The aim of this study was to identify risk determinants leading to early childhood caries (ECC) and visible plaque (VP) in toddlers. Data for mother-child pairs participating in the Growing Up in Singapore towards Healthy Outcomes (GUSTO) birth cohort were collected from pregnancy to toddlerhood. Oral examinations were performed in 543 children during their clinic visit at 24 months to detect ECC and VP. Following logistic regression, ECC and VP were jointly regressed as primary and secondary outcomes, respectively, using the bivariate probit model. The ECC prevalence was 17.8% at 2 years of age, with 7.3% of children having a VP score >1. ECC was associated with nighttime breastfeeding (3 weeks) and biological factors, including Indian ethnicity (lower ECC rate), higher maternal childbearing age and existing health conditions, maternal plasma folate <6 ng/mL, child BMI, and the plaque index, while VP was associated with psychobehavioral factors, including the frequency of dental visits, brushing frequency, lower parental perceived importance of baby teeth, and weaning onto solids. Interestingly, although a higher frequency of dental visits and toothbrushing were associated with lower plaque accumulation, they were associated with increased ECC risk, suggesting that these established caries-risk factors may be a consequence rather than the cause of ECC. In conclusion, Indian toddlers may be less susceptible to ECC, compared to Chinese and Malay toddlers. The study also highlights a problem-driven utilization pattern of dental services (care sought for treatment) in Singapore, in contrast to the prevention-driven approach (care sought to prevent disease) in Western countries.

No abstract

Introduction: Chronic periodontal disease is a highly prevalent dental condition affecting tooth-supporting tissues. Scientific evidence is accumulating on links between periodontal disease and various systemic conditions. This narrative review provides a holistic yet succinct overview that would assist medical practitioners to deliver integrated care for better clinical outcomes. Method: Scientific evidence on associations between periodontal disease and systemic conditions was synthesised and critically appraised. Key findings of latest prospective cohort studies, randomised clinical trials, and meta-analysis were closely assessed and compiled. Results: A bidirectional relationship has been established, indicating that diabetes and periodontal disease are closely linked and amplify one another, if not successfully controlled. Existing evidence also supports the associations of periodontal disease with cardiovascular diseases and adverse pregnancy outcomes. Successful treatment of periodontal disease and dental prophylaxis has been shown to improve clinical outcomes in these systemic conditions. Other systemic conditions associated with periodontal disease include respiratory diseases, Alzheimer’s disease, rheumatoid arthritis and chronic kidney disease. Although the underlying mechanisms remain to be fully elucidated, it is generally accepted that the inflammatory burden of chronic periodontal disease has an important systemic impact. Conclusion: Oral-systemic links are multifaceted and complex. While evidence linking periodontal disease with a variety of systemic conditions is still emerging, the nature of the relationship is becoming clearer. The updated understanding of these associations warrants the attention of medical experts and policymakers for a concerted effort to develop a patient-centric, integrated model for the treatment of comorbid dental and medical conditions. Keywords: Cardiovascular diseases, dentistry, diabetes, oral health, periodontal diseases, systemic diseases

Risk assessment/prediction models built using pre-GA data may be promising in identifying high-risk children prone to post-GA caries recurrence, although future internal and external validation of predictive models is warranted.

Objectives Numerous caries risk assessment tools have been proposed in the literature, with few validated in preschool children especially those receiving oral rehabilitation under general anaesthesia (GA). Past caries experience, the best predictor thus far, may not be a reliable indicator after effective clinical intervention. Hence, this longitudinal study was aimed to explore the potential role of plaque pH in predicting future caries incidence after GA among preschool children. Methods Oral examination, plaque pH measurements and questionnaire survey were performed, among pre‐schoolers indicated for GA, at baseline (n = 92), 6‐month (6M; n = 83), 12‐month (12M; n = 79) and 24‐month (24M; n = 66) recall visits after GA. Multivariable logistic regression and receiver‐operating characteristic analysis were performed to evaluate the predictive value of models with plaque pH and past caries experience. Results Individuals with low resting plaque pH at 6M and 12M were shown to be at high risk of 1‐year caries incidence at 12M [relative risk (RR) 1.41, 95% confidence interval (CI) 1.09–1.48] and 24M (RR 1.61, 95% CI 1.22–1.73) recall visit, respectively. Moreover, plaque pH demonstrated a statistically significant predictive value in the 12M and 24M models (12M/24M: 85%/77%) compared with past caries experience, which was not a significant predictor in both models (both P > 0.05). Conclusions Plaque pH may be a promising prognostic and predictive marker for early identification of high‐risk children undergoing oral rehabilitation under GA.