Disparities in Caries Experience and Socio-Behavioural Risk Indicators Among Private School Children in Lagos, Nigeria

The Global Prevalence and Severity of Dental Caries among Racially Minoritized Children: A Systematic Review and Meta-Analysis

Racially minoritized children often bear a greater burden of dental caries, but the overall magnitude of racial gaps in oral health and their underlying factors are unknown. A systematic review and meta-analysis were conducted to fill these knowledge gaps. We compared racially minoritized (E) children aged 5-11 years (P) with same-age privileged groups (C) to determine the magnitude and correlates of racial inequities in dental caries (O) in observational studies (S). Using the PICOS selection criteria, a targeted search was performed from inception to December 1, 2021, in nine major electronic databases and an online web search for additional grey literature. The primary outcome measures were caries severity, as assessed by mean decayed, missing, and filled teeth (dmft) among children and untreated dental caries prevalence (d > 0%). The meta-analysis used the random-effects model to calculate standardized mean differences (SMD) and 95% confidence intervals (95% CI). Subgroup analysis, tests for heterogeneity (I2, Galbraith plot), leave-one-out sensitivity analysis, cumulative analysis, and publication bias (Egger's test and funnel plots) tests were carried out. The New Castle Ottawa scale was used to assess risk of bias. This review was registered with PROSPERO, CRD42021282771. A total of 75 publications were included in the descriptive analysis. The SMD of dmft score was higher by 2.30 (95% CI: 0.45, 4.15), and the prevalence of untreated dental caries was 23% (95% CI: 16, 31) higher among racially minoritized children, compared to privileged groups. Cumulative analysis showed worsening caries outcomes for racially marginalized children over time and larger inequities in dmft among high-income countries. Our study highlights the high caries burden among minoritized children globally by estimating overall trends and comparing against factors including time, country, and world income. The large magnitude of these inequities, combined with empirical evidence on the oral health impacts of racism and other forms of oppression, reinforce that oral health equity can only be achieved with social and political changes at a global level.

Replication of GWAS significant loci in a sub-Saharan African Cohort with early childhood caries: a pilot study

BACKGROUND

Early childhood caries (ECC) is a rapidly progressing form of dental infection and a significant public health problem, especially among socially and economically disadvantaged populations. This study aimed to assess the risk factors for ECC among a cohort of Sub-Saharan African children and to determine the role of genetics in the etiology of ECC.

METHODS

A sample of 691 children (338 with ECC, 353 without ECC, age < 6 years) was recruited from schools in Lagos, Nigeria. Socio-demographic, dental services utilization and infant dietary data were obtained with interviewer-administered questionnaire. Oral examination was conducted using the WHO oral health diagnostic criteria. Saliva samples were collected from the children for genetic analysis. Single nucleotide polymorphisms were selected from previous study for genotyping. Genetic association analyses to investigate the role of genetics in the etiology of ECC was done. Bivariate comparisons and Multivariate logistic regression analyses were conducted to assess associations between ECC and predictor variables, p < 0.05.

RESULTS

Of the 338 children with ECC, 64 (18.9%) had Severe-Early Childhood Caries (S-ECC). Children aged 48-59 months comprised the highest proportion of subjects with ECC (165; 48.8%) and S-ECC (24; 37.5%) while female subjects had higher dt (3.13 ± 2.56) and dmft values 3.27 ± 2.64. ECC was significantly more prevalent among children who were breastfed at night ≥ 12 months (OR 3.30; CI 0.39, 4.75), those with no previous dental visit (OR 1.71; CI 0.24, 2.77), those who used sweetened pacifiers (OR 1.85; CI 0.91, 3.79) and those who daily consumed sugar-sweetened drinks/snacks (OR 1.35; CI 0.09, 18.51). A suggestive increased risk for ECC (OR 1.26, p = 0. 0.0397) was observed for the genetic variant rs11239282 on chromosome 10. We also observed a suggestive reduced risk for ECC (OR 0.80, p = 0.03) for the rs131777 on chromosome 22. None of the genetic variants were significant after correction for multiple testing (Bonferroni p value p = 0.004).

CONCLUSIONS

Prolonged night-time breastfeeding, poor utilization of dental services and daily consumption of sugar were risk factors for ECC. Larger sample size is needed to confirm the results of the genetic analysis and to conduct genome wide studies in order to discover new risk loci for ECC.

Individual and familial factors associated with caries and gingivitis among adolescents resident in a semi-urban community in South-Western Nigeria

Objectives

We describe the prevalence, and individual and familial risk indicators for dental caries and gingivitis among 10–19-year-old adolescents in Ile-Ife, South-West Nigeria.

Methods

This cross-sectional study collected data through household surveys conducted between December 2018 and January 2019. Adolescents were recruited through multistage sampling. Oral health outcomes were caries, measured by the ‘Decayed, Missing due to caries, and Filled Teeth’ (DMFT) index, and gingivitis, measured by the Loe and Silness gingival index. Explanatory variables were individual (sex, age, oral health perception) and familial (socioeconomic status, birth rank, family size and parental living status) factors. Oral health behaviors (daily tooth-brushing, use of fluoridated toothpaste, consuming refined carbohydrates in-between meals, use of dental floss, dental service utilization in past 12 months, and smoking habits) were treated as confounders. Poisson regression models with robust estimation were constructed to determine associations between explanatory factors and oral health outcomes.

Results

A total of 1472 adolescents were surveyed. Caries prevalence was 3.4%, with mean (standard deviation) DMFT of 0.06 (0.36) and plaque index of 0.84 (0.56). Only 128 (8.7%) adolescents brushed their teeth twice daily, 192 (16.1%) used dental floss daily, 14 (1.1%) utilized dental services in the last 12 months, and 508 (36.1%) consumed refined carbohydrates in-between meals less than once daily. The proportion of respondents who currently smoked cigarettes was 1.6%, and 91.7% of respondents used fluoridated toothpaste daily. The adjusted prevalence ratio of having caries increased by 18% for every additional age-year (APR: 1.18; 95% CI 1.004, 1.34). Additionally, participants with high socioeconomic status had significantly lower prevalence of caries compared to those with lower status (APR: 0.40; 95% CI 0.17, 0.91). Moderate/severe gingivitis was significantly associated with higher frequency of consuming refined carbohydrates in-between meals (APR: 2.33; 95% CI 1.36, 3.99) and higher plaque index scores (APR: 16.24; 95% CI 9.83, 26.82).

Conclusion

Caries prevalence increased with increasing age and was higher among Nigerian adolescents with low socioeconomic status, while moderate/severe gingivitis was associated with frequent consumption of refined carbohydrates and higher plaque index score. While behavioral interventions may reduce the risk of gingivitis, structural interventions may be needed to reduce the risk for caries in this population.