Association of Sleep-Time Feeding Practices with Early Childhood Caries: A Case-Control Study.

Early childhood caries (ECC) remains a public health challenge globally, more so in developing countries. The association between sleep-time feeding practices and ECC remains obscure. The study evaluated this association using Feeding At Sleep Time (FeAST) scale. A case-control study was planned among 627 toddlers, were cases included children with ECC while controls were children without ECC. Three patterns of feeding associated with sleep were recorded: beginning of sleep, during the course of sleep, and early morning hours sleep. Dental caries was scored using International Caries Detection and Assessment System (ICDAS II). The study participants included 302 (48%) cases and 325 (52%) controls. Adjusted odds ratios (AORs) for breastfeeding at the beginning of sleep, during the course of sleep, and early morning hours sleep were 6.7, 6.5, and 3.7, respectively (p = 0.001), on comparing cases versus controls. Similarly, AORs for bottle-feeding at the beginning of sleep, course of sleep, and early morning hours sleep were 5.1, 8.3, and 3.7, respectively (p = 0.001). Addition of sweeteners yielded an AOR = 2.84, while the intake of solids during sleep yielded an AOR of 6.02(p = 0.001). Other feeding modes like sippers, tumblers, etc., had a statistically significant association (p = 0.001). Sleep-time feeding practices increase the risk for ECC in 12- to 36-month-old children.

Herbal Dentifrices for Prevention of Dental Caries in Children and Adolescents: A Systematic Review.

Despite a large number of trials conducted on the use of herbal oral care products to reduce dental plaque or gingivitis, the results are conflicting and inconclusive. This systematic review aimed to evaluate the effectiveness of herbal dentifrices in caries prevention in children and adolescents and to ascertain the potential of herbal dentifrices to remineralize white spot lesions, reduce halitosis, and improve gingival and periodontal health in children with special healthcare needs (SCHN) and among orthodontic patients. A comprehensive search was designed and conducted using several databases. The articles were independently screened for eligibility by two reviewers. Seven of the 6,940 studies were found to meet the eligibility criteria. A meta-analysis showed that for bacterial scores, the standard mean difference was estimated to be 0.6 [95% confidence interval (CI): -0.78, 1.99] and was statistically insignificant (p = 0.39). Herbal dentifrice is evidenced as equally effective in reducing bacterial count and altering bacterial plaque when compared to nonherbal dentifrices within the confines of the included studies. To verify the definitive use of herbal dentifrices for daily use, further research, including randomized controlled trials (RCT) of sufficient quality, would be recommended. How to cite this article: Saikia A, Sivasubramanian A, Muthu MS, et al. Herbal Dentifrices for Prevention of Dental Caries in Children and Adolescents: A Systematic Review. Int J Clin Pediatr Dent 2024;17(2):229-236.

Herbal Mouthrinses for Prevention of Dental Caries in Children and Adolescents: A Systematic Review.

The primary aim of this study was to evaluate the effectiveness of herbal mouthrinses (HMR) on caries prevention in children and adolescents. In addition, this systematic review assessed its effectiveness in remineralization of white spot lesions, reduction of halitosis, and improving gingival and periodontal health in orthodontic patients and patients with special healthcare needs (SHCN). A comprehensive bibliographic search was conducted in PubMed, Cochrane Central, EMBASE, AMED, ProQuest, CINAHL, AYUSH, Digital Helpline for Ayurveda Research Articles (DHARA), and Clinical Trial Gov databases. A total of 3,918 titles were identified during the initial search. Of these, 32 studies were selected for quality assessment. A total of 5,038 participants from 10 countries were thus included in this review, with 22 (66.7%) studies conducted in India. All included studies were published between 2004 and 2021. Included studies investigated the effect of HMR on caries increments, which record decayed, missing, filled (DMF) [International Caries Detection and Assessment System (ICDAS)], decayed, missing, filled teeth/surfaces (DMFT/S), and incipient caries. Changes in bacterial count (Streptococcus mutans and Lactobacillus) and alterations in levels of Candida albicans from saliva or plaque samples were also reported. The effect of HMR on gingival and plaque indices among adolescents undergoing orthodontic treatment and children with SHCN was reported in two studies. The variance in the HMR formula across studies, short follow-up period, and limiting grade of evidence do not allow for conclusive evidence of the efficacy of HMR. This warrants high-quality randomized controlled trials (RCTs) with longer intervention periods involving children under 6 years to yield more conclusive results. How to cite this article: Saikia AM, Sivasubramanian A, MS M, et al. Herbal Mouthrinses for Prevention of Dental Caries in Children and Adolescents: A Systematic Review. Int J Clin Pediatr Dent 2024;17(S-1):S100-S111.

Assessment of Microbial Contamination of a Toothbrush Head with and without a Protective Cover: An Ex Vivo Study.

Introduction: The oral cavity is colonized by various groups of microorganisms. Toothbrushing is a common method of maintaining oral hygiene and, upon regular use, can become heavily contaminated with microorganisms. To avoid contamination of the toothbrush with microorganisms from the external environment, toothbrushes can be protected by a protective cap, the significance of which is unknown. Objectives: To assess the microbial contamination of the toothbrush with and without a protective cap and to find the significance of the same against microbial contamination. Materials and methods: An ex vivo study was conducted in the Faculty of Dental Sciences, Sri Ramachandra University. A total of 40 toothbrushes were distributed among dental students aged 18-25 years; 20 were protected by a cap, 20 were unprotected, and instructions were given to recap the toothbrush after brushing. After 1 month of regular usage, toothbrushes were collected, and organisms were identified based on Gram's reaction followed by a biochemical test. Results: From the study conducted, it is evident that the microbial contamination of the unprotected toothbrush is higher than that of the toothbrushes that were protected with a cover. How to cite this article: Manohar R, Venkatesan K, Raja S, et al. Assessment of Microbial Contamination of a Toothbrush Head with and without a Protective Cover: An Ex Vivo Study. Int J Clin Pediatr Dent 2022;15(4):455-457.

Feeding At Sleep Time (FeAST) Scale: Assessing Risk for Developing Early Childhood Caries in South Indian Toddlers.

PURPOSE: The Feeding At Sleep Time (FeAST) scale was developed and validated to assess sleep time feeding practices for children younger than three years. The purpose of this study was to describe the process of scoring and find an optimum clinical cutoff score for early childhood caries (ECC) using receiver operating characteristics (ROC) analysis, thereby enabling researchers and clinicians to assess risk for devel- oping ECC. METHODS: The FeAST scale was administered to mothers of 527 toddlers, aged 12 to 36 months, attending four outpatient depart- ments. The score was calculated based on subconstructs of combined breast-feeding (CBR) and combined bottle-feeding (CBO), and suitable cutoff points were identified using ROC analysis. RESULTS: The study established a cutoff score greater than 14 for the CBR construct and a cutoff score greater than 11 for the CBO construct of the FeAST scale to determine a child's risk for developing ECC. The area under the curve (AUC), which measures the overall performance of a scale, has yielded statistically significant values (P<0.001) with fair (0.707) and good (0.788) perform- ance for the CBR and CBO constructs, respectively. CONCLUSION: The Feeding at Sleep Time scale, based on receiver operating characteristics analysis, can potentially be used by clinicians and researchers to screen toddlers at risk of developing early childhood caries.

A Study to Assess the Levels of Salivary Ferritin in Iron Deficiency Anemia Subjects and Healthy Subjects.

INTRODUCTION: Iron deficiency anemia is one of the most widespread disorders in humans. Early diagnosis of iron deficiency anemia is challenged by assessing serum ferritin levels. However, studies across the globe have concluded that ferritin is present in quantifiable amounts in saliva. Thus, in the study, the scope of using salivary ferritin as a diagnostic biomarker in detecting iron deficiency anemia is studied. METHODS: Levels of salivary ferritin in patients with iron deficiency anemia (test group, n=15) and non-anemic subjects (control group, n=15) were assessed by an automated chemilumesent method with a total sample size of 30 volunteers. RESULTS: The mean level of salivary ferritin in subjects with iron deficiency anemia was 139.37±47.90 µg/dl, which was significantly higher when compared to the level in non-anemic subjects, 94.18±62.90 µg/dl, which was contradictory when compared to the levels of serum ferritin. CONCLUSION: The raise in the levels of salivary ferritin in subjects with iron deficiency anemia can be attributed to the iron-dependent enzymatic function of saliva. Thus, salivary ferritin can become a biomarker that helps in the diagnosis of iron deficiency anemia; however, more research is needed for devising a more standard cutoff value for diagnosing iron deficiency anemia.

The effect of fennel seeds on pH of saliva - A clinical study.

CONTEXT: Saliva is an oral fluid that gives a protective effect against dental caries. Chewing of fennel seeds after food is a common culture in the Indian Sub-continent. A review of previous studies on fennel seeds showed that some of them have an anti-microbial efficacy, but there are no extensive data available on the effect of chewing fennel seeds on the pH of saliva. AIM: The aim of the study was to record the baseline pH of saliva and to record the changes in salivary pH after chewing fennel seeds. SETTING AND DESIGN: The study was carried out in the Department of Public Health Dentistry, Sri Ramachandra University, Chennai, prior to which a pilot study was carried out. SUBJECTS AND METHODS: Voluntary enrolment of 30 individuals was done. A written and informed consent was obtained from the individuals prior to the study. The pH of the saliva was recorded by placing the standardized salivary strip below the tongue in the oral cavity and colour changes were matched with the pH scale colour chart within about 15 sec. The subjects were asked to chew fennel seeds for 5 min. Salivary pH was measured immediately after chewing (SP2) at 0 min and the experiment was repeated for 5 min (SP3), 10 min (SP4), 15 min (SP5) and 30 min (SP6). STATISTICAL ANALYSIS: The data was gathered and analysed using paired t test. RESULTS: There was an increase in salivary pH from baseline (SP1) to 0 min (SP2) was found to be highly significant (P = 0.000). The mean salivary pH reduced to 7.64 ± 0.06, 5 min after chewing the seeds (SP3) and the drop in pH was found to be highly significant (P = 0.000). The subsequent drop in pH from 10 min (SP4), 7.50 ± 0.05 to 15 min (SP4), 7.38 ± 0.05 to 30 min (SP4), 7.24 ± 0.05 were found to be highly significant as well (P = 0.000). CONCLUSION: Chewing of fennel seeds increases the pH of saliva, thus making it a suitable anti-cariogenic agent.

Risk Factors for Early Childhood Caries in Toddlers: An Institution-based Study.

Background Tooth decay experience among toddlers and preschoolers is of epidemic proportions worldwide and dental caries still remains an important childhood disease affecting a considerable part of this population. Though the prevalence of Early Childhood Caries (ECC) is associated with several risk factors such as feeding and oral hygiene practices, Streptococcus mutans levels, socioeconomic status (SES), etc., it is suggested that these factors should be studied adequately to aid in the early prevention and management of ECC. Objective The objectives of the study were to: a) evaluate the distribution of ECC, b) study the role of SES in the occurrence of ECC, c) record the variations in feeding and dietary practices along with oral hygiene practices and d) Correlate the sweet score with ECC. Materials and Methods This cross-sectional observational study was conducted over a period of 6 months among 100 toddlers (12-36 months) attending the Pediatric outpatient department of a single medical institution in Chennai, India. The study consisted of an intra-oral examination followed by a face to face interview of the mothers of the children using a validated structured oral health questionnaire. Results SES and ECC were negatively correlated with statistically significant association. Majority of the subjects did not follow any oral hygiene practices before teeth erupted; few subjects used tooth brush and tooth paste after teeth erupted and followed oral hygiene practices once a day. Statistically significant positive correlation with ICDAS scores was noted in relation to the sweet score and the frequency of intake of sweet foods, candy, etc. Cavitated lesions were more common than non-cavitated lesions and majority of the posterior teeth had ICDAS score 4. Conclusion Healthcare providers for children must be well informed on the etiology and risk factors of ECC and guide children for their first dental visit within one year of age.

Development and validation of a scale to assess Feeding at Sleep Time (FeAST) among infants and toddlers.

BACKGROUND: Feeding practices adopted by parents play a critical role in the development of children's taste preferences, eating habits, nutrition and eventual weight status. Many scales have been developed to assess feeding practices among children of various age groups. This paper aimed to construct and validate a robust scale for the comprehensive assessment of sleep-time feeding practices for children aged 0-3 years and to establish the risk of developing Early Childhood Caries (ECC). METHODS: There were multiple phases to the development of the scale: (a) formation of a conceptual framework, (b) systematic development of an item pool, (c) refinement of the item pool by focus group discussion, cognitive interviewing and pretesting, (d) validity testing and (e) reliability testing. The conceptual framework was built based on four broad constructs: breastfeeding, bottle-feeding, other feeding modes and 'tooth and diet' constructs. Reviews of existing scales in related areas were instrumental in scale development and helped to generate an initial pool of 45 items, which was finally refined to 28 items. RESULTS: Cognitive interviews by the 'think-aloud protocol' helped to reduce ambiguity and maximize clarity of the questions. Pretesting the scale aided increased comprehension and specificity. Face and content validity were corroborated by 'subject matter experts' who endorsed the suitability and appropriateness of items. Reliability was assessed by test-retest, and a near-perfect agreement was obtained in 96% of the items. CONCLUSIONS: This is the first validated scale currently available for recording sleep-time feeding practices of children less than three years of age. This 28-item scale can be applied as a potential clinical scale to record sleep-time feeding history and the risk of developing ECC as well as a research scale to investigate the association of sleep-time feeding practices with ECC.

Prevalence of Early Childhood Caries in India - A Systematic Review.

Early Childhood Caries (ECC) is a serious public health problem in developed as well as developing nations, with high prevalence among children around the world. This systematic review of the national literature was undertaken to document the prevalence of Early Childhood Caries. Studies evaluating the prevalence of Early Childhood Caries (ECC) in the Indian population were investigated. The method under evaluation was the use of a caries experience index to calculate the prevalence of ECC. An extensive literature search was done in the following databases: PubMed, IndMED and Cochrane upto June 2016. A modified version of the Newcastle-Ottawa Scale for cross-sectional studies was used for assessment of the quality of the studies. A systematic literature search yielded 503 publications from the various databases searched. Based on the inclusion and exclusion criteria, the final number of included studies were 54. Among the included studies, 19 studies were carried out in the state of Karnataka. Analysis of all the included studies revealed the overall prevalence of ECC in India to be 49.6%. Andhra Pradesh was found to have the highest prevalence of ECC at 63%, and the lowest prevalence was reported in Sikkim (41.92%). This review has reported a high prevalence of ECC in India. None of the states reported prevalence below 40%. The government should identify ECC as a national priority which requires significant attention.