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1.  Care coordination among pediatricians and dentists: a cross-sectional study of opinions of North Carolina dentists 
BMC Oral Health  2014;14:33.
Care coordination between physicians and dentists remains a challenge. This study of dentists providing pediatric dental care examined their opinions about physicians’ role in oral health and identified factors associated with these opinions.
North Carolina general and pediatric dentists were surveyed on their opinions of how physicians should proceed after caries risk assessment and evaluation of an 18-month-old, low risk child. We estimated two multinomial logistic regression models to examine dentists’ responses to the scenario under the circumstances of an adequate and a limited dental workforce.
Among 376 dentists, 52% of dentists indicated physicians should immediately refer this child to a dental home with an adequate dental workforce. With a limited workforce, 34% recommended immediate referral. Regression analysis indicated that with an adequate workforce guideline awareness was associated with a significantly lower relative risk of dentists’ recommending the child remain in the medical home than immediate referral.
Dentists’ opinions and professional guidelines on how physicians should promote early childhood oral health differ and warrant strategies to address such inconsistencies. Without consistent guidelines and their application, there is a missed opportunity to influence provider opinions to improve access to dental care.
PMCID: PMC3997217  PMID: 24708785
Care coordination; Guidelines; Infant oral health care; Dental workforce; Early childhood caries; Preventive dental services
2.  Update on Early Childhood Caries since the Surgeon General's Report 
Academic pediatrics  2009;9(6):396-403.
The 2000 Surgeon General's Report on Oral Health (SGROH) included a limited discussion of the condition known as Early Childhood Caries (ECC). Because of its high prevalence, its impact on young children's quality of life and potential for increasing their risk of caries in the permanent dentition, ECC is arguably one of the most serious and costly health conditions among young children.
A necessary first step in preventing dental caries in preschool children is understanding and evaluating the child's caries risk factors. Previous caries experience and white spot lesions should automatically classify a preschool child as high risk for caries. Microbial factors, such as presence of visible plaque and tests that identify a child as having high levels of mutans streptococci also predict caries in young children. Frequency of sugar consumption, enamel developmental defects, social factors such as socioeconomic status, psychosocial factors, and being an ethnic minority also have shown to be relevant in determining caries risk.
Based on this knowledge of specific risk factors for an individual, different preventive strategies as well as different intensities of preventive therapies can be employed. Caries preventive strategies in preschool children include fluoride therapy, such as supervised tooth brushing with fluoridated dentifrice, systemic fluoride supplement to children living in a non-fluoridated area that are at risk for caries, and professional topical fluoride with fluoride varnish. There is emerging evidence that intensive patient counseling or motivational interviews with parents to change specific behaviors may reduce caries prevalence in their children. Findings regarding antimicrobial interventions, efforts to modify diets, and traditional dental health education are less consistent.
PMCID: PMC2791669  PMID: 19945074
early childhood caries
3.  Early childhood caries update: A review of causes, diagnoses, and treatments 
Dental caries (decay) is an international public health challenge, especially amongst young children. Early childhood caries (ECC) is a serious public health problem in both developing and industrialized countries. ECC can begin early in life, progresses rapidly in those who are at high risk, and often goes untreated. Its consequences can affect the immediate and long-term quality of life of the child's family and can have significant social and economic consequences beyond the immediate family as well. ECC can be a particularly virulent form of caries, beginning soon after dental eruption, developing on smooth surfaces, progressing rapidly, and having a lasting detrimental impact on the dentition. Children experiencing caries as infants or toddlers have a much greater probability of subsequent caries in both the primary and permanent dentitions. The relationship between breastfeeding and ECC is likely to be complex and confounded by many biological variables, such as mutans streptococci, enamel hypoplasia, intake of sugars, as well as social variables, such as parental education and socioeconomic status, which may affect oral health. Unlike other infectious diseases, tooth decay is not self-limiting. Decayed teeth require professional treatment to remove infection and restore tooth function. In this review, we give detailed information about ECC, from its diagnosis to management.
PMCID: PMC3633299  PMID: 23633832
Early childhood caries; etiology; feeding; fluoride
4.  Infant Oral Health Care 
Canadian Family Physician  1988;34:1419-1424.
The family physician/pediatrician who sees a child from birth as part of the well-baby visit program is in the best position to identify early dental problems and to educate the family about early oral preventive health care. Since children under three years of age are not seen routinely by dentists, they are at risk of developing dental disease. This paper briefly covers the areas of infant oral pathology, early preventive care, teething, suckling habits, and dental trauma in the toddler. The physician will then be in a better position to recommend to parents when they should seek dental advice and treatment for their young children.
PMCID: PMC2219100  PMID: 21253204
infant dental care; pediatrics
5.  Pediatricians’ oral health recommendations for 0- to 3-year-old children: results of a survey in Thuringia, Germany 
BMC Oral Health  2014;14:44.
German societies of pediatricians and dentists disagree about oral health-related preventive recommendations (use of fluoride supplements, fluoride-containing toothpaste) for children aged 0–3 years. After failure to reach a consensus, there is no study that has evaluated the guidelines that pediatricians use in daily practice.
A standardized questionnaire was sent to all 167 practicing pediatricians in the state of Thuringia, Germany, to assess the current oral health-related preventive recommendations. Data were analyzed using descriptive statistics.
The response rate was 52.0%. More than 9.0% of the pediatricians advise parents with regard to diet, use of baby bottles, oral hygiene and dental visits. The majority of pediatricians recommend to start tooth-brushing after the 1st birthday and recommend the use of toothpaste and a 1st dental visit after the 2nd birthday (78.0%). Additionally, 23.3% (n = 20) of pediatricians prescribe solely vitamin D, and 20.9% (n = 18) prescribe vitamin D combined with fluoride. Fluoride supplements are given as required by 37.2% (n = 32) of pediatricians, primarily between the 1st and 6th birthdays. The guidelines of the Pediatric Society were used by 1.2% of the pediatricians, the guidelines of the dentists were used by 5.8%, and a mix of both was used by 93.0%. The simultaneous use of fluoride supplements and fluoride toothpaste in the first three years was recommended by 45.9% of the pediatricians.
Pediatricians’ oral health recommendations are based on a mix of the guidelines from the German societies of pediatricians and dentists and led to no use or possible overdose of fluoride. Against the background of early childhood caries and dental fluorosis, there is a need for uniform guidelines.
PMCID: PMC4021417  PMID: 24885353
6.  Disease Management of Early Childhood Caries: ECC Collaborative Project 
Until recently, the standard of care for early childhood caries (ECC) has been primarily surgical and restorative treatment with little emphasis on preventing and managing the disease itself. It is now recognized that surgical treatment alone does not address the underlying etiology of the disease. Despite costly surgeries and reparative treatment, the onset and progression of caries are likely to continue. A successful rebalance of risk and protective factors may prevent, slow down, or even arrest dental caries and its progression. An 18-month risk-based chronic disease management (DM) approach to address ECC in preschool children was implemented as a quality improvement (QI) collaborative by seven teams of oral health care providers across the United States. In the aggregate, fewer DM children experienced new cavitation, pain, and referrals to the operating room (OR) for restorative treatment compared to baseline historical controls. The teams found that QI methods facilitated adoption of the DM approach and resulted in improved care to patients and better outcomes overall. Despite these successes, the wide scale adoption and spread of the DM approach may be limited unless health policy and payment reforms are enacted to compensate providers for implementing DM protocols in their practice.
PMCID: PMC3958790  PMID: 24723953
7.  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
8.  Prevalence of Early Childhood Caries Among Very Young Urban Boston Children Compared with US Children 
The aims of this study were to compare prevalence of early childhood caries (ECC) in 1- to 3-year-old children seeing primary-care pediatricians at two urban medical centers in Boston to the prevalence of ECC in similarly aged US children surveyed as part of the Third National Health and Nutrition Examination Survey (NHANES III) and to assess risk factors for ECC among this cohort of children compared with risk factors among similarly aged US children.
Characteristics of 787 1- to 3-year-old children from two urban Boston medical centers were compared with those of 3,644 similarly aged US children surveyed as part of NHANES III. Demographic and social characteristics and ECC prevalence by putative risk factors were compared. A multiple logistic regression model was fit to assess putative risk factors and difference between groups simultaneously.
Race, age, previous dental visit, parents’ education, and household income were significantly associated with ECC prevalence. Parents’ place of birth was a significant effect modifier with lower ECC among Boston children of immigrants than among US children of immigrants.
Lower ECC prevalence among urban Boston children of immigrant parents compared with US children of immigrant parents may reflect changing immigrant composition in the United States since NHANES III or a different immigrant composition in the Boston area compared with the United States. This finding reinforces the need for further research of immigrants in order to understand cultural practices that may affect oral health. Finally, low ECC prevalence among very young children reinforces the importance of early intervention in reducing ECC.
PMCID: PMC2814600  PMID: 19192100
early childhood caries; oral health disparities
9.  Prevalence of early childhood caries and associated risk factors in preschool children of urban Bangalore, India: A cross-sectional study 
European Journal of Dentistry  2012;6(2):141-152.
Early childhood caries (ECC) is a devastating form of dental decay with multi-factorial origin. The aim of this cross-sectional study is to investigate the prevalence and related risk factors of ECC in preschool children of urban Bangalore (India).
A random sample of 1,500 children aged between 8 and 48 months were selected from various parts of urban Bangalore. The status of dental caries was recorded according to the World Health Organization (WHO) criteria. Information regarding oral hygiene practices, feeding habits, socio-economic status, birth weight, and educational status of the mother was obtained through a structured questionnaire given to mothers of preschool children. The data was subjected to statistical analysis using the Statistical package for social sciences (SPSS) version 12.
The prevalence of ECC in preschool children was 27.5%, while the mean deft was 0.854. ECC increased significantly with age. Children whose mothers had no schooling and those who belonged to low socioeconomic group showed higher caries prevalence. A significant increase in caries prevalence was found in children accustomed to the practice of on-demand breast feeding and bottle feeding at night. Caries also increased significantly when snacks were consumed between meals. However, increased frequency of tooth-brushing, parental supervision, use of a baby toothbrush, and fluoridated dentifrice significantly decreased caries prevalence.
ECC is a serious public health problem in this population and measures to increase awareness should be undertaken. The target candidates for oral health promotion programs should include mothers, general dentists, pediatricians, nurses, primary care health workers, care-takers at day-care centers and gynecologists.
PMCID: PMC3327493  PMID: 22509116
Early childhood caries; preschool; feeding habits; oral hygiene; prevalence; socioeconomic status
10.  Association between iron status, iron deficiency anaemia, and severe early childhood caries: a case–control study 
BMC Pediatrics  2013;13:22.
Severe tooth decay is known to affect the health and well-being of young children. However, little is known about the influence of Severe Early Childhood Caries (S-ECC) on childhood nutritional status. The purpose of this study was to contrast ferritin and haemoglobin levels between preschoolers with S-ECC and caries-free controls.
Children were recruited as part of a larger case–control study examining differences in nutritional status between those with and without S-ECC. Preschoolers with S-ECC were recruited on the day of their dental surgery, while caries-free controls were recruited from the community. Parents completed a questionnaire and the child underwent venipuncture. The study was approved by the University’s Health Research Ethics Board. Statistics included descriptive, bivariate and logistic regression analyses. A p value ≤ .05 was significant. A total of 266 children were recruited; 144 with S-ECC and 122 caries-free.
The mean age was 40.8 ± 14.1 months. The mean ferritin concentration for all children was 29.6 ± 17.9 μg/L while the mean haemoglobin level was 115.1 ± 10.1 g/L. Children with S-ECC were significantly more likely to have low ferritin (p=.033) and low haemoglobin levels (p>.001). Logistic regression analyses revealed that children with S-ECC were nearly twice as likely to have low ferritin levels and were over six times more likely to have iron deficiency anaemia than caries-free controls.
Children with S-ECC appear to be at significantly greater odds of having low ferritin status compared with caries-free children and also appear to have significantly lower haemoglobin levels than the caries-free control group. Children with S-ECC also appear to be at significantly greater odds for iron deficiency anaemia than cavity-free children.
PMCID: PMC3575235  PMID: 23388209
Early childhood caries; Iron; Iron deficiency; Anaemia; Preschool child
11.  Less counseling on Early Childhood Caries transmission by dentists 
Journal of public health dentistry  2012;73(2):10.1111/j.1752-7325.2012.00356.x.
High levels of Streptococcus mutans on teeth of young children are predictive of Early Childhood Caries (ECC). Transmission from mother-to-child is common and studies have demonstrated treatment of the mother results in less ECC. The objective of this study was to determine how dentists have adopted the practice of counseling about ECC.
In 2006 as part of a larger study on dental care for pregnant women, we surveyed 829 general dentists in Oregon. The questionnaire contained questions to capture the extent to which general dentists have adopted counseling pregnant women about ECC transmission, to describe personal and practice characteristics, and examine how dentists' views on the ease of adopting of new procedures related to ECC counseling. Multivariate logistic regression was used to identify separate and additive effects of demographic and practice characteristics, attitudes, and beliefs.
The adjusted odds of a dentist who strongly believed in the link between mothers and babies and provided ECC counseling were 1.60 (95% CI 1.3-2.0, P<0.01). The odds of a dentist who reported discussing ECC with staff members and provided counseling were 2.7 (95% CI 1.7-4.3, P<0.01). Male dentists were less likely to counsel patients than female dentists (Adjusted OR = 0.5, 95% CI 0.3-1.0, p<0.05).
The strongest predictors of counseling patients about ECC were dentists' belief in the evidence of caries transmission and dentists' discussion of ECC during staff meetings.
PMCID: PMC3855324  PMID: 22970775
dental caries; prevention; infant; pregnant woman
12.  Prevalence and risk factors of caregiver reported Severe Early Childhood Caries in Manitoba First Nations children: results from the RHS Phase 2 (2008–2010) 
International Journal of Circumpolar Health  2013;72:10.3402/ijch.v72i0.21167.
The high prevalence and severity of caries among Canadian First Nations children is a growing concern. Dental surgery in hospital is often necessary to treat the signs of decay but does not address the underlying factors contributing to its development. The purpose of this study was to determine the prevalence and risk factors of caregiver-reported Baby Bottle Tooth Decay (BBTD), or Severe Early Childhood Caries (S-ECC), among preschool children recruited in Phase 2 of the First Nations Regional Longitudinal Health Survey (RHS).
Study Design
Cross-sectional study including interviews with caregivers.
This study was limited to data from Manitoba First Nations participating in the RHS Phase 2 (2008–10). Data were restricted to caregiver interviews for their child <72 months of age. The main variable of interest was caregiver-reported BBTD, an antecedent term for S-ECC. Data analysis included descriptive statistics and bivariate analyses; p≤0.05 was significant.
Overall, caregivers of 431 preschool children responded. According to caregiver reports, 102/410 (24.9%) children had S-ECC. Further, 65.0% responded that their child had already undergone treatment for caries. Children with S-ECC were significantly older than those without. S-ECC was also associated with paternal education levels and employment status, and maternal smoking during pregnancy. Breastfed children were less likely to have S-ECC, while consuming drink crystal beverages in bottles, and daily intake of soft drinks, juice, sweets and fast food were associated with increased risk. Those who reported that healthcare services were not available and were not culturally appropriate were significantly more likely to have children with S-ECC.
Caregiver reports suggest that nearly 1 in every 4 children has been affected by S-ECC. Identified risk factors for Manitoba First Nations children included age, education and employment, dietary practices, access to care, and disruption to family and culture. This local evidence can be used to help inform future caries prevention activities in these Manitoba communities.
PMCID: PMC3753137  PMID: 23984289
early childhood caries; dental caries; First Nations; Indigenous; child; preschool; infant and toddler
13.  Microbial Risk Markers for Childhood Caries in Pediatricians Offices 
Journal of dental research  2010;89(4):378-383.
Dental caries in pre-school children has significant public health and health disparity implications. To determine microbial risk markers for this infection, this study aimed to compare the microbiota of early childhood caries with caries-free children. Plaque samples from incisors, molars, and the tongue from 195 children attending pediatrician’s offices were assayed using 74 DNA probes and by PCR to Streptococcus mutans. Caries-associated factors included visible plaque, child age, race, and snacking habits. Species were detected more frequently from tooth than tongue samples. Lactobacillus gasseri (p<0.01), Lactobacillus fermentum, Lactobacillus vaginalis, and S. mutans with Streptococcus sobrinus (all p<0.05), were positively associated with caries. By multifactorial analysis the probiotic Lactobacillus acidophilus was negatively associated with caries. Prevotella nigrescens was the only species (p<0.05) significantly associated with caries using the false discovery rate. Data suggest that selected Lactobacillus species, in addition to mutans streptococci, are risk markers for early childhood caries.
PMCID: PMC2880172  PMID: 20164496
Early Childhood Caries; S. mutans; Lactobacillus
14.  Prevalence of early childhood caries in 8 - 48 month old preschool children of Bangalore city, South India 
Early Childhood Caries (ECC) is a devastating form of dental decay having a multi - factorial origin. This study was undertaken to determine the prevalence of ECC in Bangalore city, South India, and also to study its associated risk factors. Random sample of 1500 children, aged between 8 - 48 months, was selected from play homes and nursing homes of various parts of the city. Dental caries was recorded according to World Health Organization criteria. Information regarding risk factors for caries was obtained through a structured questionnaire given to mothers or caretakers. The data was subjected to statistical analysis. The prevalence of ECC was 27.5% and the mean decayed, extracted and filled tooth index was 0.854. There was a strong association of ECC with the risk factors studied.
PMCID: PMC3341752  PMID: 22557891
Early childhood caries; feeding habits; oral hygiene
15.  Identification of Caries Risk Factors in Toddlers 
Journal of Dental Research  2011;90(2):209-214.
The purpose of this study was to identify risk factors to predict caries progression in toddlers in primary-healthcare settings for the cost-effective targeting of preventive and referral strategies. We examined 329 children (26 ± 6 mos old) twice, one year apart, in Indiana, USA. A 107-item structured interview was used to collect information from the primary caregiver and child on factors/beliefs/perceptions/behaviors that could affect caries development, transmission of bacteria, medical-dental health, and access to care. Bacterial levels, gingivitis, dental plaque, and caries experience were assessed. Multiple-variable logistic regression models of caries progression toward cavitation included family caries experience, transmission-related behaviors, dietary factors, health beliefs, and lower income, but differed in selected predictors/predictive power by race/ethnicity. Addition of clinical variables did not significantly improve the prediction.
PMCID: PMC3144099  PMID: 21173434
longitudinal study; toddler; dental caries; risk assessment
16.  Addressing Childhood Overweight and Obesity in the Dental Office: Rationale and Practical Guidelines 
Pediatric Dentistry  2010;32(5):417-423.
The prevalence of childhood obesity has increased dramatically in the past 3 decades. The purposes of this paper were to: review health and dental implications; present guidelines for tracking body mass index (BMI) percentiles in children; and discuss reasonable “next steps” to take in communicating with parents and other health professionals. The health implications of childhood obesity warrant early monitoring, diagnosis, and treatment. Trends in visitation patterns of children offer dentists an unusual opportunity and an important role in addressing childhood obesity through regular monitoring of height, weight, and BMI percentiles. Dentists’ collaborations with pediatricians, registered dietitians, and parents have the potential to address the detrimental physical and psychosocial effects of childhood obesity. We encourage dentists to determine height, weight, and BMI percentiles for their patients at least annually. They should refer patients with unhealthy weight trajectories to pediatricians or family physicians and consider ancillary referrals to registered dietitians.
PMCID: PMC3368218  PMID: 21070709
17.  Early Childhood Caries and Body Mass Index in Young Children from Low Income Families 
The relationship between early childhood caries (ECC) and obesity is controversial. This cross-sectional survey investigated this association in children from low-income families in Goiania, Goias, Brazil and considered the role of several social determinants. A questionnaire examining the characteristics of the children and their families was administered to the primary caregiver during home visits. In addition, children (approximately 6 years of age) had their height, weight, and tooth condition assessed. The primary ECC outcome was categorized as one of the following: caries experience (decayed, missing, filled tooth: “dmft” index > 0), active ECC (decayed teeth > 0), or active severe ECC (decayed teeth ≥ 6). Descriptive, bivariate and logistic regression analyses were conducted. The participants in the current study consisted of 269 caregiver-child dyads, 88.5% of whom were included in the Family Health Program. Caregivers were mostly mothers (67.7%), were 35.3 ± 10.0 years old on average and had 9.8 ± 3.1 years of formal education. The mean family income was 2.3 ± 1.5 times greater than the Brazilian minimum wage. On average, the children in the current study were 68.7 ± 3.8 months old. Of these, 51.7% were boys, 23.4% were overweight or obese, 45.0% had active ECC, and 17.1% had severe ECC. The average body mass index (BMI) of the children was 15.9 ± 2.2, and their dmft index was 2.5 ± 3.2. BMI was not associated with any of the three categories of dental caries (p > 0.05). In contrast, higher family incomes were significantly associated with the lack of caries experience in children (OR 1.22, 95%CI 1.01–1.50), but the mother’s level of education was not significantly associated with ECC.
PMCID: PMC3709291  PMID: 23462435
oral health; preschool children; body mass index; dental caries; socioeconomic status
18.  Is there an association between early childhood caries and serum iron and serum ferritin levels? 
Dental Research Journal  2012;9(3):294-298.
Early childhood caries (ECC) is a virulent form of dental caries that can destroy the primary dentition of preschool children. The purpose of this study was to investigate a possible association between ECC with serum iron and serum ferritin levels.
Materials and Methods:
Following the ethical approval, 204 children aged 24–71 months were recruited for a double-blind, randomized cross-sectional study. Each child was examined clinically for dental caries using the World Health Organization criteria in Rafsanjan, Iran. Decayed, extracted, and filled primary teeth (deft) index was used to measure the dental caries. To determine serum iron and serum ferritin levels 2 mL blood was collected from each child. Data were then analyzed by Pearson's correlation coefficient and t-test using SPSS-16.0 software.
The mean values and their standard deviations of the deft index and levels of serum iron and ferritin were 2.4(± 3.3), 93.8(± 29.0) μg/dL and 63.1(± 32.2) ng/mL, respectively, with the two latter within. There was no significant difference between genders. Pearson's correlation coefficient showed that there was a statistically significant inverse association between ECC and serum iron level (P<0.05); but no association was found with the serum ferritin level.
The deft index decreased significantly with increasing serum iron levels, but there was no association between ECC experience and serum ferritin levels.
PMCID: PMC3469895  PMID: 23087734
Deft index; early childhood caries; serum ferritin; serum iron
19.  Microbial Risk Markers for Childhood Caries in Pediatricians’ Offices 
Journal of Dental Research  2010;89(4):378-383.
Dental caries in pre-school children has significant public health and health disparity implications. To determine microbial risk markers for this infection, this study aimed to compare the microbiota of children with early childhood caries with that of caries-free children. Plaque samples from incisors, molars, and the tongue from 195 children attending pediatricians’ offices were assayed by 74 DNA probes and by PCR to Streptococcus mutans. Caries-associated factors included visible plaque, child age, race, and snacking habits. Species were detected more frequently from tooth than tongue samples. Lactobacillus gasseri (p < 0.01), Lactobacillus fermentum, Lactobacillus vaginalis, and S. mutans with Streptococcus sobrinus (all p < 0.05) were positively associated with caries. By multifactorial analysis, the probiotic Lactobacillus acidophilus was negatively associated with caries. Prevotella nigrescens was the only species (p < 0.05) significantly associated with caries by the ‘false discovery’ rate. Analysis of the data suggests that selected Lactobacillus species, in addition to mutans streptococci, are risk markers for early childhood caries.
PMCID: PMC2880172  PMID: 20164496
early childhood caries; S. mutans; Lactobacillus
20.  Dentists' use of caries risk assessment and individualized caries prevention for their adult patients: findings from The Dental Practice-Based Research Network 
Few studies have examined dentists' subjective ratings of importance of caries risk factors or tested whether dentists use this information in treatment planning. This study tested several hypotheses related to caries risk assessment and individualized caries prevention.
Data were collected as part of a questionnaire entitled “Assessment of Caries Diagnosis and Caries Treatment”, completed by 547 practitioners who belong to The Dental Practice-Based Research Network (DPBRN), a consortium of participating practices and dental organizations.
Sixty-nine percent of DPBRN dentists perform caries risk assessment on their patients. Recently-graduated dentists, dentists with busier practices, and those who believe a dentist can predict future caries were the most likely to use caries risk assessment. The association between caries risk assessment and individualized prevention was weaker than expected (r=.21). Dentists who perform caries risk assessment provide individualized caries prevention to 57% of their patients, compared to 42% for dentists who do not perform caries risk assessment. Based on their responses to radiographic and clinical scenarios in the questionnaire, dentists who use caries risk assessment appear to use this information in restorative decisions.
A substantial percentage of DPBRN dentists do not perform caries risk assessment, and there is not a strong linkage between its use and use of individualized preventive regimens for adult patients. More progress in implementation of current scientific evidence in this area is warranted.
PMCID: PMC3193859  PMID: 21726268
21.  Maternal Beliefs and Motivations for First Dental Visit by Low-Income Mexican-American Children in California 
Pediatric dentistry  2011;33(5):392-398.
To examine Mexican-American immigrant caregivers’ beliefs and motivations surrounding the first dental visit for their young children (median age 5 years).
Qualitative interviews with a convenience sample of 48 low-income, Mexican-American mothers about their young children’s oral health. Transcripts were independently read, coded and thematically analyzed.
Half (51%) of first dental visits were for parent-initiated reasons: for pain or visible dental problems, parent’s proactive desire to get a checkup, or to avoid future dental problems. The other half was initiated by external prompts, especially pediatrician recommendation and school requirement. Once a child went to the dentist for his/her first visit, 94% continued with regular checkups. The mean age for a first dental visit was 3 years. Three parents reported cases in which dentists discouraged visits for symptomatic children before 3 years of age.
These low-income, urban Mexican-American parents are taking their children to their first dental visit around 3 years of age, much later than the recommended 1 year for this at-risk population. Physicians are well-situated to play an important role in prompting first dental visits.
PMCID: PMC3536823  PMID: 22104706
Oral Health; Child; Preschool; Parent; Healthcare Disparities; Mexican Americans
22.  Early Childhood Caries 
Dental caries is one of the most common childhood diseases, and people continue to be susceptible to it throughout their lives. Although dental caries can be arrested and potentially even reversed in its early stages, it is often not self-limiting and progresses without proper care until the tooth is destroyed. Early childhood caries (ECC) is often complicated by inappropriate feeding practices and heavy infection with mutans streptococci. Such children should be targeted with a professional preventive program that includes oral hygiene instructions for mothers or caregivers, along with fluoride and diet counseling. However, these strategies alone are not sufficient to prevent dental caries in high-risk children; prevention of ECC also requires addressing the socioeconomic factors that face many families in which ECC is endemic. The aim of this paper is to systematically review information about ECC and to describe why many children are suffering from dental caries.
PMCID: PMC3191784  PMID: 22007218
23.  Feeding Practices and Early Childhood Caries: A Cross-Sectional Study of Preschool Children in Kanpur District, India 
ISRN Dentistry  2013;2013:275193.
Background. Early childhood caries (ECC) is a public health problem due to its impact on children's health, development, and wellbeing. The objective of this study was to assess the caries experience in 3–5-year-old children and to evaluate the relationship with their mothers' practices regarding feeding and oral hygiene habits in Kanpur. Method. A cross-sectional survey was undertaken on 2000 (974 boys and 1026 girls) children aged 3–5 years from a random sample of preschools in Kanpur district, India. Dental caries experience was recorded using WHO criteria. A pretested questionnaire with 9 questions was used for collecting information regarding mothers' practices regarding feeding and oral hygiene practices. Chi-square test (χ2) and Student's t-test were used for statistical analysis. Results. The prevalence of ECC was 48% with mean dmft of 2.03 ± 2.99. Boys (57%) were affected more than girls (43%) which was found to be statistically significant (P < 0.05). Caries prevalence was high and statistically significant (P < 0.05) among those who were breast fed for longer duration, during nighttime, those falling asleep with bottle, and those fed with additional sugar in milk. Conclusion. Determining the role of feeding practices on early childhood caries can help in the development of appropriate oral health promotion strategies.
PMCID: PMC3870076  PMID: 24383008
24.  Early childhood caries in preschool children of Kosovo - a serious public health problem 
BMC Public Health  2010;10:788.
Even though it has been widely studied, early childhood caries (ECC) remains a serious public health problem, especially in countries where there is no national program of oral health assessment and no genuine primary oral health care, such as in Kosovo. The purpose of this study was to assess the prevalence of ECC and analyze caries risk factors.
The subjects were 1,008 preschool children, selected by stratified random cluster sampling, in the municipality of Prishtina, capital of Kosovo. Data were collected through clinical examination and interviews. Dmft data were recorded according to WHO criteria. Bacterial examination (CRT bacteria test) and plaque test of Greene-Vermillion were used.
The mean dmft of preschool children was found to be 5.8. The prevalence of ECC was 17.36%, with a mean dmft of 11 ± 3.6. Streptococcus mutans prevalence in ECC children was 98%. A significant correlation between dmft and S mutans counts (≥105 CFU/mL saliva) was demonstrated. A correlation was also found between daily sweets consumption and dmft in children with ECC (P < 0.001). Comparing the dmft of ECC children and duration of bottle feeding showed a statistical correlation (P < 0.001). The mean plaque test was 1.52. None of the examined children had ever used fluoride.
The prevalence of ECC was high among preschool children in the municipality of Kosovo. We recommend increasing parents' knowledge of proper feeding habits and oral health practices, and increasing preschool children's accessibility to dental services.
PMCID: PMC3018445  PMID: 21184679
25.  Disparities in Early Childhood Caries 
BMC Oral Health  2006;6(Suppl 1):S3.
Despite remarkable reduction in the prevalence of dental caries in the United States, dental caries is still a highly prevalent disease among children who are socially disadvantaged (racial/ethnic minority, poor, rural, immigrants). Consequently, caries sequelae such as dental pain, need for dental treatment under general anesthesia, and future orthodontic treatment, are also concentrated among the most socially disadvantaged children. To make the situation more appalling, those children who need treatment the most are the ones least likely to visit the dentist. Low income children are less likely to visit the dentist in part because of family's competing needs for limited resources, shortage of pediatric dentists, and dentists not taking uninsured or publicly insured patients. In the same vein, if these children do not have access to dental care, they are deprived from effective caries preventive measures that are dentist-dependent such as sealants and professionally applied fluoride. Dentistry has done well at devising caries preventive and treatment strategies; but these strategies have missed the most needed segment of society: disadvantaged children. The challenge now is to develop innovative strategies to reach these children.
PMCID: PMC2147596  PMID: 16934120

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