Effectiveness of an oral health education and caries prevention program in kindergartens in China

OBJECTIVES: To evaluate the effect of a 2-year oral health education and caries prevention program implemented in kindergartens in China. METHODS: Seven hundred and thirty-one 3-year-old children were recruited from 10 kindergartens in Miyun County, Beijing, China. The kindergartens were randomly divided into two groups. Oral health education was provided to teachers in the test kindergartens every 3 months. Oral health education sessions were conducted for the test children monthly and for their parents semiannually. Children in the test kindergarten brushed their teeth twice daily with fluoridated toothpaste (1100 ppm F-) in their kindergarten under the supervision of teachers during weekdays. No oral health education session and no supervised tooth brushing activities were carried out in the control kindergartens. A clinical examination of the study children and a questionnaire survey of their parents were conducted at baseline and after a 2-year program. RESULTS: Five hundred and fourteen children remained in the study after 2 years. The mean caries increments of the test group (n = 258) and the control group (n = 256) were 2.47 and 3.56 dmfs, respectively. The reduction in dmfs increment was 30.6% (P = 0.009). At the evaluation, a significantly higher percentage of children in the test group than in the control group reported brushing their teeth twice a day (87.6% vs. 69.0%; P < 0.001). Parents of children in the test group had better oral health knowledge and attitude than the parents of children in the control group. CONCLUSION: This oral health education program was effective in establishing good oral health habits among preschool children and in increasing oral health knowledge of their parents, in conjunction with supervised daily tooth brushing with fluoridated toothpaste, which could reduce the development of new dental caries in preschool children in China.     

Report on caries reduction in French schoolchildren 3 years after the introduction of a preventive program

Abstract— A combination of preventive methods have been used to reduce dental caries in children aged 7–8 at baseline, living in a non-fluoridated area in the West of France. The preventive program involved a daily supervised toothbrushing at school with 180 mg of fluoridated toothpaste, professional prophylaxis every 2 months with topical application of fluoride gel and reinforced motivation. The oral hygiene level was measured using the Silness-Löe plaque index and caries were recorded using the def and DMF surface indices, including incipient lesions. The 3-yr results showed a signiflcant 52% plaque reduction in the test group compared with the control group. Caries reduction was signiflcant at the 0.01% level: 44% for primary teeth and 60% for permanent teeth.     

Current understanding of the epidemiology mechanisms,and prevention of dental caries in preschool children

The seriousness and societal costs of dental caries in preschool children are enormous. National data shows that caries is highly prevalent in poor and near poor US preschool children, yet this disease is infrequently treated. The etiology includes elevated colonization levels of mutans streptococci, high frequency sugar consumption, and developmental defects on primary teeth. A necessary first step in preventing dental caries in preschool children is evaluating the child's caries risk factors that include socioeconomic status, previous carious experience, presence of white spot lesions, presence of visible plaque, perceived risk by dental professionals, and microbiologic testing for the presence or quantity of mutans streptococci. Based on this knowledge, different preventive strategies, as well as different intensities of preventive therapies, can be employed. Caries preventive strategies in preschool children include diet modifications to reduce high frequency sugar consumption, supervised tooth brushing with fluoridated dentifrice, systemic fluoride supplements to children living in a nonfluoridated area that are at risk for caries, professional topical fluoride with fluoride varnish, and sealants for primary molars.     

Effect of caries preventive measures directed to expectant mothers on caries experience in their children

The aim of this prospective study was to determine the effectiveness of caries preventive measures started during pregnancy on the caries experience of first-time mothers and their infants. Eighty-one pregnant women with low social background were selected on the basis of the presence of active carious lesions and were randomly divided into control (38) and experimental (43) groups. The initial dental status (DMFS and white spot lesions) was established through clinical examination. The prophylactic measures were repeated during pregnancy and 6 and 12 months after delivery. Both groups received primary care intervention. They were instructed in relation to the etiologic factors of dental caries and received oral hygiene kits. Oral hygiene instructions were reinforced through interactive brushing. The experimental group also received antimicrobial treatment (topical application of NaF and iodine solution immediately after prophylaxis and 3 and 5 days later) and restorative care using glass ionomer cement. By the time the children were 2 years of age, 33.3% of the infants in the control group and 14.7% in the experimental group had caries activity. A significant difference in caries prevalence was observed between children with and without visible dental plaque. The mean number of tooth surfaces with carious lesions (including areas of demineralization) was higher among the children in the control group compared to the experimental group (6.3 x 3.2), however, with no statistical significance. Maternal caries increase was a significant factor influencing the caries experience of the children. These data support the evidence of an association between caries prevalence in young children and clinical (dental plaque) and maternal factors.     

The attitudes of parents toward the oral health of children and their reflection on the non-cavitated caries lesions

ObjectiveTo determine the extent of non-cavitated caries lesions in preschool children, and compare its relationship with socioeconomic status, oral and dental health practices, knowledge of caries prevention, and nutrition.Materials and methodsNinety-seven parents of 36–72 month-old children completed a questionnaire on the socioeconomic status of the family, parent's knowledge of caries prevention, the children's oral health practices, and nutrition. In the children, the cavitated dental caries were assessed according to World Health Organization (WHO) criteria and non-cavitated caries lesions on occlusal and smooth surfaces were evaluated by Universal Visual Scoring System (UniViSS). Statistical analysis was conducted using the SPSS software program. The relationships between variables were assessed using the chi-square test and logistic (ordinal) regression analysis.ResultsStatistically significant results were obtained relating to the parents' age, number of children, the time of first oral hygiene, frequency of tooth brushing, knowledge of caries prevention, drinks most often consumed by the children, and number of non-cavitated lesions. According to the regression model, the significant variables were caries activity (yes), drinks most often consumed by the children (milk–juice; juice–buttermilk), the frequency of tooth brushing (once a day, twice a day), observed changes in a child's teeth (change in color and breaks in teeth), the number of cavitated caries lesions and decayed, missing and filled teeth (dmft).ConclusionsThe primary factors contributing to non-cavitated caries lesions include the time of first oral hygiene and frequency of tooth brushing. The early diagnosis of non-cavitated caries is essential for preventive measures.     

Early childhood caries (ECC): a preventive-conservative treatment mode during a 12-month period

PURPOSE: To evaluate a preventive treatment mode for early childhood caries (ECC). POPULATION AND METHODS: The population to be studied included 30 children who, over a 12-month period, presented with ECC to a private dental clinic. Parents preferred non-invasive, preventive treatment over restorations. Parents were given hygiene and proper feeding instructions. Mesial slicing was performed where proximal caries was observed. Children were examined once every two months. They received supervised professional topical fluoride treatment. Plaque level, brushing, stopping the bottle, eating sweets, appearance of new lesions or exacerbation of existing condition were observed and recorded. RESULTS: In the vast majority of patients, the progression of ECC was arrested after the preventive regimen. Three children required restorations. They had failed to limit sugar consumption and to comply with brushing instruction. General improvement was observed in plaque control, brushing habits and sweets consumption. CONCLUSION: Preventive measures may successfully arrest ECC and thereby avoid invasive procedures as well as the need of anesthesia.     

Socioeconomic factors in adolescents’ oral health: are they mediated by oral hygiene behaviors or preventive interventions?

Polk DE, Weyant RJ, Manz MC. Socioeconomic factors in adolescents’ oral health: are they mediated by oral hygiene behaviors or preventive interventions? Community Dent Oral Epidemiol 2010; 38: 1–9. © 2009 John Wiley & Sons A/S Abstract – Objectives: To determine whether there is a socioeconomic status (SES) disparity in caries experience (i.e., DMFT) in an adolescent sample from Pennsylvania and to determine whether differences in oral hygiene behaviors and preventive interventions account for this disparity. Methods: A cross‐sectional clinical assessment was conducted on a representative sample of 9th grade and 11th grade students across Pennsylvania. These students also completed a brief questionnaire regarding their oral hygiene behaviors. From this group of students, a random subsample of 530 parents completed a questionnaire assessing SES, fluoride exposure, and recency of receipt of dental services. DMFT was examined at two thresholds of severity: simple prevalence (DMFT > 0) and severe caries (DMFT > 3). Results: Using structural equation modeling, we found that lower SES was associated with higher prevalence of DMFT and higher prevalence of severe caries. Although lower SES was associated with lower rates of brushing, less use of sealants, and less recent receipt of dental services, these oral health behaviors and preventive interventions did not account for the disparities in DMFT defined by SES. Conclusions: There is an SES gradient in caries experience in adolescents in Pennsylvania. Disparities in caries experience, however, cannot be accounted for by SES‐associated differences in brushing, flossing, sealant use, fluoride exposure, or recency of use of dental services. To facilitate the design of preventive interventions, future research should determine the pathways through which SES‐associated disparities occur.     

Effect of self-brushing with acidulated phosphate fluoride (pH 5.6) on dental caries in children

The aim of this work was to study the effect of a preventive program on the dental plaque and on the caries incidence in school children. The program comprised weekly supervised self brushing with acidulated phosphate fluoride (APF) gel (pH 5.6; concentration: 4520 ppm of ion F-). The program involved 240 children of 1st., 3rd and 5th grade of a primary school in the City of Buenos Aires (Argentina). The population was divided in 2 groups: A (experimental) and B (control). Ninety children from both groups (45 experimental and 45 control) were submitted to baseline clinical examination (DMFT and plaque index) and microbiological analysis (total streptococci, St mutans and St. mutans and St. mutans percentage). Group A was then submitted to a preventive program which included self brushing with APF gel (4520 ppm of ion F-). The 90-children sample was monitored after 1 and 2 years of program. Results were statistically processed and they revealed the following: a--DMFT was significantly greater in the control group than in the experimental group after 1 and 2 years of program; b--an 81.43% reduction in caries increment rate at the end of the 2-years program in the experimental group as compared to the control group; c--a rise in the number of colonies of total streptococci and of St. Mutans; d--a reduction in the % of St. mutans in the total streptococci flora in the plaque of children in the experimental group; e--the presence of St. mutans colonies featuring a rough surface; f--the effectiveness of the program in the modifying the profile of the diagnosed dental pathology.     

Predicting caries by measuring its activity using quantitative light-induced fluorescence in vivo: a 2-year caries increment analysis

The aim of this study was to analyse the predictive power of several clinical baseline parameters and the de-/remineralisation properties of in vivo etched sites measured with quantitative light-induced fluorescence (QLF) for subsequent 2-year caries increment. At baseline, in 44 children (8.23 ± 1.5 years) two areas (diameter 2 mm) of the buccal surface of a primary posterior tooth were etched with 36% phosphoric acid gel for 1 and 4 min, respectively. The etched sites were analysed immediately after etching (ΔQ1) and 24 h (ΔQ2) later by QLF. Additionally, caries status (deft/DMFT and initial caries), approximal plaque, bleeding on probing, and the patient's current use of fluorides were recorded. In the 2-year follow-up, 29 children were re-assessed. After clinical examination, the caries increment was calculated (ΔDMFT) and correlated with the baseline clinical variables and the QLF readings. Results showed a significant positive correlation between ΔQ(1 min) and the ΔDMFT (r = 0.44, p = 0.02). The ΔDMFT was significantly correlated with the baseline deft (r = 0.56, p = 0.002), cavitated active caries lesions (r = 0.52, p = 0.003), and filled teeth (r = 0.53, p = 0.003). In a regression analysis the use of fluoridated salt (SC = -0.10) and fluoride gel (SC = -0.14) were negatively associated with ΔDMFT. In conclusion, these findings suggest that the demineralisation properties of the etched sites and the outcome of the 24-hour measurements with QLF are significantly associated with caries increment. Previous caries experience strongly correlated with caries increment in this group of children.     

The decline in dental caries among Belgian children between 1983 and 1998

OBJECTIVES: to investigate cross-sectionally a probable dental caries decline in Belgian 12-yr-olds and to analyse some factors that may be associated with dental caries during the study period. METHODS: In the region of Brussels, children in the 7th grade at the same schools were sampled in 1983 (n=533) and 1998 (n= 496). DMFT, DMFS and dental fluorosis were clinically recorded. Data on children's home-based and professional dental health care habits were registered. RESULTS: Caries-free children increased from 4% to 50%. A reduction of the mean number of teeth attacked by dental caries from 7.5 to 1.6 and of tooth surfaces from 11.5 to 2.5 (P<0.001) was observed. Early signs of dental fluorosis were identified in 5% in 1983 and 30% of the subjects in 1998. Multiple linear regression analyses revealed that tooth brushing with fluoridated toothpaste, dental appointments and dental fluorosis were significantly related to dental caries reduction. CONCLUSIONS: A remarkable decline in dental caries was observed during the 15-yr period. The factors related to the children's home-based and professional dental health care were associated with the observed decline.     

Factors for changes of caries prevalence among adolescents in Germany

Data on caries prevalence among adolescents in East and West Germany before and after unification (1990) were compared with changes in etiologic and preventive parameters. The postwar increase of total sugar consumption resulted in an increase of caries prevalence among adolescents in both East and West Germany until 1970. Parallel to the introduction of preventive measures, especially systemic fluoridation, the national caries level in East Germany stabilized at 4–5 DMFT (in 13–14–year–olds) with significant regional differences. The introduction of fluoridated toothpaste after 1973 in West Germany was followed by a caries decline in children (1970s) and in adolescents (1980s) from very high caries levels (8.8 DMFT in 13–14–year–olds in 1983) to moderate levels (5.1 DMFT in 1989). The sudden increase from 10% to 90% fluoridated toothpaste in East Germany in 1990 was also accompanied by a caries decline in adolescents. Group prevention, which included fluoride varnish programs and the introduction of free prevention (brushing instructions, fluoridations. sealants) at private dentists for 6–19–year–olds since 1983. seems to be responsible for the latest caries reductions all over Germany.     

Dental conditions in inpatients with schizophrenia:A large-scale multi-site survey

ABSTRACT: BACKGROUND: Clinical relevance of dental caries is often underestimated in patients with schizophrenia. The objective of this study was to examine dental caries and to identify clinical and demographic variables associated with poor dental condition in patients with schizophrenia. METHODS: Inpatients with schizophrenia received a visual oral examination of their dental caries, using the decayed-missing-filled teeth (DMFT) index. This study was conducted in multiple sites in Japan, between October and December, 2010. A univariate general linear model was used to examine the effects of the following variables on the DMFT score: age, sex, smoking status, daily intake of sweets, dry mouth, frequency of daily tooth brushing, tremor, the Clinical Global Impression-Schizophrenia Overall severity score, and the Cumulative Illness Rating Scale for Geriatrics score. RESULTS: 523 patients were included in this study (mean [PLUS-MINUS SIGN] SD age = 55.6 [PLUS-MINUS SIGN] 13.4 years; 297 men). A univariate general linear model showed significant effects of age group, smoking, frequency of daily tooth brushing, and tremor (all p's < 0.001) on the DMFT score (Corrected Model: F(23, 483) = 3.55, p < 0.001, R2 = 0.42) . In other words, older age, smoking, tremor burden, and less frequent tooth brushing were associated with a greater DMFT score. CONCLUSIONS: Given that poor dental condition has been related with an increased risk of physical co-morbidities, physicians should be aware of patients' dental status, especially for aged smoking patients with schizophrenia. Furthermore, for schizophrenia patients who do not regularly brush their teeth or who exhibit tremor, it may be advisable for caregivers to encourage and help them to perform tooth brushing more frequently.     

Dental Caries-reducing Effects of a Milk Fluoridation Project in Bulgaria

Objectives: The aim of the present study was to investigate the effects of a community-based milk fluoridation project on dental caries. Methods : Fluoridated milk was provided to about one-half of kindergarten and other schoolchildren in Asenovgrad, a town in the southern part of Bulgaria. The estimated daily milk consumption was 200 ml containing 1 mg of fluoride (～5 ppm F). Cross-sectional samples of 61/2-year-olds in Asenovgrad and Panaguriche (a nearby town selected as the reference community) were examined at the start of the study in 1988 and after three years. Additional cross-sectional samples of 7 1/2-year-olds in Asenovgrad who were and were not drinking fluoridated milk were examined at baseline and at three years to provided an internal control group. Samples of 6 1/2-and 8 1/2-year-olds from Asenovgrad and Karlovo were examined in 1993 to provide for five-year follow-up comparisons. Results : In 6 1/2-year-old children who had consumed fluoridated milk for three years, there was a decrease in the mean dmft per child of 40 percent and in the mean DMFT of 89 percent compared to children examined at baseline. Children in Asenovgrad who were 4 1/2 years old at the start of the study and had been drinking fluoridated milk for three years had on average 44 percent fewer dmft and 83 percent fewer DMFT at 7 1/2 years of age than those not drinking fluoridated milk. After five years the dmft index was 40 percent less and the DMFT index 79 percent less in those children who had participated in the full five years of the program compared to the control group. Conclusions : Results seem to confirm the caries-reducing effects of milk fluoridation found in previous studies. Unexpected large caries reductions obtained in this nonexperimental study, however, probably cannot be attributed to the fluoridation of milk alone. The mere introduction of the project might have led to other changes affecting dental caries, such as improved oral hygiene and better dietary habits.     

Contribution of preventive methods in controlling caries among Saudi primary schoolchildren: a population-based cross-sectional study

Objective: This study assessed the association between caries preventive measures including regular dental checkups, twice a day tooth brushing using fluoridated toothpaste and pit and fissure sealants on one side and the presence of caries among primary schoolchildren in the Eastern Province of Saudi Arabia.

Materials and methods: A cross-sectional study was conducted in 2016 including 1198, 6–12-year-old children from 13 randomly selected schools. The outcome variable was caries presence. The explanatory variables were brushing twice a day using fluoridated toothpaste, the presence of sealant and regular dental checkups. Multivariable logistic regression model was conducted to assess the associations controlling for confounders (age, gender, ability to get treatment, being health insured and school) using SPSS version 20.0.

Results: Data of 921 participants (83.8%) were available. The prevalence of caries was 63.5%, whereas 67.6% brushed their teeth twice a day, 28.3% visited the dentist for regular checkups and 7.6% had sealant. In multivariable regression, out of the three main explanatory variables, only having regular checkups was significantly associated with caries presence (OR?=?0.65, 95% CI?=?0.48, 0.88).

Conclusions: Lower odds of caries presence were associated with regular dental checkups but not with regular brushing or having sealant.     

A combined approach to preventing dental caries in schoolchildren: caries reductions after one year.

A prototype school-based dental program is being conducted in a low-middle-income, urban area, as a demonstration project to test the combined effect on dental caries of several preventive measures. Procedures include ingestion of fluoridated water (1.0 ppm), topical application of acidulated phosphate fluoride, application of a pit and fissure sealant, early detection of caries and restoration of affected teeth, and dental health education (oral hygiene and dietary counseling program). The four-year project began in early 1973. A group of 1,200 children in the first and sixth grades was randomly separated into a treatment and a comparison group. All children participate in a dental health education program and consume fluoridated water. Dental care is provided on site at 18 schools, with the use of two mobile vans, saving time and expense in school hours lost and transportation costs. A hygienist coordinates the oral hygiene and dietary programs in classrooms with the help of teachers trained in workshops. Supervised toothbrushing, flossing, and use of disclosing agents are carried on in the classrooms. First-year caries increment data in permanent teeth indicate a high degree of success. Occlusal surfaces of permanent teeth in children in the treatment group, contrasted to those in children in the comparison group, showed an average reduction in caries of 84%. The encouraging results obtained at the end of one year indicate that a school-based preventive dentistry program may have great potential for preventing and controlling dental caries in schoolchildren.     

Arresting dentine caries in Chinese preschool children

Objectives. To investigate the incidence of rehardening of caries lesions in children in Southern China taking part in a preventive programme. Design. Longitudinal study. Sample and methods. A prevention programme was established for 168 3–6-year-old children in a kindergarten (KG1), which included regular oral health education sessions and a daily toothbrushing exercise using fluoridated toothpaste (1000 ppm F). A group of 121 children studying in two other kindergartens without a preventive programme formed the controls. Due to lack of resources and dental personnel, restorative and other curative treatments were not provided. Results. Rehardening of dentine caries (arrested caries) was found in children in both test and control groups. At the third annual examination, 45% of the caries lesions on the proximal surfaces of primary anterior teeth in KG1 children found at the baseline and previous annual examinations had become arrested. A multiple linear regression analysis indicated that baseline ds score and its interactions with the prevention programme, gender and the child’s oral hygiene all had significant effect on the number of tooth surfaces with arrested caries at the third annual examination. Conclusion. Results from this study support the use of simple prevention programmes to stabilize the caries situation in communities where intensive use of trained dental personnel is not feasible.     

Effect of fluoride on gingivitis and dental caries in a preventive program based on plaque control

ABSTRACT The purpose of the investigation was to estimate the relative effect of fluoride on caries in a preventive program based on meticulous plaque control. The material consisted of 82 children; 41 in the test and 41 in the control group. At the start of the study the children were 13–14 years of age. In August 1973 an examination was performed to obtain baseline data for the trial. Prophylactic treatment was given to the children once every second week. A total of 18 treatments were given during a 10-month period. In the control group an abrasive paste was used containing 5 % sodium monofluorophosphate (Jodka Fluor Polerpasta®). In the test group an abrasive paste was used which was identical with the control paste except that it did not contain any fluoride components. Twelve months after the baseline examination the test and control groups were reexamined. The trial demonstrated that, in children, fortnightly professional cleaning of the teeth combined with meticulous toothbrushing instructions result in (1) a high standard of oral hygiene and (2) only very few new carious surfaces. Though the control group children received fortnightly topical application of F^? during the prophylactic sessions and used a fluoridated dentifrice, there was no significant difference between the two groups regarding number of new carious tooth surfaces per child per year.     

Immediate and prolonged effect of individual preventive measures in caries and gingivitis susceptible children

A longitudinal study on the effect of an individualized preventive program was carried out on 10-11 year old children with higher caries and/or gingivitis prevalence than the average. The program was based on bimonthly professional toothcleaning as well as hygiene and dietary instructions. After an introductory period of 3 months the frequency of visits was individualized according to the gingival condition of the children (every 2nd to 4th week). For one group this program was supplemented by instruction in dental flossing for proximal tooth cleaning on a daily basis. The effects of the preventive measures were evaluated after an experimental 2 year period. Two years after withdrawal of the preventive measures, the longitudinal effects were recorded. In all 627 children were examined and of these 87 children were selected for the study on gingival and cariological indications. It was possible to follow 74 children throughout the 4 year period. After 2 years the number of new caries lesions was significantly reduced in the test groups as compared to the controls. The caries increment in the test group was 1.7 new surfaces per individual and in the control 4.5. The corresponding figures at the follow-up examination was 8.5 and 5.9 respectively. Thus any prolonged effect of the preventive program could not be confirmed. An improved cariological status was also recorded among the children selected on gingival indications. The increment was 0.8 in the test and 3.8 in the control group during the experimental period. The corresponding figures at the supervisory control was 1.8 and 4.6 new surfaces respectively indicating a prolonged effect among these children. The interpretation of the results from the "flossing" group was not clear-cut, since the flossing was performed unsupervised. However, no new decayed tooth surfaces were recorded in those children who had claimed that they had used floss at least every second day. The gingival situation improved in all test groups and was visible even in the follow-up study.     

Oral health status of children with Treacher Collins syndrome

There is a lack of data on the oral health status of individuals with craniofacial syndromes. A group of 15 children with Treacher Collins syndrome, aged 5 to 15 years old, was examined and evaluated for plaque, caries and gingival problems. The ability of the patients to clean their teeth was also investigated. A high plaque index and poor efficacy of tooth‐brushing was recorded. The caries and gingival indexes were not proportionally as high as the plaque accumulation. There was no association between the gingival index and presence of mouth breathing. There was predominance of the D component in both the dmft and DMFT indexes; this was associated with a need for restorative dental treatment in 60% of the patients, which indicated the need for dental care for these patients. Caretakers should be informed of the importance of oral health and oral hygiene and encouraged to take responsibility for the oral care of the children living at home.