Stages, risk factors and prevention of early childhood caries

Early childhood caries is a common condition that affects children and young infants. In addition to the effect of the condition on the child's oral health, it has been furtherly shown that many systemic consequences are usually associated. Therefore, it has been reported that these conditions can significantly impair the quality of life of corresponding families based on economic and health-related burdens. Affected children usually present with variable degrees of the condition, and some complications might be associated. Many risk factors have been reported in the literature for developing the condition in children. These include the presence of certain bacterial pathogens (especially through vertical transmission), dietary habits, and poor oral hygiene. Evidence indicates that these risk factors significantly contribute to the development of early childhood caries and the importance of the child's socioeconomic status and his caregivers. Targeting these factors would significantly reduce the risk of developing the condition, in addition to fluoridation as suggested by various relevant investigations.

Subtypes of early childhood caries predict future caries experience

Objectives: To test whether postulated subtypes of early childhood caries (ECC) are predictive of subsequent caries experience in a population-based cohort of Swedish children. Methods: The study included children aged between 3 and 5 years at study entry with dental records available for at least 5 years of follow-up. Dental record data were retrieved from the Swedish Quality Registry for Caries and Periodontal disease (SKaPa) for the initial and follow-up visits. Participants who had ECC at study entry were assigned to one of five ECC subtypes (termed classes 1 to 5) using latent class modelling of tooth surface-level caries experience. Subsequent experience of caries was assessed using the decayed, missing, and filled surfaces indices (dmfs/DMFS) at follow-up visits, and compared between ECC subtypes using logistic and negative binomial regression modelling. Results: The study included 128,355 children who had 3 or more dental visits spanning at least 5 years post baseline. Of these children, 31,919 had caries at the initial visit. Baseline ECC subtype was associated with differences in subsequent disease experience. As an example, 83% of children who had a severe form of ECC at age 5 went on to have caries in the permanent dentition by the end of the study, compared to 51% of children who were caries-free at age 5 (adjusted odds ratio of 4.9 for new disease at their third follow-up). Conclusions: ECC subtypes assigned at a baseline visit are associated with differences in subsequent caries experience in both primary and permanent teeth. This suggests that the development and future validation of an ECC classification can be used in addition to current prediction tools to help identify children at high risk of developing new caries lesions throughout childhood and adolescence.

Biofilm Accumulation and Sucrose Rinse Modulate the Calcium and Fluoride Bioavailability in the Saliva of Children with Early Childhood Caries

This quasi-experimental study aimed at investigating the combined effect of biofilm accumulation and 20% sucrose rinse on the modulation of calcium (Ca2+), phosphate (Pi), and fluoride (F-) bioavailability in saliva of children with early childhood caries (ECC). In-that, fifty-six preschoolers of both genders were evaluated according to caries experience and activity: caries-free (CF, n=28) and with ECC (n=28) and then, submitted to biofilm intervention (biofilm accumulation or no biofilm accumulation). In each situation, saliva samples were collected before and five minutes after a 20% sucrose rinse to determine the concentrations of Ca2+, Pi, and F−. Calcium concentration was significantly lower in the biofilm accumulation situation compared to the situation of biofilm mechanical control, except for children CF after sucrose rinse. Biofilm accumulation increased salivary calcium concentration in children with ECC after sucrose rinse, whereas mechanical biofilm control reduced it in both groups. The phosphate concentration was influenced by mechanical control of the biofilm in CF children. The fluoride bioavailability was reduced by sucrose rinse and biofilm accumulation in CF and ECC children. In conclusion, the combined effect of biofilm accumulation and sucrose rinse modifies the bioavailability of calcium and fluoride in the saliva of children with early childhood caries.

Association between Insufficient Sleep and Dental Caries among Preschoolers in Japan: A Cross-Sectional Multicentre Study

Recently, sleeping status has attracted attention for its relationship with oral health. In the present study, we have investigated the association between early childhood caries and sleeping status. A multicentre observational cross-sectional study was conducted among 332 preschoolers (aged 3–6 years) and their parents in Chitose, Japan. Dental caries and sleeping status were assessed in the children and the sleep quality and health literacy of the parents were also assessed. Univariate and multivariate regression analyses were used in order to investigate the effect of the sleeping status of the parents and their children on dental caries. Among the children, the prevalence of dental caries experience was 12.7%. The children without caries slept significantly longer and their parents had a better Pittsburgh Sleep Quality Index (PSQI) score than those with caries experience. The sleeping status and the numbers of caries in the children were significantly correlated. Health literacy was better in those without caries experience. Parents’ PSQI was significantly positively correlated with the numbers of caries in the children (r = 0.19, p = 0.0004). The children’s sleep durations, screen time, and parental smoking status were independently associated with early childhood caries. Poor sleeping status of children and their parents is related to dental caries among preschoolers.

Risk factors analysis for early childhood caries

Aim. To study the dominant antenatal and postnatal risk factors for development early childhood caries (12 – 47 months).Materials and methods. In order to study the dental morbidity of the child population aged 1 to 3 years, permanently living in Moscow, an epidemiological examination of 510 children was carried out. To determine the dental status of the subjects, clinical research methods were carried out. To assess antenatal and postnatal risk factors for the development of caries in children aged 1 to 3 years, a questionnaire survey was conducted between parents or legal representatives. The survey participants answered 5 questions that are important for understanding the causes of early tooth decay.Conclusions. With growing up, the prevalence of caries increases. The prevalence of Early Childhood Caries among the boys and the girls aged 12-23 months and 24-35 months depends on the sex of the child. A statistically significant difference in the intensity of caries in different age groups was revealed; the older the age group, the higher the intensity of caries. The risk of caries in children in the group with the pathological course of the mother's pregnancy is higher than in the group with the normal course of pregnancy. A statistically significant relationship was found between the prevalence of caries in children and the age at which toothbrushing began.

Knowledge, Attitudes, and Practices of Parents on Early Childhood Caries in Qatar—A Questionnaire Study

Objectives The aims of the present study were to evaluate the level of knowledge, attitudes, and practices (KAP) toward early childhood caries (ECC) in a group of Qatari parents and to assess the association of sociodemographic factors on their KAP. Materials and Methods A cross-sectional study which was based on a piloted self-administered questionnaire was conveniently distributed to parents who attended the Pediatric Dentistry Section, Hamad Dental Center (HDC), Doha, Qatar. The questionnaire comprised four parts which asked about sociodemographic characteristics, knowledge, attitudes, and practices. A score for each domain was given based on the percentage of correct answers. Statistical Analysis Descriptive and analytical statistics were employed. For descriptive statistics, frequency of distribution in relation to sociodemographic characteristics and responses to items of the questionnaire were presented. For analytical statistics, associations between independent variables and KAP were employed using Chi-squared tests. Results The overall mean scores of KAP were 60.8%, 65.6% and 72.7%, respectively. Females had significantly higher percentages of correct answers than males (p = 0.001). Only 20% of females had poor knowledge, while it was 40% in males. Parents with university or higher degrees had significantly higher percentage of good attitudes than parents with preparatory or less education (p = 0.05). Areas that necessitated improvement by parents included the following: the amount of toothpaste needed for brushing, signs of tooth demineralization, bacteria that causes tooth decay can be transmitted from mother to her child, and tooth decay can be transmitted by sharing utensils (i.e., spoons, forks). Conclusions The overall KAP of parents toward ECC was relatively fair. However, certain socioeconomic factors (SEF) seemed to influence each domain, and areas of improvement are needed. Areas of improvement are needed in each domain. Mothers were significantly more knowledgeable than fathers regarding oral health issues of their children. Highly educated parents demonstrated better attitudes than the less educated. Continuous educational programs coordinated by health regulatory bodies should be introduced to improve parents' KAP regarding ECC risk factors and prevention.

The Effectiveness of Early Childhood Caries Treatment with MI Varnish Fluor in Obese Subjects: A Study from Vietnam

Objective: We conducted this work to evaluate the effectiveness of treatment for early childhood caries (ECC) using MI Varnish Fluor in obese children aged from 36 to 71 months. Methods: This study was conducted on 300 carious teeth of obese children and normal-weight children in Hanoi, Vietnam, over the period 2019–2020. Diagnodent KaVo 2190 laser equipment was used to diagnose ECC. The children in each group were selected on the basis of similarities in age, gender, and study location, and the teeth in the two groups were selected on the basis of similarities in damage level and jaw position. ECC treatment was performed once a week for four consecutive weeks with MI Varnish Fluor. The child, the child’s family, and the child’s teacher were consulted on diet and oral hygiene during the treatment. Children were examined and monitored throughout the treatment period. Children were re-examined after 3 and 6 months from the start time of treatment. The Mann–Whitney U test and Kruskal–Wallis tests were used, with statistical significance indicated at p < 0.05. Results: After six months of treatment with MI Varnish Fluor, the number of cases of code 0 damage recovery (D0) increased in both groups. The result showed that MI Varnish fluor was effective in ECC treatment. D0 damage recovery rates of 79.3% in obese children and 62.7% in normal-weight children were observed after six months of treatment, but there was no statistically significant difference between the two groups. Furthermore, there was no statistically significant difference between the two groups according to age, tooth position, or tooth surface position in D0 damage recovery. Conclusions: MI Varnish Fluor was effective in ECC treatment, with D0 damage recovery rates of 79.3% in obese children and 62.7% in normal-weight children after six months of treatment.

Streptococcus mutans Antibacterial Activity of 0.1% Lysozyme Tooth Paste as an Alternative for Children Below 3 Years Old in Preventing Early Childhood Caries (ECC) (Experimental Laboratory Study)

One of many possible ways of preventing Early Childhood Caries (ECC) is by removing tooth debris. Fluoride tooth paste usage by children under 3 years old must follow recommended quantity, because of its possibility of being ingested which then might cause fluorosis. Lysozyme as an active element in a toothpaste is able to mediate bacterial aggregation and inhibit bacterial adhesion and also activate bacterial autolysin by destructing bacterial cell wall. This study aimed to compared Streptococcus mutans antimicrobial activity of non-fluoride lysozyme toothpaste of various concentration such as 0.025, 0.05, 0.1, and 0.2 %. This was an experimental research with post test only design. The tested tooth paste was lysozyme-contained with 0.025, 0.05, 0.1 and 0.2% concentrations. Children tooth paste containing fluoride, enzyme tooth paste and 0.2% chlorhexidine became the positive control. Test of S. mutans antibacterial activity used 3 methods: disc diffusion, well, and microtiter plate method. Analytical test used Anova one way with Bonferoni post hoc and p<0.05 significant level. The results showed that all concentrations of lysozyme tooth paste had inhibitory effect on the growth of S. mutans (p<0.05). The highest mean of S. mutans antibacterial activity in lysozyme tooth paste were on 0.1 and 0.2% concentrations. Conclusion stated that 0.1% concentration of lysozyme tooth paste can be used as an alternative tooth paste for children under 3 years old

Salivary cystatin S levels in children with early childhood caries in comparison with caries-free children; statistical analysis and machine learning

Background Early childhood caries is the most common infectious disease in childhood, with a high prevalence in developing countries. The assessment of the variables that influence early childhood caries as well as its pathophysiology leads to improved control of this disease. Cystatin S, as one of the salivary proteins, has an essential role in pellicle formation, tooth re-mineralization, and protection. The present study aims to assess salivary cystatin S levels and demographic data in early childhood caries in comparison with caries-free ones using statistical analysis and machine learning methods. Methods A cross-sectional, case–control study was undertaken on 20 cases of early childhood caries and 20 caries-free children as a control. Unstimulated whole saliva samples were collected by suction. Cystatin S concentrations in samples were determined using human cystatin S ELISA kit. The checklist was collected from participants about demographic characteristics, oral health status, and dietary habits by interviewing parents. Regression and receiver operating characteristic (ROC) curve analysis were done to evaluate the potential role of cystatin S salivary level and demographic using statistical analysis and machine learning. Results The mean value of salivary cystatin S concentration in the early childhood caries group was 191.55 ± 81.90 (ng/ml) and in the caries-free group was 370.06 ± 128.87 (ng/ml). T-test analysis showed a statistically significant difference between early childhood caries and caries-free groups in salivary cystatin S levels (p = 0.032). Investigation of the area under the curve (AUC) and accuracy of the ROC curve revealed that the logistic regression model based on salivary cystatin S levels and birth weight had the most and acceptable potential for discriminating of early childhood caries from caries-free controls. Furthermore, using salivary cystatin S levels enhanced the capability of machine learning methods to differentiate early childhood caries from caries-free controls. Conclusion Salivary cystatin S levels in caries-free children were higher than the children with early childhood caries. Results of the present study suggest that considering clinical examination, demographic and socioeconomic factors, along with the salivary cystatin S levels, could be usefull for early diagnosis ofearly childhood caries in high-risk children; furthermore, cystatin S is a protective factor against dental caries.

Correlation of Child Temperament with Severity of Early Childhood Caries in Children Aged 3-6 Years

Objective: To check the correlation of child temperament with severity of early childhood caries in children aged 3-6 years. Design of the Study: It’s a cross-sectional study. Study Settings: The study was conducted at Department of Dentistry and Oral Pathology, Bakhtawar Amin Medical and Dental College, Multan from August 2020 to August 2021. Material and Methods: Total 700 children aged between 3-6 years who fulfill the inclusion criteria were selected along with their parents/ primary caregivers. In the present study temperament was assessed using Thomas and Chess’s parent temperament questionnaire. Both intensity and frequency of occurrence of that particular behavior was considered, each entity is scored on a five (5) point scale. Rating is done on negative and positive directions in which scores of 1-5 represent the extremes of intensity and frequency of occurrence of that behavior. At the midpoint, score of 3 is average according to the parent’s insights. Results of the Study: Among the study group of, 24% belonged to the age group 3 years, 29% belonged to age group 4 years, 27% belonged to the age group 5 years and 20% belonged to the age group 6 years. Forty nine percent among the study group were male participants whereas 51% were female participants. Fifty percent of the participants among the study population had caries while 46% of the study participants were free of caries. The results showed that children with caries had lower overall temperament scores (36.49± 5.67) compared to subjects without caries (38.82± 5.43).There was a statistically significant correlation with p<0.001. Conclusion: There was a significant correlation between child temperament scores of Sociability, Energy and Emotionality and Caries Severity Index scores. No correlation could be established with Attentivity and Rhythmicity scores. It can be concluded that in early childhood caries child temperament is a risk factor. Keywords: Temperament, Early Childhood Caries