Severe early childhood caries and social determinants in three-year-old children from Northern Thailand: a birth cohort study
TL;DR: A very high rate of S-ECC was observed, and oral health may be influenced by social factors, as well as environmental factors.
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.
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TL;DR: While the prevalence of dental caries has decreased, the disease is prevalent in all age groups, and there is insufficient evidence to conclude thatThe prevalence of periodontitis has changed over time.
Abstract: Background
Dental caries and periodontitis are the most common oral diseases and major causes of tooth loss.
Aim
To perform a review of global prevalence and incidence of dental caries and periodontitis.
Methodology
Inclusion and exclusion criteria were developed. MEDLINE database and EMBASE database were used to search for eligible publications using keywords and MeSH terms. Additionally, WHO databank was used for obtaining dental caries information and PUBMED for a search on trends of dental caries prevalence and severity.
Results
Over the last four decades, the prevalence and severity of dentine carious lesions among 5- and 12-year-olds have declined; the decay-component is very high, with the lowest prevalence among 12-year-olds in high-income countries, which also had the lowest prevalence among 35- to 44-year-olds; and the number of retained teeth has increased around the globe. The prevalence of periodontitis is high, with approximately 10% of the global population affected by severe periodontitis. Study heterogeneity and methodological issues hamper comparisons across studies and over time.
Conclusion
While the prevalence of dental caries has decreased, the disease is prevalent in all age groups. The prevalence of periodontitis is high. There is insufficient evidence to conclude that the prevalence of periodontitis has changed over time.
599 citations
Cites background from "Severe early childhood caries and s..."
...However, studies have reported high prevalence values of cavitated dentine carious lesions in the very young: 38% and 44.1% for Canadian (Schroth et al. 2015) and Thai 3-year-olds (Peltzer & Mongkolchati 2015), respectively....
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TL;DR: Prohibition of sugary snacking in school and daily supervised tooth brushing, with or without oral health education is effective in preventing ECC among preschool children with health neglect in very low-resource settings.
Abstract: OBJECTIVES To assess the effectiveness of school-based interventions to prevent early childhood caries (ECC) among preschool children from very low socioeconomic background over a period of 2 years. MATERIALS AND METHODS Four hundred and twenty preschool children between the ages of 3-5 years participated in this double blind, three parallel arm clinical trial. School only interventions such as prohibition of sugary snack consumption in school, teacher supervised daily brushing using fluoridated toothpaste, and oral health education were implemented with regular follow-up at 6 months, 1, and 2 years. The study group had all three interventions, in active control-tooth brushing and oral health education, and in negative control, only oral health education. Decay at d1/d2 using World Health Organization criteria, visible plaque and gingival inflammation were assessed at all follow-ups. The value of P < 0.05 was considered significant. RESULTS Absolute caries risk reduction in the study group was 20 percent and 12 percent when compared to active, negative controls after 2 years. Mean caries increment in the study group was 0.4 for d1/d2, for the active control group was 0.9 and negative control 0.8. The effect of interventions to prevent ECC in each group was calculated using the Cohen's d, and the study group had a score of 0.6 when compared with active controls and 0.9 in comparison to the negative control group. CONCLUSIONS Prohibition of sugary snacking in school and daily supervised tooth brushing, with or without oral health education is effective in preventing ECC among preschool children with health neglect in very low-resource settings.
358 citations
Journal Article•
TL;DR: The strongest risk factors associated with early childhood caries was the presence of enamel defects, presence of dentinal caries and high levels of mutans streptococci.
Abstract: Purpose: The purpose of this study was to perform a systematic review to assess current evidence for association between various risk factors and the prevalence or incidence of early childhood caries (ECC). Methods: Two reviewers searched various databases until January 2019. The Newcastle-Ottawa scale was used to perform risk of bias assessment. The included studies were categorized according to the World Bank classification. Data were summarized in a meta-analysis using fixed and random effects inverse-generic meta-analyses. Results: A total of 7,034 records involving 89 studies that evaluated 1,352,097 individuals were included; 23 were high, 46 were moderate, and 20 were of low quality. A total of 123 risk factors were found. Meta-analysis revealed that the strongest risk factors found in the high-income countries were presence of dentinal caries (dmft greater than zero; odds ratio [OR] equals 4.21 [2.18 to 8.16]) and high levels of mutans streptococci (OR equals 3.83 [1.81 to 8.09]). In upper-middle-income countries, presence of enamel defects (OR equals 14.62 [6.10 to 35.03]) was found to be the strongest risk factor. Conclusion: The strongest risk factors associated with early childhood caries was the presence of enamel defects, presence of dentinal caries and high levels of mutans streptococci.
73 citations
TL;DR: This systematic review and synthesis of available literature identified parent-level proximal and distal risk factors associated with the development of ECC in developing nations and suggested interventions could be designed to improve parental oral health knowledge and behaviors in these nations.
Abstract: Background Early childhood caries (ECC) is one of the most prevalent and chronic conditions of childhood. Various factors including biological and dietary factors along with an overlay of parental social factors have been found to be associated with the progression of ECC. The objective of this systematic review is to synthesize available literature and to identify parent-level proximal and distal risk factors associated with the development of ECC in developing nations. Methods Studies conducted in developing nations, published between 2005 and 2017 in English, that included children younger than 6 years and examined ECC were included. The outcome of interest were parental risk factors, which included parental knowledge, behavior, attitudes, sense of coherence (SOC), stress, socioeconomic status (SES), education, and breastfeeding duration. The studies were retrieved from MEDLINE, Ovid Medline, and PubMed. Results The search yielded 325 studies, of which 18 were considered eligible for inclusion in this review. Ten studies found maternal education, and seven studies found parental education to be significantly associated with ECC. SES was significantly associated with ECC in 13 studies in the form of annual household income and occupation level. Four studies observed the significant association between oral health knowledge and attitudes with ECC, whereas only two studies found maternal attitude to be associated with ECC. Breastfeeding duration was a significant risk factor in four studies. One study each found significant associations of SOC, parental distress, and secondary smoke with ECC. Conclusion To date, most of the researches done in developing countries have reported distal parental factors such as income and education being significant risk factors in caries development compared to proximal risk factors in low-income groups. Only a few studies analyzed the psychosocial and behavioral factors. Interventions could be designed to improve parental oral health knowledge and behaviors in these nations.
57 citations
Cites background or result from "Severe early childhood caries and s..."
...One study assessed maternal education level as no schooling, schooling till primary level, and schooling till high school (27)....
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...It was observed that mothers who smoked had children with higher prevalence of S-ECC (27) compared to nonsmoking mothers (p ≤ 0.25, prevalence of S-ECC = 44.1%)....
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...It was observed that mothers who smoked had children with higher prevalence of S-ECC (27) compared to nonsmoking mothers (p ≤ 0....
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TL;DR: To assess the effects of interventions with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing early childhood caries, randomised controlled trials were performed in high-, middle- and low-income countries.
Abstract: Background Dental caries is one of the most common chronic diseases of childhood and is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC). Objectives To assess the effects of interventions with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years of age). Search methods Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 14 January 2019), Cochrane Pregnancy and Childbirth Group's Trials Register (to 22 January 2019), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Register of Studies, to 14 January 2019), MEDLINE Ovid (1946 to 14 January 2019), Embase Ovid (1980 to 14 January 2019) and CINAHL EBSCO (1937 to 14 January 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status. Selection criteria Randomised controlled trials (RCTs) comparing one or more interventions with pregnant women, mothers, or other caregivers of infants in the first year of life (intervention types included clinical, oral health education/promotion such as hygiene education, breastfeeding and other dietary advice, and policy or health service), versus standard care or placebo or another intervention. For inclusion, trials had to report at least one caries outcome. Data collection and analysis Two review authors independently assessed trial eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence using the GRADE approach. Main results We included 17 RCTs (4 cluster-randomised), involving 23,732 caregivers (mainly mothers) and their children. Eleven RCTs assessed four oral health education/promotion interventions against standard care: child diet advice, child diet and feeding practice advice, breastfeeding promotion and support, and oral hygiene with child diet and feeding practice advice. Six trials assessed clinical interventions in mother's dentition, four trials chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo, and two trials xylitol against CHX or CHX + xylitol. At most, three trials (maximum of 1148 children and 130 mothers) contributed data to any comparison. For many trials, risk of bias was judged unclear due to lack of methodological details reported, and there was high risk of attrition bias in some trials. None of the included trials indicated receiving funding that is likely to have influenced their results. The trials were performed in high-, middle- and low-income countries. In nine trials, participants were socioeconomically disadvantaged. For child diet and feeding practice advice versus standard care, we observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a lower mean dmfs (decayed, missing, filled primary surfaces) score (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, we are uncertain regarding the difference between the groups in mean dmft (decayed, missing, filled teeth) score (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). For breastfeeding promotion and support versus standard care, we observed that there may be little or no a difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence), or mean dmft score (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). Dmfs was not reported for this comparison. We are uncertain whether child diet advice only compared with standard care reduces risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). Dmfs and dmft were not reported for this comparison. For oral hygiene, child diet and feeding practice advice versus standard care, we observed little or no reduced risk of caries presence in primary teeth (RR 0.91, 95% CI 0.75 to 1.10; 2 trials; 365 participants; low-certainty evidence), and are uncertain regarding difference between the groups in mean dmfs score (MD -0.99, 95% CI -2.45 to 0.47; 1 trial; 187 participants; very low-certainty evidence) and dmft score (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; very low-certainty evidence). We observed there may be little or no difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment in mother's dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trials assessing this comparison reported dmfs or dmft. For xylitol compared with CHX antimicrobial treatment, we observed there may be a lower mean dmft score with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence); however, we are uncertain regarding the difference between groups in caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence). Neither trial evaluating this comparison reported dmfs. No trials assessed a health policy or service intervention. Authors' conclusions Moderate-certainty evidence suggests that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very low certainty and is insufficient for determining which, if any, other interventions types and features may be effective for preventing ECC. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine effects and relative effects of different interventions and inform practice. We have identified 12 studies currently in progress. Those designing future studies should describe the intervention components, setting and participants, consider if and how effects are modified by intervention features and participant characteristics, and adopt a consistent approach to measuring and reporting ECC.
49 citations
Cites background from "Severe early childhood caries and s..."
...…most common chronic diseases of childhood, affecting between 30% to 50% of children in high-income countries (AIHW 2016; Alsharif 2016; Dye 2015; Pitts 2015) and up to 90% in low- and middle-income countries (Ayele 2013; Peltzer 2015) and other vulnerable populations (Calvasina 2015; Smith 2015)....
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...Peltzer 2015 Peltzer K, Mongkolchati A. Severe early childhood caries and social determinants in three-year-old children from Northern Thailand: a birth cohort study....
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514 citations
Additional excerpts
...The outcome of this study was S-ECC, defined as ≥1 cavitated, missing or filled smooth surfaces in primary maxillary anterior teeth, or decayed, missing or filled surface (dmfs) values ≥4 [24]....
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TL;DR: Infant bottle-feeding habits and ethnicity other than Caucasian were significant determinants for both anterior caries pattern and severity of ECC in 4-5-year-old Australian children.
Abstract: – Objectives: The aim of this study was to investigate the association between selected social and behavioural variables and the pattern and severity of early childhood caries (ECC) within a community child population.
Methods: A cross-sectional sample of 2515 children aged 4–5 years were examined in a preschool setting using decayed, missing, filled teeth/surface (dmft/dmfs) indices and a self-administered questionnaire was used to obtain information regarding social, demographic, birth, infant feeding, oral and general health attitudes. Children with caries (847) were divided into anterior or posterior caries pattern groups and severe (dmfs score ≥6) or non-severe (dmfs score <6) caries groups. The data were analysed using a chi-square test and modelled using a logistic regression procedure.
Results: Significant variables associated with anterior ECC pattern were ethnicity other than Caucasian (OR = 2.1, 95% CI = 1.4–3.1), sipping from the bottle during the day (OR = 1.9, 95% CI = 1.3–2.7), male gender (OR = 1.6, 95% CI = 1.2–2.2) and sleeping with a bottle at night (OR = 1.5, 95% CI = 1.1–2.2). Significant variables associated with severe ECC form were sipping from the bottle during the day (OR = 2, 95% CI = 1.4–2.8), maternal age at birth ≤24 years (OR = 1.8, 95% CI = 1.3–2.7), ethnicity other than Caucasian (OR = 1.6, 95% CI = 1.1–2.5) and sleeping with a bottle at night (OR = 1.5, 95% CI = 1.1–2.2).
Conclusions: Infant bottle-feeding habits (either allowing a child to sip from a bottle during the day or put to sleep at night) and ethnicity other than Caucasian were significant determinants for both anterior caries pattern and severity of ECC in 4–5-year-old Australian children.
155 citations
"Severe early childhood caries and s..." refers background in this paper
...feeding and eating patterns such as excessive sugar intake [13, 14, 16, 17]; high snack consumption level [8, 13], breastfeeding ≥7 times daily [13], night-time breastfeeding [9], breastfeeding for more than 12 months [2, 4]; improper infant bottle-feeding habits (use of the nursing bottle in bed [2]; bottle use for liquids other than milk [13]; sleeping with a bottle containing carbohydrates during the night [4]; use of a bottle at night as a substitute for the pacifier and its use on demand during the day [9, 18]; Low-frequency toothbrushing and improper toothbrushing methods [4, 19], start of tooth brushing after the first anniversary [2] and 4) use of dental services [2] and those who utilised dental services only when they had a problem [8]....
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TL;DR: Early feeding practices which represent risk factors for caries severity in subsequent years are identified and may contribute to developing general and oral health interventions, with special attention to families with low maternal education.
Abstract: The aim of this study was to investigate the relationship between feeding practices in the first year of life and the occurrence of severe early childhood caries (S-ECC) at 4 years of age. A birth cohort study (n = 500) was conducted in children who were born within the public health system in Sao Leopoldo, Brazil. Feeding practices were assessed using standardized methods at 6 and 12 months of age. A total of 340 children were examined at 4 years of age. S-ECC was defined as recommended by an expert panel for research purposes: ≧1 cavitated, missing or filled smooth surfaces in primary maxillary anterior teeth or d1+ mfs ≧5. Poisson regression with robust variance was used in order to determine the early feeding practices which represent risk factors for the occurrence of S-ECC at 4 years of age. The multivariable model showed a higher adjusted risk of S-ECC for the following dietary practices at 12 months: breastfeeding ≧7 times daily (RR = 1.97; 95% CI = 1.45–2.68), high density of sugar (RR = 1.43; 95% CI = 1.08–1.89), bottle use for liquids other than milk (RR = 1.41; 95% CI = 1.08–1.86), as well as number of meals and snacks >8 (RR = 1.42; 95% CI = 1.02–1.97). Mother’s education ≤8 years was also associated with the outcome. The present study identified early feeding practices which represent risk factors for caries severity in subsequent years. These findings may contribute to developing general and oral health interventions, with special attention to families with low maternal education.
141 citations
Journal Article•
TL;DR: It was concluded that night-time breast-feeding in children older than 12 months of age, the use of a bottle at night as a substitute for the pacifier, and use of the bottle on demand during the day are feeding practices correlated with the etiology of SECC.
Abstract: Purpose: The objective of this study was to analyze the association between the feeding practice and presence or absence of SECC (Severe Early Childhood Caries) in Brazilian preschool children. Methods: This cross-sectional study was conducted with male and female preschool children, aged 36 to 71 months, randomly selected from a low-income population. A 24-hour recall diary was used to assess data about infant feeding practices and dietary habits. The data were statistically analyzed using the chi-square test with a significance level of 5%. Results: SECC was observed in 36% of the children examined. Infant feeding practices showed the association between SECC and night-time breast-feeding (P=.02) or breastfeeding (P=.0004) in children older than 12 months of age. The use of a bottle at night as a substitute for the pacifier and its use on demand during the day were also correlated with SECC (P<.0001). Conclusions: It was concluded that night-time breast-feeding in children older than 12 months of age, the use of a bottle at night as a substitute for the pacifier, and use of the bottle on demand during the day are feeding practices correlated with the etiology of SECC. (Pediatr Dent. 2005;27:28-33)
97 citations
"Severe early childhood caries and s..." refers background in this paper
...1 % (5–6 years) in Ajman, United Arab Emirates [8], 36 % (35–71 months old) in a health facility in Brazil [9], 46 % (2–6 years) in the Inuvik region, Northwest Territories, Canada [10], and 56 % (mean age 42 months) in Cambodia [11]....
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...The prevalence of S-ECC in pre-school age children ranged from 0.8 % (6–71 months) in Nigeria [3], 2.7 % (36–71 months) in Italy [4], 6.5 % (3 year-olds) in Lithuania [5], 9.5 % (3–5 years) in Germany [2], 17.5 % (3–5 years old) in Trinidad [6], 27 % (2 year-olds) in a sample of African Americans [7], 31.1 % (5–6 years) in Ajman, United Arab Emirates [8], 36 % (35–71 months old) in a health facility in Brazil [9], 46 % (2–6 years) in the Inuvik region, Northwest Territories, Canada [10], and 56 % (mean age 42 months) in Cambodia [11]....
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...feeding and eating patterns such as excessive sugar intake [13, 14, 16, 17]; high snack consumption level [8, 13], breastfeeding ≥7 times daily [13], night-time breastfeeding [9], breastfeeding for more than 12 months [2, 4]; improper infant bottle-feeding habits (use of the nursing bottle in bed [2]; bottle use for liquids other than milk [13]; sleeping with a bottle containing carbohydrates during the night [4]; use of a bottle at night as a substitute for the pacifier and its use on demand during the day [9, 18]; Low-frequency toothbrushing and improper toothbrushing methods [4, 19], start of tooth brushing after the first anniversary [2] and 4) use of dental services [2] and those who utilised dental services only when they had a problem [8]....
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TL;DR: Results of the study demonstrate that even in Western countries ECC and S-ECC represent a significant burden in preschool children, particularly in those disadvantaged, and that most of the known modifiable associated factors regarding feeding practices and oral hygiene are still very spread in the population.
Abstract: This survey was intended to investigate prevalence and severity of early childhood caries (ECC) in a sample of children in Southern Italy and to identify factors that may be related to this condition The study was designed as a cross-sectional survey The study population (children aged 36–71 months) attending thirteen kindergartens was randomly selected through a two-stage cluster sampling procedure Parents/guardians of all eligible children were invited to participate filling out a structured self-administered questionnaire, and after having returned the informed consent form an oral examination of the child was performed at school The questionnaire included information on: socio-demographics about parents/guardians and child, pregnancy and newborn characteristics, oral hygiene habits of child, eating habits particularly on consumption of sweets, access to dental services, and infant feeding practices The WHO caries diagnostic criteria for deciduous decayed, missing and filled teeth (dmft) and surfaces (dmfs) were used to record ECC and severe-ECC (S-ECC) Univariate and multiple logistic regression analyses were conducted to evaluate statistical associations of social demographics, infant feeding practices, oral hygiene habits, and access to dental services to ECC, S-ECC, dmft and dmfs 515 children participated in the study 19% had experienced ECC, and 27% S-ECC, with a mean dmft and dmfs scores of 051 and 099, respectively Mean dmft was 268 in ECC subjects, and 686 in S-ECC subjects Statistical analysis showed that prevalence of ECC significantly increased with age (OR = 195; 95% CI = 13-291) and duration of breastfeeding (OR = 126; 95% CI = 101-157), whereas it was significantly lower in children of more educated mothers (OR = 064; 95% CI = 042-096), and higher in those who had been visited by a dentist in the previous year (OR = 329; 95% CI = 172-633) Results of our study demonstrate that even in Western countries ECC and S-ECC represent a significant burden in preschool children, particularly in those disadvantaged, and that most of the known modifiable associated factors regarding feeding practices and oral hygiene are still very spread in the population
85 citations
"Severe early childhood caries and s..." refers background in this paper
...139) Moreover, as found in previous studies, low-frequency tooth brushing and improper tooth brushing methods [4, 19] (less than daily tooth brushing before 30 months) were associated in bivariate analysis with S-ECC....
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...feeding and eating patterns such as excessive sugar intake [13, 14, 16, 17]; high snack consumption level [8, 13], breastfeeding ≥7 times daily [13], night-time breastfeeding [9], breastfeeding for more than 12 months [2, 4]; improper infant bottle-feeding habits (use of the nursing bottle in bed [2]; bottle use for liquids other than milk [13]; sleeping with a bottle containing carbohydrates during the night [4]; use of a bottle at night as a substitute for the pacifier and its use on demand during the day [9, 18]; Low-frequency toothbrushing and improper toothbrushing methods [4, 19], start of tooth brushing after the first anniversary [2] and 4) use of dental services [2] and those who utilised dental services only when they had a problem [8]....
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