Sensitivity and responsiveness of the Chinese ECOHIS to dental treatment under general anaesthesia

Lee GHM, McGrath C, Yiu CKY, King NM. Sensitivity and responsiveness of the Chinese ECOHIS to dental treatment under general anaesthesia. Community Dent Oral Epidemiol 2011; 39: 372–377. © 2011 John Wiley & Sons A/S Abstract – Objective: This study aimed to investigate the sensitivity and responsiveness of the Chinese version of the Early Childhood Oral Health Impact Scale (ECOHIS) to dental treatment under general anaesthesia (GA). Methods: A consecutive sample of primary caregivers of children (aged 5 and younger) with early childhood caries (ECC) attending a university hospital dental clinic for dental treatment under GA was recruited over a 12‐month period. Caregivers self‐completed the ECOHIS prior to and 3 months following their child dental treatment under GA. In addition, caregivers rated the change in their child’s overall health condition compared to before treatment on a global transition scale. Sensitivity of the measure was assessed by determining distribution changes in ECOHIS scores; responsiveness was assessed by investigating whether the observed changes took the form of a gradient according to the global transition judgement, in terms of the observed change in scores and effect size. Results: Following treatment under GA, there was significant changes in ECOHIS scores (P < 0.01) and many of its sub‐domains. The magnitude of change (effect size) of the total ECOHIS following treatment was 0.89 and among sub‐domains ranged from ?0.29 to 1.33. There was an observed gradient in the changes of ECOHIS scores (and effect sizes) in relation to global transition judgement of oral change following treatment, supporting the responsiveness of the measure. Conclusions: The Chinese version of ECOHIS is sensitive and responsive to dental treatment of ECC under GA.     

静吸复合全麻下婴幼儿龋治疗的效果评估

目的:评估静吸复合全麻下婴幼儿龋治疗的效果。方法:门诊收集60名符合2002年美国儿童牙科学会重症婴幼儿龋标准的1~5岁健康儿童,其中男38人,女22人。最小年龄17个月,最大年龄60个月,龋均10.62。在静吸复合全麻下接受全口牙齿治疗,术后半年及1年复查,统计充填体保存率,继发龋出现率及经治人群的龋病发病率,使用SPSS软件进行统计学分析。结果:1年复查充填体保存率96.93%,继发龋出现率半年复查为0.32%,1年复查为4.36%,具有统计学显著差异(2χ=22.069,P=0.00)。龋病发病率半年复查为6.67%,1年复查为13.33%,虽无统计学差异,但增高趋势明显。结论:全麻下治疗婴幼儿龋疗程短,疗效佳,临床应用前景广阔。应注意取得患儿家长的配合,培养患儿良好的口腔卫生习惯,定期复查,以达到良好的远期效果。     

Testing responsiveness to change for the early childhood oral health impact scale (ECOHIS)

Abstract – Objectives: The Early Childhood Oral Health Impact Scale (ECOHIS) is a recently developed oral health‐related quality of life instrument designed to assess the impact of oral health problems in 0–5‐year‐old children. It has previously been validated as discriminative instrument. The goal of this study was to investigate the responsiveness to change of the ECOHIS. Methods: Data were collected from a convenience sample of 101 parents of 0–5‐year‐old children attending a hospital dental clinic for dental treatment. The ECOHIS was completed by parents prior to dental treatment and 2 weeks later. Subjects were also asked a global transition judgement concerning change between the second and first completion of the ECOHIS instrument. Responsiveness to change of the ECOHIS was analysed through: (i) a comparison of ECOHIS change scores with a global transition judgment by study subjects; (ii) an assessment of the statistical significance of within‐group change in scores over time for groups reporting improvement, stability and deterioration; (iii) an estimation of the ECOHIS’s sensitivity; and (iv) an investigation the effect size of the ECOHIS. Results: Of the 101 subjects recruited, 94 had full datasets. Their data were used for the analyses reported in this paper. Pre‐ and post‐treatment distributions of ECOHIS scores were strongly distributed towards no oral health impacts. Among the 94 subjects, 51.1% reported improvement, 42.6% reported no change and 6.4% reported deterioration following treatment, using the global transition judgement. The mean ECOHIS change scores for these three groups were ?0/9, +0.7 and +6.5 respectively, although none of the within‐group changes were statistically significant. The effect size for those reporting improvement was small (0.15) but for those reporting deterioration was moderate‐to‐large (0.69). Sensitivity ranged from 0.61–0.79 depending on the size of the cut‐off point, with a change of 3 points demonstrating the best sensitivity to false positive ratio (0.79 versus 0.41 respectively). Conclusion: In this sample with low levels of problems, the ECOHIS has demonstrated some limited ability to respond to change. Further work in a larger sample with higher levels of problems is needed to investigate the instrument’s ability to respond to change when it has occurred.     

Future caries susceptibility in children with early childhood caries following treatment under general anesthesia

PURPOSE: The purpose of this study was to assess the susceptibility of children to the future development of caries following comprehensive treatment for early childhood caries (ECC) under general anesthesia. METHODS: The patients selected for this retrospective study were identified by analyzing dental records of children receiving treatment at the Franciscan Children's Hospital & Rehabilitation Center, Boston, MA (FCH & RC). In total, 4,143 records were reviewed. Of these, ECC was diagnosed in 42 patients before their admission to the operating room. Thirty-one control children were selected randomly from the dental records reviewed at FCH & RC. The control group was initially caries-free. The caries status of the children diagnosed with ECC was evaluated and compared with the control group. Children in both groups were seen for recall at intervals of six to nine months over a two-year period. The carious lesions were recorded in two categories; new smooth surface caries (NSSC) and new pit and fissure caries (NPFC). RESULTS: Thirty-three of 42 (79%) ECC children compared to nine of 31 (29%) control children had detectable carious lesions at subsequent recall visits. Children with ECC demonstrated a mean number of 3.2 +/- 3.3 new carious lesions compared to a mean of only 0.8 +/- 1.6 carious lesions in the control group. These differences were statistically significant (t71 = 3.8; P < 0.001). In addition, of the 42 patients treated for ECC under general anesthesia, seven (17%) required retreatment under general anesthesia within two years following their initial full-mouth rehabilitation. The prevalence of NSSC in the ECC group was significantly higher than the control group (t71 = 3.5; P < 0.001). CONCLUSIONS: Despite increased preventive measures implemented for children who experienced ECC, this study concluded that this group of children is still highly predisposed to greater caries incidence in later years. These findings strongly suggest that more aggressive preventive therapies may be required to prevent the future development of carious lesions in children who experienced ECC.     

Prevalence of early childhood caries among 5‐year‐old children: A systematic review

The aim of the present review was to describe the updated prevalence of early childhood caries (ECC) among 5‐year‐old children globally. Two independent reviewers performed a systematic literature search to identify English publications from January 2013 to December 2017 using MEDLINE, ISI Web of Science, and Scopus. Search MeSH key words were “dental caries” and “child, preschool”. The inclusion criteria were epidemiological surveys reporting the caries status of 5‐year‐old children with the decayed, missing, and filled primary teeth (dmft) index. The quality of the publications was evaluated with the modified Newcastle‐Ottawa Scale. Among the 2410 identified publications, 37 articles of moderate or good quality were included. Twenty of the included studies were conducted in Asia (China, India, Indonesia, Korea, Nepal, and Thailand), seven in Europe (Greece, Germany, Great Britain, and Italy), six in South America (Brazil), two in the Middle East (Saudi Arabia and Turkey), one in Oceania (Australia), and one in Africa (Sudan). The prevalence of ECC ranged from 23% to 90%, and most of them (26/37) were higher than 50%. The mean dmft score varied from 0.9 to 7.5. Based on the included studies published in the recent 5 years, there is a wide variation of ECC prevalence across countries, and ECC remains prevalent in most countries worldwide.     

Social and behavioural determinants of early childhood caries

BACKGROUND: To investigate the association between selected social and behavioural (infant feeding and preventive dental practices) variables and the presence of early childhood caries in preschool children within the north Brisbane region. METHODS: A cross sectional sample of 2515 children aged four to five years were examined in a preschool setting using prevalence (percentage with caries) and severity (dmft) indices. A self-administered questionnaire obtained information regarding selected social and behavioural variables. The data were modelled using multiple logistic regression analysis at the 5 per cent level of significance. RESULTS: The final explanatory model for caries presence in four to five year old children included the variables breast feeding from three to six months of age (OR=0.7, CI=0.5, 1.0), sleeping with the bottle (OR=1.9, CI=1.5, 2.4), sipping from the bottle (OR=1.6, CI=1.2, 2.0), ethnicity other than Caucasian (OR=1.9, CI=1.4, 2.5), annual family income dollars 20,000-dollars 35,000 (OR=1.7, CI=1.3, 2.3) and annual family income less than dollars 20,000 (OR=2.1, CI=1.5, 2.8). CONCLUSIONS: A statistical model for early childhood caries in preschool children within the north Brisbane region has been constructed using selected social and behavioural determinants. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.     

Incidence of early childhood caries: A systematic review and meta‐analysis

The aim was to systemically review the incidence of early childhood caries (ECC). The addressed focused question was “What is the reported incidence of ECC?” Indexed databases were searched using various key words. Five studies were included and processed for data extraction. All studies were prospective and two studies were randomized clinical trials. The number of participants ranged between 96 and 1275 children. Two studies reported the mean age of children, that ranged between 1.8 and 2.5 years (range 0.5 to 5 years). In three studies, the follow‐up duration was 2 years, and in two studies the participants were followed‐up till 3 and 5 years, respectively. Results from all studies reported that the incidence of ECC was significantly higher among children with caries at baseline compared with caries‐free children. In conclusion, the incidence of ECC is significantly higher in children with a previous history of dental caries.     

Sensitivity to change of oral and general health‐related quality of life during prosthodontic treatment

The literature presents conflicting findings on whether health‐related quality of life (HRQoL) measures have sufficient evaluative properties to assess changes caused by dental interventions. The aim of our study was to compare sensitivity to change in HRQoL and OHRQoL in prosthodontic patients. In this prospective intervention study, a total of 165 consecutively recruited patients completed the Short Form‐36 (SF‐36) and the 49‐item Oral Health Impact Profile (OHIP), as self‐administered questionnaires, before prosthodontic treatment and 1 month after treatment was finished. Differences in SF‐36 and OHIP scores between baseline and follow up were tested for statistical significance using paired t‐tests. Effect sizes (Cohen's d) were calculated. Health‐related quality of life improved during prosthodontic treatment, indicated by a slight, but statistically significant, increase in the SF‐36 physical component (difference: 1.0 points), whereas perceived mental health did not change substantially (difference: ?0.5 points). Improvement in OHRQoL (difference in OHIP sum score: ?6.7 points) was statistically significant. Although the OHIP effect size (of 0.2) was considered as small, according to guidelines, it was greater than for the SF‐36 component scores (physical: 0.1; mental: 0.1). Sensitivity to change in quality of life measures was greater for OHRQoL than for HRQoL, limiting the usefulness of HRQoL as an outcome measure in dentistry.     

Dental treatment under general anesthesia for special‐needs patients: analysis of the literature

The aim of the present review was to identify the studies published on dental treatment under general anesthesia for special‐needs patients. A comprehensive search of the reported literature from January 1966 to May 2012 was conducted using PubMed, Medline, and Embase. Keywords used in the search were “dental treatment under general anesthesia”, “special‐needs patients”, “medically‐compromised patients”, and “children”, in various combinations. Studies published only on dental treatment under general anesthesia and in English were included. Only 10 studies were available for final analysis. Age range from 1 to 50 years, and restorative procedures, were most prevalent. Only two studies discussed repeated general anesthesia, with rates of 7.2% and 10.2%. Over time, the provision of general anesthesia for special‐needs patients has changed from dental clinics to general hospitals. The demand for dental treatment for special‐needs patients under general anesthesia continues to increase. Currently, there are no certain accepted protocols for the provision of dental treatment under general anesthesia.