Dental Caries in High-risk, School-age African American Children in Alabama: A Six-year Prospective.

PURPOSE: The purpose of this study was to assess the prevalence and incidence of dental caries in school-age African American children who received semi-annual fluoride varnish applications. METHODS: A cohort of six-year-old high caries-risk African American children (n equals 98) was recruited in Uniontown, Ala., USA, and followed for six years. Oral examinations were done annually by three trained/calibrated dentists. Tooth surfaces with cavitated caries, teeth missing due to caries, and teeth with filled surfaces were recorded using World Health Organization criteria. Also, as part of the study, children received periodic oral health instruction, fluoride varnish applications, and referrals to dentists starting at baseline. RESULTS: The person-level prevalence of decayed, missing, and filled surfaces of primary and permanent teeth (dmfs/DMFS) was: 61.2 percent at mean age of 5.9 years old (n equals 98, mean dmfs/DMFS equals 11.6); 63.8 percent at 6.7 years old (n equals 80, mean dmfs/ DMFS equals 13.2); 70.6 percent at 7.8 years old (n equals 68, mean dmfs/DMFS equals 14.2); 65.7 percent at 8.8 years old (n equals 68, mean dmfs/DMFS equals 11.8); 55.6 percent at 9.7 years old (n equals 63, mean dmfs/DMFS equals 8.8); 40.3 percent at 10.7 years old (n equals 62, mean dmfs/DMFS equals 3.4); and 37.1 percent at 11.7 years old (n equals 62, mean dmfs/DMFS equals 2.3). The six-year person-level incidence of dmfs/DMFS was 32.3 percent (mean dmfs/DMFS equals 1.6) from 5.9 to 11.7 years old (N equals 62). CONCLUSIONS: In spite of the oral health education and fluoride varnish applications, there was substantial new dental caries in this high-risk sample. Additional studies evaluating risk factors for caries development are ongoing.

Dental caries and childhood obesity: roles of diet and socioeconomic status.

OBJECTIVE: Our objective was to determine (a) if caries and obesity were associated in a pediatric population and (b) if so, then to explore diet and socioeconomic status as additional risk factors. METHODS: Subjects were recruited at birth and are members of the Iowa Fluoride Study. Data such as parental age, parental education levels and family incomes were obtained by questionnaire at recruitment. Children's primary dentition was examined and their weight and height measured at 4.5-6.9 years of age. Parental weight and height were measured when children were 7.6-10.9 years of age. Beverage and nutrient intake patterns were obtained from 3-day food and beverage diaries completed at 1, 2, 3, 4 and 5 years of age. RESULTS: Children with caries had lower family incomes, less educated parents, heavier mothers and higher soda-pop intakes at 2, 3 and for 1-5 years than children without caries (P < 0.05). 'Overweight' children had less educated fathers and heavier parents than 'normal' weight children (P < 0.05). Children 'at risk' of overweight had higher caries rates than 'normal' or 'overweight' children (P < 0.05). In stepwise logistic regression models to predict caries experience, soda-pop intakes were displaced by mother's education, leaving 'at risk' of overweight and mother's education in the final model. CONCLUSION: Caries and obesity coexist in children of low socioeconomic status. Public health measures to improve dietary education and access to appropriate foodstuffs could decrease the risk of both diseases.

Primary tooth fluorosis and fluoride intake during the first year of life.

OBJECTIVES: Few studies in North America have assessed dental fluorosis of the primary dentition and few, if any, anywhere have assessed the relative importance in fluorosis etiology of fluoride intake during different time periods or from multiple sources. The purpose of this paper is to report on analyses relating estimated prenatal fluoride intake and fluoride intake during different parts of the first year of life to primary tooth fluorosis. METHODS: As part of The Iowa Fluoride Study, subjects were recruited at birth and studied longitudinally. Trained examiners assessed dental fluorosis for children aged 4-7 years using the Tooth Surface Index of Fluorosis (TSIF) adapted for the primary dentition. Detailed parent questionnaires at childbirth were used to estimate prenatal fluoride intake and questionnaires sent at 6 weeks and 3, 6, 9, and 12 months were used to estimate fluoride intake during the first year of life (combined fluoride intake from water, food and beverage, supplements, and dentifrice). There were 504 children with prenatal and at least four of the five postnatal responses with complete data. RESULTS: Fluorosis prevalence was 12.1%, occurring primarily on the second primary molars. Receiver operating characteristic (ROC) curves and logistic regression were used to assess the importance of different time periods' fluoride intake. In bivariate analyses, fluoride intake during each time interval was individually significantly related to fluorosis occurrence. For multivariate analyses, the period from 6 to 9 months was most important individually (P = 0.0001), and no other period was jointly statistically significant. CONCLUSIONS: Results suggest that the middle of the first year of life is most important in fluorosis etiology for the primary dentition in this setting.