Aubrey Sheiham

Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children

OBJECTIVE To examine the contribution to fruit and vegetable eating in children of potential predictive variables within the domains of demographics, parental feeding practices and personality traits. DESIGN Cross-sectional survey. SETTING Questionnaires were distributed to parents through 22 London nursery schools. SUBJECTS Questionnaires were completed and returned by 564 parents or principal caregivers of 2-6-year-old children. RESULTS Significant predictors of childrens fruit and vegetable intake emerged from all three domains examined. Demographic variables associated with childs vegetable consumption were mothers education and childs age and gender. Only ethnicity was significantly associated with fruit consumption. Parental consumption, breast-feeding and early introduction to fruit and vegetables were related to intake of both. Family meal times were associated with higher intake of vegetables, but not of fruit. Two characteristics of children themselves (food neophobia and enjoyment of food) were strongly related to the consumption of fruit and vegetables. Subsequent multivariate analyses revealed that parental intake and child food neophobia independently predicted intake of both foods. In the presence of these, fruit consumption was affected by breast-feeding and early introduction to fruit, whereas vegetable consumption was related only to childs gender and enjoyment of food. CONCLUSIONS These findings may be used to inform future interventions aimed at increasing childrens consumption of fruit and vegetables. Parents should be made aware of the possible impact of their own behaviour on the eating habits of their children.

The Relationship among Dental Status, Nutrient Intake, and Nutritional Status in Older People

Dental health status may influence nutrition. The objective of this part of the National Diet and Nutrition Survey was to assess if there is a relationship between dental status in people 65 years and older and intake of certain nutrients and any link between dental status and blood-derived values of key nutrients. Random national samples of independently living subjects and those living in institutions had dental examinations, interviews, four-day food diaries, and blood and urine analyzed. In the sample living independently, intakes of most nutrients were lower in edentate than dentate subjects. Intake of non-starch polysaccharides, protein, calcium, non-heme iron, niacin, and vitamin C was significantly lower in edentate subjects. People with 21 or more teeth consumed more of most nutrients, particularly of non-starch polysaccharide. This relationship in intake was not apparent in the hematological analysis. Plasma ascorbate and plasma retinol were the only analytes significantly associated with dental status.

Oral health, general health and quality of life

The compartmentalization involved in viewing the mouth separately from the rest of the body must cease because oral health affects general health by causing considerable pain and suffering and by changing what people eat, their speech and their quality of life and well-being. Oral health also has an effect on other chronic diseases (1). Because of the failure to tackle social and material de-terminants and incorporate oral health into general health promotion, millions suffer intractable toothache and poor quality of life and end up with few teeth.Health policies should be reori-ented to incorporate oral health using sociodental approaches to assessing needs and the common risk factor approach for health promotion (1, 2). Oral diseases are the most common of the chronic diseases and are important public health problems because of their prevalence, their impact on individuals and society, and the expense of their treatment. The determinants of oral diseases are known — they are the risk factors common to a number of chronic diseases: diet and dirt (hygiene), smok-ing, alcohol, risky behaviours causing injuries, and stress — and effective public health methods are available to prevent oral diseases.In some countries, oral diseases are the fourth most expensive diseases to treat. Treating caries, estimated at US

Orthodontic treatment and its impact on oral health-related quality of life in Brazilian adolescents

3513 per 1000 children, would exceed the total health budget for children of most low-income countries (3). The situation for adults in developing coun-tries is worse, as they suffer from the accumulation of untreated oral diseases. There are few efficient dental care sys-tems to cope with their problems, and where there are, the cost is beyond most people’s means. Millions with untreated caries have cavities and suppuration, yet planners continue to overlook oral dis-eases, despite their significant impact on cost and quality of life. This oversight will lead to more decay and expensive, ineffective clinical interventions.

Association of Edentulism and Diet and Nutrition in US Adults

Objective To assess whether Brazilian adolescents who had completed orthodontic treatment had lower levels of impacts on their oral health-related quality of life. Design A cross-sectional study. Setting The study was conducted in public and private secondary schools in Bauru-SP, Brazil. Participants 1675 randomly selected adolescents aged between 15 and 16 years. Methods Adolescents were clinically examined using the Index of Orthodontic Treatment Need (IOTN). Two oral health-related quality of life measures, namely the Oral Impacts on Daily Performance (OIDP) and the shortened version of the Oral Health Impacts Profile (OHIP-14) were used to assess adolescents’ oral health-related impacts. Multiple logistic regression was used in the data analysis. Results A response rate of 100% was obtained. Adolescents who had completed orthodontic treatment had fewer oral health-related impacts compared to the other two groups. They were 1.85 times (95% CI 1.30 to 2.62) less likely to have an oral health impact on their daily life activities than adolescents currently under treatment or 1.43 (1.01 to 2.02) times than those who never had treatment. Conclusions Adolescents who had completed orthodontic treatment had a better oral health-related quality of life than those currently under treatment or those who never had treatment.

Does the condition of the mouth and teeth affect the ability to eat certain foods, nutrient and dietary intake and nutritional status amongst older people?

Dental status and its relationship to diet and nutritional status have been little explored. In this study of a representative sample of the US civilian, non-institutionalized population (NHANES III), we predicted that the intake of nutritious foods, dietary fiber, and levels of biochemical analytes would be lower, even after adjusting for potential social and behavioral factors, among those who were edentulous and wore complete dentures than for those who had all their natural teeth. Multivariate analyses indicated that intake of carrots and tossed salads among denture-wearers was, respectively, 2.1 and 1.5 times less than for the fully dentate (p < 0.0001), and dietary fiber intake was 1.2 times less (p < 0.05). Serum levels of beta carotene (9.8 μg/dL), folate (4.7 ng/dL), and vitamin C (0.87 mg/dL) were also lower among denture-wearers (p < 0.05). Intakes of some nutrient-rich foods and beta carotene, folate, and vitamin C serum levels were significantly lower in denture-wearers.

Social Gradients in Oral and General Health

OBJECTIVES To assess how the dental status of older people affected their stated ability to eat common foods, their nutrient intake and some nutrition-related blood analytes. DESIGN Cross-sectional survey part of nation-wide British National Diet and Nutrition Survey: people aged 65 years and older. Data from a questionnaire were linked to clinical data and data from four-day weighed dietary records. Two separate representative samples: a free-living and an institutional sample. Seven-hundred-and-fifty-three free-living and 196 institution subjects had a dental exam and interview. RESULTS About one in five dentate (with natural teeth) free-living people had difficulty eating raw carrots, apples, well-done steak or nuts. Foods such as nuts, apples and raw carrots could not be eaten easily by over half edentate (without natural teeth but with dentures) people in institutions. In free-living, intakes of most nutrients and fruit and vegetables were significantly lower in edentate than dentate. Perceived chewing ability increased with increasing number of teeth. Daily intake of non-starch polysaccharides, protein, calcium, non-haem iron, niacin, vitamin C and intrinsic and milk sugars were significantly lower in edentate. Plasma ascorbate and retinol were significantly lower in the edentate than dentate. Plasma ascorbate was significantly related to the number of teeth and posterior contacting pairs of teeth. CONCLUSIONS The presence, number and distribution of natural teeth are related to the ability to eat certain foods, affecting nutrient intakes and two biochemical measures of nutritional status.

Exploring the association of dental caries with social factors and nutritional status in Brazilian preschool children

There are social gradients in general health and oral health. However, there have been few studies addressing whether similarities exist in the gradients in oral and general health in the same individuals. We set out to test, using data from NHANES III, whether there are social gradients in oral health, and whether they resemble the gradients in general health. Income, indicated by poverty-income ratio, and education gradients were examined in periodontal diseases, ischemic heart disease, and perceived oral/general health. Our analysis demonstrated consistent income and education gradients in all outcomes assessed. In the adjusted regression models, the probabilities of having poorer clinical and perceived health were attenuated, but remained significantly higher at each lower level of income and education for most outcomes. The results showed similar income and education gradients in oral and general health, implying commonalities of the social determinants of both oral and general health.

The prevalence and severity of oral impacts on daily performances in Thai primary school children.

The main objective of this study was to assess whether dental caries status was related to nutritional status in preschool urban Brazilian children aged 12-59 months. Dental and anthropometric examinations were conducted on 1,018 12-59-month-old children during the National Day of Children Vaccination. Dental caries prevalence and severity were measured using the decayed, missing or filled surfaces (dmfs) index. The World Health Organization (WHO) Child Growth Standards Reference was used to evaluate nutritional status. Results on nutritional status were presented as Z-scores. The data collected included socio-economic conditions. Multilevel linear regression was applied to investigate the effect of nutritional, socio-economic, and demographic factors on the status of childrens dental caries. Caries was present in 23.4% of children. The final hierarchical logistic model showed a significant association between nutritional status and caries experience. Children with low Z-scores in some indexes had an increased risk of having caries. In addition, children whose mothers had < 8 yr of education and were from lower-income families had an increased risk of high levels of dental caries. There was an association between nutritional and socio-economic factors, and dental caries. In conclusion, underweight children and those with adverse socio-economic conditions were more likely to have caries experience.

Social deprivation, income inequality, social cohesion and dental caries in Brazilian school children

BackgroundTraditional methods of measuring oral health mainly use clinical dental indices and have been complemented by oral health related quality of life (OHRQoL) measures. Most OHRQoL studies have been on adults and elderly populations. There are no systematic OHRQoL studies of a population-based sample of children. The objective of this study was to assess the prevalence, characteristics and severity of oral impacts in primary school children.MethodsCross-sectional study of all 1126 children aged 11–12 years in a municipal area of Suphanburi province, Thailand. An OHRQoL measure, Child-Oral Impacts on Daily Performances index (Child-OIDP) was used to assess oral impacts. Children were also clinically examined and completed a self-administered questionnaire about demographic information and oral behaviours.Results89.8% of children had one or more oral impacts. The median impact score was 7.6 and mean score was 8.8. Nearly half (47.0%) of the children with impacts had impacts at very little or little levels of intensity. Most (84.8%) of those with impacts had 1–4 daily performances affected (out of 8 performances). Eating was the most common performance affected (72.9%). The severity of impacts was high for eating and smiling and low for study and social contact performances. The main clinical causes of impacts were sensitive tooth (27.9%), oral ulcers (25.8%), toothache (25.1%) and an exfoliating primary tooth (23.4%).ConclusionsThe study reveals that oral health impacts on quality of life in Thai primary school children. Oral impacts were prevalent, but not severe. The impacts mainly related to difficulty eating and smiling. Toothache, oral ulcers and natural processes contributed largely to the incidence of oral impacts.