Group-based trajectories of maternal intake of sugar-sweetened beverage and offspring oral health from a prospective birth cohort study

OBJECTIVES: To investigate the trajectory of maternal intake of sugar-sweetened beverages (SSB) during the first five years of their child's life and its effect on the child's dental caries at five years-of-age. METHODS: This is an ongoing prospective population-based birth cohort study in Adelaide, Australia. Mothers completed questionnaires on their SSB intake, socioeconomic factors and health behaviors at the birth of their child and at the ages of one, two and five years. Child dental caries measured as decayed, missing, or filled tooth surfaces was collected by oral examination. Maternal SSB intake was used to estimate the trajectory of SSB intake. The trajectories then became the main exposure of the study. Dental caries at age five years were the primary outcomes. Adjusted mean- and prevalence-ratios were estimated for dental caries, controlling for confounders. RESULTS: 879 children had dental examinations at five years-of-age. Group-based trajectory modeling identified three trajectories of maternal SSB intake: 'Stable low' (40.8%), 'Moderate but increasing' (13.6%), and 'High early' trajectory (45.6%). Multivariable regression analysis found children of mothers in the 'High early' and 'Moderate but increasing' groups to have greater experience of dental caries (MR: 1.37 (95%CI 1.01-1.67), and 1.24 (95%CI 0.96-1.60) than those in the 'Stable low' trajectory, respectively. CONCLUSION: Maternal consumption of SSB during pregnancy and in the early postnatal period influenced their offspring's oral health. It is important to create a low-sugar environment from early childhood. The results suggest that health promotion activities need to be delivered to expecting women or soon after childbirth

Common risk factor approach to address socioeconomic inequality in the oral health of preschool children – a prospective cohort study

Background: Dental caries remains the most prevalent chronic condition in children and a major contributor to poor general health. There is ample evidence of a skewed distribution of oral health, with a small proportion of children in the population bearing the majority of the burden of the disease. This minority group is comprised disproportionately of socioeconomically disadvantaged children. An in-depth longitudinal study is needed to better understand the determinants of child oral health, in order to support effective evidence-based policies and interventions in improving child oral health. The aim of the Study of Mothers’ and Infants’ Life Events Affecting Oral Health (SMILE) project is to identify and evaluate the relative importance and timing of critical factors that shape the oral health of young children and then to seek to evaluate those factors in their inter-relationship with socioeconomic influences.Methods/Design: This investigation will apply an observational prospective study design to a cohort ofsocioeconomically-diverse South Australian newborns and their mothers, intensively following these dyads as the children grow to toddler age. Mothers of newborn children will be invited to participate in the study in the early post-partum period. At enrolment, data will be collected on parental socioeconomic status, mothers’ general and dental health conditions, details of the pregnancy, infant feeding practice and parental health behaviours and practices. Data on diet and feeding practices, oral health behaviours and practices, and dental visiting patterns will be collected at 3, 6, 12 and 24 months of age. When children turn 24-30 months, the children and their mothers/primary care givers will be invited to an oral examination to record oral health status. Anthropometric assessment will also be conducted.Discussion: This prospective cohort study will examine a wide range of determinants influencing child oral health and related general conditions such as overweight. It will lead to the evaluation of the inter-relationship among main influences and their relative effect on child oral health. The study findings will provide high level evidence of pathways through which socio-environmental factors impact child oral health. It will also provide an opportunity to examine the relationship between oral health and childhood overweight.Discussion: This prospective cohort study will examine a wide range of determinants influencing child oral health and related general conditions such as overweight. It will lead to the evaluation of the inter-relationship among main influences and their relative effect on child oral health. The study findings will provide high level evidence of pathways through which socio-environmental factors impact child oral health. It will also provide an to examine the relationship between oral health and childhood overweight

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Prediction of periodontitis occurrence: Influence of classification and sociodemographic and general health information

Background: Prediction of periodontitis development is challenging. Use of oral health–related data alone, especially in a young population, might underestimate disease risk. This study investigates accuracy of oral, systemic, and socioeconomic data on estimating periodontitis development in a populationbased prospective cohort. Methods: General health history and sociodemographic information were collected throughout the lifecourse of individuals. Oral examinations were performed at ages 24 and 31 years in the Pelotas 1982 birth cohort. Periodontitis at age 31 years according to six classifications was used as the gold standard to compute area under the receiver operating characteristic curve (AUC). Multivariable binomial regression models were used to evaluate the effects of oral health, general health, and socioeconomic characteristics on accuracy of periodontitis development prediction. Results: Complete data for 471 participants were used. Periodontitis classifications with lower thresholds yielded superior predictive power. Calculus, pocket, or bleeding presence at age 24 years separately presented fair accuracy. Accuracy increased using multivariable models; for example, the Beck et al. classification AUC from 0.59 to 0.75 combining proportion of teeth with calculus, bleeding, or pocket with income; number of lost teeth; sex; education; people living in the house; prosthetic needs; or number of decayed, missing, or filled teeth (DMFT). Proportion of teeth with pocket, bleeding, or calculus; number of DMFT; toothbrushing frequency; blood pressure; sex; and income were most frequently associated. Conclusions: Choice of classification might have an impact on accuracy to predict periodontitis occurrence. Regardless of the classification, predictive value for development of periodontitis in young adults might be increased by combining periodontal information, sociodemographic information, and general health history.Fábio R.M. Leite, Karen G. Peres, Loc G. Do, Flávio F. Demarco, and Marco A.A. Pere

[In Press] Population impact of sugar-sweetened beverages on dental caries and overweight/obesity in Australian children

This study investigated population impact of sugar-sweetened beverage (SSB) intake on overweight and obesity and dental caries in Australian children. The National Child Oral Health Study collected parent-completed data (socioeconomic status, health behaviors, SSB consumption) and dental caries in the primary dentition of children aged 5 to 8 years. The outcomes (prevalence of caries and overweight and obesity) were assessed in multivariable regression models to estimate prevalence ratios (PRs) with SSB intake as the main exposure. Population attributable fraction (PAF) was calculated using population distribution of the exposure and adjusted PRs. Among 7,021 children, some 15.2% children consumed 2+ SSBs per day. Prevalence of caries and overweight and obesity was 35.8% and 28.7%, respectively, and strongly associated with SSB consumption. Adjusted PRs for 2+ SSB intake/d for having dental caries and overweight and obesity was 1.45 (95% confidence interval [CI], 1.27–1.66) and 1.49 (95% CI, 1.28–1.74), respectively. PAF of SSB consumption was 11% (95% CI, 18–35) for dental caries and 9% (95% CI, 11–34) for overweight and obesity. The reported findings consolidated evidence of detrimental effects of sugars intake on population health. Public health policy and advocacy initiatives such as a sugar tax and banning junk food advertisements should be prioritized to potentially reduce a significant proportion of cases with either condition. Knowledge Transfer Statement: The reported findings greatly consolidated evidence of detrimental effects of sugars intake on child oral health and overweight and obesity, some of the most prevalent chronic conditions in children. Evidence on population impact of sugars intake is directly informative to policy makers and the public about the potential impact of population-based programs targeting sugars intake to prevent dental caries and overweight and obesity

How readable are Australian paediatric oral health education materials?

Background: The objective of this study was to analyse the readability of paediatric oral health education leaflets available in Australia. Methods: Forty paediatric oral health education materials were analysed for general readability according to the following parameters: Thoroughness; Textual framework; Terminology; and Readability (Flesch-Kincaid grade level (FKGL), Gunning Fog index (Fog) and Simplified Measure of Gobbledygook (SMOG)). Results: Leaflets produced by the industry were among the hardest to read with an average readability at the 8th grade (8.4 ± 0.1). The readability of leaflets produced by the commercial sector was at the 7th grade (7.1 ± 1.7) and the government at the 6th grade (6.3 ± 1.9). The FKGL consistently yielded readabilities 2 grades below the Fog and SMOG indexes. In the content analyses, 14 essential paediatric oral health topics were noted and Early Childhood Caries (ECC) was identified as the most commonly used jargon term. Conclusion: Paediatric oral health education materials are readily available, yet their quality and readability vary widely and may be difficult to read for disadvantaged populations in Australia. A redesign of these leaflets while taking literacy into consideration is suggested

Social inequality in dental caries and changes over time among Indigenous and non‐Indigenous Australian children

Abstract Objective: This paper describes and compares magnitudes of socioeconomic (SES) inequalities in oral health among Indigenous and non‐Indigenous children over a 10‐year period. Methods: We analysed annual oral health survey data from NSW, NT and SA. Data were extracted for time period 1 (2000–2002, N=215,317) and time period 2 (2007–2010, N=34,495). Oral health outcomes were untreated decayed deciduous teeth (dt) and cumulative dental caries experience (dmft). Postcode‐level Socioeconomic Index for Areas was used to assess SES. Age standardisation and complex survey weights were used. Indices of socioeconomic inequality in health (Slope Index of Inequality, Relative Index of Inequality, Absolute and Relative Concentration Index) were used to quantify inequality in dental caries and its changes over time. Results: Oral health outcomes deteriorated in both Indigenous and non‐Indigenous populations over time. Indigenous children experienced higher levels of disease at both times. Untreated dt increased in both populations. The cummulative disease (dmft) increased at higher rate among children in low‐SES areas in both populations. Over time, there was an increase in socioecononomic inequalities in dmft in all children and in dt in non‐Indigenous children. Conclusion: Area‐level socioeconomic inequality in child oral health has widened due to deterioration in low‐SES children

Researching the perceptions of Vietnamese migrant caregivers for an oral health literacy study in Australia

This case study focuses on gaining access to Vietnamese migrant caregivers in South Western Sydney, Australia, for an oral health literacy study. We chose to approach this topic from the phenomenological framework which provided us with an opportunity to examine and understand non-English-speaking parents'/caregivers' perceptions related to existing oral health promotion materials. The case study starts by giving a brief overview of the research project and the complexities of carrying out a research project with migrant populations, followed by detailed description of the research process, access to participants, stakeholder involvement, building trust with participants, and data collection methods. We were able to obtain in-depth understanding using multiple data collection methods such as participant observation and indepth interviews. By applying maximum variation technique in a stratified purposive sampling, we managed to capture a comprehensive sample of Vietnamese migrant caregivers in Greater Western Sydney. Therefore, we therefore recommend employing multiple qualitative techniques to conduct qualitative research with participants from non-Englishspeaking backgrounds

Development and internal validation of the SMILE-FSS - A Free Sugars Screener for Australian children aged 2 and 5 years.

OBJECTIVE: To develop and internally validate a Free Sugars Screener (FSS) for Australian children aged 2 and 5 years. DESIGN: Using data collected from a 99-item (2-year-olds) and 98-item (5-year-olds) Food Frequency Questionnaire in the Study of Mother's and Infant's Life Events affecting oral health (SMILE-FFQ), a regression-based prediction modelling approach was employed to identify a subset of items that accurately estimate total free sugars intake (FSI). The predictors were grams of free sugars (FSg) for individual items in the SMILE-FFQ and child's age and sex. The outcome variable was total FSI per person. To internally validate the SMILE-FSS items, the estimated FSg was converted to percent energy from free sugars (%EFS) for comparison to the WHO free sugars guideline categories (<5%, 5-<10%, ≥10%EFS) using cross-classification analysis. SETTING: Australia. PARTICIPANTS: 858 and 652 2- and 5-year-old children, respectively, with complete dietary (<5% missing) and sociodemographic data. RESULTS: 22- and 26-items were important in predicting FSI at 2 and 5 years, respectively. Items were similar between ages with more discretionary beverage items (e.g., sugar-sweetened beverages) at 5 years. %EFS was overestimated by 4.4% and 2.6%. Most children (75% and 82%) were categorised into the same WHO free sugars category with most (87% and 95%) correctly identified as having <10%EFS in line with the WHO recommendation. CONCLUSIONS: The SMILE-FSS has good internal validity and can be used in research and practice to estimate young Australian children's free sugars intake and compare to the WHO free sugars guidelines to identify those 'at risk'