Incidence of dental caries in primary dentition and risk factors: a longitudinal study

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

BACKGROUND

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

AIM

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

DESIGN

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

RESULTS

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

CONCLUSION

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

Caries Incidence and Its Associated Factors in Hong Kong Kindergarten Children

OBJECTIVE

The study aimed to investigate caries incidence and its associate factors among kindergarten children in Hong Kong.

METHOD

This 30-month prospective study recruited 3- to 4-year-old children when they started their kindergarten study. A self-administered parental questionnaire survey was used to collect the children's social demographic information and their oral health-related habits. Child's caries experience was recorded using the decayed, missing, and filled tooth (dmft) index and the visible plaque index (VPI) was used to measure their oral hygiene status. A final examination was performed after 30 months when they were in the final year of kindergarten. Data were analysed using the zero-inflated negative binomial (ZINB) regression model.

RESULTS

This study examined 660 children at baseline and 501 children at the final examination (dropout 24%). At baseline, the caries prevalence among 501 children was 23%, with mean (SD) dmft scores of 0.7 (1.8). At the final examination, caries prevalence increased to 41%, with mean (SD) dmft scores of 1.6 (2.8). The 30-month incidence rate was 34%, and the mean (SD) number of new carious teeth developed was 0.9 (1.7). Lower first molars exhibited the highest caries increment rate (11%), followed by upper second molars (9%) and upper central incisors (9%). ZINB regression analysis revealed associations among caries incidence and family income, baseline dmft, and baseline VPI (P < .05).

CONCLUSIONS

One third of Hong Kong kindergarten children developed new caries. Low family income, prior caries experience and poor oral hygiene were the significant factors associated with their caries incidence.

CLINICAL RELEVANCE

Many children developed new caries during their kindergarten years, with their caries experience more than doubling. Preventive measures, including oral health education and reinforcing oral hygiene practice in kindergarten, are essential to reduce their caries incidence, particularly for children with low family income, caries experience and poor oral hygiene.

Dental Caries on Deciduous Molars among Children Visiting Dental Outpatient Department of a Tertiary Care Centre

Introduction

Dental caries is one of the most common, yet preventable childhood diseases. The aetiology of dental caries lies in the interplay between host, microorganism, substrate, and time. Risk factors for dental caries include physical, biological, environmental, behavioural, and lifestyle-related factors such as high numbers of cariogenic bacteria, inadequate salivary flow, insufficient fluoride exposure, poor oral hygiene, inappropriate methods of feeding infants, and poverty. The aim of the study was to find out the prevalence of dental caries on deciduous molars among children visiting dental Outpatient Department of a tertiary care centre.

Methods

This descriptive cross-sectional study was conducted on children who visited the dental outpatient department of Kathmandu University School of Medical Sciences, Dhulikhel Hospital from 15 June 2023 to 30 July 2023. Ethical approval was taken from the Institutional Review Committee of the same institute. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

The prevalence of dental caries on deciduous molars in children was 252 (93.33%)(90.35-96.30, 95% Confidence Interval). One-third of the children had visited dental clinics for the first time. Lack of topical fluoride application was seen in the majority of the children.

Conclusions

The prevalence of dental caries on deciduous molars among pediatric patients was found to be higher than in other studies done in similar settings.

Keywords

children; dental caries; molars; prevalence.

Two decades of socioeconomic inequalities in the prevalence of untreated dental caries in early childhood: Results from three birth cohorts in southern Brazil

OBJECTIVES

To estimate the socioeconomic disparities in untreated dental caries in early childhood according to socioeconomic characteristics in three birth cohorts in Southern Brazil.

METHODS

The socioeconomic data to this study were collected at the 48-month follow-up and oral health studies of 1993, 2004 and 2015 Pelotas birth cohort studies. The outcome was untreated dental caries in children aged 6 (1993 cohort), 5 (2004 cohort) and 4 years (2015 cohort), dichotomized into absence/presence. Analyses were stratified by maternal skin colour/race, maternal education and family income. For statistical purposes, the prevalence difference, relative risk and absolute and relative indices of health inequality (Slope Index of Inequality-SII and Concentration Index-CIX) were used.

RESULTS

The prevalence of untreated dental caries in primary dentition was 63.4%, 45.5% and 15.6%, in 1993, 2004 and 2015 cohorts, respectively. The prevalence of untreated dental caries was concentrated in the poorest quintile and lower maternal education group in both absolute (SII) and relative (CIX) measures of inequality, being characterized as a pro-poor event. A higher risk of untreated caries was found in the poorest quintile of family income compared with the richest quintile in the 1993 cohort (RR 1.44 [95% CI 1.05; 1.98]). That risk was higher considering the 2004 Cohort (RR 1.78 [95% CI 1.42; 2.23]) and 2015 cohort (RR 4.20 [95% CI 2.97; 5.94]) data.

CONCLUSIONS

Over the course of two decades, a higher prevalence of untreated dental caries is concentrated among the most socioeconomically deprived children.

Geographic Information Systems (GIS) to Assess Dental Caries, Overweight and Obesity in Schoolchildren in the City of Alfenas, Brazil

Childhood-related obesity and overweight are increasing concerns for the health and well-being of children. Dental caries (decay) is the most prevalent oral disease during childhood, and several studies have suggested that nutritional status and dental caries are associated in children. Therefore, this study aimed to determine the geographic distribution of childhood overweight/obesity and dental caries in a medium-sized Brazilian city. This cross-sectional study was conducted with 269 children of both genders enrolled in four public schools in the city of Alfenas. The children were clinically examined to assess cavitated dental caries and nutritional status (overweight and obesity). In addition, the GIS was used for the geospatial clustering analyses. A heat map was created by the Kemel method to estimate the concentration of the outcomes. The cavitated dental caries and overweight/obesity were also pointed out by dots on the map. However, of the 269 children, 118 were boys (43.87%) and 151 were girls (56.13%). One hundred fifty-seven children (58.4%) were classified as having "non-cavitated caries," while 112 (41.6%) were classified as having "cavitied caries." In the nutritional status assessment, 204 children (75.84%) were classified as "eutrophic," while 65 children (24.16%) were classified as "overweight/obesity," A geographical correlation of dental caries with overweight/obesity may exist in the northeast and southwest areas. In conclusion, a geographical concordance between the dental caries and the occurrence of overweight/obesity among the schoolchildren from Alfenas may exist in some areas. Future studies are necessary.

Translation and cultural adaptation of the Illness Perception Questionnaire-Revised for Dental to Brazil

This study aimed to translate and to perform the cultural adaptation of the instrument Illness Perception Questionnaire-Revised for Dental (IPQ-RD) into Brazilian Portuguese. The IPQ-RD consists of 34 items that assess the cognitive and emotional representation/perception of parents/caregivers of children with dental caries, with response options on a 5-point Likert scale, ranging from "Strongly agree" (score 1) to "Strongly disagree" (score 5). The higher the score, the lower the perception of the disease. The protocol consists of translation into Brazilian Portuguese, back-translation into English, revision by an Expert Review Committee, and pre-test (application in parents/caregivers of children in dental care). For some questions, the translated versions were identical (T1 = T2); for others, one version was preferred (T1 or T2); for still others, it was decided to modify terms to obtain greater clarity on the item (T3). In the first pre-test, three questions were misunderstood by more than 15% of the sample, after which the items were reviewed by the Expert Review Committee. In the second pre-test, the adapted version was applied to a new sample of parents/caregivers (n = 15) and the questions were understood by more than 85% of the participants. The Brazilian Portuguese version of the IPQ-RD was well understood by the evaluated population.

Longitudinal study for dental caries calibration of dentists unexperienced in epidemiological surveys

This study aimed to make a longitudinal analysis of interexaminer calibration reproducibility in diagnosing dental caries in posterior teeth, by examiners without previous experience in epidemiological studies. A group of 11 inexperienced examiners underwent theoretical-practical training and calibration assessments, assisted by a standard examiner. An examiner who did not participate directly in the research selected 5-year-old children with and without caries. The D3 diagnostic threshold was used to evaluate dental caries, based on the World Health Organization (WHO) criteria. The initial calibration (baseline) was performed after the theoretical-practical training session, and consisted of examining 20 children; the second calibration occurred three months later, and involved evaluating another 18 children. The interexaminer agreement was obtained by kappa statistics, and by overall percentage agreement. The paired t-test was applied to compare the values for kappa means and overall percentage agreement between the time points studied. At baseline, the values for kappa (> 0.81) and overall percentage agreement (> 95.63%) were considered high. At the 3-month calibration assessment, all the examiners showed some decrease in both kappa (p < 0.0001) and overall percentage agreement (p = 0.0102). The calibration process currently proposed by the WHO is effective. However, reproducibility was not maintained over time for inexperienced examiners evaluating the posterior teeth of 5-year-old children, under epidemiological conditions.

Cystic lesion between a deciduous tooth and the succeeding permanent tooth: a retrospective analysis of 87 cases

Objectives

The purpose of this study is to investigate the characteristics of dentigerous and radicular cysts that occur between deciduous and succeeding permanent teeth and to propose considerations for differential diagnosis of cysts at the treatment planning stage in the outpatient clinic.

Materials and Methods

A total of 87 patients with a cystic lesion located between a deciduous tooth and the succeeding permanent tooth participated in the study. Twelve variables were analyzed to diagnose such a cyst. For data analysis, Fisher's exact test was used to determine the statistical significance of the variables.

Results

Of the total 87 patients who participated in this study, 69 were diagnosed with dentigerous cysts and 18 were diagnosed with radicular cysts. Seven of the 12 differential factors analyzed in this study were statistically significant: age, location, symptoms, dental caries, endodontic treatment, delayed eruption, and size.

Conclusion

Several criteria can be considered for diagnosis of dentigerous cysts or radicular cysts. Age, location, presence of symptoms and dental caries, previous endodontic treatment, cystic size, and delayed eruption of impacted permanent teeth are reliable factors that should be considered when diagnosing dentigerous and radicular cysts.

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

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

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

Taste perception in children with different caries activity

PURPOSE

The aim of the study was to investigate whether caries-active and caries-free children differ in terms of their taste perception for sweet, sour, salty and bitter.

METHODS

The study group consisted of 100 children aged 5-10 years: 50 caries-free children and 50 children with at least four untreated carious lesions. Taste perception was analysed using two test systems. First, filter paper strips impregnated with four taste qualities (sweet, sour, salty, and bitter) at four defined intensities were used ("taste strips"). Then a tasting spray in suprathreshold concentration of the respective taste was applied. The children were asked to name the perceived taste. The parents answered a questionnaire about the children's dietary habits.

RESULTS

The children with high caries activity scored lower on average on the taste strips than the caries-free participants. For the taste sprays, the perception of the taste quality "bitter" was significantly worse in the children with caries than in caries-free children (Mann-Whitney U test p < 0.05).

CONCLUSION

The results of this study suggest that taste preferences in children are associated with increased susceptibility to tooth decay.

Dental mesenchymal stromal/stem cells in different microenvironments— implications in regenerative therapy

Current research data reveal microenvironment as a significant modifier of physical functions, pathologic changes, as well as the therapeutic effects of stem cells. When comparing regeneration potential of various stem cell types used for cytotherapy and tissue engineering, mesenchymal stem cells (MSCs) are currently the most attractive cell source for bone and tooth regeneration due to their differentiation and immunomodulatory potential and lack of ethical issues associated with their use. The microenvironment of donors and recipients selected in cytotherapy plays a crucial role in regenerative potential of transplanted MSCs, indicating interactions of cells with their microenvironment indispensable in MSC-mediated bone and dental regeneration. Since a variety of MSC populations have been procured from different parts of the tooth and tooth-supporting tissues, MSCs of dental origin and their achievements in capacity to reconstitute various dental tissues have gained attention of many research groups over the years. This review discusses recent advances in comparative analyses of dental MSC regeneration potential with regards to their tissue origin and specific microenvironmental conditions, giving additional insight into the current clinical application of these cells.

Analysis of salivary proteomic biomarkers for the surveillance of changes in high-risk status of early childhood caries

Background

Early childhood caries is an urgent public health concern. The aim of this study was to investigate salivary proteomic biomarkers for the surveillance of changes in the high-risk status of early childhood caries. The process involves the screening of specific salivary peptides that were differentially expressed only under dynamic changes in individual caries status.

Methods

Stimulated whole saliva samples were collected from 28 kindergarten children aged 3–4 years in Beijing at baseline and 3 months and 6 months after baseline. A total of 68 samples were collected. In terms of their caries status and progress during the observation period, participants were divided into 3 groups; 7 in the non-caries recurrence group, 6 in the caries recurrence group, and 15 in the healthy control group. Salivary peptides that exhibited no significant differences in cross-sectional comparisons between different groups of caries status but only expressed differentially along with dynamic changes of individual caries were screened using the technique of magnetic beads combined with matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS). The technique of liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) was employed to identify the proteins from which these peptides were derived.

Results

We found two salivary peptides differentially expressed only under dynamic changes in individual caries status in the above comparisons; mass-to-charge ratio (m/z) values of the two peptides were 1045.9 and 2517.6, respectively (P < 0.05). Principal component analysis (PCA) and the decision tree model based on these two peptides showed an acceptable distinguishing ability for changes in the high-risk status of early childhood caries. The source proteins of the two peptides with m/z values of 1045.9 and 2517.6 were identified as submandibular gland androgen regulatory protein 3B (SMR-3B) and mucin-7, respectively.

Conclusions

Two proteins in children’s saliva, namely SMR-3B and mucin-7, have the potentiality to serve as candidate biomarkers for dynamic surveillance of changes in high-risk status of early childhood caries.

A systematic review to inform the development of a Canadian caries risk assessment tool for use by primary healthcare providers

BACKGROUND

Caries risk assessment (CRA) tools may assist in identifying children at risk of early childhood caries.

AIM

To complete a systematic review of CRA and develop a Canadian CRA tool for preschool children for use in non-dental clinical settings.

DESIGN

Systematic searches of relevant databases were conducted. Potential variables were based on strength of associations (odd ratios, relative risk, hazard ratios, etc), frequency of occurrence, and existing CRA tools. Quality of the evidence assessments were performed by at least two review teams through consensus following GRADE.

RESULTS

Overall, 25 publications met the inclusion criteria, all prospective in design. Based on this review, variables to be considered when developing a new CRA tool for use with preschool children are as follows: age, socioeconomic status, family toothbrushing habits, fluoride exposure, infant feeding practices, dietary habits/behaviours, dental home, caries experience, visible plaque, and enamel defects. The environmental scan identified 22 CRA tools suggesting other additional variables to consider including in a CRA tool, including special healthcare needs, enamel defects, and dental attendance.

CONCLUSIONS

This review informed the development of a Canadian CRA tool for use by primary healthcare professionals, which may improve access to oral health assessments and increase interprofessional collaboration.

Associations between dental care approachability and dental attendance among women pregnant with an Indigenous child: a cross-sectional study

Background

Oral health during pregnancy is vital for both mother and child. Indigenous Australians face many barriers in accessing dental care. Service approachability is one of the key domains in accessing health services. There is little empirical evidence of the association between service approachability and dental care attendance or oral health outcome. The aim of this study is to examine the relationship between dental service approachability on dental care attendance and self-reported gum disease among South Australian women pregnant with an Aboriginal child.

Methods

Four hundred and twenty-seven women pregnant with an Aboriginal child completed questionnaires in both metropolitan and regional health settings in South Australia in 2011. Four variables related to approachability of dental services: (1) perception of need; (2) service-related health literacy; (3) oral health beliefs and; (4) trust and expectation of dental service. The association between service approachability-related factors, dental utilisation and self-reported gum disease during pregnancy were assessed using Generalised Poisson regression models, after adjusting for age, remoteness, employment status and education. Estimates were presented as adjusted prevalence ratios (APR).

Results

Most participants (85.8%) reported a need for dental care, had positive oral health beliefs (88.3%) and had expectations towards dental care (86.2%). Dental service utilisation during pregnancy was low (35.7%). Many participants (78.0%) expressed knowing what to do if they needed dental care, while most (39.8%) doubted that dental care would be available the next day. Poor health service literacy was identified as a risk factor for non-optimal dental attendance (APR = 0.86, 95%CI 0.74–0.99). Perceived need for dental care was positively associated with self-reported gum disease (APR = 1.24, 95%CI 1.06–1.45).

Conclusion

Inability to navigate the dental care system was a risk factor for poor dental attendance among South Australian women pregnant with an Aboriginal child. Perceived need for dental care was associated with gum disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01816-5.

Carious lesions recurrence in children with developmental disabilities: a longitudinal study

This study investigated the factors associated with new carious lesions in one-to five-year-old children with developmental disabilities. This was a retrospective cohort that evaluated 64 dental charts of individuals with caries or fillings in their first dental appointment. The dependent variable was the occurrence of a new carious lesion or restoration. Gender, age, mother's education, sugar consumption, oral hygiene, mouth breathing, reports of xerostomia, gingival status, use of psychotropic drugs, use of asthma drugs, history of asthma, bronchitis, reflux or seizures and having at least one sibling were covariates. Cox proportional hazards regression model was used to estimate the raw and adjusted hazard ratios with their respective 95% confidence interval. The average time that individuals remained free of dental caries/restoration was 79.49 months (95%CI: 64.37 to 92.61). Increase in sucrose consumption increased the rate of caries recurrence (HR = 1.16; 95%CI: 1.04 to 1.30). Individuals who had poor oral hygiene had higher rate of new dental caries (HR = 3.88; 95%CI: 1.22 to 12.37) compared to those with good oral hygiene. The presence of mouth breathing decreased the rate of recurrence of the disease when compared to the nasal breathing (HR = 0.32; 95%CI: 0.15 to 0.70). Oral health-related behaviors and nasal respiration influenced the rate of dental caries recurrence in individuals with developmental disabilities.

sCD14 Level in Saliva of Children and Adolescents with and without Dental Caries, a Hurdle Model

Objective: Soluble CD14 (sCD14) plays an important role in the innate immune response of the oral cavity. The investigation of this biomarker for detection of carious lesions is an even more actual procedure due to its non-invasiveness and the ease of withdrawal. The purpose of the present observational case-control study was to evaluate whether the quantification of sCD14 in children and adolescent’s saliva can discriminate healthy subjects from those suffering from tooth decay. Materials and Methods: 164 subjects (6 to 17 years) were selected and divided into 2 groups: those with at least 1 decayed tooth were assigned to group Decayed (n = 82) and those free from dental caries to group Healthy (n = 82). The amount of salivary soluble CD14 was quantified. Results: Mean salivary soluble CD14 was 28.3 ± 10.8 μg/mL in the Healthy group and 22 ± 9.6 μg/mL in the Decayed group. A hurdle model was applied to the data to estimate both the probability of having carious lesions and their number in relation to sCD14 levels. sCD14 was strongly associated (p < 0.01) with an inverse relation to both the probability of having caries and their number (falling rate of 5% per unit CD14 μg/mL). Conclusions: This data confirms the relationship between sCD14 and the presence of dental caries. However, there is no clear cut off level between healthy and unhealthy subjects, so it is currently not possible to use sCD14 as a biomarker to determine the risk of decays.

Discriminant validity of the CAST instrument compared to the dmf index in the deciduous dentition: a cross sectional study

This study aimed to assess the discriminant validity of the Caries Assessment Spectrum and Treatment (CAST) at different thresholds, compared with the Decayed, Missing, and Filled Teeth Index (dmf) instrument, to discriminate caries risk factors. A cross-sectional study was conducted including children aged 2-5 years from preschools in Southern Brazil. Parents answered a questionnaire, and children were clinically examined using the CAST instrument and, in the following weeks, using the dmf index. Two caries thresholds were adopted for CAST: caries in dentin (CAST4-7/CAST2,4-8) and enamel caries (CAST3-7/CAST2-8). Poisson regression was used in the analysis (p < 0.05). A total of 200 children were included. The prevalence of caries was 47.0% with dmf, 42.5% with CAST4-7, and 77.5% with CAST3-7. When the outcome was caries prevalence, CAST4-7 discriminated between sexes, household crowding, and dental pain, and CAST3-7 discriminated age and family income, while the dmf was associated with dental pain. When experience of caries was the outcome, all the criteria discriminated between sexes, age, family income, household overcrowding, visible dental plaque, and dental pain, while dmf and CAST2-8 also discriminated maternal schooling. The CAST discriminated caries risk factors similar to the dmf index when caries experience was the outcome. When prevalence was considered, CAST was able to discriminate for more individual characteristics than dmf.

Survival Rate and Cost-Effectiveness of Conventional and Atraumatic Restorative Treatment Restorations among Anganwadi Preschool Children in Bengaluru City: A Follow-up Study

Background

Atraumatic restorative treatment (ART) approach helps reduce barriers to restorative care for the patients. This study was done to compare the survival rate and cost-effectiveness of conventional and ART restorations at time-intervals of 6, 12, and 18 months among anganwadi preschool children in Bengaluru city.

Materials and Methods

133 children aged 3-5 years attending anganwadi centers in Bengaluru city based on inclusion and exclusion criteria were recruited for the present study. A split-mouth technique was used in which the participants received two types of carious cavity excavation techniques (conventional and ART) followed by restoration using glass ionomer cement. Comparison and evaluation were made at the end of 6 months, 12 months and 18 months intervals to check for the survival rate and cost-effectiveness.

Results

The survival rates of ART when compared to conventional restorations were higher at 6 months and 12 months 97.7% and 93.07%, respectively, and at 18 months survival rate of conventional restorations were higher. The cost-effectiveness ratio (CER) of the ART restoration was lower when compared to conventional restorations.

Conclusion

The carious cavities restored using ART techniques had a better survival rate at 12 months and lower CER when compared to the conventional technique.

Clinical Consequences of Dental Caries, Parents' Perception of Child's Oral Health and Attitudes towards Dental Visits in a Population of 7-Year-Old Children

This cross-sectional study aimed to assess the occurrence of the consequences of dental caries and factors affecting dental service utilization in a population of 7-year-old children. The research included oral examination of 7-year-old schoolchildren and socio-medical study of their parents/legal caregivers. It was carried out in five primary schools of two provinces, i.e., Greater Poland and Lubusz. Dental examination was performed in accordance with World Health Organization (WHO) recommendations. The socio-medical study consisted of questionnaires with close-ended questions concerning socioeconomic characteristics of the family, reasons and time of the last visit at the dental office, consequences of child’s oral health problems, parents’ attitude towards dental visits, and parental opinion about their child’s teeth. Factors affecting utilization of dental services were statistically analyzed using univariate logistic regression assuming p < 0.05. The pufa index of examined children ranged from 0 to 7 (mean 0.80 ± 1.49), while the dmf index ranged from 0 to 14 (3.86 ± 3.32). Low financial burden of oral health expenditures and university education of at least one of the parents significantly increased the chance of visiting a dentist despite lack of pain (OR = 3.0 and 2.5, respectively). In spite of the availability of free dental care for children, socioeconomic factors still determine the utilization of dental services in Poland. Poor oral health status of examined population and negligence of regular dental check-ups emphasize a need to strengthen oral health literacy of parents and children, promoting proper attitudes towards dental care.

Dental caries experience and its impact on quality of life in Latin American and Caribbean countries

Robust epidemiological data allow for logical interventions taken in the interest of public health. Dental caries is a major public health problem driven by increased sugar consumption and various biological, behavioral, and psychosocial factors, and is known to strongly affect an individual's quality of life. This study aims to critically review epidemiological data on the prevalence of dental caries in Latin American and Caribbean countries (LACC) and its impact on the oral health-related quality of life (OHRQoL) of the population. Although the majority of national surveys did not include all age groups and several countries reported a reduction in the prevalence of cavitated carious lesions, most nations still exhibited a high burden of decayed teeth. OHRQoL evaluation was limited to children and older adults only, and was not included in any national survey. Study heterogeneity and methodological issues hindered comparison of evidence between studies and over time, and updating national level data on caries prevalence and its impact on OHRQoL should be prioritized in LACCs.

Factors Affecting Future Caries Occurrence Among Preschoolers in Northern Guangdong: A Longitudinal Study

Purpose

This study aimed to investigate the new development of caries among preschoolers in northern Guangdong and to assess caries-related factors to distinguish groups with different caries risk levels.

Methods

Baseline data were recorded for participants from September to November 2019, and participants were reexamined from September to November 2020. A longitudinal observation of 11,973 preschoolers was conducted. The simplified debris index (DI-S) and decayed-missing-filled tooth (dmft) index values were obtained for each participant.

Results

Factors associated with whether caries would occur in the future and one-year increase in dmft (Δdmft) included baseline dmft, baseline DI-S, and baseline age. The risk ratio (RR) of caries occurrence and the number of teeth with new-onset caries were 4.482 (95% confidence interval, 4.056-4.957) and 2.945 (2.742-3.165) in the participants with baseline dmft ≥3, which were higher than those with baseline dmft =1 or 2. In the baseline caries-free group, whether caries would occur in the future was related to the baseline DI-S (95% confidence interval, 0.022-0.062). The caries incidence of maxillary central incisors (27.9%) was the highest among teeth of preschoolers without caries at baseline, whereas the caries incidence of mandibular first deciduous molars (42.7%) was the highest among teeth of preschoolers with caries at baseline.

Conclusion

Baseline dmft is a good predictor of future caries. Children with baseline caries-free status, baseline dmft >0, and baseline dmft ≥3 should be treated with preventive interventions of different intensities and frequencies. The occurrence of future caries in baseline caries-free participants is related to oral hygiene status. Measures to prevent caries on smooth surfaces, such as topical fluoridation, should be applied to all preschoolers. Preschoolers with caries at baseline may be given priority for pit and fissure sealing.

Outcome evaluation of the Dental Health Outreach Mobile Experience (HOME) Coach Program

BACKGROUND

The Ohio Department of Health identified dental care as the number one unmet health need for Ohio's children. The Dental Health Outreach Mobile Experience (HOME) Coach is a pediatric mobile dental unit that seeks to meet the dental needs of underserved children in the Columbus City Schools.

PURPOSE

The purpose was to conduct an outcome evaluation of the Dental HOME Coach Program and to compare the outcomes before (2010-2014) and after (2015-2019) the incorporation of the new Dental HOME Coach.

METHODS

Using a longitudinal outcome evaluation research design, the data were analyzed from 10 years of the Dental HOME Coach Program at the Ohio State University (OSU) College of Dentistry during the academic years ending in 2010-2019.

RESULTS

A total of 1063 dental students provided dental care to 26469 children in the Columbus City Schools. The top 3 performed procedures were sealants, prophylaxis, and resin composite fillings. Despite significant increases in the number of dental students providing oral health care, there were significant decreases in the number of amalgam fillings and stainless-steel crowns from before to after the incorporation of the new Dental HOME Coach.

CONCLUSION

The outcome evaluation revealed the Dental HOME Coach Program has been providing underserved children with oral health care that offers them a dental "home," giving dental students an array of hands-on learning experiences that include pediatric dentistry treatments performed under the supervision of OSU faculty members, and positively impacting the problems of access to oral health care for Ohio's families.

Physicochemical properties and filling capacity of an experimental iodoform-based paste in primary teeth

In this study, we evaluated the physicochemical properties (PCP; radiopacity, flow, pH, and solubility) and the quality of root canal filling provided by an experimental industrialized paste (EP), with the same active ingredients as those of the Guedes Pinto paste, compared with the Vitapex® paste. PCP were analyzed according to the ANSI/ADA laboratory testing methods for endodontic filling and sealing materials. To analyze filling capacity, 120 artificial primary teeth (60 maxillary incisors [MIs] and 60 mandibulary molars [MMs]) were endodontically treated. The teeth were divided into eight groups based on the dental group (MIs or MMs), filling material (Vitapex® or EP), and insertion method (syringe or lentulo). The Image J® software was used to analyze the initial an final digital radiographies of each tooth, measuring and comparing root canal and void areas. The percentage of filling failure areas was obtained. Data were submitted to ANOVA and Tukey test of mean comparison. Regarding PCP, both pastes presented results according the ANSI/ADA standards. Flow capacity: Vitapex: 19.6 mm, EP: 25 mm (p < 0.01); radiopacity: Vitapex: 4.47 mmAl, EP: 6.06 mmAl (p < 0.01); pH after 28 days: Vitapex: 7.79, EP: 8.19 (p = 0.12); and solubility after 28 days: Vitapex: 2.68%, EP: 2.89% (p > 0.05). Regarding filling capacity analysis, EP demonstrated 12.5% of failure against 31.5% of Vitapex (p < 0.01). Compared to Vitapex, EP presented statistically significantly better results in flow, radiopacity, pH, and filling capacity. Molars presented more filling failures than incisors. The insertion method using a syringe and a thin tip was significantly better than that using Lentulo spiral carriers.

Success rate of proximal tooth-coloured direct restorations in primary teeth at 24 months: a meta-analysis

The aim was to determine the survival of tooth-coloured restorative materials in proximal restorations of primary teeth at 24 months of follow-up and the influence of the following variables: use of coating, use of cavity conditioner, use of rubber dam isolation, the cavity form, the dentist's experience and the methodological characteristics of the studies. We conducted a search until May 2019, obtaining 16 articles from which 30 independent studies were extracted, which were considered as units of analysis. Four outcome measures were extracted from each study: retention, marginal integrity, anatomic form, and absence of recurrent caries. Separate meta-analyses were carried for each outcome and multiple meta-regression model was applied. The outcomes with the highest mean success rates were absence of recurrent caries and anatomic form. The type of material significantly influenced success rates. The best materials were resin-based material plus total-etching adhesion and resin-modified glass ionomer cement (RMGIC), and the worst high viscosity glass ionomer cement (HVGIC). Atraumatic restorative treatment (ART) had a lower success rate than the conventional cavity form. RMGIC had the best clinical performance and HVGIC the worst. The form of the cavity, blinding and the experience of the operator were the variables that influenced success rates. Proximal primary molar restorations should be performed with RMGIC as it combines good mechanical performance of the resins together with the prevention of secondary caries of glass ionomers.

Dental caries and oral health-related quality of life of 3-year-olds living in Lima, Peru

BACKGROUND

Untreated dental caries negatively impacts children and their families; the implication of which is best measured through assessing quality of life. Information related to Oral Health-Related Quality of Life (OHRQoL) in Peruvian pre-school children is scarce.

AIM

To investigate the relationship between dental caries and the OHRQoL of 3-year-old children.

DESIGN

Randomly selected government pre-schools (n = 17), situated in three low socio-economic status districts in Lima, participated. The OHRQoL data were obtained using the Peruvian (P) ECOHIS questionnaire. Clinical examinations using the Caries Assessment Spectrum and Treatment (CAST) instrument were performed on 308 children. From which, 213 parents returned the P-ECOHIS form. ANOVA, Tamhane, and Tukey methods were used to analyse the data.

RESULTS

The mean age of the children was 3.04 years. The two highest mean P-ECOHIS scores in the child section were 'child symptoms' and 'child psychology' while 'parent distress' scored highest in the parent section. The prevalence of dental caries was 64.3% (CAST scores 4-7). Including CASTcode 3 (enamel carious lesion), the dental caries prevalence was 93.4%. The mean P-ECOHIS scores for 'child symptoms', 'child functions', 'child impact', 'parent distress', and 'the sample' were statistically significantly higher for children with MaxCASTcodes 5 and 6 (dentine and pulpally involved cavities, respectively) than for those with MaxCASTcode 3.

CONCLUSION

The presence of cavitated teeth with and without pulpal involvement impacts negatively on the OHRQoL of 3-year-old children.

Increase in dental caries and change in the socioeconomic profile of families in a child cohort of the primary health care in Northeast Brazil

Background

Factors associated with increases in dental caries and changes in the family socioeconomic profile were investigated in a paediatric primary health care (PHC) cohort in Northeast Brazil during the implementation of social and income transfer programmes.

Method

A prospective analytical study compared data from two surveys on caries in primary dentition conducted in 2006 (age: 18–36 months, n = 1045) and 2010 (age: 5–7 years). Data from the sample recruited and re-examined in 2010 (n = 469) were analysed. Prevalences (P) and the mean primary decayed, missing and filled teeth (dmft) index, cumulative incidence and mean increase were calculated. Differences (p ≤ 0.05 and 95% CI) in dmft ≥1 were identified via McNemar’s test. Differences in the mean dmft were evaluated according to socioeconomic variables (Kruskal-Wallis test and p ≤ 0.05). Multivariate analysis with a negative binomial model was used for the risk factors associated with increasing dmft. In the univariate analyses, nonparametric methods (Kruskal-Wallis test) were used to compare subsamples. Variables with p ≤ 0.20 were included in the multivariate model and retained when p ≤ 0.05.

Results

The prevalence and mean dmft (18–36 months and 5–7 years: p = 28.6 and 68.9%, mean = 1.01 and 3.46, respectively) and variation in mean dmft changed significantly (p < 0.005) with the education level and occupation of the mother; the prevalence and mean dmft were lower for higher maternal education level and maternal participation in the labour market. The cumulative incidence and mean increase in dmft were 8.71% and 2.45, respectively. Common risk predictors for increases in caries were consumption of sweets (RR = 1.53, 95% CI 1.09–2.14) and attendance at public schools (RR = 1.49, 95% CI: 1.81–1.89). Use of private clinical services was a protective factor (RR = 0.68, 95% CI 0.54–0.87).

Conclusion

Increases in caries were observed despite positive changes in the distribution of socioeconomic indicators for the analysed children’s families. The risk factors identified for the increase in caries suggest ongoing problems regarding the effectiveness of intersectoral and health measures for controlling caries in populations exposed to PHC programmes.

Risk of Dental Caries in Primary Teeth with Developmental Defects of Enamel: A Longitudinal Study with a Multilevel Approach

The risk of dental caries seems to be greater in the presence of developmental defects of enamel (DDE). The aim was to determine whether the presence of DDE in the primary teeth of preschool children increases the risk of dental caries in the primary dentition after a period of approximately 2 years. This study was conducted in two stages: baseline (T0) and follow-up (T1). At T0, examinations were conducted for the diagnosis of enamel defects using the DDE index (FDI, 1992), dental caries, and oral hygiene. The participants were allocated to two groups according to the presence (affected) or absence (unaffected) of DDE. At the second evaluation (T1), examinations were performed for the diagnosis of dental caries. Poisson regression analysis with a multilevel approach was used to determine the association between DDE and dental caries. The two levels of the analysis were tooth and child. Among the 339 children (113 affected and 226 unaffected) examined at baseline (T0), 325 were re-examined at follow-up (T1). According to the multilevel analysis, teeth with enamel hypoplasia had a greater risk of having dental caries (RR: 1.99; 95% CI: 1.19-3.33). The risk of caries was greater on posterior teeth (RR: 2.59; 95% CI: 2.18-3.07) and maxillary teeth (RR: 1.48; 95% CI: 1.26-1.75) that had DDE at T0. On the child level, dental caries at T1 was associated with having dental caries at T0 (RR: 1.38; 95% CI: 1.32-1.46). In conclusion, enamel hypoplasia and previous dental caries are risk factors for carious lesions in the primary dentition.

The reassuring role of music associated with the personality traits of children during dental care: a randomized clinical trial

AIM

The objective of this study was to analyze the reassuring role of music associated with the personality traits of children during dental care.

METHOD

The study involved a randomized crossover clinical trial with 34 children, aged from 4 to 6 years, who exhibited two carious lesions on the occlusal surfaces of the molars. The children were divided into two groups: (G1) first tooth restoration intervention session with music, second session without music; and (G2) first tooth restoration intervention session without music, second session with music. The first consultation was to perform a clinical examination, and the second and third to perform modified Atraumatic Restorative Treatment (mART). Symphony No. 40 by Mozart was played via headphones. Pulse rate (PR) was measured using a pulse oximeter. The Brazilian version of the Eysenck Personality Questionnaire-Junior (EPQ-J) was used to measure the children's personality. For statistical analysis, descriptive, Chi-square, and Wilcoxon tests were carried out.

RESULTS

The G1 group exhibited a lower PR at the time of the intervention during the second consultation compared to the third consultation (p = 0.012). The G2 group exhibited a lower PR at the time of the intervention during the third consultation compared to the first consultation (p = 0.002). The majority of the children with a low level of extraversion presented with higher PR (p = 0.005).

CONCLUSION

Music could reduce the PR among children during dental intervention. Children with low extraversion showed a tendency towards a higher PR without music during dental care.

Caries in children with lactose intolerance and cow's milk protein allergy

Dental caries in 5-to-8-year-old children with cow's milk protein allergy (CMPA) and lactose intolerance (LI), their treatment needs, and the consumption of milk-based products and milk derivatives by these patients were investigated. A cross-sectional study was undertaken with 200 children in southern Brazil in 2017. The clinical examination was based on the World Health Organization criteria and a questionnaire was sent to parents or legal guardians to collect information on the children's food intake, pre-existing systemic diseases, medication use, and CMPA and LI. Standardization was performed to verify concordance among examiners (kappa = 0.96). Caries prevalence was 67.50% in children with CMPA or LI, but 34.37% in those without these conditions. The mean dmft (decayed, missing, and filled teeth) index in children with CMPA or LI was 1.75 ± 1.84, significantly higher than among non-allergic or lactose-tolerant children (0.83 ± 1.60) (p < 0.001). In children with CMPA or LI, the mean for treatment needs was 1.58 ± 1.50. Lactose-free milk was the most frequently consumed food among allergic/intolerant children (65.00%), with a mean dmft of 2.00 ± 2.08, higher than that obtained for those without CMPA/LI (0.82 ± 0.87), showing no significant difference (p = 0.129). Although dental caries and treatment needs in primary dentition were associated with CMPA or LI, children's intake of replacement foods did not pose any risk for the development of carious lesions. Statistically significant differences were obtained for the prevalence and severity of dental caries. This shows the need for treatment of children with CMPA or LI, who had the worst caries prevalence and severity rates.