Sugar consumption and caries risk in schoolchildren with low caries experience

Abstract This paper assesses the risk from sugar consumption in a population of schoolchildren with low caries experience. It relates eight different measures of sugar consumption to the occurrence of any DMFS increment, and, separately, to approximal and pit-and-fissure DMFS. The data are from a 3-yr longitudinal study of 429 children, initially aged 11–15, residing in non-fluoridated rural communities in Michigan, USA. All children completed at least three dietary interviews, were present for baseline and final dental examinations, and had a parent or guardian provide questionnaire information on residence history, use of fluoride and dental services, and family history. Results indicated that a higher proportion of total energy intake from sugars increased the probability of caries on all surfaces, and a higher total intake of sugars was also associated with total caries increment. No relationship, however, was found between DMFS increment and the frequency of eating high sugar foods. Each additional 5 g of daily sugars intake was associated with a 1% increase in the probability of developing caries, and those whose energy intake from sugars was 1 SD above the mean had 2.0 times the risk of developing approximal caries than did children whose energy intake from sugars was 1 SD below the mean.     

Prevalence of dental caries and gingivitis in a population of Mexican schoolchildren

Abstract – The prevalence of dental caries and gingivitis was assessed in schoolchildren of the Tlalpan region in Mexico City. A total of 700 children (age range: 11–17 yr) of both sexes were examined. The sample population included children attending the Middle-School System, where two shifts are run (A.M. and P.M.). Decayed, missing and filled surfaces (DMFS), and Gingival Index (GI) were recorded for all existing teeth. Analysis of the data showed that mean DMFS scores increased with chronological age in both genders, were higher in the P.M. session, and more elevated in females. Similarly the mean GI scores also increased with age, and were higher in the P.M. session. In contrast to the DMFS scores, males presented higher GI scores than females at all age intervals. The results of our study indicated a distinctively high prevalence of caries and gingivitis in Mexican schoolchildren.     

Prevalence of dental caries in permanent teeth of white and black schoolchildren in Brazil

abstract The authors studied the prevalence of dental caries in white and black schoolchildren of Piracicaba, State of São Paulo, Brazil. The Student t-test, applied to the coefficient of prevalence of caries, revealed means significantly greater at the 5 % level in whites than in blacks in the following groups: 7 years, both sexes; 8 years, both sexes; 9 years, males; 10 years, both sexes; 11 years, males.     

Assessing risk indicators for dental caries in the primary dentition

The aim of the present study was to assess indicators shown to be associated with the prevalence of caries in the primary dentition of 7-year-old Flemish schoolchildren. Cross-sectional first year data of the longitudinal Signal-Tandmobiel survey were analysed (n=4468). Gender, age, oral hygiene habits, use of fluorides, dietary habits, geographical factors and parental modelling were the considered predictors. From the multiple logistic regression analysis, including schools as a random effect, and after adjusting for the confounding variables-educational system and province (stratification variables), gender and age-it became clear that the following risk indicators remained significant (at 5% level) for the presence of caries: frequency of toothbrushing (P=0.05) with an OR 1.24 for brushing less than once a day, age at start of brushing (P<0.001) with an OR=1.22 for a delay of 1 year, regular use of fluoride supplements (P<0.001) with an OR=1.54 for no use, daily use of sugar-containing drinks between meals (P<0.001) with an OR=1.38, and number of between-meals snacks (P=0.012) with an OR=1.22 for using more than 2 between-meal snacks. There was a significant difference (P<0.05) in caries experience determined by the geographical spread, with an explicit trend of caries declining from the east to the west. In a model with an ordinal response outcome, the daily use of sugar-containing drinks between meals had a more pronounced effect when caries levels were high. From this study it became obvious that, in Flemish children, an early start of brushing and a brushing frequency of at least once a day need to be encouraged, while the use of sugar-containing drinks and snacks between meals needs to be restricted to a maximum of 2 per day. Geographical differences need to be investigated in more detail.     

社会行为危险因素与儿童龋病的关系初探

目的：调查儿童口腔健康状况，探讨儿童患龋情况与社会行为危险因素之间的关系。方法：调查对象为湖北省宜昌市15所小学6—7岁儿童1356名及他们的母亲。采用WHO龋病诊断标准调查儿童患龋情况。采用母亲问卷的调查方法收集儿童和母亲的口腔健康态度、行为以及相关影响因素。结果：1356名6—7岁儿童乳牙患龋率72．9％，龋均3．7。影响儿童龋齿发生的因素是餐间吃甜食、含糖食品的消费和儿童使用氟化牙膏，其中餐间吃甜食是影响龋病最危险的因素。结论：儿童的饮食习惯和氟化牙膏的使用影响儿童的口腔健康状况。     

Sociobehavioural risk factors in dental caries - international perspectives

Diseases probably have their roots in a complex chain of environmental and behavioural events which are shaped by broader socioeconomic determinants. Most studies of sociobehavioural risk factors in dental caries have been carried out in industrialized countries, but such reports from low- and middle-income countries have been published in recent years. World Health Organization international collaborative studies and other international studies of social factors in dental caries using the same methodology provide empirical evidence of social inequality in oral health across countries and across oral health care systems. The paper highlights the challenges to dental public health practice, particularly the importance of risk assessment in estimating the potential for prevention. In future public health programmes, systematic risk factor assessment may therefore be instrumental in the planning and surveillance of oral health promotion and oral disease intervention programmes.     

Ethnicity and maternal education as risk indicators for dental caries, and the role of dental behavior

Abstract – The aim of this study was to assess differences in dental health between socioeconomic and ethnic groups in a cohort of 5-yr-old children born in 1982 and in a cohort of 11-yr-old children born in 1976. A further aim was to evaluate the putative role of dental behaviors as intervening factors between ethnicity and maternal education on the one hand and caries experience on the other. A secondary analysis was performed on data collected in a study monitoring the oral health of youths covered by public health insurance (Ziekenfonds) in the Netherlands. The results showed both ethnicity and maternal education to be indicators of caries risk in the primary dentition. For caries in the permanent dentition, only maternal education could be identified as a risk indicator. Dental behaviors were related to caries experience as well as to ethnicity and maternal education, though the evidence for the role of these dental behaviors as intervening factors was weak. It is concluded that the validity and reliability of the behavioral measurements might be questionable and that the mechanism underlying the differences in caries experience between the various groups is still little understood.     

Social indicators of dental caries among Sierra Leonean schoolchildren

Most of the caries of African child populations is found in limited fractions of that population. The purpose of the present study was to analyze the caries situation of Sierra Leonean schoolchildren in relation to demographic, socioeconomic, and behavioral variables, in order to develop an appropriate index for prediction of caries. A total of 610 students from primary class 1 (mean age: 7 yr) and secondary form 1 (mean age 15 yr) were dentally examined by three examiners and interviewed by their teachers. Intra- and interexaminer reproducibilities were 82 and 70%, and interinterviewer reliability was 67–100% for the individual questions. Urban students had more caries than rural. In class 1, dmfs + DMFS was 4.1 and 1.8, respectively; in form 1, DMFS was 5.3 and 3.5. Two tribes (the Fulas and the Madingos) had higher caries means than the rest, especially in class 1, where dmfs + DMFS was 6.5 and 2.4, respectively. Form 1 students with literate parents had a higher caries mean, and class 1 pupils with defective school uniforms a lower mean. The apparently high-risk groups did not consume more sweet snacks or clean their teeth less frequently. There was clearly more caries among the quartiles of children with most visible plaque on molars, but all social and demographic subgroups had similar amounts of plaque. Multivariate analyses of class 1 children showed that pupils living in urban areas, Fulas and Madingos, and children wearing complete school uniforms had caries significantly more frequently, other factors being equal. In form 1, urban students, rural Fulas and Madingos, students with literate parents, and urban students consuming sweet snacks frequently had significantly more caries. Social criteria were sufficient to identify rural children with high caries experience, but insufficient in urban areas.     

Maternal risk indicators for childhood caries in an inner city population

OBJECTIVES: This study evaluated whether characteristics of mothers, such as high mutans streptococci (MS) level, caries experience, reported sugar consumption and demographic variables, could be important risk indicators of caries for their children. METHODS: Mothers selected on the basis of the caries status of their 3-5-year-old-children were tested for MS, caries, reported sugar consumption and demographic variables. RESULTS: We found strong associations between children's caries and their mothers' MS levels (high/low adj. OR = 11.3), maternal active caries (yes/no adj. OR = 4.0) and maternal sugar consumption (high/low adj. OR = 4.2). In this small study, mothers' demographic variables were not associated with the status of caries in their children. CONCLUSIONS: Our findings suggest that maternal high MS levels, maternal active decay and maternal sugar consumption are strong risk indicators for children's caries. Although further study is needed, these three maternal risk indicators, taken together, may prove useful in predicting children's caries risk.     

Dentin caries risk indicators in 1-year-olds. A two year follow-up study

Background: Early childhood caries (ECC) risk factors are suspected to vary between regions with different caries prevalence.

Aim: Identify ECC risk factors for 1-year-olds predicting dentin caries at 3 years of age in a region with low caries prevalence.

Design: Caries risk was assessed by dental hygienist or dental assistant in 779 one-year-olds. The oral mutans streptococci (MS) score was performed from a tooth surface or (in pre-dentate children) from oral mucosa. A parental questionnaire with questions regarding family factors (siblings with or without caries), general health, food habits (night meals, breastfeeding, other beverage than water), oral hygiene habits and emerged teeth were answered by parents of the 1-year-olds. Dentin caries was assessed when the children were 3-year-olds. Simple and multiple logistic regression analyses were used for identification of caries-associated factors.

Results: An increased caries risk was assessed in 4.4% of the 1-year-olds. Dentin caries was found in 2.6% of the 3-year-olds. Caries risk at 1 year was associated with caries at 3 years (OR?=?6.5, p?=?.002). Multiple regression analysis found the variables Beverages other than water (OR?=?7.1, p?Caries in sibling (OR?=?4.8, p?=?.002), High level of MS (score 2–3) (OR?=?3.4, p?=?.03) and Night meal (OR?=?3.0, p?=?.03) to be associated with caries. The single variables Beverage other than water between meals and Caries in sibling were more reliable than Caries risk assessed performed by dental personnel.

Conclusions: Behavioural, family and microbial factors are important when assessing caries risk among 1-year-olds in a region with low caries experience.     

Declining dental caries in Jerusalem schoolchildren

Abstract There has been an increase of dental caries in Israel during the last decade (1970–80), while most developed industrialized countries reported a decline in dental caries since 1970. A survey carried out on 267 first graders (6 yr old) by the same investigator and with the same methods as in the previous survey (1977), showed a significant decrease in prevalence of dental caries in 1985 as follows: 78% affected children with a caries score of 4.9 compared to 86.2% with a caries score of 5.2 in 1977     

Effect on dental caries of a dental public health program for Danish schoolchildren

ABSTRACT The effect of a dental public health program comprising schoolchildren under the Danish Act on Child Dental Health has been evaluated after 5 years of operation. The program comprised complete restorative care for all children from kindergarten through the 9th grade (16 years of age), but only children attending kindergarten through third grade (10 years) are included in the present study. Each grade comprised approximately 50 children. A number of preventive procedures such as topical fluoride application, oral hygiene instruction and various other educational procedures have been used. The treatment services resulted in almost complete elimination of the “D” component and the “M” component in the DMFS index. The preventive services resulted in marked reductions in the total DMFS index, and almost complete elimination of new carious lesions after enrollment in the program. The non-experimental nature of the study makes it impossible to determine the effect of each one of the preventive procedures used in the program.     

A longitudinal study of dental caries risk among very young low SES children

Abstract – Objectives: Early childhood caries (ECC) is a challenging public health problem in the United States and elsewhere; however, there is limited information concerning risk factors in very young children. The purpose of this study was to assess baseline risk factors for 18‐month caries prevalence as part of a longitudinal study of high‐risk children. Methods: About 212 children, 6–24 months of age were recruited from a rural community in Iowa. Subjects were enrolled in the WIC program, which provides nutritional support for low‐income families with children. Dental examinations using d1, d2–3 criteria were conducted at baseline and after 18 months. Caries prevalence was determined at the frank decay level (d2–3 or filled surfaces), as well as at the noncavitated level (d1), and combined (d1, d2–3 or f surfaces). Risk factor data were collected at baseline and after 9‐ and 18‐ months. These data included beverage consumption data, presence of visible plaque, and use of fluoride toothpaste for children as well as mutans streptococci (MS) levels of mothers and children and family sociodemographic factors. Results: About 128 children (60%) remained in the study after 18 months. Among these children, prevalence of d1,d2–3/f level caries increased from 9% to 77%, while d2–3/f level caries increased from 2% to 20%. Logistic regression models for baseline predictors of d2–3f caries at the 18‐month follow‐up found the presence of MS in children (OR = 4.4; 95% CI: 1.4, 13.9) and sugar‐sweetened beverages (OR = 3.0; 95% CI: 1.1, 8.6) to be the only significant risk factors. Sociodemographic factors and the use of fluoride toothpaste were not significant in these models. Conclusions: Results suggest that early colonization by MS and consumption of sugar‐sweetened beverages are significant predictors of ECC in high‐risk populations.     

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随着应用于儿童龋病治疗材料的进步和知识的更新,儿童龋病的临床治疗技术也在不断发展。由于粘接修复材料和先进仪器设备的临床应用,牙体预备和修复逐渐向无痛、微创治疗发展。儿童龋病治疗的美观和功能恢复的效果日臻完善[1]。     

上海5岁儿童乳牙患龋状况及危险因素分析

目的了解上海5岁儿童龋病流行情况及易感因素。方法对上海市15所幼儿园1478名5岁幼儿进行口腔检查,对患龋高危儿童和无龋儿童家长进行问卷调查,应用χ2检验筛选出乳牙龋病易感者的相关因素,进行Logistic回归分析。结果①5岁儿童无龋率为33.58%,33.21%儿童dmft≥6,这部分龋高发儿童龋、失、补牙数之和占总龋、失、补牙数之和的75.53%,患龋状况呈明显的两极化分布。②睡前进食甜食、家长是否监督或帮助刷牙在两组儿童间有显著性差异(P<0.01);父母口腔健康知识态度、父母受教育程度、牛奶加糖、开始刷牙年龄、进食甜食频率亦有统计学差异(P<0.05);而是否早产、孕期患病、喂养方式、刷牙频率、是否使用含氟牙膏因素在两组间无统计学差异(P>0.05)。③Logistic回归分析结果显示,乳牙龋与父母口腔健康知识态度、睡前进食甜食、开始刷牙年龄、父母受教育程度、家长监督/帮助刷牙有关。结论加强对父母口腔健康知识的宣传、刷牙指导,限制糖的摄入及避免不当进糖方式对预防乳牙龋极为重要。     

Risk factors for dental caries in children with cerebral palsy

This study was conducted to examine the oral condition and the salivary and microbiological parameters associated with dental caries in 62 children with cerebral palsy, who came from households of low socioeconomic status (Study Group). This group had mixed (6 to 11 years old) and permanent (11 to 16 years old) dentition. Dental examinations were performed to measure dental caries, plaque index, salivary levels of mutans streptococci and lactobacilli, salivary flow rate, pH of stimulated saliva, and buffer capacity of saliva. A group of 67 non-handicapped children from similar socioeconomic backgrounds also were examined using these parameters (Control Group). Data were analyzed statistically by non-parametric tests and by correlation. The results showed that children with cerebral palsy who had permanent dentitions had a higher mean decayed, missing and filled surfaces index, as well as a higher plaque index for both sexes. Microbiological examination revealed higher levels of mutans streptococci among Study Group subjects with mixed dentition than in the Control Group. Also, lactobacillus counts were higher in the Study Group, regardless of sex or dentition. With respect to salivary flow rate, pH and buffering capacity, lower mean values were obtained for the Study Group.     

Identification of high caries risk children using prevalence of filled surfaces as predictor variable for incidence

The purpose of the present study was to determine the validity of prevalence of filled surfaces at 9 years of age as a screening criterion for prediction of future caries incidence. Retrospective data were available for 114 children who had participated in an incremental dental care program from 7 to 16 years of age. There was a significant positive correlation between prevalence of filled surfaces (FS) at age 9 and increment of surfaces filled during the subsequent 7 years. Thus only 13% of the variation in increment of surfaces filled was explained by the variation in prevalence of FS. Subjects who had eight or more filled surfaces at 9 years of age were classed as the Expected H-group (22 subjects), while the Real H-group consisted of the 22 subjects who experienced the highest increment of surfaces filled between the ages of 9 and 16. Sensitivity and diagnostic power were both 45%, specificity 87%. While sensitivity decreased with increasing FS score at age 9, specificity and diagnostic power increased. A detailed analysis of the increment of surfaces filled each year from age 11 to 16 revealed that a considerable number of subjects not included in the H-groups also received many fillings.     

The University of North Carolina caries risk assessment study: caries increments of misclassified children

The University of North Carolina caries risk assessment was conducted between 1986 and 1989 with 5000 children initially in grades 1 and 5 from low fluoride sites in South Carolina and Maine. Clinical, microbiologic, behavioral, and demographic factors served as independent variables used in logistic multiple regression models to determine the predicted caries risk classification of each child. The 3-yr DMFS increment of each child was the dependent variable, and the 20-25% of those in each cohort with the highest increment were considered the high risk group. Sensitivity and specificity values averaged 0.60 and 0.83 respectively, indicating the misclassification of substantial numbers of children. This paper reports analysis of the DMFS increments of the misclassified children. The majority of children had DMFS increments within one or two surfaces of the classification cut points. Many false negative children had increments composed entirely of filled surfaces, often of minimal extent and without evidence of previous decay. Many false positive children had increments composed of decayed surfaces and would have benefitted from being identified as high risk and assigned to a preventive program. Other false positive children had sealants placed after the baseline examination that undoubtedly reduced their true increment. It is concluded that the consequences of misclassification are not serious for most children in this study.     

Pilot study on obesity in caries prediction

The aim of the present study was to explore the possibility of predicting the incidence of dental caries from obesity. The subjects were 516 children living in Luvia, Finland, born between 1972 and 1981. Obesity alone was not a very good predictor of dental decay. When predicting caries in the permanent first molars using both earlier obesity and earlier caries experience as predicting indicators, 65-70% of the true risk group was identified. This combination was even better for the prediction of caries in permanent second molars.     

Exploring the contributions of components of caries risk assessment guidelines

Abstract – Objective: To examine the relative contribution of current caries activity, past caries experience, and dentists’ subjective assessment of caries risk classifications. Methods: Administrative data from two dental plans were analyzed to determine dentists’ risk classification, as well as current caries activity and previous caries experience at the time of the classification. The performance of these predictors in identifying patients who would experience subsequent caries was then modeled using logistic regression. Results: In both plans, current caries activity alone had relatively low sensitivity and high specificity in identifying patients who would experience subsequent caries. Sensitivity improved, but at the cost of specificity when previous caries experience was included in the models. Further improvement in sensitivity accrued when dentists’ subjective assessment was included, but performance was different in the two plans in terms of false‐positives. Conclusions: Consideration of previous caries experience tends to strengthen the predictive power of caries risk assessments. Dentists’ subjective assessments also tend to improve sensitivity, but overall accuracy may suffer.