Oral administration of Lactobacillus reuteri during the first year of life reduces caries prevalence in the primary dentition at 9 years of age.

The aim of this study was to evaluate the effect on oral health, at age 9 years, of daily oral supplementation with the probiotic Lactobacillus reuteri, strain ATCC 55730, to mothers during the last month of gestation and to children through the first year of life. The study was a single-blind, placebo-controlled, multicenter trial involving 113 children: 60 in the probiotic and 53 in the placebo group. The subjects underwent clinical and radiographic examination of the primary dentition and carious lesions, plaque and gingivitis were recorded. Saliva and plaque were sampled for determination of mutans streptococci (MS) and lactobacilli (LB) in saliva and plaque as well as salivary secretory IgA (SIgA). Forty-nine (82%) children in the probiotic group and 31 (58%) in the placebo group were caries-free (p < 0.01). The prevalence of approximal caries lesions was lower in the probiotic group (0.67 ± 1.61 vs. 1.53 ± 2.64; p < 0.05) and there were fewer sites with gingivitis compared to the placebo group (p < 0.05). There were no significant differences between the groups with respect to frequency of toothbrushing, plaque and dietary habits, but to intake of fluoride supplements (p < 0.05). There were no intergroup differences with respect to L. reuteri, MS, LB or SIgA in saliva. Within the limitation of this study it seems that daily supplementation with L. reuteri from birth and during the first year of life is associated with reduced caries prevalence and gingivitis score in the primary dentition at 9 years of age.

Caries prevalence in Swedish 20-year-olds in relation to their previous caries experience.

BACKGROUND/AIM: There are few studies of caries development and caries-related factors from early age to young adulthood. The aim of the present study is to analyse caries prevalence in 20-year-olds in relation to their previous caries experience. METHOD: Oral health from 3 to 20 years of age was followed longitudinally in a cohort of 499 individuals. The clinical and radiographic incidence of caries and restorations in 494 20-year-olds was related to caries data at 3, 6 and 15 years of age. RESULTS: Twenty-six per cent of the 20-year-olds were caries-free. The mean number of initial and manifest lesions and restorations (Di + mFS) was 5.8. Initial lesions comprised 40% of the Di + mFS. Of the occlusal surfaces of molars and premolars, 12 and 4%, respectively, had manifest caries or restorations. Compared with individuals who had been caries-free during childhood (primary dentition) and adolescence, those with a history of caries activity while growing up had statistically significantly more approximal lesions at the age of 20 (DmFSa 0.6 vs. DmFSa 4.6, respectively). Those with manifest caries during childhood but caries-free at 15 years had a low caries prevalence at 20 years of age (DmFSa 1.3). Few new lesions developed after age 15. However, 50% of initial lesions at this age had progressed to manifest lesions at age 20. CONCLUSION: There is a relationship between caries prevalence at age 20 and early caries experience.

Caries in adolescence - influence from early childhood.

OBJECTIVE: To analyse the relationship between caries determinants in early childhood and caries prevalence in proximal surfaces in adolescents at the age of 15 years. METHODS: The present longitudinal study is part of a series of surveys of oral health in 671 children followed from 1 to 15 years of age. Data were selected from examinations, interviews and questionnaires at 1, 3 and 6 years and bitewing radiographs at 15 years of age. Uni- and multivariable logistic regression analyses were performed to identify caries-related determinants. The outcome variable was carious lesions and fillings (DFa) in approximal tooth surfaces at 15 years of age. Statistical comparisons were made between caries-free teenagers, DFa = 0 and teenagers with DFa > 0, DFa ≥ 4 and DFa ≥ 8, respectively. RESULTS: In the final logistic regression analyses, caries experience at 6 years and mother's self-estimation of her oral health care as being less good to poor remained statistically significant and were related to caries in all three caries groups (i.e. DF > 0, ≥4 and ≥8) at 15 years of age. The consumption of sweets at 1 year remained statistically significant, with a caries experience of DF ≥ 4 and ≥ 8. The variables 'parents born abroad' and female gender were statistically significantly associated with DFa ≥ 4 and DFa ≥ 8, respectively. Furthermore, infrequent toothbrushing habits at 3 years of age and failure to attend the examination at 1 year were statistically significantly associated with caries at 15 years in the univariable analyses. CONCLUSION: Early caries experience, consumption of sweets at an early age and mother's self-estimation of her oral health care as being less good to poor are associated with approximal caries in adolescents. The study indicates that caries determinants identified during early childhood have a strong impact on approximal caries in adolescence.

Caries prevalence, caries-related factors and plaque pH in adolescents with long-term asthma.

The aim of the present case-control study was to investigate dental caries, various caries-related factors as well as gingival condition, in 12- to 16-year-olds with long-term asthma (n = 20) and a matched healthy control group (n = 20). Data on dietary and oral hygiene habits, numbers of mutans streptococci and lactobacilli in saliva were also obtained. The plaque pH drop after a sucrose rinse was measured up to 40 min at 2 approximal tooth sites. A lower salivary flow rate was found in the asthma group compared to the control group (p < 0.05). The mean (± SD) of DFS, including manifest and initial caries, was 4.9 ± 5.5 in the asthma and 1.4 ± 2.3 (p < 0.01) in the control group. Only 1 adolescent in the asthma group was caries free compared to 13 in the control group. Concerning pH in plaque, adolescents with asthma had a lower initial value (p < 0.01) and final pH (p < 0.05) than the control group. The Cariogram data showed that 55% of the subjects in the control group had 'a high chance of avoiding caries' compared to 10% in the asthma group (p < 0.01). The asthmatic adolescents had higher numbers of sites with gingival bleeding (p < 0.01). To conclude, adolescents with long-term asthma had a higher total DFS and caries risk (according to Cariogram), decreased salivary rate, more gingival bleeding and lower plaque pH than adolescents without asthma.

Oral hygiene and parent-related factors during early childhood in relation to approximal caries at 15 years of age.

The aim was to investigate whether oral hygiene habits and parent-related factors, recorded in early childhood, have a predictive value in relation to approximal caries experience (including initial caries lesions) at the age of 15 years (n = 568). Data were selected from examinations, interviews and questionnaires at 1 and 3 years and bitewing radiographs at 15 years. Four levels of cut-off points for the statistical analysis were used: DFa = 0, > 0, > or = 4 and > or = 8. In the final logistic regression analyses, mother's self-estimation of her oral health care being less good remained statistically significant and predicted a caries experience of DFa > 0 at 15 years. The following four variables predicted DFa > or = 4: (1) female gender, (2) plaque on maxillary incisors at 1 year, (3) mother's self-estimation of her oral health care being less good and (4) father being less satisfied with his social situation. Two variables predicted DFa > or = 8: (1) toothbrushing with fluoride toothpaste just once a day, and (2) father being less satisfied with his social situation. Furthermore, children who failed to attend the examination at 1 year of age had 6.95 +/- 5.36 (mean +/- SD) DFa at 15 years compared with 3.10 +/- 3.85 for children who were examined at 1 year of age (p < 0.01). To conclude, factors explaining good dental health at 15 years of age pertained to both children and parents. Thus, it seems that good oral hygiene habits, established in early childhood, provide a foundation for a low experience of approximal caries in adolescents.

Prevalence of approximal caries in posterior teeth in 15-year-old Swedish teenagers in relation to their caries experience at 3 years of age.

The aim of the present investigation was to study the prevalence of approximal caries lesions and fillings in posterior teeth at 15 years of age in a prospectively followed Swedish population (n = 568), with special reference to their caries experience at the age of 3 years. Only approximal surfaces were recorded, since all children in the Community of Jönköping have had fissure sealing performed on all caries-free permanent molars. At 15 years of age, the mean number of approximal tooth surfaces with initial caries lesions (D(i)a), manifest caries lesions and fillings (D(m)Fa) and total caries experience and fillings (D(i + m)Fa)--recorded on bitewing radiographs--was 2.78 , 0.45 and 3.23, respectively. One third of the adolescents had no approximal caries or fillings; the D(i)a constituted 86% of the D(i + m)Fa. Children with manifest caries at 3 years of age had a higher risk of developing approximal caries in their permanent teeth than caries-free children at the same age (41 vs. 17%). Furthermore, children who were caries-free at 3 years of age were more likely to remain caries-free at 15 years of age compared to children with manifest caries (37 vs. 17%). All these differences were statistically significant (p < 0.001). Additionally, early childhood caries experience (developed before 3 years of age) had a greater predictive value than late childhood caries experience (developed between 3 and 6 years of age) concerning approximal caries at 15 years of age.

Early dental caries risk assessment and prevention in pre-school children: evaluation of a new strategy for dental care in a field study.

The aim of the present field study was to evaluate a new strategy for the dental care of pre-school children which includes an early caries risk assessment and early preventive care. One hundred and sixty-seven children were studied from 1 to 6 years of age (intervention group). A group of 125 children from the same clinic (historical control) was used as a comparison group. On the basis of the clinical examinations of the children and the interviews with the parents when the children were 3 years of age, the children in the intervention group were divided into four different risk groups: no (n = 95), low (n = 33), moderate (n = 30), and high caries risk (n = 9). Only 8 of the 95 children who had been placed in the no caries risk group at 3 years of age developed manifest carious lesions in their primary cuspids and molars by 6 years of age. At 6 years of age 81% in the intervention group were free of manifest carious lesions, compared with 55% in the comparison group (P < 0.001). Furthermore, the mean numbers of defs were 0.6 for children in the intervention group and 2.7 in the comparison group. Thus, this field study indicates that early primary prevention (before the onset of caries attack) and a structured and systematic approach to dental care for pre-school children result in good oral health for the children and may be economically profitable for a society with organized public dental service for pre-school children.

On the retention and effectiveness of fissure sealant in permanent molars after 15-20 years: a cohort study.

The aim of the present study was to clinically evaluate fissure sealants on the occlusal fissures and buccal pits of permanent first and second molars after 20 and 15 years, respectively. The population consisted of 72 children, each of whom had had their four first molars sealed between 1977 and 1980. At the annual examinations, all caries-free, newly erupted second molars were sealed. When sealant was applied to the second molars, the first molars were checked and sealant was reapplied to those that had deficient sealants. At the follow-up, when the subjects were 26-27 years of age, 27 in the original group had moved from the community. Thus, the present result is based on 45 subjects. One hundred and fifty-three sealed first molars and 161 sealed second molars were available for inspection. At the follow-up examination of the first molars 20 years after sealant had been applied, 65% showed complete retention, 22% partial retention without caries, and 13% caries or restoration in the occlusal fissures or buccal pits. At the 15-year follow-up of the second molars, the corresponding figures were 65%, 30%, and 5%, respectively. Of the restored or carious molars, significantly more were found in the mandible than in the maxilla (P<0.001). This longitudinal study showed that pit and fissure sealants--applied during childhood--have a longlasting, caries-preventive effect.

Long-term evaluation of a fissure sealing programme in Public Dental Service clinics in Sweden.

The aim of the present study was to evaluate the long-term results of a systematic fissure sealing programme of the occlusal surfaces of newly erupted permanent first molars. All 15-year-olds (n=815) who had been regularly treated at seven Public Dental Service clinics in Jönköping County, Sweden, since the eruption of their permanent first molars participated in the study. Data on fissure sealing and restorative treatment were extracted from the dental records of the patients. When the patients were 15 years of age, it was found that 6% of the original 2456 sealed occlusal permanent first molars had received Class II restorations. Seventy-eight per cent of the remaining 2322 sealed occlusal surfaces were judged to be caries-free by the child's ordinary dentist. This long-term retrospective study indicates that a structured fissure sealing programme is of great benefit for oral health.

Proximal caries prevalence in 19-year-olds living in Sweden. A radiographic study in four counties.

A random sample of all 19-year-olds in four counties in the middle of Sweden in 1994 constituted the group studied. The material consisted of posterior bitewing radiographs from 511 19-year-old patients. The purpose was to study the prevalence and distribution of initial and manifest caries. It was found that on the manifest caries level 56% of the subjects were 'free from caries', in good correspondence with the official epidemiological data from the Swedish National Board of Health and Welfare, but only 27% when initial caries was added. Initial caries lesions constituted 90% of all lesions. The distribution of caries was highly skewed on the manifest caries level whereas initial caries had a broader distribution. Thus, on the surface level 75% of the individuals had 16% of all manifest caries and restorations, and 33% of all initial caries. A high correlation was found between initial and manifest caries, besides increasing with the number of initial lesions. Thus, only 2.5% of individuals without initial caries had manifest caries, compared to 54% of individuals with more than eight affected surfaces. A correlation was also found between the prevalence of manifest caries and restoration. The prevalence of initial caries and its obvious significance for further caries development should be a reason for finding new strategies in caries prevention on a population basis.

Oral health in pre-school children living in Sweden. Part III--A longitudinal study. Risk analyses based on caries prevalence at 3 years of age and immigrant status.

A decreasing proportion of children require operative treatment each year and an increasing proportion of children will at recall require no operative care. This would provide resources to give individualised prevention to children at risk for developing new carious lesions. From 3 years of age, however, the prevalence of caries increases up to the age when the primary dentition exfoliates, even though the children attend regular dental service programmes yearly, and for some children dental caries remains a significant problem. The purpose of the present study was to describe the dental health of a group of 6-year-old children living in Sweden, with special reference to caries prevalence at 3 years of age and to immigrant status. At 6 years of age, 45% of the children were free of initial and manifest carious lesions in the primary cuspids and molars. The mean caries increment between 3 and 6 years was 0.9 tooth surfaces for children who were caries free at 3 years of age compared to 4.5 tooth surfaces for children with manifest carious lesions at the same age. The mean caries increment from 3 to 6 years was 1.3 in the non-immigrant group and 3.6 in the immigrant group. For the majority of the children in this study, current preventive dental care seems sufficient. However, for about one-third of the children (children with carious lesions at 3 years of age and/or immigrant status), current caries preventive programme used in the Public Dental Service are inadequate.

Replacements of restorations in the primary and young permanent dentition.

The present study focused on the type of restorative material used and the reasons for replacements of restorations in the primary and the young permanent dentition. All patients with restorations and who were 8 and 19 years of age in 1995 and were regularly treated at 11 Public Dental Health clinics in Jönköping County, Sweden, participated in the study. Data were extracted from the records for all types of restorations in canines and molars for the preceeding of 5 years for the 8-year-olds (i.e. from 3 to 8 years of age; n = 546) and for approximal restorations in premolars and molars for the preceeding 13 years for the 19-year-olds (i.e. from 6 to 19 years of age; n = 606). In all, 6012 restorations were evaluated. The two most common restorative materials used in the primary dentition were compomer and glass ionomer cement and in the young permanent dentition composite and amalgam. In the primary dentition, 29% of the restorations had been replaced and 4% of the teeth with restorations had been extracted. Thus, 33% of the restorations in the primary dentition failed. The corresponding figure for the young permanent dentition was 13%. The most common reason for replacements in the permanent dentition was secondary caries. That restorations often fail because of caries and that the development of secondary caries is not prevented by replacement of an old restoration indicate that more attention should be paid to preventive dental care for patients with restorations in the primary as well as in the young permanent dentition.

Analysis of caries-related factors in infants and toddlers living in Sweden.

The aims of this study were 1) to investigate whether oral hygiene and dietary habits established at 1 year of age are maintained at 2 years of age and 2) to analyze caries-related factors with regard to oral health between the age of 1 and 3 years by using the salutogenic theory-that is, focusing on behavioral factors that do not result in impairment of health. Altogether 289 children were examined at 1, 2, and 3 years of age, and their parents were interviewed about the children's oral hygiene and dietary habits at 1 and 2 years of age. The result shows that caries-related habits, such as oral hygiene and dietary habits, established during infancy are maintained throughout early childhood. The principles of the salutogenic theory were found to be applicable when studying caries-related habits and oral health. Thus, if a dietary risk behavior is established at 1 year of age, the chance of remaining caries-free until 3 years of age is highest if good oral hygiene habits, including the use of fluoride toothpaste, are present at 2 years of age. We therefore conclude that comprehensive knowledge of a child's future dental health can be obtained by using chairside information-that is, interview of the parents and clinical examination of the children.

Illness and use of medicines in relation to caries development and to immigrant status in infants and toddlers living in Sweden.

In Sweden about 28 per cent of 3-year-old children have developed carious lesions. It has been shown that children below the age of 3 have the highest hospital emergency department visiting rate and receive prescriptions for medicines more often than older preschool children. Furthermore, studies have shown that immigrants more often use hospital emergency departments than Swedes. The purpose of this study was to describe illness and use of medicines in infants and toddlers with special reference to caries prevalence at 2 and 3 years of age and to immigrant status. The study was designed as a prospective study, starting with 671 children aged 1 year. The parents were interviewed about the child's medical history. The results indicate that illness during the first year of life can influence caries prevalence in 2 and 3-year-olds. However, this study could not show any difference in caries prevalence between children who had used medicines at an early age and those who had not. Furthermore, during the first year of life the immigrants had visited a physician more often, been admitted to hospital more and consumed more medicines that non-immigrants.

Parental awareness of dental caries in toddlers.

The purpose of the study was to investigate if parents of toddlers could be taught how to discover dental caries in their children and, if carious lesions were found, contact the the child's dentist. The study was designed as a prospective study, starting with 671 children aged one year. Children examined and caries-free at one year of age were divided into two groups, an experimental and a control group. In connection with the clinical examination, the parents of the children in the experimental group were trained using a colour photo to recognize the first sign of initial dental caries on buccal surfaces of upper incisors and encouraged to contact the dentist as soon as they discovered caries in the teeth of their children. Eighteen parents contacted the dentist when the children were between one and three years of age, but none due to carious lesions. The children in the control group were re-examined at two years of age. About eight per cent of the children in the control group had manifest or initial caries at that age, predominantely in the upper incisors. At three years of age 27 per cent of the children in both the experimental and control group had detectable caries. This study has clearly shown that parents are not able to diagnose caries in their toddlers-at least they are not able to seek advice or dental treatment.

Dietary habits related to caries development and immigrant status in infants and toddlers living in Sweden.

The purpose of this study was to describe the dietary habits of infants and toddlers living in Sweden with special reference to caries prevalence at 2 and 3 years of age and to immigrant status. The study was designed as a prospective, longitudinal study starting with 671 children aged 1 year. At 3 years, all children were invited to a further examination. A total of 298 individuals, randomly selected from the original group, were also examined at 2 years. The accompanying parent was interviewed about the child's dietary habits. Children with caries at 2 and 3 years of age and immigrant children had, when they were 1 year old, consumed caries-risk products and been given nocturnal meals and sweetened liquid in a feeding bottle more often than caries-free 2- and 3-year-olds and non-immigrant children. Although a great variation in dietary habits was found in infants and toddlers, the use of sugar-containing products is widespread in Sweden even in early childhood.

Dental caries and prolonged breast-feeding in 18-month-old Swedish children.

Three thousand children aged 18 months were screened for dental caries and ongoing breast-feeding at 46 child welfare centres in different parts of Sweden. Of these, 200 children were selected for a more comprehensive examination, involving investigation of dietary, toothbrushing and sucking habits, use of fluoride, and determination of salivary levels of mutans streptococci and lactobacilli. The children were divided into four groups: group 1: children with caries not being breast-fed; group 2: children with caries being breast-fed; group 3: caries-free children being breast-fed; group 4: caries-free gender- and age-matched reference children not being breast-fed. The results showed that 63 of the children (2.1%) had caries and 61 (2.0%) were still being breast-fed. Twelve (19.7%) of the 61 children still being breast-fed had caries compared with 51 (1.7%) of the 2939 children not being breast-fed; the difference was statistically significant. Children with caries and still being breast-fed had a mean defs of 5.3, and those with caries not being breast-fed 4.9; the difference was not statistically significant. Children with caries, irrespective of whether they were being breast-fed or not, had significantly higher numbers of cariogenic food intakes per day than caries-free children. Mutans streptococci were detected in 67% of the children and lactobacilli in 13%. Children with detectable mutans streptococci and lactobacilli had significantly more caries than those without. The results indicate that Swedish children with prolonged breast-feeding have a tendency to establish unsuitable dietary habits which constitutes a risk situation for developing caries at an early age.

Infants and toddlers with caries. Mental health, family interaction, and life events in infants and toddlers with caries.

A child is part of a larger family system and the family, in turn, is part of a broader neighbourhood or community system. Consequently, changes in the family may affect the child and changes in the child, the family. Thus the basic etiological factors for caries are influenced by a number of indirect factors. The aim of this descriptive study was to investigate some of these indirect factors in families of children who had developed carious lesions at one or two years of age. By using a combination of interviews, questionnaires and video recordings, it was possible to obtain information regarding mental health, psychosocial background, life events, and family interaction. The results show that in all the investigated families, life events had occurred, that had caused a great deal of stress. From a descriptive point of view there does not seem to be a typical family in which infants develop caries. However, certain psychosocial factors could be essential for the development of caries in infants. Since family function, family interaction and life events influence many aspects of children's life, dental personnel must be aware of the repercussions this may have upon oral health in infants and toddlers.

Oral hygiene in relation to caries development and immigrant status in infants and toddlers.

The purpose of this study was to describe oral hygiene factors in infants and toddlers living in Sweden with special reference to caries prevalence at 2 and 3 yr of age and to immigrant status. The study was designed as a prospective, longitudinal study starting with 671 children aged 1 yr. At 3 yr, all the children were invited to a further examination. A total of 298 children, randomly selected from the original group, were also examined at 2 yr. The accompanying parent was interviewed about the child's oral health habits. Children who were free of caries at 3 yr had had their teeth brushed more frequently at 1 and 2 yr of age, had used fluoride (F)-toothpaste more often at 2 yr of age, and had a lower prevalence of visible plaque at 1 and 2 yr of age than children with caries. Immigrant children had had their teeth brushed less frequently, had used less F-toothpaste, and had a higher prevalence of visible plaque at 1 yr of age than nonimmigrant children. Early establishment of good oral hygiene habits and regular use of F-toothpaste seem to be important for achieving good oral health in pre-schoolchildren.