Diet and Oral Hygiene in Children Before and After Lockdown

Justine C. Manalastas DMD, Cynthia L. Wong DMD, MS, Dorota T. Kopycka Kedzierawski, DDS
Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA

PURPOSE RESULTS RESULTS

To compare changes in pre-school aged children’s diet/feeding behaviors and Pre Cov Pre Cov Post Cov Post Cov Plaque Scores: Pre and Post Lockdown
oral hygiene practices during the pre-and post-Covid-19 lockdown and to Questionnaire P-value
Mean STD Mean STD
assess their caries outcome as a result of these changes. Plaque Scores
B1. Take liquids from bottle 0.8433 0.31761 0.92 0.2768 0.0782 35
HYPOTHESIS Figure 2.
B2. Take liquids from sippy 0.5433 0.4507 0.84 0.3741 0.0045 30
Pre-school aged children’s diets converted to a more cariogenic type consumed Immediate pre-
at higher frequencies during the Covid-19 lockdown due to increased access to B3. Freq of cookies 0.7455 0.1570 0.7466 0.1870 0.8404
25
lockdown plaque
these types of foods and beverages. Additionally, children’s oral hygiene 20 scores (in blue) and
practices were disrupted during this time. These changes in health behaviors B4. Freq of candy 0.0533 0.1845 0.0533 0.1845 0.9999 immediate post-
negatively affected dental outcomes, including ECC onset in young children. 15
lockdown plaque
INTRODUCTION B5. Freq of soda w/ sugar 0.8888 0.1546 0.8800 0.1833 0.6359 10 scores (in green) for
Early childhood caries is the most common chronic infectious disease in our 25-patient
B6. Freq of 100% juice 0.4622 0.2389 0.4133 0.2551 0.1161 5 sample
childhood. Because the etiology of ECC is multi-factorial and is also influenced
by health behaviors, preventive strategies should target factors known to place 0
B7. Freq of fruit drink 0.5877 0.3652 0.5200 0.4257 0.4063 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 P-value: 0.7983
children at high risk for caries. During the Covid-19 lockdown, a “snacking
B8. Freq of breast feed at night 0.9786 0.0763 0.9875 0.0612 0.2850 Immediate pre-lockdown Immediate post-lockdown
culture” emerged that may have had negative effects on children’s diets and oral
health. It is important to understand the effects of pandemic related disruptions Caries Analysis
on these health behaviors as part of comprehensive caries management and B9. Freq of milk formula at night 0.9693 0.0860 1.000 0.000 0.0678
prevention in young children. B10. Freq of sippy cup filled w/ Breakdown of Caries Caries By Gender
0.6833 0.3377 0.8708 0.2758 0.0051
something other than water
METHODS/ ANALYSIS
H1. Share a toothbrush 0.9766 0.0816 1.000 0.000 0.1797 No caries
10 diet/feeding behavior questions (B1-B10) and 5 oral hygiene questions 12% 4 # of Females w/ caries
(H1-H5) are shown in table 1. The descriptive statistics (sample mean and H2. Do you brush your child’s teeth 0.9516 0.1093 0.8900 0.27080 0.39462
STD) were calculated. A Wilcoxon matched pairs test was used to detect 9 # of Females w/out caries
changes in these behaviors and practices from pre-and post-lockdown. H3. Does your child use F toothpaste 0.9766 0.08164 1.000 0.000 0.1088 Caries pre
52% lockdown 4
H4. Freq of brushing your child’s 36%
0.8420 0.1415 0.8120 0.2758 0.8260 # of Males w/ caries
Plaque was assessed for all surfaces of the 20 primary teeth for each child at teeth
baseline, 6 months, 12 months, 18 months, and 24 months. Scores ranged from Caries post
H5. Freq of brushing your teeth 0.6983 0.2644 0.7100 0.3281 0.9093 lockdown
8
0-3. Plaque scores from the immediate pre-lockdown visit and immediate post- # of Males w/out caries
lockdown visit were calculated for each child and compared. Table 1: Diet/Feeding and Oral Hygiene Questionnaire: Descriptive Statistics
Caries analysis The percentage of true caries conversion in our patient sample
from pre-and post-lockdown was determined. Additionally, the severity of
caries in this sample was assessed by evaluating the changes in ICDAS caries
scores from pre- and post-lockdown.
CONCLUSION
In our patient sample, there were 2 diet/feeding behaviors that showed a Figure 1.
statistically significant change from pre and post lockdown, and these were
Relationship of the mean
related to the use of a sippy cup and the frequency of sippy cup use. The
values for diet/feeding
results of the pre- and post-lockdown plaque scores in the sample were
behaviors and oral
inconclusive. 9 out of 25 patients (36%) were caries-free at all pre-lockdown
hygiene practices during
visits but were caries-active at post-lockdown. Caries severity also worsened pre and post lockdown in
at the post-lockdown visits. In this report, we found a significant change in our patient sample
the use of a sippy cup and the frequency in the use of a sippy cup and
increased severity of ECC during lockdown. Therefore, it is suggested that *Notice B02 and B10
sugar consumption frequency may be more predictive of ECC onset than the
Figure 3. Teeth and surfaces most affected Figure 4. Caries severity (ICDAS scores) over
amount consumed.
with caries from left to right on x-axis pre-and post-lockdown