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01.12.2015 | Study protocol | Ausgabe 1/2015 Open Access

BMC Oral Health 1/2015

Protocol for assessing maternal, environmental and epigenetic risk factors for dental caries in children

BMC Oral Health > Ausgabe 1/2015
Surani Fernando, David J. Speicher, Mahmoud M. Bakr, Miles C. Benton, Rodney A. Lea, Paul A. Scuffham, Gabor Mihala, Newell W. Johnson
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

SF and NWJ designed the study. NWJ initiated the project and holds the Ethics approval. SF will analyse the data for her PhD candidature, for which NWJ, PAS, RL and DJS are official supervisors. SF, MMB and NWJ perform all clinical work and data collection. DJS devised the protocols for DNA extraction and supervises laboratory work. RAL and MCB are responsible for DNA sequencing and bioinformatics. PAS coordinates merging dental and EFHL data . GM is the principal statistician for the project and will analyse data with SF. SF wrote the first draft of this manuscript which was modified by others. All authors read and approved the final manuscript.



Expenditure on dental and oral health services in Australia is $3.4 billion AUD annually. This is the sixth highest health cost and accounts for 7 % of total national health expenditure. Approximately 49 % of Australian children aged 6 years have caries experience in their deciduous teeth and this is rising. The aetiology of dental caries involves a complex interplay of individual, behavioural, social, economic, political and environmental conditions, and there is increasing interest in genetic predisposition and epigenetic modification.


The Oral Health Sub-study; a cross sectional study of a birth cohort began in November 2012 by examining mothers and their children who were six years old by the time of initiation of the study, which is ongoing. Data from detailed questionnaires of families from birth onwards and data on mothers’ knowledge, attitudes and practices towards oral health collected at the time of clinical examination are used. Subjects’ height, weight and mid-waist circumference are taken and Body Mass Index (BMI) computed, using an electronic Bio-Impedance balance. Dental caries experience is scored using the International Caries Detection and Assessment System (ICDAS). Saliva is collected for physiological measures. Salivary Deoxyribose Nucleic Acid (DNA) is extracted for genetic studies including epigenetics using the SeqCap Epi Enrichment Kit. Targets of interest are being confirmed by pyrosequencing to identify potential epigenetic markers of caries risk.


This study will examine a wide range of potential determinants for childhood dental caries and evaluate inter-relationships amongst them. The findings will provide an evidence base to plan and implement improved preventive strategies.
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