Why do my patients still have early childhood caries? a critical appraisal

It is generally thought that early childhood caries (ECC) is a public health problem associated with impaired oral health-related quality of life and high costs for families and the society in general. There are numerous epidemiological studies available from various European countries and current ECC inequalities, not only across Europe but also within countries, are obvious. The burden of caries from different countries and regions can however not directly be compared with each other due to design, methodological and reporting issues. For example, there is no consensus on the definition of ECC, which age group(s) that should be examined, sample selection techniques, calibration and number of examiners, inclusion of non-cavitated early lesions, with or without bitewing radiographs, etc. On top of that, small children are not always cooperative, allowing proper cleaning and drying before the examinations. Consequently, it is not surprising to find that prevalence of ECC, assessed with the WHO-criteria, can vary from 86% in Kosovo to 15% in Italy. Likewise, the prevalence of severe ECC seems to range between 3 and 12% across Europe. The mean dmft is reported to vary 0.9 from 10.9. In spite of the abovementioned limitations, it is possible to trace an increasing tendency in the prevalence of ECC from the north-western to the south-eastern countries of Europe. Within all European countries however, there is a clear relationship between socio-economic inequalities and caries; children to low-income and low-educated parents with and without immigrant background display a higher risk of having caries lesions early in life. Poor and near poor 2-5 year-olds have on average 3 times higher dft than non-poor children and this association can be even stronger in the most developed countries. A further problem is that the majority of the disadvantaged children remain untreated. As a first step to combat existing caries inequalities in preschool children, it is important to better map and understand the disease as well as main socio-economic and behavioral determinants. The reporting of ECC (prevalence and severity) in epidemiologic studies must be standardized and the importance of including 3 and 5-year-old children in periodical examinations should be underlined. The adoption of a validated scoring system that allows proper staging of caries lesions is another key factor that should be adopted.

Objectives:To assess the oral health status and oral health–related quality of life (OHRQoL) of young First Nations and Metis children.Methods:This cross-sectional study assessed the oral health status of Indigenous children <72 mo of age while their parents/caregivers completed a questionnaire, including the Early Childhood Oral Health Impact Scale (ECOHIS), to assess OHRQoL. Analysis included descriptive statistics, bivariate analyses, and multiple regression. A P value ≤0.05 was considered significant.Results:Overall, 146 children were recruited with a mean age of 40.1 ± 21.2 (SD) months, and 49% were male. Among First Nations children, 65.4% had early childhood caries (ECC) as compared with 45.2% among Metis children (P = 0.025). However, there was no statistically significant difference in the prevalence of severe ECC (S-ECC) between First Nations and Metis children (60.6% v. 42.9%, P = 0.051). The mean decayed, missing, and filled primary teeth (dmft) score was 4.9 ± 5.3 (range 0–20), and the mean decayed, missing, and filled surfaces (dmfs) score was 14.5 ± 20.4 (range 0–80). The total mean ECOHIS score was 4.4 ± 5.9 (range 0–25), while the mean Child Impact Section and Family Impact Section scores were 2.6 ± 4.0 (range 0–10) and 1.8 ± 2.8 (range 0–8), respectively. Multiple linear regression showed S-ECC was associated with total mean ECOHIS scores (P = 0.02). Higher total mean ECOHIS scores (which indicates poorer OHRQoL) were observed in children with ECC compared with caries-free children (5.8 v. 2.4, P = 0.0001).Conclusion:Oral health disparities such as ECC and reduced OHRQoL exist among many First Nations and Metis children in Manitoba. This is the first Canadian study exploring the OHRQoL of Indigenous children in addition to their oral health status.Knowledge Transfer Statement:This study is the first to report on the oral health–related quality of life and its relationship to early childhood caries (ECC) among young Canadian First Nations and Metis children. Metis children are just as likely to suffer from severe ECC than First Nations children. The findings of this study have informed community-based and community-developed oral health promotion and ECC prevention activities.

Early Childhood Caries (ECC) is a significant oral health condition that impacts children globally. This manuscript's main objective is to explore ECC's impact on children's oral health-related quality of life (OHRQoL) in Africa, and to highlight the policy and programme recommendations to eliminate untreated ECC as a public health threat in Africa. In Africa, ECC poses a significant public health challenge and has the potential to result in functional disabilities in children. A rapid review of the literature focusing on studies from Africa explored the impact of ECC on children's oral health-related quality of life. The three studies that met the eligibility criteria revealed that ECC negatively impacts multiple dimensions of life, including physical health (pain, malnutrition, chewing difficulties), psychological well-being (low self-esteem, stigma), and social functioning (peer relationships, school attendance). Advanced ECC had more pronounced effects, particularly in the symptom and psychological domains. The paper highlights the urgent need to recognise untreated ECC as a disability within public health frameworks in Africa. Policy recommendations include integrating oral health into primary healthcare systems, expanding community-based prevention programmes, incentivising the production of affordable oral health products, and developing school-based education initiatives. Strengthening oral health workforce capacity and enhancing data collection on ECC prevalence is critical for effective policy formulation and resource allocation. Recognising ECC as a potential disability underscores the need for a multi-sectoral approach to address this neglected public health priority and for prioritising actions to eliminate untreated ECC as the International Day of Persons with Disabilities (December 3) is marked.

This cross-sectional pilot study aims to investigate the prevalence of Early Childhood Caries (ECC) among children aged 3 to 5 years in Mumbai City, Maharashtra, following the COVID-19 pandemic. A total of 91 children were included in the study, with ECC prevalence assessed through standardized examinations and dmfs scoring. Simple random sampling was employed, and data were analyzed using descriptive statistics and inferential tests. The study found a high prevalence of ECC (63.74%) among the study population, with no significant gender-based differences observed in ECC occurrence or severity. Despite similar ECC prevalence rates between boys and girls, the overall burden of ECC underscores the urgent need for targeted interventions and preventive measures. The findings highlight the pressing oral health challenge faced by young children in urban settings post-pandemic and emphasize the importance of comprehensive oral health promotion programs and equitable access to preventive oral healthcare. Addressing modifiable risk factors and integrating oral health services into primary healthcare systems are essential steps toward improving oral health outcomes for children in Mumbai and similar urban environments.

Background: “Early childhood caries (ECC)” is a prevalent and serious oral health issue affecting preschool-aged children globally, with adverse effects on their overall health and well-being. Objective: This center-based research designed to investigate the prevalence and management of ECC among preschoolers within a specific setting and evaluate associated factors. Methods: A cross-sectional research design was employed, involving 300 preschoolers aged 3 to 5 years. Clinical examinations were conducted, and data on demographic characteristics, oral hygiene practices, dietary habits, and dental visits were collected through structured interviews. Statistical analysis was performed to assess ECC prevalence and examine associations between demographic/behavioral factors and ECC severity. Results: The prevalence of ECC among preschoolers was 65%, with a mean dmfs score of 4.2. Factors such as age, gender, socioeconomic status, and oral hygiene practices were associated with ECC severity. Management strategies included topical fluoride application, oral health education, and restorative treatments. Conclusion: ECC remains a significant public health concern among preschoolers. Comprehensive oral health programs targeting this population are essential to mitigate ECC burden and improve oral health outcomes. Further research is needed to address systemic barriers and disparities in ECC prevention and management.

BackgroundEarly childhood caries (ECC) is a public health problem due to its impact on children’s health, development and well being. Little is known about early childhood oral health in the West Indies or the influence of social and behavioural factors on the prevalence and severity of early childhood caries in this preschool population. The aims of this study were to describe the prevalence and severity of ECC in preschool children in a region of central Trinidad and to explore its relationship with social and behavioural factors.MethodA cross-sectional survey was undertaken on children aged 3-5 years-old from a random sample of preschools in central Trinidad. Oral health examinations were conducted for children for whom parental consent was given, using WHO criteria (visual diagnosis / cavitation at d3). A self-reported questionnaire was distributed to all parents and caregivers. Variables included socio-demographics, oral health knowledge, attitudes and behaviours, visible caries experience and treatment need.Results251 children were examined, 50.2% were male with a mean age of 3.7 years (SD 0.67) and 71% were of Indian ethnicity. The prevalence of ECC was 29.1% and the prevalence of severe early childhood caries (S-ECC) was 17.5%. 29.9% of children had some treatment need, with 12% in need of urgent care or referral. Poisson generalized linear mixed model analysis found a higher rate of visible caries experience for children who ate sweet snacks more than twice a day (p < 0.001), had poorer parental dental health ratings (p < 0.0001), a previous dental visit (p < 0.0001) and difficulty finding dental care (p < 0.001).ConclusionThe prevalence and severity of ECC in central Trinidad was related to oral health behaviours and access to dental care. Oral health promotion should include more supportive and practical advice for parents and caregivers of preschool children along with improved access to dental care to enable primary prevention and management of ECC.

BackgroundThe prevalence of early childhood caries (ECC) varies with geographical region and population. The Uygur people, one of 55 officially recognized ethnic minorities in China, have a population of 10,069,346. We performed a preschool-based cross-sectional study of 670 Uygur children from the southern region of Xinjiang, China, to investigate the prevalence and severity of ECC and to identify factors related to the dental health condition of this population.MethodsThe study population of children ranging in age from 3 to 5 years was invited using a three-stage stratified sampling in Kashgar, the westernmost city in China. The “dmft” index was used to assess dental caries. The diagnosis of ECC or severe ECC was based on the oral health diagnostic criteria defined by the American Academy of Pediatric Dentistry. A questionnaire was completed by the children’s caregivers. The survey included questions concerning the children’s sociodemographic background; feeding and eating habits, particularly frequency of sweet beverage and food consumption; dental hygiene-related behaviors; the general oral health knowledge of caregivers; and the dental healthcare experience of caregivers and their children.ResultsA total of 670 Uygur children underwent complete dental caries examination. Most of the children (74.2%) had ECC, with a mean dmft ± SD of 3.95 ± 3.84. The prevalence of severe ECC was 40.1% (N =269), with a mean dmft of 7.72 ± 3.14. More than 99% of caries were untreated. Statistically significant correlations were found between higher ECC prevalence and increased age and lower socioeconomic background, while greater dental health knowledge of the caregiver and positive oral hygiene behaviors were found to be protective. Our findings confirm the multi-factorial etiology of ECC.ConclusionsThe prevalence of ECC among preschool-aged Uygur children in Kashgar was high, particularly among those from lower socioeconomic backgrounds. Caries prevalence was associated with oral hygiene behaviors of children and the general oral health knowledge of caregivers. These factors could be modified through public health strategies, including effective publicity concerning general dental health and practical health advice.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6831-14-136) contains supplementary material, which is available to authorized users.

ABSTRACTBackground:Oral health plays an important role in the general health of pregnant women and their newborns. Our aim was to assess oral health-related quality of life and its association with oral health literacy and dental caries among a group of Iranian pregnant women.Materials and Methods:A cross-sectional study was conducted on 200 pregnant women attending a governmental hospital in Isfahan, Iran, applying a convenient sampling method. Self-administrated questionnaires requested information about demographics, oral health-related quality of life utilizing Oral Health Impact Profile-14 (OHIP-14), and oral health literacy. A senior dental student conducted a clinical examination to record dental caries with Decayed, Missing, and Filled Teeth (DMFT) index. Kolmogorov–Smirnov test, Mann–Whitney U-test, Kruskal–Wallis test, Spearman correlation coefficient, and logistic regression model served for analysis (P < 0.05).Results:The prevalence of oral health impacts on quality of life was 36%. In terms of the severity, the mean score of OHIP-14 was 13.2 ± 9.0 (range: 0–38). The mean score of oral health literacy was 9.7 ± 3.2 (range: 1–16). The mean DMFT was 9.8 ± 5.2. No significant relationship existed between oral health-related quality of life and oral health literacy (P = 0.347). A higher score of OHIP-14 was revealed among participants with higher DMFT index (P = 0.003, r = 0.21). In multivariate analysis, DMFT was independently associated with the likelihood of reporting one or more oral health impacts on quality of life (P < 0.05).Conclusions:Higher caries experience was associated with poorer oral health-related quality of life among pregnant women. Thus, it is recommended to increase quality of life through preventive measures to control the dental caries experience.

Background and AimDental anxiety is a prevalent issue in society, characterized by an uneasy sensation and anticipation of negative experiences in dental settings. In essence, dental anxiety, oral health literacy, and quality of life may have a relationship with each other, however, there is a shortage of evidence examining the interplay between these factors. Therefore, this study aimed to assess the relationship between dental anxiety and oral health literacy (OHL) with oral health-related quality of life (OHRQOL).MethodsThis is an analytical cross-sectional study conducted on 155 patients referred to the Department of Oromaxillofacial Diseases. Three questionnaires consisting of dental anxiety scale, oral health impact profile- 14, and oral health literacy adult questionnaire were used to measure anxiety, health literacy, and the quality of life-related to oral health. Scores were recorded and analyzed by IBM SPSS 24 software using independent samples T-test and ANOVA. Besides, the confirmatory modeling through the goodness of fit index of the model was applied.ResultsThis study involved 155 participants, with a mean age of 38.44 ± 14 years. The majority were females, comprising 99 individuals (63.9%). In this study, 89 patients (57.4%) had dental anxiety. The mean OHL score in the examined participants was 9.88 ± 3.97. Both factors of anxiety (p < 0.001) and OHL (p = 0.012) had a significant effect on the OHRQOL. There was no significant difference in the mean OHRQOL among the three categories of OHL (p = 0.085). The confirmatory modeling showed that only the fourth (p = 0.065) and fifth (p = 0.146) questions of the OHL questionnaire had no significant effect on the total score of OHL. Besides, both factors of anxiety (p < 0.001) and OHL (p = 0.012) had a significant effect on OHRQOL. With an increase of one unit in anxiety, the OHRQOL score increases by 0.31 and for a one-unit increase in the OHL score, the OHRQOL score decreases by 0.66 units.ConclusionIn conclusion, it seems that considering various dimensions of oral and dental health can help patients to have reduced psychological anxiety. Notably, further multicenter studies assessing diverse variables related to dental anxiety, OHL, and OHRQOL, and considering more comprehensive study designs with longitudinal follow-up could help provide insights into how changes in dental anxiety and OHL over time affect OHRQOL.

Early Childhood Caries (ECC) is a global oral health problem, and Peru may be one of the countries with high prevalence of untreated ECC in South America. In this study, we constructed an epidemiologic profile of ECC in Peru through a comprehensive review of published data. The prevalence of ECC, risk factors for it, its impact on child development, and public oral health interventions on ECC have been included. The study revealed extremely high rates of ECC in Peru and significant oral-health disparities. Risk factors for ECC were poverty, high sugar consumption, and low oral health literacy. However, the number of studies is limited and their quality questionable. Oral health has not received high public-health priority in Peru. However, in recent years, new regulations and evidence-based documents (the first Clinical Practice Guideline for the Prevention, Diagnosis, and Management of Caries in Children; the Guideline for Children's healthy Growth and Development; the Law on Healthy Diet; and the Manual on Food Advertising) give hope for the future of infants' oral health in the nation.

Early childhood caries (ECC) is a common oral disease among young Korean children. The purpose of this study was to examine the relationship of ECC with preschool children's oral health behavior and caregivers' oral health in Ulsan, Korea. In 2006, cross-sectional survey of 1214 children under 6 years old and their care givers were surveyed. Two dentists examined according to the WHO criteria. Outcome variable was ECC, and explanatory variables were preschool children's oral health behavior and caregivers' oral health. The chi-square test and multiple log-binomial regression models were performed. The prevalence of simple ECC was 47.5% and that of severe ECC was 34.8%. In bivariate analysis, ECC prevalence was increased according to children's age, caregiver's age, and type of housing. In multiple log-binomial regression models, preschool children's irregular oral checkup [prevalence ratio (PR): 1.7 for simple ECC and 1.8 for severe ECC] and frequent snack and soda drinking (PR: 1.2 for simple ECC, and 1.6 for severe ECC) were significant factors. This study demonstrates that the prevalence of ECC was high among Korean children. Early intervention programs for preschool children's oral health behavior should be developed based on the risk factors identified in this study.

BackgroundThis study assessed the prevalence and severity of early childhood caries (ECC) and identified socioeconomic and behavioral correlates of the disease in preschool children living in Xinjiang.MethodsFor this cross-sectional survey, 1727 children aged 3–5 years in Xinjiang were randomly recruited using a three-stage cluster sampling procedure. The “dmft” index according to the WHO 1997 criteria was used to assess ECC and severe ECC (S-ECC). A questionnaire was completed by caregivers. Variables included sociodemographic characteristics, dietary and oral hygiene behaviors, and access to dental services. The statistical associations of variables with ECC, S-ECC, and dmft were evaluated by univariate and multiple logistic regression analyses.ResultsThe prevalence of ECC was 78.2% and that of S-ECC was 41.2%; mean dmft scores were 5.61 ± 3.56 and 8.17 ± 2.94, respectively. The prevalence of ECC was significantly higher in children from Ining (OR 2.747; 95% CI 2.033–3.713), those whose caregivers had caries (OR 1.78; 95% CI 1.245–2.547), those with a dental visit in the past (OR 2.023; 95% CI 1.429–2.865), and those whose parents had received instructions on oral health care (OR 2.171; 95% CI 1.44–3.272), and increased significantly at age 4 years (OR 2.09; 95% CI 1.506–2.901) and 5 years (OR 2.666; 95% CI 1.855–3.833) and in children who starting tooth brushing at a young age (OR 1.363; 95% CI 1.171–1.587), and decreased significantly in children with a more educated mother (OR 0.817; 95% CI 0.688–1), those from high-income families (OR 0.667; 95% CI 0.582–0.765), those with low consumption of sweets (OR 0.66; 95% CI 0.57–0.763), and those who seldom ate before sleep (OR 0.557; 95% CI 0.437–0.712).ConclusionsECC and S-ECC remain a serious problem among preschool children in Xinjiang. Caries rates were associated with sociodemographic and behavioral factors, which could be modified by public health strategies, including protection of primary dentition, extension of insurance to cover oral preventive services, improvement of the oral health care system, and public health education.

BackgroundTo investigate the association between oral health literacy (OHL) and oral health-related quality of life (OHRQoL) and explore the racial differences therein among a low-income community-based group of female WIC participants.MethodsParticipants (N = 1,405) enrolled in the Carolina Oral Health Literacy (COHL) study completed the short form of the Oral Health Impact Profile Index (OHIP-14, a measure of OHRQoL) and REALD-30 (a word recognition literacy test). Socio-demographic and self-reported dental attendance data were collected via structured interviews. Severity (cumulative OHIP-14 score) and extent of impact (number of items reported fairly/very often) scores were calculated as measures of OHRQoL. OHL was assessed by the cumulative REALD-30 score. The association of OHL with OHRQoL was examined using descriptive and visual methods, and was quantified using Spearman's rho and zero-inflated negative binomial modeling.ResultsThe study group included a substantial number of African Americans (AA = 41%) and American Indians (AI = 20%). The sample majority had a high school education or less and a mean age of 26.6 years. One-third of the participants reported at least one oral health impact. The OHIP-14 mean severity and extent scores were 10.6 [95% confidence limits (CL) = 10.0, 11.2] and 1.35 (95% CL = 1.21, 1.50), respectively. OHL scores were distributed normally with mean (standard deviation, SD) REALD-30 of 15.8 (5.3). OHL was weakly associated with OHRQoL: prevalence rho = -0.14 (95% CL = -0.20, -0.08); extent rho = -0.14 (95% CL = -0.19, -0.09); severity rho = -0.10 (95% CL = -0.16, -0.05). "Low" OHL (defined as < 13 REALD-30 score) was associated with worse OHRQoL, with increases in the prevalence of OHIP-14 impacts ranging from 11% for severity to 34% for extent. The inverse association of OHL with OHIP-14 impacts persisted in multivariate analysis: Problem Rate Ratio (PRR) = 0.91 (95% CL = 0.86, 0.98) for one SD change in OHL. Stratification by race revealed effect-measure modification: Whites--PRR = 1.01 (95% CL = 0.91, 1.11); AA--PRR = 0.86 (95% CL = 0.77, 0.96).ConclusionsAlthough the inverse association between OHL and OHRQoL across the entire sample was weak, subjects in the "low" OHL group reported significantly more OHRQoL impacts versus those with higher literacy. Our findings indicate that the association between OHL and OHRQoL may be modified by race.

ABSTRACTObjectives:This study aimed at evaluating the relationships among oral health practices, early childhood caries (ECC), and oral health-related quality of life (OHRQoL) in five-year-old children in Indonesia.Materials and Methods:Overall, 266 parent–child pairs (PCPs) from preschools in Jakarta participated in a cross-sectional study. The ECC was clinically assessed by two calibrated screeners using the decayed, missing, and filled teeth (dmft) and the pufa index, which records the presence of severely decayed teeth with visible pulpal involvement (p), ulceration caused by dislocated tooth fragments (u), fistula (f), and abscess (a). The parents of the participating children completed the self-administered questionnaire comprising SOHO-5p and their oral health practices. The SOHO-5c questionnaire was used to interview the children.Results:The prevalence of ECC was 88.7%, with 35% having pufa index scores greater than 0. There were significant relationships among oral health practices, ECC, and the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) scores. There was also a significant relationship between cariogenic food consumption and the dmft and SOHO-5p scores. There was a significant relationship between ECC and the SOHO-5 scores. All the SOHO-5p variables except smile avoidance because of appearance had a significant relationship with the dmft and pufa variables. Eating and sleeping difficulties were significantly related to the dmft and pufa scores.Conclusion:OHRQoL was found to be related to the dmft and pufa scores, and the parents’ perceptions were more strongly correlated than the children’s. No significant difference was found in the perceptions indicated by the SOHO-5p and SOHO-5c scores. This suggests that parents can be used as proxies regarding their children’s OHRQoL.

Background/Objectives: Early childhood caries (ECC) and severe early childhood caries (S-ECC) are oral health problems that affect many preschool children worldwide. ECC and S-ECC negatively impact the quality of life of preschool children, including functional, psychological, and social well-being, as well as their families. There is no updated data regarding the prevalence of ECC and S-ECC in Jeddah, Saudi Arabia. Additionally, no study has been conducted on oral health-related quality of life (OHRQoL) with regard to ECC and S-ECC among preschool children in Jeddah. Thus, this investigation aimed to determine the prevalence of ECC and S-ECC in children 3 to 5 years old in Jeddah and its relation to OHRQoL. Methods: A cross-sectional survey was carried out on 322 children randomly selected from different preschools in Jeddah. The early childhood oral health impact scale (ECOHIS) questionnaires were distributed and completed by the parents followed by clinical examination. The dmft and dmfs index scores were determined by WHO diagnostic criteria. Results: A total of 322 preschool children were included in the final sample. The results indicated a caries prevalence rate of 74.2% with ECC and S-ECC prevalence rates of 34.2% and 40.1%, respectively. The mean ± SD dmft and dmfs scores were 4.6 ± 0.4 and 10.8 ± 0.9, respectively. The mean ± SD total score of the early childhood oral health impact scale (ECOHIS) was 6.1 ± 7.3. S-ECC was significantly associated with higher ECOHIS scores (p < 0.001) after controlling for age. Conclusions: ECC and S-ECC are highly prevalent in Jeddah, Saudi Arabia, and negatively impact OHRQoL.