The effect of early childhood caries on chewing function and tolerated food texture levels in preschool children.

BACKGROUND: The early form of caries can affect solid food consumption. OBJECTIVE: The aim of the study was to evaluate the effect of oral health status on chewing performance, and tolerated food texture among preschool children suffering from early childhood caries (ECC). METHODS: A cross-sectional study was conducted with a sample of 109 children aged between 3 and 6 years, who were allocated to three groups (severe-ECC (s-ECC), ECC and control) on the basis of their caries. Chewing function was evaluated by using the 'Karaduman Chewing Performance Scale (KCPS)' and the Turkish version of the 'Mastication Observation and Evaluation instrument (T-MOE)', and the tolerated food texture was determined by the 'International Dysphagia Diet Standardization Initiative (IDDSI)'. Carious lesions, oral hygiene and gingival health status were evaluated by using the 'decayed, missing, filled tooth/surface indices (dmft/s)', 'plaque and gingival indices'; respectively. RESULTS: A total of 56 children (51.4%) had s-ECC, 39 (35.8%) had ECC and 14 (12.8%) had no caries (control group). KCPS showed that 26 (86.7%) children suffering from s-ECC were at level 1, and 11 (100%) children were at level 2. Seven (100%) children with s-ECC had IDDSI level-5. All children with healthy oral status had IDSSI level-7. Compared to the ECC and control groups, the s-ECC group had significantly lower scores from the T-MOE total and subscale scores (p < .001). CONCLUSION: The evaluation of chewing performance during routine dental examinations of children with ECC (especially s-ECC) may considerably contribute to the early diagnosis of chewing problems and the provision of necessary oral rehabilitation.

Development and validation of a comprehensive food frequency questionnaire that assesses the dietary intake related with dental health in children: A pilot study.

BACKGROUND AND AIMS: This study aimed to develop a validated and reliable food frequency questionnaire (FFQ) that assess dietary intake related with dental health in children. METHODS: Children, two-to-nine-years old, who consulted to a paediatric dental clinic for any reason, were recruited to complete the FFQ and 24-h recall, inquired oral hygiene habits, performed oral examinations, recorded dmft(s)/DMFT(S) index, and taken anthropometric measurements. The statistical methods used for validation were Wilcoxon signed rank test, Spearman ranked correlations, weighted kappa statistic and Bland-Altman graphs were drawn. Besides, intraclass and spearman correlation coefficients calculated for the reliability. RESULTS: A total of 120 children participated in to the first stage of the study while 70 participants completed the 4-month period. The Spearman correlation coefficient and weighted kappa values confirmed that the FFQ had moderate validation against the food records for lactose, calcium and phosphorus. Dietary fat, fibre, lactose, calcium, potassium, fluoride, magnesium, phosphorus and zinc intakes were negatively and statistically significantly correlated with DMFT and DMFS according to both FFQ and 24-h (p < 0.05, for each). Furthermore, a positive correlation between DMFT/S and dietary carbohydrate, starch, polysaccharide and sucrose intakes was obtained. CONCLUSIONS: These results provide the preliminary evidence for the moderated reliability and validity of the FFQ; the higher DMFT and DMFS scores might be linked to lower dietary intakes of fat, fibre, lactose, calcium, potassium, fluorine, magnesium, phosphorus and zinc; and probably higher dietary intakes of carbohydrate, starch, polysaccharide and sucrose in children.

Dental caries and associated salivary biomarkers in patients with cystic fibrosis.

PURPOSE: To evaluate the caries status of the Cystic fibrosis (CF) children and adolescents with the comparation of some biochemical markers, secretory-immunoglobulin-A (sIgA), and antimicrobial peptides in the saliva. METHODS: In this cross-sectional descriptive study, the approval Ethics Board was obtained. Unstimulated saliva samples were collected from CF and healthy control children (non-CF) patients. Both groups underwent the same dental and periodontal evaluation scheme of the assessment. Human beta defensin (HBD1), human alpha defensin (HNP-1), cathelicidin (LL-37), sIgA in saliva were evaluated by enzyme-linked immunoassay method. A general biochemical analysis was performed. Statistical analysis was performed by using Statistical Package for the Social Sciences Version 20.0 (SPSS Inc.). RESULTS: A total of 21 (9 male, 12 female) CF and 23 (11 male, 12 female) control patients were participated with the mean age of 10.17 ± 3.38 and 9.52 ± 2.15 years, respectively. In control children, DMFT/S (decayed-missing-filled-tooth/surface-in-permanent-dentition), dmft/s (decayed-missing-filled-tooth/surface-in-primary-dentition) values were higher; DT (decayed-tooth in permanent dentition), ft (filled-tooth in primary dentition) and plaque index values were statistically significantly higher (p = 0.042, p = 0.005, p = 0.038, respectively) than CF patients. Bicarbonate was higher in control group; sodium, chloride, and total protein were higher in CF group; magnesium, calcium and phosphate levels were similar in each group (p > 0.05). Alpha and beta defensin-1 levels in control group was statistically significantly higher (p = 0.037 and p = 0.020, respectively), while LL37 and sIgA were not statistically significantly higher (p > 0.05) than CF group. CONCLUSIONS: Children with CF had lower caries in permanent teeth, filling in primary teeth, and an altered salivary biomarker profile, especially in HNB1, HNP1. Therefore, it is important to conduct periodic oral-dental controls among CF patients during their childhood.

Orofacial functions and oral health: An analysis on children aged 5-8 years old.

The aim of this study is to assess the orofacial function performance and oral health status of healthy children as well as their potential correlations. In this descriptive study, the oral functions of four hundred systemically healthy children who applied for the pediatric dentistry clinic were evaluated. Three scales, namely Karaduman Chewing Performance Scale (KCPS), Pediatric version of the Eating Assessment Tool (PEDI-EAT-10), and Nordic Orofacial Test Screening (NOT-S) protocol, are used to collect the data. These children's carious lesions were evaluated by using the decayed, missing, filled tooth/surface (DMFT/S, dmft/s) indices, the International Caries Detection and the Assessment-II System (ICDAS-II). In total, 400 (6.5 years [78.02 months]) children were participated in the study. Their KCPS scores indicate that 58.0% of the children were at level 0 and 35.8% were at level 1. The results of the KCPS levels and the DMFT, dmft, DT, dt, MT, mt (as =0 and ≥1) were found to be statistically significant; p = .044, p = .009, p = .008, p = .000, p = .032, and p = .003, respectively. The total PEDI-EAT-10 score of 13.4% of the children was found to be 3 or higher, suggesting that they experience a problem in swallowing. According to the NOT-S, the most affected domains were "habits" (51.0%), "facial expression" (49.3%), and "chewing and swallowing" (45.3%). Among healthy children without a defined problem in swallowing and orofacial functions, the oral health status may affect orofacial functions. Decayed (particularly, extensive caries existence) or missing tooth may have critical importance for adequate chewing in children. Especially in the presence of so many decayed or missing teeth, evaluating the orofacial functions through different scales may considerably contribute to early diagnosis of functional problems.

Professional motivations and perceptions of senior dental students in the distance education period during the first year of the Covid-19 pandemic.

Purpose: Dental students are particularly prone to be affected by the global emergency of Coronavirus-19 (Covid-19) pandemic. The aim of this study was to evaluate the professional motivations and perceptions of senior dental students during the distance education period due to pandemic. Materials and methods: The data was collected via an online questionnaire, including questions related to students' professional motivation and perceptions, and views about preventive dentistry. For identifying the distress levels, Turkish version of Depression Anxiety Stress Scale (DASS)-21 was used. Descriptive statistics and marginal homogeneity test were used for statistical analysis. Results: A total of 114 (83 female, 31 male) students, with the mean age of 23.7±1.03 participated the study. Statistically significant changes were observed on the students' career plans (p<0.001); fear about getting and transmitting infectious diseases (p<0.001); and satisfaction about their profession (p<0.001) during the Covid-19 pandemic. Motivation loss was determined on the participants. Conclusion: There is an urgent need for revision on dental education in order to ensure the students be competent to provide oral health service that can meet the latest needs and achieve professional self-confidence without deterioration on their professional motivation and perceptions. Crisis-oriented psychological support programs should be provided for students. Some improvements should be structured in terms of preventive dentistry issues, both for dental education and dental health service aspects.

Pediatric dentists can determine chewing performance level in children.

OBJECTIVES: The current study was aimed to verify whether pediatric dentists could determine chewing performance level in children by using Karaduman Chewing Performance Scale (KCPS). MATERIALS AND METHODS: Typical developing children and children with cerebral palsy (CP) who were referred to pediatric dentistry above the age of 2 years were included in the study. The chewing performance level was scored according to KCPS. One experienced physical therapist and three pediatric dentists independently assessed the chewing videos of the children and scored each child's chewing function. The correlation between the KCPS scores of the physical therapist and the pediatric dentists was used for reliability. The agreement between the scorings of the physical therapist and pediatric dentists was assessed using Fleiss kappa statistics. RESULTS: Fifty-four typical developing children and 43 children with CP were included. A strong positive correlation between the KCPS scoring of the physical therapist and pediatric dentists was found (r=0.911-0.939, p<0.001). An excellent agreement in the KCPS scoring between the physical therapist and the 1st and 3rd dentists (p<0.001, κ 0.754-0.763), and a good agreement in the KCPS scoring between the physical therapist and the 2nd dentist was detected (p<0.001, κ 0.687). CONCLUSIONS: The study results show that the KCPS is reliable for pediatric dentists in determining the chewing performance level in children. Therefore, it could be suggested that pediatric dentists could use the KCPS in their clinical settings and research studies. CLINICAL RELEVANCE: The study may have clinical implications in the evaluation of children with chewing difficulty in dental practice. CLINICAL TRIAL NUMBER: NCT04407455.

Oral health status of children and young adults with maple syrup urine disease in Turkey.

BACKGROUND: Maple syrup urine disease (MSUD) is an inherited disorder clinically characterized by ketoacidosis, seizures, coma, psychomotor delay, and intellectual disability. The treatment requires a life-long protein-restricted diet, rich in carbohydrates and fats, supplemented with a medical amino acid formula. Diet, oral health and general health influence each other in a vicious cycle. The aim of this study was to investigate the oral health status of children and young adults with MSUD in Turkey. METHODS: A descriptive study was conducted on patients with MSUD who applied for routine follow-up to the pediatric metabolic diseases clinic at Hacettepe University, Children's Hospital in Ankara, Turkey in a 12-month period. Patients with any other concomitant genetic diseases and acute infection were excluded. A total of twenty-five patients were enrolled and underwent oral examination including DMFT/S, dmft/s (decayed/missing/filled teeth/surfaces for deciduous and primary teeth, respectively), plaque and gingival indices. Panoramic radiographs were obtained in 12 cooperative patients. RESULTS: Mean age was 9.88 ± 5.68 s.d years. More than half of the parents had only primary school level education, and low income. Fourteen patients consumed medical formula during or right before sleep. Fourteen patients reported caries-associated pain. Gingival inflammation was present in all 15 patients who cooperated for evaluation. Seven out of twelve patients had at least one dental anomaly or alterations in mandibular morphology. Five patients had previously been treated for caries under general anesthesia. To our knowledge, this is the first study to document oral clinical and radiologic findings in patients with MSUD. CONCLUSIONS: Impaired oral health was observed in this rare disease population. Regular dental referral by physicians, preventive measures and dental treatments should be included in multidisciplinary management of maple syrup urine disease to promote oral health.

Oral Health Status among Children with Repaired Esophageal Atresia.

INTRODUCTION: Esophageal atresia (EA) is a congenital anomaly, presenting multifactorial etiology. Swallowing problems and gastroesophageal reflux disease may accompany EA, which have adverse effects on oral health. MATERIALS AND METHODS: In this descriptive study, intraoral examination of the children with repaired EA and of the dental patients without systemic/chronic disease was performed. Dental caries, dental erosion, and halitosis status were evaluated using the International Caries Detection and Evaluation System II, and the Basic Erosive Wear Examination indices as well as the Halimeter, respectively. RESULTS: There were 19 (n = 12 male; n = 7 female) case subjects and 16 (n = 10 male; n = 6 female) control subjects whose age ranged between 14 and 72 months. Among cases, 15 children had dental caries (78.9%; initial caries n = 4, moderate caries n = 4, and extensive caries n = 7). Of the controls, 13 had dental caries (81.2%; initial caries n = 5, moderate caries n = 5, and extensive caries n = 3). Although the median scores of decayed, missing, filled teeth (dmft) and decayed, missing, filled surfaces (dmfs)-for primary dentition-were not statistically significantly different between two groups, both dmft and dmfs were found to be higher among the case subjects (p = 0.172 for dmft; p = 0.230 for dmfs). Furthermore, six children with repaired EA had dental abnormalities (in shape, number, or calcification) and six children with repaired EA had dental erosion. The Halimeter measurement was performed for five case children of whom three had oral malodor, and for seven control children of whom two had oral malodor. CONCLUSION: Regular dental counseling adopting the multidisciplinary team approach for patients with EA is necessary to ensure better general and oral health.

Oral health and halitosis among type 1 diabetic and healthy children.

AIM: To evaluate the oral health status, oral health related habits and halitosis of children with and without type 1 diabetes. MATERIALS AND METHODS: In this study the oral health status of children with and without type 1 diabetes were evaluated by using different indices (dmft/DMFT, International Caries Detection and Assessment System(ICDAS) II, pufa, gingival and periodontal indices). Halitosis was determined by organoleptic assessment and sulfur monitoring. RESULTS: One hundred children with the age range between 6-13 years, 50 type 1 diabetics (24 boys,26 girls) with mean age (±sd) of 10.3 ± 2.1 years and 50 healthy (30 boys, 20 girls) with mean age (±sd) of 9.9 ± 1.5 years, participated in the study. The median values of dmft and dmfs was lower in children with type 1 diabetes, while for DMFT and DMFS indices were similar with the healthy group. Cavitated caries lesions were observed in 60.0% of children with diabetes and in 58.0% of healthy children. According to the ICDAS II index, 42.0% of children with diabetes and 56.0% of healthy children had severe decay. The mean plaque index was statistically significantly less in diabetic children (p = 0.04). In 12.0% of children with type 1 diabetes and in 18.0% of healthy children, volatile sulfur compounds (VSC) were determined to be ≥150 ppb and the most diagnosed score was 1 in both groups. In diabetic children with the cut off value of 7.5% HbA1c, there was no statistically significant difference in oral health indices results and VSC scores. CONCLUSION: Findings of the present study are insufficient to support a significant effect of diabetes on increasing the risk of oral and periodontal diseases. Nonetheless, it is important to emphasize the importance of oral and dental health, regular oral care and dental visits both to the patients with type 1 diabetes and their parents.

Oral health status of children with phenylketonuria.

Background Diet plays an integral role in the maintenance of oral health, but dietary modifications due to medical problems such as phenylketonuria (PKU) can have adverse effects on oral health. This descriptive study was performed to evaluate the oral health status of children with PKU. Methods One hundred and ninety-seven patients with PKU aged between 1 and 22 years were evaluated. Clinical evaluations were performed by one experienced dentist regarding dental caries, gingival health and dental erosion. Categorical variables were assessed with descriptive statistics. Differences in feeding frequencies and sociodemographic characteristics were compared regarding dental caries using chi-square (χ2) tests. Results One hundred and thirty-two patients (67%) had dental caries. The mean plaque index (PI) and gingival index (GI) values were 1.37 ± 0.58 and 1.40 ± 0.64, respectively, which shows moderate plaque accumulation and moderate gingival inflammation. Of the patients, 85.3% did not brush their teeth regularly and 90.4% had never visited a dentist before. No statistically significant differences were found in dental caries according to feeding frequencies (p = 0.448). Conclusions Despite the high prevalence of caries in patients with PKU, most had never seen a dentist. Physicians must encourage patients with PKU and their parents to have regular dental visits to maintain an optimal general and oral health.

Pufa Index and Related Factors Among 36- to 71-month-old Children in Turkey: A Cross-Sectional Study.

PURPOSE: To determine the clinical consequences of untreated dental caries among preschool children by using the pufa index (visible pulp, ulceration of the oral mucosa due to root fragments, a fistula or an abscess) and the incorporation of some risk factors. MATERIALS AND METHODS: Data were collected via structured, pre-tested questionnaires from 729 parents in Turkey's capital, Ankara. Examinations were performed under field conditions by one examiner. The decayed teeth were scored according to the International Caries Detection and Assessment System (ICDAS) II criteria. The filled and missing teeth and surfaces were also recorded as dmft and dmfs, and the pufa index was used for the consequences of untreated caries. The associations were evaluated by univariate analysis and logistic regression. RESULTS: The means age of the study population was 58.8 ± 8.6 months. 45% of the children were female and 55% were male. Mean dmft and dmfs were 4.8 ± 4.7 and 8.3 ± 10.2, respectively. 73.8% of the children had early childhood caries (ECC), while 51.0% had severe cases. Only 58 children (8.0%) had totally healthy primary teeth according to ICDAS II. Of the children with caries (n = 538), 17.5% had at least one pufa tooth. According to the logistic regression analysis, sex, having at least one sibling, extraction experience, and father's educational level were found to be the factors associated with the existence of pufa. CONCLUSION: Healthcare providers' attention must be drawn to both untreated carious lesions and the high ECC proportion among preschool children.

Oral health status of children with mouth breathing due to adenotonsillar hypertrophy.

OBJECTIVES: Mouth breathing is an important health problem, commonly encountered in children. In children, adeno-tonsillar hypertrophy is the main reason causing partial or complete upper airway obstruction and reduction in airflow. This study aimed to determine the oral health status of children aged 3-15 years, with mouth breathing who were due to have surgery for adeno-tonsillar hypertrophy and referred to the Department of Otorhinolaryngology at Children's Hospital of a University in Ankara, Turkey between January-July 2015. METHODS: The approval of the Non-Interventional Clinical Researches Ethics Board of Hacettepe University and written informed consents from the parents were obtained. The parents completed a questionnaire before the surgery. The children were examined using dental mirror and explorer under dental unit lighting. Oral health status was evaluated with DMFT/S, dmft/s, ICDAS II, dental plaque and gingival indices. The chi-square test, Kruskal Wallis and Mann Whitney U tests were used to statistically analyse the results, with statistical significance p<0.05. RESULTS: Of the 170 children who had adenotonsillar hypertrophy with mouth breathing, 150 the parents agreed to participate the study. 77 of the children (51.3%) were male; the mean age was 5.9 ±â€¯2.6. Mean dmft was 3.8 ±â€¯3.6, dmfs 9.7 ±â€¯1.1, DMFT 0.4 ±â€¯1.0 and DMFS 0.6 ±â€¯1.5 respectively. Among the children, 101 (67.3%) had cavitated dental caries, and according to ICDAS II, none had healthy teeth, 15 (10.0%) had initial, 42 (28.0%) had moderate and 93 (62.0%) had advanced caries. Of the children, 89.3% had gingivitis and the proportion of gingivitis in posterior region was found to be significantly higher than anterior region (p < 0,001). CONCLUSIONS: The oral health status of mouth breathing in children with adeno-tonsillar hypertrophy was poor. To reduce the risk of dental caries and periodontal disease among these children, regular dental follow-up and preventive programmes for oral health are needed.

Oral health status in patients with mucopolysaccharidoses.

Ballikaya E, Eymirli PS, Yildiz Y, Avcu N, Sivri HS, Uzamis-Tekçiçek M. Oral health status in patients with mucopolysaccharidoses. Turk J Pediatr 2018; 60: 400-406. The aim of this study is to assess oral clinical and radiological findings of patients with mucopolysaccharidoses (MPS) which are a group of rare inherited disorders of glycosaminoglycan catabolism. In this retrospective and descriptive study, records of all patients with MPS over 3 years of age managed at Division of Pediatric Metabolism, who were all referred to Department of Pediatric Dentistry for evaluation of their oral health status were assessed. Oral examinations were performed in 30 patients with determination of DMFT/S, dmft/s, dental plaque and gingival indices and panoramic radiological assessment was performed in 12 patients. Twenty-seven (90.0%) patients had dental caries and 19/21 (90.5%) had gingival inflammation. Radiological examination in 12 patients with panoramic image showed short mandibular ramus (100.0%), enlarged dental follicles (83.3%), taurodontism (75.0%), flat mandibular notch (66.7%). In association with the bone structure and morphology of the jaws, 11 patients (91.7%) had trabecular variation similar to osteoporotic disease. Condylar defect was observed in all patients, which might lead to temporomandibular joint disorders. Pulp chamber with three horns, which had never been reported in MPS before, was observed in panoramic images of 2 of 7 patients with MPS-VI. Oral clinical and radiological changes are very common in this population of MPS patients. These changes may impair opening of the mouth, eating and chewing and thus affect their quality of life. Regular dental counseling, preventive applications and dental treatments must be included in multidisciplinary team approach of MPS patients to provide better oral health.

Is diet quality associated with early childhood caries in preschool children? A descriptive study.

Limited evidence about the role of diet quality, an important component of nutritional status, in the etiology of dental caries has been reported. The aim of this study was to examine the association between diet and dental caries in children by using the dietary intake data, anthropometrical measurements and dental examination. A total of 395 children (52.7% boys and 42.8% girls) who were 36-71 months of age (mean age 58.7±8.6 months) and attended one of the eleven preschools within a district of Ankara participated in this descriptive study. Dental examinations were performed in the schools under day-light by a pediatric dentist; decayed, missing and filled teeth as well as surfaces were recorded. Data related to socio-demographic characteristics and 24-hour dietary recall of children were gathered via a structured, pre-tested questionnaire which was conducted by the research dietitian. The Healthy Eating Index-2010 (HEI-2010) and Mediterranean Diet Quality Index for children and adolescents (KIDMED) were used to assess dietary intake. Anthropometric measurements including weight, height, upper arm circumference and head circumference were taken by the same researcher. The percentage of Early Childhood Caries (ECC) was increased by age (p < 0.001) whereas no significant difference was observed by sex, socioeconomic status, tooth brushing frequency and body mass index (p > 0.05). Although children who had bad KIDMED scores had slightly higher mean values of decayed missing and filled teeth (dmft) (5.39± 4.6) and decayed missing and filled surface (dmfs) (8.45± 8.69), compared to the scores of children with good or medium KIDMED scores, the differences were not statistically significant (p > 0.05). On the contrary to the KIDMED findings, the mean value of tooth decay was significantly higher among children with bad HEI-2010 score (4.2±4.3) compared to children with medium HEI-2010 score (2.47±2.9) (p=0.043). It is concluded that a healthy eating pattern and high diet quality is essential for the prevention of early childhood caries in preschool children. Further studies are required to develop dietary strategies for the prevention of dental caries.