Impact of symptomatic COVID-19 on the oral health of pediatric patients in Tbilisi City

Impact of symptomatic COVID-19 on the oral health of pediatric patients in Tbilisi City | 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 Impact of symptomatic COVID-19 on the oral health of pediatric patients in Tbilisi City Lia Mania, Ketevan Nanobashvili, Tinatin Manjavidze, Mamuka Benashvili, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5174172/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 Background/Purpose: Coronavirus disease 2019 (COVID-19) has become the cause of a global health crisis during the current pandemic. This research aimed to study the impact of symptomatic COVID-19 on children’s oral health indices and salivary microbiome composition duringthe post-COVID-19 period. Methods: An observational, cross-sectional study was conducted in Tbilisi (Georgia) among those aged 7-12 years. A total of421 children included in the study had a history of laboratory-confirmed COVID-19 within one year of exposure. No participants met the criteria for comorbidconditions or for PCC. A stratified simple random selection of schools and among selected clusters was used. The selected children were divided into two groups: the exposed group, patients with a history of symptomatic COVID-19; and the control group, patients with a history of asymptomatic COVID-19. The data were collected from August 2022 to December 2023. Oralscreening, microbiological examination of saliva, and administration of questionnaires were also performed. Logistic regression was used to calculate ORs with 95% confidence intervals. The statistical processing of the data was performed with SPSS-23. The study was approved by the Biomedical Research Ethical Council of the University of Georgia (UGREC –04 –22/09.03.2022). Results: Statistically significant differences in the means of the oral health indicators between the studied groups were detected (exposed: DMFT+deft=5.9; MGI=0.92; S-OHI=1.9; control: DMFT+deft=3.8; MGI=0.56; S-OHI=1.4). According to the logistic regression, symptomatic COVID-19 had a significant effect on the following oral health indicators: DMFT+deft (OR=1.26; 95% CI=1.14-1.39); MGI (OR=2.31; 95% CI=1.50-3.55); and S-OHI (OR=3.43; 95% CI=2.03-5.76). The effect of symptomatic COVID-19 on the frequency of eradication of the studied microbiome was also significant (OR=2.12; 95% CI=1.23-3.63). Conclusion: A close association was established between symptomatic COVID-19 and microbiome changes in the oral saliva of children as well as between oral health indicators and symptomatic COVID-19. Considering the research results, it is assumed that a symptomatic course of COVID-19 may be an additional risk factor associated with poor oral health in the pediatric population in the post-COVID-19 period. Epidemiology Pediatrics Oral microbiome Oral health indicators Population-based research COVID-19 Introduction Georgia is a country in the Caucasus region. Tbilisi is the capital city, where the population as of January 1, 2023, is 1,241,700 people. The first confirmed case of COVID-19 in Georgia was recorded on February 26, 2020. According to the latest data, as of July 15, 2022, 1,673,160 cases of the disease had been officially confirmed in Georgia. ( NCDC 2020–2022 report ). By July 1, 2022, according to NCDC data, the number of test-confirmed cases in the population aged 0–18 in Georgia was 294 649 children (17.7% of all confirmed cases); of these, 115,137 children with COVID-19 were recorded in Tbilisi in this age group. (NCDC 2020–2022). Specialized testing to detect COVID-19 in Georgia began on February 4, 2020. As of July 1, 2022, the testing rate (PCR + antigen) was 4897 per 1000 inhabitants. Georgia ranks 10th among the 50 countries in the world with the highest testing rate. (NCDC) The most common symptoms of COVID-19 in children are Fever, chills, cough, and sore throat. (CDC COVID-19 Response Team et al., 2020; Mustafa & A Selim, 2020 ), WHO). Among the local symptoms of the oral cavity in the pediatric population, the most often observed were taste and smell disorders, oral candidiasis, gingivitis, Cheilitis simplex and Lingua pilacta, and inflammation of the salivary glands. (Nasiri et al., 2023 ) According to statistics described in the literature, at least one oral symptom was observed in 2/3 of COVID-19 patients. (Lin et al., 2023 ). There is evidence that a significant proportion of patients with oral symptoms have various oral pathologies three months after hospital discharge, suggesting that these changes may be a consequence of COVID-19. (Gherlone et al., 2021 ) The oral cavity is also interesting because it is known as the gateway for SARS-CoV-2 infection(Drozdzik & Drozdzik, 2022 ). The oral mucosa and salivary glands are rich in angiotensin-converting protein 2 (ACE-2) and transmembrane protease serine 2 (TMPRSS2) receptors. The virus directly binds to these receptors, damages the salivary glands, and causes inflammation, sialadenitis, xerostomia, and altered taste. (Sakaguchi et al., 2020 ; Sinjari et al., 2020 ). These events are pathogenically related to changes in the microbiome of the oral cavity (Botros et al., 2020 ; Tsuchiya, 2021 ). The oral microbiome changes throughout life and is associated with local (oral) and general diseases (Nanobashvili et al., 2021 ). The pediatric population is characterized by an asymptomatic and relatively mild clinical course of COVID-19 (Lu et al., 2020 ; Zhang et al., 2022 ). The conducted studies revealed differences in laboratory and clinical data between children with symptomatic and asymptomatic courses of COVID-19 (Yoon et al., 2020 ). Despite the diversity of related studies, relatively little scientific information is available about the impact of the virus on oral health in school-aged children. We believe that our study sheds light on the oral health outcomes of school-age children following symptomatic COVID-19 transmission, which are noteworthy and require a multidisciplinary approach to virus management. This research aimed to study the impact of the symptomatic course of COVID-19 on oral health indicators and the salivary microbiome among children aged 7 to 12 years in the post-COVID-19 period in Tbilisi City (Georgia). Methods 1. Study population This population-based oral health study included 7- to 12-year-old, laboratory-confirmed post-COVID-19 children within 1 year of exposure from Tbilisi (Georgia). No participants met the criteria for comorbid conditions or post-COVID-19 conditions (PCC). Data collection began in August 2022 and finished in December 2023. A total of 421 children were examined. The post-COVID-19 population was selected from public and private schools in Tbilisi using a stratified simple random sampling method. By 2022–2023, there were 282 general education schools in Tbilisi attended by 155,366 students aged 7–12 years. (emis.ge). The number of patients included in the study was determined using a sample size formula. The sample size was determined based on the principle that the margin error of the total results should not exceed 5%, and in detail, the reliability of the research results should be at least 90%. The following formula was used to calculate the size of the required sample: $$\:n=\frac{\text{p}\left(1-\text{p}\right)\text{*}\text{N}\text{*}{Z}_{(1+q)/2}^{2}}{\text{p}\left(1-\text{p}\right)*{Z}_{\frac{1+q}{2}}^{2}+N*{d}^{2}}*deff$$ where n is the sample size (421) N is the population size (115, 366) d - Maximum permissible error (5%) q - Confidence level (90%) \(\:{\varvec{Z}}_{\frac{1+\varvec{q}}{2}}^{2}\) - The (1+ q)/2 quantiles of the standard normal distribution \(\:\varvec{d}\varvec{e}\varvec{f}\varvec{f}\) - The importance of the design effect. The number of qualifying schools and children (421 research subjects) was proportionally distributed among the 5 main municipalities of Tbilisi. (Skolebi.emis.ge). Table 1 . Table 1 Quantitative distribution of qualifying schools and students Municipality Number of the students Number of the schools Average number of students per school who participated in the study Average number of students per class who participated in the study (6 per class) Sum 421 27 16 2—3 Municipality of Gldani-Nadzaladevi 104 6 17 2—3 Municipality of Didube-Chughureti 73 5 15 2—3 Municipality of Vake-Saburtalo 81 5 16 2—3 Municipality of Isani-Samgori 92 6 15 2—3 Municipality of Old Tbilisi 71 5 14 2—3 The selection of schools for each municipality was carried out using simple stratified random sampling supported by SPSS software. Additionally, the selection of school grades was carried out using systematic random sampling. In the selected classes, we conducted simple random sampling until a predetermined number of students were collected in the study school. Using this principle, 27 schools and 421 students were selected. A total of 4214 children and their parents were interviewed, resulting in 421 (9.9% of the total respondents) laboratory-confirmed children aged 7 to 12 years who agreed to participate in the study. According to the survey results, 547 children were infected with laboratory-confirmed COVID-19—12.98% of the respondents. Among them, 421 beneficiaries (76.96%) agreed to participate in the study. Research Design and Procedure The study was observational and cross-sectional. Exposure and outcome variables: Exposure and outcome variables: The selected children were divided into two main groups: Exposed group–Symptomatic group: Children with a history of symptomatic COVID-19. (presence of even one local or general symptom). Control group - Asymptomatic group: Children with a history of asymptomatic COVID-19. (no symptoms). The data were collected via questionnaires and verified via NCDC databases. Symptoms during COVID-19 infection were studied via questionnaires. The presence/absence of temperature was studied from the general symptoms. Thirteen symptoms have been studied from the perspective of local oral manifestations: facial asymmetry, pain in the mouth, redness on the gums or oral mucosa, bleeding from the gums, rash or ulcer on the oral mucosa, curdled plaques, itching, burning sensation, change in taste, change in smell, hypersalivation, dryness of the mouth, and excessive plaque on the teeth. (Table 3 ). The outcome was a change in the salivary microbiome and oral health indicators: Decayed, Missing, Filled teeth (DMFT) for permanent dentition; decayed, extracted, and filled teeth (deft) for milk dentition; DMFT + deft for mixed dentition; Modified Gingival Index (MGI); Simplified Oral Health Index (S-OHI); Five species of pathogenic and conditionally pathogenic microorganisms with average and excessive growth were studied in microbiological samples of saliva: Staphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus epidermalis. Assessment of oral health indicators and saliva: Oral health indicators were evaluated according to the standards provided by WHO. (Supplementary Table: 1). Evaluation of the microbiological study of oral saliva: Biological material (saliva) was collected from the oral cavity, and its transportation and subsequent microbiological research were carried out in the “Clinic Neo-Lab” laboratory based on EUCAST guidelines. For the identification of microbes in the laboratory, the culture method of bacteriological diagnostics was used, which is often called the "gold standard" (Samaranayake, 2018 ; Walley, 2012 ). When choosing the method, its budget ability was taken into account, which is important for population studies in public health. Research stages: Stage I - Selection of students for survey in selected schools and classes and telephone interviews with parents of selected children to obtain informed consent. Informed consent documents and questionnaires were left at the school for signature by the guardians of the selected children. Stage II – The guardians of the selected children completed questionnaires about their condition in the oral cavity; these questionnaires were used to determine their history of COVID-19 and clinical symptoms during infection. In addition, families' socioeconomic status, children's behavior, and knowledge regarding oral health, hygiene, and nutrition were examined. The questionnaire was developed based on the basic methods for examining the oral cavity provided by the World Health Organization. (“Basic Oral Health Screening Methods,” 2013). After the caregivers signed the informed consent document and filled out the questionnaires, the third stage of the study—screening—began. Stage III – Children were observed in medical rooms of schools, and biological material (saliva) was collected from the transport soil. The visual examination of the oral cavity included the determination of the simplified oral hygiene index (OHI-S), the caries intensity (DMFt + deft), and the modified gingival index (MGI). The data were collected on a dental card (form N 4-220). Only a disposable dental mirror was used during the examination of the oral cavity ( Oral Health Assessment, 2012 ). Dental plaques were stained with the disclosing agent. During the observation process, an intraoral photo of the oral cavity was compiled both before and after the plaque was stained (Estai et al., 2022 ) to increase the reliability of the study. Senior students of the university's dentistry program participated in the research process. The research team consisted of five researchers: one researcher performed oral cavity observation and plaque staining; the second researcher simultaneously recorded the oral indices on the patient's medical card; and the third researcher collected biological material (saliva) on the transported soil. The fourth and fifth researchers independently took intraoral dental photographs of each beneficiary. The examination of each beneficiary in the medical room lasted 12–15 minutes. Statistical analysis Descriptive and inferential statistics were used. The mean values ​​of the oral health indicators MDFT + deft, MGI, and S-OHI and the bacterial species cultivated in saliva were assessed by means of the symptomatic and asymptomatic groups, and the difference between the means was determined using a t test. P values ​​<0.05 were considered to indicate statistical significance. Cross-tabulations were used to visualize frequency distributions between variables in the symptomatic and asymptomatic groups. The chi-square test was used to determine the presence of a significant difference between the variables in the groups. In the final part, logistic regression was used to determine odds ratios (ORs), including 95% CIs, to examine the impact of the symptomatic course of COVID-19 on the oral microbiome and oral health outcomes. Data processing was carried out using SPSS-23. Research ethics (study approval) The ethical approval of the study was given by the Biomedical Research Ethical Council of the School of Health Sciences of the University of Georgia (research code UGREC − 04 − 22/09.03.2022). In accordance with the Declaration of Helsinki, informed consent was obtained from the guardians of the participants in the study prior to inclusion. Research data are confidential. The Ministry of Education and Science of Georgia permitted screenings to be conducted in schools. (Doc code MES 9 22 0000871059). Results Of the 421 children included in the study, 50.4% (n = 212) were female, and 49.6% (n = 209) were male. The mean age of the beneficiaries was 9.8 years (SD = 1.6). A total of 9997 teeth (permanent and primary teeth) were examined from 421 children. A total of 301 children had mixed dentition, and 120 had permanent dentition. For the entire population (n = 421), the average intensity of caries (DMFT + deft) was 5.6. The incidence of caries in the post-COVID population (n = 421) was 89%. It is 69% for permanent teeth and 84% for primary teeth. The prevalence of caries in the symptomatic group reached 92%, whereas that in the asymptomatic group reached 77%. In the symptomatic group, the prevalence of caries in permanent teeth was 71%, and for primary teeth, it was 88%. In the asymptomatic group, the prevalence of caries in permanent teeth was 59%, whereas that in primary teeth was 68%. (Table 2 ). The mean value of the S-OHI is 1.85, and the mean value of the MGI is 0.86. (Table 2 ). Overall, 84.3% (n = 355) of the beneficiaries were allocated to the symptomatic (exposed) group, and 15.7% (n = 66) were allocated to the asymptomatic (control) group. The mean variables of oral health in the symptomatic and asymptomatic groups are shown in Table 2 . The t test proved that the difference between the means of the oral health indicators in the symptomatic and asymptomatic groups was reliable ( p < 0.05). During the research, it was possible to identify a total of 19 microbial species: Streptococcus oralis, Streptococcus mutans, Streptococcus mitis, Streptococcus salivarius, Streptococcus pyogenus, Streptococcus pneumoniae, Streptococcus sanguinis, Streptococcus parasanguinis, Streptococcus viridans, Staphylococcus hemolyticus, Staphylococcus homini, Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Rothia dentocariosa, Escherichia coli, Klebsiella pneumoniae, Kocuria kristinae, and Candida albicans. Our study of the saliva microbiome revealed that five types of microorganisms belonging to the pathogenic and conditionally pathogenic microflora were most often cultured: Staphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus epidermidis. A total of 70.3% (n = 296) of our population had high growth of one or more of these microbes in their saliva. There was a significant difference between the frequencies of pathogenic microbes studied in the symptomatic and asymptomatic groups according to the chi-square test (p = 0.006) (Table 2 ). Table 2 Comparison of study groups Variable Level Groups Total Significance Symptomatic Asymptomatic Sample 355(82.32%) 66(15.67%) 421 Gender Female 172 (81.1%) 40 (18.9%) 212(50.4%) Male 183 (87.6%) 26 (12.4%) 209(49.6%) Age (n) 7 28 (82.4%) 6 (17.6%) 34 (8.1%) 8 59(81.9%) 13 (18.1%) 72 (17.1%) 9 71 (84.5%) 13 (15.5%) 84 (20.0%) 10 59 (80.8%) 14 (19.2%) 73 (17.3%) 11 54 (83.1%) 11(16.9%) 65 (15.4%) 12 84 (90.3%) 9 (9.7%) 93 (22.1%) Dentition Permanent dentition 105 (87.5%) 15 (12.5%) 120 (28.5%) Mixed 250 (83.1%) 51 (16.9%) 301 (71.5%) Caries prevalence Permanent teeth 71% 59% 69% Primary teeth 88% 68% 84% Permanent and Primary teeth 92% 77% 89% Teeth (n) Primary 1965 (83.1%) 400 (16.9%) 2365 (23.7%) Permanent 6464 (84.7%) 1168 (15.3%) 7632 (76.3%) 8429 (84.3%) 1568 (15.7%) 9997 (100%) DMFT (mean) 3.0 1.7 2.8 p = 0.0001 (t) D 826 (90.1%) 91 (9.9%) 917 (78.2%) M 10 (90.9%) < 5 (9.1%) 11 (0.9%) F 221 (90.6%) 23 (9.4%) 244 (20.8%) D + M + F(T) 1172(100%) deft (mean) 4.2 2.8 3.9 p = 0.002 (t) D 774 (87.0%) 116 (13.0%) 890 (75.4%) E 63 (86.3%) 10(13.7%) 73 (6.2%) F 200 (91.7%) 18 (8.3%) 218 (18.5%) d + e + f(t) 1181 DMFT + deft (mean) 5.9 3.8 5.6 p = 0.0001 (t) S_OHI(mean) 1.93 1.45 1.85 p = 0.0001 (t) Good (0.0-1.2) 52 (66.7%) 26 (33.3%) 78 (18.5%) Fair (1,3–3,0) 236 (86.1%) 38 (13.9%) 274 (65.1%) Poor (3,1–6,0) 67 (97.1%) 2 (2.9%) 69 (16.4%) 421 (100%) MGI(mean) .92 .56 .86 p = 0.0001 (t) MGI = 0 99 (75.0%) 33 (25.0%) 132 (31.4%) MGI ≥ 1 256 (88.6%) 33 (11.4%) 289 (68.6%) 421(100%) Cultivation of pathogens (n) Staphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus epiderma. Are not growing 96 (76.8%) 29 (23.2%) 125 (29.7%) p = 0.006 (Chi-Square) Growing 259 (87.5%) 37 (12.5%) 296 (70.3%) 421(100%) Cultivation of pathogens (mean of 5 species) 1.1 .7 1.0 p = 0.004 (t) Behaviors related to Hygiene (%) Good 58 (76.3%) 18 (23.7%) 76 (18.1%) p = 0.03 (Chi-Square) Poor 297 (86.1%) 48 (13.9%) 345 (81.9%) 421(100%) Behaviors related to sweet consumption (%) Rarely 49 (76.6%) 15 (23.4%) 64 (15.2%) p = 0.05 (Chi-Square) Often 306 (85.7%) 51 (14.3%) 357 (84.8%) 421 (100%) Among the symptomatic children (n = 355), 277 had oral symptoms, and 181 had a temperature consistent with her general symptoms. The most frequently mentioned oral symptoms were taste disorders (26.1%, n = 110), smell disorders (25.2%, n = 106), and excess plaque on the teeth (13.3%, n = 56%). Table 3 . Table 3 Symptoms N % Oral Symptoms Facial asymmetry 1 0.2 Pain in the oral cavity 14 3.3 Sore/red gums and mucosa 15 3.6 Bleeding gums 18 4.3 Rash, ulceration 18 4.3 Curd plaques on the mucous membrane 14 3.3 Itching 7 1.7 Burning sensation 10 2.4 Loss/change of taste 110 26.1 Loss/change in sense of smell 106 25.2 Hypersalivation 15 3.6 Dry mouth 21 5.0 Plaque on teeth 56 13.3 Another symptoms 33 7.8 None of them 100 23.8 I do not remember 22 5.2 Oral symptoms (total) 277 65.8 Only oral symptoms 174 41.3 Temperature (total) 181 43.0 Only temperature 78 18.5 Oral symptoms and temperature simultaneously 103 24.4 To examine the impact of symptomatic COVID-19 infection on the oral microbiome and oral health indicators, odds ratios were calculated using logistic regression. Symptomatic COVID-19 infection has had a significant impact on oral hygiene and the proliferation of pathogenic microorganisms. (Table 4 . ). Table 4 Odds Ratio Calculation by Logistic Regression Outcome Exposure Symptomatic course of COVID-19 OR 95% C.I. Lower Upper Cultivation of pathogenic microorganisms 2.115 1.233 3.627 S-OHI 3.428 2.037 5.768 MGI_Index 2.309 1.502 3.550 DMFT + deft Index 1.257 1.140 1.386 DMFT_index 1.318 1.146 1.516 deft_index 1.219 1.075 1.384 Discussion As the present study showed, the prevalence of caries was significantly greater in the group of children with a history of symptomatic COVID-19 infection than in the group of asymptomatic children. For permanent teeth, the symptomatic group was 71%, and the asymptomatic group was 59%. For primary teeth, the symptomatic group was 88%, and the asymptomatic group was 68%. In the symptomatic group, the mean DMFT + deft was 5.9, which was evaluated by the WHO as high caries intensity, and in the asymptomatic group, it was 3.8, which was classified as moderate. In the symptomatic group, the mean S-OHI was 1.9, which was considered to indicate fair results, while in the asymptomatic group, the mean hygiene index slightly exceeded the norm (− 1.4). In the symptomatic group, the mean MGI = 0.92; in the asymptomatic group, the mean MGI = 0.5.6. Thus, in the symptomatic group, the means of all studied oral health indicators worsened; however, it was shown that a history of the symptomatic course of COVID-19 had a greater impact on caries intensity in the post-COVID population. In the post-COVID-19 study population, the intensity of caries in primary teeth was greater (3.9) than the intensity of caries in permanent teeth (2.8). A similar trend was observed in the symptomatic and asymptomatic groups. Additionally, the prevalence of caries in primary teeth was greater (84%) than that in permanent teeth (74%). This can be explained by the older age of temporary teeth compared to permanent teeth and their anatomical and morphological features. These results are consistent with those of other studies in which the mean caries score for primary teeth in the post-COVID-19 pediatric population was 5.67, whereas it was 2.53 for permanent teeth. (Alghamdi et al., 2022 ). The abundances of the microorganisms studied in this research ( Staphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus epidermalis ) have been shown to increase abundantly in the saliva of our population; these microorganisms are pathogenic and conditionally pathogenic, but they are not considered specific causes of caries and periodontal diseases (Du et al., 2021 ; Rivas Caldas et al., 2015 ). However, their abundant growth significantly disrupts the microbial balance of the oral cavity; therefore, with the symptomatic course of COVID-19 infection, weakening of the body's general immune system may have a significant negative impact on oral health (Levinson, 2016 ). The presence of opportunistic oral infections caused by Candida albicans in symptomatic COVID-19 patients has been described in other studies. (Cuevas-Gonzalez et al., 2021 ). In contrast to these studies, our study showed that, in a group of children with a history of symptomatic COVID-19 infection, the frequency of the five studied microorganism cultures increased, and oral hygiene was significantly worse, similar to other indicators, than in children with a history of asymptomatic COVID-19. However, this study does not allow us to explain in the symptomatic group what the initial trigger for the results obtained was the following: the symptomatic course of COVID-19 had a direct impact on changes in the salivary microbiome; conversely, the symptomatic course of infection aggravated oral hygiene, which led to changes in the salivary microbiome. In addition, our study cannot determine whether symptomatic COVID-19 causes impairment of oral health. To answer such questions and determine cause-and-effect relationships, additional in-depth studies are needed, which, in our case and in many other studies, is not possible due to the lack of a control group. (Kumar & Jat, 2023 ). Based on the logistic regression results, we can only say that in our population, a symptomatic course of COVID-19 infection is associated with worsening oral health. In general, retrospective studies in the literature have shown that prepandemic children had significantly lower caries intensity and more frequent treatment than did those registered during the pandemic. (K. Moller, 2023), Lockdown and sedentarism, violation of nutrition and hygiene regime, and delay of planned dental visits had a significant impact on the oral health of children during the pandemic (Angelopoulou et al., 2023 ; Wdowiak-Szymanik et al., 2022 ). In our study, 65.8% (n = 277) of the laboratory-confirmed patients had oral symptoms. Oral symptoms were almost equally distributed between the sexes. Similar results were obtained in a study in which a meta-analysis of 35 articles was conducted (Iranmanesh et al., 2021 ). Among the oral symptoms, the most frequently reported were a decrease/change in taste (dysgeusia) of 26.1% (n = 110), which is considered to be the most recognized oral symptom of COVID-19. (Cuevas-Gonzalez et al., 2021 ; Iranmanesh et al., 2021 ). Additionally, smell disorders and an increase in plaque on the teeth were most often observed. The impact of symptomatic COVID-19 on the severity of carious lesions on permanent and primary teeth was similar, and a slightly greater impact was observed for permanent teeth: DMFT (OR = 1.32; 95% CI = 1.15–1.52) and deft (OR = 1.22; 95% CI = 1.07–1.38). The symptomatic group had a 2.1-fold greater chance of having all five studied microbes (OR = 2.1 95% CI = 1.23–3.67) and a 3.4-fold greater chance of having impaired oral hygiene (OR = 3.4; 95% CI = 2.03–5.76) than did the asymptomatic group. Additionally, the symptomatic course of COVID-19 affects periodontal health in MGI patients (OR = 2.31; 95% CI = 1.50–3.55). Thus, by comparing the means, ORs, and logistic regression results, we can conclude that the symptomatic course of COVID-19 infection is an additional risk factor that further worsens the microbial balance of oral saliva and, accordingly, the indicators of oral health. According to the research methodology, the distribution of the beneficiaries included in the research according to the principle of random selection into groups (symptomatic/asymptomatic) markedly differed: symptomatic, 355 (82.32%); and asymptomatic, 66 (15.67%). A similar trend was observed in the literature review, where a meta-analysis of 48 studies was conducted in the pediatric population of all ages; it was observed that 20% of the children had an asymptomatic course, and the rest had a mild to moderate course. (Cui et al., 2021 ). The similar distribution in our population can be explained by the fact that in the country, state funding was used to test only those with a symptomatic history, which is a significant obstacle to the detection of asymptomatic, laboratory-confirmed children. Literature analysis also confirms that a lack of testing in asymptomatic children has also been reported in other countries. (Gao et al., 2021 ; Nikolopoulou & Maltezou, 2022 ). The beneficiaries included in the study had an asymptomatic, mild to moderate course of infection. Children with a history of severe COVID-19 were not included in the selection, which is explained by the fact that severe COVID-19 infection is rare in the pediatric population. (Ludvigsson, 2020 ; Zhang et al., 2022 ). Based on the results of the present study, it is possible to hypothesize that in children with severe symptoms of COVID-19, a closer association between the symptomatic course of COVID-19 and oral health in the post-COVID-19 period is expected. The generation of such an idea allows us to recommend a similar study of diazine in the pediatric population with chronic diseases. Importantly, the present study included clinical and laboratory data to confirm the screening results, and it was not based on subjective data from questionnaires. A scientific innovation is intraoral mobile photography of the beneficiaries conducted in parallel during the screening process. The impossibility of a deeper microbiological study of oral microflora can be considered a limitation of this research. It should be noted that the PCR study of saliva would have given us the basis for a more detailed analysis and conclusions. However, since the research is not purely clinical and public health provides for budgetary studies aimed at the population, the researchers considered it relevant. Conclusion Close associations were established between the symptomatic course of COVID-19, oral health indicators (DMF/def, MGI, S-OHI), and changes in the salivary microbiome in the post-COVID-19 period. Considering the research results, it is possible to assume that a symptomatic course of COVID-19 may be an additional risk factor associated with poor oral health in the pediatric population in the post-COVID-19 period. Declarations Declaration of competing interest: The authors have no conflicts of interest relevant to this article. Acknowledgments: This work is mainly supported by the Shota Rustaveli National Science Foundation of Georgia. Project PHDF − 22–2374. This work is partially supported by Tbilisi Humanitarian Teaching University and University of Georgia. 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J Adolesc Health 72(3):321–322. https://doi.org/10.1016/j.jadohealth.2022.12.008 Cuevas-Gonzalez MV, Espinosa-Cristóbal LF, Donohue-Cornejo A, Tovar-Carrillo KL, Saucedo-Acuña RA, García-Calderón AG, Guzmán-Gastelum DA, Cuevas-Gonzalez JC (2021) COVID-19 and its manifestations in the oral cavity: A systematic review. Medicine 100(51):e28327. https://doi.org/10.1097/MD.0000000000028327 Cui X, Zhao Z, Zhang T, Guo W, Guo W, Zheng J, Zhang J, Dong C, Na R, Zheng L, Li W, Liu Z, Ma J, Wang J, He S, Xu Y, Si P, Shen Y, Cai C (2021) A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID‐19). J Med Virol 93(2):1057–1069. https://doi.org/10.1002/jmv.26398 Drozdzik A, Drozdzik M (2022) Oral Pathology in COVID-19 and SARS-CoV-2 Infection—Molecular Aspects. Int J Mol Sci 23(3):1431. https://doi.org/10.3390/ijms23031431 Du Q, Ren B, He J, Peng X, Guo Q, Zheng L, Li J, Dai H, Chen V, Zhang L, Zhou X, Xu X (2021) Candida albicans promotes tooth decay by inducing oral microbial dysbiosis. ISME J 15(3):894–908. https://doi.org/10.1038/s41396-020-00823-8 Estai M, Kanagasingam Y, Mehdizadeh M, Vignarajan J, Norman R, Huang B, Spallek H, Irving M, Arora A, Kruger E, Tennant M (2022) Mobile photographic screening for dental caries in children: Diagnostic performance compared to unaided visual dental examination. J Public Health Dent 82(2):166–175. https://doi.org/10.1111/jphd.12443 European Committee on Antibiotic Susceptibility Testing eucast EUCAST eucast: Guidance Documents Gao Z, Xu Y, Sun C, Wang X, Guo Y, Qiu S, Ma K (2021) A systematic review of asymptomatic infections with COVID-19. J Microbiol Immunol Infect 54(1):12–16. https://doi.org/10.1016/j.jmii.2020.05.001 Gherlone EF, Polizzi E, Tetè G, De Lorenzo R, Magnaghi C, Querini R, P., Ciceri F (2021) Frequent and Persistent Salivary Gland Ectasia and Oral Disease After COVID-19. J Dent Res 100(5):464–471. https://doi.org/10.1177/0022034521997112 Iranmanesh B, Khalili M, Amiri R, Zartab H, Aflatoonian M (2021) Oral manifestations of COVID -19 disease: A review article. Dermatol Ther 34(1). https://doi.org/10.1111/dth.14578 Irish Oral Health Services Guideline Initiative Oral Health Assessment: Best practice guidance for providing an oral health assessment programme for school-aged children in Ireland 2012.OralHealthAssessmentFull.pdf (ucc.i.e.,) Kumar P, Jat KR (2023) Post-COVID-19 Sequelae in Children. Indian J Pediatr 90(6):605–611. https://doi.org/10.1007/s12098-023-04473-4 Levinson W (2016) Review of medical microbiology and immunology (Fourteenth edition). McGraw-Hill Education Lin W, Gao F, Wang X, Qin N, Chen X, Tam KY, Zhang C, Zhang M, Sha O (2023) The oral manifestations and related mechanisms of COVID-19 caused by SARS-CoV-2 infection. Front Cell Neurosci 16:1006977. https://doi.org/10.3389/fncel.2022.1006977 Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, Zhang W, Wang Y, Bao S, Li Y, Wu C, Liu H, Liu D, Shao J, Peng X, Yang Y, Liu Z, Xiang Y, Zhang F, Wong GWK (2020) SARS-CoV-2 Infection in Children. N Engl J Med 382(17):1663–1665. https://doi.org/10.1056/NEJMc2005073 Ludvigsson JF (2020) Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Pediatrica 109(6):1088–1095. https://doi.org/10.1111/apa.15270 Mustafa NM, Selim A, L (2020) Characterization of COVID-19 Pandemic in Pediatric Age Group: A Systematic Review and Meta-Analysis. J Clin Virol 128:104395. https://doi.org/10.1016/j.jcv.2020.104395 Misintry of education, science and youth of Georgia Ministry of Education, Science And Youth of Georgia (mes.gov.ge). Search system for schools: სკოლების პორტალი - მთავარი (emis.ge) Nanobashvili K, Mania L, IvaniSvili R (2021) Oral Microbiome and Health. Acta Sci Dent Scienecs 5(7):138–144. https://doi.org/10.31080/ASDS.2021.05.1160 Nasiri K, Tehrani S, Mohammadikhah M, Banakar M, Alaeddini M, Etemad-Moghadam S, Fernandes GVO, Heboyan A, Imannezhad S, Abbasi F (2023) Oral manifestations of COVID‐19 and its management in pediatric patients: A systematic review and practical guideline. Clin Experimental Dent Res 9(5):922–934. https://doi.org/10.1002/cre2.776 Nikolopoulou GB, Maltezou HC (2022) COVID-19 in Children: Where do we Stand? Arch Med Res 53(1):1–8. https://doi.org/10.1016/j.arcmed.2021.07.002 Oral health surveys basic methods (2013) In Oral health surveys basic methods (fifth edition) Rivas Caldas R, Le Gall F, Revert K, Rault G, Virmaux M, Gouriou S, Héry-Arnaud G, Barbier G, Boisramé S (2015) Pseudomonas aeruginosa and Periodontal Pathogens in the Oral Cavity and Lungs of Cystic Fibrosis Patients: A Case–Control Study. J Clin Microbiol 53(6):1898–1907. https://doi.org/10.1128/JCM.00368-15 Sakaguchi W, Kubota N, Shimizu T, Saruta J, Fuchida S, Kawata A, Yamamoto Y, Sugimoto M, Yakeishi M, Tsukinoki K (2020) Existence of SARS-CoV-2 Entry Molecules in the Oral Cavity. Int J Mol Sci 21(17):6000. https://doi.org/10.3390/ijms21176000 Samaranayake LP (2018) Essential microbiology for dentistry (Fifth edition). Elsevier Sinjari B, D’Ardes D, Santilli M, Rexhepi I, D’Addazio G, Di Carlo P, Chiacchiaretta P, Caputi S, Cipollone F (2020) SARS-CoV-2 and Oral Manifestation: An Observational, Human Study. J Clin Med 9(10):3218. https://doi.org/10.3390/jcm9103218 Tsuchiya H (2021) Oral Symptoms Associated with COVID-19 and Their Pathogenic Mechanisms: A Literature Review. Dentistry J 9(3):32. https://doi.org/10.3390/dj9030032 Walley S (2012) Essential microbiology for dentistry, 4th edition. British Dental Journal , 212 (7), 350–350. https://doi.org/10.1038/sj.bdj.2012.309 Wdowiak-Szymanik A, Wdowiak A, Szymanik P, Grocholewicz K (2022) Pandemic COVID-19 Influence on Adult’s Oral Hygiene, Dietary Habits and Caries Disease—Literature Review. Int J Environ Res Public Health 19(19):12744. https://doi.org/10.3390/ijerph191912744 Yoon S, Li H, Lee K, Hong S, Kim D, Im H, Rah W, Kim E, Cha S, Yang J, Kronbichler A, Kresse D, Koyanagi A, Jacob L, Ghayda R, Shin J, Smith L (2020) Clinical Characteristics of Asymptomatic and Symptomatic Pediatric Coronavirus Disease 2019 (COVID-19): A Systematic Review. Medicina 56(9):474. https://doi.org/10.3390/medicina56090474 Zhang J, Dong X, Liu G, Gao Y (2022) Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality. Clin Rev Allergy Immunol 64(1):90–107. https://doi.org/10.1007/s12016-022-08921-5 Additional Declarations The authors declare no competing interests. Supplementary Files SupplementaryTable1.docx Evaluation of oral health indicators 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. 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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-5174172","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":360218040,"identity":"ea88aa62-c1be-4c38-a4ff-4901a2ef1ef8","order_by":0,"name":"Lia Mania","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYBACPmYIzQPEbAw8FWCOAV4tbKhazhCjBYXN20aMFnbmB0w3au7I8DfwHnvwdt5huwb25m0SDL9s8DiMzYA559gzHokDfOmGc7cdTm7gOVYmwdiXhs8vQC1sh3kYDvCYSfMCtTBI5JhJMPYcxqOF/QNzzr/DPPJgLXOAWuTfgLT8x6OFx4A5t+0wjwFYS8NhOwYJHjMJhh8H8GkpOJzbd5jH8DBfmuScY+kJbDxpxRaJDck4tfDzH9/4OOfbYXu5473HJN7UWNvzsx/eeOPDHzucWkAA4gZmHjCV2IYgCQKIFnsI5w9RWkbBKBgFo2BkAADN7UiYDiKrmwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0006-3089-5927","institution":"University of Georgia","correspondingAuthor":true,"prefix":"","firstName":"Lia","middleName":"","lastName":"Mania","suffix":""},{"id":360218041,"identity":"f8385af6-94b4-4eda-94b0-5956f0075a06","order_by":1,"name":"Ketevan Nanobashvili","email":"","orcid":"https://orcid.org/0000-0002-9992-1517","institution":"University of Georgia","correspondingAuthor":false,"prefix":"","firstName":"Ketevan","middleName":"","lastName":"Nanobashvili","suffix":""},{"id":360218042,"identity":"91fcecb6-7aee-44f0-948d-22f19efcc817","order_by":2,"name":"Tinatin Manjavidze","email":"","orcid":"","institution":"University of Georgia; NCDC","correspondingAuthor":false,"prefix":"","firstName":"Tinatin","middleName":"","lastName":"Manjavidze","suffix":""},{"id":360218043,"identity":"6e145c5d-3e9f-49c7-9e4c-1161c10b98b3","order_by":3,"name":"Mamuka Benashvili","email":"","orcid":"","institution":"National Statistics Office of Georgia","correspondingAuthor":false,"prefix":"","firstName":"Mamuka","middleName":"","lastName":"Benashvili","suffix":""},{"id":360218044,"identity":"959984e4-dbc7-4feb-a1b4-f9292520b96d","order_by":4,"name":"Ia Astamadze","email":"","orcid":"","institution":"Tbilisi Humanitarian University","correspondingAuthor":false,"prefix":"","firstName":"Ia","middleName":"","lastName":"Astamadze","suffix":""}],"badges":[],"createdAt":"2024-09-29 09:36:20","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5174172/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5174172/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65652932,"identity":"e1ed0e32-898e-4934-ac67-76b518a47451","added_by":"auto","created_at":"2024-10-01 02:33:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":757433,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5174172/v1/0d3e70d9-7e14-48db-923e-975c65f9654a.pdf"},{"id":65652810,"identity":"6d2b4d27-cd7c-4200-8d28-2c3246176beb","added_by":"auto","created_at":"2024-10-01 02:25:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20121,"visible":true,"origin":"","legend":"\u003cp\u003eEvaluation of oral health indicators\u003c/p\u003e","description":"","filename":"SupplementaryTable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5174172/v1/b105f383de99187e4a1d324f.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eImpact of symptomatic COVID-19 on the oral health of pediatric patients in Tbilisi City\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGeorgia is a country in the Caucasus region. Tbilisi is the capital city, where the population as of January 1, 2023, is 1,241,700 people. The first confirmed case of COVID-19 in Georgia was recorded on February 26, 2020. According to the latest data, as of July 15, 2022, 1,673,160 cases of the disease had been officially confirmed in Georgia. (\u003cem\u003eNCDC 2020\u0026ndash;2022 report\u003c/em\u003e). By July 1, 2022, according to NCDC data, the number of test-confirmed cases in the population aged 0\u0026ndash;18 in Georgia was 294 649 children (17.7% of all confirmed cases); of these, 115,137 children with COVID-19 were recorded in Tbilisi in this age group. (NCDC 2020\u0026ndash;2022).\u003c/p\u003e \u003cp\u003eSpecialized testing to detect COVID-19 in Georgia began on February 4, 2020. As of July 1, 2022, the testing rate (PCR\u0026thinsp;+\u0026thinsp;antigen) was 4897 per 1000 inhabitants. Georgia ranks 10th among the 50 countries in the world with the highest testing rate. (NCDC)\u003c/p\u003e \u003cp\u003eThe most common symptoms of COVID-19 in children are Fever, chills, cough, and sore throat. (CDC COVID-19 Response Team et al., 2020; Mustafa \u0026amp; A Selim, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), WHO).\u003c/p\u003e \u003cp\u003e Among the local symptoms of the oral cavity in the pediatric population, the most often observed were taste and smell disorders, oral candidiasis, gingivitis, Cheilitis simplex and Lingua pilacta, and inflammation of the salivary glands. (Nasiri et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAccording to statistics described in the literature, at least one oral symptom was observed in 2/3 of COVID-19 patients. (Lin et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). There is evidence that a significant proportion of patients with oral symptoms have various oral pathologies three months after hospital discharge, suggesting that these changes may be a consequence of COVID-19. (Gherlone et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe oral cavity is also interesting because it is known as the gateway for SARS-CoV-2 infection(Drozdzik \u0026amp; Drozdzik, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The oral mucosa and salivary glands are rich in angiotensin-converting protein 2 (ACE-2) and transmembrane protease serine 2 (TMPRSS2) receptors. The virus directly binds to these receptors, damages the salivary glands, and causes inflammation, sialadenitis, xerostomia, and altered taste. (Sakaguchi et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Sinjari et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These events are pathogenically related to changes in the microbiome of the oral cavity (Botros et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Tsuchiya, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The oral microbiome changes throughout life and is associated with local (oral) and general diseases (Nanobashvili et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe pediatric population is characterized by an asymptomatic and relatively mild clinical course of COVID-19 (Lu et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The conducted studies revealed differences in laboratory and clinical data between children with symptomatic and asymptomatic courses of COVID-19 (Yoon et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the diversity of related studies, relatively little scientific information is available about the impact of the virus on oral health in school-aged children. We believe that our study sheds light on the oral health outcomes of school-age children following symptomatic COVID-19 transmission, which are noteworthy and require a multidisciplinary approach to virus management.\u003c/p\u003e \u003cp\u003e This research aimed to study the impact of the symptomatic course of COVID-19 on oral health indicators and the salivary microbiome among children aged 7 to 12 years in the post-COVID-19 period in Tbilisi City (Georgia).\u003c/p\u003e"},{"header":"Methods","content":"\n\u003ch3\u003e1. Study population\u003c/h3\u003e\n\u003cp\u003e This population-based oral health study included 7- to 12-year-old, laboratory-confirmed post-COVID-19 children within 1 year of exposure from Tbilisi (Georgia). No participants met the criteria for comorbid conditions or post-COVID-19 conditions (PCC). Data collection began in August 2022 and finished in December 2023. A total of 421 children were examined. The post-COVID-19 population was selected from public and private schools in Tbilisi using a stratified simple random sampling method. By 2022\u0026ndash;2023, there were 282 general education schools in Tbilisi attended by 155,366 students aged 7\u0026ndash;12 years. (emis.ge).\u003c/p\u003e \u003cp\u003eThe number of patients included in the study was determined using a sample size formula. The sample size was determined based on the principle that the margin error of the total results should not exceed 5%, and in detail, the reliability of the research results should be at least 90%.\u003c/p\u003e \u003cp\u003eThe following formula was used to calculate the size of the required sample:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=\\frac{\\text{p}\\left(1-\\text{p}\\right)\\text{*}\\text{N}\\text{*}{Z}_{(1+q)/2}^{2}}{\\text{p}\\left(1-\\text{p}\\right)*{Z}_{\\frac{1+q}{2}}^{2}+N*{d}^{2}}*deff$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ewhere\u003c/p\u003e \u003cp\u003e \u003cb\u003en\u003c/b\u003e is the sample size (421)\u003c/p\u003e \u003cp\u003e \u003cb\u003eN\u003c/b\u003e is the population size (115, 366)\u003c/p\u003e \u003cp\u003e \u003cb\u003ed\u003c/b\u003e - Maximum permissible error (5%)\u003c/p\u003e \u003cp\u003e \u003cb\u003eq\u003c/b\u003e - Confidence level (90%)\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\(\\:{\\varvec{Z}}_{\\frac{1+\\varvec{q}}{2}}^{2}\\)\u003c/span\u003e \u003c/span\u003e - The (1+ q)/2 quantiles of the standard normal distribution\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\(\\:\\varvec{d}\\varvec{e}\\varvec{f}\\varvec{f}\\)\u003c/span\u003e \u003c/span\u003e - The importance of the design effect.\u003c/p\u003e \u003cp\u003eThe number of qualifying schools and children (421 research subjects) was proportionally distributed among the 5 main municipalities of Tbilisi. (Skolebi.emis.ge). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuantitative distribution of qualifying schools and students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMunicipality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of the students\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of the schools\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAverage number of students per school who participated in the study\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAverage number of students per class who participated in the study (6 per class)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u0026mdash;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMunicipality of Gldani-Nadzaladevi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u0026mdash;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMunicipality of Didube-Chughureti\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u0026mdash;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMunicipality of Vake-Saburtalo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u0026mdash;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMunicipality of Isani-Samgori\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u0026mdash;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMunicipality of Old Tbilisi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u0026mdash;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe selection of schools for each municipality was carried out using simple stratified random sampling supported by SPSS software. Additionally, the selection of school grades was carried out using systematic random sampling. In the selected classes, we conducted simple random sampling until a predetermined number of students were collected in the study school.\u003c/p\u003e \u003cp\u003eUsing this principle, 27 schools and 421 students were selected. A total of 4214 children and their parents were interviewed, resulting in 421 (9.9% of the total respondents) laboratory-confirmed children aged 7 to 12 years who agreed to participate in the study. According to the survey results, 547 children were infected with laboratory-confirmed COVID-19\u0026mdash;12.98% of the respondents. Among them, 421 beneficiaries (76.96%) agreed to participate in the study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch Design and Procedure\u003c/h2\u003e \u003cp\u003eThe study was observational and cross-sectional.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExposure and outcome variables:\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eExposure and outcome variables:\u003c/div\u003e \u003cp\u003eThe selected children were divided into two main groups:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eExposed group\u0026ndash;Symptomatic group: Children with a history of symptomatic COVID-19. (presence of even one local or general symptom).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eControl group - Asymptomatic group: Children with a history of asymptomatic COVID-19. (no symptoms). The data were collected via questionnaires and verified via NCDC databases.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eSymptoms during COVID-19 infection were studied via questionnaires. The presence/absence of temperature was studied from the general symptoms. Thirteen symptoms have been studied from the perspective of local oral manifestations: facial asymmetry, pain in the mouth, redness on the gums or oral mucosa, bleeding from the gums, rash or ulcer on the oral mucosa, curdled plaques, itching, burning sensation, change in taste, change in smell, hypersalivation, dryness of the mouth, and excessive plaque on the teeth. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe outcome was a change in the salivary microbiome and oral health indicators:\u003c/p\u003e \u003cp\u003eDecayed, Missing, Filled teeth (DMFT) for permanent dentition;\u003c/p\u003e \u003cp\u003edecayed, extracted, and filled teeth (deft) for milk dentition;\u003c/p\u003e \u003cp\u003eDMFT\u0026thinsp;+\u0026thinsp;deft for mixed dentition;\u003c/p\u003e \u003cp\u003eModified Gingival Index (MGI);\u003c/p\u003e \u003cp\u003eSimplified Oral Health Index (S-OHI);\u003c/p\u003e \u003cp\u003eFive species of pathogenic and conditionally pathogenic microorganisms with average and excessive growth were studied in microbiological samples of saliva: \u003cem\u003eStaphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus epidermalis.\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eAssessment of oral health indicators and saliva:\u003c/h3\u003e\n\u003cp\u003eOral health indicators were evaluated according to the standards provided by WHO. (Supplementary Table: 1).\u003c/p\u003e \u003cp\u003e Evaluation of the microbiological study of oral saliva: Biological material (saliva) was collected from the oral cavity, and its transportation and subsequent microbiological research were carried out in the \u0026ldquo;Clinic Neo-Lab\u0026rdquo; laboratory based on EUCAST guidelines. For the identification of microbes in the laboratory, the culture method of bacteriological diagnostics was used, which is often called the \"gold standard\" (Samaranayake, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Walley, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). When choosing the method, its budget ability was taken into account, which is important for population studies in public health.\u003c/p\u003e\n\u003ch3\u003eResearch stages:\u003c/h3\u003e\n\u003cp\u003e\u003cb\u003eStage I\u003c/b\u003e - Selection of students for survey in selected schools and classes and telephone interviews with parents of selected children to obtain informed consent. Informed consent documents and questionnaires were left at the school for signature by the guardians of the selected children.\u003c/p\u003e \u003cp\u003e\u003cb\u003eStage II\u003c/b\u003e \u0026ndash; The guardians of the selected children completed questionnaires about their condition in the oral cavity; these questionnaires were used to determine their history of COVID-19 and clinical symptoms during infection. In addition, families' socioeconomic status, children's behavior, and knowledge regarding oral health, hygiene, and nutrition were examined. The questionnaire was developed based on the basic methods for examining the oral cavity provided by the World Health Organization. (\u0026ldquo;Basic Oral Health Screening Methods,\u0026rdquo; 2013). After the caregivers signed the informed consent document and filled out the questionnaires, the third stage of the study\u0026mdash;screening\u0026mdash;began.\u003c/p\u003e \u003cp\u003e\u003cb\u003eStage III\u003c/b\u003e \u0026ndash; Children were observed in medical rooms of schools, and biological material (saliva) was collected from the transport soil. The visual examination of the oral cavity included the determination of the simplified oral hygiene index (OHI-S), the caries intensity (DMFt\u0026thinsp;+\u0026thinsp;deft), and the modified gingival index (MGI). The data were collected on a dental card (form N 4-220). Only a disposable dental mirror was used during the examination of the oral cavity (\u003cem\u003eOral Health Assessment, 2012\u003c/em\u003e). Dental plaques were stained with the disclosing agent. During the observation process, an intraoral photo of the oral cavity was compiled both before and after the plaque was stained (Estai et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) to increase the reliability of the study.\u003c/p\u003e \u003cp\u003eSenior students of the university's dentistry program participated in the research process. The research team consisted of five researchers: one researcher performed oral cavity observation and plaque staining; the second researcher simultaneously recorded the oral indices on the patient's medical card; and the third researcher collected biological material (saliva) on the transported soil. The fourth and fifth researchers independently took intraoral dental photographs of each beneficiary. The examination of each beneficiary in the medical room lasted 12\u0026ndash;15 minutes.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive and inferential statistics were used. The mean values ​​of the oral health indicators MDFT\u0026thinsp;+\u0026thinsp;deft, MGI, and S-OHI and the bacterial species cultivated in saliva were assessed by means of the symptomatic and asymptomatic groups, and the difference between the means was determined using a \u003cem\u003et\u003c/em\u003e test. P values ​​\u0026lt;0.05 were considered to indicate statistical significance. Cross-tabulations were used to visualize frequency distributions between variables in the symptomatic and asymptomatic groups. The chi-square test was used to determine the presence of a significant difference between the variables in the groups. In the final part, logistic regression was used to determine odds ratios (ORs), including 95% CIs, to examine the impact of the symptomatic course of COVID-19 on the oral microbiome and oral health outcomes. Data processing was carried out using SPSS-23.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eResearch ethics (study approval)\u003c/h2\u003e \u003cp\u003e The ethical approval of the study was given by the Biomedical Research Ethical Council of the School of Health Sciences of the University of Georgia (research code UGREC \u0026minus;\u0026thinsp;04 \u0026minus;\u0026thinsp;22/09.03.2022). In accordance with the Declaration of Helsinki, informed consent was obtained from the guardians of the participants in the study prior to inclusion. Research data are confidential. The Ministry of Education and Science of Georgia permitted screenings to be conducted in schools. (Doc code MES 9 22 0000871059).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 421 children included in the study, 50.4% (n\u0026thinsp;=\u0026thinsp;212) were female, and 49.6% (n\u0026thinsp;=\u0026thinsp;209) were male. The mean age of the beneficiaries was 9.8 years (SD\u0026thinsp;=\u0026thinsp;1.6). A total of 9997 teeth (permanent and primary teeth) were examined from 421 children. A total of 301 children had mixed dentition, and 120 had permanent dentition. For the entire population (n\u0026thinsp;=\u0026thinsp;421), the average intensity of caries (DMFT\u0026thinsp;+\u0026thinsp;deft) was 5.6. The incidence of caries in the post-COVID population (n\u0026thinsp;=\u0026thinsp;421) was 89%. It is 69% for permanent teeth and 84% for primary teeth. The prevalence of caries in the symptomatic group reached 92%, whereas that in the asymptomatic group reached 77%. In the symptomatic group, the prevalence of caries in permanent teeth was 71%, and for primary teeth, it was 88%. In the asymptomatic group, the prevalence of caries in permanent teeth was 59%, whereas that in primary teeth was 68%. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe mean value of the S-OHI is 1.85, and the mean value of the MGI is 0.86. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOverall, 84.3% (n\u0026thinsp;=\u0026thinsp;355) of the beneficiaries were allocated to the symptomatic (exposed) group, and 15.7% (n\u0026thinsp;=\u0026thinsp;66) were allocated to the asymptomatic (control) group. The mean variables of oral health in the symptomatic and asymptomatic groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The \u003cem\u003et\u003c/em\u003e test proved that the difference between the means of the oral health indicators in the symptomatic and asymptomatic groups was reliable (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eDuring the research, it was possible to identify a total of 19 microbial species: \u003cem\u003eStreptococcus oralis, Streptococcus mutans, Streptococcus mitis, Streptococcus salivarius, Streptococcus pyogenus, Streptococcus pneumoniae, Streptococcus sanguinis, Streptococcus parasanguinis, Streptococcus viridans, Staphylococcus hemolyticus, Staphylococcus homini, Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Rothia dentocariosa, Escherichia coli, Klebsiella pneumoniae, Kocuria kristinae, and Candida albicans.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eOur study of the saliva microbiome revealed that five types of microorganisms belonging to the pathogenic and conditionally pathogenic microflora were most often cultured: \u003cem\u003eStaphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus epidermidis. A total of\u003c/em\u003e 70.3% (n\u0026thinsp;=\u0026thinsp;296) of our population had high growth of one or more of these microbes in their saliva. There was a significant difference between the frequencies of pathogenic microbes studied in the symptomatic and asymptomatic groups according to the chi-square test (p\u0026thinsp;=\u0026thinsp;0.006) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of study groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSignificance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSymptomatic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAsymptomatic\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSample\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e355(82.32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66(15.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e172 (81.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (18.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e212(50.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e183 (87.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e209(49.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (82.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 (8.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59(81.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (18.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (84.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (80.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73 (17.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (83.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(16.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (90.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93 (22.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDentition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePermanent dentition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (87.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e120 (28.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e250 (83.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (16.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e301 (71.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaries prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePermanent teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePermanent and Primary teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeeth (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1965 (83.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e400 (16.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2365 (23.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6464 (84.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1168 (15.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7632 (76.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8429 (84.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1568 (15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9997 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDMFT (mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0001 (t)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e826 (90.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91 (9.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e917 (78.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (90.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e221 (90.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e244 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eD\u0026thinsp;+\u0026thinsp;M\u0026thinsp;+\u0026thinsp;F(T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1172(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edeft (mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.002 (t)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e774 (87.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116 (13.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e890 (75.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (86.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(13.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200 (91.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e218 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ed\u0026thinsp;+\u0026thinsp;e\u0026thinsp;+\u0026thinsp;f(t)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDMFT\u0026thinsp;+\u0026thinsp;deft (mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0001 (t)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS_OHI(mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0001 (t)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood (0.0-1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFair (1,3\u0026ndash;3,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e236 (86.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e274 (65.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor (3,1\u0026ndash;6,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (97.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69 (16.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e421\u0026nbsp;(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMGI(mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0001 (t)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMGI\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e132 (31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMGI\u0026thinsp;\u0026ge;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e256 (88.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e289 (68.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e421(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCultivation of pathogens (n)\u003c/p\u003e \u003cp\u003e\u003cem\u003eStaphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus epiderma.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAre not growing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96 (76.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e125 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.006 (Chi-Square)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrowing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e259 (87.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e296 (70.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e421(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCultivation of pathogens (mean of 5 species)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.004 (t)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBehaviors related to Hygiene (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (76.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (23.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76 (18.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.03 (Chi-Square)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e297 (86.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e345 (81.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e421(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBehaviors related to sweet consumption (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (76.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (23.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.05 (Chi-Square)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e306 (85.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e357 (84.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e421 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the symptomatic children (n\u0026thinsp;=\u0026thinsp;355), 277 had oral symptoms, and 181 had a temperature consistent with her general symptoms. The most frequently mentioned oral symptoms were taste disorders (26.1%, n\u0026thinsp;=\u0026thinsp;110), smell disorders (25.2%, n\u0026thinsp;=\u0026thinsp;106), and excess plaque on the teeth (13.3%, n\u0026thinsp;=\u0026thinsp;56%). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSymptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"15\" rowspan=\"16\"\u003e \u003cp\u003eOral Symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFacial asymmetry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePain in the oral cavity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSore/red gums and mucosa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBleeding gums\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRash, ulceration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurd plaques on the mucous membrane\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurning sensation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLoss/change of taste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLoss/change in sense of smell\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypersalivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDry mouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlaque on teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnother symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone of them\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI do not remember\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral symptoms (total)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnly oral symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTemperature (total)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnly temperature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral symptoms and temperature simultaneously\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTo examine the impact of symptomatic COVID-19 infection on the oral microbiome and oral health indicators, odds ratios were calculated using logistic regression. Symptomatic COVID-19 infection has had a significant impact on oral hygiene and the proliferation of pathogenic microorganisms. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. ).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOdds Ratio Calculation by Logistic Regression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eExposure\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eSymptomatic course of COVID-19\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95% C.I.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCultivation of pathogenic microorganisms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.627\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS-OHI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.768\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMGI_Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.550\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDMFT\u0026thinsp;+\u0026thinsp;deft Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.386\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDMFT_index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.516\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edeft_index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs the present study showed, the prevalence of caries was significantly greater in the group of children with a history of symptomatic COVID-19 infection than in the group of asymptomatic children. For permanent teeth, the symptomatic group was 71%, and the asymptomatic group was 59%. For primary teeth, the symptomatic group was 88%, and the asymptomatic group was 68%.\u003c/p\u003e \u003cp\u003eIn the symptomatic group, the mean DMFT\u0026thinsp;+\u0026thinsp;deft was 5.9, which was evaluated by the WHO as high caries intensity, and in the asymptomatic group, it was 3.8, which was classified as moderate. In the symptomatic group, the mean S-OHI was 1.9, which was considered to indicate fair results, while in the asymptomatic group, the mean hygiene index slightly exceeded the norm (\u0026minus;\u0026thinsp;1.4). In the symptomatic group, the mean MGI\u0026thinsp;=\u0026thinsp;0.92; in the asymptomatic group, the mean MGI\u0026thinsp;=\u0026thinsp;0.5.6. Thus, in the symptomatic group, the means of all studied oral health indicators worsened; however, it was shown that a history of the symptomatic course of COVID-19 had a greater impact on caries intensity in the post-COVID population.\u003c/p\u003e \u003cp\u003eIn the post-COVID-19 study population, the intensity of caries in primary teeth was greater (3.9) than the intensity of caries in permanent teeth (2.8). A similar trend was observed in the symptomatic and asymptomatic groups. Additionally, the prevalence of caries in primary teeth was greater (84%) than that in permanent teeth (74%). This can be explained by the older age of temporary teeth compared to permanent teeth and their anatomical and morphological features. These results are consistent with those of other studies in which the mean caries score for primary teeth in the post-COVID-19 pediatric population was 5.67, whereas it was 2.53 for permanent teeth. (Alghamdi et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe abundances of the microorganisms studied in this research (\u003cem\u003eStaphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus epidermalis\u003c/em\u003e) have been shown to increase abundantly in the saliva of our population; these microorganisms are pathogenic and conditionally pathogenic, but they are not considered specific causes of caries and periodontal diseases (Du et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Rivas Caldas et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). However, their abundant growth significantly disrupts the microbial balance of the oral cavity; therefore, with the symptomatic course of COVID-19 infection, weakening of the body's general immune system may have a significant negative impact on oral health (Levinson, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The presence of opportunistic oral infections caused by \u003cem\u003eCandida albicans\u003c/em\u003e in symptomatic COVID-19 patients has been described in other studies. (Cuevas-Gonzalez et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn contrast to these studies, our study showed that, in a group of children with a history of symptomatic COVID-19 infection, the frequency of the five studied microorganism cultures increased, and oral hygiene was significantly worse, similar to other indicators, than in children with a history of asymptomatic COVID-19. However, this study does not allow us to explain in the symptomatic group what the initial trigger for the results obtained was the following: the symptomatic course of COVID-19 had a direct impact on changes in the salivary microbiome; conversely, the symptomatic course of infection aggravated oral hygiene, which led to changes in the salivary microbiome. In addition, our study cannot determine whether symptomatic COVID-19 causes impairment of oral health. To answer such questions and determine cause-and-effect relationships, additional in-depth studies are needed, which, in our case and in many other studies, is not possible due to the lack of a control group. (Kumar \u0026amp; Jat, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Based on the logistic regression results, we can only say that in our population, a symptomatic course of COVID-19 infection is associated with worsening oral health.\u003c/p\u003e \u003cp\u003eIn general, retrospective studies in the literature have shown that prepandemic children had significantly lower caries intensity and more frequent treatment than did those registered during the pandemic. (K. Moller, 2023), Lockdown and sedentarism, violation of nutrition and hygiene regime, and delay of planned dental visits had a significant impact on the oral health of children during the pandemic (Angelopoulou et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Wdowiak-Szymanik et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, 65.8% (n\u0026thinsp;=\u0026thinsp;277) of the laboratory-confirmed patients had oral symptoms. Oral symptoms were almost equally distributed between the sexes. Similar results were obtained in a study in which a meta-analysis of 35 articles was conducted (Iranmanesh et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Among the oral symptoms, the most frequently reported were a decrease/change in taste (dysgeusia) of 26.1% (n\u0026thinsp;=\u0026thinsp;110), which is considered to be the most recognized oral symptom of COVID-19. (Cuevas-Gonzalez et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Iranmanesh et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Additionally, smell disorders and an increase in plaque on the teeth were most often observed.\u003c/p\u003e \u003cp\u003eThe impact of symptomatic COVID-19 on the severity of carious lesions on permanent and primary teeth was similar, and a slightly greater impact was observed for permanent teeth: DMFT (OR\u0026thinsp;=\u0026thinsp;1.32; 95% CI\u0026thinsp;=\u0026thinsp;1.15\u0026ndash;1.52) and deft (OR\u0026thinsp;=\u0026thinsp;1.22; 95% CI\u0026thinsp;=\u0026thinsp;1.07\u0026ndash;1.38). The symptomatic group had a 2.1-fold greater chance of having all five studied microbes (OR\u0026thinsp;=\u0026thinsp;2.1 95% CI\u0026thinsp;=\u0026thinsp;1.23\u0026ndash;3.67) and a 3.4-fold greater chance of having impaired oral hygiene (OR\u0026thinsp;=\u0026thinsp;3.4; 95% CI\u0026thinsp;=\u0026thinsp;2.03\u0026ndash;5.76) than did the asymptomatic group.\u003c/p\u003e \u003cp\u003eAdditionally, the symptomatic course of COVID-19 affects periodontal health in MGI patients (OR\u0026thinsp;=\u0026thinsp;2.31; 95% CI\u0026thinsp;=\u0026thinsp;1.50\u0026ndash;3.55). Thus, by comparing the means, ORs, and logistic regression results, we can conclude that the symptomatic course of COVID-19 infection is an additional risk factor that further worsens the microbial balance of oral saliva and, accordingly, the indicators of oral health.\u003c/p\u003e \u003cp\u003eAccording to the research methodology, the distribution of the beneficiaries included in the research according to the principle of random selection into groups (symptomatic/asymptomatic) markedly differed: symptomatic, 355 (82.32%); and asymptomatic, 66 (15.67%). A similar trend was observed in the literature review, where a meta-analysis of 48 studies was conducted in the pediatric population of all ages; it was observed that 20% of the children had an asymptomatic course, and the rest had a mild to moderate course. (Cui et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The similar distribution in our population can be explained by the fact that in the country, state funding was used to test only those with a symptomatic history, which is a significant obstacle to the detection of asymptomatic, laboratory-confirmed children. Literature analysis also confirms that a lack of testing in asymptomatic children has also been reported in other countries. (Gao et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Nikolopoulou \u0026amp; Maltezou, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe beneficiaries included in the study had an asymptomatic, mild to moderate course of infection. Children with a history of severe COVID-19 were not included in the selection, which is explained by the fact that severe COVID-19 infection is rare in the pediatric population. (Ludvigsson, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Based on the results of the present study, it is possible to hypothesize that in children with severe symptoms of COVID-19, a closer association between the symptomatic course of COVID-19 and oral health in the post-COVID-19 period is expected. The generation of such an idea allows us to recommend a similar study of diazine in the pediatric population with chronic diseases.\u003c/p\u003e \u003cp\u003eImportantly, the present study included clinical and laboratory data to confirm the screening results, and it was not based on subjective data from questionnaires. A scientific innovation is intraoral mobile photography of the beneficiaries conducted in parallel during the screening process.\u003c/p\u003e \u003cp\u003eThe impossibility of a deeper microbiological study of oral microflora can be considered a limitation of this research. It should be noted that the PCR study of saliva would have given us the basis for a more detailed analysis and conclusions. However, since the research is not purely clinical and public health provides for budgetary studies aimed at the population, the researchers considered it relevant.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eClose associations were established between the symptomatic course of COVID-19, oral health indicators (DMF/def, MGI, S-OHI), and changes in the salivary microbiome in the post-COVID-19 period. Considering the research results, it is possible to assume that a symptomatic course of COVID-19 may be an additional risk factor associated with poor oral health in the pediatric population in the post-COVID-19 period.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eDeclaration of competing interest:\u003c/h2\u003e \u003cp\u003eThe authors have no conflicts of interest relevant to this article.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eThis work is mainly supported by the Shota Rustaveli National Science Foundation of Georgia. Project PHDF \u0026minus;\u0026thinsp;22\u0026ndash;2374. 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Clin Rev Allergy Immunol 64(1):90\u0026ndash;107. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12016-022-08921-5\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"99b8c72e-5f91-4657-bb62-d0f2622f83b7","identifier":"10.13039/501100004801","name":"Shota Rustaveli National Science Foundation","awardNumber":"Project PHDF - 22 - 2374","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Georgia","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":"Oral microbiome, Oral health indicators, Population-based research, COVID-19 ","lastPublishedDoi":"10.21203/rs.3.rs-5174172/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5174172/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground/Purpose: \u003c/strong\u003e\u003c/em\u003eCoronavirus disease 2019 (COVID-19) has become the cause of a global health crisis during the current pandemic. This research aimed to study the impact of symptomatic COVID-19 on children’s oral health indices and salivary microbiome composition duringthe post-COVID-19 period.\u003cbr\u003e\n\u003cem\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eAn observational, cross-sectional study was conducted in Tbilisi (Georgia) among those aged 7-12 years. A total of421 children included in the study had a history of laboratory-confirmed COVID-19 within one year of exposure. No participants met the criteria for comorbidconditions or for PCC. A stratified simple random selection of schools and among selected clusters was used. The selected children were divided into two groups: the exposed group, patients with a history of symptomatic COVID-19; and the control group, patients with a history of asymptomatic COVID-19. The data were collected from August 2022 to December 2023. Oralscreening, microbiological examination of saliva, and administration of questionnaires were also performed. Logistic regression was used to calculate ORs with 95% confidence intervals. The statistical processing of the data was performed with SPSS-23. The study was approved by the Biomedical Research Ethical Council of the University of Georgia (UGREC –04 –22/09.03.2022).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eStatistically significant differences in the means of the oral health indicators between the studied groups were detected (exposed: DMFT+deft=5.9; MGI=0.92; S-OHI=1.9; control: DMFT+deft=3.8; MGI=0.56; S-OHI=1.4). According to the logistic regression, symptomatic COVID-19 had a significant effect on the following oral health indicators: DMFT+deft (OR=1.26; 95% CI=1.14-1.39); MGI (OR=2.31; 95% CI=1.50-3.55); and S-OHI (OR=3.43; 95% CI=2.03-5.76). The effect of symptomatic COVID-19 on the frequency of eradication of the studied microbiome was also significant (OR=2.12; 95% CI=1.23-3.63).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/em\u003e A close association was established between symptomatic COVID-19 and microbiome changes in the oral saliva of children as well as between oral health indicators and symptomatic COVID-19. Considering the research results, it is assumed that a symptomatic course of COVID-19 may be an additional risk factor associated with poor oral health in the pediatric population in the post-COVID-19 period.\u003c/p\u003e","manuscriptTitle":"Impact of symptomatic COVID-19 on the oral health of pediatric patients in Tbilisi City","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-01 02:25:19","doi":"10.21203/rs.3.rs-5174172/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":"8adc5e3b-aed0-4323-b66d-3c806878970f","owner":[],"postedDate":"October 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":38325385,"name":"Epidemiology"},{"id":38325386,"name":"Pediatrics"}],"tags":[],"updatedAt":"2024-10-01T02:25:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-01 02:25:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5174172","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5174172","identity":"rs-5174172","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}