Vitamin D status of children with severe early childhood caries: a case–control study

BMC Pediatrics

Michael EK Moffatt¹  Eleonore Kliewer²  James Friel²  Elizabeth A Sellers²  Jeremy A Levi²  Robert J Schroth³ 

[1] Winnipeg Regional Health Authority, Winnipeg, Canada;The Manitoba Institute of Child Health, Winnipeg, Canada;Department of Preventive Dental Science, Faculty of Dentistry, Department of Pediatrics & Child Health, Faculty of Medicine, University of Manitoba, 507 – 715 McDermot Avenue, Winnipeg MB R3E 3P4, Canada

关键词: Preschool children;    Parathyroid hormone;    Calcium;    Nutritional status;    Vitamin D;    Early childhood caries;   

Others  :  1144377
DOI  :  10.1186/1471-2431-13-174

 received in 2013-06-03, accepted in 2013-10-23,  发布年份 2013

【 摘 要 】

Background

Severe Early Childhood Caries (S-ECC) affects the health and well-being of young children. There is limited research in this area, though evidence suggests that children with S-ECC are at an increased risk of malnutrition. The purpose of this study was to determine the association between vitamin D (25(OH)D) levels and S-ECC.

Methods

This case–control study was conducted from 2009 to 2011 in the city of Winnipeg, Manitoba, Canada. 144 preschool children with S-ECC were recruited from a local health centre on the day of their slated dental surgery under general anesthetic. 122 caries-free controls were recruited from the community. Children underwent a blood draw for vitamin D (25(OH)D), calcium, parathyroid hormone, and albumin levels. Parents completed an interviewed questionnaire assessing the child’s nutritional habits, oral health, and family demographics. Analyses included descriptive and bivariate statistics as well as multiple and logistic regression. A p value ≤ 0.05 was significant.

Results

The mean age of participants was 40.8 ± 14.1 months. Children with S-ECC had significantly lower mean 25(OH)D (68.9 ± 28.0 nmol/L vs. 82.9 ± 31.1, p < 0.001), calcium (p < 0.001), and albumin (p < 0.001) levels, and significantly higher parathyroid hormone (p < 0.001) levels than those caries-free. Children with S-ECC were significantly more likely to have vitamin D levels below recognized thresholds for optimal and adequate status (i.e. <75 and <50 nmol/L, respectively). Multiple regression analysis revealed that S-ECC, infrequent milk consumption, and winter season were significantly associated with lower 25(OH)D concentrations. Low 25(OH)D levels, low household income, and poorer ratings of the child’s general health were significantly associated with S-ECC on logistic regression.

Conclusion

Children with S-ECC appear to have relatively poor nutritional health compared to caries-free controls, and were significantly more likely to have low vitamin D, calcium, and albumin concentrations and elevated PTH levels.

【 授权许可】

   
2013 Schroth et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Drury TF, Horowitz AM, Ismail AI, et al.: Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the National Institute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administration. J Public Health Dent 1999, 59:192-197.
• [2]American Academy of Pediatric Dentistry: Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies. Pediatr Dent 2012, 34(6):50-52.
• [3]Schroth RJ, Harrison RL, Moffatt ME: Oral health of indigenous children and the influence of early childhood caries on childhood health and well-being. Pediatr Clin North Am 2009, 56:1481-1499.
• [4]Canadian Paediatric Decision Support Network: Canadian Paediatric Decision Support Network Annual Report April 2003-March 2004. Ottawa: Canadian Paediatric Decision Support Network. Canadian Association of Paediatric Health Centres; 2004:1-54.
• [5]Feitosa S, Colares V, Pinkham J: The psychosocial effects of severe caries in 4-year-old children in Recife, Pernambuco, Brazil. Cad Saude Publica 2005, 21:1550-1556.
• [6]Williamson R, Oueis H, Casamassimo PS, et al.: Association between early childhood caries and behavior as measured by the child behavior checklist. Pediatr Dent 2008, 30:505-509.
• [7]Thomas CW, Primosch RE: Changes in incremental weight and well-being of children with rampant caries following complete dental rehabilitation. Pediatr Dent 2002, 24:109-113.
• [8]White H, Lee JY, Vann WF Jr: Parental evaluation of quality of life measures following pediatric dental treatment using general anesthesia. Anesth Prog 2003, 50:105-110.
• [9]Low W, Tan S, Schwartz S: The effect of severe caries on the quality of life in young children. Pediatr Dent 1999, 21:325-326.
• [10]Oliveira LB, Sheiham A, Bonecker M: Exploring the association of dental caries with social factors and nutritional status in Brazilian preschool children. Eur J Oral Sci 2008, 116:37-43.
• [11]Gaur S, Nayak R: Underweight in low socioeconomic status preschool children with severe early childhood caries. J Indian Soc Pedod Prev Dent 2011, 29:305-309.
• [12]Schroth RJ, Levi J, Kliewer E, et al.: Association between iron status, iron deficiency anaemia, and severe early childhood caries: a case–control study. BMC Pediatr 2013, 13:22. BioMed Central Full Text
• [13]Clarke M, Locker D, Berall G, et al.: Malnourishment in a population of young children with severe early childhood caries. Pediatr Dent 2006, 28:254-259.
• [14]Schroth R, Jeal N, Kliewer E, et al.: The relationship between vitamin D and severe early childhood caries: a pilot study. Int J Vitam Nutr Res 2012, 82:53-62.
• [15]Grant WB, Holick MF: Benefits and requirements of vitamin D for optimal health: a review. Altern Med Rev 2005, 10:94-111.
• [16]Holick MF: Vitamin D deficiency. N Engl J Med 2007, 357:266-281.
• [17]Berdal A, Bailleul-Forestier I, Davideau J, et al.: Dento-alveolar bone complex and vitamin D. In Vitamin D. Edited by Feldman D, Pike J, Glorieux F. Burlington: Elsevier Academic Press; 2005:599-607.
• [18]Mellanby M, Pattison C: The action of vitamin D in preventing the spread and promoting the arrest of caries in children. Br Med J 1928, 2:1079-1082.
• [19]Mellanby M: Diet and the teeth. An experimental study. In The effect of diet on dental structure and disease in man. III edition. Edited by Medical Research Council. London: His Majesty’s Stationery Office; 1934:1-180.
• [20]Dietrich T, Joshipura KJ, Dawson-Hughes B, et al.: Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population. Am J Clin Nutr 2004, 80:108-113.
• [21]Grant WB: Vitamin D, periodontal disease, tooth loss, and cancer risk. Lancet Oncol 2008, 9:612-613.
• [22]Grant WB: A review of the role of solar ultraviolet-B irradiance and vitamin D in reducing risk of dental caries. Dermatoendocrinol 2011, 3:193-198.
• [23]Hildebolt CF: Effect of vitamin D and calcium on periodontitis. J Periodontol 2005, 76:1576-1587.
• [24]Hewison M: Vitamin D and the immune system: new perspectives on an old theme. Endocrinol Metab Clin North Am 2010, 39:365-379. table
• [25]American Academy of Pediatric Dentistry: Definition of early childhood caries (ECC). Pediatr Dent 2010, 32:15.
• [26]Whiting SJ, Calvo MS: Overview of the proceedings from experimental biology 2005 symposium: optimizing vitamin D intake for populations with special needs: barriers to effective food fortification and supplementation. J Nutr 2006, 136:1114-1116.
• [27]Dawson-Hughes B, Heaney RP, Holick MF, et al.: Estimates of optimal vitamin D status. Osteoporos Int 2005, 16:713-716.
• [28]Committee to Review Dietary Reference Intakes for Vitamin D and Calcium FaNB: Dietary reference intakes for calcium and vitamin D. Washington, DC: Institute of Medicine; 2011.
• [29]McBeath EC, Verlin WA: Further studies on the role of vitamin D in the nutritional control of dental caries in children. J Am Dent Assoc 1942, 29:1393-1397.
• [30]Hujoel PP: Vitamin D, and dental caries in controlled clinical trials: systematic review and meta-analysis. Nutr Rev 2013, 71:88-97.
• [31]Mellanby M: The role of nutrition as a factor in resistance to dental caries. Br Dent J 1937, 62(5):241-252.
• [32]Langlois K, Greene-Finestone L, Little J, et al.: Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey. Health Reports 2010, 21(1):47-55.
• [33]Maguire JL, Lebovic G, Kandasamy S, et al.: The relationship between cow’s milk and stores of vitamin D and iron in early childhood. Pediatrics 2013, 131:e144-e151.
• [34]Hoffer L: Metabolic consequences of starvation. In Modern nutrition in health and disease. 11th edition. Edited by Ross A, Caballero B, Cousins R, Tucker K, Ziegler T. Lippincott Williams & Wilkins; 2012:660-677.
• [35]Shaoul R, Gaitini L, Kharouba J, et al.: The association of childhood iron deficiency anaemia with severe dental caries. Acta Paediatr 2012, 101:e76-e79.