Caries Research最新文献

Introduction: Adverse childhood experiences (ACEs) are negative events occurring before age 18 that may impact health. Children exposed to ACEs often receive inadequate preventive care and have a higher prevalence of diseases like dental caries. However, research on this topic remains limited. This study evaluated the association between ACEs and dental caries in adolescents.

Methods: This is a cross-sectional study nested in a cohort performed with a representative sample of preschools from Santa Maria, southern Brazil. This study used data from the last follow-up, with individuals aged between 14 and 18. Data collection was performed through structured questionnaires administered face-to-face and oral clinical examinations. All research team was previously trained and calibrated. Dental caries was measured by International Caries Detection and Assessment System (ICDAS). ACE was evaluated by questions of the Brazilian version of the Adverse Childhood Experiences-International Questionnaire (ACE-IQ), considering alcohol and drug use, suicidal intent, imprisonment, divorce, or death of family members. The co-occurrence of ACEs was also evaluated. Sociodemographic and behavioral variables were used as covariables. Poisson regression models were used to investigate the associations with results present in rate ratio (RR) and 95% confidence interval (CI).

Results: A total of 406 adolescents were examined. The mean of teeth with dental caries was 1.45 (standard deviation 3.6). The rate of dental caries was 56% higher in adolescents who lived with someone who has been sent to prison (RR: 1.56; 95% CI: 1.02-1.90) and 22% higher in adolescents who witnessed their parents' divorce (RR: 1.22; 95% CI: 1.02-1.45) compared to those counterparts. The other ACEs separately were not associated with dental caries. Adolescents exposed to one, two, or more ACEs concomitantly had significantly higher caries rates compared to those with no exposure.

Conclusion: Individuals who witnessed parental divorce or imprisonment exhibited higher rates of dental caries. Moreover, exposure to one, two, or more concurrent ACEs was associated with higher dental caries rates compared to no exposure. These findings underscore the importance of considering specific ACEs within the family environment when assessing their impact on dental caries.

Introduction: Leveraging data from a cohort study of Quebec youth with a family history of obesity, this study aimed to (i) identify neighbourhood socio-environmental typologies in childhood and (ii) estimate their associations with the incidence of dental caries in adolescence.

Methods: We used baseline (2005-2008) and second follow-up (2012-2015) data from the ongoing QUALITY cohort study in Montreal, Canada, which included 512 children aged 8-10 years with ≥1 biological parent with obesity at baseline. Based on prior literature and data availability, we selected three key neighbourhood-level indicators - social disorder, social deprivation, and material deprivation - measured in both school and residential settings. Latent class analysis was used to derive the socio-environmental typologies by combining social disorder, social deprivation, and material deprivation of the social environment in school and residential neighbourhoods. The outcome was dental caries incidence, assessed as the change in the Decayed, Missing, Filled Surface index. Negative binomial regression was performed to estimate incidence ratios (IRs) and corresponding 95% confidence intervals (CIs).

Results: Only three neighbourhood socio-environmental typologies were identified. Type 1 neighbourhoods: high social disorder, high social deprivation, and low material deprivation; type 2 neighbourhoods: median social disorder, median social deprivation, and median material deprivation; type 3 neighbourhoods: low social disorder, low social deprivation, and high material deprivation. Compared to type 1, the IRs (95% CIs) were 0.9 (0.6-1.2) for type 2 and 0.8 (0.6-1.1) for type 3.

Conclusion: Neighbourhoods with lower social disorder and social deprivation may offer a protective effect against dental caries in youth.

Introduction: Dental caries in childhood remains a major global public health issue. In response to persistently high caries levels among children, Chile implemented a national programme (Sembrando Sonrisas) including daily supervised toothbrushing and biannual fluoride varnish applications in nurseries. This study aimed to examine the association between these interventions and caries experience in preschool children, and to assess related socioeconomic inequalities.

Methods: We analysed aggregated municipality-level data (n = 346) on dental caries outcomes in 5-year-olds, coverage of fluoride varnish applications, delivery of toothbrushing materials (toothbrushes and 1,000 ppm fluoride toothpaste), exposure to community water fluoridation (CWF), rurality, and socioeconomic deprivation. The primary outcome was the caries experience of children covered by the programme since its national rollout in 2015. Univariate and multivariate weighted linear regression models assessed associations between programme interventions and caries experience, adjusting for deprivation and CWF. Socioeconomic inequalities in caries experience were evaluated using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII). The distribution of programme delivery across socioeconomic deciles was assessed using weighted regression models.

Results: Data on 309,360 5-year-olds were included. Complete delivery of toothbrushing materials was associated with lower caries experience (50.1% vs. 55.0%), a 4.9% difference (95% CI: 2.5%, 7.2%) after adjustment. CWF exposure was associated with a 7.5% lower caries experience (95% CI: 4.2%, 10.9%). The combination of both interventions showed the lowest caries levels, with a 13.4% difference compared to areas with neither intervention (95% CI: 7.5%, 19.3%). Fluoride varnish application was not significantly associated with caries experience. Delivery of interventions was equitable across socioeconomic groups. However, caries experience was significantly higher in the most deprived municipalities (SII = 14.7%, 95% CI: 11.7%, 17.7%; RII = 0.283, p < 0.001).

Conclusion: Lower caries experience was associated with supervised daily toothbrushing and CWF exposure, but not with fluoride varnish application. Despite equitable programme coverage, substantial socioeconomic inequalities persist. As this ecological study cannot establish causality, further research is needed to evaluate long-term trends and the role of broader determinants in improving child oral health.

Introduction: This study compared the diagnostic accuracy of interproximal caries detection using intraoral bitewing radiographs, assessed by both human operators and an artificial intelligence (AI) program, a near-infrared reflectance imaging (NIRI) system with operator-conducted assessment, and histological evaluation as the reference.

Methods: 100 posterior teeth with or without caries were mounted on 10 typodonts. Initially, 180 surfaces were examined, but eight were excluded for different reasons. Therefore, 171 proximal surfaces were analyzed. NIRI imaging was performed using the iTero Element 5D®, and radiographs were analyzed by operators and an AI program, Denti.AI. Results were compared with histology, assessing sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values, F1-score, areas under receiver operating characteristic curves (AUCs), and the Fleiss Kappa coefficient (k).

Results: The statistical analysis results for each diagnostic test were as follows: examiner radiographic assessment (Se = 52%, Sp = 84.6%, PPV = 71.6%, NPV = 70.3%, F1-score = 60%, AUC = 0.684, k = 0.459); NIRI (Se = 37%, Sp = 98.9%, PPV = 96.4%, NPV = 67.8%, F1-score = 52%, AUC = 0.673, k = 0.475); AI-guided radiographic assessment (Se = 13.7%, Sp = 95.9%, PPV = 71%, NPV = 59.8%, F1-score = 23%, AUC = 0.548). McNemar's test showed a p < 0.05 for all diagnostic tests.

Conclusion: Both the operator-conducted NIRI system and examiner radiographic assessment demonstrated superior detection capabilities compared to the AI program. Among these methods, the examiner radiographic assessment yielded the best results, followed by the NIRI system, demonstrating its potential for clinical use.

Introduction: Dental caries is a biofilm-mediated, multifactorial disease of the dental hard tissues. Maternal psychosocial and behavioral factors can affect a child's risk for many chronic childhood conditions including dental caries. We examined the relationship between maternal psychological well-being during and after pregnancy on caries experience in 3-year-old offspring.

Methods: Using data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study (N = 667), maternal psychological well-being including depressive symptoms (Edinburg Postnatal Depression scale [EPDS]), anxiety symptoms (State Trait Anxiety Inventory [STAI]), and sleep quality were measured. Offspring dental caries experience was defined as having at least one decayed, missing, and filled teeth or surface (dmft ≥1 vs. 0/dmfs ≥1 vs. 0). We estimated associations between maternal psychological well-being in the pre- and postnatal periods with offspring dental caries experience using logistic regression models adjusted for several maternal and child demographic and socioeconomic factors.

Results: The mean maternal age at delivery was 31 (SD: 5.1) years with ethnic distribution of 55% Chinese, 28% Malay, and 17% Indian; 8.6% of mothers had a prenatal EPDS score ≥15 indicating probable depression and 44% of the children had dmft ≥1. Children of mothers with high prenatal EPDS scores (≥15) had 1.57 times (95% CI: 0.85-2.93) the adjusted odds of dental caries experience as compared to children of mothers with prenatal EPDS score <15, although this association was not statistically significant. Moreover, children of mothers with consistently high/changing EPDS and STAI scores in the pre- and postnatal periods had adjusted odds of caries experience of 1.65 (95% CI: 1.01-2.72) and 1.24 (95% CI: 0.89-1.74), respectively, when compared to children whose mothers had consistently low EPDS and STAI scores, though only EPDS association was statistically significant. Associations with poor sleep quality followed a similar direction, although not statistically significant.

Conclusion: While the current findings did not consistently demonstrate statistically significant associations, they suggest a potential role of maternal psychological well-being during and after pregnancy on children's oral health status.

Introduction: This study aimed to describe the prevalence of untreated dental caries in early childhood based on intergenerational socioeconomic data and to evaluate the association between intragenerational socioeconomic mobility data and untreated dental caries in children aged 4.

Methods: This is a longitudinal study. Data from three birth cohorts in Pelotas (1982, 1993, and 2015) were used. Data from three generations participating in these cohorts were evaluated. Untreated dental caries in childhood (2015 cohort) was considered the dependent variable. Family income and schooling were independent variables. The social mobility variable was categorized considering income and level of schooling data in the mothers' generation. Poisson regression was performed to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CIs).

Results: A total of 286 pairs of children and mothers/grandmothers were evaluated for the intergenerational sample (1982 and 1993 cohorts), and 3,633 mothers and children for the intragenerational sample (2015 cohort). In the intergenerational analysis, there was a reduction of about 10 percentage points in the prevalence of untreated caries in children from families that experienced upward/downward income mobility compared to children whose generations remained with lower income. In the intragenerational analysis, children belonging to the ascending/descending economic mobility groups had twice the prevalence of untreated dental caries compared to those always with higher salaries (PR 2.04; 95% CI 1.52-2.71 and PR 2.07; 95% CI 1.56-2.74, respectively).

Conclusion: Findings demonstrate an association between untreated dental caries in children and family socioeconomic status, including their mothers' income/education mobility. Thus, intervening in early childhood socioeconomic conditions is needed to improve children's oral health.

Introduction: Dental caries is highly prevalent among pregnant women, and investigating potential modifying factors is particularly relevant for this population. This study aimed to evaluate the moderating effect of oral health literacy (OHL) on the relationship between socioeconomic conditions and dental caries in pregnant women.

Methods: This cross-sectional study was performed with pregnant women attending the public health service in Santa Maria, a municipality in Southern Brazil. The Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) instrument was used to evaluate OHL. The presence of dental caries was measured using the decayed, missing, or filled teeth (DMFT) index. Socioeconomic conditions were assessed based on family income and education level. The moderating effect of OHL on the relationship between income, education, and caries (D component of DMFT) was tested using multilevel Poisson regression analyses. The results are presented as prevalence ratio.

Results: A total of 520 pregnant women were examined (response rate of 93%). Pregnant women with low educational level and low OHL exhibited a 69% higher prevalence of dental caries compared to those with higher education and high OHL. Similarly, among those with high income, pregnant with low OHL had a 57% higher prevalence of untreated dental caries than their counterparts with both high income and high OHL.

Conclusion: Our findings indicate that low OHL modifies the association between socioeconomic conditions and dental caries among pregnant women. Low OHL appears to function as an aggravating factor, potentially exacerbating oral health outcomes in this population.

Introduction: Caries experience in primary teeth has been highlighted as the most important single risk factor for caries development in the subsequent permanent teeth, but at cavitated stages. This 10-year cohort study aimed to evaluate whether children with only initial caries lesions in the primary teeth could also have a higher risk for caries incidence in permanent teeth.

Methods: We evaluated Brazilian preschoolers aged 1-5 years in 2010 (T1) and re-evaluated them 2 (T2), 7 (T3), and 10 (T4) years later. Dental caries in primary and permanent teeth was assessed through the International Caries Detection and Assessment System (ICDAS). For the primary dentition (T1 and T2), the participants were categorised according to caries severity in the first two assessments into children with (i) no caries, (ii) only initial caries lesions (ICDAS scores 1 and 2), (iii) at least one moderate lesion (ICDAS scores 3 and 4), and (iv) extensive caries lesions (ICDAS scores 5 and 6). We also created a dichotomous variable considering only extensive lesions. Demographic and socio-economic data were also collected. For the permanent dentition (T3 and T4), the participants were re-evaluated for extensive caries lesions after 7 and 10 years of follow-up. The outcome variables were the number of decayed, extracted, and filled surfaces of permanent teeth and the occurrence of any extensive lesion (caries incidence) after 10 years. Associations were evaluated through negative binomial and Poisson regression analyses, respectively. Incidence rate ratios (IRRs) and relative risks, along with 95% confidence intervals (95% CIs), were derived.

Results: At the baseline, 639 children were included, and 429 were reassessed after 10 years (67.2% retention rate). Children with only initial or moderate caries lesions did not have a higher risk of caries in permanent teeth. By contrast, children with extensive caries lesions were more likely to develop caries in the permanent dentition than children without caries (IRR, 95% CI = 2.90, 1.98-4.23). This higher risk was more clearly demonstrated when the caries experience was used as a dichotomous variable (IRR, 95% CI = 4.02, 2.38-6.78).

Conclusion: Children with only initial caries lesions do not have a higher risk of developing dental caries in the permanent dentition by adolescence.

Introduction: Despite evidence supporting the clinical and cost-effectiveness of minimally invasive dentistry (MID), its adoption by the dental profession has been slow. A systematic review in 2016 found the majority of dentists intervene invasively earlier than necessary. The aim was to update this review of the assessment of dental practitioners' thresholds for providing restorative treatment for carious lesions given changes in evidence, teaching, and guidelines since 2016. The primary outcome was dental practitioners' restorative thresholds (the extent of the lesion when they would decide to intervene restoratively). Secondary outcomes were changes over time, caries risk, regional differences, and primary/permanent dentition.

Methods: This updated review replicated the methodology for the initial review, following the PRISMA 2020 guidelines (PROSPERO; CRD42023431906). Embase, MEDLINE (via PubMed), and Web of Science databases were searched (2016-2023) for observational studies reporting on dental clinicians' thresholds for restorative interventions in adults and children without language, time, or quality restrictions. Screening, data extraction, and risk of bias assessment (Modified Newcastle-Ottawa Scale) were carried out independently and in duplicate. Meta-analyses were performed using a random-effects model. No funding sought.

Results: Overall, 47 publications (30 from original publication and 17 from updated search) met the inclusion criteria and 65 datasets were included in the meta-analyses: 19 for occlusal lesions (16 pre-2016 and 3 post-2016; n = 11,946) and 46 for proximal lesions (38 pre-2016 and 8 post 2016; n = 20,428). The meta-analyses found that for occlusal lesions confined to enamel, there were fewer practitioners intervening invasively: 5% (95% confidence interval [CI]; 1-20%) post-2016, compared with 15% (95% CI; 9-23%) pre-2016. The opposite was found for proximal lesions with increased intervention levels, 27% (95% CI; 18-40%) for lesions confined to enamel post-2016, compared with 19% (95% CI; 12-29%) pre-2016, and for lesions extending up to the enamel-dentine junction 61% (95% CI; 36-81%) post-2016, compared with 39% (95% CI; 29-51%) pre-2016. There was variance between regions but too few studies to draw conclusions on individual regions.

Conclusion: There was a suggestion of less invasive treatment of occlusal lesions over time; however, this was not evident for proximal lesions.

Introduction: Determinants of oral health are formed early and influenced by variations in socioeconomic status (SES). It is unclear whether early life SES influences child oral health directly or indirectly through determinants such as intake of free sugars. This study applied the marginal structural modelling approach to household income at birth and free sugar intake to investigate pathways those determinants influence child oral health.

Methods: We used data collected in SMILE, a population-based birth cohort study of Australian mother/newborn dyads, who have been followed-up prospectively since birth with questionnaires and clinical assessment. Area- and individual-level factors collected at childbirth were background confounders. Household income at childbirth (low/medium/high) and free sugar intake at age 2 years (low/medium/high) were used as primary exposure and mediator to investigate pathways through which SES at childbirth influences oral health. By applying the causal inference approach and using marginal structural modelling, we estimated the controlled direct effect of household income and the direct effect and mediating effect of intake of free sugars on dental caries experience. We developed a causal directed acyclic graph to guide the analysis. The baseline confounders were balanced using a stabilised inverse probabilities of treatment weight, mimicking randomisation.

Results: Low household income at childbirth was associated with 1.65 (95% confidence intervals [CI]: 1.01, 3.02) times higher accumulated dental caries experience by age 5 years than in children born to high-income households. High intake of free sugars had strong direct effects on both the prevalence (1.55 [95% CI: 1.03, 2.32]) and cumulative experience (2.64 [95% CI: 1.36, 5.15]) of dental caries by age 5 years. Proportions of effects of income were mediated by intake of free sugars.

Conclusion: Socioeconomic variations at birth and immediate determinants such as intake of sugars, directly and indirectly, influence oral health. Timely and appropriate addressing of those variations may limit inequity in oral health.