Efficacy of an oral health promotion intervention in the prevention of early childhood caries

Abstract

Despite a marked improvement in oral health of Australian children over the last 30 years, severe early childhood caries (S-ECC) affects up to 17% of 2- to 3-year-old children with some requiring hospitalization and invasive treatment. This provided a compelling rationale to develop and test an oral health promotion programme which aimed to reduce this unnecessary suffering. The purpose of this study was to test the efficacy of an oral health promotion programme for the parents of infants, starting during the pregnancy, using a randomized controlled trial. A programme was developed around the provision of anticipatory guidance to nulliparous women (women expecting their first child) in Adelaide. Mothers in the test group received oral health promotion information during pregnancy, and later when the child reached 6 and 12 months of age. After the second round of information the test group mothers were randomized again. The information was reinforced in one of the test subgroups through a telephone consultation. There was no contact with mothers in the control group after enrolment. At the age of 20 +/- 2.5 months all test and control group children were examined by a dentist. The case definition of an incidence of S-ECC was one or more upper incisor teeth being carious at the level of a cavitated or noncavitated lesion. The differences in S-ECC incidence between the test and control groups, and the test subgroups were analysed. Of 649 women enroled in the programme (test group 327, control group 322), 441 had their child examined at follow-up. The incidence of S-ECC in the test group was 1.7% and in the control group 9.6% (P < 0.001). An oral health promotion programme based on repeated rounds of anticipatory guidance initiated during the mother's pregnancy was successful in reducing the incidence of S-ECC in these very young children.