Outcome of an oral health outreach programme for preschool children in a low socioeconomic multicultural area

Oral Health-Related Quality of Life in a Paediatric Population in the Dominican Republic

Introduction: During the summer of 2019 and within the framework of a social dentistry program carried out in the low-income town of San Francisco de Macorís (Dominican Republic), a descriptive study was carried out on oral health-related quality of life (OHRQoL), aiming to find out the oral health status of a population of children in the aforementioned Dominican city. Objective: The aim of this study was to describe the oral health status of a child population and its relationship with the quality of life perceived by these children in the aforementioned population of San Francisco de Macorís in order to develop an specific oral health program taking into account not only the existing oral health status but also the perceptions and feelings of the child population in this regard. Method: A descriptive cross-sectional study was carried out on a representative sample of children who were examined on their oral health status, following WHO guidelines, by professionals from the University of Seville (Spain) together with professionals from private practice (USA) and students from the Universidad Católica Nordestana (UCNE, Dominican Republic). Likewise, the children's parents voluntarily completed the Oral Quality of Life questionnaire COHIP-19 in its culturally adapted Spanish version. Results: For this purpose, 94 children with a mean age of 10.34 (SD 3.38) were observed in our study following WHO recommendations for oral health studies and evaluating OHQoL using the specific questionnaire validated in Spanish COHIP-19 in its short format (SF). The results show a state of oral health with a significant prevalence of caries (80.9%) and a DMFT of 1.70 (SD 1.90). The OHQoL perceived by these children shows that pain, bad breath or feeling sad because of the condition of their teeth were the factors with the worst evaluation score. Conclusions: The conclusion that mainly emerges from this study is that caries continues to be the main problem to be solved (more than other variables studied, such as malocclusion or fluorosis), and this ailment also causes pain, dysfunction, and bad breath and is therefore perceived as a problem to be solved in the children of this Dominican city.

The Impact of Dental Care Programs on Individuals and Their Families: A Scoping Review

BACKGROUND

Despite significant global improvements in oral health, inequities persist. Targeted dental care programs are perceived as a viable approach to both improving oral health and to address inequities. However, the impacts of dental care programs on individual and family oral health outcomes remain unclear.

OBJECTIVES

The purpose of this scoping review is to map the evidence on impacts of existing dental programs, specifically on individual and family level outcomes.

METHODS

We systematically searched four scientific databases, MEDLINE, EMBASE, CINAHL, and Sociological Abstracts for studies published in the English language between December 1999 and November 2021. Search terms were kept broad to capture a range of programs. Four reviewers (AG, VD, AE, and KKP) independently screened the abstracts and reviewed full-text articles and extracted the data. Cohen's kappa inter-rater reliability score was 0.875, indicating excellent agreement between the reviewers. Data were summarized according to the PRISMA statement.

RESULTS

The search yielded 65,887 studies, of which 76 were included in the data synthesis. All but one study assessed various individual-level outcomes (n = 75) and only five investigated family outcomes. The most common program interventions are diagnostic and preventive (n = 35, 46%) care, targeted children (n = 42, 55%), and delivered in school-based settings (n = 28, 37%). The majority of studies (n = 43, 57%) reported a significant improvement in one or more of their reported outcomes; the most assessed outcome was change in dental decay (n = 35).

CONCLUSIONS

Dental care programs demonstrated effectiveness in addressing individual oral health outcomes. However, evidence to show the impact on family-related outcomes remains limited and requires attention in future research.

Development of dental caries and risk factors between 1 and 7 years of age in areas of high risk for dental caries in Stockholm, Sweden

Purpose

To explore caries predictors at age 1 year and caries development at ages 5 and 7 years in two groups of children following different fluoride-based preventive programs.

Methods

We conducted a prospective cluster-randomized controlled intervention trial with two parallel arms comparing two prevention programs: one program included fluoride varnish applications every 6 months, the other did not; otherwise, the programs were the same. Participants were 1- and 3-year-old children enrolled at 23 dental clinics in high-risk areas in Stockholm, Sweden. The baseline examination included structured interviews. Caries data were extracted from dental records. The primary outcome measures were ICDAS 1–6 > 0 at baseline (age 1 year) and defs > 0 at ages 2, 3, 5, and 7 years. The secondary outcome measure at age 7 was DFS > 0.

Results

Continuous caries development occurred: defs > 0 in 23% at 5 years and in 42% at 7 years. We found no difference in caries development between children who had or had not received fluoride varnish as toddlers. At age 1-year, significant predictors for dental caries in later preschool years were immigrant background, family income, and sweets consumption. Fluoride toothpaste > once a day at 1 year had an OR < 1 for defs > 0 at 5- and 7 years.

Conclusions

For toddlers, fluoride varnish does not seem to be an adequate prevention tool. Brushing with fluoride toothpaste from 1 year of age could not arrest caries development. Immigrant background was the strongest predictor. A new toolbox as well as collaborative upstream actions for reducing free-sugar intake are needed.

Home-based toothbrushing interventions for parents of young children to reduce dental caries: A systematic review

BACKGROUND

Dental caries is the most prevalent preventable condition in children. A key preventive home-based oral health behaviour is the adoption and maintenance of parental supervised toothbrushing until 8 years of age.

AIM

To examine interventions promoting parental supervised toothbrushing practices to reduce dental caries in young children (<8 years old).

DESIGN

Interventions promoting parental involvement in home-based toothbrushing in children under 8 years old and their impact on caries were subjected to review. Electronic databases (MEDLINE, EMBASE, PubMed, Web of Science, PsycINFO, Scopus, and the Cochrane Library), references, and unpublished literature databases were searched for relevant literature.

RESULTS

Of the 10 176 articles retrieved, forty-two articles were included. The Theoretical Domains Framework was used to code intervention content, with the main domains addressed being knowledge (41/42), skills (35/42), and environmental context and resources (22/42). Sufficient descriptions of the intervention development, delivery, and evaluation were lacking, with only 18 studies being underpinned by theory. Twenty-nine studies explored the impact on caries yielding mixed results.

CONCLUSIONS

There are few interventions targeting home-based oral health behaviours underpinned by theory and methodological rigour in their development and evaluation. This demonstrates a clear need for future interventions to be guided by complex intervention methodology.

Impact of an extended postnatal home visiting programme on oral health among children in a disadvantaged area of Stockholm, Sweden

AIM

To evaluate oral health outcomes and early oral health promotion of children in a Swedish, parental support programme conducted in a collaboration between Child Health Services and Social Services.

METHODS

The intervention offered first-time parents six home visits from a paediatric nurse and a parental advisor with Social Services. On the fourth visit (infant age 6-8 months), parents received a toothbrush and fluoride toothpaste from non-dental staff. Twice, at child ages 18 and 36 months, a dentist used the International Caries Detection and Assessment System to record caries and conducted a structured interview with the parents on oral health habits. The intervention group (n = 72) was compared to a reference group (n = 100) from the standard child healthcare programme, which included one home visit.

RESULTS

Significantly, caries prevalence was lower and tooth brushing habits more consistent in the intervention group compared to the reference group in the standard child health programme. The difference was most pronounced at 18 months and had decreased at the 36-month follow-up.

CONCLUSION

The extended postnatal home visiting programme had a positive impact on oral health. Early oral health promotion delivered by non-dental professionals could be a beneficial approach to early caries prevention.

Effectiveness of preventive dental programs offered to mothers by non-dental professionals to control early childhood dental caries: a review

BACKGROUND

Early childhood caries is a common chronic childhood disease and maternal oral health is a risk factor. Improving the oral health behaviours of pregnant women/young mothers can positively influence the oral health of children and reduce their caries risk. Such preventative strategies have been undertaken by non-dental professionals producing mixed results encompassing various interventions across the perinatal period. However, no comprehensive review of these studies has been undertaken. The aim of this review was to assess the effectiveness of maternal oral health programs undertaken during the antenatal and/or postnatal period by non-dental health professionals to reduce early childhood caries.

METHODS

A systematic search of five databases was undertaken using key search terms. Studies were included if they (a) involved quantitative study designs with a control; (b) were published in English; (c) reported on interventions delivered by non-dental professionals (d) delivered the intervention to expectant mothers or mothers with young infants up to 24 months; (e) measured outcomes when the child was under 5 years; (f) measured changes in oral health outcomes of children clinically and oral health behaviours of mothers or children. No restrictions were placed on the study quality and setting.

RESULTS

Nine studies met the inclusion criteria and involved interventions delivered by diverse non-dental professionals across the antenatal (n = 1), postnatal (n = 6) and perinatal period (n = 2). Most studies were of low methodological quality (n = 6). The interventions focussed on oral health education (n = 8), dental referrals (n = 3) and oral health assessments (n = 1). Interventions conducted in either the postnatal or antenatal periods showed meaningful improvements in children's clinical and mother's behavioural oral health outcomes. The outcomes appear to be sustained when a suite of interventions were used along with referral reminders. There were mixed results from interventions across the perinatal period.

CONCLUSIONS

Non-dental professionals can promote maternal oral health by providing oral health education, risk assessment and referrals. Combining these interventions could provide a sustained improvement in oral health outcomes for children although current evidence is weak. More high-quality studies are needed to confirm these findings and determine whether the antenatal and/or postnatal period is best suited to deliver these interventions.

Dental caries prevention strategies among children and adolescents with immigrant - or low socioeconomic backgrounds- do they work? A systematic review

BACKGROUND

This systematic review was designed to uncover the most reliable evidence about the effects of caries preventive strategies in children and adolescents of immigrant or low socioeconomic backgrounds.

METHODS

According to pre-determined inclusion and exclusion criteria, relevant articles focusing on underprivileged groups were electronically selected between January1995 and October 2015. The literature search was conducted in five databases; PubMed, Embase, CINAHL, SweMed+ and Cochrane Library. Accepted languages for included articles were English, German and Scandinavian languages. Abstracts and selected articles in full text were read and assessed independently by two review authors. Systematic reviews and meta-analyses were not included. Also articles with topics of water fluoridation and fluoride toothpaste were excluded, this due to all existing evidence of anti-caries effect for disadvantaged groups. The key data about the main characteristics of the study were compiled in tables and a quality grading was performed.

RESULTS

Thirty-seven articles were selected for further evaluation. Supervised toothbrushing for 5-year-old school children was found to be an effective prevention technique for use in underprivileged groups. Also a child/mother approach, targeting nutrition and broad oral health education of mothers showed effectiveness. For older children, a slow-release fluoride device and application of acidulated phosphate fluoride (APF) gel showed to be effective.

CONCLUSION

On the basis of this review, we maintain that in addition to studies of water fluoridation and fluoride toothpaste, there are other preventive intervention studies providing scientific evidence for caries reduction among children and adolescents with immigrant or low socioeconomic backgrounds.

Oral health education program among pre-school children: an application of health-promoting schools approach

Background: Preschool children have a limit ability to take care of their teeth. The aim of this study was to determine the effect of an intervention based on Albanian’s Health Promoting Schools Model (Albanian’s HPSM) on the oral health behaviors among a group of Iranian female preschool (5-6 years old) children.

Methods: In this quasi-experimental study, 120 children in seventh district of Tehran, Iran were randomly recruited and assigned to either the intervention or the control groups. A scale was designed and validated to assess the oral health behaviors among the children and knowledge,attitude, self-efficacy beliefs, perceived barriers and oral health behaviors among the parents and the schoolteachers. An expert panel approved the content validity of the scale (CVR = 0.89,CVI = 0.90). The reliability was also approved applying intraclass correlation coefficient (range,0.83–0.92) and Cronbach alpha (range, 0.83–0.96). Based on the preliminary data, a 6-week intervention was designed and conducted to the intervention group. One month following the intervention, both groups were followed-up. The data were analyzed using covariance and paired t tests.

Results: Following the intervention, significant differences were found in the oral health behaviors of the children in the intervention group (P < 0.05) and knowledge, attitude, oral health behaviors, self-efficacy, and perceived barriers of their parents and the schoolteachers (P < 0.05).

Conclusion: Using Albanian’s health-promoting schools (HPSs) approach was useful in improving the oral hygiene behaviors among the preschool children.

Teeth Tales: a community-based child oral health promotion trial with migrant families in Australia

OBJECTIVES

The Teeth Tales trial aimed to establish a model for child oral health promotion for culturally diverse communities in Australia.

DESIGN

An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from migrant backgrounds. Mixed method, longitudinal evaluation.

SETTING

The intervention was based in Moreland, a culturally diverse locality in Melbourne, Australia.

PARTICIPANTS

Families with 1-4-year-old children, self-identified as being from Iraqi, Lebanese or Pakistani backgrounds residing in Melbourne. Participants residing close to the intervention site were allocated to intervention.

INTERVENTION

The intervention was conducted over 5 months and comprised community oral health education sessions led by peer educators and follow-up health messages.

OUTCOME MEASURES

This paper reports on the intervention impacts, process evaluation and descriptive analysis of health, knowledge and behavioural changes 18 months after baseline data collection.

RESULTS

Significant differences in the Debris Index (OR=0.44 (0.22 to 0.88)) and the Modified Gingival Index (OR=0.34 (0.19 to 0.61)) indicated increased tooth brushing and/or improved toothbrushing technique in the intervention group. An increased proportion of intervention parents, compared to those in the comparison group reported that they had been shown how to brush their child's teeth (OR=2.65 (1.49 to 4.69)). Process evaluation results highlighted the problems with recruitment and retention of the study sample (275 complete case families). The child dental screening encouraged involvement in the study, as did linking attendance with other community/cultural activities.

CONCLUSIONS

The Teeth Tales intervention was promising in terms of improving oral hygiene and parent knowledge of tooth brushing technique. Adaptations to delivery of the intervention are required to increase uptake and likely impact. A future cluster randomised controlled trial would provide strongest evidence of effectiveness if appropriate to the community, cultural and economic context.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12611000532909).

Sociodemographic conditions, knowledge of dental diseases, dental care, and dietary habits

OBJECTIVES

This study's aim was to present data on the sociodemographic conditions, knowledge of dental diseases, dental care, and dietary habits among children aged 3, 5, 10, and 15 years in Da Nang, Vietnam.

METHODS

A cross-sectional epidemiological questionnaire study was conducted in a population of 840 children randomly selected by their year and month of birth (January to July), including 210 individuals in each age group. A self-reported questionnaire was completed by the parents of 3- and 5-year-olds, and a modified questionnaire was given to 10- and 15-year-olds to complete by themselves.

RESULTS

Mass media constituted the main source of oral healthcare information. Parents assisted with tooth brushing in 86 percent of 3-year-olds and 71 percent of 5-year-olds. Fluoride toothpaste was used by 44-78 percent of children, with no clear age-related trend. Within the past year, 60 percent of 3- and 5-year-olds, 20 percent of 10-year-olds, and 49 percent of 15-year-olds reported they had not visited a dental professional. Sweets were consumed between principal meals by 70-80 percent of children. Milk with sugar was regularly consumed by 71 percent of 3-year-olds and 91 percent of 5-year-olds.

CONCLUSIONS

Children showed frequent sugar consumption and insufficient frequency of brushing their teeth with fluoride toothpaste. Food-based dietary guidelines should play a significant role in nutrition and oral health. It is especially important that oral health prevention programs reach preschool children before they establish unhealthy dietary habits. Parental education about oral health and access to oral healthcare services are also needed to improve children's oral health.

Effectiveness of oral health education in children - a systematic review of current evidence (2005-2011)

BACKGROUND

So that resources and manpower are allocated in a way of most benefit to the population, systematic review of available evidence on the effectiveness of programmes and interventions is required.

OBJECTIVES

To assess the quality of evidence presented in studies carried out to investigate the effectiveness of oral health education in children.

METHODS

The MEDLINE (PubMed) bibliographic database was searched for English-language articles published from 2005 to 2011. Fifty-five articles were identified by the literature search, and the relevance of each article was determined by examining the title and the abstract. Sixteen original research studies met the inclusion criteria. These articles were read in full and scored independently by two reviewers, with scoring based on predetermined criteria. Articles scoring less than 10 were excluded from the study. For each paper that achieved a validity score of more than 10 (n = 11), data concerning the objectives of the intervention, the types and numbers of participants and the outcomes were extracted from the article. Considering the absence of homogeneity among the articles (as a result of variation in the age of subjects, type of intervention and outcome measures) quantitative analysis was not conducted. The publications were grouped based on their outcome measures: (i) plaque and gingival health; (ii) caries incidence; (iii) knowledge, attitude and oral health-related behaviour; and (iv) toothbrushing skills.

RESULTS

The results of this analysis suggest that further efforts are required to synthesise, systematically, current information about dental health education, along with the maintenance of rigorous scientific standards in research.

An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds: a protocol paper for Teeth Tales

INTRODUCTION

Inequalities are evident in early childhood caries rates with the socially disadvantaged experiencing greater burden of disease. This study builds on formative qualitative research, conducted in the Moreland/Hume local government areas of Melbourne, Victoria 2006-2009, in response to community concerns for oral health of children from refugee and migrant backgrounds. Development of the community-based intervention described here extends the partnership approach to cogeneration of contemporary evidence with continued and meaningful involvement of investigators, community, cultural and government partners. This trial aims to establish a model for child oral health promotion for culturally diverse communities in Australia.

METHODS AND ANALYSIS

This is an exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds. Families from an Iraqi, Lebanese or Pakistani background with children aged 1-4 years, residing in metropolitan Melbourne, were invited to participate in the trial by peer educators from their respective communities using snowball and purposive sampling techniques. Target sample size was 600. Moreland, a culturally diverse, inner-urban metropolitan area of Melbourne, was chosen as the intervention site. The intervention comprised peer educator led community oral health education sessions and reorienting of dental health and family services through cultural Competency Organisational Review (CORe).

ETHICS AND DISSEMINATION

Ethics approval for this trial was granted by the University of Melbourne Human Research Ethics Committee and the Department of Education and Early Childhood Development Research Committee. Study progress and output will be disseminated via periodic newsletters, peer-reviewed research papers, reports, community seminars and at National and International conferences.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12611000532909).

Acceptability of different oral formulations in infants and preschool children

OBJECTIVE

Liquid medicines are easy to swallow. However, they may have disadvantages, such as a bad taste or refrigerated storage conditions. These disadvantages may be avoided by the use of oral solid medicines, such as powders or tablets. The aim of this study was to investigate the acceptability of and preference among four oral formulations in domiciliary infants and preschool children in The Netherlands.

METHODS

Parents administered four oral placebo dosage forms that were aimed at a neutral taste, at home, to their child (1-4 years of age) twice on one day following a randomised cross-over design: small (4 mm) tablet, powder, suspension and syrup. They were asked to report the child's acceptability by a score on a 10 cm visual analogue scale (VAS score) and by the result of the intake. At the end of the study, they were asked to report the preference of the child and themselves.

RESULTS

183 children were included and 148 children were evaluated. The data revealed a period/cross-over effect. The estimate of the mean VAS score was significantly higher for the tablet than for the suspension (tablet 9.39/9.01; powder 8.84/8.20, suspension 8.26/7.90, syrup 8.35/8.19; data day 1/all days). The estimate of the mean number of intakes fully swallowed was significantly higher for the tablet than for the other formulations (all p values <0.05). Children and parents preferred the tablet and syrup over the suspension and the suspension over the powder (all p values <0.05).

CONCLUSIONS

All formulations were well accepted. The tablets were the best accepted formulation; the tablets and syrup the most preferred.

TRIAL REGISTRATION NUMBER

ISRCTN63138435.

Overview of methods in economic analyses of behavioral interventions to promote oral health

BACKGROUND

Broad adoption of interventions that prove effective in randomized clinical trials or comparative effectiveness research may depend to a great extent on their costs and cost-effectiveness (CE). Many studies of behavioral health interventions for oral health promotion and disease prevention lack robust economic assessments of costs and CE.

OBJECTIVE

To describe methodologies employed to assess intervention costs, potential savings, net costs, CE, and the financial sustainability of behavioral health interventions to promote oral health.

METHODS

We provide an overview of terminology and strategies for conducting economic evaluations of behavioral interventions to improve oral health based on the recommendations of the Panel of Cost-Effectiveness in Health and Medicine. To illustrate these approaches, we summarize methodologies and findings from a limited number of published studies. The strategies include methods for assessing intervention costs, potential savings, net costs, CE, and financial sustainability from various perspectives (e.g., health-care provider, health system, health payer, employer, society). Statistical methods for estimating short-term and long-term economic outcomes and for examining the sensitivity of economic outcomes to cost parameters are described.

DISCUSSION

Through the use of established protocols for evaluating costs and savings, it is possible to assess and compare intervention costs, net costs, CE, and financial sustainability. The addition of economic outcomes to outcomes reflecting effectiveness, appropriateness, acceptability, and organizational sustainability strengthens evaluations of oral health interventions and increases the potential that those found to be successful in research settings will be disseminated more broadly.

Prevalence of dental fluorosis in children taking part in an oral health programme including fluoride tablet supplements from the age of 2 years

AIM

To investigate the prevalence of dental fluorosis in children who had participated in an oral health programme between the ages 2-5 years, including fluoride tablets from the age of 2 years.

DESIGN

The study group consisted of 135 10- to 11-year-old children who had participated in the programme, including parent education, tooth-brushing instruction and prescribed fluoride tablets (0.25 mg NaF) (2-3 years: 1 tablet/day; 3-5 years: 2 tablets/day). The prevalence of dental fluorosis in the study group was compared with that in a nonintervention reference group consisting of 129 children of the same ages. The analysis was based on photos of the permanent maxillary front teeth using the Thylstrup & Fejerskov (TF) Index.

RESULTS

No statistically significant difference in prevalence of dental fluorosis was seen between the two groups. Forty-three percent of the children in the study group and 38% in the reference group had fluorosis, the majority of a mild nature (TF-score 1). None had a TF score above 2. The pattern was the same after correction for parent reported intake of tablets at 3 and 5 years of age.

CONCLUSION

Introduction of fluoride tablets at the age of 2 years did not result in increased prevalence of dental fluorosis.

Caries preventive effect of fluoride in milk, salt and tablets: a literature review

BACKGROUND

There are a number of studies in the literature about the effectiveness of fluoride in tablets, fluoride added to frequently-consumed food like milk, or to food additives like salt, in prevention of dental caries. This literature has been evaluated in different evidence based reviews.

AIM

The scope of this paper was to identify the most recent evidence-based reviews on the effect in caries prevention from added fluoride in milk, salt and fluoride tablets/drops including newer RCT studies, and to synthesize the findings into practice guidelines. The key question was as follows: Does regular use of fluoride in milk, salt and fluoride tablets/ drops prevent dental caries among children and adolescents?

METHODS

MEDLINE, EMBASE and EBM reviews (Cochrane database of systematic reviews) were searched using modified filters from a Cochrane review. One evidence-based report on fluoridated milk was identified. Salt fluoridation was covered by three HTA reviews. One Cochrane protocol on the caries preventive effect of fluoridated salt was identified.

RESULTS

Very few studies of good quality were identified in general. Two studies on fluoridated milk were tabulated and seven studies dealing with fluoride tablets/ drops were analysed. One study showed a 78% reduction in caries in newly erupted permanent teeth among 8 year olds after 3 years with fluoridated milk. For primary teeth one study showed 31% caries reduction. The differences between fluoride-group and control were statistically significant. The reduction in caries prevalence in the fluoride tablet group compared with a negative control varied from 81% (carious surfaces in permanent teeth erupted in the study period) to 49% in DMFS for all permanent teeth. No RCT studies on fluoridated salt were identified.

CONCLUSION

There is limited evidence that F tablets and drops are effective, and compliance is a key factor. There are good reasons to believe that fluoride in different applications and formulas does work as caries preventive agents under supervision. There is a need for new, well-designed studies within this field, but the use of negative controls without any fluoride exposure is difficult due to ethical reasons. In particular new research is needed concerning possible caries preventive effect of fluoridated milk and salt.

Peer teaching pilot programme for caries prevention in underprivileged and migrant populations

BACKGROUND

Focused caries prevention programmes for migrant children often fail because there is an important barrier of linguistic and cultural diversity.

AIM

The aim of this study was to evaluate whether a tailored peer teaching approach can improve oral health behaviours of underprivileged and/or multinational migrant first graders.

DESIGN

Two fourth grade classes (30 children, mean age 9.6) and two first grade classes (38 children, mean age 6.6) with high migrant background participated. The fourth graders took part in a preparatory course of oral health and developed a concept for tutoring first graders in oral health concepts as well as the Fones toothbrushing method. Later then, the fourth graders instructed the first graders during two lessons. Toothbrushing of each first grader was filmed before and 7 days after instruction. Toothbrushing time, method, and systematic were evaluated.

RESULTS

After instruction, circular toothbrushing movements and systematic toothbrushing were observed significantly more often (P = 0.0001); toothbrushing time did not change.

CONCLUSIONS

This pilot study shows that tutoring by older peers of similar origin resulted in significant changes towards better oral health in underprivileged and/or multinational migrant first graders. Authentic role models could be provided, and communication and cultural barriers circumvented.

Oral health programme for preschool children: a prospective, controlled study

BACKGROUND

New perspectives are needed for oral health programmes (OHPs). The aim was to evaluate the preventive effect of a risk-based OHP in comparison with a traditional programme.

DESIGN

An age cohort of 794 Finnish children, 446 in the intervention group and 348 in the control group, was followed from 18 months to 5 years of age. The children were screened for mutans streptococci (MS) in the dental biofilm. The main outcome measure was the proportion of children with dental caries (decayed, missing, or filled primary teeth > 0) at the age of 5 years. The intervention, targeted to MS-positive subjects in the intervention group only, was based on repeated health education to the caretakers and xylitol lozenges for the child. Dental hygienists carried out the programme.

RESULTS

OHP was effective in white-collar families [numbers needed to treat (NNT) = 3, 95% CI 2-11]. Factors significantly associated with caries at 5 years were MS colonization at 18 months, occupation of caretaker, but also gender when incipient carious lesions were included in the index.

CONCLUSION

Early risk-based OHP, targeted to the families of MS-positive children, can reduce the risk for caries in white-collar families. For blue-collar families, different kinds of methods in caries prevention and support are needed.