Prolonged breast-feeding boosts risk of developing early childhood caries
Children who are breast-fed for at least 2 years are more than 8 times more likely to develop early childhood caries (ECC) than children who are breast-fed for less than 6 months. The finding is from a study published in the March/April issue of Journal of Clinical Pediatric Dentistry.
Authors designed the retrospective longitudinal study to measure the association between long-term breast-feeding and ECC in 3-year-old children followed-up by a public health program. The program offers clinical dental treatment, preventive care, and risk assessment for pregnant women and children up to 3 years old.
The study population included 325 children who had their first dental appointment before age 1 year and at least 1 visit per year during their first 3 years. Authors used a questionnaire to compile data on socioeconomic status, breast-feeding duration, oral hygiene, and daily frequency of sucrose intake. They used dental records to compile information on caries in the children.
Authors grouped breast-feeding duration into less than 6 months, 6 through 11 months, 12 through 23 months, and 24 months or greater. Questions related to daily sucrose intake by children included vegetables, fruits, water, sugar in tea, soft drinks, sugar in coffee, sugar in milk, yogurts, artificially sweetened juices or gelatin juices, cakes or sweet cookies, bread or crackers, and candies or lollipops. Children who consumed sweet food, sugar-sweetened beverages, or a spoonful of sugar at least 7 times per day were categorized as having high frequency sucrose intake.
Authors considered ECC an independent variable and defined ECC as the presence of 1 or more decayed, missing or filled tooth surfaces in any primary tooth in a child younger than 6 years. Authors recorded the incidence of ECC between the first and last dental examination during the child’s third year. They recorded the presence or absence of dental plaque during the child’s second-year examination.
Authors used the Mann-Whitney test for dichotomous variables and the Kruskal-Wallis test for countable variables to compare the mean incidence of caries according to independent variables. Authors used negative binomial regression models to measure the association between breast-feeding duration and caries, allowing for estimated rate ratios (RRs) and 95% confidence intervals (CIs). Covariates included frequency of sucrose intake and presence of dental plaque.
Overall, the authors found the incidence of caries was 12.92%. The mean incidence of caries was greater in children who were breast-fed longer than 24 months, with a higher frequency of sucrose intake, and those who had dental plaque. The multivariate analysis showed that children who were breast-fed more than 24 months (RR, 8.29; 95% CI, 1.82 to 37.72) were more likely to have a greater incidence of caries than children who were breast-fed for less than 6 months or not breast-fed at all. Children with a higher frequency of sucrose intake (RR, 1.36; 95% CI, 1.12 to 1.65) and those who had dental plaque (RR, 9.38; 95% CI, 3.22 to 27.35) were more likely to have caries.
“It is necessary to emphasize the importance of controlling other factors that may be associated with increased risk of caries development when combined with breastfeeding,” the authors concluded. “Frequency of sucrose intake and oral hygiene habits, such as fluoride intake, should be further analyzed to better understand this issue.”
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Environment, not genetics, a greater risk factor for caries in twins
The risk of developing caries in twin children stems more from environmental factors than genetics, according to a longitudinal study published in the May issue of Pediatrics.
Authors designed the study to assess fetal and developmental risk factors for caries and to see how much environment and genetics contributed to those risk factors. The study recruited 250 mothers during pregnancy and followed them after the birth of their twin children. The population consisted of 344 children (185 girls, 159 boys) from 172 complete twin pairs (101 dizygotic and 71 monozygotic).
Authors used a questionnaire to measure the mothers’ weight, illness, medication use, stress, alcohol intake, and smoking 3 times during pregnancy, at birth, at 18 months, and again at 6 years. They compiled data from mothers on breast-feeding duration, illnesses, hospitalization, and medication use when the twins reached 18 months. Authors used dental examinations to compile data on dietary sugar intake and oral hygiene when the twins turned 6 years. The authors determined levels of 25-hydroxyvitamin D in mothers from serum collected at 28 weeks’ gestation and in infants at birth.
Authors used the International Caries Detection and Assessment System to quantify carious lesions from early to large cavitated lesions with significant damage to tooth structure. Authors also used the International Caries Detection and Assessment System index to record the presence of any caries or advanced caries and classified twin pairs as concordant (both children affected) or discordant (1 twin affected). Authors compared case-wide concordances with 95% confidence intervals (CI) for monozygotic and dizygotic twins to measure the role of genetic and environmental factors. They created a multiple logistic regression model with generalized generating equations (GEEs) to estimate similarities for monozygotic and dizygotic twins and logistic regression models using GEEs to measure the association between environmental risk factors and the presence of any or advanced caries.
In all, authors found 111 children with any caries, with a mean of 3.0 teeth affected. A total of 39 pairs were concordant and 33 pairs were discordant for the presence of any caries. Authors found 83 children with advanced caries, with a mean of 2.8 teeth affected. A total of 26 twin pairs were concordant and 31 twin pairs were discordant for advanced caries. Overall concordance for any caries was 0.70 (95% CI, 0.61 to 0.80). In addition, authors found no evidence of higher unadjusted concordance in monozygotic twins (0.74; 95% CI, 0.58 to 0.89) than in dizygotic twins (0.69; 95% CI, 0.56 to .081), with a difference of 0.05 (95% CI, -0.14to 0.25; P = .30). The overall concordance for advanced caries was 0.63 (95% CI, 0.51 to 0.75). There was no evidence of higher unadjusted concordance in monozygotic twins (0.63; 95% CI, 0.43 to 0.82) than in dizygotic twins (0.63; 95% CI, 0.47 to 0.78), with a difference of 0.00 (95% CI, -0.26 to 0.26; P = .50).
Authors also found that maternal and newborn vitamin D levels, chorionicity, maternal obesity, smoking beyond the first trimester, age at examination, sex, nonfluoridated town water, and the presence of hypomineralized primary second molars were all associated with advanced caries in unadjusted regression models. Nonfluoridated water, maternal obesity, and hypomineralized primary second molars were strongly associated with advanced lesions after adjusting for cofounding variables.
“The perceived genetic nature of dental caries may lead to a sense of determinism that impedes rather than motivates behavioral change,” the authors concluded. “If replicated, findings from our study will help clinicians motivate such change by revealing that caries risk is modifiable.”
Read the article here or contact the ADA Library & Archives for assistance.
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Kids with Down syndrome show higher prevalence of malocclusion
Children with Down syndrome (DS) have a higher prevalence of malocclusion than children without DS, according to a meta-analysis published in the July issue of International Journal of Paediatric Dentistry.
Authors designed the systematic review to see whether children and adolescents with DS are more affected by malocclusion than children and adolescents without DS. They conducted a detailed literature search in Biblioteca, Brasileira de Odontologia, Cochrane Library, Latin American and Caribbean Health Sciences Literature, PubMed, SciELO, Scopus, and Web of Science for studies up through April 2018. They compiled data on author and year of publication, country where the study was conducted, study setting, sample size, participants’ ages, malocclusion assessment index, measurements evaluated, and obtained results. Independent reviewers used a modified version of the Newcastle-Ottawa Scale to measure the quality of the studies. Authors used I2 statistics to measure heterogeneity across studies. They used a fixed-effects model when the I2 was less than 25% and a random-effects model when the I2 was greater than 25%. The strength of evidence from the chosen studies was measured using the Grading of Recommendations Assessment, Development and Evaluation system.
From an initial search that yielded 511 studies, the authors chose 11 for review. The cross-sectional studies published from 1985 through 2016 were from Saudi Arabia, Brazil, Jordan, Mexico, Nigeria, Argentina, Denmark, Canada, and the United States. Sample size ranged from 50 (25 with DS and 25 without DS) through 1,737 (37 with DS and 1,700 without DS), with ages that ranged from 3 through 19 years. A total of 7 studies recruited patients with DS from specialized centers, 2 from public hospitals, 1 from a private office, and 1 from an unspecified location. A total of 4 studies recruited patients for the control group from regular schools, 5 from students of dental colleges, 1 from a private office, and 1 from an unspecified location.
The chosen studies evaluated malocclusion using the following indexes: Norwegian Need for Orthodontic Treatment; Dental Aesthetic Index; Angle classification; Peer Assessment Rating (PAR); Index of Complexity, Outcome and Need for Treatment (ICON); assessment of posterior and anterior crossbite; anterior open bite; mandibular overjet; mesial molar occlusion; crossbite; crowding; and cephalometric analysis.
One study using the Norwegian Need for Orthodontic Treatment index found that children with DS had a higher percentage of crossbites, impacted anterior teeth, missing teeth, agenesis of single teeth, overjet 6 millimeters or greater, anterior teeth conversion, and crowding and spacing than children without DS. Studies that used the Dental Aesthetic Index to measure malocclusion found severe malocclusion more often among adolescents with DS than adolescents without DS (P =.028). Among the 6 studies that used the Angle Classification to measure malocclusion, Class III malocclusion was more prevalent among those with DS (P < .001), (P < .05), and (P < .01). Class I and Class II malocclusions were more frequent among control participants (P < .001), (P < .05) and (P < .01).
One study that used the PAR and ICON indexes to measure malocclusion found that children and adolescents with DS had higher PAR and ICON scores than 2 controls (P = .001; P = .004 and P < .001; P = .007, respectively). Children and adolescents with DS had a higher prevalence of anterior open bite than those without DS (risk difference [RD], 0.21; 95% confidence interval [CI], 0.06 to 0.36). Children and adolescents with DS had a higher prevalence of Class III malocclusion than children and adolescents without DS (RD, 0.40; 95% CI, 0.33 to 0.46). Children and adolescents had a higher prevalence of posterior crossbite (risk ratio, 3.09; 95% CI, 2.02 to 4.73, anterior crossbite (risk ratio, 2.18; 95% CI, 1.41 to 3.39), and anterior open bite (RD, 0.21; 95% CI, 0.06 to 0.36) than those without DS.
Read the article here or contact the ADA Library & Archives for assistance.
Clear bottle-weaning guidelines needed for pediatricians, pediatric dentists
Clear, preventive guidelines should be developed to address the complete removal of a bottle from infants, according to a study published in the July-August issue of Pediatric Dentistry.
Authors designed a study to see how pediatricians and pediatric dentists interpret guidelines related to bottle-fed infants and to assess how they implement those guidelines. Authors developed a survey that included 1 qualifying, 3 demographic, and up to 11 knowledge, practice-based, or both type of questions.
The 2104 American Academy of Pediatrics policy statement recommends bottle-weaning by 12 months of age. The American Academy of Pediatric Dentistry recommends bottle-weaning by 12 through 18 months of age. Because of this, authors used 1 initial parameter statement in their survey: “All questions refer to a normal developing healthy infant or child fed primarily by bottle (containing formula and/or breastmilk).”
Authors emailed 6,337 survey invitations to American Academy of Pediatrics members and 5,142 survey invitations to American Academy of Pediatric Dentistry members. The response rate was 11.4% (721) and 19.5% (1,005), respectively. Nearly 85% of surveys were completed in 7 minutes or less. Most respondents in both groups had been practicing less than 21 years and were in private practice.
Authors found widespread agreement among physicians (MDs) and pediatric dentists (PDs) that weaning is a transitional period with a start and a finish and a statistically significant difference between MDs and PDs that weaning should start at 12 months (49.2% and 57.9%, respectively). Authors noted a significant difference (P = .038) between MDs and PDs who said the average time for weaning should be 3 months (34.3% and 33.7%, respectively) and between MDs and PDs who said the average weaning time should be 1 through 2 months (25.2% and 31.8%, respectively). Authors also observed significant differences between MDs and PDs (P < .001) regarding the age to finish weaning. The most common response from MDs was 15 months (40.7%) compared with 12 months (33%) from PDs. Most MDs (90.8%) and PDs (88.7%) said that “neither daytime nor nighttime bottle use (complete unavailability of bottle)” showed that bottle weaning was finished.
When asked about recommending only water at night in a bottle, 79.1% of MDs and 96.6% of PDs answered yes (P < .001). Most MDs said weaning recommendations should be given in 2 through 3 separate visits compared with most PDs who said weaning recommendations should be given in 1 through 2 separate visits. (P < .001).
Based on their findings, the authors posed 5 recommendations for bottle-weaning:
- explicitly state an age the bottle should be completely unavailable;
- clarify recommendations against nighttime bottle use;
- clarify guidelines to distinguish the start and finish of bottle-weaning;
- clarify terms of weaned, weaning, prolonged bottle use, nighttime bottle use, bottle-weaning;
- communicate the benefits of weaning at an earlier age.
“It is imperative that health care professionals come to a clear consensus in order to make sound and consistent public health preventive guidelines for providers, parents, and caretakers,” the authors concluded. “Duration of bottle use is a modifiable practice, and it is possible to decrease exposure to prolonged bottle use as a potential risk for disease.”
Read the article here or contact the ADA Library & Archives for assistance.
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AAPD releases 5th edition Handbook of Pediatric Dentistry
The 5th Edition Handbook of Pediatric Dentistry is the premier reference for pediatric dentists and other health professionals. Designed to serve as a quick reference guide, the handbook is a must-have addition to every practice. The Handbook of Pediatric Dentistry has been completely revised and updated to present the most up-to-date information in a quick reference format. Each chapter also suggests readings and useful Web sites for additional information. This 5th edition of the handbook is available as a mobile application too (compatible with iPad/iPhone/iPod Touch or Android mobile devices). Visit the AAPD website for more details or to purchase.
Also, customized brochures on 17 different pediatric dentistry topics are available from AAPD.
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The consulting editor for JADA+ Specialty Scan — Pediatric Dentistry is James R. Boynton, DDS, MS, Clinical Associate Professor, Pediatric Dentistry Division Head, University of Michigan School of Dentistry. |
The consulting editor for JADA+ Specialty Scan — Pediatric Dentistry is Douglas B. Keck, DMD, MSHEd, Dental Director, Healthcare Network of Southwest Florida. |
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