Quantitative analysis of salivary and biofilm bacteria associated with cavitated and non-cavitated carious lesions in pre-school children.

OBJECTIVE: To quantify and compare Streptococcus mutans (S. mutans) and Lactobacillus fermentum (L. fermentum) in saliva and biofilm of caries-free children to those with cavitated and non-cavitated lesions. DESIGN: One hundred and thirty-five 3-4 years old children were grouped (n = 45 in each group) according to their caries status: Clinical examination was done by a calibrated examiner. Biofilm and saliva were collected to quantify the microorganisms using qRT-PCR. The decayed-missing-filled surfaces (dmfs) was calculated by adding the number of decayed (ICDAS-II score 3-6), filled (ICDAS-II score 7 and 8) and missing (ICDAS-II score 9) surfaces due to caries. The correlation between the bacterial amounts and the number of carious surfaces was evaluated using Spearman's correlation coefficient. The levels and proportions of the microorganisms were compared using the Kruskal-Wallis test at an α-level of 0.05. RESULTS: The quantity of S. mutans and L. fermentum was significantly higher in saliva and biofilm of children with cavitated lesions, followed by those with non-cavitated lesions and the lowest in caries-free children. Also, salivary and biofilm S. mutans, along with biofilm L. fermentum levels, significantly correlated with the number of non-cavitated surfaces; while salivary and biofilm S. mutans and L. fermentum levels significantly correlated with the number of cavitated surfaces. Additionally, dmfs scores significantly correlated with the salivary and biofilm S. mutans and L. fermentum levels. CONCLUSIONS: S. mutans and L. fermentum in saliva and biofilm samples are associated with caries lesion severity.

Apps for Promoting Children's Oral Health: Systematic Search in App Stores and Quality Evaluation.

BACKGROUND: Increasingly, mobile apps are being used to promote oral care. Many of them are aimed at children. OBJECTIVE: This study aimed to systematically search and evaluate apps that promote oral care and hygiene for children. METHODS: A broad search strategy (13 keywords) was developed to identify apps from Apple's App Store and the Google Play Store in April 2019. After reviewing the apps' titles and summaries, potentially relevant apps were downloaded for viewing. The quality of the apps that met the inclusion criteria was assessed by the Health on the Net Foundation Code of Conduct (HONcode) criteria for medical and health websites and the Scientific Basis of Oral Self-care (SBOSC). RESULTS: More than 3000 Apps were identified and 54 relevant apps informed the review. The quality of the apps according to the HONcode criteria was generally low. The mean HONcode score was 1.8/8.0. One-quarter of the apps had a HONcode score of 0 (14/54, 26%). The SBOSC score of the apps was evaluated based on a 6-point scale. The mean SBOSC score was 1.5/6.0; 19% (10/54) of the apps had a score of 0. There was a significant and positive correlation between HONcode and SBOSC scores (r=0.37; P<.01). More recently uploaded apps had significantly higher HONcode scores (P<.05). CONCLUSIONS: There are many apps aiming to promote oral self-care among children. The quality and scientific basis of these apps are low. Newer apps are of higher quality in terms of scientific basis. There is a need to ensure high-quality and evidence-based apps are available. The effectiveness of apps in terms of oral care and clinical outcomes among children needs to be evaluated.

Horizontal Transmission of Streptococcus mutans in Children and its Association with Dental Caries: A Systematic Review and Meta-Analysis.

Purpose: To systematically evaluate the horizontal transmission of Streptococcus mutans in children and analyze its relationship with dental caries. Methods: Seven databases were searched for observational studies that have determined the transmission of S. mutans among children younger than seven years. Selection of included studies, data extraction, and quality assessment using Downs and Black's (1998) scoring system were performed. The inverse variance random-effect approach was used to pool the results, and statistical heterogeneity was evaluated using I-squared statistics. Results: Fifteen studies were included for qualitative synthesis, five of which were pooled for quantitative analysis. The risk ratio (RR) of sharing only one genotype in caries-free children versus children with caries was found to be 0.60 (95 percent confidence interval [95% CI] equals 0.45 to 0.80; P ≤ 0.001). The RR of sharing more than one genotype was 1.46 (95% CI equals 1.13 to 1.89; P=0.004) in children with caries versus caries-free children. These findings imply that children sharing only one genotype have a 40 percent lesser risk, and children sharing more than one genotype have a 46 percent higher risk of having dental caries. Conclusions: The systematic review provides evidence of the horizontal transmission of S. mutans and its association with dental caries.

Paediatric dental care during and post-COVID-19 era: Changes and challenges ahead.

BACKGROUND: COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus is transmitted through respiratory droplets and by physical contact from contaminated surfaces to the mucosa. Its route of transmission has caused a significant challenge in medical and dental healthcare. OBJECTIVE: This article aims to review the literature and information available on the provision of paediatric dental treatment during and post-pandemic and to provide specific recommendations on the safe provision of paediatric dental care. RESULTS: Children infected by SARS-CoV-2 have no or milder COVID-19 symptoms and are potential vectors in spreading the disease. Routine dental treatment is suspended in many countries because of the increased risk of cross-infection in dental practices. Only emergency dental care is provided for urgent conditions. It is necessary to gradually reinstate regular dental care to paediatric patients and maintain their good oral health. To control the disease transmission and maintain the oral health of the population, minimally intervention techniques that minimise or eliminate aerosol generation, plus comprehensive oral health preventive measures should be practised to safeguard safety at dental practices in this unprecedented time. CONCLUSIONS: Robust infection control guidelines should be implemented in dental clinics to minimise the risk of infection and to ensure the safety of patients and staff during the pandemic. Three levels of preventive care should be practised to prevent oral diseases and improve children's oral health in this COVID-19 era. Treatment should be prioritized to patients in urgent needs and aerosol-generating procedures should be minimized.

Effectiveness of Pit and Fissure Sealants for Preventing and Arresting Occlusal Caries in Primary Molars: A Systematic Review and Meta-Analysis.

OBJECTIVE: The use of pit and fissure sealants have been well supported in permanent teeth, but no concrete evidence is available to support this procedure in primary molars. This review aims to systematically assess randomized controlled trials and summarize the evidence on the effectiveness of different sealants in prevention and arrest of the pit and fissure occlusal caries in primary molars of children. MATERIALS AND METHODS: Four electronic databases were searched from inception to March 2018. Seven studies were included in the qualitative and quantitative syntheses. Two reviewers independently selected studies, extracted data, assessed risk of bias using the revised Cochrane risk of bias tool, and evaluated the certainty in the evidence adopting the Grading of Recommendations Assessment Development and Evaluation approach. Odds ratio and retention rate of different sealants were recalculated and analyzed. RESULTS: This review identified no significant difference in the overall caries incidence and progression when evaluated over 24 months between (1) resin-based sealant (RBS) and glass ionomer sealants (GIS) or resin-modified GIS; (2) conventional and newly developed RBS; (3) autopolymerized and light-polymerized RBS; (4) RBS with topical fluoride application and topical fluoride alone; and (5) RBS with topical fluoride application and resin infiltration with topical fluoride application. The pooled estimates of the mean retention rates of RBS and GIS on primary molars over an 18-months period were 85.94% and 23.18%, respectively. The certainty in the evidence of each outcome was determined as low or very low mainly because of high risk of overall bias and imprecision. CONCLUSION: There are currently insufficient well-controlled randomized controlled clinical trials to determine whether sealants are beneficial in preventing or arresting noncavitated occlusal caries in the primary molars.

Oral health status of children with epilepsy in Hong Kong.

AIM: This study assessed and compared the oral health status, dental trauma experience and oral health habits of children with and without epilepsy. METHODS: Thirty-five children with epilepsy aged 3-18 years old were recruited from the pediatric neurology clinics of 2 university-affiliated district hospitals. A sample of 35 age- and gender-matched healthy children was recruited as controls. Clinical data on caries, gingival health, oral hygiene level and dental trauma were collected and compared between the groups. Information about children's oral health habits and reported dental trauma experience were obtained by structured questionnaire. RESULTS: Children with epilepsy had significantly poorer gingival health than healthy controls. No significant differences in dental caries experience, oral hygiene level, dental trauma experience, oral health habits and dental care service utilization were observed between the children with and without epilepsy. Among the children with epilepsy, those taking more than 1 antiepileptic drug had a greater prevalence of dental caries when compared with those receiving mono-antiepileptic drug therapy. The presence of gingival hyperplasia indicated poorer gingival health in epileptic children. CONCLUSION: The study shows that children with epilepsy had poorer oral health status in terms of gingival health than those without epilepsy.

Unerupted permanent incisors and associated dental anomalies.

AIM: The aim of the present study was to investigate the association between unerupted permanent incisors and dental anomalies among children and adolescents. METHODS: The clinical records of patients between January 2005 and December 2014 were retrieved to identify those with unerupted permanent incisors. A retrospective audit on the presence or absence of any dental anomalies was done from all available records of the included patients. RESULTS: A total of 266 patients with 320 unerupted permanent incisors were identified from the 15 987 patients in the study. Among the unerupted permanent incisors, 222 (69.4%) were associated with dental anomalies, which was significantly higher than those showing an absence of dental anomalies (N = 98, 30.6%, P < 0.001). For the unerupted maxillary central incisors, a significantly higher proportion was associated with supernumerary teeth (P < 0.001). For the unerupted maxillary lateral incisors, a significantly higher proportion was associated with the ectopic eruption of permanent canines when compared with other dental anomalies (P < 0.001). The presence of the ectopic eruption of permanent canine, double teeth, and hyperdontia was significantly higher among male patients with unerupted permanent incisors. CONCLUSIONS: Unerupted permanent incisors were associated with supernumerary teeth and ectopic eruption of permanent canines. Specifically, a higher proportion of unerupted maxillary central incisors was associated with the presence of supernumerary teeth, whereas a higher percentage of unerupted maxillary lateral incisors was associated with the ectopic eruption of permanent canines.

Prevalence and Data Availability of Early Childhood Caries in 193 United Nations Countries, 2007-2017.

OBJECTIVES: To assess the relationship between health care system and economic factors and early childhood caries (ECC) data availability and prevalence. METHODS: We estimated ECC data for 193 United Nations countries from studies published between 2007 and 2017. We obtained other variables from the World Health Organization and the World Bank databases. We assessed association with ECC data availability by using logistic regression and with ECC prevalence by using linear regression. RESULTS: We included 190 publications from 88 (45.6%) countries. The mean ECC prevalence was 23.8% and 57.3% in children younger than 36 months and children aged 36 to 71 months, respectively. The odds of ECC data availability were significantly higher for countries with more physicians and more dentists. In children younger than 36 months, ECC prevalence was associated with universal health coverage (B = -6.56). In children aged 36 to 71 months, it was associated with growth of gross national income (B = 0.27). CONCLUSIONS: Countries with more physicians and more dentists were more likely to have ECC data. Among those with data, countries with higher economic growth had higher ECC prevalence.

Further investigations are needed for the use of the Early Childhood Oral Health Impact Scale in primary care settings.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Responsiveness and sensitivity of the Early Childhood Oral Health Impact Scale to primary dental care for early childhood caries. Arrow P. Community Dent Oral Epidemiol 2016; 44(1):1-10. SOURCE OF FUNDING: Government: Western Australia Health Department Targeted Research Grant Fund TYPE OF STUDY/DESIGN: Cohort study.

Developing clinical practice guidelines for caries prevention and management for pre-school children through the ADAPTE process and Delphi consensus.

BACKGROUND: This study aims to develop consensus evidence-based clinical guidelines for caries prevention and management by caries risk assessment for pre-school children in Hong Kong. METHODS: Employing the ADAPTE process, guidelines for caries prevention and management by caries risk assessment for pre-school children with a preliminary list of 91 recommendations was complied. External review of the guidelines was conducted by a panel of 41 reviewers from the Hong Kong Society of Paediatric Dentistry using a two-round web-based Delphi process. The reviewers were invited to contribute any comments on the draft-adapted guidelines and rated their agreement with each recommendation using a 9-point Likert scale. During the second round, 36 participants received anonymous feedback from the first round and assessed a narrowed list of 28 recommendations. Recommendations were retained and classified according to the median score and rating percentages by the reviewers. RESULTS: A total of 70 out of 91 recommendations were retained (five reached high consensus, 65 reached consensus), and 21 recommendations were discarded. Recommendations and guidelines were outlined. CONCLUSIONS: Caries prevention and management guidelines for pre-school children were developed for use in Hong Kong using the ADAPTE process and Delphi consensus to develop evidence-based recommendations. This can facilitate the translation of guidelines into dental practice.

Evaluating the impact of caries prevention and management by caries risk assessment guidelines on clinical practice in a dental teaching hospital.

BACKGROUND: Clinical practice guidelines on 'Dental caries prevention and management by caries risk assessment for pre-school children in Hong Kong' were developed using ADAPTE process and Delphi consensus technique. This study aimed to evaluate the feasibility of disseminating and implementing the guidelines, and to evaluate their effectiveness in changing clinical practice. METHODS: The study was conducted in two phases, examining clinical records of pre-school aged patients being treated by non-academic clinical staff in the Paediatric Dentistry Clinic of a dental teaching hospital in Hong Kong. The clinical guidelines were introduced to the staff in a departmental seminar at the end of pre-intervention phase. Post-intervention phase began one month after the introduction of guidelines. Clinical records for three consecutive months were reviewed against standards and recommendations derived from the newly developed clinical guidelines in both phases. The results were assessed by Chi-square test, ANOVA and regression analyses. RESULTS: A total of 237 and 147 clinical records were reviewed in pre-intervention and post-intervention phases, respectively. Guideline adherence percentage increased significantly on almost all aspects of the guidelines in the post-intervention phase (P < 0.05). There were a significant difference in the mean overall guideline adherence score (pre-intervention phase: [Formula: see text] = 14.86 ± 6.11; post-intervention phase: [Formula: see text] = 28.88 ± 8.75) and sub-domain adherence scores between the two phases (P < 0.001). The training grade of the clinicians was the factor associated with changes in evidence-based practice (P < 0.001). CONCLUSIONS: The developed guidelines were effective in translating evidence into best practice. The findings have implication for widespread implementation.

The care of the primary dentition by general dental practitioners and paediatric dentists.

OBJECTIVES: This study aimed to explore the preferred treatment for pre-school children with caries of different severities in primary teeth among general dental practitioners (GDPs) and specialists in paediatric dentistry (PDs) in Hong Kong, and to determine the difference in practice patterns between the groups. METHODS: A random sample of 476 GDPs (approximately 25% of all registered dentists) and all registered PDs (n = 28) were invited to participate in the study. Both groups were asked to select their single most preferred treatment option on eight hypothetical clinical case scenarios in which the severity of dental caries in a single primary molar/incisor of a 4-year-old healthy and cooperative boy differed. The distribution frequency of responses was tabled. Difference in the care approach patterns of GDPs and PDs were examined in bivariate and regression analyses. RESULTS: The overall response rate of the study was 61.5% (310/504). There were significant differences between the GDPs and PDs on their preferred treatment in six out of eight case scenarios (P < 0.05). PDs favoured comprehensive restorative treatment more than GDPs. Non-interventionist approach, atraumatic restorative technique or extraction were more popular among GDPs. Variation in treatment choices was apparent within both GDPs and PDs, in which spread of treatment options was wider among GDPs. CONCLUSIONS: GDPs and PDs have different dental care approach patterns for pre-school children with dental caries. Wide variation in the views about the best way to treat the child exists within both groups.

Sensitivity and responsiveness of the Chinese ECOHIS to dental treatment under general anaesthesia.

OBJECTIVE: This study aimed to investigate the sensitivity and responsiveness of the Chinese version of the Early Childhood Oral Health Impact Scale (ECOHIS) to dental treatment under general anaesthesia (GA). METHODS: A consecutive sample of primary caregivers of children (aged 5 and younger) with early childhood caries (ECC) attending a university hospital dental clinic for dental treatment under GA was recruited over a 12-month period. Caregivers self-completed the ECOHIS prior to and 3 months following their child dental treatment under GA. In addition, caregivers rated the change in their child's overall health condition compared to before treatment on a global transition scale. Sensitivity of the measure was assessed by determining distribution changes in ECOHIS scores; responsiveness was assessed by investigating whether the observed changes took the form of a gradient according to the global transition judgement, in terms of the observed change in scores and effect size. RESULTS: Following treatment under GA, there was significant changes in ECOHIS scores (P < 0.01) and many of its sub-domains. The magnitude of change (effect size) of the total ECOHIS following treatment was 0.89 and among sub-domains ranged from -0.29 to 1.33. There was an observed gradient in the changes of ECOHIS scores (and effect sizes) in relation to global transition judgement of oral change following treatment, supporting the responsiveness of the measure. CONCLUSIONS: The Chinese version of ECOHIS is sensitive and responsive to dental treatment of ECC under GA.

A comparison of a generic and oral health-specific measure in assessing the impact of early childhood caries on quality of life.

OBJECTIVES: The aim of this study was to compare the performance of a generic health-related quality-of-life measure, the Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0) and an oral health-specific quality-of-life measure, the Early Childhood Oral Health Impact Scale (ECOHIS) in assessing the impact of severe early childhood caries (S-ECC) on the children's quality of life. METHODS: A trained and calibrated examiner conducted a clinical oral assessment of 111 children (mean age: 49 +/- 12 months): 64 of whom were categorized as having S-ECC and 47 as being caries-free. Primary caregivers completed a Chinese version of the PedsQL 4.0 and the ECOHIS. Clinical examinations were conducted blind of the parental assessments. RESULTS: The ECOHIS scores were significantly higher for the S-ECC group than for the caries-free group (P < or = 0.001). No significant difference was found between the PedsQL 4.0 scores in relation to caries status, except for the subscale of physical functioning (P = 0.04). Correlation of caries status with the ECOHIS scores was strong (r = 0.66; P < 0.01). No significant correlation was found between PedsQL 4.0 scores and caries status (r = 0.02; P > 0.05). CONCLUSIONS: The oral health-specific measure, ECOHIS, shows better discriminant property between children with S-ECC and caries-free children than the generic measure, PedsQL 4.0. The ECOHIS appears more sensitive than PedsQL 4.0 in assessing the impact of dental caries on the life quality of preschool children.

Translation and validation of a Chinese language version of the Early Childhood Oral Health Impact Scale (ECOHIS).

OBJECTIVE: This study aimed to adapt the Early Childhood Oral Health Impact Scale (ECOHIS) for pre-school children in a Chinese speaking community and to investigate its psychometric properties (validity and reliability). METHODS: A Chinese language version of the ECOHIS was derived through a forward-backward translation and tested for face and content validity among a focus group. A convenient sample of pre-school children (n = 111) was recruited (including a sub-sample with early childhood caries and caries-free children). Parents of the children self-completed the derived Chinese-ECOHIS measure. Validity of the measure was assessed by investigating the relationship between dental caries status and Chinese-ECOHIS scores (construct and criterion validity). A sub-sample of the parents repeated the ratings of the measure to enable reliability assessments. Both internal and test-retest reliability were determined. RESULTS: A Chinese version of ECOHIS was derived with minor modification to the original version. Chinese-ECOHIS scores were associated with children's caries experience (dmft) (r = 0.66, P < 0.05) supporting convergent validity. In addition, variations in ECOHIS scores were apparent with respect to caries and caries-free groups (P < 0.001), supporting the ability to distinguish between patient groups. Cronbach's alpha values (internal reliability) for total ECOHIS score were 0.91 and intraclass correlation coefficient value (test-retest reliability) was 0.64. CONCLUSIONS: A Chinese version of the ECOHIS was developed and demonstrated acceptable validity and reliability. These findings can enable assessments of pre-school child oral health-related quality of life in Chinese speaking communities.