milk with DMM+s. After 5 days, the outcome variables surface hardness change (%SHC), microbiological composition of biofilms, and pH of supernatant were analyzed. All groups had significantly lower hardness loss compared to the DMM group with 1% of sucrose. Human and bovine milk associated with sucrose showed higher hardness loss. The supernatant pH values after 6 hours of different treatments were similar for the groups sucrose and human milk associated with sucrose (p>0.05). After 18 hours at rest in pure DMM, an increase in the pH of the supernatant was observed. Higher values of total microorganisms count were found for sucrose and bovine milk groups compared to the group supplemented only by DMM. Bovine milk group showed greater amount of total aciduric microorganisms in comparison to human milk group. Within the limits of this study, it can be infered that both human and cow milks have some cariogenic potential, although differing from sucrose in terms of mineral loss.

Deep Artificial Neural Networks for the Diagnostic of Caries Using Socioeconomic and Nutritional Features as Determinants: Data from NHANES 2013⁻2014

Oral health represents an essential component in the quality of life of people, being a determinant factor in general health since it may affect the risk of suffering other conditions, such as chronic diseases. Oral diseases have become one of the main public health problems, where dental caries is the condition that most affects oral health worldwide, occurring in about 90% of the global population. This condition has been considered a challenge because of its high prevalence, besides being a chronic but preventable disease which can be caused depending on the consumption of certain nutritional elements interacting simultaneously with different factors, such as socioeconomic factors. Based on this problem, an analysis of a set of 189 dietary and demographic determinants is performed in this work, in order to find the relationship between these factors and the oral situation of a set of subjects. The oral situation refers to the presence and absence/restorations of caries. The methodology is performed constructing a dense artificial neural network (ANN), as a computer-aided diagnosis tool, looking for a generalized model that allows for classifying subjects. As validation, the classification model was evaluated through a statistical analysis based on a cross validation, calculating the accuracy, loss function, receiving operating characteristic (ROC) curve and area under the curve (AUC) parameters. The results obtained were statistically significant, obtaining an accuracy ≃ 0.69 and AUC values of 0.69 and 0.75. Based on these results, it is possible to conclude that the classification model developed through the deep ANN is able to classify subjects with absence of caries from subjects with presence or restorations with high accuracy, according to their demographic and dietary factors.

A Case⁻Control Study of Socio-Economic and Nutritional Characteristics as Determinants of Dental Caries in Different Age Groups, Considered as Public Health Problem: Data from NHANES 2013⁻2014

One of the principal conditions that affects oral health worldwide is dental caries, occurring in about 90% of the global population. This pathology has been considered a challenge because of its high prevalence, besides being a chronic but preventable disease which can be caused by a series of different demographic, dietary, among others. Based on this problem, in this research a demographic and dietary features analysis is performed for the classification of subjects according to their oral health status based on caries, according to the age group where the population belongs, using as feature selector a technique based on fast backward selection (FBS) approach for the development of three predictive models, one for each age range (group 1: 10–19; group 2: 20–59; group 3: 60 or more years old). As validation, a net reclassification improvement (NRI), AUC, ROC, and OR values are used to evaluate their classification accuracy. We analyzed 189 demographic and dietary features from National Health and Nutrition Examination Survey (NHANES) 2013–2014. Each model obtained statistically significant results for most features and narrow OR confidence intervals. Age group 2 obtained a mean NRI = −0.080 and AUC = 0.933; age group 3 obtained a mean NRI = −0.024 and AUC = 0.787; and age group 4 obtained a mean NRI = −0.129 and AUC = 0.735. Based on these results, it is concluded that these specific demographic and dietary features are significant determinants for estimating the oral health status in patients based on their likelihood of developing caries, and the age group could imply different risk factors for subjects.