Professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries: Systematic review.

OBJECTIVES: This systematic review aimed to review the safety and effectiveness of professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries (LMICs). METHODS: Randomized controlled trials conducted in LMICs, in which professionally applied fluorides were compared with placebo/no treatment/health education only or usual care with a minimum one-year follow-up period, were included. Any topically applied fluoride agents such as sodium fluoride (NaF), acidulated phosphate fluoride, silver diamine fluoride (SDF), and nano silver fluoride (NSF) were included. Five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) were searched in May 2022. Meta-analysis was conducted using a random effect model. RESULTS: This review included 33 studies for qualitative synthesis, encompassing 16,375 children aged between 1.5 and 14 years. Nevertheless, the meta-analysis focused on only 17 studies, involving 4067 children. Fourteen papers assessed potential adverse events, none of which was reported as major adverse events. SDF and NSF were identified as effective in arresting caries on primary teeth (p < 0.05) compared with a placebo or no treatment. Fluoride varnish and gel were identified as effective in reducing new caries development on primary teeth (p < 0.05) but not on permanent teeth (p > 0.05). The certainty of the generated evidence obtained is low. CONCLUSION: The review provides valuable insights into the use of professionally applied fluorides in LMICs and contributes to recommendations for their use. However, the limited rigorous evidence suggests the need for further research to strengthen these findings and draw more robust conclusions.

The mutual relationship of the policymakers, providers, and the community on the children's oral health; New windows for more discussions.

BACKGROUND: The multidisciplinary and comprehensive nature of children`s oral health with mutual interactions among various determinants makes the area a window of more discussion among oral health policymakers, stakeholders, providers, and other interested parties. This commentary presents a triangle framework of the children`s oral health, including all the above groups, for new discussions in oral health policymaking. MAIN BODY: Three leading influencers could be recognised in children`s oral health as a triangle despite the contextual differences among the countries. The first angle, Families and community, determine the individual background, demographic, biological, genetic, and psychological factors, as well as community-based and social background, including cultural and socioeconomic factors. The second angle, Oral health providers, includes a variety of determinants from the provider`s perception toward oral health provision of services to availability of dental services, teledentistry and digital technology, surveillance, and monitoring systems for children`s oral health. And finally, as the third angle, Oral health policymakers affect the mechanism for funding dental care and supporting schemes, affordability of oral health services, regulations and standards and public education. Macro environmental policies related to the children`s ecosystem, community water fluoridation, and social marketing for promoting probiotics products` consumption are categorized in this category. CONCLUSION: The triangle framework of children`s oral health presents a big picture of the oral health concept at the multilevel. Although these determinant factors interact with each other, each can have a cumulative effect on children`s oral health; policymakers could try to consider them as a big picture with a systematic approach for better achievement of oral health among children considering the local and national contextual factors of the community.

Pairwise approach for analysis and reporting of child's free sugars intake from a birth cohort study.

OBJECTIVES: The prospective cohort design is an important research design, but a common challenge is missing data. The purpose of this study is to compare three approaches to managing missing data, the pairwise (n = 1386 children), the partial or modified pairwise (n = 1019) and the listwise (n = 546), to characterize the trajectories of children's free sugars intake (FSI) across early childhood. METHODS: By applying the Group-based Trajectory Model Technique to three waves of data collected from a prospective cohort study of South Australian children, this study examined the three approaches in managing missing data to validate and discuss children's FSI trajectories. RESULTS: Each approach identified three distinct trajectories of child's FSI from 1 to 5 years of age: (1) 'low and fast increasing', (2) 'moderate and increasing' and (3) 'high and increasing'. The trajectory memberships were consistent across the three approaches, and were for the pairwise scenario (1) 15.1%, (2) 68.3% and (3) 16.6%; the partial or modified pairwise (1) 15.9%, (2) 64.1% and (3) 20.0%; and the listwise (1) 14.9%, (2) 64.9% and (3) 20.2% of children. CONCLUSIONS: Given the comparability of the findings across the analytical approaches and the samples' characteristics between baseline and across different data collection waves, it is recommended that the pairwise approach be used in future analyses to optimize the sample size and statistical power when examining the relationship between FSI in the first years of life and health outcome such as dental caries.

Tobacco chewing and associated factors among a vulnerable youth population in Sri Lanka.

BACKGROUND: Tobacco in any form kills millions of people every year. Tobacco addiction among youth shows an increasing trend while smokeless type is becoming more common. This study aimed to describe the lifestyle of chewing smokeless tobacco among a group of high-risk youth population in Sri Lanka. METHODS: A descriptive cross-sectional study was conducted among a sample of 1431 youths aged between 15 to 24 years residing in urban slums in Colombo Sri Lanka, using a cluster sampling technique combined with probability proportionate to size technique. Data were collected using an interviewer-administered questionnaire. Chewing smokeless tobacco was assessed using betel quid chewing and commercially prepared tobacco and areca nut packet chewing. Current chewer was defined as who had the practice of chewing during past 30 days. RESULTS: The mean age of the study sample was 17.53 (95% CI: 17.40-17.65). Of the 1431 respondents, 57% were males and 43% were females. The prevalence of current smokeless tobacco chewers was 44.9% and among them 90.8% were males and 9.8% were females. Around 31.3% did not have smokeless tobacco chewing practice (Male-5.9%, Female-64.9%). Among the current smokeless tobacco chewers 21.5% chew both types of smokeless tobacco products and all of them were males. Male gender (OR 17.9; 11.4 -27.9) and ever smoking lifestyle (OR 4.4; 2.9-6.6) were significant determinants of current smokeless tobacco chewing lifestyle. CONCLUSION AND RECOMMENDATIONS: The study shows a high prevalence of smokeless tobacco use by youth aged between 15 to 24 years who were residing in urban slum areas in the district of Colombo, in Sri Lanka, highlighting this target group for early intervention to reduce the uptake and promote the quitting of this practice.

Digital Health in Children's Oral and Dental Health: An Overview and a Bibliometric Analysis.

Digital health technologies can widely increase access to oral health solutions and can make them easier to use and more accessible at all primary, secondary, and tertiary levels. This study aims to present a bibliometric analysis of published literature to identify the content, trends, and context of digital health technology use in children's oral and dental health. After finalising the research question, the Scopus database was used to search systematically for related keywords from 1997 to 2022. The PRISMA methodology applied for systematic reviews was adopted to refine search results. VOS viewer software was applied to illustrate the topics and trends of digital health technology involved in children's oral and dental health. An increase in use of the digital technologies was appeared in the index keywords after 2005. Computer-assisted therapy/surgery, computer simulation, computer program, image processing, nuclear magnetic resonance (NMR) imaging, and audio-visual equipment were more used index keywords in children's dental care re-search from 2005-2015. Telemedicine, mobile application, virtual reality, and medical information were reported with the index keywords of dental caries, dental procedures, and dental anxiety after 2015. The study also identified a gap in the published literature in applying newer digital technologies, such as the Internet of Things (IoT) and gamification, in oral and dental health research and practice. There is a growing tendency to use digital technologies in children's oral and dental health in recent years. Although the types and categorisations of the technology are typically diverse during the timeframe and by the area of dental services and oral health, identifying and categorizing these technologies based on oral health services could familiarise oral health policymakers with the application of the technology and help them design technology-based interventions to improve children's oral health.

Risk indicators for untreated dental decay among Indigenous Australian children.

OBJECTIVE: To investigate risk indicators for untreated dental decay among Indigenous Australian children using a national representative sample. METHODS: Data were from the National Child Oral Health Study 2012-2014, which included a nationally representative sample of Indigenous Australian children aged 5-14 years. Outcomes were the prevalence (% ds/DS >0) and severity (mean ds/DS) of untreated dental decay at the tooth surface level. Caries of the primary dentition was estimated among 5- to 10-year-olds, while that of the permanent dentition was among 8- to 14-year-olds. Independent variables included residential location, household income, frequency and age commencement of toothbrushing, sugar-sweetened beverages (SSB) consumption, dental visiting and residential fluoridation status. Multivariable log-Poisson regression models with robust standard error estimation were used to identify risk indicators for untreated decay. The complex sampling design was taken into account in all analyses. RESULTS: There were 720 5- to 10-year-old and 736 8- to 14-year-old Indigenous children. Indigenous children experienced significant amount of untreated dental caries. Among 5- to 10-year-olds, % ds >0 was 43.1 (95% CI: 36.8-49.6) and mean ds was 3.4 (95% CI: 2.4-4.4). Among 8- to 14-year-olds, % DS >0 was 27.3 (22.3-32.9), while mean DS was 0.8 (0.6-1.0). In multivariable modelling, risk indicators for % ds >0 among 5- to 10-year-olds were low household income, commencing toothbrushing after 30 months of age, consuming 2+ cups of SSB per day and not residing in fluoridated areas. Risk indicators for mean ds among 5- to 10-year-olds included infrequent toothbrushing and consuming 2+ cups of SSB per day. Risk indicators for % DS >0 among 8- to 14-year-olds were low household income, while risk indicators for mean DS among 8- to 14-year-olds were residing in non-capital city, low household income, consuming 2+ cups of SSB per day and not residing in fluoridated areas. CONCLUSION: Indigenous Australian children experienced significant amount of untreated dental caries. Risk indicators for untreated decay included demographic factors, socioeconomic factors, oral hygiene behaviours, dietary behaviours and environmental factors.

Early Life Professional and Layperson Support Reduce Poor Oral Hygiene Habits in Toddlers-A Prospective Birth Cohort Study.

Oral health behaviours of children are formulated from a very young age. Formation of those behaviours among very young children is dependent on their mothers/caregivers who may themselves require support from the health profession or laypersons. The study aimed to investigate if early life visits for check-up and dental advice and perceived support improved oral health behaviours as practiced by mothers of toddlers aged 24⁻30 months old. Data from a population-base birth cohort study in South Australia was used. The study recruited and followed mothers of newborn children from birth to age 24⁻30 months. Parental questionnaires collected information about socioeconomic factors, dental visiting patterns, and oral health behaviours as practiced by the mothers for their child. Self-reported putting a child to bed with a bottle and brushing a child's teeth were the outcome variables. The two main exposures of this study were (1) early visiting for a dental advice, and (2) layperson support that a mother received in the first two years of having the child. Data were analysed progressively from bivariate to multivariable regression models. A total of 1183 mother/child dyads had complete data. The retained sample was representative of the population. Approximately 36% of mothers put their child to bed with a bottle and 26% of mothers did not brush their child's teeth the night before. Around 29% of children had a visit for dental check-up and 80% of mothers reported having lay support. There were gradients in the outcome variables by socioeconomic factors and the main exposures. Multivariable regression models reported that having no dental visit for advice and having no lay support were associated with 1.30 and 1.21 imes higher rates of putting a child to bed with a bottle, respectively. Having no dental visit for advice was associated with a 1.37-times higher rate of not brushing a child's teeth, controlling for other factors. This population-based birth cohort study confirmed importance of early life dental visit for check-up and support for mothers of young children in establishing oral health behaviours of young children.

Social inequality in dental caries and changes over time among Indigenous and non-Indigenous Australian children.

OBJECTIVE: This paper describes and compares magnitudes of socioeconomic (SES) inequalities in oral health among Indigenous and non-Indigenous children over a 10-year period. METHODS: We analysed annual oral health survey data from NSW, NT and SA. Data were extracted for time period 1 (2000-2002, N=215,317) and time period 2 (2007-2010, N=34,495). Oral health outcomes were untreated decayed deciduous teeth (dt) and cumulative dental caries experience (dmft). Postcode-level Socioeconomic Index for Areas was used to assess SES. Age standardisation and complex survey weights were used. Indices of socioeconomic inequality in health (Slope Index of Inequality, Relative Index of Inequality, Absolute and Relative Concentration Index) were used to quantify inequality in dental caries and its changes over time. RESULTS: Oral health outcomes deteriorated in both Indigenous and non-Indigenous populations over time. Indigenous children experienced higher levels of disease at both times. Untreated dt increased in both populations. The cummulative disease (dmft) increased at higher rate among children in low-SES areas in both populations. Over time, there was an increase in socioecononomic inequalities in dmft in all children and in dt in non-Indigenous children. CONCLUSION: Area-level socioeconomic inequality in child oral health has widened due to deterioration in low-SES children.

Trends in caries experience and associated contextual factors among indigenous children.

OBJECTIVE: To assess dental caries trends in indigenous children in South Australia, 2001-2010; and contribution by area-level socioeconomic status (SES), remoteness and water fluoridation status. METHODS: This study is a part of the Child Dental Health Survey (CDHS) is an ongoing national surveillance survey in Australia including children enrolled in the School Dental Services (SDS). Postcode-level adjusted mean deciduous and permanent caries experience was estimated at each year. Time trend of dental caries experience was estimated using mixed effect models. Area-level socioeconomic status, remoteness, water fluoridation status were independent variables in the models. RESULTS: There was a significant upward trend of dental caries experience over the 10 years. Dental caries experience of indigenous children living in low SES areas had nearly one more deciduous tooth and a half permanent tooth with caries than indigenous children living in higher SES areas. The remote postcodes showed higher levels of decay in deciduous dentition (+1.25 teeth) compared with others regions. CONCLUSIONS: The dental caries trend increased in South Australian indigenous children over the study period, and was associated with area-level SES and remoteness. IMPLICATION: The increasing trend in dental caries in indigenous children is important evidence to inform policies to improve oral health.

Factors attributable for the prevalence of dental caries in Queensland children.

BACKGROUND: Dental caries is a multifactorial condition, prevention of which requires comprehensive understanding of both contextual and compositional determinants and their population impact. AIMS: To investigate contextual and compositional factors associated with the prevalence of dental caries in children and to estimate the population impact of those factors. METHODS: Children in one Australian state were selected through stratified random sampling selection in 2010-2011. Oral epidemiological examinations provided individual-level outcomes: prevalence of dental caries in the primary (among 5- to 8-year-olds) and permanent dentitions (9- to 14-year-olds). Socioeconomic status, oral health behaviours and practices and dietary patterns were explanatory factors at the individual-level, school-level and area-level fluoridation status. Three-level multilevel multivariable models were sequentially specified for the prevalence of dental caries to estimate prevalence ratios (PR) associated with explanatory factors, adjusting for covariates and between- and within-group variances. Population attributable fraction (PAF) was estimated as the population impact of the statistically significant explanatory factors. RESULTS: Data from 2214 5- to 8-year-olds and 3186 9- to 14-year-olds from 207 schools in 16 areas were analysed. The prevalence of dental caries in the primary and the permanent dentitions was 47.1% (43.9-50.4) and 38.8% (36.1-41.6), respectively. The highest prevalence of dental caries was observed in the nonfluoridated areas. In bivariate associations, factors at three levels were associated with prevalence of dental caries. In the full models, children in the nonfluoridated areas had significantly higher prevalence of dental caries [PR for the primary: 1.29 (1.11-1.50); PR for the permanent 1.49 (1.01-2.21)] compared with children in fluoridated areas, controlling for other factors. PAF estimates indicated that lack of water fluoridation attributed to 21% and 31% of primary and permanent dental caries, respectively in this child population. CONCLUSION: A multitude of factors had significant population impact on the prevalence of dental caries in children. Water fluoridation has a significant population impact on dental caries experience in this child population.

Clinical oral health of Australia's rural children in a sample attending school dental services.

OBJECTIVE: To examine the association between children's clinical oral health status and their residential location using the latest available data (2009) and to ascertain whether poor oral health among rural children is related to being Indigenous, having less access to fluoridated water or being of lower socioeconomic status (SES), than children from urban areas. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANT: Data were collected on 74, 467 children aged 5-12 years attending school dental services in Australia (data were not available for Victoria or New South Wales). MAIN OUTCOME MEASURES: Clinical oral health was determined by the mean number of permanent teeth with untreated caries, missing and filled permanent teeth, and the mean decayed, missing and filled permanent teeth index (DMFT) of 8 to 12-year-old-children and the mean number deciduous teeth with untreated caries, missing and filled deciduous teeth, and the mean decayed, missing and filled deciduous teeth index (dmft) of 5-10-year-olds. RESULTS: The multivariable models that included coefficients on whether the child was Indigenous, from an area with fluoridated water and SES, were controlled for age and sex. The mean DMFT of 8-12-year-old children and the mean dmft of 5-10-year-old-children were significantly higher in rural areas compared with urban centres after accounting for Indigenous status, fluoridated water and SES. CONCLUSION: Children's oral health was poorer in rural areas than in major city areas.