Follow-up of an Intervention to Reduce Dental Caries in Indigenous Australian Children: A Secondary Analysis of a Randomized Clinical Trial.
ABSTRACT: Importance:Testing the long-term usefulness of a childhood intervention and determining the best age of implementation are important for translation and policy change. Objectives:To investigate among children aged 3 years the long-term effectiveness an intervention that aimed to reduce dental caries among South Australian Aboriginal children and to assess if children in the delayed intervention (DI) group had any benefit from the intervention from ages 2 to 3 years and if the intervention usefulness was greater when delivered between pregnancy and age 2 years (immediate intervention [II] vs ages 2 to 3 years [DI]). Design, Setting, and Participants:Secondary analysis of a randomized clinical trial. The study enrolled 448 pregnant women across South Australia, Australia, at baseline (February 1, 2011, to May 30, 2012), with 223 randomly allocated to the II group and 225 to the DI group. Three-year follow-up data were collected November 2014 to February 2016. Interventions:The intervention comprised dental treatment to mothers, fluoride varnish application to children, and motivational interviewing delivered together with anticipatory guidance. This was delivered during pregnancy and at child ages 6, 12, and 18 months for the II group and at child ages 24, 30, and 36 months for the DI group. Main Outcomes and Measures:The mean number of decayed teeth measured at child age 3 years. Results:There were 324 children at age 3 years (52.3% male). The mean number of decayed teeth at age 3 years was 1.44 (95% CI, 1.38-1.50) for the II group and 1.86 (95% CI, 1.89-2.03) for the DI group (mean difference, -0.41; 95% CI, -0.52 to -0.10). The predicted mean number of decayed teeth at age 3 years for the DI group was 2.15. Between ages 2 and 3 years, the caries increment for the II group was 0.82 (95% CI, 0.75-0.89), compared with 0.97 (95% CI, 0.87-1.17) for the DI group (P?=?.05). Conclusions and Relevance:At the 3-year follow-up, II children had less dental caries than DI children, DI children developed dental caries at a lower trajectory than predicted had the intervention not been received at ages 2 to 3 years, and the caries increment was less between ages 2 to 3 years among II children compared with DI children. This study suggests that the best time to implement the intervention is earlier rather than later infancy. Trial Registration:Australian and New Zealand Clinical Trial Registry Ideintifier: ACTRN12611000111976.
Project description:In developing countries, the prevalence of dental caries in children remains high, which means that implementing a simple and convenient classification is critical. The classification needs to be evidence-based and needs to reflect tooth-level information. In this study, the prevalence of dental caries in the primary dentition of 352 Myanmar school children at the ages of 5, 6, and 7 was analyzed at the tooth level to clarify the underlying data structure of the patterns of dental caries in the population. Ninety-three percent of subjects had caries in primary dentition and the mean number of decayed teeth in primary dentition was 7.54 ± 4.82. Based on the item response theory analysis, mixed-effect modeling, and Bayesian network analysis, we proposed the following classification: Group 1: No dental caries; Group 2: Dental caries in molar teeth or dental caries in maxillary anterior teeth; Group 3: Dental caries in both molar and maxillary anterior teeth; Group 4: Dental carries in mandibular anterior teeth. Dental caries (dmft) in the groups was different between groups. The results of characteristics of tooth-level information and classification presented in this study may be a useful instrument for the analysis of the data of dental caries prevalence in primary dentition.
Project description:Importance:For an intervention delivered in early childhood to have meaningful translational effect, long-term follow-up is necessary, especially among underserved indigenous children among whom preventable dental disease is common. Objectives:To test the long-term effectiveness of an early-childhood dental intervention through a follow-up at age 5 years among Aboriginal children in Australia. Design, Setting, and Participants:This secondary analysis of a randomized clinical trial followed up on participants of the Baby Teeth Talk Study, a 2-group parallel, outcome assessor-blinded, randomized clinical trial conducted among Aboriginal children in South Australia, Australia. Participants included 448 mother or caregiver-child dyads who were enrolled in the Baby Teeth Talk trial between February 2010 and May 2011 and were randomized in the present trial to the immediate intervention group or the delayed intervention group. Intention-to-treat principles were used for all data analyses to estimate the effect of the intervention on dental caries experience. Data analysis was performed from April 10 to May 27, 2019. Interventions:The intervention comprised 4 services to participants: (1) dental care to mothers during pregnancy, (2) application of fluoride varnish to children's teeth, (3) anticipatory guidance in the form of oral health educational packages, and (4) motivational interviewing for pregnant mothers and children at ages 6, 12, and 18 months in the immediate intervention group and at ages 24, 30, and 36 months in the delayed intervention group. Main Outcomes and Measures:The primary outcome was the mean number, in the primary dentition, of decayed, missing, or filled teeth (dmft) at age 5 years. Individual components of the dmft index were examined, as was the prevalence of dmft greater than 0. Results:Of the 449 Aboriginal mothers and children recruited, 223 (49.7%) were randomized to the immediate intervention group and 225 (50.1%) to the delayed intervention group. The mean dmft at age 5 years was 2.10 (95% CI, 2.04 to 2.16) for children in the immediate intervention group and 2.91 (95% CI, 2.83 to 3.00) for children in the delayed intervention group (adjusted mean difference, -1.02; 95% CI, -1.81 to -0.22). When considering children in nonmetropolitan locations, the differences were stark; the mean dmft was 2.46 (95% CI, 2.38-2.54) for children in the immediate intervention group and 3.65 (95% CI, 3.53 to 3.78) for children in the delayed intervention group, with an adjusted mean difference of -1.52 (95% CI, -2.61 to -0.43). Most of this difference was accounted for by missing teeth, with the mean number of missing teeth of children in the immediate intervention group living in nonmetropolitan locations being 0.29 (95% CI, 0.27 to 0.31) compared with 1.02 (95% CI, 0.96 to 1.07) for their counterparts in the delayed intervention group. A 3-fold difference was observed in the percentage of missing teeth greater than 0 between children in the immediate intervention group and those in the delayed intervention group (10.8 [95% CI, 10.2 to 11.4] vs 31.0 [95% CI, 30.1 to 31.8]). Conclusions and Relevance:This trial found that a multifaceted initiative to reduce early-childhood caries continued to be efficacious in participating indigenous children aged 5 years, especially those residing in nonmetropolitan locations and with teeth missing because of dental disease. Trial Registration:anzctr.org.au Identifier: ACTRN12611000111976.
Project description:<h4>Background</h4>Dental caries are a global public health problem and influence the overall health of children. The risk factors for caries include biological, socio-behavioral and environmental factors. This cross-sectional study assessed dental caries and their associations with socioeconomic factors, oral hygiene practices and eating habits among Emirati and non-Emirati children in Abu Dhabi, United Arab Emirates (UAE).<h4>Methods</h4>The stratified sample comprised children aged 18 months to 4 years recruited from 7 nurseries. The World Health Organization (WHO) decayed, missing and filled teeth index (dmft) was used to analyze the dental status of the children. Parents completed a questionnaire regarding demographics, food consumption and oral habits. The study was approved by the Research Ethics Committee at Zayed University, UAE (ZU15_029_F).<h4>Results</h4>A total of 186 children with a mean age of 2.46 years, of which 46.2% were Emirati, participated. Overall, 41% of the children had dental caries. The mean dmft±SD was 1.70?±?2.81 with a mean?±?SD decayed component (dt) of 1.68?±?2.80 and mean?±?SD filled component (ft) of 0.02?±?0.19. Emirati children showed higher mean dmft, Plaque Index and Significant Carries Index values than non-Emirati children (P?< 0.000). Low maternal education, rural nursery location, infrequent tooth-brushing, frequent consumption of high-sugar food items and Emirati nationality were factors significantly associated with dental caries.<h4>Conclusions</h4>In this study, 4 out of 10 nursery children were found to have dental caries. Sociodemographic factors, dietary and oral health habits were associated with dental caries. Effective oral health interventions tailored to improve eating habits and the dental screening of children in this age group are imperative to mitigate these concerns.
Project description:The aim of this study was to determine the caries status and risk factors in the schoolchildren of Spain's Valencia region in 2018 and to compare them to the 20-year evolution of caries indicators in the region. A cross-sectional survey was conducted with 1722 children and adolescents aged between 6 and 15 using cluster sampling. Caries status, using International Caries Detection and Assessment System II (ICDAS II) criteria, and sociodemographic variables were recorded. To ensure the comparison with previous studies using WHO caries criteria, the cut-off point was established at ICDAS II code 4. Caries prevalence was found to be 37.4% and the decayed and filled teeth index (dft) was 1.23 at 6 years for deciduous dentition (DD). In permanent dentition (PD) at 12 years, caries prevalence was 30.1% with a 0.66 decayed, missing and filled teeth index (DMFT), and at 15 years, prevalence was 44.6% and DMFT was 1.21. Socioeconomic status poses a major risk factor for caries prevalence in deciduous dentition; it is 1.8 times higher in the lowest socioeconomic group. Deciduous dentition status has worsened in the most recent eight-year period, whereas in permanent dentition the 12- and 15-year values are similar to those of the 2010 survey. Evolution analysis suggests that community dental care programs be enhanced, involving preventive activities staring at the first year and targeting disadvantaged groups.
Project description:BACKGROUND:Preschool years are a critical period in the development of a healthy child. The consequences of poor oral health in preschool children reach beyond dental problems, with oral health-related quality of life (OHRQoL) being associated with overall systematic health as well as one's quality of life. The purpose of this study was to assess the prevalence of dental caries and its impacts on the OHRQoL in a sample of preschool children in Kisarawe. METHODS:A cross-sectional based study was conducted in 2017. A total of 1106 preschool children completed a face-to-face interview, using a translated Kiswahili version of the Michigan Oral Health-related Quality of Life Scale (MOHRQoL) -Child Version (2003), and underwent clinical oral examination using WHO (1997) criteria. RESULTS:The decayed component was the most prevalent (dft?=?2.08) and the Significant Caries Index (SiC) was 5.54 double of the (dft), showing polarization of dental caries in the studied population. After adjusting for appropriate covariates, preschool children of age 5 and 6?years old were more likely to have decayed tooth [Adjusted OR?=?3.02, (95% CI =2.01-4.54)] and [Adjusted OR?=?2.23, (95% CI?=?1.55-3.20)] respectively. Preschool children without visible plaque on the buccal surface of upper anterior teeth were less likely to have decayed teeth [Adjusted OR?=?0.21, (95% CI?=?0.09-0.45)]. Regarding measurements of oral health-related quality of life using the MOHRQoL, only preschool children who reported on 'do your teeth hurt you now?' and 'do kids make fun of your teeth?' were more likely to have a decayed tooth [Adjusted OR?=?1.74, (95% CI?=?1.12-2.71)] and [Adjusted OR?=?1.87, (95% CI?=?1.11-3.15)], respectively. CONCLUSION:Findings from this study suggest that dental caries affects a significant portion of preschool children and, was associated with poor oral hygiene. The overall impacts of dental caries prevalence to OHRQoL were low in this sample of preschool children. Children having caries (independent variable) were shown to report more frequently that 'do your teeth hurt you now?' and 'do kids make fun of your teeth?' were more likely to have a decayed tooth among preschool children in Kisarawe, Tanzania.
Project description:BACKGROUND:Children with congenital heart defects (CHD) are reported to have poorer oral health compared with healthy children. The aim of the present study was to evaluate the effectiveness of an intensive oral health care program among children with CHD followed from infancy to the age of 5 years, by comparing their oral health status at 5 years with a control group of children with CHD who had not received the program. METHODS:In this longitudinal study, children in western Norway with a need for lifelong follow-up due to congenital heart defects were invited to participate (n?=?119). Children born in 2008-2011 were offered an oral health intervention program from infancy to the age of 5 years. The outcome measures for evaluating the intervention were dental caries prevalence, dental erosion, plaque index and gingival bleeding index. The data of the intervention group were compared with cross sectional oral health data of 5 year old controls with CHD born 2005-2007 (already published). RESULTS:Early oral health intervention did not affect the prevalence of caries (25.3% versus 25.4%) or dental erosion (22.2% versus 19.7%) of children with CHD assessed at 5 years. Children in the intervention group were less likely than those in the control group to present with both dental plaque and gingival bleeding at age 5 years. In spite of no difference in caries prevalence between the groups, caries affected children (d1-5mft) in the intervention group had fewer teeth affected by caries than children in the control group (p?=?0.06). The care index was reported to be higher in the intervention group compared with the control group, implying that fewer children in the intervention group suffered from untreated dentine caries. Parents in the intervention group were more likely to brush their children's teeth twice a day than parents of children in the control group. CONCLUSION:The oral health promotive program did not influence the prevalence of caries nor dental erosion. However, the findings indicated better oral hygiene, reduced gingival bleeding and less untreated dentine caries in the intervention compared with the control group. TRIAL REGISTRATION:ClinicalTrials.gov NCT03311438 . Registration date: October 17th 2017, retrospectively registered.
Project description:AIM: To investigate the prevalence of dental caries and treatment needs in schoolchildren aged 7-14 years from Zagreb. METHODS: Dental examinations based on the World Health Organization criteria were performed on 1168 children in the period 2009-2010. The teeth were clinically examined with standard dental instruments using visual-tactile method under standard dental light. We recorded the clinical indexes of decayed, missed, and filled teeth (DMFT and dmft; upper-case letters refer to permanent and lower-case letters to primary teeth) and decayed, missed, and filled surfaces (DMFS), as well as the significant caries index (SiC). RESULTS: The median DMFT and DMFS of all children were 3 and 4, respectively. The median DMFT and DMFS of 12-year-old children were 4 and 5, respectively. The highest median DMFT score of 7 was found among 14-year-old children. There was a significant difference between age groups (7-10 years and 11-14 years) in DMFT and DMFS. Among 8-year-old children, the median dmft index was the highest (5.5) and SiC index was 7.4. As far as the location of caries on the surface of the first permanent molar is concerned, caries occurred mostly in the central occlusal surface (27.6%). CONCLUSION: Our results showed a high caries prevalence among schoolchildren in Zagreb, indicating a need for an extensive program of primary oral health care.
Project description:Background:Due to limited financial resources, poor access to basic oral care, and the high cost of restorative treatment, children of low-income nations have their general health, social well-being, and education opportunities affected by untreated dental caries. Arresting caries treatment (ACT) has been proposed to manage untreated dental caries in children of disadvantaged communities. Aims and objectives:The purpose of the present controlled clinical trial is to investigate the effectiveness of a new anticaries agent, nanosilver fluoride (NSF), preventing and arresting caries in children. Materials and methods:A total of 100 deciduous molars both maxillary and mandibular are randomly selected from 60 children of 4-9 years of age group, which were randomly divided into NSF experimental group and saline control group. Teeth were clinically diagnosed and treated by one masked examiner and followed up at 7 days, 5 months and 12 months by another calibrated examiner who was blinded to the type of treatment. The criteria of the ICDAS II were followed to determine the activity of lesion and the diagnosis of caries. The Pearson's Chi-square test was used to compare the groups during different follow-up examinations. Results:Seventy-eight percent of decayed teeth showed hard arrested dentine at 7 days; after 5-month analysis in the NSF group, 72.91% of the teeth showed arrested caries; and in the control group, only 34% of teeth showed arrest of caries. At 12-month analysis in the NSF group, 65.21% of teeth showed arrested cavities, and in the control group, 28.88% of teeth showed arrest of caries. Conclusion:The present study proves that NSF is an anticaries agent and presents a noninvasive option for caries arrest and treatment when applied directly to dentin caries lesions. How to cite this article:Nagireddy VR, Reddy D, Kondamadugu S, et al. Nanosilver Fluoride-A Paradigm Shift for Arrest in Dental Caries in Primary Teeth of Schoolchildren: A Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2019;12(6):484-490.
Project description:Dental caries, although preventable, remains one of the most prevalent chronic disease worldwide. Most studies focused on the relationship between sugar intake and caries. However, examining multidimensional dietary patterns is becoming increasingly important. Here, we examined the relationship between dietary patterns from ages 6 to 12 months and early childhood caries (ECC) at age 2 to 3-years. Infant dietary data was collected from caregivers and dietary pattern trajectories from 6 to 12 months derived. Oral examinations were carried out by trained calibrated dentists at ages 2 and 3 years. Associations between dietary pattern and ECC were estimated using generalized estimating equation. We found a 3.9 fold lower prevalence of decayed surfaces among children with high Guidelines dietary pattern scores at 6-months (IRR 0.26; CI [0.12-0.53]; p-value?<?0.001) and 100% reduction of decayed surfaces with increased intakes of Guidelines dietary pattern foods from 6 to 12-month (IRR 2.4?×?10-4; CI [4.2?×?10-7-0.13]; p-value?=?0.01). Suggesting that following the Guideline dietary pattern, which corresponds most closely to current World Health Organization weaning guidelines, at 6 months and an increase in pattern score between 6 and 12 months were protective against ECC development compared to Predominantly breastmilk, Easy-to-prepare foods and Noodles (in soup) and seafood dietary patterns.
Project description:Background: Dental caries is a chronic, multifactorial disease, with limited data available for the Egyptian population. The aim of this study is to assess the prevalence of dental caries among Egyptian children and adolescents in correlation with age, gender, body mass index, socioeconomic status, parental education, biological risk factors and dietary habits. Methods: A total number of 369 Egyptian children and adolescents (age ranges from 3-18 years) were examined over the period from 15 th November 2017 to 13 th January 2018. Socio-demographic data, oral hygiene measures and dietary habits for children were recorded. Dental status was analyzed using decayed, missing and filled tooth index (dmft) for deciduous dentition and (DMFT) index for permanent dentition. For mixed dentition (deft) index was used, d (decayed tooth indicated for filling), e (decayed tooth indicated for extraction) and f (filled tooth). Results: 74% of the children had dental caries with mean dmft: 3.23±4.07; deft: 4.21±3.21; DMFT: 1.04±1.56. In primary dentition, dmft of the children was positively correlated with age, beans, candies, crackers, chocolates and inversely correlated with gender, socio-economic status (SES), parental education, brushing frequency of the parent, brushing frequency of the parent to the child teeth, brushing frequency of the child and consumption of eggs, fruits/vegetables, milk and milk products. In mixed dentition, deft was positively correlated with candies, crackers, citric juices, while negatively correlated with age, SES, parental education, brushing frequency of the parent to the child, brushing frequency of the child, fruits/vegetables. In permanent dentition, DMFT in children was positively correlated with age and chocolates while not correlated with any of the remaining risk factors. Conclusion: The present study clarifies the significant risk factors associated with dental caries amongst Egyptian children. This will help in planning strategies to prevent and treat such disease.