Untreated severe dental decay: a neglected determinant of low Body Mass Index in 12-year-old Filipino children

Contains fulltext : 98500.pdf (publisher's version ) (Open Access)BACKGROUND: Dental decay is the most common childhood disease worldwide and most of the decay remains untreated. In the Philippines caries levels are among the highest in the South East Asian region. Elementary school children suffer from high prevalence of stunting and underweight.The present study aimed to investigate the association between untreated dental decay and Body Mass Index (BMI) among 12-year-old Filipino children. METHODS: Data collection was part of the National Oral Health Survey, a representative cross-sectional study of 1951 11-13-year-old school children using a modified, stratified cluster sampling design based on population classifications of the Philippine National Statistics Office. Caries was scored according to WHO criteria (1997) and odontogenic infections using the PUFA index. Anthropometric measures were performed by trained nurses. Some socio-economic determinants were included as potential confounding factors. RESULTS: The overall prevalence of caries (DMFT + dmft > 0) was 82.3% (95%CI; 80.6%-84.0%). The overall prevalence of odontogenic infections due to caries (PUFA + pufa > 0) was 55.7% (95% CI; 53.5%-57.9%) The BMI of 27.1% (95%CI; 25.1%-29.1%) of children was below normal, 1% (95%CI; 0.5%-1.4%) had a BMI above normal. The regression coefficient between BMI and caries was highly significant (p 0) as compared to those without odontogenic infections had an increased risk of a below normal BMI (OR: 1.47; 95% CI: 1.19-1.80). CONCLUSIONS: This is the first-ever representative survey showing a significant association between caries and BMI and particularly between odontogenic infections and below normal BMI. An expanded model of hypothesised associations is presented that includes progressed forms of dental decay as a significant, yet largely neglected determinant of poor child development

Fear of Birth Defects Is a Major Barrier to Soil-Transmitted Helminth Treatment (STH) for Pregnant Women in the Philippines

The World Health Organization recommends anthelminthic treatment for pregnant women after the first trimester in soil-transmitted helminth (STH) endemic regions to prevent adverse maternal-fetal consequences. Although studies have shown the high prevalence of infection in the Philippines, no research has evaluated deworming practices. We hypothesized that pregnant women are not receiving deworming treatment and we aimed to identify barriers to World Health Organization guideline implementation. We conducted key informant interviews with local Department of Health (DOH) administrators, focus group discussions with nurses, midwives, and health care workers, and knowledge, attitudes, and practices surveys with women of reproductive age to elicit perspectives about deworming during pregnancy. Key informant interviews revealed that healthcare workers were not deworming pregnant women due to inadequate drug supply, infrastructure and personnel as well as fear of teratogenicity. Focus group discussions showed that healthcare workers similarly had not implemented guidelines due to infrastructure challenges and concerns for fetal malformations. The majority of local women believed that STH treatment causes side effects (74.8%) as well as maternal harm (67.3%) and fetal harm (77.9%). Women who were willing to take anthelminthics while pregnant had significantly greater knowledge as demonstrated by higher Treatment Scores (mean rank 146.92 versus 103.1, z = −4.40, p<0.001) and higher Birth Defect Scores (mean rank 128.09 versus 108.65, z = −2.43, p = 0.015). This study concludes that World Health Organization guidelines are not being implemented in the Philippines. Infrastructure, specific protocols, and education for providers and patients regarding anthelminthic treatment are necessary for the successful prevention of STH morbidity and mortality among pregnant women

Issues arising following a referral and subsequent wait for extraction under general anaesthetic: impact on children

BACKGROUND: Untreated caries in young children can result in a referral for extraction in hospital under general anaesthetic (GA). This study aims to explore the impact of caries during the ensuing wait for GA on children resident in the North West of England. METHODS: The study involved 456 respondents referred to six hospitals in the Northwest of England. Over a two-month period each of these children/ families completed a questionnaire and gave permission to access their referral and consultation notes. RESULTS: Children (6.78 years old: 1.50 to 16.42) had on average five teeth extracted (ranging from one to a full clearance, with all teeth removed). Sixty seven per cent of parents reported their child had been in pain, 26% reported schools days being missed and 38% having sleepless nights. The average time from referral to operation was 137 days. Results indicated that children could be in discomfort during their wait, as pain was experienced, on average, 14 days before the operation. Wait time significantly predicated the number of sleepless nights b = .004, t(340) = 2.276, p = .023. CONCLUSIONS: It is clear that pain, sleepless nights and missed school are a feature during a wait for dental GA and can be exacerbated by an extended wait. These data support the need for not only effective prevention of caries within primary care to reduce wait times and experience of GA but also effective management of pain and infection during a prolonged wait for treatment

Associations between oral health-related impacts and rate of weight gain after extraction of pulpally involved teeth in underweight preschool Filipino children

Background Severe dental caries in young children is associated with underweight and failure to thrive. One possible mechanism for severe caries affecting growth is that the resulting pain and discomfort influences sleeping and eating, and that affects growth and weight. The objective of this study was to assess whether rate of weight gain after extraction of severely decayed teeth in underweight preschool Filipino children was related to reductions in oral health-related impacts and dental pain from severe dental caries affecting eating and sleeping. Methods Data are from the Weight Gain Study, a stepped wedge cluster randomized clinical trial where underweight Filipino children with severe dental decay had their pulpally involved teeth extracted. Day care centers were randomly divided into two groups; A and B. Group A children received treatment first and Group B children were treated four months after Group A. Clinical oral examinations used WHO criteria and the pufa-index. Self-reported oral health-related impacts and anthropometric measurements were collected for both groups at baseline, four months after treatment of Group A children and four months after treatment of Group B children. Weight-for-age z-scores were calculated using 2006 and 2007 WHO standards. Data were converted to a one-group pre-test post-test study design, where all children received treatment. Associations between changes in oral health-related impacts and weight-for-age z-scores after dental treatment were assessed. Results Data on 145 children (mean age 61.4 months) were analyzed. There was a significant association between oral health-related impacts and rate of weight gain after extraction of pulpally involved teeth (p=0.02). Children free of impacts on sleeping related to having severely decayed teeth extracted gained significantly more weight compared to children who reported sleeping problems after dental treatment (p<0.01). Conclusions After extraction of severely decayed teeth in underweight Filipino children, levels of oral health-related impacts were associated with rate of weight gain. Decreases in oral health impacts on sleeping appeared to be most strongly associated with weight gain

Preparation of N,N-bridged, nitrogen-substituted carbacyclic indolocarbazoles for use in pharmaceutical compositions as protein kinase inhibitors

This invention relates to the prepn. of novel carbacyclic indolocarbazoles, such as I [R1 = NR13R14; R2 = H, CN, alkyl, aryl, heteroaryl, acyl, carboxy, carboxamido; R1R2 = spiro nitrogen contg. heterocycle, such as spirohydantoyl; R3 = H, OR13, OCOR13, OCONHR13, OCONR13R14; R1R3 = fused heterocycle, such as -OSO2O-, and R2 = H; R4, R6 = H, CN, halogen, alkyl, alkenyl, alkynyl, aryl, heteroaryl, alkoxy, acyl, carboxy. carboxamido, etc.; R8R9, R10R11 = H2, O, S; R8 = H, R9 = OH; R10 = H, R11 = OH; R12 = H, alkyl, cycloalkyl, benzyl aryl heteroaryl, acyl, carboxy, etc.; R13, R14 = H, alkyl, cycloalkyl, acyl, aryl, etc.], for therapeutic use as protein kinase inhibitors with advantageous pharmaceutical properties. These indolocarbazoles are claimed for use in the treatment of CNS diseases, non-insulin-dependent diabetes mellitus, acute stroke and other neuro-traumatic injuries, diabetes mellitus, malignant diseases, diseases caused by malfunctioning of specific signaling pathways and neurodegenerative diseases, such as Alzheimer's disease. Thus, indolocarbazole II (R1 = \u3b2-NH2, R2 = \u3b1-H, R3 = H) was prepd. starting from cyclopentadiene, 4-methoxybenzyl amine, dichloromaleic anhydride, and indole via a multistep synthetic sequence which included a reaction of 12,13-dihydro-6-[(4-methoxyphenyl)methyl]-5H-indolo[2,3-a]pyrrolo[3,4-c]carbazole-5,7(6H)-dione with cis-3,5-dibromocyclopentene using NaH in THF to form II (R1R3 = bond, R2 = H) in 90.4% yield. II (R1R3 = bond, R2 = H), which contains the target ring skeleton, further underwent an hydroxylation sequence using BH2.THF followed by NaOH and H2O2 to form alc. II (R1 = \u3b1-OH, R2 = \u3b2-H, R3 = H), oxidn. of the alc. to the corresponding ketone II (R1R2 = O, R3 = H), reaction of the ketone with benzylamine to give N-benzyl amine II (R1 = \u3b2-NHCH2Ph, R2 = \u3b1-H, R3 = H) and, finally, N-debenzylation to give the desired indolocarbazole II (R1 = \u3b2-NH2, R2 = \u3b1-H, R3 = H). The prepd. indolocarbazoles were assayed for inhibiting the activity of a group of protein kinases consisting of extracellular signal regulated kinase 2 (ERK2), protein kinase A (PKA), protein kinase C (PKC) and glycogen synthase kinase 3\u3b2 (GSK3\u3b2)