Malnutrition, enamel defects, and early childhood caries in preschool children in a sub-urban Nigeria population

A Review on Maternal Parenting, Child's Growth Stunting, and Oral Health

Stunting has gained global attention as one of the most critical problems in public health. As the first and dominant figure in a child's life, the mother is responsible for determining the proper parenting behaviors to apply to maintain the child's physical health. Stunting is often associated with early childhood caries (ECC) and molar incisor hypomineralization, which can be manifested into each other through various mechanisms. Therefore, it is crucial to explore how far maternal parenting behaviors affect stunting and oral health. This study aims to determine which maternal parenting behaviors can affect stunting and oral health. A systematic search was used through PubMed and Google Scholar to search for published articles between 2011 and 2021. The articles analyze maternal parenting behaviors with stunting and poor oral health. Final analysis was used on 21 articles containing 18 cross-sectional studies, 2 cohort studies, and 1 randomized controlled trial. The result implied that the high prevalence of stunting and ECC is the combined result of prolonged breastfeeding practices (7 articles), poor complementary feeding practice (6 articles), high consumption of sugar (5 articles), and poor oral hygiene practices (5 articles). Maternal parenting styles in the aspect of fulfilling nutrition and maintaining oral health affect the occurrence of stunting and ECC in children.

Caries Experience among Children with History of Neonatal Stunting

OBJECTIVE

 Children with neonatal growth retardation (defined as birth length <48cm) are at risk for chronic malnutrition that begins before birth and continues into infancy. Stunting can adversely affect a child's growth and development, including oral health itself, and especially the experience of dental caries. This study analyzed the dental caries experience in children with neonatal growth retardation.

MATERIALS

AND METHODS:  This was a baseline and 1-year follow-up analysis of a cohort of stunted children in a potential stunting site in Bandung City. Annual data collection included interviews with mothers and dental and anthropometric examinations of children. Descriptive analysis was performed in SPSS.

STATISTICAL ANALYSIS

 Data were recorded on paper forms and manually entered into a Microsoft Excel spreadsheet for later analysis using IBM SPSS (version 23.0). After assessment, descriptive statistics was generated prior to bivariate analysis.

RESULTS

 Fifty-five children met the inclusion criteria and participated in the 1-year study. Decay, missing, filling teeth (Dmft) was in the intermediate category (4.13) at baseline and fell into the high category (5.16) at 1-year follow-up, although the increase in caries remained in the low category.

CONCLUSION

 Dysplastic children with a history of neonatal developmental delay experience dental caries beginning in the first year of life and may become more severe later in life.

Association between maternal decision-making and mental health and the nutritional status of children under 6 years of age in sub-urban Nigeria

BACKGROUND

We assessed the association between decision-making power and mental health status of mothers and the nutritional status of their children less than 6 years old in Ile-Ife, Nigeria.

METHODS

This was a secondary data analysis of 1549 mother-child dyads collected through a household survey conducted between December 2019 and January 2020. The independent variables were maternal decision-making and mental health status (general anxiety, depressive symptoms, parental stress). The dependent variable was the child's nutritional status (thinness, stunting, underweight and overweight). Confounders were maternal income, age, and education status, and the child's age and sex. The associations between the dependent and independent variables were determined using multivariable binary logistic regression analysis after adjusting for confounders. The adjusted odds ratios (AORs) were determined.

RESULTS

Children of mothers with mild general anxiety had lower odds of stunting than children of mothers with normal anxiety (AOR: 0.72; p = 0.034). Mothers who did not make decisions on children's access to health care (AOR: 0.65; p < 0.001) had children with lower odds of being thin than those whose mothers made decisions on their access to health care. Children of mothers with clinically significant parenting stress levels (AOR: 0.75; p = 0.033), severe depressive symptoms (AOR: 0.70; p = 0.041) and who were not decision makers on the access of their children to health care (AOR: 0.79; p = 0.035) had lower odds of underweight.

CONCLUSIONS

Maternal decision-making status and mental health status were associated with the nutritional status of children less than 6 years in a sub-urban community in Nigeria. Further studies are needed to understand how maternal mental health is associated with the nutritional status of Nigerian preschool children.

Relationships between dental fluorosis and fluoride concentrations in bottled water and groundwater in low-income children in Mexico

Introduction

The aim of the current study was to investigate associations between dental fluorosis in children living in low socioeconomic areas in Mexico, and fluoride concentrations in tap water, fluoride concentrations and in bottled water, and body mass index (BMI).

Methods

A cross-sectional study involving 585 schoolchildren aged 8-12 years was conducted in communities in a southern state of Mexico with >0.7 parts per million (ppm) fluoride in the groundwater. The Thylstrup and Fejerskov index (TFI) was used to evaluate dental fluorosis, and the World Health Organization growth standards were used to calculate age-adjusted and sex-adjusted BMI Z-scores. A BMI Z-score ≤ -1 SD was used as the cut-off point for thinness, and multiple logistic regression models for dental fluorosis (TFI ≥ 4) were constructed.

Results

The mean fluoride concentration in tap water was 1.39 ppm (SD 0.66), and the mean fluoride concentration in bottled water was 0.32 ppm (SD 0.23). Eighty-four children (14.39%) had a BMI Z-score ≤ -1 SD. More than half (56.1%) of the children presented with dental fluorosis in TFI categories ≥ 4. Children living in areas with higher fluoride concentrations in the tap water [odds ratio (OR) 1.57, p = 0.002] and bottled water (OR 3.03, p < .001) were more likely to have dental fluorosis in the severe categories (TFI ≥ 4). BMI Z-score was associated with the probability of dental fluorosis (TFI ≥ 4; OR 2.11, p < 0.001), and the effect size was 29.3%.

Discussion

A low BMI Z-score was associated with a higher prevalence of dental fluorosis in the severe category. Awareness of the fluoride concentrations in bottled water may help prevent dental fluorosis, particularly in children exposed to several high fluoride content sources. Children with a low BMI may be more vulnerable to dental fluorosis.

Beyond dirty teeth: Integrating dental calculus studies with osteoarchaeological parameters

The study of ancient human dental calculus (mineralized dental plaque, also known as tartar) is becoming increasingly important in osteoarchaeology, human palaeoecology and environmental archaeology. Microremains of different origin (e.g. starch granules, pollen, phytoliths, feather barbules) as well as biomolecules and chemical compounds retrieved from its mineral matrix may represent an important link between past humans and their physical, biological and social environment, but they are rarely fully linked to the evidence from skeletal remains. This paper critically reviews the lines of evidence retrieved from dental calculus in relation to osteoarchaeological parameters, employing macroscopic, microscopic and biomolecular approaches, assessing synergy potential and limitations. The scope of this paper is also to contribute to the building of a much needed theoretical framework in this emerging subfield.

Knowledge and Practices Regarding Oral Hygiene, Cariogenic Diet Intake, and Dental Check-Ups Among Registered Nurses in Nigeria: A Pilot Study

Objectives To investigate the knowledge and practices of registered nurses in Nigeria concerning oral hygiene, cariogenic diets, and dental check-ups through a pilot study.

Methods This study was an online survey of 129 registered nurses in Nigeria. Data were collected via the WhatsApp social media using an electronic questionnaire (Google form). Data analysis was done using the SPSS version 26 software (IBM Corp, New York, USA).

Results The response and completeness rates of this pilot study were 41.7% (129/311) and 96.9% 9125/129), respectively. The majority (62.2%) of the respondents were females. The majority (89.1%) had average/above average score on basic oral health knowledge; however, there was no significant relationship between their level of basic oral health knowledge and their sociodemographic characteristics (p > 0.05). The majority (66.7%) of the respondents brushed twice daily, 86.8% used a fluoridated toothpaste, and 60.5% changed their toothbrush every 3 months. Furthermore, more than half (55.8%) consumed sugary snack/drink on daily basis, while 55.0% rinsed their mouth with water immediately after taking sugary snack, and only 55.8% did floss their teeth. Among those who flossed their teeth, only 37.5% did it once daily. It is also striking that 26.4% of the respondents had never visited a dentist for a dental check-up.

Conclusion Study findings showed a high level of basic oral health knowledge and a lower level of appropriate oral self-care practices among nurses in Nigeria. However, there is a need for a nationally representative study of nurses in Nigeria to further establish these findings.

Novel WDR72 Mutations Causing Hypomaturation Amelogenesis Imperfecta

Amelogenesis imperfecta (AI) is a heterogeneous collection of hereditary enamel defects. The affected enamel can be classified as hypoplastic, hypomaturation, or hypocalcified in form. A better understanding of normal amelogenesis and improvements in our ability to diagnose AI through genetic testing can be realized through more complete knowledge of the genes and disease-causing variants that cause AI. In this study, mutational analysis was performed with whole exome sequencing (WES) to identify genetic etiology underlying the hypomaturation AI condition in affected families. Mutational analyses identified biallelic WDR72 mutations in four hypomaturation AI families. Novel mutations include a homozygous deletion and insertion mutation (NM_182758.4: c.2680_2699delinsACTATAGTT, p.(Ser894Thrfs*15)), compound heterozygous mutations (paternal c.2332dupA, p.(Met778Asnfs*4)) and (maternal c.1287_1289del, p.(Ile430del)) and a homozygous 3694 bp deletion that includes exon 14 (NG_017034.2:g.96472_100165del). A homozygous recurrent mutation variant (c.1467_1468delAT, p.(Val491Aspfs*8)) was also identified. Current ideas on WDR72 structure and function are discussed. These cases expand the mutational spectrum of WDR72 mutations causing hypomaturation AI and improve the possibility of genetic testing to accurately diagnose AI caused by WDR72 defects.

The association between low birth weight and/or preterm birth and dental caries -A systematic review and meta-analysis

BACKGROUND

Studies on the association between adverse birth outcomes and dental caries in children have shown conflicting results, so the aim of this systematic review and meta-analysis was to investigate the association between adverse birth outcomes and dental caries in children.

METHODS

We systematically searched articles in four electronic databases (Web of Science, PubMed, Cochrane Library and Embase) published prior to August 2021. The odds ratio (OR) (or converted OR) and the corresponding 95% confidence intervals (95% CI) were processed. The certainty of evidence was assessed using GRADE's risk bias assessment tool. Random effects model was used for this meta-analysis.

RESULTS

A total of thirty-one observational studies met the inclusion criteria. The pooled estimates indicated that children exposed to low birth weight (LBW)/preterm birth (PTB) did not experience higher dental caries in primary teeth. Subgroup analyses showed that children with LBW (OR: 1.30, 95% CI: 1.03-1.63) were prone to have dental caries in primary teeth for cross-sectional studies, but no significant differences for prospective studies. PTB children experienced more primary caries in high-income countries (OR: 1.31, 95% CI: 1.00-1.70) than in low- and middle-income countries.

CONCLUSIONS

The current evidence did not suggest a significant association between LBW and dental caries in children for primary teeth. Children with PTB in high-income countries had a higher prevalence of primary dental caries. Further prospective studies should adjust for confounding factors (age, oral health and family finances) to determine the definitive association between LBW/PTB and dental caries.

Association between developmental defects of enamel and early childhood caries in children under 6 years old: A systematic review and meta-analysis

Early childhood caries (ECC) are an oral health problem worldwide in children under 6 years of age. This disease of rapid development has a multifactorial etiology, and one of the possible risk factors is developmental defects of enamel (DDE), such as hypoplasia and opacities. The aim of this systematic review was to evaluate the association between DDE and ECC in children under 6 years of age. An electronic search was conducted until March 2022 using Medline (PubMed), Scopus, Science-Direct, LILACS, Web of Science, Cochrane Library, EBSCO-Host, EMBASE, and Google Scholar and complemented with a manual search, with no restrictions on language or date of publication. Longitudinal studies of children under 6 years of age with primary dentition were included. A total of 1158 studies were found, of which 651 records were reviewed by title and abstract, and 24 articles were selected for full-text evaluation. Finally, nine studies that met the selection criteria were included in the qualitative synthesis. Study quality and certainty were assessed using the Newcastle-Ottawa scale and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Three cohort studies of good quality were included in the meta-analysis. A risk associated with DDE (RR = 1.94; 95% CI: 1.52–2.49) and a risk associated with enamel hypoplasia (RR = 5.45; 95% CI: 1.84–16.14) were found. The results for diffuse opacity (RR = 1.21; 95% CI: 0.18–8.15) and demarcated opacity (RR = 1.26; 95% CI: 0.43–3.65) were not significant. GRADE analysis presented low and very low certainty of evidence. It was concluded that there is an association between DDE and ECC. However, the results should be interpreted with caution because of the limitations of the study.

The protocol for this study has been registered in PROSPERO under identification number CRD42021238919.

Caries Experience and Increment in Children Attending Kindergartens with an Early Childhood Caries Preventive Program Compared to Basic Prophylaxis Measures-A Retrospective Cohort Study

Dental caries constitutes a public health challenge. As preventive strategies are desirable, this retrospective cohort study aimed to assess the caries experience and increment in children attending kindergartens with an early childhood caries (ECC) preventive program (intervention group, IG) compared to basic prophylaxis measures (control group, CG) located in areas of different socioeconomic status (SES) within Marburg (Germany). The long-term caries experience (2009−2019) of these 3−5-year-old kindergarten children was evaluated. For the caries increment, dental records of 2019 were screened for the availability of a minimum of two dental examinations at least 8 months apart. Caries was scored according to the WHO criteria (dmf−t). The data were split by observation period (300−550 and >550 days). Overall, 135 children (Ø 3.7 years) attended IG, and 132 children (Ø 3.6 years) attended CG. After 300−550 days, no significant differences were found between both groups regarding mean caries increment and experience (p > 0.05). After >550 days, IG with low SES exhibited a high caries experience. Fluoride varnish applications could not reduce the caries increment compared to CG in the short-term but slightly decreased the long-term caries experience. Comprehensive ECC prevention measures actively involving parents are needed to overcome the caries burden.

Prevalence of hypomineralised second primary molars (HSPM): A systematic review and meta-analysis

AIM

To evaluate the prevalence of HSPM worldwide on a child and a tooth level and investigate the influence of diagnostic criteria on the prevalence of HSPM.

DESIGN

A comprehensive literature search was performed through MEDLINE/PubMed, Scopus, and Web of Science databases. The grey literature was also screened as were the reference lists of included studies. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of HSPM.

RESULTS

The search strategy identified 1,988 articles, 487 were retrieved for full-text evaluation, and 37 studies were included in the meta-analysis (32 for child and 23 for tooth level prevalence), providing data from 26,805 individuals and 81,107 molars. The prevalence of HSPM was 6.8% (95% CI 4.98%-8.86%) on a child level and 4.08% on a tooth level (95% CI = 2.80%-5.59%). The diagnostic criteria used did not seem to influence the prevalence results (P > .05). The majority of the papers (75%) showed a low-to-moderate risk of bias.

CONCLUSION

There was a broad variation in the prevalence reported that may be attributed to differences in the study population. The present meta-analysis showed a HSPM prevalence worldwide of 6.8% on a child level and 4.1% on a tooth level.

Relationship between preterm, low birth weight, and development defects of enamel in the primary dentition: A meta-analysis

BACKGROUND

This study aimed to systematically analyze the relationship between preterm (PT), low birth weight (LBW), and developmental defects of enamel (DDE) in the primary dentition.

METHODS

Following the retrieval of the databases, case-control studies, cross-sectional studies, and cohort studies on the relationship between PT, LBW and DDE, which had been published in English or Chinese up to January 2022 were included. The data about odds ratio (OR) and 95% confidence interval (95% CI) were extracted and calculated using STATA 12.0 Software. Case-control studies were evaluated using the Newcastle-Ottawa Scale (NOS), while cross-sectional studies and cohort studies were evaluated using the JBI scale. The heterogeneity of each study was evaluated using the Q test.

RESULTS

A total of 15 studies were included, of which 8 studied the relationship between PT and DDE, and 13 explored the relationship between LBW and DDE including three about the relationship between very low birth weight (VLBW) and DDE. Seven studies explored the relationship between PT, LBW, and DDE. The results of this meta-analysis showed that both PT and LBW especially VLBW (OR= 7.19, 95% CI: 4.98-10.38) were risk factors for DDE in the primary dentition (OR= 2.33, 95% CI: 1.55-3.51) (OR= 1.67, 95% CI: 1.08-2.59). The subgroup results showed that PT and LBW were both associated with the occurrence of enamel hypoplasia (EHP) (OR= 6.89, 95% CI: 3.33-14.34; OR= 2.78, 95% CI: 2.10-3.68) rather than enamel opacity (OR= 0.94, 95% CI: 0.55-1.61; OR= 1.03, 95% CI: 0.66-1.61). There was no publication bias about the included studies (P = 0.75 > 0.05; P = 0.47 > 0.05).

CONCLUSION

This meta-analysis demonstrated that both PT and LBW especially VLBW are associated with a higher risk of DDE in the primary dentition. PT and LBW are both related to the occurrence of EHP. However, the relationship between PT, LBW, and enamel opacity has not been verified.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?, identifier: CRD42021262761.

Neonatal stunting and early childhood caries: A mini-review

The nutritional status of pregnant women greatly determines their newborn outcome. Deficiencies of several micronutrients are associated with stunting in early childhood, affecting health into adulthood. However, apart from the systemic disease that has been a concern so far, fetal undernutrition can also be associated with dental caries in a child's early life, especially since the primary teeth begin to form during the mother's gestation period. The important thing to underline regarding the intrauterine formation of primary teeth is especially in terms of enamel formation. One of the causes of developmental enamel defects that will contribute to the emergence of early childhood caries is the malnutrition of the pregnant mother. This mini-review aims to understand the linkage mechanism behind neonatal stunting to early childhood caries. This concept is expected to generate further research to help prevent both growth stunting and early childhood caries. In addition, with some evidence-based research, the importance of the first dental visit can be further promoted.

Prenatal, perinatal and postnatal events associated with hypomineralized second primary molar: a systematic review with meta-analysis

OBJECTIVE

The etiology of hypomineralized second primary molar (HSPM) appears to be multifactorial but remains uncertain. Thus, the objective was to systematically review studies that investigated adverse health conditions in the prenatal, perinatal and postnatal periods associated with HSPM.

MATERIAL AND METHODS

The search was carried out in five databases and in gray literature. The risk of bias of observational studies was analyzed according to the Newcastle-Ottawa scale.

RESULTS

A total of 1878 studies were identified. Fourteen were eligible, and seven were included in the meta-analysis. Maternal smoking (OR = 2.88; 95%CI: 1.62-5.15) and presence of maternal hypertension (OR = 2.91; 95%CI: 1.35-6.28) were significantly associated with higher odds of HSPM. In the perinatal period, factors associated with HSPM were low birth weight (OR = 1.50; 95%CI: 1.15-1.96), prematurity (OR = 1.93; 95%CI: 1.37-2.71), delivery complications (OR = 2.42; 95%CI: 1.52-3.83) and need for an incubator (OR = 1.65; 95%CI: 1.01-2.70). Not breastfeeding (OR = 1.26; 95%CI: 1.01-1.58), use of antibiotics by the child (OR = 1.24; 95%CI: 1.04-1.48), fever (OR = 1.37; 95%CI: 1.10-1.72) and asthma (OR = 1.91; 95%CI: 1.16-3.13) were the postnatal factors associated with HSPM.

CONCLUSION

Maternal smoking, maternal hypertension, low birth weight, prematurity, delivery complications, need for incubation, not breastfeeding, antibiotic use, fever and childhood asthma were associated with HSPM. Well-designed prospective cohort studies are needed. Clinical relevance Understanding the etiological factors can be guiding aspects for individual clinical approaches, as well as guiding the design of preventive interventions for HSPM.

The use of sel-ligating appliance can reduce inflammatory response to orthodontic force and keep periodontal health in orthodontic treatment

OBJECTIVE

Orthodontics, as a common way of orthodontic treatment, is usually to maintain oral health and protect periodontal tissue. The self-ligating appliance technique, since its advent in the 1930s, have been rather popular ammong the majority of orthodontists. This study was to determine that self-ligating appliance can reduce inflammation in gingival crevicular fluid (GCF) of patients receiving orthodontic treatment and keep periodontal health.

METHODS

The clinical data of 97 orthodontic patients admitted to the Department of Stomatology of Fujian Provincial Hospital, Fujian Provincial Clinical College of Fujian Medical University from March 2019 to March 2020 were analyzed retrospectively. Among them, 42 patients receiving orthodontic treatment with traditional MBT straight-wire appliance (SWA) were included in the control group (CG) and 55 patients treated with self-ligating appliance were collected as the observation group (OG). The two cohorts were compared with respect to the following aspects: curative effect, pain degree on the 1st, 2nd, 3rd, 5th and 7th day after wearing the appliance, oral related quality of life (QoL) before and after orthodontic treatment, satisfaction with the orthodontic treatment, periodontal condition, and GCF and inflammatory factor contents before, 3 months and 6 months after orthodontic treatment.

RESULTS

OG had significantly higher therapeutic efficacy of orthodontic treatment than CG (P<0.05). At the initial stage of treatment, the pain degree in OG was obviously lower than that in CG (P<0.05). Compared with CG, the plaque index (PLI), sulcus bleeding index (SBI), gingival recession (GR), periodontal probing depth (PPD) and clinical attachment loss (CAL) were better in OG after orthodontic treatment, and the differences were statistically significant (P<0.05). The contents of GCF, prostaglandin E2 (PGE₂), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in OG were lower than those in CG after orthodontic treatment, with significant differences between the two groups (P<0.05). Oral related QoL and orthodontic satisfaction were higher in OG, and the differences were statistically significant (P<0.05).

CONCLUSIONS

Compared with traditional SWA, the self-ligating appliance in orthodontic treatment contributes to higher efficacy and satisfaction, less local inflammatory reaction, and significantly improved periodontal condition and oral health of patients.

A Qualitative and Comprehensive Analysis of Caries Susceptibility for Dental Fluorosis Patients

Dental fluorosis (DF) is an endemic disease caused by excessive fluoride exposure during childhood. Previous studies mainly focused on the acid resistance of fluorotic enamel and failed to reach a consensus on the topic of the caries susceptibility of DF patients. In this review, we discuss the role of DF classification in assessing this susceptibility and follow the “four factors theory” in weighing the pros and cons of DF classification in terms of host factor (dental enamel and saliva), food factor, bacteria factor, and DF treatment factor. From our analysis, we find that susceptibility is possibly determined by various factors such as the extent of structural and chemical changes in fluorotic enamel, eating habits, fluoride levels in diets and in the oral cavity, changes in quantity and quality of saliva, and/or oral hygiene. Thus, a universal conclusion regarding caries susceptibility might not exist, instead depending on each individual’s situation.

Epidemiological profile of early childhood caries in a sub-urban population in Nigeria

Background

The aim of the study was to determine the prevalence and severity of early childhood caries (ECC) in children 6–71-months; identify the teeth most at risk for ECC; and identify risk indicators associated with significant caries index (SiC) score in different age groups.

Methods

This was a cross-sectional study that collected data (using a household survey) on the ECC risk indicators (frequency of tooth brushing, consumption of refined carbohydrate in-between-meals, daily use of fluoridated toothpaste, and dental service utilization in the 12 months) in Ile-Ife, Nigeria. We computed the prevalence of ECC using the International Caries Detection and Assessment System (ICDASI (d^1–6)) index; caries severity using the ICDAS-2(d^1–2) and ICDAS-3(d^3–6) for non-cavitated and cavitated lesions respectively, decayed missing, filled teeth (dmft), and surfaces (dmfs) and SiC indices; and caries complications using the pulp (p), ulceration (u), fistula (f) and abscesses (a) (pufa) index, for children 6–11-months-old, 12–23-months-old, 23–35-months-old, 35–47-months-old; 48–59-months-old and 60–71-months-old. The differences in the mean dmft, dmfs, pufa scores, and ICDAS 1, 2, and 3 scores, and proportion of children with each ECC risk indicator were computed. Logistic regression analysis was conducted to identify risk indicators for the ECC SiC index score for each age group.

Results

The prevalence of ECC was 4.7%: 2.9% had non-cavitated lesions and 2.8% had cavitated lesions. The mean (SD) dmft, dmfs and pufa scores were 0.13 (0.92), 0.24 (1.91) and 0.04 (0.46) respectively. The dmft and dmfs scores were highest among the 24–35-months-olds while the SiC score was highest among the 12–23-months-olds. There were no significant differences in dmft, dmfs, and pufa scores between the different age groups. Toothbrushing more than once a day was the only factor associated with the SiC score: it decreases the odds for the SiC score in children 48–59-months-old. The teeth worst affected by ECC were #85 and #61.

Conclusion

The prevalence, severity and risk indicator for ECC seems to differ for each age group. The granular details on the risk profile of children with ECC in this population with a low ECC prevalence and burden can allow for the planning of age-targeted interventions.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Validation of maternal report of early childhood caries status in Ile-Ife, Nigeria

Background

To determine the validity of maternal reports of the presence of early childhood caries (ECC), and to identify maternal variables that increase the accuracy of the reports.

Methods

This secondary data analysis included 1155 mother–child dyads, recruited through a multi-stage sampling household approach in Ile-Ife Nigeria. Survey data included maternal characteristics (age, monthly income, decision-making ability) and maternal perception about whether or not her child (age 6 months to 5 years old) had ECC. Presence of ECC was clinically determined using the dmft index. Maternally reported and clinically determined ECC presence were compared using a chi-squared test. McNemar's test was used to assess the similarity of maternal and clinical reports of ECC. Sensitivity, specificity, positive and negative predictive values, absolute bias, relative bias and inflation factor were calculated. Statistical significance was determined at p < 0.05.

Results

The clinically-determined ECC prevalence was 4.6% (95% Confidence interval [CI]: 3.5–5.0) while the maternal-reported ECC prevalence was 3.4% (CI 2.4–4.6). Maternal reports underestimated the prevalence of ECC by 26.1% in comparison to the clinical evaluation. The results indicate low sensitivity (9.43%; CI 3.13–20.70) but high specificity (96.9%; CI 95.7–97.9). The positive predictive value was 12.8% (CI 4.3–27.4) while the negative predictive value was 95.7% (CI 94.3–96.8). The inflation factor for maternally reported ECC was 1.4. Sensitivity (50.0%; CI 6.8–93.2) and positive predictive value were highest (33.3%; CI 4.3–77.7) when the child had a history of visiting the dental clinic.

Conclusions

Mothers under-reported the presence of ECC in their children in this study population. The low sensitivity and positive predictive values of maternal report of ECC indicates that maternal reporting of presence of ECC may not be used as a valid tool to measure ECC in public health surveys. The high specificity and negative predictive values indicate that their report is a good measure of the absence of ECC in the study population. Child’s history of dental service utilization may be a proxy measure of presence of ECC.