Persistence of oral Candida albicans carriage in healthy Portuguese schoolchildren followed for 3 years

Little is known about carriage of Candida albicans, the predominant pathogenic yeast in oral infection, in children. We cultured buccal mucosal and gingival swabs from 150 Portuguese children to investigate the prevalence of C. albicans at baseline (before dental treatment), post-treatment, and 12, 24, and 36 months post-baseline. The children, aged 8 to 11 years at baseline, had no systemic disease or clinical symptoms of oral candidiasis. At each successive visit, respectively, 47, 32, 21, 27, and 28% of children were C. albicans positive, resulting in an almost 50% reduction in prevalence from baseline to post-treatment (P < 0.0005). Children who carried C. albicans at one visit had 3 to 20 times greater odds of carrying C. albicans at another visit. C. albicans was cultured from 12 children at all time-points and from 10 children at four time-points. Children with oral C. albicans frequently maintained carriage over time, even with regular dental care.     

Clonal identity of Candida albicans in the oral cavity and the gastrointestinal tract of pre‐school children

The clonal relationship between oral and fecal Candida albicans isolated from children of pre‐school age was examined using RAPD analysis. Significantly higher levels of C. albicans were found in saliva, dental plaque, carious specimens and stools of 56 patients with severe caries as compared to 52 healthy control subjects. The highest prevalence was found in carious specimens and a strong correlation was observed between its presence in saliva, dental plaque, carious specimen and feces. RAPD analysis of isolates from 23 patients with simultaneous oral and fecal C. albicans revealed clonal counterparts present in both oral and stool samples in 15 cases; five patients harbored closely related strains; and three patients harbored unrelated strains. Our results demonstrate a strong correlation between oral and gastrointestinal C. albicans colonization. We assume that carious teeth may constitute an ecologic niche for C. albicans potentially responsible for recurrent oral and non‐oral candidiasis.     

Effects of traumatic dental injuries to primary teeth on permanent teeth – a clinical follow‐up study

Abstract – Aim: This study evaluated the prevalence of developmental sequelae to permanent teeth (DSP) after traumatic dental injuries to primary teeth (TDI‐1) and their association with age, gender, type of injury, recurrence of injury and post‐traumatic damage to primary teeth. Materials and methods: Dental records of 2725 children treated from February 1993 to December 2008 in a private pediatric dental clinic were examined. A total of 308 records had 412 primary teeth that sustained traumatic injuries. Age at the time of injury ranged from 4 months to 7 years. A chi‐squared test and logistic regression were used for statistical analyses. Results: One hundred forty‐eight children (241 teeth) were followed up until the eruption of the permanent successor. The prevalence of DSP was 22.4%. Discoloration and hypoplasia were the most frequent abnormalities (74.1%), followed by eruption disorders (25.9%). Age at the time of TDI‐1 was the only variable significantly associated with DSP. Sequelae were most prevalent among children who suffered an injury between 1 and 3 years of age. Conclusions: Children who sustain traumatic dental injuries should be followed up regularly for an early diagnosis and treatment of possible DSP.     

The relationship between oral hygiene and oral colonization with Candida species in healthy adult subjects*

To cite this article:
Int J Dent Hygiene
DOI: 10.1111/j.1601‐5037.2009.00371.x
Darwazeh AM‐G, Hammad MM, Al‐Jamaei AA. The relationship between oral hygiene and oral colonization with Candida species in healthy adult subjects. Abstract: Poor oral hygiene has been frequently suggested as a predisposing factor for oral candidal colonization, but the convincing evidence is lacking. Objective: To assess and compare oral candidal colonization, both quantitatively and qualitatively, in groups of healthy dentate subjects with different levels of oral hygiene as determined by the plaque index (PI) and gingival index (GI) scores. Methods: The concentrated oral rinse technique was used to isolate Candida species from 149 healthy dentate subjects. Candida species were cultured on Sabouraud’s dextrose agar plates and identified by germ‐tube test and the automated Vitek® system biochemical yeast card. According to the PI and GI scores, subjects were divided into different groups of oral hygiene level. Results: Candida species were isolated from 86 (57.7%) subjects. The prevalence of candidal carriage increased significantly as a function of age (P = 0.023), but was comparable between males and females (58.7% and 56.7% respectively; P = 0.87). Oral candidal carriage rate and density were not affected by the levels of dental plaque or gingival condition. The prevalence of oral candididal carriage was significantly higher in the subjects who were not using dental floss compared with those who were using dental floss (P = 0.032). Conclusion: Oral hygiene status, as determined by the PI and the GI scores per se, does not affect oral candidal colonization in healthy dentate subjects.     

Severe dental caries is associated with incidence of thinness and overweight among preschool Chinese children

Abstract

Objective: To examine the association of incidence and baseline prevalence of severe dental caries with incidences of thinness and overweight among pre-school Chinese children.

Materials and methods: A longitudinal study design was used. A total of 772 children recruited from 15 kindergartens in Liaoning Province who completed baseline and follow-up assessments were included. The age range of children at baseline was 24.6–71.1 months. BMI-for-age z-score was calculated to estimate incidence of thinness and overweight. Severe dental caries was indicated by pulpal involvement, ulceration, fistula or abscess (pufa). Baseline prevalence of severe caries included children with pufa ≥1, incidence included those who changed from pufa = 0 to ≥1 at follow-up. Logistic regression was constructed to assess the association of baseline prevalence and incidence of severe caries with each of incidence thinness and overweight.

Results: Children with incidence of severe caries had higher odds for incidence thinness (OR: 4.08; 95% CI: 1.08, 15.41). Baseline prevalence of severe caries was not significantly associated with incidence thinness. Participants with severe caries at baseline had higher odds for incidence overweight (OR: 2.33; 95% CI: 1.17, 4.63). The relationship between incidence of severe caries and incidence overweight was insignificant.

Conclusions: The findings suggest a U-shaped relationship between severe dental caries and both ends of anthropometric measures among pre-school Chinese children. The findings highlight the importance of integrating oral and general health promotion policies. Primary health care providers are encouraged to incorporate dental screening, counselling and referral for treatment for severe caries to promote appropriate growth and overall health of children.     

Changes in young children's OHRQoL after dental treatment under general anaesthesia

International Journal of Paediatric Dentistry 2012; 22: 258–264 Objective. To use the Parental‐Caregivers Perceptions Questionnaire (P‐CPQ) and Family Impact Scale (FIS) to determine whether dental treatment of young Auckland children under general anaesthesia (GA) improved oral‐health‐related quality of life (OHRQoL) for them and their families. Design. A pretest/post‐test design, with a consecutive clinical sample of parents/caregivers of children (10 years or younger) treated under GA. More than half of the children were Māori or Pacific Islanders. Results. Of the 157 children in the baseline sample, 144 (91.7%) were followed up. The overall P‐CPQ score showed a large decrease following treatment, along with an increase in the number scoring 0 (no impact). Similar relative changes were observed in the oral symptoms and emotional well‐being subscales, whereas the other two subscales showed moderate decreases. All post‐treatment FIS scores were lower than pre‐treatment ones; all showed moderate effect sizes. The greatest relative changes were seen in the parental/family activity and parental emotions subscales. Conclusions. The dental treatment of young children under GA is associated with considerable improvement in their OHRQoL. The P‐CPQ and the FIS are valid and responsive to treatment‐associated changes in young children with early childhood caries (ECC).     

Genotypic distribution of Candida albicans in dental biofilm of Chinese children associated with severe early childhood caries

AimCandida albicans causes a wide range of infections in the oral mucosa, especially candidiasis. A strong association has been found between C. albicans and dental caries. In this study, we investigated the presence and genotypic distribution of C. albicans in the dental biofilm of Chinese children with severe early childhood caries (S-ECC).DesignDental biofilm samples were collected from 41 Chinese children (21 children with S-ECC and 20 children without caries) aged 3–6 years. Samples collected were cultured in CHROMagar Candida (CA) medium. Cellular DNA of typical C. albicans isolates in the CA medium was isolated, and PCR using primers reported to span a transposable intron region in the 25S rRNA gene was performed to determine genotypic subgroups.ResultsC. albicans was detected in 57.1% of individuals with S-ECC. Additionally, three genotypic subgroups of C. albicans (genotypes A, B, and C) were found in children with S-ECC, and genotype A was dominant.ConclusionsC. albicans is an important component of dental biofilm associated with S-ECC, and C. albicans genotypic subgroup A is the dominant strain in the dental biofilm of children with S-ECC.     

Prevalence of oral Candida carriage in Thai adolescents

Aim: Oral candidiasis is among the most common AIDS‐associated opportunistic infections. Adolescents remain at the highest risk of HIV infection and could suffer from oral candidiasis. However, information on oral Candida carriage in this population is limited. This study aims to evaluate the prevalence of oral Candida in Thai adolescents. Methods: Oral rinse samples from 80 healthy Thais (age: 15–17 years) were collected and analyzed for the prevalence of Candida species using culture‐based and polymerase chain reaction assays. Results: Twenty six adolescents (32.5%) carried Candida in the oral cavity. Candida albicans was detected in 28.75% (23/80). Non‐albicans Candida species were detected in 6.25% (5/80). The majority (92.3%, 24/26) of adolescents with Candida carried a single species. Two carried two species: one with Candida glabrata and Candida albicans, and the other with Candida parapsilosis and Candida albicans. Three adolescents harbored only non‐albicans species, with one carrying Candida tropicalis and two carrying Candida parapsilosis. Candida dubliniensis was not detected in this population. Most adolescents carried Candida at a low level (<500 c.f.u./mL). Conclusions: Oral Candida was present in approximately one‐third of adolescents. Candida albicans was the most prevalent (88.5%), and non‐albicans species were present in 19.2% of those with oral Candida.     

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.     

Do school‐based dental sealant programs reach higher risk children?

Objectives: This report compares sealant prevalence by caries risk status among third graders at Ohio schools with and without school‐based dental sealant programs (S‐BSPs), and estimates the percent of children receiving sealants in S‐BSPs who are higher risk for dental caries. Methods: We analyzed data from a statewide open‐mouth oral health survey of Ohio third grade schoolchildren for sealant prevalence by S‐BSP availability and caries risk classification. Children were classified as higher or lower risk for dental caries based on school lunch program enrollment and other non‐clinical access‐related indicators. Differences between groups were evaluated by the chi‐square test (P < 0.05). Results: At schools with no S‐BSPs, higher risk children were less likely to have dental sealants than lower risk children (28.7 percent versus 42.7 percent, P < 0.001). At schools with S‐BSPs, sealant prevalence for both risk categories was equivalent for higher and lower risk children (59.4 percent, 63.4 percent, P = 0.428). Higher risk children at schools with S‐BSPs were more than twice as likely to have a sealant as higher risk children at non–S‐BSP schools (59.4 percent versus 28.7 percent, P < 0.001). Of higher risk children with at least one sealant, 61 percent attended a school with an S‐BSP compared with 12.3 percent of lower risk children with at least one sealant. Higher risk children accounted for at least 75 percent of children receiving sealants through S‐BSPs. Conclusions: In Ohio, targeting S‐BSPs by family income‐based school‐level criteria was effective in reaching higher risk children.     

Dental fear and anxiety and oral health behaviour in 12‐ to 14‐year‐olds born preterm

International Journal of Paediatric Dentistry 2010; 20: 391–399 Background. An enhanced frequency of cognitive and behavioural disturbances has been reported in preterm children. It is not known if this affects their perceptions of or behaviour in the dental care situation. Hypothesis. The hypotheses were that preterm (PT) children aged 12–14 years more often exhibit dental fear and anxiety (DFA) than full‐term controls (C), while no differences were expected regarding oral health behaviour. Methods. One hundred and nine PT and 108 C children took part in the present questionnaire study. DFA was assessed using the Children’s Fear Survey Schedule – Dental Subscale (CFSS‐DS). In addition the questionnaire covered items including satisfaction with received dental care, oral health behaviour and medical health. Results. The children’s CFSS‐DS scores revealed no differences between the PT and C groups. Regarding oral health behaviour there were no differences, except that PT children more often used dental floss and extra fluoride supplements. PT children reported more medical health problems than C children. Conclusions. Preterm (PT) children 12‐ to 14‐years‐old, as well as C of same age group, seem to be satisfied with their dental care and display low prevalence of DFA. Still, a higher frequency of medical health problems in the PT children suggests that these children should be regarded as potential risk patients for oral health problems.     

Combined oral midazolam–ketamine better than midazolam alone for sedation of young children: a randomized controlled trial

International Journal of Paediatric Dentistry 2013; 23: 207–215 Background. There is a lack of clinical trials on paediatric dental sedation. Aim. We investigated whether young children’s behaviour improves during dental treatment with oral ketamine/midazolam compared with midazolam alone or no sedation. Design. Healthy children under 36 months of age, presenting early childhood caries were randomly assigned to receive protective stabilization plus: combined oral midazolam (0.5 mg/kg) and ketamine (3 mg/kg) (MK), or oral midazolam (1.0 mg/kg) (MS), or no sedative (PS). One observer scored children’s behaviour using the Ohio State University Behavior Rating Scale (OSUBRS) at determined points in a dental exam (no sedative) and treatment session. Data were analysed using nonparametric bivariate tests. Results. Forty‐one children were included. In the dental exam session, the sum of OSUBRS scores was similar for the three groups (P = 0.81). In the treatment session, the MK produced more cooperative behaviour than MS and PS (P = 0.01), longer sessions (P = 0.04), and a pattern of homogeneous OSUBRS scores from the reception area (before sedative administration) to the end of the session (P = 0.06). No immediate and post‐discharge side effects were observed in groups MK and MS. Conclusions. The combination of oral midazolam and ketamine is efficacious for guiding the behaviour of children under 3 years old.     

Trends in dental caries in 1‐ to 4‐year‐old children in a Brazilian city between 1997 and 2008

International Journal of Paediatric Dentistry 2010; 20: 125–131 Objective. The objective of this study was to assess trends in dental caries prevalence and severity in 1‐ to 4 year‐old children living in Diadema, Brazil, over a 11‐year period, from 1997 to 2008. Methods. In 2008 an epidemiological oral health survey was carried out and the results on caries were compared with five cross‐sectional studies carried out using the same methods and criteria in 1997, 1999, 2002, 2004, and 2006 in the same city. In all surveys, children were randomly selected from those attending a National Day of Children’s Vaccination. Calibrated dentists carried out the clinical examination using WHO criteria. Caries trends were assessed by time‐lag analysis. In total, 5348 children were examined in the six surveys over the 11‐year period. Results. Time‐lag analysis showed a marked and statistically significant decline in the prevalence (χ² for trends: P < 0.001) and severity (Kruskal–Wallis: P < 0.001) of dental caries between 1997 and 2008. Conclusion. In conclusion, the last cohort of preschool children in Diadema had much better dental caries status than those in 1997.     

Factors affecting dental fear in French children aged 5–12 years

International Journal of Paediatric Dentistry 2010; 20: 366–373 Background. While dental anxiety is often correlated with prior negative dental experience, prevention of dental anxiety should in theory include early exposure to the dental setting. Objective. We set out to evaluate factors affecting dental fear in French children. Methods. Dental fear was evaluated using a visual analogue scale (DF‐VAS) in a group of 1303 French children (681 boys and 622 girls) aged 5–11 years (mean: 8.12 years, SD: 1.42 years). Indicators of caries and oral hygiene were evaluated on dental examination. Indicators of well‐being related to oral health, dental experience, and oral health education were collected via a structured interview. Results. Dental fear was scored low in 75.7% (DF‐VAS 0–3), moderate in 16.7% (DF‐VAS 4–6), and high in 7.6% (DF‐VAS 7–10). DF‐VAS decreased statistically with experience of a prior dental visit. Children who had at least one decayed tooth presented a higher level of dental fear than those with no decay, while children with fillings were significantly less anxious than those without previous dental care. Conclusions. This study shows that for children aged 5–12 years, prior experience of the dental setting can act as a positive component of dental fear.     

A 4-year longitudinal study of the oral prevalence of enteric gram–negative rods and yeasts in Chinese children

A 4-year longitudinal study of the oral prevalence of enteric gram–negative rods and yeasts in 116 Chinese primary school children in Hong Kong was conducted. The oral prevalence of enteric gram-negative rods for each consecutive year was 25.3%, 37.0%, 24.0%’and 25.8% respectively, with a weighted mean of 27.9%. Enterobacteriaceae, which comprised 57% of all enteric gram–negative rods, were more common in children with no caries experience. The oral prevalence of yeasts for each consecutive year was 7.7%, 12.0%, 14.4% and 15.5% respectively, with a weighted mean of 12.5%. Candida albicans comprised 84% of all yeasts isolated. Oral yeast carriage was significantly associated with caries prevalence. While the oral prevalence of enteric gram–negative rods in primary school children in Hong Kong may be higher than in other parts of the world, repeated isolation of either enteric gram–negative rods or Candida spp. from individual children over the 4–year study period was rare, suggesting that carnage of these organisms is transient.     

Dental caries prevalence and treatment needs of 5- to 12-year-old children in relation to area-based income and immigrant background in Greece

Objectives: To investigate the association between certain socio‐demographic characteristics and dental health status of 5‐ to 12‐year‐old children attending public kindergarten and primary schools in Piraeus, Greece. Methods: Gender, age, place of residence, immigrant background and area‐based income were associated with dental caries prevalence, treatment needs and oral hygiene level in 5,116 children. Results: The mean number of decayed, missing and filled deciduous teeth (dmft) and Unmet Restorative Treatment Needs Index (UTN) at 6‐year‐olds were 1.54 and 84.6% respectively, and the DMFT and UTN at 12‐year‐olds were 1.35 and 71.8%. Caries experience/severity significantly increased with age, whereas treatment needs and oral hygiene level decreased (P < 0.001). Immigrant background and low area‐based income was associated with poorer oral health outcomes. The above associations retained statistical significance after multivariate analysis. Children who live in areas with lower average income present 1.20 to 2.14 greater risk of having higher caries severity and poorer oral hygiene in comparison to those living in more affluent areas, and children with an immigrant background have 1.68 to 4.34 higher likelihood to present higher dmft and DMFT values, higher unmet treatment needs, and poorer oral hygiene levels compared to their Greek counterparts above and beyond the effect of the other risk factors assessed. Conclusions: The present study revealed a socio‐demographic gradient in oral health status and treatment needs of children in Piraeus, Greece.     

In vivo photodynamic inactivation of Candida albicans using chloro‐aluminum phthalocyanine

This study evaluated the photoinactivation of Candida albicans in a murine model of oral candidiasis using chloro‐aluminum phthalocyanine (ClAlP) encapsulated in cationic nanoemulsions (NE) and chloro‐aluminum phthalocyanine (ClAlP) diluted in DMSO (DMSO) as photosensitizer (PS). Seventy‐five 6‐week‐old female Swiss mice were immunosuppressed and inoculated with C. albicans to induce oral candidiasis. PDT was performed on the tongue by the application of the photosensitizers and LED light (100 J cm^?2–660 nm). Twenty‐four hours and 7 days after treatments, microbiological evaluation was carried out by recovering C. albicans from the tongue of animals (CFU ml^?1). Then, mice were sacrificed and the tongues were surgically removed for histological and biomolecular analysis of pro‐ and anti‐inflammatory cytokines. Data were analyzed by ANOVA followed by Tukey's post hoc test. ClAlP‐NE‐mediated PDT reduced 2.26 log₁₀ of C. albicans recovered from the tongue when compared with the control group (P?L?) (P < 0.05). PDT did not promote adverse effects on the tongue tissue. Seven days after treatment, all animals were completely healthy. In summary, PDT mediated by chloro‐aluminum phthalocyanine entrapped in cationic nanoemulsions was effective in reducing C. albicans recovered from the oral lesions of immunocompromised mice.     

Prospective study of 5-year caries increment among children receiving comprehensive dental care in the New England children's amalgam trial

Abstract – Objective: To measure the 5‐year caries increment among high‐risk children during their participation in the New England Children’s Amalgam Trial (NECAT), and to evaluate sociodemographic factors that may account for any observed disparities. Methods: NECAT recruited 534 children aged 6–10 with at least two decayed posterior occlusal surfaces from urban Boston and rural Maine. After restoration of baseline caries and application of sealants to sound surfaces, NECAT continued to provide free comprehensive semiannual dental care to participants. The net caries increment of children who completed the 5‐year follow‐up (n = 429) was calculated and predictors of caries increment were investigated using multivariate negative binomial models. Results: The majority of children (89%) experienced new caries by the end of the 5‐year follow‐up. Almost half (45%) had at least one newly decayed surface by the first annual visit. At year 5, the mean number of new decayed teeth was 4.5 ± 3.6 (range 0–25) and surfaces was 6.9 ± 6.5 (range 0–48). Time trends showed a noticeably higher increment rate among older children and young teenagers. Multivariate models showed that age (P < 0.001), number of baseline carious surfaces (P < 0.001), and toothbrushing frequency (<1/day versus ≥2/day, P = 0.04) were associated with caries increment. Only 48 children (11%) did not develop new caries. Conclusions: Despite the receipt of comprehensive semiannual dental care, the vast majority of these high‐risk children continued to develop new caries within 5 years. While disparities were observed by age, extent of prior decay, and toothbrushing frequency, no other sociodemographic factors were associated with caries increment, suggesting that the dental care provided during the trial reduced sociodemographic disparities in prior caries experience that were observed at baseline.     

Oral health status and reasons for not attending dental care among 12- to 16-year-old children with Down syndrome in special needs centres in Jordan

To cite this article:
Int J Dent Hygiene 10 , 2012; 259–264
DOI: 10.1111/j.1601‐5037.2012.00545.x Al Habashneh R, Al‐Jundi S, Khader Y, Nofel N. Oral health status and reasons for not attending dental care among 12‐ to 16‐year‐old children with Down syndrome in special needs centres in Jordan. Abstract: Objectives: The objective of this study was to assess oral health status, treatment needs, soft and hard tissue findings, as well as reasons for not attending dental care among children with Down syndrome (DS) registered in special needs centres in Jordan. Methods: The sample consisted of a total of 206 participants with a mean age of 13.66 ± 1.47 comprising 103 with DS and 103 age‐ and gender‐matched non‐DS/public school children. Clinical levels of oral hygiene were assessed using Simplified Oral hygiene index, and caries detection was carried out according to WHO caries recording criteria. Results: Children who had DS had a significantly higher percentage of surfaces with severe gingival index (39.9 ± 9.1 versus 15.9 ± 8.0, P < 0.001) and a higher mean of probing pocket depth than children without DS (2.27 ± 0.2 versus 1.81 ± 0.32, P < 0.000). Significantly more peg‐shaped maxillary lateral incisors and retained primary teeth (P < 0.001) were observed in subjects with DS, compared with non‐DS children. Average decayed, missing and filled teeth (DMFT) was significantly lower in male children with DS compared with male non‐DS children only (P = 0.034). The most common reason cited for not taking children to the dentist for DS group was ‘Not aware of the dental problems of their children’ and for non‐DS groups ‘No awareness of the importance of dental visit’ (61.2% and 53%, respectively). Conclusions: While having similar caries level, Jordanian teenagers with DS had more dental anomalies, poorer periodontal health and less dental attendance than age‐ and gender‐matched non‐DS/public school children.