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.     

Oral health of young children in Mississippi Delta child care centers: a second look at early childhood caries risk assessment

Objectives: To identify the predictors of early childhood caries and urgent dental treatment need among primarily African‐American children in child care centers in the Delta region of Mississippi. The purpose of this study was to replicate predictors of caries and urgent dental treatment needs that were identified in an earlier study conducted in Delta child care centers and to assess additional caries risk factors not collected in the original study. Methods: Children in 19 child care centers were examined by the dentists, and the parents provided data on oral health practices, oral health history, and on children's oral health‐related quality of life (QOL). The dentists also assessed visible plaque and tested levels of mutans streptococci. Predictors of caries and treatment need among children 24 to 71 months of age were examined using logistic regression. Results: Two parent predictors of caries identified in the earlier study (parent flossing and soft/sugary drink consumption) were not predictive in the current study. Parent history of abscess continued to predict their child's urgent need for treatment. Young children's level of salivary mutans streptococci, maxillary incisor visible plaque, and parents' reports of child oral health‐related QOL measures predicted the presence of both caries and urgent treatment need. Some expected predictors, such as frequency of child's toothbrushing, were not predictive of caries. Conclusions: Parental abscess and parent's report of the child's oral health‐related QOL are risk indicators for poor oral health outcomes that could be used by nondental personnel to identify young children in need of early preventive intervention and dental referral.     

A study of prevalence of caries and oral health behavior in Japanese children with cleft lip and palate

The aims of this study were to investigate the condition of dental caries in 1–4 years old Japanese children with cleft lip and/or palate, and also to examine the relationships between age, location of the cleft, oral health behavior of cleft children and the incidence of dental caries. The study was carried out through a dental examination of a sample of children and a questionnaire to their parents which included questions about infant feeding practices, frequency of consumption of specific drinks and children's frequency of tooth brushing. A sample of 116, 1–4 years old Japanese children (58 boys and 58 girls) with oral clefts referred to the Department of Pediatric Dentistry Clinic, Showa University, after receiving surgical treatment, participated in this study. Results indicated that the prevalence of caries in cleft children was related to patient age, location of clefts and oral health behavior. A higher level of dental caries was recognized in children with cleft lip and alveolus/palate than in those with cleft lip alone. Incidence of caries increased with patient age. Children who had been fed in a determined time were less affected than those who had been fed at will. Incidence of caries was also high in the children who ingested drinks with sugar than in those who did not. The results of this study suggest that it is important to improve the oral health behavior of cleft children to minimize the risk of caries. Moreover, children with clefts and their parents should as early as possible undergo a preventive program to ensure preservation of primary dentition.     

The potential role of breast-feeding and other factors in helping to reduce early childhood caries

Objectives: Dental caries is the most common chronic disease in US children. Early childhood caries (ECC) is particularly virulent and can interfere with a child's ability to eat, grow, speak, and communicate. Studies on whether breast‐feeding or bottle‐feeding are more likely to reduce ECC have proven inconclusive. Methods: The study population included 175 children, aged 1 to 5, receiving dental care at the Hughes Spalding Children's Hospital in Atlanta, GA. Participation included a dental exam, chart data abstraction, and a personal interview with the mother. Results : Too few exclusively breast‐fed children prevented the adequate study of breast‐feeding. However, children exclusively bottle‐fed for at least 1.5 years had more decayed or filled tooth surfaces than children breast‐fed part of that time but well short of a year. No bottle at night nor juice at irregular times, the mother's brushing of her child's teeth, and adequate dental care in the mother seemed to reduce ECC. Conclusions : Our results suggest measures that might reduce ECC risk. Medical providers must discuss oral health with new mothers and educate them on the important role they play in keeping their babies' teeth healthy.     

Child and family health nurses' experiences of oral health of preschool children: a qualitative approach

Objectives: The objective of this study was to explore Child and Family Health Nurses' work‐related experiences of dental disease in young children. Methods: Child and Family Health Nurses (n = 21) who recruited new mothers to an ongoing birth cohort study that began in South Western Sydney, Australia were invited to take part in a qualitative study. A semi‐structured, in‐depth interview technique was used to explore their experiences of preschool child oral health and how this affects their working lives. Interviews were audio‐recorded, transcribed verbatim, and analyzed using a thematic analysis. Results: The nurses considered dental caries to be a significant health issue for young children and their families. They thought that the burden of dental disease in preschool children was underestimated in disadvantaged and multicultural populations. In addition, they reported that parents were often unaware of the disease process and were ignorant of the relationship between bottle feeding and dental caries. Once the parents were informed about their child's poor oral health, they had feelings of anger, despair, and guilt. Conclusions: This study highlights that oral health problems are a significant segment of the child health problems identified by nurses in their daily work. The nurses perceived the problem of dental caries to be one of a lack of parental knowledge, and families should be educated not only on “what” but also on “how” to feed their children. The primary healthcare team should work collaboratively to educate families in a culturally appropriate way.     

The attitudes of parents toward the oral health of children and their reflection on the non-cavitated caries lesions

ObjectiveTo determine the extent of non-cavitated caries lesions in preschool children, and compare its relationship with socioeconomic status, oral and dental health practices, knowledge of caries prevention, and nutrition.Materials and methodsNinety-seven parents of 36–72 month-old children completed a questionnaire on the socioeconomic status of the family, parent's knowledge of caries prevention, the children's oral health practices, and nutrition. In the children, the cavitated dental caries were assessed according to World Health Organization (WHO) criteria and non-cavitated caries lesions on occlusal and smooth surfaces were evaluated by Universal Visual Scoring System (UniViSS). Statistical analysis was conducted using the SPSS software program. The relationships between variables were assessed using the chi-square test and logistic (ordinal) regression analysis.ResultsStatistically significant results were obtained relating to the parents' age, number of children, the time of first oral hygiene, frequency of tooth brushing, knowledge of caries prevention, drinks most often consumed by the children, and number of non-cavitated lesions. According to the regression model, the significant variables were caries activity (yes), drinks most often consumed by the children (milk–juice; juice–buttermilk), the frequency of tooth brushing (once a day, twice a day), observed changes in a child's teeth (change in color and breaks in teeth), the number of cavitated caries lesions and decayed, missing and filled teeth (dmft).ConclusionsThe primary factors contributing to non-cavitated caries lesions include the time of first oral hygiene and frequency of tooth brushing. The early diagnosis of non-cavitated caries is essential for preventive measures.     

A vicious cycle in the oral health status of schoolchildren in a primary school in rural Cambodia

Abstract Objective: To investigate the oral health status and the risk factors contributing to dental caries and gum disease of schoolchildren in Cambodia. Methods: A cross‐sectional survey was conducted in a primary school in the Puok District, Siem Reap Province of Cambodia. An oral examination and self‐reported questionnaire were used to evaluate oral health status of schoolchildren, ranging in age from 6–16. Of the 512 children that were enrolled in first through sixth grade at the primary school, 332 children (62.8%) participated. Results: Of the schoolchildren that were involved in this study, the prevalence of dental caries in permanent dentition was 53.5% and gum disease was present in 46.2%. Among the participants 80% had plaque, 68.6% suffered from tooth pain and only 44.2% of the schoolchildren owned their own toothbrush. There was an association between the schoolchildren that suffered from tooth pain and those that had dental caries (P < 0.03). Plaque was related to dental caries in permanent dentition (P < 0.003), calculus (P < 0.0001) and gum disease (P < 0.0001) and was linked to the schoolchildren who did not own a toothbrush (P < 0.03) and who suffered from tooth pain (P < 0.03). Conclusion: The following sequence of events may result in a vicious cycle in the oral healthcare of schoolchildren in rural Cambodia: the lack of a personal toothbrush leads to plaque buildup, which may increase the incidence of dental caries, which has been linked to tooth pain and gum disease. Ultimately, this poor oral healthcare impacts an individual’s quality of life and can lead to more serious health issues later in life.     

Family composition and children's dental health behavior: evidence from Germany

Objective: To assess whether children's dental health behavior differs between family compositions of either natural parents or birth mothers together with stepfathers. Methods: We use data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) public use file. This is the first nationally representative sample on child health in Germany and particularly contains variables for dental attendance, tooth care, and eating behavior of 13,904 children below 14 years of age. A series of zero‐inflated Poisson, ordinary least squares, binary, and ordered logistic regression models was set up in order to identify whether family composition is a significant explanatory variable for children's dental health behavior. Results: Family composition turned out as a significant parameter for some aspects of children's dental health behavior. Specifically, children who grow up in families with a birth mother and a stepfather have only half the probability to access dental services but, once seeking treatment, the number of visits is significantly higher in comparison with children raised by their natural parents. Moreover, children growing up in such a patchwork family setting consume a higher amount of sugary foods and drinks. This appears mainly attributable to differential consumption habits for juices, cookies, and chocolate. Conclusions: Children who grow up in settings other than the nuclear family may develop different dental health behaviors than children who grow up with both natural parents, albeit more research is needed to identify the extent to which such behavioral changes lead to variations in caries occurrence.     

儿童乳磨牙金属预成冠的修复治疗

乳牙龋病是儿童常见的口腔疾病之一.第三次全国口腔健康流行病学调查结果显示,中国儿童乳牙存在患龋率高、就诊率低下的现状.由于儿童乳牙解剖形态及组织结构特点、儿童饮食特点等原因,导致儿童乳牙龋具有区别于恒牙龋的特殊临床表现,且可对继承恒牙、儿童生长发育及心理等产生不良影响.目前,针对乳牙龋的治疗主要采用药物治疗和修复治疗,修复治疗是最重要的治疗方法,其中对于较大面积的乳磨牙龋损,临床上多选择金属预成冠的修复治疗.本文从金属预成冠的背景、适应证、临床操作步骤及相关研究等方面,就儿童乳磨牙的金属预成冠修复治疗进行阐述.     

Oral health of children with attention deficit hyperactivity disorder

This study assessed and compared oral health and oral‐health behaviours among children with and without attention deficit hyperactivity disorder (ADHD). The study included 31 children, 12–18 yr of age, with ADHD and 31 age‐ and gender‐matched children without ADHD. Clinical data were recorded by a trained and calibrated examiner for caries, traumatic dental injuries, periodontal health, tooth wear, and salivary function. A questionnaire was also given to parents or caregivers about the oral health habits and behaviours of these children. Data were compared using Mann–Whitney U‐tests and chi‐square tests. No significant differences were found between children, with or without ADHD, in caries extent or prevalence, dental trauma prevalence, prevalence of periodontal disease or plaque, tooth wear, or unstimulated salivary flow. Children with ADHD had a significantly higher percentage of sites with gingival bleeding, as well as a higher frequency of parent‐reported dislike of dentists, bruxism, history of assisted toothbrushing, and toothbrushing duration <1 min. They also had higher attendance at government dental clinics. The findings indicate that children with ADHD have poorer oral hygiene and more adverse oral‐health attitudes and behaviours than do children without ADHD.     

Impact of dental caries on quality of life among preschool children: emphasis on the type of tooth and stages of progression

The aim of this cross‐sectional study was to evaluate the impact of dental caries on the quality of life of preschool children and their parents/caretakers, with an emphasis on the type of tooth and stage of progression. A randomly selected sample of preschool children, 3–5 yrs of age, underwent an oral examination for the assessment of dental caries using the International Caries Detection and Assessment System II (ICDAS II) criteria. Parents/caretakers answered two questionnaires, one on the oral health‐related quality of life (OHRQoL) of the child [the Early Childhood Oral Health Impact Scale (ECOHIS)], and the other on the socio‐economic characteristics of the family. Statistical analyses were performed using the chi‐square test, Kruskal–Wallis test, Mann–Whitney U‐test, and Poisson regression. A total of 451 preschool children participated in the study. The majority of carious lesions exhibited severe decay (60.6%) and were found in both anterior (incisors/canines) and posterior (molars) teeth. The final Poisson model revealed negative impacts on quality of life from more advanced stages of dental caries, both in incisors/canines and molars. Child's age and household income were also associated with impact on quality of life. Carious lesions in more advanced stages of progression in anterior and posterior teeth were associated with a negative impact on the quality of life of preschool children.     

Associations between school deprivation indices and oral health status

Da Rosa P, Nicolau B, Brodeur J‐M, Benigeri M, Bedos C, Rousseau M‐C. Associations between school deprivation indices and oral health status. Community Dent Oral Epidemiol 2011; 39: 213–220. © 2010 John Wiley & Sons A/S Abstract – Background: Despite an overall improvement in oral health status in several countries over the past decades, chronic oral diseases (COD) remain a public health problem, occurring mostly among children in the lower social strata. The use of publicly available indicators at the school level may be an optimal strategy to identify children at high risk of COD in order to organize oral health promotion and intervention in schools. Objective: To investigate whether school deprivation indices were associated with schoolchildren oral health status. Methods: This ecological study used a sample of 316 elementary public schools in the province of Quebec, Canada. Data from two sources were linked using school identifiers: (i) Two school deprivation indices (in deciles) from the Ministry of Education, a poverty index based on the low income cut‐offs established by Statistics Canada and a socioeconomic environment index defined by the proportions of maternal under‐schooling and of unemployed parents and (ii) Oral health outcomes from the Quebec Schoolchildren Oral Health Survey 1998–99 aggregated at the school level. These included proportions of children with dental caries and reporting oral pain. The relation between school deprivation indices and oral health outcomes was assessed with linear regression for dental caries experience and logistic regression for oral pain. Results: The mean DMF‐S (mean number of decayed, missing and filled permanent teeth surfaces) by school was 0.7 (SD = 0.5); the average proportions of children with dental caries and reporting oral pain were 25.0% and 3.0%, respectively. The poverty index was not associated with oral health outcomes. For the socioeconomic environment index, dental caries experience was 6.9% higher when comparing schools in unfavourable socioeconomic environments to the most favourable ones [95% confidence interval (CI): 2.1, 11.7%]. Furthermore, the most deprived schools, as compared to least deprived ones, were almost three times as likely to have children reporting oral pain in the previous week. Conclusion: The school socioeconomic environment index was associated with oral health outcomes, and should be studied for its potential usefulness in planning school‐based oral health promotion and screening strategies.     

Caries and background factors in Norwegian and immigrant 5-year-old children

Wigen TI, Wang NJ. Caries and background factors in Norwegian and immigrant 5‐year‐old children. Community Dent Oral Epidemiol 2010; 38: 19–28. © 2009 John Wiley & Sons A/S Abstract – Objectives: The purpose of this study was to assess the caries status of 5‐year‐olds in a low caries area, and study associations between dental caries and parent‐related factors: parents’ education, national origin, oral health behaviours and attitudes. Methods: The material consisted of 523 children and was a stratified random sample. Clinical and radiographic examination was performed in 2007. Enamel and dentine caries were recorded at surface level. Parents filled in questionnaires regarding socioeconomic status, their own oral health behaviours and attitudes. Results: Most participants (66%) had no caries experience and 16% had enamel caries only. Dentine caries experience was present in 18% of the children, and 5% had dentine caries experience in five or more teeth. Surfaces with enamel caries constituted half of all surfaces with caries experience. In multiple logistic regression, statistically significant risk indicators for the child having dentine caries experience at the age of five were: having one or both parents of non‐western origin (OR = 4.8), both parents (OR = 3.0) or one parent (OR = 2.1) with low education, parental laxness about the child’s tooth brushing (OR = 2.8), parents’ brushing their own teeth less than twice a day (OR = 2.2) and having parents with frequent sugar intakes (OR = 1.8). Conclusion: Caries prevalence in 5‐year‐olds was strongly associated with parent‐related factors signifying that information on parents’ socioeconomic status, dental behaviours and attitudes should be considered when planning dental services for young children. Our results suggest that the real high risk group is non‐western children whose parents have low education.     

Spatial analysis to identify differentials in dental needs by area-based measures

Objectives: To examine the association between tooth decay and dental treatment needs in 5–12-year-old schoolchildren in São Paulo with area-level indicators of social development. Methods: The present study refers to a representative sample of children from the city of São Paulo, Brazil, comprising 2491 girls and boys attending public and private schools in different areas of the city. The assessment of caries and treatment needs followed the international methodological standards prescribed by the World Health Organization. We used spatial data analysis to describe epidemiological measures distributed by small areas, and to explore hypotheses of ecological association between caries indexes and indicators of social development. Results: Schoolchildren in central districts were less affected by tooth decay and presented fewer dental treatment needs when compared to those in peripheral deprived areas. At the spatial level, average family income, unemployment rate, household overcrowding, and an index of inequality of income distribution were significantly correlated with variables measuring children's caries experience. Conclusions: The heterogeneous distribution of caries indexes by areas of the city indicates higher levels of dental decay in areas of social deprivation. The delimitation of areas with increased risk of caries and greater dental treatment needs should be helpful to public health services for the formulation of policies and the targeting of resources to address these problems.     

Association between developmental defects of enamel and dental caries in schoolchildren

Despite improvement, dental caries is still the main public oral health problem worldwide and the major cause of pain, tooth loss and chewing difficulties in children and adolescents; and it impacts negatively on oral health-related quality of life. A cross-sectional study of a multistage representative sample of 8–12-year-old Brazilian school children was carried out in order to investigate the association between enamel defects and dental caries. Children's mothers completed a questionnaire about socio-demographic and behavioural characteristics at home. Firth's bias reduced logistic regression models were undertaken to assess the association between the main exposure (enamel defects) and caries experience. The prevalence of any enamel defect was 64.0%; the prevalence of diffuse opacities, demarcated opacities and enamel hypoplasia was 35.0%, 29.5% and 3.7%, respectively. The prevalence of dental caries was 32.4%, with mean DMFT of 0.6 (SD, 1.2). Dental caries experience was more common among children who had enamel hypoplasia in their posterior teeth (OR = 2.79; 95% CI: 1.05, 6.51) than among those with none. In anterior teeth, there was no association. Enamel hypoplasia appears to be an important risk factor for dental caries.     

Contributions of social context to inequality in dental caries: a multilevel analysis of Japanese 3-year-old children

Abstract – Background: Community context as well as individual health behavior affects oral health status. However, the contribution of social context to dental caries among people in various regions remains unclear when individual health behavior is taken into account. Objectives: To determine the influence of community context on dmft among 3‐year‐old children. Methods: After all Japanese municipalities (n = 2522) had been stratified into nine regions with three caries levels, 44 municipalities were randomly selected. Community health service workers were asked to collect information on sociodemographic characteristics, oral health‐related behavior, and dental condition for 3‐year‐old children during community dental health check‐ups. Community‐related variables, including socioeconomic status, social support, and social cohesion, were obtained from census data. Multilevel analysis was used to determine the effects of social context and individual behavior on dental caries. Results: A total of 3301 parents (79.9%) of 3‐year‐old children from 39 municipalities participated in our survey, and complete information was obtained from 3086 of them. Results of the analysis showed that 90.8% (P < 0.001) of variance in dmft occurred at the individual level and that 9.2% (P < 0.001) of the variance occurred at the community level. Individual‐level variables explained only 6.6% of the individual level variance in dmft. Community‐level variables explained 47.2% of the community level variance. Conclusions: There are statistically significant effects of social context on dmft in municipalities in Japan.     

Dental caries and externalizing behaviour problems in a high‐risk child population

The aim of this study was to assess the association between externalizing behaviour problems and dental caries in children. A further objective was to explore direct and indirect pathways between sociodemographic factors, family functioning and parenting factors, oral health behaviours, externalizing behaviour problems, and dental caries using structural equation modelling. Cross‐sectional data were collected on 251, 5‐ to 8‐yr‐old children from a paediatric dental practice in the Netherlands. Children's decayed, missing, and filled primary teeth (dmft) scores were obtained from their dental records. Validated self‐report questionnaires were used to collect sociodemographic, behavioural, and family‐related data. Externalizing problem behaviour was significantly associated with a higher dmft score [incidence risk ratio (IRR) = 1.19; 95% CI: 1.06–1.34], but this association did not remain significant after adjustment for sociodemographic factors (IRR = 1.11; 95% CI: 0.99–1.26). A valid path model was presented after applying some modifications. Findings from the model suggest that it is plausible that child behaviour problems are directly associated with dental caries via toothbrushing behaviour. The model also provided support that maternal education level, the restrictiveness and warmth of parenting, and the communication of the family, play an indirect role in the association between children's externalizing behavioural problems and dental caries experience.     

Oral health status of New Hampshire Head Start children, 2007‐2008

Objectives: We report on the baseline prevalence and severity of dental caries of children enrolled in the New Hampshire Head Start program during the 2007‐2008 school year. Methods: We selected a random cluster sample of 607 children aged 3‐5 years attending 27 Head Start centers across the state. Four volunteer dentists provided oral examinations and determined the presence of untreated dental caries, caries experience, and treatment urgency. Results: Overall, 40 percent of the participating children had experienced dental caries, and 31 percent had at least one untreated decayed tooth. Approximately 22 percent of the children had evidence of maxillary anterior caries, 23 percent were in need of dental care, and <1 percent needed urgent care. Conclusions: The prevalence of dental caries is comparable with that reported by Head Start programs elsewhere. The prevalence of caries affecting maxillary anterior teeth is higher. Further studies should examine state‐specific barriers to dental care among this population.