Prevention of early childhood caries--results of a fluoride toothpaste demonstration trial on Chinese preschool children after three years

M. Is Non-Restorative Cavity Treatment a Practical Choice in Primary Teeth?

For years, “extension for prevention” was considered as the standard protocol for the restoration of caries. With advances in the field of cariology regarding the biofilm and improvement in materials, this perspective is being challenged. This is being challenged by more biological and less-invasive approaches, where the emphasis is on biofilm alteration to arrest carious lesions. This minimally invasive intervention is based on the concept that biofilm overlying the carious lesion is a driving force for the carious process and not the bacteria present in the infected dentin. Hence, daily removal or disruption of this biofilm will slow down the carious process or bring it to halt.

One such approach is non-restorative cavity treatment, where no caries is removed but lesions are made self-cleansable that allows it to be brushed by the parent or the child. This wholesome approach targets the disease at a causal level.

This review of literature describes the various advantages and limitations of this technique and the practicability of its use in pediatric patients during the pandemic COVID-19.

Preventing early childhood caries through oral health promotion and a basic package for oral care: A pragmatic trial

Introduction:

Untreated caries in mothers is one of the common risk factors for early childhood caries (ECC).

Aim:

The aim of the study was to investigate the impact of an oral health promotion program on ECC.

Methodology:

We conducted a pragmatic trial at 12 primary health centers in a rural community of India with 311 pregnant women using fluoride toothpaste, oral health information through pamphlets, and referral to urgent dental care or atraumatic dental treatment as the test intervention. Data were collected through structured interviews at baseline and oral examination of the children at 2 years of age.

Results:

Of the 311 women who participated, 274 children were followed up with at 2 years of age. ECC was low and comparable in both groups. When compared with the control group, significantly, more children from the intervention group were breastfed for over 6 months of age (P = 0.012) and consumed less sugar (P < 0.001). The number of mothers’ decayed teeth (P = 0.01), children's sweet scores (P < 0.001), and the age at which brushing commenced for children (P = 0.04) increased the likelihood of tooth decay in children.

Conclusion:

The oral health promotion program had some beneficial effects in preventing caries in children when provided to pregnant women.

Trends in caries experience and background factors in 3-year-old children in Poland: evidence from epidemiological surveys during 2002–2017

The prevalence of early childhood caries and its level varies. The present study was to establish the trends in dental caries and the impact of behavioural changes on the prevalence of caries in three-yearolds in Poland within a fifteen-year period. The results of a cross sectional survey carried out on 3439 three-year-olds in 2002, 2009, and 2017 using WHO criteria for dental caries (dmft, dmft=0, dmft≥4) and the results of a questionnaire filled by their parents with data on sociodemographics, oral hygiene and dietary habits, especially their sugar intake, were assessed. The dmft/dmfs index is applied to the primary dentition and is expressed as the total number of teeth/surfaces that are decayed, missing, or filled. The Cochran-Armitage test for trend was used to assess the fraction changes in time. The Pearson correlation coefficient was used to assess the changes in dmft trends and the correlations between behavioural changes, awareness levels, and the prevalence of caries. Within the fifteen-year period minimal changes in the prevalence of early childhood caries (15% down), dmft≥4 (11.4% down) and a lower dmft (36% down) were accompanied by a better parent awareness about the causes of caries and better oral hygiene routines. Sugary beverages were no longer drank at least once a day, however sweetened milk, cake, doughnuts, and sweet rolls were consumed more often. Being female, living in an urban area, having parents more aware about caries, consuming sugary beverages less frequently, brushing teeth twice a day, and using a fluoride toothpaste promoted lower early childhood caries. Gradually healthier teeth are linked to an increased awareness of the parents and healthier routines. A too frequent exposure to sugar promotes early childhood caries. Should the changes of dietary habits be insufficient, brushing teeth with fluoride toothpaste becomes crucial.

A systematic review of the effects of supervised toothbrushing on caries incidence in children and adolescents

BACKGROUND

The anticaries effect of supervised toothbrushing, irrespective of the effect of fluoride toothpaste, has not been clearly determined yet.

AIM

To assess the effects of supervised toothbrushing on caries incidence in children and adolescents.

DESIGN

A systematic review of controlled trials was performed (CRD42014013879). Electronic and hand searches retrieved 2046 records, 112 of which were read in full and independently assessed by two reviewers, who collected data regarding characteristics of participants, interventions, outcomes, length of follow-up and risk of bias.

RESULTS

Four trials were included and none of them had low risk of bias. They were all carried out in schools, but there was great variation regarding children's age, fluoride content of the toothpaste, baseline caries levels and the way caries incidence was reported. Among the four trials, two found statistically significant differences favouring supervised toothbrushing, but information about the magnitude and/or the precision of the effect estimate was lacking and in one trial clustering effect was not taken into consideration. No meta-analysis was performed due to the clinical heterogeneity among the included studies and differences in the reporting of data.

CONCLUSIONS

There is no conclusive evidence regarding the effectiveness of supervised toothbrushing on caries incidence.

WITHDRAWN: Community-based population-level interventions for promoting child oral health

BACKGROUND

Dental caries and gingival and periodontal disease are commonly occurring, preventable chronic conditions. Even though much is known about how to treat oral disease, currently we do not know which community-based population-level interventions are most effective and equitable in preventing poor oral health.

OBJECTIVES

Primary • To determine the effectiveness of community-based population-level oral health promotion interventions in preventing dental caries and gingival and periodontal disease among children from birth to 18 years of age. Secondary • To determine the most effective types of interventions (environmental, social, community and multi-component) and guiding theoretical frameworks.• To identify interventions that reduce inequality in oral health outcomes.• To examine the influence of context in the design, delivery and outcomes of interventions.

SEARCH METHODS

We searched the following databases from January 1996 to April 2014: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), BIOSIS Previews, Web of Science, the Database of Abstracts of Reviews of Effects (DARE), ScienceDirect, Sociological Abstracts, Social Science Citation Index, PsycINFO, SCOPUS, ProQuest Dissertations & Theses and Conference Proceedings Citation Index - Science.

SELECTION CRITERIA

Included studies were individual- and cluster-randomised controlled trials (RCTs), controlled before-and-after studies and quasi-experimental and interrupted time series. To be included, interventions had to target the primary outcomes: dental caries (measured as decayed, missing and filled deciduous teeth/surfaces, dmft/s; Decayed, Missing and Filled permanent teeth/surfaces, DMFT/S) and gingival or periodontal disease among children from birth to 18 years of age. Studies had to report on one or more of the primary outcomes at baseline and post intervention, or had to provide change scores for both intervention and control groups. Interventions were excluded if they were solely of a chemical nature (e.g. chlorhexidine, fluoride varnish), were delivered primarily in a dental clinical setting or comprised solely fluoridation.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed screening, data extraction and assessment of risk of bias of included studies (a team of six review authors - four review authors and two research assistants - assessed all studies). We calculated mean differences with 95% confidence intervals for continuous data. When data permitted, we undertook meta-analysis of primary outcome measures using a fixed-effect model to summarise results across studies. We used the I2 statistic as a measure of statistical heterogeneity.

MAIN RESULTS

This review includes findings from 38 studies (total n = 119,789 children, including one national study of 99,071 children, which contributed 80% of total participants) on community-based oral health promotion interventions delivered in a variety of settings and incorporating a range of health promotion strategies (e.g. policy, educational activities, professional oral health care, supervised toothbrushing programmes, motivational interviewing). We categorised interventions as dietary interventions (n = 3), oral health education (OHE) alone (n = 17), OHE in combination with supervised toothbrushing with fluoridated toothpaste (n = 8) and OHE in combination with a variety of other interventions (including professional preventive oral health care, n = 10). Interventions generally were implemented for less than one year (n = 26), and only 11 studies were RCTs. We graded the evidence as having moderate to very low quality.We conducted meta-analyses examining impact on dental caries of each intervention type, although not all studies provided sufficient data to allow pooling of effects across similar interventions. Meta-analyses of the effects of OHE alone on caries may show little or no effect on DMFT (two studies, mean difference (MD) 0.12, 95% confidence interval (CI) -0.11 to 0.36, low-quality evidence), dmft (three studies, MD -0.3, 95% CI -1.11 to 0.52, low-quality evidence) and DMFS (one study, MD -0.01, 95% CI -0.24 to 0.22, very low-quality evidence). Analysis of studies testing OHE in combination with supervised toothbrushing with fluoridated toothpaste may show a beneficial effect on dmfs (three studies, MD -1.59, 95% CI -2.67 to -0.52, low-quality evidence) and dmft (two studies, MD -0.97, 95% CI -1.06 to -0.89, low-quality evidence) but may show little effect on DMFS (two studies, MD -0.02, 95% CI -0.13 to 0.10, low-quality evidence) and DMFT (three studies, MD -0.02, 95% CI -0.11 to 0.07, moderate-quality evidence). Meta-analyses of two studies of OHE in an educational setting combined with professional preventive oral care in a dental clinic setting probably show a very small effect on DMFT (-0.09 weighted mean difference (WMD), 95% CI -0.1 to -0.08, moderate-quality evidence). Data were inadequate for meta-analyses on gingival health, although positive impact was reported.

AUTHORS' CONCLUSIONS

This review provides evidence of low certainty suggesting that community-based oral health promotion interventions that combine oral health education with supervised toothbrushing or professional preventive oral care can reduce dental caries in children. Other interventions, such as those that aim to promote access to fluoride, improve children's diets or provide oral health education alone, show only limited impact. We found no clear indication of when is the most effective time to intervene during childhood. Cost-effectiveness, long-term sustainability and equity of impacts and adverse outcomes were not widely reported by study authors, limiting our ability to make inferences on these aspects. More rigorous measurement and reporting of study results would improve the quality of the evidence.

Evaluation of low fluoride toothpaste using primary enamel and a validated pH-cycling model

AIM

To develop and validate pH-cycling model for primary enamel, which was then used to evaluate the anti-caries potential of fluoride toothpastes.

DESIGN

Human primary enamel slabs were subjected to pH-cycling model for 10 days and maintained for 6 h in demineralizing solution and 18 h in remineralizing solution daily. Twice/day, the slabs were treated. To validate it, the treatments were water or solutions containing 62.5, 125, 250, and 375 μg F/mL. Commercial toothpastes containing no fluoride, 500, 1100, and 1450 μg F/g were evaluated. Demineralization was assessed by percentage of surface hardness loss (%SHL) and cross-sectional hardness (ΔS). Fluoride dose-response effect was analysed by quadratic regression and the effects of toothpastes by Tukey's test.

RESULTS

Dose-response effect was found between fluoride concentration and %SHL (R²  = 0.7047; P < 0.01) or ΔS (R²  = 0.4465; P < 0.01). %SHL and ΔS (mean ± SD) for the group treated with 500 μg F/g toothpaste was 36.6 ± 8.0 and 6298.5 ± 1221.3, respectively, which were significantly higher than those treated with 1100 (25.2 ± 8.7; 4565.7 ± 1122) and 1450 μg F/g (24.2 ± 5.2; 2339.1 ± 879.7) toothpastes.

CONCLUSION

The developed pH-cycling model may be used to evaluate and compare the anti-caries potential of toothpaste formulations with low fluoride concentration because it presents dose-response effects on the reduction of primary enamel demineralization.

Community-based population-level interventions for promoting child oral health

BACKGROUND

Dental caries and gingival and periodontal disease are commonly occurring, preventable chronic conditions. Even though much is known about how to treat oral disease, currently we do not know which community-based population-level interventions are most effective and equitable in preventing poor oral health.

OBJECTIVES

Primary • To determine the effectiveness of community-based population-level oral health promotion interventions in preventing dental caries and gingival and periodontal disease among children from birth to 18 years of age. Secondary • To determine the most effective types of interventions (environmental, social, community and multi-component) and guiding theoretical frameworks.• To identify interventions that reduce inequality in oral health outcomes.• To examine the influence of context in the design, delivery and outcomes of interventions.

SEARCH METHODS

We searched the following databases from January 1996 to April 2014: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), BIOSIS Previews, Web of Science, the Database of Abstracts of Reviews of Effects (DARE), ScienceDirect, Sociological Abstracts, Social Science Citation Index, PsycINFO, SCOPUS, ProQuest Dissertations & Theses and Conference Proceedings Citation Index - Science.

SELECTION CRITERIA

Included studies were individual- and cluster-randomised controlled trials (RCTs), controlled before-and-after studies and quasi-experimental and interrupted time series. To be included, interventions had to target the primary outcomes: dental caries (measured as decayed, missing and filled deciduous teeth/surfaces, dmft/s; Decayed, Missing and Filled permanent teeth/surfaces, DMFT/S) and gingival or periodontal disease among children from birth to 18 years of age. Studies had to report on one or more of the primary outcomes at baseline and post intervention, or had to provide change scores for both intervention and control groups. Interventions were excluded if they were solely of a chemical nature (e.g. chlorhexidine, fluoride varnish), were delivered primarily in a dental clinical setting or comprised solely fluoridation.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed screening, data extraction and assessment of risk of bias of included studies (a team of six review authors - four review authors and two research assistants - assessed all studies). We calculated mean differences with 95% confidence intervals for continuous data. When data permitted, we undertook meta-analysis of primary outcome measures using a fixed-effect model to summarise results across studies. We used the I2 statistic as a measure of statistical heterogeneity.

MAIN RESULTS

This review includes findings from 38 studies (total n = 119,789 children, including one national study of 99,071 children, which contributed 80% of total participants) on community-based oral health promotion interventions delivered in a variety of settings and incorporating a range of health promotion strategies (e.g. policy, educational activities, professional oral health care, supervised toothbrushing programmes, motivational interviewing). We categorised interventions as dietary interventions (n = 3), oral health education (OHE) alone (n = 17), OHE in combination with supervised toothbrushing with fluoridated toothpaste (n = 8) and OHE in combination with a variety of other interventions (including professional preventive oral health care, n = 10). Interventions generally were implemented for less than one year (n = 26), and only 11 studies were RCTs. We graded the evidence as having moderate to very low quality.We conducted meta-analyses examining impact on dental caries of each intervention type, although not all studies provided sufficient data to allow pooling of effects across similar interventions. Meta-analyses of the effects of OHE alone on caries may show little or no effect on DMFT (two studies, mean difference (MD) 0.12, 95% confidence interval (CI) -0.11 to 0.36, low-quality evidence), dmft (three studies, MD -0.3, 95% CI -1.11 to 0.52, low-quality evidence) and DMFS (one study, MD -0.01, 95% CI -0.24 to 0.22, very low-quality evidence). Analysis of studies testing OHE in combination with supervised toothbrushing with fluoridated toothpaste may show a beneficial effect on dmfs (three studies, MD -1.59, 95% CI -2.67 to -0.52, low-quality evidence) and dmft (two studies, MD -0.97, 95% CI -1.06 to -0.89, low-quality evidence) but may show little effect on DMFS (two studies, MD -0.02, 95% CI -0.13 to 0.10, low-quality evidence) and DMFT (three studies, MD -0.02, 95% CI -0.11 to 0.07, moderate-quality evidence). Meta-analyses of two studies of OHE in an educational setting combined with professional preventive oral care in a dental clinic setting probably show a very small effect on DMFT (-0.09 weighted mean difference (WMD), 95% CI -0.1 to -0.08, moderate-quality evidence). Data were inadequate for meta-analyses on gingival health, although positive impact was reported.

AUTHORS' CONCLUSIONS

This review provides evidence of low certainty suggesting that community-based oral health promotion interventions that combine oral health education with supervised toothbrushing or professional preventive oral care can reduce dental caries in children. Other interventions, such as those that aim to promote access to fluoride, improve children's diets or provide oral health education alone, show only limited impact. We found no clear indication of when is the most effective time to intervene during childhood. Cost-effectiveness, long-term sustainability and equity of impacts and adverse outcomes were not widely reported by study authors, limiting our ability to make inferences on these aspects. More rigorous measurement and reporting of study results would improve the quality of the evidence.

Minimal intervention dentistry II: part 3. Management of non-cavitated (initial) occlusal caries lesions--non-invasive approaches through remineralisation and therapeutic sealants

Epidemiological data on dental caries show that prevention and treatment needs have evolved significantly over the past two decades. In younger patients the distribution of caries lesions is mainly found on the occlusal surfaces. The treatment approaches utilised by dentists must evolve to integrate preventive and treatment solutions tailored to the care needs, which are straightforward to implement in the dental office and whose effectiveness is underpinned by scientific evidence. This article aims to describe the principles of non-invasive management of non-cavitated (initial) occlusal caries lesions, based on evidence from recent studies published in the international literature.

"Everybody brush!": protocol for a parallel-group randomized controlled trial of a family-focused primary prevention program with distribution of oral hygiene products and education to increase frequency of toothbrushing

Background

Twice daily toothbrushing with fluoridated toothpaste is the most widely advocated preventive strategy for dental caries (tooth decay) and is recommended by professional dental associations. Not all parents, children, or adolescents follow this recommendation. This protocol describes the methods for the implementation and evaluation of a quality improvement health promotion program.

Objective

The objective of the study is to show a theory-informed, evidence-based program to improve twice daily toothbrushing and oral health-related quality of life that may reduce dental caries, dental treatment need, and costs.

Methods

The design is a parallel-group, pragmatic randomized controlled trial. Families of Medicaid-insured children and adolescents within a large dental care organization in central Oregon will participate in the trial (n=21,743). Families will be assigned to one of three groups: a test intervention, an active control, or a passive control condition. The intervention aims to address barriers and support for twice-daily toothbrushing. Families in the test condition will receive toothpaste and toothbrushes by mail for all family members every three months. In addition, they will receive education and social support to encourage toothbrushing via postcards, recorded telephone messages, and an optional participant-initiated telephone helpline. Families in the active control condition will receive the kit of supplies by mail, but no additional instructional information or telephone support. Families assigned to the passive control will be on a waiting list. The primary outcomes are restorative dental care received and, only for children younger than 36 months old at baseline, the frequency of twice-daily toothbrushing. Data will be collected through dental claims records and, for children younger than 36 months old at baseline, parent interviews and clinical exams.

Results

Enrollment of participants and baseline interviews have been completed. Final results are expected in early summer, 2017.

Conclusions

If proven effective, this simple intervention can be sustained by the dental care organization and replicated by other organizations and government.

Trial Registration

Trial Registration: ClinicalTrials.gov NCT02327507; http://clinicaltrials.gov/ct2/show/NCT02327507 (Archived by WebCite at http://www.webcitation.org/6YCIxJSor).

Glass ionomer ART sealants in Chinese school children-6-year results

OBJECTIVE

To evaluate longitudinally ART sealants placed in Chinese school children under field conditions.

METHOD

191 ART sealants were placed in 140 children, aged 11-14 years, by five assistant dentists in four secondary schools in Deyang, Sichuan Province, China. Teeth selected for sealing were those with pits and fissures that were deep or showing early enamel caries. Teeth were excluded if there was obvious cavitation extending into dentine. Standard instruments and procedures for ART sealants were used. The material used was a high-viscosity glass-ionomer (Ketac-Molar, 3MESPE) that was inserted into the pits and fissures with the "press-finger" technique. The status of the sealants was evaluated annually over 6 years after placement by the same examiner who was not involved in the placement of the sealants using explorers, mouth-mirrors and an intra-oral fibre-optic light. No missing sealants were replaced during the study.

RESULTS

107 sealants (56% of the original) were examined after 6 years. The cumulative survival rates of the sealants (partially or fully retained) after 2, 4 and 6 years were 79%, 68% and 59%, respectively. Caries prevention lagged the fall in sealant survival but remained high throughout the study period, being over 90% in the first 4 years and 85% after 6 years.

CONCLUSIONS

ART sealants placed under field conditions in Chinese schoolchildren have a high retention rate. Missing sealants should be replaced to maintain their preventive efficacy.

CLINICAL SIGNIFICANCE

The sealing of pits and fissures can be an effective caries preventive approach. Resin-based sealants have the disadvantage in that they require an optimal level of moisture control during placement. In children and in outreach situations glass ionomer ART sealants, which are more moisture tolerant, can offer a viable alternative.

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.

Oral health content of early education and child care regulations and standards

OBJECTIVE

Almost two out of every three US children younger than five receive child care from someone other than their parents. Health promotion in early education and child care (EECC) programs can improve the general health of children and families, but little is known about the role of these programs in oral health. We identified U.S. EECC program guidelines and assessed their oral health recommendations for infants and toddlers.

METHODS

State licensing regulations were obtained from the National Resource Center for Health and Safety in Child Care's online database. Professional standards were identified through a search of PubMed, early childhood organizations' websites, and early childhood literature. All EECC guidelines were reviewed for key terms related to oral health promotion in children and summarized by domains.

RESULTS

Thirty-six states include oral health in their licensing regulations, but recommendations are limited and most often address the storage of toothbrushes. Eleven sets of standards were identified, four of which make recommendations about oral health. Standards from the American Academy of Pediatrics/American Public Health Association (AAP/APHA) and the Office of Head Start (OHS) provide the most comprehensive oral health recommendations regarding screening and referral, classroom activities, and education.

CONCLUSIONS

Detailed guidelines for oral health practices exist but they exhibit large variation in number and content. States can use the comprehensive standards from the AAP/APHA and OHS to inform and strengthen the oral health content of their licensing regulations. Research is needed to determine compliance with regulations and standards, and their effect on oral health.

Oral health activities of early head start teachers directed toward children and parents

OBJECTIVES

This cross-sectional study examined Early Head Start (EHS) teachers' oral health program activities and their association with teacher and program characteristics.

METHODS

Self-completed questionnaires were distributed to the staff in all EHS programs in North Carolina. Variables for dental health activities for parents (four items) and children (four items) were constructed as the sum of responses to a 0-4 Likert-type scale (never to very frequently). Ordinary least squares regression models examined the association between teachers' oral health program activities and modifiable teacher (oral health knowledge, values, self-efficacy, dental health training, perceived barriers to dental activities) and program (director and health coordinator knowledge and perceived barriers to dental activities) characteristics.

RESULTS

Teachers in the parent (n=260) and child (n=231) analyses were a subset of the 485 staff respondents (98 percent response rate). Teachers engaged in child oral health activities (range = 0-16; mean = 9.0) more frequently than parent activities (range = 0-16; mean = 6.9). Teachers' oral health values, perceived oral health self-efficacy, dental training, and director and health coordinator knowledge were positively associated with oral health activities (P < 0.05). Perceived barriers were negatively associated with child activities (P < 0.05).

CONCLUSION

The level of oral health activity in EHS programs is less than optimal. Several characteristics of EHS staff were identified that can be targeted with education interventions. Evidence for effectiveness of EHS interventions needs to be strengthened, but results of this survey provide encouraging findings about the potential effects of teacher training on their oral health practices.

Managing dental caries in children in Turkey--a discussion paper

BACKGROUND

This paper describes the oral healthcare system and disease situation amongst children in Turkey. Considering the high prevalence and severity of dental caries, a proposal for improvement of oral health in this population group is formulated.

DISCUSSION

A virtual absence of palliative, preventive and restorative care characterises juvenile oral healthcare in Turkey. Consequently, carious cavities remain untreated, which may lead to pain, discomfort and functional limitation and, further, may impact negatively upon general health and cognitive development. As a first step to controlling dental caries, a national health programme including promotional, preventive and minimal intervention approaches for managing dental caries is proposed. The pros and cons of community-oriented caries-preventive measures are discussed. Daily tooth brushing with fluoridated toothpaste at home, in mother- and child-care centres, kindergartens, and schools is highlighted.

SUMMARY

The dental profession, government, university officials and other stakeholders need to meet and determine how best the oral health of children in Turkey can be improved. The present proposed plan is considered a starting point.

Update on early childhood caries since the Surgeon General's Report

The 2000 Surgeon General's Report on Oral Health included a limited discussion of the condition known as early childhood caries. Because of its high prevalence, its impact on young children's quality of life and potential for increasing their risk of caries in the permanent dentition, early childhood caries is arguably one of the most serious and costly health conditions among young children. A necessary first step in preventing dental caries in preschool children is understanding and evaluating the child's caries risk factors. Previous caries experience and white spot lesions should automatically classify a preschool child as high risk for caries. Microbial factors, such as presence of visible plaque and tests that identify a child as having high levels of mutans streptococci, also predict caries in young children. Frequency of sugar consumption, enamel developmental defects, social factors such as socioeconomic status, psychosocial factors, and being an ethnic minority also have shown to be relevant in determining caries risk. On the basis of this knowledge of specific risk factors for an individual, different preventive strategies and different intensities of preventive therapies can be implemented. Caries preventive strategies in preschool children include fluoride therapy, such as supervised tooth brushing with a fluoridated dentifrice, systemic fluoride supplement to children who live in a nonfluoridated area and who are at risk for caries, and professional topical fluoride with fluoride varnish. There is emerging evidence that intensive patient counseling or motivational interviews with parents to change specific behaviors may reduce caries prevalence in their children. Findings regarding antimicrobial interventions, efforts to modify diets, and traditional dental health education are less consistent.

Prevention of early childhood caries (ECC)--review of literature published 1998-2007

AIM

This was to examine the literature published during the last decade and review the effectiveness of methods used for the prevention of early childhood caries (ECC).

STUDY DESIGN

A critical review of papers.

METHODS

A broad search of the PubMed database was conducted from 1998 through September 2007, using "early childhood caries", "baby bottle tooth decay", "nursing caries", "infant caries", "caries prevention" and "oral health education" as index terms. Relevant papers published in English between 1998 and 2007 were identified after a review of their abstracts. Papers were selected if they reported a prospective controlled design with preventive or non-invasive intervention directed to children under the age of 3 years. A defined endpoint measure of cavitated or non-cavitated clinical caries, expressed as incidence or prevalence, was required. The targeted publications were critically assessed by the author concerning design, methodology and performance.

RESULTS

The initial search revealed 66 papers of which 22 met the inclusion criteria. The results reinforced the role of fluoride toothpaste as the most cost-effective home-care measure and semi-annual fluoride varnish applications as the best professional method for infants at risk. The evidence concerning the preventive effect of antibacterial agents, primary-primary prevention and dental health education were inconclusive but the included studies supported the importance of early start, outreach activities and motivational interviewing as key factors to overcome cultural and socioeconomic barriers.

CONCLUSIONS

Although there is a body of evidence for the use of fluoride in preventing ECC, further high-quality studies are needed to further establish the best way to maintain oral health in infants.

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

BACKGROUND

Despite a significant reduction in the prevalence of dental caries, childhood tooth decay is still a public health problem in both developed and developing countries.

OBJECTIVE

The aim of this study was to evaluate the caries preventive effect of an oral health programme for preschool children living in a low socioeconomic multicultural area in the city of Malmö, Sweden.

METHODS

Eight hundred and four 2-year-old children were enrolled and recalled every third month between ages 2 and 3 and semi-annually between ages 3 and 5 years. From an outreach facility, parents were instructed on oral health with a focus on toothbrushing and diet, and provided fluoride tablets free of charge. Participants completed a clinical examination and a structured interview at age of 5 years, at which point 651 children (81%) remained in the programme. The results of the intervention group were compared with a non-intervention reference group consisting of 201 5-year-old children from the same district.

RESULTS

In the intervention group, 96% attended four or more of their scheduled appointments, and mean caries prevalence was significantly lower than in the reference group (5.4 deft vs. 6.9 deft; P < 0.001). The prevented defs fraction was 27%. Parents' daily assistance with toothbrushing and administering fluoride tablets was significantly better in the intervention group than in the reference group (P < 0.05).

CONCLUSION

This study demonstrated that the early start of oral health programme had a significant beneficial effect on caries prevalence after 3 years.

Caries experience in preschool children referred for specialist dental care in hospital

BACKGROUND

Increasing numbers of preschool children are being referred for specialist dental management in a paediatric hospital. Most cases have severe early childhood caries and require comprehensive management under general anaesthesia. The present study investigated risk factors for disease presence at initial consultation.

METHODS

A convenience sample of 125 children under four years of age from the north Brisbane region were examined and caries experience recorded using dmft and dmfs indices. A self-administered questionnaire obtained information regarding social, demographic, birth, neonatal, infant feeding and dental health behaviour variables. The data were analysed using the chi-square and one-way analysis of variance procedures.

RESULTS

Ninety-four per cent of referred children had severe ECC with mean dmft of 10.5 +/- 3.8 and mean dmfs of 27.1 +/- 15.1. Prevalence of severe ECC was significantly higher in children allowed a sweetened liquid in the infant feeding bottle (99 per cent) and allowed to sip from an infant feeding bottle during the day (100 per cent). Mean dmfs was significantly higher in children allowed to sleep with a bottle (28.7) and sip from a bottle during the day (29.9), children from a non-Caucasian background (31.8), those children that commenced regular toothbrushing between 6 to 12 months of age (28.1), had no current parental supervision of daily tooth-brushing (34.2) and had not taken daily fluoride supplements (27.8), vitamin supplements (27.8) or prescription medicine previously (27.6).

CONCLUSIONS

The behavioural determinants for severe early childhood caries presence in hospital-referred children were similar to those identified in the regional preschool population.

Preventive strategies in oral health promotion

The biofilm control is a considerable factor in the prevention and treatment of oral diseases as caries and periodontal disease. However, according to the literature, the collective programs show frustrating results at long-term due to difficulty to change the behavior of the participant individuals. Therefore, taking into consideration the model of the dental practice in Brazil, where the population has an oral health needfulness, the purpose of this study is to introduce different strategies that allow the accomplishment of collective programs, so that they succeed in the promotion of the oral health either in individual or collective level.

Caries-preventive effect of an oral health program for preschool children in a low socio-economic, multicultural area in Sweden: results after one year

The aim of this study was to evaluate the caries-preventive effect of an oral health program for preschool children living in a multicultural, low socio-economic area. In total, 804 2-year-old children were invited and recalled every 3rd month to an outreach facility for parent education and toothbrushing instruction. In addition, fluoride tablets (0.25 mg/day) were provided free of charge. A clinical examination and questionnaire were completed at baseline and at age 3 years. The results of the intervention were compared with a non-intervention Reference group of 3-year-old children (n=217) from the same area. In the Intervention group, the 1-year attrition rate was 8.2%, and more than 90% of the children attended at least 4 of their scheduled appointments. The parents' daily assistance with toothbrushing and the use of fluoride toothpaste and tablets improved significantly during the intervention. Compared with the Reference group when the children were 3 years old, the number of children in the Intervention group who consumed frequent in-between meals and sweet drinks at night was significantly lower. Caries prevalence at age 3 was significantly lower in the Intervention group than in the Reference group (3.0 deft versus 4.4 deft; p<0.01). The number of caries-free children after the 1-year intervention was 37% in the Intervention group compared with 15% in the Reference group. The relative risk (RR) was calculated to be 2.5 (95% CI 1.8-3.4) and the number needed to treat (NNT) 4.6. In conclusion, this study demonstrated that the oral health program significantly affected the prevalence of caries and various risk factors for caries development.

Visual and visuo-tactile detection of dental caries

The objective of this review is to describe and discuss the content validity of a sample of caries detection criteria reported in the literature between January 1, 1966, and May 1, 2000. Using filters to locate randomized or controlled clinical trials on dental caries, fluorides, sealants, and "restorative" care, I identified a total of 171 documents from MEDLINE and the Cochrane Collaboration's Oral Health Group (CC-OHG) special register. These articles met the following inclusion criteria: (1) Data had been collected from samples of patients or populations; and (2) dental caries was assessed clinically, and criteria were either published or described in the paper. From the selected articles, evidence tables were prepared describing each caries detection criterion. Analysis of the content validity of the criteria systems was based on evaluation of the disease process, exclusion of non-caries lesions, subjectivity, use of explorers, and drying of teeth prior to examination. This review included 29 unique criteria systems. Of those, 13 originated from the UK, 3 from the USA, 4 from Denmark, and others from the World Health Organization (WHO), Sweden, Switzerland, Norway, Netherlands, and Canada. Thirteen of the criteria systems either measured active and inactive early and cavitated lesions or defined separate criteria for smooth and occlusal tooth surfaces. Nine systems measured early as well as cavitated stages of the caries process, and 7 measured cavitation only. Eleven of the criteria systems provided explicit descriptions of the disease process measured or information on how to exclude non-caries from caries lesions. The use of explorers and drying and cleaning of teeth varied widely among the criteria. The majority of the newly developed criteria systems originated from Europe. In conclusion, this review of the content validity of the 29 criteria systems found substantial variability in disease processes measured, inclusion and exclusion criteria, and examination conditions.

Effect of a school-based oral health education programme in Wuhan City, Peoples Republic of China

OBJECTIVES

To assess oral health outcomes of a school-based oral health education (OHE) programme on children, mothers and schoolteachers in China, and to evaluate the methods applied and materials used.

DESIGN

The WHO Health Promoting Schools Project applied to primary schoolchildren in 3 experimental and 3 control schools in Hongshan District, Wuhan City, Central China, with a 3-year follow-up. Data on dental caries, gingival bleeding and behaviour were collected.

PARTICIPANTS

803 children and their mothers, and 369 teachers were included at baseline in 1998. After three years, 666 children and their mothers (response rate 83%), and 347 teachers (response rate 94%) remained.

RESULTS

DMFT/DMFS increments were comparable but the f/F components were higher among children in experimental schools than in control schools and the gingival bleeding score was, similarly, significantly lower. More children in experimental schools adopted regular oral health behaviour such as toothbrushing, recent dental visits, use of fluoride toothpaste, with less frequent consumption of cakes/biscuits compared to controls. In experimental schools, mothers showed significant beneficial oral health developments, while teachers showed higher oral health knowledge and more positive attitudes, also being satisfied with training workshops, methods applied, materials used and involvement with children in OHE.

CONCLUSIONS

The programme had positive effects on gingival bleeding score and oral health behaviour of children, and on oral health knowledge and attitudes of mothers and teachers. No positive effect on dental caries incidence rate was demonstrated by the OHE programme.

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

OBJECTIVES

To evaluate the effect of a 2-year oral health education and caries prevention program implemented in kindergartens in China.

METHODS

Seven hundred and thirty-one 3-year-old children were recruited from 10 kindergartens in Miyun County, Beijing, China. The kindergartens were randomly divided into two groups. Oral health education was provided to teachers in the test kindergartens every 3 months. Oral health education sessions were conducted for the test children monthly and for their parents semiannually. Children in the test kindergarten brushed their teeth twice daily with fluoridated toothpaste (1100 ppm F-) in their kindergarten under the supervision of teachers during weekdays. No oral health education session and no supervised tooth brushing activities were carried out in the control kindergartens. A clinical examination of the study children and a questionnaire survey of their parents were conducted at baseline and after a 2-year program.

RESULTS

Five hundred and fourteen children remained in the study after 2 years. The mean caries increments of the test group (n = 258) and the control group (n = 256) were 2.47 and 3.56 dmfs, respectively. The reduction in dmfs increment was 30.6% (P = 0.009). At the evaluation, a significantly higher percentage of children in the test group than in the control group reported brushing their teeth twice a day (87.6% vs. 69.0%; P < 0.001). Parents of children in the test group had better oral health knowledge and attitude than the parents of children in the control group.

CONCLUSION

This oral health education program was effective in establishing good oral health habits among preschool children and in increasing oral health knowledge of their parents, in conjunction with supervised daily tooth brushing with fluoridated toothpaste, which could reduce the development of new dental caries in preschool children in China.

Effectiveness of primary school-based oral health education in West Java, Indonesia

A study in West Java has indicated that involvement of primary health care personnel and schoolteachers in oral health education (OHE) at primary schools is a feasible approach that is sustainable.

AIM

The present study aims to assess the effects of that school-based OHE programme on pupils who had completed the programme one and a half years ago.

METHODS

Eight experimental and six control primary schools in the same area participated in the study. Out of each school 10 children, aged 8-12-years old, were randomly selected.

RESULTS

ANOVA with age and gender as co-variables showed statistically significantly lower (21%) habitual plaque scores among children from experimental schools as compared to those from control schools. Tooth brushing effectiveness had significantly improved among experimental children and they took longer for tooth brushing when supervised. The dmft/dmfs values were comparable but the DMFT/DMFS values of children from experimental schools tended to be lower (not statistically significant) than of those from control schools. Differences in oral health knowledge were apparent but self-reported habits pertaining to oral health were comparable between children from experimental and control schools.

CONCLUSION

This school-based OHE programme had a moderate positive effect on oral health knowledge and on habitual plaque levels and on the effectiveness of tooth brushing. The effects on caries levels and on self-reported behaviour were inconclusive.

Caries risk assessment and prevention: strategies for Head Start, Early Head Start, and WIC

OBJECTIVES

This review updates the evidence regarding caries risk assessment for infants, toddlers, and preschool children and formulates recommendations for preventive strategies for WIC, Head Start, and Early Head Start.

METHODS

Literature on caries risk assessment and preventive strategies for infants, toddlers, and preschool children were reviewed and synthesized. Recommendations for WIC, Head Start, and Early Head Start were made based on the review.

RESULTS

Individual caries risk for children in WIC, Head Start, and Early Head Start should be based on: (1) previous caries experience, (2) precavity lesions, (3) visible plaque, and (4) perceived risk by examiners. Recommended preventive strategies for WIC and Head Start populations include: (1) daily toothbrushing in Head Start centers using fluoridated toothpaste; (2) fluoride varnish application to children enrolled in WIC, Head Start, and Early Head Start; (3) use of chlorhexidine gels and varnishes (following FDA approval); and (4) increased use of sealants on children with precavity pit and fissure lesions.

CONCLUSIONS

Early screening, risk assessment, and preventive programs in WIC, Head Start, and Early Head Start populations hold a great deal of promise for preventing dental decay in high-risk children.

Provision of Atraumatic Restorative Treatment (ART) restorations to Chinese pre-school children--a 30-month evaluation

OBJECTIVES

The objectives of this study were: to provide restorations using the ART approach to pre-school children in Southern China in a kindergarten environment, using a high-strength glass-ionomer restorative material; to assess the acceptability of this approach and to evaluate on a longitudinal basis the restorations placed.

SAMPLE AND METHODS

A total of 170 ART restorations were placed in 95 children, aged 5.1 +/- 0.7 years, by seven final-year dental students using standard ART procedures and hand instruments. The restorations were evaluated every six months thereafter by two calibrated independent examiners using explorers and mouth-mirrors.

RESULTS

93% of the children reported that they did not feel pain during treatment and 86% were willing to receive ART restorations again. The cumulative 12- and 30-month survival rates of Class I restorations were 91% and 79%, respectively. The corresponding figures for Class V restorations were 79% and 70%, while those for Class II restorations were 75% and 51%. The failure rates of Class III and IV restorations were high with more than half of them scored as missing within the first year.

CONCLUSIONS

The ART approach was shown to be acceptable to Chinese pre-school children for providing restorative dental care outside the traditional clinical setting. The success rates were high for Class I and V restorations in primary teeth, modest for Class II, and low for Class III and IV restorations.

Caries patterns and their relationship to infant feeding and socio-economic status in 2-4-year-old Chinese children

AIMS

To describe the prevalence, severity and patterns of caries in 2-4-year-old children and to evaluate the association between caries experience of the children and their feeding patterns and socio-economic background in terms of mothers' education and family income.

DESIGN

Cross-sectional survey.

SETTING

Suburban area of Hanchuan in Hubei province, China.

PARTICIPANTS

A sample of 426 children (250 boys and 176 girls).

METHODS

Dental-examinations were undertaken in kindergartens using World Health Organization diagnostic criteria for dental caries. Mothers completed a short questionnaire.

OUTCOME MEASURES

Prevalence of caries; rampant caries; caries in incisors; caries in incisors and/or canines and molars; mean number of decayed, missing and filled teeth/surfaces (dmft/s).

RESULTS

36% of the children had caries, 7% had rampant caries. The more extensive pattern of caries involving primary molars as well as incisors and/or canines was seen in 12% of children. Children who had been wholly bottle-fed had five times the risk of having rampant caries compared to children who were breast-fed.

CONCLUSIONS

The results indicated that infant feeding practice might be a key risk factor for the development of caries at an early age in this country as elsewhere.

A systematic review of clinical diagnostic criteria of early childhood caries

OBJECTIVE

This paper reviews case definitions and clinical diagnostic criteria of early childhood caries (ECC) and severe ECC (S-ECC) in children aged 1 to 5 years old. The acronym S-ECC as used in this paper refers to nursing caries, baby bottle tooth decay, rampant caries, labial caries, maxillary anterior caries, and other terms used to refer to severe dental caries in preschool children.

METHODS

A search was carried out for articles published in peer-reviewed journals and indexed in MEDLINE using the following terms: nursing caries, baby bottle tooth decay, early childhood caries, rampant caries in preschool children, labial caries, maxillary anterior caries, and nursing bottle caries. MEDLINE's MeSH terms "dental caries" and "deciduous teeth" were used to search for other relevant studies. Reports were selected if they included children 1 to 5 years of age and described diagnostic criteria or case definitions of S-ECC. Three previous reviews were searched for other relevant reports. One unpublished report was included in this review and data from NHANES III were analyzed to provide information on caries patterns in preschool children in the United States. The first author read all the abstracts from the MEDLINE search and tagged relevant reports for photocopying. He also abstracted all the information from the reports. The first author calibrated the second author, who independently read all included and excluded reports. Disagreements were resolved by consensus.

RESULTS

Out of 126 studies, 32 were excluded and 94 (93 published and 1 unpublished) were included in this review. Eighty-one of the 94 published studies were cross-sectional surveys or clinical studies, 7 were case-control clinical studies, 2 studies were controlled clinical trials, and 4 were cohort or field trials. About two-thirds of the included studies did not report on calibration of examiners. Information on reliability of examiners was reported by 19 of the 94 studies. The included studies varied widely in the name used to identify S-ECC, case definitions, and diagnostic criteria. "Cavitation" was the most common criterion used to define dental caries. Several studies measured early or noncavitated carious lesions. Twenty-seven studies used the presence of 1 dmf maxillary incisor to classify a child with S-ECC. Another 23 and 9 studies defined S-ECC by the presence of 2+ or 3+ dmf maxillary incisors, respectively. Dental caries in preschool children clusters in pits and fissures and on smooth tooth surfaces of primary molars and maxillary incisors.

CONCLUSIONS

This review found a wide variation in the case definitions and diagnostic criteria used to diagnose ECC or define S-ECC. Dental caries in the maxillary incisors is one of several patterns of dental caries that may occur in primary teeth of preschool children. A consensus is needed on case definitions and diagnostic criteria that can assist researchers to test preventive interventions and study the etiology and epidemiology of ECC.

Arresting dentine caries in Chinese preschool children

OBJECTIVES

To investigate the incidence of rehardening of caries lesions in children in Southern China taking part in a preventive programme.

DESIGN

Longitudinal study.

SAMPLE AND METHODS

A prevention programme was established for 168 3-6-year-old children in a kindergarten (KG1), which included regular oral health education sessions and a daily toothbrushing exercise using fluoridated toothpaste (1000 ppm F). A group of 121 children studying in two other kindergartens without a preventive programme formed the controls. Due to lack of resources and dental personnel, restorative and other curative treatments were not provided.

RESULTS

Rehardening of dentine caries (arrested caries) was found in children in both test and control groups. At the third annual examination, 45% of the caries lesions on the proximal surfaces of primary anterior teeth in KG1 children found at the baseline and previous annual examinations had become arrested. A multiple linear regression analysis indicated that baseline ds score and its interactions with the prevention programme, gender and the child's oral hygiene all had significant effect on the number of tooth surfaces with arrested caries at the third annual examination.

CONCLUSION

Results from this study support the use of simple prevention programmes to stabilize the caries situation in communities where intensive use of trained dental personnel is not feasible.