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PEDIATRIC DENTAL JOURNAL 22(2): 117-124, 2012

Influences of diet on caries activities and caries-risk grouping
in children, and changes in parenting behavior
Michiko Nishimura•, Omar M.M. Rodis , Seishi Matsumura" and Michiyo



Pediatric Dentistry, Okayama University Hospital of Medicine and Dentistry
2-5-1 Shikata-cho, Kita-ku, Okayama 700-8525, JAPAN
Department of Pediatric Dentistry,
Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical
2-5-1 Shikata-cho, Kita-ku, Okayama 700-8525, JAPAN

Abstract BACKGROUND: Dental caries incidence in
early childhood is known to influenced by the behavior of
parent with their children, and clinicians and dental staf
are advised to provide parents with efective oral health
instructions. The objectives of this study were to identify
the influence of diet of 18- and 24-month-old children on
caries activities and investigate changes related to the
behavior of their parents after receiving health
instructions regarding caries risk for 2-year-old children.
METHODS: The subjects were 1,206 child-parent pairs.
The children participated in 18-, 24-, and 42-month-old
health examinations at Kurashiki City Public Health Center
in Kurashiki City, Japan. Cariostat, a caries activity test
(Dentsply-Sankin Co., Tokyo), was conducted and the
children were then classified into 6 caries-risk groups
based on the 42-month-old predictive cutof points. Their
parents were given oral health instructions on caries
prevention by dental hygienists of the Kurashiki City Public
Health Center. In addition, a questionnaire regarding diet
was given to identify its influence on caries activities in 18and 24-month-old caries activities in 18- and 24-monthold children, as well as the influence of changes in
parenting behavior. RESULTS: A significant number of
children in the high-risk group received breast feeding or
bottle-feeding with liquids other than water at 18 months
of age. Also total time for sucrose- containing food intake
was significantly associated with increased caries activity
at 18 months of age. After giving oral health
instructions to parents of the 18-month-old children
dietary habits significantly correlated with the high-risk
group at 24 months of age were breast feeding or bottlefeeding with liquid other than water, total intake time of
sucrose-containing food, and frequency of sucrosecontaining foods intake. Furthermore, parents whose
children were in the higher caries-risk group at 18
months of age showed a lower level of change in
parenting behavior as compared to those with children in
the lower caries-risk group. CONCLUSION: It is important
to assess problematic dietary habits in accordance with

Key words
Caries activity,
Changes in
Dietary habit,


early prediction of caries-risk have been discussed
without giving too scientific or practical details .
Koch' emphasized the importance of early prediction The American
Academy of Pediatric Dentistry
and determination of caries-risk and the problems of
(AAPD) reported that
caries-risk assessment is an
*Correspondence to: Michiko Nishimura essential element of contemporary clinical



M. Oral Examination System of Kurashiki City oral hygiene. 1. et al. 2002 to Sep. As result. socioeconomic status and behavior are general health program.. habits of children are primarily controlled by their In addition. 2000 from Apr. children . added child are routinely performed in Japan as part of governbehavior to that list.. 2002 to Mar. and lifestyle-to us in coded form. such as sucrose intake.M. 2003 from Apr.and 42-month-old children related factors while Reich et al. We speculated the parent' comPublic Health Center ethical committee's approval pliance with oral health instructions was associated and local city health oficers completely sealed each with caries-risk grouping of their children. Monthly programs for those all related to prevention of dental caries in their ages began in 1975. 2 pediatric dentists of Okayama The objectives of this longitudinal study were University performed ) 6) ) 8) 9-11) . chronic. Matsumura.206 young children using Cariostat. 2004 to and Sep. 2005 Fig. Therefore. 1961. and 42-month-old examinations were carried out every month. However. Rodis.  Oral examination by the dentists of Kurashiki City Dental Society • Oral examination by the two pediatric dentists of Okayama University  Questionnaires • Questionnaires  Oral hygiene instruction • Oral hygiene instruction  Cariostat testing • Cariostat testing The subjects who were 18-month-old health examination 24-month old oral examination 42-month old health born between Oct. (Dentsply-Sankin Co. 2) No Cariostat test study . frequency of sucrose-containing Methods foods intake and total exposed time to such foods. 2003 from Oct.118 Nishimura. S. 2001 Mar.. M. and micro flora. and 1980. In our previous 2 Cariostat sampling periods. related disease. to be as lifestyle Oral examinations of 18. a caries activity test subjects were enlisted as participants in this study.we performed caries-risk assessment for very undertaken at 18 months of age. respectively. parent education. 1 Time schedule of the investigation 18-. In the present study. O. Dental subjects' private information and released the data caries is a multifactorial. Hunter' considered diet. Tokyo) and established 6 This study was performed through Kurashiki City caries-risk groups. the lifestyles and ment sanctioned national dental check-up activities. a 24-monthold oral examination is conparents. 24-. understanding ducted by Kurashiki City's part of the community of nutrition. the concept of risk assessments .

0 1.tionnaires were computerized and provided to us as old cutof point.5 1.0 2.and 24-month-old Cariostat test results naires were sent to individual subjects by mail along were 1. respectively . The results of the oral examinations who had a Cariostat score at or lower than the 18and the Cariostat tests as well as completed quesmonth-old cutof point but reaching the 24-month.0 Moderate caries-risk (MR) n=261 n=538 n=145 (LR) 2.5 3.5 and 2.5 Low caries-risk 2. (4) Improved border (I13): children coded data. These results 6) .0 Progressive border caries-risk (PB) Moderately high caries-risk (MHR) n=60 Improved border caries-risk (IB) n=124 High caries-risk (HR) n=78 Fig.5 0 0.5 3.0. (2) Moderate risk (MR): children who had a Oral health instructions Cariostat score higher than the 18-month-old cutof The same Kurashiki City public dental hygienists point but had scores lower than the 24-month-old provided the parents with instructions for caries cutof point.5 1. foods? 3) Do you determine the total time of your child's sucrose-containing foods intake? 4) Does Six caries-risk groups your child continue to breast feed or drink a liquids The 42-month-old predicted cutof points based other than water through a bottle? These questionon the 18. The groups used in the present study were as follows: parents completed and brought it to Kurashiki City (1) Low risk (LR): children who had a Cariostat Public Health Center on the day of their child's score at or lower than the 18-month-old cutof point. and a score lower than the 24-month-old cutof point.CHILD DIETARY INFLUENCE AND CHANGES IN BEHAVIORS 119 42-month-old predicted cutoff based on 24-month-old Cariostat scores 24-mo 18-mo 0 0.0 2. 2 Predicted caries-risk assessment at 42 months based on the 18.and 24-month cutof points Local city health oficers completely sealed and brush your child's teeth? 2) How many times subjects private information and released the data a day does your child ingest sucrose-containing to us in coded form. (3) Progressive border (PB): children prevention. The 6 caries-risk with a notification of their examination date.0 1. scheduled examination.

001 From more than 3 times to From less than 2 times toMore than 3 times at both l e s s t h a n 2 t i m e s m o r e t h a n 3 t i m e s ___ages Fig.4* LR MR Q. Q.. and IB groups had caries activities below the 42-month-old Results predictive cutof point based on the 18-month-old cutof point (Cariostat test result of 1. ***: P<0. Rodis.4** Q.2 How many times a day does your child ingest sucrosecontaining food? containing food? Q.3*.. Table 1 Significant lifestyles changes at 18 months of ageTable 2 Significant lifestyles changes at 24 months of age L R M R P B I B M H R LR MR PB IB MHR HR Q.4*** Q. Sugar-intake 24 months of age.01. PB.05.4 Does your child continue to breast feed or drink liquids Q.2*. **: P<0. as children belonging to the MR.05.001 *: P<0. S.05 was considered total time was related to the 24-month-old cutof to be significant.120 Nishimura. **: P<0. ***: P<0.01. Breast- .3** MR Q.3 LR Q. 3 Changes in patient behavior from 18 to 24 months old used to investigate changes in behavior from 18 to results of the 18-month-old children.1 Do you check and brush your child's teeth? Q.M. et al. point.1 Do you check and brush your child's teeth?Q.3* PB IB Q. M.M.2 How many times a day does your child ingest sucroseQ.4* Q.001 Q.5).4*** Q.4 Does your child continue to breast feed or drink liquids other than water through a bottle? other than water through a bottle? LR n= MR n— 261 PB jjjj n= 145 IB n=1 MHR n= 60 HR n= 78 0 Less than 2 times at both ages 100% *: P<0. A P-value of 0.3 Do you determine the total time of your child's sucroseQ. O. Matsumura.05. **: P<0.01.4*** Q.4* PB IB MHR MHR HR HR *: P<0. ***: P<0.4* Q. Q.3 Do you determine the total time of your child's sucrosecontaining foods intake? containing foods intake? Q.

001 0 Yes at both From no to From yes to no No at both ages Fig. and PB groups from 18 to 24 months old. 4 Changes in patient behavior from 18 to 24 months old Table 2 shows the influence of lifestyle on Cariostat 4) Does your child continue to breast feed or drink test results of the 24-month-old children. LR.01.CHILD DIETARY INFLUENCE AND CHANGES IN BEHAVIORS 121 Q.3 Do you determine the total time of your child's sucrose-containing foods intake? LR (Yes or No) n = 538 MR / n = 261 PB n =145 IB n MH R n= HR n= 78 100% *: P<0. MR. and IB groups from 18 to 24 months important dietary component contributing to cariesold (Fig.belonging to low-cariesrisk group (Fig. Againliquids other than water through a bottle? breast-feeding or liquid intake other than water had Changes in the behavior of children in HR group a significant relationship with increased risk for were significantly worse as compared to those in caries. 3). ***: P<0. 5). PB. risk without any doubt is ingestion of fermentable . Changes in 1) Do you check and brush your child's teeth? children's behavior belonging to moderate cariesThere were no data released from the Kurashiki City risk group were significantly worse than children Public Health Center. 2) How many times a day does your child ingest sucrose-containing foods? Discussion Changes in the behavior of children in the HR group were significantly worse as compared to those in the Caries is a multi-factorial disease " and the most LR. MR. ) .to and MR groups were significantly worse as compared 24-month examination to LR group from 18 to 24 months old. Changes in behavior of children belonging to the IB Changes in parent behavior from 18. at 24 months old. **: P<0.05.

and HR study" . the accurate prediction of caries is not of sucrose-containing food intake.M. there 1738) 19-21) ) ) . MR. M. Even with routinely of sucrose-containing food intake among children available clinical and sociodemographic information belonging to LR.. we reported that the 18-month-old caries groups. Q. et al. and IB groups whose at clinical examination.M. Rodis. Furthermore. ***: P<0. such as the frequency situation.001 0 No at both "K‘ 4 From yes to no From no to yes Yes at both ages Fig. S. PB. a dentist can identify high Cariostat scores were below or at the predicted caries risk subjects with good accuracy". which showed the importance of dietary activity influenced the child's future oral conditions habits in 18-month-old children to prevent caries compared to caries activity at more than 24 months initiation. **: P<0.4 Does your child continue to breast feed or drink liquids other than water through a bottle? (No or Yes) L n=5 MR n=2 61 PB n=1 45 ** TB n=1 24 MH R n= H R n=7 100% *: P<0. O. MR. Matsumura. cutof point at age of 24 months.cantly change their dietary habits after the parent Newbrun concluded as follows "In the clinicalreceived oral care instructions. thebrushing with their 24-monthold children. Furthermore. PB.05. Children in the HR group did not signifiof age. as important as the assessment of the individual there were significant diferences for the total time caries risk and risk factors. there were no significant diferences enced the child's caries status . In our previous in dietary habits among the LR. This result supported Newbrun's conclusion" . On the other hand..In contrast.122Nishimura. 5 Changes in patient behavior from 18 to 24 months old children is still immature• .01. mother's parenting behavior toward the child influ.

10) Huntington. compliance by the parents to early determination of References 123 1) Koch.. and Keene. oral treatment for children. T.: Early childhood caries: A synopsis. Oda.J. E. Int Dent less anxiety than mothers having other caries-risksJ 38: 211-217. When the children. G.M. B.S. especially those with very young children.116-122.J.B. The limitation of theJ 38: 177-189.Kariya.. Lussi. 2005-2006. their caries prevalence was 32. T.L.: Cariescalculation of current and predicted screening risk factors for Hispanic children afected by early indexes.M.: Guideline on preventive dental service.childhood caries.: Biological factors as indicators of future data and that what we analyzed was just the datacaries. 4) AAPD. with sampling for Cariostat tests. Matsumura. 1988. Furthermore. we managed and instructed 13) Nishimura. Ped Dent J 21: mother's parenting stress in each caries-risk group. ment in baby bottle tooth decay. study was that we did not have full access of the3) Krasse. habits. Int Dent provide efective instructions. periodicity of examination. Kariya. 2005-2006. 1988. 2011. Pediatr Dent 24: 536-542. we researched hood using a caries activity test.CHILD DIETARY INFLUENCE AND CHANGES IN BEHAVIORS health instructions for parent. The mothers' characterCaries-risk assessment.:Caries-riskassessmentinearlychildsleeping at the night. C. 8) Reich. pp. 1999. I. born in 2000. Matsumura. Newbrun. Kim. Pediatr Dent 19: 22-27. so it is also useful caries risk Int Dent J 38: 203 . A. H.: Using caries and 6) . Echeverri. Therefore.. of foods and drinks containing sucrose and at the84-86. S. N. As a result.. and FDI Commission: children (data not shown). and adolescents. from 2003 to 2004. and analyses of changes in child 11) Davies.O. The mother having a high-risk child significantly felt7) Hunter. However. determination of cutof points".4% 12) Report on the survey of dental diseases by Health Policy Bureau. Ministry of Labor and Welfare Japan.. Int Dent J 38: 219-225. 1988..N. became 116. caries. we instructed the parents to regularly anticipatory guidance and check their children's oral health to assess intake Pediatr Dent 27 (7 Suppl): 5) AAPD. might be strongly associated with the efectiveness 9) Febres.A.. same time to brush their children's teeth before6)Nishimura. 2) Federation Dentaire International (FDI) Technical to understand the rate of compliance in accordance Report No. risk assessment . P. C. mothers regarding brushing their children's teeth. awareness. Tokyo. After completing caries-riskOral Health Assoc Japan.M. M.N. parents with children in the low and moderate and Shimono. 1998. oral health instructions varies. 1999. E.V.210. G. and social factors and relationship We began research regarding caries-risk assess. Int Dent J 49: 15-26.: Importance of . 42 months old.. 1997. behaviors from 18 to 24 months performed until Community Dent Oral Epidemiol 26 (suppl 1): 106— 2005.Rodis.33-53.: Risk factors in dental caries. children. we couldtool (CAT) for infants.: Policy on use of a caries-risk assessment released by Kurashiki City. N. assessment in 2005. not analyze the data associated with the efects onPediatr Dent 27 (7 Suppl): 25-27. and Hughes. E..31: Review of methods of identification to caries-risk grouping of their children in order toof high caries risk groups and individuals.: Parental of oral care instruction. 2002. are efective tools for caries prevention.

(in Japanese) 20) Clark. M.124Nishimura.: Identifying risk factors for predicting caries in school-aged children using dental health information collected at preschool age. M. 2008. J.. Rodis.M... S.. . Fraser-Lee. and Ma. Pediatr Dent 30: 122-128. Matsumura. S.. Li.: Risk factors for severe early childhood caries in children younger than 4 years old in Beijing China. O. P. Zang. 1991. et al. T. W.M. N. and Shimono. J Dent Child 21) Quin.J. 29: 791-813.