Robert J. Schroth

Oral Health of Indigenous Children and the Influence of Early Childhood Caries on Childhood Health and Well-being

Dental caries in Indigenous children is a child health issue that is multifactorial in origin and strongly influenced by the determinants of health. The evidence suggests that extensive dental caries has an effect on health and well-being of the young child. This article focuses on early childhood caries as an overall proxy for Indigenous childhood oral health because decay during early life sets the foundation for oral health throughout childhood and adolescence. Strategies should begin with community engagement and always include primary care providers and other community health workers.

CAREGIVER KNOWLEDGE AND ATTITUDES OF PRESCHOOL ORAL HEALTH AND EARLy CHILDHOOD CARIES (ECC)

Objectives. Prevention strategies are integral to improving the oral health for young Aboriginal children. For such to be effective, it is important to understand the social value that parents and caregivers ascribe to primary teeth. The purpose of this paper is to report caregiver knowledge and attitudes toward preschool oral health and early childhood caries (ECC) from 4 communities in Manitoba. Study Design. Cross-sectional study, including a retrospective interview with caregivers. Methods. Children and their main caregivers served as the sample. Preschoolers underwent a comprehensive dental screening while caregivers completed a questionnaire that explored knowledge and attitudes toward preschool dental health. Caregiver responses were matched with findings from each child’s examination. Results. A majority agreed that primary teeth were important, that dental disease could lead to health problems and that a first dental visit should be made by age 1. Caregivers of children with ECC were more likely to believe that caries could not affect a child’s health while those who believed primary teeth are important had children with significantly less decay. Conclusions. Most caregivers believed that primary teeth are important and correctly responded to inquiries about knowledge and attitudes toward oral health. Attitudes on the importance of baby teeth and bottle feeding after one year of age, the effect of rotten teeth on childhood health and night-time nursing emerged as variables most associated with the absence/presence of ECC and deft rates. Incorporating such questioning into caries risk assessments may be a useful means to determine a child’s risk for ECC.

Review of vitamin D deficiency during pregnancy: who is affected?

Abstract Objectives. Vitamin D deficiencies have been documented in several populations, including aboriginal Canadians from isolated northern communities. Such deficiencies can impact the health of both the mother and her infant. This review was performed to determine how widespread vitamin D deficiency is during pregnancy. Study design. Electronic literature search. Methods. A Medline search was conducted using the Mesh terms “pregnancy” and “vitamin D”. Those studies meeting the inclusion criteria were reviewed. Results. 35 of 76 studies reported deficient mean, or median, concentrations of 25(OH)D. Low concentrations were reported among different ethnic groups around the world. In addition, deficient concentrations were identified in 3 northern First Nations communities in Manitoba. Conclusions. Such deficiencies are of concern, as the developing fetus acquires its 25(OH)D across the placenta and may influence infant health. Future research is required to resolve the discourse surrounding ambiguous threshold values for vitamin D deficiencies and insufficiencies and to identify effective strategies to improve the vitamin D status of expectant women. Vitamin D supplementation may be necessary for many women during pregnancy, especially those in northern regions where endogenous synthesis may be constrained. (Int J Circumpolar Health 2005; 64(2):112–120)

Prenatal Vitamin D and Dental Caries in Infants

OBJECTIVES: Inadequate maternal vitamin D (assessed by using 25-hydroxyvitamin D [25OHD]) levels during pregnancy may affect tooth calcification, predisposing enamel hypoplasia and early childhood caries (ECC). The purpose of this study was to determine the relationship between prenatal 25OHD concentrations and dental caries among offspring during the first year of life. METHODS: This prospective cohort study recruited expectant mothers from an economically disadvantaged urban area. A prenatal questionnaire was completed and serum sample drawn for 25OHD. Dental examinations were completed at 1 year of age while the parent/caregiver completed a questionnaire. The examiner was blinded to mothers’ 25OHD levels. A P value ≤ .05 was considered significant. RESULTS: Overall, 207 women were enrolled (mean age: 19 ± 5 years). The mean 25OHD level was 48 ± 24 nmol/L, and 33% had deficient levels. Enamel hypoplasia was identified in 22% of infants; 23% had cavitated ECC, and 36% had ECC when white spot lesions were included in the assessment. Mothers of children with ECC had significantly lower 25OHD levels than those whose children were caries-free (41 ± 20 vs 52 ± 27 nmol/L; P = .05). Univariate Poisson regression analysis for the amount of untreated decay revealed an inverse relationship with maternal 25OHD. Logistic regression revealed that enamel hypoplasia (P < .001), infant age (P = .002), and lower prenatal 25OHD levels (P = .02) were significantly associated with ECC. CONCLUSIONS: This study found that maternal prenatal 25OHD levels may have an influence on the primary dentition and the development of ECC.

Association between iron status, iron deficiency anaemia, and severe early childhood caries: a case–control study

BackgroundSevere 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.MethodsChildren 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.ResultsThe 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.ConclusionsChildren 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.

The Relationship Between Vitamin D and Severe Early Childhood Caries: A Pilot Study

INTRODUCTION Children with Severe Early Childhood Caries (S-ECC) routinely require dental surgery. S-ECC is known to affect childhood health and well-being. The objective of this pilot study was to assess vitamin D [25(OH)D] levels and determine whether differences exist between children with and without S-ECC. METHODS During July-September 2008, children undergoing surgery for S-ECC < 72 months of age from southern Manitoba were recruited. Age-matched controls were caries-free. Parents completed an interviewed questionnaire. A serum sample was obtained for 25(OH)D and parathyroid hormone (PTH) levels. This study was approved by the University of Manitobas Ethics Board. Statistics included chi-square analysis, t-tests, and multiple and logistic regression. A p value of <= 0.05 was significant. RESULTS Thirty-eight children participated (50 % with S-ECC). There was no significant age difference between groups (p = 0.82). The majority of the entire sample (84.2 %) had inadequate vitamin D levels. Children with S-ECC had lower concentrations of 25(OH)D (52.9 ± 15.1 nmol/L vs. 64.4 ± 21.3, p = 0.032) and were at twice the odds of having inadequate levels (<75 nmol/L). Children with S-ECC also had significantly higher PTH levels than caries-free children (53.5 ± 17.6 cm/L vs. 33.9 ± 12.9, p < 0.001). A greater number with S-ECC had elevated PTH levels (68.4 % vs. 21.1 %, p < 0.01). CONCLUSIONS This pilot study is the first to report differences in 25(OH)D between those with S-ECC and cavity-free controls. Children with S-ECC have lower vitamin D levels and increased PTH levels compared to age-matched controls.

Prevalence and risk factors of caregiver reported Severe Early Childhood Caries in Manitoba First Nations children: results from the RHS Phase 2 (2008–2010)

Objectives 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. Methods 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. Results 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. Conclusions 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.

Factors Associated With Dental Care Utilization in Early Childhood

OBJECTIVES: To identify sociodemographic, dietary, and biological factors associated with families who do not receive dental care in early childhood and to identify risk factors associated with having cavities among children who receive early dental care. METHODS: A cross-sectional study of healthy Canadian children seen for primary health care between September 2011 and January 2013 was conducted through the TARGet Kids! practice-based research network in Toronto, Canada. Adjusted logistic regression was used to determine factors associated with children who were not seen by a dentist in early childhood and to determine risk factors associated with having dental cavities among children who received early dental care. RESULTS: Of the 2505 children included in the analysis, <1% were seen by a dentist by 1 year of age. Older children were less likely to have never been to the dentist (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.87–0.90). Low family income (OR, 2.73; 95% CI, 1.47–5.06), prolonged bottle use (OR, 1.43; 95% CI, 1.03–2.00), and higher intakes of sweetened drinks (OR, 1.20; 95% CI, 1.01–1.42) were associated with increased risk for never having been to the dentist. Among those who had been to the dentist, older children (OR, 1.04; 95% CI, 1.03–1.05), children of low income families (OR, 1.90; 95% CI, 1.17–3.10), and those of East Asian maternal ethnicity (OR, 1.91; 95% CI, 1.10–3.29) were more likely to have dental cavities. CONCLUSIONS: Among healthy urban children seen by a primary care provider, those most susceptible to cavities were least likely to receive early dental care. These findings support the need for publicly funded universal early preventive dental care and underscore the importance for primary care physicians to promote dental care in early childhood.

Serum cytokine profile among Brazilian children of African descent with periodontal inflammation and sickle cell anaemia.

OBJECTIVE The aim of this study was to evaluate possible immunologic relationships between sickle cell anaemia (SCA) and periodontal inflammation and its impact on serum cytokines. DESIGN Twenty-five Brazilian children of African descent were involved in this study and divided in two groups: SCA (n=10): confirmed diagnosis of homozygous anaemia; and CTR-control (n=15): no sickle anaemia. Clinical examination included comprehensive medical (routine physical evaluation) and periodontal exams: plaque index (PI), bleeding on probing (BoP), and haematological analysis. Serum samples were collected for cytokine evaluation by microarray. Clinical and laboratorial parameters were compared statistically (alpha=5%). RESULTS The higher values of PI and BoP were similar for both groups (p>0.05) confirming a diagnosis of generalized gingivitis for all individuals. Intergroup analysis showed higher levels of interferon gamma (IFNγ), tumour necrosis alpha (TNFα), interleukin (IL)-4, -5, -8, -10 and 13 only in the SCA group (p<0.05). In addition, PI was negatively correlated with IL-2, IL-4, IL-5, IL-6, IL-8 and IL-13, while BoP was positively correlated with IL-10. CONCLUSION Within the limits of the present study, it was concluded that SCA increase the levels of serum cytokines regardless of the presence of periodontal inflammation. Therefore, a direct immunological relationship between SCA and periodontal inflammation was not established.

Racism and Oral Health Outcomes among Pregnant Canadian Aboriginal Women.

This study assessed links between racism and oral health outcomes among pregnant Canadian Aboriginal women. Baseline data were analyzed for 541 First Nations (94.6%) and Métis (5.4%) women in an early childhood caries preventive trial conducted in urban and on-reserve communities in Ontario and Manitoba. One-third of participants experienced racism in the past year determined by the Measure of Indigenous Racism Experience. In logistic regressions, outcomes significantly associated with incidents of racism included: wearing dentures, off-reserve dental care, asked to pay for dental services, perceived need for preventive care, flossing more than once daily, having fewer than 21 natural teeth, fear of going to dentist, never received orthodontic treatment and perceived impact of oral conditions on quality of life. In the context of dental care, racism experienced by Aboriginal women can be a barrier to accessing services. Programs and policies should address racism’s insidious effects on both mothers’ and children’s oral health outcomes.