Severe Early Childhood Caries Research Articles

Association between early childhood caries and parental education and the link to the sustainable development goal 4: a scoping review

BackgroundThe goal of the United Nations Sustainable Development Goal (SDG) 4 is to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. The aim of this scoping review was to map the current evidence on the association between the prevalence of early childhood caries (ECC) and parental education; and to identify possible pathways by which parental education may protect against ECC.MethodsThe two questions that guided this review were: what is the existing evidence on the association between maternal and paternal education and ECC; and what are the pathways by which parental education protects against ECC? The initial search was conducted in January 2023 in PubMed, Web of Science and Scopus. Articles published in English between January 2000 and October 2022 that reported on the association between parental education and ECC were screened, and the extracted data were compiled, summarized, and synthesized. Review papers and non-primary quantitative research papers were excluded from the full-text review. Open coding was applied to develop a conceptual framework.ResultsIn total, 49 studies were included: 42 cross-sectional, 3 case-control and 4 cohort studies. The majority (91.8%) reported on the associations between ECC and maternal (n = 33), paternal (n = 3), and parental (n = 9) level of education, and 13 (26.7%) reported on the association between parental education and the severity of ECC. Mothers with more than primary school education (n = 3), post-secondary/college/tertiary education (n = 23), and more than 4–12 years of education (n = 12) had children with lower risk for ECC. Two studies reporting on parental education found an association between maternal but not paternal education and ECC. The review suggests that achieving the SDG 4.1 may reduce the risk of ECC. Possible pathways by which maternal education protects from ECC were feeding practices, oral hygiene practices, and the use of dental services.ConclusionThe study findings suggests that higher maternal educational level may reduce the risk for the consumption of cariogenic diet, poor oral hygiene practices and poor use of dental services for caries prevention. However, the association between paternal education and ECC was not consistently observed, with significant associations less frequently reported compared to maternal education. Future studies are needed to define the magnitude and modifiers of the impact of maternal education on the risk for ECC.

Case Report: Holistic dental care for a child with Hunter syndrome: Addressing dental ramifications, overcoming challenges, and enhancing quality of life

Abstract: Hunter syndrome (MPS II), an X-linked recessive lysosomal storage disorder, is a result of deficiency of the iduronate 2-sulfatase enzyme (IDS), leading to cognitive impairment, systemic organ involvement, and increased dental problems. This case report describes the management of a child with Hunter syndrome who was referred to the Department of Paediatric and Preventive Dentistry for pain in the upper front teeth. Intraoral examination revealed severe early childhood caries, prompting planning for full-mouth rehabilitation under general anaesthesia due to the child’s uncooperative behaviour. In response to recommendations from the Department of Otolaryngology and the Department of Paediatric Surgery, a comprehensive treatment plan consolidated full-mouth rehabilitation in addition to adenoidectomy and inguinal and umbilical herniotomy procedures during a single session of general anaesthesia. Successful interventions were reflected in the uneventful one-month follow-up of the patient, highlighting the efficacy of the interdisciplinary approach. The key takeaway underscores the importance of collaborative interventions, emphasising singular intubation for patients requiring recurrent hospitalisations, providing both monetary relief and reducing post operative healing time. Designed to address global developmental delay in the child, a personalised home care plan was also implemented. Evaluation of plaque and gingival indices before and after the home care regimen demonstrated a notable improvement, indicating an enhanced oral quality of life.

Relationship between parental adverse childhood experiences and the prevalence of early childhood caries.

The aim of this study was to examine the behavioural health conditions associated with parents' retrospective adverse childhood experiences (ACEs) scores and their children's early childhood caries (ECC) in parent-child dyads. Parents with children younger than 72 months were included in the study. A relational screening model was used. Interaction among ACEs, ECC, nutritional habits and oral hygiene habits were evaluated. Chi-square tests and t-tests were used in the study. Multiple variables were evaluated using the artificial neural network (ANN) model. The mean age of the 535 children included in the study was 46.5 months, and 52% were female. Using the ANN model, there was a statistically significant relationship between the educational status of the mothers in both the ECC and severe ECC (S-ECC) groups and the socioeconomic status of the family (p < 0.05). If the number of snacks consumed daily was three or more, the risk of ECC was statistically significantly higher (chi-square test p = 0.034). The parents' ACEs scores had an impact on both ECC and S-ECC formation (p = 0.001, t-test). The higher the ACEs score, the higher the risk of S-ECC. The mean ACEs scores of the parents were also significantly higher in both the ECC and S-ECC groups compared to those of the parents of children without dental caries (p = 0.001, t-test). It was calculated that ACEs scores were effective at a rate of 18.2% on ECC (p = 0.045, ANN). The ACEs scores of parents have an impact on the oral health of young children and ECC/S-ECC formation. The long-term effects of parental ACEs are reflected in their children's oral health. Therefore, reducing the psychosocial determinants ACEs and providing parental support may help in overcoming barriers to the well-being of young children and may facilitate better oral health.

Evaluation of Changes in Oral Microflora in Children with Early Childhood Caries after Full Mouth Rehabilitation.

To evaluate the change in microflora in children suffering from severe early childhood caries (ECC) after full mouth rehabilitation. A total of 60 children, aged 3-5 years suffering from severe ECC who fulfilled the inclusion and exclusion criteria were included in the study. Pooled plaque samples were taken and subjected to quantitative reverse transcriptase polymerase chain reaction (PCR) to obtain baseline mean values of Streptococcus mutans (S. mutans), Streptococcus sobrinus (S. sobrinus), Candida albicans (C. albicans), and Candida dubliniensis (C. dubliniensis) before full mouth rehabilitation was done under general anesthesia. Posttreatment samples were collected at 6, 12, and 18 months. Wilcoxon signed-rank test was used to compare the mean values of S. mutans, S. sobrinus, C. albicans, and C. dubliniensis before and after full mouth rehabilitation. A total of 60 patients recruited for the study were present at the follow-up at 6 and 12 months. At 18 months, 55 patients returned, and five were lost due to follow-up. A statistically significant reduction was seen in all microorganisms at 6, 12, and 18 months compared to baseline values. At 18 months a slight increase in S. mutans, S. sobrinus, and C. albicans was seen. C. dubliniensis was not detected in any cases after full mouth rehabilitation. Caries recurrence was seen in four patients at 18 months. Significant reduction of S. mutans, S. sobrinus, C. albicans, and C. dubliniensis was seen at 6, 12, and 18 months. A complete reduction of only C. dubliniensis was seen. A significant but not permanent reduction of S. mutans, S. sobrinus, and C. albicans. Caries recurrence was seen in 7.27% of patients at 18 months. Mathew MG, Jeevanandan G, Rathod NN. Evaluation of Changes in Oral Microflora in Children with Early Childhood Caries after Full Mouth Rehabilitation. Int J Clin Pediatr Dent 2024;17(1):21-25.

Evaluation of possible associated factors for early childhood caries: are preterm birth and birth weight related?

BackgroundThis study aimed to evaluate the oral and dental health of preschool children aged 12–71 months living in the Eastern Anatolia Region of Turkey, and to examine the effects of low birth weight (LBW) and preterm, early term and term birth on dental caries.Methods475 participants were included in the study. Intraoral examinations were performed and evaluated for the presence of early childhood caries (ECC). These values ​​are; Relationships such as age, gender, birth weight, week of birth, tooth brushing frequency, cariogenic nutrition, and parental education levels were examined. The obtained data were analyzed statistically (chi-square, t-test, artificial neural network (ANN)).ResultsOf the 475 participants, whose parents agreed to fill out the questionnaire, 250 were female and 225 were male. While the mean age was 49.78 ± 14.78 months for those with ECC, it was 38.93 ± 17.96 months for those without. Higher duration of breastfeeding (p = 0.04), education level of parents (p = 0.001), lower socioeconomic level (p = 0.001), and lower brushing frequency (p = 0.001) were also found to be significantly associated with ECC. ECC was seen in 90% of 77 children with a history of preterm birth. In LBW, this rate was 83%. According to the ANN result, in preterm birth; 12.9% affected ECC by LBW.ConclusionAccording to the results of our study, both LBW and preterm delivery were found to be associated with ECC and S-ECC (severe early childhood caries). An additional study on parents of preterm/LBW infants would be beneficial. In the early period, regular dental examination, implementation of preventive and preventive treatments, and nutrition education to parents can make a significant difference in the prevention of ECC.

Association of Dental Caries in Primary Teeth With HLA Class II Gene Among Syrian Children.

Background and objectives Numerous studies have shown that there is evidence that genetic factors contribute in different ways to the occurrence of caries lesions, and the multiple differences in the human leucocytes antigen (HLA) gene patterns play an important role in the body's immune response. Therefore, this study aimed to evaluate the association between some HLA class II alleles (HLA-DR4, HLA-DQ2, HLA-DQ4) and early childhood caries (ECC) occurrence in Syrian children. Materials and methods The study included 80 children aged three to six, divided into two groups: Group 1 (n = 40) being severe early childhood caries (S-ECC) children (deft ≥ 10) and Group 2 (n = 40) being free caries children (deft = 0). The genomic DNAs were extracted and collected by taking a buccal swab using a sterile metal strip and were amplified by polymerase chain reaction-single specific primer (PCR-SSP) and then HLA-typing was performed for all alleles. Results There were no statistically significant differences in the frequency of occurrence of S-ECC, HLA-DR4, and HLA-DQ2 alleles (p = 0.626, 0.256 respectively), while the incidence of S-ECC was associated with the DQ4 allele (p = 0.012). Conclusion HLA class II molecules may play a crucial role in predisposing to ECC, since positive HLA-DQ4 may enhance the chance of developing ECC. However, no association were found between (HLA-DR4 and HLA-DQ2) and ECC.

Association between Serum Iron, Serum Ferritin Levels, and Severe Early Childhood Caries: A Case-Control Study.

The presence of extensive dental caries leads to pain, inflammation, and discomfort and hence interferes with their nutritional intake, which includes iron deficiency anemia. This study was undertaken to determine whether any correlation exists between severe early childhood caries (S-ECC), serum iron, and serum ferritin levels in children. A total of 688 children were examined in the age-group of 2-6 years, and 82 children who fulfilled the selection criteria were equally divided into group I, that is, case group (carious group n = 41) and group II, that is, control group (caries-free group n = 41), on the basis of decayed, missing, and filled primary teeth (dmft) scores. All the selected children in both groups underwent blood investigations through phlebotomy for assessment of serum iron and serum ferritin levels. The mean values of variables, that is, hemoglobin (Hb), serum iron, serum ferritin, total iron-binding capacity (TIBC), and unsaturated iron-binding capacity (UIBC), are lower in the case group when compared to control group. The differences observed were statistically significant in case of dmft and UIBC values at p < 0.05 but not significant in cases of other variables like Hb, serum iron, serum ferritin, and TIBC values. An inverse relationship was found between S-ECC, serum iron, and serum ferritin levels, but the evidence is still inconclusive. Atri Y, Garg N, Pathivada L, et al. Association between Serum Iron, Serum Ferritin Levels, and Severe Early Childhood Caries: A Case-Control Study. Int J Clin Pediatr Dent 2023;16(S-3):S288-S292.

The short-term impact of comprehensive caries treatment on the supragingival microbiome of severe early childhood caries.

Children affected by severe early childhood caries (S-ECC) usually need comprehensive caries treatment due to the extensive of caries. How the oral microbiome changes after caries therapy within the short-term warrant further study. This study aimed to investigate the short-term impact of comprehensive caries treatment on the supragingival plaque microbiome of S-ECC children. Thirty-three children aged 2-4 years with severe caries (dt > 7) were recruited. Comprehensive caries treatment was performed under general anesthesia in one session and included restoration, pulp treatment, extraction, and fluoride application. Supragingival plaque was sampled pre- and 1-month posttreatment. The genomic DNA of the supragingival plaque was extracted, and bacterial 16S ribosomal RNA gene sequencing was performed. Our data showed that the microbial community evenness significantly decreased posttreatment. Furthermore, comprehensive caries treatment led to more diverse microbial structures among the subjects. The interbacterial interactions reflected by the microbial community's co-occurrence network tended to be less complex posttreatment. Caries treatment increased the relative abundance of Corynebacterium matruchotii, Corynebacterium durum, Actinomyces naeslundii, and Saccharibacteria HMT-347, as well as Aggregatibacter HMT-458 and Haemophilus influenzae. Meanwhile, the relative abundance of Streptococcus mutans, three species from Leptotrichia, Neisseria bacilliformis, and Provotella pallens significantly decreased posttreatment. Our results suggested that comprehensive caries treatment may contribute to the reconstruction of a healthier supragingival microbiome.

Maternal Oral Health Education for Predicting Early Childhood Caries among Preschool Children: A Systematic Review and Meta-analysis

Introduction: Early Childhood Caries (ECC) is a pressing public health issue in preschool-aged children. Preventive guidelines have not significantly reduced ECC incidence. Maternal education programmes have been proposed as interventions, but systematic reviews on their effectiveness are scarce. Aim: To evaluate the effectiveness of oral health education programmes for mothers in preventing ECC. Materials and Methods: Eight eligible Randomised Controlled Trials (RCTs) were identified through searches in the Cochrane Oral Health Group’s Trial Register, PubMed, and Google Scholar, as well as manual review of references from Englishonly studies. The interventions targeted mothers starting from 12 weeks of pregnancy onwards, with the exclusion of treatment-based methods, pharmacological interventions, and post-pregnancy programmes. The primary outcome assessed was ECC incidence, analysed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Participants exclusively received oral health educational programmes designed to prevent ECC in their children, highlighting the importance of early preventive measures during pregnancy. Results: Global studies varied in interventions and outcomes. A study from Brazil showed no reduction in ECC, while a study from Uganda reported reduced dental caries. Another study from Australia demonstrated a significant reduction in severe ECC. Risk of bias analysis revealed that five studies had a low risk of bias while one study had an unclear risk of bias. Moderate risk of bias was found in one study. Conclusion: Evidence suggests a positive impact of maternal education on ECC prevention, supporting tailored programmes for mothers with lower education. The overall recommendation strength is modest due to intervention variations and limited trials. Tailored educational programmes for mothers, especially those with lower education levels, should be integrated into maternal and child health services to effectively address social determinants of oral health.

Association between Candida albicans and childhood dental caries in Japanese children

IntroductionThe possible association between Candida carriage in children and childhood caries has not been elucidated in the Japanese population. This study aimed to investigate the prevalence, maternal relatedness, and genotypic distribution of Candida albicans in this population. Materials and methodsWe collected dental plaque samples from 55 mother-child pairs in the Caries group and 25 pairs in the caries-free (CF) group to analyze microbial data (carriage and viable counts), focusing on Streptococcus mutans and C. albicans. Clinically isolated 118 Candida strains were further evaluated using arbitrarily primed polymerase chain reaction. ResultsA higher C. albicans carriage rate was observed in the Caries pairs (25.5 % in children, 47.3 % in mothers) than in CF pairs (0 % in children, 24.0 % in mothers). The viable counts of S. mutans were significantly higher in the Caries group than in the CF group (p < 0.05). In addition, S. mutans counts positively correlated with C. albicans counts in the dental plaque of caries-affected children (r = 0.549). Almost all Candida-positive children (92.9 %) were diagnosed with severe early childhood caries, and 79.7 % of Candida isolates from the mother-child pairs were similar at the strain level. C. albicans genotype A was the most predominant (70.6 %) strain, followed by genotype D (17.6 %) in dental plaques from children in the Caries group. ConclusionsThe presence of C. albicans is a risk factor for childhood caries in a Japanese population. Our findings provide new insights into maternal-child oral health instructions based on microbial factors associated with dental caries.

Relationship between the salivary concentrations of proteinase-3 and interleukin-8 and severe early childhood caries.

Severe early childhood caries (S-ECC) is a multifactorial transmissible infectious disease continuing to affect infants and toddlers worldwide. Saliva plays a modulatory role in the pathogenesis of dental caries. The present study aimed to assess the salivary levels of proteinase-3 (PR3) and interleukin-8 (IL-8) as pro-inflammatory cytokines related to the function of neutrophils in association with S-ECC and its treatment. Fifty children aged 36-60 months were recruited (25 caries-free controls and 25 S-ECC patients). Saliva sampling was performed in all participants. In the S-ECC group, sampling was repeated 6-8 weeks after restorative treatment. The salivary concentrations of PR3 and IL-8 were determined using the enzyme-linked immunosorbent assay (ELISA). The χ2 test, Fisher's exact test, the independent t test, and the paired t test were applied at p < 0.05. The baseline salivary concentrations of PR3 and IL-8 in the S-ECC group were significantly higher than in the caries-free group (p < 0.001). A significant reduction occurred in the levels of these cytokines following restorative treatment in the S-ECC group (p < 0.001), although they were still significantly higher than in the caries-free group (p < 0.05). The salivary levels of PR3 and IL-8 were significantly affected by the presence of dental caries in children, implying their potential efficiency as non-invasive indicators in the determination of the caries risk and treatment effectiveness.

The bi-directional relationship between growth stunting and early childhood caries: a rapid review.

This review aims to determine the two-way relationship between stunting and ECC in developing countries worldwide. The procedure in this study was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Rapid Review protocol. Article searches were carried out using databases Cochrane and PubMed. In addition, searches were also carried out using backward and forward snowballing techniques to identify articles that were not detected through database searches. Nine observational epidemiological articles were found in children aged six months to six years, published in 2015-2020. Five articles discussed the features of ECC in stunted children, and the other five discussed stunting in children with caries in their primary teeth. Several studies found associations between severe ECC and stunting, with ECC and stunting as both independent and dependent variables, suggesting a bi-directional relationship, also supported by literature on the physiological relationship between oral health and nutrition.

Association between Severe Early Childhood Caries, Dietary Preferences, and 2nd Digit-4th Digit (2D:4D) Ratio.

To evaluate the association between severe early childhood caries (S-ECC), dietary preferences, and 2nd digit-4th digit (2D:4D) ratio. The objective is to contrast the detection and prevalence of dental caries in children with different sensitivity levels to the bitter taste of 6-n-propylthiouracil (PROP) and its association with 2D:4D. A total of 300 children below 71 months of age were assigned to two study groups-group I (caries-free) and group II (caries). PROP sensitivity test was carried out to determine the inherent genetic ability to taste a bitter or sweet substance. Evaluation of dietary preferences was carried out using a food preference questionnaire, which was completed by the parents of the children to know the child's dietary habits and their sweet, sour, and strong taste preferences. The length of the index (2D) and ring (4D) finger was measured with the help of digital vernier caliper to record the 2D:4D ratio. The data obtained was subjected to statistical analysis using Pearson's Chi-squared test and one-way analysis of variance (ANOVA). The results suggested a positive association between S-ECC and dietary preferences but could not establish a straightforward 1:1 relation between 2D:4D ratio and S-ECC. An individual considered as nontaster by PROP test was a sweet liker with low 2D:4D ratio having high caries index. The association between 2D:4D ratio and S-ECC should further be explored by taking other influencing factors into consideration before arriving at a definitive conclusion. Srivastava SK, Garg N, Pathivada L, et al. Association between Severe Early Childhood Caries, Dietary Preferences, and 2nd Digit-4th Digit (2D:4D) Ratio. Int J Clin Pediatr Dent 2023;16(5):740-744.

Oral health-related quality of life and associated factors among a sample from East China with severe early childhood caries: a cross-sectional study

BackgroundTo investigate the oral health-related quality of life (OHRQoL) and associated factors among a sample from East China with severe early childhood caries (S-ECC).MethodsA total of 316 children with S-ECC and their parents were recruited to participate in a cross-sectional study. Children were examined for caries status using criteria proposed by World Health Organization (WHO). The accompanying parent was required to provide demographic information and complete two validated questionnaires in Chinese: the early childhood oral health impact scale (ECOHIS) and the 5-item oral health impact profile (OHIP).ResultsThe study had a 98.1% response rate. Finally, the data of 300 children and their parents were analyzed. Mothers cared for their children far more than fathers in the included family (78.7% mother, 21.3% father). The mean age of children was 4.1 ± 0.7 years, ranging from 3 to 5. The mean dmft score was 13.8 ± 3.8. Few (13.7%) children never had a toothache. ECOHIS scores ranged from 0 to 38, with a mean score of 16.2 ± 7.2. The mean OHIP score was 2.9 ± 2.7. The parental age, family income, residence, history of pain, the dmft scores and parents’ OHIP showed associations with ECOHIS scores or domain scores (P < 0.05). The multiple regression analysis showed that the history of pain, accompanying parents’ OHIP, and the dmft scores were mainly associated with ECOHIS and child impact (P < 0.05); parental age was associated with family impact (P = 0.024).ConclusionsThe parent’s OHRQoL was associated with the children’s OHRQoL, indicating that policymakers and clinical practitioners should improve both children’s and their parents’ oral health. Furthermore, the caries severity and the history of dental pain impacted children’s OHRQoL.

Presence of candida in the dental plaque and saliva of patients with severe early childhood caries and early childhood caries: a pilot study

Presence of candida in the dental plaque and saliva of patients with severe early childhood caries and early childhood caries: a pilot study

Small for gestational age and early childhood caries: the BRISA cohort study

This study tests the hypothesis that children 12–30 months born small for gestational age (SGA) aged are more susceptible to severe early childhood caries (S-ECC). We used data on 865 children aged 12–30 months from a prospective cohort study conducted in a city in the northeast of Brazil. The study outcome was S-ECC, defined based on the proportion of decayed tooth surfaces (cavitated or not). The main exposure variable was SGA, defined according to the Kramer criterion and the INTERGROWTH-21st standard. Direct (SGA → S-ECC) and indirect effects were estimated using structural equation modeling, calculating standardized factor loadings (SFL) and P-values (alpha = 5%). The final models showed a good fit. SGA influenced S-ECC in the direct and indirect paths. In the group of SGA children with 12 or more erupted teeth defined according to the Kramer criterion, the direct effect was positive (SFL = 0.163; P = 0.019); while among all SGA children defined according to the INTERGROWTH-21st standard, the direct effect was negative (SFL =  − 0.711; P < 0.001). Age and number of erupted teeth may influence the occurrence of S-ECC in SGA children, as the number of teeth affects the time of exposure to disease risk factors.

THE INFLUENCE OF 3D POP-UP STORYBOOK IN THE OHIS, DMFT, DMFT, DENTAL HEALTH KNOWLEDGE &amp; BEHAVIOR OF GRADE 1 STUDENT AT SDN BAKALANKRAJAN 2

Background: Caries is one of the serious health problems, especially in elementary school students. According to Riskesdas in 2018, Indonesian children aged 5-6 years categorized in severe early childhood caries. After the covid cases have decreased in Indonesia , health promotion was held again in the school. Storybook is one of the media that can be used for health promotion in children, with attractive storyline and pictures as well. Purpose: To identify the influence of “Si Gilang dan Ramuan Ajaib'' 3D Pop-Up storybook in the OHI-S, DMFT, dmft index, dental health knowledge and behavior of grade 1 students at SDN Bakalankrajan 2. Methods: This was a numerical comparative study with a cross-sectional approach. The population were grade 1 elementary school students in SDN Bakalankrajan 2 in Malang. Results: After 3D Pop-Up storybook intervention twice time and after 30 days follow-up, there is a change in the OHIS, DMFT, dmft, knowledge and tooth brushing behavior compare to the score before intervention. The OHIS index has increased (p=0,000), DMFT index has decreased (p=0,974), the dmft index have increase quite high (p=0,106), knowledge level and tooth brushing behavior has increased on average quite well (p=0,024). Conclusion: Education intervention using a 3D pop-up children's storybook entitled "Si Gilang dan Ramuan Ajaib" and introducing a 21-day morning and night toothbrush calendar to students contributed to increasing the oral hygiene index (OHIS), decreasing the caries index in permanent teeth (DMFT), increasing caries index in deciduous teeth (dmft), increasing dental health knowledge level and toothbrushing behavior of grade 1 students of SDN Bakalan Krajan 2.

Incidence and risk factors of unplanned retreatment following dental general anesthesia in children with severe early childhood caries.

This study aimed to retrospectively describe the unplanned retreatment of dental general anesthesia (DGA) in children with severe early childhood caries (S-ECC) and explore potential factors that may influence the outcome of DGA treatment. Medical records of children with S-ECC who received DGA treatment were screened, and necessary data were extracted. The Kaplan-Meier method and Cox proportional hazards model were used to estimate the DGA survival rate and explore the potential factors affecting the success rate of DGA treatment. Medical records of 852 children were included; 509 (59.7%) children with 1,212 (10.7%) teeth underwent unplanned retreatment. Restoration failure (30.12%) and new caries (29.46%) accounted for the most significant proportion of all failures. The median survival times were 510 and 1,911 days at the child and tooth levels, respectively. Unplanned retreatment risk was associated with the age of S-ECC children, frequency of follow-up, and fluoride application (hazard ratio = 0.97, 0.78, 0.69, P < 0.001). The treatment outcome of DGA administered to children with S-ECC was satisfactory at the tooth level from the perspective of the incidence of unplanned retreatment. Restoration failure was the main reason for the high unplanned retreatment rate. Strategies for a better outcome of DGA include improving the professional knowledge and skills of pediatric dentists and enhancing compliance of parents/patients. Health education and regular topical fluoride application may improve the success rate of DGA treatment.

Comparison of Total Salivary Antioxidant Capacity of Children with and without Severe Early Childhood Caries before and after Complete Dental Rehabilitation.

Early childhood caries (ECC) is the most chronic disease affecting children all over the world. Children often complain of pain and need complete rehabilitation, which is often done under general anesthesia due to extensive treatment and behavioral problems that are often encountered. The present study was undertaken to evaluate the total salivary antioxidant capacity of children with severe ECC (S-ECC) before and after complete dental rehabilitation and compare it with caries-free children. Salivary samples were obtained from 30 children aged 3-5 years and diagnosed with S-ECC, along with 30 age and sex-matched controls. Complete dental rehabilitation under general anesthesia was performed on the children with S-ECC, and follow-up salivary samples were obtained after 3 and 6 months postoperatively. Total salivary antioxidant capacity was measured using a commercially available Oxygen Radical Absorbance Antioxidant Assay measurement kit. At baseline, children with S-ECC had higher total antioxidant capacity (TAC) compared to the controls. A significant difference in total salivary antioxidant capacity between both groups was seen at baseline. At 3 months following, the total salivary antioxidant capacity of children treated for S-ECC was slightly higher than controls but had significantly reduced compared to baseline. At 6 months, there was no significant difference between both groups. Within the limitations of our study, it can be concluded that the total salivary antioxidant capacity associated with children suffering from S-ECC is reduced after complete rehabilitation. Mathew MG, Jeevanandan G. Comparison of Total Salivary Antioxidant Capacity of Children with and without Severe Early Childhood Caries before and after Complete Dental Rehabilitation. Int J Clin Pediatr Dent 2023;16(3):474-477.

Relationship between the salivary concentration of matrix metalloproteinases 8 and 20 and severe early childhood caries.

Dental caries is initiated through mineral dissolution by bacterial acids and collagen degradation by endogenous proteolytic enzymes, mainly collagenolytic matrix metalloproteinases (MMPs). The present research aimed to evaluate the relationship between severe early childhood caries (S-ECC) and salivary MMP-8 and MMP-20 concentrations. Fifty children aged 36-60 months were assigned to either the caries-free (control) group or the S-ECC group. Standard clinical examinations were performed, and approx. 1 mL of expectorated unstimulated whole saliva was collected from all participants. In the S-ECC group, the sampling was repeated 3 months after restorative treatment. All samples were analyzed for the salivary concentrations of MMP-8 and MMP-20, using the enzyme-linked immunosorbent assay (ELISA). Statistical analysis employed the t test, the Mann-Whitney U test, the χ2 test, Fisher's exact test, and the paired samples t test. The level of significance was set at 0.05. At baseline, the subjects in the S-ECC group presented with significantly elevated levels of MMP-8 as compared to the control group. However, the salivary concentration of MMP-20 did not exhibit a significant difference between the 2 groups. A significant reduction occurred in the levels of MMP-8 and MMP-20 3 months after restorative treatment in the S-ECC group. The salivary levels of MMP-8 and MMP-20 were significantly affected by dental restorative treatment in children. Furthermore, MMP-8 was observed to be a better indicator of the dental caries status than MMP-20.