ETIOLOGY/OTHER
ARTICLE ANALYSIS & EVALUATION ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Regular dental checkup and snack-soda drink consumption of preschool children are associated with early childhood caries in Korean caregiver/preschool children dyads. Han DH, Kim DH, Kim MJ, Kim JB, Kyunghee JC, Bae KH. Community Dent Oral Epidemiol 2014;42(1):70-8.
REVIEWER Hiroko Iida, DDS, MPH
Korean Preschool Children’s Snack and Soda Consumption and Lack of Regular Dental Checkup May Increase Risk for Early Childhood Caries SUMMARY Subjects This study enrolled 1454 South Korean children under age 6 years residing in Dong-gu, Ulsan using stratified cluster sampling according to the area of residence and the type/size of housing. From these, authors obtained data from 1214 child-parent dyads, including 1- to 5-year-old children (610 boys and 604 girls) and their parents (278 fathers and 936 mothers) via dental examination and self-administered questionnaire in July 2006.
Key Risk/Study Factor PURPOSE/QUESTION What is the relationship of preschool children’s oral health behavior and caregivers’ selfreported oral health to the prevalence of early childhood caries (ECC) in Dong-gu, Ulsan, Korea?
SOURCE OF FUNDING Government: National Research Foundation of Korea (NRF) grant (No. 2011-0009536) funded by the Korean Ministry of Education, Science and Technology
The authors studied parent-reported child’s oral health behaviors such as tooth brushing frequency, annual dental checkup, and frequency of snack and soda consumption as well as parental self-rating of oral health status as key risk factors. The test-retest reliability of the questionnaire was tested on 40 subjects (Intraclass Correlation Coefficient [ICC] = 0.925, p < 0.001).
Main Outcome Measure The main outcome measure was early childhood caries (ECC) as defined by the American Academy of Pediatric Dentistry. The authors defined simple ECC as the presence of one or more decayed, missing (due to caries), or filled (dmf) smooth surfaces in any primary tooth and severe ECC as (1) any sign of smooth-surface caries in children under age 3 years, (2) the presence of one or more dmf smooth surfaces in primary maxillary anterior teeth in children between ages 3 and 5 years, or (3) dmf score of $4 (age 3 years), $5 (age 4 years), or $6 (age 5 years). Dental caries (decay) was detected at the d3 level in World Health Organization (WHO) criteria using disposable mirrors and WHO probes by two calibrated dentists (k $ 0.7).
TYPE OF STUDY/DESIGN Cross-sectional study
LEVEL OF EVIDENCE Level 3: Other evidence
STRENGTH OF RECOMMENDATION GRADE Not applicable
J Evid Base Dent Pract 2014;14:154-155 1532-3382/$36.00 Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jebdp.2014.07.006
Main Results The prevalence of ECC was 47.5% and that of severe ECC was 34.8%. Multiple log-binomial regression analyzes showed that preschool children who did not have an annual dental checkup showed 1.7 and 1.8 times higher prevalence ratios (PRs) for simple ECC and severe ECC, respectively, regardless of additional adjustments. Children’s snack and soda consumption more than two times a day was associated with increased PRs for both simple and severe ECC (PRs = 1.2 to 1.3 and 1.6, respectively). Children who ate snack and soda once a day also showed PR of 1.4 relative to those who did not, after controlling for demographic confounders. No association was noted between caregivers’ self-rated oral health and ECC in most of the models they evaluated.
Conclusions The authors concluded that the absence of regular dental visits and frequent snack and soda consumption may be significant predictors of
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
simple and severe ECC among Korean children living in Dong-gu, Ulsan, and therefore should be included in the early intervention strategies to improve the oral health of Korean preschool children.
COMMENTARY AND ANALYSIS Dental caries is a chronic infectious disease that manifests as a destruction of susceptible dental hard tissue by acidic by-products from the bacterial fermentation of dietary carbohydrates.1 The process of caries development and its progression are influenced by multiple factors, including various child-, family-, and community-level biological as well as socioeconomic and cultural factors.2 The prevalence of ECC differs among racial and ethnic groups but the etiology of such differences is not well understood.3 The data analyzed in this study indicate that the prevalence of simple and severe ECC are high among Korean children living in Ulsan. Because caries was detected at the d3 level in this study, classifying non-cavitated ECC as sound, the magnitude of disease burden presented in this study could be underestimated. The findings of this study showing that frequent consumption of soda and snacks is a significant risk factor for simple and severe ECC is consistent with previous studies. Given the high prevalence of ECC among this study population, this relationship should be explored further to understand Korean children’s modern dietary practices at a multi-level context. Similarly, the association between preschool children’s dental visits and ECC deserves further investigation because the literature does not necessarily agree on the direction of the relationship.4,5 Preschool children’s effective use of dental services to prevent ECC is influenced by many community- and family-level factors, including capacity and distribution of dental workforce and availability of dental insurance in addition to the public’s awareness and acceptance of early and regular preventive dental visits. Although there is no question that caregivers of preschool children should be motivated to provide early preventive dental visits in Korea, further
Volume 14, Number 3
studies that help depict family- and community-level barriers to children’s early and regular dental visits in relation to ECC should be encouraged. Considering the limitations of the study design, the findings of this study and conclusion should be interpreted with caution. This cross-sectional study provides a snapshot of the ECC outcomes and the characteristics associated with them in Dong-gu, Ulsan, Korea, at a specific point in time, and the findings may not be applicable to other population. The evidence from this study is preliminary rather than clear or specific enough for clinical application in individual cases. The relationships between ECC and preschool children’s dental visit and snack and soda consumptions should be further evaluated with more rigorous research designs to determine the association and answer questions regarding what other factors might influence or modify the association.
REFERENCES 1. Fontana M, Young DA, Wolff MS, Pitts NB, Longbottom C. Defining dental caries for 2020 and beyond. Dent Clin North Am 2010;54(3):423-40. 2. Fisher-Owens SA, Gansky SA, Platt LJ, et al. Influences on children’s oral health: a conceptual model. Pediatrics 2007;120(3):e510-20. 3. Psoter WJ, Pendrys DG, Morse DE, Zhang H, Mayne ST. Associations of ethnicity/race and socioeconomic status with early childhood caries patterns. J Public Health Dent 2006;66(1):23-9. 4. Iida H, Auinger P, Billings RJ, Weitzman M. Association between infant breastfeeding and early childhood caries in the United States. Pediatrics 2007;120(4):e944-52. 5. Graves RC, Abernathy JR, Disney JA, Stamm JW, Bohannan HM. University of North Carolina caries risk assessment study. III. Multiple factors in caries prevalence. J Public Health Dent 1991;51:134-43.
REVIEWER Hiroko Iida, DDS, MPH Director, New York State Oral Health Center of Excellence, 259 Monroe Avenue, Rochester, NY 14607, USA, Tel.: þ1 585 325 2280x7324; fax: þ1 585 325 2293 [email protected]
155
ARTICLE ANALYSIS & EVALUATION ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Regular dental checkup and snack-soda drink consumption of preschool children are associated with early childhood caries in Korean caregiver/preschool children dyads. Han DH, Kim DH, Kim MJ, Kim JB, Kyunghee JC, Bae KH. Community Dent Oral Epidemiol 2014;42(1):70-8.
REVIEWER Hiroko Iida, DDS, MPH
Korean Preschool Children’s Snack and Soda Consumption and Lack of Regular Dental Checkup May Increase Risk for Early Childhood Caries SUMMARY Subjects This study enrolled 1454 South Korean children under age 6 years residing in Dong-gu, Ulsan using stratified cluster sampling according to the area of residence and the type/size of housing. From these, authors obtained data from 1214 child-parent dyads, including 1- to 5-year-old children (610 boys and 604 girls) and their parents (278 fathers and 936 mothers) via dental examination and self-administered questionnaire in July 2006.
Key Risk/Study Factor PURPOSE/QUESTION What is the relationship of preschool children’s oral health behavior and caregivers’ selfreported oral health to the prevalence of early childhood caries (ECC) in Dong-gu, Ulsan, Korea?
SOURCE OF FUNDING Government: National Research Foundation of Korea (NRF) grant (No. 2011-0009536) funded by the Korean Ministry of Education, Science and Technology
The authors studied parent-reported child’s oral health behaviors such as tooth brushing frequency, annual dental checkup, and frequency of snack and soda consumption as well as parental self-rating of oral health status as key risk factors. The test-retest reliability of the questionnaire was tested on 40 subjects (Intraclass Correlation Coefficient [ICC] = 0.925, p < 0.001).
Main Outcome Measure The main outcome measure was early childhood caries (ECC) as defined by the American Academy of Pediatric Dentistry. The authors defined simple ECC as the presence of one or more decayed, missing (due to caries), or filled (dmf) smooth surfaces in any primary tooth and severe ECC as (1) any sign of smooth-surface caries in children under age 3 years, (2) the presence of one or more dmf smooth surfaces in primary maxillary anterior teeth in children between ages 3 and 5 years, or (3) dmf score of $4 (age 3 years), $5 (age 4 years), or $6 (age 5 years). Dental caries (decay) was detected at the d3 level in World Health Organization (WHO) criteria using disposable mirrors and WHO probes by two calibrated dentists (k $ 0.7).
TYPE OF STUDY/DESIGN Cross-sectional study
LEVEL OF EVIDENCE Level 3: Other evidence
STRENGTH OF RECOMMENDATION GRADE Not applicable
J Evid Base Dent Pract 2014;14:154-155 1532-3382/$36.00 Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jebdp.2014.07.006
Main Results The prevalence of ECC was 47.5% and that of severe ECC was 34.8%. Multiple log-binomial regression analyzes showed that preschool children who did not have an annual dental checkup showed 1.7 and 1.8 times higher prevalence ratios (PRs) for simple ECC and severe ECC, respectively, regardless of additional adjustments. Children’s snack and soda consumption more than two times a day was associated with increased PRs for both simple and severe ECC (PRs = 1.2 to 1.3 and 1.6, respectively). Children who ate snack and soda once a day also showed PR of 1.4 relative to those who did not, after controlling for demographic confounders. No association was noted between caregivers’ self-rated oral health and ECC in most of the models they evaluated.
Conclusions The authors concluded that the absence of regular dental visits and frequent snack and soda consumption may be significant predictors of
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
simple and severe ECC among Korean children living in Dong-gu, Ulsan, and therefore should be included in the early intervention strategies to improve the oral health of Korean preschool children.
COMMENTARY AND ANALYSIS Dental caries is a chronic infectious disease that manifests as a destruction of susceptible dental hard tissue by acidic by-products from the bacterial fermentation of dietary carbohydrates.1 The process of caries development and its progression are influenced by multiple factors, including various child-, family-, and community-level biological as well as socioeconomic and cultural factors.2 The prevalence of ECC differs among racial and ethnic groups but the etiology of such differences is not well understood.3 The data analyzed in this study indicate that the prevalence of simple and severe ECC are high among Korean children living in Ulsan. Because caries was detected at the d3 level in this study, classifying non-cavitated ECC as sound, the magnitude of disease burden presented in this study could be underestimated. The findings of this study showing that frequent consumption of soda and snacks is a significant risk factor for simple and severe ECC is consistent with previous studies. Given the high prevalence of ECC among this study population, this relationship should be explored further to understand Korean children’s modern dietary practices at a multi-level context. Similarly, the association between preschool children’s dental visits and ECC deserves further investigation because the literature does not necessarily agree on the direction of the relationship.4,5 Preschool children’s effective use of dental services to prevent ECC is influenced by many community- and family-level factors, including capacity and distribution of dental workforce and availability of dental insurance in addition to the public’s awareness and acceptance of early and regular preventive dental visits. Although there is no question that caregivers of preschool children should be motivated to provide early preventive dental visits in Korea, further
Volume 14, Number 3
studies that help depict family- and community-level barriers to children’s early and regular dental visits in relation to ECC should be encouraged. Considering the limitations of the study design, the findings of this study and conclusion should be interpreted with caution. This cross-sectional study provides a snapshot of the ECC outcomes and the characteristics associated with them in Dong-gu, Ulsan, Korea, at a specific point in time, and the findings may not be applicable to other population. The evidence from this study is preliminary rather than clear or specific enough for clinical application in individual cases. The relationships between ECC and preschool children’s dental visit and snack and soda consumptions should be further evaluated with more rigorous research designs to determine the association and answer questions regarding what other factors might influence or modify the association.
REFERENCES 1. Fontana M, Young DA, Wolff MS, Pitts NB, Longbottom C. Defining dental caries for 2020 and beyond. Dent Clin North Am 2010;54(3):423-40. 2. Fisher-Owens SA, Gansky SA, Platt LJ, et al. Influences on children’s oral health: a conceptual model. Pediatrics 2007;120(3):e510-20. 3. Psoter WJ, Pendrys DG, Morse DE, Zhang H, Mayne ST. Associations of ethnicity/race and socioeconomic status with early childhood caries patterns. J Public Health Dent 2006;66(1):23-9. 4. Iida H, Auinger P, Billings RJ, Weitzman M. Association between infant breastfeeding and early childhood caries in the United States. Pediatrics 2007;120(4):e944-52. 5. Graves RC, Abernathy JR, Disney JA, Stamm JW, Bohannan HM. University of North Carolina caries risk assessment study. III. Multiple factors in caries prevalence. J Public Health Dent 1991;51:134-43.
REVIEWER Hiroko Iida, DDS, MPH Director, New York State Oral Health Center of Excellence, 259 Monroe Avenue, Rochester, NY 14607, USA, Tel.: þ1 585 325 2280x7324; fax: þ1 585 325 2293 [email protected]
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