Oral microbiota of adolescents with dental caries: A systematic review.

OBJECTIVE: This systematic review summarizes the current knowledge on the association between the oral microbiota and dental caries in adolescents. DESIGN: An electronic search was carried out across five databases. Studies were included if they conducted research on generally healthy adolescents, applied molecular-based microbiological analyses and assessed caries status. Data extraction was performed by two reviewers and the Newcastle-Ottawa Scale was applied for quality assessment. RESULTS: In total, 3935 records were reviewed which resulted in a selection of 20 cross-sectional studies (published 2005-2022) with a sample size ranging from 11 to 614 participants including adolescents between 11 and 19 years. The studies analyzed saliva, dental biofilm or tongue swabs with Checkerboard DNA-DNA hybridization, (q)PCR or Next-Generation Sequencing methods. Prevotella denticola, Scardoviae Wiggsiae, Streptococcus sobrinus and Streptococcus mutans were the most frequently reported species presenting higher abundance in adolescents with caries. The majority of the studies reported that the microbial diversity was similar between participants with and without dental caries. CONCLUSION: This systematic review is the first that shows how the oral microbiota composition in adolescents appears to differ between those with and without dental caries, suggesting certain taxa may be associated with increased caries risk. However, there is a need to replicate and expand these findings in larger, longitudinal studies that also focus on caries severity and take adolescent-specific factors into account.

Adherence to dietary guidelines and dental caries among children: a longitudinal cohort study.

BACKGROUND: Even though dietary sugars are the most important nutrient for caries development, the disease process is dependent on other dietary practices. The intake of individual nutrient components cannot be evaluated separately from the overall diet which includes other nutrients, foods and habits. Therefore, the aim of this study was to investigate the association between adherence to dietary guidelines and dental caries. METHODS: This study was embedded in the Generation R Study, conducted in Rotterdam, the Netherlands. In total, 2911 children were included in the present analyses. Dietary intake at the age of 8 years was assessed using food-frequency questionnaires. Diet quality scores were estimated, reflecting adherence to Dutch dietary guidelines. Dental caries was assessed at the age of 13 years using intra-oral photographs. Associations were estimated using multinomial logistic regression analyses, adjusted for sociodemographic characteristics and oral hygiene practices. RESULTS: The prevalence of dental caries at the age of 13 years was 33% (n = 969). Better diet quality was associated with a lower occurrence of severe dental caries after adjustments for sociodemographic factors [e.g. highest vs. lowest quartile of diet quality: odds ratio (OR) 0.62, 95% confidence interval (CI) 0.39-0.98]. After additional adjustments for oral hygiene practices, this association was not statistically significant (OR 0.65, 95% CI 0.41-1.03). CONCLUSION: Adherence to dietary guidelines has the potential to reduce dental caries in children; however, with proper oral hygiene practices, this relationship might be attenuated. To understand the role of dietary patterns and dental caries, the contributing role of daily eating occasions needs to be studied further.

Oral and craniofacial research in the Generation R study: an executive summary.

OBJECTIVES: Oral conditions are of high prevalence and chronic character within the general population. Identifying the risk factors and determinants of oral disease is important, not only to reduce the burden of oral diseases, but also to improve (equal access to) oral health care systems, and to develop effective oral health promotion programs. Longitudinal population-based (birth-)cohort studies are very suitable to study risk factors on common oral diseases and have the potential to emphasize the importance of a healthy start for oral health. In this paper, we provide an overview of the comprehensive oral and craniofacial dataset that has been collected in the Generation R study: a population-based prospective birth cohort in the Netherlands that was designed to identify causes of health from fetal life until adulthood. METHODS: Within the multidisciplinary context of the Generation R study, oral and craniofacial data has been collected from the age of 3 years onwards, and continued at the age of six, nine, and thirteen. Data collection is continuing in 17-year-old participants. RESEARCH OUTCOMES: In total, the cohort population comprised 9749 children at birth, and 7405 eligible participants at the age of seventeen. Based on questionnaires, the dataset contains information on oral hygiene, dental visits, oral habits, oral health-related quality of life, orthodontic treatment, and obstructive sleep apnea. Based on direct measurements, the dataset contains information on dental caries, developmental defects of enamel, objective orthodontic treatment need, dental development, craniofacial characteristics, mandibular cortical thickness, and 3D facial measurements. CONCLUSIONS: Several research lines have been set up using the oral and craniofacial data linked with the extensive data collection that exists within the Generation R study. CLINICAL RELEVANCE: Being embedded in a multidisciplinary and longitudinal birth cohort study allows researchers to study several determinants of oral and craniofacial health, and to provide answers and insight into unknown etiologies and oral health problems in the general population.

Comparative inequalities in child dental caries across four countries: Examination of international birth cohorts and implications for oral health policy.

Child dental caries (i.e., cavities) are a major preventable health problem in most high-income countries. The aim of this study was to compare the extent of inequalities in child dental caries across four high-income countries alongside their child oral health policies. Coordinated analyses of data were conducted across four prospective population-based birth cohorts (Australia, n = 4085, born 2004; Québec, Canada, n = 1253, born 1997; Rotterdam, the Netherlands, n = 6690, born 2002; Southeast Sweden, n = 7445, born 1997), which enabled a high degree of harmonization. Risk ratios (adjusted) and slope indexes of inequality were estimated to quantify social gradients in child dental caries according to maternal education and household income. Children in the least advantaged quintile for income were at greater risk of caries, compared to the most advantaged quintile: Australia: AdjRR = 1.18, 95%CI = 1.04-1.34; Québec: AdjRR = 1.69, 95%CI = 1.36-2.10; Rotterdam: AdjRR = 1.67, 95%CI = 1.36-2.04; Southeast Sweden: AdjRR = 1.37, 95%CI = 1.10-1.71). There was a higher risk of caries for children of mothers with the lowest level of education, compared to the highest: Australia: AdjRR = 1.18, 95%CI = 1.01-1.38; Southeast Sweden: AdjRR = 2.31, 95%CI = 1.81-2.96; Rotterdam: AdjRR = 1.98, 95%CI = 1.71-2.30; Québec: AdjRR = 1.16, 95%CI = 0.98-1.37. The extent of inequalities varied in line with jurisdictional policies for provision of child oral health services and preventive public health measures. Clear gradients of social inequalities in child dental caries are evident in high-income countries. Policy related mechanisms may contribute to the differences in the extent of these inequalities. Lesser gradients in settings with combinations of universal dental coverage and/or fluoridation suggest these provisions may ameliorate inequalities through additional benefits for socio-economically disadvantaged groups of children.

Associations Between Prenatal, Perinatal, and Early Childhood Vitamin D Status and Risk of Dental Caries at 6 Years.

BACKGROUND: Previous studies have suggested that insufficient concentrations of vitamin D are associated with dental caries in primary teeth, but evidence remains inconclusive. OBJECTIVES: We assessed the longitudinal associations between prenatal, perinatal, and early childhood serum 25-hydroxyvitamin D concentrations [25(OH)D] and the risk of dental caries in 6-year-old children. METHODS: This research was conducted within the Generation R Study, a large, multi-ethnic, prospective cohort study located in Rotterdam, the Netherlands. Dental caries were assessed in children using the decayed-missing-filled-primary teeth index at a mean age of 6.1 years (90% range, 4.8-9.1). We measured serum total 25(OH)D concentrations at 3 time points: prenatally (at 18-24 weeks of gestation), perinatally (at birth), and during early childhood (at age 6 years). We performed logistic regression analyses to determine the longitudinal association of serum 25(OH)D concentrations with caries risks in 5257 children. Additionally, we constructed a Genetic Risk Score (GRS) for the genetic predispositions to serum total 25(OH)D concentrations based on 6 vitamin D-related single nucleotide polymorphisms in a subsample of 3385 children. RESULTS: Children with severe prenatal and early childhood serum 25(OH)D deficiencies (<25 nmol/L) were more likely to be diagnosed with caries [OR, 1.56 (95% CI, 1.18-2.06) and 1.58 (95% CI, 1.10-2.25), respectively] than children with optimal concentrations (≥75 nmol/L). After adjustment for residuals of serum 25(OH)D concentrations at other time points, only the early childhood serum 25(OH)D concentration was inversely associated with the caries risk at 6 years (OR, 0.97; 95% CI, 0.95-0.98). However, our GRS analysis showed that children who are genetically predisposed to have lower serum 25(OH)D concentrations do not have a higher risk of developing caries in primary teeth. CONCLUSIONS: Our study suggests a weak association between serum 25(OH)D concentrations and risks of caries in primary teeth. Based on our results, we do not recommend vitamin D supplementation for the prevention of dental caries in children.

Breastfeeding and Childhood Dental Caries: Results from a Socially Diverse Birth Cohort Study.

Previous studies showed that prolonged breastfeeding increases the risk of caries. However, the observed associations were mainly based on non-European populations, and important confounding and mediating factors like socioeconomic position (SEP) and diet were often neglected. The aim of this study was to investigate the role of breastfeeding and bottle-feeding practices on dental caries during childhood while accounting for SEP, ethnic background, and sugar intake. This study was part of the Generation R Study, a prospective multiethnic cohort study conducted in Rotterdam, The Netherlands. In total, 4,146 children were included in the analyses. Information about feeding practices was derived from delivery reports and questionnaires during infancy. Caries was measured via intraoral photographs at the age of 6 years and defined as decayed, missing, and filled teeth (dmft). Negative binomial hurdle regression analyses were used to study the associations between several infant feeding practices and childhood caries. The prevalence of dental caries at the age of 6 years was 27.9% (n = 1,158). Prolonged breastfeeding (for >12 months) was associated with dental caries (OR 1.35, 95% CI 1.04-1.74) and the number of teeth affected by dental caries (RR 1.27, 95% CI 1.03-1.56). Furthermore, nocturnal bottle-feeding was associated with dental caries (OR 1.52, 95% CI 1.20-1.93). All associations were independent of family SEP, ethnic background, and sugar intake. Results from this Dutch cohort study confirmed the previously observed associations between prolonged breastfeeding and nocturnal bottle-feeding and the increased risk of childhood dental caries, even after proper adjustments for indicators of SEP, ethnic background, and sugar intake. Future studies are encouraged to elaborate further on possible explanations for the observed relationships. Healthcare professionals should be aware and advise caregivers about the potential risk of prolonged breastfeeding on caries development by applying the current recommendations on breastfeeding, oral hygiene, and feeding frequency.

Neighbourhood characteristics and children's oral health: a multilevel population-based cohort study.

BACKGROUND: To understand determinants of oral health inequalities, multilevel modelling is a useful manner to study contextual factors in relation to individual oral health. Several studies outside Europe have been performed so far, however, contextual variables used are diverse and results conflicting. Therefore, this study investigated whether neighbourhood level differences in oral health exist, and whether any of the neighbourhood characteristics used were associated with oral health. METHODS: This study is embedded in The Generation R Study, a prospective cohort study conducted in The Netherlands. In total, 5 960 6-year-old children, representing 158 neighbourhoods in the area of Rotterdam, were included. Data on individual and neighbourhood characteristics were derived from questionnaires, and via open data resources. Caries was assessed via intraoral photographs, and defined as decayed, missing and filled teeth (dmft). RESULTS: Differences between neighbourhoods explained 13.3% of the risk of getting severe caries, and 2% of the chance of visiting the dentist yearly. After adjustments for neighbourhood and individual characteristics, neighbourhood deprivation was significantly associated with severe dental caries (OR: 1.48, 95% CI: 1.02-2.15), and suggestive of a low odds of visiting the dentist yearly (OR: 0.81, 95% CI: 0.56-1.18). CONCLUSIONS: Childhood caries and use of dental services differs between neighbourhoods and living in a deprived neighbourhood is associated with increased dental caries and decreased yearly use of dental services. This highlights the importance of neighbourhoods for understanding differences in children's oral health, and for targeted policies and interventions to improve the oral health of children living in deprived neighbourhoods.

Caries experience among children born after a complicated pregnancy.

OBJECTIVES: Behavioural and lifestyle factors, as oral hygiene and diet, are well-established risk factors in the pathogenesis of dental caries, though displaying large differences in susceptibility across individuals. Since enamel formation already starts in utero, pregnancy course and outcome may eventually play a role in enamel strength and caries susceptibility. Therefore, we studied the association between history of pregnancy complications and the caries experience in their six-year-old children. The pregnancy complications included small for gestational age (SGA), spontaneous preterm birth (sPTB), gestational hypertension (GH), pre-eclampsia (PE), individually, and a combination of those, designated as placental syndrome. METHODS: This study was embedded in Generation R, a prospective longitudinal Dutch multiethnic pregnancy cohort study. Information about pregnancy complications was obtained from questionnaires completed by midwives and obstetricians with cross-validation in medical records. These included SGA, sPTB, GH and PE. Caries experience was assessed with the decayed, missing and filled teeth (dmft) index at a mean age of six years. The association between dental caries experience and a history of pregnancy complications was studied by using hurdle negative binomial (HNB) models. RESULTS: We were able to assess the dmft index in 5323 six-year-old children (mean age 6.2 years, SD 0.5). We did not find an association between the different pregnancy complications and dental caries experience in childhood, whether for SGA, sPTB, GH, PE, or for the combined outcome placental syndrome (HNB estimates: OR 1.02, 95%CI 0.87 - 1.19; RR 0.90, 95%CI 0.78 - 1.04). Further adjustment of the models with different confounders did not alter the outcome. CONCLUSIONS: Although it is expected that prenatal stress can be a risk factor for caries development later in life, our findings do not support this hypothesis. Therefore, we believe disparities in caries experience between children are probably not explained by early life events during a critical intrauterine period of development.

Effectiveness of the new mandatory mouthguard use and orodental injuries in Dutch field hockey.

ObjectivesUp to 68% of field hockey players have experienced at least one orodental injury in their sport career. Therefore, the Royal Dutch Hockey Association (KNHB) made mouthguard use mandatory for field hockey players during competition and training from August 2015 onwards.This study evaluates the effects of the new regulations on mouthguard use and the occurrence of injuries in Dutch field hockey.MethodsA 35-item online questionnaire about mouthguard use and orodental injuries was sent to 13 field hockey clubs in the Netherlands. Absolute numbers and percentages of mouthguard ownership, mouthguard use, number and type of injuries were assessed. The results were related to comparable data before mandatory mouthguard use. Associations of gender and training frequency with the number of injuries were analysed with logistic regression.ResultsIn total, 1169 hockey players were included in the study and almost all owned a mouthguard (females:99.6%, males:93.7%), which significantly increased after implementation (p < 0.001). 90.6% of the respondents wore a mouthguard during matches and 70.1% during training. Of the 1169 players, 68(5.8%) experienced at least one orodental injury after the implementation with a total of 100 injuries. Injuries happened more often during matches (63.2%) than during training (36.8%). Lip cuts account for most of the injuries, the number of broken (p = 0.116) and knocked out teeth (p = 0.026) decreased.ConclusionAlthough mouthguard use already increased in recent years, the new regulations led to an additional increase and a successful change of attitude towards mouthguard use. Most importantly, the severity of orodental injuries decreased measurable.

Impact of orthodontic treatment need and deviant occlusal traits on oral health-related quality of life in children: A cross-sectional study in the Generation R cohort.

INTRODUCTION: Many studies have investigated the impact of orthodontic treatment need (OTN) on children's oral health-related quality of life (OHRQOL). However, few studies have explored the impact of deviant occlusal traits on OHRQOL regarding the severity of OTN. This cross-sectional study aims to address this gap in the literature. METHODS: This study was conducted within the Generation R Study, a population-based prospective cohort study. We assessed OTN with the Index of Orthodontic Treatment Need and OHRQOL with a parental short-form of the Child Oral Health Impact Profile in 3048 children at a median age of 9.74 years (9.5-10.0). We also further assessed individual malocclusion traits in a subsample of 2714 children. We investigated the association between OTN, malocclusion traits, and OHRQOL using multiple regression analysis with weighted least squares. RESULTS: Children with definite (adjusted effect estimate = -0.81; 95% confidence interval -1.12 to -0.50) or borderline (adjusted effect estimate = -0.34; 95% confidence interval -0.61 to -0.08) OTN experienced significant decreases in their OHRQOL than those with no need. An impacted tooth, increased overjet, or crowding had significant negative impacts on children's OHRQOL. Children with an overjet experienced negative impacts on OHRQOL even when orthodontic treatment was not necessary. CONCLUSIONS: Progressively greater OTN has increasingly negative impacts on parent's perception of children's OHRQOL. In particular, children presenting with large overjets and impacted teeth have lower OHRQOL. These perspectives add to better patient-clinician communication and understanding of patient expectations around OTN, which may potentially lead to improvements in quality of care from the patient perspective.

The role of accelerated dental development on the occurrence of aberrant dental traits that indicate malocclusion.

BACKGROUND: Timing of dental development might help orthodontists to optimize initiation of treatment and to prevent and intercept dental misalignment. This study examines the association between timing of dental development and aberrant dental traits such as crowding, impaction, and hypodontia. METHODS: This study was performed using 4446 ten-year-old children from a multiethnic birth cohort, the Generation R Study. Dental development was defined using the Demirjian method. Crowding, impaction, and hypodontia were ascertained from 2D and 3D pictures and radiographs. We built three series of logistic regression models to test the associations of dental age with crowding, impaction, and hypodontia. Similar models were built to investigate the associations of the developmental stages of each left mandibular tooth with crowding, impaction, and hypodontia. RESULTS: Inverse associations were found between every 1-year increase in dental age and the presence of crowding [odds ratio (OR) = 0.84, 95% confidence interval (CI): 0.79, 0.89], impaction of teeth (OR = 0.66, 95% CI: 0.52, 0.84), and hypodontia (OR = 0.52, 95% CI: 0.47, 0.56). Lower developmental stages of the second premolar were associated with the presence of crowding (OR = 0.90, 95% CI: 0.83, 0.98). Lower developmental stages of the second premolar (OR = 0.88, 95% CI: 0.79, 0.98), first molar (OR = 0.76, 95% CI: 0.65, 0.90), and the second molar (OR = 0.83, 95% CI: 0.73, 0.94) were associated with the presence of tooth impaction. Lower developmental stages of all mandibular teeth except the central incisor were associated with hypodontia (P < 0.05). CONCLUSION: Accelerated dental development is associated with lower occurrence of crowding, impaction, and hypodontia.

Oral health among Dutch elite athletes prior to Rio 2016.

OBJECTIVES: Elite athletes are at high risk for poor oral health. A screening program to assess oral health and create dental awareness can improve oral health among elite athletes but has not been performed in the Netherlands before. We summarize the first results from such a screening conducted in Dutch elite athletes of the Nederlands Olympisch Committee*Nederlandse Sport Federatie (NOC*NSF, Dutch Olympic Committee). METHODS: In this cross-sectional study, 800 Dutch athletes eligible for the Olympic and Paralympic Games in Rio de Janeiro 2016 were invited to a costless and voluntary oral examination. The decayed, missing, and filled teeth-index (DMFT), the basic erosive wear examination (BEWE) and the Dutch Periodontal Screening-index (DPSI) were used to evaluate athlete's oral health. Information on sociodemographic variables and sport performance were collected in questionnaires. RESULTS: In total, 116 Dutch elite athletes were included in the study. The median (90%-range) DMFT-score was 3.0 (0.0-16.0), the median BEWE-score was 2.0 (0.0-10.0), and the mean± SD DPSI-score was 2.0 ± 0.73. Oral health-related quality of life was generally high, although only 28.2% of the athletes reported never having problems with their dentition or mouth. In 43% of the athlete's clinical findings were reported which needed a direct referral to the general dentist. CONCLUSION: Oral health in this subsample of Dutch elite athletes was surprisingly affected as almost half of them needed dental treatment. Further research is needed to allow conclusions about oral health in Dutch elite athletes more broadly. However, regular screening of oral health incorporated into the general preventive health care of elite athletes is necessary to ensure athletes are fully healthy during competitions like the Olympic and Paralympic Games.

Subphenotyping and Classification of Cleft Lip and Alveolus in Adult Unoperated Patients: A New Embryological Approach.

OBJECTIVE: Previously, a new embryological classification was introduced subdividing oral clefts into fusion and/or differentiation defects. This subdivision was used to classify all subphenotypes of cleft lip with or without alveolus (CL±A). Subsequently, it was investigated whether further morphological grading of incomplete CLs is clinically relevant, and which alveolar part is deficient in fusion/differentiation defects. DESIGN: Observational cohort study. SETTING: Three hundred fifty adult unoperated Indonesian cleft patients presented themselves for operation. Cephalograms, dental casts, and intraoral and extraoral photographs-eligible for the present study-were used to determine morphological severity of CL±A. PATIENTS: Patients with unilateral or bilateral clefts of the primary palate only were included. MAIN OUTCOME MEASURES: Clefts were classified-according to developmental mechanisms and timing in embryogenesis-as fusion and/or differentiation defects. Grades of incomplete CLs were related to the severity of alveolar clefts (CAs) and hypoplasia, and permanent dentition was used to investigate which alveolar part is deficient in fusion/differentiation defects. RESULTS: One hundred eight adult patients were included. All subphenotypes-96 unilateral and 12 bilateral clefts-could be classified into differentiation (79%), fusion (17%), fusion-differentiation (2%), or fusion and differentiation (2%) defects. The various grades of incomplete CLs were related to associated CAs and hypoplasia, and all alveolar deformities were located in the premaxillae. CONCLUSIONS: This study showed that all CL±A including the Simonart bands can be classified, that further morphological grading of incomplete CLs is clinically relevant, and that the premaxilla forms the deficient part in alveolar deformities.

Does dental caries affect dental development in children and adolescents?

Although a link between dietary changes, caries, and dental development has been observed, the literature provides little insight about this relationship. The aim of our study was to investigate the association between dental caries and dental development in a clinical sample of Albanian children and adolescents. In total, 118 children and adolescents, born between 1995 and 2004 and aged 6-15 years, were included. Dental caries in the deciduous dentition was assessed using the Decayed, Filled Teeth (dft) index and dental caries in the permanent dentition was assessed using the Decayed, Missing, Filled Teeth (DMFT) index. Dental development during the permanent dentition was determined using the Demirjian method. Linear and ordinal regression models were applied to analyze the associations of dental caries with dental age and developmental stages of each left mandibular tooth. Dental caries in the deciduous dentition, estimated as a median dft of 2.0 (90% range, 0.0-9.1), was significantly associated with lower dental age (ß = -0.21; 90% CI: -0.29, -0.12) and with delayed development of the canine, both premolars, and the second molar. Untreated dental caries (dt) was associated with lower dental age (ß = -0.19; 90% CI: -0.28, -0.10). Dental caries in the permanent dentition, estimated as a median DMFT of 1.0 (90% range, 0.0-8.0), was not significantly associated with dental age (ß = 0.05; 90% CI: -0.04, 0.14). However, the DMFT was associated with the advanced stages of development of both premolars and the second molar. The untreated dental caries in the deciduous dentition delays the development of permanent teeth.

Influence of self-esteem on perceived orthodontic treatment need and oral health-related quality of life in children: the Generation R Study.

Background: Self-esteem (SE) is suggested to influence the relationship between orthodontic treatment need and oral health-related quality of life (OHRQoL), but evidence lacks. The aim of the present study was to investigate SE in the relationship between subjective orthodontic need and OHRQoL in children. Methods: This cross-sectional study was embedded in the Generation R Study, a multi-ethnic population-based cohort. In total, 3796 10-year old children participated in the present study. OHRQoL, measured with the Child Oral Health Impact Profile-ortho, and subjective orthodontic need were assessed within parental questionnaires. SE was measured with a modified version of the Harter's self-perception profile rated by the children. The role of SE in the association between SOT and OHRQoL was evaluated with linear regression models. Furthermore, the difference in this association between children with high and low SE was investigated. Results: Higher subjective orthodontic need was associated with lower OHRQoL scores (borderline: ß [95% CI] = -0.55 [-0.77, -0.33]; definite: -1.65 [-1.87, -1.54]). Children with lower SE scores showed a stronger relationship between borderline and definite subjective orthodontic need with OHRQoL (ß [95% CI] = -0.56 [-0.81, -0.31] respectively -1.68 [-1.94, -1.42]) than children with higher SE scores did (ß [95% CI] = -0.51 [-0.97, -0.04] respectively -1.43 [-1.90, -0.95]). Conclusion: The relationship between subjective orthodontic need and OHRQoL is not based on the SE of children. However, SE modifies the relationship between subjective orthodontic need and OHRQoL. Work still needs to be done to find an explanation for the effect modification by SE in the relationship between subjective health perceptions and OHRQoL.

Ancestry and dental development: A geographic and genetic perspective.

OBJECTIVE: In this study, we investigated the influence of ancestry on dental development in the Generation R Study. METHODS: Information on geographic ancestry was available in 3,600 children (1,810 boys and 1,790 girls, mean age 9.81 ± 0.35 years) and information about genetic ancestry was available in 2,786 children (1,387 boys and 1,399 girls, mean age 9.82 ± 0.34 years). Dental development was assessed in all children using the Demirjian method. The associations of geographic ancestry (Cape Verdean, Moroccan, Turkish, Dutch Antillean, Surinamese Creole and Surinamese Hindustani vs Dutch as the reference group) and genetic content of ancestry (European, African or Asian) with dental development was analyzed using linear regression models. RESULTS: In a geographic perspective of ancestry, Moroccan (ß = 0.18; 95% CI: 0.07, 0.28), Turkish (ß = 0.22; 95% CI: 0.12, 0.32), Dutch Antillean (ß = 0.27; 95% CI: 0.12, 0.41), and Surinamese Creole (ß = 0.16; 95% CI: 0.03, 0.30) preceded Dutch children in dental development. Moreover, in a genetic perspective of ancestry, a higher proportion of European ancestry was associated with decelerated dental development (ß = -0.32; 95% CI: -.44, -.20). In contrast, a higher proportion of African ancestry (ß = 0.29; 95% CI: 0.16, 0.43) and a higher proportion of Asian ancestry (ß = 0.28; 95% CI: 0.09, 0.48) were associated with accelerated dental development. When investigating only European children, these effect estimates increased to twice as large in absolute value. CONCLUSION: Based on a geographic and genetic perspective, differences in dental development exist in a population of heterogeneous ancestry and should be considered when describing the physiological growth in children.

Social inequalities in children's oral health-related quality of life: the Generation R Study.

PURPOSE: Oral health-related quality of life (OHRQoL) is the most important patient-reported outcome measure in oral health research. The purpose of the present research was to study the association of family socioeconomic position (SEP) with children's OHRQoL. METHODS: This cross-sectional study was embedded in the Generation R Study, a population-based cohort study conducted in Rotterdam, The Netherlands. For the present study, OHRQoL was assessed of 3871 ten-year old children. Family SEP was assessed with the following indicators: maternal/paternal education level, maternal/paternal employment status, household income, benefit dependency, and family composition. Linear regression analyses were performed to evaluate the (independent) associations of family SEP indicators with OHRQoL. RESULTS: The median (90% range) OHRQoL score of the participating children was relatively high [50.0 (43.0-53.0)]; however, OHRQoL was consistently lower in children with low family SEP. Positive associations were found for all SEP indicators (p-values <0.05) except maternal employment status and family composition. Benefit dependency, paternal employment, and household income were the most strongly associated with OHRQoL. No family SEP indicator was significantly associated with OHRQoL independent of the other indicators. CONCLUSIONS: Based on the present findings, interventions and policies promoting good oral health and oral well-being should target children from low socioeconomic position. More research is needed, however, to understand the pathways of social inequalities in children's OHRQoL especially for the effects of material resources on subjective oral health measures.

Social inequalities and dental caries in six-year-old children from the Netherlands.

OBJECTIVES: The purpose of our study was to investigate the association of different socioeconomic and sociodemographic factors with dental caries in six-year-old children. Furthermore, we applied a district based approach to explore the distribution of dental caries among districts of low and high socioeconomic position (SEP). METHODS: In our cross-sectional study 5189 six-year-olds were included. This study was embedded in a prospective population-based birth cohort study in Rotterdam, the Netherlands, the Generation R Study. Parental education level, parental employment status, net household income, single parenting, and teenage pregnancy were considered as indicators for SEP. Dental caries was scored on intraoral photographs by using the decayed, missing, and filled teeth (dmft) index. We compared children without caries (dmft=0) to children with mild caries (dmft=1-3) or severe caries (dmft >3). Multinomial logistic regression analyses and binary logistic regression analyses were performed to study the association between SEP and caries, and between district and caries, respectively. RESULTS: Only maternal education level remained significantly associated with mild caries after adjusting for all other SEP-indicators. Paternal educational level, parental employment status, and household income additionally served as independent indicators of SEP in children with severe caries. Furthermore, living in more disadvantaged districts was significantly associated with higher odds of dental caries. CONCLUSION: Dental caries is more prevalent among six-year-old children with a low SEP, which is also visible at the district level. Maternal educational level is the most important indicator of SEP in the association with caries. CLINICAL SIGNIFICANCE: Our results should raise concerns about the existing social inequalities in dental caries and should encourage development of dental caries prevention strategies. New knowledge about the distribution of oral health inequalities between districts should be used to target the right audience for these strategies.

The association of subjective orthodontic treatment need with oral health-related quality of life.

OBJECTIVES: The existing body of evidence reports an inconsistent association between subjective and objective orthodontic treatment need. The concept of oral health-related quality of life (OHRQoL) might help to explain the differences in subjective and objective orthodontic treatment need. Our aim was to investigate the association of subjective orthodontic treatment with OHRQoL in children. METHODS: This cross-sectional study was embedded in the Generation R Study, a population-based prospective cohort study. OHRQoL and subjective orthodontic treatment need were assessed by parental questionnaires. Questionnaire items were individually compared among children with no, borderline and definite subjective orthodontic need. The association between subjective orthodontic treatment need and OHRQoL was investigated in multivariate regression analysis with weighted least squares. Differences by sex and levels of objective orthodontic treatment need were evaluated. RESULTS: In total, 3774 children were included in the analysis. Children with borderline subjective orthodontic treatment need and those with definite subjective orthodontic treatment need had significantly poorer OHRQoL based on the fully adjusted model (adjusted regression coefficient (aß)=-0.49, 95% CI: -0.75, -0.30; (aß)=-1.58, 95% CI: -1.81, -1.58, respectively). The association between subjective orthodontic treatment need and OHRQoL was stronger in girls than in boys and stronger in children with objective orthodontic treatment need than in those with none. CONCLUSIONS: Oral health-related quality of life is poorer in children with subjective orthodontic treatment need. This has not been investigated before in such a large-population-based study and clearly offers an explanation for the lack of concurrence between objective and subjective orthodontic treatment need.

Ethnic Disparities in Dental Caries among Six-Year-Old Children in the Netherlands.

The aim of this study was to investigate potential differences in caries prevalence of children from ethnic minority groups compared to native Dutch children and the influence of socio-economic status (SES) and parent-reported oral health behaviour on this association. The study had a cross-sectional design, embedded in a population-based prospective multi-ethnic cohort study. 4,306 children with information on caries experience, belonging to 7 different ethnic groups, participated in this study. The decayed, missing, and filled teeth (dmft) index was assessed at the age of 6 and categorized in two ways for analysis: children without caries (dmft = 0) versus any caries experience (dmft >0) and children without caries (dmft = 0) versus children with mild caries (dmft = 1-3) or severe caries (dmft >3). Compared to native Dutch children, children with a Surinamese-Hindustani, Surinamese-Creole, Turkish, Moroccan, and Cape Verdean background had significantly higher odds for dental caries. Especially the Surinamese-Hindustani, Turkish, and Moroccan group had significantly higher odds for severe dental caries. Household income and educational level of the mother explained up to 43% of the association between ethnicity and dental caries, whereas parent-reported oral health behaviour did not mediate the association. Alarming disparities in caries prevalence between different ethnic (minority) groups exist, which cannot be fully explained by social inequalities. Public health strategies can apply this new knowledge and specifically focus on the reduction of ethnic disparities in oral health. More research is needed to explain the high caries prevalence among different ethnic minority groups.