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.

Lactobacillus rhamnosus GG, ATCC (LGG), has shown antagonism to many bacteria including mutans streptococci. This randomized, double–blind, placebo–controlled intervention study was

Effect of Long–Term Consumption of a Probiotic Bacterium, Lactobacillus rhamnosus GG, in Milk on Dental Caries and Caries Risk in Children

Dental caries in very young children may be severe, result in serious infection, and require general anesthesia for treatment. Dental caries results from a shift within the biofilm community specific to the tooth surface, and acidogenic species are responsible for caries. Streptococcus mutans, the most common acid producer in caries, is not always present and occurs as part of a complex microbial community. Understanding the degree to which multiple acidogenic species provide functional redundancy and resilience to caries-associated communities will be important for developing biologic interventions. In addition, microbial community interactions in health and caries pathogenesis are not well understood. The purpose of this study was to investigate bacterial community profiles associated with the onset of caries in the primary dentition. In a combination cross-sectional and longitudinal design, bacterial community profiles at progressive stages of caries and over time were examined and compared to those of health. 16S rRNA gene sequencing was used for bacterial community analysis. Streptococcus mutans was the dominant species in many, but not all, subjects with caries. Elevated levels of S. salivarius, S. sobrinus, and S. parasanguinis were also associated with caries, especially in subjects with no or low levels of S. mutans, suggesting these species are alternative pathogens, and that multiple species may need to be targeted for interventions. Veillonella, which metabolizes lactate, was associated with caries and was highly correlated with total acid producing species. Among children without previous history of caries, Veillonella, but not S. mutans or other acid-producing species, predicted future caries. Bacterial community diversity was reduced in caries as compared to health, as many species appeared to occur at lower levels or be lost as caries advanced, including the Streptococcus mitis group, Neisseria, and Streptococcus sanguinis. This may have implications for bacterial community resilience and the restoration of oral health.

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Beyond Streptococcus mutans: Dental Caries Onset Linked to Multiple Species by 16S rRNA Community Analysis

This systematic review addresses the question: In the modern age of extensive fluoride exposure, do individuals with a high level of sugar intake experience greater caries severity relative to those with a lower level of intake? The MEDLINE and EMBASE databases were searched for English-language papers published between 1980 and 2000 using a search expression developed in conjunction with an experienced librarian. There were 809 papers located in the initial search. A review of titles and abstracts to identify clearly irrelevant papers reduced this number to 134. Two readers each read one half of these papers, and application of predetermined inclusion/exclusion criteria reduced this number of papers to sixty-nine. Criteria were established for scoring the quality of each of these papers on evidence tables. The maximum score for each paper was 100; the sixty-nine papers rated scored between 12 and 79. Final judgment of results was limited to those thirty-six papers that scored 55 or higher on the evidence tables and that reported studies carried out in countries where there is moderate-to-extensive fluoride exposure. Results showed that only two papers found a strong relationship between sugar consumption and caries development, sixteen found a moderate relationship, and eighteen found weak-to-no relationship. It was concluded that the relationship between sugar consumption and caries is much weaker in the modern age of fluoride exposure than it used to be. Controlling the consumption of sugar remains a justifiable part of caries prevention, however, if not always the most important aspect.

Sugar consumption and caries risk: a systematic review.

It is generally understood that the teeth of pre-school-aged children are healthy, but the improvement in the dmft index has halted in the industrialized countries. Those few children who have caries have more of it than before. Little is known of the family-related factors which are associated with this polarization of caries. A representative population-based sample consisted of 1443 mothers expecting their first child. The children were followed at well-baby clinics and public dental health clinics for over five years. The objective was to study the prevalence of dental caries and its predictors in five-year-old children and to assess children's own dental health habits and the meaning of family-related factors in dental health. The findings were based on questionnaire data from parents and on clinical dental examinations of the five-year-old children as completed by 101 public health dentists. In firstborn five-year-old children, dental health was found to be good in 72%, fair in 20%, and poor in 8% of the cases. The final multivariate analysis illustrated that the dmft index > 0 was independently associated with the mother's irregular toothbrushing (OR 2.2; 95% CI 1.4-3.5), annual occurrence of several carious teeth in the father (OR 2.6; 95% CI 1.9-3.6), daily sugar consumption at the age of 18 months (OR 2.4; 95% CI 1.4-4.1), occurrence of child's headaches (OR 3.7; 95% CI 1.5-8.8), parents' cohabitation (OR 3.3; 95% CI 1.5-7.6), rural domicile (OR 2.4; 95% CI 1.2-4.5), and mother's young age (OR 5.0; 95% CI 1.3-19.8). The findings indicated that attention should be paid not only to the child's dental health care but also to that of the whole family. Parents should be supported in their upbringing efforts and encouraged to improve their children's dental health habits. In everyday life, parents function as role models for their children, and therefore, parents' own dental hygiene habits are very meaningful.

Caries in Five-year-old Children and Associations with Family-related Factors

The aim was to elucidate whether variables recorded in early childhood would have a long-lasting predictive value of poor dental health at the age of 10 years in a prospectively followed Finnish population-based cohort setting. The second aim was to find new tools for preventive work in order to improve dental health among children. Poor dental health (dmft + DMFT >or= 5) at 10 years of age was associated with child's nocturnal juice drinking at 18 months. It was associated with the following factors at age 3 years: frequent consumption of sweets; infrequent tooth brushing; plaque and caries on teeth. Of family factors, the following were significant: father's young age at birth of the child; mother's basic 9-year education; mother's caries (i.e. several carious teeth per year), and father's infrequent tooth brushing. Early childhood risk factors of poor dental health seem to be stable even after 10 years of life and the changing of teeth from primary to permanent ones. In preventive work, dental health care staff could offer support to those parents with risk factors in their child rearing tasks.

Behavioural and demographic factors during early childhood and poor dental health at 10 years of age.

The aim of this study was to examine how dental health related habits, infectious diseases and long-term illness are associated with dental health at the age of 3 in first-born children resident in a Finnish province. The study was designed as a survey using stratified randomised cluster sampling, confidential questionnaires and clinical dental examinations. The results were analysed using polytomous logistic models. In the stepwise analysis the only statistically significant explanatory factors were the use of juice at night and dental cleanliness. Antibiotic treatment or long-term illness was not significantly associated with dental health.

The Finnish Family Competence Study: The Relationship between Caries, Dental Health Habits and General Health in 3-Year-0ld Finnish Children

Sucking habits and their connection with family background was investigated in 3-year-old Finnish children. The association between sucking habits and malocclusion was also studied. The study was based on a survey with stratified randomized cluster sampling, confidential questionnaires, and clinical dental examinations. Dummy (pacifier) use was often associated with a negligent attitude towards the child's toothbrushing. This may imply that these parents need more support, encouragement, and counseling from the well-baby clinic than others. Sucking habits were strongly associated with malocclusion.

The Finnish Family Competence Study: the effects of living conditions on sucking habits in 3-year-old Finnish children and the association between these habits and dental occlusion.

Objectives: This study sought to determine how dental health and dental health habits change from 3 to 5 years of age and to consider whether preventive dental health care helped in preventing or halting caries in children. Methods: The study included 67 maternity health care clinics, 72 well-baby clinics, and 69 dental health care clinics. Of the 1,292 newborn children, 1,003 (90.8%) were included in this study. Results: Preventive dental health care contributed to dental caries being halted in only 13.2 percent of those children who had enamel caries at 3 years of age. The dmft index did not increase in 22.6 percent of those children who had dentinal caries at 3 years of age. For all others, the disease became more severe. Toothbrushing habits of 3-year-old children were very consistent over the two years studied. Children were at a risk for caries when their mothers had nine years of basic education, when they already had plaque and caries at 3 years of age, and when the frequency of eating sweets increased the most during the two-year study period. Conclusion: Among 3-year-old children, plaque is an indicator of caries risk and therefore should be a key element in health education. Those children who already have evidence of caries at 3 years of age should be the target of preventive dental services because of their increased risk.

P. Paunio

Papers

Caries in Five-year-old Children and Associations with Family-related Factors

Behavioural and demographic factors during early childhood and poor dental health at 10 years of age.

The Finnish Family Competence Study: The Relationship between Caries, Dental Health Habits and General Health in 3-Year-0ld Finnish Children

The Finnish Family Competence Study: the effects of living conditions on sucking habits in 3-year-old Finnish children and the association between these habits and dental occlusion.

Changes in dental health and dental health habits from 3 to 5 years of age.