Vitamin D status of children with severe early childhood caries: a case-control study.

BACKGROUND: Severe Early Childhood Caries (S-ECC) affects the health and well-being of young children. There is limited research in this area, though evidence suggests that children with S-ECC are at an increased risk of malnutrition. The purpose of this study was to determine the association between vitamin D (25(OH)D) levels and S-ECC. METHODS: This case-control study was conducted from 2009 to 2011 in the city of Winnipeg, Manitoba, Canada. 144 preschool children with S-ECC were recruited from a local health centre on the day of their slated dental surgery under general anesthetic. 122 caries-free controls were recruited from the community. Children underwent a blood draw for vitamin D (25(OH)D), calcium, parathyroid hormone, and albumin levels. Parents completed an interviewed questionnaire assessing the child's nutritional habits, oral health, and family demographics. Analyses included descriptive and bivariate statistics as well as multiple and logistic regression. A p value ≤ 0.05 was significant. RESULTS: The mean age of participants was 40.8 ± 14.1 months. Children with S-ECC had significantly lower mean 25(OH)D (68.9 ± 28.0 nmol/L vs. 82.9 ± 31.1, p < 0.001), calcium (p < 0.001), and albumin (p < 0.001) levels, and significantly higher parathyroid hormone (p < 0.001) levels than those caries-free. Children with S-ECC were significantly more likely to have vitamin D levels below recognized thresholds for optimal and adequate status (i.e. < 75 and < 50 nmol/L, respectively). Multiple regression analysis revealed that S-ECC, infrequent milk consumption, and winter season were significantly associated with lower 25(OH)D concentrations. Low 25(OH)D levels, low household income, and poorer ratings of the child's general health were significantly associated with S-ECC on logistic regression. CONCLUSION: Children with S-ECC appear to have relatively poor nutritional health compared to caries-free controls, and were significantly more likely to have low vitamin D, calcium, and albumin concentrations and elevated PTH levels.

Association between iron status, iron deficiency anaemia, and severe early childhood caries: a case-control study.

BACKGROUND: Severe tooth decay is known to affect the health and well-being of young children. However, little is known about the influence of Severe Early Childhood Caries (S-ECC) on childhood nutritional status. The purpose of this study was to contrast ferritin and haemoglobin levels between preschoolers with S-ECC and caries-free controls. METHODS: Children were recruited as part of a larger case-control study examining differences in nutritional status between those with and without S-ECC. Preschoolers with S-ECC were recruited on the day of their dental surgery, while caries-free controls were recruited from the community. Parents completed a questionnaire and the child underwent venipuncture. The study was approved by the University's Health Research Ethics Board. Statistics included descriptive, bivariate and logistic regression analyses. A p value ≤ .05 was significant. A total of 266 children were recruited; 144 with S-ECC and 122 caries-free. RESULTS: The mean age was 40.8 ± 14.1 months. The mean ferritin concentration for all children was 29.6 ± 17.9 µg/L while the mean haemoglobin level was 115.1 ± 10.1 g/L. Children with S-ECC were significantly more likely to have low ferritin (p=.033) and low haemoglobin levels (p>.001). Logistic regression analyses revealed that children with S-ECC were nearly twice as likely to have low ferritin levels and were over six times more likely to have iron deficiency anaemia than caries-free controls. CONCLUSIONS: Children with S-ECC appear to be at significantly greater odds of having low ferritin status compared with caries-free children and also appear to have significantly lower haemoglobin levels than the caries-free control group. Children with S-ECC also appear to be at significantly greater odds for iron deficiency anaemia than cavity-free children.

The relationship between vitamin D and severe early childhood caries: a pilot study.

INTRODUCTION: Children with Severe Early Childhood Caries (S-ECC) routinely require dental surgery. S-ECC is known to affect childhood health and well-being. The objective of this pilot study was to assess vitamin D [25(OH)D] levels and determine whether differences exist between children with and without S-ECC. METHODS: During July-September 2008, children undergoing surgery for S-ECC < 72 months of age from southern Manitoba were recruited. Age-matched controls were caries-free. Parents completed an interviewed questionnaire. A serum sample was obtained for 25(OH)D and parathyroid hormone (PTH) levels. This study was approved by the University of Manitoba's Ethics Board. Statistics included chi-square analysis, t-tests, and multiple and logistic regression. A p value of <= 0.05 was significant. RESULTS: Thirty-eight children participated (50 % with S-ECC). There was no significant age difference between groups (p = 0.82). The majority of the entire sample (84.2 %) had inadequate vitamin D levels. Children with S-ECC had lower concentrations of 25(OH)D (52.9 ± 15.1 nmol/L vs. 64.4 ± 21.3, p = 0.032) and were at twice the odds of having inadequate levels (<75 nmol/L). Children with S-ECC also had significantly higher PTH levels than caries-free children (53.5 ± 17.6 cm/L vs. 33.9 ± 12.9, p < 0.001). A greater number with S-ECC had elevated PTH levels (68.4 % vs. 21.1 %, p < 0.01). CONCLUSIONS: This pilot study is the first to report differences in 25(OH)D between those with S-ECC and cavity-free controls. Children with S-ECC have lower vitamin D levels and increased PTH levels compared to age-matched controls.

Early childhood caries among Hutterite preschool children in Manitoba, Canada.

INTRODUCTION: This study investigated the prevalence of early childhood caries (ECC) among Hutterite preschool children from different colonies in southwestern Manitoba, Canada. METHODS: Following informed consent from the child's parent, children under 72 months of age underwent a dental screening examination. Approval was granted by the University of Manitoba's Health Research Ethics Board. RESULTS: A total of 66 children with a mean age of 40.1 ± 20.1 months participated. The prevalence of ECC was 53%, while the mean decayed, extracted and filled teeth (deft) score was 2.8 ± 4.0 (range 0-20). A total of 42.4% had severe ECC (S-ECC). There was no difference in prevalence among the 6 participating colonies. Only 15 children had already been to the dentist, with the majority of these visits due to decay or dental pain. Of those, the mean age for a first visit was 2.7 ± 0.6 years. Children with ECC were determined to be significantly older than those who were caries-free (p<.0001). Early childhood caries and higher caries rates were associated with lower maternal ratings of their child's dental health. Both ECC and increased deft scores were significantly associated with the number of children in the home. CONCLUSIONS: This is the first study to report the prevalence of primary tooth decay in Hutterite children. Rates were comparable with other Canadian data for rural dwelling children. Effective and culturally appropriate prevention and health promotion activities are warranted, including fluoride varnish and early dental visits.