Severe early childhood caries and behavioural risk indicators among young children in Ajman, United Arab Emirates

Risk determinants associated with early childhood caries in Uygur children: a preschool-based cross-sectional study

Abstract: The prevalence of early childhood caries (ECC) varies with geographical region and population. The Uygur people, one of 55 officially recognized ethnic minorities in China, have a population of 10,069,346. We performed a preschool-based cross-sectional study of 670 Uygur children from the southern region of Xinjiang, China, to investigate the prevalence and severity of ECC and to identify factors related to the dental health condition of this population. The study population of children ranging in age from 3 to 5 years was invited using a three-stage stratified sampling in Kashgar, the westernmost city in China. The “dmft” index was used to assess dental caries. The diagnosis of ECC or severe ECC was based on the oral health diagnostic criteria defined by the American Academy of Pediatric Dentistry. A questionnaire was completed by the children’s caregivers. The survey included questions concerning the children’s sociodemographic background; feeding and eating habits, particularly frequency of sweet beverage and food consumption; dental hygiene-related behaviors; the general oral health knowledge of caregivers; and the dental healthcare experience of caregivers and their children. A total of 670 Uygur children underwent complete dental caries examination. Most of the children (74.2%) had ECC, with a mean dmft ± SD of 3.95 ± 3.84. The prevalence of severe ECC was 40.1% (N =269), with a mean dmft of 7.72 ± 3.14. More than 99% of caries were untreated. Statistically significant correlations were found between higher ECC prevalence and increased age and lower socioeconomic background, while greater dental health knowledge of the caregiver and positive oral hygiene behaviors were found to be protective. Our findings confirm the multi-factorial etiology of ECC. The prevalence of ECC among preschool-aged Uygur children in Kashgar was high, particularly among those from lower socioeconomic backgrounds. Caries prevalence was associated with oral hygiene behaviors of children and the general oral health knowledge of caregivers. These factors could be modified through public health strategies, including effective publicity concerning general dental health and practical health advice.

Severe early childhood caries and social determinants in three-year-old children from Northern Thailand: a birth cohort study

Abstract: The purpose of this study was to investigate the prevalence and social risk factors of severe early childhood caries in three-year-old children in Northern Thailand, using a birth-cohort study The data utilized in this study were from the prospective cohort study of Thai children (PCTC) from the 28 to 38 weeks gestational age until the children reached the age of 36 months (N = 597) in Mueang Nan district, Northern Thailand. Questionnaires were administered at different time points and dental examination was conducted at the age of 3 years of the child. 44.1 % of the 3 year old children had S-ECC. In multivariate logistic regression analysis, environmental factors (the use of rain or well water as drinking water, no schooling of mother of child, being male), and risk behaviour (sleeping with a bottle at 30 months) were associated with S-ECC. Further, in bivariate analysis, psychological distress in the mother, lack of spousal relationship support, suckle to sleep when going to bed, introduction of soft drinks at 12 months, having had more frequently sweet food, and less than daily tooth brushing before 30 months were associated with S-ECC. A very high rate of S-ECC was observed, and oral health may be influenced by social factors.

Maternal education is an independent determinant of cariogenic feeding practices in the first year of life

Abstract: AIM: To identify risk factors for cariogenic feeding practices in the first year of life. STUDY DESIGN: Cohort study. METHODS: 500 children born within the public health care system in Sao Leopoldo, Brazil, were recruited in a follow-up program. Anthropometric and demographic data were collected soon after birth; data on feeding practices were assessed at 12 months of age using a standardised questionnaire; clinical examination at 4 years of age allowed identification of cariogenic feeding practices in the first year of life and to quantify their relative risks. In the present study, the attributable risks of each child were summed, and the outcome was assessed for the upper quartile of scores for cariogenic feeding practices. STATISTICS: Adjusted relative risks for the outcome were estimated using robust Poisson regression models. RESULTS: A total of 327 children comprised the final study sample, i.e. were followed from birth to 4 years of age. Multivariate analysis showed that the risk of cariogenic feeding practices doubled in children from mothers with less than 5 years of education (RR 2.19, 95%CI 1.26–3.82) and was 70% higher in children from mothers with 5–8 years of education when compared with maternal education >8 years. The other independent variables were not associated with the outcome. CONCLUSIONS: Low maternal education is a risk factor for cariogenic feeding practices, independently of other factors. Mothers with low educational levels should be the focus of child health promotion interventions, especially those aimed at controlling dental caries.

Epidemiology of dental caries in children in the United Arab Emirates.

Abstract: Dental caries has a significant impact on the general health and development of children. Understanding caries epidemiology is an essential task for the United Arab Emirates (UAE) policymakers to evaluate preventive programmes and to improve oral health. The purpose of this review is to collect and summarise all data available in the published literature on the epidemiology of dental caries in the UAE in children aged under 13 years. This will provide dental health planners with a comprehensive data summary, which will help in the planning for and evaluation of dental caries prevention programmes. Data were collected from the various published studies in PubMed, Academic Search Complete, Google, and the reference lists in relevant articles. Four keywords were used in the search: 'dental caries,' 'epidemiology,' 'prevalence,' and 'UAE'. All studies conducted in the UAE in general or any single emirate that sheds light on the prevalence of dental caries of children under 13 years were included in this literature review. Studies on early childhood caries and factors associated with dental caries were also included. The review comprises 11 published surveys of childhood caries in UAE. The earliest study was published in 1991 and the most recent was published in 2011. The range of decayed, missing and filled primary teeth (dmft) in UAE children (age between 4 years and 6 years) was 5.1-8.4. For the 12-year-old group the decayed missing and filled permanent teeth (DMFT) ranged from 1.6 to 3.24. Baseline data on oral health and a good understanding of dental caries determinants are necessary for setting appropriate goals and planning for preventive oral health programmes. The current data available on the dmft and DMFT indicate that childhood dental caries is still a serious dental public health problem in the UAE that warrants immediate attention by the government and policy makers.

Risk Factors associated with Early Childhood Caries.

Abstract: Objective To analyse factors associated with the susceptibility of early childhood caries (ECC), populations with a high risk of ECC were screened and guidance for ECC prevention was proposed. Methods A total of 392 children aged 24 to 71 months were selected for oral examination in Qingdao. Parents or guardians of the participants completed the questionnaires and decayed missing filled surface (dmfs) were recorded. Differences in caries condition and oral health behaviour in different families were compared. Risk factors related to ECC were screened. The subjects were finally grouped based on the obtained dmfs into three groups: caries-free, ECC and S-ECC (severe ECC). Association of risk factors with the caries status was analysed using the Kruskal-Wallis test, the chi-square test and logistic regression analysis. Results There were significant differences among the caries-free, ECC and S-ECC groups in three parameters: eating too many sweets each day, brushing before and after sleeping, and whether parents helped to brush (P 0.05). Conclusion Eating a lot of sweets, an incorrect brushing method, starting brushing at a later stage and not brushing regularly are susceptible factors for ECC. Emphasising oral health knowledge to parents and guardians, conducting proper brushing methods, limiting the frequency of sweets being eaten and avoiding an inappropriate habit of eating sweets are very important factors in the prevention of ECC.

From victim blaming to upstream action: tackling the social determinants of oral health inequalities

Abstract: The persistent and universal nature of oral health inequalities presents a significant challenge to oral health policy makers. Inequalities in oral health mirror those in general health. The universal social gradient in both general and oral health highlights the underlying influence of psychosocial, economic, environmental and political determinants. The dominant preventive approach in dentistry, i.e. narrowly focusing on changing the behaviours of high-risk individuals, has failed to effectively reduce oral health inequalities, and may indeed have increased the oral health equity gap. A conceptual shift is needed away from this biomedical/behavioural 'downstream' approach, to one addressing the 'upstream' underlying social determinants of population oral health. Failure to change our preventive approach is a dereliction of ethical and scientific integrity. A range of complementary public health actions may be implemented at local, national and international levels to promote sustainable oral health improvements and reduce inequalities. The aim of this article is to stimulate discussion and debate on the future development of oral health improvement strategies.

Socioeconomic inequalities in oral health in childhood and adulthood in a birth cohort

Abstract: – Objectives: To determine whether adult oral health is predicted by (a) childhood socioeconomic advantage or disadvantage (controlling for childhood oral health), or (b) oral health in childhood (controlling for childhood socioeconomic advantage or disadvantage), and whether oral health in adulthood is affected by changes in socioeconomic status (SES). Methods: Participants in a longstanding cohort study underwent systematic dental examination for dental caries and tooth loss at ages 5 and 26 years. The examination at age 26 years included the collection of data on periodontal attachment loss and plaque level. Childhood SES was determined using parental occupation, and adult SES was determined from each study member's occupation at age 26 years. Regression models were used to test the study hypotheses. Results: Complete data were available for 789 individuals (47.4% female). After controlling for childhood oral health, those who were of low SES at age 5 years had substantially greater mean DFS and DS scores by age 26 years, were more likely to have lost a tooth in adulthood because of caries, and had greater prevalence and extent of periodontitis. A largely similar pattern was observed (after controlling for childhood SES) among those with greater caries experience at age 5 years. For almost all oral health indicators examined, a clear gradient was observed of greater disease at age 26 years across socioeconomic trajectory groups, in the following order of ascending disease severity and prevalence: ‘high–high’, ‘low–high’ (upwardly mobile), ‘high–low’ (downwardly mobile) and ‘low–low’. Conclusion: Adult oral health is predicted by not only childhood socioeconomic advantage or disadvantage, but also by oral health in childhood. Changes in socioeconomic advantage or disadvantage are associated with differing levels of oral health in adulthood. The life-course approach appears to be a useful paradigm for understanding oral health disparities.

Efficacy of an oral health promotion intervention in the prevention of early childhood caries.

Abstract: – Objective: Despite a marked improvement in oral health of Australian children over the last 30 years, severe early childhood caries (S-ECC) affects up to 17% of 2- to 3-year-old children with some requiring hospitalization and invasive treatment. This provided a compelling rationale to develop and test an oral health promotion programme which aimed to reduce this unnecessary suffering. The purpose of this study was to test the efficacy of an oral health promotion programme for the parents of infants, starting during the pregnancy, using a randomized controlled trial. Methods: A programme was developed around the provision of anticipatory guidance to nulliparous women (women expecting their first child) in Adelaide. Mothers in the test group received oral health promotion information during pregnancy, and later when the child reached 6 and 12 months of age. After the second round of information the test group mothers were randomized again. The information was reinforced in one of the test subgroups through a telephone consultation. There was no contact with mothers in the control group after enrolment. At the age of 20 ± 2.5 months all test and control group children were examined by a dentist. The case definition of an incidence of S-ECC was one or more upper incisor teeth being carious at the level of a cavitated or noncavitated lesion. The differences in S-ECC incidence between the test and control groups, and the test subgroups were analysed. Results: Of 649 women enroled in the programme (test group 327, control group 322), 441 had their child examined at follow-up. The incidence of S-ECC in the test group was 1.7% and in the control group 9.6% (P < 0.001). Conclusion: An oral health promotion programme based on repeated rounds of anticipatory guidance initiated during the mother’s pregnancy was successful in reducing the incidence of S-ECC in these very young 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

Abstract: 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.