Development Of Early Childhood Caries Research Articles

More than clean teeth! Identifying factors that contribute to the development of early childhood caries.

This review aimed to identify established and updated evidence-based factors that could contribute to a child's development of Early Childhood Caries (ECC). Four online databases were used to source evidence including the Cochrane Library, EMBASE, MEDLINE, and Scopus. The data search selected studies published between 2017 and 2021. Three specific terms were used to search: Dental Caries, Children, and Risk Assessment. There were three teams involved in data collection, two teams then reviewed selected articles. Exclusion criteria included any duplicate studies, commentaries, and editorials. Inclusion criteria included only randomised control trials and cohort studies. Selected studies must include children younger than 72 months, define the demographics, their clinical characteristics, and have clear follow-up of the patients involved. Commonly identified factors that were mentioned in multiple studies were then collected and assigned strength depending on the evidence measured using ratios. These could then beutilised to form a draft Caries Risk Assessment tool. 512 abstracts and 52 articles were screened, having matched the criteria set. Extraction of the data was completed under four headings: the child's age at the time of study (in years/months), risk predictors, the outcome, and the quality of the evidence presented. The GRADE system was then employed to separate the studies into high, moderate, low, and very low categorisation. Eventually, 22 new studies were included that would build on the original 25 articles that were identified in the previous systematic review. The most defining factors across the most recent systematic reviews in 2021 highlighted behavioural factors such as toothbrushing quality - parental supervision, frequency, and fluoride exposure. Specifically, the presence of plaque was used as a marker for oral hygiene evaluation. Dietary history included snacking frequency and, controversially, baby-toddler breastfeeding patterns. However, this does not take into consideration the dental impact - mainly the frequency or timing of breastfeeding (e.g. overnight). The review emphasises the importance of consideration of socio-economic factors though this may be a difficult topic of discussion if families are struggling i.e. household income and education level of parents or guardians. There is also mention of factors that do not have a significant evidence base such as the child's gender, ethnicity, and parental smoking status. In conclusion, the factors found to be relevant in the development of ECC were the child's age, toothbrushing quality/plaque control, parental involvement in toothbrushing, fluoride exposure, pattern of dental attendance, dietary sugar exposure, and habits, clinically carious active lesion presence, the oral bacterial composition (Streptococcus mutanspresence) and the socio-economic status of the child and their family. Though the review encourages identification of the caries risk factors in the mentioned groups, separated by both dental and non-dental professionals, ideally the aim would be to create a holistic care approach for management and signposting.

The Associations between Snack Intake and Cariogenic Oral Microorganism Colonization in Young Children of a Low Socioeconomic Status.

Cariogenic microorganisms are crucial pathogens contributing to the development of early childhood caries. Snacks provide fermentable carbohydrates, altering oral pH levels and potentially affecting microorganism colonization. However, the relationship between snack intake and cariogenic microorganisms like Candida and Streptococcus mutans in young children is still unclear. This study aimed to assess this association in a prospective underserved birth cohort. Data from children aged 12 to 24 months, including oral microbial assays and snack intake information, were analyzed. Sweet and non-sweet indices based on the cariogenic potential of 15 snacks/drinks were created. Mixed-effects models were used to assess the associations between sweet and non-sweet indices and S. mutans and Candida carriage. Random forest identified predictive factors of microorganism carriage. Higher non-sweet index scores were linked to increased S. mutans carriage in plaques (OR = 1.67, p = 0.01), potentially strengthening with age. Higher sweet index scores at 12 months were associated with increased Candida carriage, reversing at 24 months. Both indices were top predictors of S. mutans and Candida carriage. These findings underscore the associations between snack intake and cariogenic microorganism carriage and highlight the importance of dietary factors in oral health management for underserved young children with limited access to dental care and healthy foods.

Pregnant women's attitudes and knowledge about oral health

Background: Good oral health of pregnant women is important for their own health and the health of the fetus and can reduce the risk of complications in pregnancy. The development of early childhood caries is associated with the transfer of bacteria from the mother's oral cavity, and there is a need to promote oral health during pregnancy and the perinatal period. Aim: This cross-sectional study aimed to evaluate attitudes and knowledge regarding oral health and infant oral health among pregnant women. Materials and methods: The study involved 130 pregnant women in the Republic of North Macedonia who completed an anonymous online questionnaire (Google Forms) from January to June 2022. The questionnaire was divided into three parts. The first part contained questions about the general demographic data of the respondents and their own experience with oral health in pregnancy. The second part was related to the knowledge of the relationship between oral health and pregnancy. The third section consisted of questions related to knowledge about the oral health of children at the earliest age. The results were analyzed with descriptive statistics. Results: The study involved 130 pregnant 19 to 42-year-old women. The women are most informed about oral health in pregnancy from their dentists (30.8 %), but least from doctors of family medicine (3.1%). In pregnancy, gingival bleeding was observed by 60.8 % of respondents, and tooth mobility by 22.3 %. The chi-square test found that there was a difference in attitude regarding the age at which they should stop breastfeeding between respondents who had their first pregnancy and those who already had children (Chi-square value =13.216, p = 0.004, p < 0.05). Only 20.5 % of respondents are aware that breastfeeding can cause tooth decay. Linear regression analysis showed that pregnant women's knowledge about the association between pregnancy and periodontal diseases is statistically significantly positively associated with their gynecologist's advice to visit a dentist (β = 1.282, p ≤ 0.001). In addition, pregnant women's knowledge about children's oral health is statistically significantly negatively associated with women already having children (β = -0.693, p = 0.043). Conclusion: Pregnant women in the Republic of North Macedonia do not have sufficient knowledge, and they are neither aware of the importance of oral health during pregnancy nor infant oral health.

Oral health during pregnancy: an analysis of interprofessional guideline awareness and practice behaviors among prenatal and oral health providers

BackgroundPoor oral health during pregnancy has significant implications across the life course, including increased risk for adverse pregnancy, birth outcomes, and the development of early childhood caries. In efforts to improve perinatal oral health in the United States, a set of national interprofessional guidelines were developed that include recommended practice behaviors for both oral health providers and prenatal providers. The purpose of this study was to examine guideline awareness, familiarity, beliefs, and practice behaviors among both provider types.MethodsPrenatal providers and oral health providers in Florida were recruited via random and convenience sampling to complete an online survey guided by the Consolidated Framework for Implementation Research (CFIR) and the Cabana Framework. The present analysis focused on the Individuals Involved domain (CFIR), awareness and familiarity with the guidelines (Cabana Framework), confidence, and practice behaviors as recommended by prenatal oral health guidelines (assess, advise, refer, share/coordinate). Data were analyzed using chi-square tests, independent samples t-tests, Pearson correlation coefficients, and one-way analysis of variance (ANOVA) and analyses were conducted in SPSS.ResultsPrenatal and oral health providers did not differ significantly in their awareness of the guidelines, but awareness was significantly associated with three of the four practice behaviors for prenatal providers. Familiarity with the guidelines was significantly higher among oral health providers and was associated with all four practice behaviors for both provider types. Five out of ten oral health belief items were significantly associated with practicing the guidelines among prenatal providers, but only two among oral health providers. Confidence in performing the practice behaviors was significantly associated with guideline implementation among both groups. Years in practice was significantly associated with performing practice behaviors for prenatal providers, but not for oral health providers.ConclusionsOur findings highlight the importance of professional organizations and the role of clinical guidelines on practice behaviors. Although provider education is a key implementation strategy, organizational and policy-level system changes could also be critical in supporting practice behaviors.

Is there an association between maternal factors and the development of early childhood caries?

To assess the possible associations between the following characteristics/behavior of the mother: oral health, oral hygiene, smoking habits, diet, food insecurity, stress, employment, marital status, household income and size and insurance status, with the development of dental caries in their children up to 3 yearsold. Pregnant women aged 18 yearsor more who delivered at term and whose children had regular dental check-ups were enrolled in a longitudinal study. Oral health status of participants was assessed at enrollment, 2 months and annually thereafter. Sociodemographic characteristics and mothers' behaviors were collected through face-to-face and telephone interviews. By the three-year visit, 6% of the children had 1 or more cavitated dentine caries lesions. Maternal education and state of residence increased the chances of the child presenting with a caries lesion by the age of three, in addition to influencing the magnitude of the associations detected with other variables. Mothers' prior pregnancies, maternal cigarette smoking, household income and untreated dental decay were also significantly related to childhood caries. Sociodemographic variables were shown to have an important influence on the development of early childhood caries, highlighting the need of addressing structural problems that limit the availability of dental care and healthy foods.

Knowledge of Breastfeeding Mothers Regarding Caries Prevention in Toddlers.

Mothers' awareness regarding the risk factors for the development of early childhood caries is crucial. The current study aims to examine the knowledge of breastfeeding mothers about their baby's dental health and prevention of ECC while comparing primiparous mothers to multiparous mothers. A total of 165 mothers aged 20-49 y/o participated in the study by completing questionnaires that assessed the knowledge and attitudes of mothers toward their infants' oral health. Results showed that (1) mothers were found to be highly knowledgeable regarding the oral hygiene of their infants and the recommended breastfeeding best practices (71%); (2) mothers with lower education showed poor knowledge regarding the recommended practices of infant oral health; (3) a large proportion of the mothers in the sample (62%) reported that they usually tasted the food before giving it to their baby, in a way they could transmit bacteria to infants; (4) most of the mothers (68%) were not aware that their dental health during pregnancy affects the infants' dental health; and (5) multiparous mothers were more knowledgeable regarding artificial baby milk composition (96%) in comparison with mothers with only a single child (60%). According to the results, there is a need to improve the knowledge of breastfeeding mothers, especially mothers who have one child and mothers with a lower education about their baby's dental health. The results of this study shed light on the knowledge of breastfeeding mothers on this important topic and could serve policymakers to improve practices toward advancing better oral health for infants, without sacrificing the benefits of breastfeeding, which are so crucial for infant health and development.

Determination of salivary concentrations of leptin and adiponectin, ability to reduce ferric ions and total antioxidant capacity of saliva in patients with severe early childhood caries.

IntroductionOne of the most common oral diseases affecting children is early childhood caries (ECC). The link between oxidative stress and ECC has been proven in numerous clinical studies. Technical and biological variability were so high in most of the studies that none of the markers have yet been proven suitable for routine clinical use. This study aimed to evaluate the antioxidant status and the levels of leptin and adiponectin in saliva of children with severe early childhood caries (S-ECC).MethodsMorning unstimulated saliva samples were collected from children (n = 40, 0–6 years old) for the evaluation of oxidative stress which were measured by total antioxidant capacity (TAC), and by the ferric reducing antioxidant power (FRAP) assays, as well as to assess the salivary levels of leptin and adiponectin. FRAP, TAC, leptin and adiponectin concentrations were evaluated in S-ECC group (n = 31) and caries free group CF (n = 9). All results were analyzed based on age and sex.ResultsOverall median salivary leptin and adiponectin levels were 5.59 pg/mL and 24.86 ng/mL, respectively. Significantly lower leptin levels were observed in saliva of caries free children (4.66 pg/mL) than in the S-ECC group (6.64 pg/mL, p < 0.01). No significant difference was observed for adiponectin levels (S-ECC and CF, 25.31 and 23.2 ng/mL, respectively, p = 0.961). TAC and FRAP values of saliva had similar values in children with S-ECC and caries free children. TAC and FRAP values also remained stable with the age of the children, without significant differences with respect to sex.ConclusionThe increased concentrations of leptin in saliva of children with S-ECC suggests that leptin may play a role in inflammatory and immune responses in the development of early childhood caries.

Risk Factors in Development of Early Childhood Caries in 12–18-month-old Indian Children: A Prospective Study

Risk Factors in Development of Early Childhood Caries in 12–18-month-old Indian Children: A Prospective Study

Stages, risk factors and prevention of early childhood caries

Early childhood caries is a common condition that affects children and young infants. In addition to the effect of the condition on the child's oral health, it has been furtherly shown that many systemic consequences are usually associated. Therefore, it has been reported that these conditions can significantly impair the quality of life of corresponding families based on economic and health-related burdens. Affected children usually present with variable degrees of the condition, and some complications might be associated. Many risk factors have been reported in the literature for developing the condition in children. These include the presence of certain bacterial pathogens (especially through vertical transmission), dietary habits, and poor oral hygiene. Evidence indicates that these risk factors significantly contribute to the development of early childhood caries and the importance of the child's socioeconomic status and his caregivers. Targeting these factors would significantly reduce the risk of developing the condition, in addition to fluoridation as suggested by various relevant investigations.

Dietary Habits Dietary Habits and Oral Health Practices among Children with Early Childhood Caries and Caries Free Children: A Case-Control Study

Background: Dietary habits and practices affect dental health. Objective: To determine the dietary habits and oral health practices among children with early childhood caries and caries-free children. Methodology: Study Design: Case-control study. Study setting and duration: Department of Operative Dentistry and Oral Pathology HBS Medical and Dental College, Islamabad, from November 2018 to September 2021. Sample of 212 children (106 cases, 106 controls) having either sex, ages between 2 to 5 years with minimum of 12 erupted teeth (including lost) were enrolled in this study. Children's clinical examination was done on dental chair using explorer and mouth mirror. Current study focused on the relationship between oral practices, feeding habits, and early childhood caries. Results: Two hundred and twelve children, 90 (42.45%) male were included. Among these 106 were caries-free and 106 had early childhood caries. Children having early childhood caries (ECC) were mostly firstborn, 72.38% in contrast with children without ECC, 55.24%. (p=0.005). Mean of the decayed, missing, and filled teeth (DMFT) of children with early childhood caries was 5.2 (3.9). A greater number of children with ECC were observed to visit the dental doctor as compared to children without ECC (31.3% vs. 7.54%; p=0.0001). Brushing was observed in 61.32% of children having ECC and in children without ECC it was 69.81%, p=0.71. Conclusion: In this study, the use of bottle feeding among children with early childhood caries, along with delay in starting oral practices in the form of dentists visits and first birth orders was significantly associated with the development of Early Childhood Caries.

The effect of feeding methods and non-nutritive sucking habits on early childhood caries and development of occlusion (A cross-sectional study)

Background and objectives: Early Childhood Caries (ECC ) is the most common chronic disease conditioning childhood and involves the presence of one or more decayed (noncavitated or cavitated lesions),missing(due to caries), or filled tooth surfaces in children under 72 months of age.Time and frequency of breast-feeding, artificial feeding and of non-nutritive sucking habits can influence orofacial development, and when negative can provoke instability of orofacial function. Sucking habits involving digits or dummies are the most tangible environmental factors that play a role in the etiology of malocclusion.Subjects and method: A cross sectional study performed on aconvenient samples of 500 preschool child renaged between 4-6 years old in Erbil city. Parents (mothers ) were asked for a permission to include their children in the study. A short interview with the mothers of the children preceded the dental examination. The clinical examination included child weight, height determination and dental examination.Results: The results showed that prevalence of caries in breast fed children was (70.6%), in bottle was (62.4%) and both fed children was (65%) with no significant association between type of feeding and caries prevalence (P=0.298). Mean dmfs in males was (9.84±12.99) which is higher than mean dmfs of females (7.39 ±10.58). Class II canine classification was higher in bottle and both feeding than in breast feeding and there was no prevalence of Class III canine relation was found in bottle feeding.Conclusion: Type of feeding was not found to be related to development of early childhood caries in primary dentition of preschool children. Bottle feeding was considered as a risk factor for development of class II canine relation. Non-nutritive sucking (finger, pacifier sucking and both) were found to be risk factors for the development of anterior open bite and posterior cross bite. Finger sucking produces the development of unilateral posterior cross bite in primary dentition.

Can probiotic supplements prevent early childhood caries? A systematic review and meta-analysis.

The aim of this study was to explore the preventive effect of probiotic supplements on the development of early childhood caries (ECC). We searched the PubMed, Google Scholar and Cochrane databases up to January 15, 2021. The authors screened the hits independently for relevance, extracted outcome data and assessed the risk of bias. We performed a random effects meta-analysis to pool and compare the incidence of ECC in children assigned to test or placebo groups, respectively. The authors included nine randomised controlled trials published between 2001 and 2021, involving 2,363 preschool children. We assessed two publications with a moderate risk of bias and seven with high risk of bias. The median caries incidence in the probiotic test groups was 8.5% compared with 17.5% in the placebo groups and this difference was statistically significant (P<0.001). A pooled random effects meta-analysis on caries incidence on subject level showed a small but statistically significant risk difference in favour of the probiotic intervention (-0.05, 95% confidence interval (CI) -0.10, -0.00; P<0.05). The mean difference in caries increment on tooth/surface level was -0.57, (95% CI -0.91, -0.23; P<0.01). In conclusion, we demonstrated a small but statistically significant preventive effect of probiotic supplements on ECC. However, the certainty of this finding was low due to the risk of bias, heterogeneity and inconsistencies across the studies. Further long-term randomised controlled trials with low risk of bias are required in order to answer the research question with a higher certainty.

Impact of Breastfeeding and Cosleeping on Early Childhood Caries: A Cross-Sectional Study.

The type and duration of breastfeeding can be key factors in the development of early childhood caries (ECC). The association between nighttime feeding and ECC was investigated. Specifically, whether cosleeping is a potential mediator of children’s oral health was investigated, considering many of the etiological factors of caries. In this cross-sectional study, 212 children (aged 2–4 years) from Madrid (Spain) who breastfed at night were examined to assess the mean decayed/filled primary teeth (dft) index, and a questionnaire was administered to the mothers to collect data on the practice of breastfeeding and cosleeping and its duration, the number of nighttime feeding sessions, sugar content in the diet, dental hygiene habits, and age at first dental visit. The dft index was lower in the group that breastfed for less than 18 months (p = 0.02). In addition, there were significant differences in the dft index in the group breastfeeding for more than 18 months between those who coslept for 18 months or more and those who coslept for less than 18 months (p < 0.05), as well as between those who coslept for 18 months or more and those who did not cosleep (p < 0.01). In conclusion, breastfeeding at night from 18 months onwards is considered a risk factor for ECC.

Analysis of oral microbial dysbiosis associated with early childhood caries

Background"Core microbes" play a key role in the development of caries and lead to microbial disorders. Our goal was to detect the core microbes associated with the microbiota imbalance in early childhood caries (ECC).MethodsFifteen caries-free children and fifteen high-caries (DMFT ≥ 10) children aged 4–6 years old were recruited according to the diagnostic criteria of caries suggested by the WHO. The 16S rRNA genes from samples of plaque in saliva were amplified by PCR, and the PCR products were sequenced by the Illumina Miseq platform. The sequencing results were analyzed by professional software to determine the composition and structure of the saliva microorganisms.ResultsThere were statistically significant differences between the groups regarding the relative abundance of Streptococcus mutans (Wilcoxon rank-sum test, P < 0.05). No significant difference was found between the groups regarding other species or functional genes.ConclusionS. mutans, together with other pathogens, may play a prominent role and act as "core microbes" in the occurrence and development of early childhood caries.

Early childhood caries predictors

Background/Aim. Dental caries represents a health problem of all ages, but it is especially significant in the earliest age of children. Early childhood caries can develop immediately after the eruption of deciduous teeth, resulting in many complications, such as tooth extraction, which is reflected in the quality of life and health. Early childhood caries is influenced by a large number of predictors. Considering that the data on predictors for the development of deciduous teeth caries are scarce, the aim of this paper was to determine the prevalence of deciduous teeth caries and detect the predictors for the development of early childhood caries. Methods. Our survey included 117 children of both genders, aged 3 to 6 years, from the territory of Kosovska Mitrovica and Zvecan. All respondents, including children and parents, were surveyed, and thus general data was obtained. A dental examination was performed on all children. The current state of dental health was inserted into special research cards that were in line with the recommendations of the World Health Organization. Those predictors of dental health level that were statistically significant in models of univariate ordinal logistic regression at the significance level of 0.05 were included in the model of multivariate ordinal logistic regression. Results. According to the full structure, there were 49.6% of boys and 50.4% of girls. Healthy teeth were present in 25 (21.4%) children, 19 had reversible changes (16.2%), while 73 (62.4%) children had irreversible carious changes on teeth. The most important detected predictors were sweets consummation, sleeping with a baby bottle, 6 and more meals per day, frequent usage of medical syrups, child?s daily tooth-brushing frequency, child?s independent toothbrushing frequency, usage of non-fluoride toothpaste, a lack of professional fluoride application, and mouth breathing. Conclusion. This research contributed to the detection of a large number of predictors that are most important for the development of early childhood caries. In order to reduce the risk of caries development, it is necessary to act in more spheres. This certainly requires planning and implementing preventive dental programs.

Relationship between Vitamin D status and dental caries in children of Ahmedabad city

Aim: The aim of the study is to determine the association between Vitamin D status and development of early childhood caries (ECC) in Ahmedabad city. Materials and Methods: A total of 80 children aged between 3 and 6 years were divided into two groups (case and control, n = 40 each). A structured questionnaire was prepared which included basic information of the child; oral examination was done using decayed, missing, and filled teeth index to record caries status of each child. Blood samples were collected for serum analysis of 25(OH)D levels. Results: In case group, the mean serum 25(OH)D level was 12.07 ng/ml, and in control group, the mean serum 25(OH)D level was 20.15 ng/ml. Statistically significant difference was found between serum 25(OH)D levels in both the groups. Conclusion: The results showed that Vitamin D deficiency has been associated with ECC.

Impact of problematic eating behaviour and parental feeding styles on early childhood caries

Eating behaviour in childhood has been implicated in development of early childhood caries. Parenting feeding styles can also contribute to development of various eating behaviours. To evaluate relationship between children's eating behaviour and parental feeding styles with ECC in preschool children. A case-control study was conducted in 440 children who were selected and divided into 2 groups: Group A-children with ECC and Group B-children without ECC. Dental caries was recorded using dmft index. The parents of children in both groups were requested to complete the Children's Eating Behaviour Questionnaire (CEBQ) and Parental Feeding Style Questionnaire (PFQ). There was positive association of food avoidance subscales of CEBQ (Satiety Responsiveness, Food Fussiness, Slowness in Eating, and Emotional Undereating) along with certain food-approaching subscales (Desire to Drink and Emotional Overeating) with dental caries status. It was also seen that parental feeding patterns such as Encouragement and Instrumental feeding contributed to decrease in dental caries of the child when compared to Control and Emotional feeding. Certain eating and feeding behaviours can possibly be associated with development of ECC, such behaviours can be successfully identified using CEBQ and PFQ.

Knowledge, Attitude and Practice of Saudi Parents Towards Their Children's Oral Health: An Online Questionnaire Survey

Children's oral health is of paramount importance as it governs the oral health status of the upcoming generation. Their oral hygiene is a vital part of general childcare. This under-appraised issue is often neglected by young parents, which can result in poor children's oral health. Aim: To assess standard knowledge, attitude and behavior of Saudi parents pertaining to the oral health of their young children. Materials and Methods: a prospective cross-sectional online survey was conducted in Saudi Arabia in 2017. The questionnaire included a total of 16 questions which were divided into two parts; the first part asked about parents' general information such as the name, age, gender, educational level, occupation and total family income. The second part included questions related to knowledge, attitude and practices toward children on selected oral health issues. Results: 1038 Saudi parents responded to the online questionnaire (70% Females and 30% male). Majority Saudi parents recognized many preventive dental aspects like importance of early acquisition of tooth brushing, avoidance of caries-related diet and nocturnal on demand breast feeding. Seventy three percent were convinced that it is better to take their children to a specialized pediatric dentist rather than a general dental practitioner. However, it was revealed that there was limited knowledge and awareness of Saudi parents about the significance of the routine dental checkups, ideal timing of first dental visit and importance of topical fluoride. Hypothetical myths and social beliefs associated with dental treatment like endodontic treatment were common; creating barriers to early preventive and curative dental care of young Saudi children. Conclusion: Parents were found to have inadequate knowledge in regard to oral health of their young children. The present research points to a need for enhanced dental education of parents, particularly in planning for their children's first visit and effect of prolonged on-demand at night breast feeding on development of early childhood caries. Community based oral health programs are required in order to raise parents' awareness regarding their children's oral health.

Feasibility and development of a cariogenic diet scale for epidemiological research.

Diet cariogenicity plays a major role as both a protective and risk factor in the development of early childhood caries (ECC). Develop a scale measuring the cariogenicity of foods and beverages and employ it to describe the cariogenicity of young children's diets and predict dental caries outcomes. Scores of cariogenicity and consumption frequency were applied to food frequency questionnaire (FFQ) collected from an Australian children's cohort study with three time-points of data. One-way ANOVA, with post hoc Tukey test compared mean cariogenic scale measured at 18months between the subsample of children with caries classification at age 5years. At 6months, children's mean cariogenic score was 10.05, increasing to 34.18 at 12 and 50.00 at 18months. Mean cariogenic scale score at 18months was significantly higher in children with advanced disease at 5years (mean scale score: 59.0±15.9) compared to those that were healthy (mean score 47.7±17.5, P=0.007) or had mild-moderate disease (mean score 48.2±17.3, P=0.008). The cariogenic diet scale provides a useful indication of the increasing cariogenicity of children's diets with age and highlights the incorporation of discretionary choice foods and beverages into the diets of young children much earlier than nutritionally recommended.

The Role of Salivary Cortisol and Mutans Streptococci in the Development of Early Childhood Caries

Hypothalamic-pituitary-adrenal system release salivary cortisol hormone, which may encourage the proliferation of Mutans Streptococci. The aim of this study was to assess the impact of salivary cortisol and Mutans streptococci on the development of early childhood caries. Eighty children aged 4-5 years old were selected randomly were divided into two groups (forty for each), early childhood caries group and caries free group. Dental caries was determined by measuring the dmfs according to WHO (1987), collection of unstimulated saliva was done and laboratory investigations was carried out to measure the viable count of Mutans Streptococci. Salivary cortisol was measured using cortisol kit (electrochemiluminescence immunoassay “ECLIA”). Statistical analysis was done using SPSS version 23. The statistical analysis showed that salivary cortisol and the viable count of Mutans Streptococci were significantly higher among the early childhood caries group than that found among the caries free group. Moreover, a significant positive association was found between salivary cortisol and the viable count of Mutans Streptococci. Salivary cortisol level was increased in children with early childhood caries so as the viable count of Mutans Streptococci, so it may play a role and has an impact on the bacterial proliferation in those children.