Chronic Malnutrition and Oral Health Status in Children Aged One to Five Years
Condition: Malnutrition, Child
MeSH terms: Malnutrition; Child Nutrition Disorders
Study type: Observational

Summary: 
      Malnutrition is a public health problem that can exert a negative impact on the general and
      oral health of children. The aim of the present study was to evaluate the effect of chronic
      malnutrition on the oral health of children aged one to five years. An observational,
      analytical, cross-sectional study was conducted at the Nutritional Recovery Center and
      involved 82 children between 12 and 71 months of age. Nutritional status was evaluated using
      anthropometric indicators and oral health status was measured using the dmft index.
      Non-stimulated saliva was collected. Flow rate and buffering capacity was then measured with
      the aid of a pH meter.
    

Detailed description: 
      Malnutrition is a public health problem that can exert a negative impact on the general and
      oral health of children. The aim of the present study was to evaluate the effect of chronic
      malnutrition on the oral health of children aged one to five years. An observational,
      analytical, cross-sectional study was conducted at the Nutritional Recovery Center and
      involved 82 children between 12 and 71 months of age. Nutritional status was evaluated using
      anthropometric indicators. The children were weighed on a previously calibrated electronic
      scale (capacity: 150 kg; precision: 100 g) barefoot and wearing light clothing in the
      presence of the mother or caregiver. Height was determined using a non-flexible metric tape
      (maximum length: 2 m; precision: 0.1 cm). Each measurement was made twice and the mean was
      used for the calculation height for age, weight for height and weight for age. The guidelines
      of the World Health Organization, were the reference for the evaluation of nutritional
      status. Oral health status was measured using the dmft index. The criteria adopted for the
      determination of prevalence followed by guidelines of the Oral Health Surveys - Basic
      Methods, 4th edition - described in the examiner's manual and annotator's manual produced by
      the coordination team of the Brazil Oral Health Project. Non-stimulated saliva was collected
      and Flow rate and buffering capacity was then measured with the aid of a pH meter. The
      salivary flow volume was calculated and expressed as ml/min. The following categories were
      considered in the analysis of salivary flow: < 0.1 ml/min = xerostomia; 0.1 to 0.6 ml/min =
      very low flow; 0.7 to 0.9 mL/min low flow; 1.0 to 2.0 ml/min = normal flow; and > 2.0 ml/min
      = high flow. The following categories were considered: ≥ 5.5 = very good buffering capacity;
      5.4 to 5.0 = good buffering capacity; 4.9 to 4.5 = medium good buffering capacity; 4.4 to 4.0
      = low buffering capacity; and ≤ 3.9 very low buffering capacity.
    

Intervention name(s): Caries detection - dmtf index; Saliva flow rate; Saliva Buffering Capacity
Intervention type(s): Diagnostic Test; Diagnostic Test; Diagnostic Test
Intervention description(s): Dental caries experience was recorded using the dmft index, which was employed following the recommendations of the WHO to establish the prevalence and severity of caries. Active visible white spots were also recorded. The examinations were performed in duplicate for each child with the aim of establishing inter-examiner agreement using the Kappa statistic which demonstrated good agreement (K = 0.81).
The criteria adopted for the determination of prevalence followed by guidelines of the Oral Health Surveys - Basic Methods, 4th edition (WHO, 1997) described in the examiner's manual and annotator's manual produced by the coordination team of the Brazil Oral Health Project. The severity and prevalence of dental caries were determined based on the dmft index.; Samples of non-stimulated saliva were collected from the participants for five minutes using two aspirator tubes connected to a 15-ml Falcon tube. One aspirator tube was positioned under the child's tongue and the other was attached to the aspirator device. After five minutes, the amount of saliva was measured for the determination of salivary flow. Collections were performed between 9 and 11 am and the time of the last meal was recorded. At least a one-hour interval was required between the last meal and the collection of the saliva sample. The volume of saliva was measured. The salivary flow volume was calculated and expressed as ml/min. The following categories were considered in the analysis of salivary flow: < 0.1 ml/min = xerostomia; 0.1 to 0.6 ml/min = very low flow; 0.7 to 0.9 mL/min low flow; 1.0 to 2.0 ml/min = normal flow; and > 2.0 ml/min = high flow.; an aliquot of 1 ml was transferred to a test tube with 3 ml of hydrochloric acid (HCl 5 mM) for titration and the determination of salivary buffering capacity (SBC). The saliva/acid solution was shaken in a q 220 vortex tube agitator (Quimis, Diadema, SP, Brazil) for 15 seconds. Next, pH was determined in a portable pH meter (KASVI K39-0014P, Curitiba, PR, Brazil) for the determination of the SBC. The following categories were considered: ≥ 5.5 = very good buffering capacity; 5.4 to 5.0 = good buffering capacity; 4.9 to 4.5 = medium good buffering capacity; 4.4 to 4.0 = low buffering capacity; and ≤ 3.9 very low buffering capacity.
Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        This cross-sectional study will use a sample of children aged 12 to 71 months of the 7th
        Administrative Region of Maceió. This region is one of the poorest region in Maceió. The
        children's parents/guardians will be interviewed at the Center for Educational and
        Nutrition Recovery (CREN) in the city of Maceió, state of Alagoas, Brazil. The sample size
        was estimated considering a prevalence of malnutrition of about 20% in children under 6
        years old, with statistical power of 80% and 95% significance, resulting in a sample of 100
        children.
      
Biospecimen description: 
      saliva
    
Keywords: dental caries; saliva; child