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Almutairi B, Conway D, Ross A, Hattan M, Almogren F, McMahon AD. Toothbrushing programme in Saudi Arabia 'TOPS': a study protocol for a cluster randomised controlled trial in kindergartens, Riyadh. BMJ Open 2024; 14:e083504. [PMID: 39097315 PMCID: PMC11298734 DOI: 10.1136/bmjopen-2023-083504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/16/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Dental caries among children is a major global health problem and is a particular public health challenge in Saudi Arabia. Dental caries cause pain, infection and negatively impact quality of life. As part of population oral health improvement efforts in Saudi Arabia, this project aims to evaluate the effectiveness of a supervised toothbrushing programme in kindergartens. METHODS AND ANALYSIS This study is a cluster randomised controlled trial. Enrolment began in September 2022, for two academic years (2022-2024) on 20 randomly selected kindergartens in Riyadh. The data collection phase will be completed in September 2024. Ten kindergartens are randomly allocated to supervised toothbrushing and 10 to treatment as usual, which is an annual oral health awareness visit. The primary endpoint will be the worsening of obvious decay experience as measured by decayed (into dentine), missing and filled teeth (d3mft) from baseline to the second year of follow-up. The secondary endpoint will be the increase in the number of teeth affected. A priori subgroups of the region of Riyadh, school type (public, private), child sex and presence/absence of prior decay at baseline, will be analysed. We require 244 evaluable endpoints using a power of 80% to meet the sample size requirement. In addition, questionnaires on behaviours, quality of life, process monitoring and cost analysis are being deployed. ETHICS AND DISSEMINATION Ethics approval for this study was given by the King Fahad Medical City Institutional Review Board in the Saudi Ministry of Health (22-083E/March 2022). The data analysis has been approved by the University of Glasgow Medical Veterinary and Life Sciences Research Ethical Committee (200220194/March 2023). The results of this study will be disseminated through presentations at scientific conferences and in scientific journals. TRIAL REGISTRATION NUMBER NCT05512156.
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Affiliation(s)
- Budur Almutairi
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
- Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
| | - D Conway
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | - Alastair Ross
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | | | | | - Alex D McMahon
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
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Sharda S, Gupta A, Jyani G, Prinja S, Goyal A. Modeling the cost-effectiveness of school-based supervised toothbrushing program in reducing the dental caries burden in India. Int J Paediatr Dent 2024. [PMID: 38807269 DOI: 10.1111/ipd.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Supervised toothbrushing (STB) significantly reduces the incidence and progression of dental caries. School years present a favorable age for introducing such healthy habits for a lifetime. AIM To estimate the cost-effectiveness of implementing a STB program in India in preventing dental caries incidence. DESIGN An operational framework of a national STB program was devised. A mathematical model was then developed to evaluate this program's clinical effectiveness and economic impact in the Indian scenario. This study considered a hypothetical cohort of the Indian population aged from 6 to 75 years. Two groups were compared: no intervention and STB in government schools. The health outcomes assessed were a number of tooth caries incidences averted and quality-adjusted life years gained. RESULTS The STB program in the government schools of India would prevent at least one tooth from developing caries in an individual's lifetime. Considering the current treatment-seeking behavior, the STB program saves INR 153 (US$ 1.95) per carious tooth incidence averted and INR 22 202 (US$ 283) per QALY gained. CONCLUSION In India, the school-based STB program is expected to be a cost-effective strategy for reducing the dental caries burden and its associated treatment costs.
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Affiliation(s)
- Shweta Sharda
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Arpit Gupta
- Unit of Public Health & Preventive Dentistry, Oral Health Sciences CentreI National Resource Centre for Oral Healthcare of Children & Elderly, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashima Goyal
- Head, Oral Health Sciences Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Gomersall JC, Slack-Smith L, Kilpatrick N, Muthu MS, Riggs E. Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries. Cochrane Database Syst Rev 2024; 5:CD012155. [PMID: 38753314 PMCID: PMC11098061 DOI: 10.1002/14651858.cd012155.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Dental caries, a common chronic disease of childhood, is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC). This review updates one published in 2019. OBJECTIVES To assess the effects of interventions undertaken with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years). SEARCH METHODS We searched Cochrane Oral Health's Trials Register, Cochrane Pregnancy and Childbirth's Trials Register, CENTRAL, MEDLINE (Ovid), Embase (Ovid), CINAHL EBSCO, the US National Institutes of Health Ongoing Trials Register (clinicaltrials.gov) and WHO International Clinical Trials Registry Platform (apps.who.int/trialsearch). The latest searches were run on 3 January, 2023. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing interventions with pregnant women, or new mothers and other primary caregivers of infants in the first year of life, against standard care, placebo or another intervention, reporting on a primary outcome: caries presence in primary teeth, dmfs (decayed, missing, filled primary surfaces index), or dmft (decayed, missing, filled teeth index), in children up to six years of age. Intervention types include clinical, oral health promotion/education (hygiene education, breastfeeding and other dietary advice) and policy or service. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence (GRADE). MAIN RESULTS We included 23 RCTs (5 cluster-randomised), involving 25,953 caregivers (mainly mothers) and their children. Fifteen trials assessed oral health education/promotion interventions against standard care. Six trials assessed a clinical intervention for mother dentition, against placebo, or a different type of clinical intervention. Two trials assessed oral health/education promotion plus clinical intervention (for mother's dentition) against standard care. At most, five trials (maximum of 1326 children and 130 mothers) contributed data to any comparison. Enamel-only caries were included in the diagnosis of caries in some studies. For many trials, the risk of bias was unclear due to lack of methodological details reported. In thirteen trials, participants were socioeconomically disadvantaged. No trial indicated receiving funding that was likely to have influenced their results. Oral health education/promotion interventions Child diet and feeding practice advice versus standard care: We observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a slightly lower mean dmfs (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, the evidence is very uncertain regarding the difference between groups in mean dmft (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). Breastfeeding promotion and support versus standard care: We observed little or no difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence) and in mean dmft (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). dmfs was not reported. Child diet advice compared with standard care: We are very uncertain about the effect on the risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). dmfs and dmft were not reported. Oral hygiene, child diet and feeding practice advice versus standard care: The evidence is very uncertain about the effect on the risk of caries presence in primary teeth (RR 0.73, 95% CI 0.50 to 1.07; 5 trials; 1326 participants; very low-certainty evidence) and there maybe little to no difference in mean dmfs (MD -0.87, 95% CI -2.18 to 0.43; 2 trials; 657 participants; low-certainty evidence) and mean dmft (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; low-certainty evidence). High-dose versus low-dose vitamin D supplementation during pregnancy: We are very uncertain about the effect on risk of caries presence in primary teeth (RR 0.99, 95% CI 0.70 to 1.41; 1 trial; 496 participants; very low-certainty evidence). dmfs and dmft were not reported. Clinical interventions (for mother dentition) Chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo: We are very uncertain regarding the difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment for mother dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trial reported dmfs or dmft. Xylitol compared with CHX antimicrobial treatment: We are very uncertain about the effect on caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence), but we observed there may be a lower mean dmft with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence). No trial reported dmfs. Oral health education/promotion plus clinical interventions (for mother dentition) Diet and feeding practice advice for infants and young children plus basic dental care for mothers compared with standard care: We are very uncertain about the effect on risk of caries presence in primary teeth (RR 0.44, 95% CI 0.05 to 3.95; 2 trials, 324 participants; very low-certainty evidence) or on mean dmft (1 study, not estimable). No trial reported dmfs. No trials evaluated policy or health service interventions. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very-low certainty and is insufficient for determining which, if any, other intervention types and features may be effective for preventing ECC, and in which settings. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine the effects and relative effects of different interventions and inform practice. We have identified 13 ongoing studies. Future studies should consider if and how effects are modified by intervention features and participant characteristics (including socioeconomic status).
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Affiliation(s)
- Judith C Gomersall
- Life Course and Intergenerational Health Research Group, Robinson Research Institute and School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Nicky Kilpatrick
- Vascular Biology, Murdoch Children's Research Institute, Melbourne, Australia
- Plastic and Maxillofacial Surgery, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Carlton, Australia
| | - M S Muthu
- Centre for Early Childhood Caries Research, Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
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Gimenez T, Estevam LR, de Oliveira Ponte Y, Dalboni A, Calvo AFB, Tedesco TK, Pontes LRA, Moro BLP, Raggio DP, Braga MM, Mendes FM. Is there an acceptable surrogate for caries clinical trials? Evidence from a systematic review of primary studies. Community Dent Oral Epidemiol 2023; 51:1057-1064. [PMID: 37246464 DOI: 10.1111/cdoe.12861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND There is currently a lack of evidence supporting the use of valid surrogates in caries clinical trials. This study aimed at examining the validity of two surrogate outcomes used in randomized clinical trials for caries prevention, pit and fissure sealants and fluoridated dentifrices, according to the Prentice criteria. METHODS A systematic review was conducted in MEDLINE (PubMed), LILACS and Scopus databases up to 05 October 2022. The grey literature and the list of eligible studies' references were also screened. The search was conducted, selecting randomized clinical trials focussed on dental caries prevention using pit and fissure sealants or fluoridated dentifrices and with at least one surrogate endpoint for cavitated caries lesions. The risk of each surrogate endpoint and for the occurrence of cavitated caries lesions was calculated and compared. The association between each surrogate and the presence of cavitation was quantified, and each outcome was assessed graphically for validity according to the Prentice criteria. RESULTS For pit and fissure sealants, from 1696 potentially eligible studies, 51 were included; while for fluoridated dentifrices, of 3887 potentially eligible studies, four were included. Possible surrogates assessed were retention of sealants, presence of white spot lesions, presence of plaque or marginal discoloration around the sealants, oral hygiene index, radiographic and fluorescence caries lesion assessments. However, only the retention of sealants and the presence of white spot lesions could be evaluated for their validity according to the Prentice criteria. CONCLUSION Loss of retention of sealants and the presence of white spot lesions do not fulfil all of the Prentice criteria. Therefore, they cannot be considered valid surrogates for caries prevention.
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Affiliation(s)
- Thais Gimenez
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Luana Rodrigues Estevam
- Graduate Program in Dentistry, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo Mandic, Campinas, Brazil
| | - Yohana de Oliveira Ponte
- Graduate Program in Dentistry, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo Mandic, Campinas, Brazil
| | - Adriana Dalboni
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Ana Flávia Bissoto Calvo
- Graduate Program in Dentistry, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo Mandic, Campinas, Brazil
| | | | | | | | - Daniela Prócida Raggio
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
- School of Dentistry, Cardiff University, Cardiff, UK
| | - Mariana Minatel Braga
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
| | - Fausto Medeiros Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
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Ugolini A, Porro F, Carli F, Agostino P, Silvestrini-Biavati A, Riccomagno E. Probabilistic graphical modelling of early childhood caries development. PLoS One 2023; 18:e0293221. [PMID: 37903153 PMCID: PMC10615302 DOI: 10.1371/journal.pone.0293221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/23/2023] [Indexed: 11/01/2023] Open
Abstract
In order to develop a statistical model for complex interactions among factors affecting early childhood caries development (ECC), 234 children from the "XXXX oral growth longitudinal study" were analysed at ages 3, 4 and 5. A questionnaire for children's parents (clinical history, nutritional and oral hygiene habits) and clinical oral examinations were recorded each year. The probabilistic dependence structure on the most significant factors was modelled with an Undirected Graphical Model (UGM or Markov random fields) which provides a probabilistic reasoning approach for the establishment of multi-way associations. The best fitting UGM was estimated through the maximum likelihood principle and two-way factor associations were verified through Fisher's exact statistical hypothesis tests for count data. The effect of sugar intake on caries incidence is mediated by oral hygiene; for caries incidence, oral hygiene quality is more relevant than toothbrushing time; the effect of pacifier on caries incidence is statistically significant only when considered in combination with breastfeeding time. Among behavioural ECC risk factors, the quality of oral hygiene, and not the toothbrushing frequency, is a primary factor that modulates the sugar intake in his primary role of the ECC developer. School-based oral health programs for ECC prevention should be improved with supervised toothbrushing program. UGM analysis could improve the school-based oral health programs with more effective and efficient prevention strategies based on the hierarchical interactions among the ECC risk factors. Oral hygiene plays a pivotal role in early childhood caries and can modulate positively or negatively their development. Supervised toothbrushing is a crucial intervention to be included in the daily educational and clinical practice and in the school-based oral health promotion programs. Trial registration: Clinical trial registration number: NCT02798809.
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Affiliation(s)
- Alessandro Ugolini
- Department of Surgical and Integrated Diagnostic Sciences, University of Genova, Genoa, Italy
| | - Francesco Porro
- Department of Mathematics, University of Genova, Genoa, Italy
| | - Federico Carli
- Department of Mathematics, University of Genova, Genoa, Italy
| | - Paola Agostino
- Department of Surgical and Integrated Diagnostic Sciences, University of Genova, Genoa, Italy
| | | | - Eva Riccomagno
- Department of Mathematics, University of Genova, Genoa, Italy
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Alayadi H, Alsiwat A, AlAkeel H, Alaskar M, Alwadi M, Sabbah W. Impact of virtual supervised tooth brushing on caries experience and quality of life among primary school children: study protocol for a randomized controlled trial. Trials 2023; 24:118. [PMID: 36803406 PMCID: PMC9939371 DOI: 10.1186/s13063-023-07111-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/21/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Dental caries is one of the most common diseases affecting children world widely as well as in the Kingdom of Saudi Arabia. Supervised tooth brushing programs are implemented throughout the world to provide young children's developing teeth with additional fluoride as a form of dental caries prevention. While school-based supervised tooth brushing programs have been proven to improve young children's oral health, virtual supervised teeth brushing programs have not been assessed. The purpose of this protocol is to assess the impact of virtual supervised tooth brushing on caries experience and quality of life among primary school students in Riyadh, Saudi Arabia. METHODS This is a cluster randomized controlled trial comparing a virtual supervised tooth brushing program against no intervention applied. A total of 1192 (596 in each group) 8-9-year-old children in Riyadh primary schools, Saudi Arabia, will be recruited for the trial. Schools (cluster) will be randomly selected and allocated to either group. Clinical assessment for caries experience will be conducted in six points (baseline, + 3 months, + 6 months, + 12 months, + 24 months, + 36 months) by dental hygienists using the World Health Organization criteria. Data on sociodemographic behavioral factors and children's quality of life will be collected with every clinical assessment through a structured questionnaire. The primary outcome is the change in caries experience (the number of teeth with untreated dental caries, filled and missing teeth) in both primary and permanent teeth over 36 months. DISCUSSION Virtual education as well as some health consultation through the pandemic period had enabled an effective IT infrastructure in Saudi Arabia. Virtual supervised tooth brushing is a proposed initiative. It is also an opportunity for targeting a large portion of the population with a high level of disease as a quarter of the Saudi population is younger than 15 years. This project should provide high level evidence on the effectiveness of virtual supervised tooth brushing. The findings should potentially inform policies related to the continuation/implementation of school-based programs in Saudi Arabia. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT05217316. Registered on 19 January 2022.
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Affiliation(s)
- Haya Alayadi
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Areej Alsiwat
- grid.56302.320000 0004 1773 5396Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Haifa AlAkeel
- grid.415696.90000 0004 0573 9824Dental Services Development Team, Dental Services Department, Riyadh Second Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Munirah Alaskar
- grid.56302.320000 0004 1773 5396Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Maram Alwadi
- grid.56302.320000 0004 1773 5396Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Wael Sabbah
- grid.13097.3c0000 0001 2322 6764Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
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Sobiech P, Olczak-Kowalczyk D, Spodzieja K, Gozdowski D. The association of maternal smoking and other sociobehavioral factors with dental caries in toddlers: A cross-sectional study. Front Pediatr 2023; 11:1115978. [PMID: 37077335 PMCID: PMC10106726 DOI: 10.3389/fped.2023.1115978] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/01/2023] [Indexed: 04/21/2023] Open
Abstract
Background Severe early childhood caries (S-ECC) is a form of dental caries in toddlers, which can strongly affect general health and quality of life. Studies on factors that can contribute to the development of caries immediately after tooth eruption are sparse. The aim of this study was to assess the role of sociobehavioural factors and pre- and postnatal exposure to tobacco smoke in the aetiology of dental caries in children up to 3 years old. Methods A cross-sectional study was conducted between 2011 and 2017 to assess oral health and teething in urban children 0-4 years of age. The number of teeth and surfaces with white spot lesions (d1,2), as well as decayed (d), missing (m), and filled (f) teeth classified according to ICDAS II was evaluated in a dental office setting. d1,2dmft and d1,2dmfs were calculated. Severe early childhood caries was diagnosed for d1,2dmfs > 0. Parents completed a self-administered questionnaire on socioeconomic factors, maternal health, course of pregnancy, child's perinatal parameters, hygiene and dietary practices, as well as maternal smoking during and after pregnancy. Data on children aged 12-36 months were collected and analysed statistically using the t-test, Spearman rank correlations and Poisson regression. Significance level was set at 0.05. Results Dental caries was found in 46% of 496 children aged 12-36 months. Mean d1,2dmft and d1,2dmfs were 2.62 ± 3.88 and 4.46 ± 8.42, respectively. Tobacco smoking during and after pregnancy was reported by 8.9% and 24.8% of women, respectively. Spearman's rank correlation analysis confirmed a relationship between S-ECC and parental education, maternal smoking, bottle feeding, avoiding springy foods, number of meals, and the age of tooth brushing initiation. Pre- and postnatal exposure to tobacco smoke increased the risk of S-ECC especially in children in age 19-24 months. Maternal smoking was correlated with the level of education and dietary practices. Conclusion Our study confirmed that prenatal smoking is associated with increased risk of severe-early childhood caries (S-ECC) while the association with post-natal smoking is also evident, the increase in risk is not statistically clear. Both maternal smoking and the child's tooth decay are associated with poor parental education and other improper oral health behaviours. The positive impact of quitting smoking on the oral health in children should be part of anti-smoking advice.
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Affiliation(s)
- Piotr Sobiech
- Department of Paediatric Dentistry, Medical University of Warsaw, Warszawa, Poland
| | - Dorota Olczak-Kowalczyk
- Department of Paediatric Dentistry, Medical University of Warsaw, Warszawa, Poland
- Correspondence: Dorota Olczak-Kowalczyk
| | - Karolina Spodzieja
- Department of Paediatric Dentistry, Medical University of Warsaw, Warszawa, Poland
| | - Dariusz Gozdowski
- Department of Experimental Design and Bioinformatics, Warsaw University of Life Sciences, Warsaw, Poland
- Department of Agriculture and Biology, Warsaw University of Life Sciences, Warsaw, Poland
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Mendes S, Ferreira D, Bernardo M. Parent-reported toothbrushing behaviour in the Portuguese preschool population. Eur Arch Paediatr Dent 2022; 23:961-968. [PMID: 36083464 DOI: 10.1007/s40368-022-00749-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 08/28/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Study toothbrushing behaviours and associated factors in a Portuguese preschool population. METHODS The study population was the parents of children attending Portuguese kindergartens. The data on sociodemographic and toothbrushing behaviours, at home and at school, were collected by an online questionnaire. The data analysis was performed using Chi-square, Fisher, Mann-Whitney and Kruskal-Wallis tests (α = 0.05). RESULTS The sample included 711 parents. Most of the children brushed their teeth at home at least twice-a-day (65.3%), with the help of an adult (62.9%). The majority of the children did not brush their teeth at school (71.2%); however, only 9.9% of the parents reported that they don't/wouldn't authorise it. Considering both toothbrushing, at home and at school, 75% of the children brushed their teeth twice-a-day. However, only 7.8% of the children performed all the correct toothbrushing related procedures. Toothbrushing at school was more frequent in private kindergartens (p < 0.001). A higher level of education was associated with non-authorisation of toothbrushing at school (p = 0.019) and with performing the correct toothbrushing related procedures (p = 0.007). Attending an oral health professional appointment was also associated with performing the correct toothbrushing related procedures (p = 0.005). CONCLUSION Toothbrushing twice-a-day was frequent in the studied population, however, the percentage of children who brushed at school was low, as well as the percentage of children who performed all the correct toothbrushing related procedures. Toothbrushing at school was more likely in private kindergartens. Performing correct toothbrushing related procedures was more frequent in children who had a previous oral health appointment and whose parents had a higher education level.
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Affiliation(s)
- S Mendes
- Faculdade de Medicina Dentária da Universidade de Lisboa, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Rua Prof. Teresa Ambrósio, Cidade Universitária, 1600-277, Lisbon, Portugal.
| | - D Ferreira
- Faculdade de Medicina Dentária da Universidade de Lisboa, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Rua Prof. Teresa Ambrósio, Cidade Universitária, 1600-277, Lisbon, Portugal
| | - M Bernardo
- Faculdade de Medicina Dentária da Universidade de Lisboa, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Rua Prof. Teresa Ambrósio, Cidade Universitária, 1600-277, Lisbon, Portugal
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Featherstone JDB, Crystal YO, Alston P, Chaffee BW, Doméjean S, Rechmann P, Zhan L, Ramos-Gomez F. Evidence-Based Caries Management for All Ages-Practical Guidelines. FRONTIERS IN ORAL HEALTH 2022; 2:657518. [PMID: 35048005 PMCID: PMC8757692 DOI: 10.3389/froh.2021.657518] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/08/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction: The purpose of the present paper is to provide step-by-step guidelines for dental healthcare providers to manage dental caries based upon caries risk assessment (CRA) for ages 0–6 years and 6 years through adult. The manuscript reviews and updates the CAMBRA (caries management by risk assessment) system which includes CRA and caries management recommendations that are guided by the assessed risk level. Caries Risk Assessment: CAMBRA CRA tools (CRAs) have been evaluated in several clinical outcomes studies and clinical trials. Updated CAMBRA CRAs for ages 0–6 years and 6 years through adult are provided. These CRAs have been refined by the addition of a quantitative method that will aid the health care provider in determining the caries risk of individuals. Caries Management Based Upon Risk Assessment: Guidelines for individualized patient care are provided based upon the caries risk status, results of clinical exams and responses of the patient to questions in the CRA. These guidelines are based upon successful outcomes documented in several clinical outcomes studies and clinical trials. The paper includes a review of successful caries management procedures for children and adults as previously published, with additional emphasis on correct use of silver diamine fluoride (SDF) for children. The caries management plan for each individual is based upon reducing the caries risk factors and enhancing the protective factors with the additional aid of behavior modification. Beneficially altering the caries balance is coupled with minimal intervention restorative dentistry, if appropriate. These methods are appropriate for the management of dental caries in all patients.
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Affiliation(s)
- John D B Featherstone
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Yasmi O Crystal
- Pediatric Dentistry Department, College of Dentistry, New York University, New York, NY, United States.,Comprehensive Pediatric Dentistry, Bound Brook, NJ, United States
| | - Pamela Alston
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Benjamin W Chaffee
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Sophie Doméjean
- Department of Operative Dentistry and Endodontics, UFR d'Odontologie de Clermont-Ferrand, Clermont-Ferrand, France.,EA 4847, Clermont-Ferrand, France.,Université Clermont Auvergne, Clermont-Ferrand, France.,Service d'Odontologie, CHU Estaing, Clermont-Ferrand, France
| | - Peter Rechmann
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Ling Zhan
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Francisco Ramos-Gomez
- Section of Pediatric Dentistry, School of Dentistry, University of California, Los Angeles, Los Angeles, CA, United States
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10
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Asao Y, Iwamoto Y, Mitsuhata C, Naito M, Kozai K. Three-year survey of oral hygiene conditions of Cambodian public primary school children. J Oral Sci 2022; 64:208-211. [DOI: 10.2334/josnusd.21-0464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Yuria Asao
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Yuko Iwamoto
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Chieko Mitsuhata
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Mariko Naito
- Department of Oral Epidemiology, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Katsuyuki Kozai
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University
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11
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Wang MC, Wu JY, Shih WY. A scoping review of intervention components of school-based oral health-related behavioural interventions using the Theoretical Domains Framework. Eur J Oral Sci 2021; 130:e12841. [PMID: 34935210 DOI: 10.1111/eos.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/24/2021] [Indexed: 11/27/2022]
Abstract
The aim of this study was to review the intervention components of school-based oral health-related behavioural interventions using the Theoretical Domains Framework (TDF). We identified relevant papers from the review of Cooper et al., and these papers came from both the original inclusion and exclusion article lists. We also modified and updated their search strategies (2013 - April 2019). The 53 included papers reported on 79 interventions (experimental groups = 57 interventions, control groups = 22 interventions). Most of the papers used three to nine domains (average = 5.6) in their experimental interventions, and the most commonly used domains were 'knowledge,' 'skills,' 'social influences,' and 'environmental context and resources.' Considering the complexity of intervention components in one programme, there is no one specific domain or domain set that can determine the success of behavioural interventions. The design of future programmes should be guided by a complex intervention methodology. However, the best combination set might not exist, and the choice of domains should depend on local context or resources. This study can be used as a resource for identifying previous papers, which have used the same domains.
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Affiliation(s)
- Min-Ching Wang
- Department of Dentistry, Taipei Municipal Wanfang Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.,Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jing-Yi Wu
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Yu Shih
- Department of Dentistry, School of Dentistry, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.,Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
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12
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A Longitudinal Study on the Relationship of Oral Health at 4 Years of Age with That in Adulthood. Dent J (Basel) 2021; 9:dj9020017. [PMID: 33535419 PMCID: PMC7912716 DOI: 10.3390/dj9020017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 11/17/2022] Open
Abstract
This longitudinal study aimed to clarify the relationship of oral health in infancy with that in adulthood among participants who were the subjects of the oral health promotion project (OHPP) conducted in Miyako Island, Okinawa Prefecture, Japan, since 1984. Twenty-seven subjects, around 35 years of age, were examined for dental caries, periodontal diseases (community periodontal index), dental plaque, occlusion, and bite-force and compared with those at 4 and 13-15 years of age. The dental caries status and maximum bite force in adulthood was significantly reflected for those at 4 and 13-15 years of age (p < 0.05). CPI in adulthood was related to the dental caries status at 4 and 13-15 years of age but not to the gingival score at 4 years of age, and it was weakly related to the gingival score at 13-15 years (r = 0.264, p > 0.05). Most of the normal occlusion at 4 years of age became normal permanent occlusion in adulthood (88.9%). Most of the cases involving the discrepancy factor retained the same condition in both the deciduous and permanent dentitions (83.3%) (p < 0.001). Those who participated in the OHPP soon after birth showed significantly fewer DMFT (p < 0.05) compared with those who did not. This study revealed that oral health at 4 years of age was related to that in adulthood, suggesting that fostering good oral health soon after birth is of great importance.
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13
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Marquillier T, Lombrail P, Azogui-Lévy S. [Social inequalities in oral health and early childhood caries: How can they be effectively prevented? A scoping review of disease predictors]. Rev Epidemiol Sante Publique 2020; 68:201-214. [PMID: 32631663 DOI: 10.1016/j.respe.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/20/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Early childhood caries represent a major public health problem. In addition to their individual impact, the massive social inequalities in oral health that are at the roots and result from the disease have largely underestimated consequences for the child, his family and the community. In response to the question of "how and where to act?", this scoping review identifies the individual characteristics associated with the disease on which it would be possible to act, using appropriate prevention strategies. METHODS This scoping review is aimed at describing and analyzing available data in the literature on the different factors associated with early childhood caries. RESULTS The predictors of early childhood caries are represented by mediating (knowledge, attitudes and parents' oral health practices) and moderating (psychosocial parameters, parental health literacy and alcohol consumption) factors. Twenty-eight articles fulfilled the selection criteria, twenty of which studied mediators related to early childhood caries, and fourteen of which dealt with moderators. The lower the parents' level of knowledge and literacy in oral health, the higher a child's dmft index. Additional studies are needed to assess the role of psychosocial parameters. CONCLUSION Parents' knowledge and oral health literacy are the key predictors to be preferentially targeted in view of reducing social inequalities in health through actions undertaken on a local scale. The prevention of early childhood caries necessitates a combination of generic and targeted interventions.
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Affiliation(s)
- T Marquillier
- Pediatric Dentisry, CHU de Lille, university of Lille, 59000 Lille, France; Educational and Health Practices Laboratory, LEPS, UR 3412, Université Sorbonne Paris Nord, 74, rue Marcel-Cachin, 93017 Bobigny, France.
| | - P Lombrail
- Educational and Health Practices Laboratory, LEPS, UR 3412, Université Sorbonne Paris Nord, 74, rue Marcel-Cachin, 93017 Bobigny, France
| | - S Azogui-Lévy
- Educational and Health Practices Laboratory, LEPS, UR 3412, Université Sorbonne Paris Nord, 74, rue Marcel-Cachin, 93017 Bobigny, France; Public health Department, Dentistry Faculty, university of Paris, 75006 Paris, France
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14
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Yazdani R, Mohebbi SZ, Fazli M, Peighoun M. Evaluation of protective factors in caries free preschool children: a case-control study. BMC Oral Health 2020; 20:177. [PMID: 32586302 PMCID: PMC7318423 DOI: 10.1186/s12903-020-01154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 06/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing the proportion of caries-free children following the WHO's global target has led to more desirable welfare and a higher level of quality of life for children. In the present study, we aimed to evaluate the factors contributing to a caries-free condition in preschool children as a basic action towards the global goals of children's oral health. METHODS This was a case-control study evaluating the protective factors contributing to dental caries free in 4-6-year-old children in Tehran/Iran in 2017. 500 preschool children and their mothers were selected from 22 randomly selected preschools and were enrolled in the study. The participants were divided into two case (caries-free) and control (with dental caries) groups. The data were collected using two data gathering tools; the child oral examination form and the mother's valid questionnaire. The latter included three domains; socio-demographic factors, behavioral oral health measures, and feeding practices and dietary habits. The criteria for caries detection were cavities in the enamel and dentine. A logistic regression model was applied to identify caries-free protective factors (P < 0.05). RESULTS Among 230 caries-free and 270 non-caries-free children who participated in the study, boys were more caries-free (P = 0.001). The protective factors against dental caries that were identified in the study were dental check-up as the cause of dental visit, being the first child in the family, the fewer sessions night feeding of the child's, family's house ownership, and parent's university education (P < 0.05). CONCLUSIONS Dental health can be achieved by considering protective factors like the regular dental check-up and socio-economic factors. Communities are invited to pay close attention to these important protective factors as far as they can increase the proportion of caries-free among preschool children especially in countries with developing oral health care systems.
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Affiliation(s)
- Reza Yazdani
- Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Simin Zahra Mohebbi
- Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Fazli
- Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Peighoun
- Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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15
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Comparison of two caries prevention programs among Thai kindergarten: a randomized controlled trial. BMC Oral Health 2020; 20:119. [PMID: 32306953 PMCID: PMC7168866 DOI: 10.1186/s12903-020-01107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/05/2020] [Indexed: 11/12/2022] Open
Abstract
Background Intensified preventive regimen based on a ‘high-risk’ approach has been proposed instead the routine prevention that is generally given to the whole population. The effectiveness of these regimens may still be an issue. Therefore, the aim of this study was to compare two preventive programs carried out in a Public School for kindergarten children. Methods The data from clinical examinations were used to assess the caries risk for 121 children. Children with at least 2 carious lesions were considered as high risk for dental caries development. These children were randomized into two groups. Half (High risk basic-HRB group) were provided the basic prevention regimen (oral-hygiene instruction and hands-on brushing practice for teachers and caregivers, daytime tooth brushing supervised by teachers at least once a week, newly erupted first permanent molar sealant, provision of toothbrush, fluoride-containing dentifrice, and a guidebook), which was also given to low-risk children (Low risk basic-LRB group). The other half (High risk intensive-HRI group) were additionally given an intensified preventive regimen (F-varnish application, primary molar sealant, and silver diamine fluoride (SDF) application on carious lesions). Clinical examinations were performed semiannually to determine the dmfs caries increment of the three groups. Results The 89 children completed the 24-month examination were 3- to 5-year-old with 19, 35, and 35 children in the LRB, HRB, and HRI group, respectively. The new caries development at 24 months of the HRB group (75%) was higher than that of the HRI group (65.7%) and the LRB group (21.1%). One-way analysis of variance (ANOVA) indicated no significant differences of caries increment between the HRB and HRI groups at the end of our study (p = 0.709). Conclusions The negligible difference in caries increment between the HRI and HRB groups implies that intensified prevention produced minimal additional benefit. Offering all children only basic prevention could have obtained virtually the same preventive effect with substantially less effort and lower cost. Trial registration Thai Clinical Trials Registry (TCTR), TCTR20180124001. Registered 24 January 2018 - Retrospectively registered.
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16
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Pine CM, Adair PM, Burnside G, Brennan L, Sutton L, Edwards RT, Ezeofor V, Albadri S, Curnow MM, Deery C, Hosey MT, Willis-Lake J, Lynn J, Parry J, Wong FSL. Dental RECUR Randomized Trial to Prevent Caries Recurrence in Children. J Dent Res 2020; 99:168-174. [PMID: 31944893 DOI: 10.1177/0022034519886808] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to determine the efficacy of a dental nurse-delivered intervention-the Dental RECUR Brief Negotiated Interview for Oral Health (DR-BNI)-in reducing the recurrence of dental caries in children who have a primary tooth extracted. It was based on a 2-arm multicenter randomized controlled trial with blinded outcome assessment. Participants were 5- to 7-y-old children (n = 241) scheduled to have primary teeth extracted in 12 UK centers. Test intervention parents (n = 119) received DR-BNI led by trained dental nurses. DR-BNI is a 30-min structured conversation informed by motivational interviewing with a forward focus to prevent future caries. Preventive goals are agreed, and a review appointment is made with child's general dental practitioner, who is advised to treat the child as being at high caries risk. The control intervention (n = 122) was a parent-nurse conversation about child's future tooth eruption, with advice given to visit a general dental practitioner as usual. At baseline, the DR-BNI group's mean dmft was 6.8, and the control group's was 6.3. A median of 5 teeth were extracted, mainly under general anesthesia. Final dental assessments were conducted by a single examiner visiting 189 schools 2 y after intervention; 193 (80%) of 241 children were examined. In the control group, 62% developed new caries in teeth that were caries-free or unerupted at baseline, as compared with 44% in the test group, a significant reduction (P = 0.021). The odds of new caries experience occurring were reduced by 51% in the DR-BNI group as compared with control. There was a 29% decrease in the relative risk of new caries experience in the DR-BNI group as compared with control. This single low-cost, low-intensity intervention was successful in significantly reducing the risk of recurrence of dental caries in children. This trial has implications for changing pediatric dental practice internationally. Training in and implementation of a motivational interviewing-informed brief intervention provides opportunities for dental nurses to facilitate behavior change improving the oral health of children at high caries risk (ISRCTN 24958829).
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Affiliation(s)
- C M Pine
- Research and Innovation, Salford Royal NHS Foundation Trust, Northern Care Alliance NHS Group, Summerfield House, Salford, UK.,Barts and the London Schools of Medicine and Dentistry, Institute of Dentistry, Queen Mary University of London, London, UK
| | - P M Adair
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University, Belfast, UK
| | - G Burnside
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - L Brennan
- Health Education North West, Regatta Place, Liverpool, UK
| | - L Sutton
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - R T Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - V Ezeofor
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - S Albadri
- Paediatric Dentistry, School of Dentistry, University of Liverpool, Liverpool, UK
| | - M M Curnow
- Public Dental Service, Broxden Dental Centre, NHS Tayside, Perth, UK
| | - C Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - M T Hosey
- Paediatric Dentistry, Centre of Oral, Clinical and Translational Science, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, UK
| | - J Willis-Lake
- Kent Community Health NHS Foundation Trust, Maidstone, UK
| | - J Lynn
- Community Dental Service, Arches Health and Care Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - J Parry
- Special Care Dental Service, Sussex Community NHS Foundation Trust, Brighton, UK.,Paediatric Dentistry, University College Cork, Cork, Ireland
| | - F S L Wong
- Barts and the London Schools of Medicine and Dentistry, Institute of Dentistry, Queen Mary University of London, London, UK
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Riggs E, Kilpatrick N, Slack‐Smith L, Chadwick B, Yelland J, Muthu MS, Gomersall JC. Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries. Cochrane Database Syst Rev 2019; 2019:CD012155. [PMID: 31745970 PMCID: PMC6864402 DOI: 10.1002/14651858.cd012155.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dental caries is one of the most common chronic diseases of childhood and is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC). OBJECTIVES To assess the effects of interventions with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years of age). SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 14 January 2019), Cochrane Pregnancy and Childbirth Group's Trials Register (to 22 January 2019), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Register of Studies, to 14 January 2019), MEDLINE Ovid (1946 to 14 January 2019), Embase Ovid (1980 to 14 January 2019) and CINAHL EBSCO (1937 to 14 January 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing one or more interventions with pregnant women, mothers, or other caregivers of infants in the first year of life (intervention types included clinical, oral health education/promotion such as hygiene education, breastfeeding and other dietary advice, and policy or health service), versus standard care or placebo or another intervention. For inclusion, trials had to report at least one caries outcome. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence using the GRADE approach. MAIN RESULTS We included 17 RCTs (4 cluster-randomised), involving 23,732 caregivers (mainly mothers) and their children. Eleven RCTs assessed four oral health education/promotion interventions against standard care: child diet advice, child diet and feeding practice advice, breastfeeding promotion and support, and oral hygiene with child diet and feeding practice advice. Six trials assessed clinical interventions in mother's dentition, four trials chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo, and two trials xylitol against CHX or CHX + xylitol. At most, three trials (maximum of 1148 children and 130 mothers) contributed data to any comparison. For many trials, risk of bias was judged unclear due to lack of methodological details reported, and there was high risk of attrition bias in some trials. None of the included trials indicated receiving funding that is likely to have influenced their results. The trials were performed in high-, middle- and low-income countries. In nine trials, participants were socioeconomically disadvantaged. For child diet and feeding practice advice versus standard care, we observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a lower mean dmfs (decayed, missing, filled primary surfaces) score (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, we are uncertain regarding the difference between the groups in mean dmft (decayed, missing, filled teeth) score (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). For breastfeeding promotion and support versus standard care, we observed that there may be little or no a difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence), or mean dmft score (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). Dmfs was not reported for this comparison. We are uncertain whether child diet advice only compared with standard care reduces risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). Dmfs and dmft were not reported for this comparison. For oral hygiene, child diet and feeding practice advice versus standard care, we observed little or no reduced risk of caries presence in primary teeth (RR 0.91, 95% CI 0.75 to 1.10; 2 trials; 365 participants; low-certainty evidence), and are uncertain regarding difference between the groups in mean dmfs score (MD -0.99, 95% CI -2.45 to 0.47; 1 trial; 187 participants; very low-certainty evidence) and dmft score (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; very low-certainty evidence). We observed there may be little or no difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment in mother's dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trials assessing this comparison reported dmfs or dmft. For xylitol compared with CHX antimicrobial treatment, we observed there may be a lower mean dmft score with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence); however, we are uncertain regarding the difference between groups in caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence). Neither trial evaluating this comparison reported dmfs. No trials assessed a health policy or service intervention. AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very low certainty and is insufficient for determining which, if any, other interventions types and features may be effective for preventing ECC. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine effects and relative effects of different interventions and inform practice. We have identified 12 studies currently in progress. Those designing future studies should describe the intervention components, setting and participants, consider if and how effects are modified by intervention features and participant characteristics, and adopt a consistent approach to measuring and reporting ECC.
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Affiliation(s)
- Elisha Riggs
- Murdoch Children's Research InstituteIntergenerational HealthFlemington RoadParkvilleVictoriaAustralia3052
- The University of MelbourneDepartment of General PracticeBerkeley StreetMelbourneVictoriaAustralia3000
| | - Nicky Kilpatrick
- Murdoch Children's Research InstituteVascular BiologyFlemington RoadParkvilleMelbourneVictoriaAustralia3052
- Royal Children's HospitalPlastic and Maxillofacial Surgery50 Flemington RoadParkvilleVictoriaAustralia3052
- The University of MelbourneDepartment of PaediatricsBerkeley StreetCarltonVictoriaAustralia3010
| | - Linda Slack‐Smith
- The University of Western AustraliaSchool of Population and Global Health35 Sterling Highway, CrawleyPerthWestern AustraliaAustralia6009
| | - Barbara Chadwick
- Cardiff UniversitySchool of DentistryHeath ParkCardiffUKCF14 4XY
| | - Jane Yelland
- Murdoch Children's Research InstituteIntergenerational HealthFlemington RoadParkvilleVictoriaAustralia3052
- The University of MelbourneDepartment of General PracticeBerkeley StreetMelbourneVictoriaAustralia3000
| | - M S Muthu
- Pedo Planet ‐ Children Dental CentersPediatric Dentistry161/62 A Mount Poonamallee RoadPorurChennaiIndia600116
- Sri Ramachandra Institute of Higher Education and ResearchCentre for Early Childhood Caries Research, Department of Pediatric and Preventive DentistryChennaiIndia
| | - Judith C Gomersall
- Women and Kids, South Australian Health and Medical Research InstituteWomen’s and Children’s Hospital7th Floor, 72 King William RoadAdelaideSouth AustraliaAustralia5006
- School of Public Health, University of AdelaideAdelaideAustralia
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Gasoyan H, Safaryan A, Sahakyan L, Gasoyan N, Aaronson WE, Bagramian RA. School-Based Preventive Dental Program in Rural Communities of the Republic of Armenia. Front Public Health 2019; 7:243. [PMID: 31555630 PMCID: PMC6722182 DOI: 10.3389/fpubh.2019.00243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 08/13/2019] [Indexed: 12/02/2022] Open
Abstract
Objectives: This paper describes a school-based preventive dental program implemented in 14 rural schools within nine villages of Armenia. As part of the program, school-based toothbrushing stations (called Brushadromes) were installed in the participating schools. The intervention included school-based supervised toothbrushing with fluoride toothpaste and oral hygiene education. Methods: The study evaluates the prevalence and levels of dental caries among rural schoolchildren in 2013 (before the implementation of the preventive program, referred to as a pre-intervention group) and 2017 (4 years after the start of the program, referred to as an intervention group) in two randomly selected villages where the program was implemented. A repeated cross-sectional study design was used. The prevalence of caries and the number of decayed, missing, and filled teeth in permanent dentition (DMFT) and primary dentition (dmft) were recorded among 6–7 and 10–11-year-old schoolchildren in 2013 (n = 166) and 2017 (n = 148). The pre-intervention and intervention groups include different children in the same age range, from the same villages, examined at different time points. In both instances, they represented over 95% of the 6–7 and 10–11-year-old student populations of the studied villages. Pearson Chi-square, Fisher's Exact test, independent t-test, and quasi-likelihood Poisson regression were utilized for data analysis. Results: Schoolchildren involved in the intervention had significantly less decay levels compared to same-age pre-intervention groups. For 10–11-year-old schoolchildren involved in the program, the mean number of permanent teeth with caries was lower by a factor of 0.689 (lower by 31.1%), p = 0.008, 95% CI, 0.523; 0.902, compared to the 10–11-year-old pre-intervention group, after controlling for age, sex, child's socio-economic vulnerability status, the village of residence, and the number of permanent teeth with fillings. Conclusions: The study indicates a significantly lower level of caries among schoolchildren in the studied two villages where the intervention was implemented. The described intervention is particularly suitable in rural settings where water fluoridation is not available and homes have limited availability of running water.
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Affiliation(s)
- Hamlet Gasoyan
- Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA, United States.,Visiting Scientist in Health Services Administration and Policy, Yerevan State Medical University, Yerevan, Armenia
| | - Armen Safaryan
- Faculty of Public Health, Yerevan State Medical University, Yerevan, Armenia
| | | | - Nairuhi Gasoyan
- Faculty of Public Health, Yerevan State Medical University, Yerevan, Armenia
| | - William E Aaronson
- Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Robert A Bagramian
- School of Dentistry, University of Michigan, Ann Arbor, MI, United States.,Dean Emeritus, School of Public Health, American University of Armenia, Yerevan, Armenia
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Walsh T, Worthington HV, Glenny A, Marinho VCC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev 2019; 3:CD007868. [PMID: 30829399 PMCID: PMC6398117 DOI: 10.1002/14651858.cd007868.pub3] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). Regular toothbrushing with fluoride toothpaste is the principal non-professional intervention to prevent caries, but the caries-preventive effect varies according to different concentrations of fluoride in toothpaste, with higher concentrations associated with increased caries control. Toothpastes with higher fluoride concentration increases the risk of fluorosis (enamel defects) in developing teeth. This is an update of the Cochrane Review first published in 2010. OBJECTIVES To determine and compare the effects of toothpastes of different fluoride concentrations (parts per million (ppm)) in preventing dental caries in children, adolescents, and adults. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 August 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7) in the Cochrane Library (searched 15 August 2018); MEDLINE Ovid (1946 to 15 August 2018); and Embase Ovid (1980 to 15 August 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (15 August 2018). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials that compared toothbrushing with fluoride toothpaste with toothbrushing with a non-fluoride toothpaste or toothpaste of a different fluoride concentration, with a follow-up period of at least 1 year. The primary outcome was caries increment measured by the change from baseline in the decayed, (missing), and filled surfaces or teeth index in all permanent or primary teeth (D(M)FS/T or d(m)fs/t). DATA COLLECTION AND ANALYSIS Two members of the review team, independently and in duplicate, undertook the selection of studies, data extraction, and risk of bias assessment. We graded the certainty of the evidence through discussion and consensus. The primary effect measure was the mean difference (MD) or standardised mean difference (SMD) caries increment. Where it was appropriate to pool data, we used random-effects pairwise or network meta-analysis. MAIN RESULTS We included 96 studies published between 1955 and 2014 in this updated review. Seven studies with 11,356 randomised participants (7047 evaluated) reported the effects of fluoride toothpaste up to 1500 ppm on the primary dentition; one study with 2500 randomised participants (2008 evaluated) reported the effects of 1450 ppm fluoride toothpaste on the primary and permanent dentition; 85 studies with 48,804 randomised participants (40,066 evaluated) reported the effects of toothpaste up to 2400 ppm on the immature permanent dentition; and three studies with 2675 randomised participants (2162 evaluated) reported the effects of up to 1100 ppm fluoride toothpaste on the mature permanent dentition. Follow-up in most studies was 36 months.In the primary dentition of young children, 1500 ppm fluoride toothpaste reduces caries increment when compared with non-fluoride toothpaste (MD -1.86 dfs, 95% confidence interval (CI) -2.51 to -1.21; 998 participants, one study, moderate-certainty evidence); the caries-preventive effects for the head-to-head comparison of 1055 ppm versus 550 ppm fluoride toothpaste are similar (MD -0.05, dmfs, 95% CI -0.38 to 0.28; 1958 participants, two studies, moderate-certainty evidence), but toothbrushing with 1450 ppm fluoride toothpaste slightly reduces decayed, missing, filled teeth (dmft) increment when compared with 440 ppm fluoride toothpaste (MD -0.34, dmft, 95%CI -0.59 to -0.09; 2362 participants, one study, moderate-certainty evidence). The certainty of the remaining evidence for this comparison was judged to be low.We included 81 studies in the network meta-analysis of D(M)FS increment in the permanent dentition of children and adolescents. The network included 21 different comparisons of seven fluoride concentrations. The certainty of the evidence was judged to be low with the following exceptions: there was high- and moderate-certainty evidence that 1000 to 1250 ppm or 1450 to 1500 ppm fluoride toothpaste reduces caries increments when compared with non-fluoride toothpaste (SMD -0.28, 95% CI -0.32 to -0.25, 55 studies; and SMD -0.36, 95% CI -0.43 to -0.29, four studies); there was moderate-certainty evidence that 1450 to 1500 ppm fluoride toothpaste slightly reduces caries increments when compared to 1000 to 1250 ppm (SMD -0.08, 95% CI -0.14 to -0.01, 10 studies); and moderate-certainty evidence that the caries increments are similar for 1700 to 2200 ppm and 2400 to 2800 ppm fluoride toothpaste when compared to 1450 to 1500 ppm (SMD 0.04, 95% CI -0.07 to 0.15, indirect evidence only; SMD -0.05, 95% CI -0.14 to 0.05, two studies).In the adult permanent dentition, 1000 or 1100 ppm fluoride toothpaste reduces DMFS increment when compared with non-fluoride toothpaste in adults of all ages (MD -0.53, 95% CI -1.02 to -0.04; 2162 participants, three studies, moderate-certainty evidence). The evidence for DMFT was low certainty.Only a minority of studies assessed adverse effects of toothpaste. When reported, effects such as soft tissue damage and tooth staining were minimal. AUTHORS' CONCLUSIONS This Cochrane Review supports the benefits of using fluoride toothpaste in preventing caries when compared to non-fluoride toothpaste. Evidence for the effects of different fluoride concentrations is more limited, but a dose-response effect was observed for D(M)FS in children and adolescents. For many comparisons of different concentrations the caries-preventive effects and our confidence in these effect estimates are uncertain and could be challenged by further research. The choice of fluoride toothpaste concentration for young children should be balanced against the risk of fluorosis.
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Affiliation(s)
- Tanya Walsh
- The University of ManchesterDivision of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and HealthCoupland Building 3Oxford RoadManchesterUKM13 9PL
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthCoupland Building 3Oxford RoadManchesterUKM13 9PL
| | - Anne‐Marie Glenny
- The University of ManchesterDivision of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and HealthCoupland Building 3Oxford RoadManchesterUKM13 9PL
| | - Valeria CC Marinho
- Queen Mary University of LondonClinical and Diagnostic Oral Sciences, Barts and The London School of Medicine and DentistryTurner StreetWhitechapelLondonUKE1 2AD
| | - Ana Jeroncic
- University of Split School of MedicineDepartment of Research in Biomedicine and HealthSoltanska 2SplitCroatia21000
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Salama MT, Alsughier ZA. Effect of Green Tea Extract Mouthwash on Salivary Streptococcus mutans Counts in a Group of Preschool Children: An In Vivo Study. Int J Clin Pediatr Dent 2019; 12:133-138. [PMID: 31571786 PMCID: PMC6749881 DOI: 10.5005/jp-journals-10005-1610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM This study was conducted to evaluate the effectiveness of green tea mouthwash on the salivary level of Streptococcus mutans in the preschool children. MATERIALS AND METHODS In this randomized controlled clinical trial, 40 cooperative children (4-5 years old) were divided into two groups. The study group included 20 children who did the routine tooth brushing 3 times/day, and then green tea extract mouthwash (8 mL/day) 2 times/day for 4 weeks. The control group included other 20 children who did the routine tooth brushing as the study group but did not use any green tea extract mouthwash. The quantitative microbiological laboratory cultivation method of S. mutans was carried out for each child at the baseline, after 2 weeks, and after 4 weeks of the study period. RESULTS Statistically, the results showed that there was a statistically significant difference in the mean log S. mutans counts between the study and control groups in both follow-up periods after 2 weeks and after 4 weeks. Also, there were statistically significant mean percentage decreases in log S. mutans counts for the two groups. CONCLUSION The use of green tea mouthwash showed promising results in reducing the cariogenic salivary S. mutans counts. CLINICAL SIGNIFICANCE Green tea extract mouthwash is a nontoxic and safe, particularly for children. Catechins, the main bioactive ingredient of green tea, show an antibacterial action; thus, it has a promising effect in decreasing the count of salivary S. mutans and in the prevention of dental caries. HOW TO CITE THIS ARTICLE Salama MT, Alsughier ZA. Effect of Green Tea Extract Mouthwash on Salivary Streptococcus mutans Counts in a Group of Preschool Children: An In Vivo Study. Int J Clin Pediatr Dent 2019;12(2):133-138.
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Affiliation(s)
- Mohamed Th Salama
- Department of Oral Public Health, Pediatric Dentistry and Orthodontics, Alrass College of Dentistry, Alrass, Qassim, Saudi Arabia
| | - Zeyad A Alsughier
- Department of Orthodontics and Pediatric Dentistry, College of Dentistry, Qassim University, Almulida, Qassim, Saudi Arabia
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Skeie MS, Klock KS. Dental caries prevention strategies among children and adolescents with immigrant - or low socioeconomic backgrounds- do they work? A systematic review. BMC Oral Health 2018; 18:20. [PMID: 29415706 PMCID: PMC5803902 DOI: 10.1186/s12903-018-0478-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 01/24/2018] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Marit S Skeie
- Department of Clinical Dentistry, Pediatric Dentistry, The Faculty of Medicine, University of Bergen, Aarstadveien 19, N-5009, Bergen, Norway.
| | - Kristin S Klock
- Department of Clinical Dentistry, Community Dentistry, The Faculty of Medicine, University of Bergen, Aarstadveien 19, N-5009, Bergen, Norway.
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22
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Dos Santos APP, de Oliveira BH, Nadanovsky P. A systematic review of the effects of supervised toothbrushing on caries incidence in children and adolescents. Int J Paediatr Dent 2018; 28:3-11. [PMID: 28940755 DOI: 10.1111/ipd.12334] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Ana Paula Pires Dos Santos
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Branca Heloisa de Oliveira
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Nadanovsky
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
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Winter J, Jablonski-Momeni A, Ladda A, Pieper K. Long-term effect of intensive prevention on dental health of primary school children by socioeconomic status. Clin Oral Investig 2017; 22:2241-2249. [PMID: 29288402 DOI: 10.1007/s00784-017-2318-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/15/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Children in a German region took part in regular toothbrushing with fluoride gel during their time in primary school after having received a preventive program in kindergarten. The study aimed at determining the dental health of the students as a function of prevention in kindergarten and at school while taking into account their socioeconomic status and other confounders. MATERIALS AND METHODS The subjects were in six groups: groups 1 and 2, intensive prevention in kindergarten with and without fluoride gel at school; groups 3 and 4, basic prevention in kindergarten with and without fluoride gel at school; groups 5 and 6, no organized prevention in kindergarten with and without fluoride gel at school. Two dental examinations were performed for assessing caries experience and calculating caries increment from second grade (7-year-olds) to fourth grade (9-year-olds). A standardized questionnaire was used to record independent variables. To compare caries scores and preventive measures of various subgroups, non-parametric tests and a binary logistic regression analysis were performed. RESULTS A significant difference was found in the mean decayed, missing, and filled tooth/teeth (DMFT) depending on socioeconomic status (no prevention in kindergarten, fluoride gel at school in children with low SES: DMFT = 0.47 vs. DMFT = 0.18 in children with high SES; p = 0.023). Class-specific differences were no longer visible among children who had taken part in an intensive preventive program combining daily supervised toothbrushing in kindergarten and application of fluoride gel in school. CONCLUSIONS Early prevention, focusing on professionally supported training of toothbrushing in kindergarten and at school, has a positive effect on dental health and is able to reduce class-specific differences in caries distribution. CLINICAL RELEVANCE Early training of toothbrushing and fissure sealing of first permanent molars are the most important factors for the dental health of primary school children.
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Affiliation(s)
- Julia Winter
- Department of Paediatric and Community Dentistry, Philipps-University Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany.
| | - Anahita Jablonski-Momeni
- Department of Paediatric and Community Dentistry, Philipps-University Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | | | - Klaus Pieper
- Department of Paediatric and Community Dentistry, Philipps-University Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany
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24
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Goldman A, Leal SC, de Amorim RG, Frencken JE. Treating High-Caries Risk Occlusal Surfaces in First Permanent Molars through Sealants and Supervised Toothbrushing: A 3-Year Cost-Effective Analysis. Caries Res 2017; 51:489-499. [DOI: 10.1159/000477822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/26/2017] [Indexed: 11/19/2022] Open
Abstract
We conducted a 3-year cost-effectiveness analysis on the cavitated dentine carious lesion preventive capabilities of composite resin (CR) (reference group) and atraumatic restorative treatment (ART) high-viscosity glass-ionomer cement (HVGIC) sealants compared to supervised toothbrushing (STB) in high-risk first permanent molars. School children aged 6-7 years in 6 schools (2 per group) received CR and ART/HVGIC sealants or STB daily for 180 days each school year. Data were collected prospectively and cost estimates were made for sample data and a projection of 1,000 sealants/STB high-risk permanent molars. Although STB had the best outcome, its high implementation cost (95% of cost for supervisors visiting schools 180 days/school year) affected the results. ART/HVGIC was cost-effective compared to CR for the sample data (savings of USD 37 per cavitated dentine carious lesion prevented), while CR was cost-effective compared to ART/HVGIC for the projection (savings of USD 17 per cavitated dentine carious lesion prevented), and both were cost-saving compared to STB. Two STB scenarios were tested in sensitivity analyses with variations in caries incidence and number of supervision days; results showed STB had lower costs and higher savings per cavitated dentine carious lesion prevented than CR and ART/HVGIC. A major assumption is that both scenarios have the same high effectiveness rate experienced by STB under study conditions; however, they point to the value of further research on the benefits of adopting STB as a long-term venture in a general population of school children.
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25
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Cakar T, Harrison-Barry L, Pukallus ML, Kazoullis S, Seow WK. Caries experience of children in primary schools with long-term tooth brushing programs: A pilot Australian study. Int J Dent Hyg 2017; 16:233-240. [PMID: 28345213 DOI: 10.1111/idh.12275] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate a primary school-based tooth brushing (TB) program conducted in a low socio-economic area of Queensland, Australia, to determine its effectiveness in reducing caries. METHODS Records kept at the central dental clinic of the district were used to analyse the caries experience (decayed, missing, filled teeth [dmft/DMFT]) and caries prevalence in children from two schools with long-term TB programs (TB) (N=1191) and three Non-TB schools (N=553). The schools were matched by socio-economic indices. RESULTS Historical records showed that the baseline caries experience in all TB and Non-TB primary schools were similar at each primary school year. After a mean period of 5-9 years of the TB program, the caries experience (mean decayed, missing, filled teeth, dmft/DMFT) and prevalence were lower for TB group than Non-TB group. In the primary dentition, the overall mean dmft (±standard deviation) of TB group (2.53±3.00) was significantly lower than the Non-TB group (3.06±3.30) (P<.001). Similarly, in the permanent dentition, the overall mean DMFT of TB group (0.47±1.05) was reduced significantly compared to the Non-TB group (1.15±1.72) (P<.001). The overall caries prevalence in the TB group was 68% compared to 78% in Non-TB (P<.001). Overall, the mean annual DMFT increments of children in the TB schools were also significantly less compared with children in the Non-TB schools (P<.001). CONCLUSION A long-term primary school TB program significantly reduced caries experience and caries prevalence in an optimally fluoridated (1-ppm), very low socio-economic district.
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Affiliation(s)
- T Cakar
- Centre for Paediatric Dentistry, School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - L Harrison-Barry
- Centre for Paediatric Dentistry, School of Dentistry, The University of Queensland, Brisbane, QLD, Australia.,MetroSouth Oral Health Logan-Beaudesert Area, MetroSouth Health Brisbane, Queensland, Australia
| | - M L Pukallus
- Centre for Paediatric Dentistry, School of Dentistry, The University of Queensland, Brisbane, QLD, Australia.,MetroSouth Oral Health Logan-Beaudesert Area, MetroSouth Health Brisbane, Queensland, Australia
| | - S Kazoullis
- Centre for Paediatric Dentistry, School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - W K Seow
- Centre for Paediatric Dentistry, School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
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Gray-Burrows KA, Day PF, Marshman Z, Aliakbari E, Prady SL, McEachan RRC. Using intervention mapping to develop a home-based parental-supervised toothbrushing intervention for young children. Implement Sci 2016; 11:61. [PMID: 27153832 PMCID: PMC4859968 DOI: 10.1186/s13012-016-0416-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 04/01/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Dental caries in young children is a major public health problem impacting on the child and their family in terms of pain, infection and substantial financial burden on healthcare funders. In the UK, national guidance on the prevention of dental caries advises parents to supervise their child's brushing with fluoride toothpaste until age 7. However, there is a dearth of evidence-based interventions to encourage this practice in parents. The current study used intervention mapping (IM) to develop a home-based parental-supervised toothbrushing intervention to reduce dental caries in young children. METHODS The intervention was developed using the six key stages of the IM protocol: (1) needs assessment, including a systematic review, qualitative interviews, and meetings with a multi-disciplinary intervention development group; (2) identification of outcomes and change objectives following identification of the barriers to parental-supervised toothbrushing (PSB), mapped alongside psychological determinants outlined in the Theoretical Domains Framework (TDF); (3) selection of methods and practical strategies; (4) production of a programme plan; (5) adoption and implementation and (6) Evaluation. RESULTS The comprehensive needs assessment highlighted key barriers to PSB, such as knowledge, skills, self-efficacy, routine setting and behaviour regulation and underlined the importance of individual, social and structural influences. Parenting skills (routine setting and the ability to manage the behaviour of a reluctant child) were emphasised as critical to the success of PSB. The multi-disciplinary intervention development group highlighted the need for both universal and targeted programmes, which could be implemented within current provision. Two intervention pathways were developed: a lower cost universal pathway utilising an existing national programme and an intensive targeted programme delivered via existing parenting programmes. A training manual was created to accompany each intervention to ensure knowledge and standardise implementation procedures. CONCLUSIONS PSB is a complex behaviour and requires intervention across individual, social and structural levels. IM, although a time-consuming process, allowed us to capture this complexity and allowed us to develop two community-based intervention pathways covering both universal and targeted approaches, which can be integrated into current provision. Further research is needed to evaluate the acceptability and sustainability of these interventions.
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Affiliation(s)
| | - P. F. Day
- School of Dentistry, Clarendon Way, Leeds, LS2 9JT UK
| | - Z. Marshman
- School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA UK
| | - E. Aliakbari
- School of Dentistry, Clarendon Way, Leeds, LS2 9JT UK
| | - S. L. Prady
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - R. R. C. McEachan
- Bradford Institute for Health Research, Duckworth Lane, Bradford, BD9 6RJ UK
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Brown MD, Campbell PM, Schneiderman ED, Buschang PH. A practice-based evaluation of the prevalence and predisposing etiology of white spot lesions. Angle Orthod 2016; 86:181-6. [PMID: 26241805 PMCID: PMC8603611 DOI: 10.2319/041515-249.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/01/2015] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE To use an alumni-centered, practice-based research network to evaluate white spot lesions (WSLs) among treated orthodontic patients. MATERIALS AND METHODS An initial survey was conducted to ascertain whether orthodontic alumni from Texas A&M University Baylor College of Dentistry were willing to participate. Twenty randomly selected alumni participated, providing 158 treated cases. Each alumnus (1) obtained internal review board consent; (2) submitted pre- and posttreatment photographs of 10 consecutively finished cases; (3) completed a treatment survey; and (4) had the patient/parent complete the American Dental Association (ADA) Caries Risk Assessment. RESULTS Almost 90% of the alumni surveyed were willing to participate in the practice-based research, primarily because a fellow alumnus asked them to. Approximately 28% of the patients developed WSLs. The average patient developed 2.4 white spots, affecting 12.7% of the teeth examined. WSLs were significantly (P < .001) more (2.3-3.2 times) likely for patients who were identified on the ADA Caries Risk Assessment. The risk of developing WSLs during treatment was also increased for those with fair (2.7 times) or poor (3.5 times) oral hygiene, poor gingival health (2.3 times), and extended treatment times (2.1 times). CONCLUSIONS There is a substantial risk of developing WSLs among private practice patients, depending partially on the length of treatment. Patients at greatest risk can be identified prior to treatment based on the ADA Caries Risk Assessment, oral hygiene, and gingival health.
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Affiliation(s)
| | - Phillip M. Campbell
- Chairman, Associate Professor, Orthodontic Department, Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, Tex
| | - Emet D. Schneiderman
- Professor, Department of Biomedical Sciences, Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, Tex
| | - Peter H. Buschang
- Regents Professor and Director of Orthodontic Research, Orthodontic Department, Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, Tex
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Pine C, Adair P, Robinson L, Burnside G, Moynihan P, Wade W, Kistler J, Curnow M, Henderson M. The BBaRTS Healthy Teeth Behaviour Change Programme for preventing dental caries in primary school children: study protocol for a cluster randomised controlled trial. Trials 2016; 17:103. [PMID: 26897029 PMCID: PMC4761186 DOI: 10.1186/s13063-016-1226-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/11/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Oral health behaviours such as establishing twice-daily toothbrushing and sugar control intake need parental self-efficacy (PSE) to prevent the development of childhood dental caries. A previous study has shown that behaviour change techniques (BCTs) delivered via a storybook can improve parental self-efficacy to undertake twice-daily toothbrushing. OBJECTIVE to determine whether an intervention (BBaRTS, Bedtime Brush and Read Together to Sleep), designed to increase PSE; delivered through storybooks with embedded BCTs, parenting skills and oral health messages, can improve child oral health compared to (1) an exactly similar intervention containing no behaviour change techniques, and (2) the BBaRTS intervention supplemented with home supply of fluoride toothpaste and supervised toothbrushing on schooldays. METHODS/DESIGN A 2-year, three-arm, multicentre, cluster randomised controlled trial. PARTICIPANTS children (estimated 2000-2600) aged 5-7 years and their families from 60 UK primary schools. INTERVENTION Test group 1: a series of eight children's storybooks developed by a psychologist, public health dentist, science educator, children's author and illustrators, with guidance from the Department for Education (England). The books feature animal characters and contain embedded dental health messages, parenting skills and BCTs to promote good oral health routines focused on controlling sugar intake and toothbrushing, as well as reading at bedtime. Books are given out over 2 years. Test group 2: as Test group 1 plus home supplies of fluoride toothpaste (1000 ppmF), and daily supervised toothbrushing in school on schooldays. Active Control group: series of eight books with exactly the same stories, characters and illustrations, but without BCTs, dental health messages or parenting skills. Annual child dental examinations and parental questionnaires will be undertaken. A sub-set of participants will be invited to join an embedded study of the child's diet and salivary microbiota composition. PRIMARY OUTCOME MEASURE dental caries experience in permanent teeth at age 7-8 years. DISCUSSION A multi-disciplinary team was established to develop the BBaRTS Children's Healthy Teeth Programme. The books were developed in partnership with the Department for Education (England), informed by a series of focus groups with children, teachers and parents. TRIAL REGISTRATION ISRCTN21461006 (date of registration 23 September 2015).
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Affiliation(s)
- Cynthia Pine
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Whitechapel, London, E1 2BA, United Kingdom.
- R&D Department, Salford Royal NHS Foundation Trust, Mayo Building, 3rd Floor, Stott Lane, Salford, M6 8HD, United Kingdom.
| | - Pauline Adair
- Health Psychology and Behavioural Medicine Research Group, School of Psychological Sciences and Health, University of Strathclyde, 40 George Street, Glasgow, G1 1QE, United Kingdom.
| | - Louise Robinson
- R&D Department, Salford Royal NHS Foundation Trust, Mayo Building, 3rd Floor, Stott Lane, Salford, M6 8HD, United Kingdom.
| | - Girvan Burnside
- Department of Biostatistics, University of Liverpool, Institute of Translational Medicine, Crown Street, Liverpool, L69 3BX, United Kingdom.
| | - Paula Moynihan
- Centre for Oral Health Research, Institute of Health and Society, Newcastle University, Framington Place, Newcastle upon Tyne, NE24BW, United Kingdom.
| | - William Wade
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, United Kingdom.
| | - James Kistler
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, United Kingdom.
| | - Morag Curnow
- NHS Tayside, Tweed Place, Perth, PH1 1TJ, United Kingdom.
| | - Mary Henderson
- Kent Community Health NHS Foundation Trust, Capital House, Jubilee Way, Faversham, Kent, ME 13 8GD, United Kingdom.
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Pine C, Adair P, Burnside G, Robinson L, Edwards RT, Albadri S, Curnow M, Ghahreman M, Henderson M, Malies C, Wong F, Muirhead V, Weston-Price S, Whitehead H. A new primary dental care service compared with standard care for child and family to reduce the re-occurrence of childhood dental caries (Dental RECUR): study protocol for a randomised controlled trial. Trials 2015; 16:505. [PMID: 26537725 PMCID: PMC4634579 DOI: 10.1186/s13063-015-1010-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In England and Scotland, dental extraction is the single highest cause of planned admission to the hospital for children under 11 years. Traditional dental services have had limited success in reducing this disease burden. Interventions based on motivational interviewing have been shown to impact positively dental health behaviours and could facilitate the prevention of re-occurrence of dental caries in this high-risk population. The objective of the study is to evaluate whether a new, dental nurse-led service, delivered using a brief negotiated interview based on motivational interviewing, is a more cost-effective service than treatment as usual, in reducing the re-occurrence of dental decay in young children with previous dental extractions. METHODS/DESIGN This 2-year, two-arm, multicentre, randomised controlled trial will include 224 child participants, initially aged 5 to 7 years, who are scheduled to have one or more primary teeth extracted for dental caries under general anaesthesia (GA), relative analgesia (RA: inhalation sedation) or local anaesthesia (LA). The trial will be conducted in University Dental Hospitals, Secondary Care Centres or other providers of dental extraction services across the United Kingdom. The intervention will include a brief negotiated interview (based on the principles of motivational interviewing) delivered between enrollment and 6 weeks post-extraction, followed by directed prevention in primary dental care. Participants will be followed up for 2 years. The main outcome measure will be the dental caries experienced by 2 years post-enrollment at the level of dentine involvement on any tooth in either dentition, which had been caries-free at the baseline assessment. DISCUSSION The participants are a hard-to-reach group in which secondary prevention is a challenge. Lack of engagement with dental care makes the children and their families scheduled for extraction particularly difficult to recruit to an RCT. Variations in service delivery between sites have also added to the challenges in implementing the Dental RECUR protocol during the recruitment phase. TRIAL REGISTRATION ISRCTN24958829 (date of registration: 27 September 2013), Current protocol version: 5.0.
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Affiliation(s)
- Cynthia Pine
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner Street, Whitechapel, London, E1 2BA, UK.
- R&D Department, Salford Royal NHS Foundation Trust, Mayo Building, 3rd Floor, Stott Lane, Salford, M6 8HD, UK.
| | - Pauline Adair
- Health Psychology and Behavioural Medicine Research Group, School of Psychological Sciences and Health, University of Strathclyde, 40 George Street, Glasgow, G1 1QE, UK.
| | - Girvan Burnside
- Department of Biostatistics, University of Liverpool, Institute of Translational Medicine, Crown Street, Liverpool, L69 3BX, UK.
| | - Louise Robinson
- R&D Department, Salford Royal NHS Foundation Trust, Mayo Building, 3rd Floor, Stott Lane, Salford, M6 8HD, UK.
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Ardudwy Hall, Bangor University, Bangor, Gwynedd, LL57 2PZ, UK.
| | - Sondos Albadri
- School of Dentistry, University of Liverpool, Pembroke Place, Liverpool, L3 5PS, UK.
| | | | - Marjan Ghahreman
- North East London NHS Foundation Trust, Tantallon House, Goodmayes Hospital Site, Barley lane, Essex, IG3 8XJ, UK.
| | - Mary Henderson
- Kent Community Health NHS Trust, Capital House, Jubillee Way, Faversham, Kent ME, 13 8GD, UK.
| | - Clare Malies
- Salford Royal NHS Foundation Trust, Community Dental Service, Dental Department, Pendleton Gateway, 1 Broadwalk, Salford, M6 5FX, UK.
| | - Ferranti Wong
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner Street, Whitechapel, London, E1 2BA, UK.
| | - Vanessa Muirhead
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner Street, Whitechapel, London, E1 2BA, UK.
| | - Sally Weston-Price
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner Street, Whitechapel, London, E1 2BA, UK.
| | - Hilary Whitehead
- Salford Royal NHS Foundation Trust, Community Dental Service, Dental Department, Pendleton Gateway, 1 Broadwalk, Salford, M6 5FX, UK.
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Pareek S, Nagaraj A, Yousuf A, Ganta S, Atri M, Singh K. Effectiveness of supervised oral health maintenance in hearing impaired and mute children- A parallel randomized controlled trial. J Int Soc Prev Community Dent 2015; 5:176-82. [PMID: 26236676 PMCID: PMC4515799 DOI: 10.4103/2231-0762.159953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Individuals with special needs may have great limitations in oral hygiene performance due to their potential motor, sensory, and intellectual disabilities. Thus, oral health care utilization is low among the disabled people. Hearing disorders affect the general behavior and impair the level of social functioning. OBJECTIVES The present study was conducted to assess the dental health outcomes following supervised tooth brushing among institutionalized hearing impaired and mute children in Jaipur, Rajasthan. MATERIALS AND METHODS The study followed a single-blind, parallel, and randomized controlled design. A total of 315 students were divided into three groups of 105 children each. Group A included resident students, who underwent supervised tooth brushing under the supervision of their parents. The non-resident students were further divided into two groups: Group B and Group C. Group B children were under the supervision of a caregiver and Group C children were under the supervision of both investigator and caregiver. RESULTS There was an average reduction in plaque score during the subsequent second follow-up conducted 3 weeks after the start of the study and in the final follow-up conducted at 6 weeks. There was also a marked reduction in the gingival index scores in all the three groups. CONCLUSION The program of teacher and parent supervised toothbrushing with fluoride toothpaste can be safely targeted to socially deprived communities and can enable a significant reduction in plaque and gingival scores. Thus, an important principle of oral health education is the active involvement of parents and caregivers.
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Affiliation(s)
- Sonia Pareek
- Department of Public Health Dentistry, Government Dental College, Jaipur, Rajasthan, India
| | - Anup Nagaraj
- Department of Public Health Dentistry, Jaipur Dental College, Jaipur, Rajasthan, India
| | - Asif Yousuf
- Department of Public Health Dentistry, Government Dental College, Shireen Bagh, Srinagar, Jammu and Kashmir, India
| | - Shravani Ganta
- Department of Public Health Dentistry, Jaipur Dental College, Jaipur, Rajasthan, India
| | - Mansi Atri
- Department of Public Health Dentistry, ESIC Dental College and Hospital, Delhi, India
| | - Kushpal Singh
- Department of Public Health Dentistry, The Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, India
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Levin L, Bilder L, Borisov O. Improving oral hygiene skills among children undergoing treatment at the haemato-oncology department - an interventional programme. Int Dent J 2015; 65:211-5. [PMID: 26032332 PMCID: PMC9376498 DOI: 10.1111/idj.12171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aim of this interventional programme was to educate children undergoing treatment at the haemato-oncology department in how to improve their oral hygiene skills. METHODS Children (and their parents) treated at the haemato-oncology department for haematological malignancies and disorders were educated and instructed in how to improve their dental oral hygiene skills. Instructions, demonstration and practice of toothbrushing techniques, as well as interproximal cleaning, were carried out in three separate sessions. In each session, toothbrushing skills were evaluated using the Ashkenazi index to assess improvement in oral hygiene skills over time. Four assessments were performed and recorded for each participant: before the initial explanation; immediately following the explanation; and 3 and 6 weeks following the first visit. RESULTS Overall, 52 children were enrolled in the programme. The first toothbrushing performance skill evaluation revealed a low score of 10.44 out of a total of 40; this was significantly increased, following the instruction session, to 33.02 (P < 0.001). This improvement was maintained at the follow-up visits at 3 weeks (35.09 ± 6.3) and 6 weeks (36.34 ± 8.3). Following the instructions, a significant increase was accomplished in both 'reach' and 'stay' components of the score, to 18.44 out of 20 for 'reach' and 17.9 out of 20 for 'stay' at the last visit (P < 0.01). CONCLUSIONS Individual supervised toothbrushing education, including a methodological toothbrushing technique, appears to be very effective. Educating medically compromised high-risk patients, such as hospitalised children, might be a good way to improve oral health and prevent future disease in this population.
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Affiliation(s)
- Liran Levin
- Division of Periodontology, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Leon Bilder
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel
| | - Oxana Borisov
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel
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Hilgert LA, Leal SC, Mulder J, Creugers NHJ, Frencken JE. Caries-preventive Effect of Supervised Toothbrushing and Sealants. J Dent Res 2015; 94:1218-24. [PMID: 26116491 DOI: 10.1177/0022034515592857] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To investigate the effectiveness of 3 caries-preventive measures on high- and low-caries risk occlusal surfaces of first permanent molars over 3 y. This cluster-randomized controlled clinical trial covered 242 schoolchildren, 6 to 7 y old, from low socioeconomic areas. At baseline, caries risk was assessed at the tooth surface level, through a combination of ICDAS II (International Caries Detection and Assessment System) and fissure depth codes. High-caries risk occlusal surfaces were treated according to daily supervised toothbrushing (STB) at school and 2 sealants: composite resin (CR) and atraumatic restorative treatment-high-viscosity glass-ionomer cement (ART-GIC). Low-caries risk occlusal surfaces received STB or no intervention. Evaluations were performed after 0.5, 1, 2, and 3 y. A cavitated dentine carious lesion was considered a failure. Data were analyzed according to the proportional hazard rate regression model with frailty correction, Wald test, analysis of variance, and t test, according to the jackknife procedure for calculating standard errors. The cumulative survival rates of cavitated dentine carious lesion-free, high-caries risk occlusal surfaces were 95.6%, 91.4%, and 90.2% for STB, CR, and ART-GIC, respectively, over 3 y, which were not statistically significantly different. For low-caries risk occlusal surfaces, no statistically significant difference was observed between the cumulative survival rate of the STB group (94.8%) and the no-intervention group (92.1%) over 3 y. There was neither a difference among STB, CR, and ART-GIC on school premises in preventing cavitated dentine carious lesions in high-caries risk occlusal surfaces of first permanent molars nor a difference between STB and no intervention for low-caries risk occlusal surfaces of first permanent molars over 3 y.
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Affiliation(s)
- L A Hilgert
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - S C Leal
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - J Mulder
- Department of Oral Global Health, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N H J Creugers
- Department of Oral Rehabilitation, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J E Frencken
- Department of Oral Global Health, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Dental Imaging Using Mesoscopic Fluorescence Molecular Tomography: An ex Vivo Feasibility Study. PHOTONICS 2014. [DOI: 10.3390/photonics1040488] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Woodall J, Woodward J, Witty K, McCulloch S. An evaluation of a toothbrushing programme in schools. HEALTH EDUCATION 2014. [DOI: 10.1108/he-12-2013-0069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to assess the effectiveness of a toothbrushing intervention delivered in primary schools in Yorkshire and the Humber, a Northern district of England. The toothbrushing intervention was designed with the intention of improving the oral health of young children. The paper reports the effectiveness of the intervention and explores process issues related to its co-ordination and delivery.
Design/methodology/approach
– The evaluation had three data gathering approaches. These were: in-depth case studies of three selected schools participating in the toothbrushing programme; interviews with oral health promoters responsible for the programme in the district; and a small scale questionnaire-based survey which was sent to the 18 schools participating in the intervention.
Findings
– The intervention was accepted by children and they enjoyed participating in the toothbrushing scheme. Children had often become more knowledgeable about toothbrushing and the consequences of not regularly cleaning their teeth. The scheme was contingent on key staff in the school and the programme was more successful where school's embraced, rather than rejected the notion of improving children's health alongside educational attainment. Whether the intervention made differences to brushing in the home requires further investigation, but there is a possibility that children can act as positive “change agents” with siblings and other family members.
Practical implications
– This paper suggests that schools can be an effective setting for implementing toothbrushing interventions.
Originality/value
– Toothbrushing in schools programmes are a relatively new initiative that have not been fully explored, especially using qualitative approaches or focusing on the views of children. This paper makes a particular contribution to understanding the process and delivery of toothbrushing interventions delivered in primary schools. The implications for programmes outside of the UK context are discussed.
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Lynch RJ. The primary and mixed dentition, post-eruptive enamel maturation and dental caries: a review. Int Dent J 2013; 63 Suppl 2:25-30. [DOI: 10.1111/idj.12074] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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O’Mara-Eves A, Brunton G, McDaid D, Oliver S, Kavanagh J, Jamal F, Matosevic T, Harden A, Thomas J. Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. PUBLIC HEALTH RESEARCH 2013. [DOI: 10.3310/phr01040] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundCommunity engagement has been advanced as a promising way of improving health and reducing health inequalities; however, the approach is not yet supported by a strong evidence base.ObjectivesTo undertake a multimethod systematic review which builds on the evidence that underpins the current UK guidance on community engagement; to identify theoretical models underpinning community engagement; to explore mechanisms and contexts through which communities are engaged; to identify community engagement approaches that are effective in reducing health inequalities, under what circumstances and for whom; and to determine the processes and costs associated with their implementation.Data sourcesDatabases including the Cochrane Database of Systematic Reviews (CDSR), The Campbell Library, the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment (HTA) database, the NHS Economic Evaluation Database (NHS EED) and EPPI-Centre’s Trials Register of Promoting Health Interventions (TRoPHI) and Database of Promoting Health Effectiveness Reviews (DoPHER) were searched from 1990 to August 2011 for systematic reviews and primary studies. Trials evaluating community engagement interventions reporting health outcomes were included.Review methodsStudy eligibility criteria: published after 1990; outcome, economic, or process evaluation; intervention relevant to community engagement; written in English; measured and reported health or community outcomes, or presents cost, resource, or implementation data characterises study populations or reports differential impacts in terms of social determinants of health; conducted in an Organisation for Economic Co-operation and Development (OECD) country. Study appraisal: risk of bias for outcome evaluations; assessment of validity and relevance for process evaluations; comparison against an economic evaluation checklist for economic evaluations. Synthesis methods: four synthesis approaches were adopted for the different evidence types: theoretical, quantitative, process, and economic evidence.ResultsThe theoretical synthesis identified key models of community engagement that are underpinned by different theories of changes. Results from 131 studies included in a meta-analysis indicate that there is solid evidence that community engagement interventions have a positive impact on health behaviours, health consequences, self-efficacy and perceived social support outcomes, across various conditions. There is insufficient evidence – particularly for long-term outcomes and indirect beneficiaries – to determine whether one particular model of community engagement is likely to be more effective than any other. There are also insufficient data to test the effects on health inequalities, although there is some evidence to suggest that interventions that improve social inequalities (as measured by social support) also improve health behaviours. There is weak evidence from the effectiveness and process evaluations that certain implementation factors may affect intervention success. From the economic analysis, there is weak but inconsistent evidence that community engagement interventions are cost-effective. By combining findings across the syntheses, we produced a new conceptual framework.LimitationsDifferences in the populations, intervention approaches and health outcomes made it difficult to pinpoint specific strategies for intervention effectiveness. The syntheses of process and economic evidence were limited by the small (generally not rigorous) evidence base.ConclusionsCommunity engagement interventions are effective across a wide range of contexts and using a variety of mechanisms. Public health initiatives should incorporate community engagement into intervention design. Evaluations should place greater emphasis on long-term outcomes, outcomes for indirect beneficiaries, process evaluation, and reporting costs and resources data. The theories of change identified and the newly developed conceptual framework are useful tools for researchers and practitioners. We identified trends in the evidence that could provide useful directions for future intervention design and evaluation.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- A O’Mara-Eves
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| | - G Brunton
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| | - D McDaid
- Personal Social Services Research Unit and European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
| | - S Oliver
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| | - J Kavanagh
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| | - F Jamal
- Institute for Health and Human Development, University of East London, London, UK
| | - T Matosevic
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - A Harden
- Institute for Health and Human Development, University of East London, London, UK
- Barts Health NHS Trust, London, UK
| | - J Thomas
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
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Mijan M, de Amorim RG, Leal SC, Mulder J, Oliveira L, Creugers NHJ, Frencken JE. The 3.5-year survival rates of primary molars treated according to three treatment protocols: a controlled clinical trial. Clin Oral Investig 2013; 18:1061-1069. [PMID: 23943256 DOI: 10.1007/s00784-013-1077-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study aimed to test the hypothesis that there is no difference in the survival rates of molars treated according to the conventional restorative treatment (CRT) using amalgam, atraumatic restorative treatment (ART) using high-viscosity glass ionomer, and ultraconservative treatment (UCT) protocol after 3.5 years. MATERIALS AND METHODS Cavitated primary molars were treated according to CRT, ART, and UCT (small cavities were restored with ART and medium/large cavities were daily cleaned with toothpaste/toothbrush under supervision). Molar extractions resulting from toothache, sepsis, or pulp exposure were failures. The Kaplan-Meier method was used to estimate the survival curves. RESULTS The numbers of treated teeth, among the 302 6-7-year-old children, were 341 (CRT), 244 (ART), and 281 (for UCT group: 109 small ART, 166 open cavities, and 6 combinations). Protocol groups were similar at baseline regarding gender and mean decayed missing filled tooth score, but not regarding age and type of surface. The numbers of molars extracted were 22 (CRT), 16 (ART), and 26 (UCT). Fistulae were most often recorded. After 3.5 years, the cumulative survival rate ± standard error for all molars treated was 90.9 ± 2.0 % with CRT, 90.4 ± 2.4 % with ART, and 89.0 [corrected] ± 1.9 % with UCT (p = 0.13). Only a type of surface effect was observed over the 3.5-year period: survival rates for molars were higher for single- than for multiple-surface cavities. CONCLUSION There was no difference in the cumulative survival rates of primary molars treated according to the CRT, ART, and UCT protocols over a 3.5-year period. CLINICAL RELEVANCE Keeping cavities in primary molars biofilm-free might be another treatment option alongside restoring such cavities through conventional and ART protocols.
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Affiliation(s)
- Maite Mijan
- Department of Global Oral Health, College of Dental Sciences, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Pediatric Dentistry, School of Health Sciences, University of Brasília, Brasília, Brazil
| | - Rodrigo Guedes de Amorim
- Department of Global Oral Health, College of Dental Sciences, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Soraya Coelho Leal
- Department of Pediatric Dentistry, School of Health Sciences, University of Brasília, Brasília, Brazil
| | - Jan Mulder
- Department of Global Oral Health, College of Dental Sciences, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Luciana Oliveira
- Department of Pediatric Dentistry, São Leopoldo Mandic School of Dentistry, Campinas, Brazil
| | - Nico H J Creugers
- Department of Oral Rehabilitation, College of Dental Sciences, Radboud University Nijmegen Medical Centre, 6500 HB, Nijmegen, The Netherlands
| | - Jo E Frencken
- Department of Global Oral Health, College of Dental Sciences, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Cooper AM, O'Malley LA, Elison SN, Armstrong R, Burnside G, Adair P, Dugdill L, Pine C. Primary school-based behavioural interventions for preventing caries. Cochrane Database Syst Rev 2013:CD009378. [PMID: 23728691 DOI: 10.1002/14651858.cd009378.pub2] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Anna M Cooper
- Directorate of Psychology and Public Health, School of Health Sciences, University of Salford, Salford, UK.
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Colak H, Dülgergil CT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. J Nat Sci Biol Med 2013; 4:29-38. [PMID: 23633832 PMCID: PMC3633299 DOI: 10.4103/0976-9668.107257] [Citation(s) in RCA: 305] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Dental caries (decay) is an international public health challenge, especially amongst young children. Early childhood caries (ECC) is a serious public health problem in both developing and industrialized countries. ECC can begin early in life, progresses rapidly in those who are at high risk, and often goes untreated. Its consequences can affect the immediate and long-term quality of life of the child's family and can have significant social and economic consequences beyond the immediate family as well. ECC can be a particularly virulent form of caries, beginning soon after dental eruption, developing on smooth surfaces, progressing rapidly, and having a lasting detrimental impact on the dentition. Children experiencing caries as infants or toddlers have a much greater probability of subsequent caries in both the primary and permanent dentitions. The relationship between breastfeeding and ECC is likely to be complex and confounded by many biological variables, such as mutans streptococci, enamel hypoplasia, intake of sugars, as well as social variables, such as parental education and socioeconomic status, which may affect oral health. Unlike other infectious diseases, tooth decay is not self-limiting. Decayed teeth require professional treatment to remove infection and restore tooth function. In this review, we give detailed information about ECC, from its diagnosis to management.
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Affiliation(s)
- Hakan Colak
- Kirikkale University Dental Faculty, Department of Restorative Dentistry, Kirikkale, Turkey
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Monse B, Benzian H, Naliponguit E, Belizario V, Schratz A, van Palenstein Helderman W. The Fit for School Health Outcome Study - a longitudinal survey to assess health impacts of an integrated school health programme in the Philippines. BMC Public Health 2013; 13:256. [PMID: 23517517 PMCID: PMC3610233 DOI: 10.1186/1471-2458-13-256] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 03/11/2013] [Indexed: 11/26/2022] Open
Abstract
Background Child health in many low- and middle-income countries lags behind international goals and affects children’s education, well-being, and general development. Large-scale school health programmes can be effective in reducing preventable diseases through cost-effective interventions. This paper outlines the baseline and 1-year results of a longitudinal health study assessing the impact of the Fit for School Programme in the Philippines. Methods A longitudinal 4-year cohort study was conducted in the province of Camiguin, Mindanao (experimental group); an external concurrent control group was studied in Gingoog, Mindanao. The study has three experimental groups: group 1—daily handwashing with soap, daily brushing with fluoride toothpaste, biannual deworming with 400 mg albendazole (Essential Health Care Program [EHCP]); group 2—EHCP plus twice-a-year access to school-based Oral Urgent Treatment; group 3—EHCP plus weekly toothbrushing with high-fluoride concentration gel. A non-concurrent internal control group was also included. Baseline data on anthropometric indicators to calculate body mass index (BMI), soil-transmitted helminths (STH) infection in stool samples, and dental caries were collected in August 2009 and August 2010. Data were analysed to assess validity of the control group design, baseline, and 1-year results. Results In the cohort study, 412 children were examined at baseline and 341 1 year after intervention. The baseline results were in line with national averages for STH infection, BMI, and dental caries in group 1 and the control groups. Children lost to follow-up had similar baseline characteristics in the experimental and control groups. After 1 year, group 1 showed a significantly higher increase in mean BMI and lower prevalence of moderate to heavy STH infection than the external concurrent control group. The increases in caries and dental infections were reduced but not statistically significant. The results for groups 2 and 3 will be reported separately. Conclusions Despite the short 1-year observation period, the study found a reduction in the prevalence of moderate to heavy STH infections, a rise in mean BMI, and a (statistically non-significant) reduction in dental caries and infections. The study design proved functional in actual field conditions. Critical aspects affecting the validity of cohort studies are analysed and discussed. Trial registration DRKS00003431 WHO Universal Trial Number U1111-1126-0718
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Affiliation(s)
- Bella Monse
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, GIZ Office Manila, PDCP Bank Centre, V.A. Rufino cor. L.P. Leviste Str, Makati, Metro Manila, Philippines
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Mahaboob Basha P, Saumya SM. Suppression of Mitochondrial Oxidative Phosphorylation and TCA Enzymes in Discrete Brain Regions of Mice Exposed to High Fluoride: Amelioration by Panax ginseng (Ginseng) and Lagerstroemia speciosa (Banaba) Extracts. Cell Mol Neurobiol 2013; 33:453-64. [DOI: 10.1007/s10571-013-9912-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 01/19/2013] [Indexed: 01/10/2023]
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Young DA, Featherstone JDB. Caries management by risk assessment. Community Dent Oral Epidemiol 2013; 41:e53-63. [DOI: 10.1111/cdoe.12031] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Douglas A. Young
- Department of Dental Practice; University of the Pacific; San Francisco; CA; USA
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Caries prevention with fluoride toothpaste in children: an update. Eur Arch Paediatr Dent 2012; 10:162-7. [DOI: 10.1007/bf03262678] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Macpherson LMD, Anopa Y, Conway DI, McMahon AD. National supervised toothbrushing program and dental decay in Scotland. J Dent Res 2012; 92:109-13. [PMID: 23264611 DOI: 10.1177/0022034512470690] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We aimed to assess the association between the roll-out of the national nursery toothbrushing program and a reduction in dental decay in five-year-old children in a Scotland-wide population study. The intervention was supervised toothbrushing in nurseries and distribution of fluoride toothpaste and toothbrushes for home use, measured as the percentage of nurseries participating in each health service administrative board area. The endpoint was mean d(3)mft in 99,071 five-year-old children, covering 7% to 25% of the relevant population (in various years), who participated in multiple cross-sectional dental epidemiology surveys in 1987 to 2009. The slope of the uptake in toothbrushing was correlated with the slope in the reduction of d(3)mft. The mean d(3)mft in Years -2 to 0 (relative to that in start-up Year 0) was 3.06, reducing to 2.07 in Years 10 to 12 (difference = -0.99; 95% CI -1.08, -0.90; p < 0.001). The uptake of toothbrushing correlated with the decline in d(3)mft (correlation = -0.64; -0.86, -0.16; p = 0.011). The result improved when one outlying Health Board was excluded (correlation = -0.90; -0.97, -0.70; p < 0.0001). An improvement in the dental health of five-year-olds was detected and is associated with the uptake of nursery toothbrushing.
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Affiliation(s)
- L M D Macpherson
- University of Glasgow, College of Medical, Veterinary and Life Sciences, Glasgow Dental School, 378 Sauchiehall Street, Glasgow, UK
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Monse B, Heinrich-Weltzien R, Mulder J, Holmgren C, van Palenstein Helderman WH. Caries preventive efficacy of silver diammine fluoride (SDF) and ART sealants in a school-based daily fluoride toothbrushing program in the Philippines. BMC Oral Health 2012; 12:52. [PMID: 23171244 PMCID: PMC3549940 DOI: 10.1186/1472-6831-12-52] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 10/31/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Occlusal surfaces of erupting and newly erupted permanent molars are particularly susceptible to caries.The objective of the study was to assess and compare the effect of a single application of 38% SDF with ART sealants and no treatment in preventing dentinal (D3) caries lesions on occlusal surfaces of permanent first molars of school children who participated in a daily school-based toothbrushing program with fluoride toothpaste. METHODS The prospective community clinical trial in the Philippines was conducted over a period of 18 months and included 704 six- to eight-year-old school children in eight public elementary schools with a daily school-based fluoride toothpaste brushing program. Children were randomly assigned for SDF application or ART sealant treatment. Children from two of the eight schools did not receive SDF or ART sealant treatment and served as controls. SDF or ART sealant treatment was applied on sound occlusal surfaces of permanent first molars. Surfaces that were originally defined as sound at baseline but which changed to dentinal (D3) caries lesions were defined as surfaces with new caries (caries increment). Non-compliance to the daily toothbrushing program in three schools offered the opportunity to analyze the caries preventive effect of SDF and sealants separately in fluoride toothpaste brushing and in non-toothbrushing children. RESULTS In the brushing group, caries increment in the SDF treatment group was comparable with the non-treatment group but caries increment in the sealant group was lower than in the non-treatment group with a statistically significant lower hazard ratio of 0.12 (0.02-0.61). In the non-brushing group, caries increment in the SDF treatment group and the sealant group was lower than the non-treatment group but the hazard ratio was only statistically significant for the sealant group (HR 0.33; 0.20-0.54). Caries increment was lower in toothbrushing children than in non-toothbrushing children. Hazard ratios reached statistical significance for the non-treated children (HR 0.43; 0.21-0.87) and the sealant-treated children (HR 0.15; 0.03-0.072). CONCLUSIONS A one-time application of 38% SDF on the occlusal surfaces of permanent first molars of six- to eight-year-old children is not an effective method to prevent dentinal (D3) caries lesions. ART sealants significantly reduced the onset of caries over a period of 18 months. TRIAL REGISTRATION NUMBER German Clinical Trial Register DRKS00003427.
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Affiliation(s)
- Bella Monse
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, GIZ Office Manila, PDCP Bank Centre, V,A, Rufino cor, L,P, Leviste Str, Makati City, Metro Manila, Philippines.
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Damle SG, Deoyani D, Bhattal H, Yadav R, Lomba A. Comparative efficacy of dentifrice containing sodium monofluorophosphate + calcium glycerophosphate and non-fluoridated dentifrice: A randomized, double-blind, prospective study. Dent Res J (Isfahan) 2012; 9:68-73. [PMID: 22363366 PMCID: PMC3283981 DOI: 10.4103/1735-3327.92948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The efficacy of fluoridated dentifrices in caries prevention has been well documented and research into various formulations continues for a more effective dentifrice. This study evaluated the anti-caries and anti-plaque efficacy of a dentifrice containing sodium monofluorophosphate (1000 ppm) and calcium glycerophosphate, and compared it with a non-fluoridated dentifrice. Materials and Methods: A total of 595 school children (12–15 years) were divided into test (302 children) and control (293 children) groups. The test group used the dentifrice containing sodium monofluorophosphate (1000 ppm) and calcium glycerophosphate, whereas the control group was given a placebo dentifrice. Oral examination for dental caries and plaque assessment was carried out at the start of the study and the children were followed up semiannually up to 18 months. Data were analyzed using repeated-measure analysis of variance (ANOVA) followed by one-way ANOVA. Results: The values for decayed missing filled teeth (DMFT) increased from baseline to 18 month examination from 4.43±2.03 and 4.67±2.25 (P=0.175) to 5.84±2.29 and 5.13±2.30 (P=0.001) for control and test groups, respectively. Similarly, the increase in decayed missing filled surface (DMFS) values were from 6.42±4.10 and 7.06±4.77 (P=0.082) to 8.64±4.51 and 7.92±5.07 (P=0.095) for test and control groups, respectively. The mean DMFT and DMFS values increased for both the groups; however, the increase was less in test group as compared to control group. The baseline plaque score reduced from 2.94±0.72 and 2.91±0.72 (P=0.679), respectively, for control and test groups to 1.33±0.46 and 0.91±0.38 (P<0.001), respectively, at 18 month examination. Conclusion: Results revealed that the test dentifrice was effective in inhibiting the progression of plaque and control of dental caries as compared to the placebo dentifrice.
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Affiliation(s)
- Satyawan G Damle
- Department of Pediatric Dentistry, Maharishi Markandeshwar University, Mullana, Ambala, India
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Rosema NAM, van Palenstein Helderman WH, Van der Weijden GA. Gingivitis and plaque scores of 8- to 11-year-old Burmese children following participation in a 2-year school-based toothbrushing programme. Int J Dent Hyg 2012; 10:163-8. [PMID: 22540419 DOI: 10.1111/j.1601-5037.2012.00553.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The present study assessed whether gingivitis and plaque scores of 8- to 11-year-old school children who participated in a SBTB programme for 2 years were lower than those of children who did not participate in the programme. MATERIAL AND METHODS The present study was performed using an examiner-blind, parallel group design and was performed in Burma (Myanmar) in 2006. Three of the five schools where daily SBTB programmes took place after lunch and which were performed under teacher supervision were randomly selected; three non-participating schools (non-SBTB) from the same area were assigned as controls. Twenty-five children per school were examined for gingivitis (bleeding on marginal probing) and plaque (Quigley & Hein). RESULTS In total, 150 8- to 11-year-old children participated, with 75 children in either group. The test group (SBTB) exhibited an overall mean bleeding score of 0.76. For the control group (non-SBTB), this score was 0.83. With respect to the overall mean plaque scores, the test group exhibited a score of 2.93, whereas the control group exhibited a score of 2.91. No statistically significant differences between the test and the control group were observed. CONCLUSION The present study did not reveal a statistically significant effect of daily SBTB programmes in 8- to 11-year-old school children with respect to gingivitis and plaque scores.
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Affiliation(s)
- N A M Rosema
- Department of Periodontology, Academic Centre for Dentistry, Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands.
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Arruda AO, Senthamarai Kannan R, Inglehart MR, Rezende CT, Sohn W. Effect of 5% fluoride varnish application on caries among school children in rural Brazil: a randomized controlled trial. Community Dent Oral Epidemiol 2011; 40:267-76. [DOI: 10.1111/j.1600-0528.2011.00656.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stokes E, Ashcroft A, Burnside G, Mohindra T, Pine CM. Randomised controlled trial of the efficacy of a high-fluoride gel self-applied by toothbrushing in children at high caries risk. Caries Res 2011; 45:475-85. [PMID: 21912128 DOI: 10.1159/000331205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 07/21/2011] [Indexed: 11/19/2022] Open
Abstract
The primary objective of this clinical trial was to assess the caries-preventive efficacy of 2 years of twice weekly supervised brushing with a self-applied gel containing 12,500 ppm fluoride on schooldays compared with weekly supervised use in children at high caries risk (with prior caries experience on first permanent molars). The secondary objective was to assess efficacy compared with similar children who continued with their usual oral hygiene care. This was a single-centre, single-blind, randomised, parallel-groups trial comprising two test groups and one untreated control group. 1,075 pupils aged 12-13 years at baseline received a baseline and final examination 2 years later. For all children completing the trial no significant difference was found between groups. For children compliant with study protocol no significant difference was found in the primary outcome (D(1)FS caries increment), but significant differences were found between the three groups overall in the secondary outcome, D(3)FT caries increment, with a significant pairwise difference between control and twice per week gel brushing (29%, p = 0.023 D(3)FT visual + fibre-optic transillumination). Analysis of the relationship between number of gel applications and caries showed that children who brushed with the gel at least 60 times over a 2-year period developed significantly fewer carious lesions into dentine than children who followed their usual oral hygiene routine. Some caution is needed as greatest benefit was shown by compliant children. Where schools are co-operative, it is recommended that the gel be used twice a week within a school-based programme over a 2-year period.
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Affiliation(s)
- E Stokes
- WHO Collaborating Centre for Research in Oral Health in Deprived Communities, University of Liverpool, Liverpool, UK
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Frazão P. Effectiveness of the bucco-lingual technique within a school-based supervised toothbrushing program on preventing caries: a randomized controlled trial. BMC Oral Health 2011; 11:11. [PMID: 21426572 PMCID: PMC3068992 DOI: 10.1186/1472-6831-11-11] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 03/22/2011] [Indexed: 05/26/2023] Open
Abstract
Background Supervised toothbrushing programs using fluoride dentifrice have reduced caries increment. However there is no information about the effectiveness of the professional cross-brushing technique within a community intervention. The aim was to assess if the bucco-lingual technique can increase the effectiveness of a school-based supervised toothbrushing program on preventing caries. Methods A randomized double-blinded controlled community intervention trial to be analyzed at an individual level was conducted in a Brazilian low-income fluoridated area. Six preschools were randomly assigned to the test and control groups and 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice supervised directly by a dental assistant, was developed four times per year. At the remaining school days the children brushed their teeth under indirect supervising of the teachers. In test group, children also underwent a professional cross-brushing on surfaces of first permanent molar rendered by a specially trained dental assistant five times per year. Enamel and dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars during 18-month follow-up. Exposure time of surfaces was calculated and incidence density ratio was estimated using Poisson regression model. Results Difference of 21.6 lesions per 1,000 children between control and test groups was observed. Among boys whose caries risk was higher compared to girls, incidence density was 50% lower in test group (p = 0.016). Conclusion Modified program was effective among the boys. It is licit to project a relevant effect in a larger period suggesting in a broader population substantial reduction of dental care needs. Trial registration ISRCTN18548869.
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Affiliation(s)
- Paulo Frazão
- Public Health School, University of São Paulo, São Paulo, Brazil.
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