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Open AccessArticle

The Association between Molar-Incisor Hypomineralization and Dental Caries with Socioeconomic Status as an Explanatory Variable in a Group of Finnish Children

by Emma Wuollet, Sakari Laisi, Satu Alaluusua and Janna Waltimo-Sirén

Int. J. Environ. Res. Public Health 2018, 15(7), 1324; https://doi.org/10.3390/ijerph15071324 - 25 Jun 2018

Cited by 23 | Viewed by 5341

Abstract

The aim of this study was to investigate if a developmental enamel defect known as Molar-Incisor Hypomineralization (MIH) is associated with dental caries. Socioeconomic status (SES) was examined as a confounding factor between caries and MIH. In this cross-sectional study, 636 children, aged [...] Read more.

The aim of this study was to investigate if a developmental enamel defect known as Molar-Incisor Hypomineralization (MIH) is associated with dental caries. Socioeconomic status (SES) was examined as a confounding factor between caries and MIH. In this cross-sectional study, 636 children, aged 8 to 13 years, from three towns (two rural areas and one urban area) in Finland were examined for MIH in line with the criteria of the European Academy of Paediatric Dentistry. Caries status for permanent teeth was recorded as decayed, missing and filled teeth (DMFT). Caries experience (DMFT > 0) in the first permanent molars (FPMs) was set as an outcome. SES was determined using a questionnaire completed by parents. The prevalence of MIH was 18.1%. The mean DMFT in FPMs for children with MIH was higher than for their peers, 1.03 ± 1.25 vs. 0.32 ± 0.80 (p = 0.000, Mann-Whitney U test). In a multivariate analysis using the generalized linear mixed model where locality, SES, age and MIH were taken into account as caries risk indicators, MIH was the strongest risk indicator of caries in FPMs (Odds Ratio: 6.60, 95% Confidence Interval: 3.83–11.39, p = 0.000). According to the study results, children with MIH have a higher risk for dental caries than children without MIH. Full article

(This article belongs to the Special Issue Epidemiology and Determinants of Dental Caries in Children)

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Open AccessArticle

Factors Associated with Dental Caries in Primary Dentition in a Non-Fluoridated Rural Community of New South Wales, Australia

by Amit Arora, Narendar Manohar and James Rufus John

Int. J. Environ. Res. Public Health 2017, 14(12), 1444; https://doi.org/10.3390/ijerph14121444 - 23 Nov 2017

Cited by 11 | Viewed by 5800

Abstract

Dental caries persists as one of the most prevalent chronic diseases among children worldwide. This study aims to determine factors that influence dental caries in primary dentition among primary school children residing in the rural non-fluoridated community of Lithgow, New South Wales, Australia. [...] Read more.

Dental caries persists as one of the most prevalent chronic diseases among children worldwide. This study aims to determine factors that influence dental caries in primary dentition among primary school children residing in the rural non-fluoridated community of Lithgow, New South Wales, Australia. A total of 495 children aged 5–10 years old from all the six primary schools in Lithgow were approached to participate in a cross-sectional survey prior to implementation of water fluoridation in 2014. Following parental consent, children were clinically examined for caries in their primary teeth, and parents were requested to complete a questionnaire on previous fluoride exposure, diet and relevant socio-demographic characteristics that influence oral health. Multiple logistic regression analysis was employed to examine the independent risk factors of primary dentition caries. Overall, 51 percent of children had dental caries in one or more teeth. In the multiple logistic regression analysis, child’s age (Adjusted Odd’s Ratio (AOR) = 1.30, 95% CI: 1.14–1.49) and mother’s extraction history (AOR = 2.05, 95% CI: 1.40–3.00) were significantly associated with caries experience in the child’s primary teeth. In addition, each serve of chocolate consumption was associated with 52 percent higher odds (AOR = 1.52, 95% CI: 1.19–1.93) of primary dentition caries. Full article

(This article belongs to the Special Issue Epidemiology and Determinants of Dental Caries in Children)

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Open AccessArticle

Development and Relative Validity of a Food Frequency Questionnaire to Assess Intakes of Total and Free Sugars in Australian Toddlers

by Gemma Devenish, Aqif Mukhtar, Andrea Begley, Loc Do and Jane Scott

Int. J. Environ. Res. Public Health 2017, 14(11), 1361; https://doi.org/10.3390/ijerph14111361 - 8 Nov 2017

Cited by 16 | Viewed by 4808

Abstract

Background: Dental research into early childhood caries is hindered by a lack of suitable dietary assessment tools that have been developed and validated for the population and outcomes of interest. The aim of this study was to develop and investigate the relative [...] Read more.

Background: Dental research into early childhood caries is hindered by a lack of suitable dietary assessment tools that have been developed and validated for the population and outcomes of interest. The aim of this study was to develop and investigate the relative validity and reproducibility of the Study of Mothers’ and Infants’ Life Events Food Frequency Questionnaire (SMILE-FFQ), to assess the total and free sugars intakes of Australian toddlers. Methods: The SMILE-FFQ was designed to capture the leading dietary contributors to dental caries risk in toddlers aged 18–30 months via a proxy report. Ninety-five parents of Australian toddlers completed the questionnaire online before and after providing three 24-h recalls (24HR), collected on non-consecutive days using the multipass method. Total and free sugars were compared between the two SMILE-FFQ administrations and between each SMILE-FFQ and the 24HR using multiple statistical tests and standardised validity criteria. Correlation (Pearson), mean difference (Wilcoxon rank test) and Bland Altman analyses were conducted to compare absolute values, with cross-classification (Chi-Square and Weighted Kappa) used to compare agreement across tertiles. Results: All reproducibility tests showed good agreement except weighted kappa, which showed acceptable agreement. Relative validity tests revealed a mix of good and acceptable agreement, with total sugars performing better at the individual level than free sugars. Compared to the 24HR, the SMILE-FFQ tended to underestimate absolute values at lower levels and overestimate them at higher levels. Conclusions: The combined findings of the various tests indicate that the SMILE-FFQ performs comparably to the 24HR for assessing both total and free sugars among individuals, is most effective for ranking participants rather than determining absolute intakes, and is therefore suitable for use in observational studies of Australian toddlers. Full article

(This article belongs to the Special Issue Epidemiology and Determinants of Dental Caries in Children)

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Open AccessFeature PaperArticle

Factors Influencing Early Feeding of Foods and Drinks Containing Free Sugars—A Birth Cohort Study

by Diep H. Ha, Loc G. Do, Andrew John Spencer, William Murray Thomson, Rebecca K. Golley, Andrew J. Rugg-Gunn, Steven M. Levy and Jane A. Scott

Int. J. Environ. Res. Public Health 2017, 14(10), 1270; https://doi.org/10.3390/ijerph14101270 - 23 Oct 2017

Cited by 32 | Viewed by 5732

Abstract

Early feeding of free sugars to young children can increase the preference for sweetness and the risk of consuming a cariogenic diet high in free sugars later in life. This study aimed to investigate early life factors influencing early introduction of foods/drinks containing [...] Read more.

Early feeding of free sugars to young children can increase the preference for sweetness and the risk of consuming a cariogenic diet high in free sugars later in life. This study aimed to investigate early life factors influencing early introduction of foods/drinks containing free sugars. Data from an ongoing population-based birth cohort study in Australia were used. Mothers of newborn children completed questionnaires at birth and subsequently at ages 3, 6, 12, and 24 months. The outcome was reported feeding (Yes/No) at age 6–9 months of common foods/drinks sources of free sugars (hereafter referred as foods/drinks with free sugars). Household income quartiles, mother’s sugar-sweetened beverage (SSB) consumption, and other maternal factors were exposure variables. Analysis was conducted progressively from bivariate to multivariable log-binomial regression with robust standard error estimation to calculate prevalence ratios (PR) of being fed foods/drinks with free sugars at an early age (by 6–9 months). Models for both complete cases and with multiple imputations (MI) for missing data were generated. Of 1479 mother/child dyads, 21% of children had been fed foods/drinks with free sugars. There was a strong income gradient and a significant positive association with maternal SSB consumption. In the complete-case model, income Q1 and Q2 had PRs of 1.9 (1.2–3.1) and 1.8 (1.2–2.6) against Q4, respectively. The PR for mothers ingesting SSB everyday was 1.6 (1.2–2.3). The PR for children who had been breastfed to at least three months was 0.6 (0.5–0.8). Similar findings were observed in the MI model. Household income at birth and maternal behaviours were significant determinants of early feeding of foods/drinks with free sugars. Full article

(This article belongs to the Special Issue Epidemiology and Determinants of Dental Caries in Children)

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Open AccessArticle

Maintaining Traditions: A Qualitative Study of Early Childhood Caries Risk and Protective Factors in an Indigenous Community

by Ana Levin, Karen Sokal-Gutierrez, Anita Hargrave, Elizabeth Funsch and Kristin S. Hoeft

Int. J. Environ. Res. Public Health 2017, 14(8), 907; https://doi.org/10.3390/ijerph14080907 - 11 Aug 2017

Cited by 21 | Viewed by 7218

Abstract

In lower middle-income economies (LMIE), the nutrition transition from traditional diets to sugary foods and beverages has contributed to widespread early childhood dental caries. This qualitative study explores perceived risk and protective factors, and overall experiences of early childhood nutrition and oral health [...] Read more.

In lower middle-income economies (LMIE), the nutrition transition from traditional diets to sugary foods and beverages has contributed to widespread early childhood dental caries. This qualitative study explores perceived risk and protective factors, and overall experiences of early childhood nutrition and oral health in indigenous Ecuadorian families participating in a community-based oral health and nutrition intervention. Dental exams of 698 children age 6 months through 6 years determined each child’s caries burden. A convenience sample of 18 “outlier” families was identified: low-caries children with ≤2 carious teeth vs. high-caries children with ≥10 carious teeth. Semi-structured in-depth interviews with parents/caregivers explored the child’s diet, dental habits, and family factors related to nutrition and oral health. Interviews were transcribed and thematically analyzed using grounded theory. In the high-caries families, proximity to highway and stores, consumption of processed-food, and low parental monitoring of child behavior were identified as risk factors for ECC (early childhood caries). In the low-caries families, protective factors included harvesting and consuming food from the family farm, remote geography, and greater parental monitoring of child behavior. The study results suggest that maintaining traditional family farms and authoritative parenting to avoid processed foods/drinks and ensure tooth brushing could improve early childhood nutrition and oral health. Full article

(This article belongs to the Special Issue Epidemiology and Determinants of Dental Caries in Children)

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Open AccessArticle

Associations between Malocclusion and Oral Health-Related Quality of Life among Mongolian Adolescents

by Miyu Araki, Yuko Yasuda, Takuya Ogawa, Tsasan Tumurkhuu, Ganjargal Ganburged, Amarsaikhan Bazar, Takeo Fujiwara and Keiji Moriyama

Int. J. Environ. Res. Public Health 2017, 14(8), 902; https://doi.org/10.3390/ijerph14080902 - 10 Aug 2017

Cited by 25 | Viewed by 5611

Abstract

Malocclusion may affect oral health-related quality of life (OHR-QoL), however, the previously detected associations were affected by confounding factors. We hypothesized that there is indeed an association between OHR-QoL and malocclusion and investigated in a population-based study of 420 Mongolian adolescents mean age: [...] Read more.

Malocclusion may affect oral health-related quality of life (OHR-QoL), however, the previously detected associations were affected by confounding factors. We hypothesized that there is indeed an association between OHR-QoL and malocclusion and investigated in a population-based study of 420 Mongolian adolescents mean age: 12.6 (standard deviation (SD) = 1.09) years from two secondary schools, located in an urban and a suburban area. We randomly selected two classes from each school. The Index of Orthodontic Treatment Need (IOTN) was used to assess malocclusion. OHR-QoL was assessed using the Child Perceptions Questionnaire (CPQ). Multivariate analysis was used to determine whether malocclusion had an independent effect on OHR-QoL. Overall, the existence of any type of malocclusion was not significantly associated with CPQ results. However, increased overjet was significantly associated with oral symptoms (coefficient: 0.66, 95% CI: 0.14–1.19), functional limitations (coefficient: 0.62, 95% CI: 0.17–1.08), and social well-being (coefficient: 0.50, 95% CI: 0.06–0.93). Deep bite was also significantly associated with oral symptoms (coefficient: 0.54, 95% CI: 0.23–0.84) and functional limitations (coefficient: 0.45, 95% CI: 0.19–0.72). Although malocclusion per se was not significantly associated with OHR-QoL, specific types of malocclusion, i.e., increased overjet and deep bite, were associated with OHR-QoL. Full article

(This article belongs to the Special Issue Epidemiology and Determinants of Dental Caries in Children)

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Open AccessArticle

Associations of Community Water Fluoridation with Caries Prevalence and Oral Health Inequality in Children

by Han-Na Kim, Jeong-Hee Kim, Se-Yeon Kim and Jin-Bom Kim

Int. J. Environ. Res. Public Health 2017, 14(6), 631; https://doi.org/10.3390/ijerph14060631 - 13 Jun 2017

Cited by 21 | Viewed by 7329

Abstract

This study aimed to confirm the association between the community water fluoridation (CWF) programme and dental caries prevention on permanent teeth, comparing to a control area, neighbouring population without the programme, and verifying whether the programme can reduce the socio-economic inequality related to [...] Read more.

This study aimed to confirm the association between the community water fluoridation (CWF) programme and dental caries prevention on permanent teeth, comparing to a control area, neighbouring population without the programme, and verifying whether the programme can reduce the socio-economic inequality related to the oral health of children in Korea. Evaluation surveys were conducted among 6-, 8-, and 11-year-old children living in Okcheon (CWF) and neighbouring Yeongdong (non-CWF, control area) towns in South Korea. Data on monthly family income, caregiver educational level, and Family Affluence Scale scores were evaluated using questionnaires that were distributed to the parents. The effectiveness of CWF in caries reduction was calculated based on the differences in decayed, missing, and filled teeth and decayed, missing, and filled tooth surfaces indices between the two towns. The data were analysed using logistic regression and univariate analysis of variance. Both 8- and 11-year-old children living in the CWF area had lower dental caries prevalence than those living in the non-CWF community. Differences in dental caries prevalence based on educational level were found in the control area but not in the CWF area. Socio-economic factor-related inequality in oral health were observed in the non-CWF community. Additionally, 8- and 11-year-old children living in the CWF area displayed lower dental caries prevalence in the pit-and-fissure and smooth surfaces than those living in the non-CWF community. These results suggest that CWF programmes are effective in the prevention of caries on permanent teeth and can reduce oral health inequalities among children. The implementation of CWF programmes should be sustained to overcome oral health inequalities due to socio-economic factors and improve children’s overall oral health. Full article

(This article belongs to the Special Issue Epidemiology and Determinants of Dental Caries in Children)

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Open AccessArticle

Occlusal Features and Caries Experience of Hong Kong Chinese Preschool Children: A Cross-Sectional Study

by Shinan Zhang, Edward Chin Man Lo and Chun Hung Chu

Int. J. Environ. Res. Public Health 2017, 14(6), 621; https://doi.org/10.3390/ijerph14060621 - 9 Jun 2017

Cited by 7 | Viewed by 5462

Abstract

Objective: To study occlusal features and their relation to caries experience in Hong Kong Chinese preschool children. Methods: Seven kindergarten classes in Hong Kong were selected using a stratified random sampling method, and the 4- and 5-year-old Chinese kindergarten children were invited to [...] Read more.

Objective: To study occlusal features and their relation to caries experience in Hong Kong Chinese preschool children. Methods: Seven kindergarten classes in Hong Kong were selected using a stratified random sampling method, and the 4- and 5-year-old Chinese kindergarten children were invited to join the survey. Two calibrated dentists performed the clinical examinations in the kindergartens. Occlusion features, including incisal overjet; canine and molar relationship; median diastema; and primate space as well as malocclusion features, including crossbite; anterior open bite; and scissor bite, were recorded. Caries experience was recorded with the dmft index. Results: A total of 538 children were invited to participate in the study, and finally 495 children were examined (92%). Approximately half (52%) had a normal incisor relationship. Most children had a class I canine relationship (left-79%; right-75%). Approximately two-thirds had a flush terminal plane (left-64%; right-65%). Most children (76%) had a maxillary primate space, and 47% had a mandibular primate space. The prevalence of median diastema, anterior crossbite, and unilateral posterior crossbite was 30%, 12% and 1%, respectively. No bilateral posterior crossbite or scissor bite was found. Approximately half (49%) had caries experience. The mean dmft score was 2.1. Gender and age were not associated with either the studied occlusal features or the mean dmft score (p > 0.05). Conclusion: Approximately half of the Hong Kong preschool children studied had a normal occlusion, and two-thirds of them had a flush terminal plane. About three-quarters of them had a maxillary primate space, and half of them had a mandibular primate space. Their occlusal traits were not associated with caries experience and prevalence. Full article

(This article belongs to the Special Issue Epidemiology and Determinants of Dental Caries in Children)

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Open AccessArticle

Early Childhood Dental Caries, Mouth Pain, and Malnutrition in the Ecuadorian Amazon Region

by Marvin So, Yianni A. Ellenikiotis, Hannah M. Husby, Cecilia Leonor Paz, Brittany Seymour and Karen Sokal-Gutierrez

Int. J. Environ. Res. Public Health 2017, 14(5), 550; https://doi.org/10.3390/ijerph14050550 - 22 May 2017

Cited by 39 | Viewed by 8668

Abstract

Malnutrition and dental caries in early childhood remain persistent and intertwined global health challenges, particularly for indigenous and geographically-remote populations. To examine the prevalence and associations between early childhood dental caries, parent-reported mouth pain and malnutrition in the Amazonian region of Ecuador, we [...] Read more.

Malnutrition and dental caries in early childhood remain persistent and intertwined global health challenges, particularly for indigenous and geographically-remote populations. To examine the prevalence and associations between early childhood dental caries, parent-reported mouth pain and malnutrition in the Amazonian region of Ecuador, we conducted a cross-sectional study of the oral health and nutrition status of 1407 children from birth through age 6 in the “Alli Kiru” program (2011–2013). We used multivariate regression analysis to examine relationships between severe caries, parent-reported mouth pain measures, and nutritional status. The prevalence of dental caries was 65.4%, with 44.7% of children having deep or severe caries, and 33.8% reporting mouth pain. The number of decayed, missing and filled teeth (dmft) increased dramatically with age. Malnutrition was prevalent, with 35.9% of children stunted, 1.1% wasted, 7.4% underweight, and 6.8% overweight. As mouth pain increased in frequency, odds for severe caries increased. For each unit increase in mouth pain frequency interfering with sleeping, children had increased odds for being underweight (Adjusted Odds Ratio (AOR): 1.27; 95% CI: 1.02–1.54) and decreased odds for being overweight (AOR: 0.76; 95% CI: 0.58–0.97). This relationship was most pronounced among 3–6 year-olds. Early childhood caries, mouth pain and malnutrition were prevalent in this sample of young children. Parent-reported mouth pain was associated with severe caries, and mouth pain interfering with sleeping was predictive of poor nutritional status. We demonstrate the utility of a parsimonious parent-reported measure of mouth pain to predict young children’s risk for severe early childhood caries and malnutrition, which has implications for community health interventions. Full article

(This article belongs to the Special Issue Epidemiology and Determinants of Dental Caries in Children)

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Open AccessArticle

Income-Related Inequalities in Access to Dental Care Services in Japan

by Akemi Nishide, Misuzu Fujita, Yasunori Sato, Kengo Nagashima, Sho Takahashi and Akira Hata

Int. J. Environ. Res. Public Health 2017, 14(5), 524; https://doi.org/10.3390/ijerph14050524 - 12 May 2017

Cited by 36 | Viewed by 5941

Abstract

Background: This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods: The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 [...] Read more.

Background: This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods: The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 to 31 March 2015. The presence or absence of dental visits and number of days spent on dental care services during the year were calculated using insurance claims submitted. Equivalent household income was calculated using individual income data from 1 January to 31 December 2013, declared for taxation. Results: Of the 216,211 enrolled subjects, 50.3% had dental care during the year. Among those with dental visits, the average number of days (standard deviation) spent on dental care services per year was 7.7 (7.1). Low income was associated with a decreased rate of dental care utilization regardless of age and sex. However, there was a significant inverse linear association between the number of days spent on dental care services and income levels for both sexes. Conclusions: There were income-related inequalities in access to dental care services, regardless of the age group or sex, within the Japanese universal health insurance system. Full article

(This article belongs to the Special Issue Epidemiology and Determinants of Dental Caries in Children)

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Open AccessArticle

Prevalence of Malocclusion in 3- to 5-Year-Old Children in Shanghai, China

by Xinhua Zhou, Ying Zhang, Yan Wang, Hao Zhang, Li Chen and Yuehua Liu

Int. J. Environ. Res. Public Health 2017, 14(3), 328; https://doi.org/10.3390/ijerph14030328 - 22 Mar 2017

Cited by 27 | Viewed by 8220

Abstract

The aim of the present study was to obtain the prevalence of malocclusions in preschool children in Shanghai, China. A cross-sectional survey was conducted among 2335 children aged 3–5 years from kindergartens. Several occlusal parameters were clinically assessed, including second deciduous molar terminal [...] Read more.

The aim of the present study was to obtain the prevalence of malocclusions in preschool children in Shanghai, China. A cross-sectional survey was conducted among 2335 children aged 3–5 years from kindergartens. Several occlusal parameters were clinically assessed, including second deciduous molar terminal plane, canine relationship, degree of overjet and overbite, anterior and posterior crossbite, and the presence or absence of physiologic spaces and crowding. All parents of subjects were asked to fill in the oral health knowledge questionnaires. The prevalence of malocclusion in primary dentition in Shanghai was 83.9%, and no significant differences were found in genders. Data showed that the prevalence of deep overbite (63.7%) was the highest in children with malocclusion, followed by deep overjet (33.9%), midline deviation (26.6%), anterior crossbite (8.0%) and anterior crowding (6.5%). The results revealed a high prevalence of malocclusion in primary dentition in children aged 3–5 years old of Shanghai, especially in vertical anomalies. The need for preventive orthodontic therapy is extremely desired and oral health education about malocclusion should be strengthened. Full article

(This article belongs to the Special Issue Epidemiology and Determinants of Dental Caries in Children)

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Review

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Managing Early Childhood Caries with Atraumatic Restorative Treatment and Topical Silver and Fluoride Agents

by Duangporn Duangthip, Kitty Jieyi Chen, Sherry Shiqian Gao, Edward Chin Man Lo and Chun Hung Chu

Int. J. Environ. Res. Public Health 2017, 14(10), 1204; https://doi.org/10.3390/ijerph14101204 - 10 Oct 2017

Cited by 66 | Viewed by 13490

Abstract

Early childhood caries (ECC) is a significant global health problem affecting millions of preschool children worldwide. In general, preschool children from families with 20% of the lowest family incomes suffered about 80% of the ECC. Most, if not all, surveys indicated that the [...] Read more.

Early childhood caries (ECC) is a significant global health problem affecting millions of preschool children worldwide. In general, preschool children from families with 20% of the lowest family incomes suffered about 80% of the ECC. Most, if not all, surveys indicated that the great majority of ECC was left untreated. Untreated caries progresses into the dental pulp, causing pain and infection. It can spread systemically, affecting a child’s growth, development and general health. Fundamental caries management is based on the conventional restorative approach. Because preschool children are too young to cope with lengthy dental treatment, they often receive dental treatment under general anaesthesia from a specialist dentist. However, treatment under general anaesthesia poses a life-threatening risk to young children. Moreover, there are few dentists in rural areas, where ECC is prevalent. Hence, conventional dental care is unaffordable, inaccessible or unavailable in many communities. However, studies showed that the atraumatic restorative treatment had a very good success rate in treating dentine caries in young children. Silver diamine fluoride is considered safe and effective in arresting dentine caries in primary teeth. The aim of this paper is to review and discuss updated evidence of these alternative approaches in order to manage cavitated ECC. Full article

(This article belongs to the Special Issue Epidemiology and Determinants of Dental Caries in Children)

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