Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2017  |  Volume : 35  |  Issue : 2  |  Page : 110--114

Assessment of maternal risk indicators for the development of caries in their children: A comparative, cross-sectional study


HR Priyadarshini1, Bennete Aloysius Fernandes1, SS Hiremath2, Avita Rath1, Vanishree Shivakumar1, Anand Siddappa Tegginamani1,  
1 Faculty of Dentistry, SEGi University, Petaling Jaya, Selangor, Malaysia
2 Department of Public Health Dentistry, Oxford Dental College and Hospital, Bengaluru, Karnataka, India

Correspondence Address:
H R Priyadarshini
Faculty of Dentistry, SEGi University, Jalan Teknologi, Kota Damansar, PJU 5, Petaling Jaya 47810, Selangor
Malaysia

Abstract

Introduction: Certain factors in mothers could be risk indicators for certain diseases in their children. Hence, this study was undertaken to assess maternal risk indicators for the development of early childhood caries in their children. Methodology: A comparative, cross-sectional study was designed among 180 mother-child pairs attending various Anganwadi centers. Demographic, dietary, oral hygiene practices and other necessary information were collected from mothers using a structured questionnaire. Caries status and amount of plaque were recorded through clinical examination. Nonstimulated saliva from mothers was cultured for mutans streptococci (MS). Data were analyzed using SPSS version 17. Chi-square, Student's t-test, and logistic regression were used. A P ≤ 0.05 was considered statistically significant. Results: In the study group, 73.3% of mothers had caries as compared to only 53.3% mothers in control group. While mean DMFT and mean DMFS of mothers in the study group was 3.78 ± 3.91 and 8.37 ± 12.2, respectively, the same for the mothers in the control group was 2.66 ± 3.01 and 5.8 ± 5.3. Sixty (66.7%) out of ninety mothers in the study group had a high MS count as compared to only 40 (44.4%) mothers in control group (P = 0.003). Conclusion: The present study showed that high salivary MS count and decay in mothers could be important risk indicators for the development of caries in their children.



How to cite this article:
Priyadarshini H R, Fernandes BA, Hiremath S S, Rath A, Shivakumar V, Tegginamani AS. Assessment of maternal risk indicators for the development of caries in their children: A comparative, cross-sectional study.J Indian Soc Pedod Prev Dent 2017;35:110-114


How to cite this URL:
Priyadarshini H R, Fernandes BA, Hiremath S S, Rath A, Shivakumar V, Tegginamani AS. Assessment of maternal risk indicators for the development of caries in their children: A comparative, cross-sectional study. J Indian Soc Pedod Prev Dent [serial online] 2017 [cited 2020 Oct 26 ];35:110-114
Available from: https://www.jisppd.com/text.asp?2017/35/2/110/206035


Full Text

 Introduction



Early childhood caries (ECC) is the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child under the age of 6 years.[1] The disease of ECC has serious implications on the primary dentition,[2] yet it remains relatively unexplored and poorly defined in many developing countries.[3],[4] Even though the role of microorganisms, feeding and dietary practices is well established in the development of ECC,[5] it has not been able to control the disease, thus shifting the focus of researchers to other additional risk factors.

Research into the etiology of caries in children has implicated transmission of mutans streptococci (MS) from mothers to their children,[6] poor oral hygiene of mothers,[7] high sugar intake in mothers,[8] high caries experience in mothers,[9] health behavior of mothers, which in turn may be influenced by many factors such as cultural, social, and socioeconomic status.[10] Yet, relatively little attention has so far been given to identify such maternal risk indicators for caries development in children in India.

Hence, this study was undertaken to assess whether certain of these maternal factors could be important risk indicators for the development of caries in their children. If so, such maternal risk indicators might ultimately be useful in developing necessary strategies for prevention of ECC at a primordial level.

 Methodology



A comparative, cross-sectional study was designed among 180 mother-child pairs attending various Anganwadi centers in Bengaluru. The study was approved by the Institutional Ethical Committee. Informed consent was obtained from mothers to examine them and their children.

One hundred and eighty children aged 3–5 years attending 10 Anganwadi centers in Bengaluru South, which were randomly selected from the list of Anganwadis, were chosen and included in the study; out of 312 children, after applying the inclusion and exclusion criteria, a total of 180 mother-child pairs were included. Ninety children with one or more carious lesions formed the study group along with their mothers, and ninety caries-free children formed the control group along with their mothers. Children or mothers suffering from systemic diseases, on chemotherapy or radiotherapy, on long-term oral medication, or who had consumed antibiotics in the past 3 months were excluded from the study.

Questionnaire interview

Information on demographic and other factors was obtained from mothers through an interview using a structured questionnaire, which was pretested on twenty mothers who were not part of this study.

Clinical examination

Children and their mothers were examined on an ordinary chair using mouth mirror and community periodontal index probe with artificial illumination. Caries experience was recorded using DMFT index. Only frank cavitation was considered as caries for the present study. Amount of plaque was recorded using Silness and Loe index. Mothers were allocated into study and control groups exclusively on the caries status of their children.

Salivary sample collection and processing

Whole unstimulated saliva was collected from mothers and cultured on MSB agar prepared according to Gold et al.[11] Plates were incubated at 37°C in a 5% CO2 atmosphere for 48 h and colony-forming units were counted. A colony count of ≥100 (100 × 104) was considered as high.[12]

Statistical analysis

Data were analyzed using SPSS software version 17 (IBM SPSS statistics). Categorical variables were analyzed using Chi-square test. Difference in mean carious experience, mean plaque scores, and mean salivary MS counts in mothers of two groups was tested using Student's t-test. Logistic regression was used to estimate odds ratio of caries experience in children in relation to different maternal variables. A P ≤ 0.05 was considered statistically significant.

 Results



In the present study, the mean age of mothers was 25.58 ± 4.18 years. About 50% of mothers were illiterates, 93% of mothers were homemakers, and 90% of mothers had a family income of <Rs. 5000 a month (not mentioned in the table) in both groups. No significant association was found between ECC and mothers' age, level of education, occupation, or income of the family [Table 1].{Table 1}

About 75% of mothers in both groups consumed sugar <2 times/day. More than 60% of mothers in both groups had never visited dentist. No significant difference was found in their mean plaque score either [Table 2].{Table 2}

Sixty (66.7%) out of ninety mothers in the study group had a high MS count as compared to only 40 (44.4%) mothers in control group. This was statistically significant with P= 0.002. Furthermore, in the study group, 66 (73.3%) out of 90 (100%) mothers had caries compared to only 48 (53.3) mothers in the control group, and this was statistically significant with P < 0.001. While mean DMFT and mean DMFS of mothers in study group were 3.78 ± 3.91 and 8.37 ± 12.2, respectively, the same for the mothers in control group was 2.66 ± 3.01 and 5.8 ± 5.3 (P = 0.03). In addition, mothers in the study group had a significantly higher mean number of missing teeth (0.89) compared to mothers in control group (0.41) [Table 3].{Table 3}

 Discussion



ECC is a serious sociobehavioral and dental problem that afflicts infants and toddlers,[13],[14] with the disease concentrating disproportionately in deprived families.[15]

Maternal characteristics such as age, education, socioeconomic status have been associated with caries in their children by some studies.[8],[16],[17],[18],[19] Low socioeconomic status and low maternal education are commonly associated with economic and familial stresses that place a child at risk for ECC.[19],[20] However, in the present study, no significant difference was found between mothers of the two groups with respect to age, level of education, occupation, or family income. This could be due to the fact that usually all children attending Anganwadis are from low socioeconomic background.

Frequency of dental visit, maternal sugar consumption, oral hygiene practices, amount of plaque in mothers have also been linked to childhood caries by some previous studies.[7],[8],[9] However, in the present study, no such differences were found among mothers of two groups with respect to their frequency of dental visit, sugar consumption, oral hygiene practices, or amount of plaque. This could also be attributed to the common background of low socioeconomic status among mothers of two groups.

The two maternal characteristics which were associated with caries in their children in the present study were the caries experience and levels of salivary MS. The odds ratio of having a child with caries was 9 times higher in mothers having caries as compared to caries-free mothers. Mean DMFT and mean DMFS were significantly high among mothers of study group as compared to mothers in control group. This is in accordance with the results of some studies.[9],[16],[21],[22],[23],[24] Furthermore, mothers in study group had more missing teeth than their control group counterparts. This could be suggestive of negligence toward their and their children's oral health.

A strong association was found between maternal MS levels and caries in their children. The odds ratio of having a child with caries was over 2.5 times greater in mothers with high MS counts as compared to mothers with low MS counts. Many previous studies in the past have found that mothers who harbored high levels of MS with high DMFS scores shared similar genotypes of Streptococcus mutans with their 2–3-year-old children. Thus, mothers with high MS levels and high DMFS scores may affect the child's early infection with S.mutans resulting in an increase of ECC.[16],[25],[26]

The limitation of the study was that some mothers and children may have been misclassified as caries free as examination was carried out with minimum instruments and lighting on an ordinary chair. The pattern of sugar consumption is another area where there could have been a bias as form, consistency, and time of intake were not recorded.

 Conclusion



The present study showed that dental caries and high salivary MS counts in mothers could be important risk indicators for the development of caries in their children. However, detailed longitudinal studies would be required to better explain the effects of these maternal risk indicators on development of childhood caries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Policy on Early Childhood Caries (ECC). Classifications, Consequences, and Preventive Strategies. Vol. 37. AAPD Reference Manual; 2008. p. 15-6.
2Nunn ME, Braunstein NS, Krall Kaye EA, Dietrich T, Garcia RI, Henshaw MM. Healthy eating index is a predictor of early childhood caries. J Dent Res 2009;88:361-6.
3Vadiakas G. Case definition, aetiology and risk assessment of early childhood caries (ECC): A revisited review. Eur Arch Paediatr Dent 2008;9:114-25.
4Postma TC, Ayo-Yusuf OA, van Wyk PJ. Socio-demographic correlates of early childhood caries prevalence and severity in a developing country – South Africa. Int Dent J 2008;58:91-7.
5Palmer CA, Kent R Jr., Loo CY, Hughes CV, Stutius E, Pradhan N, et al. Diet and caries-associated bacteria in severe early childhood caries. J Dent Res 2010;89:1224-9.
6Caufield PW, Cutter GR, Dasanayake AP. Initial acquisition of mutans streptococci by infants: Evidence for a discrete window of infectivity. J Dent Res 1993;72:37-45.
7Retnakumari N, Cyriac G. Childhood caries as influenced by maternal and child characteristics in pre-school children of Kerala-an epidemiological study. Contemp Clin Dent 2012;3:2-8.
8Wigen TI, Wang NJ. Parental influences on dental caries development in preschool children. An overview with emphasis on recent Norwegian research. Nor Epidemiol 2012;22:13-9.
9Smith RE, Badner VM, Morse DE, Freeman K. Maternal risk indicators for childhood caries in an inner city population. Community Dent Oral Epidemiol 2002;30:176-81.
10Febres C, Echeverri EA, Keene HJ. Parental awareness, habits, and social factors and their relationship to baby bottle tooth decay. Pediatr Dent 1997;19:22-7.
11Gold OG, Jordan HV, Van Houte J. A selective medium for Streptococcus mutans. Arch Oral Biol 1973;18:1357-64.
12Roeters FJ, van der Hoeven JS, Burgersdijk RC, Schaeken MJ. Lactobacilli, mutants streptococci and dental caries: A longitudinal study in 2-year-old children up to the age of 5 years. Caries Res 1995;29:272-9.
13Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH. Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the National Institute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administration. J Public Health Dent 1999;59:192-7.
14Tyagi R. The prevalence of nursing caries in Davangere preschool children and its relationship with feeding practices and socioeconomic status of the family. J Indian Soc Pedod Prev Dent 2008;26:153-7.
15Tandon S, Sethi B. Caries pattern in pre-school children. J Am Dent Assoc 1996;67:141-5.
16Ersin NK, Eronat N, Cogulu D, Uzel A, Aksit S. Association of maternal-child characteristics as a factor in early childhood caries and salivary bacterial counts. J Dent Child (Chic) 2006;73:105-11.
17Agarwal V, Nagarajappa R, Keshavappa SB, Lingesha RT. Association of maternal risk factors with early childhood caries in schoolchildren of Moradabad, India. Int J Paediatr Dent 2011;21:382-8.
18Niji R, Arita K, Abe Y, Lucas ME, Nishino M, Mitome M. Maternal age at birth and other risk factors in early childhood caries. Pediatr Dent 2010;32:493-8.
19Psoter WJ, Pendrys DG, Morse DE, Zhang H, Mayne ST. Associations of ethnicity/race and socioeconomic status with early childhood caries patterns. J Public Health Dent 2006;66:23-9.
20Kim Seow W. Environmental, maternal, and child factors which contribute to early childhood caries: A unifying conceptual model. Int J Paediatr Dent 2012;22:157-68.
21Wan AK, Seow WK, Purdie DM, Bird PS, Walsh LJ, Tudehope DI. Oral colonization of Streptococcus mutans in six-month-old predentate infants. J Dent Res 2001;80:2060-5.
22Vachirarojpisan T, Shinada K, Kawaguchi Y, Laungwechakan P, Somkote T, Detsomboonrat P. Early childhood caries in children aged 6-19 months. Community Dent Oral Epidemiol 2004;32:133-42.
23Irigoyen Camacho ME, Sánchez Pérez L, García Pérez A, Zepeda Zepeda MA. Relationship between severe early childhood caries, mother's oral health and mutans streptococci in a low-income group: Changes from 1996 to 2007. J Clin Pediatr Dent 2009;33:241-6.
24de Souza PM, Mello Proença MA, Franco MM, Rodrigues VP, Costa JF, Costa EL. Association between early childhood caries and maternal caries status: A cross-section study in São Luís, Maranhão, Brazil. Eur J Dent 2015;9:122-6.
25Ersin NK, Kocabas EH, Alpoz AR, Uzel A. Transmission of Streptococcus mutans in a group of Turkish families. Oral Microbiol Immunol 2004;19:408-10.
26Chaffee BW, Gansky SA, Weintraub JA, Featherstone JD, Ramos-Gomez FJ. Maternal oral bacterial levels predict early childhood caries development. J Dent Res 2014;93:238-44.