Oral health status of mississippi delta 3- to 5-year-olds in child care: an exploratory study of dental health status and risk factors for dental disease and treatment needs

OBJECTIVES: For poor and minority young children, disparities exist in dental health and treatment. In rural impoverished areas, institutions that reach young children and potentially offer access to care are limited. In the current Mississippi Delta study, child care centers were examined as potential venues for oral health intervention and research, and potential risk factors for dental caries and treatment urgency in high-risk preschool children were explored. METHODS: Child care centers were selected and attending children recruited. Data on oral health practices were collected from surveys of center directors and parents/caregivers. Children were examined for caries and treatment urgency at centers by dentists. Bivariate and multivariate analyses with a 0. 05 alpha were used to examine data. RESULTS: A total of 346 preschool children at 15 participating centers were examined: 46% were female, 68% minority. Minority children and those with public insurance were more than twice as likely to have caries and urgent treatment needs as non-minorities or those with private insurance. The odds of children having caries were half as great if parents reported using floss and nearly twice as great if the parent had experienced a dental abscess. For every soft drink the parent consumed daily, the odds of dental caries for children increased by 44%. CONCLUSIONS: Conducting oral health exams and research in child care venues was possible, yet presented challenges. The combined use of two parental variables, reported soft drink consumption and abscess history, appears promising for caries prediction. Implementation of oral health programs and research in child care venues merits further exploration.     

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-related quality of life and caries experience of Hong Kong preschool children

Objective: This study aimed to investigate the association between oral health-related quality of life (OHRQoL) and caries experience of Hong Kong preschool children. Methods: Parents or primary caregivers of Hong Kong preschool children were invited to complete a self-administered dental health questionnaire. The study children were examined in their classrooms. The decayed, missing and filled primary teeth (dmft) index was used for documenting the caries status. The questionnaire included the Chinese Early Childhood Oral Health Impact Scale (ECOHIS) and collected sociodemographic information on the parents and children. Logistic regression analysis was used to determine the association between OHRQoL and caries experience of preschool children. Results: A total of 434 preschool children were invited to participate in the study; 336 (77.4%) received a dental examination and returned a parental questionnaire. The mean (SD) age of the study children was 4.7 (0.3) years. An OHRQoL impact (ECOHIS score of >0) for at least one item was reported by 236 (70.2%) parents/caregivers of the children included in the study. The overall mean (SD) ECOHIS score was 5.8 (6.2). A caries prevalence (dmft > 0) of 36.9% and a mean (SD) dmft score of 1.7 (3.2) were calculated for the study children. In the final logistic regression model, children with a higher dmft score had a significantly higher chance of having a poorer OHRQoL (OR = 1.20, 95% CI: 1.07–1.35, P = 0.002), whereas children’s sex, parent’s education levels and the respondent’s relationship to the child were not associated with OHRQoL (P > 0.05). Conclusion: Caries experience is associated with lower OHRQoL of Hong Kong preschool children.Key words: Child, dental caries, early childhood caries, oral health, quality of life     

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

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

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.     

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.     

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.     

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.     

Effectiveness of an oral health education and caries prevention program in kindergartens in China

OBJECTIVES: To evaluate the effect of a 2-year oral health education and caries prevention program implemented in kindergartens in China. METHODS: Seven hundred and thirty-one 3-year-old children were recruited from 10 kindergartens in Miyun County, Beijing, China. The kindergartens were randomly divided into two groups. Oral health education was provided to teachers in the test kindergartens every 3 months. Oral health education sessions were conducted for the test children monthly and for their parents semiannually. Children in the test kindergarten brushed their teeth twice daily with fluoridated toothpaste (1100 ppm F-) in their kindergarten under the supervision of teachers during weekdays. No oral health education session and no supervised tooth brushing activities were carried out in the control kindergartens. A clinical examination of the study children and a questionnaire survey of their parents were conducted at baseline and after a 2-year program. RESULTS: Five hundred and fourteen children remained in the study after 2 years. The mean caries increments of the test group (n = 258) and the control group (n = 256) were 2.47 and 3.56 dmfs, respectively. The reduction in dmfs increment was 30.6% (P = 0.009). At the evaluation, a significantly higher percentage of children in the test group than in the control group reported brushing their teeth twice a day (87.6% vs. 69.0%; P < 0.001). Parents of children in the test group had better oral health knowledge and attitude than the parents of children in the control group. CONCLUSION: This oral health education program was effective in establishing good oral health habits among preschool children and in increasing oral health knowledge of their parents, in conjunction with supervised daily tooth brushing with fluoridated toothpaste, which could reduce the development of new dental caries in preschool children in China.     

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.     

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.     

Caries experience in the primary dentition among French 6-year-olds between 1991 and 2000

BACKGROUND: There are few national caries preventive policies for children in France. Various surveys suggest that in the late 1980s, oral health of the 6-year olds in France was poorer than in those of other European countries. In Val de Marne (a Department just east of Paris) a public dental service was established in 1991. A programme to inform preschool staff about dental diseases was commenced and volunteers brought oral health information to parents and health professionals. Periodical monitoring of primary tooth caries of 6-year olds was planned. AIM: The aim of the study was to evaluate changes in primary tooth caries in 6-year olds over the 10 years of the programme. METHODS: Participating 6-year olds, randomly selected, were examined in schools by dentists. Clinical data were collected (WHO criteria). Sociodemographic data were collected through questionnaire. Statistical analysis involved comparison of mean values, variance analysis and chi-square test for categorical variables. RESULTS: The proportions of children with caries experience were, 38.9%, 30.6% and 22.2% in 1991, 1995 and 2000 respectively (P < 0.01). The dft index decreased from 1.74 to 1.39 and 1.05 respectively. About 75% of children with dental caries remained untreated. Children of non-European native parents or belonging to low socioeconomic families remained those most affected by dental caries in 2000. CONCLUSION: Dental caries in 6-year olds improved between 1991 and 2000 in Val de Marne but caries remained a socially inequitable disease. Most children did not have access to dental care. The situation requires changes to the dental care provision system.     

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.     

Socio‐economic inequality in oral health in childhood to young adulthood,despite full dental coverage

The aim of this cross‐sectional study was to assess differences in caries experience according to socio‐economic status (SES) in a health‐care system with full coverage of dental costs for children up to the age of 18 yr. In 2011 and 2014, by performing hurdle negative binomial models, we obtained data on 3,022 children and young adults aged 5, 8, 11, 14, 17, 20, and 23 yr, living in four cities in the Netherlands. At all ages between 5 and 23 yr, the percentages of children with caries‐free dentitions were lower and mean caries experience were higher in low‐SES than in high‐SES participants. In 5‐yr‐old children with dmft > 0, mean caries experience was 3.6 in those with low SES and 2.3 in those with high SES. In 23‐yr‐old participants, these estimates were 6.8 and 4.4, respectively (P < 0.05). Low‐SES children have a greater risk of more caries experience than high‐SES children. Thus, in a system with full free paediatric dental coverage, socio‐economic inequality in caries experience still exists. Dental health professionals, well‐child care doctors and nurses, general practitioners, and elementary school teachers should collaborate to promote oral health at the community level, with specific targeting of low‐SES families. We further need policy measures to curtail, at community level, the increasing availability and consumption of highly processed, carbohydrate‐rich foods, with particular attention for low‐SES families.     

Oral health behaviour of schoolchildren and parents in Jordan

Summary. Objectives. The objectives of the study were: (i) to assess the level of dental knowledge and attitudes towards child dental care among parents in Jordan, (ii) to analyse the oral health care habits of schoolchildren and parents, and (iii) to evaluate the oral hygiene habits and use of professional dental services of children in relation to socio‐demographic conditions. Design. Cross‐sectional, self‐administered questionnaires for parents. Sample and methods. National representative sample of 6–16‐year‐olds living in urban areas (n = 1556, children and parents, response rate 92%, 48·7% boys, 51·3% girls). Results. In all, 80% of the parents knew about the harmful effect of sugar and 79% thought that poor oral hygiene may induce dental caries. In addition to proper oral hygiene (79%) and restriction of sugar/sweets (42%), 36% of the parents emphasized regular dental visits for the prevention of dental disease in children. However, most children saw a dentist for symptomatic reasons only (86%), while 11% attended for dental check‐ups. At their last visit to the dentist, 49% of the children had tooth extraction and only 8% had preventive services (fissure sealing). Toothbrushing at least twice a day was reported for 31% of the children; 14% of children aged 6–9 years had assistance from adults in brushing. Dental care habits of children were highly affected by dental visiting habits of parents, and variations by level of education of parents were also found. Conclusions. The discrepancy between dental knowledge and attitudes of parents and oral health care practices indicate the need for oral health education. School‐based oral health promotion programmes should be established in Jordan to influence the oral health behaviour of children and parents and to avoid further deterioration in their oral health.     

济南市学龄前儿童乳牙患龋情况及其家长口腔保健知识调查

目的探讨济南市学龄前儿童乳牙的患龋情况及与其家长口腔卫生知识认知度的相关性,为针对性开展儿童口腔保健工作提供依据。方法采用多阶段、分层、随机抽样的方法,在济南市4个地区的幼儿园(城乡各2个)抽取学龄前儿童共538人,城市儿童282人,农村儿童256人。运用世界卫生组织《口腔健康调查基本方法》诊断标准进行乳牙龋病情况检查,并对受检者家长行口腔保健行为问卷调查。结果学龄前儿童乳牙患龋率为71.95%,龋均(dmft)3.84,城市儿童乳牙患龋率为62.18%,农村儿童为81.72%,两者之间具有统计学差异(P<0.01);学龄前儿童进食含糖食品的频率偏高,农村儿童进食碳酸饮料、果汁、糖果等方面的频率高于城市儿童,城市儿童开始刷牙时间早于农村儿童,刷牙频率和使用含氟牙膏的比例均高于农村儿童;学龄前儿童家长的口腔卫生知识认知度相对不足,知晓率为59.48%,其中城市家长(66.07%)要好于农村家长(52.88%),城乡对比差异有统计学意义(P<0.01)。结论学龄前儿童乳牙患龋状况与家长口腔卫生知识认识度呈正相关。济南市亟待加强儿童家长尤其是农村家长的口腔卫生知识的宣传教育。     

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.     

Family history and oral health: findings from the Dunedin Study

Shearer DM, Thomson WM, Caspi A, Moffitt TE, Broadbent JM, Poulton R. Family history and oral health: findings from the Dunedin Family History Study. Community Dent Oral Epidemiol 2011. © 2011 John Wiley & Sons A/S Abstract – Context: The effects of the oral health status of one generation on that of the next within families are unclear. Objectives: To determine whether parental oral health history is a risk factor for oral disease. Methods: Oral examination and interview data were collected during the age‐32 assessments in the Dunedin Study. Parental data were also collected on this occasion. The sample was divided into two familial‐risk groups for caries/tooth loss (high risk and low risk) based on parents’ self‐reported history of tooth loss at the age‐32 assessment interview. Main outcome measures: Probands’ dental caries and tooth loss status at age 32, together with lifelong dental caries trajectory (age 5–32). Results: Caries/tooth loss risk analysis was conducted for 640 proband‐parent groups. Reference groups were the low‐familial‐risk groups. After controlling for confounding factors (sex, episodic use of dental services, socio‐economic status and plaque trajectory), the prevalence ratio (PR) for having lost 1+ teeth by age 32 for the high‐familial‐risk group was 1.41 [95% confidence interval (CI) 1.05, 1.88] and the rate ratio for DMFS at age 32 was 1.41 (95% CI 1.24, 1.60). In the high‐familial‐risk group, the PR of following a high caries trajectory was 2.05 (95% CI 1.37, 3.06). Associations were strongest when information was available about both parents’ oral health. Nonetheless, when information was available for one parent only, associations were significant for some outcomes. Conclusions: People with poor oral health tend to have parents with poor oral health. Family/parental history of oral health is a valid representation of the intricacies of the shared genetic and environmental factors that contribute to an individual’s oral health status. Associations are strongest when data from both parents can be obtained.