ORIGINAL RESEARCH


https://doi.org/10.5005/jp-journals-10015-2054
World Journal of Dentistry
Volume 13 | Issue 4 | Year 2022

Correlation between Early Childhood Caries and Maternal Oral Hygiene Status: A Cross-sectional Study in Vijayawada, Andhra Pradesh, India


Mahali Sai Divya1, Saraswati Srikanth Raju2, Pallamala Gowtham3

1Consultant Pedodontist, Suryapet, Telangana, India

2Department of Pedodontics, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Telangana, India

3Consultant Pedodontist, Hyderabad, Telangana, India

Corresponding Author: Saraswati Srikanth Raju, Department of Pedodontics, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda,Telangana, India, Phone: +91 9030912230, e-mail: srikanth1090@gmail.com

ABSTRACT

Aim: This study was undertaken to evaluate the extent of influence maternal oral hygiene status exert on ECC below 6-year-old children.

Materials and methods: The study was conducted in a random sample of 140 mother child pairs. A single calibrated examiner performed all clinical examinations under natural light using a mouth mirror and probe. Data such as the prevalence of caries in children, dental caries of the mothers was measured using DMFT index, plaque index (PI), and oral hygiene index (OHI) was obtained. The data was then tabulated and statistically analyzed.

Results: Out of the 140 samples, 103 (73.57%) children had ECC of which 5–6 year children were more prevalent (84%). The association between ECC and mother’s DMFT was significant (p = 0.0024). The correlation between ECC and mother’s PI was significant (p = 0.0156).

Conclusion: Maternal factors such as maternal dental caries and maternal oral hygiene status are important risk factors significantly associated with early childhood caries (ECC) in children. Clinicians should consider dental caries in the mother as a risk indicator for caries activity in children.

Clinical significance: Mother needs to be counseled regarding their oral hygiene maintenance, which ultimately helps to prevent ECC at the primordial level.

How to cite this article: Divya MS, Raju SS, Gowtham P. Correlation between Early Childhood Caries and Maternal Oral Hygiene Status: A Cross-sectional Study in Vijayawada, Andhra Pradesh, India. World J Dent 2022;13(4):336-340.

Source of support: Nil

Conflict of interest: None

Keywords: Children, Early childhood caries, Maternal oral hygiene

INTRODUCTION

Early childhood caries is defined as “the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child 71 months of age or younger.1 The cariogenic organisms implicated in ECC include mutans streptococci (MS) and Lactobacillus species. Vertical and horizontal transmission of MS from the mother or caregiver and other family members to the infant is the major route for MS infection in children.2,3 Once acquired, MS colonizes the surfaces of teeth and these children are more susceptible to caries than the children who haven’t acquired MS colonies.2,4 Hence, poor maternal caries are considered to be one of the direct risk factors for ECC.

Children’s quality of life can be seriously affected by ECC because of pain and discomfort which could lead to disfigurement, acute and chronic infections, altered eating and sleeping habits, high treatment costs, and loss of school days with the consequent diminished ability to learn. In most small children, ECC is associated with reduced growth and reduced weight gain due to insufficient food consumption to meet the metabolic and growth needs of children less than 2 years old.5 Children of 3 years of age with nursing caries weighed about 1 kg less than control children because toothache and infection alter eating and sleeping habits, dietary intake, and metabolic processes. Disturbed sleep affects glucosteroid production. In addition, there is suppression of hemoglobin from depressed erythrocyte production. Early tooth loss caused by dental decay has been associated with the failure to thrive, impaired speech development, absence from and inability to concentrate in school, and reduced self-esteem.6-8

Decay of primary teeth can lead to malocclusion by adversely affecting the correct guidance of the permanent dentition. An untreated carious primary tooth is often associated with a higher risk of the new carious lesion in the other primary teeth and succeeding permanent dentition. The adverse scenario is the need for hospitalization and general anesthesia to carry out some procedures. This highlights the importance of preventive modalities in controlling ECC. This can be best achieved by understanding the risk factors associated with the disease. Hence in this study, a random sample of mother children pairs were screened to evaluate the extent of influence of maternal oral hygiene status exert on ECC below 6-year-old children.

MATERIALS AND METHODS

This is a cross-sectional study approved by the ethical committee of a recognized institution with ethical committee approval number O.C.No./IEC/25/2015. The study was conducted in a random sample of 140 mother children pairs who reported to the Department of Pedodontics and Preventive Dentistry, Drs Sudha and Nageswararao Siddhartha Institute of Dental Sciences, Gannavaram Mandal, Andhra Pradesh and Department of Paediatrics, Siddhartha Medical College, Vijayawada, Andhra Pradesh Mothers were explained about the study and written consent was obtained from them. Children with ages between 12 and 71 months along with their mothers (as per the ECC definition by the AAPD-2014) and children who did not have any systemic ailments were included in the study. The screened sample was divided into two categories, that is, good oral hygiene status and bad oral hygiene status of mother, and it was correlated with absence and presence of ECC in children. Children who belong to 12–71 months age group and lost their mothers, Children who belong to 12–71 months age group whose mothers were not residing with them, and children and mothers with systemic diseases, congenital syndromes, and dental developmental disorders were excluded from the study.

The criteria established to be considered as ECC was based on the number of carious teeth/the surfaces of teeth to be carious/ missing teeth due to caries/filled teeth present in the children. Clinical examination of the mother children pairs was carried out by a single calibrated examiner in broad daylight following WHO type II examination. The following data were recorded:

The obtained data was tabulated by using Excel (Microsoft). The completed proformas were statistically analyzed to find the correlation between ECC and maternal caries, oral hygiene, and risk factors. Descriptive statistical analysis was carried out in the present study. Results were represented as mean ± SD (Min-Max) and categorical measurements were presented as percentages using SPSS-software (version 20). Pearson correlation coefficient was used to compare continuous data and Chi-square test was used to compare qualitative data.

RESULTS

Data were presented as Mean ± Standard Deviations and proportions as percentages. Correlation between deft with DMFT, PI, and OHI-S are done by Spearman’s rank correlation method. Categorical data were analyzed by using the Chi-Square test (χ2). A “p” value of 0.05 or less was considered for statistical significance.

Out of the 140 samples, 103 children had ECC and 37 children had no ECC. ECC was more prevalent in the age group of 5–6-year-old children. The relationship between the age group of the children and ECC was statistically significant (Fig. 1).

Fig. 1: Association between the prevalence of primary caries and age groups of children

Out of 140 mother-child pairs, very low DMFT score in mother was correlated with ECC in 57 mother-child pairs of 91 mother-child pairs, low DMFT score in mother was correlated with ECC in 33 mother-child pairs of 36 mother-child pairs, moderate DMFT score in mother was correlated with ECC in 11 mother-child pairs of 11 mother-child pairs and high DMFT score in mother was correlated with ECC in two mother-child pairs of two mother-child pairs. The association between ECC children and mother’s DMFT scores was significant (Table 1) (Fig. 2).

Table 1: Association between children’s deft and mother’s DMFT
DMFT Deft
No ECC % ECC % Total %
Very low; <5 34 37.36 57 62.64 91 65.00
Low; 5–8.9 3 8.33 33 91.66 36 25.71
Moderate; 9–13.9 0 0.00 11 100.00 11 7.86
High; >13.9 0 0.00 2 100.00 2 1.43
Total 37 26.42 103 73.58 140 100.00

Chi-square = 14.3283; p = 0.0024

Fig. 2: Correlation between deft of child and mother’s DMFT

Good Plaque Index in mother was correlated with ECC in 15 mother-child pairs of 28 mother-child pairs, fair plaque index in mother was correlated with ECC in 66 mother-child pairs of 87 mother-child pairs, poor plaque index in mother was correlated with ECC in 22 mother-child pairs of 25 mother-child pairs. The association between ECC and mother’s plaque index (PI) was significant (Table 2) (Fig. 3).

Table 2: Association between children’s deft and mother’s PI
PI Deft
No ECC Percentage (%) ECC Percentage (%) Total Percentage (%)
0–0.9 = good 13 46.43 15 53.57 28 20.00
1–1.9 = fair 21 24.14 66 75.86 87 62.14
2–3 = poor 3 12.00 22 88.00 25 17.86
Total 37 26.42 103 73.58 140 100.00

Chi-square = 8.3172; p = 0.0156

Fig. 3: Correlation between deft of child and mother’s plaque index

Out of 140 mother-child pairs, good oral hygiene index in mother was correlated with ECC in one mother-child pair of two mother-child pairs, fair oral hygiene index in mother was correlated with ECC in 81 mother-child pairs of 114 mother-child pairs, poor oral hygiene index in mother was correlated with ECC in 21 mother-child pairs of 24 mother-child pairs. The association between ECC and mother’s oral hygiene was not significant (Table 3).

Table 3: Association between children’s deft and OHI-S of mother
OHI-S of mother Deft
No ECC Percentage (%) ECC Percentage (%) Total Percentage (%)
0–1.2 = good 1 50.00 1 50.00 2 1.43
1.3–3.0 = fair 33 28.94 81 71.05 114 81.43
3.0–6.0 = poor 3 12.50 21 87.50 24 17.14
Total 37 26.42 102 73.58 140 100.00

Chi-square = 3.5452; p = 0.1699

Out of 140 children, 66 children were males and 74 children were females. A total of 47 male children and 56 female children had ECC in the sample. However, the relationship between ECC and the gender of children was not statistically significant.

Most of the mothers belong to the 25–29 year age group and no association can be found between the age group of mothers and ECC.

Out of 140 samples, 43 mothers were educated and 97 mothers were primary/uneducated. Only eight children of educated mothers had ECC while all the children of primary or uneducated mothers had ECC. The association between the educational status of the mother and ECC was statistically significant.

The maternal sample was almost equally distributed between normal delivery (50.7%) and C-section (49.3%). However, 33 children of 69 C-sectioned mothers had no ECC which was significant statistically (Fig. 4).

Fig. 4: Association between mode of delivery and ECC

The oral hygiene status of mothers and ECC in children was strongly correlated. Maternal oral hygiene status was an important risk factor that exerts a great influence on ECC below 6 years children.

DISCUSSION

The infectious and transmissible nature of cariogenic oral flora was demonstrated by Keyes in 1960 between mothers and offspring in both Osborne Mendel rats and hamsters.9 Further, a Maryland study associated the dmfs scores of children with their parents especially mother’s.10 Many cross-sectional studies and longitudinal studies have studied the association between parental dental status and offspring caries.11-15 In the literature there are several studies which had established the transmission of MS from mothers to their children and the chance of mothers with elevated levels of MS having children with similar levels of MS and experiencing caries is high.16-19 This can be attributed to frequent maternal contact during the window of infectivity from 19–31 months of age.20 A recent study established the presence of MS in the mouth as early as 6 months of age and prior to tooth eruption.20 Once initiated, the carious lesions can rapidly progress to cavitations within months.21 Hence, this study was undertaken to assess whether the maternal factors could be important risk indicators for the development of ECC in their children in this geography. Once identified, they might ultimately be useful in developing necessary strategies for the prevention of ECC at a primordial level.

The present study demonstrated that the prevalence of ECC increases with age. Similar results were shown in studies conducted by Ferreira et al. and Nahed AA Abu et al.22,23 This is partly due to the lack of an organized preventive oral health care system, limited accessibility to prevention, and the inability of practitioners to provide care for young children. This indicates that educational programs intended to prevent caries on deciduous teeth should begin in the first year of life before the condition becomes too advanced to prevent, with a view to avoid the difficulties and huge expenses.

Female children had more carious lesions compared to males in this study and this observation was corroborated in the studies by Rosenblatt & Zarzar and Moreinike O Folayan.19,24 The greater risk for the development of caries among girls may be partly on account of the earlier growth and development.2 Conversely, in some studies males, were significantly more affected than females.23

In our study, no association was found between the age group of mothers and ECC in children. Similar findings were observed in studies conducted by Sham S Bhat,25 Hiroko Lida,26 and N Retna Kumari.2 Contrary to these, Rie Niji et al., observed an association between maternal age and caries in children.27

A significant correlation was observed between the mother’s DMFT and ECC in this study. Several studies revealed that the mother’s dental caries scores were associated with children’s caries experience though varying in significance. Smith RE et al. concluded that maternal high MS levels, maternal active decay, and maternal sugar consumption are strong risk indicators for children’s caries.28 Ersin NK et al., found that the mothers’ DMFS scores are strong risk indicators for colonization of cariogenic microorganisms and ECC.16 Thitasomakul, de Souza Pd et al., and Bathsheba J Turton et al., found a significant association between maternal caries experience and ECC.11,17,29 It can be assumed that the cariogenic microflora in the mother’s mouth is passed on to children thereby putting them at elevated risk for ECC. On the contrary, Shalu Verma noted that there was no correlation between the caries status of the child and mother.30

A significant association was observed between the mother’s plaque scores and ECC in this study. Soyolmaa et al. studied the levels of S mutans and S sobrinus in plaque samples from Mongolian mother-child population and the findings of the study suggested that mother and child had a tendency for similar bacterial colonization.31 Wan et al., found that mothers with periodontal pockets, more visible plaque, and subgingival calculus were more at risk of having infected infants.21 Plaque bacteria also contain S mutans and an increase in plaque scores might ultimately lead to an increase in the prevalence of caries in children.

In the present study, no correlation was observed between the mother’s OHI-S and ECC. This might be due to skewed sample distribution with the majority of mothers having fair oral hygiene scores (81.1%). Very few studies correlating a mother’s oral hygiene and child’s deft are available. Contrary findings were observed in a study by Retna Kumari N wherein the severity of ECC was higher among the children whose mothers had fair or poor oral hygiene status than those whose mothers had good oral hygiene status.2

Epidemiological evidence suggests that better the maternal level of education, lower the occurrence of caries in children.22,32,33 In the present study, an inverse relationship was observed between maternal educational status and ECC. This was in concurrence with studies by Shalu Verma Bhardwaj, Kinirons & McCabe and Kim Seow.30,34,35 This can be attributed to false notions, lack of awareness, and negligence toward preventive care in mothers with a low level of education. However, Pinto et al. reported no association between parental education and dental caries of child.36

One interesting observation found in this study was normally delivered mothers had children with high ECC rates than C-sectioned mothers. This can be due to vaginally delivered newborns exposed to a greater number and variety of maternal indigenous bacteria from the perineum (vagina and anus) as they pass through the birth canal than do the relatively aseptically delivered Caesarean-born babies.16 Recently studies conducted by Pattanaporn et al., Lif Holgerson et al., and Barfod et al. reported that vaginally delivered infants had distinct oral microbial colonization patterns with high levels of MS compared with C-section born infants.37-39 Poureslami H et al., found no correlation between mode of delivery and dental caries.40

Limitations of the Study

The main limitation of the present study was small sample size of mother children pairs. Hence further studies should be done on larger sample sizes to correlate maternal oral hygiene status and ECC in children.

CONCLUSION

Maternal dental caries and maternal oral hygiene status are important risk factors for ECC. It is imperative to counsel, educate and motivate the mothers or care givers regarding their oral hygiene status as they are the main transmission agents to children which ultimately help to prevent the ECC at primordial level.

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