Dental caries status and its associated factors among 5-year-old Hong Kong children: a cross-sectional study

Prevalence of dental carries and its association with breastfeeding duration among young children in Addis Ababa, Ethiopia

BACKGROUND

Breastfeeding is a crucial feeding practices that significantly contributes to the healthy development of children. However, the effect of breastfeeding duration on caries risk is unclear, as different studies have found different results. This study aims to assess the prevalence of dental caries and its association with breastfeeding duration among young children aged 12-36 months in selected health facilities of Addis Ababa, Ethiopia.

METHODS

A cross-sectional study among 380 children aged 12-36 months from 11 health centers in Addis Ababa was conducted. Questionnaires and dental examinations were used to collect data. Dental caries was measured by the deft (decayed-extracted-filled teeth) index. Binary logistic regression was used to assess the association between dental caries and duration of breastfeeding, after adjusting for the confounders.

RESULTS

The prevalence of dental caries was 53.4% (95% CI: 48.3, 58.5%), with 13.7% having high caries and 39.7% having low caries. Breastfeeding duration was not significantly associated with dental carries, after adjusting for confounders. However, sugar intake, older age, mothers' unemployment, and not being in marital union are risk factors for dental caries development.

CONCLUSIONS

Promotion of healthy diet, especially limiting intake of sugar and sweets, and integration of oral health into primary health care programs are recommended. Further research using longitudinal design or meta-analysis is recommended to establish more concise evidence on the association between breastfeeding duration and dental caries.

Early Childhood Caries and Dental Public Health Programmes in Hong Kong

The objective of this study was to investigate the relationship amongst early childhood caries (ECC), economic development, and dental public health programmes in Hong Kong. We searched exhaustively qualitative and quantitative data on the oral health policy, dental service, public health strategies of caries control and epidemiologic surveys on ECC. We then performed meta-regression to explore the impact of the Human Development Index (HDI), gross domestic product (GDP) growth, water fluoridation, oral health promotion, dental school establishment, free education, and dental workforce on ECC prevalence in 5-year-olds. We found that the first government oral health survey was conducted in 1960, when Hong Kong experienced significant growth, as the HDI indicated. The survey revealed that 97% of 6- to 8-year-old children experienced ECC. Water fluoridation was implemented in 1961 at 0.7 ppm (0.9 ppm in winter) to prevent caries. The government offered free 9-year education in 1978. In 1981, the government established a dental school to improve a low dentist-to-population ratio of 1:9000. The ECC prevalence amongst 5- to 6- year-old children was reduced from 84% in 1968 to 63% in 1986. The Department of Health created an oral health education division in 1989. The ECC prevalence for 5-year-old children was further reduced to 44% in 1997. The ECC prevalence amongst 5-year-old children was stabilised at 51% both in 2001 and 2011. However in 2021, the prevalence of untreated ECC increased to 57% during the outbreak of COVID-19. Meta-regression analysis showed that ECC prevalence was not linked to GDP growth but decreased with improvements in HDI, the provision of 9-year free education, the establishment of a dental school, fluoridation of water supply, and implementation of territory-wide oral health promotion. In conclusion, better education, living conditions, and dental public health programmes have improved children's oral health in Hong Kong.

Self-reported oral health-related quality of life and caries experiences of 5-year-old children in Mandalay, Myanmar

BACKGROUND

This study aimed to examine the impact of dental caries and other potential socio-demographic factors on the oral health-related quality of life (OHRQoL) of preschool children from Myanmar. This was done using the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) as reported by both the children and their parents.

METHODS

A structured questionnaire was conducted to collect demographic information about the children and their caregivers, as well as socioeconomic data. The OHRQoL was assessed by interviewing the children and their parents using the Myanmar versions of SOHO-5c and SOHO-5p, respectively. Caries experience was assessed by two calibrated examiners and recorded using the dmft index. The Poisson regression model was adopted to investigate the association between OHRQoL and dental caries including socioeconomic factors.

RESULTS

A total of 454 pairs participated in the study. Among them, 64% of children and 70% of parents reported a negative impact on OHRQoL (with SOHO-5c and SOHO-5p scores exceeding 0). The mean score (SD) of the child self-report and parental version of the SOHO-5 was 1.86 (2.27) and 2.65 (3.13), respectively. Difficulties in eating and sleeping were the most commonly reported by both children and parents. The overall prevalence of dental caries was 87% (mean dmft score:5.59, SD:4.65). The final multivariate-adjusted model revealed that children with higher caries experiences were more likely to have lower OHRQoL for both child self-report (RR 4.38, 95% CI 3.16-6.14, p < 0.001) and parental report (RR 6.07, 95% CI 4.38-8.41, p < 0.001), respectively. A lower family income had a negative impact on the children's OHRQoL in child self-report (RR 1.59, 95% CI 1.26-2.04, p < 0.001) and parental report (RR 1.46, 95% CI 1.19-1.78, p < 0.001).

CONCLUSION

Two-thirds of the study children and their parents perceived the negative impact on children's OHRQoL. Higher caries experience and lower family income were associated with poorer OHRQoL of 5-year-old Myanmar children.

Improvement of parents' oral health knowledge by a school-based oral health promotion for parents of preschool children: a prospective observational study

BACKGROUND

Parents of preschool children have inadequate oral health knowledge in Hong Kong. Parents play a critical role in preschool children's dietary patterns and oral health behaviors. A school-based oral health promotion (OHP) for parents of preschoolers was developed and investigated.

OBJECTIVES

The objective of this study was to evaluate effects of the school-based OHP for parents of preschool children on parents' oral health knowledge and preschool children's early childhood caries (ECC).

MATERIALS AND METHODS

This was a quasi-experimental study. Parents of preschool children were divided into the intervention group (IG) and the control group (CG) according to their own selection. Parents in the IG participated in a structured school-based OHP workshop, while those in the CG did not attend the OHP workshop. Parents in both groups were invited to complete a questionnaire assessing their oral health knowledge before (T0), one month after (T1), and twelve months after (T2) the OHP workshop. Preschool children's caries was examined via dmft score at T0 and T2.

RESULTS

Parents' oral health knowledge was negatively correlated with preschool children's dmft scores (R = -0.200, P < 0.001). Oral health knowledge was significantly improved in IG (P < 0.001) but not in CG (P = 0.392) at T1. Both groups experienced a significant improvement in oral health knowledge from T0 to T2 (P < 0.001). Parents' oral health knowledge in the IG was significantly higher compared to the CG at T1 (P < 0.001), but difference in the scores at T2 between the two groups showed no significant difference (P = 0.727). No significant difference was found in changes in children's dmft score from T0 to T2 between the IG and CG (p = 0.545).

CONCLUSION

Preschool children's high ECC is associated with the limited oral health knowledge of their parents. The school-based OHP workshop for parents increased parents' oral health knowledge within one month. This positive effect was maintained for twelve months and can be extended to a larger scale in the school setting.

Risk Indicators for Noncavitated and Cavitated Carious Lesions in Preschool Children

OBJECTIVE

The aim of this study was to evaluate the risk indicators associated with noncavitated and cavitated lesions in preschool children.

METHODS

The cross-sectional study included 3- to 4-year-old healthy children (N = 741) recruited in a randomised controlled clinical trial. After obtaining written informed consent, parents completed a questionnaire about their child's sociodemographic background and oral health-related behaviours and parents' oral health-related knowledge and attitude. Caries and plaque were evaluated using International Caries Detection and Assessment System-II and Visible Plaque Index (VPI), respectively. Children were grouped according to their oral health status as being caries-free (CF), having only noncavitated lesions (NC), or having cavitated lesions (CL). The least absolute shrinkage and selection operator (LASSO) sparse multinomial regression was used to study the variables using 1 standard error above the minimum criterion set at P < .05.

RESULTS

The prevalence of children with NC and CL was 29.1% and 49.4%, respectively, with a prevalence of early childhood caries being 78.5%. The proportion of children who brushed twice or more than twice a day was highest in CF (71.7%), followed by NC (58.3%), and was least in CL (57.7%). A higher percentage of CL children (56.2%) had twice or more than twice the frequency of between-meal snacking than CF (41.7%) and NC (41.1%) (P < .001) children. The variables included with non-zero coefficients in the model were mean parental oral health knowledge, attitude score, and children's mean VPI score, and all were significant for CL; however, in NC, only VPI score was found to be significant.

CONCLUSIONS

Poor oral hygiene is the risk indicator associated with the presence of NC in preschool children, whilst poor oral hygiene and poor parental oral health knowledge and attitude are associated with the presence of cavitated lesions.

Relevance of Sociocultural Inequalities and Parents' Origins in Relation to the Oral Health of Preschoolers in Lanzarote, Spain

Approaching inequalities to achieve health equity requires joint action. Early childhood caries affects disadvantaged population groups. The objective of this study was to determine the relevance of sociocultural inequalities and parental origin with respect to oral health in preschool children in Lanzarote. A transversal epidemiological study was carried out. Sociocultural data and information about parental origin were collected via a questionnaire. The decayed and filled teeth (dft), decayed teeth (dt), filled teeth (ft), restorative index (RI), plaque index (PI) and gingival index (GI) were obtained via an investigator's examination. Statistical analysis of the data indicated that children of semi-skilled manual workers (28.15%) had the highest prevalence of caries (46.9%). Additionally 43.7 of the mothers had second grade and first cycle studies. When relating the medium and high level of education, there were statistically significant differences in relation to the cod index (p = 0.046). When the origin was foreign (48.4%), preschoolers presented 10.7% more active or untreated caries than Spaniards (p = 0.038). Low socioeconomic cultural level and foreign origin is associated with a more deficient state of oral health in preschoolers. Oral health programs are needed to minimize social inequalities.

Fewer Children in Families Associated with Lower Odds of Early Childhood Caries: A Sample from Three Countries

Childhood caries experience is influenced by family characteristics and oral health practices in the context of many social-commercial determinants. The aim of this study was to explore the relationship between families' number of children, oral health practices and child caries experience in a convenience sample of 1374 children aged 6 months through 6 years and their families from Ecuador, Nepal, and Vietnam. Data were collected by mother interviews and child dental exams. Multivariate logistic and Zero-Inflated-Poisson regression analyses assessed associations between number of children, oral health practices and decayed, missing or filled teeth (dmft). Families had a mean of 2.2 children (range 1-12); 72% of children had tooth decay, with mean dmft of 5.4. Adjusting for child age, sex, and urban/rural location, a greater number of children in the family was associated with significantly less likelihood of unhealthy bottle feeding practices, having a toothbrush/toothpaste and parent helping child brush, and being cavity-free; higher number of dmft, and greater likelihood of having a dental visit. Early childhood oral health promotion should include focus on oral hygiene and healthy feeding-particularly breastfeeding and healthy bottle feeding practices-as well as access to family planning services and support for childcare.

Effectiveness of Silver Diamine Fluoride and Sodium Fluoride Varnish in Preventing New Carious Lesion in Preschoolers: A Randomized Clinical Trial

Introduction

Dental caries is a site-specific, multifactorial chronic disease affected globally. The prevalence of dental caries is strongly associated with social and economic disadvantage, and also the susceptibility of children to dental caries. Dental caries prevention can be achieved with topical fluoride agents. Topical fluoride promotes the remineralization of early carious lesions and reduces the demineralization of healthy enamel.

Aim

The aim of this randomized clinical trial was to compare the effectiveness of silver diamine fluoride (SDF) and sodium fluoride varnish (FV) in preventing new carious lesions in preschoolers.

Materials and methods

This randomized clinical trial was conducted on 285 children aged 3-6 years. Children were randomly allocated into three groups namely, group I-deionized distilled water (DIW), group II-sodium FV, and group III-SDF. The biannual application was performed at an interval of 6 months. New carious lesions were recorded using defs and International Caries Detection and Assessment System (ICDAS II) under LED magnifying loupes. Descriptive and inferential statistics were applied and tabulated using Statistical Package for the Social Sciences (SPSS) 23.0 software.

Result

There was a significant difference seen in the mean values of group III (SDF) when compared with group II (FV) and also between group III (SDF) and group I (DIW) when defs index was used. The mean score of ICDAS II after 12 months in group I (DIW) was -1.171, group II (FV) was -0.690, and group III (SDF) was -0.374.

Conclusion

silver diamine fluoride (SDF) was found to be most effective in preventing dental caries and also it appears to be the most cost-saving fluoride therapy.

How to cite this article

Jain A, Deshpande AN, Shah YS, et al. Effectiveness of Silver Diamine Fluoride and Sodium Fluoride Varnish in Preventing New Carious Lesion in Preschoolers: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(1):1-8.

Outcomes of root canal treatment of first permanent molars among children in Jeddah, Saudi Arabia: A retrospective cohort study

Objectives

The first permanent molar (FPM) is considered the tooth most susceptible to caries, as it is the first permanent tooth to erupt in the oral cavity, making it susceptible to environmental conditions that may appear as caries, hypoplasia, or hypomineralization. Several treatment options are available for managing deep caries, including root canal treatment (RCT). However, there is a lack of data on the success and failure rates of RCT in FPM among children. This study aimed to determine the success and failure rates of RCT in FPM among children and related factors.

Methods

This retrospective cohort study was conducted at three major centers in Jeddah, Saudi Arabia. Children aged 9–18 years who underwent an RCT between 2010 and 2019 were included. Clinical and radiographic examinations were also performed.

Results

Based on the loose criteria, most of the evaluated teeth (79.6%) were successfully treated. The treatment failed in only 20.4% of participants. Older patients and teeth with acceptable restoration quality had an increased success rate compared to younger patients and teeth with unacceptable restoration quality. A shorter time lapse between treatment and assessment resulted in a lower success rate compared to a longer time lapse. Based on strict criteria, 72.9% of the patients were successfully treated. The use of a microscope and teeth with acceptable restoration quality resulted in an increased success rate compared to teeth treated without the microscope and with unacceptable restoration quality.

Conclusions

The success rate of this procedure was high. Several factors, including older age, acceptable restoration quality, and the use of a microscope, increase the probability of success.

Principals' Perspectives on Joining a Kindergarten Outreach Dental Service: A Qualitative Study

In this qualitative study, the researchers explored principals' perspectives on a free outreach dental service with silver diamine fluoride (SDF) therapy for children in kindergarten. Two researchers recruited kindergarten principals using purposive sampling. They conducted individual semi-structured interviews to collect the principals' perspectives regarding their adoption of and experience with the service. They manually transcribed the interview verbatim into text and followed a thematic approach for data analysis. The researchers interviewed eight principals. The principals identified the prevalent caries status and importance of oral health promotion for kindergarten children. They acknowledged that the service enhanced dental knowledge, fostered oral hygiene practice and improved children's oral health. To adopt this service, they needed to ensure adequate capacity to perform the service. They had no concern with staining by SDF because the parents were informed and consented to the SDF therapy. They appreciated the free service provided by a professional team managed by a reputable university. In conclusion, the principals were generally satisfied with the outreach dental service. They realised the necessity of oral health promotion. They found that parents accepted the SDF therapy although the SDF stained their children's carious teeth. They needed support from their teachers and the children's parents to run the service.

Parental Knowledge and Awareness of Fluoride Varnish Application on Their Children - A Cross-Sectional Study

Introduction

Fluoride varnishes are forms of topical fluoride that are applied on the surfaces of teeth to prevent from dental caries. It contains sodium fluoride, which is the active ingredient in the varnish and the concentration is about 22,600 ppm. Fluoride can promote enamel remineralization which protect against dental caries and it can be professionally applied by dentists and physicians for infants and young children.

Methods

In this, cross-sectional study, a close-ended survey containing 14 items was given to 399 randomly assigned parents in Jeddah, Saudi Arabia. The questionnaire included demographic data and items to assess the general knowledge about fluoride and fluoride varnish. The responses were coded and statistical analysis was performed.

Results

About 65.3% of males and 47.4% females were not sure if fluoride application was safe for their children, however, 67.2% of the population revealed that tooth pastes were one among the fluoride sources for their children. Pearson’s correlation test showed high statistical significance between the parents’ educational background and awareness level of fluoride varnish was of with p-value-0.000 and correlation coefficient (r-value-0.427).

Conclusion

The lack of awareness among parents on an important caries-control measure warrants the implementation of special awareness programs on fluorides and its benefits in young children.

Ultra-processed food consumption and dental caries in children and adolescents: a systematic review and meta-analysis

This study summarised the association between ultra-processed food (UPF) consumption and dental caries in children and adolescents through a systematic review and meta-analysis. The search of PubMed, Cochrane, Web of Science and Scopus databases using the 'PECOS' strategy retrieved 1462 eligible articles. Only studies with humans aged ≤ 19 years; that assessed groups of any UPF or specific UPF items; that measured dental caries as the decayed, filled and missing surfaces or teeth indexes, based on the WHO criteria; cross-sectional, case-control, cohort and all types of interventions that examined the adjusted association between UPF consumption and dental caries were included. All studies received qualitative evaluation. Meta-analysis using random-effects models combined multivariable-adjusted OR for case-control and cross-sectional studies and risk ratio (RR) for longitudinal studies of the highest v. lowest category of UPF consumption. Forty-two studies were included in the qualitative synthesis and twenty-seven in the meta-analysis. The pooled RR was 1·71 (95 % CI 1·31, 2·24), and the pooled OR was 1·55 (95 % CI 1·37, 1·75). The highest OR was found among participants who had dental caries prevalence >70 % (OR = 3·67, 95 % CI 2·16, 6·23). Better evidence quality was found among cohort studies that evaluated children <6 years old. The findings suggest that higher UPF consumption is associated with greater dental caries in children and adolescents. Public health efforts to reduce UPF consumption are needed to improve the oral health of children and adolescents.

Health belief model for empowering parental toothbrushing and sugar intake control in reducing early childhood caries among young children-study protocol for a cluster randomized controlled trial

Background

It has been recognized that oral health education for parents is critical for preventing early childhood caries (ECC). Few parents practiced caries prevention procedures for their children in daily life, though. A novel intervention scheme using mobile messages will be developed in this study under the framework of the health belief model (HBM). The objective of the present randomized clinical trial (RCT) is to evaluate the effectiveness of the new scheme in promoting oral health of young children by reducing dental caries.

Methods

This RCT will involve 26–36 child care centers or kindergartens with nursery classes (clusters) located in Hong Kong. A total of 518–628 child-parent dyads (child age 18–30 months) will be recruited and randomly allocated at the cluster level into the test or control group with a 1:1 ratio. For parents in the test group, the intervention will consist of a set of HBM-based text messages sent regularly in 48 weeks. A standard text message will be sent to the parents in the control group in the first week. The primary outcome will be dental caries measured by dmft/dmfs of the children after 2 years (around 4 years of age). The secondary outcomes will be toothbtushing and sugar intake.

Discussion

HBM-based intervention via a low-cost text messaging vehicle may serve as a viable way to empower parents to establish proper oral health behaviors for their children and safeguard the oral health of children in Hong Kong.

Trial registration

ClinicalTrials.govNCT04665219. Registered on 11 December 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06208-w.

Caries prevalence of the first permanent molar and associated factors among second-grade students in Xiangyun of Yunnan, China: A cross-sectional study

PURPOSE

This study aimed to explore the caries prevalence of the first permanent molar (FPM) and the associated factors among second-grade students in Xiangyun of Yunnan, China.

MATERIALS AND METHODS

A cross-sectional survey was conducted in Xiangcheng Town, Xiangyun County, China, from September to November 2020. The methodology recommended by WHO was used for the dental examination. All the parents were required to complete a questionnaire to collect information on children's family background, dietary habits, oral health behaviors and parental oral health-related knowledge. The tests of significance used were the chi-square test. The association between dental caries prevalence and its associated factors was investigated using logistic regression analysis. Statistical significance was set at P < 0.05.

RESULTS

Data of 1,295 second graders consisting of 665 males and 630 females were analyzed. The caries prevalence of FPM was 47.6%, and the mean DMFT was 1.11 ± 1.394 in this sample. Among all the children with caries, the filling rate is meager, 2.6%. There were statistically significant differences in the caries prevalence of FPM among age groups. No significant difference existed between the sexes. Logistic regression analysis showed that the most significantly associated factors were: consuming desserts at least once a day, no fluoride varnish application experience, worse parental perception of children's oral health status, and incorrect parental knowledge of whether decayed primary teeth need treatment.

CONCLUSION

Caries prevalence of FPM among second-grade schoolchildren in Xiangyun was considerably higher than the average prevalence nationwide in China. As China aims to reduce dental caries to <25% of 12-year-old children in 2030, the local government of remote regions like Xiangyun needs to do much more to achieve this goal. Results of this study could provide a framework for ongoing and future public oral health programs and policy planning in Xiangyun, with particular attention to early preventive and therapeutic measures.

Prevalence of Untreated Early Childhood Caries of 5-Year-Old Children in Hong Kong: A Cross-Sectional Study

This cross-sectional survey investigated untreated early childhood caries (ECC) and its associated factors among 5-year-old children in Hong Kong. Children were recruited using a multistage sampling method. One dentist examined the children in kindergarten to diagnose untreated ECC (dt) at the cavitation level. Each child’s demographic information, snacking behaviour, and oral health-related practice were collected using a parental questionnaire. The relationships between the untreated ECC and demographic information, snacking behaviours, and oral health-–related practice were analysed by zero-inflated negative binomial (ZINB) regression analysis. This survey recruited 404 children. Their dt score was 2.8 ± 3.8. The significant untreated ECC (SiUC) index, which was one-third of the children with the highest dt score, was 7.1 ± 3.6. Their untreated ECC prevalence was 57%, which was associated with the district the child lived in. Most children with untreated ECC (71%, 164/231) had never visited a dentist. Children who brushed without toothpaste had more untreated ECC. Children coming from low-income families and with a lower maternal education level had a higher risk of ECC. In conclusion, untreated ECC was prevalent and unevenly distributed among 5-year-old children in Hong Kong. Its prevalence was associated with toothpaste use, family income, maternal education level and the district they lived in.

Risk factors associated with early childhood caries among Wenzhou preschool children in China: a prospective, observational cohort study

OBJECTIVES

Early childhood caries (ECC) is a serious health public problem that affects a large proportion of children in China. This study aimed to assess risk factors for the incidence of ECC among Wenzhou (China) preschoolers.

DESIGN

Prospective, observational cohort study.

SETTING

Kindergartens (n=6) in Wenzhou, China.

PARTICIPANTS

606 children who were 3-4 years of age and newly arrived in the kindergartens in September 2011.

METHODS

This was a longitudinal observational study with a 2-year follow-up of preschoolers of 3-4 years of age in Wenzhou (Southeast China). Oral health data were collected annually after the baseline survey. The risk factors associated with visible caries and increment of decayed, missing and filled teeth (dmft) were analysed through univariable and multivariable regression using generalised estimating equations.

RESULTS

The prevalence of ECC was increasing during the follow-up period (59.8% at enrolment, 71.8% at first year, and 76.4% at second year). Older age (b=0.07; 95% CI: 0.05 to 0.09; p<0.001), caregivers (relatives or nannies) (b=-1.20; 95% CI: -2.23 to -0.16; p=0.023), lower annual family income (¥10 000-¥20 000: b=2.04; 95% CI: 1.04 to 3.04; p<0.001; <¥10 000: b=1.78; 95% CI: 0.65 to 2.92; p=0.002) and more frequent consumption of sugary snacks/drinks at night (sometimes: b=0.88; 95% CI: 0.20 to 1.56; p=0.011; always: b=1.19; 95% CI: 0.13 to 2.25; p=0.028) were independently associated with the increments of dmft. Older age (OR=1.04, 95% CI: 1.03 to 1.05, p<0.001) and more frequent consumption of sweet snacks (OR=1.86, 95% CI: 1.06 to 3.27; p=0.030) were independently associated with a higher risk of visible caries.

CONCLUSIONS

The occurrence and severity of ECC were associated with older age, caregivers (relatives or nannies), lower annual family income and more frequent consumption of sweet snacks. It is imperative to strengthen oral health education for parents and limit sugary foods/snacks.

Effectiveness of Family-Centered Oral Health Promotion on Toddler Oral Health in Hong Kong

Early childhood caries is common in Hong Kong, and parental practices on maintaining good oral health of their young children are far from satisfactory. This article reports on the effectiveness of a randomized controlled trial on family-centered oral health promotion to new parents in establishing proper feeding habits and oral hygiene practices and in reducing caries risk among 3-y-old toddlers. At baseline, pregnant mothers and their husbands were recruited and randomly allocated into 2 groups. The test group received individualized oral health education (OHE) via a behavioral and educational counseling approach while the control group received the OHE pamphlets only. Information related to the feeding habits, oral hygiene practices, and oral health of the toddlers was collected by parent-completed questionnaires and oral examination annually via home visits. A total of 580 families were recruited at baseline, and 436 toddlers were followed up when they reached 3 y old (test, n = 228; control, n = 208; follow-up rate, 75.2%). The proportions of toddlers who held food in the mouth, fell asleep when milk feeding, had prolonged use of the nursing bottle, ate before bed, and consumed a sweet snack daily were significantly lower in the test group than in the control group (all P < 0.05). Significantly higher proportions of toddlers brushed their own teeth twice daily, were brushed by their parents twice daily, and used fluoride toothpaste than in the control group (all P < 0.001). Toddlers in the test group had better oral health status with a lower level of visible plaque, Streptococcus mutans, white spot lesion, and cavitated lesion (all P < 0.05). Family-centered oral health promotion and individualized OHE for parents via a behavioral and educational counseling approach are more effective in establishing good feeding habits and parental toothbrushing practices and in decreasing the caries risk of their toddlers than the distribution of OHE pamphlets alone (ClinicalTrials.gov NCT02937194).

Prediction Models of Early Childhood Caries Based on Machine Learning Algorithms

In this study, we developed machine learning-based prediction models for early childhood caries and compared their performances with the traditional regression model. We analyzed the data of 4195 children aged 1-5 years from the Korea National Health and Nutrition Examination Survey data (2007-2018). Moreover, we developed prediction models using the XGBoost (version 1.3.1), random forest, and LightGBM (version 3.1.1) algorithms in addition to logistic regression. Two different methods were applied for variable selection, including a regression-based backward elimination and a random forest-based permutation importance classifier. We compared the area under the receiver operating characteristic (AUROC) values and misclassification rates of the different models and observed that all four prediction models had AUROC values ranging between 0.774 and 0.785. Furthermore, no significant difference was observed between the AUROC values of the four models. Based on the results, we can confirm that both traditional logistic regression and ML-based models can show favorable performance and can be used to predict early childhood caries, identify ECC high-risk groups, and implement active preventive treatments. However, further research is essential to improving the performance of the prediction model using recent methods, such as deep learning.

Comparing two fluoride therapies for caries management in young children: study protocol for a randomised clinical trial

Background

Silver diamine fluoride (SDF) and sodium fluoride (NaF) are widely used for caries management. The objectives of this study are (i) to compare the caries-arresting and caries-preventive effects of SDF and NaF in young children, (ii) to determine children’s and parents’ acceptance of these fluoride therapies and (iii) to investigate the short-term (1 day) and long-term (1 year) adverse effects of these fluoride therapies.

Methods/design

This is a randomised, double-blind, active-controlled clinical trial to be conducted in Hong Kong kindergartens. The study has received approval from the local institutional review board. Written consent will be obtained from the parents/guardians before the study. The study will recruit at least 688 healthy 3-year-old children. This sample size is sufficient for an appropriate statistical analysis. Stratified randomisation will be performed for intervention allocation. The two intervention groups are 38% SDF and 5% NaF varnish applied on six primary upper anterior teeth. At baseline, one trained examiner will perform clinical examinations of the children in the kindergartens. The caries experience and oral hygiene status of each child will be recorded using the decayed, missing (due to caries) and filled primary tooth index and visual plaque index, respectively. Then, an independent operator will apply the assigned fluoride after the dental examinations. The examiner, the children and their parents will be blinded to the intervention allocation. In addition, a research assistant will evaluate the child’s acceptance using interval rating scales for children’s uncooperative behaviour. The examiner will then visit the children the next day to study the short-term potential adverse effects of the fluoride therapies. The same examiner will perform a follow-up examination after 1 year to evaluate the children’s caries experiences, their oral hygiene statuses and the adverse effects of the fluoride. Parental questionnaires will be used to assess parental satisfaction and concerns about the fluoride therapies.

Discussion

This study provides essential information about using SDF in an outreach kindergarten service for caries management from different aspects, which include the caries-arresting and caries-preventive effects, the adverse effects and children’s and parents’ acceptance. The success of the service can help to increase the adoption of SDF to reduce the global burden of early childhood caries.

Trial registration

ClinicalTrials.gov NCT04399369. Registered on May 2020

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05496-y.

Early Childhood Caries in Victorian Preschoolers: A Cross-Sectional Study

AIM

The objective of this work was to determine the prevalence of early childhood caries (ECC) in children attending preschools that are enrolled in the Smiles 4 Miles health promotion program in Victoria and determine the sociodemographic variables associated with ECC.

MATERIALS AND METHODS

A cross-sectional sample of 1,845 3- to 5-year-old children attending 61 preschools was selected by stratified cluster sampling. Dental caries was classified as non-cavitated/early lesions (d^1-2), cavitated (d^3-6) lesions, and cavitated/non-cavitated (d^1-6) lesions using the International Caries Detection and Assessment System. A self-administered parental questionnaire captured sociodemographic and behavioural data. Multivariate logistic regression and Poisson mixed model analysis was used to examine associations amongst sociodemographic variables, child oral health behaviours, and decayed tooth surfaces.

RESULTS

In all, 56.6% (n = 1,044) of the children had ECC; more than one-third (36.6%) presented exclusively non-cavitated/early lesions, 5.7% solely cavitated lesions, and 14.2% both. Children from socioeconomically disadvantaged backgrounds had higher levels of dental caries. Parental pensioner/health care card status (incidence rate ratio [IRR] = 1.76, 95% CI, 1.57-1.97), non-English-speaking background (IRR = 2.09, 95% CI, 1.80-2.43), and Indigenous status (IRR = 1.91, 95% CI, 1.50-2.43) were associated with higher rates of cavitated lesions. Children who consumed soft drinks once or more per week had 1.66 times more cavitated lesions (95% CI, 1.48-1.86) compared to children who never/rarely consumed soft drinks. Soft drink consumption of once or more per week was associated with parental health care/pensioner card status (odds ratio [OR] = 1.73, 95% CI, 1.36-2.18), non-English-speaking background (OR = 1.58, 95% CI, 1.11-2.27), and Indigenous status (OR = 1.92, 95% CI, 1.04-3.52).

CONCLUSIONS

Higher levels of more severe caries rates in children from socioeconomically disadvantaged background highlight an opportunity for early preventive interventions targeting these groups.

Parental Compliance towards Oral Health Education among Preschoolers with Special Healthcare Needs

Background: Young children with special needs greatly rely on their parents to support their daily living activities; parental compliance may have great impact on the implementation of health promotion activities among those children. This study aimed to investigate the parental compliance towards oral health education (OHE) among children with special healthcare needs (SHCN). Method: The participants were 306 parents whose children had participated in a 24-month OHE program for preschool children with SHCN. The primary outcome of this cross-sectional study was parental compliance towards the OHE program. Parents’ oral health literacy (OHL) was assessed by a validated tool. Parents’ socioeconomic status, attitudes towards OHE topics, perceptions of children’s oral hygiene status, and usefulness of OHE materials were collected via questionnaires. Results: A higher dropout rate was observed among parents who perceived that their children had unfavorable oral hygiene status (p = 0.038), or parents who had poor OHL skills (p = 0.015). Parental noncompliance was more likely to be observed among parents who perceived that the OHE materials were not useful for their children (OR = 3.63, 95% CI 1.56 to 8.47, p = 0.003), or parents whose children had been diagnosed with developmental delays (OR = 5.45, 95% CI 1.59 to18.74, p = 0.007). Conclusion: Non-compliance existed among parents whose children had received OHE intervention. Parental compliance towards OHE intervention might be associated with parents’ OHL skills, usefulness of OHE materials, and children’s developmental conditions. OHE programs should be individually tailored to support children whose parents are at a higher risk of noncompliant behaviors.

Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions

Aim: Early childhood caries (ECC) has significant public health implications but has received inadequate global attention. There is limited information regarding the success of oral health policies implemented to address the challenges of ECC. This review aimed to summarize such policies to tackle ECC from different countries/regions. Method: Independent collaborators from 14 countries/regions (Australia, Brazil, Cambodia, China, Hong Kong, Egypt, India, Indonesia, Japan, Nigeria, Thailand, UK, USA, and Venezuela) collected the data. The ECC status, dental workforce, oral health policies on ECC prevention in different countries/regions were summarized by each country. Results: The findings indicated that ECC prevalence varied in different countries/regions. The lowest prevalence of ECC among 5-year-old children was found in Nigeria (7%), and the highest was found in Indonesia (90%). The existing dental workforce and resources are limited in most countries. The smallest dentist to population ratio was reported by Nigeria at 1:48,400, whereas the highest ratio was in Brazil (1:600). Out of 14, three (21%) countries namely India, Venezuela and Cambodia had no national oral health policies addressing ECC and four (29%) countries (Cambodia, China, India, Venezuela) had no publicly funded dental care program for 0-5-year-old children. Water fluoridation is available in four countries/regions (Australia, Brazil, Hong Kong, USA). Conclusion: ECC remains a global health challenge and dental workforce is limited. National/regional programs to tackle ECC are not yet prioritized in many countries/regions. Evidence to support demonstration projects is limited. Further research on the cost-effectiveness of interventions strategies is required for policymakers.

Pre-schoolers' tooth brushing behaviour and association with their oral health: a cross sectional study

Background

Toothbrushing is an important yet neglected behaviour that affects the oral health of preschool children. Little is reported on parental supervision, an essential aspect of routine effective toothbrushing in this age group. The aim of this study was to evaluate pre-schoolers’ toothbrushing behaviour including parental involvement and its association with their oral health.

Methods

This was a cross-sectional study. A total of 92 preschool children (4–6 years) were invited to participate with their parents/guardians. Nine parameters of toothbrushing behaviour were assessed from parental responses (questionnaire) and observation of child and parents/guardians (video recording). Oral examination included recording plaque, gingival and dental caries indices. BORIS software was used to assess toothbrushing parameters and Smart PLS was used to perform association with a second-generation multivariate analysis to create models with and without confounding factors.

Results

Girls were slightly more (53%) than boys (47%). Children aged 4 years were slightly more in number (38%), followed by 6-year-olds and 5-year-olds. Nearly, 90% parents had tertiary education and 46% had more than 2 children. Differences were recorded in the reported and observed behaviour. Thirty-five percent parents/guardians reported using pea-size toothpaste amount but only 28% were observed. Forty percent reported to brush for 30 s–1 min, however 51% were observed to brush for 1–2 min. Half the children were observed to use fluoridated toothpaste (F < 1000 ppm) under parental supervision (11%). The mean (SD) plaque score reduction after toothbrushing was 10.80 (2.46), mean pre-brushing plaque score was 90.3 (10.2), mean gingival index was 0.89 (0.65) and mean dental caries status (ICDAS_(1–6)) was 18.87 (12.39). Toothbrushing behaviour in terms of toothbrushing technique, duration, pattern and frequency, toothbrush type and grip type, toothpaste type and amount, post-brushing mouth rinsing and parental involvement contributed significantly to plaque score change (86%), dental caries status (73%), gingival index (66%) and pre-brushing plaque score (31%). The significant confounding variables had a small influence on oral health of preschool children.

Conclusions

Preschool children’s toothbrushing behaviour was inadequate while their oral health was poor, with a significant association between the two parameters.

The Effects of Metal Exposures on Charlson Comorbidity Index Using Zero-Inflated Negative Binomial Regression Model: NHANES 2011-2016

BACKGROUND

With the rising incidence of chronic diseases, and the increase of aging population has led to multimorbidity a serious public health problem. The aim of this study was to explore the association between metal exposures and Charlson comorbidity index (CCI), which will provide valuable information for improving quality of life and reducing mortality.

METHODS

The study sample consists of three continuous cycles (2011-2016) of the National Health and Nutrition Examination Survey (NHANES), and 4901 eligible subjects were included in the study. Zero-inflated negative binomial (ZINB) model was utilized to investigate the effects in metal exposures on CCI, which includes spot urine (arsenic, mercury, and cadmium), whole blood (manganese, selenium, and lead), and serum (copper and zinc).

RESULTS

In count part (CCI ≥ 0), holding other variables constant, the expected change in CCI for a one-unit increase in blood selenium is 0.997 (RR = 0.997, p = 0.017). In logit part (CCI = 0), the log odds of having CCI equals zero would increase by 0.659, 1.073, and 0.963 for every additional urinary cadmium (OR = 0.659, p = 0.007), blood lead (OR = 1.073, p = 0.023), blood manganese (OR = 0.963, p = 0.025), respectively.

CONCLUSIONS

Our findings indicated that cadmium and manganese were likely to increase mortality. Inversely, selenium and lead might be positive on people's health. The findings may be extremely essential for preventing diseases and improving life quality.

Untreated dental caries and visible plaque of mothers are not determinant for the incidence of caries in dentin among children: evidence from a 3-year prospective cohort study

OBJECTIVES

To evaluate whether characteristics related to mother's oral health, trajectory of family income, and maternal education are associated with the incidence of caries in dentin in preschool children.

MATERIALS AND METHODS

One hundred fifty-eight mothers and their children were evaluated at baseline and re-evaluated after 3 years. Sociodemographic variables, dental caries, and biofilm of the mothers and children and daily sugar intake of the children were evaluated. Poisson regression was used to evaluate what factor represents risk for the incidence of caries in dentin at four to 6 years of age.

RESULTS

The risk of the incidence of caries in dentin was 54% higher in children whose mothers had a low level of education at both baseline and follow-up. Children from families with an income lower at baseline and follow-up (RR 2.49; 95% CI 1.62-3.83) and those whose families experienced a reduction in income in this period (RR 2.05; 95% CI 1.29-3.26) had a greater risk of the incidence of caries in dentin. Moreover, children who increased their daily sugar intake (RR 1.67; 95% CI 1.09-2.52), those that maintained high sugar intake (RR 1.81; 95% CI 1.14-2.87), and those with cavitated caries at baseline (RR 1.53; 95% CI 1.19-1.97) had a greater risk of the incidence of caries in dentin.

CONCLUSIONS

Low mother's education, a lower family income, a reduction in family income, a high frequency of daily sugar intake, and a history of cavitated caries were risk factors for the incidence of caries in dentin.

CLINICAL RELEVANCE

The results could help in the targeting of improved prevention and control strategies for dental caries.

A Kindergarten-Based Oral Health Preventive Approach for Hong Kong Preschool Children

Early childhood caries (ECC) remains the single most common chronic childhood disease. Untreated caries can cause tooth loss and compromised dentition. Severe ECC can also influence nutrition intake, cognitive development, general health and quality of life. In Hong Kong, approximately half of 5-year-old children suffer from ECC, and more than 90% of these caries remain untreated. Thus, the development of effective strategies for promoting the oral health of preschool children is warranted. The Faculty of Dentistry of the University of Hong Kong has provided kindergarten-based dental outreach services to selected kindergartens since 2008. In 2020, the project expanded to serve all kindergarten children in Hong Kong. The aim of the service is to improve oral health through the prevention and control of ECC among preschool children. The service provides dental screening and silver diamine fluoride treatment for ECC management. In addition, the parents receive oral health talks, and teachers receive training in delivering regular oral health education at kindergarten. The objectives of this service are to improve oral and general health of preschool children, develop the children’s good oral health-related behaviours, maintain the children’s psychological well-being and reduce the burden on their family. This paper describes this kindergarten-based dental outreach service.

Arresting early childhood caries using silver and fluoride products - A randomised trial

OBJECTIVE

The aim of this randomised non-inferiority clinical trial was to compare the effectiveness of semi-annual (every six months) applications of 25 % silver nitrate (AgNO₃) solution followed by 5 % sodium fluoride (NaF) varnish to semi-annual applications of 38 % silver diamine fluoride (SDF) solution in arresting early childhood caries (ECC).

METHODS

Three-year-old children with active cavitated carious lesions were recruited and randomly assigned to two intervention groups. Children in Group A received semi-annual applications of 25 % AgNO₃ solution followed by 5 % NaF varnish on carious lesions. Children in Group B received semi-annual applications of 38 % SDF solution followed by a placebo varnish. One trained dentist assessed ECC status at baseline and in all follow-up examinations. An independent operator performed the interventions. The dentist, the children, and their caretakers were blinded to the intervention allocation. Data were analysed using a non-inferiority test. Group A's non-inferiority would be accepted if the lower limit of the 95 % confidence interval (CI) for the difference in the mean number of arrested decayed surfaces (ds) was greater than -0.5.

RESULTS

At baseline, 1,070 children were recruited, and 535 children were assigned to each group. After 30 months, the mean arrested ds in Groups A (n = 447) and B (n = 433) were 3.7 ± 3.6 and 3.6 ± 3.7, respectively (p = 0.694). The difference in the mean arrested ds between the two groups was 0.088 (95 % CI: -0.351 to 0.526).

CONCLUSION

Semi-annual application of 25 % AgNO₃ followed by 5 % NaF is at least as effective as the semi-annual application of 38 % SDF in arresting ECC.

CLINICAL SIGNIFICANCE

Silver and fluoride products are effective in arresting caries. As a simple, non-invasive, and inexpensive strategy, it can be used in young children, elderly adults, and people with special needs.

A 24-month randomized controlled trial on the success rates of restoring untreated and SDF-treated dentine caries lesions in primary teeth with the ART approach

OBJECTIVE

To compare the success rates of restoring untreated and SDF-treated dentine caries lesions in primary teeth with atraumatic restorative treatment (ART) approach.

METHOD

Cavitated dentine caries lesions in preschool children were randomly allocated to two groups to be applied with either 38% silver diamine fluoride (SDF) solution or tonic water (control) ten weeks before being restored with the ART approach. Status of the restorations were assessed every six months by a blinded independent examiner. Multilevel logistic regression and multilevel survival analyses were conducted to assess the restoration success rates.

RESULTS

A total of 194 children (SDF group, 101; control group, 93) were included, with 260 and 249 ART restorations placed in the SDF and the control groups, respectively. At 24-month follow-up, 88 (87 %) and 84 (90 %) children remained in the SDF and the control groups, respectively. There was no significant difference between the ART restoration success rates of the two study groups (p > 0.05). The success rate of ART restorations was associated with the class of restorations. Class I restorations had the highest success rate (∼50 %), followed by Class V (∼35 %), Class II (∼15 %) and Class III (<10 %). Besides, the mean time used to place an ART restoration in a SDF-treated caries lesion was shorter than that in untreated lesion (4.8 vs. 5.1 min, p = 0.006).

CONCLUSION

Prior SDF application does not significantly affect the success rate of ART restorations placed in primary teeth. Besides, it is faster to place ART restorations in caries lesions that have been previously treated with SDF.

CLINICAL SIGNIFICANCE

Prior application of silver diamine fluoride solution on cavitated dentine caries lesions in primary teeth can shorten the average time required to place an ART restoration while not jeopardizing the success rate of the restorations.

Assessment of risk factors for early childhood caries at different ages in Shandong, China and reflections on oral health education: a cross-sectional study

BACKGROUND

The high prevalence of early childhood caries (ECC) is widespread around the world, and oral health education (OHE) plays a vital role in preventing ECC. Numerous studies on ECC risk factor assessment have assisted us in enriching the content of OHE. The objective of this study was to further assess independent risk factors for ECC at different ages to provide evidence and insights for OHE.

METHODS

Children aged 3-5 years old (N = 1301) in Shandong Province were enrolled in this cross-sectional study. Data about oral health status and caregivers' oral health knowledge, attitude, and practice (KAP) were extracted from the 4th National Oral Health Survey of China. The associations between ECC prevalence and various KAP variables were tested with chi-square tests, bivariate analysis and multivariable logistic regression analyses.

RESULTS

The ECC prevalence in Shandong Province was 64.6%, and the dmft mean was 3.15. The independent variables with an increased risk for ECC were age, feeding method within 6 months of birth, bedtime sugar frequency, experience of toothache over the past year and dental visits (P < 0.05, chi-square tests). Complete breastfeeding within 6 months of birth primarily contributed to the high ECC risk of the 3-year-old group (OR: 3.39, 95% CI: 1.41-8.17), while high frequency bedtime sweet consumption mainly contributed to that of the 5-year-old group (OR: 3.22, 95% CI: 1.03-10.06; logistic regression analysis). Tooth brushing was not associated with ECC in this study, and some positive knowledge and attitude variables were positively correlated with a high risk of ECC.

CONCLUSION

These data provide evidence to suggest that the ECC-related risk factors at different ages are inconsistent, which provides some insights for OHE. We should highlight the effects of feeding methods in the early stages of deciduous dentition and sugar habits in the late stages of deciduous dentition on ECC, as well as encourage preventive dental visit and supplemental training for oral health practices.

Dental Fear and Anxiety of Kindergarten Children in Hong Kong: A Cross-Sectional Study

Objectives: The objectives of this cross-sectional study were to investigate the fear level of kindergarten children in the general population during dental outreach in a familiar kindergarten setting, and to explore the factors associated with the dental fear of kindergarten children. Method: Consecutive sampling method was used to select kindergarten children aged 3 to 5 to participate in a questionnaire survey and an outreach service. A behavioural observation type of instrument for dental fear and anxiety assessment-Frankl Behaviour Rating Scale (FBRS)-was chosen to investigate the fear level of the children. Bivariate analyses between various factors and children's dental fear and anxiety were carried out using Chi-square test. Results: A total of 498 children participated in this study. Almost half (46%) of the children have had caries experience, and the mean dmft score was 2.1 ± 3.4. The prevalence of dental caries was 32%, 43%, and 64% in the 3-, 4- and 5-year-olds, respectively. Only 4% of the children scored negatively for dental fear and anxiety (95% CI 2.3%-5.7%). Children at three years of age displayed more dental fear and anxiety than children of older ages, but the difference in dental fear and anxiety among the genders and caries status was not statistically significant. Most of the children (92%) brushed daily, but only 20% of them used toothpaste. Most (85%) of them had never visited the dentist, and over 70% of them were mainly taken care by their parents. High levels of positive and cooperative behaviour and low levels of fear were found in this population. No statistical significance was found between the child's dental fear and any factors except age. Conclusion: Children generally displayed low fear or anxiety levels in a dental outreach consisting of a non-invasive oral examination and preventive treatment in a familiar kindergarten setting. Conducting regular outreach dental services to kindergartens by providing oral examination and simple remineralisation therapies could be a promising strategy to not only control childhood caries, but also manage and reduce dental fear and encourage long term dental attendance in line with the medical model.

Late bedtime and dental caries incidence in Kuwaiti children: A longitudinal multilevel analysis

OBJECTIVE

Inadequate sleep contributes to several adverse systemic health outcomes due to hormonal and metabolic disorders. The purpose of this study was to determine the effect of bedtime on the development of dental caries and the relationship with salivary ghrelin and leptin in a prospective cohort study of Kuwaiti children.

METHODS

Data were collected from 5456 10-year-old children in 2012 and repeated in 2014. We selected children from 138 middle schools representing the six governorates of Kuwait. We derived data from oral examinations, self-reported sleep interviews, body and weight measurements, and chemical analysis of whole saliva samples. Leptin and ghrelin were determined by salivary assay in a subset of 744. Two separate analyses were performed. a) Using the entire longitudinal data set (n = 5456), multilevel random intercept analysis was conducted to assess the relationship between reported bedtime and dental caries. b) Using data from a subset of the original sample (n = 744), multiple linear regression analysis was conducted to determine the relationship between dental caries and salivary ghrelin and leptin. The outcome variable was the development of dental caries in children. The independent explanatory variables and confounders were bedtime, sleep duration, salivary ghrelin and leptin; confounders assessed were gingivitis, sex, age and governorate (school location).

RESULTS

With every additional hour past 8 pm for bedtime, there was a 20% increase in dental caries incidence over two years (B = 0.2, P = .01), adjusting for age, gender, gingivitis and governorate. There was a significant difference in the magnitude of dental caries between the six governorates of Kuwait. Lower levels of salivary leptin and higher levels of salivary ghrelin were associated with increased dental caries, and sleep duration was an effect modifier that negatively affected the relationship between leptin and dental caries (B = -0.09, P < .05) and positively affects the relationship between ghrelin and dental caries (B = 0.07, P < .05). Additionally, there was a significant clustering effect within schools in this cohort.

CONCLUSION

In a cohort study of Kuwaiti children, late bedtime was associated with increased dental caries incidence. Additionally, dental caries experience increased with higher levels of salivary ghrelin and lower levels of salivary leptin, and sleep duration mediates the relationship between these two biomarkers and dental caries.

Preventing early childhood caries with silver diamine fluoride: study protocol for a randomised clinical trial

BACKGROUND

Silver diamine fluoride (SDF) solution is effective in arresting early childhood caries (ECC). Previous studies have suggested that it might exert a preventive effect in managing ECC. However, no well-designed clinical trials have yet been performed to study the effect of SDF on caries prevention. The objective of this randomised clinical trial is to determine whether 38% SDF solution is superior to 5% sodium fluoride (NaF) varnish in preventing new carious lesions in primary anterior teeth.

METHODS/DESIGN

This is a phase II, single-centre, randomised, double-blind, active-controlled, parallel-group pragmatic trial. The hypothesis tested is that 38% SDF would be more effective than 5% NaF in preventing new caries development in primary anterior teeth. Approximately 730 3-year-old children who are generally healthy and with parental consent will be recruited from Hong Kong kindergartens. This sample size will be sufficient for appropriate statistical analysis of a superiority trial with 90% power, allowing for a 20% drop-out rate. Stratified randomisation will be adopted for allocating the intervention. The intervention will either be 38% SDF or 5% NaF (as a positive control) therapy on primary upper anterior teeth. A single trained examiner will conduct a dental examination every 6 months until 30 months in kindergarten. Another operator will provide fluoride therapy immediately after each dental examination. The examiner, children and children's parents will be blinded to the treatment allocation. A questionnaire survey will be conducted to study the children's oral health-related behaviours and socioeconomic backgrounds. Chi-square tests, t tests, regression analyses and survival analyses will be adopted for data analysis.

DISCUSSION

The effectiveness of 38% SDF in preventing ECC remains uncertain. If the results are as anticipated, care standards using 5% NaF for ECC prevention will be changed. In addition, the results will be widely available and increase the adoption of SDF in other countries to reduce the global burden of ECC.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04075474. Registered on 30 Aug 2019.

Translation and validation of the Chinese version of the scale of oral health outcomes for 5-year-old children

OBJECTIVE

To adapt the oral health-related quality of life (OHRQoL) measurement tool SOHO-5 (scale of oral health outcomes for 5-year-old children) for use in Chinese populations, and to investigate the validity and reliability of the Chinese version of SOHO-5 (C-SOHO-5).

MATERIALS AND METHODS

The draft C-SOHO-5 was developed by a forward-backward process and pilot-tested on 20 child-parent pairs. The final version was tested on a sample of 5-year-old children and their parents. Clinical examinations were conducted to record the children's caries experience. The reliability of C-SOHO-5 was assessed by both internal consistency and test-retest reliability. Its discriminant validity and construct validity were also investigated.

RESULTS

A total of 249 child-parent pairs participated in this study. Cronbach's alpha values for the child's version of C-SOHO-5 (C-SOHO-5c) and the parental version of C-SOHO-5 (C-SOHO-5p) were 0.71 and 0.82, respectively. The intraclass correlation coefficient values for C-SOHO-5c and C-SOHO-5p were 0.85 and 0.46, respectively. Both the child's and the parental version were able to discriminate the caries and caries-free children groups. Children with caries experience had higher mean ranks of the total score of both C-SOHO-5c and C-SOHO-5p than those of the caries-free children (134.9 vs. 113.8, P = 0.015; 134.7 vs. 93.2, P < 0.001). In addition, the total scores of both child's and parental reports were significantly correlated with the global rating questions.

CONCLUSION

The C-SOHO-5 demonstrated good reliability and validity. This tool, which uses both child's and parental reports, can be used to assess the OHRQoL of 5-year-old children in Chinese-speaking communities.

The impact of a school-based tooth-brushing program on dental caries: a cross-sectional study

Background

Promotion of oral health in children is recognized as one of the components of health-promoting schools (HPSs). However, few studies have addressed supportive school environments for children’s oral health. This study aimed to evaluate the status of dental caries in school children at HPSs, with the objective of examining the impact of a supportive school environment for oral health, considering the lifestyles of individual children and the socioeconomic characteristics of their communities.

Methods

Data of 2043 5th-grade students in 21 elementary schools in Ichikawa city between 2008 and 2013 were analyzed. Children’s oral health status was evaluated using the decayed, missing, and filled permanent teeth (DMFT) index. A self-reported lifestyle questionnaire, a survey of the school environment promoting tooth-brushing, and community socioeconomic characteristics derived from the National Census data were included in the analyses. Bivariate analyses were conducted to evaluate the children’s DMFT status, and zero-inflated negative binominal (ZINB) regression was used to assess the relationships between DMFT and other variables.

Results

Prevalence of dental caries in the permanent teeth of 5th-grade children (aged 10–11 years) was 33.3%, with a mean DMFT score (± SD) of 0.83 ± 1.50. According to multilevel ZINB regression analysis, children from schools with after-lunch tooth-brushing time showed a higher odds ratio (OR) for excess zero DMFT (OR = 1.47, 95% CI = 1.00–2.15, P = 0.049) as compared to those from schools without it. Neither bivariate analysis nor ZINB model analysis revealed any significant influence of children’s gender or use of a toothpaste with fluoride.

Conclusions

The school-based environment supportive of oral health was significantly associated with a zero DMFT status in children. School-based efforts considering the socioeconomic characteristics of the area warrant attention even with declining prevalence of dental caries.

Exploring an Association of Demographic, Oral, and Systemic Health Factors Among Patients Attending a Teaching Dental Center

Background:

Updated information on oral health status could be used to monitor oral disease patterns, as widespread variations in oral health outcomes within and between different countries are reported.

Aim:

The objective was to examine the status of oral and systemic health and their association with demographic characteristics of the population attending a public dental center.

Methods:

A cross-sectional secondary analysis of the patients’ record was conducted during June 2017 attending the dental center of Madina Teaching hospital Faisalabad, Pakistan. Study variables were analyzed using the t test and the c2 test with a significance level of P ≤ .050.

Results:

The mean age of the study sample was 31.9 ± 14.5 years; 56% were females; 48% had primary or higher education; 9% were hypertensive; 5% had hepatitis; and 5% diabetes mellitus; 52% were with poor oral hygiene, 68% had dental caries, 84% had no fillings, 27% had tooth loss, and 99% functional dentition; 74% patients had calculus, 67% had gingivitis, and 5% had periodontitis. Age was the strongest risk indicator. Dental caries, tooth loss, poor oral hygiene, gingivitis, periodontitis, and tooth mobility were significantly associated with diabetes mellitus; tooth loss and tooth mobility were associated with cardiac disease; tooth loss, periodontitis, and tooth mobility were associated with hypertension, whereas tooth loss and calculus were associated with hepatitis. Higher age and lower income were positively associated with poor oral hygiene.

Conclusion:

Age and gender remain to be the strongest predictors for both oral and systemic conditions. Poor oral health and tooth loss showed a strong relationship with chronic systemic conditions.

The Impact of Adaptive Functioning and Oral Hygiene Practices on Observed Tooth-Brushing Performance Among Preschool Children with Special Health Care Needs

OBJECTIVES

To investigate the impact of adaptive functioning and oral hygiene practices on tooth-brushing performance among preschool children with special health care needs (SHCN).

METHODS

A cross-sectional study was conducted in Special Child Care Centers. Children's tooth-brushing performance was assessed by a standardized 13-step pro forma. Information regarding children's socio-economic status, adaptive skills, and oral hygiene practices were collected. Bivariate analysis and ANCOVA were used to explore the potential factors which might be associated with children's tooth-brushing performance.

RESULTS

The tooth-brushing assessment was provided to 379 children with SHCN. Approximately 3% of the recruited children performed the whole tooth-brushing procedure independently. The number of tooth-brushing steps practiced by those children was 4.47 ± 3.56. Children who had established tooth-brushing habit before age one practiced more tooth-brushing steps than children who brushed their teeth after age one (p = 0.029). When children's age, gender, and socio-economic status were adjusted, children who had established regular tooth-brushing habit or children who had high levels of adaptive skills showed better tooth-brushing performance than their peers. Children who used gauze, cotton swab, or dental floss to clean their teeth practiced fewer key tooth-brushing steps than their peers who had never used additional cleaning approaches (p = 0.038).

CONCLUSIONS FOR PRACTICE

Children's tooth-brushing performance was associated with adaptive skills and oral hygiene practices. Tooth-brushing training should be provided to children with SHCN in early childhood. For children who had limitations in adaptive functioning, parental assistance or supervision is recommended to guarantee the efficacy and safety of daily tooth brushing.

Structural equation modelling for associated factors with dental caries among 3-5-year-old children: a cross-sectional study

Background

The aim of the current study was to explore the factors influencing dental caries among 3–5-year-old children in Sichuan Province and the interrelationship between these factors using structural equation modelling (SEM).

Methods

A cross-sectional study was conducted among 2746 3–5-year-old children in Sichuan Province. Examination of caries was conducted on all children and a questionnaire was answered by the children’s caregiver. SEM alternative models were constructed to interpret the intricate relationships between socio-economic status (SES), caregiver’s oral health knowledge, attitudes, children’s oral health behaviours and children’s dental caries.

Result

The results showed that dental caries were significantly associated with dietary behaviours (β = 0.11, SE = 0.03, P = 0.001, BC 95% CI =0.05/0.18) and SES (β = − 0.17, SE = 0.03, P<0.001, BC 95% CI = -0.23/− 0.10) directly, While the indirect effect of SES on dmft is in an opposite direction (β = 0.08, SE = 0.02, BC 95% CI = 0.04/0.12).

Conclusion

We found that unhealthy dietary behaviours increased the prevalence of dental caries. However, oral health knowledge and attitude failed to affect dietary behaviour in this model. This result warns that oral health education should strengthen feeding-related knowledge. Meanwhile, it also reminds that it is easier known than done. Future oral health education should focus on exploring a more effective way for the public to turn knowledge into action.

Oral health and associated factors among preschool children with special healthcare needs

OBJECTIVE

To investigate the oral health status and associated factors among preschool children with special healthcare needs.

SUBJECTS AND METHODS

This was designed as a cross-sectional study. Dental examination was provided to 383 children at Special Child Care Centres. Covariates of interest included children's age, developmental profile, oral health-related behaviours and family social-economic status. The association between children's dental caries experiences, dental plaque deposition and gingival health status were analysed by negative binomial regression, multiple factor ANOVA and binary logistic regression when appropriate.

RESULTS

The proportion of children with caries, gingival inflammation and plaque were 30.3%, 89.6% and 95.0%, respectively. Final regression models indicated that (a) tooth decay was associated with dental visit experiences, night bottle-feeding habit, fluoridated toothpaste and monthly income; (b) plaque deposition was associated with intellectual functioning, practical skills, night bottle-feeding habit, use of toothpaste, initiation of toothbrushing habit, toothbrushing duration and additional cleaning habit; (c) gingival status was associated with children's intellectual functioning and toothbrushing frequency.

CONCLUSIONS

Poor oral hygiene status existed among preschool children with special healthcare needs. Children's oral health status was associated with their developmental profile, oral health-related behaviours and social-economic status.

Randomized Trial of Silver Nitrate with Sodium Fluoride for Caries Arrest

OBJECTIVES

The aim of this noninferiority double-blind randomized clinical trial was to compare the effectiveness of the topical semiannual application of a 25% silver nitrate (AgNO₃) solution followed by a 5% sodium fluoride (NaF) varnish with that of a 38% silver diamine fluoride (SDF) solution in arresting caries among preschool children.

METHODS

Healthy 3-y-old children with active dentine carious lesions were randomly allocated to 2 groups via computer-generated random numbers. Lesions in group A received applications of a 25% AgNO₃ solution followed by a 5% NaF varnish semiannually (every 6 mo). Lesions in group B received semiannual applications of a 38% SDF solution followed by a placebo varnish. A trained examiner recorded the status of caries and oral hygiene at baseline and during follow-up examinations. The examiner, children, and their caretakers were blinded to the intervention allocation. This study adopted an intention-to-treat analysis. A noninferiority test was conducted for the data analysis. Group A's noninferiority was accepted if the lower limit of the 95% CI for the difference in the mean number of arrested surfaces was >-0.5.

RESULTS

A total of 1,070 children were recruited at baseline, with 535 children in each group. After 18 mo, the mean ± SD number of arrested surfaces was 3.3 ± 3.4 in group A (n = 484) and 3.2 ± 3.5 in group B (n = 476; P = 0.664). The difference in the mean number of arrested surfaces between the groups was 0.092 (95% CI, -0.322 to 0.505). Apart from black staining on the arrested lesions, no other significant side effect was observed.

CONCLUSION

A semiannual application of 25% AgNO₃ followed by 5% NaF is no worse than a 38% SDF in arresting dentine caries among preschool children over 18 mo. The Hong Kong Research Grants Council (GRF 17107315) funded this trial, which was registered at ClinicalTrials.gov (NCT02019160).

KNOWLEDGE TRANSFER STATEMENT

This randomized clinical trial found that silver nitrate solution followed by sodium fluoride varnish is effective in arresting dentine caries among preschool children. As silver nitrate followed by sodium fluoride is a noninvasive and simple protocol, it can be an alternative strategy to manage dental caries among young children, especially in countries where silver diamine fluoride is not available.

Early childhood caries and oral health care of Hong Kong preschool children

Surveys have shown that the prevalence of early childhood caries (ECC) among 5-year-old children decreased from 63% in 1993 to 55% in 2017. Caries experience was unevenly distributed; 81% of the caries lesions were found in 26% of the children. Risk factors, including oral hygiene practice behaviors, sugar consumption, parental oral health-related knowledge, and sociodemographic backgrounds, were significantly related to ECC. Oral health promotion aimed at managing the burden of ECC has been implemented. Water fluoridation was launched in 1961, and the fluoride concentration has been adjusted to 0.5 ppm since 1988. It is considered an important dental public health measure in Hong Kong. The Department of Health set up the Oral Health Education Unit in 1989 to deliver oral health education to further improve the oral health of preschool children. Other nongovernmental organizations also launched short-term oral health promotion programs for preschool children. However, no significant change in the prevalence of ECC has been observed in the recent two decades. There is a necessity to revisit dental public health policies and develop effective evidence-based strategies to encourage changes in oral health-related behaviors to forestall the impending epidemic of ECC in Hong Kong.

Erosive tooth wear among preschool children in Hong Kong

OBJECTIVE

This study aimed to assess the prevalence of erosive tooth wear among 3- to 5-year-old children in Hong Kong and to determine the effect of socio-economic factors, dental habits, and oral hygiene on their dental erosive wear status.

METHODS

Stratified random sampling was adopted. Their parents were asked to complete a questionnaire regarding their children's backgrounds. A single examiner evaluated the children for erosive tooth wear using Basic Erosive Wear Examination (BEWE) criteria. Multiple logistic regression was used to determine the relationship between erosive wear and the children's socio-economic factors, dental habits, and oral hygiene.

RESULTS

1204 children participated in this study. Prevalence of erosive tooth wear (BEWE score > 0) was 14.9%. Among these, 153 children (12.8%) had initial wear, 21 children (1.8%) had distinct tooth loss, and five (0.4%) had severe erosive wear. Prevalence of erosive wear among the 3-, 4-, and 5-year-old children was 10.7%, 15.0%, and 17.7%, respectively. Increasing age, the low education of mother and high plaque scores were risk factors of erosive wear (P < 0.05).

CONCLUSION

Prevalence of erosive tooth wear is low among preschool children in Hong Kong. The erosive tooth wear prevalence increased with increasing age, lower education of mother, and poorer oral hygiene.

Early childhood caries among 3- to 5-year-old children in Hong Kong

OBJECTIVE

The aim of this study was to describe the prevalence of dental caries among 3- to 5-year-old children in Hong Kong and to investigate the factors associated with their dental caries status.

METHODS

Seven kindergartens in Hong Kong were selected using stratified random sampling. The 3- to 5-year-old kindergarten children were invited to join the study. The participants' parents were asked to complete a questionnaire regarding their children's demographic and socio-economic backgrounds, their dental habits and their own dental knowledge. Dental caries experience was measured using the decayed, missing and filled primary teeth (dmft) index. The visible plaque index was adopted for recording oral hygiene. The relationships between caries experience and children's demographic backgrounds, dental habits, oral hygiene and parental dental knowledge were studied using a zero-inflated negative binomial (ZINB) regression analysis.

RESULTS

Among the 1,204 participating preschool children, the overall prevalence of dental caries (dmft > 0) was 46%. The mean dmft score was 2.1 ± 3.4. The prevalences of dental caries among the 3-, 4- and 5-year-old children were 38%, 43% and 55%, respectively. ZINB regression analysis revealed that the study children who were boys, came from families with lower incomes, had dental visit experiences, had higher plaque scores and had parents with lower levels of dental knowledge, had higher dmft scores (P < 0.05).

CONCLUSIONS

Dental caries is prevalent among preschool children in Hong Kong. The caries experiences of the study children are associated with gender, family income, parental dental knowledge, dental visit experience and oral hygiene.

The caries-arresting effect of incorporating functionalized tricalcium phosphate into fluoride varnish applied following application of silver nitrate solution in preschool children: study protocol for a randomized, double-blind clinical trial

BACKGROUND

Dental caries in primary teeth is prevalent, affecting millions of children around the world. Functionalized tricalcium phosphate (fTCP) has been incorporated into sodium fluoride (NaF) varnish to enhance the remineralization process. NaF varnish with the adjunctive application of silver nitrate (AgNO3) solution is effective in arresting dentine caries. So far, there is no published randomized clinical trial investigating the effectiveness of the adoption of AgNO3 solution and NaF varnish containing fTCP in arresting dentine caries in preschool children. The objective of this study is to compare the effectiveness of a 25% AgNO3 solution plus a 5% NaF varnish containing fTCP and a 25% AgNO3 solution plus a 5% NaF varnish in arresting coronal dentine caries among preschool children when applied semi-annually over a 30-month period.

METHODS/DESIGN

This is a randomized, double-blind controlled trial. The null hypothesis tested is that no difference exists between the effectiveness of a 25% AgNO3 solution plus a 5% NaF varnish with fTCP and a 25% AgNO3 solution plus a 5% NaF varnish in arresting dentine caries in preschool children when applied semi-annually. According to the sample size calculation, approximately 2000 3- to 4-year-old kindergarten children will be screened, and at least 408 children with coronal dentine caries will be recruited. The children will be randomly allocated to two treatment groups via stratified randomization: group A - biannual application of a 25% AgNO3 solution followed by a 5% NaF varnish, and group B - biannual application of a 25% AgNO3 solution followed by a 5% NaF varnish with fTCP. Clinical examinations will be conducted every 6 months to assess whether the carious lesions have become arrested (primary outcome). Confounding factors, such as demographic background and oral hygiene behaviors, will be collected through a parental questionnaire.

DISCUSSION

The effectiveness of the topical application of a 25% AgNO3 solution followed by a 5% NaF varnish with fTCP in arresting coronal dentine caries among preschool children remains unknown. Because the proposed caries-arresting methods are simple, noninvasive and low cost, these can be widely recommended for caries control in young children.

TRIAL REGISTRATION

ClinicalTrials.gov (U.S.): NCT03423797 on 6 February 2018.