Prevalence of sustained hypertension and obesity among urban and rural adolescents: a school-based, cross-sectional study in North India.

OBJECTIVE: Recent data on sustained hypertension and obesity among school-going children and adolescents in India are limited. This study evaluates the prevalence of sustained hypertension and obesity and their risk factors among urban and rural adolescents in northern India. SETTING: A school-based, cross-sectional survey was conducted in the urban and rural areas of Ludhiana, Punjab, India using standardised measurement tools. PARTICIPANTS: A total of 1959 participants aged 11-17 years (urban: 849; rural: 1110) were included in this school-based survey. PRIMARY AND SECONDARY OUTCOME MEASURES: To measure sustained hypertension among school children, two distinct blood pressure (BP) measurements were recorded at an interval of 1 week. High BP was defined and classified into three groups as recommended by international guidelines: (1) normal BP: 95th percentile. The Indian Academy of Pediatrics classification was used to define underweight, normal, overweight and obesity as per the body mass index (BMI) for specific age groups. RESULTS: The prevalence of sustained hypertension among rural and urban areas was 5.7% and 8.4%, respectively. The prevalence of obesity in rural and urban school children was 2.7% and 11.0%, respectively. The adjusted multiple regression model found that urban area (relative risk ratio (RRR): 1.7, 95% CI 1.01 to 2.93), hypertension (RRR: 7.4, 95% CI 4.21 to 13.16) and high socioeconomic status (RRR: 38.6, 95% CI 16.54 to 90.22) were significantly associated with an increased risk of obesity. However, self-reported regular physical activity had a protective effect on the risk of obesity among adolescents (RRR: 0.4, 95% CI 0.25 to 0.62). Adolescents who were overweight (RRR: 2.66, 95% CI 1.49 to 4.40) or obese (RRR: 7.21, 95% CI 4.09 to 12.70) and reported added salt intake in their diet (RRR: 4.90, 95% CI 2.83 to 8.48) were at higher risk of hypertension. CONCLUSION: High prevalence of sustained hypertension and obesity was found among urban school children and adolescents in a northern state in India. Hypertension among adolescents was positively associated with overweight and obesity (high BMI). Prevention and early detection of childhood obesity and high BP should be strengthened to prevent the risk of cardiovascular diseases in adults

Global Oral Health Policies and Guidelines: Using Silver Diamine Fluoride for Caries Control

Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is a clear solution containing silver and fluoride ions. Because of its anti-bacterial and remineralizing effect, silver diamine fluoride has been used in managing dental caries for decades worldwide. This paper aims to summarize and discuss the global policies, guidelines, and relevant information on utilizing SDF for caries management. SDF can be used for treating dental caries in most countries. However, it is not permitted to be used in mainland China. Several manufacturers, mainly in Australia, Brazil, India, Japan, and the United States, produce SDF at different concentrations that are commercially available around the world. The prices differ between contents and brands. Different government organizations and dental associations have developed guidelines for clinical use of SDF. Dental professionals can refer to the specific guidelines in their own countries or territories. Training for using SDF is part of undergraduate and/or postgraduate curriculums in almost all countries. However, real utilization of SDF of dentists, especially in the private sector, remains unclear in most places because little research has been conducted. There are at least two ongoing regional-wide large-scale oral health programs, using SDF as one of the components to manage dental caries in young children (one in Hong Kong and one in Mongolia). Because SDF treatment does not require caries removal, and it is simple, non-invasive, and inexpensive, SDF is a valuable strategy for caries management in young children, elderly people, and patients with special needs. In addition, to reduce the risk of bacteria or virus transmission in dental settings, using SDF as a non-aerosol producing procedure should be emphasized under the COVID-19 outbreak.</p

Association of severe early childhood caries with iron deficiency anemia

Background: Severe tooth decay is known to affect the health and well-being of young children. However, there has been minimal research showing the association of severe early childhood caries (S-ECC) and iron deficiency anemia (IDA). Aims: The primary aim of this study was to investigate an association between S-ECC with IDA. The secondary objective was to find an association between severe caries and body weight of the child. The oral health-related quality of life of children with S-ECC was also assessed. Materials and Methods: Following the ethical approval, 60 children aged 2-6 years (30 with S-ECC and 30 controls with caries status <2) were recruited for this cross-sectional association study. Each child received a clinical examination for dental caries status using deft index and a blood investigation to determine various parameters; hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration, and packed cell volume (PCV). Children underwent venipuncture after due parental consent, and 2.5 mL blood was collected from each child to evaluate the above parameters. Following this, the parents filled up a 10 point questionnaire to determine the child′s quality of life. Data were then analyzed by t-test and Fischer′s exact t-test. Result: On comparison of percentage of children with IDA in S-ECC and control group, it was found that children with S-ECC were more likely to have IDA odds ratio (95% confidence interval): 10.77 (2.0, 104.9), (P = 0.001). In addition to this, S-ECC children were significantly more likely to have low Hb, MCV, and PCV levels (P < 0.001) which imply that S-ECC may be a risk marker for the development of anemia. More children (93%) with severe caries were found to have less body weight than ICMR standard weight for age as compared to children with low caries (P < 0.05%). Conclusion: S-ECC is strongly associated with the anemia due to iron deficiency, and efforts should be made toward the preventive and curative aspects of ECC, which may improve the general well-being and quality of life of a child

Study of prevalence of depression in adolescent students of a public school

Background: Three to nine per cent of teenagers meet the criteria for depression at any one time, and at the end of adolescence, as many as 20% of teenagers report a lifetime prevalence of depression. Usual care by primary care physicians fails to recognize 30-50% of depressed patients. Materials and Methods: Cross-sectional one-time observational study using simple screening instruments for detecting early symptoms of depression in adolescents. Two psychological instruments were used: GHQ-12 and BDI. Also socio-demographic data (e.g. academic performance, marital harmony of parents, bullying in school, etc) was collected in a separate semi-structured performa. Statistical analysis was done with Fisher′s Exact Test using SPSS17. Results: 15.2% of school-going adolescents were found to be having evidence of distress (GHQ-12 score e"14); 18.4% were depressed (BDI score e"12); 5.6% students were detected to have positive scores on both the instruments. Certain factors like parental fights, beating at home and inability to cope up with studies were found to be significantly (P < 0.05) associated with higher GHQ-12 scores, indicating evidence of distress. Economic difficulty, physical punishment at school, teasing at school and parental fights were significantly (P < 0.05) associated with higher BDI scores, indicating depression. Conclusion: The study highlights the common but ignored problem of depression in adolescence. We recommend that teachers and parents be made aware of this problem with the help of school counselors so that the depressed adolescent can be identified and helped rather than suffer silently

Effect of high-molecular-weight component of Cranberry on plaque and salivary Streptococcus mutans counts in children: An in vivo study

Background: Previous investigations showed that a high-molecular-weight, nondialyzable material (NDM) from cranberries inhibits the adhesion of a number of bacterial species and prevents the coaggregation of many oral bacterial pairs. Aim: In the present study, the effect of mouthrinse containing high-molecular-weight component of cranberry was evaluated on colonization of Streptococcus mutans in children and compared it with a control mouthrinse without high-molecular-weight component on Streptococcus mutans counts. Materials and Methods: A high-molecular-weight NDM was isolated from cranberry juice concentrate after the dialysis of the cranberry concentrate; followed by lyophilization. A mouthwash was prepared especially for the study having NDM in the concentration of 3 mg/ml. Following 4 weeks of daily usage of cranberry-containing mouthwash by the children of an experimental group (n = 20), the Streptococcus mutans counts in plaque and saliva were compared with that in control group using placebo mouthwash (n = 20) with the help of Dentocult SM strips. Results: There was a highlysignificant reduction in Streptococcus mutans counts in saliva and plaque of children using mouthwash containing cranberry NDM (P < 0.05) compared to control. Conclusion: The data suggest that the high-molecular-weight cranberry extract in mouthwash has a significant potential in reducing the Streptococcus counts in the oral environment

Remineralizing efficacy of Calcarea Fluorica tablets on the artificial carious enamel lesions using scanning electron microscope and surface microhardness testing: In vivostudy

Context: Remineralization is defined as the process whereby calcium and phosphate ions are supplied from a source external to tooth to promote ion deposition into crystal voids in demineralized enamel to produce net mineral gain. The remineralization produced by saliva is less and also a slow process, therefore remineralizing agents are required. Aims: The study was planned to evaluate the effectiveness of homeopathic Calcarea Fluorica (calc-f) tablets as remineralizing agents on artificial carious lesions using scanning electron microscope (SEM) and surface microhardness (SMH) testing. Subjects and Methods: A total of 24 patients needing removable orthodontic treatment were included in the study. They were divided into two groups of 12 patients each. The Group I consisted of patients in whom no tablets were given while Group II consisted of patients in whom calc-f tablets were given in a dosage of 4 tablets twice a day. Four enamel samples with the artificial carious lesions were then embedded in the removable appliance for a period of 6 weeks. After 6 weeks, the enamel samples were retrieved and evaluated by SEM and SMH. Statistical Analysis Used: One-sample Kolmogorov-Smirnov test and Student′s t-test were applied to analyze the difference in the Vickers microhardness number (VHN) values of remineralized enamel obtained from control and experimental group. Results: The signs of remineralization such as reduction in depth prismatic holes or decrease in porosity, variable sized uneven distribution of deposits and amorphous deposits were seen in enamel samples of both the groups. The mean SMH of remineralized enamel sample of Group I and Group II were 270.48 and 302.06, respectively, and the difference was statistically significant. Conclusions: (1) Remineralization occurred in both the groups as indicated by SEM and the increase in surface hardness values in both the groups. (2) Remineralization of enamel samples in the control group as indicated by SEM and also by increase in VHN values indicated that the saliva has a tendency of remineralizing the early carious lesions. Conclusions drawn from the study are that the calc-f tablets can be used as safe and cost effective remineralizing agent