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Tavares M, Chiu CJ, Hasturk H, Lake K, O’Keefe AC, De Armas V, Yaskell T, Esberg A, Johansson I, Tanner AC. Household, dietary, and clinical characteristics of childhood caries and overweight progression-A prospective cohort study. Int J Paediatr Dent 2024; 34:35-46. [PMID: 37309985 PMCID: PMC10716355 DOI: 10.1111/ipd.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/08/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Childhood caries and obesity are complex chronic diseases with negative health outcomes. AIM This study sought a risk profile for childhood caries and overweight. DESIGN Children were recruited into a longitudinal prospective cohort study. Caries and overweight characteristics were obtained at baseline, 6, 12, and 18 months. Sequential data modeling steps determined a disease risk profile. RESULTS At baseline, 50% of the children (n = 194, 3.0 to 6.9 years) had caries; 24% were overweight, of whom 50% had caries. Correlation analysis separated child characteristics from household circumstances. Principal component modeling separated child snacking from meal-eating patterns, and household smoking from parent education variables. Baseline caries and overweight were not associated, but they grouped together in the modeling of composite features. Forty-five percent of children showed caries progression, 29% overweight progression, and 10% progression of both diseases. The strongest predictors of progression were disease presence, household-based characteristics, and sugary drinks. Children with caries and overweight progression shared multiple child- and household-based features. CONCLUSION Individually, caries and overweight were not associated. Children with progression of both conditions shared a profile and multiple risk characteristics suggesting these findings could be useful in assessing the risk for the most extreme cases of caries and overweight.
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Affiliation(s)
- Mary Tavares
- The Forsyth Institute, Cambridge, MA, 02142, USA
- Harvard School of Dental Medicine, Boston, MA, 02115, USA
| | | | | | - Kristina Lake
- Waterville Community Dental Center, Waterville ME. 04901, USA
| | - Anna C. O’Keefe
- Waterville Community Dental Center, Waterville ME. 04901, USA
| | | | - Tina Yaskell
- The Forsyth Institute, Cambridge, MA, 02142, USA
| | - Anders Esberg
- Department of Odontology, Umeå University, Umeå, Sweden
| | | | - Anne C Tanner
- The Forsyth Institute, Cambridge, MA, 02142, USA
- Harvard School of Dental Medicine, Boston, MA, 02115, USA
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Nadeeshani H, Kudagammana ST, Herath C, Jayasinghe R, Liyanage R. Early Childhood Caries and Nutritional Status of Children: A Review. Food Nutr Bull 2023; 44:249-264. [PMID: 38095292 DOI: 10.1177/03795721231209358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Early childhood caries (ECC) is a serious public health issue affecting children around the world. Severe symptoms and complications commonly found with ECC are adverse effects on health and growth retardation triggered by sensitivity, pain, and abscesses associated with decayed teeth, premature tooth loss, and insufficient food intake due to difficulty in chewing and keeping food in the mouth. OBJECTIVE This article aims to provide an overview of the most recent and current evidence on the association between ECC and nutritional status with an aim to stimulate further research and to identify the impact of nutritional status on ECC and vice versa. METHODS PubMed, Web of Science, and Google Scholar databases were used to search the studies conducted between 2016 and 2022. The included studies were searched using some keyword combinations and saved in Mendeley Desktop for review and referencing. All books, policy briefs, thesis/dissertations, and non-peer-reviewed articles were excluded, and 47 studies were selected for this narrative review. RESULTS Many studies have identified long-term, frequent, and nocturnal bottle-feeding and breastfeeding as well as frequent consumption of sugary food and beverages as high-risk factors for ECC. Adverse nutritional status assessed by anthropometric measures, vitamin D status, and iron-deficiency anemia have been studied as risk factors for ECC. CONCLUSIONS Most of the prevailing studies are either case-control or cross-sectional studies, which are unable to provide strong evidence to prove the direction of causality. Thus, further prospective studies are needed to clarify the association between ECC and the nutritional status of children.
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Affiliation(s)
- Harshani Nadeeshani
- Division of Nutritional Biochemistry, National Institute of Fundamental Studies, Kandy, Sri Lanka
| | | | - Chandra Herath
- Department of Community Dental Health, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ruwan Jayasinghe
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ruvini Liyanage
- Division of Nutritional Biochemistry, National Institute of Fundamental Studies, Kandy, Sri Lanka
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da Fonseca Cumerlato CB, Cademartori MG, Barros FC, Dâmaso AH, da Silveira MF, Hallal PC, Demarco FF, Corrêa MB. Maternal depression in first 1000 days of life and early childhood caries prevalence at 48 months of age. Clin Oral Investig 2023; 27:7625-7634. [PMID: 37897660 DOI: 10.1007/s00784-023-05351-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the effect of maternal's depression trajectory in the first 1000 days of the child's life on the prevalence of early childhood dental caries (ECC), in a birth cohort. MATERIALS AND METHODS All infants born in Pelotas in 2015 were identified, and the mothers were invited to participate in the cohort. A total of 3645 children were included in the study. The outcome was ECC at 48 months of age assessed according to ICDAS. Maternal depression was collected using Edinburgh Postnatal Depression Scale (EPDS) antenatally, at 3, 12, and 24 months of age. Maternal depressive symptom trajectory variables were created using group-based trajectory models and adopting two cutoff points. Poisson regression model with robust variance was used to identify the total effect of maternal depressive symptom trajectories on ECC, adjusting by confounders. RESULTS A total of 29.2% of the mothers presented a high trajectory for screening of depression, and 18.8% presented a high trajectory of depression diagnosis. The prevalence of ECC was 26.7%. After adjusted analysis, maternal depression trajectories (screening and diagnosis) from pregnancy to 24 months increased the risk for ECC at 48 months of age (RR = 1.14; 95% CI 1.02-1.28 and RR = 1.19; 95% CI 1.05-1.35). CONCLUSIONS Children from mothers with high depression trajectory had higher risk of having dental caries at 48 months compared to children from mothers with low depression trajectory. CLINICAL RELEVANCE Strategies of early detection and treatment of maternal mental disorders during the Golden Period should be considered of high priority in health services since it could impact positively in children's life.
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Affiliation(s)
| | - Mariana Gonzalez Cademartori
- Graduate Program in Dentistry, Federal University of Pelotas, Rua Gonçalves Chaves, 457, 5th floor, Pelotas, RS, 96015560, Brazil
| | - Fernando Celso Barros
- Catholic University of Pelotas, Gonçalves Chaves, 373, Pelotas, RS, 96015560, Brazil
| | - Andréa Homsi Dâmaso
- Graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Mariângela Freitas da Silveira
- Graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Pedro Curi Hallal
- Graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Flávio Fernando Demarco
- Graduate Program in Dentistry, Federal University of Pelotas, Rua Gonçalves Chaves, 457, 5th floor, Pelotas, RS, 96015560, Brazil
- Graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160, 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Marcos Britto Corrêa
- Graduate Program in Dentistry, Federal University of Pelotas, Rua Gonçalves Chaves, 457, 5th floor, Pelotas, RS, 96015560, Brazil.
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Sarkis-Onofre R, Girotto C, Agostini BA. Exploring the use of preprints in dentistry. J Dent 2023; 136:104634. [PMID: 37488044 DOI: 10.1016/j.jdent.2023.104634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE This study aims to assess the use, impact, and dissemination of preprints in dentistry. METHODS This is a meta-research study with a cross-sectional design. We included preprints published in dentistry, regardless of the year of publication. Searches were performed in the medRxiv.org and Preprints.org platforms and restricted to English. One researcher extracted the data, and another researcher verified data consistency. The following data were extracted: year of publication, country of the corresponding author, number of abstract and full-text views and downloads, Altmetric attention score, whether the preprint was mentioned in other servers such as Twitter and Publons, number of mentions in other servers, number of citations in the Dimensions database, and whether the preprint had already been published in a peer-reviewed journal. If already published, we extracted the journal's impact factor (JCR 2021) and the number of citations in the Dimensions database. We conducted a descriptive analysis of the extracted characteristics and explored relationships between metrics using the Spearman correlation. RESULTS We identified 276 preprints. Most of the studies were published between 2020 and 2022 (n = 229), especially those from ten countries. The most-cited preprint and published article are the same study. Only the correlation between the number of preprint citations and peer-reviewed article citations in the Dimensions database showed a large positive association (Spearman's rho = 0.5809). CONCLUSION Preprints gained popularity over the last several years due to the COVID-19 pandemic and reached a larger audience, especially on platforms such as Twitter. CLINICAL SIGNIFICANCE Preprint publishing allows faster dissemination of science for the benefit of society.
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Affiliation(s)
- Rafael Sarkis-Onofre
- Graduate Program in Dentistry, Atitus Educação, 304, Senador Pinheiro Street, Passo Fundo, Brazil.
| | - Carolina Girotto
- Graduate Program in Dentistry, Atitus Educação, 304, Senador Pinheiro Street, Passo Fundo, Brazil
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Vali L, Zare Z, Jahani Y, Kalavani K. Investigating the access barriers to oral and dental health services for children from the perspective of parents attending the health centers of Kerman. Dent Res J (Isfahan) 2023; 20:49. [PMID: 37304422 PMCID: PMC10247869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/26/2022] [Accepted: 03/06/2023] [Indexed: 06/13/2023] Open
Abstract
Background Oral health plays a key role in people's overall health. Dental caries is the most important problem in children's oral health. Despite significant advances made in the area of oral health around the world, there is inequality in access to oral health within Iran and abroad, and this is considered a public health challenge. This study was conducted to investigate the access barriers to children's oral health services from the perspective of parents attending the health centers of Kerman, Iran. Materials and Methods The present descriptive-analytical study was carried out, as a cross-sectional survey, on 410 parents of children living in Kerman, Iran. The data were collected by access barriers questionnaire, and then were analyzed by SPSS software using descriptive statistical methods and the multiple linear regression test. Confidence interval (CI) in this study was 95% (95% CI). Results The most common access barrier to children's oral health was the high treatment cost. The access barriers to children's oral health services were significantly associated with parental education (P = 0.00), maternal employment (P = 0.04), supplementary insurance (P = 0.00), and family income (P = 0.01). Parental satisfaction was also significantly correlated to the child's sex (P = 0.04), supplementary insurance (P = 0.04), and number of filled teeth (P = 0.04). The mean score of parental satisfaction was 1.83 ± 0.34; within the range of 1-3 from satisfied to dissatisfied. Conclusion The cost of dental treatment services high and there are many barriers to accessing children's oral health.
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Affiliation(s)
- Leyla Vali
- Associate Professor, Environmental Health Engineering Research Center, Department of Health Services Management, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Zare
- Ph.D. Candidate of Health Care Management, Department of Health Services Management, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yones Jahani
- Associate Professor, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Science, Kerman, Iran
| | - Khalil Kalavani
- Ph.D. Candidate of Health Care Management, Student Research Committee, Department of Health Services Management, Kerman University of Medical Sciences, Kerman, Iran
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Park AH, Kulchar RJ, Susarla SM, Turton B, Sokal-Gutierrez K. Fewer Children in Families Associated with Lower Odds of Early Childhood Caries: A Sample from Three Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2195. [PMID: 36767562 PMCID: PMC9916343 DOI: 10.3390/ijerph20032195] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Childhood caries experience is influenced by family characteristics and oral health practices in the context of many social-commercial determinants. The aim of this study was to explore the relationship between families' number of children, oral health practices and child caries experience in a convenience sample of 1374 children aged 6 months through 6 years and their families from Ecuador, Nepal, and Vietnam. Data were collected by mother interviews and child dental exams. Multivariate logistic and Zero-Inflated-Poisson regression analyses assessed associations between number of children, oral health practices and decayed, missing or filled teeth (dmft). Families had a mean of 2.2 children (range 1-12); 72% of children had tooth decay, with mean dmft of 5.4. Adjusting for child age, sex, and urban/rural location, a greater number of children in the family was associated with significantly less likelihood of unhealthy bottle feeding practices, having a toothbrush/toothpaste and parent helping child brush, and being cavity-free; higher number of dmft, and greater likelihood of having a dental visit. Early childhood oral health promotion should include focus on oral hygiene and healthy feeding-particularly breastfeeding and healthy bottle feeding practices-as well as access to family planning services and support for childcare.
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Affiliation(s)
- Amy H. Park
- Rausser College of Natural Resources, University of California, Berkeley, CA 94704, USA
| | - Rachel J. Kulchar
- Department of Chemistry, Princeton University, Princeton, NJ 08544, USA
| | | | - Bathsheba Turton
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA
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Korolenkova MV, Khachatryan AG, Ivanova ES. [The impact of dental caries prevention program on the anthropometric measurements of preschool children]. STOMATOLOGIIA 2023; 102:46-51. [PMID: 36800785 DOI: 10.17116/stomat202310201146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
THE AIM OF THE STUDY Was to compare body mass indices (BMI) of children receiving and not receiving dental caries prevention program in preschool institutions at the age of 3-6 years. MATERIAL AND METHODS The study comprised163 children (76 boys and 87 girls) initially examined at the age of 3 years in nurseries of the Khimki city region. In one of the nurseries 54 children received dental caries prevention and educational program for 3 years. Other 109 children not receiving any special programs served as controls. Data on caries prevalence and intensity as well as weight and height were collected at baseline examination and 3 years after. BMI was calculated by standard formula and WHO criteria for weight deficiency, normal weight, overweight and obesity for children aged 2-5 and 6-17 years were applied. RESULTS Caries prevalence in 3-years-old was 34.1% with dmft median of 1.4 teeth. After 3 years the prevalence of dental caries reached 72.5% in controls and was almost twice as low in the main group (39.3%). Caries intensity growth was also significantly higher in controls (p<0.0001). There was statistically significant difference on the rate of underweight and normal weight in children receiving and not receiving dental caries preventive program (p<0.05). The rate of normal and low BMI in the main group was 82.6% (vs. 66% in controls) and 7.7% (vs. 22%), correspondingly. The higher the caries intensity the more is the risk for being underweight (11.5% in caries-free children vs 25.7% in having DMFT+dft more than 4, p=0.034). CONCLUSION Our study showed positive impact of dental caries prevention program on the anthropometric measurements of children aged 3-6 years which increases the significance of this type of programs in pre-school institutions.
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Affiliation(s)
- M V Korolenkova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.,Moscow Regional Research Institute named after M.F. Vladimirskiy, Moscow, Russia
| | - A G Khachatryan
- Moscow Regional Research Institute named after M.F. Vladimirskiy, Moscow, Russia
| | - E S Ivanova
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of the Russian Federation, Moscow, Russia
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Caries Experience and Treatment Needs in Urban and Rural Environments in School-Age Children from Three Provinces of Ecuador: A Cross-Sectional Study. Dent J (Basel) 2022; 10:dj10100185. [PMID: 36285995 PMCID: PMC9600713 DOI: 10.3390/dj10100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022] Open
Abstract
In Ecuador, national epidemiological surveys have not been updated; however, some regional studies in the northern areas of the country still report a high prevalence of dental caries. The aim of this study was to determine the experience, severity, and need for treatment of dental caries in school children aged 6 to 12 years in urban and rural settings in three provinces of southern Ecuador. This cross-sectional, relational study examined 1938 schoolchildren in the provinces of Azuay, Cañar, and Morona Santiago. The survey instruments were based mainly on the WHO manual Methods of Oral Health Surveys (dmft) for primary and permanent dentition (DMFT), as well as the prevalence, severity, and Significant Caries Index (SCI). The parametric Student’s t-test was used to compare two groups, and the Spearman’s Rho and Tau-c Kendall correlation coefficients were used to associate the categorical variables. Results: The prevalence of caries in the primary dentition was 78% and 89.2% in the permanent dentition. The dmft (M = 4.12, SD = 2.86) and DMFT (M = 3.62: SD = 3.07) placed the general group in a moderate caries index. The need for treatment was 90.68% in the primary dentition, while it was 87.99% in the permanent dentition. Caries severity in both dentitions was high (M = 7.74; SD = 3.42). Conclusions. Alarming indicators of caries experience and the need for treatment were observed in the population studied.
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Shinde N, Kanabar DJ, Miles LJ. Narrative review of the prevalence and distribution of acute pain in children in the self-care setting. PAEDIATRIC & NEONATAL PAIN 2022; 4:169-191. [PMID: 36618510 PMCID: PMC9798044 DOI: 10.1002/pne2.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/16/2022] [Accepted: 07/20/2022] [Indexed: 01/11/2023]
Abstract
Acute pain among children is common, yet it may be underestimated and undertreated if the pain is not recognized. Assessing and managing pediatric pain can be complicated, and as such, measuring the prevalence of acute pain in children can be challenging. We sought to provide a consolidated review of the available data on the prevalence of commonly occurring acute pain in children in the self-care setting. An extensive literature search was performed to determine the prevalence of acute pain at multiple bodily locations in children aged between 3 months and 18 years. We considered the influence of age, sex, and sociodemographic factors on prevalence estimates. We also sought to identify some of the challenges involved in assessing and managing pediatric pain, thus shedding light on areas where there may be clinical and medical unmet needs. In general, a high prevalence of acute pain in children was detected, particularly headache, menstruation-related pain, and dental and back pain. Older age, female sex, and lower socioeconomic status were associated with increased pain prevalence. Risk factors were identified for all pain types and included psychological issues, stress, and unhealthy lifestyle habits. Owing to the heterogeneity in study populations, the prevalence estimates varied widely; there was also heterogeneity in the pain assessment tools utilized. The paucity of information regarding pain prevalence appears to be out of proportion with the burden of acute pain in children. This could indicate that clinicians may not be equipped with an optimal pain management strategy to guide their practice, especially regarding the use of developmentally appropriate pain assessment tools, without which prevalence data may not be captured. If acute pain is not accurately identified, it cannot be optimally treated. Further investigation is required to determine how the information from prevalence studies translates to the real-world setting.
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Affiliation(s)
- Nutan Shinde
- Reckitt Benckiser plc (Global Headquarters)BerkshireUK
| | | | - Lisa J. Miles
- Reckitt Benckiser plc (Global Headquarters)BerkshireUK
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Nantanee R, Sriratanaban J. Cost‐effectiveness and estimated net monetary benefits of a fluoride varnish application program during well‐child visits by 9‐ to 30‐month‐old children in three areas of Thailand. Community Dent Oral Epidemiol 2022; 51:512-518. [DOI: 10.1111/cdoe.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/10/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ratichanok Nantanee
- Department of Preventive and Social Medicine, Faculty of Medicine Chulalongkorn University Bangkok Thailand
- Department of Pediatric Dentistry, Faculty of Dentistry Chulalongkorn University Bangkok Thailand
| | - Jiruth Sriratanaban
- Department of Preventive and Social Medicine, Faculty of Medicine Chulalongkorn University Bangkok Thailand
- Thailand Research Center for Health Services System, Faculty of Medicine Chulalongkorn University Bangkok Thailand
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Susarla SM, Trimble M, Sokal-Gutierrez K. Cross-Sectional Analysis of Oral Healthcare vs. General Healthcare Utilization in Five Low- and Middle-Income Countries. FRONTIERS IN ORAL HEALTH 2022; 3:911110. [PMID: 35815119 PMCID: PMC9259954 DOI: 10.3389/froh.2022.911110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Oral health is integral to overall health and is often neglected, especially in low- and middle-income countries (LMICs). Oral disease, including untreated dental caries, affects nearly 3.5 billion people globally, contributing to poor health and quality of life. To examine the relationship between the utilization of general healthcare and oral healthcare, we conducted an exploratory cross-sectional study of first-visit interview data collected from a convenience sample of 3,422 low-income mothers and 4,324 children aged 6 months through 6 years participating in a community-based oral health and nutrition program in five LMICs (Ecuador, El Salvador, India, Nepal, and Vietnam) from 2006–2015. We used descriptive and exploratory association analysis to identify patterns of oral healthcare utilization for mothers and children compared to medical care utilization, specifically maternal prenatal care and child immunizations. Overall, 89.6% of the mothers had received prenatal care for at least one child, but only 76.4% had ever received dental care and 50% were currently suffering from oral health symptoms, primarily oral pain. Mothers who received prenatal care were significantly more likely to have accessed dental care compared to those who had not received prenatal care (OR = 2.62, 95% CI: 2.06, 3.32). Overall, 95.4% of the children had current immunizations, but only 30.1% had ever received dental care, and 32.4% were currently suffering from oral pain. Children whose immunizations were up-to-date were more likely to have received dental care, with a significant association in Ecuador (OR = 3.29, 95% CI: 2.06, 5.30). Compared to utilization of general healthcare, oral healthcare was under-utilized by mothers and children in our sample from five LMICs. Integration of prevention- and treatment-oriented oral healthcare into primary medical care services, particularly prenatal care and child immunizations, could help increase access to oral healthcare and improve women's and children's oral health.
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Prevalence of Caries According to the ICDAS II in Children from 6 and 12 Years of Age from Southern Ecuadorian Regions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127266. [PMID: 35742515 PMCID: PMC9223782 DOI: 10.3390/ijerph19127266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/04/2022]
Abstract
In Ecuador, national data on dental caries are scarce and the detection of incipient enamel lesions has been omitted. The objective of this study was to determine the prevalence of caries in school children aged 6 and 12 years of both sexes, belonging to urban and rural areas of three provinces of the country, using the International Caries Detection and Assessment System (ICDAS II). The sample consisted of 665 children from public schools, examined according to ICDASII. Caries prevalence and caries index were established using ICDAS II 2-6/C-G and ICDAS II 4-6/E-G criteria for comparison with WHO indicators. The Mann−Whitney U statistical test was used for comparison of two groups, the effect size was measured with the correlation coefficient. and the Kruskal−Wallis H test (p < 0.05) for multiple comparisons. Caries prevalence exceeded 87% for primary and permanent dentition. There were no significant differences according to province (p ≤ 0.05). The caries index at 6 years was 6.57 and at 12 years 9.21. The SIC was high at 12 years in rural areas. The prevalence of caries in the population studied was high despite the preventive measures established by health agencies.
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Individual, Family, and Socioeconomic Contributors to Dental Caries in Children from Low- and Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127114. [PMID: 35742362 PMCID: PMC9222700 DOI: 10.3390/ijerph19127114] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023]
Abstract
Introduction: Collective evidence on risk factors for dental caries remains elusive in low- and middle-income countries (LMICs). The objective was to conduct a systematic review and meta-analysis on risk factors for dental caries in deciduous or permanent teeth in LMICs. Methods: Studies were identified electronically through databases, including Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, and CINAHL, using “prevalence, dental caries, child, family, socioeconomic, and LMIC” as the keywords. A total of 11 studies fit the inclusion criteria. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale (NOS). The MedCalc software and Review Manager 5.4.1 were used. Results: From 11,115 participants, 38.7% (95% CI: 28.4−49.5%) had caries and 49.68% were female. Among those with caries, 69.74% consumed sugary drinks/sweets (95% CI: 47.84−87.73%) and 56.87% (95% CI: 35.39−77.08%) had good brushing habits. Sugary drinks had a two times higher likelihood of leading to caries (OR: 2.04, p < 0.001). Good oral hygiene reduced the risk of caries by 35% (OR: 0.65, p < 0.001). Concerning maternal education, only secondary education reduced the likelihood of caries (OR: 0.96), but primary education incurred 25% higher risks (OR: 1.25, p = 0.03). A 65% reduction was computed when caregivers helped children with tooth brushing (OR: 0.35, p = 0.04). Most families had a low socioeconomic status (SES) (35.9%, 95% CI: 16.73−57.79), which increased the odds of caries by 52% (OR: 1.52, p < 0.001); a high SES had a 3% higher chance of caries. In the entire sample, 44.44% (95% CI: 27.73−61.82%) of individuals had access to dental services or had visited a dental service provider. Conclusion: Our findings demonstrate that high sugar consumption, low maternal education, and low and high socioeconomic status (SES) increased the risk of dental caries in LMICs. Good brushing habits, higher maternal education, help with tooth brushing, and middle SES provided protection against caries across LMIC children. Limiting sugars, improving oral health education, incorporating national fluoride exposure programs, and accounting for sociodemographic limitations are essential for reducing the prevalence of dental caries in these settings.
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Echeverria MS, Schuch HS, Cenci MS, Motta JVS, Bertoldi AD, Hallal PC, Demarco FF. Trajectories of Sugar Consumption and Dental Caries in Early Childhood. J Dent Res 2022; 101:724-730. [PMID: 35114848 DOI: 10.1177/00220345211068743] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study verifies the association between the trajectory of sugar consumption and dental caries in the 2015 Pelotas Birth Cohort in Pelotas, Brazil. It was conducted with data from the follow-ups at 3, 12, 24, and 48 mo from the 2015 Birth Cohort, which included 4,275 children born alive in hospitals in Pelotas. Data collection included standardized questionnaires for first caregivers applied by trained interviewers at all follow-ups. Exposure was the trajectory of sugar consumption from 3 to 48 mo (always low, always intermediate, increasing, and always high), obtained by group-based trajectory modeling. The outcome of this study was dental caries, obtained through clinical examination performed by calibrated dentists at 48 mo of age. Socioeconomic conditions and oral health instruction from a health professional during the first 4 y of life were included in the analysis as potential confounders. Prevalence ratios and their 95% confidence intervals were provided from generalized estimating equations with a log-Poisson with robust variance specification. In total, 3,654 (91.1%) children participated in the survey at 48 mo, and 2,806 children had complete data for the analyzes performed. Of these, 1,012 (36.1%; 95% confidence interval [CI], 34.3-37.8) experienced caries, and 723 (25.8%; 95% CI, 24.2-27.4) had cavitated caries. Regarding cavitated caries, the prevalence was 1.48 times higher in the group with increasing sugar consumption than children with always low consumption. There is an association between the trajectory of sugar consumption and dental caries at 48 mo. Children with increasing and always high sugar consumption have the highest prevalence of caries.
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Affiliation(s)
- M S Echeverria
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - H S Schuch
- Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - M S Cenci
- Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - J V S Motta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - A D Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - P C Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - F F Demarco
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil.,Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
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O'Donoghue R, Walker D, Beaumont J. Children of the abyss: Investigating the association between isotopic physiological stress and skeletal pathology in London during the Industrial Revolution. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 35:61-80. [PMID: 34715484 DOI: 10.1016/j.ijpp.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This project sought to investigate whether an association may be observed between isotopic stress indicators and skeletal evidence of pathological conditions. MATERIALS Deciduous and permanent teeth of 15 non-adults from two contemporaneous mid-19th century London burial grounds (City Bunhill, Lukin Street). METHODS δ13C and δ15N was measured in the incrementally sectioned dentine collagen. Isotopic profiles for each individual included death during tooth development. RESULTS Individuals with skeletal evidence of chronic pathological conditions (e.g., rickets, tuberculosis) exhibited raised δ15N values of 0.5-1.7‰ in the months prior to death. Isotopic change consistent with chronic physiological stress prior to death was also recorded in two individuals with no skeletal evidence of disease. An offset was observed between co-forming bone and dentine δ15N values in both populations, indicating that bone and dentine are not recording the same isotopic changes. CONCLUSIONS Isotopic change consistent with chronic physiological stress was observed in both those with and without skeletal evidence of disease, suggesting that adaptation to chronic stress in childhood was not uncommon within these 19th century London populations. SIGNIFICANCE Chronic physiological stress prior to death may be seen in the incrementally sampled dentine of non-adults who die during tooth formation. LIMITATIONS The temporal resolution of current dentine micro-sampling methods may mask or minimise visibility of shorter-term periods of stress or dietary change. SUGGESTIONS FOR FURTHER RESEARCH Future research should further explore the relationship between specific skeletal pathologies and isotopic evidence for stress.
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Affiliation(s)
- Ruth O'Donoghue
- School of Archaeological and Forensic Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.
| | - Don Walker
- Museum of London Archaeology, Mortimer Wheeler House, 46 Eagle Wharf Road, London, N1 7ED, UK
| | - Julia Beaumont
- School of Archaeological and Forensic Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK
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Ndekero TS, Carneiro LC, Masumo RM. Prevalence of early childhood caries, risk factors and nutritional status among 3-5-year-old preschool children in Kisarawe, Tanzania. PLoS One 2021; 16:e0247240. [PMID: 33630949 PMCID: PMC7906390 DOI: 10.1371/journal.pone.0247240] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early childhood dental caries (ECC), a serious public health problem lacks information on the association between ECC, risk factors and nutritional status among children in Tanzania. Therefore, this study aimed to determine the prevalence of ECC, risk factors and nutritional status among 3-5-year-old preschool children and to assess its correlation with the form, visible plaque scores in upper anterior teeth, total sugar exposure, anthropometric measures, and socio demographic attributes. METHODS This cross-sectional study was conducted on 831 children registered in public preschools in Kisarawe District. Assessment of ECC used the WHO (2013) criteria and anthropometric measures used the WHO Child Growth Standards (2006). Structured questionnaires were completed by children's parents through an interview. Collected information on socio-demographic attributes including oral hygiene and sugar exposure to their children was analyzed. RESULTS Only 459 children (55.2%) were recognized as caries-free. Dental caries experience in terms of decayed, missing and filled teeth (dmft) index was 2.51. Children with visible plaque were the majority (56.1%). The dmft score index was negatively and significantly associated with weight-for-age z-score [Coefficient: -0.11 (95% CI: -0.76, -0.11)] and positively significantly associated with visible plaque score index [Coefficient: 0.16 (95% CI: 0.18, 0.52)] and total sugar exposure [Coefficient: 0.19 (95% CI: 0.15, 0.38)] in the adjusted model. The prevalence of underweight was 4.2% [95% CI: (3.0-5.8)] and severe underweight was 0.2% [95% CI: (0.1-0.9)] while prevalence of stunting was 1.6% [95% CI: (0.9-2.7)] and severe stunting was 0.4% [95% CI: (0.1-1.1)]. CONCLUSION This study demonstrated a significant negative relationship between ECC and children's anthropometric measures indicated by weight-for-age, and positive relationship with sugar exposure and poor oral hygiene indicated by visible plaque on upper anterior teeth. Controlling risk factors will reduce the occurrence of ECC thereby catering for a healthy population of well-nourished children.
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Affiliation(s)
- Tumaini S. Ndekero
- Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Lorna C. Carneiro
- Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Ray M. Masumo
- Oral Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
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Cayo-Rojas CF, Santillán-Espadín KDR, Nicho-Valladares MK, Ladera-Castañeda MI, Aliaga-Mariñas AS, Cervantes-Ganoza LA. Conocimiento en salud oral, PH salival, índice de masa corporal y su relación con caries dental en preescolares. REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v69n4.88709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La caries dental es una condición causada por la interacción de múltiples factores, entre ellos la dieta, ya que, con frecuencia, de ella depende el desarrollo del medio biológico propicio para el metabolismo bacteriano cariogénico.
Objetivo. Determinar la prevalencia de experiencia de caries en preescolares de Huaura, Perú, y confirmar si hay una asociación con el pH salival y el índice de masa corporal (IMC) de los preescolares, y con el nivel de conocimiento en salud oral de uno de sus padres.
Materiales y métodos. Estudio no experimental, correlacional y transversal realizado en 126 preescolares distribuidos equitativamente en 3 grupos etarios (3, 4 y 5 años). La asociación entre experiencia de caries y las variables consideradas se determinó mediante la prueba de independencia de chi cuadrado, con un nivel de confianza del 95% y error tipo I del 5%; además, se realizó un análisis de regresión logística múltiple para calcular la probabilidad de ocurrencia de experiencia de caries en relación con cada factor de riesgo.
Resultados. La prevalencia de experiencia de caries fue de 80.2% (IC:73.2%-87.2%); además, el pH salival (p=0.012) y nivel de conocimiento de los padres (p<0.001) se asociaron significativamente con la experiencia de caries. En cuanto al análisis de regresión múltiple, se obtuvo un OR=0.12 (IC95%:0.02-0.63) para el pH y un OR=0.50 (IC95%:0.35-0.74) para el nivel de conocimiento en relación con la probabilidad de tener experiencia de caries.
Conclusión. El nivel de conocimiento sobre salud oral de los padres y los niveles altos de pH salival de los preescolares fueron factores protectores frente a la experiencia de caries en la población de estudio. Por otra parte, no se encontró una asociación entre IMC y experiencia de caries en los preescolares de 5 años.
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Stunting Malnutrition Associated with Severe Tooth Decay in Cambodian Toddlers. Nutrients 2021; 13:nu13020290. [PMID: 33498508 PMCID: PMC7909538 DOI: 10.3390/nu13020290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/18/2023] Open
Abstract
Background: The persistently high prevalence of undernutrition in Cambodia, in particular stunting or chronic malnutrition, calls for innovative investigation into the risk factors that affect children’s growth during critical phases of development. Methods: Secondary data analysis was performed on a subgroup of children who were present at two time points within the Cambodian Health and Nutrition Monitoring Study (CAHENMS) and who were less than 24 months of age at the nominated baseline. Data consisted of parent interviews on sociodemographic characteristics and feeding practices, and clinical measures for anthropometric measures and dental status. Logistic regression modelling was used to examine the associations between severe dental caries (tooth decay)—as indicated by the Significant Caries Index—and the presence of new cases of stunting malnutrition at follow-up. Results: There were 1595 children who met the inclusion criteria and 1307 (81.9%) were followed after one year. At baseline, 14.4% of the children had severe dental caries, 25.6% presented with stunted growth. 17.6% of the children transitioned from healthy status to a low height-for-age over the observation period. Children with severe dental caries had nearly double the risk (OR = 1.8; CI 1.0–3.0) of making that transition. Conclusion: Severe caries experience was associated with poorer childhood growth and, as such, could be an underinvestigated contributor to stunting.
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Low-Temperature Plasma as an Approach for Inhibiting a Multi-Species Cariogenic Biofilm. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11020570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study aimed to determine how low-temperature plasma (LTP) treatment affects single- and multi-species biofilms formed by Streptococcus mutans, Streptococcus sanguinis, and Streptococcus gordonii formed on hydroxyapatite discs. LTP was produced by argon gas using the kINPen09™ (Leibniz Institute for Plasma Science and Technology, INP, Greifswald, Germany). Biofilms were treated at a 10 mm distance from the nozzle of the plasma device to the surface of the biofilm per 30 s, 60 s, and 120 s. A 0.89% saline solution and a 0.12% chlorhexidine solution were used as negative and positive controls, respectively. Argon flow at three exposure times (30 s, 60 s, and 120 s) was also used as control. Biofilm viability was analyzed by colony-forming units (CFU) recovery and confocal laser scanning microscopy. Multispecies biofilms presented a reduction in viability (log10 CFU/mL) for all plasma-treated samples when compared to both positive and negative controls (p < 0.0001). In single-species biofilms formed by either S. mutans or S. sanguinis, a significant reduction in all exposure times was observed when compared to both positive and negative controls (p < 0.0001). For single-species biofilms formed by S. gordonii, the results indicate total elimination of S. gordonii for all exposure times. Low exposure times of LTP affects single- and multi-species cariogenic biofilms, which indicates that the treatment is a promising source for the development of new protocols for the control of dental caries.
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Korolenkova MV, Khachatryan AG, Ivanova ES. [Child's weight as a risk factor for early childhood caries]. STOMATOLOGIIA 2021; 100:70-74. [PMID: 34953192 DOI: 10.17116/stomat202110006170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
THE AIM OF THE STUDY Was to reveal possible correlation between child's birth weight, BMI at examination, dental caries prevalence and intensity. MATERIALS AND METHODS The study comprised 220 healthy children aged 3-6 born mature and attending nursery schools in Khimky city (Moscow region, Russia). Data on birth weight were extracted from a healthcare reports database, current height and weight were measured and BMI was calculated and interpreted according to WHO criteria. Calibrated pediatric dentists performed oral examination registering the dmft index. RESULTS Children suffering from dental caries at the age of 3-6, have lower birth weight and struggle to put it on later in life. This results in higher proportion of children with underweight. Among children with caries 69.2% had BMI lower than 15th percentile, and 28.3% had very low IMT (lower than 5th percentile) vs 5.6% in the group without caries (p<0.05). The mechanisms and the direction of this correlation are unclear. CONCLUSION There is a necessity for further investigations on the role of various factors associated with body weight and alimentary status in the development of the early childhood caries.
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Affiliation(s)
- M V Korolenkova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
- Moscow Regional Research Institute named after M.F. Vladimirskiy, Moscow, Russia
| | - A G Khachatryan
- Moscow Regional Research Institute named after M.F. Vladimirskiy, Moscow, Russia
| | - E S Ivanova
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of the Russian Federation, Moscow, Russia
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Pentapati KC, Yeturu SK, Siddiq H. Global and regional estimates of dental pain among children and adolescents-systematic review and meta-analysis. Eur Arch Paediatr Dent 2021; 22:1-12. [PMID: 32557184 PMCID: PMC7943429 DOI: 10.1007/s40368-020-00545-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/07/2020] [Indexed: 01/13/2023]
Abstract
AIM We aimed to evaluate the pooled prevalence of dental pain amongst children and adolescents. METHODS Studies conducted in children and adolescents up to18 years of age and where prevalence of dental is reported or calculated were included. Search was performed in four major databases from inception to June 1st, 2019. Prevalence estimate at the maximal recall for the dental pain for the individual study was used to calculate the overall pooled estimate. RESULTS The prevalence of dental pain ranged from 1.33 to 87.8% in the included publications for quantitative synthesis (n = 97). More than half of the publications reported the lifetime prevalence of dental pain (n = 51) while few studies reported the current prevalence of dental pain (n = 3) and only one study evaluated the dental pain in the past one week. Heterogeneity was high among the included publications (Q = 49,063.12; P < 0.001; df = 96 and I2 = 99.8; P < 0.001). Overall pooled prevalence of dental pain was 32.7 (CI = 29.6-35.9). No difference was seen with respect to the trends in prevalence of dental pain (Coefficient: 0.005; 95% CI - 0.001-0.011; P-value: 0.101). CONCLUSION Two out of ten children below five years, four out of ten children between 6 and 12 years and three out of ten adolescents between 13 and 18 years would have experienced pain in the past. Overall, three out of ten children or adolescents might have experienced dental pain in the past. There was no difference in the pain prevalence between male and females. Studies from Africa reported highest pooled prevalence (50.1%) with least being from Australia (20.7%). Studies from India (40.4%), China (41.3%) and Iran (42.6%) reported high pooled prevalence estimates of dental pain.
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Affiliation(s)
- Kalyana Chakravarthy Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Sravan Kumar Yeturu
- grid.411370.00000 0000 9081 2061Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Viswavidya Peetham, Kochi, India
| | - Hanan Siddiq
- grid.411639.80000 0001 0571 5193Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, 576104 Karnataka India
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Sheen MH, Hsiao SY, Huang ST. Translation and validation of Taiwanese version of the Early Childhood Oral Health Impact Scale (ECOHIS). J Dent Sci 2020; 15:513-518. [PMID: 33505624 PMCID: PMC7816025 DOI: 10.1016/j.jds.2020.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/25/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/PURPOSE Treating and preventing dental caries in children have been major health concerns in Taiwan. However, little discussion on oral health-related quality of life in Taiwanese preschooler exists. This study aimed to construct and validate a Taiwanese version of the Early Childhood Oral Health Impact Scale (ECOHIS) for preschool children in Taiwan. MATERIALS AND METHODS A Taiwanese version of the ECOHIS was developed using the forward-backward translation method. Our study population (n = 251) comprised children aged 3-6 years old. Parents of the children signed informed consent and self-completed ECOHIS. Data were analyzed for internal reliability using Cronbach's alpha coefficient, and item-to-total correlation was determined. Criterion validity was tested for the relationship between ECOHIS scores and caries experience (dmft). A multiple linear regression model was used to assess the independent variables of the ECOHIS. RESULTS Cronbach's alpha for the total score of the Taiwanese version of ECOHIS was 0.76. The validity of the ECOHIS was tested, and scores of both the total scale and family impact section were found to be statistically significantly related to dmft (P < 0.005). Multiple linear regression analysis revealed that with an increase in dmft, the total score of the ECOHIS significantly increased (95% CI = 0.22-0.63, P < 0.001). CONCLUSION The Taiwanese version of the ECOHIS is a valid and reliable tool to assess the oral health-related effect on 3- to 6-year-old children in Taiwan.
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Affiliation(s)
- Ming-Hsuan Sheen
- Division of Pediatric Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of Special Care Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Szu-Yu Hsiao
- Division of Pediatric Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of Special Care Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shun-Te Huang
- Division of Special Care Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Athavale P, Khadka N, Roy S, Mukherjee P, Chandra Mohan D, Turton B(B, Sokal-Gutierrez K. Early Childhood Junk Food Consumption, Severe Dental Caries, and Undernutrition: A Mixed-Methods Study from Mumbai, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228629. [PMID: 33233797 PMCID: PMC7699964 DOI: 10.3390/ijerph17228629] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/14/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022]
Abstract
In India, globalization has caused a nutrition transition from home-cooked foods to processed sugary snacks and drinks, contributing to increased early childhood caries (ECC). This mixed-methods study describes risk factors for ECC and associations with undernutrition in low-income communities in Mumbai. Interviews with mothers of 959 children, ages six-months through six-years, addressed maternal-child nutrition and oral health, and children received dental exams and anthropometric assessments. Focus groups with community health workers and mothers explored experiences and perceptions of oral health, nutrition, and ECC. Descriptive and logistic regression analyses of quantitative data, and content analysis of qualitative data were performed. Eighty percent of children lived 5 min from a junk-food store, over 50% consumed junk-food and sugary tea daily, 50% experienced ECC, 19% had severe deep tooth decay, 27% experienced mouth pain, and 56% experienced chronic and/or acute malnutrition. In children ages 3–6, each additional tooth with deep decay was associated with increased odds of undernutrition (Odds Ratio [OR] 1.10, Confidence Interval [CI] 1.02–1.21). Focus groups identified the junk-food environment, busy family life, and limited dental care as contributors to ECC. Policy interventions include limits on junk-food marketing and incorporating oral health services and counseling on junk-food/sugary drinks into maternal–child health programs.
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Affiliation(s)
- Priyanka Athavale
- School of Public Health, University of California, Berkeley, CA 94704, USA; (N.K.); (S.R.); (D.C.M.); (K.S.-G.)
- School of Medicine, University of California, San Francisco, CA 94143, USA
- Correspondence: ; Tel.: +1-(408)-647-0477
| | - Nehaa Khadka
- School of Public Health, University of California, Berkeley, CA 94704, USA; (N.K.); (S.R.); (D.C.M.); (K.S.-G.)
- Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles, CA 90095, USA
| | - Shampa Roy
- School of Public Health, University of California, Berkeley, CA 94704, USA; (N.K.); (S.R.); (D.C.M.); (K.S.-G.)
| | | | - Deepika Chandra Mohan
- School of Public Health, University of California, Berkeley, CA 94704, USA; (N.K.); (S.R.); (D.C.M.); (K.S.-G.)
| | | | - Karen Sokal-Gutierrez
- School of Public Health, University of California, Berkeley, CA 94704, USA; (N.K.); (S.R.); (D.C.M.); (K.S.-G.)
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Associations between Child Snack and Beverage Consumption, Severe Dental Caries, and Malnutrition in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217911. [PMID: 33126647 PMCID: PMC7672540 DOI: 10.3390/ijerph17217911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 12/01/2022]
Abstract
The global nutrition transition and increased consumption of sugar-sweetened beverages and ultra-processed snacks have contributed to increasing rates of child obesity and dental caries in developing countries. In Nepal, where child malnutrition rates are high, the relationship between malnutrition and dental caries is poorly understood. This cross-sectional study aims to assess this relationship among a convenience sample of 273 children age six months to less than 12 years in three communities in Nepal, using parent/caregiver interviews, child dental exams, and anthropometric measurements. Fisher’s exact test and independent t-tests examined associations between dietary practices and severe caries and between severe caries and malnutrition, respectively. Children consumed sugar-sweetened beverages and processed snacks frequently: 80% consumed tea with sugar, 60% consumed sweet snacks, and 65% consumed processed savory snacks daily. Overall, 74% of children had untreated tooth decay, and 21% exhibited stunting malnutrition, 14% were underweight, and 6% presented wasting. Significant associations were found between daily consumption of sweets and processed snacks with severe caries and between severe caries and poorer nutritional status. These findings underscore the need to incorporate nutrition and oral health promotion and dental treatment into maternal–child health services and schools and to strengthen policies to reduce children’s access to junk food.
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Ultra-processed foods and early childhood caries in 0–3‐year‐olds enrolled at Primary Healthcare Centers in Southern Brazil. Public Health Nutr 2020; 24:3322-3330. [DOI: 10.1017/s1368980020002839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractObjective:To investigate the relationship between ultra-processed food consumption and early childhood caries.Design:Cross-sectional analysis of baseline data from a cluster randomised controlled study. Outcomes included the prevalence of children with non-cavitated and cavitated caries. The main exposure was the total daily consumption of ultra-processed foods (up to three times and four times or more), assessed through a FFQ. Potential confounders were socio-demographic characteristics of the child and caregiver/family, child breast-feeding, oral hygiene and use of dental services. Poisson regression using robust variance adjustment was used to estimate prevalence ratios (PR) and their respective 95 % CI.Setting:Primary Healthcare Centers in an urban area of Pelotas, Southern Brazil.Participants:Children aged 0–3 years (n 309).Results:Consumption of ultra-processed foods four times or more a day was found in 67·6 % of children; 24·4 and 12·0 % presented non-cavitated and cavitated caries, respectively. After adjustment, children who consumed ultra-processed foods four times or more a day were more likely to present both non-cavitated caries (PR 2·25, 95 % CI 1·19, 4·27, P = 0·013) and cavitated caries (PR 3·48, 95 % CI 1·18, 10·30, P = 0·024) compared with those who have consumed them up to three times a day.Conclusions:Consumption of ultra-processed foods is associated with early childhood caries. Interventions aiming at reducing ultra-processed food consumption should be implemented to improve children’s oral health.
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Abstract
OBJECTIVE In low- and middle-income countries, undernutrition remains a major risk factor for child growth retardation. In addition, the emergence of obesity in recent years is adding another public health concern in that both stunting and obesity are associated with serious adverse health consequences. This review was designed to evaluate the prevalence of stunting and obesity in Ecuador. DESIGN Electronic databases were searched for articles published through February 2018 reporting the prevalence of stunting and/or obesity. Selected data were subjected to meta-analysis and pooled prevalence and their 95 percentiles (95 % CI) were calculated. SETTING Studies were identified in Medline, Web of Science, CINAHL, Cochrane Database and Ibero-America databases. PARTICIPANTS Population of Ecuador. RESULTS Twenty-three articles were selected according to the inclusion/exclusion criteria of the study. The estimate of pooled prevalence of stunting was 23·2 % (95 % CI 23·3, 23·5) in preschoolers (age < 5 years), but was markedly higher in indigenous and rural communities. Pooled prevalence of obesity was 8·1 % (95 % CI 6·9, 9·3), 10·7 % (95 % CI 9·6, 11·7) and 10·5 % (95 % CI 9·2, 11·8) in preschoolers, school-age children (age: 5-11 years) and adolescent (age: 12-18 years), respectively. In adults (age ≥ 19 years), the rate of obesity was remarkably high as indicated by an overall estimate equal to 44·2 % (95 % CI 43·1, 45·4). CONCLUSIONS This study underlines high levels of stunting among children and obesity among adults in Ecuador, both of which are not equally distributed among the population. The magnitude of this double burden emphasises the need for sustained and targeted interventions.
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Lee ZL, Gan WY, Lim PY, Hasan R, Lim SY. Associations of nutritional status, sugar and second-hand smoke exposure with dental caries among 3- to 6-year old Malaysian pre-schoolers: a cross-sectional study. BMC Oral Health 2020; 20:164. [PMID: 32493338 PMCID: PMC7268511 DOI: 10.1186/s12903-020-01152-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dental caries in primary teeth is a serious oral health concern among children. It can lead to detrimental impacts on a child's growth, development, and quality of life. Therefore, this cross-sectional study aimed to examine the prevalence of dental caries and its associations with nutritional status, sugar and second-hand smoke exposure among pre-schoolers. METHODS A total of 26 pre-schools in Seremban, Malaysia were randomly selected using the probability proportional to size sampling. Dental examination was performed by a dentist to record the number of decayed teeth (dt). Weight and height of the pre-schoolers were measured. The mother-administered questionnaire was used to gather information pertaining to the sociodemographic characteristics and second-hand smoke exposure. Total sugar exposure was calculated from a 3-day food record. RESULTS Among the 396 participating pre-schoolers, 63.4% of them had at least one untreated caries, with a mean ± SD dt score of 3.56 ± 4.57. Negative binomial regression analysis revealed that being a boy (adjusted mean ratio = 1.42, 95% CI = 0.005-0.698, p = 0.047), exposed to second-hand smoke (adjusted mean ratio = 1.67, 95% CI = 0.168-0.857, p = 0.004) and those who had more than 6 times of daily total sugar exposure (adjusted mean ratio = 1.93, 95% CI = 0.138-0.857, p = 0.013) were significantly associated with dental caries among pre-schoolers. CONCLUSION A high prevalence of dental caries was reported in this study. This study highlights the need to reduce exposure to second-hand smoke and practice healthy eating behaviours in reducing the risk of dental caries among pre-schoolers.
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Affiliation(s)
- Zhi Ling Lee
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Wan Ying Gan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor Darul Ehsan, Malaysia.
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Ruhaya Hasan
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Sing Ying Lim
- Department of Paediatric Dental, Tuanku Ja'afar Hospital, Jalan Rasah, Bukit Rasah, 70300, Seremban, Negeri Sembilan, Malaysia
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Associations between early childhood caries, malnutrition and anemia: a global perspective. BMC Nutr 2020; 6:16. [PMID: 32467766 PMCID: PMC7197144 DOI: 10.1186/s40795-020-00340-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/05/2020] [Indexed: 01/02/2023] Open
Abstract
Background Malnutrition is the main risk factor for most common communicable diseases. The aim of this study is to determine the relationship between country-level prevalence of early childhood caries (ECC), malnutrition and anemia in infants and preschool children. Methods Matched country-level ECC, malnutrition and anemia prevalence were generated from databases covering the period 2000 to 2017. Multivariate general linear models were developed to assess the relationship between outcome variables (prevalence of stunting, wasting, overweight, and anemia) and the explanatory variable (ECC prevalence) adjusted for gross national income per capita. Adjusted regression coefficients (B) and partial eta squared were computed. Results The mean (standard deviation (SD)) ECC prevalence was 23.8 (14.8)% for 0-2 year-olds and 57.3 (22.4)% for 3-5-year-olds. The mean (SD) prevalence of wasting was 6.3 (4.8)%, overweight 7.2 (4.9)%, stunting 24.3 (13.5)%, and anemia 37.8 (18.1)%. For 0-2-year-olds, the strongest and only significant association was between the prevalence of ECC and overweight (η2 = 0.21): 1 % higher ECC prevalence was associated with 0.12% higher prevalence of overweight (B = 0.12, P = 0.03). In 3-5-year-olds, the strongest and only significant association was between the prevalence of ECC and anemia (η2 = 0.08): 1 % higher prevalence of ECC was associated with 0.14% lower prevalence of anemia (B = - 0.14, P = 0.048). Conclusion Country-level prevalence of ECC was associated with malnutrition in 0-2-year-olds and with anemia in 3-5-year-olds. The pathway for the direct relationship between ECC and overweight may be diet related. The pathway for the inverse relationship between ECC and anemia is less clear and needs further investigations.
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Rizzardi KF, Rodrigues LKA, Steiner-Oliveira C, Nobre-Dos-Santos M, Parisotto TM. Plaque Fluoride Levels as a Predictor of Caries Development in Early Childhood with High Sugar Exposure - A Preliminary Study. Clin Cosmet Investig Dent 2020; 12:71-78. [PMID: 32210634 PMCID: PMC7069582 DOI: 10.2147/ccide.s230809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/28/2019] [Indexed: 12/03/2022] Open
Abstract
Objective This longitudinal study aimed to investigate if the plaque fluoride (PF) concentration can predict the early childhood caries onset. Design: As part of a larger study, 188 preschoolers were clinically evaluated for early childhood caries diagnosis, at baseline and after 1-year follow-up. After that, the final sample comprised: 1. children who had already caries at baseline (decayed, missing or filled surfaces, as well as white chalky white spot lesions adjacent to gingival margins) and developed at least one more cavitation after one year (n=16), and 2. children who never had or developed any caries lesions, including active white spots lesions (n=15). Before the clinical examinations, dental plaque was collected. PF concentration was determined with an ion-specific electrode. A chart was used to estimate the mean daily sugar exposure. The results were statistically analyzed by Spearman correlation and logistic regression analyses (α=0.05). Results After one year, a positive significant correlation between caries development and liquid sucrose, total sugar and total sucrose consumption increments was found (p<0.05). Moreover, the solid sugar, solid sucrose and total sugar exposure at baseline were positively correlated with the presence of dental plaque at follow-up (p<0.05). To top it all, children with PF concentrations ≤0.1 μg/mg at baseline were 10 times more likely to develop caries. Conclusion In conclusion, this study demonstrated for the first time in vivo that low PF concentration is a predictor of caries development in primary teeth.
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Affiliation(s)
- Karina Ferreira Rizzardi
- Laboratory of Molecular and Clinical Microbiology, University São Francisco, Bragança Paulista, SP, Brazil
| | | | | | | | - Thaís Manzano Parisotto
- Laboratory of Molecular and Clinical Microbiology, University São Francisco, Bragança Paulista, SP, Brazil
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Kalanzi D, Mayanja-Kizza H, Nakanjako D, Mwesigwa CL, Ssenyonga R, Amaechi BT. Prevalence and factors associated with dental caries in patients attending an HIV care clinic in Uganda: a cross sectional study. BMC Oral Health 2019; 19:159. [PMID: 31324242 PMCID: PMC6642521 DOI: 10.1186/s12903-019-0847-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Chronic Human Immunodeficiency Virus (HIV) infection is associated with reduced saliva flow rate due to infiltration of HIV and proliferation of CD8 lymphocytes in salivary glands. It is unclear whether HIV infection and antiretroviral therapy (ART) increase caries risk. This study aimed to determine the prevalence and factors associated with dental caries in HIV infected adults attending the Mulago Immune Suppression Syndrome (ISS) clinic in Uganda. METHODS A cross-sectional study was conducted among HIV infected persons. Dental examinations were performed by two calibrated dentists using the WHO Radke's caries classification criteria and reported using the decayed (D), missing (M), filled (F), teeth (DMFT) index. The prevalence and factors associated with dental caries was examined through linear regression analyses. RESULTS Overall, 748 participants (females = 491, 65.6%) with a mean age of 39 ± 9.4 years were included in the final analysis; of whom 83.7% had caries (DMFT> 0), with a significantly (p < 0.05) higher prevalence among females 86.6% than males 78.2%. The mean DMFT was 5.9 ± 5.5, with statistically significant differences based on gender (males 4.9 ± 4.8 and females 6.3 ± 5.9, p < 0.05) and duration on ART (< 2 years 4.8 ± 4.4, > 2 years but < 5 years 5.7 ± 5.5, > 5 years 6.6 ± 6.0 p < 0.05). The majority (67.2%) of participants reported brushing their teeth twice or more a day, and sugar intake was not associated with dental caries. CONCLUSION Caries prevalence is high among HIV infected adults under care. Duration of ART was associated with increased risk and severity of caries. Therefore, we recommend integration of dental care in HIV treatment programs.
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Affiliation(s)
- Dunstan Kalanzi
- Department of Dentistry School of Health Sciences, Makerere University College of Health Sciences, P.O.Box 7072, Kampala, Uganda.
| | - Harriet Mayanja-Kizza
- Department of Medicine School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Catherine Lutalo Mwesigwa
- Department of Dentistry School of Health Sciences, Makerere University College of Health Sciences, P.O.Box 7072, Kampala, Uganda
| | - Ronald Ssenyonga
- Department of Epidemiology and Biostatistics School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Bennett T Amaechi
- Department of Comprehensive Dentistry, University of Texas Health San Antonio School of Dentistry, San Antonio, TX, USA
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Motedayen M, Dousti M, Sayehmiri F, Pourmahmoudi AA. An Investigation of the Prevalence and Causes of Malnutrition in Iran: a Review Article and Meta-analysis. Clin Nutr Res 2019; 8:101-118. [PMID: 31089464 PMCID: PMC6494749 DOI: 10.7762/cnr.2019.8.2.101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 12/13/2022] Open
Abstract
Malnutrition is one of the most important health issues in developing countries, which might have adverse effects on the physical and intellectual health of children. The search process was started to find Persian and English articles published until September 2017 regarding the prevalence of malnutrition in children under the age of six in Iran using national and international databases including SID, Magiran, Irandoc, IranMedex, PubMed, Medline, Scopus, and ISI Web of Science. The data were analyzed using meta-analysis methods and the random effects model. The heterogeneity of studies was analyzed using the I2 index. The data were analyzed using R and STATA software (ver. 11.2). Twenty seven articles conducted from 2002 to 2016 were collected to be included in the meta-analysis process. The total sample size was 161,941 patients in an age range of 0-6 years. The final estimate of the prevalence of different forms of malnutrition through meta-analysis of data extracted from studies in Iran was as follows: severe underweight (1%; 95% confidence interval [CI], 1–1), moderate underweight (6%; 95% CI, 5–7), mild underweight (25%; 95% CI, 21–28), severe short stature (3%; 95% CI, 2–3), moderate short stature (8%; 95% CI, 6–9), mild short stature (21%; 95% CI, 17–24), severe slimness (1%; 95% CI, 1–1), moderate slimness (5%; 95% CI, 4–5) and mild slimness (20%; 95% CI, 17–24). Considering that the prevalence of malnutrition is relatively high in Iran, health authorities should plan to improve the nutritional status of children.
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Affiliation(s)
- Morteza Motedayen
- Department of Cardiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan 45156-13191, Iran
| | - Majid Dousti
- Department of Parasitology, Faculty of Medicine, Shiraz University of Medical Sciences, Fars 71348-14336, Iran
| | - Fatemeh Sayehmiri
- Student Research Committee, Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran 19839-63113, Iran
| | - Aziz A Pourmahmoudi
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj 75919-51176, Iran.,Department of Nutrition, Yasuj University of Medical Sciences, Yasuj 75918-75114, Iran
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Curtis D, Ortega F, Eckhart S, Monar J, Thompson P. Utilizing the caries risk assessment model (Caries management by risk assessment) in Ecuador. J Int Oral Health 2018. [DOI: 10.4103/jioh.jioh_195_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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