A staged intervention dental health promotion programme to reduce early childhood caries

OBJECTIVE: This paper reports the results of a community trial to assess the effects of a multi-stage dental health promotion programme in reducing Early Childhood Caries (ECC). RESEARCH DESIGN: Two health districts (Primary Care Groups) were matched for dental disease levels and socio-demographic factors. One was randomly allocated to be the test Primary Care Group (PCG), the other the control PCG. Children in the test PCG received a series of interventions to support positive dental health behaviour from the age of 8 to 32 months. Interviews were conducted with parents of children aged 21 months and clinical examinations were undertaken on a larger cohort of children aged 3-4 years in test and control PCGs. SETTING: The interventions were gift bags containing a trainer cup, toothpaste containing 1,450 ppm F and toothbrush, and advice given to the children's parents on attendance at designated clinics and medical practices and further paste and brushes posted to the children's homes. Parents were interviewed on the telephone. Examinations took place at Children's Centres and nursery departments attached to primary schools. OUTCOME MEASURES: Severity and prevalence of ECC and general caries and proportion of parents reporting adopting dentally healthy behaviours. RESULTS: In the test PCG the prevalence of ECC in children who had received the interventions was 16.6% compared with 23.5% of children in the control area, a reduction of 29% (p=0.003). The mean dmft (1.17) and prevalence of general caries experience (28.7%) in the test children were also significantly lower than for children in the control PCG (1.72: 39.2%) (p=0.001). Analysis from a community perspective, which included data from all children examined in both areas, showed the prevalence of ECC in the test and control PCGs was 21.3% and 22.8% respectively and the mean dmft 1.47 and 1.72. The proportion with general caries experience remained statistically significant in favour of the test area 33.8% vs 39.9% (p=0.01). Parents in the test PCG were more likely to report cessation of bottle use (33% vs 18%), use of sugar-free drinks (49% vs 24%), commencement of brushing before first birthday (45% vs 27%) and twice daily brushing (52% vs 34%). CONCLUSION: The parents who received this multi-stage intervention were more likely to report adoption of three positive oral health behaviours; using a trainer cup from one year of age, using safe drinks and brushing twice daily with a fluoride toothpaste. The programme failed to reduce the prevalence of ECC in the community but the prevalence of ECC and general caries experience among the children who participated was less than among children in the control PCG.     

A comparison of restorations for children with early childhood caries treated under general anesthesia or conscious sedation

PURPOSE: There is no data in the dental literature concerning the quality of the restorations performed in young children with early childhood caries (ECC) under sedation as compared with those treated under general anesthesia (GA). The aim of this study was to compare the quality of restorations and recurrent caries in 65 children with ECC who had dental treatment under GA or sedation. METHODS: Thirty-four children, mean age 34.4 months were treated under GA and 31 children with a mean age of 37.2 months were treated under sedation and re-examined 6-24 months after completion of treatment. The quality of the restorations was evaluated using a modified Cvar & Ryge index. RESULTS: Fifty-nine percent of children treated under GA required further dental treatment compared to 74% of children treated under sedation. The majority of the required treatment was due to new caries: 57% in the GA group and 60% in the sedation group. A total of 248 restorations were evaluated for the GA group, with a 94% success rate for marginal adaptation, 92% success for anatomic form, and 97% had no secondary caries. In the sedation group, out of 224 restorations, 78% demonstrated perfect marginal adaptation, 79% showed adequate anatomic form, and 90% had no secondary caries. Successful marginal adaptation was found in 90% of strip crowns placed under GA, compared to 63% of those placed under sedation. CONCLUSION: It is concluded that the outcome of treatments related to quality of the restorations performed under GA is better for all parameters examined.     

Behavioural and demographic factors during early childhood and poor dental health at 10 years of age

The aim was to elucidate whether variables recorded in early childhood would have a long-lasting predictive value of poor dental health at the age of 10 years in a prospectively followed Finnish population-based cohort setting. The second aim was to find new tools for preventive work in order to improve dental health among children. Poor dental health (dmft + DMFT >or= 5) at 10 years of age was associated with child's nocturnal juice drinking at 18 months. It was associated with the following factors at age 3 years: frequent consumption of sweets; infrequent tooth brushing; plaque and caries on teeth. Of family factors, the following were significant: father's young age at birth of the child; mother's basic 9-year education; mother's caries (i.e. several carious teeth per year), and father's infrequent tooth brushing. Early childhood risk factors of poor dental health seem to be stable even after 10 years of life and the changing of teeth from primary to permanent ones. In preventive work, dental health care staff could offer support to those parents with risk factors in their child rearing tasks.     

上海市1296名3~5岁儿童龋病及其相关危险因素分析

目的 了解上海市3~5岁儿童低龄儿童龋患病情况及相关危险因素,为龋病防治提供参考。方法 根据第4次全国口腔健康流行病学调查要求,采用多阶段分层、等容量随机抽样方法,抽取上海市1 296名4个区、12个幼儿园中3~5岁儿童进行龋病检查,对其家长进行口腔健康知识问卷调查。采用SPSS 21.0软件包进行统计学分析。结果 上海市3~5岁儿童的乳牙患龋率、龋均分别为58.07%、2.99,各年龄组及性别间差异均有统计学意义(P<0.05)。龋病相关单因素分析及多因素Logistics回归分析均显示,饮用甜饮料频率高、睡前吃甜食、刷牙频率少于每天1次、开始刷牙年龄大于2岁、家长受教育程度低及口腔健康知识水平差是患龋的危险因素。结论 上海市3~5岁儿童乳牙患龋率较高,加强儿童的饮食习惯及口腔卫生行为教育,提高家长口腔健康知识水平,是防治儿童龋病的有效途径。     

成都市1～3岁低龄儿童龋齿患病与家庭口腔卫生行为调查

目的：调查成都市1~3岁低龄儿童的龋患情况及家庭口腔卫生行为习惯。方法：选取成都市5所幼儿园1~3岁儿童共计1000名作为研究对象,对其进行口腔卫生检查,根据是否患龋分为病例组与对照组。向2组儿童发放调查问卷,了解其口腔卫生习惯相关情况,对比、分析调查结果。采用SPSS 20.0软件包对数据进行统计学分析。结果：共有331名儿童患龋,患龋率为33.10%。病例组与对照组儿童在性别、低体重儿、胎龄、病史、父母最高学历、主要抚养人方面相比,差异均无统计学意义（P>0.05）;2组在年龄分布、喂养方式、家庭年收入方面比较,差异均有统计学意义（P<0.05）。除家长使用牙线和家长刷牙频率2项外,2组儿童的其他家庭口腔卫生行为（定期检查牙、儿童吃甜食频率、儿童睡前进食频率、家长吃甜食频率）相比,差异均有统计学意义（P<0.05）。多因素分析结果显示,年龄、家庭年收入、含奶瓶睡觉、定期检查乳牙、儿童吃甜食频率、儿童睡前进食频率均是低龄儿童患龋的影响因素（P<0.05）。结论：成都市低龄儿童的龋患率较高,低龄儿童患龋与家庭口腔卫生行为有显著相关性,是低龄儿童患龋的因素之一。建立良好的家庭口腔卫生行为习惯,有助于降低低龄儿童龋齿的发生风险。     

3--6岁儿童龋齿患病情况调查及相关因素分析

目的了解呼和浩特市3～6岁儿童龋齿发病情况及影响龋齿的相关因素,为学龄前儿童防治龋病提供科学依据。方法采取整群抽样方法,随机抽取6所幼儿园的1358名3-6岁儿童进行口腔龋齿检查,并对其口腔卫生、生活习惯等进行问卷调查。使用Epidata3．0软件录入问卷,SPSS15．0进行统计分析。结果1358名儿童乳牙龋患率为51．3％,6岁组儿童龋患率较高为68．3％,龋均为2．77,不同性别龋齿患病率无统计学差异（P〉0．5）。经多因素分析,发现年龄、喂养方式、早晚坚持刷牙、甜食摄入及家长对口腔健康的重视程度与儿童龋患有着密切关系。结论本地区学龄前儿童龋齿患病率较高,应加大健康教育宣传力度,家长定期检查口腔卫生问题,促使儿童尽早刷牙,控制儿童龋齿患病率。     

Future caries susceptibility in children with early childhood caries following treatment under general anesthesia

PURPOSE: The purpose of this study was to assess the susceptibility of children to the future development of caries following comprehensive treatment for early childhood caries (ECC) under general anesthesia. METHODS: The patients selected for this retrospective study were identified by analyzing dental records of children receiving treatment at the Franciscan Children's Hospital & Rehabilitation Center, Boston, MA (FCH & RC). In total, 4,143 records were reviewed. Of these, ECC was diagnosed in 42 patients before their admission to the operating room. Thirty-one control children were selected randomly from the dental records reviewed at FCH & RC. The control group was initially caries-free. The caries status of the children diagnosed with ECC was evaluated and compared with the control group. Children in both groups were seen for recall at intervals of six to nine months over a two-year period. The carious lesions were recorded in two categories; new smooth surface caries (NSSC) and new pit and fissure caries (NPFC). RESULTS: Thirty-three of 42 (79%) ECC children compared to nine of 31 (29%) control children had detectable carious lesions at subsequent recall visits. Children with ECC demonstrated a mean number of 3.2 +/- 3.3 new carious lesions compared to a mean of only 0.8 +/- 1.6 carious lesions in the control group. These differences were statistically significant (t71 = 3.8; P < 0.001). In addition, of the 42 patients treated for ECC under general anesthesia, seven (17%) required retreatment under general anesthesia within two years following their initial full-mouth rehabilitation. The prevalence of NSSC in the ECC group was significantly higher than the control group (t71 = 3.5; P < 0.001). CONCLUSIONS: Despite increased preventive measures implemented for children who experienced ECC, this study concluded that this group of children is still highly predisposed to greater caries incidence in later years. These findings strongly suggest that more aggressive preventive therapies may be required to prevent the future development of carious lesions in children who experienced ECC.     

A review of a community program aimed at preventing early childhood caries among Jerusalem infants--a brief communication

Early childhood caries (ECC) has not been adequately investigated in Israel. A previous Jerusalem study has demonstrated a potential effect on toothbrushing among infants. The present study was initiated in order to examine caries prevalence and the potential effect of a community intervention program. OBJECTIVES: This study aims to review an intervention program and assess ECC distribution and associated variables. METHODS: The study sample included 1,500 infants in matched "intervention" and "control" Mother and Child Health centers. The 2-year program, initially including all children at the age of 6 months, focused on the free distribution of toothbrushes and toothpastes. ECC prevalence was determined in a cross-sectional study. RESULTS: At 2.5 years, 596 children were examined (40 percent compliance). About half of the parents reported that they had participated once or not at all over the 2-year period, which demonstrated low program participation. Among the examined children, ECC prevalence was 15.3 percent. No difference in caries levels was found between the program and control groups. The reported level of brushing twice daily was 13.9 percent, while 26.8 percent reported not brushing at all. Eighty-one percent reported going to bed at night with a bottle. Children who drank sugar-sweetened beverages had ECC levels significantly higher than those who drank milk or natural juice (18.8 percent versus 8.9 percent). CONCLUSIONS: The dental health and behavior and lack of intervention success emphasized the need to seek a more effective strategy. Emphasis on toothbrushing might not be the only nor optimal solution for this serious public health problem.     

Early childhood caries lesions in preschool children in Kerala, India

PURPOSE: No data are available on possible risk indicators or the prevalence of caries lesions for preschool children under 4 years of age in Kerala, southern India. Therefore, the aims of this study were: (1) to gather data on caries lesion frequency and distribution; (2) to determine any possible associations with feeding habits and oral health care practices. METHODS: A sample of 530 children, aged from 8 to 48 months (mean=2.5+/-0.96 years), who attended 13 day care centers were clinically examined for caries lesions using a disposable mouth mirror, tongue spatula, and a torch light. There were 513 dentate children. The caregiver of each child then completed, by interview, a structured questionnaire. RESULTS: Among the group of 252 girls and 278 boys, the dmft was 1.84+/-2.87 with 56% of the children being caries-lesion free. Fifty-nine (12%) were considered to have early childhood caries (ECC), based on the criteria that smooth surface caries lesions on all 4 maxillary incisor teeth indicated severe ECC. Breast-feeding was practiced by 99% of the mothers, and 5% did so exclusively. Generally, breast-feeding was on demand. Statistically significant correlations were found between caries lesions and the child's dental condition, as perceived by the mother or caregiver (P<.0001), the dental status of the caregiver (P=.0417), consumption of snacks (P=.0177), giving of sweets as a reward (P<.0001), cleaning of the child's mouth (P<.0001), oral hygiene status of the child (P<.0001) and low socioeconomic status, as measured by income (P<.0001). CONCLUSION: From the results of this study of preschool children in Kerala, the groups at high risk from dental caries lesions are: (1) those with poor oral hygiene status; (2) those who consume snacks and are given sweets as rewards; (3) those belonging to a lower socioeconomic class.     

Determinants of early childhood caries in a group of inner-city children.

OBJECTIVE: This study aimed to determine the prevalence of early childhood caries (ECC) and severe early childhood caries (s-ECC) in inner-city children in Ghent, Belgium, and to investigate the independent impact of its determinants. METHOD AND MATERIALS: In a non-randomized cross-sectional research design, all children between 24 and 34 months of age attending the final consultation at a participating Child and Family Health Clinic were included (n = 385). Data on oral hygiene and caries were collected by oral examination. Caries prevalence and oral hygiene were determined according to established criteria. Data on oral health habits and socioeconomic status were obtained by a validated questionnaire. All analyses were performed with ECC and s-ECC as response variables. RESULTS: The mean DMFS was 0.83 (SEM = 0.14). ECC was diagnosed in 18.5% of the children and s-ECC was found in 12.2%. Treatment need was 100%. From the multiple regression analysis it became clear that ethnicity and neighborhood significantly determined ECC. From all oral health-related behavioral variables, only daily use of a bottle with sweetened drinks other than milk or water, frequency of brushing, and quality of oral hygiene as expressed by Plaque Index scores remained significantly associated with ECC. CONCLUSION: Children whose mothers had an Eastern European nationality at birth and who live in a deprived neighborhood, daily use a bottle with sweetened drinks other than milk or water, brush less than once a day, and have plaque are at higher risk for ECC and s-ECC.     

Determinants of early childhood caries (ECC) in a rural Manitoba community: a pilot study

PURPOSE: Preschool oral health is often overlooked as an important aspect of childhood health and well-being. The purposes of this study were to: (1) determine the dental status of 3-year-old children in the community of Carman, Manitoba, Canada; and (2) identify the principal determinants of Early Childhood Caries (ECC) in 2 consecutive years. METHODS: All children and mothers attending a preschool health screening fair were invited to participate. Study procedures included a retrospective interview with parents and dental examination of the child. Statistical analyses included ANOVA, chi-square, and multiple regression. A P value of <.05 denoted significance. RESULTS: A total of 61 children participated (mean age=45.7+/-3.4 months). The prevalence of ECC was 44%, while the mean deft was 2+/-3.3. Increased caries activity and ECC were associated with lower maternal level of education (P<.01). Family size was associated with deft scores (P=.03) while the presence of debris was also associated with ECC (P<.05). CONCLUSIONS: ECC prevalence among these 3-year-olds is less than exhibited among other Canadian preschool children. Factors associated with ECC included debris on the primary teeth and low maternal education. Factors most associated with increased caries activity included low maternal education and increased family size. In addition, parents were able to reliably assess their child's dental health status. Larger epidemiological studies of ECC are needed to better assess prevalence and risk factors. Such data may, therefore, assist in identifying those children at greatest risk for ECC. It may also help in the redirection of scarce resources to effective preventive oral health interventions, as these children have an increased caries burden along the continuum of childhood.     

Multiple regression analysis of dental status and related food behaviour of French Canadian adolescents

Variables included in a theoretical model of the caries process have been studied in an adolescent population. Four multiple regression analyses were performed to uncover significant explanatory factors for: DMF(T) index, plaque index, frequency of sweets consumption between meals and frequency of sweets consumption at meals. Each analysis produced a significant R2 explaining respectively 29%, 15%, 74% and 62% of the variance. The results demonstrated the contribution of the different factors included in the proposed model. They suggested that plaque index was by far the most significant factor of the DMF(T) index. Sweets consumption was a significant determinant of caries experience independent of any relation to plaque index. Adolescent girls, even with less plaque accumulation, had a higher caries index than boys of the same age. Parent's education was related to dental status of children at time of adolescence.     

Psychosocial factors and early childhood caries among low-income African-American children in Detroit

Objectives: This study sought to advance knowledge of the social determinants of oral health, by examining how several specific maternal health beliefs, behaviors, and psychosocial factors relate to young children's early childhood caries (ECC) status in a lower‐income African–American population. Methods: Data were collected by the Detroit Dental Health Project (NIDCR grant), a population‐based study of 1021 African–American families with at least one child under 6 years of age and living in 39 low‐income Census tracts in Detroit, Michigan. Analyses were limited to 719 children aged 1–5 years and their biological mothers, and conducted in SUDAAN to account for the complex sampling design. Survey data included health belief scales on mothers’ self‐efficacy, feelings of fatalism, knowledge about appropriate bottle use and children's oral hygiene needs, brushing habits, psychosocial measures of depressive symptoms (CES‐D), parenting stress, and availability of instrumental social support. The child's age, dental insurance status, dental visit history, and 1‐week brushing frequency were also included in the model. Children's ECC status, based on a dental examination, was the main outcome. The dental team used the International Caries Detection and Assessment System (ICDAS) criteria for caries detection. Each child was classified as either caries‐free or having ECC or severe ECC (S‐ECC) based on the case definition of ECC proposed by an expert panel for research purposes with preschool‐aged children. Results: The dental team followed a specific examination protocol and established reliable and consistent ratings of ECC based on the ICDAS criteria. The inter‐rater reliability kappa was 0.83 overall, and the intra‐rater reliability kappa was 0.74 overall. One‐third of the children had ECC, and 20% had severe ECC. Age of the child and lower parenting stress scores were each positively associated with ECC, while higher education and income were protective. Maternal oral health fatalism and knowledge of children's hygiene needs were associated with ECC among preschool‐aged children. ECC was higher among younger children who had past restorative care. Conclusions: These findings call attention to the high prevalence of ECC in this population and the need to consider psychosocial as well as traditional risk factors in developing interventions to reduce oral health disparities.     

Risk indicators for early childhood caries in Taiwan

OBJECTIVES: The purpose of this study was to investigate the prevalence, patterns, and etiological factors for caries in children. METHODS: A total of 981 children less than 6 years of age were examined using a dental mirror and explorer. A parent or a caregiver was asked to complete a questionnaire regarding information about the child, the household, and oral hygiene. The prevalence and patterns of dental caries including pit and fissure caries, facial/lingual caries, molar proximal caries, and facial/lingual molar proximal lesions, were analyzed. Each child was classified as caries free or as having one of these four caries patterns. RESULTS: Weighted mean deft was 0.14 at age 2, 2.58 at age 3, 4.41 at age 4, 6.94 at age 5, and 7.31 at age 6. Weighted mean defs was 4.71, 8.44, 16.45 and 18.64 at ages 3, 4, 5, and 6, respectively. By age 2, 5.09% of children had caries. By age 6, 89.38% of children had caries. By age 3, 30.02% of children fitted the facial and lingual pattern of caries and by age 6, 52.90% of children fit the 'facial-lingual and molar-proximal' pattern, indicating extensive smooth surface decay. The total prevalence of early childhood caries was 56%. Multivariate-adjusted odds ratios identified factors associated with the high caries experience of the young children and found caries was strongly associated with the lack of proper tooth brushing and high consumption of sweets. Higher caries scores were also associated with areas of low urbanization. CONCLUSIONS: The findings of this survey indicated a high level of untreated caries among children in Taiwan.     

Early childhood caries in northern Philippines

OBJECTIVES: To determine prevalence and severity of early childhood caries (ECC) among children in northern Philippines. Further, to describe and determine the impact of child-rearing practices and dental visits on caries status. METHODS: Cross-sectional survey of 993 children aged 2-6 years. Caries was diagnosed based on WHO recommendations. Additional behavioral information was obtained from 452 children aged 3-6 years. RESULTS: Caries prevalence and mean dmft (+/-SD) by age were as follows: 2 years = 59% (4.2 +/- 5.3); 3 years = 85% (7.4 +/- 5.5); 4 years = 90% (8.8 +/- 5.6); 5 years = 94% (9.8 +/- 5.5); and 6 years = 92% (10.1 +/- 5.5). Caries rates mirrored those of developing countries with untreated lesions dominating all ages. Mixed breast and bottle feeding was the norm. Almost half were weaned at more than 2 years old. Majority had toothbrushing practices, but mostly without parental assistance. Toothbrushing was initiated at an average age of 2 years. Only a small proportion had a dental visit, mostly for emergency reasons. Among 3-4-year-old children, a significant increase in caries levels were noted for those who started brushing at a later age, had frequent snacks, and had a dental visit for emergency reasons. For children aged 5-6 years, those who went for emergency visits also had significantly more caries. Results indicated an urgent need to (i) increase awareness that ECC is a public health problem in these areas, (ii) advocate use of fluoride as a public health measure, and (iii) increase access to preventive dental services for preschool children.     

The efficacy of a school-based caries preventive program: a 4-year study

Abstract:  This longitudinal study aimed at testing the efficacy of a school-based caries preventive program, by comparing dental caries status of two groups, a study group (436 children) and a control group (420 children) over a period of 4 years. The study group received a preventive program which consisted of intensive oral hygiene instructions sessions, and supervised daily tooth brushing using fluoridated tooth paste in schools. The control group received only oral hygiene instructions sessions. Annual dental examination to record dental caries status, using Decayed Missed Filled Teeth Index (DMFT) and deft, was conducted for both groups over a period of 4 years. At the end of the fourth year the efficacy of the program was tested by comparing the DMFT and deft indices for the two groups using Pearson chi-square test and Cochran–Mantel–Haenzele test. The level of significance was set at P  < 0.05. The results after 4 years showed that the caries status of the children in the study group was better than that of the control group. The difference was statistically significant ( P -value 0.001). The estimates of relative risk values also showed that children in the control group are 3.1 and 6.4 times at higher risk of having dental caries than those in the study group for age group 12 and 6 respectively. This study proves that supervised daily tooth brushing using fluoridated toothpaste is successful in controlling dental caries in children.     

Failure of intense preventive efforts to arrest early childhood and rampant caries: three case reports.

This report presents the first three children who developed dental caries despite being enrolled in a randomized, control trial to test methods to prevent early childhood caries. The children's caretakers received education on decreasing frequent and prolonged feeding with a nursing bottle and other sugar containing foods, as well as brushing the children's teeth daily with 0.4% SnF2 gel. One of the child's caretaker additionally received training sessions to improve confidence in eliminating the child's nursing bottle habit and in performing daily tooth brushing. The two other children received monthly topical fluoride treatments with 2% NaF. Despite these intensive preventive efforts, these three children developed dental caries. Two of the children had mutans streptococci colonization at the time of initial visit, (12 and 14 months of age, respectively). All had high mutans streptococci levels at the time that caries was detected. Incorrigible, high-frequency sugar consumption from a bottle or from solid foods was suggested in all three cases. In one case, dental caries was associated with defects of the tooth enamel. Conceivably, the cariogenic challenge and harmful behaviors in certain children may be so extreme that they can overwhelm even extraordinary preventive efforts.     

Early childhood caries — a synopsis

All the papers presented at the conference are reviewed and comparisons are made with past beliefs on the topic. Early childhood caries (ECC) is a serious public health problem in disadvantaged communities in both developing and industrialized countries in which under-nutrition is common. ECC involves the maxillary primary incisors within months after their eruption and spreads rapidly to involve other primary teeth. The early implantation of mutans streptococci, the use of a feeding bottle containing sugary solutions and prolonged breast-feeding, especially at night, are important predisposing factors. Attention is drawn to the need for more research into the factors which determine the resistance of the enamel and particularly the elucidation of the relationship established in several countries between early enamel caries, enamel hypoplasia, and perinatal under- or malnutrition. Primary preventive measures should be applied during the ante- and immediate post-natal periods. Secondary preventive measures include the use of chemotherapeutic agents such as fluoride, and antimicrobials. The most appropriate tertiary preventive measure is the atraumatic restorative technique (ART). Broadly based committees should be established by governments to address the issues of caries risk in young children. Parents and all personnel involved in infant health and welfare should be shown how to recognize early signs of the condition, as well as to promote early intervention and referral.     

Clinicians' preventive strategies for children and adolescents identified as at high risk of developing caries

International Journal of Paediatric Dentistry 2011; 21: 167–174 Background. Clinicians handle diagnosis and treatment planning of caries in different ways, and the underlying factors leading to management of risk and choice of treatment strategies are poorly understood. Aim. The aim of this study was to investigate dentists’ and dental hygienists’ choices of preventive strategies for children and adolescents identified as at high risk of developing caries. Design. A sample of dental records from 432 of a total of 3372 children in a Swedish county identified as at high risk of developing caries, aged 3–19 years, was randomly selected for analysis in the study. Information of importance for the therapists’ choice of caries management strategies were obtained from the dental records. Results. The results showed that therapists considered tooth brushing instruction and fluoride treatment at the clinic to be of primary importance as treatment given in 60% of the cases, respectively. Fluoride treatment at home and diet counselling were both chosen in half of the cases. Fissure sealant therapy was used in 21% of the cases, and 15% of the patients did not receive any preventive treatment at all. The results also showed that girls more often received fluoride treatment, tooth brushing instruction and oral hygiene information than boys. Conclusions. In the majority of the children and adolescents, several preventive measures were given. The more background factors included in the risk assessment, the more preventive measures were given. The differences between the treatments given to girls and the boys need to be further investigated.