Thursday, July 28, 2011

Mutans Streptococcus Counts Following Treatment for Early Childhood Caries

Resident’s Name: Jessica Wilson

Article title: Mutans Streptococcus Counts Following Treatment for Early Childhood Caries

Author(s): Peretz, B et al.

Journal: Journal of Dentistry for Children

Year. Volume (number). Page #’s: 2003. 70:2. 111-114.

Major topic: ECC

To assess MS count in children who were treated for EEC in a follow-up exam.

The saliva of 44 children treated for ECC under GA was cultured and MS colonies were counted at a follow-up exam. Birth timing and weight were recorded based on parental memory.

Key points/Summary:
1. Children who were tested closer to the date of dental treatment had significantly lower levels of MS.
2. Significantly more parents of children with high MS levels believed that OHI greatly reduced children’s plaque levels.
3. Children with higher birth weight demonstrated lower levels of MS. All children born preterm had high MS levels, whereas only 77% of full term children had high levels.
4. Among the high MS group, more mothers had 12 years or less of formal education than the low MS group, however this statistic was not significant.

Assessment of Article:
The sample size was very small and we cannot generalize the findings. Need further studies on the reasons behind these correlations as we know they exist.

Wednesday, July 27, 2011

Body Mass Index of Children With Severe Early Childhood Caries

Body Mass Index of Children With Severe Early Childhood Caries

Resident’s Name: Matthew Freitas

Article title: Body Mass Index of Children With Severe Early Childhood Caries

Author(s): B. Sheller et al.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2009. 31:3. 216-221.

Major topic: BMI and Severe ECC


-Unhealthy food choices and eating behaviors increase risk for overweight and dental caries.

-Research of obesity and prevalence of dental caries has yielded contradictory conclusions.

-Some studies found an association between overweight and caries, while others have not.

-Results show a shift towards more overweight and fewer underweight children with ECC.


-Clarify and describe the association between body weight and severe ECC in healthy children receiving dental rehab under general anesthesia.


1. Weight of study population similar to national reference sample.

2. Overweight children: higher dmft.

3. Underweight children: more pulp-involved teeth.


-Retrospective, cross-sectional case study of 293 healthy children with severe ECC.

-Subjects received dental treatment under general anesthesia at a children’s hospital.

-Three-year period between June 1, 2002 and May 31, 2005.

-Subjects: 2-6 yrs old, no medical history, no meds, only primary teeth, and had severe ECC.

-Study population compared with national reference group of similar socioeconomic status.

-dmft and pulp-involved teeth were continuous variables.

-2 groups; 24 to 36 months and greater than 37 months.


-No significant correlation between BMI and dmft or pulp-involved teeth.

-BMI distribution: 11% underweight, 67% normal, 9% risk for overweight, 11% overweight.

-Study group vs. reference group: 2.5 x higher underweight (11% vs. 5%) and fewer overweight (11% vs. 14%).

-Mean number: of dmft =11.8 and of pulp-involved = 4.1.

-Asian and Hispanic children: significantly higher dmft and more extractions.

-Older children: significantly higher dmft and number of pulp-involved teeth.

Assessment of Article:

-Expand study population to more than just one children’s hospital.

-Is underweight trend due to symptoms and results of dmft and pulp involved teeth?

Malnourishment in a Population of Young Children with Severe Early Childhood Caries (S-ECC)

Fotini M. Dionisopoulos

Title: Malnourishment in a Population of Young Children with Severe Early Childhood Caries (S-ECC)
Author: Clarke, et. al
Journal: Pediatric Dentistry- 28:3 2006

Main Purpose: 1) Describe the Nutritional Status of children with S-ECC and 2) Assess the ability of various nutritional status measurement to detect malnutrition in children with S-ECC

Methods: Fifty-six (56) children between 2-6 years old having dental treatment under GA at underwent 1) anthropometric measurements (height, weight, arm circumference and triceps fold thickness) by a sole examiner and 2) blood collections (samples of serum albumin, hemoglobin, MCV, and serum ferritin).

The anthropometric measurements were then converted to Ideal Body Weight Percentiles, BMI, and MAMC (mid-arm muscle circumference)

Key Points:
1) With the anthropometric measurements, Most of the children (66%) were considered to be ideal body weight, 12% showed mild malnutrition, 5% showed moderate malnutrition
2) With the blood tests, the test that "stood out" regarding malnutrition in this group was the Serum Ferritin test. The majority of subjects tested low. One-quarter (24%) showed evidence of iron depletion. (only 9% had an acceptable rate)
3) Therefore, the blood tests detected more cases of nutritional deficiencies than the anthropometric tests.
4) Children's dietary intake of protein and energy was thought to possibly be lower than acceptable. This could be due to the inability to chew properly due to rampant decay. (but, as the article notes, it could be due to other factors too, it could also be due to lower SES)
5) There was a significant amount of children with unacceptably low levels of hemoglobin and serum ferritin which is associated with iron deficiency
6) The article strongly suggests that S-ECC patients should have a CBC, serum ferritin test, careful height and weight measurement, as well as a dietary intake assessment

Overall, S-ECC has been identified as a marker for malnutrition, and dentists working with children need to consistently consider S-ECC as a risk marker for malnutrition. With respect to physicians, nutritional deficiencies should alert them to the possibility that S-ECC is present and that S-ECC is a possible explanation for deficiencies.

Assessment: This article can be used as an effective interdisciplinary tool both for pediatric dentists, physicians or other health care providers (i.e. nutritionists) to verify that S-ECC can affect proper growth and development for the child. Some limitations to this article are that the group of subjects was a small one, the study was based solely in a hospital and as the article noted, not completely representative of the entire population that may present with S-ECC. Furthermore, the testing was confined to only one location that may not have enough ethnic diversity for characteristics in blood samples. But as stated previously, this study is a great supplement for physicians, dentists, and other health care providers that may deal with proper growth and development for the child and how one issue affects the other.

Tuesday, July 26, 2011

Maternal Age at Birth and Other Risk Factors in Early Childhood Caries

Resident Name: Elliot Chiu

Title: Maternal Age at Birth and Other Risk Factors in Early Childhood Caries

Author: Rie Nij, DDS, Kenji Arita, DDS, PhD, Yoko Abe, DDS, PhD, Milanita Lucas, DDS, PhD, Mizuno Nishino, DDS, PhD, Masato Mitome, DDS, PhD

Journal: Pediatric Dentistry V32 / No 7, Nov/Dec 2010, page 493-498

Main Purpose

To assess whether or not ECC is affected by how old a mother is when she gives birth to her first child.


646 mother-and-first-child pairs were given a questionnaire about demographic data, household environment, dietary habits, and oral hygiene practices. At age 1.5 and 3, pediatric dentists also recorded DMFT scores on the children and performed a caries activity test (CAT) on both the mothers and children.

Key Points

-Previous studies have shown that the caregiver impacts the child’s oral health (income, education level, knowledge, health practices, etc.) However, there have only been a few reports on the impact of a caregiver’s age.

-Children born to mothers in the age group [17-22] had the highest percentage of caries prevalence and DMFT.

-Other risk factors for ECC: snacking between meals 4x/day, child’s CAT score > +1.5

-NOT risk factors for ECC:

-high CAT score mothers

-mothers over 23 y/o


-Good article that identified a risk factor for ECC that has never been tested before.

-Future studies with different populations would allow us to make broader generalizations

-This study tested only first children. It would be interesting to test if there was an improvement/decline in oral health of subsequent children.

-Take home message: When we do baby exams and notice a young mother, be aware they are at higher risk for ECC and stress OHI and diet.

Determinants of Early Childhood Caries in Low-income African American Young Children

Kyung-Hong Cal Kim

Determinants of Early Childhood Caries in Low-income African American Young Children

Authors: Ismail AI, Lim S, Sohn W, Willem, JM

Journal of Pediatric Dentistry, 2008

Purpose: Evaluate the association between ECC and S-ECC and social, dietary, and behavioral risk factors.

Method: 1021 0- to 5-year-old African American children and their caregivers from low-income residential areas in the city of Detroit were randomly selected, interviewed, and examined in wave 1 (2002-03), and 788 of those children from wave 1 were interviewed and examined again in wave 2 (2004-05).

-Of 20 selected and evaluated predictors for ECC and S-ECC, three were statistically significant: age of the children and caregivers, consumption of soft drinks, and religiosity of the caregiver.

-Noncavitated carious lesions were more prevalent in very young children, but the ratio of noncavitated to cavitated decreased with age.

-Frequency of consumption of sugary drinks were positively associated with the development of S-ECC but not ECC, indicating soft drinks were associated with development of smooth surface caries.

-Reported religiosity of the caregiver was negatively associated with development of ECC and S-ECC. Religiosity was found to be indirect indicator of the income level, level of education, mental stability, perceived discrimination, and frequency of moving for the caregivers.

-This statistically significant association between development of ECC and S-ECC and social, dietary, and behavioral risk factors calls for a replacement of the current ineffective system for the delivery of dental care through medicaid with comprehensive approaches at multiple levels involving families, clinicians, and child service providers.

Assessment of Article: Interesting article with interesting choice of samples and interesting predictors that were used in the study. I am curious to find out why only African American children were chosen for the study and why religiosity of the caregiver was chosen to be one of the predictors of development of ECC and S-ECC. What was more interesting was to learn that religiosity ended up being one of the three most significant predictors of development of ECC and S-ECC. Follow up studies on how caregivers’ mental state or perceived discrimination affect the development of caries would also be interesting, if they are not already available. Limitations of this study were its reliance on questionnaires for collecting their data, as subjective reports given by the caregivers may not truly represent their current living condition. I felt, however, that this study shows enough evidence that multi-disciplinary approach involving dentists, social workers, and nutritionists may be more effective in preventing and treating ECC and S-ECC than the current system that is rather reactive or short-term goal-oriented.

Antibiotics Usage in Early Childhood and Early Childhood Caries

Resident: Swan

Title: The Association Between Antibiotics Usage in Early Childhood and Early Childhood Caries
Author: Alaki, et al.
Journal: Pediatric Dentistry V31 No. 1 Jan/Feb 09.

Main Purpose: determine if the intake of systemic antibiotics during the first year of age (period of primary tooth development) was associated with an increased risk for ECC during the following years, and after the first year of age was associated with a lower risk for ECC during following years.

Methods: Existing Medicaid insurance data from Michigan between 2001 and 2004 was secondarily analyzed. 4 data files were analyzed: enrollment, medical, pharmaceutical, dental. ECC risk after age 1 was evaluated using 4 models (b-3 months, 4-6 months, 7-9 months, 10-12 months) for antibiotics taken prior to age 1. For antibiotics taken after age 1, the 2 models were 13-18 months and 19-24 months. Data from 29,485 children was analyzed. ECC criteria: from AAPD Guidelines

Key Points:
-in this study, when antibiotics were taken 7-12 mo. old, risk for ECC during follow-up significantly increased. Another model showed intake during entire first year resulted in increased ECC risk during follow-up.
-also correlated with increased number of antibiotic prescriptions.
-for antibiotic use after age one, only usage during 13-18 months showed a significant association between antibiotic use and higher SCC risk.

-possible explanation: kids sick before age 1 continue to get sick after age 1; they may have used other oral meds and been affected by their sugar content.
-also, parents of sick kids tend to offer more sugary, kid-friendly foods
-finally, antibiotic prescription may be a proxy for infections, which are known to increase dental caries risk via developmental enamel defects.

Assessment: I liked this article. It presented a thoughtful argument. Some limitations include the fact that "ECC or not" was diagnosed on the presence of dental claims for restorations or extractions in these young kids. Since each provider treats ECC differently, the study may actually underestimate the true prevalence of ECC. Also, the study couldn't take into account things like diet, bottle use, oral hygiene practice, etc.

Early Childhood Caries

Resident Name: Sadler
Article Info: Maternal Transmission of Mutans Streptococci in Severe-Early Childhood Caries

Stephen C. Mitchell, DMD, MS, John D. Ruby, DMD, PhD Stephen Moser, PhD Stephanie Momeni, BS, MBA Anita Smith, Robert Osgood, PhD Mark Litaker, PhD Noel Childers, DDS, PhD

Pediatric Dentistry May/June 2009

Main Purpose: Evaluate maternal transmission of strep mutans in kids with s-ecc
Methods: Twenty-seven mother/child pairs were selected from children with S-ECC before treatment in the OR. Plaque samples were collected from the mother, child, and the child’s carious lesion. Samples were analyzed and compared.

Key Points:

· Majority of kids (74%) contained strains that did not match their mother’s strain

· Evidence of transmission was present in 41% of pairs

· Of four sibling pairs, all shared at least one phenotype but only one set matched the mother’s strain

· Emphasis on maternal transmission of strep mutans may be misplaced.

Assessment of Article: I thought the article was fairly well done. The evaluation of the bacterial strains was very in depth in identifying not just strep mutans bacteria but specific strains. I do think the sample was a bit small and results would be more applicable with a larger sample and a more diverse population. 78% were males and 78% were white.

Clinical Outcomes for Early Childhood Caries: Influence of Aggressive Dental Surgery

Meghan M. Sullivan July 25, 2011

Clinical Outcomes for Early Childhood Caries: Influence of Aggressive Dental Surgery

Authors: C.E. Graves, DDS, R.j. Berkowitz, DDs, H.M. Proskin, PhD, I. Chase, DDS, P.Weinstein, PhD, R. Billings, DDS, MSD

Journal of Dentistry for Children, 2004

Methods: 57 children were treated for ECC under GA ages 2.3-7.3 with aggressive dental surgery. 6 months post surgery these patients returned for follow-up and charted for relapse, presence and/or absence of new decay.


*21 of the 57 patients (37%) relapsed.

*The number of SSC’s placed were also scored and determined if these numbers had any effect on the relapse of patients.

*The surfaces at risk or SAR for new caries were also determined and evaluated if this affected the relapse or non-relapse of the patients.

*neither the amount of SSC’s or an increase in SAR’s contributed to the high percentage of relapse patients.

*regardless of ‘aggressive’ treatment performed in the OR there is still a high percentage of patients treated for ECC who return with new decay post 6 months GA.

Assessment: Great study, very concrete and well organized. Results are similar to other studies of this nature. Disappointing outcomes, considering the patient population in this study is similar to our patient population at St. Joes. Confirmation that these patients need to return more frequently for follow-up appointments not only for diagnosing new and recurrent decay, but also eliminating the risk factors at home which are causing these children to be at high risk.

Monday, July 25, 2011

Child Temperament and Risk Factors for Early Childhood Caries

Resident: Cho
Date: 7/27/2011

Author(s): Spitz et al.

Journal: J Dent Child 2006

Main Purpose: To determine if a mother’s perception of her child’s temperament has a correlation with early childhood caries.

Overview of method of research: 629 charts of the University of Iowa’s Infant Oral Health Program were reviewed of children aged 0 to 4 years old. The following were recorded: maternal report of the child’s temperament, knowledge of ECC, dietary and oral hygiene habits, clinical evidence of caries and visible plaque on maxillary incisors. The child was placed in the “easy” or “difficult” category based on which the following the mother had marked as applying to her child: “calm”, “fussy”, “crying”, “demanding”, “stubborn”, and “other”.

Key points in the article discussion: Male children were more likely to be considered “difficult” than female children. Children reported as “easy” were more likely to be younger, be breast-fed to sleep, be breast-fed throughout the night, and have their teeth brushed twice daily. Children reported as “difficult” were more likely to be bottle-fed to sleep, have their teeth brushed once daily, and have noncavitated caries.

Summary of conclusions: Maternal reported child temperament may be related to early childhood caries. Temperament should be considered while assessing a child’s caries risk and to understand what type of child the parents is dealing with when educating the parents about prevention of caries.

Assessment of article: Interesting article. I think that children who are breast-fed vs. bottle-feeding would play a greater role in predicting early childhood caries more than the child’s temperament. I don’t think that the child’s temperament needs to be recorded when assessing caries risk, however, I agree with the author that asking about the child’s temperament could help set up REALISTIC self-management goals when trying to reduce the risk of ECC for a child.