An evaluation of NHANES III estimates of early childhood caries

OBJECTIVES: The purposes of this study were to estimate and evaluate the prevalence for the United States of early childhood caries (ECC) among children 12 to 23 months of age. METHODS: The 1988-94 National Health and Nutrition Examination Survey (NHANES III) public-use data set was analyzed using SUDAAN. Two ECC case definitions were used. Definition #1 was restricted to the caries score called by the examiner. Definition #2 liberally included children identified by definition #1 and those possibly having questionable caries scores. RESULTS: The NHANES III six-year prevalence estimates of caries in the maxillary anterior incisors of children 12 to 23 months of age were 1.0 percent for definition #1 and 1.7 percent for definition #2. Mexican-American and economically disadvantaged children were disproportionally represented with ECC. CONCLUSIONS: The prevalence of ECC among children 12 to 23 months of age is barely detectable at the national level. Alternative study designs and improved case definitions are needed for further advances in ECC.     

Early childhood caries lesions in preschool children in Kerala, India

PURPOSE: No data are available on possible risk indicators or the prevalence of caries lesions for preschool children under 4 years of age in Kerala, southern India. Therefore, the aims of this study were: (1) to gather data on caries lesion frequency and distribution; (2) to determine any possible associations with feeding habits and oral health care practices. METHODS: A sample of 530 children, aged from 8 to 48 months (mean=2.5+/-0.96 years), who attended 13 day care centers were clinically examined for caries lesions using a disposable mouth mirror, tongue spatula, and a torch light. There were 513 dentate children. The caregiver of each child then completed, by interview, a structured questionnaire. RESULTS: Among the group of 252 girls and 278 boys, the dmft was 1.84+/-2.87 with 56% of the children being caries-lesion free. Fifty-nine (12%) were considered to have early childhood caries (ECC), based on the criteria that smooth surface caries lesions on all 4 maxillary incisor teeth indicated severe ECC. Breast-feeding was practiced by 99% of the mothers, and 5% did so exclusively. Generally, breast-feeding was on demand. Statistically significant correlations were found between caries lesions and the child's dental condition, as perceived by the mother or caregiver (P<.0001), the dental status of the caregiver (P=.0417), consumption of snacks (P=.0177), giving of sweets as a reward (P<.0001), cleaning of the child's mouth (P<.0001), oral hygiene status of the child (P<.0001) and low socioeconomic status, as measured by income (P<.0001). CONCLUSION: From the results of this study of preschool children in Kerala, the groups at high risk from dental caries lesions are: (1) those with poor oral hygiene status; (2) those who consume snacks and are given sweets as rewards; (3) those belonging to a lower socioeconomic class.     

Longitudinal study of caries,cariogenic bacteria and diet in children just before and after starting school

Fifty 5-yr-old preschool children living in Akranes, a small community in West Iceland known to have a high caries prevalence, were investigated with respect to caries, salivary counts of mutans streptococci and lactobacilli and consumption of cariogenic foods. Fifteen months later, after being in school for half a year, 43 of the 50 children were reexamined and investigated as before. Mean dmfs scores rose from 7.1 to 9.0. but the scores including initial caries rose from 9.7 to 15.3. Mutans streptococci were carried by 84% of children on both occasions with a mean count 2.1 and 3.6 × 10⁵ cfu/ml. Lactobacillus carriage increased from 29 to 38% and the mean count from 5.1 to 13 × 10³ cfu/ml at 6 yr. The frequency of consumption of sugar-containing foods increased from 4.2 to 5.2 intakes per day and between-meal snacks rose from 3.0 to 3.7 per day. Children classified as “misusing” sugar were 59% at 5 yr and 83% at 6 yr. The mean caries score at 6 yr for children “misusing” sugar was 10.7 but only 2.0 for those not misusing sugar. Thus the deterioration in dental health appears, in these children, to be associated with the increased consumption of sweets and other cariogenic between-meal snacks after starting school.     

南京市低龄儿童龋相关危险因素初步研究

目的:研究南京市低龄儿童龋相关危险因素.方法:调查南京市某幼儿园共342例3～5岁儿童口腔健康状况,通过问卷调查收集基线资料,采用横断面研究方法探讨各因素的影响.结果:205例诊断为低龄儿童龋,患龋率为60.0％,其中119例诊断为重度低龄儿童龋,患病率为34.8％.简化软垢指数、菌斑指数、菌斑产酸能力、深点隙裂沟、母...     

维生素D水平与低龄儿童龋风险的相关性分析

目的探讨维生素D水平与低龄儿童龋(early childhood caries,ECC)发生风险的相关性分析,为ECC儿童的一级预防提供依据。方法收集389名6~48月龄儿童的月龄、喂养方式、口腔健康行为等资料,记录龋、失、补指数(decayed?missing?filled teeth,dmft),分为ECC组(n=146)和无龋组(n=243),采集指尖末梢血检测维生素D体内活性形式--25?羟维生素D[25(OH)D],采集牙菌斑行龋活跃性检验检测龋态(Cariostat)值,Logistic回归分析25(OH)D等龋相关因素与ECC发生风险的相关性。结果25(OH)D缺乏、不足、正常的儿童的患龋率差异无统计学意义(c2=2.320,P=0.313)。dmft与25(OH)D水平之间无相关(dmft=1~3,r<0.001,P>0.05;dmft>3,r=0.009,P>0.05)。而月龄(OR=1.082,95%CI:1.045~1.121,P<0.001)、出生后6个月内母乳喂养(OR=2.789,95%CI:1.581~4.921,P<0.001)、吃夜奶或含乳头睡(OR=4.187,95%CI:1.938~9.048,P<0.001)、1.5~3.0的高Cariostat值(OR=4.173,95%CI:2.014~8.646,P<0.001)是ECC的风险因素。结论25(OH)D水平与6~48月龄儿童龋无相关性,而月龄、出生后6个月内母乳喂养、吃夜奶或含乳头睡、高龋活跃性(Cariostat值1.5~3.0)是ECC的风险因素,提倡母乳喂养的同时,应为幼儿树立良好的喂养习惯及口腔卫生习惯。     

Determining the prevalence and risk factors for early childhood caries in a community dental health clinic

PURPOSE: The purposes of this study were to: (1) determine the prevalence of early childhood caries (ECC) among young children accessing dental services at a community dental clinic; (2) identify factors associated with the presence of ECC; and (3) determine the percentage of children who received treatment for ECC in this setting and the number who required referral to specialists. METHODS: The study population comprised children younger than 72 months attending the clinic between 1991 and 2004. A chart review was conducted. RESULTS: Eight hundred thirty-four charts met inclusion criteria; 71% had ECC, while the mean deft was 3.7+/-3.9 (SD). The average age at the first visit was 50.0+/-12.7 (SD) months. Those with ECC were significantly older at the first visit (P<.001), and the prevalence increased with family size (P=.011) and number of siblings (P=.019). ECC children were significantly more likely to come from households with lower monthly incomes (P=.033). The prevalence of ECC did not vary according to specific areas in Winnipeg where children resided (P=.20). CONCLUSIONS: Key risk factors for ECC included: (1) the child's sex; (2) low monthly income; (3) whether the child resided with both parents; and (4) a history of foiled dental visits. These data may assist in identifying children at greatest risk for ECC and may help public health agencies develop appropriate prevention strategies, including promoting early dental visits for infants.     

DENTAL CARIES PREVALENCE IN CHILDREN UP TO 36 MONTHS OF AGE ATTENDING DAYCARE CENTERS IN MUNICIPALITIES WITH DIFFERENT WATER FLUORIDE CONTENT

This study determined the prevalence of cavitated caries lesions (CCL) and early childhood caries (ECC), and the contribution of some variables in children up to 36 months of age attending daycare centers in municipalities with different fluoride levels in the water supply: AFC (adequate fluoride content) and LFC (low fluoride content). After approval of the Ethics Committee, the parents were interviewed. The children were clinically examined using the same codes and criteria established by the WHO (World Health Organization) and the ADA (American Dental Association). Fisher''s exact test (p<0.05) was applied for statistical analysis of data. The dmft indices calculated in the LFC and AFC municipalities were 0.57 and 0.68, respectively. Considering all children examined, 17.6% presented CCL and 33.8% ECC. The economic classification, mother''s education level and duration of breastfeeding were considered statistically significant with regards to CCL prevalence. The age group, duration of the habit of drinking milk before bedtime and age at which oral hygiene started were considered statistically significant with regards to ECC prevalence.     

Assessing risk indicators for dental caries in the primary dentition

The aim of the present study was to assess indicators shown to be associated with the prevalence of caries in the primary dentition of 7-year-old Flemish schoolchildren. Cross-sectional first year data of the longitudinal Signal-Tandmobiel survey were analysed (n=4468). Gender, age, oral hygiene habits, use of fluorides, dietary habits, geographical factors and parental modelling were the considered predictors. From the multiple logistic regression analysis, including schools as a random effect, and after adjusting for the confounding variables-educational system and province (stratification variables), gender and age-it became clear that the following risk indicators remained significant (at 5% level) for the presence of caries: frequency of toothbrushing (P=0.05) with an OR 1.24 for brushing less than once a day, age at start of brushing (P<0.001) with an OR=1.22 for a delay of 1 year, regular use of fluoride supplements (P<0.001) with an OR=1.54 for no use, daily use of sugar-containing drinks between meals (P<0.001) with an OR=1.38, and number of between-meals snacks (P=0.012) with an OR=1.22 for using more than 2 between-meal snacks. There was a significant difference (P<0.05) in caries experience determined by the geographical spread, with an explicit trend of caries declining from the east to the west. In a model with an ordinal response outcome, the daily use of sugar-containing drinks between meals had a more pronounced effect when caries levels were high. From this study it became obvious that, in Flemish children, an early start of brushing and a brushing frequency of at least once a day need to be encouraged, while the use of sugar-containing drinks and snacks between meals needs to be restricted to a maximum of 2 per day. Geographical differences need to be investigated in more detail.     

Dental caries in a cohort of very young American Indian children

Objectives: This paper reports the prevalence and severity of caries in a group of 16‐month‐old American Indian children. Methods: The study is an ongoing longitudinal study of risk factors for caries in children from a Northern Plains Tribal community. Children were examined for caries and risk factor data collected at approximately 1, 4, 8, 12, and 16 months of age. Surface‐specific caries data were collected and the presence of precavitated “white spot” lesions was recorded at the subject level. Results: The mean age was 15.4 months for the sample of 232 children. Caries prevalence was 31.9 percent, while an additional 29.3 percent had white spot lesions only. Mean dmfs was 1.57, and ranged from 0 to 44 surfaces. Nearly 3 percent of all erupted tooth surfaces were affected and maxillary central incisors had the highest prevalence of caries (22 percent). Conclusions: Among the very youngest children, dental caries prevalence was very high among these American Indian children.     

A review of a community program aimed at preventing early childhood caries among Jerusalem infants--a brief communication

Early childhood caries (ECC) has not been adequately investigated in Israel. A previous Jerusalem study has demonstrated a potential effect on toothbrushing among infants. The present study was initiated in order to examine caries prevalence and the potential effect of a community intervention program. OBJECTIVES: This study aims to review an intervention program and assess ECC distribution and associated variables. METHODS: The study sample included 1,500 infants in matched "intervention" and "control" Mother and Child Health centers. The 2-year program, initially including all children at the age of 6 months, focused on the free distribution of toothbrushes and toothpastes. ECC prevalence was determined in a cross-sectional study. RESULTS: At 2.5 years, 596 children were examined (40 percent compliance). About half of the parents reported that they had participated once or not at all over the 2-year period, which demonstrated low program participation. Among the examined children, ECC prevalence was 15.3 percent. No difference in caries levels was found between the program and control groups. The reported level of brushing twice daily was 13.9 percent, while 26.8 percent reported not brushing at all. Eighty-one percent reported going to bed at night with a bottle. Children who drank sugar-sweetened beverages had ECC levels significantly higher than those who drank milk or natural juice (18.8 percent versus 8.9 percent). CONCLUSIONS: The dental health and behavior and lack of intervention success emphasized the need to seek a more effective strategy. Emphasis on toothbrushing might not be the only nor optimal solution for this serious public health problem.     

Early childhood caries in northern Philippines

OBJECTIVES: To determine prevalence and severity of early childhood caries (ECC) among children in northern Philippines. Further, to describe and determine the impact of child-rearing practices and dental visits on caries status. METHODS: Cross-sectional survey of 993 children aged 2-6 years. Caries was diagnosed based on WHO recommendations. Additional behavioral information was obtained from 452 children aged 3-6 years. RESULTS: Caries prevalence and mean dmft (+/-SD) by age were as follows: 2 years = 59% (4.2 +/- 5.3); 3 years = 85% (7.4 +/- 5.5); 4 years = 90% (8.8 +/- 5.6); 5 years = 94% (9.8 +/- 5.5); and 6 years = 92% (10.1 +/- 5.5). Caries rates mirrored those of developing countries with untreated lesions dominating all ages. Mixed breast and bottle feeding was the norm. Almost half were weaned at more than 2 years old. Majority had toothbrushing practices, but mostly without parental assistance. Toothbrushing was initiated at an average age of 2 years. Only a small proportion had a dental visit, mostly for emergency reasons. Among 3-4-year-old children, a significant increase in caries levels were noted for those who started brushing at a later age, had frequent snacks, and had a dental visit for emergency reasons. For children aged 5-6 years, those who went for emergency visits also had significantly more caries. Results indicated an urgent need to (i) increase awareness that ECC is a public health problem in these areas, (ii) advocate use of fluoride as a public health measure, and (iii) increase access to preventive dental services for preschool children.     

Dental Caries in African Preschool Children: Social Factors as Disease Markers

Objective : This study investigated the associations between dental caries prevalence and severity and social factors in 3- to 5-year-old African children. Methods : Dental caries was diagnosed in natural light using WHO criteria, mirrors, and explorers. Socioeconomic information was obtained by questionnaire. Results : The percentages of 3-, 4-, and 5-year-olds with any caries experience were 47 percent, 58 percent, and 63 percent, respectively. Mean dmfs scores ( sd ) were 2.2(3.6), 3.0(3.8), and 3.7(4.1), respectively. Family education was associated with caries prevalence (P=.03) and severity (P=.008) in a multivariable regression model. Conclusion : In the indigenous African group studied, family education is a disease marker to target in future caries risk evaluations.     

Early childhood caries status and its associated factors among young children in a rural area of Cambodia

BackgroundThe purpose of this cross-sectional study was to measure prevalence and severity of early childhood caries (ECC), and its associated factors among 1- and 2-year-old children in Kampong Cham province, Cambodia.Materials and methodsData, from a representative sample of 128 children (69 males, 59 females; mean age = 22.98 ± 7.68 months), were collected at seven villages in Khpob Ta Nguon district, Kampong Cham province from May to October in 2018. The dental caries status was recorded following WHO guidelines. The socio-economic status, dietary habits and oral hygiene habits of the children were assessed through an interview questionnaire administered to their primary caregivers.ResultsECC prevalence was 50.0%. The mean dft was 2.46 ± 3.08, and 100% of cavitated lesions were untreated. A logistic regression revealed that 1-year-old children who continued night breast-feeding after 12 months were more likely to have ECC (OR = 5.32, 95%CI = 1.33–21.30), whereas the 2-year-old children who continued night breast-feeding beyond 12 months (OR = 13.36, 95%CI = 2.14–82.31), bottle-feeding after 12 months (OR = 6.10, 95%CI = 1.56–23.87), and children who did not adopt tooth brushing by the 1st birthday (OR = 32.23, 95%CI = 4.51–230.54) were more likely to have ECC.ConclusionThe findings of this study indicate that ECC prevalence and severity among this group of rural Cambodian children were high. Oral health programs focusing ECC prevention from an early age should be conducted in this population.     

A longitudinal study of dental caries risk among very young low SES children

Abstract – Objectives: Early childhood caries (ECC) is a challenging public health problem in the United States and elsewhere; however, there is limited information concerning risk factors in very young children. The purpose of this study was to assess baseline risk factors for 18‐month caries prevalence as part of a longitudinal study of high‐risk children. Methods: About 212 children, 6–24 months of age were recruited from a rural community in Iowa. Subjects were enrolled in the WIC program, which provides nutritional support for low‐income families with children. Dental examinations using d1, d2–3 criteria were conducted at baseline and after 18 months. Caries prevalence was determined at the frank decay level (d2–3 or filled surfaces), as well as at the noncavitated level (d1), and combined (d1, d2–3 or f surfaces). Risk factor data were collected at baseline and after 9‐ and 18‐ months. These data included beverage consumption data, presence of visible plaque, and use of fluoride toothpaste for children as well as mutans streptococci (MS) levels of mothers and children and family sociodemographic factors. Results: About 128 children (60%) remained in the study after 18 months. Among these children, prevalence of d1,d2–3/f level caries increased from 9% to 77%, while d2–3/f level caries increased from 2% to 20%. Logistic regression models for baseline predictors of d2–3f caries at the 18‐month follow‐up found the presence of MS in children (OR = 4.4; 95% CI: 1.4, 13.9) and sugar‐sweetened beverages (OR = 3.0; 95% CI: 1.1, 8.6) to be the only significant risk factors. Sociodemographic factors and the use of fluoride toothpaste were not significant in these models. Conclusions: Results suggest that early colonization by MS and consumption of sugar‐sweetened beverages are significant predictors of ECC in high‐risk populations.     

Prevalence of Early Childhood Caries Among Very Young Urban Boston Children Compared with US Children

Objectives: The aims of this study were to compare prevalence of early childhood caries (ECC) in 1- to 3-year-old children seeing primary-care pediatricians at two urban medical centers in Boston to the prevalence of ECC in similarly aged US children surveyed as part of the Third National Health and Nutrition Examination Survey (NHANES III) and to assess risk factors for ECC among this cohort of children compared with risk factors among similarly aged US children. Methods: Characteristics of 787 1- to 3-year-old children from two urban Boston medical centers were compared with those of 3,644 similarly aged US children surveyed as part of NHANES III. Demographic and social characteristics and ECC prevalence by putative risk factors were compared. A multiple logistic regression model was fit to assess putative risk factors and difference between groups simultaneously. Results: Race, age, previous dental visit, parents' education, and household income were significantly associated with ECC prevalence. Parents' place of birth was a significant effect modifier with lower ECC among Boston children of immigrants than among US children of immigrants. Conclusions: Lower ECC prevalence among urban Boston children of immigrant parents compared with US children of immigrant parents may reflect changing immigrant composition in the United States since NHANES III or a different immigrant composition in the Boston area compared with the United States. This finding reinforces the need for further research of immigrants in order to understand cultural practices that may affect oral health. Finally, low ECC prevalence among very young children reinforces the importance of early intervention in reducing ECC.     

Longitudinal associations between children's dental caries and risk factors

Dental caries is a common disease in children of all ages. It is desirable to know whether children with primary, mixed, and permanent dentitions share risk factors for cavitated and non-cavitated caries. Objective: To assess the longitudinal associations between caries outcomes and modifiable risk factors. Methods: One hundred and fifty-six children in the Iowa Fluoride Study met inclusion criteria of three dental examinations and caries-related risk factor assessments preceding each examination. Surface-specific counts of new non-cavitated caries and cavitated caries at the primary (Exam 1: age 5), mixed (Exam 2: age 9) and permanent (Exam 3: age 13) dentition examinations were outcome variables. Explanatory variables were caries-related factors, including averaged beverage exposure frequencies, tooth brushing frequencies, and composite water fluoride levels collected from 3-5, 6-8, and 11-13 years, dentition category, socioeconomic status, and gender. Generalized linear mixed models (GLMMs) were used to explore the relationships between new non-cavitated or cavitated caries and caries-related variables. Results: Greater frequency of 100 percent juice exposure was significantly associated with fewer non-cavitated and cavitated caries surfaces. Greater tooth brushing frequency and high socioeconomic status (SES) were significantly associated with fewer new non-cavitated caries. Children had significantly more new cavitated caries surfaces at the mixed dentition examination than at the primary and permanent dentition examinations. Conclusions: There were common caries-related factors for more new non-cavitated caries across the three exams, including less frequent 100 percent juice exposure, lower tooth brushing frequency and lower SES. Less frequent 100 percent juice exposures might be associated with higher exposures to several other cariogenic beverages.     

The association between environmental tobacco smoke and primary tooth caries

OBJECTIVE: Environmental tobacco smoke (ETS) has been associated with a number of negative health outcomes for exposed children. The goal of this study was to assess the association between ETS and dental caries in a pediatric population. METHODS: This study included 637 Iowa Fluoride Study children whose parents provided socioeconomic information, completed at least three questionnaires during the first year of life, and had a primary dentition exam at age 4-7 years. Households reporting in all questionnaires that someone smoked in the home were categorized as regularly smoking homes. Socioeconomic status (SES) was divided into three groups (low, middle, and high) based on family income and mother's education. Children were classified as having caries if any of the primary teeth had fillings or cavitated lesions at the primary dentition exam. RESULTS: Overall, children residing in regularly smoking homes had a higher prevalence of caries. For the middle SES group and overall, the children from smoking homes had a significantly higher prevalence of caries compared to nonregular/nonsmoking homes (52% vs 24%, P=.05 and 44% vs 25%, P=.002, respectively). After adjusting for age, SES, toothbrushing frequency, total ingested fluoride, and combined intake of soda pop and powdered drink beverages, the relationship of smoking and caries still remained significant (odds ratio [OR]=3.38; P=.001). CONCLUSIONS: Environmental tobacco smoke was associated with an increased risk of caries among children.     

Determinants of early childhood caries in a group of inner-city children.

OBJECTIVE: This study aimed to determine the prevalence of early childhood caries (ECC) and severe early childhood caries (s-ECC) in inner-city children in Ghent, Belgium, and to investigate the independent impact of its determinants. METHOD AND MATERIALS: In a non-randomized cross-sectional research design, all children between 24 and 34 months of age attending the final consultation at a participating Child and Family Health Clinic were included (n = 385). Data on oral hygiene and caries were collected by oral examination. Caries prevalence and oral hygiene were determined according to established criteria. Data on oral health habits and socioeconomic status were obtained by a validated questionnaire. All analyses were performed with ECC and s-ECC as response variables. RESULTS: The mean DMFS was 0.83 (SEM = 0.14). ECC was diagnosed in 18.5% of the children and s-ECC was found in 12.2%. Treatment need was 100%. From the multiple regression analysis it became clear that ethnicity and neighborhood significantly determined ECC. From all oral health-related behavioral variables, only daily use of a bottle with sweetened drinks other than milk or water, frequency of brushing, and quality of oral hygiene as expressed by Plaque Index scores remained significantly associated with ECC. CONCLUSION: Children whose mothers had an Eastern European nationality at birth and who live in a deprived neighborhood, daily use a bottle with sweetened drinks other than milk or water, brush less than once a day, and have plaque are at higher risk for ECC and s-ECC.     

Prevalence of early childhood caries in a population of children with history of maltreatment

OBJECTIVE: The purpose of this study was to investigate the prevalence of early childhood caries (ECC) in a population of maltreated children in Toronto, Ontario, Canada. METHODS: The sample consisted of preschool-aged children (2 to 6 years) admitted to the care of the Children's Aid Society of Toronto (CAST) between 1991 and 2004. Data were collected by reviewing the dental and social workers' records of CAST ECC was determined using the decayed, missing, and filled deciduous teeth (dmft) index. The type and severity of maltreatment were obtained from the Eligibility Spectrum. RESULTS: The study included 66 children: 37 (56 percent) boys and 29 (44 percent) girls, with an average age of 4.1 years [standard deviation (SD) = 1.2]. Four (6 percent) children had evidence of dental injury, and none had teeth filled or extracted as a result of decay ECC was observed in 58 percent of the abused children. Of these, the mean decayed teeth ("dt") value was 5.63 (SD = 4.17, n = 38) and 3.24 (SD= 4.21) for the whole sample (n = 66). The proportion of children with untreated caries was 57 percent among "neglected" children (n = 53) and 62 percent in physically/sexually abused cases (n = 13). Logistic regression revealed that children in permanent CAST care and those in its care more than once were significantly less likely to have experienced caries. CONCLUSIONS: Abused and neglected young children had higher levels of tooth decay than the general population of 5-year-olds in Toronto (30 percent prevalence, mean dt= 0.42, SD = 1.20, n = 3185). However, this study did not find any difference in ECC prevalence between children with different types of maltreatment. The study did find that CAST services had a protective effect on children's oral health, which supports the recommendation that child protection services should investigate possible dental neglect in physical/sexual abuse and neglect cases.