Presence of Initial Caries Lesions as a Risk Factor for Caries in Preschool Children: A Cohort Study

The Impact of Socio-Environmental, Individual, and Biological Factors on Oral Health-Related Quality of Life among Preschool Children: A Cohort Study with 3-Year Follow-Up

This study assessed impact of socio-environmental, individual, and biological factors on the worsening and severe worsening of oral health-related quality of life (OHRQoL) among preschoolers and their families. A cohort study was conducted in Diamantina, Brazil, with 151 children between 1 and 3 years of age and their mothers, who were evaluated at baseline (2014) and re-evaluated after 3 years (2017). The children were clinically examined to assess the presence of dental caries, malocclusion, dental trauma, and enamel defects. The mothers answered the Early Childhood Oral Health Impact Scale (B-ECOHIS) and a questionnaire addressing individual characteristics of the child and socio-environmental factors. Extensive caries found in the follow-up (relative risk [RR] = 1.91; 95% confidence interval [CI] = 1.26-2.91) and failure to undergo the dental treatment recommended at baseline (RR = 2.49; 95% CI = 1.62-3.81) were associated with worsening of OHRQoL over 3 years. An increase in the number of children in the household (RR = 2.95; 95% CI = 1.06-8.25), occurrence of extensive caries in the follow-up (RR = 2.06; 95% CI = 1.05-4.07), and failure to undergo the dental treatment recommended at baseline (RR = 3.68; 95% CI = 1.96-6.89) were associated with a severe worsening of OHRQoL. In conclusion, the risk of worsening and severe worsening of OHRQoL was higher in preschoolers with extensive caries at follow-up and among those who did not undergo dental treatment. Furthermore, severe worsening of OHRQoL was also impacted by an increase in the number of children in the household.

Impact of dental bullying on bruxism associated with poor sleep quality among adolescents

This study aimed to investigate the impact of school bullying and oral health-related verbal bullying on the occurrence of bruxism associated with poor sleep quality among adolescents. This cross-sectional study was nested in a cohort study performed with a sample of children from southern Brazil. Possible sleep bruxism was determined by the question: "Has anyone told you that you grind your teeth in your sleep?" Sleep quality was determined by answering the following question: "How would you classify the quality of your sleep?". The outcome was created by combining occurrence of sleep bruxism and poor sleep quality. The Sense of Coherence (SOC) was assessed using the SOC-13 scale. Bullying was investigated using the victim scale of the Olweus Bullying Questionnaire and oral health-related verbal bullying using an item from the Child Perceptions Questionnaire-11-14. Demographic, socioeconomic, psychosocial, and clinical data were also collected. Poisson regression models with robust variance were used. Results were expressed as prevalence ratio (PR) and 95% confidence intervals (95% CI). A total of 429 adolescents with a mean age of 12.6 (standard deviation 1.3) years were evaluated. The prevalence of bruxism associated with poor sleep quality was 23.7%. Victims of school bullying (PR 2.06; 95%CI: 1.01-4.22) and oral health-related verbal bullying (PR 1.87; 95%CI: 1.18-2.95) presented higher prevalence of bruxism associated with poor sleep quality. Factors such as skin color and SOC were also associated with the outcome. These findings suggest an association between episodes of bullying and bruxism related to poor sleep quality.

Impact of early childhood caries severity on oral health-related quality of life among preschool children in Mexico: A cross-sectional study

BACKGROUND

Information is scarce on Early Childhood Caries (ECC) in Mexican preschool children and its impact on quality of life.

AIM

To evaluate the ECC prevalence and its impact on OHRQoL in 3-5 years-old Mexican children according to disease severity.

DESIGN

Caries was determined at two thresholds: (1) children with at least one caries lesion (ICDAS-1-6) and (2) children with at least one lesion in dentin (ICDAS-3-6). OHRQoL was assessed through the Mexican Early Childhood Oral Health Impact Scale (M-ECOHIS). Associations among caries severity, M-ECOHIS, and other variables were assessed by ordinal logistic regression.

RESULTS

A total of 409 children participated (53.8% girls, 46.2% boys). Caries prevalence was 82.2% considering all lesions, and 45.0% for dentinal lesions. Significant linear trends (p < .05) among caries levels and categories of exposure were found for socioeconomic variables, dietary habits, and toothbrushing habits. Attending rural private schools (OR = 1.39, 95%CI = 1.11-1.72; p < .01), two main meals/day (OR = 2.75, 95%CI = 1.26-6.03; p = .01) and unsupervised toothbrushing (OR = 3.20, 95%CI = 1.96-5.24; p < .01) increased the risk to have high caries severity levels. M-ECOHIS scores were statistically significant associated with caries levels (χ² ₍₄₎  = 175.85, p < .01; trend across groups z = 12.63 Prob > |z| < 0.01).

CONCLUSIONS

M-ECOHIS was significantly associated with caries severity. Type of school, age groups, parents' educational level, family income, and living conditions were correlated with caries, showing how distinctive risk indicators were associated with different caries stages.

Cross Sectional Study on the Association between Dental Caries and Life Habits in School Age Italian Children

Dental caries is still a major public health issue and influences the overall health of children. The risk factors for caries include biological, socio-behavioral, and environmental factors. Our aim is to assess the association between dental caries and the life habits of children and their parents. A cross-sectional study was conducted in Rome (Italy) among primary school children aged 5 to 11. Parents completed the anamnestic questionnaire, and a dental clinical examination was performed on 333 children. Caries prevalence was 38.7% overall, 47% in males and 31.9% in females. The association between bottle night-time feeding and caries was statistically significant (43.2%; p = 0.013). Usage of a honeyed pacifier was also significantly associated with the presence of caries (72.7%; p = 0.027). Finally, higher caries prevalence was found among male children (47% vs. 31.9%; p = 0.005). The present study shows that the percentage of caries is still high in the paediatric population, and caries prevalence is associated with life habits. Our results highlight the importance of oral health education programs at primary school that involve teachers and parents to contribute to improving lifestyles.

Comparison of Two Types of Pit and Fissure Sealants in Reducing the Incidence of Dental Caries Using a Split-Mouth Design

Objectives

To evaluate the effectiveness of two pit and fissure sealants (PFS) in reducing the incidence of dental caries in schoolchildren.

Material and Methods

A randomized split-mouth experimental design was used in a sample of 140 subjects assigned to two groups. The sealants used were Clinpro©3M and BeautiSealant©Shofu placed in first permanent molars (FPMs). Each sealant was compared to molars in the controls to determine effectiveness over a period of 6 months. The study had a 12.9% loss to follow-up. No statistically significant differences (p>0.05) were observed for sex, age, baseline dmft, or type of sealants. Nonparametric tests were used for statistical analysis.

Results

Average dmft index at baseline was 4.10±3.16. Lower incidence of caries was observed in FPMs with pit and fissure sealants (p<0.01), regardless of the type used. When sealants remained intact there was a lower caries incidence compared to sealants partially or completely missing – but differences were only significant for FPM 16. Caries incidence was higher for BeautiSealant sealed teeth than for Clinpro’s, but only statistically significant in FPMs 16, 36 and 46 (p< 0.05). Caries incidence was higher in those cases with a higher baseline dmft but it only reached statistical significance in FPMs 26 and 36. Relative risks for dental caries were lower in sealed teeth (p<0.01).

Conclusions

Pit and fissures sealants are an effective preventive treatment to reduce caries during a 6-month follow-up in schoolchildren 6 to 8 years of age, regardless of the type of sealant used. The sealant brand that showed greater effectiveness in terms of prevention and retention was Clinpro©3M.

How combining different caries lesions characteristics may be helpful in short-term caries progression prediction: model development on occlusal surfaces of primary teeth

Background

Few studies have addressed the clinical parameters' predictive power related to caries lesion associated with their progression. This study assessed the predictive validity and proposed simplified models to predict short-term caries progression using clinical parameters related to caries lesion activity status.

Methods

The occlusal surfaces of primary molars, presenting no frank cavitation, were examined according to the following clinical predictors: colour, luster, cavitation, texture, and clinical depth. After one year, children were re-evaluated using the International Caries Detection and Assessment System to assess caries lesion progression. Progression was set as the outcome to be predicted. Univariate multilevel Poisson models were fitted to test each of the independent variables (clinical features) as predictors of short-term caries progression. The multimodel inference was made based on the Akaike Information Criteria and C statistic. Afterwards, plausible interactions among some of the variables were tested in the models to evaluate the benefit of combining these variables when assessing caries lesions.

Results

205 children (750 surfaces) presented no frank cavitations at the baseline. After one year, 147 children were reassessed (70%). Finally, 128 children (733 surfaces) presented complete baseline data and had included primary teeth to be reassessed. Approximately 9% of the reassessed surfaces showed caries progression. Among the univariate models created with each one of these variables, the model containing the surface integrity as a predictor had the lowest AIC (364.5). Univariate predictive models tended to present better goodness-of-fit (AICs < 388) and discrimination (C:0.959–0.966) than those combining parameters (AIC:365–393, C:0.958–0.961). When only non-cavitated surfaces were considered, roughness compounded the model that better predicted the lesions' progression (AIC = 217.7, C:0.91).

Conclusions

Univariate model fitted considering the presence of cavitation show the best predictive goodness-of-fit and discrimination. For non-cavitated lesions, the simplest way to predict those lesions that tend to progress is by assessing enamel roughness. In general, the evaluation of other conjoint parameters seems unnecessary for all non-frankly cavitated lesions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01568-2.

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.

Sedentary behavior, unhealthy food consumption and dental caries in 12-year-old schoolchildren: a population-based study

This study analyzed the association between sedentary behavior (SB), unhealthy food consumption, and dental caries amongst 12-year-old schoolchildren. An epidemiological survey was carried out in the five largest cities (> 80,000 inhabitants) of the State of Mato Grosso do Sul, Brazil. Data were collected on decayed, missing and filled teeth index (DMFT), sociodemographic characteristics, SB, unhealthy food consumption, and water fluoridation status. The analysis was based on the theoretical framework established by J Sisson. Structural equation models were performed to test the association of dental caries experience with sociodemographic, contextual, and behavioral factors. The mean DMFT index in the five cities was 1.02 (95%CI: 0.39-1.66). Higher sedentary behavior (more than 2 hours/day) [standardized coefficient (SC) = 0.21 95%CI: 0.07-0.39] and higher unhealthy food consumption (more than 4 times/week) [SC = 0.23 (0.10-0.45)] were associated with higher DMFT index than their counterparts. Also, cities with fluoridated water were associated with lower DMFT index [SC = -0.85 (-1.20--0.50)]. Families who had a per capita income above the poverty line had a direct association with unhealthy food consumption [SC = -0.24 (-0.38--0.11)]. Unhealthy food consumption mediated the association of sedentary behavior on DMFT index [SC=0.07 (0.02-0.13)]. Sensitivity analysis confirmed the findings. Sedentary behavior mediated by unhealthy food consumption had a significant association with dental caries experience. Public policies must address transdisciplinary actions to reduce sedentary behavior and unhealthy food consumption and promote water fluoridation.

THE PERCEPTION OF CAREGIVERS OF POOR ORAL HEALTH OF THEIR CHILDREN AND ITS RELATED CLINICAL CONDITIONS

Objective:

To determine the association between the perception of caregivers regarding the oral health of their children and socio-demographic characteristics, report of dental pain, and clinical oral conditions.

Methods:

A cross-sectional study was conducted with 570 children aged two to five years old, enrolled at public preschools, and with their caregivers. Data regarding perceptions of oral health status in children, socio-demographic characteristics, and dental pain were collected from a questionnaire. Three examiners (Kappa>0.7) evaluated children’s oral health status using the dmft index, pufa index, and the Andreasen classification for traumatic dental injury (TDI). The occurrence of open bite and overjet was also investigated. Descriptive analyses, and unadjusted and adjusted logistic regression were used, considering a 5% significance level.

Results:

A total of 24.7% of children had poor oral health status, which increased 4.92-fold (95% confidence interval [95%CI] 3.05-7.93) when children had dental caries, and 3.78-fold (95%CI 1.63-8.76) when there were consequences from dental caries. The perception of poor oral health was also associated to open bite (Odds Ratio [OR] 1.98; 95%CI 1.16-3.38) and TDI (OR 1.68; 95%CI 1.06-2.68). No associations were found between the perception of caregivers and socio-demographic variables or overjet.

Conclusions:

The perception of caregivers of poor oral health in their children was associated to dental caries, its consequences, TDI, and open bite.

Caries prevalence and caries experience (ICDAS II criteria) of 5-, 12- and 15-year-old Greek children in relation to socio-demographic risk indicators. Trends at the national level in a period of a decade

PURPOSE

To study the caries status of 5, 12 and 15-year-old Greek children, assess how disease parameters are related to socio-demographic indicators and identify relevant trends at the national level.

METHODS

A stratified cluster sample of 3702 children in total was randomly selected and examined clinically for caries (ICDAS II criteria). Caries experience was outlined by adapting ICDAS_0-6 criteria to the d/D component of the WHO dmf/DMF index configuration. Percentages (%) of caries experience-free children, of children with initial caries (ICDAS_1-2), and the mean d_1-2t/D_1-2T, d_3-6mft/D_3-6MFT and d_3-6mfs/D_3-6MFS indices were calculated. The probability of presenting with d_1-2t/D_1-2T ≥ 1 was assessed by binary logistic regression analysis, whereas negative binomial regression models examined the effect of socio-demographic parameters on d_3-6mfs/D_3-6MFS indices (level of significance: p ≤ 0.05).

RESULTS

60.1%, 48.1%, and 34.7% of the 5, 12, and 15-year-old children, respectively, had no caries experience at the defect level (d_3-6mft/D_3-6MFT = 0). Initial lesions (ICDAS_1-2) were detected in 17.7%, 19.3% and 17.4% of the 5, 12 and 15-year-olds, accordingly. Mean d_1-2t/D_1-2T was 0.93, 1.70, and 2.51, whereas mean d_3-6mft/D_3-6MFT was 1.48, 1.61, and 2.46 for the 5, 12, and 15-year-olds, respectively. Children with higher educated parents and 15-year-old urban residents exhibited significantly less caries experience at the defect level. Initial caries lesions presented a significantly higher probability of being detected in urban-residing 5- and 15-year-olds, while no consistent trend could be identified for parental education level. Caries prevalence and experience levels declined for all age groups in ten years.

CONCLUSION

Although the dental health of Greek children has improved disparities remain, calling for organised primary and secondary preventive interventions.

Inclusion of initial caries lesions in a population-based sample of Brazilian preschool children: Impact on estimates and treatment needs

This study aimed to assess changes in epidemiological estimates and treatment needed when initial caries lesions are included in a population-based survey of preschool children. A cross-sectional survey was conducted in a Brazilian municipality, collecting data of preschool children in 16 health centers. Caries detection used the merged codes (epi-codes) for ICDAS/ICCMS. An option for treatment, according to ICCMS, was chosen during the examination. Caries experience (dmft/dmfs) and prevalence were estimated considering three thresholds (A- initial, moderate, and severe lesions, B- only moderate and severe lesions and C- severe lesions). Incremental need for non-operative care was also verified. The sample consisted of 663 children aged 2–4 years (response rate of 99.85%). Including initial lesions, a 2-fold increase in dmft was observed (A: 3.36, B: 1.02, p<0.001). With the inclusion, the caries prevalence increased to 75% compared to threshold B only (28%). The majority (76%) of children who required any intervention (56%) should be scheduled for non-operative care. We suggest that including initial caries lesions in an epidemiological survey may significantly impact assessment of population caries experience.

Enamel and Dentin Caries Risk Factors of Adolescents in the Context of the International Caries Detection and Assessment System (ICDAS): A Longitudinal Study

Objective: The objective of this study was to identify risk factors for enamel and dentin caries in adolescents. Method: This 1-year longitudinal study was conducted in 2018 and 2019; 13- to 14-year-old adolescents were recruited. The merged International Caries Detection and Assessment System (ICDAS) was used to identify caries. The relationships between the caries increment and variables were analyzed with a zero-inflated negative binomial (ZINB) regression model. Results: A total of 1,016 participants completed the assessment. The ZINB analysis found that individuals with caries at baseline were more likely to develop new dentin caries. Females, or individuals who had a high cariostat score had an increased likelihood of having a high ΔD4-6MFT score. Among the caries-free adolescents at baseline, females, or individuals who consumed snacks once or more than once a day were more likely to develop caries. Individuals from one-child families, who used fluoride toothpaste, and who had a high saliva buffering capability (pH≥4.25) had an increased likelihood of a low ΔD1-6MFT score. Conclusion: The results suggest that there are some specific risk factors of initiating of enamel caries in adolescents, including the frequency of snack consumption, sex, saliva buffering capability, fluoride toothpaste usage and belonging to a one-child family. In all adolescents, most of whom have enamel caries, the dentin caries risk factors were past caries experience, cariostat score and sex.