Nutritional factors associated with early childhood caries: A systematic review and meta-analysis

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.

The Response of the Indonesian Dental Community to the COVID-19 Pandemic

OBJECTIVE

The aim of this study was to assess the response of dental health care workers in Indonesia to the COVID-19 pandemic through (1) a countrywide web-based, questionnaire survey of their knowledge, attitude, and infection control (IC) practices during the pandemic and (2) a focus group discussion (FGD) on the latter aspects with infected personnel, as well as (3) archival data collection on the epidemiology of COVID-19 amongst dentists in Indonesia.

METHODS

A questionnaire survey using a web platform was conducted in May 2020 using a simple random sample of 3586 dentists working in different regions of Indonesia. The questionnaire attempted to elicit their knowledge and attitudes towards COVID-19, implementing IC measures, and providing dental care during the outbreak. The questionnaire comprised sections assessing participants' knowledge, awareness, and IC practice. In this study, the data were subjected to analysis through descriptive statistics and one-way analysis of variance (ANOVA) with a predetermined significance level of <.05. The study's second phase involved an FGD with dentists who had contracted the disease to discuss the impediments they faced during dental practice. We collected data on the number of dentists with COVID-19 from May 2020 to March 2022.

RESULTS

The questionnaire survey revealed that the dentists had a satisfactory understanding of COVID-19 spread and the IC measures required to curb disease spread in the dental clinic. Of note, some dentists lacked knowledge of the incubation period of 5 days (21.19%). The vast majority of the respondents (>80%) were aware of the nature of the SARS-CoV-2 virus. Community health centres and the personnel who served there were the most exposed health care providers.

CONCLUSIONS

Results suggest that the vast majority of the dental care professionals in Indonesia had adequate knowledge and awareness of COVID-19. However, some aspects of practice need to be improved in IC and related aspects.

Scoping review on the link between economic growth, decent work, and early childhood caries

BACKGROUND

Early Childhood Caries (ECC) is a prevalent chronic non-communicable disease that affects millions of young children globally, with profound implications for their well-being and oral health. This paper explores the associations between ECC and the targets of the Sustainable Development Goal 8 (SDG 8).

METHODS

The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In July 2023, a search was conducted in PubMed, Web of Science, and Scopus using tailored search terms related to economic growth, decent work sustained economic growth, higher levels of productivity and technological innovation, entrepreneurship, job creation, and efforts to eradicate forced labor, slavery, and human trafficking and ECC all of which are the targets of the SDG8. Only English language publications, and publications that were analytical in design were included. Studies that solely examined ECC prevalence without reference to SDG8 goals were excluded.

RESULTS

The initial search yielded 761 articles. After removing duplicates and ineligible manuscripts, 84 were screened. However, none of the identified studies provided data on the association between decent work, economic growth-related factors, and ECC.

CONCLUSIONS

This scoping review found no English publication on the associations between SDG8 and ECC despite the plausibility for this link. This data gap can hinder policymaking and resource allocation for oral health programs. Further research should explore the complex relationship between economic growth, decent work and ECC to provide additional evidence for better policy formulation and ECC control globally.

Child dental neglect and legal protections: a compendium of briefs from policy reviews in 26 countries and a special administrative region of China

Background

Child neglect is a public health, human rights, and social problem, with potentially devastating and costly consequences. The aim of this study was to: (1) summarize the oral health profile of children across the globe; (2) provide a brief overview of legal instruments that can offer children protection from dental neglect; and (3) discuss the effectiveness of these legal instruments.

Methods

We summarized and highlighted the caries profile and status of implementation of legislation on child dental neglect for 26 countries representing the World Health Organization regions: five countries in Africa (Nigeria, South Africa, Sudan, Tanzania, Zimbabwe), eight in the Americas (Argentina, Brazil, Canada, Chile, Mexico, Peru, Unites States of America, Uruguay), six in the Eastern Mediterranean (Egypt, Iran, Libya, Jordan, Qatar, Saudi Arabia), four in Europe (Italy, Latvia, Serbia, United Kingdom), two in South-East Asia (India and Indonesia) and one country (China) with its special administrative region (Hong Kong) in the Western Pacific.

Results

Twenty-five of the 26 countries have legal instruments to address child neglect. Only two (8.0%) of these 25 countries had specific legal instruments on child dental neglect. Although child neglect laws can be interpreted to establish a case of child dental neglect, the latter may be difficult to establish in countries where governments have not addressed barriers that limit children's access to oral healthcare. Where there are specific legal instruments to address child dental neglect, a supportive social ecosystem has also been built to facilitate children's access to oral healthcare. A supportive legal environment, however, does not seem to confer extra protection against risks for untreated dental caries.

Conclusions

The institution of specific country-level legislation on child dental neglect may not significantly reduce the national prevalence of untreated caries in children. It, however, increases the prospect for building a social ecosystem that may reduce the risk of untreated caries at the individual level. Social ecosystems to mitigate child dental neglect can be built when there is specific legislation against child dental neglect. It may be more effective to combine public health and human rights-based approaches, inclusive of an efficient criminal justice system to deal with child dental neglect.

Patient Safety Culture Analysis in Dental Hospital Using Dental Office Survey on Patient Safety Culture Questionnaire: A Cross-cultural Adaptation and Validation Study

BACKGROUND

The culture of safety and patient safety management in dental practice lags compared with medical practice. Hospitals strive to pursue quality and safety of healthcare services, with evidence of patient safety incidents in medical practice demonstrating the importance of promoting a safety culture. Measuring patient safety culture is a necessary first step to improving safety culture in clinical settings. As a hospital, dental hospital should improve the quality and culture of patient safety. Thus, our objective was to conduct a cross-cultural adaptation of a US measure of dental office patient safety culture for use in Indonesian dental hospitals.

METHOD

A cross-sectional study was conducted on 200 respondents at a dental hospital in Java, Indonesia. The first stage includes cultural adaptation and translation, followed by developing a questionnaire that was tested through expert agreement and analysis of validity and reliability using Spearman, Cronbach correlation coefficients, and correlation coefficients between classes. The Dental Office Survey on Patient Safety Culture consists of 58 items and 10 dimensions (overall perceptions of patient safety and quality, organizational learning, teamwork, staff training, work pressure and pace, management support for patient safety, office processes and standardization, communication about errors, communication openness, and patient care tracking/follow-up).

RESULTS

A total of 200 respondents with a response rate of 61.5% and 77 invalid responses due to incomplete filling, so 123 respondents were analyzed. The validity test results on 38 question items from 10 dimensions, with a sign of 0.05%, 35 items are declared valid.

CONCLUSIONS

The Indonesian version of the Dental Office Survey on Patient Safety Culture shows good validity and good reliability and has the potential to be used to evaluate patient safety culture in dental hospitals in Indonesia.

Regulations on nutrition in Indonesia and its relation to early childhood caries

There is a close relationship between food and nutrition policies and oral health. The relationship between nutrition and dental problems has been widely discussed, including the major dental problem in children: early childhood caries (ECC). Health-oriented national policies are the main principles of public health welfare. This article is a policy brief that provide a review of the food and nutrition policies in Indonesia that may have a relationship with ECC. It is concluded that some policies support the efforts to prevent ECC however, other technical explanations are still needed for health workers and especially parents regarding its simple implementation in everyday life. Multisectoral approaches that includes health, nutrition and education are needed to address ECC.

Factors of Dental Caries, Tooth Mobility, and Periodontal Pockets on the Occupation of Tooth Loss in the Elderly. (A Study in Karikil Village, Mangkubumi District, Tasikmalaya City)

BACKGROUND: Loss of teeth can disrupt daily activities such as chewing disorders, causing emotional problems, and loss of self-confidence. Tooth loss in the elderly is usually caused by dental caries and periodontal disease which are influenced by several other factors. AIM: This study aims to obtain a mathematical equation for predicting tooth loss in the elderly based on dental caries, tooth mobility, and periodontal pockets which have been shown to have an effect. MATERIALS AND METHODS: This research is a survey research with a cross-sectional design. The research subjects were 210 elderly people from Karikil Village, Mangkubumi District, Tasikmalaya City, sampling using the purposive sampling technique affected tooth loss, while the effects were dental caries, tooth mobility, and periodontal pockets. Tooth loss, dental caries, mobility of teeth, and periodontal pockets were measured using the fill-in format from the World Health Organization. Data analysis used the Chi-square correlation test and multiple logistic regression. RESULTS: The results of the Chi-square test analysis showed that the variables of dental caries and tooth mobility had a very significant effect on tooth mobility (p = 0.000 and 0.007). The pocket periodontal variable did not show a significant relationship to tooth mobility (p = 0.947). The results of the multiple logistic regression analysis of dental caries and tooth mobility together contributed 12.2% (R2 = 0.122) to tooth mobility in the elderly. Dental caries gave the greatest contribution to tooth loss, namely, 87.6%. CONCLUSION: Dental caries gives the greatest contribution compared to tooth mobility and periodontal pockets to the occurrence of tooth loss in the elderly. In the elderly, the higher the level of dental caries and tooth mobility, the higher the risk of tooth loss.

Correction to: An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries

An amendment to this paper has been published and can be accessed via the original article.

An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries

Background

Universal health care (UHC) may assist families whose children are most prone to early childhood caries (ECC) in accessing dental treatment and prevention. The purpose of this study was to determine the association between UHC, health expenditure and the global prevalence of ECC.

Methods

Health expenditure as percentage of gross domestic product, UHC service coverage index, and the percentage of 3–5-year-old children with ECC were compared among countries with various income levels using one-way analysis of variance (ANOVA). Three linear regression models were developed, and each was adjusted for the country income level with the prevalence of ECC in 3–5-year-old children being the dependent variable. In model 1, UHC service coverage index was the independent variable whereas in model 2, the independent variable was the health expenditure as percentage of GDP. Model 3 included both independent variables together. Regression coefficients (B), 95% confidence intervals (CIs), P values, and partial eta squared (ƞ²) as measure of effect size were calculated.

Results

Linear regression including both independent factors revealed that health expenditure as percentage of GDP (P < 0.0001) was significantly associated with the percentage of ECC in 3–5-year-old children while UHC service coverage index was not significantly associated with the prevalence of ECC (P = 0.05). Every 1% increase in GDP allocated to health expenditure was associated with a 3.7% lower percentage of children with ECC (B = − 3.71, 95% CI: − 5.51, − 1.91). UHC service coverage index was not associated with the percentage of children with ECC (B = 0.61, 95% CI: − 0.01, 1.23). The impact of health expenditure on the prevalence of ECC was stronger than that of UHC coverage on the prevalence of ECC (ƞ² = 0.18 vs. 0.05).

Conclusions

Higher expenditure on health care may be associated with lower prevalence of ECC and may be a more viable approach to reducing early childhood oral health disparities than UHC alone. The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01500-8.

Governance, maternal well-being and early childhood caries in 3-5-year-old children

Background

This study assessed the direct, indirect and total effect of distal – political - risk indicators (affecting populations), and proximal risk indicators (affecting women) on the global prevalence of early childhood caries (ECC) in 3–5 year old children.

Methods

Data on global ECC prevalence were obtained from a prior study. Data for distal risk indicators (voice and accountability; political stability/absence of terrorism; control of corruption) were obtained from the World Bank Governance indicators, 2016. Data for proximal risk indicators (women’s opportunity for leadership; percentage of female legislators, top officials and managers; basic employability status of women; ability of women to afford time off work to care for newborns; gross national income (GNI) per capita for females) were derived from the Human Development Index, 2016. Associations between variables were assessed with path analysis.

Results

Voice and accountability (β = − 0.60) and GNI per capita for females (β = − 0.33) were directly associated with a lower ECC prevalence. Political stability/absence of terrorism (β =0.40) and higher percentage of female legislators, senior officials and managers (β = 0.18) were directly associated with a higher ECC prevalence. Control of corruption (β = − 0.23) was indirectly associated with a lower ECC prevalence. Voice and accountability (β = 0.12) was indirectly associated with a higher ECC prevalence. Overall, voice and accountability (β = − 0.49), political stability/absence of terrorism (β = 0.34) and higher female GNI (β = − 0.33) had the greatest effects on ECC prevalence.

Conclusion

Distal risk indicators may have a stronger impact on ECC prevalence than do proximal risk indicators.. Approaches to control ECC may need to include political reforms.

Women's economic empowerment, participation in decision-making and exposure to violence as risk indicators for early childhood caries

Objectives

In view of the association between early childhood caries (ECC])and maternal social risk factors, this study tried to determine if there were associations between indicators of processes, outputs and outcomes of women’s empowerment, and the prevalence of ECC.

Methods

In this ecological study, indicators measuring the explanatory variables - economic empowerment, decision-making and violence against women - were selected from the Integrated Results and Resources Framework of the UN-Women Strategic Plan 2018–2021 and WHO database. Indicators measuring the outcome variables - the prevalence of ECC for children aged 0 to 2 years, and 3 to 5 years - were extracted from a published literature. The general linear models used to determine the association between the outcome and explanatory variables were adjusted for economic level of countries. Regression estimates (B), 95% confidence intervals and partial eta squared (η²) were calculated.

Results

Countries with more females living under 50% of median income had higher prevalence of ECC for 3 to 5-year olds (B = 1.82, 95% CI = 0.12, 3.52). Countries with higher percentage of women participating in their own health care decisions had higher prevalence of ECC for 0 to 2-year-olds (B = 0.85, 95% CI = 0.03, 1.67). Countries with higher percentage of women participating in decisions related to visiting family, relatives and friends had higher prevalence of ECC for 3 to 5-year-olds (B = 0.67, 95% CI = 0.03, 1.32). None of the indicators for violence against women was significantly associated with the prevalence of ECC.

Conclusion

Empowerment of women is a welcome social development that may have some negative impact on children’s oral health. Changes in policies and norms are needed to protect children’s oral health while empowering women.

Association between early childhood caries and poverty in low and middle income countries

Background

The aim of this study was to assess the relationship between early childhood caries (ECC) in 3–5-year-old children, seven indicators of poverty and the indicator of monetary poverty in low- and middle-income countries (LICs, MICs).

Methods

This ecologic study utilized 2007 to 2017 country-level data for LICs and MICs. Explanatory variables were seven indicators of poverty namely food, water, sanitation, health, shelter, access to information, education; and monetary poverty. The outcome variable was the percentage of 3–5-year-old children with ECC. A series of univariate general linear regression models were used to assess the relationship between the percentage of 3–5 year-old children with ECC and each of the seven indicators of poverty, and monetary poverty. This was followed by multivariable regression models to determined the combined effect of the seven indicators of poverty, as well as the combined effect of the seven indicators of poverty and monetary poverty. Adjusted R² measured models’ ability to explain the variation among LICs and MICs in the percentage of 3–5-year-old children with ECC.

Results

Significantly more people had food, sanitation, shelter, access to information, education and monetary poverty in LICs than in MICs. There was no difference in the prevalence of ECC in 3–5-year-old children between LICs and MICs. The combination of the seven indicators of poverty explained 15% of the variation in the percentage of 3–5-year-old children with ECC compared to 1% explained by monetary poverty. When the seven indicators of poverty and the indicator for monetary poverty were combined, the amount of variation explained by them was 10%. Only two of the poverty indicators had a direct relationship with the percentage of children with ECC; there was a higher percentage of ECC in countries with higher percentage of population living in slums (B = 0.35) and in those countries with higher percentage of the population living below poverty lines (B = 0.19). The other indicators had an inverse relationship.

Conclusion

The use of multiple indicators to measures of poverty explained greater amount of variation in the percentage of 3–5-year-olds with ECC in LICs and MICs than using only the indicator for monetary poverty.

Association Between Environmental Health, Ecosystem Vitality, and Early Childhood Caries

Background: Environmental issues lead to serious health problems in young growing children. This study aims to determine the association between a country's level of environmental health, ecosystem vitality, and prevalence of early childhood caries (ECC). Methods: This was an ecological study. The data for the explanatory variables-country-level environmental performance index (EPI), environmental health, and ecosystem vitality-were obtained from the Yale Center for Environmental Law and Policy. The outcome variables were country-level prevalence of ECC in 0- to 2-year-old and 3- to 5-year-old children. The country EPI, environmental health, and ecosystem vitality were matched with country ECC prevalence for 0- to 2-year-olds and 3- to 5-year-olds for the period of 2007 to 2017. Differences in the variables by country income level were determined using ANOVA. Multivariate ANOVA was used to determine the association between ECC prevalence in 0- to 2-year-olds and 3- to 5-year-olds, and EPI, environmental health, and ecosystem vitality, adjusting for each country's per-capita gross national income. Results: Thirty-seven countries had complete data on ECC in 0- to 2-year-old and 3- to 5-year-old children, EPI, environmental health, and ecosystem vitality scores. There were significant differences in ECC prevalence of 0- to 2-year-olds and 3- to 5-year-olds between countries with different income levels. Also, there were significant differences in EPI (P < 0.0001), environmental health score (P < 0.0001), and ecosystem vitality (P = 0.01) score by country income levels. High-income countries had significantly higher EPI scores than did low-income countries (P = 0.001), lower-middle-income countries (P < 0.0001), and upper-middle-income countries (P < 0.0001). There was an inverse non-significant relationship between ECC prevalence and EPI in 0- to 2-year-olds (B = -0.06; P = 0.84) and 3- to 5-year-olds (B = -0.30; P = 0.50), and ecosystem vitality in 0- to 2-year-olds (B = -0.55, P = 0.08) and 3- to 5-year-olds (B = -0.96; P = 0.02). Environmental health was directly and non-significantly associated with ECC in 0- to 2-year-olds (B = 0.20; P = 0.23) and 3- to 5-year-olds (B = 0.22; P = 0.32). Conclusions: There was a complex relationship between various indicators of environmental performance and ECC prevalence. The association with EPI and ecosystem vitality was inverse whereas the association with environmental health was direct. Only the inverse association with ecosystem vitality in 3-5 year old children was significant. There may be higher risk of ECC with greater economic development, industrialization, and urbanization, while better ecosystem vitality may offer protection against ECC through the rational use of resources, healthy life choices, and preventive health practices.

Indonesia: Epidemiological Profiles of Early Childhood Caries

The Indonesia government has succeeded in achieving national health development targets and has invested heavily in public health. Many positive results have been achieved, which indicate an increasing number of school-aged children free of caries and a decrease in caries experience scores. However, result of previous studies on early childhood caries (ECC) in pre-school children showed high prevalence and severity. Understanding the link between the epidemiology of the ECC and components of health development is critical for formulating appropriate actions. The purpose of this study is to provide a comprehensive review of the epidemiology of ECC in Indonesia based on the results of the national basic health surveys. The complementary data describes access, utilization and profile of oral health personnel in Indonesia.

Impact of school-based dental program performance on the oral health-related quality of life in children

OBJECTIVE

To assess the association between the performance of school-based dental programs (SBDPs) and oral health-related quality of life (OHRQoL) in school children, in the province of Yogyakarta, Indonesia, taking into account untreated caries and sociodemographic factors.

METHODS

A cross-sectional survey was administered with 1906 children aged 12 and participating in SBDPs. Four SBDPs were chosen to represent good and poor performance in urban and rural areas. Caries was assessed using World Health Organization (WHO) criteria, whereas the children were interviewed for the OHRQoL and sociodemographic data. The OHRQoL was assessed using the Condition-Specific Child-Oral Impact on Daily Performances (CS Child-OIDP) index related to dental caries.

RESULTS

The mean CS Child-OIDP score was 1.63 (SD ± 3.20) for good performance SBDP and 6.89 (SD ± 8.85) for poor performance SBDP. Analysis by negative binomial regression showed that being served by a poorly performing SBDP (RR = 4.45, 95% CI = 3.87-5.13), and to some extent living in a rural area and being a girl, were significantly associated with a greater risk of having a lower quality of life than were the counterparts. Untreated caries did not show an association with OHRQoL.

CONCLUSION

There are substantial indications that SBDP performance is related to children's OHRQoL.

The role of school-based dental programme on dental caries experience in Yogyakarta Province, Indonesia

OBJECTIVES

To assess the effectiveness of a school-based dental programme (SBDP) in controlling caries by measuring the relationship between the SBDP performance and caries experience in children aged 12 in Yogyakarta Province, Indonesia, by taking into account influencing factors.

METHODS

A cross-sectional survey was undertaken of 1906 children participating in SBDPs. Four SBDPs were chosen by good and poor performances in urban and rural areas. Caries was assessed using WHO criteria whereas behaviour and socio-demographic factors were collected using a questionnaire administered to the children.

RESULTS

The decayed, missed, and filled teeth (DMFT) of children in good SBDPs (2.8 ± 2.4) was lower than that of the counterparts (3.8 ± 3.4). From path analysis using a structural equation model (SEM), place of residence (OR = 4.0) was shown to have a strongest direct relationship to caries experience, whereas SBDP performance showed no direct relationship. At the same time, SBDP performance was significantly related to frequencies of dental visits (OR = 0.3), sugar consumption (OR = 0.8), and tooth brushing (OR = 3.2), which in turn are interrelated with place of residence, gender, and mother's education.

CONCLUSIONS

The study suggests that the differences in DMFT of children in good and poor performance SBDPs were caused by relation to social factors rather than by relation to oral health service activities.

Manajemen nasehat nutrisi dalam praktek dokter gigi Management of nutrition advised in dentist practice

The evidence of relation between nutrition and oral health has addressed nutrition issues on a new urgency indental practices as a part of efforts in developing quality of care. Nutrition is a modifiable factors and could beadviced to patients that ensure progression and maintainance of oral health status. Dietary advice to patientsshould be positive and personalized if possible and can be in line with general health. This paper is intended toprovide an overview of management of dietary advice for patients with dental caries, periodontal disease and oralsurgery which could be implemented in dental practice setting. The appropriate and specified nutrition advice canhelp patient recover from dental disease and achieved the best result of dental treatment and prevention.