Childhood Caries Research Articles

Association Between Type 1 Diabetes Mellitus and Dental Caries in Children: A Systematic Review

Background: Diabetes mellitus is one of the diseases with chronic prevalence. Keep going increased, not only in adults but also in children. Diabetes mellitus type 1, the most common, occurs in children. Dental caries is an infection caused by metabolizing bacteria Streptococcus mutans, and Lactobacilli that convert carbohydrates into acid that damages tooth enamel. Diabetes can cause changes in saliva composition and flow. Saliva is vital in guarding a healthy tooth by neutralizing acid and providing minerals for remineralizing tooth enamel. Method: A systematic review was done by reviewing research through English data sources Pub Med, Proquest, Cochran, and Wiley. Four studies were included according to the inclusion criteria. Result: The results of a review of these four journals showed that children aged 6-18 who have type 1 or type 2 diabetes mellitus have a higher risk of developing dental caries or dental diseases. Children with diabetes are predisposed to have more glucose in their saliva. High glucose can become a source of nutrition for bacteria cariogenic, which contributes to the formation of plaque and acids that damage teeth. Conclusion: Diabetes mellitus is a risk factor for oral health. Diabetes Mellitus had a significant correlation with dental caries in children. Keywords: Diabetes Mellitus, Children.

COMPARATIVE CHARACTERISTICS OF METHODS FOR THE PREVENTION OF DENTAL CARIES IN CHILDREN OF EARLY CHILDHOOD

The high prevalence and intensity of early childhood caries in Ukraine and in the world indicate insuffi cient attention of practical dentistry to the prevention of dental caries in young children. The development of adapted prevention programs considering the risk factors for the development of the disease remains relevant.Aim of the study. To compare the eff ectiveness of methods of pre- and postnatal prevention of early childhood dental caries based on correction of the microbial environment of the oral cavity and macro- and microelemental nutrition.Material and methods. The work was carried out within the framework of the research work of the Department of Pediatric Dentistry of the Bukovinian State Medical University «Development of methods of prevention and treatment of major dental diseases in children, taking into account the risk factors of their development» (DR # 0121U110122). The prenatal method of dental caries prevention was applied to a group of pregnant women (30 persons) whose average age was (25,17±1,05) years. It included the use of Elevit Pronatal and Iodomarin 200, one tablet daily, starting from the second trimester ofpregnancy, and a course of local probiotic therapy with BioGaya ProDentis chewable tablets, used for 20 days in the second trimester of pregnancy and 20 days before delivery. As a method of postnatal prevention of dental caries in children, a preventive complex was used, including the use of the probiotic BioGaya ProDentis and the vitamin and mineral complex Supervit. The course lasted three weeks twice a year. The preventive complex was applied to a group of children aged 2-3 years. The number of children in the control group was 30. The mean age of the group was (2.51±1.30) years. The eff ectiveness of preventive measures was evaluated by the prevalence and intensity of caries of primary teeth («kpv» and «kpppv»), the state of oral hygiene (M. E. Kuzmina index), the content of phosphate ions, inorganic and ionized calcium in the oral fluid of children, the content of mutans streptococci in the oral cavity and the concentration of sIgA in the oral fl uid of children. Statistical processing of the study results was performed using standard methods of variation. The study complied with all bioethical norms (conclusion of the Bioethics Commission of the Bukovinian State Medical University No. 4 dated 15.12.2022).Results of the study. The use of preventive complexes for early childhood caries, based on the supplementation of macro- and microelements and the infl uence on the microbial landscape of the oral cavity, are eff ective methods of prevention of caries of temporary teeth in children, which is confi rmed by a decrease in the prevalence and intensity of dental caries in children in the dynamics of their observation. Prenatal measures are more eff ective in the prevention of early childhood caries in children, as they optimize the processes of primary mineralization of hard dental tissues and thus strengthen them, reducing the risk of dental caries. Postnatal use of the drugs has a slightly lower preventive eff ect on early childhood caries, while it has a positive eff ect on the processes of secondary mineralization of tooth enamel, as it was found that the level of phosphate ions in the oral fl uid of children under these conditions increased by 23.72 % (p<0.05), and the level of total calcium decreased by 15.84 % and its free fraction by 25.86 % (p<0.05).Conclusions. Our results suggest that both methods of prevention of early childhood caries are eff ective, but prenatal prophylaxis is clinically more eff ective with respect to the hard tissues of temporary teeth in children, due to its eff ect on the processes of primary mineralization of enamel. Postnatal prophylactic measures have a positive eff ect on the secondary mineralization of the hard tissues of temporary teeth and the primary mineralization of permanent teeth and will have a clinical result in the long term.

Abstract 4138333: Childhood Oral Health Associates with the Incidence of Ischemic Heart Disease, Myocardial Infarction and Ischemic Stroke in Adulthood

Introduction: Cardiovascular disease remains a considerable source of years of life lost. Thus, identification of possible risk factors and prevention strategies continues to be important. In adults, oral diseases are associated with the risk of cardiovascular disease, including ischemic heart disease (IHD), myocardial infarction (MI) and ischemic stroke (IS). Few studies have examined the effect of oral health in childhood on the risk of cardiovascular disease in adulthood, thus overlooking a potentially important avenue of early detection of high-risk individuals. Hypothesis: We hypothesize that poor childhood oral health is associated with IHD, MI, and IS in adulthood. Methods: Using nationwide Danish registry data from the National Child Odontology Register, National Patient Register, and the Central Person Register we followed individuals born between 1963 and 1972. Follow-up started in 1995 or by age 30 (whichever occurred last), and ended in 2018, where study participants were aged 46 to 56. Using Cox-proportional hazards modelling we examined the association of childhood oral health, defined as the highest registered level of dental caries and gingivitis for any one individual, with the occurrence of IHD, MI, and IS in adulthood. The highest achieved level of education between ages 25 and 30 was used as Cox-strata. Results: The study consisted of n = 569.057 individuals, 51.2% male, 48.8% female. The incidence of IHD was 26% (1.17; 1.86) higher in females with high levels of caries in childhood compared to those with low-level caries, 19% (1.08; 1.40) higher in males. Severe caries in childhood was associated with a 58% (1.19; 2.09) higher incidence of MI in females, 19% (1.01;1.42) higher in males, and a 45% (1.19; 1.78) higher incidence of IS, 52% (1.27; 1.81) in males. Females had a 52% (1.19; 1.94) higher incidence of MI, and males a 32% (1.15; 1.52) higher incidence of IS, if they had high levels of gingivitis as children (table 1). Conclusion: Poor oral health in childhood is associated with an increased incidence of IHD, MI, and IS, pointing to a potential new avenue for early identification of and prevention amongst high-risk individuals.

The influence of maternal long term health conditions including multimorbidity on child oral health: A scoping review and evidence gap map protocol

Objective This scoping review will map the extent and type of evidence in relation to the association between maternal long term health conditions (LTCs), including multimorbidity, and child oral health. Introduction Newer theories are emerging that detail the many factors that can influence child oral health at child, family and community levels. More recently, the association between maternal general health and child oral health has been explored, with preliminary evidence suggesting a link between shared environmental factors and diet/substance use during pregnancy causing childhood caries. Inclusion criteria All published studies that describe the relationship between maternal LTCs (including multimorbidity) and child oral health. There will be no limitation on the date of publication due to the limited number of studies available from the initial search of PubMed. The review will exclude case studies, abstracts, and grey literature. Literature must be in English language. Methods The following databases will be searched; CINAHL, Cochrane Library, Maternity and Infant Care, Medline via PubMed, Scopus, Web of Science. The search will include sources in English only and will be undertaken between April and July 2024. Studies to be included will be of any type of study design that describe a relationship between maternal long term health conditions, including maternal long term oral health conditions, and child oral health. Data extraction will be undertaken using tabulation of results by at least two independent reviewers. Narrative analysis of the evidence will be undertaken, and results will be presented in a narrative and tabular manner due to the heterogenous and limited evidence base found in the test search. This review has been registered prospectively on Open Science Framework, (https://doi.org/10.17605/OSF.IO/ECSWJ). The review will also inform an Evidence Gap Map (EGM) to illustrate the current evidence base regarding maternal health factors that influence child oral health.

Topical silver diamine fluoride (SDF) for preventing and managing dental caries in children and adults.

Topical silver diamine fluoride (SDF) for preventing and managing dental caries in children and adults.

ADAPT: Analysis of Microbiome Differential Abundance by Pooling Tobit Models.

Microbiome differential abundance analysis remains a challenging problem despite multiple methods proposed in the literature. The excessive zeros and compositionality of metagenomics data are two main challenges for differential abundance analysis. We propose a novel method called "Analysis of Differential Abundance by Pooling Tobit Models" (ADAPT) to overcome these two challenges. ADAPT interprets zero counts as left-censored observations to avoid unfounded assumptions and complex models. ADAPT also encompasses a theoretically justified way of selecting non-differentially abundant microbiome taxa as a reference to reveal differentially abundant taxa while avoiding false discoveries. We generate synthetic data using independent simulation frameworks to show that ADAPT has more consistent false discovery rate control and higher statistical power than competitors. We use ADAPT to analyze 16S rRNA sequencing of saliva samples and shotgun metagenomics sequencing of plaque samples collected from infants in the COHRA2 study. The results provide novel insights into the association between the oral microbiome and early childhood dental caries. The R package ADAPT can be installed from Bioconductor at https://bioconductor.org/packages/release/bioc/html/ADAPT.html or from Github at https://github.com/mkbwang/ADAPT. The source codes for simulation studies and real data analysis are available at https://github.com/mkbwang/ADAPT_example. The supplementary notes and figures are compiled together in a PDF document. The supplementary tables are combined in an excel file. Both the PDF document and the excel file are available online.

Caries Incidence in School-Based Prevention Programs in the Presence of Interval Censoring

Background/Objectives: School-based caries prevention can increase access to critical dental services and reduce oral health inequities. However, little is known regarding the incidence of dental caries in children participating in school caries prevention, and caries diagnosis is often interval censored. Methods: In this paper, we used data from a longitudinal, school-based, randomized clinical trial of minimally invasive treatments for dental caries to estimate the per-visit incidence rate and compare the hazard of dental caries in children receiving either silver diamine fluoride or glass ionomer dental sealants. To account for interval censoring, we used semiparametric transformation models for univariate failure time data and imputed caries incidence using G-imputation. Results: There were 3040 children that met inclusion criteria for analysis, 1516 (49.9%) of which were randomly assigned to receive silver diamine fluoride and 1524 (50.1%) were assigned to receive glass ionomer dental sealants and atraumatic restorations. There were no differences in the hazard of caries between treatments (HR = 0.99, 95% CI = 0.72, 1.24), while children with caries at baseline had a significant increase in the hazard of new caries (HR = 2.54, 95% CI = 2.26, 2.83) compared to those that were caries free. The per-visit caries incidence ranged from 4.8 to 11.1 at the individual level and increased with each successive study observation. Conclusions: School-based caries prevention can positively affect caries incidence, and the results can be used to inform future program design and implementation.

Exploring and enhancing the accessibility of children's oral health resources (called HABIT) for high risk communities

BackgroundWithin the city of Bradford in West Yorkshire, South Asian and Eastern European communities have an increased risk of childhood tooth decay, especially among families with Limited English Proficiency. Tooth decay is preventable, with national guidelines advocating home-based behaviours (toothbrushing with fluoride toothpaste and reducing sugar intake). In England, Health Visitors have opportunities to undertake oral health conversations during universal visits for children aged 0–24 months. The HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing) intervention provides structured oral health conversations, underpinned by complex intervention methodology. A feasibility study found HABIT acceptable to parents, feasible to deliver and led to improvements in home-based behaviours. However, the reach of this original study was limited to those proficient in English. This new study focused on exploring and enhancing the accessibility of the HABIT intervention to parents with Limited English Proficiency.MethodTwenty-four parents participated in interviews and focus groups, with 21 requesting support from interpreters. Community centres and WhatsApp were used to maximise inclusivity. Interviews and focus groups, followed a topic guide and the “Think Aloud” technique, were professionally transcribed, managed in NVivo, and thematically analysed. Team discussions facilitated analytical rigour. Recruitment continued until data saturation.ResultsThree themes were developed: (1) Navigating linguistic barriers; (2) Engagement through visuals; and (3) Addressing oral health challenges. Parents employed diverse strategies to interpret resources, including Google Translate, as well as family and wider community members. Consequently, the HABIT resources were modified to include simple text, subtitles, and translation tools. Parents highlighted the benefits of shorter oral health messages with clear visuals to help understanding, and this strategy was applied across all resources. Challenges surrounding children's resistance to toothbrushing, high sugar intake within their wider families and communities, and limited dental access were all raised. The HABIT resources were updated to address these challenges.ConclusionCollaborative community engagement has enhanced the HABIT resources, enabling access for high-risk communities to preventive oral-health programmes thereby promoting health equity.

Assessment of parental attitude, knowledge and awareness towards preventive dentistry in south zone of Chhatrapati Sambhajinagar: A questionnaire based cross sectional survey

Introduction: Oral health is a pivotal aspect of overall well-being. In early childhood, primary teeth play a vital role in development of speech, chewing, maintaining proper spacing, and guiding the eruption of permanent teeth. Common oral conditions comprise dental caries, malocclusion, childhood caries, and trauma. Aim: The present study was conducted to assess paternal knowledge towards the forestallment of oral conditions and application of preventive dental procedures in children in South zone of Chhatrapati Sambhajinagar. Materials and Methods: A cross-sectional questionnaire was administered to parents of pediatric patients of age group 3 to12 years in South zone of Chhatrapati Sambhajinagar, Maharashtra, with a sample size of 270 participants. A structured questionnaire, comprising 14 questions in English, was developed, translated and back translated into the local language Marathi by experts to ensure better comprehension by the parents. The questionnaire was divided into two sections: the first focused on demographic information, while the second included 14 multiple-choice, close-ended questions. These questions included topics such as preventive treatments for dental caries, childhood caries, topical fluoride application, fluoridated toothpaste, pit and fissure sealants, habit-breaking dental appliances, malocclusion, mouth guards, and space maintainers. Additionally, the survey addressed harmful habits such as thumb-sucking, tongue-thrusting, and nail-biting. Result: 56.6% of parents sought dental care only after experiencing pain. Additionally, parents of paediatric patients have restricted knowledge about preventive dentistry. Conclusion: Parental knowledge about preventive dental procedures is limited, as is the utilization of these measures.

The Role of Nationality in Childhood Caries in Qatar.

There were two objectives. First, to understand the variation of primary dentition caries among 4- to 8-year-old children in Qatar across nationality classified into four groups, and second, to explore whether the association persisted in the presence of socio-demographic and behavioural indicators. The study used data from the Qatar Child Oral Health Survey 2017 (QCOHS 2017). Detailed information was collected through a parental dual-language questionnaire and an oral epidemiological examination conducted by calibrated dentist examiners. Children in 20 kindergartens and 40 schools across Qatar were recruited. Data were weighted to represent the Qatar child population. Overall, 1154 children aged 4-8 years old (48.9% female, 51.1% male) participated. Qatari children made up 26.3%, Non-Qatari (N-Q) Arabic children 44.2% N-Q Indian sub-continent 16.4% and N-Q Other 13.1%. There were no significant differences by nationality for age or sex, but differences existed for kindergarten/school type and parents' highest level of education. Among behavioural indicators, Qatari and N-Q Arabic children began toothbrushing later, and more N-Q Other children brushed 2+ times a day and had made a check-up visit in the last 12 months. More Qatari children were in the highest tertial for sugar intake and drank bottled water with no fluoride. All N-Q children had a significantly lower prevalence and experience of caries. The means ratio (95% CI) for N-Q Arabic (0.78; 0.65-0.94), Indian (0.58; 0.46-0.72) and other children (0.61; 0.42-0.88) were all significant against Qatari nationality children. Multivariable models showed an attenuation of the association with caries with the means ratio for N-Q Arabic (0.92; 0.73-1.16), Indian (0.79; 0.57-1.11) and other children (0.94; 0.61-1.44) being non-significant compared to Qatari nationality children. The variables which were significantly associated with caries were parental education, toothbrushing frequency, sugar intake and check-up visiting in the last 12 months in the multivariable models. Primary dentition caries in children resident in Qatar differed by nationality. The association of primary dentition caries with nationality was markedly attenuated and non-significant in the presence of socio-demographic and behavioural variables, pointing towards the importance of these variables as the pathways to improving primary dentition caries prevalence and experience of children in Qatar.

The Correlation Between Dental Caries And Nutritional Status In Children Between The Ages Of Three And Five

Data from the Indonesian Ministry of Health in 2018 indicate that only 7% of children in Indonesia are cavity-free, while a staggering 93% of children under the age of three experience dental caries. The pathological process known as tooth decay is characterized by damage restricted to the hard tissues of the tooth, starting with the enamel and progressing to the dentin. Nutritional status, which can be classified as adequate, inadequate, poor, or stunted, plays a crucial role in the overall health of children, including their oral health. This study aims to investigate the relationship between dental caries levels and nutritional status among preschool children at Aisyiyah Kindergarten/RA Kemantren Tulangan, Sidoarjo. The study employs a cross-sectional methodology and adopts an analytical survey approach. The sample used in this research consists of a total sampling of sixty individuals. The def-t index is utilized as the measuring tool to evaluate the presence of cavities, while the PB/U or TB/U index is used to determine the short nutritional status based on the WHO Anthro 2005 reference standards. Data analysis is conducted using SPSS, where a Chi-square test is performed to ascertain the association between the degree of dental caries in preschool-aged children and their nutritional status. The results of the study are presented in both tabular and narrative forms to provide a comprehensive overview of the relationships identified. This research is expected to contribute to a deeper understanding of the importance of proper dental care and nutrition in promoting the health of young children

The prevalence of dental caries in children with iron deficiency anemia in the Karaganda Region

Aim of the study. To assess the prevalence of caries in children with iron deficiency anemia.Materials and methods. A study was conducted on 1500 children and adolescents in 3 areas of the Karaganda region, of which 54% suffer from IDA. Study examined children and adolescents aged 3 to 17 years, who were classified into three age categories: preschool children (3-6 years), primary school age (7-11 years), and high school age (12-17 years). The analysis was aimed at identifying the connection between iron deficiency anemia and the prevalence of caries among children and adolescents in the Karaganda region. To achieve this goal, statistical methods were applied, including correlation analysis and analysis of variance, considering age groups and regional characteristics.Results and discussion. All study participants examined showed a direct connection between the degree of iron deficiency anemia (IDA) and the prevalence of caries, amounting to 67.98%, which is a significant correlation. This effect is especially noticeable among children aged 7 to 11 years. It was also found that with an increase in the severity of iron deficiency anemia, an increase in the number of cases of decompensated caries is observed.Conclusions. Children and adolescents with iron deficiency anemia (IDA) exhibit higher rates of caries activity. In severe iron deficiency anemia, there is a high prevalence of caries, which indicates a significant impact of iron deficiency on dental health. Such figures indicate the importance of timely diagnosis and treatment of iron deficiency anemia to improve overall health and prevent possible complications in the form of oral diseases, including caries.

EBD spotlight: Effectiveness of nanosilver fluoride in arresting dental caries in children

EBD spotlight: Effectiveness of nanosilver fluoride in arresting dental caries in children

A INFLUÊNCIA DO AMBIENTE FAMILIAR NA SAÚDE BUCAL INFANTIL: UM RELATO DE EXPERIÊNCIA

In Brazil, around 53.4% of children aged five years have tooth decay in their primary teeth, highlighting the need for its control. The objective of this work is to report the experience of Dentistry students on the causes of the presence of tooth decay in children, throughout their training with children and their guardians. The results of the reflections were: presence of many carious lesions, difficulty in performing and supervising oral hygiene; excessive sugar consumption; neglect of oral care for deciduous teeth and misinformation about the harmful effects of this attitude on the quality of permanent dentures; perception that, although families are aware of the measures to be adopted to control these problems, in some of them those responsible do not have a routine supervision of oral hygiene or nutrition with excessive consumption of carbohydrates and sweets. The academics found that the more effective participation of Dentistry students in real practice scenarios in Primary Health Care can contribute to changing this perception. It is concluded that the Dentistry student, the general dentist or pediatric dentist and the family must work together to ensure that pediatric patients have better quality oral health.

THE EFFECT OF CONSUMING YOGHURT ON THE SALIVARY PH OF MILDLY MENTALLY RETARTED CHILDREN

The percentage of people with disabilities in Indonesia is 56% and the prevalence of dental caries in children with disabilities reaches 82.6%. One alternative to prevent dental caries is by consuming probiotic drinks such as yogurt. Yoghurt is sour milk produced by fermenting milk and the group of probiotic products most accepted by children. Objective: This study aims to determine the effect of consuming yogurt on the pH of saliva of children with mild deformities SLB Patriot Tasikmalaya City. Methods: The type of research used is a quasi experiment research method with a one group pre-test and post-test research design with a sample of 20 mildly retarded children. The research measuring instrument used a pH meter, and the data was analyzed using a paired sample t-test. Results: Based on the results of the paired sample t-test statistical test, the p-value = 0.001 (p < 0.05) means that there is an effect of consuming yogurt on the pH of the saliva of mildly retarded children of SLB Patriot Tasikmalaya City. Conclusion: Consuming yogurt regularly for seven days can increase salivary pH in mildly retarded children.

Relationship Between Body Mass Index (BMI) and Severity of Caries Among Primary School Children: A Scoping Review.

The relationship between body mass index (BMI) and the severity of dental caries in children varies significantly across different age groups, with some studies showing favorable associations. At the same time, some found no or inverse links. This review examines the existing literature on the relationship between BMI and the severity of dental caries among primary school children specifically between the ages of six and 12. This review follows the preferred reporting items for scoping reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR)) guidelines. A comprehensive literature search was performed utilizing PubMed, Scopus, and Web of Science (WoS) to identify relevant studies published in English from January 2015 to June 2024. Studies on primary school children aged six to 12 years old, BMI, and severity of caries were included. Five hundred and seventy-seven articles were screened with 26 meeting the inclusion criteria. The majority of the studies were cross-sectional in design. The study identified a varied association between BMI and dental caries. Further understanding of this relationship can guide the development of preventive strategies and interventions that address childhood disproportionate BMI and dental caries, ultimately enhancing oral health and overall well-being in this population.

Clinical study of pit and fissure sealant combined with light-cured flowable resin in prevention of dental caries in children.

Clinical study of pit and fissure sealant combined with light-cured flowable resin in prevention of dental caries in children.

Social Vulnerability Index and Dental Caries in Children: An Exploratory Study.

This retrospective cross-sectional study evaluated the association between caries outcomes in a pediatric population visiting a dental clinic and the social vulnerability index, an area-based measure capturing 4 main social determinants of health: socioeconomic status, household composition/disability, minority status/language, and housing/transportation. The Centers for Disease Control Social Vulnerability Index (SVI) and electronic dental record data of children (0 to 18 y) reporting a caries diagnosis at the Children's Hospital Colorado in 2020 were extracted for 9,201 children. Logistic regressions were used to test the association between SVI and the presence or absence of dental caries, adjusting for age, sex, ethnicity, and race. Children with a caries diagnosis had a greater mean overall SVI percentile (62.0, standard deviation [SD] = 29.1) compared with patients without a caries diagnosis (59.1, SD = 29.8; P < 0.001). With each 10-point increase in the overall SVI percentile, having a caries diagnosis visit was 2.7% more likely compared with having a visit without a caries diagnosis (odds ratio [OR] 1.027, 95% confidence interval [CI] 1.012, 1.042; P = 0.0004). Those with an overall SVI percentile between 51 and 75 were 23% more likely to have a caries diagnosis compared with those with a percentile ≤25 (OR 1.23, 95% CI 1.07, 1.42; P = 0.003), and those with a percentile >75 were 23.6% more likely to have a caries diagnosis compared with those with a percentile ≤25 (OR 1.236, 95% CI 1.09, 1.40; P = 0.001). Children (0 to 18 y) living in socially vulnerable environments or areas were more likely to have a caries diagnosis at their dental exam. This study showed an association between social determinants of health demonstrating social vulnerability and dental caries in children. Ultimately, understanding upstream factors for children living in socially vulnerable areas could support policymakers in creating more effective policies to support socially vulnerable populations.

Increasing mothers' knowledge, and attitudes, and children's oral hygiene index simplified (OHI-S): an experimental study on the “EKARINI” educational method

ABSTRACTIntroduction: The high incidence of dental caries in children is partly due to the lack of parental participation in estabilishing children's tooth-brushing habits. This research aims to see an increase in the variables tested in the EKARINI, an educational model on mothers’ knowledge, attitudes, and children's OHIS. Methods: This study employs an experimental design, collecting pretest and posttest data from mothers and their children following the intervention. The intervention provided in this study involved the EKARINI educational model, which included a pre-test and post-test in the form of a questionnaire consisting of several questions about maternal knowledge and attitudes toward dental health, and the control group received standard education using media such as leaflets, videos, and phantom models. The sample consisted of two groups: an intervention group with 20 respondents and a control group with 20 respondents. Data analysis was conducted using either the independent t-test or the Mann-Whitney test. Results: The findings revealed a significant difference between the posttest scores of the intervention group and the control group The p-values indicate significant differences for each variable: knowledge (p = 0.006), attitude (p = 0.016), and OHIS (p = 0.010), showing that the EKARINI educational model effectively improved maternal knowledge, attitudes, and children's oral hygiene compared to the control group. Based on the average value, the group that received the educational model had a higher average value than the control group. Conclusion: The EKARINI educational model is in increasing mothers’ knowledge, attitudes, and better OHIS values.

Area-Level Factors of Dental Caries in Children and Adolescents in European Neighborhoods - a Systematic Review.

The WHO emphasizes the importance of taking area-level factors into account when formulating public health interventions. The aim of this systematic review was to identify which area-level factors are associated with children's dental caries in Europe and might therefore be a suitable starting point for public health interventions. We conducted a systematic review based on a search in PubMed, Web of Science, and Cochrane Library including all European studies on caries in children and their area-level factors published since the year 2000 in English or German. We included 39 studies and identified 13 area-level factors investigated in the literature: degree of urbanization, deprivation, mean housing price, gross-national product, mean level of education, unemployment proportion and income, density of supermarkets, snack bars and dental offices, health, diet, and crime. Rural residency and higher unemployment were weakly associated with poorer oral health regarding dental caries. Deprivation showed a stronger (inverse) association. For income, findings were ambiguous; studies showed associations in both directions. For the other determinants, the included studies found no association. Many studies reported associations between place of residence and children's dental caries, but the mediators on this causal path are still not clearly established. The area-level factors analyzed in this review seem to play a role, but more studies with designs that allow causal interpretation of findings are needed to establish solid robust evidence that can be used in the formulation of future health policies.