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      Guardian Reports of Children's Sub-optimal Oral Health Are Associated With Clinically Determined Early Childhood Caries, Unrestored Caries Lesions, and History of Toothaches

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          Abstract

          Background: Parents'/guardians' perceptions of their children's oral health are useful proxies of their clinically determined caries status and are known to influence dental care-seeking behavior. In this study, we sought to examine (1) the social and behavioral correlates of fair/poor child oral health reported by guardians and (2) quantify the association of these reports with the prevalence of early childhood caries (ECC), unrestored caries lesions and toothaches.

          Methods: We used guardian-reported child oral health information (dichotomized as fair/poor vs. excellent/very good/good) obtained via a parent questionnaire that was completed for n = 7,965 participants (mean age = 52 months; range = 36-71 months) of a community-based, cross-sectional epidemiologic study of early childhood oral health in North Carolina between 2016 and 2019. Social, demographic, oral health-related behavioral data, and reports on children's history of toothaches (excluding teething) were collected in the same questionnaire. Unrestored ECC (i.e., caries lesions) was measured via clinical examinations in a subset of n = 6,328 children and was defined as the presence of one or more tooth surfaces with an ICDAS ≥ 3 caries lesion. Analyses relied on descriptive and bivariate methods, and multivariate modeling with average marginal effect (A.M.E.) estimation accounting for the clustered nature of the data. Estimates of association [prevalence ratios (PR) and adjusted marginal effects (AME) with 95% confidence intervals (CI)] were obtained via multilevel generalized linear models using Stata's svy function and accounting for the clustered nature of the data.

          Results: The prevalence of fair/poor oral health in this sample was 15%–it increased monotonically with children's age, was inversely associated with parents' educational attainment, and was higher among Hispanics (21%) and African Americans (15%) compared to non-Hispanic whites (11%). Brushing less than twice a day, not having a dental home, and frequently consuming sugar-containing snacks and beverages were significantly associated with worse reports ( P < 0.0005). Children with fair/poor reported oral health were twice as likely to have unrestored caries lesions [prevalence ratio (PR) = 2.0; 95% confidence interval (CI) = 1.8-2.1] and 3.5 times as likely to have experienced toothaches [PR = 3.5; 95% CI = 3.1-3.9] compared to those with better reported oral health.

          Conclusions: Guardian reports of their children's oral health are valuable indicators of clinical and public health-important child oral health status. Those with fair/poor guardian-reported child oral health have distinguishing characteristics spanning socio-demographics, oral-health related practices, diet, and presence of a dental home.

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          Most cited references44

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          The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries.

          This paper describes early findings of evaluations of the International Caries Detection and Assessment System (ICDAS) conducted by the Detroit Center for Research on Oral Health Disparities (DCR-OHD). The lack of consistency among the contemporary criteria systems limits the comparability of outcomes measured in epidemiological and clinical studies. The ICDAS criteria were developed by an international team of caries researchers to integrate several new criteria systems into one standard system for caries detection and assessment. Using ICDAS in the DCR-OHD cohort study, dental examiners first determined whether a clean and dry tooth surface is sound, sealed, restored, crowned, or missing. Afterwards, the examiners classified the carious status of each tooth surface using a seven-point ordinal scale ranging from sound to extensive cavitation. Histological examination of extracted teeth found increased likelihood of carious demineralization in dentin as the ICDAS codes increased in severity. The criteria were also found to have discriminatory validity in analyses of social, behavioral and dietary factors associated with dental caries. The reliability of six examiners to classify tooth surfaces by their ICDAS carious status ranged between good to excellent (kappa coefficients ranged between 0.59 and 0.82). While further work is still needed to define caries activity, validate the criteria and their reliability in assessing dental caries on smooth surfaces, and develop a classification system for assessing preventive and restorative treatment needs, this early evaluation of the ICDAS platform has found that the system is practical; has content validity, correlational validity with histological examination of pits and fissures in extracted teeth; and discriminatory validity.
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            Using the Margins Command to Estimate and Interpret Adjusted Predictions and Marginal Effects

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              Early childhood caries and quality of life: child and parent perspectives.

              The purpose of this study was to investigate the effects of early childhood caries (ECC) on children's oral health-related quality of life (QOL) before and 4 weeks after its treatment, as assessed by the children themselves as well as by their parents/guardians. This study had a longitudinal intervention design. Sixty-nine children diagnosed with ECC and 43 children without caries (combined children's mean age=50.4 months; range=22 to 70 months) and their parents/guardians responded to face-to-face administered surveys before a dental treatment was started (baseline assessment). Thirty-seven children with ECC completed dental rehabilitation. Four weeks after the treatment was completed, these 37 children as well as their parents/guardians responded to a second survey (follow-up assessment). The results show that children with ECC have significantly lower oral health-related QOL than children without ECC as assessed both by the children and the parents/guardians at baseline. The children with ECC who received dental treatment had a significantly improved oral health-related QOL at the follow-up assessment when compared with their baseline measurement as measured both with the children's self-ratings of oral health-related QOL and the parents'/guardians' perception of their child's oral health-related QOL. ECC and its treatment affect children's oral health-related QOL in a significant way. Oral health-related QOL can be assessed validly and reliably both in self-reports from children as young as 36 months of age as well as by asking parents/guardians about their perceptions of their child's oral health-related QOL.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                24 December 2021
                2021
                : 9
                : 751733
                Affiliations
                [1] 1Doctor of Dental Surgery (DSS) Curriculum, Adams School of Dentistry, University of North Carolina at Chapel Hill , Chapel Hill, NC, United States
                [2] 2Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill , Chapel Hill, NC, United States
                [3] 3Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, NC, United States
                Author notes

                Edited by: Maha El Tantawi, Alexandria University, Egypt

                Reviewed by: Kitty Jieyi Chen, Sun Yat-sen University, China; Hisham Yehia ElBatawi, University of Sharjah, United Arab Emirates; Ramesh Nagarajappa, Siksha O Anusandhan University, India; Jessica Klöckner Knorst, Federal University of Santa Maria, Brazil

                *Correspondence: Kimon Divaris kimon_divaris@ 123456unc.edu

                This article was submitted to Children and Health, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2021.751733
                8739514
                7eddee26-8603-426a-963a-2fb638eee04c
                Copyright © 2021 Imes, Ginnis, Shrestha, Simancas-Pallares and Divaris.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 01 August 2021
                : 06 December 2021
                Page count
                Figures: 0, Tables: 3, Equations: 0, References: 44, Pages: 8, Words: 5792
                Funding
                Funded by: National Institute of Dental and Craniofacial Research, doi 10.13039/100000072;
                Award ID: U01DE025046
                Categories
                Public Health
                Original Research

                parents,subjective oral health,children,dental caries,pediatric dentistry

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