Previous studies showed that prolonged breastfeeding increases the risk of caries. However, the observed associations were mainly based on non-European populations, and important confounding and mediating factors like socioeconomic position (SEP) and diet were often neglected. The aim of this study was to investigate the role of breastfeeding and bottle-feeding practices on dental caries during childhood while accounting for SEP, ethnic background, and sugar intake. This study was part of the Generation R Study, a prospective multiethnic cohort study conducted in Rotterdam, The Netherlands. In total, 4,146 children were included in the analyses. Information about feeding practices was derived from delivery reports and questionnaires during infancy. Caries was measured via intraoral photographs at the age of 6 years and defined as decayed, missing, and filled teeth (dmft). Negative binomial hurdle regression analyses were used to study the associations between several infant feeding practices and childhood caries. The prevalence of dental caries at the age of 6 years was 27.9% (n = 1,158). Prolonged breastfeeding (for >12 months) was associated with dental caries (OR 1.35, 95% CI 1.04–1.74) and the number of teeth affected by dental caries (RR 1.27, 95% CI 1.03–1.56). Furthermore, nocturnal bottle-feeding was associated with dental caries (OR 1.52, 95% CI 1.20–1.93). All associations were independent of family SEP, ethnic background, and sugar intake. Results from this Dutch cohort study confirmed the previously observed associations between prolonged breastfeeding and nocturnal bottle-feeding and the increased risk of childhood dental caries, even after proper adjustments for indicators of SEP, ethnic background, and sugar intake. Future studies are encouraged to elaborate further on possible explanations for the observed relationships. Healthcare professionals should be aware and advise caregivers about the potential risk of prolonged breastfeeding on caries development by applying the current recommendations on breastfeeding, oral hygiene, and feeding frequency.

Purpose Ethnic background is known to be related to oral health and socioeconomic position (SEP). In the context of patient-centered oral health care, and the growing number of migrant children, it is important to understand the influence of ethnic background on oral health-related quality of life (OHRQoL). Therefore, we aimed to identify the differences in children’s OHRQoL between ethnic groups, and the contribution of oral health status, SEP, and immigration characteristics. Methods This study was part of the Generation R Study, a prospective cohort study conducted in Rotterdam, the Netherlands. In total, 3121 9-year-old children with a native Dutch ( n = 2510), Indonesian ( n = 143), Moroccan ( n = 104), Surinamese ( n = 195), or Turkish ( n = 169) background participated in the present study. These ethnicities comprise the most common ethnic groups in the Netherlands. OHRQoL was assessed using a validated short form of the child oral health impact profile. Several regression models were used to study an association between ethnic background and OHRQoL, and to identify potential mediating factors. Results Turkish and Surinamese ethnic background were significantly associated with lower OHRQoL. After adjusting for mediating factors, only Surinamese children had a significantly lower OHRQoL than Dutch children (β:− 0.61; 95% CI− 1.18 to –0.04). Conclusions Our results show that Turkish and Surinamese children have a significantly lower OHRQoL than native Dutch children. The association was partly explained by oral health status and SEP, and future studies are needed to understand (cultural) the determinants of ethnic disparities in OHRQoL, in order to develop effective oral health programs targeting children of different ethnic groups. Electronic supplementary material The online version of this article (10.1007/s11136-019-02159-z) contains supplementary material, which is available to authorized users.

Background To understand determinants of oral health inequalities, multilevel modelling is a useful manner to study contextual factors in relation to individual oral health. Several studies outside Europe have been performed so far, however, contextual variables used are diverse and results conflicting. Therefore, this study investigated whether neighbourhood level differences in oral health exist, and whether any of the neighbourhood characteristics used were associated with oral health. Methods This study is embedded in The Generation R Study, a prospective cohort study conducted in The Netherlands. In total, 5 960 6-year-old children, representing 158 neighbourhoods in the area of Rotterdam, were included. Data on individual and neighbourhood characteristics were derived from questionnaires, and via open data resources. Caries was assessed via intraoral photographs, and defined as decayed, missing and filled teeth (dmft). Results Differences between neighbourhoods explained 13.3% of the risk of getting severe caries, and 2% of the chance of visiting the dentist yearly. After adjustments for neighbourhood and individual characteristics, neighbourhood deprivation was significantly associated with severe dental caries (OR: 1.48, 95% CI: 1.02–2.15), and suggestive of a low odds of visiting the dentist yearly (OR: 0.81, 95% CI: 0.56–1.18). Conclusions Childhood caries and use of dental services differs between neighbourhoods and living in a deprived neighbourhood is associated with increased dental caries and decreased yearly use of dental services. This highlights the importance of neighbourhoods for understanding differences in children’s oral health, and for targeted policies and interventions to improve the oral health of children living in deprived neighbourhoods.

Background Even though dietary sugars are the most important nutrient for caries development, the disease process is dependent on other dietary practices. The intake of individual nutrient components cannot be evaluated separately from the overall diet which includes other nutrients, foods and habits. Therefore, the aim of this study was to investigate the association between adherence to dietary guidelines and dental caries. Methods This study was embedded in the Generation R Study, conducted in Rotterdam, the Netherlands. In total, 2911 children were included in the present analyses. Dietary intake at the age of 8 years was assessed using food-frequency questionnaires. Diet quality scores were estimated, reflecting adherence to Dutch dietary guidelines. Dental caries was assessed at the age of 13 years using intra-oral photographs. Associations were estimated using multinomial logistic regression analyses, adjusted for sociodemographic characteristics and oral hygiene practices. Results The prevalence of dental caries at the age of 13 years was 33% (n = 969). Better diet quality was associated with a lower occurrence of severe dental caries after adjustments for sociodemographic factors [e.g. highest vs. lowest quartile of diet quality: odds ratio (OR) 0.62, 95% confidence interval (CI) 0.39–0.98]. After additional adjustments for oral hygiene practices, this association was not statistically significant (OR 0.65, 95% CI 0.41–1.03). Conclusion Adherence to dietary guidelines has the potential to reduce dental caries in children; however, with proper oral hygiene practices, this relationship might be attenuated. To understand the role of dietary patterns and dental caries, the contributing role of daily eating occasions needs to be studied further.

Introduction: Dental caries remains one of the most prevalent but preventable diseases among children worldwide and especially affects children with a lower socioeconomic status or ethnic minority background. It is important that all groups of children are reached by preventive interventions to reduce oral health inequalities. So far, it is unknown whether children from different social and ethnic groups benefit equally from potentially effective oral health interventions. Objectives: This scoping review aimed to identify European public health interventions that report their effect on dental caries across different social groups. Methods: Four databases were searched for studies evaluating the effect of oral health interventions on dental caries among children from 0 to 12 y, and studies were included when results were presented by children of different social groups separately. Results: A total of 14 studies were included, representing 4 different countries: 3 randomized and 11 nonrandomized studies. Most studies were performed at schools. Six studies showed results indicative of a reduction in oral health inequalities, 4 studies showed results that potentially widen oral health inequalities, and 5 studies showed results that were indicative of no impact on oral health inequalities. Interventions that contain early approaches, with a high frequency, approaching multiple levels of influence, and including at least the broader organizational or public policy level, may have the potential to reduce oral health inequalities among children from birth to young adolescence. Conclusion: We recommend researchers to perform high-quality intervention studies and to evaluate the effectiveness of oral health intervention always in different socioeconomic or ethnic groups separately, to better understand their contribution toward oral health (in)equalities. Knowledge Transfer Statement: This review offers insight in the differential effects that oral health interventions might have across different social groups. Its results can be used to develop interventions that might reduce oral health inequalities among children. Also, we recommend future researchers to always evaluate the effects of any preventive oral health measure in different social groups separately.