The Relationship between Dental Caries and Salivary TGF-β Level and Growth Indicators in 5-6-Year-Old Children: A case-control study

The Relationship between Dental Caries and Salivary TGF-β Level and Growth Indicators in 5-6-Year-Old Children: A case-control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Relationship between Dental Caries and Salivary TGF-β Level and Growth Indicators in 5-6-Year-Old Children: A case-control study Shokoofeh Derakhshan, Zahra Kamiab, Donya Pourjahanshah, Faezehe Hoseinzade, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4734598/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Pro-inflammatory cytokines in the saliva were detected in periodontitis and dental caries. This study aims to compare the concentration of pro-inflammatory cytokines Transforming growth factor beta (TGF-β) in the saliva of dental caries patients and survey growth indices from childhood to the present, in children with dental caries. Methods In this case-control study, two groups of 30 cases (children with tooth decay) and control (without tooth decay), aged 5–6 years, were selected by using the Decayed, Missing, and Filled Teeth (DMFT) index and were matched based on age and sex. They were evaluated in terms of growth indices (BMI, gender, weight, height, and head circumference) from childhood to the present, as well as salivary TGF-β levels. Finally, the data were analyzed by SPSS22. Results The DMFT index in the case group was 7.03 ± 3.32 and they had significantly lower BMI (p = 0.042), but no relationship was observed with height and weight. The mean level of TGF-β (Pg/mL) in the case group was significantly higher than the control group (p = 0.047). Conclusions The study results indicate that TGF B level is higher in children with dental caries. Children with dental caries weigh less than children of the same age; therefore, dental examination in preschool children is necessary, with the aim of preventing DMFT. Dental Caries TGF-β Children Saliva Inflammatory DMFT Index INTRODUCTION Dental Caries is essentially a microbial disease of the tooth. Scientists characterize Dental Caries as an inorganic demineralization and decay of the organic matter in the tooth that would normally cause cavitation [1, 2]. The cariogenic bacteria can utilize any type of carbohydrates to produce acid which in turn initiates the process of tooth decay[3]. Some of the boosting factors for Dental Caries are aging, amiss oral hygiene, and dental plaque[4]. Still, to prevent infections, the body’s immune system can have nonspecified powerful maneuvers[5]. Exposure to infectious agents will stimulate and reactivate the acquired immunity. T-cells are the mediums for cellular immunity which is the general resistance response against viral and certain bacterial infections. On the other hand, humoral immunity would be concerned with antibody circulation[6]. Both humoral and Cellular immune responses have a significant role in the defense against dental carries[7]. One of the protective agents is the secretory immunoglobulin-A (IgA) which inhibits the adhesion of Streptococcus mutans to the tooth surface[8]. The inflammation is caused by the colonization of the bacteria in the oral cavity. Such damages to the host, initiate adaptive as well as innate immune responses[9]. The periapical lesions host several cells including macrophages, neutrophils, T- and B-lymphocytes, osteoclasts, fibroblasts, and mast cells. Such cells create extensive amounts of pro-inflammatory cytokines such as interleukin IL-1-a, IL-1-b, IL-4, IL-6, lymphotoxin, and Transforming growth factor beta (TGF-β)[9, 10]. It has also been proved that TGF-β prevents macrophages and T cells from producing pro-inflammatory cytokines[11]. TGF-β can also originate from sources other than immune cells, and such TGF-β would have a complementary function in protection against inflammation[11, 12]. Available literature does not consider the function of TGF- β concerning dental caries. Nonetheless, multiple studies confirm the radical anti-inflammatory function of TGF-β in pulp inflammation as TGF-β down-regulates odontoblast responses and prevents TLR4 and TLR2 proteins from being expressed[13]. Another function of the TGF-β is repairing dental tissue after a lesion[14]. Still, the molecular mechanisms in association with dental caries need further study to be fully understood. The functions of pro-inflammatory cytokines in such molecular mechanisms have been outlined and yet their details are still unknown. Studying the cytokines can be very beneficial for monitoring the oral cavity and also for diagnosis. Moreover, saliva is quite useful in detecting biomarkers associated with the initiation and progression of the disease as saliva can be used as a non-invasive diagnostic tool. Multiple studies have examined the concentrations of pro-inflammatory cytokines in the saliva of groups affected with periodontitis, oral lichen planus, squamous cell carcinoma, and Aphthous stomatitis plus their control groups [15–18]. The study at hand would compare the concentrations of pro-inflammatory cytokine TGF-β in the saliva of dental caries subjects and their control group, and then review growth indicators in children with dental caries in a timespan of childhood up to the present. MATERIALS AND METHODS 1.1. Study population The study at hand is of the case-control kind. The population for this study consisted of 60 children between 5 to 6 years of age who visited the city of Rafsanjan’s dental unit of health centers. Based on the sample size formula below and the information of the study by Agnieszka Gornowicz and her colleagues[19], the sample size was estimated to be 30 people in each group.The children were divided into two groups of 30 subjects with tooth decay and 30 control subjects with healthy teeth. The subjects’ levels of salivary TGF-β were examined through the Decayed, Missing, and Filled Teeth (DMFT) index. Also, clinical evaluation procedures were employed to examine the state of teeth, the periodontal and oral mucosal status, to evaluate the malocclusion, and to collect saliva samples. The physician in the center utilized an electronic scale (Seca) and a Holtain anthropometer to measure the subjects’ height and weight. The result data were reviewed in comparison with the updated national reference. Then, the Body Mass Index (BMI) was estimated for each subject with a standard method. Moreover, informed consent from all subjects and parties involved was received and documented. The inclusion criteria in the case group were age 5–6 years, DMFT greater than or equal to one, and consent to participate in the study, and in the control group were age 5–6 years, DMFT equal to zero, and consent to participate in the study The exclusion criteria in both groups were presence of systemic diseases, including diabetes, cystic fibrosis, autoimmune diseases, and other oral and dental diseases, including periodontal disease, oral ulcers, and genetic oral disorders. After obtaining the ethics committee code, 60 children, including 30 healthy people in terms of dental examination (DMFT equal to zero) as the control group and 30 people with tooth decay (DMFT greater than or equal to one) were included in the study. Two groups were homogenized in terms of gender by individual matching. The sampling method was convenient sampling method. The most common epidemiological scale in caries is the DMFT index, in which the number of decayed (D), missing (M) or filled (F) permanent teeth was evaluated by a dentist colleague. It is considered that the missing or filled teeth had caries before the epidemiological evaluation and were treated for this reason. To calculate the DMFT of a society, the number of decayed, filled, and missing teeth of each individual of that society is counted and its average is calculated. Usually, the mean DMFT is divided into 5 levels (24): Between zero and 1.1 as very little The average is between 1.2 and 2.6 km 2/7 − 4/4 average 6/5–4/5 above And more than 6.6 is very high A checklist was prepared by the researcher to collect other information for this study, in which information related to gender, parents' education, place of residence, birth weight, gestational age, type of feeding during infancy, brushing status, annual examination by the dentist, height, weight, and head circumference of these children were collected by a dental assistant and a medical student Salivary sample collection Test subjects’ saliva samples were collected via the standard method. Saliva samples were collected in a timespan between 9 and 11 o’clock in the PM. The examination subjects didn’t eat or drink for two hours. Utilizing the spitting method, samples of unstimulated saliva were collected from the subjects for 10 minutes. Studying the TGF-β in salivary samples with ELISA A commercial enzyme-linked immunosorbent assay kit (R&D Systems Inc., Minneapolis, MN, USA) was used to determine the concentration of TGF-β. Statistical analysis The results were summarized via percentages and absolute frequencies for categorical variables, and results for numeric variables were documented as mean ± standard deviation. Independent two-sample t-tests were used in the comparison of numeric variables, while the chi-square test or Fisher’s exact test was used in the comparison of the categorical variables of the sample and control groups. The results of comparisons between the two groups were also reported as ORs (odds ratios) and 95% CIs (confidence intervals). Non-parametric Kolmogorov-Smirnov test indicated that the presumption of normality was met for numeric variables (P > 0.05). For the statistical analysis, the statistical software SPSS version 24.0 for windows (IBM SPSS Inc., Chicago, IL, USA) was used. All p-values were 2-tailed, with statistical significance defined by p ≤ 0.05. RESULTS A total of 60 children aged 5–6 years were compared in two groups of 30 individuals (with tooth decay) and control (without tooth decay) in terms of the level of beta-transforming growth factor and physical growth. In the case group, the decay index was 3.32 ± 7.03. There was no statistically significant difference between the frequency of gender (50% girl, 50% boy, p = 1.000) and mean score of birth weight (3155.00 ± 658.39, 3155.00 ± 391.14, p = 1.000), birth height (48.73 ± 2.56, 48.47 ± 1.83, p = 0.644), and head circumference (34.27 ± 0.87, 34.13 ± 1.25, p = 0.634) of children at birth in the case group versus control group. Table 1 reveals that in the assessment of maternal characteristics in these children, there was no statistically significant difference in terms of education level, place of residence, and gestational age at the time of delivery. However, diploma and sub-diploma education, living in the village, and full-term babies were 2.36 times, 1.97 times, and 1.6 times more at risk of caries, respectively. Table 1 Maternal characteristics in the study population Group Variable Case (n = 30) Control (n = 30) OR (95% CI) Test Statistic P-value Chi square Education University Diploma or less 4 (13.3) 26 (86.7) 8 (26.7) 22 (73.3) ref. 2.363 (0.626–8.916) χ2 = 1.667, df = 1 0.197 Location City Village 14 (46.7) 16 (53.3) 19 (63.3) 11 (36.7) ref. 1.974 (0.703–5.543) χ2 = 1.684, df = 1 0.194 Gestational age status Term Preterm 28 (93.3) 2 (6.7) 27 (90.0) 3 (10.0) ref. 0.643 (0.100–4.153) Fisher’s exact test 0.999 Data are expressed as mean ± standard deviation or n (%). OR: Odds Ratio, CI: Confidence Interval, df: degree of freedom Hint: OR > 1 shows more likely to be Case and OR < 1 shows less likely to be Case. There was no significant difference between case and control groups in terms of breastfeeding status, the mean age of starting complementary feeding, and the age of starting complementary feeding status (Table 2 ). Table 2 Nutritional status during infancy in the study population Nutritional status of infants Case N = 30 Control N = 30 OR (95% CI) Test statistic p-value Feeding status Breastfeeding Breastfeeding and formula (83.3%)25 (16.7%)5 (76.7%)27 (23.3%)3 Ref. 0.657 (0.183–2.363) χ2 = 0.417 df = 1 0.519 Age of onset of complementary feeding (month) 6.07 ± 1.44 6.03 ± 1.65 1.015 (0.727–1.415) t = 0.083, df = 58 0.934 Age of starting complementary feeding status Before 6 months At 6 months After 6 months (26.7%)8 (60%)18 (13.3%)4 (23.3%)7 (66.7%)20 (10%)3 Ref. 0.788 (0.238–2.609) 1.167(0.191–7.116) Fisher’s exact test 0.865 Data are expressed as mean ± standard deviation or n (%). OR: Odds Ratio, CI: Confidence Interval, df: degree of freedom Hint: OR > 1 shows more likely to be Case and OR < 1 shows less likely to be Case. Table 3 indicates the growth status of children at the age of 5–6 in both case and control groups. The mean age of weight and height in the two groups of children had no statistically significant difference. However, the BMI in the case group was less than the control group and this difference was statistically significant. The risk of abnormal BMI in the case group was 1.217 times that of the control group. Table 3 The relationship between tooth decay and growth indicators in the study population Growth indicators of children at the age of 5–6 years Case group Tooth decay N = 30 Control group No tooth decay N = 30 OR (95% CI) Test statistic p-value Weight (kg) 19.17 ± 2.9 20 ± 2.6 0.892 (0.736–1.081) t = -1.172, df = 58 0.246 Height (cm) 111.83 ± 2.6 110.73 ± 3.46 1.129 (0.0949–1.343) t = 1.391, df = 58 0.170 BMI (kg/m2) 15.28 ± 1.93 16.29 ± 1.84 0.742 (0.549–1.002) t = -2.065, df = 58 0.043 BMI group Normal Abnormal (76.7%)23 (23.3%)7 (80%)8 (20%)18 Ref. 1.217 (0.355–4.169) χ2 = 0.098, df = 1 0.745 Data are expressed as mean ± standard deviation or n (%). OR: Odds Ratio, CI: Confidence Interval, df: degree of freedom, BMI: Body Mass Index, dmft: decayed, missing, filled teeth Hint: OR > 1 shows more likely to be Case and OR < 1 shows less likely to be Case. In the case group, more children did not brush their teeth during the day compared to control group (46.7% vs. 30%, p = 0.184). The frequency of children's visits by dentists in the case group was fewer than the control group (63.3% vs. 76.7%, p = 0.260), but this difference was not statistically significant. Table 4 shows that the mean level of the factor in the case and control groups. The mean TGF B level in the group of children with tooth decay was 17.28 ± 6.87 and in the control group was 13.91 ± 5.93, which were statistically significant. In the investigation of the relationship between the level of TGF B and the index of tooth decay, no significant relationship was observed. Table 4 The relationship between tooth decay and the mean level of transforming growth factor beta Case group Tooth decay N = 30 Control group No tooth decay N = 30 OR (95% CI) p-value TGF-β (Pg/ml) 17.28 ± 6.87 13.91 ± 5.93 1.088 (0.999–1.186) 0.047 Data are expressed as mean ± standard deviation. OR: Odds Ratio, CI: Confidence Interval, df: degree of freedom, Hint: OR > 1 shows more likely to be Case and OR < 1 shows less likely to be Case. DISCUSSION In the current study, the DMFT index in 5-6-year-old children in the case group was 7.03 ± 3.32. In the study by Jafari et al. in Hashtroud city, the mean DMFT index in 6-year-old children was 4 ± 2.75[20]. In another similar study by Faezi et al. in students aged 6–12 years was 2.9 ± 1.81[21]. In a survey in one of the cities of Serbia the mean DMFT in preschool children was 5.8 [22]. This amount in Turkey was 3.74 [23], and in Saudi Arabia reported 5.7 [24]. Overally, compared to the other studies, the DMFT index was higher, indicating the average number of filled and missing decayed teeth. In the present study, comparing the growth indices (height, weight, and BMI) between children with and without tooth decay did not show a difference between the height and weight of these two groups, while the BMI in children with tooth decay was significantly lower than the control group. In the study by Alkarimi et al. in Saudi Arabia on 6–8 year old children, there was an inverse linear relationship between tooth decay and height, weight, and BMI growth indicators [24]. Van Gemert-Schriks et al. also prospectively followed the development of 6-year-old children for 3 years and found that tooth decay has adverse effects on children's physical growth, including height, weight, and BMI [25]. In internal studies also conducted by Jabarifar et al. in the city of Kazerun, similar to the mentioned studies, there was a significant relationship between tooth decay and children's height, and BMI [26]. However, in the study by Banakar's et al. the relationship between tooth decay and underweight was seen only in male students and this relationship was not seen in girls, which is in line with the present study[27]. Porhashmi et al. reported a clear relationship between BMI and caries[28]. The reason for low BMI in this group could be toothache, which will affect the quality and quantity of the child's nutrition, as well as inflammation of the pulp and dental abscesses through internal metabolic pathways, causing a decrease in hemoglobin, anemia, and on the other hand, weight loss and disruption in the child's growth. The present study showed that the level of TGF-β is higher in children with dental caries. There was also a significant relationship between DMFT index and TGF-β. Piatelli et al. showed in their study that in the odontoblastic and sub-odontoblastic layers of the samples with irreversible pulp inflammation, the expression of TGF-β1 was higher than that of healthy samples[29]. The current study also did not show a difference between tooth brushing and examination by a dentist with tooth decay, which is consistent with the study of Cianetti et al. They reported that there was no statistically significant difference in the presence of caries between children who had been visited by a dentist at least once and children who had not been visited by a dentist before [30]. However, many studies have shown that brushing, the number of times brushing, and examination by a dentist had a significant relationship with the reduction of caries in children [31–35]. Cytokines are also known to function as regulators of the immune response. Adhesion markers and (probably) their associated chemokines involved in leukocyte trafficking are known to function and find expression under the influence of cytokines. During the innate response of the immune system, oral pathogen-associated molecular patterns for microbial invasion stick to receptors on host cells. The pattern-recognition receptors on host cells also include dendritic cells. The significance of dendritic cells is releasing pro-inflammatory cytokines to activate the inflammatory response. The formation of gingivitis is highly likely in the beginning. Although, after the successful culmination of the immune response the gingivitis will disappear. Nonetheless, if the bacteria spread extensively the infection will continue which intensifies the inflammatory response. According to the study by Vadiakas et al. various therapies resulted in decreasing concentrations of pro-inflammatory cytokines [36]. In a study conducted by Albert et al. dental caries patients were examined and the results proved a decrease in osteoblasts and fibroblast count due to the increase in the TGF-β levels. It is noteworthy that osteoblasts and fibroblasts are radical elements in the development of dental caries and demineralization of teeth [37]. The research at hand affirms a positive association between Salivary TGF-β, Growth indices, TGF-β, and Dental Caries. As an effector cytokine, this agent causes oral disease [38]. In conclusion Dental caries subjects had increased levels of TGFβ in comparison to the healthy control subjects. Children afflicted with dental caries registered decreased weights in comparison to healthy counterparts of the same age. Consequently, the examination of dental status in preschool children seems quite rudimentary. Declarations Acknowledgments This project was financially supported by a grant from the Rafsanjan University of Medical Sciences. Also, the authors of this study are grateful for the cooperation of the Clinical Research Development Unit of Ali-Ibn Abi-Talib Hospital for the implementation of this study. Author's contributions M. NK. and Z.K. D. P. made substantial contributions to acquisition of data and revised the manuscript critically for important intellectual content; Z. K. D.P. analysis or interpretation of data and drafted the article ; Z K and Sh.D. and M. N. conceptualized and designed the study, made substantial contributions to conception and acquisition of data, critically reviewed the manuscript for important intellectual content, and approved the final version; F.H. and Sh. D. made substantial contributions to acquisition of data; Z K and Sh.D. F.H. and M. NK. D.P reviewed the manuscript for important intellectual content. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Availability of data and materials The datasets analyzed in the current study are available from the corresponding author on reasonable request. Ethical Approval The informed consent form was signed by the participants prior enter into the project and the project protocol was approved by the local ethical committee: IR.RUMS.REC.1399.187. Consent to participate Written informed consent was collected from each participant prior to study inclusion. Consent for publication All Authors agreed for publication Competing interests The authors declare that there is no conflict of interest. References Rajendran, R., Shafer's textbook of oral pathology . 2009: Elsevier India. Berkowitz, R.J., Causes, treatment and prevention of early childhood caries: a microbiologic perspective. J Can Dent Assoc, 2003. 69 (5): p. 304-7. Touger-Decker, R. and C. Van Loveren, Sugars and dental caries. The American journal of clinical nutrition, 2003. 78 (4): p. 881S-892S. 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Williams, Dental caries in pre-school children: associations with social class, toothbrushing habit and consumption of sugars and sugar-containing foods. Further analysis of data from the National Diet and Nutrition Survey of children aged 1.5-4.5 years. Caries Res, 1999. 33 (2): p. 101-13. Elamin, A., M. Garemo, and A. Gardner, Dental caries and their association with socioeconomic characteristics, oral hygiene practices and eating habits among preschool children in Abu Dhabi, United Arab Emirates - the NOPLAS project. BMC Oral Health, 2018. 18 (1): p. 104. Cariño, K.M., K. Shinada, and Y. Kawaguchi, Early childhood caries in northern Philippines. Community Dent Oral Epidemiol, 2003. 31 (2): p. 81-9. Vadiakas, G., Case definition, aetiology and risk assessment of early childhood caries (ECC): a revisited review. Eur Arch Paediatr Dent, 2008. 9 (3): p. 114-25. Albert, R.J., et al., Nursing caries in the Inuit children of the Keewatin. J Can Dent Assoc, 1988. 54 (10): p. 751-8. Rosenblatt, A. and P. Zarzar, The prevalence of early childhood caries in 12- to 36-month-old children in Recife, Brazil. ASDC J Dent Child, 2002. 69 (3): p. 319-24, 236. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4734598","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":328845525,"identity":"19e3d763-6760-431a-99e5-ac43b6a0588f","order_by":0,"name":"Shokoofeh Derakhshan","email":"","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Shokoofeh","middleName":"","lastName":"Derakhshan","suffix":""},{"id":328845528,"identity":"9a25c328-bfef-4649-93a0-c475417146dc","order_by":1,"name":"Zahra Kamiab","email":"","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Kamiab","suffix":""},{"id":328845530,"identity":"2a349a58-dd16-4a7c-ac75-f25b21253178","order_by":2,"name":"Donya Pourjahanshah","email":"","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Donya","middleName":"","lastName":"Pourjahanshah","suffix":""},{"id":328845531,"identity":"3b57ac04-4156-474f-bc59-3fe8f5354d43","order_by":3,"name":"Faezehe Hoseinzade","email":"","orcid":"","institution":"Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Faezehe","middleName":"","lastName":"Hoseinzade","suffix":""},{"id":328845532,"identity":"818ca7ee-4132-4e82-b3a2-fdaa4e7a7878","order_by":4,"name":"Mojgan Noroozi Karimabad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYHCCBCS2gQ0DgwSJWtKI0oICDhPWotve8PjFzx0MefzShw8+/FFwPrF/dvPBBww1NtG4tJidOZBm2XuGoViyLy3ZQMLgduKMO8eSDRiOpeU24NJyIyHNgLeNIXHDGR4zCQOgloYbOWYSjA2H8Wox/AvTkmBwLnE+EVqSH8NtOWBwIHEDQS1AvzDLtkkkzuxhSzZsMEg23ngD6KkEfH453pP88W2bTWI/DzMwxP7Yyc67kXzwwYcaG5xaGBh40iSQ48IRrDIBp3IQYD/8AZlrj1fxKBgFo2AUjEgAANRGXsiS1dwlAAAAAElFTkSuQmCC","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mojgan","middleName":"Noroozi","lastName":"Karimabad","suffix":""}],"badges":[],"createdAt":"2024-07-13 09:42:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4734598/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4734598/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65920675,"identity":"163657b3-1df5-425f-93b8-d87c94489f38","added_by":"auto","created_at":"2024-10-04 11:47:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":579402,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4734598/v1/935939c5-07f3-458e-bcd0-90377deffdef.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Relationship between Dental Caries and Salivary TGF-β Level and Growth Indicators in 5-6-Year-Old Children: A case-control study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eDental Caries is essentially a microbial disease of the tooth. Scientists characterize Dental Caries as an inorganic demineralization and decay of the organic matter in the tooth that would normally cause cavitation [1, 2]. The cariogenic bacteria can utilize any type of carbohydrates to produce acid which in turn initiates the process of tooth decay[3]. Some of the boosting factors for Dental Caries are aging, amiss oral hygiene, and dental plaque[4]. Still, to prevent infections, the body\u0026rsquo;s immune system can have nonspecified powerful maneuvers[5]. Exposure to infectious agents will stimulate and reactivate the acquired immunity. T-cells are the mediums for cellular immunity which is the general resistance response against viral and certain bacterial infections. On the other hand, humoral immunity would be concerned with antibody circulation[6]. Both humoral and Cellular immune responses have a significant role in the defense against dental carries[7].\u003c/p\u003e \u003cp\u003eOne of the protective agents is the secretory immunoglobulin-A (IgA) which inhibits the adhesion of Streptococcus mutans to the tooth surface[8]. The inflammation is caused by the colonization of the bacteria in the oral cavity. Such damages to the host, initiate adaptive as well as innate immune responses[9]. The periapical lesions host several cells including macrophages, neutrophils, T- and B-lymphocytes, osteoclasts, fibroblasts, and mast cells. Such cells create extensive amounts of pro-inflammatory cytokines such as interleukin IL-1-a, IL-1-b, IL-4, IL-6, lymphotoxin, and Transforming growth factor beta (TGF-β)[9, 10]. It has also been proved that TGF-β prevents macrophages and T cells from producing pro-inflammatory cytokines[11]. TGF-β can also originate from sources other than immune cells, and such TGF-β would have a complementary function in protection against inflammation[11, 12].\u003c/p\u003e \u003cp\u003eAvailable literature does not consider the function of TGF- β concerning dental caries. Nonetheless, multiple studies confirm the radical anti-inflammatory function of TGF-β in pulp inflammation as TGF-β down-regulates odontoblast responses and prevents TLR4 and TLR2 proteins from being expressed[13]. Another function of the TGF-β is repairing dental tissue after a lesion[14]. Still, the molecular mechanisms in association with dental caries need further study to be fully understood. The functions of pro-inflammatory cytokines in such molecular mechanisms have been outlined and yet their details are still unknown. Studying the cytokines can be very beneficial for monitoring the oral cavity and also for diagnosis. Moreover, saliva is quite useful in detecting biomarkers associated with the initiation and progression of the disease as saliva can be used as a non-invasive diagnostic tool.\u003c/p\u003e \u003cp\u003eMultiple studies have examined the concentrations of pro-inflammatory cytokines in the saliva of groups affected with periodontitis, oral lichen planus, squamous cell carcinoma, and Aphthous stomatitis plus their control groups [15\u0026ndash;18]. The study at hand would compare the concentrations of pro-inflammatory cytokine TGF-β in the saliva of dental caries subjects and their control group, and then review growth indicators in children with dental caries in a timespan of childhood up to the present.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003e1.1. Study population\u003c/h2\u003e\n\u003cp\u003eThe study at hand is of the case-control kind. The population for this study consisted of 60 children between 5 to 6 years of age who visited the city of Rafsanjan\u0026rsquo;s dental unit of health centers. Based on the sample size formula below and the information of the study by Agnieszka Gornowicz and her colleagues[19], the sample size was estimated to be 30 people in each group.The children were divided into two groups of 30 subjects with tooth decay and 30 control subjects with healthy teeth. The subjects\u0026rsquo; levels of salivary TGF-\u0026beta; were examined through the Decayed, Missing, and Filled Teeth (DMFT) index. Also, clinical evaluation procedures were employed to examine the state of teeth, the periodontal and oral mucosal status, to evaluate the malocclusion, and to collect saliva samples. The physician in the center utilized an electronic scale (Seca) and a Holtain anthropometer to measure the subjects\u0026rsquo; height and weight. The result data were reviewed in comparison with the updated national reference. Then, the Body Mass Index (BMI) was estimated for each subject with a standard method. Moreover, informed consent from all subjects and parties involved was received and documented.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria in the case group were age 5\u0026ndash;6 years, DMFT greater than or equal to one, and consent to participate in the study, and in the control group were age 5\u0026ndash;6 years, DMFT equal to zero, and consent to participate in the study\u003c/p\u003e\n\u003cp\u003eThe exclusion criteria in both groups were presence of systemic diseases, including diabetes, cystic fibrosis, autoimmune diseases, and other oral and dental diseases, including periodontal disease, oral ulcers, and genetic oral disorders.\u003c/p\u003e\n\u003cp\u003eAfter obtaining the ethics committee code, 60 children, including 30 healthy people in terms of dental examination (DMFT equal to zero) as the control group and 30 people with tooth decay (DMFT greater than or equal to one) were included in the study. Two groups were homogenized in terms of gender by individual matching. The sampling method was convenient sampling method.\u003c/p\u003e\n\u003cp\u003eThe most common epidemiological scale in caries is the DMFT index, in which the number of decayed (D), missing (M) or filled (F) permanent teeth was evaluated by a dentist colleague. It is considered that the missing or filled teeth had caries before the epidemiological evaluation and were treated for this reason.\u003c/p\u003e\n\u003cp\u003eTo calculate the DMFT of a society, the number of decayed, filled, and missing teeth of each individual of that society is counted and its average is calculated.\u003c/p\u003e\n\u003cp\u003eUsually, the mean DMFT is divided into 5 levels (24):\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eBetween zero and 1.1 as very little\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eThe average is between 1.2 and 2.6 km\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e2/7\u0026thinsp;\u0026minus;\u0026thinsp;4/4 average\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e6/5\u0026ndash;4/5 above\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAnd more than 6.6 is very high\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eA checklist was prepared by the researcher to collect other information for this study, in which information related to gender, parents' education, place of residence, birth weight, gestational age, type of feeding during infancy, brushing status, annual examination by the dentist, height, weight, and head circumference of these children were collected by a dental assistant and a medical student\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSalivary sample collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTest subjects\u0026rsquo; saliva samples were collected via the standard method. Saliva samples were collected in a timespan between 9 and 11 o\u0026rsquo;clock in the PM. The examination subjects didn\u0026rsquo;t eat or drink for two hours. Utilizing the spitting method, samples of unstimulated saliva were collected from the subjects for 10 minutes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudying the TGF-\u0026beta; in salivary samples with ELISA\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA commercial enzyme-linked immunosorbent assay kit (R\u0026amp;D Systems Inc., Minneapolis, MN, USA) was used to determine the concentration of TGF-\u0026beta;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results were summarized via percentages and absolute frequencies for categorical variables, and results for numeric variables were documented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Independent two-sample t-tests were used in the comparison of numeric variables, while the chi-square test or Fisher\u0026rsquo;s exact test was used in the comparison of the categorical variables of the sample and control groups. The results of comparisons between the two groups were also reported as ORs (odds ratios) and 95% CIs (confidence intervals).\u003c/p\u003e\n\u003cp\u003eNon-parametric Kolmogorov-Smirnov test indicated that the presumption of normality was met for numeric variables (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). For the statistical analysis, the statistical software SPSS version 24.0 for windows (IBM SPSS Inc., Chicago, IL, USA) was used. All p-values were 2-tailed, with statistical significance defined by p\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 60 children aged 5\u0026ndash;6 years were compared in two groups of 30 individuals (with tooth decay) and control (without tooth decay) in terms of the level of beta-transforming growth factor and physical growth.\u003c/p\u003e\n\u003cp\u003eIn the case group, the decay index was 3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;7.03. There was no statistically significant difference between the frequency of gender (50% girl, 50% boy, p\u0026thinsp;=\u0026thinsp;1.000) and mean score of birth weight (3155.00\u0026thinsp;\u0026plusmn;\u0026thinsp;658.39, 3155.00\u0026thinsp;\u0026plusmn;\u0026thinsp;391.14, p\u0026thinsp;=\u0026thinsp;1.000), birth height (48.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.56, 48.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83, p\u0026thinsp;=\u0026thinsp;0.644), and head circumference (34.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87, 34.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25, p\u0026thinsp;=\u0026thinsp;0.634) of children at birth in the case group versus control group.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e reveals that in the assessment of maternal characteristics in these children, there was no statistically significant difference in terms of education level, place of residence, and gestational age at the time of delivery. However, diploma and sub-diploma education, living in the village, and full-term babies were 2.36 times, 1.97 times, and 1.6 times more at risk of caries, respectively.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMaternal characteristics in the study population\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup\u003c/p\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCase (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR (95% CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTest Statistic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003cp\u003eChi square\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEducation\u003c/p\u003e\n\u003cp\u003eUniversity\u003c/p\u003e\n\u003cp\u003eDiploma or less\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (13.3)\u003c/p\u003e\n\u003cp\u003e26 (86.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (26.7)\u003c/p\u003e\n\u003cp\u003e22 (73.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eref.\u003c/p\u003e\n\u003cp\u003e2.363 (0.626\u0026ndash;8.916)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026chi;2\u0026thinsp;=\u0026thinsp;1.667,\u003c/p\u003e\n\u003cp\u003edf\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.197\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLocation\u003c/p\u003e\n\u003cp\u003eCity\u003c/p\u003e\n\u003cp\u003eVillage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14 (46.7)\u003c/p\u003e\n\u003cp\u003e16 (53.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 (63.3)\u003c/p\u003e\n\u003cp\u003e11 (36.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eref.\u003c/p\u003e\n\u003cp\u003e1.974 (0.703\u0026ndash;5.543)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026chi;2\u0026thinsp;=\u0026thinsp;1.684,\u003c/p\u003e\n\u003cp\u003edf\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.194\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGestational age status\u003c/p\u003e\n\u003cp\u003eTerm\u003c/p\u003e\n\u003cp\u003ePreterm\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 (93.3)\u003c/p\u003e\n\u003cp\u003e2 (6.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27 (90.0)\u003c/p\u003e\n\u003cp\u003e3 (10.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eref.\u003c/p\u003e\n\u003cp\u003e0.643 (0.100\u0026ndash;4.153)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFisher\u0026rsquo;s exact test\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.999\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eData are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or n (%).\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eOR: Odds Ratio, CI: Confidence Interval, df: degree of freedom\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eHint: OR\u0026thinsp;\u0026gt;\u0026thinsp;1 shows more likely to be Case and OR\u0026thinsp;\u0026lt;\u0026thinsp;1 shows less likely to be Case.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThere was no significant difference between case and control groups in terms of breastfeeding status, the mean age of starting complementary feeding, and the age of starting complementary feeding status (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eNutritional status during infancy in the study population\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNutritional status of infants\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCase\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eControl\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR (95% CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTest statistic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFeeding status\u003c/p\u003e\n\u003cp\u003eBreastfeeding\u003c/p\u003e\n\u003cp\u003eBreastfeeding and formula\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(83.3%)25\u003c/p\u003e\n\u003cp\u003e(16.7%)5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(76.7%)27\u003c/p\u003e\n\u003cp\u003e(23.3%)3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003cp\u003e0.657 (0.183\u0026ndash;2.363)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026chi;2\u0026thinsp;=\u0026thinsp;0.417 df\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.519\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge of onset of complementary feeding (month)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e6.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.015 (0.727\u0026ndash;1.415)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.083, df\u0026thinsp;=\u0026thinsp;58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.934\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge of starting complementary feeding status\u003c/p\u003e\n\u003cp\u003eBefore 6 months\u003c/p\u003e\n\u003cp\u003eAt 6 months\u003c/p\u003e\n\u003cp\u003eAfter 6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(26.7%)8\u003c/p\u003e\n\u003cp\u003e(60%)18\u003c/p\u003e\n\u003cp\u003e(13.3%)4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(23.3%)7\u003c/p\u003e\n\u003cp\u003e(66.7%)20\u003c/p\u003e\n\u003cp\u003e(10%)3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003cp\u003e0.788 (0.238\u0026ndash;2.609)\u003c/p\u003e\n\u003cp\u003e1.167(0.191\u0026ndash;7.116)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFisher\u0026rsquo;s exact test\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.865\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eData are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or n (%).\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eOR: Odds Ratio, CI: Confidence Interval, df: degree of freedom\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eHint: OR\u0026thinsp;\u0026gt;\u0026thinsp;1 shows more likely to be Case and OR\u0026thinsp;\u0026lt;\u0026thinsp;1 shows less likely to be Case.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e indicates the growth status of children at the age of 5\u0026ndash;6 in both case and control groups. The mean age of weight and height in the two groups of children had no statistically significant difference. However, the BMI in the case group was less than the control group and this difference was statistically significant. The risk of abnormal BMI in the case group was 1.217 times that of the control group.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eThe relationship between tooth decay and growth indicators in the study population\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGrowth indicators of children at the age of 5\u0026ndash;6 years\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCase group\u003c/p\u003e\n\u003cp\u003eTooth decay\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eControl group\u003c/p\u003e\n\u003cp\u003eNo tooth decay\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR (95% CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTest statistic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWeight (kg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.892 (0.736\u0026ndash;1.081)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et = -1.172, df\u0026thinsp;=\u0026thinsp;58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.246\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeight (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e111.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e110.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.129 (0.0949\u0026ndash;1.343)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.391, df\u0026thinsp;=\u0026thinsp;58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.170\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI (kg/m2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e16.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.742 (0.549\u0026ndash;1.002)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et = -2.065, df\u0026thinsp;=\u0026thinsp;58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.043\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI group\u003c/p\u003e\n\u003cp\u003eNormal\u003c/p\u003e\n\u003cp\u003eAbnormal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(76.7%)23\u003c/p\u003e\n\u003cp\u003e(23.3%)7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(80%)8\u003c/p\u003e\n\u003cp\u003e(20%)18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003cp\u003e1.217 (0.355\u0026ndash;4.169)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026chi;2\u0026thinsp;=\u0026thinsp;0.098, df\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.745\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eData are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or n (%).\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eOR: Odds Ratio, CI: Confidence Interval, df: degree of freedom, BMI: Body Mass Index, dmft: decayed, missing, filled teeth\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eHint: OR\u0026thinsp;\u0026gt;\u0026thinsp;1 shows more likely to be Case and OR\u0026thinsp;\u0026lt;\u0026thinsp;1 shows less likely to be Case.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIn the case group, more children did not brush their teeth during the day compared to control group (46.7% vs. 30%, p\u0026thinsp;=\u0026thinsp;0.184). The frequency of children's visits by dentists in the case group was fewer than the control group (63.3% vs. 76.7%, p\u0026thinsp;=\u0026thinsp;0.260), but this difference was not statistically significant.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e shows that the mean level of the factor in the case and control groups. The mean TGF B level in the group of children with tooth decay was 17.28\u0026thinsp;\u0026plusmn;\u0026thinsp;6.87 and in the control group was 13.91\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93, which were statistically significant. In the investigation of the relationship between the level of TGF B and the index of tooth decay, no significant relationship was observed.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eThe relationship between tooth decay and the mean level of transforming growth factor beta\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCase group\u003c/p\u003e\n\u003cp\u003eTooth decay\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eControl group\u003c/p\u003e\n\u003cp\u003eNo tooth decay\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR (95% CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTGF-\u0026beta; (Pg/ml)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.28\u0026thinsp;\u0026plusmn;\u0026thinsp;6.87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.91\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.088 (0.999\u0026ndash;1.186)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.047\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eData are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eOR: Odds Ratio, CI: Confidence Interval, df: degree of freedom,\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eHint: OR\u0026thinsp;\u0026gt;\u0026thinsp;1 shows more likely to be Case and OR\u0026thinsp;\u0026lt;\u0026thinsp;1 shows less likely to be Case.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn the current study, the DMFT index in 5-6-year-old children in the case group was 7.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32. In the study by Jafari et al. in Hashtroud city, the mean DMFT index in 6-year-old children was 4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75[20]. In another similar study by Faezi et al. in students aged 6\u0026ndash;12 years was 2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81[21]. In a survey in one of the cities of Serbia the mean DMFT in preschool children was 5.8 [22]. This amount in Turkey was 3.74 [23], and in Saudi Arabia reported 5.7 [24].\u003c/p\u003e \u003cp\u003eOverally, compared to the other studies, the DMFT index was higher, indicating the average number of filled and missing decayed teeth. In the present study, comparing the growth indices (height, weight, and BMI) between children with and without tooth decay did not show a difference between the height and weight of these two groups, while the BMI in children with tooth decay was significantly lower than the control group.\u003c/p\u003e \u003cp\u003eIn the study by Alkarimi et al. in Saudi Arabia on 6\u0026ndash;8 year old children, there was an inverse linear relationship between tooth decay and height, weight, and BMI growth indicators [24]. Van Gemert-Schriks et al. also prospectively followed the development of 6-year-old children for 3 years and found that tooth decay has adverse effects on children's physical growth, including height, weight, and BMI [25]. In internal studies also conducted by Jabarifar et al. in the city of Kazerun, similar to the mentioned studies, there was a significant relationship between tooth decay and children's height, and BMI [26]. However, in the study by Banakar's et al. the relationship between tooth decay and underweight was seen only in male students and this relationship was not seen in girls, which is in line with the present study[27]. Porhashmi et al. reported a clear relationship between BMI and caries[28]. The reason for low BMI in this group could be toothache, which will affect the quality and quantity of the child's nutrition, as well as inflammation of the pulp and dental abscesses through internal metabolic pathways, causing a decrease in hemoglobin, anemia, and on the other hand, weight loss and disruption in the child's growth.\u003c/p\u003e \u003cp\u003eThe present study showed that the level of TGF-β is higher in children with dental caries. There was also a significant relationship between DMFT index and TGF-β. Piatelli et al. showed in their study that in the odontoblastic and sub-odontoblastic layers of the samples with irreversible pulp inflammation, the expression of TGF-β1 was higher than that of healthy samples[29].\u003c/p\u003e \u003cp\u003eThe current study also did not show a difference between tooth brushing and examination by a dentist with tooth decay, which is consistent with the study of Cianetti et al. They reported that there was no statistically significant difference in the presence of caries between children who had been visited by a dentist at least once and children who had not been visited by a dentist before [30]. However, many studies have shown that brushing, the number of times brushing, and examination by a dentist had a significant relationship with the reduction of caries in children [31\u0026ndash;35].\u003c/p\u003e \u003cp\u003eCytokines are also known to function as regulators of the immune response. Adhesion markers and (probably) their associated chemokines involved in leukocyte trafficking are known to function and find expression under the influence of cytokines. During the innate response of the immune system, oral pathogen-associated molecular patterns for microbial invasion stick to receptors on host cells. The pattern-recognition receptors on host cells also include dendritic cells. The significance of dendritic cells is releasing pro-inflammatory cytokines to activate the inflammatory response. The formation of gingivitis is highly likely in the beginning. Although, after the successful culmination of the immune response the gingivitis will disappear. Nonetheless, if the bacteria spread extensively the infection will continue which intensifies the inflammatory response.\u003c/p\u003e \u003cp\u003eAccording to the study by Vadiakas et al. various therapies resulted in decreasing concentrations of pro-inflammatory cytokines [36]. In a study conducted by Albert et al. dental caries patients were examined and the results proved a decrease in osteoblasts and fibroblast count due to the increase in the TGF-β levels. It is noteworthy that osteoblasts and fibroblasts are radical elements in the development of dental caries and demineralization of teeth [37]. The research at hand affirms a positive association between Salivary TGF-β, Growth indices, TGF-β, and Dental Caries. As an effector cytokine, this agent causes oral disease [38]. In conclusion Dental caries subjects had increased levels of TGFβ in comparison to the healthy control subjects. Children afflicted with dental caries registered decreased weights in comparison to healthy counterparts of the same age. Consequently, the examination of dental status in preschool children seems quite rudimentary.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was financially supported by a grant from the Rafsanjan University of Medical Sciences. Also, the authors of this study are grateful for the cooperation of the Clinical Research Development Unit of Ali-Ibn Abi-Talib Hospital for the implementation of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026apos;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eM. NK. and Z.K.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eD. P.\u003c/strong\u003e made substantial contributions to acquisition of data and revised the manuscript critically for important intellectual content;\u0026nbsp;\u003cstrong\u003eZ. K. D.P.\u0026nbsp;\u003c/strong\u003eanalysis or interpretation of data and drafted the article\u003cstrong\u003e;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eZ K and Sh.D. and M. N.\u0026nbsp;\u003c/strong\u003econceptualized and designed the study, made substantial contributions to conception and acquisition of data, critically reviewed the manuscript for important intellectual content, and approved the final version;\u003cstrong\u003e\u0026nbsp;F.H. and Sh. D.\u0026nbsp;\u003c/strong\u003emade substantial contributions to acquisition of data;\u003cstrong\u003e\u0026nbsp;Z K and Sh.D. F.H. and M. NK. D.P\u0026nbsp;\u003c/strong\u003ereviewed the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eAvailability of data\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand materials\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe datasets analyzed in \u0026nbsp;the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe informed consent form was signed by the participants prior enter into the project and the project protocol was approved by the local ethical committee:\u0026nbsp;IR.RUMS.REC.1399.187.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was collected from each participant prior to study inclusion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll Authors agreed for publication\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u0026nbsp;Competing interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRajendran, R., \u003cem\u003eShafer's textbook of oral pathology\u003c/em\u003e. 2009: Elsevier India.\u003c/li\u003e\n\u003cli\u003eBerkowitz, R.J., \u003cem\u003eCauses, treatment and prevention of early childhood caries: a microbiologic perspective.\u003c/em\u003e J Can Dent Assoc, 2003. \u003cstrong\u003e69\u003c/strong\u003e(5): p. 304-7.\u003c/li\u003e\n\u003cli\u003eTouger-Decker, R. and C. 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Shaker, \u003cem\u003eLevels of salivary IFN-gamma, TNF-alfa, and TNF receptor-2 as prognostic markers in (erosive) oral lichen planus.\u003c/em\u003e Mediators of Inflammation, 2010. \u003cstrong\u003e2010\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eGornowicz, A., et al., \u003cem\u003ePro-inflammatory cytokines in saliva of adolescents with dental caries disease.\u003c/em\u003e 2012. \u003cstrong\u003e19\u003c/strong\u003e(4).\u003c/li\u003e\n\u003cli\u003eJafari, F., et al., \u003cem\u003eEvaluationof DMFT and dmft indexes and affecting factors in students of Hashtrood City in 2013-2014.\u003c/em\u003e Journal of Ilam University of Medical Sciences, 2017. \u003cstrong\u003e25\u003c/strong\u003e(4): p. 179-186.\u003c/li\u003e\n\u003cli\u003eFaezi, M., S. Farhadi, and H. NikKerdar, \u003cem\u003eCorrelation between DMFT, diet and social factors in primary school children of Tehran-Iran in 2009-2010.\u003c/em\u003e Journal of Mashhad dental school, 2012. \u003cstrong\u003e36\u003c/strong\u003e(2): p. 141-148.\u003c/li\u003e\n\u003cli\u003eBegzati, A., M. Berisha, and K. Meqa, \u003cem\u003eEarly childhood caries in preschool children of Kosovo-a serious public health problem.\u003c/em\u003e BMC Public Health, 2010. \u003cstrong\u003e10\u003c/strong\u003e(1): p. 1-8.\u003c/li\u003e\n\u003cli\u003eNamal, N., A.A. Y\u0026uuml;ceokur, and G. Can, \u003cem\u003eSignificant caries index values and related factors in 5-6-year-old children in Istanbul, Turkey.\u003c/em\u003e East Mediterr Health J, 2009. \u003cstrong\u003e15\u003c/strong\u003e(1): p. 178-84.\u003c/li\u003e\n\u003cli\u003eAlkarimi, H.A., et al., \u003cem\u003eDental caries and growth in school-age children.\u003c/em\u003e Pediatrics, 2014. \u003cstrong\u003e133\u003c/strong\u003e(3): p. e616-e623.\u003c/li\u003e\n\u003cli\u003evan Gemert-Schriks, M., et al., \u003cem\u003eThe influence of dental caries on body growth in prepubertal children.\u003c/em\u003e Clinical oral investigations, 2011. \u003cstrong\u003e15\u003c/strong\u003e(2): p. 141-149.\u003c/li\u003e\n\u003cli\u003eJabarifar, S.E., et al., \u003cem\u003eRelationship and Association of Preterm Labor with Developmental Defects of Enamel and Dental Caries.\u003c/em\u003e مجله دانشکده دندانپزشکی اصفهان, 2009: p. 159~ 163-159~ 163.\u003c/li\u003e\n\u003cli\u003eBanakar, S. and K. Keshavarz, \u003cem\u003eAn Investigation on Relationship between Prevalence of Dental Caries and Underweight in 6-10 Year Old Children in Gachsaran.\u003c/em\u003e Journal of Dentistry, 2005. \u003cstrong\u003e6\u003c/strong\u003e(3, 4): p. 10-16.\u003c/li\u003e\n\u003cli\u003ePorhashemi, J., K.G. Garshasby, and A. Nahvi, \u003cem\u003eRelationship between Sever Early Childhood Caries and BMI in 2-4-Year-Old Children in Tehran Kindergartens.\u003c/em\u003e Journal of Mazandaran University of Medical Sciences, 2016. \u003cstrong\u003e26\u003c/strong\u003e(140): p. 197-201.\u003c/li\u003e\n\u003cli\u003ePiattelli, A., et al., \u003cem\u003eTransforming Growth Factor‐beta 1 (TGF‐beta 1) expression in normal healthy pulps and in those with irreversible pulpitis.\u003c/em\u003e International endodontic journal, 2004. \u003cstrong\u003e37\u003c/strong\u003e(2): p. 114-119.\u003c/li\u003e\n\u003cli\u003eCianetti, S., et al., \u003cem\u003eDental caries, parents educational level, family income and dental service attendance among children in Italy.\u003c/em\u003e Eur J Paediatr Dent, 2017. \u003cstrong\u003e18\u003c/strong\u003e(1): p. 15-18.\u003c/li\u003e\n\u003cli\u003eCorr\u0026ecirc;a-Faria, P., et al., \u003cem\u003eFactors associated with the development of early childhood caries among Brazilian preschoolers.\u003c/em\u003e Braz Oral Res, 2013. \u003cstrong\u003e27\u003c/strong\u003e(4): p. 356-62.\u003c/li\u003e\n\u003cli\u003eDu, M., et al., \u003cem\u003eCaries patterns and their relationship to infant feeding and socio-economic status in 2-4-year-old Chinese children.\u003c/em\u003e Int Dent J, 2000. \u003cstrong\u003e50\u003c/strong\u003e(6): p. 385-9.\u003c/li\u003e\n\u003cli\u003eGibson, S. and S. Williams, \u003cem\u003eDental caries in pre-school children: associations with social class, toothbrushing habit and consumption of sugars and sugar-containing foods. Further analysis of data from the National Diet and Nutrition Survey of children aged 1.5-4.5 years.\u003c/em\u003e Caries Res, 1999. \u003cstrong\u003e33\u003c/strong\u003e(2): p. 101-13.\u003c/li\u003e\n\u003cli\u003eElamin, A., M. Garemo, and A. Gardner, \u003cem\u003eDental caries and their association with socioeconomic characteristics, oral hygiene practices and eating habits among preschool children in Abu Dhabi, United Arab Emirates - the NOPLAS project.\u003c/em\u003e BMC Oral Health, 2018. \u003cstrong\u003e18\u003c/strong\u003e(1): p. 104.\u003c/li\u003e\n\u003cli\u003eCari\u0026ntilde;o, K.M., K. Shinada, and Y. Kawaguchi, \u003cem\u003eEarly childhood caries in northern Philippines.\u003c/em\u003e Community Dent Oral Epidemiol, 2003. \u003cstrong\u003e31\u003c/strong\u003e(2): p. 81-9.\u003c/li\u003e\n\u003cli\u003eVadiakas, G., \u003cem\u003eCase definition, aetiology and risk assessment of early childhood caries (ECC): a revisited review.\u003c/em\u003e Eur Arch Paediatr Dent, 2008. \u003cstrong\u003e9\u003c/strong\u003e(3): p. 114-25.\u003c/li\u003e\n\u003cli\u003eAlbert, R.J., et al., \u003cem\u003eNursing caries in the Inuit children of the Keewatin.\u003c/em\u003e J Can Dent Assoc, 1988. \u003cstrong\u003e54\u003c/strong\u003e(10): p. 751-8.\u003c/li\u003e\n\u003cli\u003eRosenblatt, A. and P. Zarzar, \u003cem\u003eThe prevalence of early childhood caries in 12- to 36-month-old children in Recife, Brazil.\u003c/em\u003e ASDC J Dent Child, 2002. \u003cstrong\u003e69\u003c/strong\u003e(3): p. 319-24, 236.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dental Caries, TGF-β, Children, Saliva, Inflammatory, DMFT Index","lastPublishedDoi":"10.21203/rs.3.rs-4734598/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4734598/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003ePro-inflammatory cytokines in the saliva were detected in periodontitis and dental caries. This study aims to compare the concentration of pro-inflammatory cytokines Transforming growth factor beta (TGF-β) in the saliva of dental caries patients and survey growth indices from childhood to the present, in children with dental caries.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this case-control study, two groups of 30 cases (children with tooth decay) and control (without tooth decay), aged 5\u0026ndash;6 years, were selected by using the Decayed, Missing, and Filled Teeth (DMFT) index and were matched based on age and sex. They were evaluated in terms of growth indices (BMI, gender, weight, height, and head circumference) from childhood to the present, as well as salivary TGF-β levels. Finally, the data were analyzed by SPSS22.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe DMFT index in the case group was 7.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32 and they had significantly lower BMI (p\u0026thinsp;=\u0026thinsp;0.042), but no relationship was observed with height and weight. The mean level of TGF-β (Pg/mL) in the case group was significantly higher than the control group (p\u0026thinsp;=\u0026thinsp;0.047).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe study results indicate that TGF B level is higher in children with dental caries. Children with dental caries weigh less than children of the same age; therefore, dental examination in preschool children is necessary, with the aim of preventing DMFT.\u003c/p\u003e","manuscriptTitle":"The Relationship between Dental Caries and Salivary TGF-β Level and Growth Indicators in 5-6-Year-Old Children: A case-control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-13 11:31:58","doi":"10.21203/rs.3.rs-4734598/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"55b37c5a-97f0-4490-bf6f-c5a9b11c0cdd","owner":[],"postedDate":"August 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-04T11:39:06+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-13 11:31:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4734598","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4734598","identity":"rs-4734598","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}