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.     

Oral health status, treatment needs, and obstacles to dental care among noninstitutionalized children with severe mental disabilities in The Netherlands

The objective of this study was to assess the oral health status, treatment needs, and barriers to dental care of noninstitutionalized children in The Netherlands who have severe disabilities. The oral health status of 61 children (38% female; 4-12 years of age; M = 7.7, SD = 2.2), randomly selected from seven different daycare centers, was evaluated. Caretakers (n = 126) and dentists (n = 40) completed questionnaires concerning demographic information, oral hygiene, frequency of dental visits, and possible barriers to the daily oral care of the children. Of all the children, 57.4% had untreated caries (mean dmft/DMFT = 3.0; SD = 3.1). The proportion of caries-free children was 29.5%. In comparison to Dutch children, a significantly higher proportion of children with disabilities belonging to an ethnic minority did not receive any routine dental care (53.1% and 23.8%, respectively). Caretakers considered the noncooperation of their patients as the most troublesome aspect of their daily oral care (68%). Dentists considered communication problems as the most important barrier to treatment (75%). In conclusion, Dutch noninstitu-tionalized children with severe disabilities still receive a relatively low degree of quality dental care. This is particularly true for children from ethnic minority groups.     

A comparison of perceived and actual dental needs of a select group of children in Texas.

Dental caries (DMFS) evaluations were made for 150 children in Grades 2 to 7. Three months later, a trained interviewer questioned 120 children from 100 families to determine atitudes toward oral hygiene and dental health on the part of (a) the child, (b) the parent, along with (c) the child's perception of the parent's attitude, and (d) the parent's perception of the child's attitude. Evaluation of the perceived attitudes toward oral hygiene revealed a statistically significant correlation between the child's attitude and the degree of dental health as well as between the attitudes of child and parent. Conclusions were: (1) parents were not accurate in their perception of the dental health habits of their children, (2) children were not performing acceptable routine oral hygiene procedures, (3) children accurately perceived the attitudes of their parents toward dental health, and (4) children's actual dental health behavior as manifested by dental health status was related to the attitudes of their parents.     

Characteristics of publicly insured children with high dental expenses

BACKGROUND: Dental coverage is provided for all children with Medicaid in Washington State. The goal of this study was to illuminate the characteristics of a sample of Medicaid-enrolled children with high dental expenses. METHODS: Dental care utilization data for a 33-month period were obtained from Washington State's Medicaid database. For children, 0 to 6 years, these data were linked with a parent survey addressing oral health behaviors, knowledge, family history of caries, snacking patterns, and access to dental care. Children with dental expenses of $1,000 or more were classified as the "high-expense" group. Risk factors for the high-expense group were evaluated using multiple logistic regression. RESULTS: 345 children had at least one dental procedure including preventive and diagnostic care. Among these, 30 children (9 percent) incurred 64 percent of total dental expenses for the entire group. Parent perception of lack of dental coverage was associated with incurring high dental expenses. Children of Asian or Pacific Islander heritage were at disproportionately high risk compared to White children. Age of child and family history of caries were also associated with increased risk for high expenses. CONCLUSIONS: Not all low-income children on Medicaid are at high risk for caries. A combination of factors, including family history of caries and parent's perception of lack of dental insurance coverage, can potentially increase a child's likelihood for high-expense dental treatment. This study highlighted a small group of children with disproportionately high dental expenses. For some, earlier knowledge of coverage may have resulted in more timely access to preventive and diagnostic care, reducing the subsequent need for expensive restorative treatment.     

Caries conditions among 2-5-year-old immigrant Latino children related to parents' oral health knowledge, opinions and practices

Objectives : To collect baseline data prior to initiating a community-based, oral health promotion program in an inner city Latino community in Washington DC, populated by Central American immigrants. Methods: In 1995, an oral survey of a convenience sample of children 2–5 years of age ( n = 142) and a survey of the knowledge, opinions and practices (KOP) of their parents ( n = 121) were completed. Clinical data of children were matched with parent respondents of the KOP survey. Data were analyzed for statistical associations using univariate odds ratios, Fisher's exact tests, and multiple logistic regression. Results: Only 53% of the children were caries free. Eighteen percent of all children were in need of immediate dental care and 26% were in need of early or non-urgent dental care. Only 7% of the parents knew the purpose of sealants and 52% knew the purpose of fluorides. Further, only 9% thought that brushing with toothpaste can prevent tooth decay. The strongest predictors of dental caries in this population, after adjusting for child's age and mother's education, were recency of mother's residence in the United States and report of an uncooperative child when attempting toothbrushing. Conclusions: Regimens of caries prevention have been successful in reducing dental decay for a large segment of the US population, yet this disease remains prevalent especially among low socioeconomic groups. The oral health status of the children and the oral health KOP of the parents in this community are disturbingly deficient.     

Oral health and use of dental services among Hispanics

OBJECTIVES: This study examined factors related to oral health and dental service use among Mexican-Americans, Cuban-Americans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982-84 (HHANES). METHODS: Categorical measures of oral health were created: (1) perceived oral health status, (2) evaluated oral health status, (3) decayed permanent teeth, (4) teeth missing due to caries, (5) total permanent teeth present, and (6) periodontal classification. The effects of acculturation, education, dental insurance, and perceived condition of teeth and gums on dental service use in the past two and five years were examined using logistic regression. All analyses were performed separately for each of the three samples using SAS-callable SUDDAN. RESULTS: Dental insurance and education were the most important factors in determining use of dental cleanings and use of dental care. For Mexican-Americans, Cuban-Americans, and Puerto Ricans, acculturation was a factor in determining use of dental care in the past five years. CONCLUSIONS: While dental insurance and education appear to be the most important factors for determining both use of dental cleaning services and use of dental care in all three samples, acculturation also had some impact for determining use of dental care.     

Well-baby dental examinations: a survey of preschool children's oral health

Well-baby dental visits provide early prevention and detection of dental disease for the infant and preschool child. A survey of the dental records of 379 preschool children from the ages of 6 months to 4.5 years were reviewed from a population of military family dependents. The caries activity of this population was found to be 8.9%, with a dft of 0.25. Nursing caries was clinically definable in 5.3% of the children, accounting for 58.8% of all reported caries. Malocclusion occurred in 6.3%, with anterior open bite and posterior crossbite found most commonly. No soft tissue pathology was noted. Evidence of previous dental trauma to the maxillary incisors with crown discoloration was found in 2.9%. These early dental visits provide a pleasant introduction to dental oral health and prevention for both parents and children. Early dental examinations should focus the parent's attention on the child's future oral health and provide an understanding of the causes of nursing caries.     

Use of preschool dental services in a New Zealand birth cohort

Abstract The utilisation of preschool dental services was examined prospectively in a birth cohort of New Zealand 4-year-old children. There were highly significant associations between non-utilisation of dental care services and a series of measures of family social background and the quality of care provided to the child. Factors associated with increased risks of non-utilisation of dental services included: mother of non-European ethnic origin; low gross family income; single parent family; non-attendance at preschool education facilities; failure to attend community nurse services and a lower utilisation of routine child health care services including immunisations and routine postnatal checks. The implications of the non-utilisation of preschool dental care are discussed in the context of the more general problem of providing an adequate and equitable standard of health care for children.     

Oral health status in relation to ethnicity of children in the Municipality of Copenhagen,Denmark

Summary. Approximately 25% of children under the age of 18 in the Municipality of Copenhagen have a non‐Danish ethnic background, and it is suspected that there may be major inequalities in oral health as a result. Objectives. The objectives of this study were to describe the occurrence of dental caries in different ethnic minorities, and to analyse whether the dental caries experience of the children may be affected by cultural and behavioural differences. Materials and methods. The study was conducted in Copenhagen as a cross‐sectional investigation of 794 children, aged 3 and 5 years old (preschool), 7 years old (Grade 1) and 15 years old (Grade 9). Children of Danish, Turkish, Pakistani, Albanian, Somali and Arabian backgrounds were selected by convenience sampling. Epidemiological data were retrieved from the Danish Recording System for the Public Dental Health Services (SCOR) and sociological data were collected by postal questionnaires. Results. Marked differences in dental caries prevalence were observed when different ethnic minorities were compared to Danish children. These were most prominent for the primary dentition. At age 7, 53% of the Danish and 84% of the Albanian children were affected by dental caries, the mean caries experience was 3·5 dmfs (decayed, missed and filled surfaces) and 13·8 dmfs, respectively. Caries in incisors and/or smooth surfaces was observed in 10% of the Danish children and 48% of the Albanian children. There were cultural differences in dental attendance and self‐care practices of children and parents. These socio‐behavioural factors may help to explain the differences in dental caries prevalence and severity. Conclusions. Development of appropriate oral health promotion strategies is urgently needed to improve oral health behaviour and attitudes of parents and children of ethnic minorities. Preventive programs should be organized at local community level in close collaboration with key persons of ethnic minority societies.     

Maternal perception about child oral health is associated to child dental caries and to maternal self-report about oral health

Objective: To test the association between maternal perception about child’s oral health and child dental caries experience and maternal self-perception about oral health.

Materials and methods: A cross-sectional study was performed with mothers and their children aged six to 13 years. A questionnaire was applied to mothers. Children were dentally examined using the DMF-T/dmf-t Index. For analysis, Poisson regression models with robust variance were employed for each variable of interest (child dental caries experience and maternal self-report about oral health). Magnitudes of associations were estimated through Prevalence Ratio (PR) as effect measure with 95% confidence intervals (CI). A significant level of p?≤?.05 was adopted.

Results: Overall, 131 mothers-children dyads were included. Most of children were girls (52.7%) and aged between 10 to 13 years (60.3%). Negative maternal perception about child’s oral health was associated to maternal negative self-perception about oral health (PR 2.54; 95%CI 1.54–4.30) and to higher child dental caries experience (PR 2.21; 95%CI 1.41–3.47).

Conclusion: Maternal perception about child oral health was associated to child dental caries and to maternal self-report about oral health.     

Prevention of early childhood caries: a public health perspective

This paper proposes strategies for preventing early childhood caries (ECC), preferably for the greatest number of children at the lowest cost. Population-based, public health approaches are more likely to reach the target population groups at risk of developing ECC than individual, private practice-based approaches. Different prevention and early intervention strategies are discussed and the following recommendations are made: 1) Continue to promote community water fluoridation. 2) Evaluate the effectiveness of other public health oriented measures to prevent ECC. 3) Develop a national ECC and rampant caries registry. 4) Link oral health screening and easily implemented, low-cost interventions with immunization schedules and public health nursing activities. 5) Increase opportunities for community-based interventions conducted by dental hygienists. 6) Change insurance reimbursement schedules to provide incentives for dentists to prevent disease. 7) Include dentistry in new child health insurance legislation for children as well as parents of infants and preschool children.     

Community socioeconomic status and children's dental health

BACKGROUND: Although a substantial decline in dental caries has occurred among U.S. children, not everyone has benefited equally. The first-ever surgeon general's report on oral health in America indicates that the burden of oral diseases is found in poor Americans. This study investigates the relationship between community socioeconomic status, or SES, and dental health of children. METHODS: An oral health survey of 17,256 children, representing 93 percent of children residing in 62 Tennessee communities, was conducted in public elementary schools during the 1996-1997 school year. Portable dental equipment was used for examinations, and data from each examination were entered directly into a laptop computer. The authors performed analyses of covariance to examine the relationship between community SES (low/medium/high) and dental health, controlling for community fluoridation. RESULTS: Community SES was significantly related to caries experience in the primary teeth, the proportion of untreated caries in the primary and permanent teeth, dental treatment needs, dental sealants and incisor trauma. Overall, dental health was significantly worse for low-SES communities than for medium- and high-SES communities. CONCLUSION: The authors conclude that all specific dental indexes used to measure children's dental health in this study, with the exceptions of caries experience in the permanent teeth and sealant presence, were inversely related to the communities' SES. The percentage of children with dental sealants was directly related to the community's SES. PRACTICE IMPLICATIONS: Further improvements in oral health will necessitate that community-based preventive programs and access to quality dental care be made available to children who are identified as being at highest risk of experiencing oral disease.     

Need for dental care drives utilisation of dental services among children in Saudi Arabia

Objectives: This study used Andersen’s predisposing, enabling and need behavioural model to predict factors that influence utilisation of oral health services for children in Saudi Arabia. Methods: The model was tested in a random sample of parents of third- and eighth-grade children in Jeddah (n = 1,668) using the access to care questionnaire adapted from the Basic Screening Survey. Predisposing (sex, parent education, nationality); enabling (school type, family income, government financial support, health insurance); and need for dental care (examined or perceived) were modelled to assess children’s use of dental services. Univariate and multivariate logistic regression models were conducted. Significant findings were reported at P ≤ 0.05. Results: About 84% of parents responded to our questionnaire (n = 1,397). One in four children have never visited a dentist. Our findings indicate that need and predisposing factors explained oral health services’ use among younger children, whereas need, predisposing and enabling factors predicted use of services among older children. Perceived barriers to dental care for children who never went to a dentist and for those who needed dental care and could not get it included oral health illiteracy (82.3%, 49.7%), dentist-related (19.9%, 42.1%), financial (22.8%, 37.1%) and transportation (9.8%, 20.8%), respectively. Conclusions: The need for dental care, predominantly for illness-related dental care, drives utilisation of dental health services among children in Saudi Arabia. Enhancing oral health literacy and mitigating organisational and financial barriers to dental care for families will increase children’s access to quality oral healthcare, and promote better oral health practices and outcomes.Key words: Utilisation, oral health services, oral health literacy, children, Basic Screening Survey, Saudi Arabia     

Evaluation of information on dental health care at child health centers. Differences in educational level, attitudes, and knowledge among parents of preschool children with different caries experience.

The aim of this study was to interpret the manner in which information on dental health care, systematically offered at child health centers, is assimilated among parents of preschool children with different caries experience. The material comprised children who, on the basis of defined criteria were classified as 'healthy' or 'diseased' with regard to caries and restorations. The investigation was mainly performed as telephone interviews with the parents. The results showed no difference between the groups with regard to diet, oral hygiene, and use of fluorides. However, parents of healthy children had a statistically significantly higher level of education than parents of diseased children. The level of education did not influence the knowledge as such but rather the ability to put the knowledge into practice. Parents of healthy children claimed to a greater extent than parents of diseased children to have received a combination of verbal and written information. This could be because the first group had a greater interest in assimilating new information and in creating a two-way communication with the informer. This is probably an effect of the level of education and confirms that it is essential to make people aware of the information's importance rather than merely teaching facts.     

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.     

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.     

Dental caries, age and anxiety: factors influencing sedation choice for children attending for emergency dental care

OBJECTIVES: The aim of the study was to examine how physical (dental caries) and psychosocial (age, dental anxiety and dental health behaviour) factors, associated with child and parent, influenced dentists' sedation choice when a child presents in pain. METHODS: 600 parents whose children were aged between 5 and 11 years took part: 200 attended for routine dental care (RDC); the remaining 400 attended as emergency patients and were offered either dental general anaesthesia (DGA) or relative analgesia (RA). The subjects were approached and invited to take part. The researcher was blind as to the child's pattern of dental attendance and the type of sedation offered. All parents and children completed self-reported ratings of dental anxiety. The children's teeth were examined to determine past and present dental caries experience. RESULTS: The results showed that children who were offered DGA had greater experience of dentinal caries, were younger and dentally anxious. The children offered RA were older, had a higher frequency of brushing their teeth with fluoride toothpaste and were also dentally anxious. Discriminant analysis showed that 2 canonical functions provided clear categorisation of the three treatment groups. Function 1 was a physical (dental caries) factor, which was related to the child's experience of dentinal caries. Function 2 was a psychosocial factor, which was related to the child's age, dental anxiety and frequency of tooth brushing. A greater proportion of the variance in the treatment offered was explained by Function 1, suggesting that the most important factor in the decision to offer DGA was dentinal caries. Function 2 was of lesser importance. CONCLUSIONS: The findings have implications for the type of sedation offered to children presenting for emergency care. These children may not otherwise receive treatment and the need to provide less anxiety provoking forms of sedation must be promoted. By doing so, parents who have only brought their children when in pain may take advantage of RDC and the treatments offered to prevent and control dental caries and anxiety in their children.     

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目的了解辽宁省沈阳市铁西区3岁儿童口腔健康行为和口腔健康状况,从而为制定相应的龋齿预防措施提供参考。方法通过临床检查与问卷调查相结合的方式,于2011年11月至2012年2月对随机抽取的沈阳市铁西区10所幼儿园共计473名3岁儿童进行龋病流行病学调查,并对结果进行分析。临床检查参照世界卫生组织口腔健康调查标准。结果本次共抽样调查3岁儿童473人,其中患龋者236人,占调查总人数49.9%。被调查儿童龋面均(DMFS)为3.53。最易患龋的牙面为上颌中切牙近中面。Logistic回归分析显示:儿童缩短使用奶瓶时间和家长协助儿童刷牙可有效降低牙齿患龋率。结论沈阳市铁西区3岁儿童患龋率较高,充填率低。建议加大该区口腔教育宣传,推广牙病防治适宜技术,减少儿童口腔疾病的发生。