Family characteristics and caries experience in preschool children. A longitudinal study from pregnancy to 5 years of age

Wigen TI, Espelid I, Skaare AB, Wang NJ. Family characteristics and caries experience in preschool children. A longitudinal study from pregnancy to 5 years of age. Community Dent Oral Epidemiol 2011; 39: 311–317. © 2010 John Wiley & Sons A/S Abstract – Objective: The purpose of the study was to explore associations between family status, family income, family size, mother’s age at child birth, mother’s education and parents’ national background and caries experience in 5‐year‐old children. Method: This study is based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and the Public Dental Services. A total of 1348 children were followed from pregnancy to the age of 5 years. Questionnaires were completed by mothers twice during pregnancy and when the children were 3 and 5 years of age. Clinical and radiographic examination of the children was performed at the age of 5 years. Results: Caries experience in the 5‐year‐old children was low; 89% had no caries experience (d_3–5 mft = 0). In multiple logistic regression having one or both parents of non‐western origin (OR 3.4, CI 1.6–7.3), having had a change in family status from pregnancy to 5 years of age (OR 2.0, CI 1.1–3.4) and having mother with low education (OR 1.9, CI 1.3–2.8) were statistically significant risk indicators for having caries experience at the age of five. Conclusion: Family characteristics in pregnancy and early life were associated with caries experience in 5‐year‐old children. Primary care personnel meeting young children with one or several of these characteristics should consider referring the child to dental personnel to enable early initiation of health‐promoting activities.     

Epidemiology of dental caries in Finland and the Soviet Union – a joint study

Abstract A study was begun in order to describe the epidemiology of dental caries among children 9 and 12 years old in Finland and the Soviet Union. In addition, the effectiveness of caries prevention will be evaluated. The study is to be done in three towns in Finland and five towns in the Soviet Union.     

The role of sugar, xylitol, toothbrushing frequency, and use of fluoride toothpaste in maintenance of adults' dental health: findings from the Finnish National Health 2000 Survey

We assessed the effect of certain oral health-related behaviours on adults' dental health. As part of the Finnish nationwide Health 2000 Survey, dentate subjects, 30-64 yr of age, reported their frequency of consumption of eight sugar- and xylitol-containing products, together with toothbrushing frequency and use of fluoride toothpaste, and underwent clinical oral examination (n = 4,361). The mean number of teeth present (NoT) was 24.2 and the mean numbers of sound teeth (ST), filled teeth (FT), and decayed teeth (DT) were 10.8, 12.1, and 1.1 for men and 9.6, 13.8, and 0.5 for women, respectively. Consumption of sugar-sweetened beverages was more frequent than that of other sugar-containing products, and greater in men than in women. Daily use of xylitol chewing gum was reported by 13% of the men and by 22% of the women. Toothbrushing at least twice daily was reported by 47% of the men and by 79% of the women; 86% and 96%, respectively, reported daily use of fluoride toothpaste. The frequency of consumption of sugar- and xylitol-containing products and of toothbrushing, as well as use of fluoride toothpaste, play a role in the dental health of dentate adults, with the impact being weak on NoT, ST, and FT, but stronger on DT, especially concerning toothbrushing frequency (relative risk = 1.5) and use of fluoride toothpaste (relative risk = 1.8). Understanding the impact of certain oral health-related behaviours on dental health in adults would facilitate better targeting of oral self-care messages.     

The utility of the zero-inflated Poisson and zero-inflated negative binomial models: a case study of cross-sectional and longitudinal DMF data examining the effect of socio-economic status

OBJECTIVES: To examine the utility of the zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB) modelling approaches for modelling four sets of dental caries data from the same cohort study [with particular attention to the influence of childhood socioeconomic status (SES)]: cross-sectional data on the deciduous dentition at age 5 years; cross-sectional data on the permanent dentition at age 18 and 26 years; and longitudinal data on caries increment between ages 18 and 26 years. METHODS: Data on dental caries occurrence at ages 5, 18 and 26 years were obtained from the Dunedin Multidisciplinary Health and Development Study (DMHDS). ZIP and ZINB models were fitted to the cross-sectional (n = 745) and longitudinal (n = 809) data sets using Stata (Intercooled Stata 7.0). The dependent variables for the three cross-sectional analyses were the DMFS indices at age 5, 18, and 26 years, and net DFS increment (NETDFS) was the dependent variable for the longitudinal analysis. RESULTS: The empty ZIP model was a poor fit for all four data sets, whereas the empty ZINB model showed good fit; consequently both the cross-sectional and longitudinal analyses were conducted using ZINB modelling. Being in the high-SES group during childhood was associated with a greater probability of being caries-free by age 18 years, over and above that which would be expected from the negative binomial process. Low childhood SES also had the largest coefficient in the modelling of the negative binomial process, but at age 5 years, where the adjusted mean dmfs score in the low-SES group was 6.8 (compared with 4.7 and 2.9 in the medium- and high-SES groups, respectively). The substantial SES differences which existed at age 5 years (in the deciduous dentition) had reduced somewhat by age 18 years, and had widened again by age 26 years. In the longitudinal analysis, "baseline" caries experience (age 18-year DMFS) was a predictor both of being an extra zero and of caries severity. CONCLUSION: This investigation of the utility of the zero-inflated approach for modelling both cross-sectional and longitudinal caries data has shown that ZIP/ZINB models can provide new insight into disease patterns. It is anticipated that they will become increasingly useful in epidemiological studies that use the DMF index as the outcome measure.     

Assessing graduating dental students’ competencies: the impact of classroom,clinic and externships learning experiences

Objectives: The present study assessed recent dental graduates’ educational experiences with regard to competency development in different learning contexts and preparedness for independent professional performance. Methods: The present study employed a questionnaire examining University of Manitoba graduating dental students’ confidence and perceived importance of 47 competencies expected by the ACFD/CDA by requiring students to rate each competency on a five‐point Likert scale. In addition, contribution of each of the three learning environments (classroom, clinic, and externship) towards competency development was assessed. Results: Recent graduates reported most confidence in areas of basic clinical procedures involving radiographic, pharmacologic and caries management, with least confidence in implantology, orofacial pain, trauma and surgical management. Most importance was attributed to interpersonal‐communication and basic clinical skills, with least importance in scientific research, implantology and prosthetic laboratory aspects. Overall, graduates felt that clinical setting contributed the most to competency development, followed by classroom and then externship contexts. Conclusion: Graduating students’ professional preparedness can reflect the quality of dental programme. However, the amount of importance that graduates place on each competency might impact their confidence in the associated competencies and vice versa. In addition, learning settings must be effectively utilised for particular competencies’ development.     

A Comparison of the Caries-preventive Effects of Fluoride Mouthrinsing, Fluoride Tablets, and Both Procedures Combined: Final Results after Eight Years

This paper presents final results of an eight-year clinical trial designed to compare the caries-preventive benefits of two self-administered fluoride procedures when used separately and in combination with one another. Children in kindergarten and first grade residing in Springfield, Ohio, a nonfluoridated community, were assigned randomly within school to one of three groups that either (a) rinsed once a week in school with a 0.2 percent neutral NaF solution; (b) chewed, rinsed with, and then swallowed daily in school a neutral 2.2 mg NaF tablet; or (c) carried out both procedures. At baseline (1981), 1,640 participants were examined clinically using the DMF surface index. Findings for 640 children remaining after eight years show that subjects in the combination group experienced a mean caries increment of 2.40 DMFS, 15.2 percent lower than the mean score of 2.83 DMFS for children in the tablet group and 32.8 percent lower than the 3.57 DMFS for those in the rinse group. Only the difference in incremental caries scores between the combined fluoride procedure and the fluoride rinse was statistically significant (P less than .05). The pattern of these findings is similar to that found on the two interim examinations. Even though the combined regimen showed an additional caries-preventive benefit compared with the rinse, considerations of cost effectiveness and feasibility do not support changing an ongoing rinse program to one that employs both procedures. For new programs the best choice appears to be the tablet procedure alone.