Source 28

Early childhood caries (ECC) is a severe form of dental caries (DC), in which one or more decayed (cavitated or non cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth, are present in a child 71 months of age or younger. In 2004, the American Academy of Pediatric Dentistry defined severe early childhood caries (sECC) as any sign of smooth-surface caries in children younger than three years of age. For children in the age group of three to five, one or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth, or a decayed, missing, or filled score of > 4 (3 years old), > 5 (4 years old), or > 6 (5 years old) surfaces constitutes sECC. Despite the advances in the field of medical science, dental caries continues to be a major health problem in the developing nations because of the lack of education, awareness and poor socio economic status. Socio economic status influences the nutrition and access for health care services. In the developing nations children suffer from a dual risk of malnutrition, with obesity in those living in urban areas and under nutrition in children from rural and slum areas. Recently, United Nations International Children's Emergency Fund (UNICEF) reported that about 146 million children below five years of age were underweight. It was the target of the millennium's development goals to half the count of the world's population of underweight five year old children by 2015.

This cannot be accomplished with food deliveries alone. Factors like maternal educational levels, socio-economic status and family size have to be addressed, to reduce the number of children in the underweight category.

Prevalence of DC is more in younger children. A study by Goel P et al. showed a prevalence of DC at about 81.25% in the age group of five to six years. Children with DC (with at least one pulpally involved tooth) can weigh less than those without it. It can also have a major impact on their physical, mental and overall systemic health. DC increases their susceptibility for iron deficiency anaemia, by lowering the serum ferritin levels. Some severe cases have even shown features of failure to thrive without any other obvious reasons.

Anthropometry is the single most universally applicable, inexpensive, and non-invasive method available to assess the size, proportions, and composition of the human body. Paediatricians have long used child growth as an important parameter in evaluating the health and general well-being of children. Low height and/or weight relative to reference data have been used as classic indicators of undernutrition for individuals and groups. World health Organization (WHO) has recommended the use of pediatric growth charts by the health professionals to monitor the physical growth of infants, children and adolescents. The measured values are plotted on the growth chart to determine the percentile relative to the child's age and gender. The anthropometric parameters below 3 rd percentile are indicative of insufficient growth and nutrition.

With this background, the present study was conducted with the objectives of evaluating the affect of sECC and its comprehensive rehabilitation on the growth parameters and QoL of children from low socioeconomic strata of the society.

In the present study, 100 preschool children from low socioeconomic sections of the society were evaluated. The results suggested that DC had a negative impact on QoL of children, and if left untreated may affect the weight of children. All untreated DC may not be detrimental to the general health; however, it significantly influences the QoL and dietary intake of children, especially when it is associated with pain and discomfort. Disturbed sleep as a result of pain can affect glucosteroid production in the body and thereby the growth. Another possible mechanism of impact of sECC on growth could relate to chronic inflammation from pulpitis and dental abscesses. Both of these conditions alter the metabolic pathways resulting in increased cytokine production. Cytokines like interleukin- 1 (IL-1) inhibit the process of erythropoiesis in bone marrow. The resultant reduced levels of haemoglobin may lead to anaemia of chronic disease.

According to WHO, affected eating pattern can rapidly manifest in younger children of 3 to 6 years of age. Hence, this age group was selected for the study. The children were from similar socioeconomic background and were provided with daytime meal from the preschool, this minimized the bias between the controls and sECC group for any change in weight related to different eating patterns.

Low QoL was observed in children with sECC. The mean values of anthropometric measurements were lower in the sECC group as compared to the controls (Wt ~ 850gms less). Similar results have also been reported earlier in 3 year old children with nursing caries.

After dental rehabilitation, there was a significant improvement in the QoL of sECC group children. The mean values of growth parameters were still higher in the control group as compared to sECC group; however, the difference in values was less as compared to baseline. There was a significant increase in Wt of the children after dental rehabilitation, which was similar to that reported in earlier studies. Overall intergroup comparison after dental rehabilitation showed that sECC group no longer differed from the controls in relation to various growth parameters.

This will be interesting to observe in India because a large part of its population is in poverty. Along with poverty comes poor nutrition and possibly lower QoL. I won't be testing this exactly, but it is good information to know that those with severe childhood caries may face more problems than those without.