Association between Early Childhood Caries and Quality of Life: Early Childhood Oral Health Impact Scale and Pufa Index

Impact of Clinical Consequences of Pulp Involvement due to Caries on Oral Health-Related Quality of Life in Children and Adolescents: A Systematic Review and Meta-Analysis

INTRODUCTION

Dental caries with pulp involvement potentially impacts the oral health-related quality of life (OHRQoL). This meta-analysis aimed to evaluate whether clinical consequences of pulp involvement due to dental caries impacts OHRQoL of children and adolescents.

METHODS

Observational studies evaluating whether children/adolescents (population) with pulp involvement due to caries (exposition) compared with those without it (comparison) have more negative impact on their OHRQoL (outcome) were included. A systematic search was undertaken in August 2022 in seven databases. Alerts were set until August 2023. JBI Critical Appraisal tool for cross-sectional studies was used for methodological quality assessment. Random-effects meta-analyses were performed to calculate mean differences (MD) or standardized mean differences (SMD) of impact on OHRQoL. For studies with dichotomous outcome, meta-analysis calculated the odds ratio (OR). Robustness, heterogeneity, certainty of evidence, and publication bias were evaluated.

RESULTS

From 29 included studies, 14 assessed preschoolers, nine assessed schoolchildren, four assessed adolescents, and two assessed children/adolescents. PUFA was the main index used to assess the exposure. ECOHIS (preschoolers) and CPQ (children/adolescents) were the main tools used to assess the outcome. Only five articles fully adhered to the quality criteria. The meta-analyses found the following main results: (a) preschoolers: MD -10.79 (-16.50; -5.09); (b) schoolchildren: MD -5.12 (-7.51; -2.72); (c) adolescents: MD -1.86 (-4.59; 0.87); (d) overall impact: SMD -2.18; (CI: -3.21;-1.15) and OR 0.52 (CI: 0.30; 0.90).

CONCLUSION

Pulp involvement impacted OHRQoL of children negatively. In adolescents, this impact was not observed. Results must be interpreted with caution due to very low certainty of evidence.

Caries in orphan children: prevalence and determinants-a systematic review and meta-analysis

BACKGROUND

Orphan children represent a category of children who lost their family support. Their health status is poorer when compared to their parented counterparts. As the most prevalent disease in the world, dental caries is expected to affect orphans greatly. Being vulnerable, health status of orphan children must be monitored and studied; so that health improvement plans would be formulated. Therefore, this systematic review focuses on the extent of the dental caries problem among institutionalized orphan children and its determinants.

METHODS

The review has two outcomes: comparing caries experience of institutionalized children to their parented counterparts, and reviewing the determinants of caries in the exposure group. Two systematic searches (one for each outcome) were run on MedLine via PubMed, Cochrane library, LILACS, Egyptian knowledge bank (EKB) and Google Scholar; beside hand search and searching grey literature.

RESULTS

The searches yielded 17,760, followed by 16,242 records for the first and second outcomes respectively. The full text was screened for 33 and 103 records for the two outcomes respectively; after translating non-English reports. Finally, the review included 9 records to address the first outcome and 21 records for the second. The pooled results showed that the exposure group may show slightly poorer caries experience regarding permanent teeth (pooled mean difference of DMF = 0.09 (-0.36, 0.55)); but they have a much poorer caries experience regarding primary teeth health (pooled mean difference of dmf = (0.64 (-0.74, 2.01)). Meta-analysis of the caries determinants showed that institutionalization increases the risk of caries by 19%. Gender showed slight effect on caries risk with males being more affected; while primary teeth revealed higher risk of caries when compared to permanent teeth.

CONCLUSION

Limited by the heterogeneity and risk of bias of the included studies, meta-analyses concluded that institutionalized orphan children have higher risk of caries. Yet, the institutionalization circumstances were not well-documented in all the included studies. So, the complete picture of the children's condition was not possibly sketched.

TRIAL REGISTRATION

Protocol has been registered online on the PROSPERO database with an ID CRD42023443582 on 24/07/2023.

Impact of oral conditions on oral health-related quality of life among Indians- a systematic review and Meta-analysis

OBJECTIVE

This review assessed the impact of oral conditions on Oral Health Related Quality of Life among Indians.

METHODS

Databases, including PubMed and Scopus, CINAHL, Web of Science, PsycInfo were systematically searched for English Language studies conducted among Indians up to July 2022. Two independent reviewers assessed studies selected for retrieval for methodological quality using standardised quality assessment instruments for analytical cross-sectional studies in JBI SUMARI.

RESULTS

Fourty one publications were included in this review (N = 23,090). Studies includes both cross sectional study and Randomized Controlled Trials. Based on the JBI critical appraisal tools, the quality of the included studies was low to high. Twenty-six studies were considered for the meta-analysis. Individuals with dental caries [OR: 3.54 (95% CI 2.24- 5.60), ten studies, 4945 participants] and malocclusion [ OR: 5.44 (95% CI 1.61, 18.39), six studies, 3720 participants] had poor OHRQoL compared to individuals without oral conditions.

CONCLUSIONS

Despite the various definitions of the exposures and instruments used to assess Oral Health-Related Quality of Life, our review found that people with dental caries and malocclusion have a significantly higher experience of poor quality of life.

PROSPERO SYSTEMATIC REVIEW REGISTRATION NO

CRD42021277874.

Does the severity of untreated dental caries of preschool children influence the oral health-related quality of life?

AIM

To assess the impact of untreated dental caries and its severity on the oral health-related quality of life (OHRQoL) of Kuwaiti preschool children and their caregivers.

METHODS

Participants were 4- and 5-year-old kindergarten children attending preselected public schools from one of the Governorates in Kuwait. Early childhood caries (ECC) was evaluated by clinical examinations and presented using decayed, missed, filled teeth/surface (dmft/dmfs). The clinical consequences of untreated dental caries were assessed using the pufa (pulp, ulcers, fistula, abscess) index for primary teeth. A structured questionnaire obtained demographic information of children and their caregivers. OHRQoL was assessed using the Arabic version of Early Childhood Oral Health Impact Scale (A-ECOHIS).

RESULTS

Among the 334 participants, 171 were kindergarten level-1 (KG1), and 163 were level-2 (KG2). The overall prevalence of dental caries was 78.9% for KG1 children and 67.4% for KG2 children. Decayed teeth were the main component for both dmft (84%) and dmfs (68%). The total mean (SD) pufa score was 0.54 (1.5), and about 19.2% of participants had at least one tooth with pufa > 0. A total of 207 A-ECOHIS were completed. Both family and child impact scores were significantly higher for children with a dmft score of 1 or more (p < 0.001) or with one or more pufa (p < 0.001). Child impact section scores were significantly higher with the increasing degrees of untreated caries (dt) (p = 0.004).

CONCLUSION

The severity of untreated dental caries and caries experience had a negative impact on the OHRQoL of Kuwaiti preschool children and their families. Using the pufa index had provided additional information about the effect of the caries severity on the OHRQoL than assessing the caries experience alone.

Prevalence and severity of coronal and radicular caries among patients with type 2 diabetes mellitus: A cross sectional study

Background

Studies among type 2 diabetes mellitus patients have reported total caries experience; however the severity and clinical consequences of untreated dental caries are often ignored.

Methods

For this study, 150 well (I) and poorly controlled (II) diabetic participants were recruited. The spectrum of caries was evaluated using DMFT (Decayed, Missing and Filled Tooth) index, Dental Caries Severity Classification Scale, PUFA (Pulpal involvement, Ulceration, Fistula and Abscess) index, RCI (Root Caries Index) and the severity of radicular caries by Root Surface Caries Severity Index.

Results

The prevalence of coronal and root caries was 90.7% and 23.3%, respectively. There was significant difference among caries experiences for D, M and DMFT. In group II, severity of coronal caries and mean rank of P, F, A and PUFA scores were higher, so were prevalence of root caries and severity of RD2, RD3 and RD4. HbA1c level had positive correlation with DMFT and PUFA scores (r = 0.458 and 0.522), so was the duration of diabetes with coronal caries, DMFT, PUFA score, root caries and RCI score (r = 0.235, 0.320, 0.273, 0.308 and 0.323).

Conclusion

This is probably the first study to examine the severity of coronal caries, prevalence of untreated dental caries and severity of radicular caries in diabetic patients. Uncontrolled diabetes causes substantial increase in prevalence and severity of coronal and radicular caries.

Effect of self-perceived oral habits on orofacial dysfunction and oral health-related quality of life among a group of Egyptian children: a cohort study

PURPOSE

This study aims to investigate the relationship between OHRQoL and orofacial dysfunction in children practicing oral habits.

METHODS

Thirty Egyptian Children, aged from five to seven years, practicing oral habits (habit practicing/exposed group), were examined for orofacial dysfunction using Nordic Orofacial Test-Screen (NOT-S). Their parents were asked to fill 8-item Parental-Caregiver Perception Questionnaire (P-CPQ), translated to Arabic, as an assessment tool for their children's OHRQoL. The scores of the habit practicing group were compared to those obtained from another 30 children with matched criteria not practicing oral habits (habit free/ control group).

RESULTS

Children in the exposure group showed higher total NOT-S score (median 3, range 1-5) and higher P-CPQ (median 6, range 1-16) than the control group (median 0.5, range 0-2) and (median 4, range 1-8), with a statistical significance (p = 0.00, p = 0.014), respectively. A statistically significant moderate positive correlation was found between OHRQoL and orofacial dysfunction in the habit practicing group, (R = 0.384, p = 0.036). The exposure group was found to be 7.4 and 1.5 times the control group in developing orofacial dysfunction, and having inferior OHRQoL, respectively.

CONCLUSION

An existing association between the degree of orofacial dysfunction and OHRQoL in children practicing oral habit(s) is suggested.

TRIAL REGISTRATION NUMBER

NCT04575792, date of registration: 26/9/2020, first posted (approved): 5/10/2020.

Oral health-related quality of life in children with celiac disease

PURPOSE

There is limited knowledge about oral health-related quality of life (OHRQoL) in children with celiac disease (CD). This study aimed to assess OHRQoL in children with CD compared to healthy controls.

METHODS

This case-control study included children with CD and healthy controls. Three scales were used to assess OHRQoL in different age groups: 6-7 years, 8-10 years, and 11-14 years. The OHRQoL scores were compared between cases and controls to examine the possible associations between OHRQoL and demographics, socioeconomic status, and oral health.

RESULTS

Overall, 104 children with CD and 104 healthy children (controls) were included. The mean age was 10.67 ± 2.39 years in CD patients and 10.69 ± 2.36 in controls (P = 0.971). Male and female children constituted 50% of each group. Children with CD had significantly higher OHRQoL scores than controls (P = 0.003). Low education levels of parents of children with CD and a higher number of siblings in controls were associated with high OHRQoL scores (P = 0.002, P < 0.020, and P = 0.010, respectively). Recurrent aphthous stomatitis (RAS) increased the OHRQoL scores by 7.5 on average (P = 0.016).

CONCLUSION

Children with CD had poor OHRQoL compared with healthy controls. Poor OHRQoL in children with CD was associated with RAS and with lower parental income and education. RAS was an independent predictor of poor OHRQoL in children with CD.

Oral health-related quality of life (OHRQOL) of preschool children's anterior teeth restored with zirconia crowns versus resin-bonded composite strip crowns: a 12-month prospective clinical trial

OBJECTIVES

To compare oral health-related quality of Life (OHRQOL) of preschool children's anterior teeth restored with prefabricated zirconia crowns (ZC) versus resin-bonded composite strip crown (RCSC).

MATERIALS AND METHODS

A prospective clinical trial included 136 children with early childhood caries aged 36-71 months who were assigned into prefabricated ZC and RCSC groups. A total of 344 teeth were restored either with 170 ZCs (49.4%) and 174 RCSCs (50.6%). Wilson and Cleary's conceptual model was to associate the study predictors to the OHRQOL. Early Childhood Oral Health Impact Scale (ECOHIS) was used to assess the OHRQOL at 6 and 12 months. Mann-Whitney U test was used in comparing OHRQOL mean scores in the two groups and Wilcoxon signed-rank test with the effect size (r) to measure the intragroup OHRQOL change. A Poisson regression model was used to study potential risk factors associated with the overall OHRQOL.

RESULTS

After 12 months, the USPHS parameters of the ZC were significantly superior compared to the RCSC. Overall ECOHIS mean scores in the ZC group were significantly lower than that of the RCSC group at T₁ and T₂ (p < 0.001). Remarkable enhancement of the OHRQOL at the follow-ups with a large effect size (r < 0.8) was observed. Restoration type, retention, baseline OHRQOL, and color had a significant impact on the overall OHRQOL at 12 months.

CONCLUSIONS

Preschool children OHRQOL treated with ZC were significantly better than those who received RCSC.

CLINICAL RELEVANCE

One of the optimum treatment standards in pediatric dentistry is the esthetic demand which has significance on the child's OHRQOL and subsequently child's general health quality of life. It is beneficial to the dentist to identify the influence of esthetic restorations on the OHRQOL of preschool children which aids in future decision-making. The longitudinal nature of the study enables the dentist to identify the changes of children's OHRQOL.

Dental caries severity and oral health-related quality-of-life in Brazilian preschool children

The impact of dental caries on oral health-related quality-of-life (OHRQoL) may be influenced by disease severity. This study evaluated the impact of caries severity on OHRQoL in preschool children. A school-based, cross-sectional study was conducted with 205 children (aged 2-5 years) in Southern Brazil. Parents answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and provided sociodemographic information. The Caries Assessment Spectrum and Treatment criteria were used to evaluate caries severity, and Poisson regression with robust variance estimation conducted to determine the rate ratio (RR) and 95% confidence intervals (CIs) of the mean OHRQoL scores according to severity level. Most children had at least one tooth in the morbidity (37%) or pre-morbidity (35%) stages, and the prevalence of impacts on OHRQoL was 40%. Caries severity was associated with the impact scores: after adjustments, the mean B-ECOHIS scores were 6.31 (95% CI: 4.24-9.38) higher for children in the morbidity stage, and 10.84 (95% CI: 6.51-18.05) higher in the severe morbidity stage, than for healthy children [RR = 10.84 (95% CI: 6.51-18.05)]. Children with carious lesions into dentine or with pulpally-involved or abscessed teeth had poorer OHRQoL than children without such lesions.

Oral-Health-Related Quality of Life and Cosleeping: The Role of Nocturnal Breastfeeding

The purpose of this paper is to analyse the association between cosleeping and the number of breastfeeding sessions in infants, OHRQoL of the child and the family, and the DMFT Child’s index. The sample comprised 273 children (2–4 years old). In addition to the clinical examination of the child to assess the DMFT Index, the mother was requested to complete a questionnaire to collect data about the breastfeeding practice, diet, dental hygiene, dental check-ups, quality of the child’s oral life, and family impact (ECOHIS Scale). The children’s OHRQoL is positively correlated with number of night-time breastfeeding sessions at 12 months (r² = 0.40 **), DMFT index (r² = 0.60 **), impact family (r² = 0.65 **), and duration of cosleeping (r² = 0.36 **). The moderating effect explained 41% of OHRQoL; the interaction between the number of breastfeeding sessions at 18 months and the DMFT index significantly increased the coefficient of determination. A longer practice time for cosleeping was associated with an increase in breastfeeding sessions, a higher impact on OHRQoL, a higher family impact, and a higher DMFT index. More than three night-time breastfeeding sessions moderate the relationship between the DMFT index and the child’s OHRQoL.

Recommendations from paediatric dentistry associations of the Americas on breastfeeding and sugar consumption and oral hygiene in infants for the prevention of dental caries: A bibliometric review

BACKGROUND

The Internet provides a plethora of information on health issues related to children's oral health.

AIM

Identify online recommendations of paediatric dentistry associations of the Americas (PDAAs) regarding breastfeeding practices, weaning, sugar introduction and initiating oral hygiene.

DESIGN

Websites of PDAAs were accessed to record recommendations/questions (Q) relevant to early childhood that specifically covered issues about exclusive breastfeeding-Q1, indications of bottle feeding-Q2, when and how to start weaning-Q3 and Q4, respectively, association of breast milk and dental caries-Q5, when to start oral hygiene and how to introduce it-Q6 and Q7, respectively, and guidance on the introduction of sugar-Q8. Similarity/dissimilarity frequencies between the associations (Euclidean distances) were calculated.

RESULTS

From 35 countries on the two American continents, 21 associations were affiliated with the International Association of Paediatric Dentistry and/or the Latin American Pediatric Dentistry Association, whereas eight did not have websites. Higher (P < .05) dissimilarities for Q6 (68.2%), Q7 (72.7%), and Q8 (62.1%) were observed. Results were similar for Q1 and Q5 (P > .05). No association mentioned Q2, Q3 or Q4 responses, whereas Q7 was the most frequently discussed issue.

CONCLUSION

Not all of the investigated issues are mentioned on websites of PDAAs, potentially stymieing efforts by both the layperson and health professional to gather information.

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.

Probiotic fermented milks: Children's emotional responses using a product-specific emoji list

This study aimed to develop and validate a product-specific emoji list and use this list to analyse children's emotional responses associated with the consumption of probiotic fermented milks prepared with different probiotic strains. Furthermore, the overall liking of the products was studied during a sensory test. Six formulations were studied: Bifidobacterium BB12 (BB), Lactobacillus acidophilus L3 (LA3), Lactobacillus acidophilus LA 05 (LA5), Lactobacillus delbrueckii subsp. lactis (LL), Lacticaseibacillus casei 01 (LC), and Streptococcus thermophilus and Lactobacillus delbrueckii subsp. bulgaricus (CONV). A total of 132 children (7-14 years old) participated in two study phases: development (n = 32) and validation (n = 100) of the list. Fifteen emoji were selected to be included in the product-specific list, which had a high frequency of citations in the first phase. The formulations with the highest overall liking (LL, BB, LC and CONV) were correlated with positive emoji, while the least-liked formulations (LA3 and LA5) were associated with negative emoji. Furthermore, the utilisation of emoji enabled the differentiation among formulations with similar overall liking. Therefore, this study developed and validated an emoji list to be used in the evaluation of fermented milks by children. The results suggest that the type of probiotic culture impacted the sensory characteristics of fermented milks, supporting the use of Bifidobacterium, L. lactis or L. casei in these products.

Cross cultural adaptation and psychometric properties of the Bengali version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5)

BACKGROUND

The oral health related quality of life (OHRQoL) of children in Bangladesh has not yet been measured, as there is no validated OHRQoL measure for that population. The aim of this study was to cross-culturally adapt the child self-report and parental proxy report versions of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) into Bengali and test their psychometric properties: face validity, construct validity (convergent and discriminant validity) and reliability (internal consistency and test-retest reliability), among 5-9-year-old children and their parents in Bangladesh and assess associations between dental caries/sepsis and OHRQoL in this population.

METHODS

The forward-backward translated Bengali SOHO-5 was piloted among 272 children and their parents to test its face validity. The questionnaire was administered to 788 children and their parents to evaluate its psychometric properties. Internal consistency of Bengali SOHO-5 was assessed using Cronbach's alpha, and test-retest reliability was assessed using Kappa. Convergent and discriminant validity were assessed through nonparametric tests. The calculation of effect sizes and standard error of measurement facilitated the assessment of minimally important difference (MID) for SOHO-5. The associations of reporting an oral impact with caries and sepsis were assessed via logistic regression models.

RESULTS

Both child self-report and parental proxy report questionnaires showed good face validity. Cronbach's alpha scores were 0.79 and 0.87 for child and parental questionnaire, respectively. A weighted Kappa score of 0.85 demonstrated test-retest reliability of child questionnaire. SOHO-5 scores were significantly associated with subjective oral health outcomes and discriminated clearly between different caries severity and sepsis groups. These differences were considerably higher than the MID. After adjusting for child's age, sex, setting, maternal education and family income, the odds of reporting an oral impact were 2.25 (95% CI 1.98-2.56) and 4.44 (95% CI 3.14-6.28) times higher for each additional tooth with caries and sepsis, respectively.

CONCLUSION

This study provided strong evidence supporting the validity and reliability of both versions of Bengali SOHO-5 as OHRQoL measures. Dental caries and sepsis were associated with poor OHRQoL in this population. The Bengali SOHO-5 is expected to be a useful outcome measure for research and clinical purposes in Bengali speaking child populations.

Perception of Dental Caries and Parental Difficulties in Implementing Oral Hygiene for Children Aged Less Than 6 Years: A Qualitative Study

BACKGROUND

Despite extensive prevention programs, dental hygiene remains inadequate, particularly among children under the age of six, and early childhood caries (ECC) are still a concern. Oral hygiene behavior and preventive practices seem difficult to change at a family level.

AIM

The present study aimed to better understand the reasons behind this behavior and to identify the different barriers to the implementation of adequate preventive measures.

METHODS

A qualitative study was conducted in the pediatric dentistry service of the Montpellier University Hospital (France) in 2019. A thematic analysis concerning three domains was performed: family environment, dental literacy, and oral hygiene.

RESULTS

The main barriers encountered by the parents were, respectively, (1) a weakness in the organization of familial life, together with a low-medium family income and a lack of authority, (2) ignorance of the necessity of treating carious primary teeth, and (3) a lack of time for brushing or supervising their children's teeth.

CONCLUSION

These results showed that oral hygiene and primary teeth care could not be easily achieved in the family environment of the participants, and oral health strategies should be focused not only on children but also on their parents.