Dental caries and growth in school-age children

Study on the association between malnutrition, early childhood caries and caries activity among children aged 3-5 years

BACKGROUND

This study aims to investigate the association between malnutrition and early childhood caries (ECC) and caries activity among children aged 3-5 years, in order to provide a theoretical basis for preventing and blocking ECC and improving malnutrition.

METHODS

Children aged 3-5 years from six kindergartens in Zhao Xian, China were enrolled in this study. The decayed, missing, filled teeth (dmft) of all children were examined and recorded. The Cariostat method was used to detect dental caries activity, collect anthropometric data and measure haemoglobin concentration. Parents were asked to complete a questionnaire on the general characteristics and oral health behaviour of the participants. The "Growth Standards for Chinese Children Under 7 Years Old" was used to assess the nutritional status of all participating children. Wilcoxon rank sum test and multivariate logistic regression analysis were used to analyse and evaluate the relationship between ECC, caries activity and malnutrition.

RESULTS

A total of 635 children who met the criteria were included in this study. After adjusting for confounding factors, logistic regression showed that the risk of ECC was significantly increased in underweight children compared with normal children (OR = 5.43, P < 0. 05); compared with normal children, the risk of ECC decreased in overweight and obese children (OR = 0.31, P < 0.001); underweight children had higher caries severity than normal weight children, and the difference was statistically significant (OR = 2.69, P < 0. 05); stunted children had higher caries severity than normal weight children and the difference was statistically significant (OR = 2.28, P < 0.05); underweight was positively associated with caries activity and the association was statistically significant (OR = 2.33, P < 0. 05); stunting was positively associated with caries activity and the association was statistically significant (OR = 2.1, P < 0.05); overweight and obesity were negatively associated with caries activity and the association was statistically significant (OR = 0.61, P < 0.05).

CONCLUSIONS

The risk of ECC among children aged 3-5 years was positively associated with undernutrition and negatively associated with overnutrition. The severity of ECC among children aged 3-5 years was positively associated with undernutrition. The caries activity among children aged 3-5 years was positively associated with undernutrition and negatively associated with overnutrition.

Unmasking caries risk: a multi-regional study in Saudi Arabia

BACKGROUND

Dental caries are common and troublesome and may affect individuals' health conditions. It is crucial to comprehend the caries experience for prevention, management, and enhancing oral health. Techniques such as CAMBRA can help assess an individual's risk factors for caries lesions. This study aims to assess the caries risk in five distinct regions of Saudi Arabia, utilizing the CAMBRA methodology.

METHODS

This multiregional cross-sectional study was conducted at university dental clinics across the five regions of Saudi Arabia, using a Caries Management by Risk Assessment (CAMBRA) tool. This study used binary logistic regression analysis, the Pearson Chi-square test, and descriptive analysis as statistical methods.

RESULTS

A total of 551 respondents participated in the study, with 59.7% being male and 40.3% being female. The age group with the highest proportion was 20-29, making up 31.6% of the participants. All participants exhibited at least one caries lesion (100%), with white spots (66.4%) and enamel lesions (56.1%) being the most prevalent. The moderate-risk category encompassed the largest proportion of participants, accounting for 60% of the total. High caries risk had a significant association with age group (P < 0.001), education (P < 0.001), profession (P < 0.001), and socio-economic status (P < 0.001). Furthermore, only age and socio-economic status showed a significant relationship with high caries risk in the multiple logistic regression.

CONCLUSION

The CAMBRA tool indicates a high prevalence of moderate risk across the five regions of Saudi Arabia, identifying age and socio-economic status as significant predictors of caries risk.

Association of Salivary Vitamin D and Vitamin C Levels with Dental Caries in Children: A Cross-sectional Study

Aim

Dental caries is a prevalent chronic disease affecting children worldwide. This study aimed to investigate the association between dental caries and salivary levels of vitamin D and vitamin C in children.

Materials and methods

This cross-sectional research was conducted at RAK College of Medical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates, in children between the ages of 4 and 12 years, with a sample of 60 children divided into study and control groups based on the presence or absence of dental caries. Saliva samples were collected, and levels of vitamin D and vitamin C were measured using enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 29.

Results

The results showed that children without dental caries had higher salivary vitamin D and vitamin C levels compared to those with caries.

Conclusion

These findings highlight the potential role of these vitamins in preventing dental caries in children and support the need for public health initiatives promoting optimal oral health through appropriate dietary habits and sun exposure.

Clinical significance

The clinical significance of the study lies in its potential to inform preventive strategies and improve oral health outcomes in children. By recognizing the association between salivary vitamin levels and dental caries, healthcare professionals can take proactive steps to promote better oral health and overall well-being in children worldwide.

How to cite this article

Padmanabhan V, Islam MS, Goud M, et al. Association of Salivary Vitamin D and Vitamin C Levels with Dental Caries in Children: A Cross-sectional Study. Int J Clin Pediatr Dent 2024;17(7):773-776.

SEQUEL: Prevalence of dental caries in Saudi Arabia: A systematic review and Meta-analysis

This meta-analysis investigated the prevalence of dental caries throughout the Kingdom of Saudi Arabia (KSA) between 2011 and 2023 as a follow-up to a previously published review in 2013 by Khan et al. and aimed to provide an update on the current status of caries prevalence in the KSA. A literature search was conducted, and thirty-three articles were included in the final analysis. To determine the prevalence of caries in primary teeth, the 2- to 12-year-old Saudi population was included in the search, and an age range of 6-18 years was used for permanent teeth. The prevalence of caries in the primary and permanent dentition was analyzed separately. As the included studies for the primary and permanent teeth had insignificant heterogeneity, fixed-effect models and forest plots were used to evaluate caries prevalence in both dentitions. In the primary dentition, the mean decayed-missing-filled teeth (dmft) index was 4.14 (95 % confidence interval (CI): 3.11-5.18), with an average prevalence of 75.43 %. For the permanent teeth, the mean DMFT (uppercase used for permanent dentition) was 1.28 (95 % CI: 0.93-1.64), with an average prevalence of 67.7 %. The average dmft/DMFT scores decreased in both primary and permanent teeth compared to the previous meta-analysis by Khan et al., suggesting a beneficial effect of preventative measures on caries prevalence. Continuing these measures is necessary to maintain the downward trend of caries prevalence in the KSA.

Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries

BACKGROUND

Dental caries, a common chronic disease of childhood, is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC). This review updates one published in 2019.

OBJECTIVES

To assess the effects of interventions undertaken with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years).

SEARCH METHODS

We searched Cochrane Oral Health's Trials Register, Cochrane Pregnancy and Childbirth's Trials Register, CENTRAL, MEDLINE (Ovid), Embase (Ovid), CINAHL EBSCO, the US National Institutes of Health Ongoing Trials Register (clinicaltrials.gov) and WHO International Clinical Trials Registry Platform (apps.who.int/trialsearch). The latest searches were run on 3 January, 2023.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing interventions with pregnant women, or new mothers and other primary caregivers of infants in the first year of life, against standard care, placebo or another intervention, reporting on a primary outcome: caries presence in primary teeth, dmfs (decayed, missing, filled primary surfaces index), or dmft (decayed, missing, filled teeth index), in children up to six years of age. Intervention types include clinical, oral health promotion/education (hygiene education, breastfeeding and other dietary advice) and policy or service.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed study eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence (GRADE).

MAIN RESULTS

We included 23 RCTs (5 cluster-randomised), involving 25,953 caregivers (mainly mothers) and their children. Fifteen trials assessed oral health education/promotion interventions against standard care. Six trials assessed a clinical intervention for mother dentition, against placebo, or a different type of clinical intervention. Two trials assessed oral health/education promotion plus clinical intervention (for mother's dentition) against standard care. At most, five trials (maximum of 1326 children and 130 mothers) contributed data to any comparison. Enamel-only caries were included in the diagnosis of caries in some studies. For many trials, the risk of bias was unclear due to lack of methodological details reported. In thirteen trials, participants were socioeconomically disadvantaged. No trial indicated receiving funding that was likely to have influenced their results. Oral health education/promotion interventions Child diet and feeding practice advice versus standard care: We observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a slightly lower mean dmfs (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, the evidence is very uncertain regarding the difference between groups in mean dmft (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). Breastfeeding promotion and support versus standard care: We observed little or no difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence) and in mean dmft (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). dmfs was not reported. Child diet advice compared with standard care: We are very uncertain about the effect on the risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). dmfs and dmft were not reported. Oral hygiene, child diet and feeding practice advice versus standard care: The evidence is very uncertain about the effect on the risk of caries presence in primary teeth (RR 0.73, 95% CI 0.50 to 1.07; 5 trials; 1326 participants; very low-certainty evidence) and there maybe little to no difference in mean dmfs (MD -0.87, 95% CI -2.18 to 0.43; 2 trials; 657 participants; low-certainty evidence) and mean dmft (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; low-certainty evidence). High-dose versus low-dose vitamin D supplementation during pregnancy: We are very uncertain about the effect on risk of caries presence in primary teeth (RR 0.99, 95% CI 0.70 to 1.41; 1 trial; 496 participants; very low-certainty evidence). dmfs and dmft were not reported. Clinical interventions (for mother dentition) Chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo: We are very uncertain regarding the difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment for mother dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trial reported dmfs or dmft. Xylitol compared with CHX antimicrobial treatment: We are very uncertain about the effect on caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence), but we observed there may be a lower mean dmft with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence). No trial reported dmfs. Oral health education/promotion plus clinical interventions (for mother dentition) Diet and feeding practice advice for infants and young children plus basic dental care for mothers compared with standard care: We are very uncertain about the effect on risk of caries presence in primary teeth (RR 0.44, 95% CI 0.05 to 3.95; 2 trials, 324 participants; very low-certainty evidence) or on mean dmft (1 study, not estimable). No trial reported dmfs. No trials evaluated policy or health service interventions.

AUTHORS' CONCLUSIONS

There is moderate-certainty evidence that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very-low certainty and is insufficient for determining which, if any, other intervention types and features may be effective for preventing ECC, and in which settings. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine the effects and relative effects of different interventions and inform practice. We have identified 13 ongoing studies. Future studies should consider if and how effects are modified by intervention features and participant characteristics (including socioeconomic status).

Dental decay in children and the link to weight status: A cross-sectional analysis of national school health data

Recent national reports have indicated an increasing trend of dental decay among school-aged children. National school-based data are required to guide decision-making to ensure effective public health efforts to manage dental decay. This study aimed to assess the prevalence of dental decay among school-age children in Saudi Arabia and explore the possible link between dental decay and weight status. This was a cross-sectional analysis of a national sample including 1,134,317 Saudi children in the 1st, 4th, 7th, and 10th grades who participated in a national school screening program. Data for weight, height, body mass index (BMI), dental decay prevalence, and decayed, missing, and filled teeth (DMFT) index were analysed. An independent t-test, one-way analysis of variance, and chi-square test were used to compare the means, while Pearson's r correlation and multiple linear regression were used to examine the relationships between the study variables. The prevalence of dental decay was 24.20%, and dental decay was the highest among female students (26.5%), students in primary school (25.9%), students living in the eastern region (35.2%), in the administrative capital (27.6%), and in rural areas (23.4%). Dental decay was the highest among students who were underweight. Female sex and living in rural areas significantly predicted higher DMFT while being overweight/obese significantly predicted lower DMFT. Dental decay is highly prevalent among underweight students, female students, and students living in rural areas and the eastern regions of Saudi Arabia. To reduce the prevalence of dental decay and related health disparities, dental health screening programs should be designed to detect dental decay early among children at high risk due to abnormal BMIs and sociodemographic factors. In addition, dental health screening and management programs should utilize standardized dental decay assessment methods and ethnically representative growth charts.

Fracture strength of preformed zirconia crown and CAD-CAM zirconia, ceramic, and hybrid composite crowns for the restoration of primary molars: An in vitro study

BACKGROUND

Paediatric-preformed zirconia crowns have been associated with several issues, primarily their inability to be crimped and the need for extensive tooth preparation. Additionally, the capacity to adjust the size, shape, and fit of these crowns is very limited.

AIM

To evaluate and compare the fracture strength of four different types of dental crowns intended for paediatric patients.

DESIGN

The fracture resistance of four types of paediatric crowns was evaluated using the universal testing machine; freshly extracted primary molars received one of the following: preformed zirconia crowns, custom-made computer-aided design and computer-aided manufacturing (CAD-CAM) zirconia crowns, custom-made CAD-CAM ceramic crowns, and custom-made CAD-CAM hybrid composite crowns. Data were statistically compared using the Kruskal-Wallis test followed by the Bonferroni test, and the level of significance was set at 5%.

RESULTS

Results showed that there was a statistically significant difference among the four groups (p < .001). The highest value of fracture force was observed for the milled zirconia crown and the lowest for the prefabricated zirconia.

CONCLUSION

The implementation of the CAD-CAM digital crown fabrication technique has the potential to address issues associated with preformed crowns in paediatric patients, particularly in terms of fracture resistance.

Dental caries and associated factors among preschool children in Southwest Ethiopia: a cross-sectional study

BACKGROUND

Dental caries is a global public health problem, especially for young children. This study aimed to assess the prevalence of dental caries and its associated factors among preschool children in Mizan Aman town, Southwest Ethiopia.

METHODS

A school-based cross-sectional study was conducted from 1 October to 1 December 2022. A total of 354 children and their parents participated using simple random sampling techniques. Data were collected through an oral clinical examination, interviewing the parents and measuring the anthropometry of the children.

RESULTS

The prevalence of dental caries was 36.4% (95% CI 31.2% to 41.8%). Night feeding (adjusted OR (AOR)=3.98, 95% CI 1.56 to 10.15), children who did not brush their teeth under parental supervision (AOR=2.98, 95% CI 1.60 to 5.57), body mass index (AOR=3.48, 95% CI 1.30 to 9.41) and history of dental visits (AOR=3.05, 95% CI 1.61 to 5.81) were significantly associated with dental caries.

CONCLUSION

The prevalence of dental caries in preschool children was found to be high. Children who did not brush their teeth under parental supervision, who had experience of night feeding, who had a high body mass index and who had a history of dental visits were at risk for dental caries. Prevention of those identified modifiable risk factors should be considered to reduce dental caries.

Sugar-Sweetened Beverages, Foods of Low Nutritional Value, and Child Undernutrition in Cambodia

Child undernutrition persists in Cambodia despite recent progress. As Cambodia undergoes a shift in dietary consumption that coincides with economic, demographic, and epidemiologic changes, there is risk of ultra-processed foods and sugar-sweetened beverages displacing nutrient-dense foods during the critical period of infant growth in the first 24 months. The aim of this study was to assess the introduction and intake of foods of low nutritional value and sugar-sweetened beverages and their association with undernutrition among children 24 months of age in rural and semi-urban Cambodia. Cross-sectional analyses of a 24-h dietary recall from a sample (n = 377) of 24-month-olds found that the majority of infants had been introduced to packaged salty snacks and sweets by 12 months of age and to sugar-sweetened beverages by 15 months. By 24 months of age, 78% of children had consumed foods of low nutritional value and 57% consumed a sugar-sweetened beverage on the previous day. Multivariate logistic regression analyses demonstrated that infant intake of a flavored sugary drink on the previous day was associated with over two times the odds of both stunting and wasting, and consumption of packaged sweets on the previous day was associated with over two times the odds of wasting, but no association was found with stunting. These findings underscore the need to improve educational and policy interventions to support healthy feeding practices for infants and young children.

Association between Salivary Cortisol Levels, Dental Anxiety, and Dental Caries in Children: A Cross-Sectional Study

AIM

This study aimed to investigate the relationship between dental caries, dental anxiety, and salivary cortisol levels in children visiting pediatric dental clinics and their implications on pediatric oral health.

MATERIALS AND METHODS

A cross-sectional study was conducted at a dental university in the UAE. A total of 60 children, aged 4-12 years, were included. Salivary cortisol levels were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) kit. Dental caries status was evaluated, and dental anxiety levels were assessed using the Modified Dental Anxiety Scale (MDAS). Statistical analyses, including Mann-Whitney U test and Pearson's correlation coefficient, were performed to determine significant differences and associations.

RESULTS

The study group showed significantly higher salivary cortisol levels compared to the control group (p < 0.0001). A strong positive correlation was found between salivary cortisol levels and dental caries status (p < 0.001). However, no significant difference in dental anxiety levels was observed between the study and control groups (p = 0.85). A strong positive correlation was found between dental anxiety levels and dental caries status (p < 0.001).

CONCLUSION

The findings indicate a significant association between salivary cortisol levels and dental caries, suggesting that higher cortisol levels are associated with active caries. Dental anxiety levels were positively correlated with dental caries. Understanding the relationship between these variables can contribute to better oral health strategies and interventions for children, emphasizing the importance of managing dental anxiety and stress in pediatric dental care.

CLINICAL SIGNIFICANCE

This study highlights the potential of salivary cortisol as a biomarker for assessing stress and its impact on oral health in children. By addressing dental anxiety and stress, dental professionals can provide child-friendly dental care, enhance preventive measures, and improve oral health outcomes in pediatric patients.

Association between obesity and dental caries among adolescents in UAE: a pilot cross sectional study

Background

Obesity and dental caries among adolescents is a growing worldwide public health issue. They share some common and modifiable influences. The objective of this study was to evaluate the association between obesity and dental caries among adolescents in the United Arab Emirates (UAE).

Methods

This pilot cross-sectional study enrolled 161 adolescents 13-19 years old from private and public schools in the UAE. Participants were classified as normal weight, underweight, overweight or obese. Dental caries was diagnosed according to the criteria recommended by the World Health Organization (WHO). Independent t-tests were used to compare average number of decayed, missing and filled surfaces (DMFS) by age, sex, school type, mothers' employment, BMI categories, waist circumference, oral health habits and plaque index. Additionally, a multiple linear regression model was applied to analyze the association between BMI, waist circumference and dental caries, adjusted for confounding factors considered in this study.

Results

The average age of the participants was 16.2 ± 1.4 years old. The prevalence of overweight/obesity was 42% (N = 68) measured by BMI. In addition, 82% (N = 132) had average waist circumference and 18% (N = 29) with above average waist circumference. Overall, the average DMFS score was 4.35 ± 4.5, with significantly lower dental caries rates among girls ([3.3 (SD:4.0)] than boys (6.7 (SD:5.3), (p < 0.05). The linear regression model revealed that, being a male, attending a public school and having average waist circumference were all positively and significantly associated with dental caries (p < 0.05).

Conclusion

Obesity measured by waist circumference was significantly associated with dental caries among adolescents in the UAE. Further research is required to investigate the complex association between obesity and dental caries and how dietary habits, oral hygiene habits, and parental socioeconomic status mediate the association between obesity and dental caries.

Evaluation of the relationship between pain inflammation due to dental caries and growth parameters in preschool children

OBJECTIVES

To evaluate the relationship between pain inflammation due to dental caries and growth parameters, sleep disturbances, and oral health-related quality of life (OHRQoL) in preschool children before/after dental treatment and compare the results with the control group.

MATERIALS AND METHODS

Study (pain inflammation due to caries) and control groups were included in this prospective clinical trial. The Child Sleep Habits Questionnaire (CSHQ) assessing sleep disturbances and the Early Childhood Oral Health Impact Scale (ECOHIS) assessing OHRQoL were applied in the corresponding time intervals to the study and control groups, respectively: baseline (T0_study), 7 days after treatment (T1_study), and following 6 months (T2_study); baseline (T0_control), and the following 6 months (T2_control). Biochemical growth parameters (insulin-like growth factor-1 and insulin-like growth factor binding protein-3) and anthropometric measurements (standard deviation score of height, weight, and body mass index) were obtained at T0_study, T2_study, and T0_control. Mann-Whitney U and the Student t-tests were used for statistical analyses. The significance level was set at p < 0.05.

RESULTS

Data on 45 children (mean age: 55.6 ± 10.37 months) were analyzed. T2_study was statistically higher than T0_study for the anthropometric measurements and biochemical growth parameters (p < 0.05). T0_study was statistically higher than T0_control for biochemical growth parameters (p < 0.05). CSHQ and ECOHIS scores were found statistically significant at T0_study than T0_control (p < 0.05). Statistical scores of CSHQ and ECOHIS in T2_study were significantly reduced compared to T0_study (p < 0.05).

CONCLUSION

Children's growth parameters, sleep disturbances, and OHRQoL improved after the elimination of pain and inflammation.

CLINICAL RELEVANCE

This study's novelty is the observation of drastically increased growth parameters and reduced sleep disturbances following dental treatment.

Change in Growth Status and Obesity Rates among Saudi Children and Adolescents Is Partially Attributed to Discrepancies in Definitions Used: A Review of Anthropometric Measurements

Anthropometric measurements are the first step in determining the health status in children and adolescents. Clinicians require standardized protocols for proper assessment and interpretation. Therefore, this study aims to review the literature of international and Saudi national guidelines and studies previously conducted in Saudi children and adolescents to provide recommendations to establish Saudi guidelines in line with the Saudi 2030 Vision. Systematic search was conducted in several databases: Medline, PubMed, Saudi Digital Library and Google Scholar from January 1990 to January 2021. Further, 167 studies measured anthropometrics in Saudi children/adolescents; 33 of these studies contributed to the establishment/adjustment of Saudi growth charts or specific cutoffs or studied the trend of growth in representative samples or adjusted the international curves to be used in Saudis. This review warrants updating growth charts and establishing the standard cutoffs of Saudi adolescent anthropometrics to avoid over/underreporting. This review provides insights and recommendations regarding the resources that can be used to establish national guidelines in anthropometric measurements for Saudi children/adolescents. This review will help policymakers and the Ministry of Health to establish standardized protocols to be used in Saudi Arabia for anthropometric measurements that may assist in detecting malnutrition.

Assessing Risks of Early Childhood Caries in Primary Care Practice Using Electronic Health Records and Neighborhood Data

CONTEXT

Early childhood caries (ECC) is a persistent public health challenge, affecting more than 56% of US toddlers and preschool-aged children. Despite this, ECC is largely preventable with routine oral hygiene practices, diet, and application of topical fluoride.

OBJECTIVE

This study assessed the utilization of preventive oral health care in primary care practices and evaluated the variation in patient characteristic and geographic disparities.

DESIGN

We conducted a retrospective study using electronic health records (EHRs) over a 2-year period. Patients' home addresses were geocoded and linked to census-based neighborhood statistics and fluoridated water accessibility. Multiple logistic regression modeling was used to assess the risk of ECC in patients with fluoride preventive care, controlled for demographics, comorbid conditions, and neighborhood risk factors.

PARTICIPANTS

Patients aged 6 to 71 months who had primary care providers at family medicine and general pediatric clinics in a large academic medical center.

MAIN OUTCOME MEASURE

The presence of dental caries based on diagnoses in EHRs.

RESULTS

The study consisted of 10 836 patients: 17% treated with topical fluoride varnish (TFV), 12% prescribed oral fluoride supplement, 6.1% with both TFV and supplement, and 64% without fluoride treatment. Patients with fluoride treatment were 24% to 53% less likely to have ECC. Children living in rural and nonfluoridated water communities had 1.7 to 1.8 times greater risk of developing ECC. Minority, under/uninsured, and low-income patients also were at an increased risk of ECC.

CONCLUSION

Despite continuing efforts to improve access to dental care for vulnerable populations, substantial disparities remain among socioeconomically disadvantaged children. To address dental care shortage, primary care clinicians should serve as the safety net to care for vulnerable and underserved children who have no or limited access to oral health services. Future research into the collaboration between primary care and dental providers at the level of both practice and professional education should be considered.

Caries Incidence Is Associated with Wasting among Cambodian Children

Evidence suggests that dental caries is associated with chronic and acute malnutrition, manifested as stunting and wasting in children. However, studies have not always appropriately accounted for confounding factors or for the temporal ordering between exposure and outcome. This study examined relationships between the development of caries lesions with subsequent stunting and wasting outcomes using data from a population-based cohort in Cambodia. Caries incidence was assessed based on the presence of a new cavitated carious lesion or a new pulpally involved lesion across a 6-mo observation period. Anthropometric measurements were taken at regular intervals. Effects of carious lesions on stunting and wasting were assessed using inverse probability treatment weighting, adjusting for potential confounders, using z scores for height-for-age (HAZ) and weight-for-height (WHZ) as outcomes. In total, 894 children (mean age 20 mo at baseline) were followed over 2 y. At baseline, 350 (39.1%) were identified as having stunting malnutrition. At follow-up, 58 (6.5%) had a new pulpally involved lesion. There was no association between incidence of cavitated or pulpally involved carious lesions at follow-up and stunting (relative risk [RR] = 1.06; 95% confidence interval [CI]: 0.75, 1.50). The incidence of pulpally involved carious lesions had an effect on wasting prevalence (WHZ <-2; RR = 1.35; 95% CI: 0.70, 2.62) and WHZ scores (average treatment effect = -0.294; 95% CI: -0.538, -0.050). This study offers evidence that the development of pulpally involved carious lesions has an effect on WHZ scores. Oral health promotion and clinical prevention and management of dental caries should be explored as interventions to promote normal growth and development among preschool children, particularly in low-income settings.

Association between dental caries and obesity among Libyan schoolchildren during the armed conflict in Benghazi

BACKGROUND

Dental caries and Obesity in children are issues of public health concern. Even though researching the relationship between these two noncommunicable diseases has been conducted for many years, the results remain equivocal. This paper aimed to examine the association between dental caries and obesity among 12-year-old schoolchildren living in war-affected environment in Benghazi.

METHODS

A secondary analysis of a cross-sectional study was conducted to determine the prevalence of caries among 12-year-old school children in Benghazi in 2017 during the armed conflict that affected the city. The data extracted for the analysis included sociodemographic of the participants (gender, maternal education and school type), caries experience (DMFT index), and anthropometric measures (height in cm, weight in kg, BMI and Z score for BMI). Comparisons of anthropometric measures were conducted according to caries experience. Linear regression models were developed to determine the association between Body Mass Index and Z score as outcome variables, caries as an explanatory variable, and covariates (gender, maternal education and school type). Beta coefficient (β) and 95% confidence intervals were calculated. All statistical tests were conducted at p ≤ 0.05.

RESULTS

There were 782 children with a mean (SD) BMI of 20.7 SD5.09 and an average z (SD) score of 0.56 SD1.51. Also, 159 (20%) children had obesity. No significant association was observed between caries and anthropometric measures. However, higher BMI was observed in children from a private school (p ≤ 0.001***), females (p ≤ 0.001***) and self-reported regular sugary drinks consumers (p ≤ 0.001***).

CONCLUSION

The present study shows no significant association between dental caries and anthropometric measures. However, the study findings support the notion of tackling sugar intake as a common risk factor for caries and obesity, which should be encouraged in the Libyan culture.

Body Mass Index and Caries: Machine Learning and Statistical Analytics of the Dental, Oral, Medical Epidemiological (DOME) Nationwide Big Data Study

The objectives of the research were to analyze the association between Body Mass Index (BMI) and dental caries using novel approaches of both statistical and machine learning (ML) models while adjusting for cardiovascular risk factors and metabolic syndrome (MetS) components, consequences, and related conditions. This research is a data-driven analysis of the Dental, Oral, Medical Epidemiological (DOME) big data repository, that integrates comprehensive socio-demographic, medical, and dental databases of a nationwide sample of dental attendees to military dental clinics for 1 year aged 18−50 years. Obesity categories were defined according to the World Health Organization (WHO): under-weight: BMI < 18.5 kg/m2, normal weight: BMI 18.5 to 24.9 kg/m2, overweight: BMI 25 to 29.9 kg/m2, and obesity: BMI ≥ 30 kg/m2. General linear models were used with the mean number of decayed teeth as the dependent variable across BMI categories, adjusted for (1) socio-demographics, (2) health-related habits, and (3) each of the diseases comprising the MetS definition MetS and long-term sequelae as well as associated illnesses, such as hypertension, diabetes, hyperlipidemia, cardiovascular disease, obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD). After the statistical analysis, we run the XGBoost machine learning algorithm on the same set of clinical features to explore the features’ importance according to the dichotomous target variable of decayed teeth as well as the obesity category. The study included 66,790 subjects with a mean age of 22.8 ± 7.1. The mean BMI score was 24.2 ± 4.3 kg/m2. The distribution of BMI categories: underweight (3113 subjects, 4.7%), normal weight (38,924 subjects, 59.2%), overweight (16,966, 25.8%), and obesity (6736, 10.2%). Compared to normal weight (2.02 ± 2.79), the number of decayed teeth was statistically significantly higher in subjects with obesity [2.40 ± 3.00; OR = 1.46 (1.35−1.57)], underweight [2.36 ± 3.04; OR = 1.40 (1.26−1.56)] and overweight [2.08 ± 2.76, OR = 1.05 (1.01−1.11)]. Following adjustment, the associations persisted for obesity [OR = 1.56 (1.39−1.76)] and underweight [OR = 1.29 (1.16−1.45)], but not for overweight [OR = 1.11 (1.05−1.17)]. Features important according to the XGBoost model were socioeconomic status, teeth brushing, birth country, and sweetened beverage consumption, which are well-known risk factors of caries. Among those variables was also our main theory independent variable: BMI categories. We also performed clinical features importance based on XGBoost with obesity set as the target variable and received an AUC of 0.702, and accuracy of 0.896, which are considered excellent discrimination, and the major features that are increasing the risk of obesity there were: hypertension, NAFLD, SES, smoking, teeth brushing, age as well as our main theory dependent variable: caries as a dichotomized variable (Yes/no). The study demonstrates a positive association between underweight and obesity BMI categories and caries, independent of the socio-demographic, health-related practices, and other systemic conditions related to MetS that were studied. Better allocation of resources is recommended, focusing on populations underweight and obese in need of dental care.

The role of oral health-related quality of life in the association between dental caries and height, weight and BMI among children in Bangladesh

OBJECTIVES

To examine whether oral health-related quality of life (OHRQoL) explained the negative associations between dental caries and anthropometric measures of child growth among a sample of 5- to 9-year-old children in Dhaka, Bangladesh, while taking potential confounding factors (maternal education, family income, study setting, child's birth weight and childhood diseases) into account. In addition, to test whether specific oral impacts had a role in explaining these associations.

METHODS

Data collection was conducted via a cross-sectional survey among children and their parents from both hospital and school settings in Dhaka. Dental caries and severe consequences of dental caries (defined here as dental sepsis) were the exposure variables, and age- and sex-adjusted height-z-scores (HAZ), weight-z-scores (WAZ) and BMI-z-scores (BAZ) were the outcome variables. OHRQoL was measured using the Bengali version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). First, associations between oral impacts (prevalence of overall impacts and specific items of the SOHO-5) and outcome measures were assessed. Multiple linear regression was used to assess associations between caries and anthropometric measures, adjusted for potential confounders. Oral impacts were then added to test whether their inclusion attenuated the associations between exposures and outcomes. To further investigate potential mediating role of oral impacts, structural equation modelling (SEM) was used to test the hypothesis that dental caries and sepsis were associated with the outcomes directly and also indirectly via oral impacts in general. A similar approach was used to investigate mediation by specific SOHO-5 items.

RESULTS

The sample consisted of 715 children, 73.1% of whom had dental caries, 37.5% presented with sepsis, and 57.3% reported at least one oral impact (SOHO-5 score ≥1). Prevalence of overall oral impacts and also the impact on 'eating difficulty' (a specific item of SOHO-5) were negatively associated with all three outcomes. Dental caries and sepsis was associated with lower HAZ, WAZ and BAZ, and adjustment for overall oral impacts considerably attenuated the associations between 'severe dental caries' and outcomes, and dental sepsis and outcomes. Using SEM, we found significant indirect associations between caries and sepsis and anthropometric measures via oral impacts (except for dental caries and HAZ). Considering specific oral impacts, eating difficulties explained about 44% and 65% of the associations between caries and anthropometric outcomes, and dental sepsis and anthropometric outcomes, respectively.

CONCLUSIONS

Oral impacts, in particular eating difficulties, appear to mediate associations between caries and markers of child growth among this population.

Prevalence of Caries among School Children in Saudi Arabia: A Meta-Analysis

Introduction

Children's dental health has become the primary concern, because of the increase in the prevalence of caries amongst school children in Saudi Arabia. Therefore, a meta-analysis was conducted to assess the prevalence and severity of dental caries among school children in Saudi Arabia.

Method

A systematic search of Scopus, ISI Web of Science, EMBASE, Saudi digital library, Google Scholar, and MEDLINE via Ovid for cross-sectional studies with healthy participants between 5and -15 years. Two authors independently extracted the prevalence of caries. With 95% confidence intervals (CIs) using a random-effects model, we calculated caries prevalence.

Results

Dental caries prevalence data were extracted from 18 cross-sectional studies (n = 56,327 children). The pooled estimate for the caries prevalence among 5-7 years' children was 84% (95% CI: 0.81-0.87%; I2 = 91%) while among 12-15 years' children was 72% (95% CI: 0.63-0.79; I 2 = 96.2%). Discussion. In this systematic review, the summary estimate of the prevalence of dental caries among children of 5-7 years and 12-15 years were 84% and 72%, respectively. Further research is required to identify approaches for preventing and treating dental caries in schoolchildren.

The effect of unhealthy dietary habits on the incidence of dental caries and overweight/obesity among Egyptian school children (A cross-sectional study)

Background

Obesity and dental caries are public health problems in Egypt. Factors such as unhealthy diet, poor oral hygiene, and physical inactivity can play a major role in both problems. This study was carried out to illuminate the mutual unhealthy dietary risk factors associated with the incidence of both health conditions.

Methods

Between 1 October 2020 and 1 July 2021, 369 Egyptian children (5-10 years) were examined. Dental status was assessed using decayed, missing/extracted, and filled tooth indices (dmft, deft, and DMFT) for deciduous, mixed, and permanent dentitions, respectively. Moreover, the lifestyle, food habits, and body mass index (BMI) were recorded.

Results

A total of 342 (93.7%) of the included subjects suffered from caries, and only 27(7.3%) were caries-free. Based on BMI percentiles, 247 (66.9%) of the youngsters were overweight/obese, while 122 (33.1%) had normal weight. The mean dmft was 6.9 (±4.6), deft 4.2 (±3.3), and DMFT 0.1 (±1.7). In the primary dentition, a significant positive correlation was detected between dmft and BMI, legumes, sweetened milk and juice, soft drinks, and desserts, while a significant negative correlation was detected between dmft/deft, meat/poultry/fish, fresh fruits, and vegetables. A significant positive correlation was detected between deft and BMI, sweetened milk and juice, ice cream, candies, and crackers. In the permanent dentition, a significant positive correlation was detected between age, soft drinks, sweetened juice, desserts, and DMFT, while a significant negative correlation was detected with fresh fruits and vegetables. BMI was significantly negatively correlated with a healthy lifestyle, meat/poultry/fish consumption, and fresh fruits and vegetables while positively correlated with legumes, ice cream, soft drinks, granulated sugars, desserts, fast food, and caffeinated drinks.

Conclusion

Overweight/obesity was positively correlated with primary dentition dental caries. Desserts (sweetened snacks) and soft drinks could be the common risk factors associated with high caries and overweight/obesity incidence among Egyptian school children; conversely, consumption of fruits and vegetables could hinder both health conditions. Moreover, sweetened juices were associated with primary and permanent dental caries.

A Narrative Review on Current Diagnostic Imaging Tools for Dentomaxillofacial Abnormalities in Children

The current review narrates the findings and discusses the available diagnostic tools for detecting structural abnormalities. The review discusses several diagnostic tools, such as magnetic resonance imaging, cone beam computed tomography, multi detector row CT and positron emission tomography. The vital findings and comparative analysis of different diagnostic tools are presented in this review. The present review also discusses the advent of newer technologies, such as the HyperionX9 scanner with less field of view and 18F-FDG PET/CT (positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose, integrated with computed tomography), which can give more efficient imaging of dentomaxillofacial structures. The discussion of effective comparative points enables this review to reveal the available diagnostic tools that can be used in the detection of dentomaxillofacial abnormalities in the pediatric population. The advantages and disadvantages of each tool are discussed, and the findings of past publications are also presented. Overall, this review discusses the technical details and provides a comparative analysis of updated diagnostic techniques for dentomaxillofacial diagnosis.

Association between Body Mass Index (BMI) and Dental Caries among 6-12-Year-Old School Children

This study aimed to identify the association between BMI and dental caries in 6−12-year-old children. This cross-sectional study was carried out among 6−12-year-old school children and their parents. The data on Body Mass Index (BMI) and dental caries for study participants were included in the study. The association between BMI and dental caries was evaluated using SPSS software. The study comprises 400 school children (157 boys and 243 girls) aged an average of 8.9 years. The overall prevalence of dental caries was 84% in primary dentition and 75% in permanent dentition, with a mean DMFT and dmft (decayed, missing and filled teeth) of 2.85 and 5.48, respectively. There was a significant association witnessed between mothers’ education and BMI status. A significant association was also evident between decayed (d), missing (m) and filled (f) teeth and overall dmft with different BMI categories (p < 0.05). There was no significant association evident between DMFT and each category of BMI (p > 0.05). The dmft and DMFT within the four BMI categories by one-way ANOVA were highly significant (p < 0.001). Post hoc analysis helped us identify the relationship among the various categories of BMI with dental caries. There was a positive association evident between the BMI of the children and dental caries.

Review on Preformed Crowns in Pediatric Dentistry—The Composition and Application

The purpose of this review is to compare and contrast the various types of preformed crowns that can be used to restore the primary teeth in children. Historically, preformed crowns have been widely available for the past 50 years. The clinical performance of preformed crowns has evolved to meet higher functional, mechanical, and aesthetic demands. Preformed crowns are available in a range of prefabricated sizes and shapes. Preformed crowns can vary depending on their properties, compounds, methods of preparation, and biocompatibility.

Child-, Family-, and Community-Level Facilitators for Promoting Oral Health Practices among Indigenous Children

Despite the preventive nature of oral diseases and their significance for general wellbeing, poor oral health is highly prevalent and has unfavourable ramifications for children around the world. Indigenous children in Australia experience disproportionate rates of early childhood caries compared to their non-Indigenous counterparts. Therefore, this paper aims to collate parental experiences and generate an understanding of facilitators for Indigenous childhood oral health. This project aggregated stories from parents of Indigenous children across South Australia who were participants in an early childhood caries-prevention trial. This paper explores facilitators for establishing oral health and nutrition behaviours for Indigenous children under the age of three through reflexive thematic analysis. Fisher-Owens' conceptual model for influences on children's oral health is utilised as a framework for thematic findings. Child-level facilitators include oral hygiene routines and regular water consumption. Family-level facilitators include familial ties, importance of knowledge, and positive oral health beliefs. Community-level facilitators include generational teaching, helpful community resources, and holistic health care. Recommendations from findings include the following: exploration of Indigenous health workers and elder participation in oral health initiatives; inclusion of Indigenous community representatives in mainstream oral health discussions; and incorporation of child-level, family-level, and community-level facilitators to increase support for efficacious oral health programs.

Positive Parenting Styles Tied to Less Unmet Dental Needs in Children with Developmental Disabilities

This study aimed to identify factors, particularly positive parenting styles, associated with unmet dental needs, defined as no dental visit for the past 12 months, in children with developmental disabilities (DD). Participants included 263 primary caregivers of children with DD. Children exposed to less positive parenting styles were more than two times (aOR, 2.19, 95%CI, 1.12-4.32) more likely to have unmet dental needs. Children who were male (aOR, 1.88, 95%CI, 1.04-3.41), aged < 4 years (aOR, 2.95, 95%CI, 1.2-7.27) or aged ≥ 11 years (aOR, 2.65, 95%CI, 1.25-5.64), had higher illness severity (aOR, 2.04, 95%CI, 1.09-3.81), had primary caregivers with less than or equal to high school education (aOR, 2.45, 95%CI, 1.13-5.30) were also more likely to have unmet dental needs.

The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children’s oral health: A systematic review and meta-analysis

Objectives

Dental caries is the most common preventable childhood condition. Non-dental professionals and health workers are often well placed to support parents in adopting positive oral health behaviours for their children. The aim of this study was to determine the effectiveness of behaviour change interventions and their individual component behaviour change techniques (BCTs), that were delivered by non-dental professionals and health workers.

Methods

A systematic search of Ovid MEDLINE, PubMed, CINAHL, Cochrane Library, Web of Science, TRoPHI and PROQUEST from inception until March 2021 was conducted. Randomised controlled trials and quasi-experimental studies for improving oral health outcomes in children were included. Quality assessment was carried out using Cochrane Risk of Bias tool and ROBINS-I tool. Publication bias was assessed using funnel plots and Egger’s regression intercept. Effect sizes were estimated as standardised mean difference (SMD) and odds ratio/risk ratio for proportions. Meta-analyses were performed for studies reporting mean decayed, missing, filled surfaces (dmfs) and mean decayed, missing, filled, teeth (dmft) indices. Behaviour change technique coding was performed using behaviour change technique taxonomy v1 (BCTTv1).

Results

Out of the 9,101 records retrieved, 36 studies were included with 28 showing a significant effect either in clinical and/or behavioural/knowledge outcomes. Most studies (n = 21) were of poor methodological quality. The pooled SMD for caries experience showed statistically significant result for caries prevention at surface level -0.15 (95% CI -0.25, -0.04) and at the tooth level -0.24 (95% CI -0.42, -0.07). In 28 effective interventions, 27 individual BCTs were identified and the most frequently used were: “Instructions on how to perform the behaviour” and “Information about health consequences”.

Conclusion

There is low quality of evidence suggesting non-dental professionals and health workers may help improve oral health outcomes for children. To confirm these findings, further high-quality studies incorporating a variety of BCTs in their interventions for adoption of good oral health behaviours are needed.

Dental caries and anthropometrics of children living in an informal floating Amazonian community: a cross-sectional pilot study

AIMS

Increasing evidence supports a relationship between poor oral health and growth in children. Our objective was to assess the association between the presence of dental caries and anthropometric measurements of children residing in Claverito, a floating slum community in the Peruvian Amazon.

METHODS

For this cross-sectional study, presence of caries was assessed using dmft/DMFT (decayed, missing, filled teeth) scores and the SiC Index (mean dmft/DMFT of one-third of the study group with the highest caries score). Anthropometric categories for age-sex-specific z-scores for height and weight were calculated based on WHO standardized procedures and definitions. The association between SiC (measured by dmft/DMFT) and anthropometric measures was estimated using unadjusted and adjusted multivariable linear regression models. Critical value was established at 5%.

RESULTS

Our study population consisted of 67 children between the ages of 1 and 18 years old. Mean age was 9.5 years old (SD: 4.5), and the majority were female (52.2%). Almost all had dental caries (97.0%) and the mean dmft/DMFT score was 7.2 (SD: 4.7). The SiC Index of this population was 9.0. After adjusting for confounding variables, participants who had permanent dentition with the highest dmft/DMFT levels had statistically significant decreased height-for-age z-scores (HAZ) (p=0.04).

CONCLUSIONS

We found an inverse linear association between SiC Index and height-for-age z-scores (HAZ) among children living in poverty in a floating Amazonian community in Peru. Children from under-resourced communities, like floating slums, are at high risk for oral disease possibly negatively impacting their growth and development.

The Effect of Parental Education and Socioeconomic Status on Dental Caries among Saudi Children

Parental attitudes toward the importance of oral hygiene have an impact on the formation of their children’s oral habits and the prevalence of oral diseases. Our aim was to assess the association between parents’ education and socioeconomic status and their children’s oral health. A cross-sectional study was conducted between the years of 2018 and 2020 in the eastern province of Saudi Arabia among primary school children. Two pre-calibrated dentists performed the clinical examination of the children, and a self-administered validated questionnaire was obtained from their parents. Clinical examination was performed on 589 children with an age range of 3 to 14 years, where 47% were males and 53% were females, 70% with dental caries. Both parents with higher education and a high monthly income were significantly associated with lower prevalence of decayed teeth in their children, respectively. Mother’s education, age, gender and application of sealant were found significantly associated with the high prevalence of caries. High prevalence of tooth decay was reported among school children in the eastern province of Saudi Arabia. A high educational level of parents and high income were correlated with a lower prevalence of decayed teeth, similarly to the situation in the case of presence of medical insurance.

Aspirations and Worries: The Role of Parental Intrinsic Motivation in Establishing Oral Health Practices for Indigenous Children

Aboriginal and Torres Strait Islander (respectfully, subsequently referred to as Indigenous) children in Australia experience oral disease at a higher rate than non-Indigenous children. A history of colonisation, government-enforced assimilation, racism, and cultural annihilation has had profound impacts on Indigenous health, reflected in oral health inequities sustained by Indigenous communities. Motivational interviewing was one of four components utilised in this project, which aimed to identify factors related to the increased occurrence of early childhood caries in Indigenous children. This qualitative analysis represents motivational interviews with 226 participants and explores parents’ motivations for establishing oral health and nutrition practices for their children. Findings suggest that parental aspirations and worries underscored motivations to establish oral health and nutrition behaviours for children in this project. Within aspirations, parents desired for children to ‘keep their teeth’ and avoid false teeth, have a positive appearance, and preserve self-esteem. Parental worries related to child pain, negative appearance, sugar consumption, poor community oral health and rotten teeth. A discussion of findings results in the following recommendations: (1) consideration of the whole self, including mental health, in future oral health programming and research; (2) implementation of community-wide oral health programming, beyond parent-child dyads; and (3) prioritisation of community knowledge and traditions in oral health programming.

Comparative Evaluation of Adaptation of Esthetic Prefabricated Fiberglass and CAD/CAM Crowns for Primary Teeth: Microcomputed Tomography Analysis

Adaptation is an important factor for the clinical success of restorations. However, no studies are available evaluating the adaptation of primary crowns. The aim of this study was to compare the adaptation of crowns fabricated by CAD/CAM technology versus prefabricated fiberglass primary crowns. Typodont maxillary central, canine, and mandibular molar teeth were prepared to serve as master dies after the size of Figaro crowns was determined (n = 10). Master dies were scanned with an intraoral scanner, and 10 identical CAD/CAM crowns were fabricated from resin-ceramic blocks. Figaro and CAD/CAM crowns were placed on the corresponding master dies and scanned via micro-CT. Three-dimensional volumetric gap measurements were performed to evaluate the overall adaptation. A total of 255 location-based linear measurements were allocated into 4 categories: marginal, cervical-axial, middle-axial, and occlusal. Statistical analyses were performed with factorial ANOVA, repeated measure ANOVA, and LSD tests (α = 0.05). CAD/CAM crowns showed significantly lower overall and location-based gap measurements than Figaro crowns regardless of tooth number (p < 0.05). For all groups, mean marginal discrepancies were lower than occlusal measurements (p < 0.05). Both crown types showed higher marginal gaps for molar teeth than for canine and central incisors with no significant difference between them (p > 0.05). CAD/CAM-fabricated crowns showed better marginal and internal adaptation than prefabricated Figaro crowns.

Dental caries in Saudi Arabia: A systematic review

OBJECTIVES

In KSA, numerous studies are conducted to measure the prevalence of dental caries. However, the prevalence of dental caries varies in KSA. This systematic review aims to improve the understanding of the prevalence of dental caries among adults and children residing in KSA.

METHODS

Online databases of MEDLINE, EMBASE, and the Cochrane Library were searched. The Saudi Dental Journal was hand-searched. Study selection and data extraction were conducted in duplicate. The studies on dental caries in the Saudi population were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the selected studies. Finally, a narrative synthesis was conducted.

RESULTS

Forty-nine cross-sectional studies were identified. Areas of weakness in study design/conduct were low response rates, reliable outcome measurement, and identification and handling of confounding factors. Statistical pooling of data was not appropriate due to substantial heterogeneity, also in part to a variation in geographical location and the target population. Twenty-nine studies presented data for primary dentition. The proportion of dental caries among primary teeth ranged from 0.21 to 1.00. Eighteen studies presented data for permanent dentition. The proportion of dental caries across permanent teeth ranged from 0.05 to 0.99.

CONCLUSIONS

In general, the methodological quality of the included studies was poor. Dental caries proportion level ranged from 0.05 to 0.99 in permanent teeth, and 0.21 to 1.00 across primary teeth. The available data does not provide a complete assessment of dental caries across KSA. Existing studies are limited in terms of the populations studied for dental caries.

"What are we doing to our babies' teeth?" Barriers to establishing oral health practices for Indigenous children in South Australia

BACKGROUND

During the 1970s, optimal oral health was experienced more frequently amongst Indigenous children in Australia than their non-Indigenous counterparts. As a result of public health interventions targeting oral disease, oral health has improved for most children; however, Indigenous children today experience oral disease at alarmingly high rates. A history of colonisation, assimilation, racism and cultural annihilation has had profound impacts on oral health for Indigenous peoples; compounded by environmental dispossession and a shift from traditional diets to one of processed and nutrient-poor foods, often high in sugar.

METHODS

This project aimed to identify factors related to the increased occurrence of caries in Indigenous children. Using purposive sampling from the larger project, this paper thematically analyses 327 motivational interviews to explore current barriers impeding parental efforts to establish oral health and nutrition practices for Indigenous children. Representation of socioeconomic positions of families were compared across themes, as based on maternal age, employment, residency and number of children in care.

RESULTS

Findings resulted in a conceptual model of barriers that exist across knowledge, social, structural and parental factors. Major thematic results include: social consumption of processed foods, busy households, misleading nutrition marketing, sugar cravings and lack of oral health and nutrition knowledge.

CONCLUSION

A discussion of the findings results in the following recommendations increased oral health promotion efforts in non-metropolitan areas; utilisation of community experiences in creating strategies that encourage oral health and nutrition knowledge; and the extension of oral health initiatives and future research to include all family members. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12611000111976; registered 01/02/2011.

Iron deficiency anaemia and early childhood caries: a cross-sectional study

BACKGROUND

This study aimed to assess the association between iron deficiency anaemia (IDA) and dental caries in early childhood.

METHODS

A total of 40 children with proven IDA and another 40 healthy age and sex-matched children were enrolled in this cross-sectional study. Legal guardians were interviewed to collect data on oral hygiene measures and dietary habits. Anthropometric measurements were performed for all participants, and blood samples were collected to assess complete blood count and body iron status. Patients were confirmed to have IDA based on haemoglobin level (Hb), red blood cells indices and body iron status. Caries experience was determined based on the number of decayed, missing and filled primary teeth using dmft index.

RESULTS

A statistically significant negative correlation between dmft index scores and haemoglobin level (r = -0.454, P < 0.001) and mean corpuscular haemoglobin (MCH) level (r = -0.380, P = 0.001) was detected, and in accordance there was a positive statistically significant correlation between caries experience and the presence of anaemia (r = -0.60, P < 0.001).

CONCLUSION

In early childhood, dental caries might coexist with IDA even in its mildest form. All children exhibiting severe early childhood caries should be investigated for IDA and anaemia should be managed if present.

Dental caries prevalence among elementary school students and its relationship with body mass index and oral hygiene in Ardabil in 2019

BACKGROUND AND AIM

Tooth decay as a significant but preventable public health priority continues to be a common disease in developing countries, including Iran, which is particularly prevalent among children. The present study aims to determine dental caries prevalence among elementary school students and its relationship with body mass index and oral hygiene in Ardabil, Iran in 2019.

MATERIALS AND METHODS

This cross-sectional study was conducted on 581 elementary school students selected through cluster random sampling method in Ardabil city in 2019. Demographic data was collected using questionnaire and anthropometric indices (height, weight) were measured using the weighing scale and stadiometer, and dental caries was evaluated using the decayed, missing, or filled teeth index (dmft for primary teeth and DMFT for permanent).

RESULTS

The mean age of students was 9.61 ± 1.76 years, and 50.8% of them were female. 20.7% (n = 120) were obese, and 19.1% (n = 111) were overweight. The overall prevalence of caries was 74.9% (n = 435) in primary teeth, 72.8% (n = 423) in permanent teeth, and 96.6% (n = 561) in all teeth. The average dmft and DMFT scores were 4.16 ± 3.72 and 1.96 ± 1.76, respectively. There was a significant inverse relationship between body mass index and dmft (r = -0.146, P < 0.0001) and DMFT (r = -0.111, P = 0.004).

CONCLUSION

The findings showed that prevalence of dental caries in elementary school children in Ardabil city is higher than global standards, obese and over-weight children experience fewer caries compared to normal-weight children, and there is a significant relation between not brushing the teeth and dental caries.

Association of Dental Caries and Anthropometric Measures among Primary School Children

Aim: This study aimed to investigate an association between dental caries status and anthropometric measures in primary school children. Methods and Materials: An analytical cross-sectional study (n = 376) was conducted among primary school children (age range = 6–9 years) registered in private schools. Non-clinical data was gathered from parents of participating children through a self-administered structured questionnaire as well as from the children through an interviewer-administered questionnaire. Clinical data included the examination of dental caries using dmft/DMFT index and anthropometric measures including calculated z-scores of height-for-age (HAZ), weight-for-age (WAZ), BMI-for-age (BAZ), and physical examination. Inferential statistics included Kruskal Wallis and linear regression for univariate and multivariate analysis respectively. Results: The proportion of dental caries in primary and secondary dentition was 67.6% and 8.2% respectively. A significant association was observed between dental caries status and HAZ, WAZ, and BAZ (p < 0.001). An inverse relation was found between low, medium, and high dental caries categories and anthropometric measures. Conclusions: In the primary dentition, dental caries were significantly and inversely related to weight-for-age, height-for-age, and BMI-for-age. Hence, it can be concluded that among the low-income population dental caries is associated with lower anthropometric outcomes in children and therefore caries management should be considered an approach impacting overall health and quality of life.

Association of Body Mass Index and Waist Circumference With Dental Caries and Consequences of Untreated Dental Caries Among 12- to 14-Year-old Boys: A Cross-Sectional Study

OBJECTIVE

To evaluate the association between body mass index (BMI) and waist circumference (WC) and dental caries (DC), and the clinical consequences of untreated dental caries (U-DC) among 12- to 14-year-old male public-school adolescents in the Northern Province, Saudi Arabia.

METHODS

The demographic and anthropometric measurements of 302 boys 12 to 14 years of age (mean: 12.5 years) were recorded. BMI and central obesity (based on WC) were measured. The decayed-missing-filled teeth (DMFT) index was used to record DC. The pulp involvement, ulceration, fistula, abscess (PUFA) index was used to quantify the clinical consequences of U-DC. Multiple logistic regression analysis was performed to evaluate the risk factors related to DC and clinical consequences of U-DC.

RESULTS

A high prevalence of DC was found in adolescents who were underweight according to BMI and nonobese based on WC (46.7% vs 34.5%). The association between underweight (BMI) and obese (WC) with DC (odds ratio [95% CI]) was 1.91 (0.87, 4.18) and 0.34 (0.18, 0.63), respectively, while with PUFA (adjusted odds ratio [AOR]; 95%CI), it was 1.76 (0.76, 4.09) and 0.19 (0.06, 0.63) respectively. The logistic regression model showed that consuming sugar more than once a day led to a 2.87-fold greater likelihood of DC (AOR [95% CI] = 2.87 [1.68, 4.88]) and a 3.91-fold greater likelihood of mean PUFA score (AOR [95% CI] = 3.91 [2.05, 7.44].

CONCLUSION

High risks for DC and clinical consequences of U-DC were observed among underweight and nonobese adolescent males. The frequency of sugar consumption was significantly associated with both conditions.

Statistical analysis of criteria for efficiency of filling of permanent teeth in children

Introduction: The effectiveness of caries treatment depends on many factors, such as the condition of dental tissues, the stage of root development, the period of dentition, the quality of preparation and isolation, the optimal choice of material for restoration. The problem of choosing the filling material is acute in each treatment of caries in children with mixed and permanent dentition. The aim: Todetermine and statistically substantiate parameters for choosing restorative material for permanent teeth in children with different stages of root development. Materials and methods: 248 children aged 7 to 11 (122 boys and 126 girls) and 246 children aged 12 to 17 (120 boys and 126 girls),students of Uzhhorod Secondary School №20 were examined. Restoration materials -"Polofil Supra" (VOCO, Germany) and "DyracteXtra" (Densply, USA). The following criteria were investigated: saliva pH, area of destruction of the occlusal surface of masticatory teeth, stage of root development, depth of the lesion and cavity topography, the acid resistance of the enamel. For the purpose of statistical justification of the selected parameters that pointed as significant in the choice of restorative materials, and for the analysis of the interrelations of the parameters studied, the Spearman correlation coefficient (r) was determined. The correlation coefficient was considered statistically significant when p <0.05. Results: For children aged 7-17 years to restore permanent teeth during the period of mixed and permanent dentition, the best materials in use were: "Polofil Supra" (VOCO, Germany) and "DyracteXtra" (Dentsply, USA). Conclusion: To restore permanent teeth in any stage of root development, it is rational to use a compomer material "DyracteXtra" (r = 0.80), and a composite material "Polofil Supra" -under the conditions of the formed root, at a pH level of more than 6.2, a high degree acid resistance of the enamel and the area of destruction of the occlusal surface less than 0.55 (r = 0.72).

The association between nutritional status and dental caries in low-income children: A multilevel analysis

BACKGROUND

The possible association between obesity, underweight, and dental caries remains in debate. In addition, the role of sugar consumption on the abovementioned relationship was little explored.

AIM

This study aimed to investigate the relationship between nutritional status and dental caries in 12-year-old low-income children.

DESIGN

This cross-sectional school-based study involved 406 12-year-old children living with limited economic resources. Dental caries was assessed using the decayed component of DMFT and PUFA/pufa index. Children were weighed and measured to assess nutritional status according to z-score/body mass index. Data on socio-economic and demographic characteristics, sugar consumption, sedentary behaviour, and psychosocial factors were collected through validated questionnaires. Multivariable multilevel Poisson regression was performed.

RESULTS

Underweight children had 60% (RR = 1.60; 95% CI 1.13-2.57) higher mean of decayed teeth and had mean PUFA/pufa 2.8 times higher than children with normal nutritional status. Underweight children with high annual sugar intake had a greater mean of decayed teeth (RR = 2.72; 95% CI 1.46-5.06) than underweight children with low sugar intake.

CONCLUSIONS

Our findings suggest that malnutrition is associated with dental caries among children from low-income families.

Undernutrition is associated with change in severe dental caries

OBJECTIVES

To examine the association of baseline prevalence of thinness or stunting and the incidence of dental caries among preschool children in Liaoning Province, China.

METHODS

Children were recruited from 15 kindergartens in Liaoning Province. A total of 772 children were assessed at baseline and follow-up. The mean age of children at baseline was 50.82 months, and the median follow-up time was 10.12 months. Anthropometric measurement, dental caries, and questionnaire were assessed overtime, whereas only baseline questionnaire was used in the data analysis. z-Score for body mass index (BMI)-for-age, weight-for-age, and height-for-age were calculated using World Health Organisation (WHO) Child Growth Standards. Dental caries was assessed according to the fifth WHO Basic Methods for Oral Health Surveys. The presence of pulpal involvement, ulceration, fistula, and abscess (pufa) were used to indicate severe dental caries in deciduous teeth. A structured questionnaire mainly based on the fifth WHO Oral Health Surveys was used to collect sociodemographic and behavior data. Logistic regression was constructed to assess the association between change in severe dental caries and prevalence of thinness and stunting.

RESULTS

There was a positive association between prevalence of stunting and incidence of severe caries in the fully adjusted model [odds ratios 2.88; 95 percent confidence interval (CI): 1.01, 8.27]. Prevalence of thinness showed insignificant positive association with incidence of severe caries.

CONCLUSIONS

While undernutrition indicated by stunting appeared to be a risk factor for severe dental caries, it could also be a marker for other determinants of progress of dental caries including socioeconomic factors and lack of use of dental services.

The Effect of Dental Treatment under General Anesthesia on Quality of Life and Growth and Blood Chemistry Parameters in Uncooperative Pediatric Patients with Compromised Oral Health: A Pilot Study

BACKGROUND

The effect of untreated dental caries and their treatment under general anesthesia (GA) on the quality of life, growth, and blood chemistry parameters in uncooperative pediatric patients has not been extensively elucidated. The aims are to evaluate the impact of dental treatment under GA on oral health-related quality of life (OHRQoL) in uncooperative pediatric patients with severe dental caries and to assess the effect of dental treatment under GA on children's weight (Wt), height (Ht), Body Mass Index (BMI), and blood chemistry parameters.

METHODS

Forty-three uncooperative children aged 3-14 years were selected. OHRQoL, through ECOHIS (Early Childhood Oral Health Impact Scale) and COHRQoL (Child Oral Health-Related Quality of Life) questionnaires, Wt, Ht, BMI, and blood chemistry parameters were measured at baseline and eight months after dental treatment under GA.

RESULTS

At follow up, the reductions in the ECHOIS and the COHRQoL components were statistically significant (p < 0.0001), there was significant improvement in the anthropometric measures: 76.5% of children increased the percentile curves for weight, 68.6% for height, and 51.4% for BMI; for the blood chemistry parameters: ferritin improved in 68.6% of the samples, PCR in 65.7%, ESR in 68.6%, Vitamin D in 68.6%, and IGF-1 in 65.7%.

CONCLUSIONS

Oral health status significantly influences OHRQoL, growth, and blood chemistry parameters in uncooperative pediatric patients.

Association between body mass index and dental caries in the Kingdom of Saudi Arabia: Systematic review

OBJECTIVE

The Kingdom of Saudi Arabia (KSA) has one of the highest prevalence of both obesity and dental caries. To date, there has not been any documented evidence linking these two factors. Therefore, the objective was to conduct a systematic review of published studies that have analysed the association between body mass index and dental caries in the KSA for both children and adults.

METHODS

A systematic database search [PubMed, EMBASE, Web of Science, CINAHL and Cochrane Library] was conducted following the PRISMA guidelines. The inclusion criteria were observational studies, with no limit on the publication date. Search terms included: dental caries, obesity, overweight, body mass index, BMI 'AND' Saudi Arabia. The independent variable was body mass index (BMI), and the primary outcome measure was dental caries prevalence and severity.

RESULTS

From 951 search results, 935 citations were identified and excluded. Of the 16 potentially eligible studies, two citations were excluded, because the studies did not meet the inclusion criteria. This left fourteen studies meeting the criteria to be included in this systematic review. Ten studies outlined children, and four studies assessed adults. For children, two studies resulted in a positive association between high BMI and caries, six studies resulted in a negative association, and two studies had a non-significant association. For adults, two studies resulted in a positive association between high BMI and dental caries, and two studies had a non-significant association. These were rated as having low to moderate risk of bias.

CONCLUSION

As a result of this equivocal outcome within the systematic review, body mass index and dental caries present as a complex association. Further long-term studies are required to translate the findings into clinical practice.

Association of body mass index and gross national income with caries experience in children in 117 countries

Objective: To evaluate the association of body mass index (BMI) and gross national income (GNI) per capita with dental caries experience in children at population levels.Methods: This ecological study used global data of decay, missing, and filled teeth (DMFT), BMI, and GNI. DMFT data of 12 years old children from 117 countries were obtained from the World Health Organization. BMI data of children and adolescents from the same 117 countries were retrieved from the NCD Risk Factor Collaboration and GNI per capita from the World Bank. ANOVA test, Pearson's correlation coefficient (r), and multivariable linear regression were performed.Results: Globally mean BMI ranged from 16.1 to 22.2 in children. Low-income countries had the lowest BMI (17.41 ± 0.57) and high-income countries had the highest BMI (20.14 ± 0.87) (p < .001). The highest mean DMFT was observed in upper-middle-income countries (2.48 ± 1.16) and the lowest in low-income countries (1.22 ± 0.83) (p = .001). There was no significant correlation between BMI and dental caries (DMFT) (r = .063; p = .498). However, there were significant correlations between GNI per capita and BMI (r = 0.366; p < .001) and GNI per capita and DMFT (r= -0.252; p = .007). In multivariable linear regression, GNI per capita was negatively associated with caries experience in children (B= -1.83; p < .001).Conclusion: The study found that BMI was associated with income levels of the countries. GNI per capita significantly and negatively correlated with DMFT in children. Further investigation into the association between BMI and dental caries is warranted.

Correlation between Caries, Body Mass Index and Occlusion in an Italian Pediatric Patients Sample: A Transverse Observational Study

BACKGROUND

The aim of this study was to evaluate the correlation between caries, body mass index (BMI) and occlusion in a sample of pediatric patients.

METHODS

The study group included 127 patients (72 female, 55 male) aged between 6 and 16 years (mean age 10.2) and selected between January and June 2019 at the Department of Pediatric Dentistry, University of Messina. Caries incidence was evaluated using the decayed, missing and filled teeth (DMFT) index. On the basis of BMI values, using a table adjusted for age and gender, patients were grouped into four categories (underweight, normal weight, risk of overweight, overweight).

RESULTS

There was no significant correlation between BMI and DMFT in the whole sample. The study of the correlation between BMI and DMFT in patients with different types of malocclusion showed a significant inverse correlation for patients affected by II class and deepbite malocclusion.

CONCLUSIONS

The incidence of caries does not seem to be significantly related to BMI and occlusal patterns, but it decreases with increasing age.

Oral Hygiene Awareness and Practices among a Sample of Primary School Children in Rural Bangladesh

Inadequate oral health knowledge and awareness is more likely to cause oral diseases among all age groups, including children. Reports about the oral health awareness and oral hygiene practices of children in Bangladesh are insufficient. Therefore, the objective of this study was to evaluate the oral health awareness and practices of junior school children in Mathbaria upazila of Pirojpur District, Bangladesh. The study covered 150 children aged 5 to 12 years of age from three primary schools. The study reveals that the students have limited awareness about oral health and poor knowledge of oral hygiene habits. Oral health awareness and hygiene practices amongst the school going children was found to be very poor and create a much-needed niche for implementing school-based oral health awareness and education projects/programs.

Severe dental caries is associated with incidence of thinness and overweight among preschool Chinese children

Objective: To examine the association of incidence and baseline prevalence of severe dental caries with incidences of thinness and overweight among pre-school Chinese children.Materials and methods: A longitudinal study design was used. A total of 772 children recruited from 15 kindergartens in Liaoning Province who completed baseline and follow-up assessments were included. The age range of children at baseline was 24.6-71.1 months. BMI-for-age z-score was calculated to estimate incidence of thinness and overweight. Severe dental caries was indicated by pulpal involvement, ulceration, fistula or abscess (pufa). Baseline prevalence of severe caries included children with pufa ≥1, incidence included those who changed from pufa = 0 to ≥1 at follow-up. Logistic regression was constructed to assess the association of baseline prevalence and incidence of severe caries with each of incidence thinness and overweight.Results: Children with incidence of severe caries had higher odds for incidence thinness (OR: 4.08; 95% CI: 1.08, 15.41). Baseline prevalence of severe caries was not significantly associated with incidence thinness. Participants with severe caries at baseline had higher odds for incidence overweight (OR: 2.33; 95% CI: 1.17, 4.63). The relationship between incidence of severe caries and incidence overweight was insignificant.Conclusions: The findings suggest a U-shaped relationship between severe dental caries and both ends of anthropometric measures among pre-school Chinese children. The findings highlight the importance of integrating oral and general health promotion policies. Primary health care providers are encouraged to incorporate dental screening, counselling and referral for treatment for severe caries to promote appropriate growth and overall health of children.

Family Impacts of Severe Dental Caries among Children in the United Kingdom

The aim of this study was to evaluate the family impacts of severe dental caries among children. Data from 3859 school-age children (5-, 8-, 12- and 15-year-olds) who participated in the 2013 Children's Dental Health Survey, a national cross-sectional survey in England, Wales and Northern Ireland, were used. Severe dental caries was defined as having at least one tooth with pulpal involvement, ulceration, fistula, or abscess (PUFA). Family impacts were measured using seven items of the Family Impact Scale (FIS). The association between severe dental caries and family impacts was assessed in logistic regression models, adjusting for child's age, gender, and country of residence; parent's marital status, education, and job classification; and area deprivation. Severe dental caries among children showed a significant negative impact on family life (Odds Ratio: 6.00; 95% Confidence Interval: 3.34-10.78). Parents of children with severe dental caries had greater odds of taking time off work (OR: 2.75; 95% CI: 1.16-6.54), reporting the child needed more attention (OR: 4.08; 95% CI: 2.15-7.75), feeling guilty (OR: 6.32; 95% CI: 3.26-12.26), feeling stressed (OR: 7.34; 95% CI: 4.15-12.99), having normal activities disrupted (OR: 5.78; 95% CI: 2.71-12.34), and having sleep disrupted (OR: 4.94; 95% CI: 2.78-8.76). Having severe dental caries was not associated with financial difficulties in the family (OR: 1.64; 95% CI: 0.49-5.51). The observed association between severe dental caries and family impacts was independent of child and family sociodemographic characteristics. The findings underscore the importance of preventive interventions to avoid severe dental caries in children and subsequently reduce negative impacts on their family life.

Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries

BACKGROUND

Dental caries is one of the most common chronic diseases of childhood and is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC).

OBJECTIVES

To assess the effects of interventions with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years of age).

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 14 January 2019), Cochrane Pregnancy and Childbirth Group's Trials Register (to 22 January 2019), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Register of Studies, to 14 January 2019), MEDLINE Ovid (1946 to 14 January 2019), Embase Ovid (1980 to 14 January 2019) and CINAHL EBSCO (1937 to 14 January 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing one or more interventions with pregnant women, mothers, or other caregivers of infants in the first year of life (intervention types included clinical, oral health education/promotion such as hygiene education, breastfeeding and other dietary advice, and policy or health service), versus standard care or placebo or another intervention. For inclusion, trials had to report at least one caries outcome.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence using the GRADE approach.

MAIN RESULTS

We included 17 RCTs (4 cluster-randomised), involving 23,732 caregivers (mainly mothers) and their children. Eleven RCTs assessed four oral health education/promotion interventions against standard care: child diet advice, child diet and feeding practice advice, breastfeeding promotion and support, and oral hygiene with child diet and feeding practice advice. Six trials assessed clinical interventions in mother's dentition, four trials chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo, and two trials xylitol against CHX or CHX + xylitol. At most, three trials (maximum of 1148 children and 130 mothers) contributed data to any comparison. For many trials, risk of bias was judged unclear due to lack of methodological details reported, and there was high risk of attrition bias in some trials. None of the included trials indicated receiving funding that is likely to have influenced their results. The trials were performed in high-, middle- and low-income countries. In nine trials, participants were socioeconomically disadvantaged. For child diet and feeding practice advice versus standard care, we observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a lower mean dmfs (decayed, missing, filled primary surfaces) score (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, we are uncertain regarding the difference between the groups in mean dmft (decayed, missing, filled teeth) score (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). For breastfeeding promotion and support versus standard care, we observed that there may be little or no a difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence), or mean dmft score (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). Dmfs was not reported for this comparison. We are uncertain whether child diet advice only compared with standard care reduces risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). Dmfs and dmft were not reported for this comparison. For oral hygiene, child diet and feeding practice advice versus standard care, we observed little or no reduced risk of caries presence in primary teeth (RR 0.91, 95% CI 0.75 to 1.10; 2 trials; 365 participants; low-certainty evidence), and are uncertain regarding difference between the groups in mean dmfs score (MD -0.99, 95% CI -2.45 to 0.47; 1 trial; 187 participants; very low-certainty evidence) and dmft score (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; very low-certainty evidence). We observed there may be little or no difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment in mother's dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trials assessing this comparison reported dmfs or dmft. For xylitol compared with CHX antimicrobial treatment, we observed there may be a lower mean dmft score with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence); however, we are uncertain regarding the difference between groups in caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence). Neither trial evaluating this comparison reported dmfs. No trials assessed a health policy or service intervention.

AUTHORS' CONCLUSIONS

Moderate-certainty evidence suggests that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very low certainty and is insufficient for determining which, if any, other interventions types and features may be effective for preventing ECC. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine effects and relative effects of different interventions and inform practice. We have identified 12 studies currently in progress. Those designing future studies should describe the intervention components, setting and participants, consider if and how effects are modified by intervention features and participant characteristics, and adopt a consistent approach to measuring and reporting ECC.

Body mass index and dental caries experience in Nepalese schoolchildren

OBJECTIVES

The aim was to investigate the severity of untreated dental caries among Nepalese schoolchildren and its association with their body mass index (BMI) using IOTF, WHO and Nepalese growth reference systems.

METHODS

This school-based clinical cross-sectional study was conducted with three WHO index age groups (5- to 6-, 12- and 15-year-olds) in 18 out of 75 districts of Nepal, selected using stratified random sampling. A total of 1135 schoolchildren were included in the study. A validated structured questionnaire was used to assess the children's oral hygiene practices and dietary habits. Clinical oral examinations investigated the status of untreated dental caries in primary and permanent teeth (dt/DT) along with its consequences (pufa/PUFA). Later, the grade of severity of untreated dental caries (GUDC) was determined using both dt/DT and pufa/PUFA. Height (cm), weight (kg), waist circumference (cm) and hip circumference (cm) were measured, and the body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. The findings were presented as proportions, and the chi-square test was performed to compare differences between groups. Generalized linear mixed models with random effects assessed the association between the severity of untreated dental caries and the BMI.

RESULTS

According to the IOTF, WHO and Nepalese growth reference systems, the overall proportions of children with a low BMI were 38.6%, 15.4% and 12.8%, and those with a high BMI were 7.9%, 4.6% and 8.4%, respectively. Untreated dental caries was common among the youngest age group and those with infrequent tooth brushing habits or frequent consumption of sweet bakery products, sweets or candy, or tea with sugar. Neither a low nor a high BMI was associated either with dt + DT or with pufa + PUFA, after adjusting for confounders. However, both a low and a high BMI (all three references) were associated with the severity of dental caries or GUDC.

CONCLUSION

Regardless of the growth reference system used, children with either low or high BMI may be at risk of developing untreated dental caries lesions and related consequences. Both underweight and overweight/obese and dental caries share common risk factors, mostly dietary. Preventive and intervention approaches/strategies such as behavioural and dietary modifications should be implemented to improve both children's oral health and their nutrition in Nepal.