RESUMO
Young children need increased access to dental prevention and care. Targeting high caries risk children first helps meet this need. The objective of this study was to develop a parent-completed, easy-to-score, short, accurate caries risk tool for screening in primary health care settings to identify children at increased risk for cavities. A longitudinal, prospective, multisite, cohort study enrolled (primarily through primary health care settings) and followed 985 (out of 1,326) 1-y-old children and their primary caregivers (PCGs) until age 4. The PCG completed a 52-item self-administered questionnaire, and children were examined using the International Caries Detection and Assessment Criteria (ICDAS) at 12 ± 3 mo (baseline), 30 ± 3 mo (80% retention), and 48 ± 3 mo of age (74% retention). Cavitated caries lesion (dmfs = decayed, missing, and filled surfaces; d = ICDAS ≥3) experience at 4 y of age was assessed and tested for associations with questionnaire items using generalized estimating equation models applied to logistic regression. Multivariable analysis used backward model selection, with a limit of 10 items. At age 4, 24% of children had cavitated-level caries experience; 49% were female; 14% were Hispanic, 41% were White, 33% were Black, 2% were other, and 10% were multiracial; 58% enrolled in Medicaid; and 95% lived in urban communities. The age 4 multivariable prediction model, using age 1 responses (area under the receiver operating characteristic curve = 0.73), included the following significant (P < 0.001) variables (odds ratios): child participating in public assistance programs such as Medicaid (1.74), being non-White (1.80-1.96), born premature (1.48), not born by caesarean section (1.28), snacking on sugary snacks (3 or more/d, 2.22; 1-2/d or weekly, 1.55), PCG cleaning the pacifier with juice/soda/honey or sweet drink (2.17), PCG daily sharing/tasting food with child using same spoon/fork/glass (1.32), PCG brushing their teeth less than daily (2.72), PCG's gums bleeding daily when brushing or PCG having no teeth (1.83-2.00), and PCG having cavities/fillings/extractions in past 2 y (1.55). A 10-item caries risk tool at age 1 shows good agreement with cavitated-level caries experience by age 4.
Assuntos
Cárie Dentária , Gravidez , Humanos , Criança , Feminino , Pré-Escolar , Lactente , Masculino , Cárie Dentária/diagnóstico , Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controle , Estudos de Coortes , Estudos Prospectivos , Cesárea , Atenção Primária à Saúde , Índice CPORESUMO
Dental caries lesions are a clinical manifestation of disease, preceded by microbial dysbiosis, which is poorly characterized and thought to be associated with saccharolytic taxa. Here, we assessed the associations between the oral microbiome of children and various caries risk factors such as demographics and behavioral and clinical data across early childhood and characterized over time the salivary and dental plaque microbiome of children before clinical diagnosis of caries lesions. Children (N = 266) were examined clinically at ~1, 2.5, 4, and 6.5 y of age. The microbiome samples were collected at 1, 2.5, and 4 y. Caries groups consisted of children who remained caries free (International Caries Detection and Assessment System [ICDAS] = 0) at all time points (CFAT) (n = 50); children diagnosed with caries (ICDAS ≥ 1) at 6.5 y (C6.5), 4 y (C4), or 2.5 y of age (C2.5); and children with early caries or advanced caries lesions at specific time points. Microbial community analyses were performed on zero-radius operational taxonomic units (zOTUs) obtained from V4 of 16S ribosomal RNA gene amplicon sequences. The oral microbiome of the children was affected by various factors, including antibiotic use, demographics, and dietary habits of the children and their caregivers. At all time points, various risk factors explained more of the variation in the dental plaque microbiome than in saliva. At 1 y, composition of saliva of the C4 group differed from that of the CFAT group, while at 2.5 y, this difference was observed only in plaque. At 4 y, multiple salivary and plaque zOTUs of genera Prevotella and Leptotrichia were significantly higher in samples of the C6.5 group than those of the CFAT group. In conclusion, up to 3 y prior to clinical caries detection, the oral microbial communities were already in a state of dysbiosis that was dominated by proteolytic taxa. Plaque discriminated dysbiotic oral ecosystems from healthy ones better than saliva.
Assuntos
Cárie Dentária , Placa Dentária , Microbiota , Criança , Humanos , Pré-Escolar , Disbiose , Saliva , Microbiota/genética , RNA Ribossômico 16S/genéticaRESUMO
BACKGROUND: US data on the validity and reliability of the short-form Family Impact Scale (FIS-8; a scale for measuring the impact of a child's oral condition on his/her family) are lacking. METHODS: Cross-sectional analysis of data on four-year-old US children taking part in a multi-center cohort study. For child-caregiver dyads recruited at child age 12 months, the impact of the child's oral condition on the family was assessed at age 48 months using the FIS-8, with a subsample of 422 caregivers (from 686 who were approached). Internal consistency reliability was assessed using Cronbach's α, with concurrent validity assessed against a global family impact item ("How much are your family's daily lives affected by your child's teeth, lips, jaws or mouth?") and a global oral health item ("How would you describe the health of your child's teeth and mouth?"). RESULTS: Cronbach's alpha was 0.83. Although gradients in mean scores across ordinal response categories of the global family impact item were inconsistent, there were marked, consistent gradients across the ordinal categories of the global item on the child's oral health, with scores highest for those rating their child's oral health as 'Poor'. CONCLUSIONS: While the findings provide some evidence for the utility of the FIS in a US child sample, the study's replication in samples of preschoolers with greater disease experience would be useful.
Assuntos
Qualidade de Vida , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Psicometria , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Understanding the development of the oral microbiota in healthy children is of great importance to oral and general health. However, limited data exist on a healthy maturation of the oral microbial ecosystem in children. Moreover, the data are biased by mislabeling "caries-free" populations. Therefore, we aimed to characterize the healthy salivary and dental plaque microbiome in young children. Caries-free (ICDAS [International Caries Detection and Assessment System] score 0) children (n = 119) and their primary caregivers were followed from 1 until 4 y of child age. Salivary and dental plaque samples were collected from the children at 3 time points (T1, ~1 y old; T2, ~2.5 y old; and T3, ~4 y old). Only saliva samples were collected from the caregivers. Bacterial V4 16S ribosomal DNA amplicons were sequenced using Illumina MiSeq. The reads were denoised and mapped to the zero-radius operational taxonomic units (zOTUs). Taxonomy was assigned using HOMD. The microbial profiles of children showed significant differences (P = 0.0001) over time. Various taxa increased, including Fusobacterium, Actinomyces, and Corynebacterium, while others showed significant decreases (e.g., Alloprevotella and Capnocytophaga) in their relative abundances over time. Microbial diversity and child-caregiver similarity increased most between 1 and 2.5 y of age while still not reaching the complexity of the caregivers at 4 y of age. The microbiome at 1 y of age differed the most from those at later time points. A single zOTU (Streptococcus) was present in all samples (n = 925) of the study. A large variation in the proportion of shared zOTUs was observed within an individual child over time (2% to 42% of zOTUs in saliva; 2.5% to 38% in dental plaque). These findings indicate that the oral ecosystem of caries-free toddlers is highly heterogeneous and dynamic with substantial changes in microbial composition over time and only few taxa persisting across the 3 y of the study. The salivary microbiome of 4-y-old children is still distinct from that of their caregivers.
Assuntos
Cárie Dentária , Microbiota , Pré-Escolar , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , RNA Ribossômico 16S , SalivaRESUMO
Expanded partnership with the medical community is a promising strategy for reducing disparities in dental caries among young children. However, no validated caries risk instrument exists for use in primary health care settings. To help resolve this gap, a 52-item caries risk questionnaire was developed and targeted to primary caregivers (PCGs) to test in a 3-y prospective study. To begin to understand the validity of the questionnaire items, the purpose of this study was to compare responses to the questionnaire based on key demographic characteristics known to be associated with disparities in caries experience (e.g., race/ethnicity and insurance status). A total of 1,323 one-year-old children were recruited primarily through 3 medical research networks. Baseline questionnaire responses were analyzed via logistic regression. The sample was 49% female. Its racial/ethnic makeup was as follows: 13% Hispanic, 37% White, 37% Black, and 13% other or multiracial. Sixty-one percent were enrolled in Medicaid, and 95% resided in urban communities. Mothers represented 94% of PCGs. There were significant differences ( P < 0.05) in baseline responses based on Medicaid status and race/ethnicity. As compared with those not enrolled in Medicaid, children in the Medicaid group were significantly more likely (after adjusting for race/ethnicity) to 1) go to sleep while nursing or drinking something other than water, 2) eat sugary snacks between meals, 3) consume sugary drinks between meals, 4) receive topical fluoride from a health professional, 5) visit the dentist, and 6) not have an employed adult in the household. PCGs of children enrolled in Medicaid were significantly more likely to be the mother, have bleeding gums, eat sugary snacks between meals, consume sugary drinks between meals, eat or drink something other than water before going to bed, and not get regular dental checkups. In conclusion, there are significant differences in caries risk questionnaire responses based on Medicaid status and race/ethnicity that provide construct and criterion validity to the developed caries risk tool (ClinicalTrials.gov NCT01707797).
Assuntos
Cárie Dentária , Etnicidade , Disparidades nos Níveis de Saúde , Medicaid/estatística & dados numéricos , Adulto , Povo Asiático , População Negra , Criança , Pré-Escolar , Feminino , Hispânico ou Latino , Humanos , Lactente , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico , Estudos Prospectivos , Fatores de Risco , Estados Unidos , População BrancaRESUMO
Expanded partnership with the medical community is an important strategy for reducing dental caries disparities. The purpose of this study was to assess the relationship between fluoride (F) "in office" (drops/tablets and/or varnish), as prescribed or applied by a health care professional by age 1 y, and 1) caries development and 2) presence of other caries risk factors or mediators (e.g., socioeconomic status). Child-primary caregiver (PCG) pairs ( N = 1,325) were recruited in Indiana, Iowa, and North Carolina as part of a longitudinal cohort study to validate a caries risk tool for primary health care settings. PCGs completed a caries risk questionnaire, while children received caries examinations per the criteria of the International Caries Detection and Assessment System at ages 1, 2.5, and 4 y. Baseline responses regarding children's history of F in office were tested for association with other caries risk variables and caries experience at ages 2.5 and 4 y via generalized estimating equation models applied to logistic regression. The sample was 48% female, and many children (61%) were Medicaid enrolled. The prevalence of cavitated caries lesions increased from 7% at age 2.5 y to 25% by age 4 y. Children who received F in office were likely deemed at higher caries risk and indeed were significantly ( P < 0.01) more likely to develop cavitated caries lesions by ages 2.5 and 4 y, even after F application (odds ratios: 3.5 and 2.3, respectively). Factors significantly associated with receiving F included the following: child being Medicaid enrolled, not having an employed adult in the household, child and PCG often consuming sugary drinks and snacks, and PCG having recent caries experience. Increased F in office from a health care provider by age 1 y was associated with known caries risk factors. Most (69%) children had never been to the dentist, suggesting that risk factors could be alerting medical providers and/or parents, thereby affecting in-office F recommendations. Differences among states could also be related to state-specific F-varnish reimbursement policies (ClinicalTrials.gov NCT01707797).
Assuntos
Cariostáticos/uso terapêutico , Cárie Dentária/prevenção & controle , Fluoretos/uso terapêutico , Medição de Risco/métodos , Pré-Escolar , Cárie Dentária/epidemiologia , Inquéritos de Saúde Bucal , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Medicaid , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
This study used an 11-month break in water fluoridation to identify the time when developing incisors are most sensitive to fluorosis development. The study was based in Durham, NC, where an interruption to water fluoridation occurred between September, 1990, and August, 1991. A total of 1896 children was dentally examined. Fluorosis was measured by the TF index, and parents or guardians completed a questionnaire on demographics and fluoride history. Age cohorts ranged from those born 5 years before the break, to those born 1 year after the resumption of fluoridation. Fluorosis prevalence for seven age cohorts whose birth years ranged from 1985-86 to 1991-92 was 57.1, 62.3, 33.0, 32.3, 39.8, 30.2, and 36.8%, respectively. Children aged from birth to 3 years at the break, and those born 1 year after it, had less fluorosis than those aged 4-5 years at the break.
Assuntos
Fluoretação , Fluorose Dentária/etiologia , Cariostáticos/administração & dosagem , Cariostáticos/uso terapêutico , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Fluoretos/administração & dosagem , Fluoretos/uso terapêutico , Fluorose Dentária/classificação , Seguimentos , Humanos , Incisivo/patologia , Lactente , Modelos Logísticos , Masculino , Antissépticos Bucais/uso terapêutico , Análise Multivariada , North Carolina , Variações Dependentes do Observador , Razão de Chances , Reprodutibilidade dos Testes , Inquéritos e Questionários , Escovação Dentária , Cremes Dentais/uso terapêuticoRESUMO
The influences that link social factors and caries development are not well understood, although mediation by stress has been suggested. The association between caregiver stress and early childhood caries (ECC), in particular, remains unclear. The purpose of this study was to examine the relationships between parenting stress and ECC while controlling for behavioral and biological factors in a high-risk population. One hundred and fifty healthy children aged 18-36 months were examined in a cross-sectional study design. Parental interviews were conducted to obtain demographic, oral health behavior and parenting stress data. Clinical data included parent and child bacterial measures, fingernail fluoride analyses, caries prevalence and presence of child enamel hypoplasia. Bivariate analyses revealed that parenting stress predicted caries. Multivariate analyses demonstrated that a combination of psychosocial, behavioral, temporal and biological variables predicted ECC outcomes. Total parenting stress did not contribute independently to the best prediction model. Our findings suggest the need for the development of a multidimensional stress model that considers the parent-child dyad to elucidate further the link between psychosocial factors and ECC.
Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária/etiologia , Adulto , Análise de Variância , Atitude Frente a Saúde , Cariostáticos/análise , Estudos Transversais , Cárie Dentária/classificação , Cárie Dentária/psicologia , Hipoplasia do Esmalte Dentário/classificação , Escolaridade , Feminino , Fluoretos/análise , Previsões , Comportamentos Relacionados com a Saúde , Humanos , Lactente , Modelos Lineares , Modelos Logísticos , Masculino , Boca/microbiologia , Análise Multivariada , Unhas/química , Relações Pais-Filho , Pais/psicologia , Pobreza , Fatores de Risco , Método Simples-Cego , Streptococcus mutans/crescimento & desenvolvimento , Estresse Psicológico/psicologia , Saúde da População UrbanaRESUMO
Pediatric patients can present with various intraoral lesions that require accurate diagnosis, treatment or reassurance, and possible referral for a dental evaluation. Periodic review of oral soft-tissue pathology can help the medical team to easily recognize common and rare abnormalities affecting children. Recent years have brought new insights into the causes and treatment of periodontal diseases of children, making prevention or treatment of many formerly untreatable conditions possible. Early detection of these oral conditions may be life saving.
Assuntos
Anormalidades da Boca/diagnóstico , Neoplasias Bucais/diagnóstico , Doenças Periodontais/diagnóstico , Anormalidades Dentárias/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Anormalidades da Boca/patologia , Anormalidades da Boca/terapia , Neoplasias Bucais/patologia , Neoplasias Bucais/terapia , Doenças Periodontais/patologia , Doenças Periodontais/terapia , Prognóstico , Anormalidades Dentárias/patologia , Anormalidades Dentárias/terapiaRESUMO
Durham, NC, fluoridated since 1962, had an 11-month cessation of fluoridation between September, 1990, and August, 1991. The purpose of this study was to assess the effects of this break on the development of caries and fluorosis in children. Study participants were continuously-resident children in Kindergarten through Grade 5 in Durham's elementary schools. There were 1696 children, 81.4% of those eligible, for whom a questionnaire was completed and clinical data recorded. Age cohorts were defined by a child's age at the time that fluoridation ceased. Caries was recorded in children in the Birth Cohort through Cohort 3, and fluorosis for children in Cohorts 1 through 5. Caries was assessed in the primary first and second molars according to the decayed-filled index; fluorosis on the labial surfaces of the upper permanent central and lateral incisors was assessed by the Thylstrup-Fejerskov (TF) index. Mother's education was associated with caries; higher education of the mother had an odds ratio of 0.53 (95% CI 0.40, 0.76) for caries in the child. No cohort effects could be discerned for caries. Overall prevalence of fluorosis was 44%. Prevalence in Cohorts 1, 2, 3, 4, and 5 was 39.8%, 32.3%, 33.0%, 62.3%, and 57.1%, respectively. These cohort differences remained statistically significant in regression analysis. It was concluded that while the break had little effect on caries, dental fluorosis is sensitive to even small changes in fluoride exposure from drinking water, and this sensitivity is greater at 1 to 3 years of age than at 4 or 5 years.
Assuntos
Cárie Dentária/epidemiologia , Fluoretação , Fluorose Dentária/epidemiologia , Fatores Etários , Análise de Variância , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos de Coortes , Intervalos de Confiança , Índice CPO , Escolaridade , Seguimentos , Humanos , Incisivo , Lactente , Dente Molar , Mães/educação , Análise Multivariada , North Carolina/epidemiologia , Razão de Chances , Prevalência , Análise de Regressão , Sensibilidade e Especificidade , Inquéritos e Questionários , Dente DecíduoRESUMO
OBJECTIVE: To determine how well the current fluoride supplementation schedule was known by academic pediatricians and to examine the fluoride supplement prescribing and dental referral practices among primary care faculty pediatricians at four medical centers. SETTING: Four university medical centers in North Carolina. SUBJECTS: Primary care faculty pediatricians. METHOD: A questionnaire pretested for clarity was distributed to all identified full-time primary care pediatric faculty (42 members). RESULTS: A total of 40 completed questionnaires were returned. Thirty-seven (93%) primary care faculty pediatricians reported that they routinely addressed the need for fluoride supplements for their patients, but only 28 (70%) determined the fluoride content of the drinking water before prescribing supplements. Thirty-five (87.5%) began supplements at the correct age, but fewer knew the correct doses for children of various ages. Only 23 (58%) referred their patients for oral examination and preventive care before the age of 36 months, contrary to American Academy of Pediatrics recommendations. CONCLUSIONS: Pediatricians in an academic setting would be expected to be more knowledgeable of current recommendations than those in private practice. Failure to know and teach correct fluoride supplement recommendations and failure to recommend early professional dental involvement can result in less than optimum oral health.
Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Odontologia , Conhecimentos, Atitudes e Prática em Saúde , Pediatria/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Fluoreto de Sódio/administração & dosagem , Adulto , Atitude do Pessoal de Saúde , Pré-Escolar , Cárie Dentária/prevenção & controle , Humanos , Lactente , North Carolina , Atenção Primária à Saúde/estatística & dados numéricos , Fluoreto de Sódio/uso terapêutico , Inquéritos e QuestionáriosAssuntos
Odontologia/estatística & dados numéricos , Odontólogas/estatística & dados numéricos , Exposição Ocupacional/estatística & dados numéricos , Administração da Prática Odontológica/estatística & dados numéricos , Gravidez/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados UnidosRESUMO
The potential effects of paternal exposures on fetal development are of great public and scientific concern, yet few epidemiologic studies have examined this association. Single live births from 1959 to 1966 among 14,685 Kaiser Foundation Health Plan members who participated in the Child Health and Development Studies were analyzed to assess the impact of paternal age, cigarette smoking, and alcohol consumption on the occurrence of birth defects in the offspring. Prevalence odds ratios for anomalies identified by age 5 were analyzed, contrasting exposed to unexposed fathers with adjustment for maternal age, race, education, smoking, and alcohol use. Advanced paternal age was associated with increased risk of preauricular cyst, nasal aplasia, cleft palate, hydrocephalus, pulmonic stenosis, urethral stenosis, and hemangioma. Father's cigarette smoking was more common among children with cleft lip +/- cleft palate, hydrocephalus, ventricular septal defect, and urethral stenosis. Alcohol use by the father was most positively related to the offspring's risk of ventricular septal defect. For both smoking and alcohol use, inverse associations were more common than positive associations. These data generally do not indicate strong or widespread associations between paternal attributes and birth defects. However, because of this study's imprecision, limited ability to isolate defects most likely to be of paternal origin, and the identification of several suggestive associations with age and smoking, further study of this issue would be of value.
Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/fisiopatologia , Anormalidades Congênitas/epidemiologia , Idade Paterna , Fumar/efeitos adversos , Anormalidades Congênitas/classificação , Anormalidades Congênitas/etiologia , Desenvolvimento Embrionário e Fetal , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Prevalência , Fatores de Risco , São FranciscoRESUMO
The surface enamel of fetal bovine teeth was stained with GBHA to indicate the position of bands of smooth-ended and ruffle-ended ameloblasts relative to the developing enamel. The boundaries of the bands were scored, under a dissecting microscope, and the bulk enamel under each band was collected. The enamel samples were assayed for Ca, Pi, F, and proline. The amount of Ca and Pi in the enamel increased in successive bands and seemed unrelated to the overlying ameloblast cell type. The loss of proline seemed unrelated to cell type. The fluoride content of enamel increased by approximately 50% in the first stained band immediately adjacent to the secretory zone. The F level returned to secretory values in the succeeding unstained band. Thus, only changes in the F level of developing enamel appeared to be related to GBHA staining patterns.