Incidence of caries in an infant population in Mostoles, Madrid. Evaluation of a preventive program after 7.5 years of follow-up

Role of Fluoride in Dentistry: A Narrative Review

Fluoride has performed a central role in the growth over the last fifty years. This report examines the present state of knowledge about fluoride's involvement in preventing dental caries. In recent years, our knowledge of the development of dental caries and the manner of operation of fluoride has been shifted. Dental caries is a constant procedure for enamel demineralization and remineralization, and fluoride plays an important part in this action by acting at the plaque-enamel contact. Fluoride's major method of action is now recognized as posteruptive. Fluoride's post-eruptive activity has led to the development of novel fluoride delivery systems. The importance of various fluoride delivery techniques on a population and societal level is discussed, along with suggestions.

IMPACT OF FLUORIDE ON DENTAL HEALTH QUALITY

INTRODUCTION

Fluoride is natural element that strengthens teeth and prevents their decay. Experts believe that the best way to prevent cavities is the use of fluoride from multiple sources. Studies even show that in some cases, fluoride can stop already started damage of the teeth. In children younger than 6 years fluoride is incorporated into the enamel of permanent teeth, making the teeth more resistant to the action of bacterial and acids in food.

GOAL

The aim of this study is to determine the effects of improving the health status of teeth after six months treatment with the use of topical fluoridation 0.5% NaF, and the level and quality of the impact of treatment with chemical 0.5% NaF on the dental health of children at age from 8 to 15 years, in relation to gender and chronological age. This study included school children aged 8 to 15 years who visited health and dental services dependent in Mostar.

RESULTS

It is obvious that after the implementation of treatment with 5% NaF by the method of topical fluoridation, health status of subjects from the experimental group significantly improved, so that at the final review 89.71% or 61 subjects of the experimental group had healthy (cured teeth), tooth with dental caries only 5.88% or 4 respondents tooth with dental caries and filling 4.41% or 3 respondents, extracted baby tooth 14.71% or 10 respondents, while for 13.24% of respondents was identified state with still unerupted teeth. Our findings are indirectly confirmed that the six-month treatment of fluoridation with 5% NaF, contributed to statistically significant improvement in overall oral health of the experimental group compared to the control group which was not treated by any dental treatment.

CONCLUSION

It can be concluded that there is a statistically significant difference in the evaluated parameters of oral health of children in the control group compared to the studied parameters of oral health the experimental group of children at the final dental examination.

Primary school-based behavioural interventions for preventing caries

BACKGROUND

Dental caries is one of the most common global childhood diseases and is, for the most part, entirely preventable. Good oral health is dependent on the establishment of the key behaviours of toothbrushing with fluoride toothpaste and controlling sugar snacking. Primary schools provide a potential setting in which these behavioural interventions can support children to develop independent and habitual healthy behaviours.

OBJECTIVES

To assess the clinical effects of school-based interventions aimed at changing behaviour related to toothbrushing habits and the frequency of consumption of cariogenic food and drink in children (4 to 12 year olds) for caries prevention.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 18 October 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), MEDLINE via OVID (1948 to 18 October 2012), EMBASE via OVID (1980 to 18 October 2012), CINAHL via EBSCO (1981 to 18 October 2012) and PsycINFO via OVID (1950 to 18 October 2012). Ongoing trials were searched for using Current Controlled Trials (to 18 October 2012) and ClinicalTrials.gov (to 18 October 2012). Conference proceedings were searched for using ZETOC (1993 to 18 October 2012) and Web of Science (1990 to 18 October 2012). We searched for thesis abstracts using the Proquest Dissertations and Theses database (1950 to 18 October 2012). There were no restrictions regarding language or date of publication. Non-English language papers were included and translated in full by native speakers.

SELECTION CRITERIA

Randomised controlled trials of behavioural interventions in primary schools (children aged 4 to 12 years at baseline) were selected. Included studies had to include behavioural interventions addressing both toothbrushing and consumption of cariogenic foods or drinks and have a primary school as a focus for delivery of the intervention.

DATA COLLECTION AND ANALYSIS

Two pairs of review authors independently extracted data related to methods, participants, intervention design including behaviour change techniques (BCTs) utilised, outcome measures and risk of bias. Relevant statistical information was assessed by a statistician subsequently. All included studies contact authors were emailed for copies of intervention materials. Additionally, three attempts were made to contact study authors to clarify missing information.

MAIN RESULTS

We included four studies involving 2302 children. One study was at unclear risk of bias and three were at high risk of bias. Included studies reported heterogeneity in both the intervention design and outcome measures used; this made statistical comparison difficult. Additionally this review is limited by poor reporting of intervention procedure and design. Several BCTs were identified in the trials: these included information around the consequences of twice daily brushing and controlling sugar snacking; information on consequences of adverse behaviour and instruction and demonstration regarding skill development of relevant oral health behaviours.Only one included study reported the primary outcome of development of caries. This small study at unclear risk of bias showed a prevented fraction of 0.65 (95% confidence interval (CI) 0.12 to 1.18) in the intervention group. However, as this is based on a single study, this finding should be interpreted with caution.Although no meta-analysis was performed with respect to plaque outcomes (due to differences in plaque reporting between studies), the three studies which reported plaque outcomes all found a statistically significant reduction in plaque in the intervention groups with respect to plaque outcomes. Two of these trials involved an 'active' home component where parents were given tasks relating to the school oral health programme (games and homework) to complete with their children. Secondary outcome measures from one study reported that the intervention had a positive impact upon children's oral health knowledge.

AUTHORS' CONCLUSIONS

Currently, there is insufficient evidence for the efficacy of primary school-based behavioural interventions for reducing caries. There is limited evidence for the effectiveness of these interventions on plaque outcomes and on children's oral health knowledge acquisition. None of the included interventions were reported as being based on or derived from behavioural theory. There is a need for further high quality research to utilise theory in the design and evaluation of interventions for changing oral health related behaviours in children and their parents.

Childhood caries as influenced by maternal and child characteristics in pre-school children of Kerala-an epidemiological study

Purpose:

The most common chronic disease of childhood is early childhood caries which is five times more prevalent than asthma and seven times higher than that of allergic rhinitis. Most children do not receive dental care until they are three years old, yet by the time more than thirty percent of children from lower socioeconomic groups already have caries. To determine the prevalence and severity of early childhood caries among pre-school children, to describe the child characteristics associated with the development of early childhood caries and to find the association of early childhood caries and maternal risk factors.

Materials and Methods:

This descriptive study was carried out among children attending the immunization clinic of Sree Avittam Thirunal Hospital, Medical College, Trivandrum and children attending the randomly selected Anganwadies and Day care centres in Trivandrum, the capital of Kerala, wherein there are migrants from all over the State. A total of 350 children aged 12-36 months and their mothers were studied. The mother was first interviewed by a structured questionnaire; then the child's and mothers clinical examination was carried out covering caries experience and oral hygiene status.

Results:

Among 350 children studied the prevalence of dental caries in this study population was found to be 50.6 %(177). Statistically significant associations were found between the severity of decay and the child's age(P<0.001), female gender(P<0.05),low socioeconomic status (P<0.05), feeding frequency (P<0.05), type of feeding(P<0.01), fell asleep with nipple in mouth (P<0.05), duration of breast feeding(P<0.001), consumption of cariogenic type of snacks(P<0.01), age of commencement of tooth brushing(P<0.05), brushing frequency(P<0.05), oral hygiene status of child(P<0.001), DMFS scores of mothers (P<0.001), and oral hygiene status of mother (P<0.001).

Long-term Caries Preventive Effects of a School-Based Fluoride Mouth Rinse Program in Adulthood

The purpose of this study was to evaluate the long-term caries preventive effects of school-based fluoride mouth rinse (FMR) program in adults aged 20 years and older. 637 mothers aged from 20 to 39 years were surveyed. Clinical examinations were carried out for subjects to obtain data on dental caries prevalence when they visited local health centers to take their children for medical and dental check-ups at 1.5- or 3-years old. We also obtained information regarding the FMR program: the duration that the subjects participated between nursery school and junior high school. When analyzing data, subjects were divided into 4 groups: FMR from nursery to junior high school group (N-JH group, n=22), FMR limited to the elementary school group (El group, n=62), FMR no-experience group (n=545), and other subjects whose FMR experience is not clear (n=8). For evaluation of the FMR program effect, multiple regression analysis was used. As independent variable, the FMR program patterns were converted into dummy data, and mean DMFT was used as dependent variable. The results of multiple regression analysis between mean DMFT and FMR program patterns showed that the N-JH group and El group were negatively associated with the mean DMFT (ß=-0.20, p<0.001 for N-JH group and ß=-0.11, p=0.003 for El group).

The positive caries preventive effects of school-based FMR program from nursery school to junior high school can continue in adults aged 20 years and older.

[Analysis of different cultural aspects regarding oral health care in citizens of the rural riverside region in Rondônia State, Brazil]

This study aimed to assess the popular practices in oral health care on pathologies such as dental caries, periodontal disease and others, in Tabajara District, Rondonia State, Brazil as folklore has a great importance on cultural aspects of the Brazilian people, and can be considered a social and cultural aspect at the same time, reaching and influencing people in oral health care. It was based in a quanti-qualitative study, being the sample composed by 14 women and 6 men. The research instrument comprehends a questionnaire with direct and subjective questions, for data analysis in descriptive form. The results show a low knowledge about oral health aspects, as well as many alternative methods for "treatment" and "prevention" of oral diseases. There is a need of deeply knowledge about the target population on health programs, as many times it can insert cultural changes and, in order to avoid being destructives, must analyses the social-cultural structure of the community.

[The importance of health education in prevention of oral health in children]

HEALTH EDUCATION: The aim of education is to impart knowledge on the causes of disease and decay of the teeth and periodontium, on the ways and possibilities of disease prevention and adequate treatment; to point out to the necessity of proper nutrition, regular and proper oral hygiene, proper use of fluoride products as well as to the significance of regular check-ups with a dentist.

NUTRITION

Frequent intake of carbohydrates leads to a higher prevalence of caries. Taking into consideration that it is neither obtainable nor recommendable to completely eliminate glucoses from the nutrition components, it is necessary to advice parents and children to take glucose (if possible) only along with the regular meal when the saliva flow is increased.

ORAL HYGIENE

In order to establish oral hygiene as an important prophylactic measure influencing successful protection of oral health of the whole population, it is necessary to inform as many people as possible about oral hygiene effectiveness and its necessity in preventing oral and dental diseases; to develop the habits of regular oral hygiene maintenance in the youngest children as well as to refer them to the use of most adequate paraphernalia and agents for performing the daily oral hygiene procedures.

FLUORIDE PROPHYLAXIS

Undoubtedly, fluoride is currently the most efficient agent for the prevention of dental pathology. The anticaries efficacy of fluoride is a consequence of the cumulative effect of several different mechanisms. They can occur on the dental surface or directly influence the mineral phase in the enamel. Each dental hygiene preventive program must include the content about the use of fluoride as the basic prophylactic measure. It is recommended to be the sum of the combined effect of systemic (endogenic) and local (exogenic) application.

CONCLUSION

Regarding high prevalence of caries in children, the issue of prophylaxis is of great significance and current interest. In that respect, health education should point out to the significance of proper nutrition, regular oral hygiene and fluoride prophylaxis, all aimed at preventing dental diseases. It is certain that parents must take an active part in these activities both as educators and controllers of the proposed measures.

Prospective study of 5-year caries increment among children receiving comprehensive dental care in the New England children's amalgam trial

OBJECTIVE

To measure the 5-year caries increment among high-risk children during their participation in the New England Children's Amalgam Trial (NECAT), and to evaluate sociodemographic factors that may account for any observed disparities.

METHODS

NECAT recruited 534 children aged 6-10 with at least two decayed posterior occlusal surfaces from urban Boston and rural Maine. After restoration of baseline caries and application of sealants to sound surfaces, NECAT continued to provide free comprehensive semiannual dental care to participants. The net caries increment of children who completed the 5-year follow-up (n = 429) was calculated and predictors of caries increment were investigated using multivariate negative binomial models.

RESULTS

The majority of children (89%) experienced new caries by the end of the 5-year follow-up. Almost half (45%) had at least one newly decayed surface by the first annual visit. At year 5, the mean number of new decayed teeth was 4.5 +/- 3.6 (range 0-25) and surfaces was 6.9 +/- 6.5 (range 0-48). Time trends showed a noticeably higher increment rate among older children and young teenagers. Multivariate models showed that age (P < 0.001), number of baseline carious surfaces (P < 0.001), and toothbrushing frequency (<1/day versus >or=2/day, P = 0.04) were associated with caries increment. Only 48 children (11%) did not develop new caries.

CONCLUSIONS

Despite the receipt of comprehensive semiannual dental care, the vast majority of these high-risk children continued to develop new caries within 5 years. While disparities were observed by age, extent of prior decay, and toothbrushing frequency, no other sociodemographic factors were associated with caries increment, suggesting that the dental care provided during the trial reduced sociodemographic disparities in prior caries experience that were observed at baseline.

[Research on health education and promotion in Spanish nursery and primary schools. A systematic review of studies published between 1995 and 2005]

OBJECTIVE

To identify the characteristics of health education and promotion interventions in Spanish nursery and primary schools, through the studies published in scientific journals.

METHOD

We performed a review of studies on health education and promotion interventions in Spanish nursery and primary schools, published from 1995 to 2005. The information sources were Medline (through Pubmed), Cinhal, Eric, Sociological Abstracts, Science Citation Index, and Isooc (CSIC). Studies performed in Spanish nursery and primary schools that incorporated health education and promotion interventions were selected. The studies' general features, main subject and aims, methodology, the kind of intervention described, and compliance with the criteria for Healthy Schools were analyzed.

RESULTS

Only 26 of the 346 articles identified met the inclusion criteria. Health education programs focussed more on disease prevention than on health promotion and only a few studies were performed in nursery and primary schools. The criteria for health promotion in schools were included in 5 articles (19.2%). The importance of health institutions (n = 7; 26.9%) and universities (n = 8; 30.8%) as promoters of programs was notable. The most frequent subject was smoking (n = 11; 42.3%).

CONCLUSIONS

Teachers play a lesser role in health promotion in schools than health institutions in the implementation and dissemination of health programs. Research into health promotion in nursery and primary schools is scarce.

Influence of sociodemographic variables on dental service utilization and oral health among the children included in the year 2001 Spanish National Health Survey

OBJECTIVES

To ascertain the possible influence of sociodemographic variables on dental service utilization and oral health among Spanish children.

METHODS

This is a descriptive cross-sectional study using secondary individualized data drawn from 4,023 interviews conducted with parents or guardians of children aged 3-15 years as part of the 2001 Spanish National Health Survey. The dependent variables analyzed were use of dental services in the preceding 12 months, and caries ever. Classification of children was affirmative if their parents answered that the last time their child visited the dentist it was for a filling and/or had fillings in his/ her teeth/molars. Independent variables were sex, age, size of town or city, parents' educational level and monthly income of the family unit.

RESULTS

A total of 47.1% of the study children had visited a dentist, stomatologist or dental hygienist in the preceding 12 months. Children having parents or guardians with the lowest educational level were 1.36 times (95% Cl: 1.10-1.68) more likely to have received no dental care than those having parents or guardians with the highest educational level. The likelihood of not having made use of such dental services rose 2.03-fold (95% CI: 1.58-2.61) in cases where monthly income was less than 900 euros versus greater than 1800 euros. Reported prevalence of caries for the sample as a whole was 31.45%. Children whose parents were in the lowest educational range were 1.37 times (95% CI: 1.08-1.71) more likely to have caries than those in the highest range.

CONCLUSION

There is social inequality in the use of dental services and oral health among Spanish children.

Models and theories in studies on educating and counseling children about physical health: a systematic review

The aim of this review is to gain a comprehensive view on the theories and models referred to in studies on educating and counseling children about physical health. A computer search was conducted using PubMed Medline, and Silverplatter Webspirs Psycinfo. Original studies, reviews, and theoretical papers published between 1992-2003 were included. The review presents the results of the 35 studies in which the majority of the subjects were between 0 and 12 years of age. A classification system is proposed that helped grouping the models, and the interrelationship between this classification and the characteristics of the reviewed studies is explored. The classification could function as an introductory guide and help to select appropriate theories and models when defining future research agenda's. The results of this review may attribute to the refinement of the theoretical underpinning of child education and counseling in physical health.

Influence of sociodemographic variables on use of dental services, oral health and oral hygiene among Spanish children

OBJECTIVES

To analyse the possible influence of sociodemographic variables on use of dental services, oral health and oral hygiene among Spanish children.

METHODS

Descriptive cross-sectional study based on 1,676 interviews conducted with parents or guardians of children ages 3-15 years. The dependent variables analysed were: use of dental services in the preceding 12 months; self-reported caries ever; and daily dental hygiene measured as toothbrushing frequency. Independent variables were sex, age, size of town or city, educational level, and monthly income of the family unit.

RESULTS

A total of 60% of the study children had not visited a dental professional in the preceding 12 months. Children having parents or guardians with the lowest educational level were 1.592 times more likely to have received no dental care than those with the highest educational level. The likelihood of not having made use of such dental services rose 2.232-fold in cases where income was < 600 versus >1200 per month. Overall prevalence of self-reported caries for the sample as a whole was 34.4%. Subjects in the lowest income bracket (< 600 per month) were 1.497 times more likely to have caries than those in the highest income bracket. In all, 68.5% brushed their teeth every night, but the percentage rose significantly with age, size of town or city, and income.

CONCLUSION

There is considerable social inequality in the use of dental services, oral health and oral hygiene among Spanish children.

[Effectiveness of fissure sealants in child population at high risk of caries]

OBJECTIVES

To asses the effectiveness of fissure sealants in a high risk infant population and to evaluate the criteria to determine when to apply them.

DESIGN

Prospective cohort study.

SETTING

Primary care.

PARTICIPANTS

607 scholars that are included at the age of 6 years and followed for 4,5 years.Intervention. We have defined three groups. Groups I and II were included in a dental preventive program with and without fissure sealants in the first permanent molars, respectively, and group III received no preventive measures at all.

MAIN MEASUREMENTS

The dental explorations according to WHO recommendations were conducted before entering the study, at the age of six years, after the fissure sealant were applied, at the age of eight years and finally 4.5 years after the beginning.

RESULTS

After 4.5 years group I had a CAOD index of 0.59, group II 0.79 and group III 1.52 (P<.001). Group III has 2.57 times greater risk the group I of suffering caries in the permanent teeth.

CONCLUSIONS

The application of occlusive fissure sealant in the first permanent molar of an infant high risk population has a protective effect on dental caries. Therefore occlusive fissure sealant should be offered to all scholars because those without neither the preventive program nor occlusive fissure sealant had a significantly higher risk of caries.