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Three hundred and ninety boys aged 2, 4 or 6 years from Riyadh, Saudi Arabia, took part in a survey in 1993/94. The main aims of the study were first, to identify factors related to malnutrition in young children since a study of older children from the same area 1 year before had shown malnutrition to be strongly related to prevalence of developmental defects of enamel (DDE) of permanent teeth and, second, to identify factors related to the prevalence of developmental defects of primary teeth. Enamel defects were recorded by clinical examination of the buccal surfaces of all primary teeth by 1 examiner using the DDE index. A questionnaire to parents provided information on socio-economic status, illness in the mother and child, infant feeding, trauma to teeth and toothbrushing. A 24-hour dietary record, to estimate water and milk intake, and a 24-hour urine collection were obtained for each child twice. Nutritional status was calculated from height for age using WHO methods. Multiple regression analyses revealed four variables related (p < 0.05) to malnourished status: low birth-weight, low volume of water drunk, child stopped breast- and bottle-feeding before 1 year of age, and low class urban or rural area of residence. Birth-weight was itself related to area of residence (p = 0.02), parental education (p = 0.02) and maternal illness during pregnancy (p = 0.06). Malnutrition (p < 0.001), low birth-weight (p < 0.001), childhood illness (p < 0.001), brushing of child's teeth (p = 0.003) and swallowing toothpaste (p < 0.001) were related to the prevalence of developmental defects of primary teeth. This study indicated several independent variables which may be related to the prevalence of enamel defects in primary and permanent teeth, but longitudinal studies are required to determine which are causes and which are markers of these developmental defects. [ABSTRACT FROM AUTHOR]

Due to very high levels of caries experience in Saudi Arabia's 6-year-olds living in a city with a near-optimal water fluoride level, a study of younger children was undertaken in Riyadh, the country's capital, which has a similar, near-optimum water fluoride level. A total of 390 boys were dentally examined, in the age groups of 2, 4 and 6. More children from the high socio-economic group were included than from the low or rural socio-economic group. For all three age groups, caries prevalence was the highest in the low socio-economic group.

Fourteen-year-old boys from three regions of Saudi Arabia were surveyed in 1992/3. These regions were Jeddah (which receives desalinated water containing 0.22 mgF/l), Riyadh (receiving water containing 0.78 mgF/l) and Qassim (2.66 mgF/l). For each of these urban communities an adjacent rural community was selected; these received water with 0.25, 0.80, and 2.71 mg/l, respectively. Subjects from the urban communities were classified into high, medium and low socio-economic status based on area of residence, income and education level of parents. Nutritional status was calculated from height and age using WHO methods and expressed as height for age percentage of the median of the reference population (HAM); children with HAM scores of less than 95% were classed as malnourished. The developmental defects of enamel index was recorded on the buccal surface of all permanent teeth, by one examiner. Colour photographs of anterior teeth were read 'blind' to investigate examiner bias between regions-there was no bias. A total of 1,539 children were examined who had been continuously resident in that community. Overall, 83% of subjects had one or more enamel defects with a mean number of teeth affected per person of 9.6. Diffuse defects were the most common. Multivariate analyses revealed that all three variables-region, nutritional status, socio-economic status-were statistically significantly related to the prevalence of defects and the number of teeth affected: prevalence was highest in the region with the highest water fluoride concentration, in rural areas and in malnourished subjects. Maxillary incisor teeth were the most affected teeth in all regions. The findings have implications for those in public health who determine optimum fluoride levels in drinking water in Saudi Arabia and beyond.