Background Early childhood caries (ECC) describes dental caries affecting children aged 0–71 months. Current research suggests ECC has important aetiological bases during the first year of life. Gaps in knowledge about disease progression prevent the effective and early identification of ‘at risk’ children. Aim To conduct a systematic review of research studies focusing on (a) acquisition and colonization of oral bacteria and ECC and (b) risk and/or protective factors in infants aged 0–12 months. Design Ovid Medline and Embase databases (1996–2011) were searched for RCT, longitudinal, cross‐sectional and qualitative studies. Two investigators undertook a quality assessment for risk of bias. Results Inclusion criteria were met for (a) by four papers and for (b) by 13 papers; five papers were rated medium or high quality. Bacterial acquisition/colonization and modifying factor interrelationships were identified, but their role in the caries process was not clarified. Key risk indicators were infant feeding practices (nine papers), maternal circumstances and oral health (6) and infant‐related oral health behaviours (4). Conclusion This review confirmed that factors occurring during the first year of life affect ECC experience. Despite heterogeneity, findings indicated maternal factors influence bacterial acquisition, whereas colonization was mediated by oral health behaviours and practices and feeding habits.
Objectives. The objectives of this article were to examine the literature published from 1982 to 2006 and to evaluate prevalence of dental fear and anxiety (DFA) and dental behaviour management problems (DBMP) in children and adolescents, and their relationships to age, sex, general anxiety, temperament, and general behavioural problems. Methods. A broad search of the PubMed database was performed using three combinations of search terms. Results. A large proportion of the identified articles could not be used for the review owing to inadequate endpoints, measures or poor study design. Thirty‐two papers of acceptable quality were identified and reviewed. The prevalence of both DFA and DBMP were estimated to 9%, with a decrease in prevalence with age. DFA/DBMP were more frequent in girls. DFA/DBMP were related to general fear and both internalizing and externalizing behavioural problems, although these relationships were not clear‐cut. Temperament was related to both DFA and DBMP but with different temperamental characteristics, while general behavioural problems mainly correlated with DBMP. Conclusions. DFA/DBMP are common, and several psychological factors are associated with the development of these problems. In order to better understand these relationships, a number of issues concerning design of research and measurement of DFA/DBMP have to be dealt with.
Background This paper is a summary of the proceedings of the International Association of Paediatric Dentistry Bangkok Conference on early childhood caries (ECC) held in 3‐4 November 2018. Aim The paper aims to convey a global perspective of ECC definitions, aetiology, risk factors, societal costs, management, educational curriculum, and policy. Design This global perspective on ECC is the compilation of the state of science, current concepts, and literature regarding ECC from worldwide experts on ECC. Results Early childhood caries is related to frequent sugar consumption in an environment of enamel adherent, acid‐producing bacteria in a complex biofilm, as well as developmental defects of enamel. The seriousness, societal costs, and impact on quality of life of dental caries in pre‐school children are enormous. Worldwide data show that ECC continues to be highly prevalent, yet infrequently treated. Approaches to reduce the prevalence include interventions that start in the first year of a child's life, evidence‐based and risk‐based management, and reimbursement systems that foster preventive care. Conclusions This global perspective on ECC epidemiology, aetiology, risk assessment, global impact, and management is aimed to foster improved worldwide understanding and management of ECC.
Summary Background Hypophosphatasia (HPP) is a rare inherited metabolic disease in which mutations in the ALPL gene (encoding tissue‐nonspecific alkaline phosphatase) result in varying degrees of enzyme deficiency. HPP manifests in a spectrum of symptoms, including early primary tooth loss (root intact) and alveolar bone mineralisation defects. Objective To provide an overview of HPP for dental professionals to help recognise and differentially diagnose patients for appropriate referral to a specialist team. Methods A non‐systematic review of publications on HPP was performed. Results Different forms of HPP are described, along with characteristic symptoms and laboratory findings. Diagnosis is challenging due to the rareness and variable presentation of symptoms. Low alkaline phosphatase levels are a signature of HPP, but reference ranges vary according to gender and age. Key features are defined and management strategies discussed, focusing on enzyme replacement therapy. Finally, a patient registry aimed at better defining the prevalence of HPP and raising awareness is described. Conclusions HPP is a rare disease with a wide spectrum of manifestations, with orodental symptoms featuring prominently in the natural history. Dental professionals may be positioned at the beginning of the diagnostic pathway; thus, recognition of HPP features for timely referral and optimal disease management is important.
International Journal of Paediatric Dentistry 2012; 22: 157–168 Objectives. Although the general pathways connecting the external social environment and child risk factors of early childhood caries (ECC) have been previously identified, the maternal and other links to ECC are not well understood. The aim of this paper is to propose a unifying conceptual model that ties together the broad social environmental, maternal, and child factors that are commonly associated with ECC. Methods. The aetiological factors of ECC are first reviewed individually to demonstrate their connections with ECC risk followed by presentation of the unifying conceptual model. Results. In severe ECC cases, there is usually a background of social disadvantage associated with low socioeconomic status, ethnicity or immigrant status, and low maternal educational level. These factors are commonly associated with economic and familial stresses which may in turn result in maternal psychological distress. The distress may be compounded by difficult temperaments of the children and can lead to dysfunctional parenting behaviours that place a child at risk for ECC. Conclusions. The proposed conceptual model provides a framework that connects the social, psychological, and behavioural mediating factors involved in ECC. It demonstrates that the causative pathways involved are best explored using a combination of quantitative and qualitative research.
This policy document was prepared by J.C. Harris, R.C. Balmer, and P.D. Sidebotham on behalf of the British Society of Paediatric Dentistry (BSPD). Policy documents produced by the BSPD represent a majority view, based on consideration of currently available evidence. They are produced to provide guidance with the clear intention that the policy be regularly reviewed and updated to take account of changing views and developments.
Background Several restorative materials with specific indications are used for filling cavities in primary teeth. Aim To systematically review the literature in order to investigate the longevity of primary teeth restorations and the reasons for failure. Design Electronic databases were screened, and eligible studies were hand‐searched to find longitudinal clinical studies evaluating the survival of restorations (class I, class II, and crown) placed with different materials in primary teeth with at least one year of follow‐up. Results Thirty‐one studies were included, and a high bias risk was observed. Overall, 12,047 restorations were evaluated with 12.5% of failure rate. A high variation on annual failure rate (AFR) was detected (0–29.9%). Composite resin showed the lowest AFRs (1.7–12.9%). Stainless steel crowns (SSC) had the highest success rate (96.1%). Class I restorations and restorations placed using rubber dam presented better AFR. The main reason for failure observed was secondary caries (36.5%). Conclusions An elevated number of failures were observed due to recurrent caries, highlighting the need for professionals to work with a health‐promoting approach. The high variation on failure rate among the materials can be due to children's behavior during the procedure, which demands short dental appointments and a controlled environment.
Summary Background Molar incisor hypomineralization (MIH) is a defect of enamel. The lower strength of the enamel can lead to fractures that predispose for plaque accumulation and caries. Aim This systematic review aimed to assess the association between MIH and caries. Design Studies involving children of all ages, which reported results on MIH and caries in the permanent dentition, were considered eligible. A search was performed in PubMed and was limited to the period from January 2003 to November 2015, and to studies written in English. Reviews, meta‐analyses, and case reports were excluded. The studies were evaluated by use of the Newcastle‐Ottawa Quality Assessment Scale (NOS). Results Seventeen publications were compiled in the review. Most publications reported that children with MIH have higher caries experience. One study did not observe a difference in DMF values among children affected or not by MIH. Three studies reported that children with MIH were 2.1 to 4.6 times more likely to have caries in the permanent dentition than children without MIH. Conclusions A significant association between MIH and caries was found. The results should, however, be interpreted cautiously due to the lack of high‐quality studies. The present systematic review confirms the need for further well‐designed studies.
Background Dental caries has significant impact on children and their families and may necessitate treatment under general anaesthesia (GA). The use of oral health‐related quality‐of‐life (OHRQoL) measures enables evaluation of dental treatment from a patient's perspective. Objective This systematic review aimed to assess change in OHRQoL in children following treatment under GA for the management of dental caries. Methods A comprehensive search was conducted to identify articles which were assessed against inclusion criteria before data extraction. Studies involving children under 16 years, having treatment for dental caries under GA, were considered eligible. Included studies were quality assessed. Results Twenty studies were included, which demonstrated significant heterogeneity. Most studies employed a pre‐test–post‐test design. All but one study relied on proxy reports of OHRQoL. Only half the studies used instruments validated in the study population. Whereas all studies reported improved OHRQoL overall, some subscales showed changes which were not significant or worsened OHRQoL. The scientific quality of the studies varied considerably. Conclusion Heterogeneity of included papers limited the conclusions which could be drawn. Treatment under GA appears to result in overall improvements in proxy‐reported OHRQoL; however, there is a need for further high‐quality studies employing validated, child‐reported measures of OHRQoL.
Background More conservative techniques for managing dental caries including ‘partial’ and ‘no caries removal’ have been increasingly of interest. Aim To compare children's behaviour and pain perception, also technique acceptability (parents and dentists), when approximal dentinal lesions (ICDAS 3–5) in primary molars (3–8‐year‐olds) were managed with three treatment strategies; conventional restorations (CR), hall technique (HT), and non‐restorative caries treatment (NRCT). Design Secondary care‐based, three‐arm parallel‐group, randomised controlled trial, with 169 participants treated by 12 dentists. Outcome measures: child's pain perception (Visual Analogue Scale of Faces); behaviour (Frankl scale); and parents' and dentists' treatment opinions (5‐point Likert scales). Results Children showed more negative behaviour in the CR group (37%) compared to NRCT (21%) and HT (13%) (P = 0.047, CI = 0.41 to 0.52). Pain intensity was rated ‘very low’ or ‘low’ in 88% NRCT, 81% HT, and 72% CR (P = 0.11, CI = 0.10 to 0.12). NRCT and HT were ‘very easy’ or ‘easy’ to perform for >77% of dentists, compared to 50% in CR group (P < 0.000). There were no statistically significant differences in parents' rating of their child's level of comfort (P = 0.46, CI = 0.45 to 0.48). Conclusions Dentists reported more negative behaviour in CR group. For all techniques, children's pain perception and dentist/parent acceptability were similar.
Background The etiology of molar‐incisor hypomineralization (MIH) remains unknown. Studies indicate that it is multifactorial, and that genetic and environmental factors are involved. Research with twins provides important subsidy to investigate the Influence of genetics and environmental factors that act during pregnancy on the etiology of alterations. Aim This cross‐sectional study evaluated the agreement of molar incisor hypomineralization (MIH) between monozygotic and dizygotic twin pairs and the association with environmental factors. Design The sample consisted of 167 pairs of twins (8–15 years old), 94 monozygotic and 73 dizygotic. The parents answered a questionnaire on sociodemographic data and pre‐, peri‐, and postnatal health. A dental examination was performed by two calibrated examiners (Kappa ≥0.88) for MIH diagnosis, following the criteria proposed by the European Academy of Pediatric Dentistry in 2003. Results The prevalence of MIH was 29.3%. There was greater concordance of MIH between monozygotic twins for affected first molars and permanent incisors (P = 0.0012) and pairs of twins assessed (P = 0.0211). The presence of MIH was associated with family income between one and two wages (P = 0.009, prevalence ratio [PR] = 3.82, confidence interval [CI 95%] 1.40–10.44), above two wages (P = 0.007, PR = 4.60, 95% CI: 1.51–14.05), and gestational hemorrhage (P = 0.032, PR = 5.70, 95% CI: 1.16–28.14). Conclusions The greater concordance in the diagnosis of MIH among monozygotic twins indicates a genetic influence, although environmental factors, such as family income and hemorrhage during pregnancy, are also associated with the occurrence of MIH.
Aim To examine the evidence on the influence of oral health status on school performance and school attendance in children and adolescents. Design A systematic review was performed in accordance with PRISMA included epidemiological studies that assessed concomitantly oral health measures, participants’ school performance and/or school attendance. Electronic search was conducted on MEDLINE, SCOPUS, Web of Science, ScienceDirect, and LILACS. Studies published up to May 2018 in any language were eligible. The risk of bias was assessed using the Newcastle‐Ottawa Scale. Meta‐analysis was used to obtain pooled estimates between oral health measures and school performance and school attendance. Results Eighteen studies were included. Of them, fifteen studies were used for the meta‐analyses. Most studies were assessed as moderate quality. Children with one or more decayed teeth had higher probability of poor school performance (OR = 1.44 95%CI: 1.24‐1.64) and poor school attendance (OR = 1.57 95%CI: 1.08‐2.05) than caries‐free children. Poor parent's perception of child's oral health increased the odds of worse school performance (OR = 1.51 95%CI: 1.10‐1.92) and poor school attendance (OR = 1.35 95%CI: 1.14‐1.57). Conclusions Children and adolescents with dental caries and those reporting worse oral health experience poor school performance and poor school attendance.
Background Oral health policy and funding must be informed by well‐designed studies which monitor oral health and the factors which influence it. Aim This study aimed to analyse the oral health of the Longitudinal Study of Australia Children (LSAC). Design The LSAC is a dual‐cohort cross‐sequential study run biennially since 2004. Carer‐report measures for oral health were measured across six biennial waves and included frequency of tooth brushing, dental service use, and dental problems since the previous wave. Results A total of 10 090 Australian children participated at baseline (birth [B] n = 5017 and kindergarten [K] n = 4983). Most carers reported that children brushed daily and had regular access to dental care. Increasing age was a significant predictor of dental caries, whereas no differences were observed between time periods and cohorts. Dental caries was more frequently reported than dental injuries. Caries was highest at age eight for the B (n = 1234, 30.5%) and K (n = 1355, 31.5%) cohorts. Conclusions By the age of six, caries prevalence had already begun to climb despite the majority of carers reporting good oral health behaviours for their children. Early intervention in the prevention of dental caries is essential, as children appear to attend dental services when caries is already occurring.
Objective To determine whether distraction techniques (DT) reduce children's/adolescent's anxiety and fear during dental treatment. Methods Randomized controlled trials (RCTs) in which any type of DT were used to manage dental anxiety and dental fear in children/adolescents were included. A systematic search of PubMed, Web of Science, Scopus, Cochrane Library, Lilacs, and Google Scholar was conducted. Two independent reviewers selected studies, extracted data, assessed methodological quality of studies using the Cochrane Collaboration's Risk of Bias tool (CCRBT), and approached certainty of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Data were analysed descriptively. Results Twenty studies covering several types of DT (audio, audiovisual, instruments camouflage, biofeedback, dental operating microscope, toys) were included. Qualitative analysis showed with very low certainty of evidence that DT effectively reduced dental anxiety and fear depending on the distraction type, instrument used to measure dental anxiety and dental fear, and dental procedure. CCRBT evaluation identified many methodological issues in included studies. Conclusion There is a very low certainty of evidence that DT can be effective in managing children's/adolescents’ dental fear and anxiety during dental treatment. The heterogeneity of methodologies and findings in the studies, however, suggests more robust, and well‐executed RCTs are needed.
Background Developmental enamel defects (DDE) represent one of the prevalent oral problems in childhood; however, few studies have evaluated its impact on quality of life in the children's own perception. Aim To evaluate the DDE impact on quality of life of 5‐year‐old children. Methods This cross‐sectional observational study assessed 566 children aged 5 years old, in Teresina, Piauí, Brazil, according to their self‐perceptions. Children answered the Pediatric Quality of Life Inventory™ Version 4.0 and Oral Health Scale. The dmft index, modified DDE index and Foster and Hamilton criteria were used to diagnose dental caries, DDE and malocclusion, respectively. A single examiner performed the clinical examination. Descriptive analyses and Poisson regression with robust variance were performed. Results The prevalence of DDE was 33.7%. For children's self‐reports, the presence of DDE had a negative association with oral health‐related quality of life (OHRQoL; PR 1.09, 95% CI 1.02‐1.15). Enamel hypoplasia had a negative impact on the physical function (PR 1.05; 95% CI 1.01‐1.10) and oral health (PR 1.06, 95% CI 1.01‐1.11) domains. Diffuse opacity had a negative impact on the social aspect (PR 1.09, 95% CI 1.02‐1.18). Conclusions Enamel defects had a negative impact on OHRQoL according to the self‐reports of the children.
Background The Hall Technique is a less invasive caries management technique for treating carious primary molars. It has become a routine treatment at specialists’ practices. Aim To retrospectively evaluate the clinical success and survival rates of preformed metal crowns placed on primary molars using the Hall Technique in a Paediatric Dentistry Setting. Design Patient records of children receiving Hall crowns (with or without proximal slicing) between 2011 and 2017 were reviewed. Teeth with no clinical or radiographic evidence of pulp involvement at baseline and at least six months’ follow‐up were included. Kaplan‐Meier survival analyses and Mantel‐Cox statistics were carried out. Results In total, 181 Hall crowns performed in 2‐ to 10‐year‐olds with a mean follow‐up period of 22 months were included for analysis. Mean d3mft/D3MFT was 6.55 ± 3.48/0.18 ± 0.66. The majority of crowns were successful (92.3%; n = 167), four presented at least one minor failure (2.2%; reversible pulpitis, crown lost, or secondary caries) and ten were major failures (5.5%; irreversible pulpitis or abscess). When comparing crowns performed with no tooth preparation to crowns performed with proximal slicing, no differences were observed (P = 0.70, CI = 0.68‐0.83). Conclusion The survival rate and clinical efficacy of Hall crowns were high in a secondary care‐based setting. The HT is an effective and less invasive management option for asymptomatic carious primary molars.
Aim To compare (a) enamel carious (EC) and dentin carious (DC) lesions and (b) caries risk, between normal‐weight (NW) and overweight/obese (OW) children/adolescents. Design In this cross‐sectional study, 91 participants aged 6‐12 years were classified according to the body mass index (BMI): NW (n = 50) and OW (n = 41). Caries experience was evaluated using the International Caries Detection and Assessment System (ICDAS) with two thresholds: “EC/DC” (ICDAS 1‐3/4‐6) and “DC” (ICDAS 4‐6). Caries risk was determined by the Caries Management by Risk Assessment (CAMBRA) system. A logistic regression analysis was performed to determine the association among OW, caries thresholds, and caries risk. Results Caries experience was similar for both groups at the “EC/DC” threshold (P = .477) and higher for the NW group at the “DC” threshold (P = .009). For CAMBRA, caries risk classification was similar for both groups (P = .082). The logistic regression showed the OW group was less likely to exhibit radiographically visible proximal carious lesions (odds ratio [OR] of 0.330, P = .019), thick biofilm visible on the tooth surface (OR = 0.360, P = .019), high caries risk (OR = 0.367, P = .039), and moderate‐to‐high caries levels (OR = 0.190, P = .022). Conclusion OW children/adolescents had lower caries experience, at both ICDAS thresholds, and lower caries risk, compared to NW children/adolescents.
Background Molar incisor hypomineralization (MIH) is frequent in children and etiology is different. Aim The aim of this study was to determine the prevalence, severity, and risk factors of MIH and to investigate the relationship between the severity of the defect in the teeth affected by MIH and the risk factors. Design The study included patients at the age range of 9 and 10 years, who were admitted to the clinic of paediatric dentistry in Dokuz Eylul University and had four‐first molar teeth (FMT) and eight incisor teeth eruptions in the jaws. The presence of only demarcated opacities in one or several FMT and incisor teeth was defined as MIH1, and the presence of post‐eruptive breakdown (PEB), atypical restorations, and extracted teeth was defined as MIH2. Results MIH was detected in 142 (11.5%) of 1237 children. Although there was no statistically significant difference between upper and lower FPM and the occurrence of MIH (P < 0.902), there was a difference between upper and lower central and lateral teeth (P < 0.001; P < 0.009). A significant difference was detected between birth week, birthweight, high fever, and asthma/bronchitis and MIH1 and MIH2 (P < 0.001). Conclusion The prevalence of MIH was found to be 11.5%. It was observed that the patients undergoing low birthweight, preterm delivery, high fever, and asthma/bronchitis were more severely affected by MIH.
Background Dental fear/anxiety is associated with numerous negative outcomes. State dental fear is known to be transmitted from parents to their children in the dental setting, but it is not known how trait fear/anxiety might be shared between parents and offspring long term, and especially for adolescents. Aim This study aimed to: (a) compare dental fear levels of adolescents and their parents; (b) predict adolescent dental fear based on demographic variables, fear of pain, and parental dental fear; and, (c) determine relative contributions of mothers' and fathers' dental fear to adolescent fear. Design In this cross‐sectional study, the Dental Fear Survey and Fear of Pain Questionnaire‐9 were administered to 350 adolescents (age range 11‐17) and 515 of their parents, with t test and ANOVA used to calculate between‐group differences; multiple linear regression was used to predict adolescent fear from parent fear. Results Adolescents' dental fear was predicted by their own fear of pain and their parents' dental fear, but not their parents' fear of pain nor their own age or gender. When considered together, fathers' but not mothers' dental fear predicted adolescents' dental fear. Conclusions Parents' fears/anxieties about dentistry are associated with adolescents' dental fear in a manner suggestive of intergenerational transmission.