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Wang D, Wang X, Zhao C, Ma S, Zhang Y, Shi H. Study on the association between malnutrition, early childhood caries and caries activity among children aged 3-5 years. BMC Oral Health 2024; 24:1035. [PMID: 39227939 PMCID: PMC11370079 DOI: 10.1186/s12903-024-04802-9] [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: 03/08/2024] [Accepted: 08/23/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND This study aims to investigate the association between malnutrition and early childhood caries (ECC) and caries activity among children aged 3-5 years, in order to provide a theoretical basis for preventing and blocking ECC and improving malnutrition. METHODS Children aged 3-5 years from six kindergartens in Zhao Xian, China were enrolled in this study. The decayed, missing, filled teeth (dmft) of all children were examined and recorded. The Cariostat method was used to detect dental caries activity, collect anthropometric data and measure haemoglobin concentration. Parents were asked to complete a questionnaire on the general characteristics and oral health behaviour of the participants. The "Growth Standards for Chinese Children Under 7 Years Old" was used to assess the nutritional status of all participating children. Wilcoxon rank sum test and multivariate logistic regression analysis were used to analyse and evaluate the relationship between ECC, caries activity and malnutrition. RESULTS A total of 635 children who met the criteria were included in this study. After adjusting for confounding factors, logistic regression showed that the risk of ECC was significantly increased in underweight children compared with normal children (OR = 5.43, P < 0. 05); compared with normal children, the risk of ECC decreased in overweight and obese children (OR = 0.31, P < 0.001); underweight children had higher caries severity than normal weight children, and the difference was statistically significant (OR = 2.69, P < 0. 05); stunted children had higher caries severity than normal weight children and the difference was statistically significant (OR = 2.28, P < 0.05); underweight was positively associated with caries activity and the association was statistically significant (OR = 2.33, P < 0. 05); stunting was positively associated with caries activity and the association was statistically significant (OR = 2.1, P < 0.05); overweight and obesity were negatively associated with caries activity and the association was statistically significant (OR = 0.61, P < 0.05). CONCLUSIONS The risk of ECC among children aged 3-5 years was positively associated with undernutrition and negatively associated with overnutrition. The severity of ECC among children aged 3-5 years was positively associated with undernutrition. The caries activity among children aged 3-5 years was positively associated with undernutrition and negatively associated with overnutrition.
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Affiliation(s)
- Duorui Wang
- Department of Pediatric Dentistry, Hospital of Stomatology and Hebei Provincial Key Laboratory of Stomatology, Hebei Medical University, Shijiazhuang, China
| | - Xinfeng Wang
- Qingdao Stomatological Hospital, Qingdao University, No.17, Daode County Road, Zhongshan Road Street, Shinan District, Qingdao City, China
| | - Caiyun Zhao
- Department of Pediatric Dentistry, Hospital of Stomatology and Hebei Provincial Key Laboratory of Stomatology, Hebei Medical University, Shijiazhuang, China
| | - Siting Ma
- Department of Pediatric Dentistry, Hospital of Stomatology and Hebei Provincial Key Laboratory of Stomatology, Hebei Medical University, Shijiazhuang, China
| | - Yanning Zhang
- Department of oral pathology, Hospital of Stomatology and Hebei Provincial Key Laboratory of Stomatology, Hebei Medical University, Shijiazhuang, China
| | - Hong Shi
- Department of Pediatric Dentistry, Hospital of Stomatology and Hebei Provincial Key Laboratory of Stomatology, Hebei Medical University, Shijiazhuang, China.
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Crystal YO, Luo YL, Duangthip D, Tantawi ME, Benzian H, Schroth RJ, Feldens CA, Virtanen JI, Al-Batayneh OB, Diaz ACM, Vukovic A, Pavlic V, Mfolo T, Daryanavard HA, Gaffar BO, Shamala A, Foláyan MO. A scoping review of the links between early childhood caries and clean water and sanitation: the Sustainable Development Goal 6. BMC Oral Health 2024; 24:769. [PMID: 38982426 PMCID: PMC11234638 DOI: 10.1186/s12903-024-04535-9] [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] [Received: 12/26/2023] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION The United Nation's Sustainable Development Goal (SDG) 6 calls for universal access to clean water, sanitation and hygiene (WASH), which are crucial elements of health and well-being and fundamental for a life in dignity. Early childhood caries (ECC) is a preventable disease affecting health and quality of life of millions of young children worldwide. This scoping review aims to explore the connection between ECC and access to clean water and sanitation. METHODS This scoping review, registered on the Open Science Framework and following PRISMA-ScR guidelines, conducted a thorough search in databases (PubMed, Web of Science, Embase, Google Scholar, SciELO) and websites (via Google) in November 2023. The search, without date limitations, targeted studies in English and Spanish linking ECC to SDG6. Exclusions were made for studies solely focusing on ECC without a direct connection to clean water and sanitation. Descriptive statistics summarized the retrieved papers. RESULTS The initial search yielded 303 articles. After removing duplicates, 264 articles remained for title and abstract screening after which 244 were excluded and one report was added through citation searching. The 21 remaining articles underwent full text review. There were no studies on a direct association between access to clean water and sanitation and the prevalence of ECC. There were nine studies that showed indirect associations between ECC and access to clean water and sanitation through the links of: water and sanitation access as a marker for poverty (n = 1), water consumption as a feeding practice (n = 4), and the effectiveness of water fluoridation (n = 4). These were used to develop a conceptual model. CONCLUSIONS While it is conceivable that a direct link exists between ECC and access to clean water and sanitation, the available body of research only offers evidence of indirect associations. The exploration of potential pathways connecting water access to ECC warrants further investigation in future research.
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Affiliation(s)
- Yasmi O Crystal
- Early Childhood Caries Advocacy Group, Winnipeg, Canada.
- Department of Pediatric Dentistry, College of Dentistry, New York University, 234 24th Street, New York, NY, 10010, USA.
| | - Yuanyuan Laura Luo
- Department of Pediatric Dentistry, College of Dentistry, New York University, 234 24th Street, New York, NY, 10010, USA
| | - Duangporn Duangthip
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Maha El Tantawi
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Habib Benzian
- Department of Epidemiology & Health Promotion and WHO Collaborating Center Quality Improvement & Evidence-Based Dentistry, College of Dentistry, New York University, New York, NY, USA
- Stellenbosch Institute of Advanced Study, Stellenbosch, South Africa
| | - Robert J Schroth
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carlos Alberto Feldens
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Pediatric Dentistry, Universidade Luterana Do Brasil, Canoas, Brazil
| | - Jorma I Virtanen
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ola B Al-Batayneh
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Orthodontics, Pediatric and Community Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Aida Carolina Medina Diaz
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Pediatric Dentistry and Orthodontics Department, Pediatric Dentistry and Orthodontics Department, Universidad Central de Venezuela, Centro Medico Docente, Caracas, Venezuela
| | - Ana Vukovic
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Clinic for Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Verica Pavlic
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Periodontology and Oral Medicine, Medical Faculty University of Banja Luka, 78000, Banja Luka, Bosnia and Herzegovina
| | - Tshepiso Mfolo
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Community Dentistry, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Hamideh A Daryanavard
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Dental Department, Dubai Health, Dubai, United Arab Emirates
| | - Balgis O Gaffar
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Preventive Dental Sciences, College of Dentistry - Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Anas Shamala
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Preventive and Biomedical Sciences, Faculty of Dentistry, University of Science & Technology, Aden, Yemen
| | - Morẹ́nikẹ́ Oluwátóyìn Foláyan
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Sandy L, Helmyati S, Amalia R. Nutritional factors associated with early childhood caries: A systematic review and meta-analysis. Saudi Dent J 2024; 36:413-419. [PMID: 38525179 PMCID: PMC10960096 DOI: 10.1016/j.sdentj.2023.12.001] [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: 08/02/2023] [Revised: 11/26/2023] [Accepted: 12/06/2023] [Indexed: 03/26/2024] Open
Abstract
Background Many studies have examined the relationship between nutrition and dental caries. However further studies are needed regarding nutritional factors that can have a strong impact on the incidence of early childhood caries (ECC). Nutrition is one factor that determines caries occurrence. Exposure to carbohydrates in the oral cavity causes carbohydrate fermentation, which produces acids. This acidic substance erodes the enamel surface of teeth, leading to ECC. This systematic review and meta-analysis of cohort studies assessed the aspects of nutrition and diet that contribute to the incidence of ECC in children. Materials and methods We conducted a systematic review by extracting data according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. A search was conducted of published articles in Scopus, MEDLINE via PubMed, and Science Direct using the keywords "nutrition," "sugar," "carbohydrate," "dietary habit," "dental caries," and "oral health." The protocol was registered at PROSPERO 2023 (Registration ID: CRD42023394583). Results The article screening yielded 6 articles that met the inclusion criteria. From the total of 443 studies found. Those that could not determine a correlation between the ECC variables and nutrition and with data analyses that only used a bivariate analysis were excluded. The results of the meta-analysis showed that nutritional factors had the strongest impact on caries including feeding practice (OR 3.64; 95% CI 2.03, 6.55), sugar intake (OR 3.24; 95% CI 2.59, 4.03), and low fruit and vegetable intake (OR 2.71; 95% CI 1.47, 5.01). Conclusion Two nutritional factors had the strongest relationship with the risk of ECC: feeding practice and sugar intake. The lowest risk factor for causing ECC was low fruit and vegetable intake.
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Affiliation(s)
- L.P.A. Sandy
- Doctorate Program of Medical and Health Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada Yogyakarta Indonesia, 55281, Indonesia
| | - S. Helmyati
- Department of Nutrition and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada Yogyakarta Indonesia, 55281, Indonesia
- Center for Health and Human Nutrition, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada Yogyakarta Indonesia, 55281 Indonesia, Indonesia
| | - R. Amalia
- Department Dental Public Health, Faculty of Dentistry, Universitas Gadjah Mada Yogyakarta Indonesia, 55281, Indonesia
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Brown A, Trimble M, Sokal-Gutierrez K, Fernald L, Madsen K, Turton B. Sugar-Sweetened Beverages, Foods of Low Nutritional Value, and Child Undernutrition in Cambodia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:169. [PMID: 38397660 PMCID: PMC10887798 DOI: 10.3390/ijerph21020169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
Child undernutrition persists in Cambodia despite recent progress. As Cambodia undergoes a shift in dietary consumption that coincides with economic, demographic, and epidemiologic changes, there is risk of ultra-processed foods and sugar-sweetened beverages displacing nutrient-dense foods during the critical period of infant growth in the first 24 months. The aim of this study was to assess the introduction and intake of foods of low nutritional value and sugar-sweetened beverages and their association with undernutrition among children 24 months of age in rural and semi-urban Cambodia. Cross-sectional analyses of a 24-h dietary recall from a sample (n = 377) of 24-month-olds found that the majority of infants had been introduced to packaged salty snacks and sweets by 12 months of age and to sugar-sweetened beverages by 15 months. By 24 months of age, 78% of children had consumed foods of low nutritional value and 57% consumed a sugar-sweetened beverage on the previous day. Multivariate logistic regression analyses demonstrated that infant intake of a flavored sugary drink on the previous day was associated with over two times the odds of both stunting and wasting, and consumption of packaged sweets on the previous day was associated with over two times the odds of wasting, but no association was found with stunting. These findings underscore the need to improve educational and policy interventions to support healthy feeding practices for infants and young children.
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Affiliation(s)
- Akemi Brown
- University of California San Francisco Joint Medical Program, University of California, Berkeley, CA 94720, USA;
| | - Margaret Trimble
- School of Public Health, University of California, Berkeley, CA 94720, USA; (M.T.); (L.F.); (K.M.)
| | - Karen Sokal-Gutierrez
- University of California San Francisco Joint Medical Program, University of California, Berkeley, CA 94720, USA;
| | - Lia Fernald
- School of Public Health, University of California, Berkeley, CA 94720, USA; (M.T.); (L.F.); (K.M.)
| | - Kristine Madsen
- School of Public Health, University of California, Berkeley, CA 94720, USA; (M.T.); (L.F.); (K.M.)
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Abdulaziz R, Suryanti N, Setiawan AS. A Review on Maternal Parenting, Child's Growth Stunting, and Oral Health. Eur J Dent 2024; 18:26-40. [PMID: 37105223 PMCID: PMC10959610 DOI: 10.1055/s-0043-1764428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Stunting has gained global attention as one of the most critical problems in public health. As the first and dominant figure in a child's life, the mother is responsible for determining the proper parenting behaviors to apply to maintain the child's physical health. Stunting is often associated with early childhood caries (ECC) and molar incisor hypomineralization, which can be manifested into each other through various mechanisms. Therefore, it is crucial to explore how far maternal parenting behaviors affect stunting and oral health. This study aims to determine which maternal parenting behaviors can affect stunting and oral health. A systematic search was used through PubMed and Google Scholar to search for published articles between 2011 and 2021. The articles analyze maternal parenting behaviors with stunting and poor oral health. Final analysis was used on 21 articles containing 18 cross-sectional studies, 2 cohort studies, and 1 randomized controlled trial. The result implied that the high prevalence of stunting and ECC is the combined result of prolonged breastfeeding practices (7 articles), poor complementary feeding practice (6 articles), high consumption of sugar (5 articles), and poor oral hygiene practices (5 articles). Maternal parenting styles in the aspect of fulfilling nutrition and maintaining oral health affect the occurrence of stunting and ECC in children.
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Affiliation(s)
- Rasyid Abdulaziz
- Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Netty Suryanti
- Department of Community Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Arlette Suzy Setiawan
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
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6
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Aulia RN, Indriyanti R, Setiawan AS. The bi-directional relationship between growth stunting and early childhood caries: a rapid review. Front Public Health 2023; 11:1234893. [PMID: 38146474 PMCID: PMC10749356 DOI: 10.3389/fpubh.2023.1234893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023] Open
Abstract
Objective This review aims to determine the two-way relationship between stunting and ECC in developing countries worldwide. Methods The procedure in this study was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Rapid Review protocol. Article searches were carried out using databases Cochrane and PubMed. In addition, searches were also carried out using backward and forward snowballing techniques to identify articles that were not detected through database searches. Results Nine observational epidemiological articles were found in children aged six months to six years, published in 2015-2020. Five articles discussed the features of ECC in stunted children, and the other five discussed stunting in children with caries in their primary teeth. Conclusion Several studies found associations between severe ECC and stunting, with ECC and stunting as both independent and dependent variables, suggesting a bi-directional relationship, also supported by literature on the physiological relationship between oral health and nutrition.
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Affiliation(s)
- Refine Nissa Aulia
- Dental Education Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Ratna Indriyanti
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Arlette Suzy Setiawan
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
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Turton B, Sullivan S, Chher T, Hak S, Sokal-Gutierrez K, Wieringa F, Singh A. Caries Incidence Is Associated with Wasting among Cambodian Children. J Dent Res 2023; 102:157-163. [PMID: 36217721 DOI: 10.1177/00220345221126713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Evidence suggests that dental caries is associated with chronic and acute malnutrition, manifested as stunting and wasting in children. However, studies have not always appropriately accounted for confounding factors or for the temporal ordering between exposure and outcome. This study examined relationships between the development of caries lesions with subsequent stunting and wasting outcomes using data from a population-based cohort in Cambodia. Caries incidence was assessed based on the presence of a new cavitated carious lesion or a new pulpally involved lesion across a 6-mo observation period. Anthropometric measurements were taken at regular intervals. Effects of carious lesions on stunting and wasting were assessed using inverse probability treatment weighting, adjusting for potential confounders, using z scores for height-for-age (HAZ) and weight-for-height (WHZ) as outcomes. In total, 894 children (mean age 20 mo at baseline) were followed over 2 y. At baseline, 350 (39.1%) were identified as having stunting malnutrition. At follow-up, 58 (6.5%) had a new pulpally involved lesion. There was no association between incidence of cavitated or pulpally involved carious lesions at follow-up and stunting (relative risk [RR] = 1.06; 95% confidence interval [CI]: 0.75, 1.50). The incidence of pulpally involved carious lesions had an effect on wasting prevalence (WHZ <-2; RR = 1.35; 95% CI: 0.70, 2.62) and WHZ scores (average treatment effect = -0.294; 95% CI: -0.538, -0.050). This study offers evidence that the development of pulpally involved carious lesions has an effect on WHZ scores. Oral health promotion and clinical prevention and management of dental caries should be explored as interventions to promote normal growth and development among preschool children, particularly in low-income settings.
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Affiliation(s)
- B Turton
- University of Puthisastra and Boston University, Boston, MA, USA
| | - S Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - T Chher
- Oral Health Bureau, Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia
| | - S Hak
- Oral Health Bureau, Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia
| | | | - F Wieringa
- UMR QualiSud (Université Montpellier, Université Avignon, CIRAD, Institut Agro, IRD, Université de la Réunion), French National Research Institute for Sustainable Development (IRD), Montpellier, France
| | - A Singh
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
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Chinnakotla B, Susarla SM, Mohan DC, Turton B, Husby HM, Morales CP, Sokal-Gutierrez K. Associations between Maternal Education and Child Nutrition and Oral Health in an Indigenous Population in Ecuador. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:473. [PMID: 36612796 PMCID: PMC9819843 DOI: 10.3390/ijerph20010473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
The global nutrition transition has increased the prevalence of childhood dental caries. Greater understanding is needed of the impact of social determinants—including maternal education—on child oral health. This is a cross-sectional analysis of a convenience sample of families of 458 indigenous Ecuadorian children aged 6 months through 6 years from 2011−2013. Data was collected by mother interviews and child dental and anthropometric examinations. Multivariate logistic and Zero-Inflated-Poisson regression analyses assessed associations between years of maternal education and maternal-child oral health practices and child oral health outcomes. Each additional year of maternal education was significantly (p < 0.05) associated with some healthier practices including greater likelihood of mothers and children drinking milk daily (OR 1.20; 95% CI 1.08, 1.34); and less healthy practices including greater likelihood of bottle-feeding children with sugary liquids (OR 1.14; 95% CI 1.06, 1.22) and to older age, giving children sweets daily, calming children with a bottle or sweets, and less likelihood of helping brush their children’s teeth (OR 0.93; 95% CI 0.88, 0.98). Each year of maternal education had a small but statistically non-significant influence on increasing the odds of children being among those who are cavity-free (OR 1.03; 95% CI 0.92, 1.16). Interventions to improve health outcomes should focus not just on maternal education but also address social and commercial determinants of health through nutrition and oral health education, as well as policies to reduce sugar and ensure universal access to oral health care.
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Affiliation(s)
| | | | | | - Bathsheba Turton
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA
| | - Hannah M. Husby
- School of Public Health, University of California, Berkeley, CA 94704, USA
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Stunted children display ectopic small intestinal colonization by oral bacteria, which cause lipid malabsorption in experimental models. Proc Natl Acad Sci U S A 2022; 119:e2209589119. [PMID: 36197997 PMCID: PMC9573096 DOI: 10.1073/pnas.2209589119] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Environmental enteric dysfunction (EED) is an inflammatory syndrome postulated to contribute to stunted child growth and to be associated with intestinal dysbiosis and nutrient malabsorption. However, the small intestinal contributions to EED remain poorly understood. This study aimed to assess changes in the proximal and distal intestinal microbiota in the context of stunting and EED and to test for a causal role of these bacterial isolates in the underlying pathophysiology. We performed a cross-sectional study in two African countries recruiting roughly 1,000 children aged 2 to 5 years and assessed the microbiota in the stomach, duodenum, and feces. Upper gastrointestinal samples were obtained from stunted children and stratified according to stunting severity. Fecal samples were collected. We then investigated the role of clinical isolates in EED pathophysiology using tissue culture and animal models. We find that small intestinal bacterial overgrowth (SIBO) is extremely common (>80%) in stunted children. SIBO is frequently characterized by an overgrowth of oral bacteria, leading to increased permeability and inflammation and to replacement of classical small intestinal strains. These duodenal bacterial isolates decrease lipid absorption in both cultured enterocytes and mice, providing a mechanism by which they may exacerbate EED and stunting. Further, we find a specific fecal signature associated with the EED markers fecal calprotectin and alpha-antitrypsin. Our study shows a causal implication of ectopic colonization of oral bacterial isolated from the small intestine in nutrient malabsorption and gut leakiness in vitro. These findings have important therapeutic implications for modulating the microbiota through microbiota-targeted interventions.
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Turton B, Chher T, Hak S, Sokal-Gutierrez K, Lopez Peralta D, Laillou A, Singh A. Associations between dental caries and ponderal growth in children: A Cambodian study. J Glob Health 2022; 12:04046. [PMID: 35713031 PMCID: PMC9204672 DOI: 10.7189/jogh.12.04046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background The evidence around the relationship between Early Childhood Caries (ECC) and undernutrition is sparse and mostly reported from cross-sectional data sets. This paper aimed to test the relationship between ECC and linear and ponderal growth trajectories. Methods This project involves secondary data analysis from the Cambodia Longitudinal Health and Nutrition Study. The analytical sample included a 2y-cohort of 894 children who were younger than 2 years of age at the time of first height and weight measurement. Statistical analysis used both logistic regression modelling and Latent Class Analysis to examine the effect of exposure to dental caries in the first 1000 days on weight for height Z-score (WHZ) and height for age Z-score (HAZ) trajectory class groups. The presence of any cavity and pulp involvement were examined using multinomial regression adjusting for gender, socioeconomic status, maternal age and education. Findings Within each class groupings (HAZ and WHZ groupings), there was a trend whereby those with one or more cavities had lower Z-scores across the three follow-up time points of observation. There was an association between exposure to caries and WHZ class membership whereby children with caries exposure were more likely belong to WHZ class groups with lower Z-scores over time. Conclusions The study offers evidence that ECC is correlated with less favourable ponderal growth categorized by WHZ trajectory class groups.
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Affiliation(s)
- Bathsheba Turton
- University of Puthisastra, Phnom Penh, Cambodia.,Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
| | - Tepirou Chher
- Oral Health Bureau, Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia
| | - Sithan Hak
- Oral Health Bureau, Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia
| | | | - Diego Lopez Peralta
- Centre for Epidemiology and Biostatistics and Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | | | - Ankur Singh
- Centre for Epidemiology and Biostatistics and Melbourne Dental School, University of Melbourne, Melbourne, Australia
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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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Woelber JP, Vach K. The Emerging Field of Nutritional Dentistry. Nutrients 2022; 14:2076. [PMID: 35631217 PMCID: PMC9146355 DOI: 10.3390/nu14102076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 01/02/2023] Open
Abstract
Nutrition is, like oxygen, one of the basic requirements for animals and, accordingly, Homo sapiens to live [...].
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Affiliation(s)
- Johan Peter Woelber
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Kirstin Vach
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Faculty of Medicine, Institute of Medical Biometry and Statistics, University of Freiburg, Zinkmattenstr. 6A, 79108 Freiburg, Germany
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