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BACKGROUND: Severe early childhood caries (S-ECC) is recognized as a significant chronic disease which affects the quality of life starting at very young ages and has a very rapid evolution towards pulp complication and loss of dental tissue. Children with a high caries index DMFT are more likely to develop high levels of dental anxiety, which will influence the degree of cooperation during dental procedures. Emotions play an important role in the psychosomatic development of children, and all the factors that contribute to the modeling of these emotional states must be known and taken into consideration. AIM: The aim of this study was to assess the association between dental anxiety in children with S-ECC and the color preferences for the components of the dental environment to reduce the levels of dental anxiety during medical visits. MATERIAL AND METHOD: For this study, 91 children between 3 and 6 years of age diagnosed with S-ECC were selected from the Pediatric Dentistry Department of UMFST from Targu Mures and from a private dental office. The level of dental anxiety was determined by measuring the pulse rate, and a questionnaire was completed to establish the color preferences for the dental office environment and the dentist's attire. For this purpose, six different colors and their variants with three shades less intensity were chosen by using RGB (Red, Green, and Blue) identification codes for each color. RESULT: The results showed that there was a statistically significant difference between the age of the subjects and dental anxiety levels, but there was no significant correlation between the DMFT score and dental anxiety. Also, the results showed that there was no significant difference between girls and boys when choosing the colors preferred by them for the dental office, but when comparing the colors that represented happiness, significant statistical difference was found between the girls' and boys' groups (p = 0.0039). For all the subjects, the colors associated with happiness were light yellow and pink, while the colors associated with anxiety were red and dark blue. CONCLUSION: The data obtained showed that dental anxiety is strongly influenced by age, and an important role in inducing positive emotions is played by the dental environment if dressed in specific colors in order to reduce dental anxiety and create familiar conditions, especially for young children with S-ECC.

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Background and objectives Numerous studies have shown that there is evidence that genetic factors contribute in different ways to the occurrence of caries lesions, and the multiple differences in the human leucocytes antigen (HLA) gene patterns play an important role in the body's immune response. Therefore, this study aimed to evaluate the association between some HLA class II alleles (HLA-DR4, HLA-DQ2, HLA-DQ4) and early childhood caries (ECC) occurrence in Syrian children. Materials and methods The study included 80 children aged three to six, divided into two groups: Group 1 (n = 40) being severe early childhood caries (S-ECC) children (deft ≥ 10) and Group 2 (n = 40) being free caries children (deft = 0). The genomic DNAs were extracted and collected by taking a buccal swab using a sterile metal strip and were amplified by polymerase chain reaction-single specific primer (PCR-SSP) and then HLA-typing was performed for all alleles. Results There were no statistically significant differences in the frequency of occurrence of S-ECC, HLA-DR4, and HLA-DQ2 alleles (p = 0.626, 0.256 respectively), while the incidence of S-ECC was associated with the DQ4 allele (p = 0.012). Conclusion HLA class II molecules may play a crucial role in predisposing to ECC, since positive HLA-DQ4 may enhance the chance of developing ECC. However, no association were found between (HLA-DR4 and HLA-DQ2) and ECC.

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Background: Primary dental caries is the most prevalent oral disease among preschool children, which can cause severe damage to teeth and even affect the mental well-being of children. Various studies have demonstrated that the oral microbiome plays a pivotal role in the onset and development of dental caries. However, it remains uncertain about the key microbial markers associated with caries, owing to the limited evidence. Methods: Fifteen S-ECC children and fifteen healthy controls were selected from three-year-old children in this study. Their clinical data and oral saliva samples were collected. Shotgun sequencing was conducted to investigate the microbial differences and the relevant functions between the two groups. Results: We observed no apparent difference in oral microbial community diversity between the two groups. Still, at the genus/species levels, several characteristic genera/species such as Propionibacterium, Propionibacterium acidifaciens, Prevotella denticola, Streptococcus mutans and Actinomyces sp. oral taxon 448/414 increased significantly in S-ECC children, compared with the oral health group. Furthermore, we found that functional pathways involving glycolysis and acid production, such as starch and sucrose metabolism, fructose and mannose metabolism, glycolysis/gluconeogenesis, were prominently up-regulated in the high-caries group. Conclusions: Our study showed that dental caries in children were associated with the alterations in the oral microbiota at the composition and functional levels, which may potentially inspire the exploration of microbial diagnosis or therapeutic treatments.

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BACKGROUND: Severe-early childhood caries (S-ECC) a global problem of significant concern, commonly manifest on the occlusal, and proximal surfaces of affected teeth. Despite the major ecological differences between these two niches the compositional differences, if any, in the microbiota of such lesions is unknown. METHODS: Deep-dentine caries samples from asymptomatic primary molars of children with S-ECC (n 19) belonging to caries-code 5/6, (ICDAS classification) were evaluated. Employing two primer pools, we amplified and compared the bacterial 16S rRNA gene sequences of the seven hypervariable regions (V2-V4 and V6-V9) using NGS-based assay. RESULTS: Bray-Curtisevaluation indicated that occlusal lesions (OL) had a more homogeneous community than the proximal lesions (PL) with significant compositional differences at the species level (p = 0.01; R- 0.513). Together, the occlusal and proximal niches harbored 263 species, of which 202 (76.8%) species were common to both , while 49 (18.6%) and 12 (4.6%) disparate species were exclusively isolated from the proximal and occlusal niches, respectively. The most commonl genera at both niches included Streptococcus, Prevotella, and Lactobacillus. S. mutans was predominant in PL (p ≤ 0.05), and Atopobium parvulum (p = 0.01) was predominant in OL. CONCLUSIONS: Distinct differences exist between the caries microbiota of occlusal and proximal caries in S-ECC.

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Purpose: Severe early childhood caries (S-ECC) is a microbe-mediated disease with tooth hard tissue destruction. However, the role of the fungal community in various ecological niches of deciduous dental caries has not been fully elucidated. This study aimed to analyze the differences of mycobiome in diverse spatial niches with and without S-ECC. Method: A total of 48 samples were obtained from 8 S-ECC children (SE group) and 8 caries-free children (CF group) aged 4-5 years. Unstimulated saliva (S), healthy supragingival plaque (FMIX), mixed plaque from decayed teeth (SMIX) and carious lesion (DMIX) samples were collected. The ITS2 region of the fungi was amplified and sequenced using the Ion S5™XL platform. Results: A total of 281 species were identified. Candida albicans showed relatively higher abundance in S-ECC children, while Alternaria alternata and Bipolaris sorokiniana were more enriched in CF group. In this study, the relative abundance of C. albicans in CF.FMIX (0.4%), SE.FMIX (12.5%), SE.SMIX (24.0%), and SE.DMIX (37.2%) increased successively. Significant differences of fungal species richness and diversity were observed between SE.FMIX-SE.SMIX, SE.FMIX-SE.DMIX (P < 0.05). Conclusions: The diversity of fungal communities in S-ECC children showed significant differences in various spatial niches of primary teeth. The richness of C. albicans was closely related to the caries states and depth, suggesting that it may play a crucial role in caries pathogenicity.

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Introduction: The retentive niches of deep caries lesions have a distinct biome. Methods: We evaluated the site-specific (occlusal and proximal) Candida-biome of Severe-Early Childhood Caries (S-ECC) in 66- children (132 lesions). Asymptomatic primary molars fitting the definition of the International Caries Detection and Assessment-(ICDAS)-caries-code 5/6 were analyzed. Deep-dentinal sampling and simultaneous assessment of pH were performed. Clinical isolates were speciated using multiplex-PCR and evaluated for their acidogenic and aciduric potential.Results: Surprisingly, a high prevalence of Candida species (72.7%), either singly or in combination, was noted from both the proximal and occlusal cavities. C. tropicalis was the most prevalent species (47%; 34/72), followed by C. krusei (43.1%; 31/72) and C. albicans (40.3%; 29/72), with C. glabrata being the least (9.7%; 7/72). Over 45% low-pH niches (pH <7) of both sites yielded either dual or triple species of Candida. Genotyping revealed three distinct C. albicans genotypes (A, B, and C) with (14/29; 48.3%) of strains belonging to Genotype A. All four evaluated Candida species exhibited acidogenic and aciduric potential, C. tropicalis being the most potent.Conclusion: This, the first report of the high-density, multispecies, yeast colonization of deep-dentinal lesions in S-ECC, suggests that the Candida-biome plays a significant etiologic role in the condition, possibly due to their profound acidogenicity in milieus rich in dietary carbohydrates.

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OBJECTIVE: The study aimed to assess the association between parental-reported vitamin D supplementation and caries in a national sample of 3-year-olds in Poland. MATERIALS AND METHODS: A total of 1900 children, representing all provinces of Poland, were invited. The questionnaires concerned vitamin D supplementation, socio-demographics, and oral health behaviours. Based on dental examination, caries scores (dmft/dmfs), prevalence of early childhood caries (ECC) and severe ECC (S-ECC) were calculated. The Spearman's correlation, linear regression and logistic regression were used to assess the association between various factors and caries (p < 0.05). RESULTS: A total of 1638 children were tested. Of this number, 99.1% infants were supplemented with vitamin D. Supplementation had been continued seasonally in 55.2% children. ECC/S-ECC prevalence were significantly lower in children receiving vitamin D (ECC 38.3% vs. 44.7%, OR = 0.77; S-ECC 20.5% vs. 27.1%, OR = 0.69; p < 0.05). Mean dmft/dmfs were lower in those with supplementation (1.54 ± 2.72 vs. 2.24 ± 3.55; 2.40 ± 5.56 vs. 3.72 ± 7.56, respectively; p < 0.001). After controlling for confounding factors, supplementation was not significantly associated with caries; only dt/ds were still associated. Maternal education, sweetened beverages before bedtime, bottle use were significantly associated with S-ECC. CONCLUSIONS: Lower caries prevalence was observed in those with vitamin D supplementation. The association between parental-reported vitamin D and ECC/S-ECC was not significant in Polish children. Decayed teeth and supplementation were still associated. Dietary habits can modify the association with caries. CLINICAL RELEVANCE: There may be an association between vitamin D supplementation and lower caries in children. Parents should supplement their children during periods of significant growth and development.

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BACKGROUND: The microbiome of Severe-Early Childhood Caries (S-ECC), is characterized by an ecosystem comprising bacterial and fungal species, with a predominance of Candida species. Hence, an anti-cariogen effective against both bacteria and fungi would be valuable in the management of S-ECC. Here we evaluate the antifungal effect of silver diamine fluoride (SDF) against 35-clinical yeast isolates (Ten-each of C. albicans, C. krusei, C. tropicalis and five C. glabrata strains) from dentinal caries-lesions from S-ECC. RESULTS: Disc-diffusion and time-kill assays as well as MIC50 and MIC90 evaluations against therapeutic concentrations confirmed the broad-spectrum anti-candidal potency of SDF. Ultrastructural images revealed morphologic aberrations of yeast-cell walls on exposure to SDF. All C. krusei and C. glabrata isolates were significantly more sensitive to SDF, relative to the standard antifungal fluconazole. Further, SDF appears to effectively abrogate filamentation of C. albicans even at very low concentrations. CONCLUSIONS: Our data, for the first time, elucidate the antifungal potency of SDF, in addition to its known antibacterial activity, in the management of S-ECC.

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The protected niche of deep-caries lesions is a distinctive ecosystem. We assessed the Candida biome and its cariogenic traits from dentin samples of 50 children with severe-early childhood caries (S-ECC). Asymptomatic, primary molars belonging to International Caries Detection and Assessment-ICDAS caries-code 5 and 6 were analyzed, and C. albicans (10-isolates), C. tropicalis (10), C. krusei (10), and C. glabrata (5) isolated from the lesions were then evaluated for their biofilm formation, acidogenicity, and the production of secreted hydrolases: hemolysins, phospholipase, proteinase and DNase. Candida were isolated from 14/43 ICDAS-5 lesions (32.5%) and 44/57 ICDAS-6 lesions (77.2%). Compared to, ICDAS-5, a significantly higher frequency of multi-species infestation was observed in ICDAS-6 lesions (p=0.001). All four candidal species (above) showed prolific biofilm growth, and an equal potency for tooth demineralization. A significant interspecies difference in the mean phospholipase, as well as proteinase activity was noted (p < 0.05), with C. albicans being the predominant hydrolase producer. Further, a positive correlation between phospholipase and proteinase activity of Candida-isolates was noted (r = 0.818, p < 0.001). Our data suggest that candidal mycobiota with their potent cariogenic traits may significantly contribute to the development and progression of S-ECC.

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BACKGROUND: Early Childhood Caries (ECC) is a chronic childhood disease affecting children worldwide. Severe cases of ECC can significantly affect child's Oral Health Related Quality of Life (OHRQoL) owing to its consequences. The purpose of present study was to find out association between severe early childhood caries (s-ECC) and OHRQoL of children and their parents/care-givers visiting a Government dental hospital in Delhi, India. METHODS: Data was collected from a hospital - based sample of 454 child-parent pair. OHRQoL of the child and parent was assessed using the Hindi version of Early Childhood Oral Health Impact Scale (Hi-ECOHIS). Children with s-ECC were identified as per definition given by American Academy of Paediatric Dentistry. Chi square test and Binary regression analysis were used to evaluate the effect of s-ECC on OHRQoL and to study role of various socio demographic factors. RESULTS: The prevalence of s-ECC was 77.1% (n = 350).The mean dmft index score was 5.67 ( ±3.72) and dmfs was 11.21 ( ±11.03). The mean overall ECOHIS score was 7.02 ( ±5.47). Child impact items such as Pain, fever, caries associated swelling along with difficulty in eating food, halitosis, disturbed sleep, frequent absenteeism from school were found to be more significantly more frequent in children with s-ECC than ECC. Children with bottle-feeding habit of more than one year, having fewer siblings, and whose parents belong to upper socio economic class were at higher odds of suffering from s-ECC.Conclusion: s-ECC has significantly more detrimental impact on the OHRQoL of children and their parents in comparison to ECC.

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OBJECTIVE: To evaluate the cost-effectiveness of comprehensive oral health care for severe early childhood caries (S-ECC) in urban Beijing, China. METHODS: A randomised cluster sampling method was used to select 187 children aged 3 to 5 years with S-ECC from two kindergartens in urban Beijing. Comprehensive oral health care and questionnaires for the parents/guardians were provided to the test group, while an oral health examination and questionnaires for the parents/guardians were provided to the control group. Data were collected and a Markov model was established for a cost-effectiveness analysis. RESULTS: One year later, 614 RMB yuan and 184 RMB yuan were needed for the control and test group, respectively, to reduce one average decayed tooth. The cost for the test group was continuously lower than for the control group during the 4-year simulation. The cumulative cost for the test group was lower than for the control group when the model was circulated for more than 1.5 years. At this time, the change of decayed teeth was stable in the test group. CONCLUSION: Comprehensive oral health care had extraordinary cost-effectiveness for S-ECC. The optimal time to process S-ECC may be after 1.5 years.

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BACKGROUND: Severe early childhood caries (s-ECC), which has quite high prevalence among children, is a widespread problem with significant impacts among both developing and developed countries. At present, it is widely known that no early detective techniques and diagnostic tests could have high sensitivity and specificity when using for clinical screening of s-ECC. In this study, we had applied magnetic bead (MB)-based matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) to screen distinctive candidate biomarkers of this disease, so as to establish protein profiles and diagnostic models of s-ECC. METHODS: Firstly, we used the technique mentioned above to detect specifically expressed peptides in saliva samples from ten children with s-ECC, separately at the time point of before, 1 and 4 weeks after dental treatment. Then a diagnostic model for s-ECC was established with the K nearest-neighbour method, which was validated in another six children in the next stage of study. After that, linear ion trap-orbitrap-mass spectrometry (LTQ-Orbitrap-MS) was performed to identify which of the proteins in saliva might be the origination of these peptides. RESULTS: We found that seven peptide peaks were significantly different when comparing the three time points, among them two were higher, while other five were lower in the pre-treatment s-ECC group compared with post-treatment. The sensitivity and specificity of the diagnostic model we built were both 83.3 %. Two of these peptides were identified to be segments of histatin-1, which was one important secretory protein in saliva. CONCLUSIONS: Hereby we confirmed that MB-based MALDI-TOF MS is an effective method for screening distinctive peptides from the saliva of junior patients with s-ECC, and histatin-1 may probably be one important candidate biomarker of this common dental disease. These findings might have bright prospect in future in establishing new diagnostic methods for s-ECC.

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BACKGROUND: Dental caries is the most prevalent chronic disease in early childhood in most communities worldwide. Several studies conducted in the Gulf Cooperation Council countries have documented a high prevalence of early childhood caries (ECC). To date, no studies have been conducted in Qatar to examine the prevalence of ECC and enamel developmental defects in preschool children. The present study aimed to determine the prevalence of ECC and enamel defects in preschool children aged four and five years attending kindergartens in Qatar. METHODS: A descriptive cross-sectional study was performed among 250 children randomly selected from 16 public kindergartens. Caries experience was measured using the World Health Organization caries criteria (dmft) for tooth rather than surface; enamel defects were scored by the modified developmental defects of enamel index. Descriptive statistics and Chi-Square test of relatedness were used. RESULTS: A response rate of 63 % was reported. The overall caries prevalence of the study sample was 89.2 %; 15.6 % of the examined children had ECC and 73.6 % had severe ECC. Developmental enamel defects were present in 39 % of children and 27 % had demarcated enamel opacities. CONCLUSION: The high rate of dental caries and enamel defects recorded in this study for this young age group has strongly emphasized the necessity of community-based preventive programs and professional care that should begin during pregnancy and in early childhood.

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BACKGROUND: Children who have severe early childhood caries (S-ECC) weigh significantly less than caries-free children. The association between S-ECC and weight suggests that its timely treatment at early stages may preserve general health, in addition to preventing pain and infection. OBJECTIVE: This study was conducted to evaluate whether children with untreated S-ECC had lower weight and height as compared with children with low caries and to evaluate whether full mouth rehabilitation of children with S-ECC resulted in the phenomenon of catch-up growth. MATERIALS AND METHODS: The weight and height of children with noncontributory medical histories and S-ECC (3-6 years) were compared with caries-free children, before and 6 months after full mouth dental rehabilitation. RESULTS: Prior to dental rehabilitation, children with S-ECC had significantly less weight and height than their comparison counterparts (p < 0.001). Following therapeutic intervention, the test group children exhibited catch-up growth in relation to weight, as there was no significant difference in the body weight of the test and control groups (p = 0.171). CONCLUSION: Comprehensive full mouth rehabilitation of children with S-ECC results in catch-up growth, thus improving the overall health of the child. How to cite this article: Sachdev J, Bansal K, Chopra R. Effect of Comprehensive Dental Rehabilitation on Growth Parameters in Pediatric Patients with Severe Early Childhood Caries. Int J Clin Pediatr Dent 2016;9(1):15-20.

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The purpose of this study was to investigate the toothbrushing habits and risk indicators among aboriginal children with severe early childhood caries (S-ECC). This was a cross-sectional purposive sampling study that included 281 aboriginal children aged 2 to 5 years living in remote regions in southern Taiwan. Participant received dental examinations and questionnaires that were completed by caretakers. From among the 281 participants, 238 children (84%) presented with S-ECC. A low-frequency toothbrushing habit among the children with S-ECC was associated with caretakers with low-frequency toothbrushing (P = .001). The odds ratio of a child using improper toothbrushing methods having a caretaker with a low brushing frequency was 3.45 (P = .0157). Low-frequency toothbrushing and improper toothbrushing methods were associated with S-ECC. The caretakers' brushing frequency was a risk indicator associated with the children's poor oral hygiene.

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Severe-early childhood caries (S-ECC) is a specific form of rampant decay of primary teeth in infants, characterized by aggressive tooth destruction. This multifactorial disease in young infants is associated with the frequent use of sweetened fluids and fermentable carbohydrates over extended periods, poor oral hygiene as well as high level of mutans streptococci infection. The disease control and restoration of severely decayed primary teeth in children with S-ECC remains a challenge to general as well as pediatric dentists. This article portrays the oral rehabilitation of a five and half-year-old girl presenting with S-ECC with an 18 months follow-up.