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Background Early childhood caries (tooth decay) can adversely affect child growth, development and well-being and is a leading cause of preventable hospitalisation for pre-school aged children. This necessitates the introduction of preventive measures in infancy, including twice daily toothbrushing and timely dental visits. This study explored the barriers and enablers parents face in providing optimal oral care for their young children. Methods We interviewed Australian parents with 0-36-month-old children about two key behaviours related to their child’s oral health: (1) the timing of first dental visit and (2) twice daily toothbrushing. Parents were recruited via social media advertising and all interviews were conducted online via Zoom. Interviews were based on a semi-structured interview guide mapped to the Theoretical Domains Framework (TDF). All interviews were audio recorded and transcribed. Data was coded to the TDF, summarised, and categorised as a barrier or enabler before being grouped into themes and sub-themes using framework analysis. Results Fifteen interviews were completed between May 2022– May 2023. Thirteen of the 14 TDF domains were represented in the data. The three most dominant TDF domains across the dataset were social influences , environmental context and resources , and knowledge. Four themes were developed from the data: (1) Conflict, (2) Family and social norms, (3) Wanting a positive oral health experience, and (4) Uncertainty. These themes represent both barriers and enablers to optimal infant and young children’s oral care. Parents face complex decision-making challenges regarding their young children’s oral health care, particularly managing actual and perceived conflicts with their child. Knowledge and social and family norms influence their approach to managing these barriers. Conclusions The key influences enabling or preventing optimal infant oral care identified in this study lay the foundation for interventions to target these behaviours. To encourage a timely first dental visit, parents need consistent messaging from dental and other health professionals. To encourage twice daily toothbrushing, parents need more support in managing their child’s behaviour and competing priorities.

IntroductionDental caries is the most common oral disease worldwide, affecting up to 90% of children globally. It can lead to pain, infection and impaired quality of life. Early prevention is a key strategy for reducing the prevalence of dental caries in young children. Valid and reliable diagnostic or prognostic tools that enable accurate individualised prediction of current or future dental caries are essential for facilitating personalised caries prevention and early intervention. However, no efficacious tools currently exist in early childhood—the optimal period for disease prevention. We aim to develop and validate diagnostic and prognostic prediction tools for dental caries in young children, using a combination of environmental, physical, behavioural and biological early life data.Methods and analysisData sources include two prospective studies, with a total sample size of approximately 600 children. These cohorts have collected detailed demographic, antenatal, perinatal and postnatal data from medical records and parent-completed questionnaires and biological samples including a dental plaque swab. Candidate predictor variables will include sociodemographic characteristics, health history, behavioural and microbiological characteristics. The outcome variable will be the presence, incidence or severity of dental caries diagnosed using the International Caries Detection and Assessment System. Statistical and machine learning approaches will be used for selection of predictor variables and model development. Internal validation will be conducted using resampling methods (i.e., bootstrapping) and nested cross-validation. Model performance will be evaluated using standard performance metrics such as accuracy, discrimination and calibration. Where feasible, external validation will be performed in an independent cohort. Model development and reporting will be guided by the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) statement and the Prediction model Risk Of Bias Assessment Tool (PROBAST) guidelines.Ethics and disseminationThis study has ethical and governance approval from The Royal Children’s Hospital Melbourne Human Research Ethics Committee (HREC/111803/RCHM-2024). Results of this study will be published in peer-reviewed journals and presented at scientific conferences.Trial registration numberInfant2Child: ACTRN12622000205730—pre-results; MisBair: NCT01906853—post results.

To determine the early dental service utilisation patterns among Australian children and investigate barriers to care. Randomly selected adults aged 18 years and older who were parents or caregivers of children under 18 years of age completed an online nationally representative cross‐sectional survey which was then analysed using descriptive statistics. A total 2,048 parents of 3,660 children, including 1,179 aged between one and six years, completed the survey. Utilisation of professional dental care was low among children under six years of age, with just 118 (27.3%) at one year of age having ever received professional dental care. The most frequently reported reasons for lack of professional dental care were that the child was too young, their teeth were healthy or that the child would be scared. Cost was the fourth most frequently reported reason in young children. Only 459 (22.4%) parents knew that the first dental visit should be at one year of age or earlier. Parents are unaware that children should have their first dental visit at 12 months, and therefore most children miss out on essential early health promotion. As many parents are unaware of the importance of early dental visits, integrating and strengthening oral health promotion screening and referral within broader early childhood health services is essential.

Dental caries is a common chronic disease in children. Digital tools such as intraoral scanners (IOSs) may offer an efficient, scalable alternative to conventional visual examination for dental caries detection. IOSs are handheld devices that generate 3-dimensional (3D) models of the teeth and surrounding structures. Recent advances incorporating fluorescence technology into scanner hardware offer the potential for supporting dental caries detection. However, the performance of digital caries detection methods using 3D models that include both color and fluorescence in children's teeth remains unknown. This study aimed to assess the diagnostic agreement between visual examination and on-screen assessment of 3D models generated by an IOS in color and supplemented with fluorescence for caries detection in primary teeth. Children participating in a clinical trial (n=216, mean age 5.6, SD 0.4 y) underwent visual examination using the International Caries Detection and Assessment System (ICDAS) and intraoral scanning using the TRIOS 4 IOS. Four trained registered dental practitioners independently assessed each participant's 3D models in color and then supplemented with fluorescence, using a previously validated ICDAS index modified for on-screen assessments of 3D models. All 3D models were assessed again after 4 weeks. The time taken for intraoral scanning and on-screen assessment was recorded. Multilevel logistic regression was used to estimate and compare the likelihood of detecting caries between methods, and Bland-Altman plots were used to visualize agreement. Analyses were performed at the initial (ICDAS ≥01), moderate (ICDAS ≥03), and extensive (ICDAS ≥05) dental caries thresholds. Intraclass correlation coefficient (ICC) estimated method agreement and examiner reliability. Of 219 children enrolled, 216 completed dental assessments. A total of 9470 visible primary tooth surfaces were included in the analysis. The average time taken for on-screen assessment of each 3D model (color with fluorescence) was 3.5 (SD 2.3) minutes. The likelihood of detecting caries using color assessment of 3D models was similar to visual examination at all disease thresholds: initial (odds ratio [OR] 1.1, 95% CI 1.0-1.3), moderate (OR 0.9, 95% CI 0.7-1.1), and extensive (OR 1.0, 95% CI 0.7-1.3). When color assessments were supplemented with fluorescence, the likelihood of detecting caries was 30% higher at the initial threshold relative to visual examination (OR 1.3, 95% CI 1.1-1.5) and similar at the moderate (OR 0.9, 95% CI 0.7-1.1) and extensive thresholds (OR 0.9, 95% CI 0.7-1.3). Bland-Altman plots showed a high level of agreement at both moderate and extensive thresholds. Agreement between methods was high (ICC 0.9, 95% CI 0.9-1.0). Intra- and inter-examiner reliability using intraoral scans ranged from good to excellent (ICC 0.8-1.0). On-screen assessment of 3D models in color demonstrated the highest agreement with visual examination for caries detection across all disease thresholds.

Birthweight has been consistently related to risk of cardiometabolic disorders in later life. Twins are at higher risk of low birthweight than singletons, so understanding the links between birthweight and cardiometabolic health may be particularly important for twins. However, evidence for the association of birthweight with childhood markers of cardiometabolic health in twins is currently lacking. Previous studies have often failed to appropriately adjust for gestational age or fully implement twin regression models. Therefore, we aimed to evaluate the association of birthweight-for-gestational-age z-scores with childhood cardiometabolic health in twins, using within-between regression models. The Peri/Postnatal Epigenetic Twins Study is a Melbourne-based prospective cohort study of 250 twin pairs. Birthweight was recorded at delivery, and childhood anthropometric measures were taken at 18-month and 6-year follow-up visits. Associations of birthweight with markers of cardiometabolic health were assessed at the individual, between- and within-pair level using linear regression with generalised estimating equations. Birthweight-for-gestational-age z-scores were associated with height, weight and BMI at 18 months and 6 years, but not with blood pressure (twins-as-individual SBP: β = 0.15, 95% CI: −0.81, 1.11; twins-as-individual DBP: β = 0.22, 95% CI: −0.34, 0.77). We found little evidence to indicate that the within-between models improved on the twins-as-individuals models. Birthweight was associated with childhood anthropometric measures, but not blood pressure, after appropriately adjusting for gestational age. These associations were consistent across the within-between and twins-as-individuals models. After adjusting for gestational age, results from the twins-as-individuals models are consistent with singleton studies, so these results can be applied to the general population.

Digital methods that enable early caries identification can streamline data collection in research and optimize dental examinations for young children. Intraoral scanners are devices used for creating 3D models of teeth in dentistry and are being rapidly adopted into clinical workflows. Integrating fluorescence technology into scanner hardware can support early caries detection. However, the performance of caries detection methods using 3D models featuring color and fluorescence in primary teeth is unknown. This study aims to assess the diagnostic agreement between visual examination (VE), on-screen assessment of 3D models in approximate natural colors with and without fluorescence, and application of an automated caries scoring system to the 3D models with fluorescence for caries detection in primary teeth. The study sample will be drawn from eligible participants in a randomized controlled trial at the Royal Children's Hospital, Melbourne, Australia, where a dental assessment was conducted, including VE using the International Caries Detection and Assessment System (ICDAS) and intraoral scan using the TRIOS 4 (3Shape TRIOS A/S). Participant clinical records will be collected, and all records meeting eligibility criteria will be subject to an on-screen assessment of 3D models by 4 dental practitioners. First, all primary tooth surfaces will be examined for caries based on 3D geometry and color, using a merged ICDAS index. Second, the on-screen assessment of 3D models will include fluorescence, where caries will be classified using a merged ICDAS index that has been modified to incorporate fluorescence criteria. After 4 weeks, all examiners will repeat the on-screen assessment for all 3D models. Finally, an automated caries scoring system will be used to classify caries on primary occlusal surfaces. The agreement in the total number of caries detected per person between methods will be assessed using a Bland-Altman analysis and intraclass correlation coefficients. At a tooth surface level, agreement between methods will be estimated using multilevel models to account for the clustering of dental data. Automated caries scoring of 3D models was completed as of October 2023, with the publication of results expected by July 2024. On-screen assessment has commenced, with the expected completion of scoring and data analysis by March 2024. Results will be disseminated by the end of 2024. The study outcomes may inform new practices that use digital models to facilitate dental assessments. Novel approaches that enable remote dental examination without compromising the accuracy of VE have wide applications in the research environment, clinical practice, and the provision of teledentistry. Australian New Zealand Clinical Trials Registry ACTRN12622001237774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384632. DERR1-10.2196/51578.

Objective: To systematically review and quantify the effectiveness of interventions in reducing caries development during orthodontic treatment and evaluate the quality of evidence for the development of clinical guidelines. Materials and methods: A comprehensive literature search of the Cochrane, EMBASE and MEDLINE databases was conducted to identify eligible randomised controlled trials (RCTs). The risk of bias was assessed using the Cochrane risk of bias (RoB 2) tool. In order to facilitate the development of clinical guidelines, the quality of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results: A total of 18 RCTs were included in the qualitative synthesis, of which 10 had a high risk of bias, and eight had minor concerns. Three RCTs that investigated the efficacy of fluoride interventions during fixed orthodontic treatment were included in the quantitative synthesis. The pooled effect size resulted in a risk reduction of 0.23 (95% CI: -0.35, -0.11, p < 0.001) in the intervention group compared to controls. The GRADE evaluation identified the evidence as moderate due to the limited number of RCTs and moderate heterogeneity (I-squared statistic of 49.3%). Conclusions: Although fluoride is the most effective evidence-based preventive intervention during orthodontic treatment, large RCTs are required to provide high quality evidence. Further studies are needed to evaluate the caries preventive effects of oral hygiene programs, chlorhexidine, CPP-ACP and other interventions.

Background: Molar incisor hypomineralisation (MIH) is a common disorder of tooth development, which has recently been found to be associated with a higher prevalence of hypodontia. The aim of this international multicentre study is to determine the association between MIH and other developmental anomalies in different populations. Methods: Investigators were trained and calibrated for the assessment of MIH and dental anomalies and ethical approvals obtained in each participating country. The study aimed to recruit 584 children with MIH and 584 children without MIH. Patients aged 7–16 years who attend specialist clinics will be invited to participate. Children will undergo a clinical examination to determine the presence and severity of MIH, using an established index. The presence of any other anomalies, affecting tooth number, morphology, or position, will be documented. Panoramic radiographs will be assessed for dental anomalies and the presence of third permanent molars. Statistical analysis, using a chi squared test and regression analysis, will be performed to determine any differences in dental anomaly prevalence between the MIH and non-MIH group and to determine any association between dental anomalies and patient characteristics. Conclusion: This large-scale study has the potential to improve understanding about MIH with benefits for patient management.

Molar incisor hypomineralisation (MIH) is a qualitative developmental enamel defect with a prevalence of 13% worldwide. This review aims to outline the current evidence regarding the impact of MIH on children’s oral health and, more broadly, their day-to-day activities. MIH is associated with negative sequelae, including hypersensitivity, post-eruptive breakdown, the rapid development of carious lesions and poor aesthetics. Other concerns pertain to the clinical management of MIH and include difficulty in achieving local anaesthesia, increased dental fear and anxiety (DFA) and increased behaviour management problems. Oral health-related quality of life (OHRQoL) is the most standardised measure of patient impact; however, no instruments have been validated for use in MIH populations. The few existing observational studies investigating the impact of MIH on OHRQoL in children have produced conflicting results. Interventions to alleviate hypersensitivity and improve aesthetics had a positive impact on the OHRQoL of MIH-affected children. Multiple methodological issues make it difficult to measure the impact of MIH, including heterogeneity in the MIH severity classification, an overlap in the indices used to diagnose dental caries and MIH as well as the subjectivity of outcome measures for hypersensitivity and DFA.

Excess free sugars intake contributes to dental caries and obesity in children. Food frequency questionnaires (FFQ) that assess free sugars intake in young children are limited. This study evaluated the utility of a 68-item FFQ to assess free sugars intake in Australian young children against three 24-h recalls at ages 1.5, 3.5, and 5.0 years. Free sugars intakes estimated from two methods were compared using group- and individual-level validation tests. Group-level tests revealed that mean free sugars intakes estimated from two methods were similar and Bland-Altman tests revealed no presence of proportional bias at age 1.5 years. For ages 3.5 and 5.0 years, the FFQ underestimated the free sugars intake compared to the recalls, and Bland-Altman tests revealed proportional bias. For individual-level tests, the deattenuated correlation (R) between free sugars intakes estimated from two methods exhibited good agreement across three time-points (R: 0.54–0.62), as were the percentage agreement (68.5–73.6%) and weighted kappa (Kw: 0.26–0.39). The FFQ showed good validity at age 1.5 years. For ages 3.5 and 5.0 years, the FFQ showed good validity for individual-level tests only. The FFQ provided stronger validity in the ranking of individuals according to free sugars intake than comparing absolute free sugars intake at group level.