@article{ec7412cc62ac4ae68248cdb89a8027cd,
title = "Developmental defects of enamel increase caries susceptibility in Chinese preschool children",
abstract = "Objectives: The present epidemiological study aimed to compare the prevalence and severity of developmental defects of enamel (DDE) and dental caries between urban and suburban Chinese preschool children. Methods: A total of 1351 3- to 6-year-old children were invited to participate in this study and received dental examinations. A modified DDE index was used to assess the prevalence and severity of DDE. The dental caries diagnosis was based on the World Health Organization (WHO) health survey methods for field studies and was recorded using the decayed, missing and filled tooth (dmft) index. The caries status was further classified as caries or severe caries according to a modification of the American Academy of Pediatric Dentistry definition. Results: Overall, the DDE prevalence was 48.3% among the 1351 preschool children. The DDE prevalence was higher in innercity children (54.1%) than in suburban children (42.0%; P < 0.001). In contrast, the suburban children had a higher prevalence of dental caries (65.2% vs 57.5%; P = 0.004) and a higher mean dmft score (3.5 ± 4.2 vs 2.9 ± 3.8; P = 0.005) than the innercity children. Only 23.9% of the children were free of both DDE and caries. The caries risk increased significantly and independently as DDE severity increased (linear trend, 95% confidence interval = [1.32, 1.69], age [1.60, 1.88], urban residence [1.18, 2.15] and breastfeeding experience [1.04, 1.60]) after controlling for other demographic risk factors. Conclusions: The study provides new evidence that DDE is a significant contributing factor for the highly prevalent and progressive dental caries observed in Chinese preschool children. These results highlight the importance of including DDE in caries risk assessments.",
keywords = "dental caries, developmental defect of enamel, epidemiology, preschool children, risk assessments",
author = "Yihong Li and Xi Chen and Shuli Chen and Janal, {Malvin N.} and Haim Sarnat",
note = "Funding Information: This study was supported by research funds from the Joint Key Projects of Shanghai Pudong New District Commission of Health and Family Planning (PW2015D-6, Chen) and the New York University College of Dentistry. The authors thank Dr. Yan Wang of the Shanghai Stomatological Hospital and Dr. Xiping Feng, School of Stomatology, Jiaotong University, for their support, and Elizabeth I. Wang, New York University College of Dentistry for her assistant. Funding Information: FI GU RE 3 The Association Between Developmental Defects of Enamel (DDE) and Caries Outcomes. The Stacked Bar Chart Illustrates the Distribution of the Caries Status in Children with Different Types of DDE. As the DDE Severity Increased from Discoloration (1) to Severe Enamel Defects (5), More Children Experienced Caries, Especially Severe Caries. The Association was Further Supported by the Logistic Regression Analysis. The Model Demonstrated that Children who had DDE Ratings of 1 or Greater were Associated with an Increased Odds Ratio (OR) for Caries (Present or Absent) Relative to those with a DDE Rating of 0 (P < 0.001) highest in China.7,8,14 The recently completed Forth National Oral Health Survey and the Global Burden of Disease Study reported a caries prevalence of 66.0% among 5‐year‐old children in Shanghai.15 There are three major dental schools and hospitals, including a specialized hospital centre for preventive dentistry, located in the Shanghai metropolitan area. Substantial preventive efforts have been provided by local dental professionals, including the establishment of a dental public healthcare network, providing fluoride varnish treatment and oral health educational programmes to preschool children and increasing utilization of fluoride toothpaste in the community.14 Although a decline in caries has been observed in recent years, the caries prevalence of 61.1% found in this study remains unacceptably high. Furthermore, the present study found that 27.2% of the preschool children had severe caries, which was higher than the disease rate reported for children living in other regions of China.51,52 Although the specific disease aetiology responsible for the persistently high disease rate among Chinese children is not fully understood, a number of epidemiological studies have suggested a list of risk factors, including DDE, in addition to poor oral hygiene, inappropriate feeding practices, a lack of oral health knowledge, increased sugar consumption and a high level of mutans streptococci colonization (cariogenic microbes) in the oral cavity, which have been associated with the early‐onset and aggressive progression of the disease.16,53-57 However, DDE is not included in regular caries risk assessments in dental clinics due to a lack of specific tools for early diagnosis. Publisher Copyright: {\textcopyright} 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",
year = "2018",
month = oct,
doi = "10.1111/cdoe.12403",
language = "English (US)",
volume = "46",
pages = "500--510",
journal = "Community Dentistry and Oral Epidemiology",
issn = "0301-5661",
publisher = "Blackwell Munksgaard",
number = "5",
}