A total of 1344 children, 3-5 yr old, from two rural counties, Haidian and Miyun, close to Beijing, China, were examined in 1992. A modified DDE Index was employed in this study, and a pre-designed formula was used to calculate an enamel defect score (EDS) for each individual in the study. Oral examination was performed by one dentist under natural light using a standard mouth mirror and dental probe. Developmental enamel lesions were diagnosed without drying or cleaning the teeth prior to examination. Results from this study showed that primary teeth with defective enamel were seen in 23.9% of the children examined, opacity in 1.6%, and hypoplasia in 22.2%. Among the teeth, maxillary central and lateral incisors were affected by enamel hypoplasia most often (40.8% and 39.2%), followed by maxillary canines (25.7%), maxillary 1st molars (22.1%), and mandibular 1st molars (18.5%). The enamel defects occurred more frequently on the buccal surfaces of teeth than on any other surface. The study did not find a significant association of the children's age, family socioeconomic status, and anthropometric measurements with the distribution of enamel defects. However, there was a significantly higher prevalence of teeth with defects in males compared to females (P < 0.001), as well as mean tooth surfaces with defects (P < 0.05), and mean EDS (P < 0.05). Children born prematurely were shown to have four times more enamel lesions than children who were full term (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The association of enamel hypoplasia (EHP) with dental caries of the deciduous dentition was determined in 1,344 rural Chinese children aged 3–5 years. The degree of EHP was determined using a modified DDE Index. Number of decayed, missing, and filled teeth and tooth surfaces were determined for all subjects. Anthropometric assessment of body weight and height was done as an indirect measure of the nutritional status of the children. Results from the study showed that the prevalence of EHP was 22.3% in the total study population. The prevalence of dental caries was 82.3%. There was no difference in the caries experience between males and females. Significantly greater caries experience was observed among the children living in a low socioeconomic county and children with low height for age. Children with low birth weight showed a slightly higher percentage of caries than those born with normal birth wight. Children with enamel hypoplasia demonstrated a significantly higher caries experience than those who did not have such defects. The results of this study consistently support previous studies that found nutritional deficiency to have an important impact on tooth development and susceptibility to dental diseases. This study also indicates that the presence of enamel hypoplasia may be a predisposing factor for initiation and progression of dental caries, and a predictor of high caries susceptibility in a community, particularly if fluoride programs are not implemented.

A prospective, four-year longitudinal study of 209 Peruvian children was conducted to evaluate the effect of a single malnutrition episode occurring at infancy (i.e., < 1 year of age) on dental caries in the primary teeth. Children were recruited into the study at age 6-11 months after they had suffered from a malnutrition episode and were thus classified by anthropometry as either: (1) Normal; (2) Wasted (low weight for height); (3) Stunted (low height for age); or (4) Stunted and Wasted (S and W). Eruption of the primary teeth was significantly delayed in all malnourished children; however, the effect of stunting--that is, retarded linear growth--was more pronounced and lasted longer than that of wasting or acute malnutrition (i.e., 2.5 vs. 1.5 years, respectively). By age 4 years, children from group 4 (S and W) showed a significantly higher caries experience in the primary teeth than did those in any of the other three groups. In summary, this longitudinal study has confirmed previous studies in animals and indirect epidemiological evidence which had suggested a cause-effect relationship between early malnutrition and increased dental caries.

Gnotobiotic rats infected with Streptococcus mutans 6715 at 19 days of age and fed a purified diet (305) containing 5% sucrose developed extensive caries lesions on all molar surfaces within 16 days (35 days of age). Approximately twice as many lesions developed when infected rats were maintained until 45 days of age, whereas noninfected rats did not develop caries when fed diet 305. Gnotobiotic rats infected with S. mutans 6715 and fed a purified diet containing no sucrose (300) until day 25 and subsequently fed diet 305 for 10 days developed lesions similar to rats fed diet 305 for 16 days. Furthermore, rats infected with S. mutans 6715 and fed diet 300 until 45 days of age developed approximately one-half the smooth surface lesions as infected rats fed diet 305 for the same length of time. The level of caries on buccal and proximal molar surfaces in 45-day-old gnotobiotic rats varied when animals were infected with S. mutans AHT, BHT, NCTC 10449, 6715, or LM-7. Animals infected with S. mutans AHT showed more severe lesions on the buccal surfaces than those observed in animals infected with the other strains of S. mutans tested, whereas S. mutans 6715 caused significantly more caries on proximal surfaces. On the other hand, rats infected with S. mutans LM-7 exhibited the lowest level of caries on all molar surfaces of the five strains of S. mutans tested.

A cross-sectional evaluation of dental caries in primary teeth and nutritional status was conducted involving 285 Peruvian children from low socioeconomic conditions aged 3-9 y. Forty-nine percent of the children were found to be chronically malnourished (stunted) whereas acute malnutrition (wasting) was infrequent (2%). Stunted children showed a delayed exfoliation of primary teeth. The caries prevalence curve as a function of age (ie, a plot of decayed, extracted, and filled teeth vs age) was found to be shifted to the right by approximately 15 mo in stunted children as compared with well-nourished children. Children aged 7-9 y with stunted growth showed a significantly higher percentage of carious teeth than did well-nourished children of the same age (40 and 29%, respectively; p less than 0.005). Nutritional deficits that lead to chronic malnutrition not only may affect tooth exfoliation but also appear to render the primary teeth more susceptible to caries attack later in life.

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A cross-sectional study of dental caries in the primary teeth as a function of nutritional status was conducted on 1481 children one to 13 years old in Lima, Perú. Forty-one percent of the children were found to be chronically malnourished (stunted), 3% were acutely malnourished (wasted), and 5% were both stunted and wasted. A plot of decayed, extracted, and filled teeth (deft) vs. age resulted in a bell-shaped curve that was shifted to the right by 2.5 years for malnourished groups, compared with normal children (p less than 0.01). The shift to the right of the age distribution of caries was associated with a delay in both the eruption and exfoliation of the primary teeth in malnourished children. Peak caries activity was significantly higher in wasted and in stunted and wasted children, when compared with normal controls. It is concluded that malnutrition delayed tooth development, affected the age distribution of dental caries, and resulted in increased caries experience in the primary teeth.

Animal studies have shown that early malnutrition affects tooth structure, delays tooth eruption, and results in increased dental caries. However, epidemiologic evidence in support of these findings has been elusive. Cross-sectional surveys show that populations with a higher prevalence of caries in their deciduous teeth also show a lower prevalence of caries in their permanent teeth. However, longitudinal data from individuals show exactly the opposite. Caries development is also delayed as a consequence of a delayed tooth eruption and thus the bell-shaped curve that results from plotting deciduous caries prevalence vs age is shifted to the right in malnourished children. This effect will result in an apparently negative association between caries in deciduous and permanent teeth when cross-sectional surveys are compared. Once the effect on tooth eruption is taken into account, the contribution of malnutrition to increased caries susceptibility may be observed, as demonstrated by a recent cross-sectional study involving Peruvian children.