Objective To conduct a systematic review of the literature on risk factors for dental caries in deciduous teeth of children aged six years and under, to give a scientific framework for the international collaborative studies on inequalities in childhood caries. Method Accepted guidelines were followed. Studies were identified by electronic searching and reviewed on the basis of key words, title and abstract by two reviewers to assess whether inclusion criteria were met. Copies of all articles were obtained and assessed for quality according to the study design. Results 1029 papers were identified from the electronic search, 260 met the prima facie inclusion criteria. 183 were excluded once full copies of these papers were obtained. Of the 77 studies included, 43 were cross sectional, 19 cohort studies, 8 case control studies and 7 interventional studies. Few obtained the highest quality scores. 106 risk factors were significantly related to the prevalence or incidence of caries. Conclusion There is a shortage of high quality studies using the optimum study design, i.e. a longitudinal study. The evidence suggests that children are most likely to develop caries if Streptococcus Mutans is acquired at an early age, although this may be partly compensated by other factors such as good oral hygiene and a non- cariogenic diet. Diet and oral hygiene may interact so that if there is a balance of ‘good’ habits by way of maintaining good plaque control and ‘bad’ habits by way of having a cariogenic diet, the development of caries may be controlled.

https://www.who.int/oral_health/media/en/orh_cdh_0304_05_risk_factors.pdf

Risk factors for dental caries in young children: a systematic review of the literature.

Dental caries (decay) is an international public health challenge, especially amongst young children. Early childhood caries (ECC) is a serious public health problem in both developing and industrialized countries. ECC can begin early in life, progresses rapidly in those who are at high risk, and often goes untreated. Its consequences can affect the immediate and long-term quality of life of the child's family and can have significant social and economic consequences beyond the immediate family as well. ECC can be a particularly virulent form of caries, beginning soon after dental eruption, developing on smooth surfaces, progressing rapidly, and having a lasting detrimental impact on the dentition. Children experiencing caries as infants or toddlers have a much greater probability of subsequent caries in both the primary and permanent dentitions. The relationship between breastfeeding and ECC is likely to be complex and confounded by many biological variables, such as mutans streptococci, enamel hypoplasia, intake of sugars, as well as social variables, such as parental education and socioeconomic status, which may affect oral health. Unlike other infectious diseases, tooth decay is not self-limiting. Decayed teeth require professional treatment to remove infection and restore tooth function. In this review, we give detailed information about ECC, from its diagnosis to management.

Early childhood caries update: A review of causes, diagnoses, and treatments.

Dental erosion is a multifactorial condition: The interplay of chemical, biological and behavioural factors is crucial and helps explain why some individuals exhibit more erosion than others. The erosive potential of erosive agents like acidic drinks or foodstuffs depends on chemical factors, e.g. pH, titratable acidity, mineral content, clearance on tooth surface and on its calcium-chelation properties. Biological factors such as saliva, acquired pellicle, tooth structure and positioning in relation to soft tissues and tongue are related to the pathogenesis of dental erosion. Furthermore, behavioural factors like eating and drinking habits, regular exercise with dehydration and decrease of salivary flow, excessive oral hygiene and, on the other side, an unhealthy lifestyle, e.g. chronic alcoholism, are predisposing factors for dental erosion. There is some evidence that dental erosion is growing steadily. To prevent further progression, it is important to detect this condition as early as possible. Dentists have to know the clinical appearance and possible signs of progression of erosive lesions and their causes such that adequate preventive and, if necessary, therapeutic measures can be initiated. The clinical examination has to be done systematically, and a comprehensive case history should be undertaken such that all risk factors will be revealed.

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Erosion—diagnosis and risk factors

There is some evidence that the presence of erosion is growing steadily. Because of different scoring systems, samples and examiners, it is difficult to compare and judge the outcome of the studies. Preschool children aged between 2 and 5 years showed erosion on deciduous teeth in 6-50% of the subjects. Young schoolchildren (aged 5-9) already had erosive lesions on permanent teeth in 14% of the cases. In the adolescent group (aged between 9 and 17) 11-100% of the young people examined showed signs of erosion. Incidence data (= increase of subjects with erosion) evaluated in three of these studies were 12% over 2 years, 18% over 5 years and 27% over 1.5 years. In adults (aged between 18 and 88), prevalence data ranged between 4 and 82%. Incidence data are scarce; only one study was found and this showed an incidence of 5% for the younger and 18% for the older examined group (= increase of tooth surfaces with erosion). Prevalence data indicated that males had somewhat more erosive tooth wear than females. The distribution of erosion showed a predominance of occlusal surfaces (especially mandibular first molars), followed by facial surfaces (anterior maxillary teeth). Oral erosion was frequently found on maxillary incisors and canines. Overall, prevalence data are not homogeneous. Nevertheless, there is already a trend for more pronounced rate of erosion in younger age groups. Therefore, it is important to detect at-risk patients early to initiate adequate preventive measures.

Prevalence, Incidence and Distribution of Erosion

Background: Despite the fact that it is largely preventable, dental caries (decay) remains one of the most common chronic diseases of early childhood. Dental decay in young children frequently leads to pain and infection necessitating hospitalization for dental extractions under general anaesthesia. Dental problems in early childhood have been shown to be predictive of not only future dental problems but also on growth and cognitive development by interfering with comfort nutrition, concentration and school participation. Objective: To review the current evidence base in relation to the aetiology and prevention of dental caries in preschool-aged children. Methods: A search of MEDLINE, CINALH and Cochrane electronic databases was conducted using a search strategy which restricted the search to randomized controlled trials, meta-analyses, clinical trials, systematic reviews and other quasi-experimental designs. The retrieved studies were then limited to articles including children aged 5 years and under and published in English. The evidence of effectiveness was then summarized by the authors. Conclusions: The review highlighted the complex aetiology of early childhood caries (ECC). Contemporary evidence suggests that potentially effective interventions should occur in the first 2 years of a child's life. Dental attendance before the age of 2 years is uncommon; however, contact with other health professionals is high. Primary care providers who have contact with children well before the age of the first dental visit may be well placed to offer anticipatory advice to reduce the incidence of ECC.

Early childhood caries: Current evidence for aetiology and prevention

OBJECTIVES\nThe aim of this study was to investigate the possible association between dental erosion and caries, and variables including socio-economic status, reported dietary practices and oral hygiene behaviour, in a sample of children in Jeddah, Saudi Arabia. A cross-sectional study including dental examination and questionnaire survey was carried out at a number of kindergartens.\n\n\nSAMPLE AND METHODS\nA sample of 987 children (2-5-year-olds) was drawn from 17 kindergartens. Clinical examinations were carried out under standardized conditions by a trained and calibrated examiner (MAM). Information regarding diet and socio-economic factors was drawn from questionnaires distributed to the parents through the schools. These were completed before the dental examination.\n\n\nRESULTS\nOf the 987 children, 309 (31%) showed signs of erosion. Caries were diagnosed in 720 (73%) of the children and rampant caries in 336 (34%). Vitamin C supplements, frequent consumption of carbonated drinks and the drinking of fruit syrup from a feeding bottle at bed- or nap-time when the child was a baby, were all related to erosion. Consumption of carbonated drinks and fruit syrups was also related to caries but they were part of a larger number of significant factors including socio-demographic measures and oral hygiene practices.\n\n\nCONCLUSIONS\nThere was no clear relationship between erosion and social class, or between erosion and oral hygiene practices; the reverse was true for caries. Dietary factors relating to both erosion and caries and/or rampant caries were found in this sample of children.

The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia: Relationship between erosion, caries and diet in children

Summary.

Objectives.

The aim of this study was to investigate the possible association between dental erosion and caries, and variables including socio-economic status, reported dietary practices and oral hygiene behaviour, in a sample of children in Jeddah, Saudi Arabia. A cross-sectional study including dental examination and questionnaire survey was carried out at a number of kindergartens.



Sample and methods.

A sample of 987 children (2–5-year-olds) was drawn from 17 kindergartens. Clinical examinations were carried out under standardized conditions by a trained and calibrated examiner (MAM). Information regarding diet and socio-economic factors was drawn from questionnaires distributed to the parents through the schools. These were completed before the dental examination.



Results.

Of the 987 children, 309 (31%) showed signs of erosion. Caries were diagnosed in 720 (73%) of the children and rampant caries in 336 (34%). Vitamin C supplements, frequent consumption of carbonated drinks and the drinking of fruit syrup from a feeding bottle at bed- or nap-time when the child was a baby, were all related to erosion. Consumption of carbonated drinks and fruit syrups was also related to caries but they were part of a larger number of significant factors including socio-demographic measures and oral hygiene practices.



Conclusions.

There was no clear relationship between erosion and social class, or between erosion and oral hygiene practices; the reverse was true for caries. Dietary factors relating to both erosion and caries and/or rampant caries were found in this sample of children.

/pdf/the-relationship-between-erosion-caries-and-rampant-caries-2arbr4xfz6.pdf

The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia

Objectives: The objective of this study was to determine the prevalence of dental erosion in preschool children in Jeddah, Saudi Arabia, and to relate this to caries and rampant caries in the same children. Methods: A sample of 987 children (2–5 years) was drawn from 17 kindergartens. Clinical examinations were carried out under standardised conditions by a trained and calibrated examiner (M.Al-M.). Measurement of erosion was confined to primary maxillary incisors and used a scoring system and criteria based on those used in the UK National Survey of Child Dental Health. Caries was diagnosed using BASCD criteria. Rampant caries was defined as caries affecting the smooth surfaces of two or more maxillary incisors. Results: Of the 987 children, 309 (31%) had evidence of erosion. For 186 children this was confined to enamel but for 123 it involved dentine and/or pulp. Caries were diagnosed in 720 (73%) of the children and rampant caries in 336 (34%). The mean dmft for the 987 children was 4.80 (±4.87). Of the 384 children who had caries but not rampant caries, 141 (37%) had erosion, a significantly higher proportion than the 72 (27%) out of 267 who were clinically caries free (SND=2.61, P<0.01). Of the 336 with rampant caries, 96 (29%) also had evidence of erosion. Conclusions: The level of erosion was similar to that seen in children of an equivalent age in the UK. Caries was a risk factor for erosion in this group of children.

Erosion, caries and rampant caries in preschool children in Jeddah, Saudi Arabia

Purpose: The aim of this study was to determine the prevalence, severity, and pattern of dental caries, as well as the prevalence of rampant caries in preschool children in Jeddal1, Saudi Arabia and to relate this to socioeconomic factors, diet, and oral hygiene practices. Methods: A random sample of 987 children was drawn from 17 nursery schools. Results: Caries were diagnosed in 720 (73%) of the children: 256 (26%) of the children had caries confined to posterior teem, 54 (6%) had caries only in anterior teeth, and in 382 (39%) both tooth types were affected. Forty-eight children (5%) had caries only in incisors. Rampant caries was diagnosed in 336 (34%). Mean dmft for the 987 children was 4.80 (±4.87) per child and mean dmfs 12.67 (± 15.46). Caries and rampant caries were related to social class. Conclusions: Thete was little evidence of differing patterns of caries having clearly defined etiology. (f Dent Child. 2003;70:235-242)

Prevalence and patterns of caries, rampant caries, and oral health in two- to five-year-old children in Saudi Arabia.

Dental General Anaesthesia (DGA) has been shown to be of value in providing both restorative treatment and extractions in children who are unable to accept this using other methods of management.

Aims. The aims of this retrospective study were to determine the characteristics of patients attending for treatment under DGA at a centre in Saudi Arabia, to describe the type of dental treatment carried out using DGA and in the subsequent 3-year period.

Sample and Method. Data were collected from hospital records of 555 patients who received treatment under DGA at King Fahad Hospital in Jeddah, Saudi Arabia, between 1995 and 1997.

Results. Ninety three percent of the patients were aged 8 or younger at the time of DGA, with 43% being under 5 years of age. The main indications for use of DGA in the youngest age group were dental management of rampant caries (77% of the youngest age group) and inability to accept treatment under local anaesthesia (49% of those aged 5–8 years). Seventy percent of patients had treatment involving both extractions and restorative care, and the majority, 81%, had one tooth or more restored with preformed metal crowns. Sixty-three percent of patients attended for recall after 6 months but only 10% did so after a 3-year interval. Only one of the 555 patients received a second DGA at the same centre during the 3 years following treatment.

Conclusions. The service studied provides dental treatment primarily for children with extensive disease. Failure to attend for recall was common, suggesting that preventive methods which rely on regular attendance may not be successful in this group of children.

M. I. Al-Malik

Papers

The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia: Relationship between erosion, caries and diet in children

The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia

Erosion, caries and rampant caries in preschool children in Jeddah, Saudi Arabia

Prevalence and patterns of caries, rampant caries, and oral health in two- to five-year-old children in Saudi Arabia.

Dental treatment under general anaesthesia at a hospital in Jeddah, Saudi Arabia.