Early childhood caries (ECC) is a rampant, infectious dental disease that affects children up to age six, with effects lasting well into their adulthood. ECC predicts high rates of morbidity in adulthood, is one of the most frequently found childhood illnesses, and is theoretically preventable. Lesion formation follows a particular pattern based in part on the pattern of primary tooth eruption, and is similar to caries formation at any age, with the balance of demineralization and remineralization. Commonly observed effects of ECC include failure to thrive due to pain and discomfort with eating, decreased attentiveness and socialization, and increased number of missed school days. The lesions associated with ECC are often very painful and frequently remain untreated in high-risk populations. Unfortunately, children’s oral health needs are often overlooked in research and public health practices, leaving many untreated and suffering. Risk indicators for ECC include socioeconomic status and race or ethnicity. One of the most critical risk factors for the disease is dietary quality, which has been studied to some extent in attempts to discern the epidemiology of ECC, and which has been shown to have causative effects on the disease process. What has not been studied, however, is how these risk indicators and risk factors interrelate to contribute to the high prevalence of ECC in the United States. Without studying the effect that an overlap in associated risks for these problems has, it is not possible to create a truly comprehensive public health prevention program that will efficaciously decrease the incidence of early childhood caries. Multiple studies have shown the effects of poor diet quality on the development of ECC. When studying nutritional intake alone, ECC is far more common in groups consuming a less healthful diet. Not only does dietary intake affect the formation of caries, caries experience also affects the ability to consume a nutritious diet. Socioeconomic status has also been cited as a crucial determinant of risk for developing ECC. Those children living at or below the Federal Poverty Line are at high risk for disease, regardless of their race or ethnicity. This is hypothesized to relate to nutrition, as healthier diets are frequently found to be more costly than cariogenic diets, which rely heavily on refined and processed grain products. Nutrition is the single risk factor that bridges the risk indicators of socioeconomic status and race or ethnicity. For this reason, improving dietary quality and nutritional status may prove to be the most effective method of decreasing the prevalence of ECC in the United States. Future studies should focus on effective methods to educate the population to alter the quality of the American diet as a whole. By doing so, the prevalence of this disease can be reduced, and more children can have successful, happier, and healthier childhood years. Creating better oral health in children will decrease morbidity for both oral and systemic disease in adulthood, ultimately improving the overall health of the population of the United States.

Purpose: This is a pilot study to determine if there is a relationship between vitamin D deficiency and the development of early childhood caries (ECC). Methods: Serum 25(OH) vitamin D, parathyroid hormone and calcium were measured from children with ECC, who presented for dental rehabilitation under general anesthesia. Samples were obtained from caries free controls examined during a well-child medical check. Parents from both sample sizes filled out a questionnaire consisting of 22 questions regarding the child and parent’s medical and dental history as well as socioeconomic background. Results: ECC patients were found to have deficient serum levels of 25(OH) vitamin D and calcium compared to caries free controls. Conclusions: This study observed a difference in 25(OH) vitamin D levels between the two groups. Due to limited sample size and confounding variables contributing to ECC, a definitive relationship between vitamin D deficiency and ECC cannot be made at this time.

Purpose: To determine if there is an association between early childhood caries (ECC) and vitamin D deficiency, as measured via a serum sample. An exploratory goal was to investigate the possibility of measuring vitamin D with a salivary assay. Methods: Serum samples of patients who were scheduled for a dental or otolaryngology procedure under general anesthesia were assessed for 25-hydroxyvitamin D (25(OH)D), parathyroid hormone and calcium. Results: Our analysis indicates that the vitamin D levels of the controls and ECC group were significantly different. There were significant inverse correlations between: 1) PTH levels and vitamin D and 2) decayed, missing, filled teeth (dmft) and vitamin D. Conclusions: A relationship between low serum levels of vitamin D and the prevalence of ECC for children 0 to 6 years of age was observed. The salivary assay was unable to measure vitamin D, but future studies should still explore this non-invasive technique.

Abstract THE EFFECTIVENESS OF A PREVENTIVE RECALL STRATEGY IN CHILDREN FOLLOWING DENTAL REHABILITATION UNDER GENERAL ANESTHESIA By Amanda Kerns, DDS A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University. Virginia Commonwealth University, 2016 Thesis Advisor: Elizabeth Berry, DDS, MPH, MSD Vice Chair, Assistant Professor, Department of Pediatric Dentistry Purpose: This was a prospective randomized controlled trial assessing the impact of a preventive strategy following full-mouth dental rehabilitation (FMDR) in children with early childhood dental caries. Methods: 130 patients completed FMDR and were included in the analysis. Caries risk assessment (CRA), dental exam, and a caregiver oral health knowledge (OHK) questionnaire was completed for each patient. Patients were randomized into two groups; intervention returned at 3 and 6 months and control returned at only 6 months post-surgery. At each recall, CRA and dental exam information was recorded, and at the six month recall, all caregivers completed the OHK questionnaire. Results: Actual recall data showed a statistically significant difference in CRA at six months, with 71.8% of patients in the control and 44.8% of patients in the intervention assessed as high caries risk. Conclusions: The actual recall data suggests this recall strategy is effective in reducing CRA level following FMDR.

Dental caries is a very common chronic infectious disease that is preventable and related to dental behaviours. The objective of this study was to develop a parental questionnaire to predict the child’s caries risk without professional evaluation and assess if risk factors worked together and if behaviours changed over time. At baseline, a survey and examination for caries were administered to 100 subjects aged 1 to 3 years old in Winnipeg, Manitoba. Six months later the same survey and examination were administered. Statistical analysis included logistic regression, Pearson Chi-squared, McNemar’s, Fisher’s exact tests and paired T-tests. The main finding was this survey could not predict future caries risk. Parents’ reports of visible cavities/fillings in their child predicted caries. Few risk factors changed significantly over time. A change in developmental delay corresponded to a change in caries. Overall, caries risk was found to be complex and requires further investigation.

Made available in DSpace on 2014-06-11T19:27:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-02-25Bitstream added on 2014-06-13T19:15:16Z : No. of bitstreams: 1 carvalho_fg_me_ararafo.pdf: 2242133 bytes, checksum: 8b913a63b61cf88bd8cc0476d909d6d7 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / O presente estudo teve o objetivo de investigar o número (UFC) e a prevalência de Streptococcus grupo mutans e Candida spp. e das respectivas espécies no biofilme dental supragengival de crianças sem cárie, com cárie e cárie de mamadeira, e na dentina cariada de crianças com cárie e cárie de mamadeira, comparando a freqüência destes microrganismos nos sítios coletados. Foram coletadas amostras de biofilme dental e dentina cariada de 56 crianças de 1 a 5 anos de idade, as quais foram divididas em 3 grupos: 1- cárie de mamadeira (n=24); 2- cárie (n= 11) e 3- livres de cárie (n=21). As amostras foram semeadas em SB20 e SA, para S. mutans e Candida spp., respectivamente, e após 48h foram contadas. As espécies de S. mutans foram identificadas bioquimicamente, enquanto que as espécies de Candida foram identificadas pelo CHROMagar® Candida. Os testes estatísticos de Kruskall-Wallis e Mann-Whitney foram aplicados aos valores de unidades formadoras de colônias (UFC) e para as freqüências de cultura das espécies de S. mutans e Candida spp. foram aplicados testes estatísticos de Fisher. Os resultados mostraram que na contagem de UFC para S. mutans houve apenas diferença estatística entre os grupos 1 e 3 e entre os grupos 2 e 3 no biofilme, não existindo diferença na dentina. Com relação à contagem de UFC para Candida ssp. houve apenas diferença entre os grupos 1 e 3 no biofilme, não existindo diferença na dentina. A espécie mais prevalente foi S. mutans c, f e Candida albicans estando presentes com maior freqüência na cárie de mamadeira (85,4% e 60,4%, respectivamente), independente do local da coleta. Apenas para S. mutans c, f houve associação significante para dentes cariados, seja cárie de mamadeira ou não. Porém, a freqüência de Candida albicans no grupo cárie de mamadeira foi destacadamente maior quando comparada a dos grupos sem cárie e cárie... / The present study aimed to determine count (CFU) and the prevalence of Streptococcus mutans and Candida spp., and respectives species, in the dental supragengival biofilm of children caries-free, with early childhood caries and caries. Carious dentin was collected in the children with caries and early childhood caries to compare the frequency of these microorganisms in the collected sites. Pooled samples of dental biofilm and carious dentin were collected from 56 children aged 1 to 5 years, which were divided in 3 groups: 1 - early childhood caries (n=24); 2 - caries (n = 11) and 3 - caries-free (n=21). The samples were inoculated in SB20 medium and SA medium, for S. mutans and Candida spp., respectively, and incubated by 48 hours/37°C. Colonies growth were counted and identification was performed by biochemical tests. The statistical tests of Kruskall-Wallis and Mann-Whitney were applied to the total count of microorganisms (CFU). Fisher's tests were applied with the objective to evaluated the independence between the species and the caries type. The results showed that the count of CFU for S. mutans was statisticaly different between groups 1 and 3 and groups 2 and 3 in the biofilm, but not in dentin. The count of CFU for Candida ssp. was statisticaly different between groups 1 and 3 in the biofilm, but not in dentine. The more prevalent species was S. mutans c, f and Candida albicans, present more frequently in early childhood caries (85.4% and 60.4%, respectively), independent of the sampling site. Just S. mutans c, f had significant association for carious teeth, wether early childhood caries or not. However, the frequency of Candida albicans in the group early childhood caries was higher when compared to the groups caries-free and caries. There is a significant association between the presence of C. albicans and early childhood caries.

Orientador: Denise Madalena Palomari Spolidorio / Banca: Regina Maria Puppin Rontani / Banca: Josimeri Hebling / Resumo: O presente estudo teve o objetivo de investigar o número (UFC) e a prevalência de Streptococcus grupo mutans e Candida spp. e das respectivas espécies no biofilme dental supragengival de crianças sem cárie, com cárie e cárie de mamadeira, e na dentina cariada de crianças com cárie e cárie de mamadeira, comparando a freqüência destes microrganismos nos sítios coletados. Foram coletadas amostras de biofilme dental e dentina cariada de 56 crianças de 1 a 5 anos de idade, as quais foram divididas em 3 grupos: 1- cárie de mamadeira (n=24); 2- cárie (n= 11) e 3- livres de cárie (n=21). As amostras foram semeadas em SB20 e SA, para S. mutans e Candida spp., respectivamente, e após 48h foram contadas. As espécies de S. mutans foram identificadas bioquimicamente, enquanto que as espécies de Candida foram identificadas pelo CHROMagar® Candida. Os testes estatísticos de Kruskall-Wallis e Mann-Whitney foram aplicados aos valores de unidades formadoras de colônias (UFC) e para as freqüências de cultura das espécies de S. mutans e Candida spp. foram aplicados testes estatísticos de Fisher. Os resultados mostraram que na contagem de UFC para S. mutans houve apenas diferença estatística entre os grupos 1 e 3 e entre os grupos 2 e 3 no biofilme, não existindo diferença na dentina. Com relação à contagem de UFC para Candida ssp. houve apenas diferença entre os grupos 1 e 3 no biofilme, não existindo diferença na dentina. A espécie mais prevalente foi S. mutans c, f e Candida albicans estando presentes com maior freqüência na cárie de mamadeira (85,4% e 60,4%, respectivamente), independente do local da coleta. Apenas para S. mutans c, f houve associação significante para dentes cariados, seja cárie de mamadeira ou não. Porém, a freqüência de Candida albicans no grupo cárie de mamadeira foi destacadamente maior quando comparada a dos grupos sem cárie e cárie...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The present study aimed to determine count (CFU) and the prevalence of Streptococcus mutans and Candida spp., and respectives species, in the dental supragengival biofilm of children caries-free, with early childhood caries and caries. Carious dentin was collected in the children with caries and early childhood caries to compare the frequency of these microorganisms in the collected sites. Pooled samples of dental biofilm and carious dentin were collected from 56 children aged 1 to 5 years, which were divided in 3 groups: 1 - early childhood caries (n=24); 2 - caries (n = 11) and 3 - caries-free (n=21). The samples were inoculated in SB20 medium and SA medium, for S. mutans and Candida spp., respectively, and incubated by 48 hours/37°C. Colonies growth were counted and identification was performed by biochemical tests. The statistical tests of Kruskall-Wallis and Mann-Whitney were applied to the total count of microorganisms (CFU). Fisher's tests were applied with the objective to evaluated the independence between the species and the caries type. The results showed that the count of CFU for S. mutans was statisticaly different between groups 1 and 3 and groups 2 and 3 in the biofilm, but not in dentin. The count of CFU for Candida ssp. was statisticaly different between groups 1 and 3 in the biofilm, but not in dentine. The more prevalent species was S. mutans c, f and Candida albicans, present more frequently in early childhood caries (85.4% and 60.4%, respectively), independent of the sampling site. Just S. mutans c, f had significant association for carious teeth, wether early childhood caries or not. However, the frequency of Candida albicans in the group early childhood caries was higher when compared to the groups caries-free and caries. There is a significant association between the presence of C. albicans and early childhood caries. / Mestre

In lower middle-income economies (LMIE), the nutrition transition from traditional diets to sugary foods and beverages has contributed to widespread early childhood dental caries. This qualitative study explores perceived risk and protective factors, and overall experiences of early childhood nutrition and oral health in indigenous Ecuadorian families participating in a community-based oral health and nutrition intervention. Dental exams of 698 children age 6 months through 6 years determined each child's caries burden. A convenience sample of 18 "outlier" families was identified: low-caries children with <= 2 carious teeth vs. high-caries children with >= 10 carious teeth. Semi-structured in-depth interviews with parents/caregivers explored the child's diet, dental habits, and family factors related to nutrition and oral health. Interviews were transcribed and thematically analyzed using grounded theory. In the high-caries families, proximity to highway and stores, consumption of processed-food, and low parental monitoring of child behavior were identified as risk factors for ECC (early childhood caries). In the low-caries families, protective factors included harvesting and consuming food from the family farm, remote geography, and greater parental monitoring of child behavior. The study results suggest that maintaining traditional family farms and authoritative parenting to avoid processed foods/drinks and ensure tooth brushing could improve early childhood nutrition and oral health.

Magister Scientiae Dentium - MSc(Dent) / Early Childhood Caries (ECC) is a public health problem both in developing and developed countries. Its widespread prevalence among children makes it ideal for assessing the risk factors and identifying specific strategies that could be implemented to prevent the disease. The aim of the present study was to determine the risk factors associated with early childhood caries among 5 – 48 month children in Mariental, Namibia. The objectives were to determine (i) the prevalence and severity of early childhood caries in 5 – 48 months old children (ii) the risk of early childhood caries associated with feeding practices, social and cultural behaviour, sugar consumption, dental health awareness, fluoride and risk behaviour. The study design used was cross-sectional and descriptive. A convenience sample was used as mothers visited the post-natal clinic or the hospital for treatment of other ailments or problems. The sample size comprised 230 mothers and their children and only mothers and their biological children in the age range 5- 48 months were included in the survey. Data was collected by using an open- and closed-ended questionnaire that included questions regarding the child‘s dietary and nutritional habits, oral hygiene habits, socio-economic status and beliefs. Mothers and their biological children were examined for presence or absence of dental caries and the findings were recorded on a modified WHO data sheet. The mean age of the children was 24 months, the mean deft 1.5 and the Significant Caries Index (SiC) was 4.5. There was an increase in caries prevalence (add caries prevalence) with increasing age both among girls and boys. The mean DMFT of the mothers was 7.1, their SiC was 17.11 and more than three quarters had at least one tooth missing which was extracted due to caries and just under a quarter had one or more decayed teeth. Despite the fact that most of the mothers reported knowing the importance of good oral hygiene, brush their own teeth and cleaning their children‘s mouth both mothers and their children had high DMFT or deft indices. This is due to a multiplicity of factors – the majority of the mothers were both uneducated and unemployed and have difficulty in making or taking appropriate choices conducive to healthy lifestyles in turn affecting their behaviours and oral hygiene practices.

With over 20 million Americans living in food deserts, it is no wonder why the children who living in these areas are consuming more processed foods. Processed foods and lack of proportional diet can have an adverse effect on the oral health of children and adults leading to tooth decay. Early Childhood Caries (ECC) is the most chronic disease in children and it is especially chronic within children who come from disadvantage backgrounds. The objective of this study is to explore the multiple paradigms of tooth decay that exist within the minority population of children. The mechanism behind what leads to tooth decay will be evaluated in conjunction with other factors such as: disparities within minority children, insurance coverage, and agriculture to demonstrate the high prevalence of ECC within minority children. What goes in a child’s mouth can really determine the state of their oral healthcare, however more times than not children lack the responsibility and depend heavily upon their guardian to get their dental needs met. The development of ECC can lead to more severe problems if left untreated, and currently there is a high prevalence of untreated ECC in predominantly minority neighborhoods where families are typically low income. Low-income means they are less likely to have a primary dentist leading to more untreated ECC, however it is also important to look at the federally funded programs. The government has been able to take strides in helping provided coverage for these at-risk children. ECC is chronic and can be detrimental to a child’s healthcare. What goes in the child’s mouth is also important in that in low-income neighborhoods there are deserts full of no organic options. This can have an adverse effect on the child’s help by their famine nutritional needs. There is a need for new policy to be implemented in order to increase the rate at which children go to the dentist as well as gain access to avoidable options. Although there were limits within this study, there are many suggested improvements and directions for future research to address. In conclusion, although the data reported here supports the conclusion that more evidence is needed that will lead to significant policy reform to eliminate the high prevalence of ECC especially within children coming from minority backgrounds. Positive progress is being made due to the constant support from both the government and community resources as well as dental practitioners who are focused on making a difference in the oral health and overall well-being of children.