Dental caries patterns and oral health behaviors in Arizona infants and toddlers

OBJECTIVES: The aim of this study was to use tooth eruption sequence, and a tooth- and surface-specific caries analysis method to determine: (1) the temporal relationship between tooth eruption and caries onset; (2) the validity of pre-existing concepts of caries progression; and (3) the relationship of certain putative health behaviors with caries prevalence. METHODS: A total of 2,428 Arizona children aged 6-36-months, who were recruited from WIC programs (a federal program for low-income children at nutritional risk), health fairs and private day care centers, received visual dental caries examinations. Additionally, an oral health behavior survey was administered to the parents of the 1,529 children recruited from the WIC programs. RESULTS: Dental caries was detected soon after tooth eruption, and by 34-36 months of age 25% of this population had caries. Maxillary anterior caries developed as early as 10-12 months of age. Fissure caries of the molars, either by itself or with maxillary anterior caries, was seen as early as 13-15 months of age. Posterior proximal caries was seen as early at 19-21 months, and only was present in conjunction with the other patterns. Over 40% of the 13-36-month-old children whose parents completed the survey still used a bottle. Night-time bottle use was associated with maxillary anterior caries in 24-36-month-old children, but no association was found in younger children or with posterior caries patterns. Survey responses also showed that fewer than 15% of these children reported having had a dental visit. CONCLUSIONS: Dental caries was a significant health issue for these children under 3 years of age, and factors other than bottle feeding may play an important role in its etiology. Prevention of dental caries in children under age three will depend on a better understanding of the etiology as well as improved access to care.     

An oral health promotion program for an urban minority population of preschool children

The objective of this project was to design, implement and evaluate an oral health promotion program for inner-city Vietnamese preschool children in Vancouver, British Columbia, Canada. The project comprised of four general phases: information-gathering, project planning, project implementation, and project evaluation. The information-gathering phase of the project demonstrated extensive tooth decay in young children, bottle use during the day and during sleep-time long past recommended weaning age, and a belief of many parents that primary teeth were not important. Based on this information, the project planning committee designed a program that featured one-to-one counseling supported by community-wide activities. A Vietnamese lay health counselor provided counseling to mothers with telephone follow-up that coincided with scheduled infant immunization visits to a twice-monthly Child Health Clinic for Vietnamese families. At all the follow-up assessment clinics scheduled over the 7-year duration of this continuing project, mothers who had had more than one counseling visit reported significantly less use of sleep-time and daytime bottles for their children, and their children demonstrated significantly reduced prevalence of caries compared to similarly aged children at baseline. One-to-one counseling with regular follow-up provided by a lay person of similar background and culture to the participants is an effective way to facilitate adoption of healthy behaviors and to improve oral health of children.     

Restoring oral health

During the last decade, a continuous decrease in dental caries has been observed among schoolchildren in Iceland. In this paper, various epidemiological studies have been reviewed and summarized to illustrate caries prevalence, and how it has changed during the last decades. Furthermore, an attempt has been made to describe some of the factors involved and their possible effects on caries disease. During this period, sugar consumption increased, especially in the form of sweets and soft drinks. At the same time, the import of toothpaste increased, and preventive measures such as fissure sealants and fluoride rinsing programs were intensified. Other factors likely to have had an impact were changes in treatment philosophy and increased personnel resources. There does not seem to be any single factor responsible for the onset of the caries decline. It rather looks as if this was a multifactorial effect due to a number of different preventive measures. During recent years, a change in treatment philosophy, the evident increase in fluoride toothpaste consumption, and possible changes in the oral microbial flora, together with the use of fluoride varnishes, sealants, and increased manpower, may explain the decline.     

Child and family health nurses' experiences of oral health of preschool children: a qualitative approach

Objectives: The objective of this study was to explore Child and Family Health Nurses' work‐related experiences of dental disease in young children. Methods: Child and Family Health Nurses (n = 21) who recruited new mothers to an ongoing birth cohort study that began in South Western Sydney, Australia were invited to take part in a qualitative study. A semi‐structured, in‐depth interview technique was used to explore their experiences of preschool child oral health and how this affects their working lives. Interviews were audio‐recorded, transcribed verbatim, and analyzed using a thematic analysis. Results: The nurses considered dental caries to be a significant health issue for young children and their families. They thought that the burden of dental disease in preschool children was underestimated in disadvantaged and multicultural populations. In addition, they reported that parents were often unaware of the disease process and were ignorant of the relationship between bottle feeding and dental caries. Once the parents were informed about their child's poor oral health, they had feelings of anger, despair, and guilt. Conclusions: This study highlights that oral health problems are a significant segment of the child health problems identified by nurses in their daily work. The nurses perceived the problem of dental caries to be one of a lack of parental knowledge, and families should be educated not only on “what” but also on “how” to feed their children. The primary healthcare team should work collaboratively to educate families in a culturally appropriate way.     

Metabolism of xylitol in dental plaque

Abstract – It has been reported previously that xylitol added to glucose used to challenge dental plaque in vivo caused a reduced acid formation. The aim of the present study was to approach the mechanism by which xylitol may affect glucose catabolism in plaque bacteria. Suspensions of freshly collected 4-day-old plaque bacteria were ineubated, one batch with labeled xylitol, one with labeled glucose, in vitro at 37°C. Samples of cells were taken out at time intervals, collected on paper discs and subjected to scintillation counting. It was observed that the plaque bacteria took up xylitol, the uptake increasing with incubation of more than 3–4 h, whereas the same cells took up glucose immediately. Cells which had taken up xylitol were extracted with boiling water, extracts concentrated and applied on thin-layer chromatography sheets. A radioactive component with mobility like xylitol-5-phosphate was isolated from the cell extracts, and also a component where labeled xylitol was associated with macromolecules. It is suggested that the accumulation of the metabolities within the cells inhibits glycolysis.     

Response to Horowitz: Research issues in early childhood caries

Interest in early childhood caries (ECC) remains strong internationally, yet a name remains elusive. Baby bottle tooth decay (BBTD) was widely recognized by non-dental health professionals — a factor to consider in choosing a more appropriate name. Due to limits in historic data, progress against the disease remains difficult to determine. As reflected by Dr Horowitz's list of recommendations, a focused agenda is not at hand on research leading to specific interventions. We also struggle to develop a specific set of interventions suitable for public health settings. In the absence of research-based effective interventions, I hope we do not withdraw from efforts to reduce ECC.     

Factors associated with dental caries experience in 1-year-old children

OBJECTIVES: Dental caries in early childhood is an important public health problem. Previous studies have examined risk factors, but they have focused on children during the later stages of the disease process. The purpose of this study was to assess the factors associated with caries in children aged 6 to 24 months as part of a cross-sectional analysis. METHODS: Two hundred twelve mothers with children 6 to 24 months of age were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children clinic sites in southeastern Iowa for participation in a longitudinal study of dental caries. Baseline assessments included detailed questions regarding the children's beverage consumption, oral hygiene, and family socioeconomic status. Dental caries examinations using the d(1)d(2-3)f criteria and semiquantitative assessments of salivary mutans streptococci (MS) levels of mother and child were also conducted. Counts of the number of teeth with visible plaque were recorded for maxillary and mandibular molars and incisors. RESULTS: Of the 212 child/mother pairs, 187 children had teeth. Among these children, the mean age was 14 months, and 23 of the children exhibited either d(1), d(2-3), or filled lesions. Presence of caries was significantly associated with older age, presence of MS in children, family income <$25,000 per year, and proportion of teeth with visible plaque. CONCLUSIONS: Results suggest that not only microbial measures, including MS and plaque levels, are closely associated with caries in very young children, but that other age-related factors may also be associated with caries. Continued study is necessary to more fully assess the risk factors for caries prevalence and incidence in preschool children.     

Fissure sealing with Nuva Seal® in a public health program for Danish schoolchildren after 12 months' observation

ABSTRACT – The purpose of the present study was to evaluate the effect of the Nuva-Seal® method in a public health program for Danish schoolchildren, when applied by a specially trained chairside assistant. Forty-nine children 7 to 9 years of age had a total of 148 permanent first molars sealed. The results after 12 months showed that retention of sealant material was comparable to that found in other studies. However, no caries preventive effect of the procedure could be demonstrated. It is concluded that sealing should be performed earlier than was done in this study in older to prevent caries.     

Caries-preventive effectiveness of fluoride varnish as adjunct to oral health promotion and supervised tooth brushing in preschool children: A double-blind randomized controlled trial

Objectives

To evaluate the effect of biannual fluoride varnish applications in preschool children as an adjunct to school-based oral health promotion and supervised tooth brushing with 1000 ppm fluoride toothpaste.

Methods

424 preschool children, 2–5 year of age, from 10 different pre schools in Athens were invited to this double-blind randomized controlled trial and 328 children completed the 2-year programme. All children received oral health education with hygiene instructions twice yearly and attended supervised tooth brushing once daily. The test group was treated with fluoride varnish (0.9% diflurosilane) biannually while the control group had placebo applications. The primary endpoints were caries prevalence and increment; secondary outcomes were gingival health, mutans streptococci growth and salivary buffer capacity.

Results

The groups were balanced at baseline and no significant differences in caries prevalence or increment were displayed between the groups after 1 and 2 years, respectively. There was a reduced number of new pre-cavitated enamel lesions during the second year of the study (p = 0.05) but the decrease was not statistically significant. The secondary endpoints were unaffected by the varnish treatments.

Conclusions

Under the present conditions, biannual fluoride varnish applications in preschool children did not show significant caries-preventive benefits when provided as an adjunct to school-based supervised tooth brushing with 1000 ppm fluoride toothpaste.

Clinical significance

In community based, caries prevention programmes, for high caries risk preschool children, a fluoride varnish may add little to caries prevention, when 1000 ppm fluoride toothpaste is used daily.     

Long‐term effectiveness of a nutritional program in reducing early childhood caries: a randomized trial

Feldens CA, Giugliani ERJ, Duncan BB, Drachler ML, Vítolo MR. Long‐term effectiveness of a nutritional program in reducing early childhood caries: a randomized trial. Community Dent Oral Epidemiol 2010; 38: 324–332. © 2010 John Wiley & Sons A/S Abstract – Objectives: To investigate the effectiveness of home visits advising mothers about healthy feeding practices during the first year of life on the occurrence of early childhood caries and severe early childhood caries at 4 years of age. Methods: We conducted a parallel randomized trial of mothers of single, full‐term children with birthweight ≥ 2500g in São Leopoldo, Brazil. The intervention group received monthly advice up to 6 months and then at 8, 10 and 12 months by undergraduate nutrition students, based on the ``Ten Steps for Healthy Feeding'', a Brazilian national health policy for primary care based on World Health Organization guidelines. The primary outcome was the occurrence of early childhood caries at age four. Secondary outcomes included the occurrence of severe early childhood caries and the number of affected teeth: decayed (white spots and cavities), missing and filled teeth (d₁₊mft). Blinded observers ascertained feeding habits in the home and one blinded dentist performed dental examinations in a municipal clinic. This study is registered with ClinicalTrials.gov, number NCT00629629. Results: Of 500 mother‐child pairs (200 intervention, 300 control) enrolled, 340 (141 intervention, 199 control) completed 4 year follow‐up. As 138 (69.3%) controls but only 76 (53.9%) intervention children had early childhood caries, home counseling reduced incidence by 22% (RR 0.78; 95% CI 0.65‐0.93). Severe early childhood caries incidence was reduced by 32% (RR 0.68; 95% CI 050‐0.92). The mean number of affected teeth was lower for the intervention group (3.25) compared with the control group (4.15) (Mann Whitney U‐test; p=0.023). No adverse effects were noted. Conclusions: Home nutritional advice during the first year of life decreases caries incidence and severity at four years of age in a low income community.     

Prevention of early childhood caries: a public health perspective

This paper proposes strategies for preventing early childhood caries (ECC), preferably for the greatest number of children at the lowest cost. Population-based, public health approaches are more likely to reach the target population groups at risk of developing ECC than individual, private practice-based approaches. Different prevention and early intervention strategies are discussed and the following recommendations are made: 1) Continue to promote community water fluoridation. 2) Evaluate the effectiveness of other public health oriented measures to prevent ECC. 3) Develop a national ECC and rampant caries registry. 4) Link oral health screening and easily implemented, low-cost interventions with immunization schedules and public health nursing activities. 5) Increase opportunities for community-based interventions conducted by dental hygienists. 6) Change insurance reimbursement schedules to provide incentives for dentists to prevent disease. 7) Include dentistry in new child health insurance legislation for children as well as parents of infants and preschool children.     

Three methods of oral health education in secondary schools

In 1990, three methods of oral health education (OHE) were implemented in three secondary schools in the city of Pori, Finland, one method in each school. The traditional OHE consisted of a lecture given by a dentist with the aid of transparencies and slides. The peer OHE consisted of a lecture given by six pupils from the upper grades. These pupils used transparencies and extracts of video films and had a classroom exhibition with pictures, slogans, and dental aids and instruments. The self-teaching OHE was based on an exhibition from which the pupils searched for the information themselves. After the programs, the pupils' opinions about the method itself, its contents and implementation, knowledge about certain oral health issues, and the possible effect of the method were determined by a questionnaire. The attitudes and opinions were most positive in the peer OHE group. The traditional OHE was quite well accepted, but the self-teaching method was not very successful. The participants in the traditional OHE more often felt that they had been encouraged to pursue good oral health habits. In all groups, the topic considered to be the most boring was tooth brushing. Peer OHE can be recommended for Finnish secondary schools. The issue of tooth brushing should be played down, however, as too frequent repetition of the topic may cause more negative attitudes towards oral health education and practices.     

Effect of a preventive program on dental caries and mutans streptococci in Polish schoolchildren

The effect of a preventive program was studied in Polish schoolchildren. The study was carried out in a group of 133 children, aged 10-12 yr, divided into a test and a control group. Children in the test group were initially treated with temporary restorations and were then given oral health education and preventive treatment by a specially trained chairside assistant. The preventive treatment included prophylaxis and topical fluoride treatment and was carried out at least 10 times a year. The mean 3-yr DFS increment was 1.7 in the test and 10.9 in the control group. The salivary counts of mutans streptococci were similar in test and control group at baseline and after 1 and 2 yr. At the examination after 3 yr, a difference was established between the two groups.     

An assessment of oral health promotion programmes in the United Kingdom

Background: Improving oral health and reducing tooth decay is a key area for action, both in the United Kingdom (UK) and overseas. The World Health Organization (WHO) has highlighted the unique advantage schools have in promoting oral health. Aim: We summarise current oral health promotion strategies in the United Kingdom and estimate the spread of their use as well as their impact on oral health and influence on the oral health‐related knowledge and behaviour in a patient population. Methods: A structured overview of published papers, government publications, official government websites and policy reports. A cross‐sectional study of patients referred for a tooth extraction in one dental surgery in south‐east London. Statistical methods consisted of logistic and ordinal regressions to model the likelihood of exposure to oral health promotion and of obtaining higher levels of knowledge of oral health issues, respectively. Linear regression was used to model the level of oral health and knowledge of oral health issues. Results: We found three main promotion programmes, namely, National Healthy Schools (NHS), Sure Start and Brushing for life plus a small number of local initiatives. Sure Start targets disadvantaged areas, but is limited. In our observational study, 34% of the patients reported exposure to a settings‐based oral health education programme: Sure Start (5%), NHS (7%) and other (22%). This exposure was not influenced by age or gender, but an association with education was detected. Although oral health promotion was not found to influence the actual knowledge of oral health issues, it was found to influence some oral health‐related attitudes and perceptions. Conclusions: Participation in an oral health promotion programme was found to be significantly associated with the patients’ education, their belief that they can prevent oral disease and the subjective perception of their own oral health. The WHO principles need to be embedded across all schools to achieve a true national oral health promotion programme for the United Kingdom. The National Healthy Schools programme provides the perfect platform.     

A three-year retrospective study of emergency visits at an oral health clinic in south-east Queensland

Background: There is little information available regarding dental emergencies for children in Australia. The aim of this study was to investigate the reasons for dental emergency cases which were treated at a public oral health clinic in a low socioeconomic district in south‐east Queensland. Methods: From a register kept at a public oral health clinic, we analysed the monthly number of emergency visits for children over a three‐year period (January 2008 to August 2010) with respect to numbers treated, reasons for presentation and types of treatment rendered. Results: During the period 2008–2010, there was a mean of 196 ± 86 cases presenting for emergency care each month. The proportions of the various types of emergencies remained fairly consistent over the three‐year period, with the majority presenting for caries related problems (74–75%), followed by trauma (8–9%), orthodontic treatment related (2–5%) and other reasons (16–11%). Between 8–11% of cases were preschool children who were added to the waitlist for treatment for caries under general anaesthesia at the public hospital. Conclusions: Trends in the past three years at a public oral health clinic in a low socioeconomic district in south‐east Queensland show that dental caries constitute nearly three‐quarters of all paediatric emergency appointments.     

A community participatory oral health promotion program in an inner-city Latino community

OBJECTIVES: This paper reports the planning, implementation, process evaluation, and refinement of an oral health community participatory project in Mount Pleasant, an inner-city Latino neighborhood of Washington, DC. The main goal was to explore the feasibility of implementing such a project. METHODS: The PRECEDE-PROCEED model was used to guide the planning and process evaluation of this project, in conjunction with community organizational methods. A steering committee, which met periodically, was formed to assist in program planning, implementation, and evaluation. The needs assessment of the community identified extensive dental health problems among children and deficiencies in their parents' oral health knowledge, opinions, and practices. In response, culturally appropriate health education and promotion activities were planned and implemented in collaboration with local community organizations, volunteers, and local practitioners. Process evaluation was used to provide feedback into the refinement of the community approach, which included record keeping and an inventory approach to activities completed and resources used. The overall impact and usefulness of this program were assessed informally using an anonymous open-ended questionnaire directed to members of the steering committee, and an outreach survey using a convenience sample at a local Latino health fair. RESULTS: The implementation of such a community participatory approach was feasible and useful for building upon existing local resources and addressing oral health concerns in a community not reached by traditional dental care and health promotion initiatives. Individuals in this community showed a substantial interest in oral health matters and participated in a variety of oral health prevention activities. The community approach adhered to community-based research principles.