Oral health-related quality of life of children by dental caries and fluorosis experience

OBJECTIVE: To evaluate the oral health-related quality of life (OHRQoL) of children by dental caries and fluorosis status. METHODS: A random sample of South Australian 8- to 13-year-old children was selected. Caries data were collected from school dental service records to group children by combined deciduous and permanent tooth caries experience. Children were examined for fluorosis using the Thylstrup and Fejerskov (TF) Index to form groups by fluorosis scores on maxillary central incisors. Occlusal traits were recorded using the Dental Aesthetic Index. Children and their parents completed the Child Perception Questionnaire (CPQ) and the Parental Perception Questionnaire (PPQ) and a global rating of oral health (OH). OHRQoL indicators, rating OH as Excellent/Very good, and mean overall CPQ/PPQ scores were compared between groups by fluorosis scores and caries experience. Multivariate models were generated for both OH and CPQ/PPQ indicators. RESULTS: Two hundred forty-two children (43.0 percent) had 0 decayed, missing, and filled primary and permanent tooth surface (dmfs/DMFS), while 170 (23.9 percent) had 5+ dmfs/DMFS. The prevalence of TF scores 1, 2, and 3 were 14.5, 9.5, and 1.9 percent, respectively. The proportion of children/parents rating OH as Excellent/Very good was significantly associated with children's caries experience. That proportion increased when fluorosis severity increased from a TF score of 0 to 2, but decreased with a TF of 3. Having low caries experience and better dental appearance were associated with parents' perception of good OH. Having mild fluorosis and more acceptable appearance were significant factors for children's perception of good OH. Caries and malocclusion were associated with lower OHRQoL, while having a TF score of 2 was associated with better OHRQoL in multivariate models for overall CPQ/PPQ scores. CONCLUSION: Caries and less acceptable appearance showed a negative impact, while mild fluorosis had a positive impact on child and parental OHRQoL.     

Dental fluorosis in Chilean children: evaluation of risk factors

The purpose of this case-control study was to determine the association between very-mild-to-moderate enamel fluorosis and exposure during early childhood to fluoridated water, mainly through ingestion of powdered milk. Analysis was performed on 136 residents of the optimally fluoridated community of San Felipe in the Chilean Fifth Region, who were categorised into one of three groups according to their age when water fluoridation was introduced in 1986: Group I was born after 1986; Group II was 16–24 months old in 1986; and Group III was >24 months of age. The case and control subjects were selected on the basis of a clinical examination given in July 1996. Dean's scoring system was used to determine fluorosis status. Risk factor exposure was ascertained by a questionnaire used in interviews with mothers of participating children. Logistic regression analysis, after adjustment for confounding variables, revealed that very-mild-tomoderate enamel fluorosis of permanent central maxillary incisors (CMI) was strongly associated both with the age of the subjects when water fluoridation began and with breast-feeding duration for children belonging to Group I. Subjects in Group I were 20.44 times more likely (95% CI: 5.00–93.48) to develop CMI fluorosis than children who were older than 24 months (Group III) when fluoridation began. Subjects who were between 16 and 24 months old when water fluoridation began were 4.15 times more likely (95% CI: 1.05–16.43) to have CMI fluorosis than children older than 24 months. An inverse association was found with breast-feeding duration (OR=0.86, 95% CI: 0.75–0.98) among Group I subjects but not in Groups II and III. Results obtained suggest that the current fluoride concentration in drinking water may be contributing to fluorosis. Further studies will be necessary to determine the relative competing risks of dental fluorosis and dental caries in Chilean children in order to establish the most appropriate water fluoridation level in Chile.     

Caries experience of disabled school-age children

Abstract A group of 415 disabled school-age children representing 10 different disabling conditions (hereafter called diagnostic groups) were examined and DMFT Registered. Parents were interviewed about problems and habits relevant to dental health. The purpose was to study the relationship between different background variables and DMFT. It was assumed that the DMFT might have been influenced by both various predisposing conditions and factors of everyday life. Therefore two indices were made. A multiple classification analysis (MCA) was used to assess the relative importance of different background variables. Age, mother's education, everyday life factors and diagnosis were the variables showing the strongest association with DMFT. Children with juvenile rheumatoid arthritis, epilepsy and cystic fibrosis had a higher DMFT than the other diagnostic groups.     

Alveolar bone loss in 5-year-old New Zealand children: its prevalence and relationship to caries prevalence, socio-economic status and ethnic origin

Abstract This study investigated the prevalence of alveolar bone loss (ABL) in 5-year-old New Zealand children. The relationship of bone loss with the prevalence of caries, socio-economic status and ethnic origin was examined. Standardized bite-wing radiographs from 317 children were used to examine the alveolar bone in 1784 sites. Questionable bone loss (QBL) was evident in 8.5% of the children and definite bone loss (DBL) in 2.1%. The children with suitable radiographs had a mean dmft of 1.8. ± 2.9. and mean dmfs of 2.7. ± 5.0. When the children were divided into 3 groups having no bone loss (NBL), QBL only or DBL, analysis of variance on the logarithmic transformation of both the dmft and dmfs scores showed significant differences among the groups. Post hoc tests showed that the means for the DBL group were significantly different from those of the other 2 groups for both dmft and dmfs scores. Logistic regression analysis indicated that the odds ratio for having definite alveolar bone loss was slightly increased in children with a dmft of ≥9.     

Decline in the prevalence of dental fluorosis among South Australian children

BACKGROUND: The use of fluoride involves a balance between protection against dental caries and risk of dental fluorosis. Fluorosis in Australian children was highly prevalent in the early 1990 s. Policy measures were introduced to control fluoride exposure so as to reduce the prevalence of fluorosis. OBJECTIVE: To evaluate the effectiveness of policy measures in reducing the prevalence of fluorosis among Australian children. METHODS: A random sample of South Australian children born in 1989-1994 was selected in 2002/2003, stratified by fluoridation status and urban/rural residence. Children were targeted to form three successive birth cohorts: those children born in 1989/1990, 1991/1992 and 1993/1994, respectively. Fluoride exposures were assessed by questionnaire. One dentist examined 677 children for fluorosis using the Thylstrup and Fejerskov (TF) Index. Data were reweighted to reflect the state's child population. Case definitions of fluorosis were: having a TF score of 1+ (TF1+) or a TF score of 2+ (TF2+) on one or both maxillary central incisors. Results: A higher proportion of children in the later birth cohorts used low-concentration fluoridated toothpaste, and a smaller amount of toothpaste was used when they commenced toothbrushing. The fluorosis experience in this population was mostly very mild to mild. There was a significant decline in the prevalence of fluorosis across the three successive birth cohorts. The prevalence of fluorosis by TF1+ case definition declined from 34.7% to 22.1% and by TF2+ case definition from 17.9% to 8.3%. Risk factors for fluorosis were use of standard-concentration fluoridated toothpaste, an eating and/or licking toothpaste habit and exposure to fluoridated water. CONCLUSION: The experience of fluorosis among the South Australian child population was mostly very mild to mild. There was a marked decline in the prevalence of fluorosis across the three successive birth cohorts. The decline was mainly linked with the reduction in exposure to fluoride from fluoridated toothpaste.     

Caries prevalence in a rural Chilean community after cessation of a powdered milk fluoridation program

OBJECTIVE: The milk fluoridation scheme established in Codegua, Chile, between 1994 and 1999 demonstrated the effectiveness of powdered milk as a community-based vehicle for fluoride to prevent dental caries. The present study aimed to compare caries prevalence in both the Codeguan control and test communities, three years after ending fluoride distribution through the powdered milk fluoridation scheme, to assess whether the benefits of such milk fluoridation were still present in the test community. METHODS: Children 3-6 years old living in Codegua (test community) and La Punta (control community) were examined for dental caries at their educational facilities by three trained and calibrated examiners using natural light, dental mirrors, and sickle probes. Differences in caries prevalence (dmfs) by year of the study were tested for statistically significant differences using the Mann-Whitney U test. RESULTS: Findings from Codegua (1999-2002) indicate that the dental caries experience increased in all age groups following the termination of powdered milk fluoridation. These differences reached levels of statistical significance in the 3-, 4-, and 5- year old group (P < .03). Comparing results from Codegua and La Punta (2002), no statistically significant differences were found. CONCLUSIONS: Termination of the powdered milk fluoridation scheme resulted in a deterioration of the dental health of children. After three years, dental caries prevalence was higher than that reached at the end of the scheme and equivalent to that of the control community without fluoride exposure. These results emphasize the need to establish and maintain an alternative mechanism of community-based fluoridation of proven effectiveness for the prevention of dental caries in communities where water fluoridation is not available.     

Caries prevalence in Danish pre-school children delivered vaginally and by caesarean section

Abstract

Objective. The mode of delivery may significantly influence the diversity and composition of the oral microflora and facilitate early acquisition of mutans streptococci. The aim was to compare caries prevalence and experience in 3-year-old children delivered vaginally and by caesarean section (C-section). Materials and methods. The study had an observational cohort protocol based on extracted information from governmental databases and nationwide registers concerning birth, social and educational levels and dental status. Children born at the Copenhagen University Hospital in 2005 were eligible and the final study group with complete information consisted of 594 children, 443 delivered vaginally and 151 by C-section. Results. The total caries prevalence was 8% and no significant difference was displayed between the groups. When only the children with caries (dmfs > 0) were compared, those delivered by C-section had a higher mean value in comparison with those delivered vaginally (dmfs 6.8 vs 3.2), but the difference was not statistically significant. There was a significant relationship between caries prevalence and low family income in the total study group (OR = 5.8, p < 0.05). Conclusions. Within the limitations of this observational cohort study, caries prevalence in 3-year-old children was not related to the mode of delivery. However, the tendency of more severe caries in the C-section group justifies further studies, preferably with a prospective design.     

Caries and dental fluorosis in a western Saharan population of refugee children

The aim of this study was to investigate the relationship between dental fluorosis and dental caries among western Saharan refugee children. The western Saharan child population is characterized by adverse living conditions, an unbalanced diet, poor oral hygiene habits, and a concentration of fluoride in the drinking water of around 2 p.p.m. (2 mg l^?1). A sample consisting of 360 children, 6–7 yr of age, and 212 children, 11–13 yr of age, was obtained from four refugee camps (Smara, Awsard, El‐Aaiun, and 27‐February) situated in the vicinity of Tindouf (southern Algeria). The children were examined using the World Health Organization criteria for caries diagnosis and Dean’s index for fluorosis. The decayed, missing or filled teeth (DMFT) score was 0.48 in the 6–7‐yr‐old children and 1.69 in the 11–13‐yr‐old children, with a caries prevalence (DMFT > 0 or decayed and filled primary teeth (dft) > 0) of 47.2% and 63.2%, respectively. Among the 6–7 yr‐old children examined, 36.9% were free of fluorosis, 15.6% presented moderate fluorosis, and 7.8% presented severe fluorosis. Among 11–13 yr‐old children, only 4.2% were free of fluorosis, 30.2% exhibited moderate fluorosis, and 27.4% presented severe fluorosis. The mean DMFT, decayed permanent teeth (DT), and caries prevalence (DMFT > 0 and DMFT or dft > 0) scores were significantly higher among the children affected by severe fluorosis, suggesting that severe fluorosis might increase the susceptibility to dental caries.     

Caries and fluorosis in 6- and 9-year-old children residing in three communities in Iran

OBJECTIVES: The aim of this study was to investigate the caries and fluorosis prevalence among 6- and 9-year-old students in three communities in Iran with varying urbanization and fluoride in piped water. METHODS: Data were obtained from 523 dental examinations of 6- and 9-year olds in an upper middle class district in Teheran (T) (0.3 mg F/l), the city of Semnan (S) (1.3 mg F/l), and the village Dibaj (D) (0.2 mg F/l). RESULTS: Children in the naturally fluoridated town showed slightly higher dmfs/dfs (SD) values for both 6-year olds [S: 9.1 (9.2), T: 7.2 (7.4), D: 7.1 (6.1)] and 9-year olds [S: 6.0 (6.2), T: 4.4 (4.2), D: 5.0 (4.7)], whereas the mean dmft/dft values as well as the numbers of caries-free children were comparable. A lower prevalence of dental restorations was reported for both Semnan and Dibaj compared with Teheran. A higher prevalence of fluorosis [Tooth Surface Index of Dental Fluorosis (TSIF) 3-7] was observed in the naturally fluoridated town compared with the low-fluoridated communities. CONCLUSIONS: The ingestion of naturally fluoridated water (1.3 mg F/l) seemed to have a negligible effect on caries prevalence, but resulted in higher prevalence of dental fluorosis. It is emphasized that the study population was not adjusted for socioeconomic status, availability of dental care nor for exposures to other sources of fluoride. Nevertheless, it can be concluded that caries prevalence in Iran is quite low compared with that in other countries in the Middle East and that the elevated fluoride levels in the drinking water in Semnan may contribute to the development of mild to severe fluorosis.     

The prevalence and severity of enamel fluorosis in North American children

The question considered in this review is the extent to which changes in the prevalence or severity of enamel fluorosis have occurred over the last half-century. Emphasis is given to a review of those studies in which subjects are drinking water that is fluoride deficient and those in which subjects are drinking optimally fluoridated water, either adjusted or natural. Trends in fluorosis were examined using two definitions of fluorosis (definite and any signs) and three types of comparisons--comparisons of pooled estimates from all available studies that include data from different communities and time periods, comparisons of estimates from the same communities at different times, and comparisons of estimates from selected studies in the early years of fluorosis research with results of the US National Fluorosis Survey done by the National Institute of Dental Research. A clear increase in fluorosis among populations drinking community water that contains less than 0.3 ppm fluoride was found. Results of the comparisons using studies with Dean's Index pooled at different time points, comparisons in the same communities over time, and comparisons of prevalence found in selected communities before fluoride was widely available with the National Fluorosis Survey all support this conclusion. An increase in the prevalence of fluorosis in those drinking optimally fluoridated water likely has occurred as well; however, evidence for such a trend is not as clear as for fluoride deficient communities because of mixed results depending on the type of comparison. The majority of fluorosis cases continue to be mild and seem of little esthetic consequence for most of the public or dental profession. But a few cases of more severe fluorosis can be found now in some communities. Because the prevalence of fluorosis is now higher than 50 years ago, we can conclude that fluoride availability to the developing enamel during critical periods when enamel is at risk of fluorosis has increased in North American children.     

黑龙江省12岁儿童患龋状况与饮水氟浓度关系的抽样调查

目的:研究黑龙江省不同地区12岁儿童龋齿和氟斑牙的发病情况与当地饮水氟浓度的关系。方法:按照WHO《口腔健康调查基本方法》的要求,采用多阶段分层等容量随机抽样方法,抽取全省城乡6个地区的12岁年龄组792例儿童进行龋齿和氟牙症调查。采用SPSS12.0软件包进行统计学分析。结果:6个地区饮水氟浓度分别为0.29、0.40、0.68、0.77、0.80和1.14mg/L;相应的患龋率为44.7%、43.2%、41.7%、37.1%、28.0%和40.5%。除饮水氟浓度1.14mg/L组外,随着饮水氟浓度的增高,患龋率有下降趋势,两者呈负相关关系(r=-0.81)。社区氟牙症指数(CFI)与饮水氟浓度呈正相关关系(r=0.78)。结论:适当的饮水氟浓度可有效降低龋齿的发病率,在水氟过高的情况下,可能会引起龋病和氟牙症的高发。     

A blind caries and fluorosis prevalence study of school-children in naturally fluoridated and nonfluoridated townships of Morayshire, Scotland

OBJECTIVES: To undertake a blind caries and fluorosis prevalence study of Grade 1 (aged 5/6 yr) and Grade 4-7 (aged 8-12 yr) children from naturally water-fluoridated (1 ppm, since 1985) Burghead, Findhorn & Kinloss (F), and nearby nonfluoridated Buckie & Portessie (N-F), in rural Morayshire, Scotland. METHODS: A blind clinical (+ 10% repeats) caries study of the above townships' 5/6-yr-old lifetime (15 F; 43 N-F), and 8-12-yr-old lifetime (55 F; 136 N-F)/school-lifetime (31 F; 37 N-F) residents was undertaken following bussing of these children to a common examination site in close-by Elgin Town Hall. Initially, each child was asked about their own perception of the aesthetics of their maxillary front teeth. Fluorosis was assessed clinically using the TF Index, as well as photographically - for later blind scoring (+ 10% repeats for lifetime 8-12-yr-olds) of slides by four dental and two lay 'jurors', alongside a now-established UK 'bench-mark' mildly mottled (TFI = 2), fluorosis comparator slide, judged in previous studies to be aesthetically lay-acceptable. In addition, by parental questionnaire, information was sought concerning their child's fluoride supplement and dentifrice usage histories. RESULTS: For 5/6-yr-olds, mean primary caries scores were 96.0% less in fluoridated than nonfluoridated subjects (P < 0.01). In 8-12-yr-olds, DMFT values favoured water-fluoridated subjects; their caries-free trend was significant (P < 0.001 overall). Clinically, 33% of all lifetime F subjects and 18% of all N-F pupils had fluorosed maxillary anterior teeth (P = 0.045), but no statistically significant difference was found between the 7% F and 3% N-F subjects with TFI scores > 2 (P = 0.25). Photographically, 'jury' mottling assessment (+ 10% repeats) of projected slides resulted in at least 1 : 6 positive scores in 43.6% of F and 30.9% of N-F pupils, albeit they unanimously scored only nine F and five N-F children as having fluorosed teeth (P < 0.01). In no case did all members score TFI > 2. Dental and lay scorers rated TFI = (1/2) in only a further 9.1% and 5.5% of F subjects, respectively, compared to 0.7% and 1.5% respectively of N-F pupils. Again, TFI > 2 was scored unanimously in no child. No differences were found regarding the children's own degree of anterior tooth aesthetic nonacceptability between F (11%) and N-F (12%) prevalence (P = 0.75). Finally, only one F child had taken F supplements and, while 26 N-F had used F drops, no significant relationship was found between their usage and TFI values in the latter group (P = 0.49). Additionally, no relationship was noted between clinical TFI scores and the age at which parents stated fluoridated dentifrice toothbrushing commenced, between 0 and 24 + months of age. CONCLUSIONS: Considerable caries benefit has accrued to those Morayshire rural children who have received naturally fluoridated water (at 1 ppm) throughout their lives, as compared to their socioeconomically similar, nonfluoridated rural counterparts. Furthermore, in spite of all but two subjects claiming to have brushed regularly with fluoridated dentifrice (and no evidence of the availability of nonfluoridated toothpaste being purchasable in the five townships), only borderline mild fluorosis disadvantages have been noted clinically, and none by the subjects' own aesthetic perceptions. Finally, no evidence was found to suggest any delay in permanent tooth eruption patterns of the F subjects. It would seem appropriate therefore, that adjustment of Scots' drinking waters' natural fluoride levels to 1 ppm should be pursued to extend similar dental advantages to the vast majority of that population (both young and old) which, it is well documented, has the worst dental health of mainland UK.     

Caries experience of urban and rural children in Saudi Arabia

OBJECTIVE: Caries experience and restorative treatment needs often are reported to be higher in urban than rural areas in developing countries. The purpose of this study was to compare caries experience in 12- and 13-year-old children in urban and rural areas of Saudi Arabia, a young, oil-rich, developing country. METHODS: A random sample of 1,873 schoolchildren aged 12-13 years from urban and adjoining rural areas of 10 administrative regions in the Kingdom of Saudi Arabia were examined for dental caries. Questionnaires also were administered to elicit information on the frequency of snacking as well as consumption of sweets and soft drinks. RESULTS: No statistically significant differences were found between urban and rural children in caries experience in permanent teeth (mean DMFT = 2.69 in urban areas; 2.65 in rural areas), frequency of snacking, or frequency of consumption of sweets and soft drinks. The percentage of DMFT found to be D was equally high (> 89%) in both urban and rural areas, indicating a high level of restorative treatment need. CONCLUSION: In Saudi Arabia, an economically prosperous developing country, exposure to cariogenic diet in urban and rural areas does not differ. Also, a difference in caries experience in urban and rural areas often reported for developing countries does not apply to Saudi Arabia.     

Use of fluoride tablets and effect on prevalence of dental caries and dental fluorosis

A study was executed to investigate the relation between the use of fluoride tablets by children in the age period 1.5-6 yr on the one hand and the caries experience at the age of 6 and 15 yr and the prevalence of fluorosis at the age of 15 yr on the other hand. The year of birth of the child, the motivation of the mother to engage in preventive dental behavior, the level of her school education and her place of birth were taken into account as possible confounding factors. A significant relation was found between the use of fluoride tablets and the prevalence of fluorosis. The most important predicting factor for the caries experience of the child was the mother's motivation to engage in preventive dental behavior. An effect of fluoride tablets on the caries experience could not be demonstrated.     

Caries prevalence in Icelandic chilcjren in 1970 and 1983

In the autumn of 1983 a clinical survey was carried out on 756 children aged 6-14 yr, residing in three non-fluoridated communities in Iceland. The aim of the survey was to assess what changes, if any, in caries prevalence may have taken place as a result of the provision of free dental restorative services for these children since 1974. The 1983 prevalence data were compared with data obtained from a caries survey conducted in 1970 in the same areas in Iceland. The same examiner performed all examinations in both studies. Although considerable increase was noted in number of filled teeth with a corresponding decrease in carious and missing teeth, a statistically significant change in caries prevalence, (dft, dfs, DMFT, DMFS) did not manifest itself. The dfs and DMFS in 1983 was 8.9 and 9.5, respectively, compared to 8.5 and 10.4 in 1970. Over 90% of the toothpaste used in Iceland during the 1970's contained fluoride. The children in the three study areas had not been provided with any public preventive programs.     

Associations among dental caries experience,fluorosis, and fluoride exposure from drinking water sources in Saudi Arabia

Objectives: a) To correlate fluoride levels in drinking water sources with caries experience and dental fluorosis in Saudi Arabia, and suggest appropriate fluoride concentration for drinking water in the country. Methods: Fluoride levels were determined from 3,629 samples obtained from drinking water sources in 11 regions of Saudi Arabia. Based on the fluoride concentrations, a stratified sample of subjects aged 6‐7, 12‐13, and 15‐18 years was obtained from the regions. A total of 12,200 selected subjects were examined for dental caries according to the World Health Organization criteria, and dental fluorosis, using Thylstrup and Fejerskov classification. Results: There was an inverse relationship between fluoride exposure and caries experience, but the prevalence of dental fluorosis increased with increase in fluoride concentration. There was no significant difference in caries experience or in the prevalence of dental fluorosis when fluoride levels increased from 0.3 ppm to 0.6 ppm. In contrast, caries experience was lower, while severity of fluorosis was significantly higher at fluoride levels above 0.6 ppm. Conclusions: a) Fluoride levels in drinking water sources in Saudi Arabia correlate significantly with caries experience and prevalence of dental fluorosis. b) Appropriate fluoride concentration for drinking water in Saudi Arabia may be about 0.6 ppm.     

Caries and background factors in Swedish 4-year-old children with special reference to immigrant status

Objective. This study assesses the prevalence of caries and some background factors in 4-year-old children in the city of Umeå, northern Sweden, and compares this with data from earlier studies to reveal changes over time. Materials and methods. Children from the catchment areas of three Public Dental Health Service clinics in Umeå (n = 224) born during the third quarter of 2008 were invited to undergo a clinical dental examination. Decayed surfaces (including both dentine and enamel, except for enamel lesions on buccal and lingual surfaces), missing and filled surfaces (dmfs) were recorded using the same methods and criteria as in a series of earlier studies performed between 1980–2007. Background data were collected in a case-history and a questionnaire. Results. The proportion of children with caries significantly decreased from 2007 (38%) to 2012 (22%) (p < 0.05). In addition, the distribution of dmfs differed significantly between these years (p < 0.05). More immigrant children had caries (42%) than non-immigrant children (15%) (p < 0.05). For children with caries, there were no significant changes in the distribution of dmfs between 1980–2012 (p > 0.05). An immigrant background was associated with a lower frequency of tooth brushing and a higher intake of ice cream, sweets and chocolate drinks (p < 0.05). Conclusion. Although the proportion of children with caries declined between 2007–2012, this decline was limited to non-immigrant children. Since 1980 the distribution of dmfs remained unchanged among children with caries. More research on interventions for changing oral health behaviours is needed, specifically for immigrant children.