Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective.

BACKGROUND: This paper is a summary of the proceedings of the International Association of Paediatric Dentistry Bangkok Conference on early childhood caries (ECC) held in 3-4 November 2018. AIM: The paper aims to convey a global perspective of ECC definitions, aetiology, risk factors, societal costs, management, educational curriculum, and policy. DESIGN: This global perspective on ECC is the compilation of the state of science, current concepts, and literature regarding ECC from worldwide experts on ECC. RESULTS: Early childhood caries is related to frequent sugar consumption in an environment of enamel adherent, acid-producing bacteria in a complex biofilm, as well as developmental defects of enamel. The seriousness, societal costs, and impact on quality of life of dental caries in pre-school children are enormous. Worldwide data show that ECC continues to be highly prevalent, yet infrequently treated. Approaches to reduce the prevalence include interventions that start in the first year of a child's life, evidence-based and risk-based management, and reimbursement systems that foster preventive care. CONCLUSIONS: This global perspective on ECC epidemiology, aetiology, risk assessment, global impact, and management is aimed to foster improved worldwide understanding and management of ECC.

A Controlled Study of Pre-Eruptive Intracoronal Resorption and Dental Development.

AIM: To compare the prevalence of PEIR in Australian and Saudi Arabian children and to investigate the relationship of PEIR with dental development. STUDY DESIGN: Panoramic (PAN) radiographs of 842 Australian and 456 Saudi children were screened for PEIR. The dental ages of the children with and without PEIR were assessed from the PAN radiographs using the method of Demirjian and co-workers. RESULTS: The subject prevalence of PEIR was not statistically significant between Australian (2%) and Saudi children (0.6%) (p>0.1). The teeth most commonly affected by PEIR were the mandibular second molars and premolars. Dental impaction was observed in 31% of teeth with PEIR compared to only 0.1% of control teeth (p<0.0001). Children with PEIR showed a mean delay in dental development of 0.54±0.85 years compared with ageand gender-matched controls (p<0.0001). CONCLUSIONS: The present study provides the first evidence that there are no differences in PEIR prevalence between Australian and Saudi populations, and that dental development is significantly delayed in children with PEIR.

Interference of Antimicrobial Activity of Combinations of Oral Antiseptics Against Streptococcus mutans, Streptococcus sanguinis, and Lactobacillus acidophilus.

PURPOSE: The purpose of this study was to compare the effects of combinations of sodium fluoride and antiseptic compounds on the growth of Streptococcus mutans, Streptococcus sanguinis, and Lactobacillus acidophilus. METHODS: The agar diffusion assay was used to determine bacterial growth inhibition. RESULTS: Of the combinations tested, 0.1 percent sodium fluoride and five percent povidone iodine produced synergistic antibacterial effects against S. mutans and S. sanguinis. The combination of 10 percent povidone iodine and 0.5 percent sodium hypochlorite produced additive antibacterial effects against L. acidophilus. Interference was seen in some combinations such as 0.01 percent chlorhexidine and 0.25 percent sodium lauryl sulphate, 0.5 percent sodium hypochlorite and 10 percent povidone iodine, and 0.01 percent cetyl pyridium chloride and 0.1 percent sodium fluoride. However, 0.1 percent sodium fluoride combined with 0.01 percent chlorhexidine did not interfere with the antibacterial effects of chlorhexidine against S. mutans or S. sanguinis. CONCLUSIONS: Combinations of common antiseptics and fluoride compounds can produce interference, synergistic, or additive effects. The combination of 0.1 percent sodium fluoride and five percent povidone iodine had the greatest potential for suppression of S. mutans.

Effects of water fluoridation on caries experience in the primary dentition in a high caries risk community in Queensland, Australia.

OBJECTIVES: In December 2008, artificial water fluoridation was introduced for the first time to the Logan-Beaudesert district in the state of Queensland, Australia. The aim of this study was to evaluate the effects of water fluoridation in the primary dentition in this community after a period of 36 months. METHODS: Children aged 4-9 years with clinical examinations and bitewing radiographs (BWs) taken before water fluoridation (pre-F) were randomly selected as comparison controls for age matched children who had been exposed to a mean period of 36 months of water fluoridation (post-F). A total of 201 sets of pre-F BWs from children (mean age 6.95 ± 1.05 years) and 256 sets of post-F BWs from children (mean age 7.19 ± 1.23 years) attending schools in the district were randomly selected. Caries experience in the primary dentition was determined as decayed, missing or filled teeth/surfaces (dmft/dmfs). RESULTS: The caries prevalence for the pre-F group was 87% compared to 75% in the post-F group (Odds ratio (OR): 0.44, 95% CI: 0.27-0.72). Overall, there was a 19 percent reduction of mean dmft from 4.54 in the pre-F group to 3.66 in the post-F group (p = 0.005). After fluoridation, the dmfs was reduced from 6.68 to 5.17 (p = 0.0056). The distal surfaces of maxillary first primary molars experienced the greatest reduction (26%) in caries experience after water fluoridation (p < 0.001). CONCLUSIONS: After only 36 months of water fluoridation there was a significant drop in caries prevalence from 87 to 75% and a 19% reduction in caries experience in a community with one of the highest caries rates in Australia.

Association of erosion with timing of detection and selected risk factors in primary dentition: a longitudinal study.

OBJECTIVE: The aims of this study were to determine the prevalence of erosion in a birth cohort at 24, 36, and 48 months and to investigate risk factors for erosion. METHODS: One hundred and fifty-four children from a birth cohort were followed at 24, 36, and 48 months of age. RESULTS: Of the 154 children examined, 0% (0/154), 7% (11/154), and 28% (40/154) had erosion detected for the first time at 24, 36, and 48 months, respectively (P < 0.001). A cumulative total of 51 (33%) children and 256 (8%) teeth had erosion by the age of 48 months. There were no significant associations between erosive lesions first detected at 36 months and oral hygiene behaviour, medical conditions, or dietary habits reported at the 24- or 36-month examinations (all P > 0.05). In contrast, erosive lesion first detected at 48 months was positively associated with the use of a feeding bottle reported at the 36-month examination (P = 0.026). CONCLUSIONS: The prevalence of dental erosion in young children increased with age, with clinically detectable lesions forming between 24 and 36 months of age. Erosive lesions first detected at 48 months were positively associated with the use of a feeding bottle reported at 36 months.

Assessment of Er:YAG laser for cavity preparation in primary and permanent teeth: a scanning electron microscopy and thermographic study.

PURPOSE: Most studies of cavity preparation using Er:YAG lasers have employed permanent teeth. This study's purpose was to compare the cutting efficiency of an Er:YAG laser versus diamond burs in primary and permanent teeth in order to measure thermal effects on the pulp and evaluate lased surfaces using scanning electron microscopy (SEM). METHODS: A total of 80 primary and permanent teeth were used. Crater depths and mass loss were measured after delivering laser pulses at varying energies onto sound or carious enamel or dentin using the Key-3 laser. Control samples were cut using diamond burs in an air turbine handpiece. Thermal changes were measured using miniature thermocouples placed into the pulp chamber. Lased surfaces were evaluated using SEM. RESULTS: Laser ablation crater-like defects were deeper in dentin than enamel at the same pulse energy. Greater ablation rates for dentin and enamel and significantly more efficient removal of carious tooth structure by laser was present in primary teeth. Temperature rises in the pulp did not exceed the 5.5 degrees Celsius threshold in any teeth during laser ablation. CONCLUSIONS: The Er:YAG laser is an efficient device for cavity preparations in primary teeth, with no unacceptable increases in temperature detected in this model.

Regional odontodysplasia: literature review and report of an unusual case located in the mandible.

The purpose of this report was to describe the clinical, radiological, and histopathological features of a case of regional odonto- dysplasia (RA) in a seven-year-old boy who was followed for approximately two years. The case is unusual in that the dysplasia occurred in the mandible, and there was a normal-appearing tooth within the lesion, suggesting that there may be local factors that determine susceptibility of individual teeth in RA. The diagnosis of RA was based on the typical features of "ghost" teeth and evidence of disrupted calcification characterized by psammomatous bodies, hypomineralization of enamel, and the presence of interglobular dentin. Sequential orthopantomograms provide evidence of delayed dental development.

Bacterial colonization, enamel defects and dental caries in 4-6-year-old mono- and dizygotic twins.

BACKGROUND: Knowledge of the genetic and environmental influences in caries aetiology has relevance for preventive dentistry. AIMS: This classical twin study compared concordance of mutans streptococci (MS) and lactobacilli (LB) colonization, enamel defects, and caries in a cohort of 4-6-year-old mono- (MZ) and dizygotic (DZ) twin pairs. DESIGN: The twins were examined for prevalence and concordance of enamel opacities and hypoplasia, oral counts of MS and LB, and dental caries. Bacterial counts were assessed using a commercial microbiological kit. RESULTS: Thirty-four MZ and 50 DZ twins (mean gestational age 35.0 ± 2.4 weeks, and birthweight 2.4 ± 0.6 kg) were examined. There were no statistically significant differences between MZ and DZ twins in the prevalence of MS, LB, and enamel hypoplasia. Concordance rates for MS and LB presence and prevalence of enamel defects within MZ and DZ twin pairs were not significantly different. There were more children with caries in DZ compared with MZ twins (18% vs 3%, P = 0.0029), most likely due to increased daily frequency of sugar consumption and less toothbrushing. CONCLUSIONS: Concordance data from MZ and DZ twins did not demonstrate any statistically significant difference in susceptibility for enamel defects and colonization of MS and LB.

Cost-effectiveness of a telephone-delivered education programme to prevent early childhood caries in a disadvantaged area: a cohort study.

OBJECTIVES: Early childhood caries is a highly destructive dental disease which is compounded by the need for young children to be treated under general anaesthesia. In Australia, there are long waiting periods for treatment at public hospitals. In this paper, we examined the costs and patient outcomes of a prevention programme for early childhood caries to assess its value for government services. DESIGN: Cost-effectiveness analysis using a Markov model. SETTING: Public dental patients in a low socioeconomic, socially disadvantaged area in the State of Queensland, Australia. PARTICIPANTS: Children aged 6 months to 6 years received either a telephone prevention programme or usual care. PRIMARY AND SECONDARY OUTCOME MEASURES: A mathematical model was used to assess caries incidence and public dental treatment costs for a cohort of children. Healthcare costs, treatment probabilities and caries incidence were modelled from 6 months to 6 years of age based on trial data from mothers and their children who received either a telephone prevention programme or usual care. Sensitivity analyses were used to assess the robustness of the findings to uncertainty in the model estimates. RESULTS: By age 6 years, the telephone intervention programme had prevented an estimated 43 carious teeth and saved £69 984 in healthcare costs per 100 children. The results were sensitive to the cost of general anaesthesia (cost-savings range £36 043-£97 298) and the incidence of caries in the prevention group (cost-savings range £59 496-£83 368) and usual care (cost-savings range £46 833-£93 328), but there were cost savings in all scenarios. CONCLUSIONS: A telephone intervention that aims to prevent early childhood caries is likely to generate considerable and immediate patient benefits and cost savings to the public dental health service in disadvantaged communities.

Genetic, epigenetic, and environmental influences on dentofacial structures and oral health: ongoing studies of Australian twins and their families.

The Craniofacial Biology Research Group in the School of Dentistry at The University of Adelaide is entering an exciting new phase of its studies of dental development and oral health in twins and their families. Studies of the teeth and faces of Australian twins have been continuing for nearly 30 years, with three major cohorts of twins recruited over that time, and currently we are working with twins aged 2 years old to adults. Cross-sectional data and records relating to teeth and faces of twins are available for around 300 pairs of teenage twins, as well as longitudinal data for 300 pairs of twins examined at three different stages of development, once with primary teeth, once at the mixed dentition stage, and then again when the permanent teeth had emerged. The third cohort of twins comprises over 600 pairs of twins recruited at around birth, together with other family members. The emphasis in this third group of twins has been to record the timing of emergence of the primary teeth and also to sample saliva and dental plaque to establish the timing of colonization of decay-forming bacteria in the mouth. Analyses have confirmed that genetic factors strongly influence variation in timing of primary tooth emergence. The research team is now beginning to carry out clinical examinations of the twins to see whether those who become colonized earlier with decay-forming bacteria develop dental decay at an earlier age. By making comparisons within and between monozygotic (MZ) and dizygotic (DZ) twin pairs and applying modern molecular approaches, we are now teasing out how genetic, epigenetic, and environmental factors interact to influence dental development and also oral health.

A randomised, controlled clinical trial comparing chlorhexidine gel and low-dose fluoride toothpaste to prevent early childhood caries.

OBJECTIVES. This randomised, controlled trial compared the effectiveness of 0.12% chlorhexidine (CHX) gel and 304% fluoride toothpaste to prevent early childhood caries (ECC) in a birth cohort by 24 months. METHODS. The participants were randomised to receive either (i) twice daily toothbrushing with toothpaste and once daily 0.12% CHX gel (n = 110) or (ii) twice daily toothbrushing with toothpaste only (study controls) (n = 89). The primary outcome measured was caries incidence and the secondary outcome was percentage of children with mutans streptococci (MS). All mothers were contacted by telephone at 6, 12, and 18 months. At 24 months, all children were examined at a community dental clinic. RESULTS. At 24 months, the caries prevalence was 5% (3/61) in the CHX and 7% (4/58) in the controls (P = 0.7). There were no differences in percentages of MS-positive children between the CHX and control groups (54%vs 53%). Only 20% applied the CHX gel once daily and 80% less than once daily. CONCLUSIONS. Toothbrushing using 304% fluoride toothpaste with or without the application of chlorhexidine gel (0.12%) reduces ECC from 23% found in the general community to 5-7%. The lack of effect with chlorhexidine is likely to be due to low compliance.

A controlled, longitudinal study of home visits compared to telephone contacts to prevent early childhood caries.

BACKGROUND: Home visits (HV) provide excellent opportunities for health promotion. AIM: This longitudinal study compared the effects of HV and telephone contacts (TC) in preventing early childhood caries (ECC) and colonisation of mutans streptococci (MS) and lactobacilli (LB) from 0 to 24 months. DESIGN: A total of 325 children were recruited from community health centres at mean age of 42 days, and randomly assigned to receive either HV or TC. A total of 188 children completed three, 6 monthly HV, and another 58 had three, 6 monthly TC. An additional 40 age-matched children from childcare facilities served as reference controls (RC). At 24 months, all groups were examined at a community dental clinic. RESULTS: At 24 months, three HV children of 188 (1.5%) had caries, compared to four TC of 58 (6.8%) and nine RC of 40 (22.5%) (P < 0.001 for HV versus RC; P = 0.05 for HV versus TC and P = 0.03 for TC versus RC). There were also more children with MS in the TC (47%) and RC (35%) compared to HV (28%) group (P = 0.01 and P = 0.02). CONCLUSIONS: Home visits and telephone contacts conducted 6 monthly from birth are effective in reducing ECC prevalence by 24 months.

A randomized controlled trial of a 10 percent CPP-ACP cream to reduce mutans streptococci colonization.

PURPOSE: The purpose of this study was to investigate the effectiveness of a 10 percent casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) cream to reduce mutans streptococci (MS) colonization and prevent early childhood caries. METHODS: The cohort was randomized at mean age of 11 days old to receive once-daily CPP-ACP cream (n=102) or no product (comparison group; n=89) from the time of first tooth eruption. All mothers were contacted by telephone at six, 12, and 18 months and advised to brush their children's teeth twice daily with low-dose fluoride toothpaste. At 24 months, all children were examined at a community clinic. RESULTS: At 24 months old, one out of 65 (2 percent) children in the CPP-ACP group had caries vs. four out of 58 (seven percent) in the comparison group (difference not statistically significant). There were fewer MS-positive children in the CPP-ACP group (26 percent) vs. the comparison group (47 percent; P=.02). A dose-response effect of CPP-ACP usage on MS was observed, where MS was present in eight percent of regular CPP-ACP users, 28 percent of irregular users, and 47 percent of non-users (P<.02). CONCLUSIONS: CPP-ACP reduced the percentages of mutans streptococci-positive 24-month-old children, although it did not reduce caries prevalence.

Congenital aplasia of the major salivary glands: literature review and case report.

Congenital aplasia of the major salivary glands is rare, and there have been few cases of the condition reported to date. In many cases, absence of the salivary glands is associated with syndromes involving the ectodermal tissues. The xerostomia encountered in affected children is usually associated with increased risk for caries and infections of the soft tissues. The purpose of this paper was to describe the case of a 10-year-old boy with bilateral aplasia of the submandibular and parotid salivary glands and the preventive and restorative treatment rendered. This case study demonstrates the importance of timely diagnosis of this condition in order to prevent the serious oral complications from xerostomia.

Comparison of enamel defects in the primary and permanent dentitions of children from a low-fluoride District in Australia.

PURPOSE: The purpose of this study was to compare developmental defects of enamel (DDE) in the primary and permanent dentitions of children from a low-fluoride district. METHODS: A total of 517 healthy schoolchildren were examined using the modified DDE criteria. RESULTS: The prevalence of DDE in the primary and permanent dentition was 25% and 58%, respectively (P<.001). The mean number of teeth with enamel opacity per subject was approximately threefold compared to that affected by enamel hypoplasia (3.1±3.8 vs 0.8±1.4, P<.001 in the primary dentition and 3.6±4.7 vs 1.2±2.2, P<.001 in the permanent dentition). Demarcated opacities (83%) were predominant compared to diffuse opacities (17%), while missing enamel was the most common type of enamel hypoplasia (50%), followed by grooves (31%) and enamel pits (19%) (P=.04). In the permanent dentition, diffuse and demarcated opacities were equally frequent, while enamel grooves were the commonest type of hypoplasia (52%), followed by missing enamel (35%) and enamel pits (5%; P<.001). CONCLUSIONS: In a low-fluoride community, developmental defects of enamel were twice as common in the permanent dentition vs the primary dentition. In the primary dentition, the predominant defects were demarcated opacities and missing enamel, while in the permanent dentition, the defects were more variable.

Increased traffic exposure and negative birth outcomes: a prospective cohort in Australia.

BACKGROUND: Pregnant women exposed to traffic pollution have an increased risk of negative birth outcomes. We aimed to investigate the size of this risk using a prospective cohort of 970 mothers and newborns in Logan, Queensland. METHODS: We examined two measures of traffic: distance to nearest road and number of roads around the home. To examine the effect of distance we used the number of roads around the home in radii from 50 to 500 metres. We examined three road types: freeways, highways and main roads. RESULTS: There were no associations with distance to road. A greater number of freeways and main roads around the home were associated with a shorter gestation time. There were no negative impacts on birth weight, birth length or head circumference after adjusting for gestation. The negative effects on gestation were largely due to main roads within 400 metres of the home. For every 10 extra main roads within 400 metres of the home, gestation time was reduced by 1.1% (95% CI: -1.7, -0.5; p-value = 0.001). CONCLUSIONS: Our results add weight to the association between exposure to traffic and reduced gestation time. This effect may be due to the chemical toxins in traffic pollutants, or because of disturbed sleep due to traffic noise.

Enamel hypoplasia in the primary dentition of monozygotic and dizygotic twins compared with singleton controls.

BACKGROUND: The study of enamel hypoplasia (EH) and opacity in twins provides insights into the contribution of genetic and environmental factors in the expression of enamel defects. AIM: This study examined prevalence and site concordance of EH and opacity in the primary dentition of 2- to 4-year-old twins and singleton controls to assess the relative contribution of genetics and the environment to the aetiology of these defects. DESIGN: The study sample consisted of 88 twin children and 40 singletons aged 2-4 years of age. Medical histories were obtained and the children examined for enamel defects. RESULTS: The prevalence of EH by teeth was 21% in monozygotic twins (MZ), 22% in dizygotic twins (DZ), and 15% in singleton controls. Twins showed a higher prevalence of EH compared with singletons (P < 0.05). Factors contributing to increase EH in twins were neonatal complications including intubation. There were no significant differences in site concordance of EH within the MZ twin pairs compared with DZ twin pairs when only presence of EH was considered, whereas a greater concordance was noted between MZ twin pairs compared with DZ twin pairs when both presence and absence of EH were considered. CONCLUSIONS: The results suggest that both genetic and environmental factors contribute to observed variation of EH, although it is likely that environmental factors exert a greater influence.