Prolonged breastfeeding and dental caries in preschool children.

PURPOSE: To explore breastfeeding from 6 to 18 months of age and to study the association between breastfeeding and caries prevalence at 5 years of age. METHODS: The study included 1088 children from one Norwegian county and was based on the Norwegian Mother, Father and Child Cohort Study (MoBa). The children had clinical dental examination at 5 years of age, and parents answered a questionnaire, which included information on breastfeeding, oral health behaviour and child characteristic. Multivariate logistic regressions were performed. The study was ethically approved. RESULTS: Of the studied children, 77% were breastfed at 6 months of age and 16% were still breastfed at 18 months of age. Few children (6%) were breastfed during night at 18 months of age, while 11% received sugary drink during night. No association was found between breastfeeding up to 18 months of age and caries prevalence at 5 years of age (p > .05). Children who at 18 months of age had their teeth brushed less than twice daily (OR 2.4, CI 1.5-3.9), consumed sugary drink once a week or more often (OR 1.7, CI 1.1-2.7) and had non-Western parents (OR 3.4, CI 1.5-8.1) were more likely to have caries experience at 5 years of age than other children. CONCLUSION: Breastfeeding up to 18 months of age was not associated with caries development during preschool age.

Health nurses' experiences and attitudes regarding collaboration with dental personnel.

BACKGROUND: Collaboration between primary care personnel and dental personnel to prevent early childhood caries has been established in several countries. The purpose of this study was, firstly, to describe health nurses' experiences and attitudes regarding collaboration with dental personnel, and secondly, to identify characteristic of health nurses and health centres associated with the collaboration. METHODS: Health nurses working with children answered a questionnaire. In total, 163 of 296 health nurses (55 %) reported demographic information, referral routines, frequency of and reasons for referral of young children to dental personnel, contact with dental personnel and satisfaction with the collaboration. Data were analysed using multivariate logistic regression. RESULTS: The majority of health nurses (83 %) were familiar with referral routines and 31 % reported referring children to dental personnel monthly or more often. The most frequent reasons for referral were clinical caries (52 %), dental discolouration (38 %) and dental trauma (34 %). Few health nurses (18 %) had contact with dental personnel monthly or more often. Two-thirds of health nurses (71 %) reported being satisfied with the collaboration with dental personnel. Results of multivariate analysis showed that health nurses were more likely to refer children when the proportion of immigrant children under care in the health centres was high than when proportion of immigrant children was low (OR 6.4, CI 2.7-14.9). Health nurses working in small health centres were more likely to be satisfied with the collaboration than health nurses working in large health centres (OR 3.2, CI 1.4-7.0). Health nurses 45 years or older were more likely to possess knowledge of referral routines than younger health nurses (OR 2.7, CI 1.1-6.4). CONCLUSIONS: The results indicated that the majority of health nurses possessed knowledge of collaboration routines and were satisfied with the collaboration. The proportion of immigrant children under care in the health centres, the size of the health centres and the age of health nurses were factors influencing the collaboration between primary care personnel and dental personnel.

Enamel defects on permanent successors following luxation injuries to primary teeth and carers' experiences.

BACKGROUND: Trauma to primary teeth may have consequences. AIM: To study frequency of enamel defects in permanent successors after luxation injuries, and to report carers' experiences. METHODS: Children 8-15 years (n = 170) suffering luxation injury to primary dentition in 2003 were reexamined in 2010. Permanent successors (n = 300) were clinically examined and photographed. Data from dental records, registration form and a questionnaire were analysed by cross-tabulation and tested by chi-square and t-test. RESULTS: Enamel defects were registered in 130 successor teeth, 22% due to trauma, 21% due to other aetiological factors (MIH, dental fluorosis, idiopathic). Successors with enamel defects were after concussion 8%, subluxation 18%, lateral luxation 41%, intrusion 38% and avulsion 47%. Enamel defects were associated with the child's age and severity of the injury (P < 0.05). Six children had enamel defects in successors of non-injured primary teeth. Anxiety recorded by carers was associated with severity and number of injured teeth (P < 0.05). According to carers eight children developed dental fear, seven were younger than 3.5 years and had had their injured teeth removed. CONCLUSION: Minor luxation injuries and indirect trauma may cause enamel defects in permanent successors. Lower age at injury, severity and number of injured teeth affect carer and child negatively.

Does early establishment of favorable oral health behavior influence caries experience at age 5 years?

OBJECTIVE: The purpose was to study associations between tooth brushing frequency, use of fluoride lozenges and consumption of sugary drinks at 1.5 years of age and having caries experience at 5 years of age. METHODS: This study was based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and by the Public Dental Services. A total of 1095 children were followed from pregnancy to the age of 5 years. Questionnaires regarding oral health behavior were completed by the parents at 1.5 and 5 years of age. Clinical and radiographic examination of the children was performed at the age of 5 years. RESULTS: In multiple logistic regression, having caries experience at 5 years of age was associated with; at 1.5 years of age having the teeth brushed less than twice daily (OR = 2.1, CI = 1.3-3.6) and being offered sugary drinks at least once a week (OR = 1.8, CI = 1.1-2.9) when controlled for family characteristics and oral health behavior at 5 years of age. CONCLUSIONS: Tooth brushing frequency and consumption of sugary drinks in early childhood were related to caries development during pre-school age, independent of family characteristics and oral health behavior at 5 years of age. The results indicate that early established habits regarding tooth brushing and consumption of sugary drinks have long-term effects on caries development. Parents encountering difficulties in establishing favorable oral health behavior in children's first years of life should receive special attention from health personnel.

Tooth brushing frequency and use of fluoride lozenges in children from 1.5 to 5 years of age: a longitudinal study.

OBJECTIVES: The purpose of the analyses was to study development, stability and changes in oral health behaviour - tooth brushing frequency, use of fluoride lozenges and fluoridated toothpaste in children from 1.5 to 5 years of age - and to study associations between oral health behaviour and family characteristics. METHODS: This study was based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and data from the Public Dental Services. A total of 771 children were followed from 1.5 to 5 years of age. Questionnaires regarding oral health behaviour in children were completed by the parents three times during preschool age. RESULTS: More than half of the children (52%) had their teeth brushed twice daily at 1.5 years of age, increasing to 61% at 3 years and 76% at 5 years of age. At 1.5 years of age, 37% of the children used fluoride lozenges daily, increasing to 74% at 3 years and 75% at 5 years of age. The majority of the children who had started brushing twice daily and used fluoride lozenges daily at 1.5 years of age continued these behaviours until the age of 5 years. At 1.5 years of age, children who brushed twice daily were more likely to use fluoride lozenges daily than children who brushed less frequently (P = 0.03). Multiple logistic regression showed that the probability of a child having its teeth brushed twice daily continuously during preschool age was higher when both parents were of western origin [odds ratios (OR) 4.0, confidence intervals (CI) 1.3-11.9] than when one or both parents were of non-western origin. Children with one older sibling brushed more frequently (OR 1.4, CI 1.0-1.9) and used fluoride lozenges more often (OR 1.6, CI 1.1-2.2) during preschool age than children without older siblings. CONCLUSIONS: Oral health behaviour established in early life was stable during preschool age. The results indicate that tooth brushing frequency and use of fluoride lozenges were not in accordance with the present recommendations based on the scientific literature. The teeth of Norwegian preschoolers were brushed less frequently than recommended, and more children than recommended were using fluoride lozenges.

Enamel defects in permanent incisors after trauma to primary predecessors: inter-observer agreement based on photographs.

UNLABELLED: Trauma to primary teeth may cause mineralization disturbances in the permanent successors. OBJECTIVE: To study the distribution and type of enamel defects in permanent incisors after trauma to primary teeth and to examine inter-observer agreement when registrations were based on photographs. MATERIAL AND METHODS: Of 266 children who suffered an oral injury to primary teeth in one county of Norway in 2003, 193 were included in a follow-up study to record enamel defects in the permanent successors 7 years later (age, 8-15 years). Clinical examination and intraoral photographs were undertaken by the principal investigator. The photographs were evaluated twice for enamel defects by three paediatric dentists. Evaluation 1: age at the time of injury, traumatized teeth and diagnoses were kept unknown to the examiners. Evaluation 2: age and trauma diagnoses were known to the examiners. Inter-observer agreement was calculated using Cohen's kappa and chi-square test. RESULTS: Of 338 successor teeth, 42% exhibited enamel defects. In neighbouring teeth (339) with non-injured predecessors, 30% were registered with defects. The most common enamel disturbance in successors was demarcated opacities, recorded in 18% of the teeth. Enamel defects owing to a previous trauma were registered in 37% of the children in Evaluation 1, kappa 0.88-0.93 and in 21% in Evaluation 2, kappa 0.63-0.84. The examiners disagreed on a higher proportion of the children when all information on the injury was available (P < 0.001). CONCLUSION: Demarcated enamel opacities were the most common defects in permanent successors. Although the inter-examiner agreement was good, the results indicated that recordings of enamel disturbances following trauma is associated with uncertainty.

Maternal health and lifestyle, and caries experience in preschool children. A longitudinal study from pregnancy to age 5 yr.

In this study, associations were explored between maternal health and lifestyle during pregnancy and in early motherhood, and preschool children's caries experience. The study was based on the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and on data from the Public Dental Services. A total of 1348 children were followed from pregnancy to age 5 yr. A clinical dental examination was performed at age 5 yr. Questionnaires were completed by the mothers during pregnancy and in the first 18 months of their child's life, and as part of the dental examination. Results from the multivariate logistic regression analysis showed that having an obese mother (OR = 2.3, 95% CI: 1.3-4.1), a mother who consumed a diet containing more fat (OR = 1.6, 95% CI: 1.1-2.5) or sugar (OR = 1.5, 95% CI: 1.1-2.3) than recommended, a mother with low education (OR = 1.5, 95% CI: 1.1-2.3) or one or both parents of non-western origin (OR = 5.4, 95% CI: 2.8-10.6) were statistically significant risk indicators for caries experience at age 5 yr. In conclusion, maternal weight and intake of sugar and fat in pregnancy were associated with caries experience in preschool children. These characteristics may enable early referral to the dental services and preventive care to be delivered.

Nordic dental hygienists' willingness to perform new treatment measures: barriers and facilitators they encounter.

BACKGROUND: In the Nordic countries, discussion on redistribution of clinical tasks between dentists and dental hygienists continues intensely. OBJECTIVES: The aim of this study was to analyse Nordic dental hygienists' willingness to perform new treatment measures as well as their perceived barriers and facilitators to carrying out such measures. METHODS: A questionnaire survey was conducted among a representative sample of dental hygienists in Finland and Norway (n=1733). The questionnaires enquired whether the dental hygienists were willing to provide 25 given treatment measures beyond those involved in their current practice. The chi-square test and linear regression served for the statistical analyses. RESULTS: The dental hygienists worked predominantly (62%) in the public sector in both countries. A majority (67%) of the dental hygienists agreed that they fully used their professional skills in their current clinical work. In addition to their daily activities, high percentages of the dental hygienists reported a willingness to carry out 'more often than now' procedures related to orthodontics (59%), local anaesthesia (59%), clinical photographing (58%), glass-ionomer fillings (57%), composite fillings (51%), and tooth bleaching (47%). The most frequently reported barrier was the dental hygienists' perceived competency (39%). Additionally, the dental hygienists identified the homogeneity of their current patient group (32%) and the traditional manner of delegating tasks in their workplaces (31%) as barriers to carrying out up to date clinical treatment measures. The dental hygienists' working community had a significant effect on their willingness to carry out new treatment measures (p<0.05). CONCLUSION: Our study indicates that dental hygienists desire to perform more clinical treatment measures than their current daily activities entail, but their self-perceived competency was insufficient to carry out such measures. Consequently, changes in dental hygienists' training programmes to provide hygienists with sufficient skills and confidence to perform up to date clinical treatments are required.

Oral health-related quality of life and associated factors in Norwegian adults.

OBJECTIVE. To investigate associations between oral health-related quality of life assessed with the Oral Health Impact Profile (OHIP)-14 and demographic factors, number of teeth present, dental visits, dental health behaviour and self-rated oral health in a representative sample of 20-80-year-old Norwegians. MATERIAL AND METHODS. The study was conducted in a stratified random sample of 3538 individuals. Questionnaires including questions on demographic factors, number of remaining teeth, dental visits, dental health behaviour, self-rated oral health and OHIP-14 were mailed to the sample. Bivariate and multivariate analyses were performed. RESULTS. The response rate was 69%. The mean OHIP-14 score was 4.1 (standard deviation = 6.2). No problem was reported by 35% of the respondents. The most frequently reported problems were: physical pain (56%), psychological discomfort (39%) and psychological disability (30%). When the effect of all independent variables was analysed in multivariate analysis, self-rated oral health, frequency of dental visits, number of teeth, age and sex were significantly (P < 0.05) associated with the prevalence of having problems and frequent problems. Self-rated oral health had the strongest association with having problems [odds ratio (OR) 4.5; 95% confidence interval (CI) 3.4-6.0] and with having frequent problems (OR 4.0; 95% CI 2.7-5.8). Dental health behaviour, use of floss and toothpicks and oral rinsing were not associated with having problems related to oral quality of life in multivariate analyses. CONCLUSION. In this Norwegian adult sample, self-rated oral health, frequency of dental visits, number of teeth, age and sex were associated with having problems as estimated using the OHIP-14.

Family characteristics and caries experience in preschool children. A longitudinal study from pregnancy to 5 years of age.

OBJECTIVE: The purpose of the study was to explore associations between family status, family income, family size, mother's age at child birth, mother's education and parents' national background and caries experience in 5-year-old children. METHOD: This study is based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and the Public Dental Services. A total of 1348 children were followed from pregnancy to the age of 5 years. Questionnaires were completed by mothers twice during pregnancy and when the children were 3 and 5 years of age. Clinical and radiographic examination of the children was performed at the age of 5 years. RESULTS: Caries experience in the 5-year-old children was low; 89% had no caries experience (d(3-5) mft = 0). In multiple logistic regression having one or both parents of non-western origin (OR 3.4, CI 1.6-7.3), having had a change in family status from pregnancy to 5 years of age (OR 2.0, CI 1.1-3.4) and having mother with low education (OR 1.9, CI 1.3-2.8) were statistically significant risk indicators for having caries experience at the age of five. CONCLUSION: Family characteristics in pregnancy and early life were associated with caries experience in 5-year-old children. Primary care personnel meeting young children with one or several of these characteristics should consider referring the child to dental personnel to enable early initiation of health-promoting activities.

The risk of enamel fluorosis and caries among Norwegian children: implications for Norway and the United States.

BACKGROUND: The authors investigated the associations between enamel fluorosis, caries and early fluoride use among Norwegian children who received fluoride supplementation under a protocol similar to the current U.S. protocol. METHODS: Two examiners whose techniques were calibrated examined randomly selected middle-school-aged children living in Bergen, Norway-where the water supply contains less than 0.10 milligrams of fluoride per liter-for both enamel fluorosis and caries by using the Fluorosis Risk Index and modified National Institute of Dental and Craniofacial Research criteria. The authors ascertained past fluoride exposure via a follow-up questionnaire mailed to parents. RESULTS: The questionnaire had an 88 percent response rate and 87 percent reliability. Adjusted analyses revealed a strong association between regular supplementation (given in the form of lozenges) and mild to moderate enamel fluorosis (odds ratio [OR], 6.85; P < .05), as well as fluorosis of lesser severity (OR, 3.07; P < .05). No children who had exclusively used only a pea-sized amount of toothpaste (0.1 percent fluoride) had mild to moderate fluorosis. The authors found a 40 percent reduction in caries risk associated with early use of pea-sized amounts of fluoridated toothpaste and a 46 percent reduction associated with regular use of fluoride supplement lozenges. CONCLUSIONS: These findings suggest that both risk of fluorosis development and caries-preventive benefit are associated with regular use of fluoride supplements, and caries prevention was associated with early use of a pea-sized amount of toothpaste. CLINICAL IMPLICATIONS: These findings underscore the need for clinicians to consider thoroughly-and discuss with a child's parent or guardian-both the benefit and the potential risk of fluorosis development associated with preventive fluoride agents before introducing them. Clinicians also should emphasize the proper use of such agents.

Caries and background factors in Norwegian and immigrant 5-year-old children.

OBJECTIVES: The purpose of this study was to assess the caries status of 5-year-olds in a low caries area, and study associations between dental caries and parent-related factors: parents' education, national origin, oral health behaviours and attitudes. METHODS: The material consisted of 523 children and was a stratified random sample. Clinical and radiographic examination was performed in 2007. Enamel and dentine caries were recorded at surface level. Parents filled in questionnaires regarding socioeconomic status, their own oral health behaviours and attitudes. RESULTS: Most participants (66%) had no caries experience and 16% had enamel caries only. Dentine caries experience was present in 18% of the children, and 5% had dentine caries experience in five or more teeth. Surfaces with enamel caries constituted half of all surfaces with caries experience. In multiple logistic regression, statistically significant risk indicators for the child having dentine caries experience at the age of five were: having one or both parents of non-western origin (OR = 4.8), both parents (OR = 3.0) or one parent (OR = 2.1) with low education, parental laxness about the child's tooth brushing (OR = 2.8), parents' brushing their own teeth less than twice a day (OR = 2.2) and having parents with frequent sugar intakes (OR = 1.8). CONCLUSION: Caries prevalence in 5-year-olds was strongly associated with parent-related factors signifying that information on parents' socioeconomic status, dental behaviours and attitudes should be considered when planning dental services for young children. Our results suggest that the real high risk group is non-western children whose parents have low education.

Dental avoidance behaviour in parent and child as risk indicators for caries in 5-year-old children.

AIM: The aim of this study was to explore associations between avoidance behaviour and dental anxiety in both parents and children and caries experience in 5-year-old children. It was hypothesised that parents' dental avoidance behaviour and dental anxiety were related to dental caries in 5-year-old children. DESIGN: Data were collected from dental records and by clinical and radiographic examination of 523 children. The parents completed a questionnaire regarding education, national background, dental anxiety, dental attendance, and behaviour management problems. Bivariate and multivariate logistic regression was conducted. RESULTS: Children having one or more missed dental appointments (OR = 4.7), child behaviour management problems (OR = 3.3), child dental anxiety (OR = 3.1), and parents avoiding dental care (OR = 2.1) were bivariately associated with caries experience at the age of 5 years. In multivariate logistic regression, having one or more missed dental appointments (OR = 4.0) and child behaviour management problems (OR = 2.4) were indicators for dental caries in 5-year-old children, when controlling for parents education and national origin. CONCLUSION: Parents that avoid bringing their child to scheduled dental appointments and previous experiences of behaviour management problems for the child indicated risk for dental caries in 5-year-old children.

Factors associated with traumatic dental injuries among 12-year-old schoolchildren in South India.

AIMS: To assess the prevalence of, and correlates of traumatic dental injuries among 12-year-old schoolchildren in Kerala. MATERIAL AND METHODS: A cross-sectional, two-stage cluster sampling technique was used. The sample size included 838 12-year-old school children. Traumatic dental injuries to the anterior teeth were evaluated clinically by one examiner. Teeth examined were maxillary and mandibular incisors and canines. The children answered a structured questionnaire on sociodemographics, subjective oral health assessments and behavioural aspects. RESULTS: Six per cent of the 12-year-old school children had traumatic dental injuries to the anterior teeth. The right central incisors were most frequently affected. Multiple logistic regression analysis showed that boys (Adjusted Odds Ratio (Adj OR) = 2.2, 95% Confidence Interval (CI) = 1.1-4.1) and children who disagreed that good marks in school were important to them (Adj OR = 2.3, 95% CI = 1.2-4.3) had a higher probability of having traumatized teeth than other children. CONCLUSIONS: The prevalence of traumatized anterior teeth among 12-year-olds in Kerala was low compared with other studies. Being male and negative about future career were associated with a higher probability of having a traumatized tooth.

Prevalence and correlates of self-reported state of teeth among schoolchildren in Kerala, India.

BACKGROUND: Oral health status in India is traditionally evaluated using clinical indices. There is growing interest to know how subjective measures relate to outcomes of oral health. The aims of the study were to assess the prevalence and correlates of self-reported state of teeth in 12-year-old schoolchildren in Kerala, India. METHODS: Cross-sectional survey data were used. The sample consisted of 838 12-year-old schoolchildren. Data was collected using clinical examination and questionnaire. The clinical oral health status was recorded using Decayed, Missing and Filled Teeth (DMFT) and Oral Hygiene Index-Simplified (OHI-S). The questionnaire included questions on sociodemographics, self reports of behaviour, knowledge and oral problems and a single-item measuring self-reported state and satisfaction with appearance of teeth. The Kappa values for test-retest of the questionnaire ranged from 0.55 to 0.97. RESULTS: Twenty-three per cent of the schoolchildren reported the state of teeth as bad. Multivariate logistic regression showed significant associations between schoolchildren who reported to have bad teeth and poor school performance (Odds Ratio (OR) = 2.5), having bad breath (OR = 2.4), food impaction (OR = 1.7) dental visits (OR = 1.6), being dissatisfied with appearance of teeth (OR = 4.2) and caries experience (OR = 1.7). The explained variance was highest when the variables dental visits, bleeding gums, bad breath, food impaction and satisfaction with appearance were introduced into the model (19%). CONCLUSION: A quarter of 12-year-olds reported having bad teeth. The self-reported bad state of teeth was associated with poor school performance, having bad breath and food impaction, having visited a dentist, being dissatisfied with teeth appearance and having caries experience. Information from self-reports of children might help in planning effective strategies to promote oral health.

Caries preventive methods in child dental care reported by dental hygienists, Norway, 1995 and 2004.

Dental hygienists are used as first-line personnel in child dental care in Norway, and have an increasing influence on the delivery of preventive dental services. The purpose of this study was to describe: (1) preventive methods reported by hygienists in child dental care in Norway and (2) changes in preventive care during the 9-year period 1995 to 2004. Questionnaires were sent to all dental hygienists in the public dental services in Norway in 1995 and 2004; 70% (199 of 286) were returned in 1995 and 71% (210 of 297) in 2004. The hygienists considered one-third of children to be at risk of caries and spent 45 min of preventive care on these children every 16th month, while the remaining children were given 15 min of prevention every 20th month. One-third of the hygienists provided fluoride varnish for all children and one-fourth placed sealants routinely. Ninety percent of the hygienists reported that all children were given information on diet, hygiene, and fluoride. Most of the preventive practices of dental hygienists reflected limited changes in the period 1995 to 2004. However, the hygienists had reduced the use of fluoride varnishes and less often recommended fluoride tablets. The majority of hygienists reported that they individualized clinical prevention, while individual oral health information was standardized and given to all children. The results indicate that in 2004 a preventive approach combining individual information for all with intensified clinical prevention for children considered at risk was followed in child dental care.