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1.  Persistent oral health disparity in 12-year-old Hispanics: a cross-sectional study 
BMC Oral Health  2016;16:10.
Dental caries is the most prevalent chronic illness worldwide. In the US dental caries has been described as a “silent epidemic”, affecting 58.2 % of 12–15 year-olds, particularly in minority and immigrant groups. Caries is associated with complex yet preventable biological and behavioral factors such as dental plaque and diet, as well as social determinants of health. In developed nations, a higher risk caries has been associated with populations of low socio-economic status (SES), especially in areas with greater income disparity. An island-wide study conducted in Puerto Rico in 1997 revealed a high prevalence of dental caries in 12-year-olds and a significant health disparity between children attending private and public schools. The purpose of the present study was twofold: 1) to estimate caries levels of 12-year-old school Puerto Ricans in 2011; and 2) compare results to data obtained in 1997 to explore any possible change in caries outcomes after a government health insurance (GHI) reform was implemented.
In this cross-sectional study, a probability sample of 133 out of 1,843 schools was selected proportional to enrollment size, and stratified by 1997 GHI regions, school type, and gender. Calibrated examiners conducted oral soft tissue and caries examinations. Dental caries prevalence was estimated. Mean Decayed Missing Filled Tooth/Surface (DMFT/S) indices and mean Significant Caries Index (SiC) were calculated and compared retrospectively to data obtained in 1997.
The final sample included 1,587 school-enrolled children. About 53 % of participants were female and 77 % attended public schools. Between 1997 and 2011, reductions were observed in caries prevalence (81 to 69 %), mean DMFT scores (3.8 to 2.5), mean DMFS scores (6.5 to 3.9), and mean SiC index (7.3 to 5.6) in both private and public schools, with a more prominent decrease in private schools. Between 1997 and 2011, overall the filled component increased (50 to 67 %), while decayed and missing component decreased (42 to 30 %) and (8 to 3 %), respectively.
Among 12-year-old schoolchildren in Puerto Rico between 1997 and 2011, caries prevalence, extent, and severity decreased as well as the DMFT missing component, while the filled component increased. Dental caries prevalence was high and the health disparity persists between children enrolled in public and private schools after more than a decade of the GHI implementation. The relationship between GHI implementation and other potentially relevant co-factors for caries warrants further research, as does the seemingly entrenched disparity across groups.
PMCID: PMC4736133  PMID: 26830842
Dental caries; Children; Puerto Rico; Prevalence; Healthcare disparities
2.  Salutogenesis: A New Approach toward Oral Health Promotion 
Contemporary Clinical Dentistry  2017;8(3):387-390.
Sense of coherence (SOC) is hypothesized to be an important psychological factor that enables people to cope with stressors and successfully maintain and improve health. Very few publications report on the relationship between “salutogenesis,” as measured by the concept of SOC and oral health status. However, little is known about the relationship between the mother's SOC and dental caries of their children.
Aims and Objectives:
The aim of the present study was to explore the impact of mother's SOC level on dental caries status of their children.
Materials and Methods:
A school-based cross-sectional study was conducted with the children aged 4–8 years attending public school (n = 200). Questionnaires were applied to mothers to obtain level of SOC. Dental caries status in children was assessed using decayed, missing, filled tooth surfaces (DMFS) and/or dmfs index. One-way analysis of variance F-test and post hoc Tukey test were used to assess the effect of mother's SOC level on their children's caries dmfs index.
Mean of dmfs and/or DMFS in children showed statistically significant relation with their mother's SOC level (P < 0.01). On intergroup comparison, significant (P < 0.01) difference was found when mean of dmfs and/or DMFS with mothers having low SOC and high SOC was compared. However, there was no significant relation when mean was compared to mothers with medium and low SOC.
Dental caries of children gets influenced by mother's SOC level. There was an inverse relationship between mother's SOC level and their children dental caries status.
PMCID: PMC5643994
Decayed; missing; filled tooth surfaces; oral health promotion; sense of coherence; stress
3.  Maternal Dental Anxiety and its Effect on Caries Experience Among Children in Udaipur, India 
Dental caries is a common oral disease among children. There are various factors that influence caries development. Parents and family environment influence oral health behaviours among children. Dental Anxiety is a common hindrance in seeking dental treatment. Mothers’ dental anxiety may act as a barrier to seek professional advice about their children’s caries experience.
To evaluate dental anxiety among mothers and its possible relationship with caries experience in their children in Udaipur city, India
Setting and Design
The sample was selected from those attending Darshan Dental College and Hospital, Udaipur for dental treatment. The study period was from June 2014 to November 2014.
Materials and Methods
A cross-sectional survey was designed. A total of 187 mother-child pairs were recruited for the study. The children’s age ranged from 3-14 years. Modified Dental Anxiety Scale (MDAS), Hindi version, was used to evaluate dental anxiety among the mothers that categorizes the dental anxiety into five levels. Demographic detail such as age, educational level, and family income was also collected. The World Health Organization (WHO) criteria was utilized for the diagnosis of dental caries in children. DMFT (Decayed, missing and filled teeth) and DMFS (Decayed, missing and filled surfaces) scores were then calculated.
Statistical Analysis
Statistical Package for Social Sciences (SPSS) version 20.0 was used to interpret data. Maternal anxiety scores taken as mean MDAS were compared with various independent variables. Statistical tests were used to compare maternal anxiety and children’s caries experience. A p value equal or less than 0.05 was considered as statistically significant.
Almost half (49.7%) of the mothers reported as being ‘fairly anxious’ or ‘very anxious’. There was a significant (p=.001) difference in maternal dental anxiety level in relation to age of the children. Mothers of younger children reported higher anxiety scores. Similarly, mothers with lesser education and lesser family income reported higher anxiety scores. The mean decayed score in children of very anxious mothers and phobic mothers was significantly (p=.001) higher as compared to the children of the mothers with lower anxiety levels.
There was a strong positive association between maternal dental anxiety and children’s dental caries experience.
PMCID: PMC4525606  PMID: 26266216
Dental caries; Epidemiology; Oral health; Paediatric dentistry
4.  Oral hygiene habits and oral health status of female adolescents under state protection: a pilot study 
The aim of this study is to evaluate oral health status and oral hygiene practices of female adolescents under state protection.
Subjects and Methods:
Fifty-five female participants between the age of 12 and 18 who are under the care of The Child Protection Institution were included in this study. Self-administered questionnaires were used to obtain information regarding knowledge of oral health and habits. Dental caries status was scored according to the criteria of the World Health Organization (WHO), using the indices of Decayed (D), Missing (M), Filled (F), Surfaces (S) (DMFS). In addition, Gingival Index (GI) and Plaque Index (PI) were recorded during periodontal assessment. Data was statistically analyzed by using Oneway analysis of variance, Tukey’s HSD and Student’s t tests.
Fourteen children had dental fear and 52.7% of them were not satisfied with their esthetic appearance. Although 78.2% of the children knew that brushing prevents dental caries, only 18 of them were brushing regularly twice per day. Mean DMFS, GI and PI scores were 13.18±5.68, 1.35±0.37 and 1.33±0.45, respectively. Only 20% of the children were using dental floss. There was statistically no significant difference between the DMFS scores of the children in terms of flossing. However, the difference between the mean GI and PI of the same group was found to be statistically significant (p<0.05).
Children under state protection were found to have a reasonable knowledge of the causes of dental caries and gum bleeding. Therefore, adequate management of this positive attitude can significantly improve the oral health of this population.
PMCID: PMC5573488
Female adolescents; institutionalized; oral health; habits; orphans
5.  Factors Associated with Dental Caries in a Group of American Indian Children at age 36 Months 
Early childhood caries (ECC) is rampant among American Indian children, but there has been relatively little study of this problem. This paper reports on risk factors for caries for a group of American Indian children at age 36 months as part of a longitudinal study.
Pregnant women from a Northern Plains Tribal community were recruited to participate in a longitudinal study of caries and caries risk factors. Standardized dental examinations were completed on children and questionnaires were completed by mothers at baseline and when children were 4, 8, 12, 16, 22, 28 and 36 months of age. Examinations were surface-specific for dental caries, and the questionnaires collected data on demographic, dietary and behavioral factors. Non-parametric bivariate tests and logistic regression models were used to identify risk factors for caries at 36 months, and negative binomial regression was used to identify factors related to caries severity (dmf counts).
Among the 232 children, and caries prevalence for cavitated lesions was 80%, with an additional 15% having only non-cavitated lesions. The mean dmfs was 9.6, and of the total dmfs, nearly 62% of affected surfaces were decayed, 31% were missing, and 7% were filled. Logistic regression identified higher added sugar beverage consumption, younger maternal age at baseline, higher maternal DMFS at baseline, and greater number of people in the household as significant (p<0.05) risk factors. Negative binomial regression found that only maternal DMFS was associated with child dmf counts.
By the age of 36 months, dental caries is nearly universal in this population of American Indian children. Caries risk factors included sugared beverage consumption, greater household size and maternal factors, but further analyses are needed to better understand caries in this population.
PMCID: PMC4777677  PMID: 26544674
Dental Caries; Children; Risk factors; Oral health disparities
6.  Oral health status, salivary pH status, and Streptococcus mutans counts in dental plaques and saliva of children with acute lymphoblastic leukemia 
Dental Research Journal  2017;14(3):188-194.
Acute lymphoblastic leukemia (ALL), accounting for 23% of all malignancies in children, is the most prevalent pediatric malignancy. This study compared dental caries, oral hygiene status, salivary pH, and Streptococcus mutans counts in dental plaques and saliva of children with leukemia with those of healthy controls.
Materials and Methods:
This case–control cross-sectional study assessed 32 children with ALL and 32 healthy children (4–9-year-old) for gingival bleeding index (GBI), decayed, missing, and filled/decayed, missing, and filled surfaces (DMF/dmfs), and plaque index (PI). Sampling was performed to determine salivary pH and S. mutans counts of the participants. The two groups matched in terms of age, gender, and socioeconomic status. The groups were compared using independent t-test, Mann–Whitney test, Chi-square test, and Spearman's and Pearson's correlation analyses.
The mean DMF/dmfs and GBI were significantly higher in the ALL group (PDMF/dmfs= 0.03; PGBI= 0.04). However, the two groups were not significantly different in the mean PI values (P = 0.47). The mean S. mutans counts in dental plaques and saliva of the children with leukemia were significantly lower than the healthy controls (P < 0.01). Moreover, the mean salivary pH was significantly lower in the ALL group compared to the control group (P < 0.01).
Higher caries and gingival bleeding rates, higher dental plaque accumulation in children with ALL, decreased salivary pH, and cumulative effects of other risk factors highlight the significance of oral hygiene training programs (for the parents of these children) and regular dental examinations for these children.
PMCID: PMC5504871  PMID: 28702060
Acute lymphoblastic leukemia; caries; children; dental plaque; gingival health; Streptococcus mutans
7.  Clustering Tooth Surfaces into Biologically Informative Caries Outcomes 
Journal of Dental Research  2013;92(1):32-37.
Dental caries affects most adults worldwide; however, the risk factors for dental caries do not necessarily exert their effects uniformly across all tooth surfaces. Instead, the actions of some risk factors may be limited to a subset of teeth/surfaces. Therefore, we used hierarchical clustering on tooth surface-level caries data for 1,068 Appalachian adults (ages 18-75 yrs) to group surfaces based on co-occurrence of caries. Our cluster analysis yielded evidence of 5 distinct groups of tooth surfaces that differ with respect to caries: (C1) pit and fissure molar surfaces, (C2) mandibular anterior surfaces, (C3) posterior non-pit and fissure surfaces, (C4) maxillary anterior surfaces, and (C5) mid-dentition surfaces. These clusters were replicated in a national dataset (NHANES 1999-2000, N = 3,123). We created new caries outcomes defined as the number of carious tooth surfaces within each cluster. We show that some cluster-based caries outcomes are heritable (i.e., under genetic regulation; p < 0.05), whereas others are not. Likewise, we demonstrate the association between some cluster-based caries outcomes and potential risk factors such as age, sex, educational attainment, and toothbrushing habits. Together, these results suggest that the permanent dentition can be subdivided into groups of tooth surfaces that are useful for understanding the factors influencing cariogenesis. Abbreviations: COHRA, Center for Oral Health in Appalachia, the principal study sample; C1-5, clusters 1-5, groups of similarly behaving tooth surfaces identified through hierarchical clustering; DMFS index, decayed, missing, or filled surfaces, a traditional caries measure representing the number of affected surfaces across the entire dentition; DMFS1-5, partial DMFS indices representing the number of affected surfaces within a hierarchical cluster; and NHANES, National Health and Nutrition Examination Survey, the secondary study sample.
PMCID: PMC3521447  PMID: 23064960
dental caries; permanent dentition; white spots; hierarchical clustering; cluster analysis; heritability
8.  Dental Caries Prevalence in Human Immunodeficiency Virus Infected Patients Receiving Highly Active Anti-Retroviral Therapy in Kermanshah, Iran 
Cell Journal (Yakhteh)  2014;16(1):73-78.
Introduction of new approaches for the treatment of human immunodefi- ciency virus (HIV) infection such as anti-retroviral medicines has resulted in an in- crease in the life expectancy of HIV patient. Evaluating the dental health status as a part of their general health care is needed in order to improve the quality of life in these patients. The aim of this study was to compare the root and crown caries rate in HIV patients receiving highly active antiretroviral therapy (HAART) with that rate in HIV patients without treatment option.
Materials and Methods
This cross sectional study consisting of 100 individuals of both genders with human immunodeficiency virus were divided into two groups: i. group 1 (treat- ment group) including 50 patients with acquired immunodeficiency syndrome (AIDS) receiving HAART and ii. group 2 (control group) including 50 HIV infected patients not receiving HAART. Dental examinations were done by a dentist under suitable light using periodontal probe. For each participant, numbers of decay (D), missed (M), filled (F), Decayed missed and filled teeth (DMFT), decay surface (Ds), missed surface (Ms), filled surface (Fs), Decayed missed and filled surfaces (DMFS), and tooth and root caries were recorded. Data were analyzed using Chi-square test and independent t test using SPSS 13.0, while p-value of <0.05 was considered statistically significant in all analysis.
The mean and standard deviation (SD) of decayed, missed and filled teeth of those who were on highly active antiretroviral therapy was 6.86 ± 3.57, 6.39 ± 6.06 and 1.89 ± 1.93, respectively. There was no significant difference between these values regarding to the treat- ment of patients. The mean and standard deviation of DMFT, DMFS and the number of de- cayed root surfaces were 15.14 ± 6.09, 56.79 ± 28.56, and 4.96 ± 2.89 in patients treated by anti-retroviral medicine which were not significantly different compared to those without this treatment.
According to the results of the present study, highly active antiretroviral ther- apy could not be considered as a single factor for dental caries prevalence in HIV-infected patients. However, more research is recommended to evaluate the cariogenic potential of these medicines.
PMCID: PMC3933441  PMID: 24518976
Dental Caries; HIV Infection; Anti-Retroviral Agents; Root Caries; Iran
9.  Caries prevalence and impact on oral health-related quality of life in children with sickle cell disease: cross-sectional study 
BMC Oral Health  2015;15:68.
Children with sickle cell disease (SCD) may present oral conditions that can compromise children's health even more. However, there is still no consensus on the association between SCD and dental caries. The aim of this study was to assess caries prevalence in children with sickle cell disease (SCD), and the association of dental caries with socioeconomic factors, disease severity, and oral-health related to quality of life (OHRQoL).
The sample was comprised of 106 children with SCD aged 8 to 14 years who were attending the Center for Hematology (Hemominas) in Belo Horizonte, Brazil. They were matched to 385 healthy peers. Data collection included interviews with guardians concerning SCD characteristics, and previous social and oral examinations to determine the caries prevalence. Caries prevalence as measured through the Decayed, Missing and Filled (dmft and DMFT) indices. OHRQoL was evaluated through the Brazilian versions of the Child Perceptions Questionnaires (CPQ8–10, and CPQ11–14 short-form version). Statistical analyses were performed using the chi-square test or Fisher`s exact test and the Mann Whitney test, as well as linear regression.
The DMFT index was 1.3 (SD: 2.1) in younger children with SCD and 1.5 (SD: 1.9) in SCD teens. Younger children with SCD had lower caries experience compared to healthy peers (p = .03). The experience of dental caries among teens with SCD was similar to healthy peers (p > 0.05). In addition, we did not see a significant difference on the mean overall scores of CPQ8–10 between SCD younger children and controls. There was no statistically significant difference in the mean overall scores of teens CPQ11-14 between SCD and the control group. Socioeconomic variables were not associated with dental caries in the participants with SCD. However, SCD severity was associated with higher DMFT indexes (p < 0.05).
Younger children with SCD had a low experience of dental caries. The dental caries experience in teenagers with SCD was similar to their healthy peers. OHRQoL was similar between SCD participants and controls.
PMCID: PMC4472155  PMID: 26085066
Quality of life; Sickle cell disease; Dental caries; Socioeconomic factors
10.  Child, neglect and oral health 
BMC Pediatrics  2013;13:188.
Despite advancements in oral health policies, dental caries still a problem. The lack of parents/caregiver’s care regarding child’s oral health, which characterizes neglect, may lead to a high prevalence of caries. Therefore, the objective of this study was to analyze the relation between dental caries and neglect in five year-old children.
Quantitative study performed in two different moments. First, the children underwent oral examinations and physical inspection. Then, a semi-structured interview was performed with parents of children with high and low caries rate.
In all, 149 physical inspections and oral exams were performed. The number of decayed, missing and filled teeth – dmf-t was 2.75 (SD 2.83); 16 children had extremely high values (dmf-t ≥7), 85 intermediate values (1 ≤ dmf-t ≥ 6) and 48 extremely low (dmf-t = 0). Nearly all caregivers were female (96.7%; n = 29), mostly mothers (93.3%; n = 28). Associations were found between caries experience and reason of the last consultation (p = 0.011), decayed teeth and child’s oral health perception (p = 0.001). There was a trend towards a significant association between general health and decayed teeth (p = 0.079), general hygiene and caries experience (p = 0.083), and caries experience and number of times the child brushes the teeth (p = 0.086).
There’s a relation between caries experience and children’s oral health perception by caregivers, as well as between caries experience and children’s access to dental care. There is a trend towards association between caries experience and risk factors suggestive of neglect.
PMCID: PMC3834883  PMID: 24238222
Neglect; Oral health; Maternal behavior
11.  Relationship Between Different Types and Forms of Anti-Asthmatic Medications and Dental Caries in Three to 12 Year Olds 
Asthma is a common chronic disease. Asthma and anti-asthmatic medications have been suggested as risk factors for increased susceptibility to caries. This study was conducted to evaluate the effects of different types and forms of antihistaminic medications and the duration of drug consumption on the severity of dental caries in asthmatic children.
Materials and Methods:
This cross-sectional study was conducted in Asthma and Allergy Department of Children’s Medical Center in Tehran, Iran. Eighty-five children between three to 12 years who had been diagnosed with asthma, by means of taking medical history, clinical examination and spirometry were chosen by non-simple random sampling. The participants and their parents were interviewed. Oral examination was performed by a qualified dentist. The data were collected by use of questionnaires and analyzed by the stepwise multivariate linear regression analysis, using SPSS version 16. P<0.05 was considered statistically significant.
There was a significant correlation between the number of cetirizine and ketotifen tablets taken and decayed/missing/filled (dmf/DMF) teeth score (P=0.006). There were no correlations between the number of consumed sprays and dmf/DMF score (P=0.923), the duration of drug therapy (P=0.907) or the type of medication taken including ß2 agonists, antihistamines, steroids or a combination of them (P=0.907).
The present study showed that the tablet form of medications significantly increased the severity of dental caries even in presence of confounders (sex, age, duration of disease, tooth brushing, sugar consumption, fluoride therapy, mouth dryness).
PMCID: PMC5253216  PMID: 28127315
Asthma; Anti-Asthmatic Agents; Dental Caries
12.  Reliability of self-reported toothbrushing frequency as an indicator for the assessment of oral hygiene in epidemiological research on caries in adolescents: a cross-sectional study 
In the present state of knowledge regarding the etiology of dental caries, it is unacceptable for studies addressing factors associated with this outcome to disregard oral hygiene. Simple, valid methods are needed for the assessment of oral hygiene in adolescents to allow this condition to be properly investigated in epidemiological studies on caries and assist in the establishment of health promotion measures. The aim of the present study was to test the hypothesis that the self-reported toothbrushing frequency can be used as a proxy measure for clinical oral hygiene indices in epidemiological studies on dental caries in adolescents.
A cross-sectional study was conducted with a representative sample (n = 589) of 12-year-old school children in a medium-sized city in southern Brazil. A detailed questionnaire addressing socio-demographic and economic characteristics was sent to primary caregivers. Adolescents answered a brief self-administered questionnaire on behavioral characteristics, including toothbrushing frequency and sugar intake. Samples of stimulated saliva were collected from the adolescents and evaluated for levels of mutans streptococci and lactobacilli using Dentacult kits I and II, respectively. Examiners who had undergone a training and calibration exercise (kappa > 0.81) performed the clinical examination of the adolescents. Caries experience was assessed using the decayed, missing and filled teeth index. Oral hygiene was determined using the Simplified Oral Hygiene Index and the Visible Plaque Index.
When the oral hygiene variables were used alone in the multiple models, significant associations with dental caries were found. When Simplified Oral Hygiene Index and/or Plaque Index were used together with toothbrushing frequency in the same model, only the latter was significantly associated with dental caries. A significant association was also found between self-reported toothbrushing frequency and the clinical indices.
Based on the present findings, self-reported toothbrushing frequency can be used as a proxy measure for clinical oral hygiene indices, which facilitates data collection in epidemiological studies addressing dental caries in adolescents.
PMCID: PMC4355135  PMID: 25887179
Toothbrushing; Adolescent; Dental plaque indices; Self report
13.  Prevalence, Severity and Related Factors of Dental Caries in School Going Children of Vadodara City – An Epidemiological Study 
Objective: Among dental diseases, dental caries is an important dental public health problem in India which is irreversible in nature, and is predominantly a disease of childhood. Till date no study has been carried out in Vadodara. As baseline data of caries is required to improve oral health of children, the present study was undertaken to determine the pattern of dental caries in school children of Vadodara city in the mixed dentition period considering age, sex and dietary patterns.
Methods: An epidemiological cross sectional descriptive study was carried out among 1600 school children aged 6-12 years in Vadodara city. A closed ended questionnaire according to World Health Organisation 1997 methodology was used to collect the data. The children were examined for the presence of dental caries using decayed missing filled teeth/decayed missing filled surfaces and Decayed Missing Filled Teeth/Decayed Missing Filled Surfaces index. Related factors which predispose caries such as age, sex and dietary patterns were recorded.
Results: The prevalence of dental caries was 69.12%. The mean dmft/dmfs and DMFT/DMFS were 3.00/4.79 and 0.45/0.56 respectively. The prevalence was higher in deciduous teeth than in permanent teeth. Positive association was found between dental caries and age, sex, frequency of sugar consumption in between meals.
Conclusion: The study concludes that the prevalence and severity of dental caries in Vadodara city is high. So, in developing country like India, it is imperative to introduce primary prevention and increased restorative care for the purpose of both reducing the caries prevalence and maintaining those caries free children.
How to cite this article: Joshi N, Sujan SG, Joshi K, Parekh H, Dave B. Prevalence, Severity and Related Factors of Dental Caries in School Going Children of Vadodara City – An Epidemiological Study. J Int Oral Health 2013; 5(4):40-48.
PMCID: PMC3780368  PMID: 24155618
Epidemiology; Dental Caries; Prevalence; Severity; Risk Factors; Odd's Ratio
14.  Dental Caries in High-Risk School-Aged African-American Children in Alabama: A Six-Year Prospective Cohort Study 
Pediatric dentistry  2016;38(3):224-230.
To assess the prevalence and incidence of dental caries in school-aged African-American children who received semi-annual fluoride varnish applications.
A cohort of six-year-old high caries-risk African-American children (n=98) was recruited in Uniontown, Alabama and followed for six years. Oral examinations were done annually by three trained/calibrated dentists. Tooth surfaces with cavitated caries, missing due to caries and with filled surfaces were recorded, using WHO criteria. Also, as part of the study, children received periodic oral health instruction, fluoride varnish applications and referral to dentists starting at baseline.
The person-level prevalence of dmfs/DMFS was: 61.2 percent at mean age 5.9 (n=98, mean dmfs/DMFS=11.6); 63.8 percent at age 6.7 (n=80, mean dmfs/DMFS=13.2); 70.6 percent at age 7.8 (n=68, mean dmfs/DMFS=14.2); 65.7 percent at age 8.8 (n=68, mean dmfs/DMFS=11.8); 55.6 percent at age 9.7 (n=63, mean dmfs/DMFS=8.8); 40.3 percent at age 10.7 (n=62, mean dmfs/DMFS=3.4); and 37.1 percent at age 11.7 (n=62, mean dmfs/DMFS=2.3). The six-year person-level incidence of dmfs/DMFS was 32.3 percent (mean dmfs/DMFS=1.6) from age 5.9 to age 11.7 (n=62).
In spite of the oral health education and fluoride varnish applications, there was substantial new dental caries in this high-risk sample. Additional studies evaluating risk factors for caries development are ongoing.
PMCID: PMC4911818  PMID: 27306247
dental caries; African-American; prevalence; incidence; child
15.  Dental Caries Status of Institutionalized Orphan Children from Jammu and Kashmir, India 
It has been well documented that the absence of family support influences the general and oral health of the children. Factors that lead to the development of disease at a given point in time are likely to have their roots in a complex chain of environmental events that may have begun years before. A number of studies have examined the relationship between dental caries and material deprivation and found a positive association between them. Though orphans contribute to 2% of world’s population, literature regarding their oral health status is very scarce. This study was carried out with the aim to assess the dental caries status of institutionalized orphan children from Jammu and Kashmir.
Materials and methods
A total of 1,664 children that included 1,201 boys and 463 girls from registered orphanages in the state of Jammu and Kashmir were included in the study. Written informed consent was obtained prior to the start of the study; decayed, extracted, filled teeth (deft)/ decayed, extracted, filled surface (defs) and decayed, missing, and filled teeth (DMFT)/decayed, missing, and filled surface (DMFS) indices were used to assess the caries status of primary and permanent dentition. Multiple choice, close-ended questionnaires were administered to assess the oral hygiene habits, knowledge, and dietary behavior of orphan children prior to examination. The study subjects were divided into three groups according to the age of ≤ 6, 7 to 11, and ≥12 years.
Results showed that caries prevalence in primary dentition was higher in subjects’ ≤6 years of age where the prevalence was 50.9%; in subjects 7 to 11 years of age, the prevalence was 25.2%. Caries prevalence in permanent dentition within the age group 7 to 11 was 69.1%, while in subjects’ ≥12 years, the prevalence was 66.2%. Use of toothbrush was the most prevalent method of cleaning the teeth in both the genders, while toothpaste was reported to be the most prevalent material to be used for tooth cleaning followed by tooth-powder. Highest caries prevalence was seen in the subjects using datun sticks as a method to clean their teeth (80.5%).
How to cite this article
Shah AF, Tangade P, Ravishankar TL, Tirth A, Pal S, Batra M. Dental Caries Status of Institutionalized Orphan Children from Jammu and Kashmir, India. Int J Clin Pediatr Dent 2016;9(4):364-371.
PMCID: PMC5233705  PMID: 28127170
Dental caries; Jammu and Kashmir; Orphans; Prevalence; Toothbrushing.
16.  Demographic, socioeconomic, and behavioral factors affecting patterns of tooth decay in the permanent dentition: Principal components and factor analyses 
Dental caries of the permanent dentition is a multi-factorial disease resulting from the complex interplay of endogenous and environmental risk factors. The disease is not easily quantified due to the innumerable possible combinations of carious lesions across individual tooth surfaces of the permanent dentition. Global measures of decay, such as the DMFS index (which was developed for surveillance applications), may not be optimal for studying the epidemiology of dental caries because they ignore the distinct patterns of decay across the dentition. We hypothesize that specific risk factors may manifest their effects on specific tooth surfaces leading to patterns of decay that can be identified and studied. In this study we utilized two statistical methods of extracting patterns of decay from surface-level caries data in order to create novel phenotypes with which to study the risk factors affecting dental caries.
Intra-oral dental examinations were performed on 1,068 participants aged 18 to 75 years to assess dental caries. The 128 tooth surfaces of the permanent dentition were scored as carious or not and used as input for principal components analysis (PCA) and factor analysis (FA), two methods of identifying underlying patterns without a priori knowledge of the patterns. Demographic (age, sex, birth year, race/ethnicity, and educational attainment), anthropometric (height, body mass index, waist circumference), endogenous (saliva flow), and environmental (tooth brushing frequency, home water source, and home water fluoride) risk factors were tested for association with the caries patterns identified by PCA and FA, as well as DMFS, for comparison. The ten strongest patterns (i.e., those that explain the most variation in the data set) extracted by PCA and FA were considered.
The three strongest patterns identified by PCA reflected (i) global extent of decay (i.e., comparable to DMFS index), (ii) pit and fissure surface caries, and (iii) smooth surface caries, respectively. The two strongest patterns identified by FA corresponded to (i) pit and fissure surface caries and (ii) maxillary incisor caries. Age and birth year were significantly associated with several patterns of decay, including global decay/DMFS index. Sex, race, educational attainment, and tooth brushing were each associated with specific patterns of decay, but not with global decay/DMFS index.
Taken together, these results support the notion that caries experience is separable into patterns attributable to distinct risk factors. This study demonstrates the utility of such novel caries patterns as new outcomes for exploring the complex, multifactorial nature of dental caries.
PMCID: PMC3568445  PMID: 23106439
dental caries; permanent dentition; pit and fissure surfaces; smooth surfaces; tooth surfaces; principal components analysis; factor analysis; tooth brushing
17.  Do the more caries in early primary dentition indicate the more caries in permanent dentition? Results of a 5-years follow-up study in rural-district 
In the deprived communities with high caries incidence, determination of high-risk children in early age is a valuable tool to apply the individual and/or community-level preventive measures. The purpose of this 5-years follow-up study was to examine the relationship between early caries occurrence on primary incisors and the future caries occurrence on both first permanent molars and all permanent dentition in the children living in rural Turkey.
Materials and Methods:
Total 34 children living in rural-districts of southeastern Anatolia were included, and divided in both test (caries positive for maxillary primary incisors) and control groups (caries free on the same teeth). During the 5-years they were examined annually regarding new caries occurrence in either first permanent molars for the Decayed, Missing, Filled Tooth Index [(DMF(T)[6])] or all permanent dentition (DMF(T)).
At the beginning of the study, the age range of the children was 3 to 5 (mean ± St dv; 4.03 1.24), and d(t)[max 1,2] and df(t) indices for the deciduous dentition of test and control groups were 2.65 ± 0.78; 4.29 ± 2.08 and 0; 0.24 ± 0.43, respectively. After 5-years mean DMF(T)[6] and total DMF(T) for test and control groups were 1.88 ± 0.66; 3.12 ± 0.69 and 0.47 ± 0.62; 0.65 ± 0.93, respectively (for each parameters the difference was statistically significant P < 0.01). For test group the number of caries on primary-incisors (d(t)[max 1,2]) was correlated with the DMF(T)[6] (r = 0.80) and DMF(T) (r = 0.59).
The caries-information including the early primary incisors could be helpful in identifying children with increased risk so that preventive measures could be directed at those who fit the high-risk-caries profile.
PMCID: PMC3894087  PMID: 24478967
Anticipatory guidance; diet; early childhood caries; oral hygiene; patient centered dental home
18.  The severity of dental caries in adults aged 35 to 44 years residing in the metropolitan area of a large city in Brazil: a cross-sectional study 
BMC Oral Health  2012;12:25.
In recent decades, studies in the field of public health have increasingly focused on social determinants that affect the health-illness process. The epidemiological perspective considers oral health to be a reflection of socioeconomic and environmental aspects, and it is particularly influenced by the social context. The aim of the present study was to assess the association between the severity of dental caries among adults aged 35 to 44 years and characteristics on the different levels at which the determinants of caries operate (individual, social structure and social context).
A home-based, cross-sectional field study was carried out involving a sample of 1,150 adults (35 to 44 years of age) residing in metropolitan Belo Horizonte, Brazil. The DMFT (decayed, missing, filled tooth) index (≥14) was used to determine the severity of dental caries. Bivariate and multivariate analyses were carried out using the Poisson regression model with the level of significance set at 5% (p < 0.05) and 95% confidence intervals.
The majority of the participants (68.5%) had high caries severity. The rate of high-severity caries in the group between 40 and 44 years of age was 1.15-fold (CI: 1.04-1.26) greater than that among those aged 35 to 39 years. A greater prevalence of high caries severity was found among those who frequently visited the dentist (PR = 1.18; CI: 1.07-1.30), those with a lower income (PR = 1.11; CI: 1.01-1.23), those who reported that their neighborhood did not come together in the previous year to petition political leaders for benefits (PR = 1.16; CI: 1.05-1.28) and those who are unable to make decisions (without empowerment) (PR = 1.12; CI: 1.01-1.24).
The present study revealed high dental caries severity in adults, which was associated with individual characteristics, health-related behavior and social structure and contextual variables. These findings underscore the importance of considering social determinants involved in the health-illness process when carrying out epidemiological studies on dental caries.
PMCID: PMC3532240  PMID: 22849537
Socioeconomic factors; Oral health; Epidemiology
19.  Dental caries and treatment needs of Yemeni children with down syndrome 
Dental Research Journal  2014;11(6):631-635.
Oral health in Down syndrome (DS) children has some peculiar aspects that must be considered in the follow-up of these patients. The objective of the present study was to assess the prevalence of dental caries and treatment needs among children with DS in Yemen and also to investigate the association between these outcomes with various socio-demographic and clinical variables.
Materials and Methods:
This cross-sectional study involved 96 children with DS aged between 6 and 15 years. Data were gathered through the use of a questionnaire and clinical observation. The dentition status and the treatment needs were recorded according to World Health Organization recommendations. ANOVA, Chi-square test, t-test and multiple regression analyses were applied using the statistical package for the social sciences (SPSS, Chicago, IL, USA) version 20.0 software, with P < 0.05 considered as significant.
The results showed that 93.8% of the subjects had dental caries; overall, decayed missing filled surfaces (dmfs), decayed missing filled teeth (dmft), DMFS, DMFT were 10.35, 4.44, 4.32 and 2.45, respectively. Stepwise linear regression analysis has revealed that age was the most important predictor for DMFT and DMFS, while early age and less frequent teeth brushing were the most predictors for dmft and dmfs. Restorative care and extractions were the most needed specific treatments.
The findings of this study demonstrate that children with DS in Yemen have a high prevalence of dental caries and extensive unmet needs of dental treatment. They would benefit from frequent oral health assessment.
PMCID: PMC4275630  PMID: 25540656
Dental caries; down syndrome; risk factors; Yemen
20.  Oral health status in Navajo Nation Head Start Children 
This study assessed oral health status for preschool aged children in Navajo Nation to obtain baseline decayed, missing, and filled tooth surfaces (dmfs) data and dental caries patterns, describe socio-demographic correlates of children’s baseline dmfs measures, and compare the children’s dmfs measures to previous dental survey data for Navajo Nation from Indian Health Service and the National Health and Nutrition Examination Survey (NHANES).
The analyzed study sample included 981 child/caregiver dyads residing in Navajo Nation who completed baseline dmfs assessments for an ongoing randomized clinical trial involving Navajo Nation Head Start Centers. Calibrated dental hygienists collected baseline dmfs data from child participants ages 3–5 years (488 males and 493 females), and caregivers completed a Basic Research Factors Questionnaire (BRFQ).
Mean dmfs for the study population was 21.33 (SD =19.99) and not appreciably different from the 1999 Indian Health Service survey of Navajo Nation preschool aged children (mean=19.02, SD=16.59, p=0.08). However, 69.5 percent of children in the current study had untreated decay compared to 82.9 percent in the 1999 Indian Health Service survey (p<0.0001). Study results were considerably higher than the 16.0 percent reported for 2–4 year old children in the Whites Only group from the 1999–2004 NHANES data. Age had the strongest association with dmfs, followed by child gender, and caregivers’ income and education.
Dental caries in preschool aged Navajo children is extremely high compared to other US population segments and dmfs has not appreciably changed for more than a decade.
PMCID: PMC4267958  PMID: 24954053
21.  Childhood caries as influenced by maternal and child characteristics in pre-school children of Kerala-an epidemiological study 
The most common chronic disease of childhood is early childhood caries which is five times more prevalent than asthma and seven times higher than that of allergic rhinitis. Most children do not receive dental care until they are three years old, yet by the time more than thirty percent of children from lower socioeconomic groups already have caries. To determine the prevalence and severity of early childhood caries among pre-school children, to describe the child characteristics associated with the development of early childhood caries and to find the association of early childhood caries and maternal risk factors.
Materials and Methods:
This descriptive study was carried out among children attending the immunization clinic of Sree Avittam Thirunal Hospital, Medical College, Trivandrum and children attending the randomly selected Anganwadies and Day care centres in Trivandrum, the capital of Kerala, wherein there are migrants from all over the State. A total of 350 children aged 12-36 months and their mothers were studied. The mother was first interviewed by a structured questionnaire; then the child's and mothers clinical examination was carried out covering caries experience and oral hygiene status.
Among 350 children studied the prevalence of dental caries in this study population was found to be 50.6 %(177). Statistically significant associations were found between the severity of decay and the child's age(P<0.001), female gender(P<0.05),low socioeconomic status (P<0.05), feeding frequency (P<0.05), type of feeding(P<0.01), fell asleep with nipple in mouth (P<0.05), duration of breast feeding(P<0.001), consumption of cariogenic type of snacks(P<0.01), age of commencement of tooth brushing(P<0.05), brushing frequency(P<0.05), oral hygiene status of child(P<0.001), DMFS scores of mothers (P<0.001), and oral hygiene status of mother (P<0.001).
PMCID: PMC3341753  PMID: 22557889
Early childhood caries; prevalence and severity; maternal risk factors
22.  Parents’ Oral Health Literacy and its Impact on their Children’s Dental Health Status 
Electronic Physician  2016;8(12):3421-3425.
Because parents play a key role in children’s dental health, the aim of this study was to determine the relationship between parents’ oral health literacy (OHL) and their children’s dental health status in Babol, Iran.
In this cross sectional study a total of 384 children aged 21 months to 84 months who attended the dental clinic of Babol University of Medical Sciences between September 2015 and February 2016 were examined. We measured dmft index only for primary dentition; during examination the accompanying parent completed the “Oral Health Literacy-Adults Questionnaire”. Comparing mean analysis, such as one-way analysis of variance (ANOVA), and an independent-samples t-test, served to compare children’s dental caries, missing, and dental fillings’ mean differences, between subgroups. In addition, the relationship between OHL, children’s dental caries, and dental fillings was assessed using multiple linear regression models while controlling for socioeconomic and demographic factors. All data were analyzed by SPSS version 22.
Children’s mean age was 55.1 months (SD: 13.7), while 47% were girls. Mean children’s dental caries, missing, filling, and mean dmft index were 6.5, 0.4, 1.2, and 8.2 respectively. Parents with inadequate OHL had children with more dental caries (p=0.005), however this relation had no significance while controlling for background factors. Increasing children’s dental fillings was significantly related with families living in urban regions (p=0.01, 95% CI: 0.11 to 1.12), and parents with adequate OHL (p=0.02, 95% CI: 0.08 to 1.05).
Inadequate parents’ OHL was associated with children having high dental caries and less dental fillings. Therefore, providing interventions to improve parents’ OHL would be valuable in children’s dental health promotion programs, especially in countries with a developing oral health system.
PMCID: PMC5279976  PMID: 28163858
Caregiver; Oral health literacy; Oral health status; Child
23.  Caries prevalence among schoolchildren in Zagreb, Croatia 
Croatian Medical Journal  2011;52(6):665-671.
To investigate the prevalence of dental caries and treatment needs in schoolchildren aged 7-14 years from Zagreb.
Dental examinations based on the World Health Organization criteria were performed on 1168 children in the period 2009-2010. The teeth were clinically examined with standard dental instruments using visual-tactile method under standard dental light. We recorded the clinical indexes of decayed, missed, and filled teeth (DMFT and dmft; upper-case letters refer to permanent and lower-case letters to primary teeth) and decayed, missed, and filled surfaces (DMFS), as well as the significant caries index (SiC).
The median DMFT and DMFS of all children were 3 and 4, respectively. The median DMFT and DMFS of 12-year-old children were 4 and 5, respectively. The highest median DMFT score of 7 was found among 14-year-old children. There was a significant difference between age groups (7-10 years and 11-14 years) in DMFT and DMFS. Among 8-year-old children, the median dmft index was the highest (5.5) and SiC index was 7.4. As far as the location of caries on the surface of the first permanent molar is concerned, caries occurred mostly in the central occlusal surface (27.6%).
Our results showed a high caries prevalence among schoolchildren in Zagreb, indicating a need for an extensive program of primary oral health care.
PMCID: PMC3243318  PMID: 22180264
24.  Prevalence of caries among preschool-aged children in a central Anatolian population 
Early childhood caries (ECC) is a particularly destructive form of tooth decay that afflicts young children. The etiology and associated factors of ECC should be studied adequately to overcome this health hazard. The aim of this study was to determine caries prevalence and its consequences in toddlers in an Anatolian city, Kırıkkale.
Materials and Methods:
Examinations were performed in family medicine centers by three calibrated dentists during a period of 6 months. The status of dental caries was recorded according to the World Health Organization (WHO) criteria. We recorded the clinical indexes of decayed, missed, and filled teeth (DMFT and dmft; upper-case letters refer to permanent and lower-case letters to primary teeth), and decayed, missed, and filled surfaces (DMFS).
Totally 3171 toddlers were included (52% males and 48% females). The mean age was 25.8 ± 10.1 months. The prevalence of ECC in preschool children was 17.3%, while the mean df(t) was 0.63 ± 1.79. ECC increased significantly with age. Dental caries were mostly observed in primary maxillary central teeth. Occlusal and buccal surfaces were the most affected sites. The difference in distribution of caries between maxilla and mandibula was found to be statistically significant (P < 0.05).
When compared to other data obtained from various epidemiologic studies, the toddlers living in Kırıkkale city center had a significant caries level. This observation had clearly suggested that early preventive measures should urgently be put into effect all over the city.
PMCID: PMC3783774  PMID: 24082726
Dental caries; df(t); early childhood caries; prevalence
25.  Dental and medical health status and oral health knowledge among visually impaired and sighted female schoolchildren in Riyadh: a comparative study 
BMC Oral Health  2017;17:154.
The impact of visual impairment on oral health in the literature is inconclusive, and the available information on the medical and dental health status of visually impaired children is limited. The aim of this study was to evaluate the dental and medical health status, and to assess the oral health knowledge of visually impaired girls aged 6–12 years, and compare them to that of sighted children.
This analytical cross-sectional study was carried out on 79 visually impaired and 83 age-matched sighted female primary school children. The children’s demographic data, medical history, and dental history were obtained through a validated questionnaire. The study population was examined to evaluate their dental caries status using the Decayed Missing Filled Teeth/Surface indices DMFT/DMFS/ and dmft/dmfs for permanent and primary teeth, respectively. Oral hygiene index (OHI), Plaque index (PI) and gingival index (GI) were obtained for periodontal evaluation. Pearson’s Chi-square test and t-test were used for the statistical analyses.
The general health for both groups was found to be good; however, 21.5% of the visually impaired children had systemic diseases compared with only 4.8% of the sighted children (P = 0.002). Statistically significant differences (P < 0.001) were found between the two groups with regards to OHI. Among the sighted children, 49.4% had good oral hygiene compared with only 22.8% of the visually impaired group. The plaque accumulation was found to be greater among the visually impaired group and gingivitis was also higher. The DMFS score was found to be higher (P = 0.03) among the visually impaired group.
The visually impaired children had more medical conditions and poorer oral health status compared to their sighted peers.
PMCID: PMC5735896  PMID: 29258491
Visually impaired children; Oral health; Plaque scores; Gingival scores

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