|Year : 2020 | Volume
| Issue : 2 | Page : 115-118
Severe Early Childhood Caries in IVF Children: An Observational Study with Comparative Evaluation
Sudipta Kar1, TK Pal1, SL Seal2, Gautam Kumar Kundu3
1 Department of Oral and Dental Sciences, JIS University, Kolkata, West Bengal, India
2 Department of Gynaecology and Obstetrics, R. G. Kar Medical College, Hospital, Kolkata, West Bengal, India
3 Department of Paedodontics and Preventive Dentistry, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India
|Date of Submission||01-May-2020|
|Date of Acceptance||09-Jun-2020|
|Date of Web Publication||14-Dec-2020|
Dr. Sudipta Kar
21F, Charakdanga Road, Uttarpara, Hooghly - 712 258, West Bengal
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Context: Severe early childhood caries (S-ECC) is one of the major problems affecting the tooth structure in childhood before 71 months of age. It may affect both In vitro fertilization (IVF) and spontaneously conceived children. Aims: This study was aimed to evaluate, identify, and compare the prevalence of S-ECC in the deciduous dentition of IVF and spontaneously conceived children before 71 months of age. Settings and Design: In a cross-sectional, observational, case–control study, the S-ECC status of children aged 24–71 months was assessed. The studied case group comprised term, singleton babies who were the outcome of IVF in the studied area. The control group comprised term, first child, singleton, and spontaneously conceived 24–71-month-old children who were also resident of the studied area. A sample of 103 IVF and 162 spontaneously conceived children was examined utilizing Caries Assessment Spectrum and Treatment (CAST). Statistical Analysis Used: Statistical analysis was done using Chi-square tests (c2) or Z test. Results: A statistically significant difference was found in some aspects among the studied, i.e., IVF children, and control group, i.e., spontaneously conceived children. Conclusions: IVF children are considered better than spontaneously conceived children in some aspects when studied in relation to S-ECC status evaluated through CAST.
Keywords: Children, dental, in vitro fertilization, prevalence, severe early childhood caries
|How to cite this article:|
Kar S, Pal T K, Seal S L, Kundu GK. Severe Early Childhood Caries in IVF Children: An Observational Study with Comparative Evaluation. J Int Clin Dent Res Organ 2020;12:115-8
|How to cite this URL:|
Kar S, Pal T K, Seal S L, Kundu GK. Severe Early Childhood Caries in IVF Children: An Observational Study with Comparative Evaluation. J Int Clin Dent Res Organ [serial online] 2020 [cited 2021 Jun 19];12:115-8. Available from: https://www.jicdro.org/text.asp?2020/12/2/115/303399
| Introduction|| |
Dr. Patrick Steptoe and Dr. Robert Edwards – two researchers – intended to take humanity toward a new hope in achieving parenthood by the birth of the first-ever in vitro fertilized (IVF) child that occurred in Oldham, England, on July 25, 1978. The world’s 2nd test-tube baby “Durga” was born as a result of the untiring effort advocated by Dr. Saroj Bhattacharya and Dr. Subhas Mukherjee in the same year, on October 3, in Kolkata, West Bengal. According to the American Academy of Pediatric Dentistry, severe early childhood caries (S-ECC) is defined as, in children who are younger than 3 years of age, any sign of smooth-surface caries is indicative of S-ECC. For children aged 3–5 years, one or more cavitated lesion, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth or a decayed, missing, or filled with score of ≥ 4 (age 3), ≥5 (age 4), or ≥ 6 (age 5) surfaces constitutes S-ECC.., ECC is considered the most widespread dental disease affecting young children. S-ECC is considered the severe form of early childhood caries affecting multiple teeth. Although it is not causing any life-threatening effect, it hampers chewing efficacy, growth rate as well as quality of life of children. Researchers of the University of Brasília, Brazil, and the Radboud University Nijmegen Medical Centre of the Netherlands had designed the “caries assessment spectrum and treatment” (CAST), which was done by incorporating the benefits of PUFA, DMF, and ICDAS indexes in an innovative way. Because there has been no study on S-ECC status in the deciduous dentition of IVF children of the studied area, it was decided to conduct a cross-sectional observational study in that area to investigate the prevalence and severity of S-ECC among IVF children.
| Materials and Methods|| |
The present study was a cross-sectional observational study, approved by the Ethical Committee of JIS University, Kolkata. The S-ECC status of 24–71-month-old children was evaluated thoroughly. Children in both case (IVF) and control (spontaneously conceived) groups based on the route of pregnancy were enrolled in the study. Specific inclusion criteria of sample selection for the present study were babies must be of 37–42 weeks’ gestational age and singleton babies participating from medium and high socioeconomic condition were preferred. Congenitally malformed children, children whose parents have a history of multiple pregnancies, or child having genetic syndromes and chromosomal abnormalities, were excluded from the present study. Singleton IVF babies of the studied area were chosen by a computer-generated random number list. The control group constituted of spontaneously conceived 24–71-month-old term, first child, singleton, children who were referred to the Department of Pedodontics and Preventive Dentistry for the purpose of initial dental health checkup. Case and control children were matched for year of birth, socioeconomic status, maternal age and weight, area of residence, and gestational age. A total of 453 parents of the studied samples were approached to participate in the present study. Out of the above total sample, the parents of 103 IVF and 162 spontaneously conceived children agreed to participate in the study [Table 1] and [Table 2]. Informed consent was procured from the respective guardians of the selected children. To exclude inter-observer error, all dental examinations and documentation were made by a trained single examiner who was not informed about the birth status of these studied samples. Before the examination, each tooth was wiped with a sterile cotton roll to get a dry surface for proper evaluation. After collection of data, Chi-square test or Z tests were used for statistical analysis.
|Table 1: Gender-wise distribution status of in vitro fertilized children and spontaneously conceived children|
Click here to view
|Table 2: Severe early childhood caries distribution among in-vitro fertilized children and spontaneously conceived children according to caries detection|
Click here to view
| Results|| |
In this study, a total of 453 parents were approached for the analysis. Among them, 103 IVF parents and 178 spontaneously conceived parents were agreed for participation. Among the total IVF children, 57.28% were male and 42.71% were female and in spontaneously conceived group, 52.24% were male and 47.75% were female [Table 1]. Among the IVF children group, 8.73% were having S-ECC (4.85% were male and 3.88% were female) and among the spontaneously conceived children group, 31.46% were having S-ECC (20.22% were male and 11.23% were female). Among the IVF children group, 91.26% were having healthy teeth (50.48% were male and 40.77% were female) and among the spontaneously conceived children group, 68.53% were having healthy teeth (39.88% were male and 28.65% were female) [Table 2] and [Table 3].
|Table 3: Gender-wise distribution of severe early childhood caries among in-vitro fertilized children and spontaneously conceived children|
Click here to view
When we compared sound tooth structure category, the value of z was 4.3527, and the value of P was < 0.00001. The result was statistically significant at P < 0.05. During the comparison of S-ECC involvement, the value of z was −4.3527, and the value of P was < 0.00001. The result was statistically significant at P < 0.05. During the comparison of sealed tooth category, the value of z was −0.8251, and the value of P was 0.40654. The result was not statistically significant at P < 0.05. During the comparison of restored tooth category, the value of z was −1.7163, and the value of P was 0.08544. The result was not statistically significant at P < 0.05. During the comparison of distinct visual change in enamel category, the value of z was −1.2438, and the value of P was 0.21498. The result was not statistically significant at P < 0.05. During the comparison of internal caries-related discoloration in dentine category, the value of z was −2.1829, and the value of P was 0.02926. The result was statistically significant at P < 0.05. During the comparison of distinct cavitation in dentine category, the value of z was −2.0809, and the value of P was 0.03752. The result was statistically significant at P < 0.05. During the comparison of involvement of pulp chamber category, the value of z was −2.0809, and the value of P was 0.03752. The result was statistically significant at P < 0.05. During the comparison of abscess/fistula category, the value of z was −1.6164, and the value of P was 0.10524. The result was not statistically significant at P < 0.05. During the comparison of lost (due to caries) category, the value of z was −1.0796, and the value of P was 0.28014. The result was not statistically significant at P < 0.05 [Table 4] and [Table 5].
|Table 4: Prevalence of severe early childhood caries in in vitro fertilized children according to Caries Assessment Spectrum And Treatment|
Click here to view
|Table 5: Prevalence of severe early childhood caries in spontaneously conceived children according to Caries Assessment Spectrum And Treatment|
Click here to view
| Discussion|| |
The statistical analysis revealed that IVF children have more healthy oral health condition than spontaneously conceived children of same age group (91.26% vs. 68.53%), and the result was statistically significant in nature. When we searched for S-ECC cases in both groups, we also observed a statistically significant difference between the two groups (8.73% vs. 31.46%). These results reflect that IVF parents are more careful than parents of the spontaneously conceived group. When observed internal caries-related discoloration in dentine, distinct cavitation into dentine, and involvement of pulp chamber, we also found a statistically significant difference between both groups, depicting more cautious nature of IVF parents. When the children were in distressed condition, both groups of parents had taken aggressive care to their beloved. There was no statistically significant difference found in both abscess/fistula and lost due to caries group though the number of affected children is more in the spontaneously conceived group. No previous study has been found involving IVF children, S-ECC, and new caries detection tool (CAST), hence, no comparison was possible with the previous study. This was probably the first study on CAST, which demonstrates S-ECC prevalence in IVF children.
| Conclusions|| |
In our study, IVF children exhibited dissimilar kind of S-ECC pattern than spontaneously conceived children. IVF children are considered better than spontaneously conceived children when studied in relation to S-ECC status. This study invites further scope for cross-sectional and longitudinal studies with larger sample size. Different preventive strategies may be formulated to prevent S-ECC in both IVF and spontaneously conceived children groups.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo. Lancet 1978;2:366.
Chakraborty BN. Test Tube Baby Procedures Miracles, Mysteries and Miseries. 1st
ed.. Kolkata: The Standard Literature Company Pvt. Ltd; 2005. p. 1-3.
American Academy of Pediatric Dentistry. Symposium on the prevention of oral disease in children and adolescents. Chicago, Ill; November 11-12, 2005: Conference papers. Pediatr Dent 2006;28;196-8.
AAPD. Definition of early childhood caries (ECC). Classification, consequences and preventive strategies. Pediatr Dent 2004;25 Suppl: 31-2.
Gaur S, Nayak R. Underweight in low socioeconomic status preschool children with severe early childhood caries. J Indian Soc Pedod Prev Dent 2011;29:305-9.
] [Full text]
Frencken JE, de Amorim RG, Faber J, Leal SC. The caries assessment spectrum and treatment (CAST) index: Rational and development. Int Dent J 2011;61:117-23.
Monse B, Heinrich-Weltzien R, Benzian H, Holmgren C, Helderman WP. PUFA – An index of clinical consequences of untreated dental caries. Community Dent Oral Epidemiol 2010;38:77-82.
de Amorim RG, Figueiredo MJ, Leal SC, Mulder J, Frencken JE. Caries experience in a child population in a deprived area of Brazil, using ICDAS II. Clin Oral Investig 2012;16:513-20.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]