Use of asthma drugs and prevalence of molar incisor hypomineralization.

BACKGROUND: Asthma and molar incisor hypomineralization (MIH) are common diseases among children and have been suspected to be associated with each other. AIM: To examine the association between asthma or the use of asthma drugs and the prevalence of MIH. DESIGN: In a population-based cross-sectional study, we recorded MIH in 9-year-old children in Aalborg Municipality, Denmark, born in the year 2000. We used a unique 10-digit civil personal number to link data on MIH to population-based medical register data. The exposure was inhaled asthma medication from birth date until date of dental examination. The outcome was the overall prevalence of MIH according to use of asthma medication. Odds ratios (OR) of having MIH were adjusted for gender, use of antibiotics and amoxicillin, maternal smoking, pre- and perinatal complication, and hospital admissions. RESULTS: We examined 1837 children, of which 542 (29.5%) had one or more molar(s) with MIH. The adjusted odds ratio of having MIH was 0.95 (95% CI: 0.60-1.51) among children with prescriptions of inhaled asthma medication. CONCLUSION: In this study, where the results have been adjusted for confounding, we found no association between use of inhaled asthma medication and the prevalence of MIH.

Oral health-related quality of life among survivors of childhood cancer.

BACKGROUND. Childhood cancer survivors may have experienced a high number of invasive medical and dental procedures, which may affect their oral health-related quality of life (OHRQoL). AIM. To compare children who have survived cancer and children without cancer with respect to OHRQoL. DESIGN. In a cross-sectional study, we compared the OHRQoL of children treated for cancer at Aalborg Hospital with the OHRQoL of classmates without cancer. All children answered The Danish version of the Child Perceptions Questionnaire (CPQ). Children aged 8-10 (n = 95) answered CPQ(8-10) , with 27 questions, and children aged 11-14 (n = 138) answered the CPQ(11-14,) with 39 questions. RESULTS. Children with cancer rated their OHRQoL better or equal to those without cancer. The mean overall CPQ(8-10) score was 5.6 (95% CI: 2.5-8.6) among 18 children who have survived cancer and 8.8 (95% CI: 7.3-10.3) among those without cancer (n = 77); the mean difference was -3.3 (95% CI: -6.5 to 0.1). The overall mean CPQ(11-14) score was 12.5 (95% CI: 6.8-18.2) among 24 children who have survived cancer and 11.8 (95% CI: 10.3-13.3) among those without cancer (n = 114); the mean difference was -0.7 (95% CI: -4.9 to 6.3). CONCLUSION. Cancer and cancer treatment during childhood was not associated with a decreased OHRQoL.

Maternal use of oral contraceptives during early pregnancy and risk of hypospadias in male offspring.

OBJECTIVES: To examine the association between maternal use of oral contraceptives in early pregnancy and increased prevalence of hypospadias in male offspring. METHODS: We conducted a nationwide population-based case-control study using data from nationwide medical databases. Among live male births between January 1, 1996, and December 31, 2005, we identified all cases of hypospadias recorded anytime postpartum (n = 1683) and randomly selected 10 controls per case without such a diagnosis (n = 15 650), matched by year and hospital of birth. We used conditional logistic regression to estimate prevalence ratios stratified according to time of diagnosis (within 6 months postpartum, >6 months postpartum), controlling for potential confounding factors including maternal age, birth order, maternal smoking, prescriptions for ovulation-inducing drugs, antiepileptics, and antidiabetics, and a maternal diagnosis of pre-eclampsia. RESULTS: We included 1683 cases of hypospadias and 15,650 population controls during 1996-2005. Among the 1186 boys who had their hypospadias diagnosis recorded within 6 months postpartum, 28 (2.4%) had been exposed to oral contraceptives between 30 days before conception until the end of the first trimester. Among the controls, 307 (2.8%) were similarly exposed, corresponding to a prevalence ratio of 0.85 (95% CI: 0.57-1.27) after adjusting for possible confounders. For a diagnosis registered >6 months postpartum, the adjusted prevalence ratio was 1.12 (95% CI: 0.61-2.06). CONCLUSIONS: Our data do not support the hypothesis that maternal use of oral contraceptives around conception is associated with an increased prevalence of hypospadias in the offspring.

Development of Danish version of child oral-health-related quality of life questionnaires (CPQ8-10 and CPQ11-14).

BACKGROUND: The Child Perceptions Questionnaire (CPQ) is a self-reported questionnaire developed to measure oral health-related quality of life in children. The CPQ aims to improve the description of children's oral health, while taking into consideration the importance of psychological aspects in the concept of health. The CPQ exists in two versions: the CPQ8-10 for children aged 8-10 years and the CPQ11-14 for those aged 11-14 years. The aim of this study was to develop a Danish version of the CPQ8-10 and the CPQ11-14 and to evaluate its validity for use among Danish-speaking children. METHODS: The instruments were translated from English into Danish in accordance with a recommended translation procedure. Afterwards, they were tested among children aged 8-10 (n = 120) and 11-14 years (n = 225). The validity was expressed by the correlation between overall CPQ scores and i) self-reported assessment of the influence of oral conditions on everyday life (not at all, very little, some, a lot, very much) and ii) the self-reported rating of oral health. Furthermore, groups of children with assumed decreased oral health-related quality of life were compared with children with healthy oral conditions. Finally, we examined the internal consistency. RESULTS: The correlation between overall CPQ scores and global assessments of the influence of oral conditions on everyday life showed Spearman correlation coefficients of 0.45, P < 0.001 for CPQ8-10 and 0.50, P < 0.001 for CPQ11-14. The correlation between overall CPQ scores and the self-reported rating of oral health showed Spearman correlation coefficients of 0.45, P < 0.001 for CPQ8-10 and 0.17, P = 0.010 for CPQ11-14.The median overall CPQ8-10 scores were 7 for individuals with healthy oral conditions, 5 for individuals with cleft lip and palate, and 15 for individuals with rare oral diseases. The median overall CPQ11-14 scores were 9 for individuals with healthy oral conditions, 9 for individuals with cleft lip and palate, 17.0 for individuals with rare oral diseases, and 22.0 for individuals with fixed orthodontic appliances. There were statistically significant differences between the groups of children with healthy oral conditions and each of the subgroups, except for children with cleft lip and palate.Chronbach'alpha were 0.82 for CPQ8-10 and 0.87 for CPQ11-14. CONCLUSION: The results of this study reveal that the Danish CPQ8-10 and CPQ11-14, seem to be valid instruments for measuring oral health-related quality of life in children although its ability to discriminate between children with cleft lip and palate and healthy children seem to be limited.

Dental anxiety among survivors of childhood cancer: a cross-sectional study.

BACKGROUND: Childhood cancer survivors may have experienced a high number of invasive medical and dental procedures which are known to be risk factors for dental anxiety. AIM: The aim of this study was to examine the prevalence of dental anxiety among children who have survived cancer. DESIGN: In a cross-sectional study, we examined 51 6- to 14-year-old children who had been treated for cancer at Aalborg Hospital, and 192 children without cancer. All children answered the Dental Subscale of the Children's Fear Survey Schedule. Dental anxiety was defined as a dental anxiety score exceeding the mean dental anxiety score + 1 standard deviation for the children without cancer. RESULTS: Children with cancer did not have an increased prevalence of dental anxiety compared with children without cancer: the prevalence ratio was 0.41 [95% confidence interval (CI): 0.10-1.24]. The mean dental anxiety score was 23.1 (95% CI: 21.2-25.0) among children who had been treated for cancer, and 24.7 (95% CI: 23.4-26.0) among children without cancer (mean difference: 1.6; 95% CI: 1.1-4.3). CONCLUSION: Cancer and cancer treatment during childhood were not associated with an increased risk of dental anxiety in this population.

The incidence of interstitial lung disease 1995-2005: a Danish nationwide population-based study.

BACKGROUND: Current data on incidence of interstitial lung diseases (ILDs) are sparse and concerns about an increasing trend have been raised. We examined incidence rates (IRs) of ILDs and changes in IRs between 1995 and 2005. METHODS: All persons with a first-time hospital discharge or outpatient diagnosis of ILD were identified through the Danish National Registry of Patients, which covers all Danish hospitals. Crude and age-standardised IRs were computed for ILD overall, as well as stratified by ILD subcategories. RESULTS: A total of 21,765 patients with ILD were identified. Between 1995 and 1998 the overall standardised IR of ILD decreased from 27.14 (95% CI 25.82-28.46) per 100,000 person-years to 19.36 (95% CI 18.26-20.46) per 100,000 person-years. After 1998 the IR increased considerably, peaking at 34.34 (95% CI 32.84-35.85) per 100,000 person-years in 2002. Subsequently there was a slight decrease. The highest IR was observed in the non-specific category "Respiratory disorders in diseases classified elsewhere". By ILD subcategory, the greatest average increase during the study period was observed in "Respiratory disorders in diseases classified elsewhere". CONCLUSION: The incidence rate of ILD in Denmark increased during the study period, most pronounced for ILDs associated with systemic diseases.

Prevalence and distribution of demarcated opacities in permanent 1st molars and incisors in 6 to 8-year-old Danish children.

OBJECTIVE: To estimate the prevalence and describe the distribution of demarcated opacities and possible consequences of this condition in permanent 1st molars and incisors in Danish children. MATERIAL AND METHODS: Among all 6 to 8-year-old children in two municipalities, 745 (83.6%) were clinically examined for the occurrence of creamy-white or yellowish-brown demarcated opacities, posteruptive breakdown of tooth substance in relation to the opacities, atypical restorations, and extractions, i.e. restorations or extractions as a result of the occurrence of demarcated opacities. RESULTS: In 647 children with four fully erupted permanent 1st molars, the prevalence of demarcated opacities and of lesions with loss of tooth substance due to demarcated opacities in any 1st molar was 37.3% (95% confidence interval (95% CI) 33.6-41.0%) and 6.3% (95% CI 4.7-8.5%), respectively. Permanent incisors were 2.5 times more frequently affected among children with one or more affected permanent 1st molar than among children with no such teeth. Demarcated creamy-white opacities were the type of lesion found most frequently, and the most frequently affected tooth types were the upper central incisors followed by 1st molars. CONCLUSIONS: Nearly half of the examined 6 to 8-year-old children had permanent 1st molars or incisors with demarcated opacities. More than 6% of the children had macroscopic loss of tooth substance due to demarcated opacities.

A population-based observational study of dental caries among survivors of childhood cancer.

BACKGROUND: The few published studies on caries among childhood cancer survivors are small and their results are conflicting. The study aim was to examine the risk of dental caries among children who have survived cancer. PROCEDURE: We included 299,426 7-year-old, 313,461 12-year-old, and 301,930 15-year-old children born between 1984 and 1988 in a nationwide population-based study linking records from Danish Cancer Registry with records from the national database on oral health. Children whose dental examinations had been preceded by a cancer diagnosis (288 7-year-old, 459 12-year-old, and 526 15-year-old) were compared with children without cancer according to presence of caries: caries-free children; children with any caries experience; and children with severe caries experience (i.e., caries in one or more smooth tooth surface). RESULTS: Children diagnosed with cancer before the age of 5 years did not have increased caries prevalence in permanent teeth at ages 12; and 15. Children diagnosed with cancer between 5 and 6 years of age had an increased prevalence of severe caries at age 12 years (prevalence ratio (PR) = 1.59 (95% CI: 1.09-2.31; P = 0.02)), but this difference disappeared by age 15. For children diagnosed with cancer at 5 or 6 years of age and who received radiation therapy the PR of severe caries was 1.52 (95% CI: 0.97-2.37; P = 0.07), 2.13 (95% CI: 0.89-5.10; P = 0.09), and 0.31 (95% CI: 0.07-1.45; P = 0.13) at ages seven, 12 and 15 years respectively. CONCLUSION: Cancer and cancer treatment during childhood are risk factors for caries.

Maternal use of oral contraceptives and risk of hypospadias - a population-based case-control study.

The aim of this population-based case-control study was to examine the risk of isolated hypospadias in boys born to mothers who have used oral contraceptives in early pregnancy. The study was based on data from the Hungarian Case-Control Surveillance of Congenital Abnormalities from 1980 to 1996, and included 3,038 boys with hypospadias (cases), 24,799 boys without congenital abnormalities (CA-free controls), and 11,881 boys with abnormalities other than hypospadias. We used unconditional logistic regression to adjust for birth order, maternal age, maternal employment status, maternal diabetes, and pre-eclampsia. When comparing cases with CA-free controls the OR for maternal use of OC was 1.21 (95% CI: 0.67-2.17). When comparing cases with boys with other abnormalities, the OR for maternal use of OC was 0.83 (95% CI: 0.46-1.50). Our data showed that self-reported maternal use of oral contraceptives during pregnancy was not associated with an increased risk of hypospadias in the offspring.

Maternal use of selective serotonin reuptake inhibitors and risk of congenital malformations.

BACKGROUND: Human data on the teratogenicity of selective serotonin reuptake inhibitors (SSRIs) are limited. We examined the association between SSRI use during early pregnancy and the risk of congenital malformations in the offspring. METHODS: In a population-based cohort study from Denmark, we identified 1051 women who filled prescriptions for SSRIs from 30 days before conception to the end of the first trimester; of those, 453 filled the prescription during the second or third pregnancy month. We included 150,780 women with no SSRI prescriptions as a reference cohort. Drug use data were extracted from prescription databases. Data on congenital malformations and potential confounders were extracted from hospital discharge registries and the National Birth Registry. RESULTS: The 150,780 women with no SSRI prescriptions gave birth to 5112 (3.4%) children with congenital malformations. The 1051 women with SSRI prescriptions any time during early pregnancy gave birth to 51 (4.9%) children with congenital malformations. The corresponding adjusted relative risk (aRRs) was 1.34 (95% confidence interval = 1.00-1.79). The 453 women with prescriptions during the second or third month of pregnancy gave birth to 31 (6.8%) children with congenital malformations. The corresponding aRR was 1.84 (1.25-2.71). CONCLUSIONS: We found an increased risk of congenital malformations after exposure to SSRIs in early pregnancy. It is unclear whether the effects were causal or due to factors related to the underlying disease. There was no evidence that the association was specific to particular malformations.

Further analysis of the risk of adverse birth outcome after maternal use of fluoroquinolones.

In a database cohort study, the risk of adverse birth outcome in Danish women who redeemed a fluoroquinolone prescription during pregnancy was examined. Among 87 women who redeemed a fluoroquinolone prescription at any time during the pregnancy, the prevalence ratio of preterm birth was 1.4 (95% confidence interval (CI), 0.6-3.2), one woman had a stillbirth, and no children died during the perinatal period. Among 130 women who redeemed a prescription during the first trimester or 30 days before conception, the prevalence ratio of congenital malformation was 0.7 (95% CI, 0.3-2.0) and the prevalence ratio of bone malformations was 2.2 (95% CI, 0.7-6.7). Our study raises the concern that prenatal fluoroquinolone exposure may be associated with an increased risk of bone malformations.

Associations between dental anxiety, dental treatment due to toothache, and missed dental appointments among six to eight-year-old Danish children: a cross-sectional study.

The aims of this study were to estimate the prevalence of missed dental appointments among Danish children at 6 to 8 years of age and to examine the association between dental anxiety, dental treatment due to toothache, and missed dental appointments in a population-based cross-sectional study. The study was conducted in four municipalities in the County of North Jutland, Denmark, and included a total of 1,235 children (response rate 74.1%). Data on missed dental appointments and toothache were obtained from dental records, and data on dental anxiety from the Children's Fear Survey Schedule-Dental Subscale. Overall, 37.7% of children missed one or more dental appointments, while 17.7% missed two or more appointments. These proportions did not differ by age or gender. Among children with dental anxiety, the adjusted OR for an association with two or more missed dental appointments was 1.32 (95% CI: 0.72-2.40), and among children who had dental treatment due to toothache, the adjusted OR of two or more missed dental appointments was 2.61 (95% CI: 1.63-4.18).

Validity of parental-reported questionnaire data on Danish children's use of asthma-drugs: a comparison with a population-based prescription database.

The aim of this study was to examine the validity--estimated as the sensitivity, specificity, and predictive values--of questionnaire-based parental reporting on Danish children's use of asthma drugs. Within a population-based cross-sectional study on the association between asthma and dental anxiety, we compared parental answers on their children's use of asthma drugs during the past 12 months with National Health Service (NHS) data from a prescription database on prescriptions of inhaled beta 2-agonists, inhaled corticosteroids, or both for a period of 14 months preceding the date of posting the parental questionnaires. In four municipalities in North Jutland County, Denmark, in 2001, parents of 1273 children between the ages of 6 and 8 years completed the questionnaire. For frequency of use, the sensitivity increased from 57.9% (95% confidence interval [CI]: 47.8-67.3%) for the answer 'Every day' to 91.6% (95% CI: 84.3-95.7%) when the answers 'Every day', 'Often', and 'Sometimes' were combined. The specificity exceeded 95.9% (95% CI: 94.6-96.9%) for all answers. The positive predictive value (PPV) increased from 64.4% (95% CI: 56.1-72.0%) when the answers 'Every day', 'Often', and 'Sometimes' were combined to 94.8% (95% CI: 85.9-98.2%) for the answer 'Every day'. The negative predictive value (NPV) both exceeded 96.7% (95% CI: 95.5-97.6%) for all answers. Questionnaire-based parental reporting on children's one-year asthma-drug use appears to be valid in epidemiological research depending on the study question and design.

Use of asthma-drugs and risk of dental caries among 5 to 7 year old Danish children: a cohort study.

OBJECTIVE: To estimate the risk of dental caries in 5-7 year old Danish children who received prescriptions for asthma-drugs. DESIGN: Population-based cohort-study based on data from a prescription registry and dental database. Setting The County of North Jutland, Denmark. PARTICIPANTS: 4,920 children born in 1993, and followed to the end of 2000. Main outcome measures Dental caries in primary canines and molars, and permanent teeth. RESULTS: Between the age 3 and 5 years 30.4% of the children received one or more prescriptions for asthma-drugs compared to 18.8% between 5 and 7 years of age. Children often received two or more drugs in combination. Approximately 6% of the children received both inhaled cortico-steroids and inhaled beta2-agonists between 3 and 7 years of age. No increased risk of caries could be shown in the primary teeth, while the relative risk of caries in the permanent teeth was estimated at 1.45 (95% C.I.: 0.99-2.11) in children who received prescriptions of both inhaled beta2-agonists and corticosteroids between 5 and 7 years. Of the 169 children who received prescriptions of both inhaled beta2-agonists and cortico-steroids between the ages of 3 and 7 years, the relative risk was estimated at 1.62 (95% C.I.: 1.03-2.56). CONCLUSIONS: Asthma-drugs may increase the risk of caries in newly erupted permanent molars.

Asthma, ear problems, and dental anxiety among 6- to 8-yr-olds in Denmark: a population-based cross-sectional study.

The aim of this study was to examine the association between asthma, ear problems, and dental anxiety in children in a population-based cross-sectional study. The population included four municipalities in the County of North Jutland, Denmark, in 2001. A total of 1235 children aged 6-8 yr, and their parents, were identified. Data were obtained from a prescription database, from parental-answered questionnaires, and from dental records. Children with asthma were defined as children that had received prescriptions for both inhaled beta2-agonists and corticosteroids during the past year. Data on ear problems and dental anxiety were obtained from the questionnaires. Dental anxiety was measured using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Use of asthma-drugs was associated with dental anxiety (odds ratio = 1.70; 95% confidence interval 0.90-3.22). A history of often ear problems was also associated with dental anxiety (odds ratio = 1.83; 95% confidence interval 1.20-2.80). It is concluded that asthma and ear problems may be risk factors for dental anxiety in children.