Search Results (15)

Background/Objectives: Maintaining oral hygiene in infants in neonatal and pediatric intensive care is essential for preventing ventilator-associated pneumonia (VAP). Chlorhexidine (CHX) is widely used in adults but its safety and efficacy in infants remain uncertain, and it is not recommended for children under 6 years due to rinsing difficulties and mucosal irritation risk. Expressed breast milk (EBM), rich in immunological and antimicrobial components, has been explored as a biologically appropriate alternative. This review synthesizes evidence on EBM effectiveness and safety and contextualizes it against limited indirect evidence for CHX, as no head-to-head comparative trials were identified. Methods: A systematic search of PubMed, EMBASE, Cochrane Library, CINAHL, and Web of Science (January 2015–January 2026) identified randomized and non-randomized studies involving infants ≤ 12 months receiving EBM, colostrum, or CHX for oral care. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for non-RCTs. Due to substantial clinical and methodological heterogeneity (differing populations, dosages, frequencies, delivery methods, and outcome definitions), a narrative synthesis was performed. Results: Seventeen studies met inclusion criteria (11 RCTs, n = 1185; 6 non-RCTs, n > 3000). EBM and oropharyngeal colostrum were associated with trends toward lower VAP incidence trends (0–4%), reduced bacterial colonization, improved oral health indices, shorter mechanical ventilation time, and reduced ICU/hospital stays, with no reported adverse events. Evidence for CHX in infants was limited to a single paediatric RCT and bundled interventions, showing no significant VAP reduction and associations with mucosal irritation. The risk of bias was generally low to moderate. Conclusions: Indirect evidence suggests EBM is a potentially beneficial option for infant oral hygiene, with favourable trends for infection-related outcomes and recovery parameters. However, all EBM–CHX comparisons are indirect, and CHX evidence in infants is limited by the risk of bias and heterogeneity. High-quality head-to-head randomized controlled trials are needed to determine optimal strategies and inform guidelines. Full article

Background/Objectives: Although the benefits of breastfeeding on the development and health of the infant are well known, the relationship between breastfeeding, oral health and attachment style or emotional bonding is not fully known. This research sought to explore, from a comprehensive perspective, the associations between breastfeeding history and children’s attachment styles, as well as the relationships between breastfeeding history and oral health indicators within conceptual psychophysiological frameworks discussed in the literature. Methods: This was a cross-sectional (descriptive and analytical) and correlational study. In this work, the associations of breastfeeding with attachment and oral health were analyzed in 100 children between 9 and 11 years old at a primary school in the municipality of José Azueta, Veracruz, Mexico, from December 2023 to September 2024 by a clinical history, dental examinations (Oral Hygiene Index-Simulated (OHI-S), Dental Caries History (DEOPT) and Detection of Malocclusions (DAI)) and the Attachment and Interaction Styles Instrument. Results: Significant differences were found in the security and closeness attachment style, the oral-hygiene index, the caries index, and occlusion by type of breastfeeding, showing better values in boys and girls who were exclusively breastfed. Likewise, both in the correlation analysis and in the multiple regression model, associations were observed between having been exclusively breastfed and the attachment style and oral indices. Conclusions: Our data show the importance of breastfeeding in pubertal children, since it was associated with better attachment and oral health; however, these findings reflect patterns of co-occurrence and should not be interpreted as causal relationships. Full article

Background: Early childhood caries (ECC) remains one of the most prevalent chronic conditions among preschool children worldwide. Feeding practices during infancy play a significant role in shaping oral microbial colonization and caries risk. This study aimed to evaluate the association between breastfeeding, artificial feeding, and the occurrence of ECC among children aged 3–5 years. Methods: A cross-sectional clinical and epidemiological study was conducted involving 103 children aged 3–5 years. Parents completed a structured questionnaire. Participants were divided into three groups based on infant feeding history: exclusively breastfed, exclusively artificially fed, and mixed-fed. Clinical oral examinations assessed dmft indices. Statistical analysis included Kruskal–Wallis and Mann–Whitney U tests for dmft scores, Chi-square tests for categorical variables, Spearman correlations, and binary logistic regression to identify predictors of dental caries. Results: Among participants, 43.6% were exclusively breastfed, 41.7% mixed-fed, and 14.5% exclusively artificially fed. The mean dmft index was highest in formula-fed children (4.2 ± 3.78), followed by mixed-fed (2.97 ± 3.19) and breastfed children (1.75 ± 2.99). Kruskal–Wallis analysis showed significant differences in dmft among groups (p = 0.005), with breastfed children having lower dmft than both formula-fed (p = 0.009) and mixed-fed (p = 0.006) children. Caries presence was significantly associated with feeding type (χ² = 14.00, p = 0.001) and fluoride toothpaste use (χ² = 7.56, p = 0.023). A weak negative correlation was observed between dmft and breastfeeding duration (ρ = −0.266, p = 0.007). Logistic regression identified longer breastfeeding duration (OR = 0.889, 95% CI: 0.81–0.97, p = 0.010) and use of fluoride toothpaste (OR = 0.323, 95% CI: 0.13–0.81, p = 0.012) as protective factors against dental caries. Parental questionnaire responses suggested prolonged bottle feeding and nocturnal feeding habits as contributing factors. Conclusions: Longer breastfeeding duration and regular use of fluoride toothpaste were associated with lower risk of dental caries in children. Formula feeding was associated with higher dmft scores. Infant feeding practices significantly influence the risk of early childhood caries. Encouraging breastfeeding and educating parents on appropriate weaning and oral hygiene measures may reduce ECC incidence and support better long-term oral health outcomes. Full article

Background/Objectives: Oral candidiasis is frequently encountered in pediatric populations, particularly in infants and toddlers, where the development of immunity and inconsistent oral hygiene contribute to disease susceptibility. While topical antifungal agents remain the standard of care, treatment challenges persist, especially regarding adherence and recurrence. Aloe vera, recognized for its antimicrobial, anti-inflammatory, and mucosal healing properties, may offer therapeutic benefits when used in conjunction with standard regimens. This study aimed to evaluate the adjunctive effect of topical Aloe vera gel, when added to standard antifungal therapy, on reducing fungal load and improving treatment adherence in children with moderate oral candidiasis. Methods: A prospective controlled study was conducted among 54 children diagnosed with moderate oral candidiasis. Participants were randomly assigned to receive either standard topical nystatin or nystatin in conjunction with Aloe vera gel over a 7 day treatment duration. Fungal load was assessed using colony-forming units (CFU) counts from oral swabs collected at baseline and day 7, analyzed via ANCOVA. Additional parameters included treatment adherence, compared using an independent t-test, and clinical recurrence at a 14-day post-treatment follow-up, assessed through logistic regression. Results: Baseline characteristics were similar across groups. By day 7, children in the Aloe vera group exhibited a greater reduction in fungal load compared to those receiving standard therapy alone. Adherence was significantly higher in the aloe group (92.73% vs. 89.21%; p < 0.0001). Regression analysis identified both baseline fungal burden and adherence as factors associated with an increased risk of recurrence. Conclusions: The addition of Aloe vera gel to standard therapy may support a more effective fungal clearance and improved treatment adherence in children with moderate oral candidiasis, suggesting its potential as a complementary treatment option. Given the single-center design, short follow-up, and underpowered recurrence analysis, these findings should be considered preliminary, pending confirmation in larger studies with symptom-anchored endpoints. Full article

The infant oral microbiome is a complex and dynamic microbial community that undergoes various transformations during human development. From birth, these microorganisms are modulated by factors such as birth type, nutrition, oral hygiene, hormonal changes, and environmental and socioeconomic conditions. These elements interact continuously, shaping the diversity and stability of the oral microbiome and consequently influencing the oral and general health of individuals. The main objective of this study was to review the literature on the evolution of the oral microbiome at different stages of growth, with special emphasis on the maintenance of dental homeostasis and prevention of pathologies such as caries and periodontitis. A bibliographic review of scientific databases was conducted, focusing on the last decade. In general, oral microbiome dysbiosis increases the risk of oral diseases and systemic conditions. Diet, parental practices, and horizontal transmission of bacteria from caregivers have been shown to modulate and influence the composition and functioning of the infant oral microbiome. Despite these advances, gaps remain in our understanding of the impact of the pediatric oral microbiome on long-term comprehensive health. Therefore, longitudinal research is needed to understand the development of the oral microbiome and its potential role in early prediction, prevention, and treatment of oral and systemic diseases. Full article

Background: Prematurely born newborns with low birth weight constitute a group of patients who require special care from the first days of life. Prematurity and low birth weight affect about 13.4 million infants. Risk factors include placental disorders but also factors related to the mother, such as smoking, alcohol drinking, drug use, malnutrition, or certain diseases. It is imperative to educate women of reproductive age (15–49) about the basic factors influencing embryonic development, such as oral health, diet, medicine intake, and harmful habits. Even though most women are aware of the negative impact of harmful habits on the fetus, still too little attention is paid to oral health in pregnant women. Poor oral health may influence the well-being of the future mother, as well as of the child. Therefore, women of reproductive age and those who are pregnant must have adequate knowledge on this subject. The aim of this study was to assess the knowledge of Polish women of reproductive age (15–49) regarding oral health during pregnancy, including the impact of dental treatment, oral hygiene, and maternal oral conditions on pregnancy outcomes and the health of the newborn. Materials and Methods: This was a cross-sectional study of 508 women, in the reproductive age, whose age ranged from 18 to 49 years old. The surveys were conducted from April 2020 to November 2020. The questionnaire was originally developed based on the available literature and consisted of seven sections: basic information, general health and habits, pregnancy status and dental care, knowledge of treatment options during pregnancy, oral health status and its association with the risk of preterm birth, prematurity and the child’s oral health, and breastfeeding and oral development. Results: After excluding incomplete questionnaires, a total of 499 questionnaires were included in the analysis. Women participating in the study had a fairly good understanding of the impact of oral health on the fetus and the role of breastfeeding in the development of the stomatognathic system (from 50% to 70% correct answers). However, even though most respondents had completed higher education (344/68.94%), their knowledge of oral health, preterm birth, and low birth weight was very limited (including the impact of inflammation on the intrauterine development of the child or bacteria and transfer across the placenta). In these sections, the percentage of correct answers ranged from less than 20% to 50%. When analyzing knowledge by age, education, number of births, and place of residence, the highest levels of knowledge were observed among respondents with higher education, particularly those aged 27–32. Conclusions: Respondents had a fairly good understanding of the general impact of oral health during pregnancy and recognition of the importance of breastfeeding for infants. However, their knowledge about the impact of bacteria and inflammation in the mother’s oral cavity on prematurity and low birth weight was limited. Therefore, educating women of reproductive age and pregnant women on this topic is essential, as it may help reduce the adverse consequences of prematurity. Full article

This study aimed to investigate the association between the different information sources on infant oral hygiene accessed by mothers and infant oral hygiene practices in South Australia. Information on the oral hygiene practices used in 6-month-old infants—gum/tooth cleaning in the past 3 months, frequency of brushing, and the usage of fluoridated toothpaste—were acquired from the Study of Mothers’ and Infants’ Life Events Affecting Oral Health (SMILE) cohort survey. Descriptive statistics and multivariable logistic regression modelling were used to analyse the relationship between the information sources and infant oral hygiene practices. The majority of mothers (60.4%) reported not having cleaned their 6-month-old’s gums/teeth in the past 3 months. One-third of mothers with 6-month-olds did not seek information on infant oral hygiene. Mothers who sought advice from dentists were more likely to have cleaned their infant’s gums/teeth in the past 3 months, and those with infants whose teeth had erupted were also more likely to clean their infants’ teeth twice or more daily. We can conclude that mothers who sought information on infant oral hygiene from more than one source adopted generally better oral hygiene practices for their infants, with a dentist’s advice notably increasing the likelihood of mothers following the guidelines for cleaning their infants’ teeth. Full article

Background and objectives: The development of the oral microbiome begins in the prenatal stage. Breast milk contains antimicrobial proteins, microorganisms, metabolites, enzymes, and immunoglobulins, among others; therefore, differences have been noted in the type of microorganisms that colonize the oral cavity of children who are breastfed compared to those who are formula-fed. Our objective was to establish the relationship between breastfeeding, formula feeding, or mixed feeding (breastfeeding and formula) with the presence of S. mutans in a population of children under 6 months of age. Materials and Methods: The patients were recruited from the Child Care Center of Ciudad Juárez, Chihuahua, and from the pediatric dentistry postgraduate clinics of the Autonomous University of Ciudad Juárez; children exclusively fed maternally, with formula, and/or mixed were included. Those who had been fed within the previous hour were excluded. The sample was taken with a smear of the jugal groove using a sterile micro-brush. For the identification of Streptococcus mutans, a culture of Mitis Salivarius Agar (Millipore) was used. Results: 53.3% corresponded to females and 46.7% to males, 36.7% corresponded to maternal feeding, 23.3% corresponded to formula feeding, and 40% corresponded to mixed feeding. In 90% of the infants, the parents indicated that they did not perform oral hygiene. The CFU count showed that infants who were exclusively breastfed had an average of 9 × 10 CF/mL, formula-fed infants had an average of 78 × 10 CFU/mL, and those who had mixed feeding 21 × 10 CFU/mL. Conclusions: According to the results obtained, it was possible to corroborate that exclusive breastfeeding limits the colonization of Streptococcus mutans compared to those infants who receive formula or mixed feeding; these results could have a clinical impact on the dental health of infants by having a lower presence of one of the main etiological factors involved in dental caries and the type of microbiome established in the oral cavity. Full article

Echinococcosis is considered a neglected disease in most European countries. However, migratory flows of populations, long-term stays in endemic areas, uninterrupted tourism (travel to Echinococcus-endemic countries), traveling dogs and dog translocations from endemic areas, and inappropriate hygiene practices are potential factors that alarm public health officials. Identifying a cyst-like mass in the liver or lung of an individual with a travel history of likely exposure to sheepdogs in an area where the parasite Echinococcus (E.) granulosus (sive cysticus) is endemic advocates for a prompt preliminary diagnosis of cystic echinococcosis (CE), no matter the age of the affected individuals. Routine imaging techniques, including ultrasonography, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans, are used to detect cysts. After a cyst has been discovered, serologic investigations are used to confirm the diagnosis. Typically, alveolar echinococcosis (AE) is found in older individuals. Yet young people are also affected because frequent oral exploration of the environment is a regular behavior for infants and toddlers. In this review, therapeutic considerations for pediatric echinococcosis—drug-based benzimidazole therapy; AE: atypical liver resection, the resection of individual or multiple segments, a right or left hemi-hepatectomy, or an extended hemi-hepatectomy; CE: PAIR-technique, cyst excision, liver segment(s) resection (laparoscopically or conventionally)—are revised following experience in one of the most affected regions of Europe. In addition, we performed a systematic review using three databases (i.e., PubMed, EMBASE, and Scopus) to evaluate the quality of evidence in published studies on pediatric echinococcosis. Full article

Mothers’ awareness regarding the risk factors for the development of early childhood caries is crucial. The current study aims to examine the knowledge of breastfeeding mothers about their baby’s dental health and prevention of ECC while comparing primiparous mothers to multiparous mothers. A total of 165 mothers aged 20–49 y/o participated in the study by completing questionnaires that assessed the knowledge and attitudes of mothers toward their infants’ oral health. Results showed that (1) mothers were found to be highly knowledgeable regarding the oral hygiene of their infants and the recommended breastfeeding best practices (71%); (2) mothers with lower education showed poor knowledge regarding the recommended practices of infant oral health; (3) a large proportion of the mothers in the sample (62%) reported that they usually tasted the food before giving it to their baby, in a way they could transmit bacteria to infants; (4) most of the mothers (68%) were not aware that their dental health during pregnancy affects the infants’ dental health; and (5) multiparous mothers were more knowledgeable regarding artificial baby milk composition (96%) in comparison with mothers with only a single child (60%). According to the results, there is a need to improve the knowledge of breastfeeding mothers, especially mothers who have one child and mothers with a lower education about their baby’s dental health. The results of this study shed light on the knowledge of breastfeeding mothers on this important topic and could serve policymakers to improve practices toward advancing better oral health for infants, without sacrificing the benefits of breastfeeding, which are so crucial for infant health and development. Full article

The relationship between maternal gingival health status and low birth weight or preterm delivery is controversial. The aim of this study was to analyze the association between maternal oral knowledge and the level of oral health during pregnancy with the risk of obstetric complications and breastfeeding. A descriptive cross-sectional study was conducted after an oral health educational intervention in a consecutive sample of 97 pregnant women. Data collection consisted of a validated questionnaire, oral examination, the Caries Index (CAOD) and the Simplified Oral Hygiene Index (IHOS). The participants had a mean age of 32.5 ± 5.19 years and a predominantly university education (57.1%). The level of knowledge regarding oral health was fair (12.5 ± 3.56 correct answers). Older pregnant women (33.0 ± 4.80 years) practiced breastfeeding and had a higher number of correct answers to the questionnaire. Adequate IHOS was associated with higher birth-weight newborns (3333 ± 0.3), whereas poor oral hygiene control was associated with lower birth-weight newborns (2960 ± 0.1) (p < 0.05). A lower level of academic education was associated with worse oral hygiene (p < 0.05). In addition, the greater the number of children, the higher the CAOD. Finally, among non-smoking women, the weight of infants was 437 mg higher. Maternal oral hygiene and the week of delivery were associated with newborn weight (p < 0.05) in a multiple linear regression model. Smoking was also related to low birth weight (p < 0.05). Educational interventions in pregnancy are necessary to decrease the incidence of obstetric adverse effects and improve the oral health of mothers and their children. Full article

The purpose of this paper is to analyse the association between cosleeping and the number of breastfeeding sessions in infants, OHRQoL of the child and the family, and the DMFT Child’s index. The sample comprised 273 children (2–4 years old). In addition to the clinical examination of the child to assess the DMFT Index, the mother was requested to complete a questionnaire to collect data about the breastfeeding practice, diet, dental hygiene, dental check-ups, quality of the child’s oral life, and family impact (ECOHIS Scale). The children’s OHRQoL is positively correlated with number of night-time breastfeeding sessions at 12 months (r² = 0.40 **), DMFT index (r² = 0.60 **), impact family (r² = 0.65 **), and duration of cosleeping (r² = 0.36 **). The moderating effect explained 41% of OHRQoL; the interaction between the number of breastfeeding sessions at 18 months and the DMFT index significantly increased the coefficient of determination. A longer practice time for cosleeping was associated with an increase in breastfeeding sessions, a higher impact on OHRQoL, a higher family impact, and a higher DMFT index. More than three night-time breastfeeding sessions moderate the relationship between the DMFT index and the child’s OHRQoL. Full article

Background: Several genes and single nucleotide polymorphisms (SNPs) have been associated with early childhood caries. However, they are highly age- and population-dependent and the majority of existing caries prediction models are based on environmental and behavioral factors only and are scarce in infants. Methods: We examined 6 novel and previously analyzed 22 SNPs in the cohort of 95 Polish children (48 caries, 47 caries-free) aged 2–3 years. All polymorphisms were genotyped from DNA extracted from oral epithelium samples. We used Fisher’s exact test, receiver operator characteristic (ROC) curve and uni-/multi-variable logistic regression to test the association of SNPs with the disease, followed by the neural network (NN) analysis. Results: The logistic regression (LogReg) model showed 90% sensitivity and 96% specificity, overall accuracy of 93% (p < 0.0001), and the area under the curve (AUC) was 0.970 (95% CI: 0.912–0.994; p < 0.0001). We found 90.9–98.4% and 73.6–87.2% prediction accuracy in the test and validation predictions, respectively. The strongest predictors were: AMELX_rs17878486 and TUFT1_rs2337360 (in both LogReg and NN), MMP16_rs1042937 (in NN) and ENAM_rs12640848 (in LogReg). Conclusions: Neural network prediction model might be a substantial tool for screening/early preventive treatment of patients at high risk of caries development in the early childhood. The knowledge of potential risk status could allow early targeted training in oral hygiene and modifications of eating habits. Full article

Childhood diarrhea is one of the leading causes of morbidity and mortality in children under five in low and middle-income countries, second only to respiratory illness. The mouthing behavior that is common in children exposes them to fecal-orally transmitted pathogens that can result in diarrhea; however, there is a need for further evidence on specific exposure routes. This study describes the frequency and diversity of two important routes of enteric pathogen exposure among infants 3–9 months of age: infant oral contact behavior and caregiver handwashing behavior. Data were collected through structured observations of 25 index infants for the oral contact data and 25 households for the caregiver handwashing data in a peri-urban setting in Kisumu (Obunga), Kenya. Breast was the most common type of oral contact event with an average of 3.00 per observation period and 0.5 events per hour. This was followed by a range of physical objects with an average of 2.49 per observation and 0.4 events per hour. The “infant’s own hands” was the third most common oral contact, with an average of 2.16 events per hour, and 0.4 oral contact events per hour. Food and liquids were the 4th and 5th most common oral contact events with an average of 1.64 food contacts and 0.52 liquid oral contact events per observation period. Feeding events, including breastfeeding, were the most commonly observed key juncture—71% of total junctures observed were caregivers feeding children. This was followed by child cleaning (23%), caregiver toilet uses at (4%), and lastly food preparation at 2%. HWWS was observed only once before a feeding event (1%), twice after cleaning a child (9%), and twice after caregiver toilet use (40%). The combined implication of data from observing oral contact behavior in children and hand hygiene of caregivers suggests that caregiver hand hygiene prior to feeding events and after cleaning a child are priority interventions. Full article

The objective of the present study was to investigate the prevalence and severity of early childhood caries (ECC) and severe early childhood caries (S-ECC) in 3-year-old Lithuanian children. The impact of selected behavioral risk factors on the development of S-ECC was investigated.
Material and methods. A total of 950 children were examined in kindergartens. Diagnosis of dental caries followed the WHO criteria. Questionnaires were delivered to mothers of the children with S-ECC and caries-free children. The questions were related to the children’s dietary habits, temperament, oral hygiene, and the use of fluoride toothpaste.
Results. The prevalence of ECC was 50.6% with a mean dmft of 2.1 (SD, 0.1) and a mean dmfs of 3.4 (SD, 0.2). The prevalence of S-ECC was 6.5% with a mean dmft of 7.8 (SD, 0.1) and dmfs of 18.1 (SD, 0.6). A significantly higher percentage of children developed S-ECC when they were breast-fed for a period longer than one year, were sleeping with a bottle containing carbohydrates during the night, or were allowed to sip from a bottle either going to sleep or during the day. A significantly higher percentage of mothers having caries-free children knew about risk factors of S-ECC and started tooth brushing after the eruption of the first tooth. There was no significant difference between the groups regarding the use of fluoride toothpaste.
Conclusions. Improper infant bottle-feeding habits and no tooth brushing were found to be significant for the development of S-ECC among 3-year-old Lithuanian children. Full article