Oral health status of San Francisco public school kindergarteners 2000-2005

OBJECTIVES: To determine the prevalence of dental caries and oral health disparities in San Francisco kindergarten public school children from 2000-2005. METHODS: The San Francisco Department of Public Health in partnership with the San Francisco Dental Society and assistance from the National Dental Association, has been conducting annual dental screenings of kindergarten children enrolled in the San Francisco Unified School District since 2000. Outcomes assessed from this series of cross-sectional screenings included prevalence of caries experience, untreated caries, treatment needs, and caries severity by child's sex, race/ethnicity, residential zip code, and a proxy for socioeconomic status. RESULTS: Of 76 eligible schools, 62-72 participated, and 86-92% of enrolled children (n=3,354-3,527) were screened yearly. Although there was a small, significant decrease over the time period, in 2005, 50.1% of children had caries experience; 28.8% had untreated caries and 7.6% had urgent treatment needs. Each year caries prevalence was greatest for Asian children, those attending schools with > 50% children eligible for the free or reduced-price meal program, and children living in zip codes in and around Chinatown and San Francisco's southern border. CONCLUSIONS: Despite signs of improvement, caries remains a public health problem especially in Asian and Hispanic children, and children living in certain sections of San Francisco.     

Caries experience associated with attention-deficit/hyperactivity disorder

The purpose of this cross-sectional study was to examine whether children with attention-deficit/hyperactivity disorder (ADHD) had a total caries experience that was equivalent to children without the disorder. METHODS: The test sample included children ages 6 to 10 years old diagnosed with ADHD by physicians at Duke University Medical Center. The control group also included healthy children 6 to 10 years old without the diagnosis of ADHD. A visual dental exam for caries was performed and a sample of whole, unstimulated saliva was collected. The parent/guardian of each participant completed a health/medication history and a questionnaire concerning the child's oral health and habits, daily routine, and demographic information. RESULTS: Wilcoxon and chi-square tests showed that children with ADHD have significantly more enamel caries in the primary and permanent dentitions and a significantly higher prevalence of total caries experience when compared to controls. There was no significant difference in whole saliva production between the ADHD children and the controls. CONCLUSIONS: Dentists should be aware that children with ADHD are at higher risk for caries.     

Oral health disparities in children of immigrants: dental caries experience at enrollment and during follow-up in the New England Children's Amalgam Trial

OBJECTIVES: Previous research shows increased dental decay among immigrants, but little is known about the oral health of the growing population of children of immigrants. We compared the children of immigrants to the children of US-born caregivers in their caries experience at enrollment and their new caries increments during the 5-year New England Children's Amalgam Trial (NECAT). METHODS: NECAT recruited 283 Boston-area children aged 6 to 10 with untreated caries and offered free semiannual preventive and restorative dental care during the trial. Sociodemographic factors and caregiver immigrant status were assessed through interviews. Multivariate negative binomial models evaluated the association between caregiver immigrant status and clinically assessed carious surfaces. RESULTS: Forty percent of these Boston-area children had immigrant caregivers. At baseline, the children of immigrants had more carious surfaces (11.5 versus 9.4, adjusted for race/ethnicity, age, gender, and caregiver smoking status). Caregiver language preference explained some of this association. Immigrant status and language preference were not associated with 5-year caries increments. CONCLUSIONS: Prevalent disparities in the unmet dental needs of the immigrants' children were quickly ameliorated during participation in NECAT Dental initiatives that target neighborhoods and are sensitive to acculturation levels may help improve and maintain the oral health of immigrant families.     

Dental caries and associated factors in Mexican schoolchildren aged 6-13 years

The objectives of the present study were to establish dental caries prevalence (percentage with caries) and experience in the primary and permanent dentition (dmft and DMFT) of 6 to 13-year-old schoolchildren in Campeche, Mexico, and to estimate the contributing roles of the likely risk indicators. A cross-sectional study was carried out in 1,644 children aged 6-13 years. Self-administered questionnaires obtained information on social, economic, behavioral, and demographic variables. The primary dentition of 1,309 children and the permanent dentition of 1,640 children were evaluated in the oral examinations. The main outcome measures were DMFT, dmft, and SiC indices. Data were modeled using logistic regression analysis. The overall caries prevalence was 77.4%, 73.6% in the primary dentition (61.6% in 6-year-olds), and 49.4% in the permanent dentition. The dmft and DMFT indices were 2.85+/-2.73 and 1.44+/-2.05, respectively (DMFT = 3.11+/-2.62 in 12-year-olds). The SiC index was 6.05 at 12 years of age. Associated variables to dental caries in both dentitions were presence of enamel defects, presence of dental plaque, low socio-economic status, female sex, and older age. Mother's schooling was negatively associated (OR = 0.95) with caries in primary dentition. Caries experience in the primary dentition (OR = 6.02) was positively associated with caries in the permanent dentition. Dental caries status in these Mexican children was closer to the goals proposed by the WHO/FDI for 2000 than previous studies. This study has identified clinical, socio-economic, and behavioral determinants for dental caries in primary and permanent dentition on Mexican schoolchildren.     

Oral health status among schoolchildren in Romania, 1992

Abstract – In Romania, systematic information on the occurrence of oral diseases in children is scarce. The purpose of the present study was to describe the prevalence and the pattern of dental caries in schoolchildren, and to use the data to provide a baseline for planning and evaluation of oral health care. A national sample of children at grade I ( n = 729) and grade 6 ( n = 660) was chosen consistent with the WHO pathfinder principle. Clinical examinations were carried out according to the recording system for the Danish Municipal Dental Service and the following results were obtained. In children of grade 1 (7-yr-olds) the prevalence proportion of caries in primary teeth was 86% and in permanent teeth 39%. The mean caries indices were 11.4 dels and 1.3 DMFS. At grade 6 (12-yr-olds) the prevalence proportion of caries in primary teeth was 17% and in permanent teeth 90%. The mean caries experience was 0.8 defs and 6.5 DMFS, and a mean of 4.1 DMFT was observed. In both groups, the D-component of the caries index was dominant. The children were also classified by caries severity zone. At grade 1, 61% had a very severe pattern of caries in the primary teeth, i.e. caries in pits/fissures, proximal surfaces, smooth surfaces, and incisors. Forty-three percent of the children at grade 6 showed this pattern in permanent teeth. In Romanian schoolchildren the present level and pattern of dental caries are most severe and the implementation of oral health promotion and prevention at the community level is urgently needed.     

Sugar consumption and caries risk in schoolchildren with low caries experience

Abstract This paper assesses the risk from sugar consumption in a population of schoolchildren with low caries experience. It relates eight different measures of sugar consumption to the occurrence of any DMFS increment, and, separately, to approximal and pit-and-fissure DMFS. The data are from a 3-yr longitudinal study of 429 children, initially aged 11–15, residing in non-fluoridated rural communities in Michigan, USA. All children completed at least three dietary interviews, were present for baseline and final dental examinations, and had a parent or guardian provide questionnaire information on residence history, use of fluoride and dental services, and family history. Results indicated that a higher proportion of total energy intake from sugars increased the probability of caries on all surfaces, and a higher total intake of sugars was also associated with total caries increment. No relationship, however, was found between DMFS increment and the frequency of eating high sugar foods. Each additional 5 g of daily sugars intake was associated with a 1% increase in the probability of developing caries, and those whose energy intake from sugars was 1 SD above the mean had 2.0 times the risk of developing approximal caries than did children whose energy intake from sugars was 1 SD below the mean.     

Dental caries and associated factors in Mexican schoolchildren aged 6–13 years

The objectives of the present study were to establish dental caries prevalence (percentage with caries) and experience in the primary and permanent dentition (dmft and DMFT) of 6 to 13-year-old schoolchildren in Campeche, Mexico, and to estimate the contributing roles of the likely risk indicators. A cross-sectional study was carried out in 1,644 children aged 6–13 years. Self-administered questionnaires obtained information on social, economic, behavioral, and demographic variables. The primary dentition of 1,309 children and the permanent dentition of 1,640 children were evaluated in the oral examinations. The main outcome measures were DMFT, dmft, and SiC indices. Data were modeled using logistic regression analysis. The overall caries prevalence was 77.4%, 73.6% in the primary dentition (61.6% in 6-year-olds), and 49.4% in the permanent dentition. The dmft and DMFT indices were 2.85±2.73 and 1.44±2.05, respectively (DMFT=3.11±2.62 in 12-year-olds). The SiC index was 6.05 at 12 years of age. Associated variables to dental caries in both dentitions were presence of enamel defects, presence of dental plaque, low socio-economic status, female sex, and older age. Mother's schooling was negatively associated (OR=0.95) with caries in primary dentition. Caries experience in the primary dentition (OR=6.02) was positively associated with caries in the permanent dentition. Dental caries status in these Mexican children was closer to the goals proposed by the WHO/FDI for 2000 than previous studies. This study has identified clinical, socio-economic, and behavioral determinants for dental caries in primary and permanent dentition on Mexican schoolchildren.     

Exploring the association between overweight and dental caries among US children

PURPOSE: The purpose of this study was to examine the relationship between age-specific body mass index (BMI-for-age) and dental caries among US children. METHODS: Body measures data and oral health data came from the 1999-2002 National Health and Nutrition Examination Survey. Outcome measures for primary and permanent dentitions were: (1) dental caries prevalence; and (2) severity (geometric mean dft and DMFT). Covariates included: (1) age; (2) gender; (3) race/ethnicity; and (4) poverty status. Analysis was limited to children 2 to 17 years old. RESULTS: Approximately 36% of overweight children 2 to 6 years old and 39% of overweight children 6 to 17 years old had dental caries. Geometric mean dental caries scores for overweight children were dft=3.3 and DMFT=2.5 for primary and permanent dentitions, respectively. Controlling for covariates, there was no significant association between BMI-for-age and dental caries prevalence in either dentition. In addition, among children with a positive history of dental caries, BMI-for-age was significantly associated with dental caries severity in the permanent dentition - overweight children had a lower geometric mean DMFT than did normal weight children. CONCLUSIONS: Although it was hypothesized that age-specific body mass index would be associated with increased dental caries prevalence and severity, these associations were not found. Rather, overweight was found to be associated with lower geometric mean DMFT. Future studies should address which factors specific to overweight in children might be protective against dental caries in the permanent dentition. Given the importance of overweight as a public health problem, however, clinicians are encouraged to continue providing health education and dietary counseling to their overweight child patients.     

Risk assessment criteria applied to a screening exam: implications for improving the efficiency of a sealant program

OBJECTIVES: The present study aimed to determine the ability of first-grade screening exam findings to predict carious lesions in permanent first molars by fourth grade. The ability to identify high-risk children would be useful in the rational allocation of limited public health resources, such as the application of sealants. METHODS: Screening exams were performed on 204 children in 1st grade and 4th grade. Analyses were conducted at both the child- and molar- levels. Cross-tabulations were used to identify the threshold dmfs + DMFS in first grade that had the highest sensitivity and highest negative predictive value for discriminating between children with and without permanent caries (1) in the entire population and (2) in subpopulations defined by race/ethnicity, gender, and language spoken at home. This threshold then was entered into logistic regression models. RESULTS: On the child and molar level, the study determined that dmfs + DMFS > 0 had the highest sensitivity (child: 69.4%, molar: 74.7%) and negative predictive value (child: 87.8%, molar: 94.4%). Using this test criterion, univariate logistic regression of the child-level data revealed an odds ratio of 2.72 (p = 0.012) for presence of permanent tooth caries experience. Controlling for gender, grade, race/ethnicity, and language spoken at home, the odds ratio increased slightly to 2.76 (p = 0.012). CONCLUSIONS: There is a relationship between carious lesion experience in 1st grade and carious lesion incidence in the first permanent molars by 4th grade. Using the dmfs + DMFS > 0 criterion may help public health providers determine which children should receive sealants when resources do not allow the delivery of sealants to all children.     

Dental caries prevalence and treatment need among racial/ethnic minority schoolchildren

A study was undertaken to estimate dental caries prevalence and treatment need among racial/ethnic minority schoolchildren in the Bronx. Oral examinations were conducted on 148 second graders, 193 fourth graders and 299 sixth graders in three different schools. A single examiner trained to use the DMFS index according to National Institute of Dental and Craniofacial Research (NIDCR) diagnostic criteria and procedures examined all the children between November 1999 and July 2000. The study revealed that 39% of the children exhibited dental caries experience in their permanent dentition (mean DMFS = 1.45), treatment need (D/DMFS = 28%); 26.4% of children in their primary dentition (mean dfs = 1.01) and treatment need (d/dfs = 18%). Hispanic children (mean DMFS = 1.71) had higher dental caries experience compared to African-Americans (mean DMFS = 1.14). This was found to be statistically significant (p = 0.004). Treatment need in Hispanics was (30%, 17%) and in African-Americans (30%, 18%) in permanent and primary dentition respectively. Treatment need was highest among sixth grade African-Americans in their permanent dentition and in second grade Hispanics in the primary dentition. The study showed a difference in dental caries prevalence, but the treatment need percentages did not differ between Hispanics and African-Americans in both dentition.     

Oral health status of preschool children attending Head Start in Maryland, 2000

PURPOSE: The objective of this study was to determine the oral health status of preschool children attending Head Start Centers in Maryland. METHODS: Clinical caries examinations were conducted on 482 children between ages 3-5 from 37 Maryland Head Start Centers in 2000. Additionally, 560 questionnaires were completed by their caretakers regarding their child's access to care, potential caries risk factors and history of toothaches. RESULTS: The overall prevalence of untreated decay was 52%, with a higher prevalence found in rural than urban centers (64% vs 48%). For all children, the mean decayed, filled surfaces (dfs) was 3.64, while the mean decayed surfaces (ds) was 2.90. For those who had caries experience, the dfs was 6.67 and the ds was 5.32. The percentage of children with caries increased by age from 43% for three-year-olds to 62% for four-year-olds. Of those children with caries experience, 17% had complained of a toothache and 9% reportedly cried because of a toothache. CONCLUSIONS: Of significance in this study were the findings that: caries is highly prevalent in this underserved preschool population; pain due to dental caries is not uncommon; and there is little utilization of dental care despite federally mandated and Head Start and Medicaid requirements.     

Caries experience of 5-6-year-old and 12-13-year-old schoolchildren in central and western Nepal

OBJECTIVE: To describe and analyse the caries experience and caries prevalence in the deciduous dentition of 5-6-year-old schoolchildren and in the permanent dentition of 12-13-year-old schoolchildren in western and central Nepal. Design: Non-randomised cross-sectional surveys conducted by trained and calibrated examiners. SETTING: Surveys were conducted in private and government rural and urban schools at 10 sites along the Terai and the foothills in eight districts of western and central Nepal. SUBJECTS: A total of 2,177, 5-6-year-old and 3,323, 12-13-year-old schoolchildren from urban and rural areas were examined under WHO Pathfinder methodology. OUTCOME MEASURES: Prevalence of caries and dental caries experience (dmft/DMFT). RESULTS: The caries prevalence and mean dmft score of 5-6-year-olds was 67% and 3.3 (urban 64% and 2.9; rural 78% and 4.0). The caries prevalence and mean DMFT score of 12-13-year-olds was 41% and 1.1 (urban 35% and 0.9; rural 54% and 1.5). The d/D-component constituted almost the entire dmft/DMFT index. CONCLUSION: The recorded prevalence of untreated dental caries in schoolchildren requires an appropriate oral health response based primarily on prevention and health promotion. Foremost in this regime would be the promotion and use of accessible and affordable fluoridated toothpaste.     

Oral health status and access to dental care for ohio head start children

PURPOSE: The purpose of this survey were to assess the dental caries prevalence rate among children enrolled in Ohio's Head Start programs and assess factors relating to their dental care access. METHODS: Oral screenings were conducted on 2,555 children, ages 3 through 5 years, at 50 Ohio Head Start centers using probability-proportional-to-size sampling. In addition, parental responses to 6 access-oriented questions on the consent form were analyzed. RESULTS: Overall, 38% of 3- to 5-year-old Head Start children screened had experienced dental caries, and 28% had at least 1 untreated decayed tooth. Of the children with caries experience, 73% had decayed teeth, while the remaining 27% had restorations only. Among children, there were no statistically significant differences associated with race or payment method. With regard to dental care access, 11% of Head Start parents reported they could not get wanted dental care for their children during the previous 12 months, most often due to cost of care/lack of insurance. Nine percent of children had a toothache in the previous 6 months. Although 85% of Head Start children had visited a dentist in the previous 12 months, another 10% had never visited a dentist. CONCLUSIONS: The significant prevalence rate of dental caries among Ohio Head Start children is consistent with other states' reports. Although almost 9 of 10 children visited a dentist during the year, three fourths of children with dental caries did not have their care completed by the time they were screened during the second half of the school year. Oral health disparities according to race and payment source were not found among Ohio Head Start children.     

Race/ethnicity and untreated dental caries: the impact of material and behavioral factors

OBJECTIVE: To use nationally representative data, group variables into categories of material and behavioral factors, and assess their relative contribution to racial/ethnic variation in untreated caries. METHODS: Participants were from the Third National Health and Nutrition Examination Survey (NHANES III), aged 20-50 years. Material factors were income, education, employment status, dental insurance status, and urban residence. Behavioral factors were marital status, tobacco use, alcohol use, obesity, and social support. All models were additionally adjusted for age, gender, and quartile of missing teeth. The outcome was three or more carious teeth. RESULTS: Non-Hispanic blacks and Mexican-Americans displayed excess risk of untreated caries compared with non-Hispanic whites when adjusted for age, sex, and missing teeth (adjusted odds ratios 1.73 and 1.69, respectively). The addition of behavioral factors to this model resulted in virtually no changes in the adjusted odds ratios for race/ethnicity and untreated caries. When material factors were added to the basic model the excess risk for untreated caries among non-Hispanic blacks was reduced by approximately 21% and that of Mexican-Americans was no longer statistically significant compared with non-Hispanic whites (adjusted odds ratios 1.36 and 0.83, respectively). CONCLUSIONS: Much of the excess risk for untreated dental caries among non-Hispanic blacks and Mexican-Americans compared with non-Hispanic whites was eliminated when material factors were controlled, while no risk reductions were observed when behavioral factors were controlled. Addressing material factors may provide greater reductions in untreated caries disparities than behavioral interventions, and these risk reductions may vary with racial/ethnic group.     

Dental Caries and Fluorosis Prevalence and Their Relationship with Socioeconomic and Behavioural Variables Among 12-year-old Schoolchildren

Purpose: To evaluate caries experience and fluorosis prevalence in 12-year-old schoolchildren in Piracicaba, Brazil in 2007 and to verify the relationship of these changes with socioeconomic and behavioural variables. Materials and Methods: The sample consisted of 724 schoolchildren from public and private schools. A calibrated dentist performed the examination under natural light using CPI probes and mirrors. The mean number of decayed, missing and filled permanent teeth (DMFT) and the SiC (Significant Caries Index) were determined for dental caries and the Thylstrup and Fejerskov index (T-F) for fluorosis. Socioeconomic and behavioural variables were collected by means of a questionnaire. Multiple logistic regression analyses were performed to verify the relationship of caries and fluorosis with socioeconomic and behavioural variables. Results: The DMFT and SiC indices were 0.85 (±1.54) and 2.52 (±1.72). Fluorosis prevalence was 29.42%. The regression models showed that children whose families earned up to four minimum wages were 2.58 times more prone to having caries than those whose families earned over four minimum wages. Furthermore, children who visited the dentist were 4.27 times more likely to have DMFT > 0. However, for fluorosis, the regression model was not significant. Conclusions: The 12-year-old schoolchildren in Piracicaba presented very low caries prevalence. Significant associations were observed between the presence of caries, monthly family income and visiting the dentist. Considering dental fluorosis, the majority of the sample presented no clinical signs of fluorosis.     

Assessing the relationship between children's oral health status and that of their mothers

BackgroundThe authors conducted a study to describe the relationship between the oral health of young children and that of their mothers.MethodsUsing data from the Third National Health and Nutrition Examination Survey and a related birth certificate–linked file, the authors compiled a sample of 1,184 mother/child pairs for children aged 2 through 6 years. The authors performed logistic and cumulative logistic regression analyses by using children's caries experience and untreated caries status as dependent variables. They evaluated the mothers' untreated caries status and tooth loss status along with other covariates, including age, race/ethnicity and poverty status.ResultsChildren of mothers who had high levels of untreated caries were more than three times as likely (odds ratio [OR], 3.5; 95 percent confidence interval [CI], 2.0–6.2) to have higher levels of caries experience (treated or untreated dental caries) compared with children whose mothers had no untreated caries. A similar relationship was observed between mothers' tooth loss and caries experience among their children. The children of mothers with high levels of tooth loss were more than three times as likely (OR, 3.3; 95 percent CI, 1.8–6.4) to have higher levels of caries experience compared with children of mothers with no tooth loss; for mothers with moderate tooth loss, the OR was 2.3 (95 percent CI, 1.5–3.5).ConclusionsMothers' oral health status is a strong predictor of the oral health status of their children.Practice ImplicationsPreventive plans for children should be based on a caries risk assessment. The results of this study demonstrate that basic information obtained from the child's mother regarding her oral health status is valuable in helping the dentist determine the child's caries risk.     

Caries increment in the permanent dentition of Mexican children in relation to prior caries experience on permanent and primary dentitions

OBJECTIVE: To evaluate the likelihood of caries increment in schoolchildren, based on their prior caries experience. MATERIAL AND METHODS: We undertook a longitudinal study in 452 six-to-nine year olds between 1999 and 2001 in Mexico, with dental exams conducted by two standardized examiners (kappa>0.85). The dependent variable was the DMFT increment, dichotomized as without increment, and at least one unit of increment. Independent variables estimated caries experience at baseline. Data were analyzed using non-parametric tests and generalized linear models (log-binomial) to calculate relative risk (RR) adjusted for age and sex. RESULTS: The percentage of caries-free children diminished by 20.5% from 1999 to 2001. DMFT index increased two-fold, from 0.25+/-0.70 in 1999 to 0.77+/-1.30 in 2001 (p<0.001). The overall risk for this sample was 24%. The DMFT increment was higher (p<0.001) in children with DMFT>0 and dmft>0 in 1999 (RR=1.89, 95% CI=1.37-2.62; RR=2.71, 95% CI=1.94-3.76, respectively). The likelihood for DMFT increment from the 1999 levels was: (1) 2.78 times higher (95% CI=2.06-3.76) if schoolchildren had caries in any of the first permanent molars and (2) 1.62 times higher (95% CI=1.20-2.19) if schoolchildren were affected by high severity caries at baseline. CONCLUSIONS: Both caries prevalence and mean DMFT had significant increments in 18 months. Dental caries in the primary (dmft) and permanent (DMFT) dentitions at baseline are goods indicators of subsequent caries development in this group of children in a medium income country. This relationship became stronger when the occurrence of caries in the first permanent molars was included.