Maternal vitamin D status in pregnancy and molar incisor hypomineralisation and hypomineralised second primary molars in the offspring at 7-9 years of age: a longitudinal study.

PURPOSE: The study aimed to investigate associations between maternal vitamin D status during pregnancy and molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) among children. METHODS: The study had a longitudinal design using prospectively collected data from 176 mother and child pairs. Mothers were initially recruited in a randomised controlled trial to assess a pregnancy exercise programme. Along with the 7-year follow-up, we invited the children to a dental examination. The exposure variable was maternal serum 25-hydroxyvitamin D in gestational weeks 18-22 and 32-36, categorised as insufficient (< 50 nmol/l) and sufficient (≥ 50 nmol/l). Negative binomial hurdle models were used to analyse potential associations between the exposure variables and MIH or HSPM. The models were adjusted for potential confounders. RESULTS: Among the children (7-9 years old), 32% and 22% had at least one tooth with MIH or HSPM, respectively. A significant association was found between insufficient maternal vitamin D measured in gestational weeks 18-22 and the number of affected teeth among those with MIH at 7-9 years (adjusted RR = 1.82, 95% CI 1.13-2.93). CONCLUSION: Considering any limitations of the present study, it has been shown that insufficient maternal serum vitamin D at mid-pregnancy was associated with a higher number of affected teeth among the offspring with MIH at 7-9 years of age. Further prospective studies are needed to investigate whether this finding is replicable and to clarify the role of maternal vitamin D status during pregnancy and MIH, as well as HSPM, in children.

In children and adolescents with temporomandibular disorder assembled with juvenile idiopathic arthritis - no association were found between pain and TMJ deformities using CBCT.

BACKGROUND: Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer from temporomandibular disorder (TMD). Due to this, imaging diagnosis is crucial in JIA with non-symptomatic TM joint (TMJ) involvement. The aim of the study was to examine the association between clinical TMD signs/symptoms and cone-beam computed tomography (CBCT) findings of TMJ structural deformities in children and adolescents with JIA. METHODS: This cross-sectional study is part of a longitudinal prospective multi-centre study performed from 2015-2020, including 228 children and adolescents aged 4-16 years diagnosed with JIA, according to the International League of Associations for Rheumatology (ILAR). For this sub-study, we included the Bergen cohort of 72 patients (32 female, median age 13.1 years, median duration of JIA 4.5 years). Clinical TMD signs/symptoms were registered as pain on palpation, pain on jaw movement, and combined pain of those two. The severity of TMJ deformity was classified as sound (no deformity), mild, or moderate/severe according to the radiographic findings of CBCT. RESULTS: Of 72 patients, 21 (29.2%) had pain on palpation at and around the lateral pole, while 41 (56.9%) had TMJ pain upon jaw movement and 26 (36.1%) had pain from both. Of 141 TMJs, 18.4% had mild and 14.2% had moderate/severe structural deformities visible on CBCT. CBCT findings were not significantly associated with either the pain on palpation or the pain on jaw movement. A significant difference was found between structural deformities in CBCT and the combined pain outcome (pain at both palpation and movement) for both TMJs for the persistent oligoarticular subtype (p = 0.031). CONCLUSIONS: There was no association between painful TMD and CBCT imaging features of the TMJ in patients with JIA, but the oligoarticular subtype of JIA, there was a significant difference associated with TMJ pain and structural CBCT deformities.

Prevalence of temporomandibular disorder in children and adolescents with juvenile idiopathic arthritis - a Norwegian cross- sectional multicentre study.

BACKGROUND: Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer pain from temporomandibular disorder (TMD). Still, routines for the assessment of temporomandibular joint (TMJ) pain in health and dental care are lacking. The aims of this study were to examine the prevalence of TMD in children and adolescents with JIA compared to their healthy peers and to investigate potential associations between JIA and TMD. METHODS: This comparative cross-sectional study is part of a longitudinal multicentre study performed during 2015-2020, including 228 children and adolescents aged 4-16 years with a diagnosis of JIA according to the ILAR criteria. This particular substudy draws on a subset of data from the first study visit, including assessments of TMD as part of a broader oral health examination. Children and adolescents with JIA were matched with healthy controls according to gender, age, and centre site. Five calibrated examiners performed the clinical oral examinations according to a standardised protocol, including shortened versions of the diagnostic criteria for TMD (DC/TMD) and the TMJaw Recommendations for Clinical TMJ Assessment in Patients Diagnosed with JIA. Symptoms were recorded and followed by a clinical examination assessing the masticatory muscles and TMJs. RESULTS: In our cohort of 221 participants with JIA and 221 healthy controls, 88 (39.8%) participants with JIA and 25 (11.3%) healthy controls presented with TMD based on symptoms and clinical signs. Painful TMD during the last 30 days was reported in 59 (26.7%) participants with JIA vs. 10 (5.0%) of the healthy controls (p <  0.001). Vertical unassisted jaw movement was lower in participants with JIA than in controls, with means of 46.2 mm vs. 49.0 mm, respectively (p <  0.001). Among participants with JIA, a higher proportion of those using synthetic disease-modifying antirheumatic-drugs and biologic disease-modifying antirheumatic-drugs presented with painful masticatory muscles and TMJs at palpation. CONCLUSION: Symptoms and clinical signs of TMD were seen in approximately half of the JIA patients compared to about one fourth of their healthy peers. Painful palpation to masticatory muscles and decreased vertical unassisted jaw movement were more frequent in participants with JIA than among healthy controls and should be part of both medical and dental routine examinations in patients with JIA.

Oral-health-related background factors and dental service utilisation among Sudanese children with and without a congenital heart defects.

BACKGROUND: Sudanese children with congenital heart defects (CHDs) were found to have poorer oral health than those without CHDs. The aims of this study were to: describe the patterns of oral-health-related background factors in children with and without CHD and explore any differences, and to evaluate the effects of background factors on caries and gingivitis prevalence and dental services utilisation. METHODS: In this analytical cross-sectional study, caregivers of children aged 3-12 years with (CHD cases n = 111) and without CHDs (Controls n = 182), underwent face-to-face interviews using a structured questionnaire. The questionnaire items covered several oral health background factors (independent variables) including: child's health status, oral hygiene practices, dental services utilization, mother's level of education, and caregiver's perception and awareness of their child's oral health. The relationship between these factors and occurrence of 'caries' and 'gingivitis' as well as 'child's dental services utilisation' (dependent variables) were explored using multiple adjusted and hierarchal logistic regression analyses. RESULTS: Compared with controls, CHD cases had lower frequencies of brushing and use of fluoridated toothpaste, and their caregivers were less knowledgeable about caries. Among CHD cases, the variables (brushing and fluoridated toothpaste use) had significant impacts on caries prevalence (odd ratio (OR) =5.6, 95% confidence interval (CI): 1.4-22.8 and OR = 0.3, 95% CI: 0.1-0.8 for infrequent compared to frequent ones, respectively) as well as the mother's level of education (OR = 2.6, 95% CI: 1.0-6.4). When differences in background factors were controlled for, the adjusted ORs for caries and gingivitis prevalence in CHD cases compared with controls were 1.8, (95% CI: 1.1-3.2) and 5.3 (95% CI: 2.9-9.4), respectively. Among CHD cases, the child's age (8-12 years: OR = 11.9, 95% CI: 1.9-71.6), and the mother's level of education (lower education: OR = 0.2, 95% CI: 0.03-0.9) were significantly associated with the child's dental services utilisation. CONCLUSIONS: Lower frequencies of brushing and use of fluoride tooth paste were reported among CHD cases, and brushing had the predominant significant impact on caries prevalence. The child's age and the mother's level of education were the main factors affecting the child's (CHD cases) dental services utilisation.

Oral health among children with congenital heart defects in Western Norway.

AIM: This was to describe oral health in children with congenital heart defects (CHD), to evaluate association of different background variables with oral health, and to compare caries prevalence at dentine level with caries data in the general population. METHODS: In this cross-sectional study, 5-year-old children in Western Norway with a need for lifelong follow-up due to CHD were invited to participate (n = 100). Children born in 2005, 2006, and 2007 underwent a comprehensive oral health examination during the period 2010-2012. Caries prevalence at the dentine level was compared with data available for 5-year-old children from the general population of Western Norway (n = 18,974). RESULTS: The response rate was 67 %. Caries prevalence in children with CHD at d1-5mft was 37.3 % and at d3-5mft 25.4 %. Few children (n = 4) had experienced fillings, indicating an unmet need for operative treatment. Enamel lesions (d1-2s) exceeded dentine lesions (d3-5s) in the study group, 60 % versus 40 %, indicating a significant need of non-operative treatment. At dentine level, caries prevalence in children with CHD was significantly higher than in children in the general population (25.4 versus 18.3 %). Erosion was more prevalent than caries (50.7 versus 37.3 %). In total, 37.3 % of all children had d3-5mfs caries, erosion (grades 3 or 4), developmental defects of enamel (DDE) with post-eruptive breakdown of enamel and exposure into dentine, or combinations of the diagnoses. Investigated background factors did not significantly affect caries, erosion, or DDE. CONCLUSION: More than a third of the children with CHD were found to have an oral health status that may imply risk for systemic hazardous effects.

Caries increment in primary teeth from 3 to 6 years of age: a longitudinal study in Swedish children.

AIM: To longitudinally follow and analyse caries prevalence and development in primary dentition in Swedish preschool children from 3 to 6 years of age. STUDY DESIGN: A longitudinal clinical study. METHODS: Three hundred 3-year-old children in the Public Dental Service were consecutively included. The children underwent annual clinical examinations at 3, 4, 5 and 6 years of age, performed by four calibrated dentists in clinical settings. Initial (d1-2) and manifest (d3-5) lesions were registered at surface and tooth level. Radiographs were taken when indicated and possible. STATISTICS: Chi-squared test was used for group comparisons. Friedman's test, Wilcoxon non-parametric test and logistic regression analyses explored caries development over the years. RESULTS: The parents of 271 children agreed to their children participating in the study (total dropout rate at 6 years, 10.3%). At baseline, 27.3% of the children had carious lesions (d1-5 mean 0.98, SD ± 2.44), and only 50.6% of the children were totally caries-free at 6 years (d1-5 mean 1.88, SD ± 2.81). Initial carious lesions made up the greater share at all ages. The greater part of the caries increment occurred between 3 and 4 years of age (p < 0.001). Having initial and/or manifest carious lesions at 3 years of age was a significant explanatory factor for new lesions at 6 years of age (OR 2.29; 95% CI 1.58-3.31). CONCLUSION: Children with an early caries experience had a high risk of further disease progression. Oral health promotion and prevention programmes should target small children and their carers.

The relationship between caries in the primary dentition at 5 years of age and permanent dentition at 10 years of age - a longitudinal study.

OBJECTIVES: To explore a possible relationship between the caries experience and pattern in the primary dentition at 5 years of age and the permanent dentition at 10 years of age. Further, to examine the possibility of predicting children in a caries-risk group at 5 years verified at 10 years of age. MATERIALS AND METHODS: A sample of 186 children (90 males) were clinically examined as 5-year-olds and re-examined as 10-year-olds by calibrated dentists. A five-graded diagnostic system including enamel caries was used. Bitewing radiographs were taken. A true risk group of children at 10 years were defined as those with at least one dentin or filled lesion on the mesial surface of 6-year molars, and/or on incisors, and/or total DMFS (decayed, missing, and filled surfaces) more than 1 SD above the mean. The prediction was measured in terms of OR (odds ratio), sensitivity/specificity, and receiver operating characteristic curves. RESULTS: Statistically significant correlations (r=0.5) were found between the caries experience in the two dentitions as well as between the primary second molars at baseline and the permanent teeth at 10 years. 'Primary second molars' and 'all primary molars' were the most powerful predictors for allocation into the risk group (24% of the sample). The highest achieved sum of sensitivity and specificity, 148%, was attained at a cut-off point above two carious surfaces in enamel and/or dentin in primary second molars. CONCLUSIONS: Statistically significant relationship in disease between the dentitions was found. More than two surfaces with caries experience in primary second molars are suggested as a clinically useful predictor at 5 years of age for being at high risk at age 10.

Caries patterns in an urban preschool population in Norway.

AIM: This was to describe the prevalence, severity and distribution of caries in a preschool population in Oslo, Norway, and to compare the findings in subgroups according to immigrant status and age. Furthermore, the present data should serve as a baseline for longitudinal studies. METHODS: The participating children (n = 775), chosen from 7 clinics in the Public Dental Health Service, were of various socioeconomic backgrounds and immigrant status (IM, immigrant group-mother of non-western origin or WN, western native group-mother of western background). The study design was descriptive cross-sectional. The caries examinations were carried out by calibrated examiners, and a detailed 5-graded caries diagnosis system including incipient caries was used. Radiographs (BW) were taken of the 5-year-old children. RESULTS: The percentage of caries free children, aged 3 years (mean 3.0) and 5 years (mean 4.8) were 80.1% and 48.0% respectively. The subgroup of immigrant children showed a considerably higher caries prevalence, it was more often affected by severe caries and experienced an earlier onset of the disease than the subgroup of western native children. The most marked skewness of the caries data was seen within the WN group, especially at 3 years of age. CONCLUSIONS: The present study has revealed disparities in dental health associated with ethnic origin seen at the age of 3. The disparities in dental health are still evident at 5 years of age, but then caries is more common for the whole population.

Caries in primary teeth at 5 and 10 years of age: a longitudinal study.

AIM: This was to explore the caries development in the primary dentition in children aged 5 and later when they were 10, with an emphasis on the caries increment according to type of teeth and surfaces. METHODS: The study was a prospective, longitudinal survey where the children were examined in 1993 when they were 5 years of age (n=217) and re-examined in 1998 when they were 10 (n=186). Caries was examined clinically and with radiographs by calibrated dentists based on a caries diagnostic grading system from 0 to 5. Primary incisors were excluded from the registrations at 10 years of age, while teeth exfoliating during the period were included, based on notes from the dental records. RESULTS: Intra- and inter-examiner reliability ranged from kappa 0.62 to 0.90. Dmfs at 5 years was 5.4 (incisors included) and 7.4 at 10 years (incisors excluded, other exfoliated teeth included). The mean caries increment during the age period showed no significant difference between children with and without caries at 5 years of age. Molar-approximal lesions dominated the increment, and when such lesions were diagnosed at 5 years of age, there was an increased risk for more severe caries (dentine lesions) during the period. CONCLUSION: The caries increment in the primary dentition is considerable for the majority of children during the age period 5-10 years. Even if a risk assessment based on the prevalence of approximal caries at 5 years of age may be useful for deciding individual recall intervals, the results of this study seem to suggest frequent check-ups are needed for the whole population.