Developmental Defects of Enamel in Primary Teeth and Association with Early Life Course Events: A Study of 6--36 Month old Children in Manyara, Tanzania.

Children with low birth weight show an increased prevalence of developmental defects of enamel in the primary dentition that subsequently may predispose to early childhood caries (ECC).Focusing 6--36 months old, the purpose of this study was to assess the frequency of enamel defects in the primary dentition and identify influences of early life course factors; socio-demographics, birth weight, child's early illness episodes and mothers' perceived size of the child at birth, whilst controlling for more recent life course events in terms of current breastfeeding and oral hygiene. A cross-sectional study was conducted in the high fluoride area of Manyara, northern Tanzania including 1221 child-mother pairs who attended Reproductive and Child Health (RCH) clinics for immunization and/or growth monitoring. After the primary caregivers had completed face to face interviews at the health care facility, children underwent oral clinical examination whereby ECC and developmental defects of enamel were recorded using field criteria. All erupted teeth were examined and the enamel defects were assessed on buccal surfaces according to the modified DDE Index. The prevalence of enamel defects was 33.3%. Diffuse opacities were the most common defects identified (23.1%), followed by hypoplasia (7.6%) and demarcated opacities (5.0%). The most frequently affected teeth were the upper central incisors (29.0% - 30.5%), whereas lower central incisors (4.3% to 4.5%) were least frequently affected. Multiple logistic regression analysis, adjusting for confounding the factors revealed that having normal birth weight (equal or more than 2500 g) associated with lower odds of having enamel hypoplasia [OR 0.22 (95% CI 0.1-0.7)]. No statistically significant association occurred between birth weight and diffuse opacities, demarcated opacities or combined DDE. Children with the history of low birth weight were more likely than their normal birth weight counterparts to present with enamel hypoplasia. In view of the frequent occurrence of enamel defects and the fact that hypoplasia may constitute a risk factor for future ECC, enamel defects should be included as a dental health indicator in epidemiological studies of children in northern Tanzania

Socioeconomic Inequality in Professionally Administered Topical Fluoride among Mexican Schoolchildren

Objective: To identify and characterize socio-economic inequalities in professionally administered topical fluoride treatment to schoolchildren. Methods: One thousand six hundred and forty-four schoolchildren [6 to 13 years of age, mean 9.06 ± 2.02; years 50.9% boys] were included in a cross-sectional study. Using questionnaires directed to mothers/guardians, we collected sociodemographic, socio-economic and dental variables. The dependent variable was at least one professional application of topical fluoride by a dentist in the previous year. Dentists in Mexico carry out the scope of clinical care traditionally assigned to dental hygienists in the United States of America (USA) and Canada. A multivariate logistic regression model was generated. Results: The prevalence of fluoride application was 11.5 % (95% CI = 9.9, 13.0). In the multivariate model, the odds of having a topical fluoride application was higher in children who reported brushing teeth more often (OR = 1.62, 95% CI = 1.22, 2.15) and in children from families with better socio-economic position (OR = 1.26, 95% CI = 1.06, 1.50). Conclusions: The experience of having fluoride administered by a dentist in the previous year was low overall in this sample of Mexican children. The results of the study suggest certain socio-economic inequalities. Strategies aimed at eliminating such inequalities across the socioeconomic spectrum are necessary if this population group is to follow recommended frequency schedules for topical fluoride applications

Indicators of oral health in older adults with and without the presence of multimorbidity: a cross-sectional study

Horacio Islas-Granillo,1 Socorro Aida Borges-Yañez,2 José de Jesús Navarrete-Hernández,1 Miriam Alejandra Veras-Hernández,1 Juan Fernando Casanova-Rosado,3 Mirna Minaya-Sánchez,3 Alejandro José Casanova-Rosado,3 Miguel Ángel Fernández-Barrera,1 Carlo Eduardo Medina-Solís1,4 1Academic Area of Dentistry, Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca, Mexico; 2DEPeI Faculty of Dentistry, National Autonomous University of Mexico, Ciudad de Mexico, Mexico; 3Faculty of Dentistry, Autonomous University of Campeche, Campeche, Mexico; 4Advanced Studies and Research Center in Dentistry “Dr Keisaburo Miyata”, Faculty of Dentistry, Autonomous University State of Mexico, Toluca, Mexico Purpose: The aim of this study was to determine whether there are differences in the distribution of various indicators of oral health among elderly people with and without multimorbidity (ie, two or more chronic diseases). Subjects and methods: A cross-sectional, comparative study was conducted using a sample of Mexican elderly individuals aged ≥60 years. The average age of the cohort was 79.06±9.78 years, and 69.1% were women. The variables indicating oral health were as follows: functional dentition, edentulism, hyposalivation, xerostomia, root caries and periodontitis. The multimorbidity variable was operationally categorized as follows: 0= subjects with no chronic disease or one chronic disease and 1= subjects with two or more chronic diseases. Questionnaires were used to collect information on various variables regarding general health. Likewise, the participants underwent a clinical oral examination. The analysis was performed using Stata 11.0. Results: The overall prevalence of multimorbidity was 27.3%. The prevalences of various oral health indicators were as follows: without functional dentition 89.9%; hyposalivation 59.7%; edentulism 38.9% and self-reported xerostomia 25.2%. Dental caries were observed in 95.3% of the subjects, and the prevalence of severe periodontitis was 80%. We found a significant difference only in edentulism; its prevalence was higher among subjects with multimorbidity (55.3% vs 32.7%, P=0.015) than among those without multimorbidity. Conclusion: The presence of edentulism in this sample of Mexican older adults was higher in subjects with multimorbidity. Multimorbidity and oral diseases constitute a true challenge in elderly people, because they affect quality of life and are associated with high health care costs. Keywords: older adults, multimorbidity, oral health, edentulism, tooth los