allergy-associated symptoms are linked to early childhood caries dr. bindu karunakaran

181 Pages·2014·5.32 MB·English

ALLERGY-ASSOCIATED SYMPTOMS ARE
LINKED TO EARLY CHILDHOOD CARIES

DR. BINDU KARUNAKARAN
(BDS)

A THESIS SUBMITTED FOR THE DEGREE OF
MASTER OF SCIENCE

FACULTY OF DENTISTRY

NATIONAL UNIVERSITY OF SINGAPORE
2014
DECLARATION

I hereby declare that this thesis is my original work and it has been written by
me in its entirety and I have duly acknowledged all the sources of information
which have been used in the thesis.
This thesis has also not been submitted for any degree in any university
previously.

Signature ................................. December 10, 2014
Dr. Bindu Karunakaran

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ACKNOWLEDGEMENTS

This thesis is the result of a research journey, which was accompanied and
supported by many people. I am glad to take this opportunity to express my
gratitude to them, Prof. Stephen Hsu, for his support of my Master's study and
research. My heartfelt appreciation goes to Prof. Shek Lynette and Dr. Chan
for their guidance, insightful comments and advice. I would also like to extend
my thanks to Ms. Pei Ting and Ms. Nura for their unconditional support.

I would like to acknowledge Faculty of Dentistry, National University of
Singapore, for providing me this research opportunity and an excellent
research environment.

This work could never have been started and completed without the support of
my husband and best friend, Rajasegaran. I would like to thank him for the
support he provided me through my life, without whose love, encouragement,
continuous support and editing assistance, I would not have finished this
thesis. I am proud of my son, Aarav and appreciate his co-operation and
understanding throughout my candidature.

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ABBREVIATIONS
ECC Early Childhood Caries
SECC Severe early childhood caries
AAPD American Academy of Pediatric Dentistry
CAT Caries risk assessment tool
WHO World Health Organization
NIDCR National Institute of Dental and Craniofacial Research
ICDAS International Caries Detection and Assessment System
DMFT Decayed Missing Filled Teeth Index for permanent dentition
DMFS Decayed Missing Filled Surface Index for permanent dentition
dmft decayed missing filled teeth index for deciduous dentition
dmfs decayed missing filled surface index for deciduous dentition
MS Mutans streptococci
LB Lactobacilli
DMH Deciduous molar hypomineralisation
HASECC Hypoplasia associated severe early childhood caries
EHP Enamel hypoplasia
OHRQOL Oral health - related quality of life
ISAAC International study of asthma and allergies in childhood
NSCH National survey of children's health
AHR Airways hyperresponsiveness
COPSAC Copenhagen Prospective Study on Asthma in Childhood
SIgA Secretory immunoglobulin A
OR Odds ratio
RR Relative risk
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OE Oral examination
SM Streptococcus mutans
KKH KK Women’s and Children’s Hospital
NUH National University Hospital
GUSTO Growing Up in Singapore Towards healthy Outcomes
NUSIRB National University of Singapore Institutional Review Board
PI Plaque index
HI Household Income
IV Input variables
PC Potential confounders
OV Outcome variable

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TABLE OF CONTENTS
DECLARATION ........................................................................................... I
ACKNOWLEDGEMENTS .......................................................................... II
ABBREVIATIONS ..................................................................................... III
TABLE OF CONTENTS ............................................................................. V
SUMMARY .................................................................................................. X
LIST OF FIGURES .....................................................................................XI
LIST OF TABLES .................................................................................... XIII
1. INTRODUCTION AND LITERATURE REVIEW ................................. 2
1.1. OVERVIEW ................................................................................................. 2
1.2. EARLY CHILDHOOD CARIES ....................................................................... 4
1.2.1. Preface .............................................................................................. 4
1.2.2. Terminology ...................................................................................... 5
1.2.3. Definition .......................................................................................... 6
1.2.4. Classification .................................................................................... 7
1.2.5. Epidemiology .................................................................................. 11
1.2.6. Etiology ........................................................................................... 16
1.2.6.1. Microorganisms ................................................................................ 21
1.2.6.2. Teeth ................................................................................................. 23
1.2.6.3. Diet ................................................................................................... 26
1.2.6.4. Saliva ................................................................................................ 28
1.2.7. Consequences .................................................................................. 30
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1.2.8. Caries Management ........................................................................ 33
1.3. ALLERGIC DISEASE .................................................................................. 37
1.3.1. Overview ......................................................................................... 37
1.3.2. Mechanism of allergic diseases ....................................................... 39
1.3.3. Eczema ............................................................................................ 41
1.3.4. Rhinitis ............................................................................................ 42
1.3.5. Asthma ............................................................................................ 44
1.3.5.1. Risk Factors ...................................................................................... 44
1.3.5.2. Bacterial Infection in Respiratory track ............................................. 46
1.3.5.3. Role of CD4/CD8 cells in asthma ...................................................... 49
1.3.5.4. Effects of asthma on oral cavity ........................................................ 50
1.3.5.4.1. Effect of Asthmatic drugs on saliva ........................... 51
1.3.5.4.2. Mouth Breathing ....................................................... 54
1.4. ALLERGIC DISEASE AND DENTAL CARIES: A DIVERGENT CLINICAL
EVIDENCE ...................................................................................................... 55
1.5. KNOWLEDGE GAP .................................................................................... 65
1.6. OBJECTIVES ............................................................................................. 65
1.7. HYPOTHESIS ............................................................................................ 66
1.7.1. Primary hypothesis .......................................................................... 66
CHAPTER II MATERIALS AND METHODS ......................................... 68
2.1. INTRODUCTION TO GUSTO STUDY ................................................. 68
2.2. RECRUITMENT OF SUBJECTS: TARGET POPULATION ................. 69
2.2.1. Subjects inclusion and exclusion Criteria. ....................................... 69
2.3. ETHICAL CONSIDERATIONS ............................................................. 70
2.3.1. Ethical Approval ............................................................................. 70
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2.3.2. Parents Informed consent ................................................................ 70
2.3.2.1. Consent (1): for participation in the study.......................................... 70
2.3.2.2. Consent (2): for oral examination ...................................................... 71
2.4. DATA COLLECTION ............................................................................ 71
2.4.1. Preparations ................................................................................... 71
2.4.2. Questionnaire Survey ...................................................................... 71
2.4.3. Clinical visit .................................................................................... 72
2.4.3.1. Maternal and Infant data: Questionnaire ............................................ 72
2.4.3.2. Infant data: Oral Examination ........................................................... 72
2.4.4. Information for parents after data collection. .................................. 75
2.5. DATA ENTRY AND VERIFICATION .................................................. 76
2.6. DATA ANALYSIS ................................................................................. 77
2.6.1. Dealing with missing data ............................................................... 77
2.6.2. List of all variables used in this study. ............................................. 77
2.6.3. Selection of Statistical Model ........................................................... 78
CHAPTER III RESULTS ........................................................................... 81
3.1. DEMOGRAPHIC AND SOCIOECONOMIC PROFILE OF GUSTO COHORT STUDY 81
3.2. INFERENTIAL DATA FROM MULTI-VARIATE REGRESSION ............................ 83
3.2.1. Association of Allergic diseases on Early Childhood Caries ............ 83
3.2.1.1. Distribution of outcome variable - ECC according to the various
variables included in the study. ...................................................................... 83
3.2.1.2. Preliminary Analysis - First Approach .............................................. 84
3.2.1.3. Final model and analysis. .................................................................. 86
CHAPTER IV: DISCUSSION .................................................................... 94
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4.1. ORAL EXAMINATION ................................................................................ 94
4.1.1. Examination methods ...................................................................... 94
4.1.1.1. Diagnostic criteria ............................................................................. 95
4.1.1.2. Caries Incidence ................................................................................ 95
4.2. QUESTIONNAIRE SURVEY ......................................................................... 96
4.2.1. Interview-administered approaches ................................................. 96
4.2.1.2. Child's Allergic diseases.................................................................... 96
4.2.1.2.1. Asthma with nebulizer ............................................... 97
4.2.1.2.2. Eczema...................................................................... 99
4.2.1.2.3. Rhinitis.................................................................... 100
4.3. DEMOGRAPHIC BACKGROUND ................................................................ 101
4.3.1. Maternal Factors........................................................................... 101
4.3.1.1. Maternal Educational Level............................................................. 102
4.3.1.2. Household Income .......................................................................... 102
4.3.1.3. Maternal Medical history ................................................................ 103
4.3.2. Child factors .................................................................................. 104
4.3.2.1. Gender ............................................................................................ 104
4.3.2.2. Ethnicity ......................................................................................... 104
4.3.2.3. Mode of delivery ............................................................................. 105
4.3.2.4. Feeding habits at nighttime ............................................................. 106
4.3.2.4.1. Breast feeding at night ............................................. 107
4.3.2.4.2. Bottlefeeding at night .............................................. 108
4.3.2.5. Medical Conditions ......................................................................... 109
4.3.2.6. Topical Steroid ................................................................................ 109
4.3.2.7. Oral medicine.................................................................................. 110
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4.3.2.8. Dry mouth ....................................................................................... 111
4.3.2.9. Plaque Index ................................................................................... 112
4.3.2.10. Oral habits..................................................................................... 113
4.4. LIMITATIONS ......................................................................................... 113
4.5. CONCLUSION AND FUTURE STUDIES ........................................................ 114
4.5.1. Conclusion .................................................................................... 114
4.5.2. Future studies ................................................................................ 115
REFERENCES: ......................................................................................... 118
APPENDIX ................................................................................................ 137
Appendix I: Oral Health Questionnaire - English, Chinese & Malay version.137
Appendix II: Participation Information Sheet - NUH and KKH site ............. 142
Appendix III: Oral Examination Record ...................................................... 151
Appendix IV: Biofilm (Specimen) Processing Form .................................... 152
Appendix V: Results from Poisson regression, OV - dmft ............................ 153
Appendix VI: Results from Logistic regression based on severity of caries .. 156
APPENDIX VII: Results from Poisson & Logistic regression - Split data
analysis........................................................................................................ 159

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