Early Childhood Caries Research Articles

Maternal factors associated with early childhood caries among 3–5-year-old children with low socio-economic status in Trishal, Bangladesh

IntroductionEarly Childhood Caries (ECC) is more prevalent in nations where a larger portion of the population resides below the poverty line. This study aimed to evaluate the connections between maternal awareness, attitudes, practices related to oral health, and the occurrence of ECC among children aged 3–5 years in Bangladesh, a low–middle income country with high level of poverty.MethodsThis cross–sectional study recruited mother–child pairs with a focus on children aged 3–5 years from low socioeconomic backgrounds in Trishal, Bangladesh. Data collected included maternal oral health knowledge, attitudes, and behaviors. Clinical examinations were conducted to check for dental plaque on the upper central incisors' labial surfaces. ECC was identified using the ICDAS II index criteria. Associations between maternal oral health knowledge, attitudes, behaviors, and children's plaque score and caries status were analyzed using multivariable logistic regression, and adjusting for confounding variables (child's age, gender, mother's age, education, and number of children).ResultsAmong 532 mother-child pairs, 491 (93.2%) mothers were unaware of the role of fluoride in preventing caries, while 516 (97%) recognized the importance of using fluoridated toothpaste during brushing. Additionally, 520 (97.7%) mothers reported not knowing how to brush their child's teeth, and 87 (16.4%) brushed their children's teeth twice daily. Visible dental plaque was observed in 420 (78.9%) children, and 321 (60.3%) had ECC. Higher plaque score increased the odds of ECC in the study population (AOR: 5.617, 95% CI: 3.511–8.987).ConclusionsMothers of preschool children with low socioeconomic status were poorly aware of caries preventive behaviors and had suboptimal oral health practices for their children. The plaque score was the only oral health factor that seems to increase the risk for ECC among children with low socio-economic status in Bangladesh. It is imperative to prioritize support and interventions aimed at improving oral hygiene practices to reduce ECC risk in this population.

The Evaluation of Postoperative Complications and Oral Health-Related Quality of Life Following Dental General Anesthesia for Early Childhood Caries.

Aim The study aims toevaluate the postoperative complications and oral health-related quality of life (OHRQoL) following dental general anesthesia for early childhood caries (ECC). Materials and methods Two hundred children aged between three and six requiring full-mouth rehabilitation for general anesthesia were recruited for the study. Demographic data and oral health-related quality of life using the Early Childhood Oral Health Impact Scale (ECOHIS) were collected before the surgery. Postoperative complications and oral health-related quality of life were evaluated after 24hours and at a one-week follow-up appointment. Results All 200 children returned for the follow-up appointment after one week. Pain was found to be the most common postoperative complication after 24 hours (52%) and one week (6%). The oral health-related quality of life showed a significant improvement after one week (P < 0.001) Conclusion Children may experience a postoperative complication after full-mouth rehabilitation, which resolves within a week. Dental pain was the most common operative complication in the present study. Oral health-related quality of life showed significant improvement after full-mouth rehabilitation.

Research Paper: The relationship between child temperament and early childhood caries in 3 to 6 year-old children

Introduction: The etiology of Early Childhood Caries (ECC) is very complex and includes biological, behavioral, social and demographic factors. Regarding the importance of evaluating the factors affecting ECC, the present research was aimed to evaluate the relationship between temperament and ECC. Methods: This descriptive-analytical study was performed on 150 children referred to kindergartens in Rasht. The Child Behavior Questionnaire (CBQ) was used to evaluate the temperament of children and clinical examinations were used to evaluate ECC. The collected data were analyzed by SPSS software version 24 and at a significance level of 5%. Results: The descriptive findings showed that the temperament score in girls was higher than in boys. Also, temperament score, activity level, smile, perceptual sensitivity, and pleasure intensity had a negative and significant relationship with decay-missing-filled teeth (DMFT) and decay-missing-filled surface (DMFS) indices. Only the inhibitory control subscale had a positive and significant relationship with these two criteria. The subscales of discomfort, positive anticipation, and reactivity had a significant and negative relationship with DMFT. There was a positive and statistically significant relationship between the number of brushing times a day with inhibitory control, sadness, focusing, smile, perceptual sensitivity, pleasure intensity, reactivity, and temperament. Conclusion: According to the results, temperament must be considered as an effective factor in ECC. Temperament and subscales of activity level, discomfort, inhibitory control, smile, positive anticipation, reactivity, perceptual sensitivity, and pleasure intensity were identified as the factors affecting ECC.

Perceived Outcomes, Parental Satisfaction, and Oral Health-Related Quality of Life After Full Mouth Rehabilitation Under General Anesthesia for Early Childhood Caries.

The aim of this article is to evaluate the perceived outcomes, parental satisfaction, and oral health-related quality of life after full mouth rehabilitation under general anesthesia for children with early childhood caries. A total of 200 children requiring full-mouth rehabilitation under general anesthesia for the management of early childhood caries were recruited for the study. Perceived outcomes, oral health-related quality of life, and parental satisfaction were evaluated at the follow-up visit after six months. All participants reported back for the follow-up visit after six months. Oral health-related quality of life after full-mouth rehabilitation showed statistically significant improvement at follow-up (P <0.001); 97.5% of the parents were satisfied with the treatment. Perceived outcomes were found to be satisfactory, and a significant improvement (P <0.001) was seen after treatment. The perceived outcomes of participating parents were met. Significant improvement in oral health was seen after full-mouth rehabilitation under general anesthesia. Parental satisfaction was found to be high at the follow-up visit after six months. Parents found the improvement in the oral and general health of their child to be significant.

Parental Feeding Styles and Risk of a New Carious Lesion in Preschool Children: A Longitudinal Study.

Parents may influence children's intake of sweets and sugar-sweetened beverages through their feeding styles. This study prospectively assessed the association between parental feeding styles and caries risk in preschool children. In November and December 2021, we recruited 1181 preschool children aged 3-4 years in Guangzhou, China, and then conducted a follow-up visit after 15 months. The children were examined for dental caries, and their parents answered the Chinese version of the Parental Feeding Style Questionnaire. Data were analyzed using logistic regression analysis. At baseline, 'control over eating' was found to be negatively associated with early childhood caries (OR = 0.60, 95%CI = 0.44, 0.83). After 15 months, no significant association between baseline parental feeding styles and the risk of a new carious lesion was found. When considering changes in parental feeding styles between the baseline and the follow-up visit, we found children with increasing scores on 'instrumental feeding' during the 15 months had a higher risk of a new carious lesion (OR = 1.91, 95%CI = 1.18, 3.12). However, children with always-intermediate scores (OR = 0.51, 95%CI = 0.30, 0.86), always-high scores (OR = 0.42, 95%CI = 0.23, 0.77), or increasing scores (OR = 0.50, 95%CI = 0.31, 0.83) on 'control over eating' had a lower risk of a new carious lesion. Our study highlighted the influence of parental feeding styles on caries risk in preschool children.

Evaluation of the Effect of Maternal Education on Toddler Dental Plaque Removal Based on a Health Belief Model.

Objectives: The objective of this study was to investigate the impact of an educational intervention, guided by the Health Belief Model (HBM), on promoting preventive behaviors among mothers to combat early childhood caries (ECC) in toddlers aged 12 to 18 months. Materials and Methods: This single-blind interventional study evaluated 92 toddlers between 12 to 18 months and their mothers, who were selected by stratified random sampling. Data regarding demographic and nutritional factors were collected using a questionnaire. The dental status of children was evaluated by clinical examination and measuring the plaque index (PI) of maxillary central incisors and the dmfs index. A pamphlet designed according to the HBM was used for oral hygiene instruction in both the intervention and control groups. All of the mothers in the intervention group received a music file to listen to when brushing their children's teeth. Data were analyzed using chi-square, Fisher exact, Mann-Whitney, and Wilcoxson tests. P<0.05 was considered significant. Results: No significant correlation was noted between the daily frequency of sugary substance intake and primary PI in the intervention or control group with/without dental plaque (P>0.05). In the intervention group, PI significantly decreased after the intervention compared to baseline (P<0.001). However, there was no significant change in PI after the intervention in the control group compared with baseline (P=0.1). Conclusion: The findings indicate that a combination of educational intervention and incentives, such as using age-appropriate music for toddlers, can significantly enhance mothers' effectiveness in removing dental plaque.

A scoping review linking early childhood caries to violence, neglect, internally displaced, migrant and refugee status

BackgroundThe aim of the scoping review was to identify and synthesize the available literature concerning the relationship between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC) as it relates to the United Nation’s Sustainable Development Goal 16 (SDG 16).MethodsData regarding the links between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC), and the associations between ECC and maternal and child exposure to physical and sexual abuse, insecurity, crime, exploitation, torture, and displacement were extracted. The search was carried out in January 2023 across three databases (PubMed, Web of Science, and Scopus). Only publications in English with accessible full texts were included. Descriptive statistics were utilized to summarize the categories of the retrieved papers, and graphical representation was employed for visualization purposes. The relationships between the publications and each of the 10 targets of Sustainable Development Goal 16 (SDG 16) were also assessed.ResultsForty-five studies were reviewed. Most studies (42.2%) originated from the Americas Regions, while no studies were identified from the Africa Region. A significant portion (46.7%) of the papers focused on abuse, violence, and neglect as risk factors for ECC. Migrants, refugees, and IDPs were the most investigated populations (44.4%). Only one study specifically focused on IDPs and migrants respectively. The prevalence of untreated caries was higher among migrants, refugees, and IDPs compared to the host community, ECC was more prevalent among children who experienced abuse, neglect, or were in protective care. The was no clear direction on the associations between ECC and intimate partner violence, adverse childhood experiences, and wars. In terms of the SDGs, the reviewed publications addressed four targets (SDG16.1, SDG16.2, SDG16.3, and SDG16.5) out of the ten targets outlined in SDG 16.ConclusionThere is available evidence regarding the connections between ECC and war, refugees, migration, violence, and neglect, as outlined in SDG 16. Future studies are needed to investigate how forced movements directly affects ECC status, how disruptions of peace and stability is a risk factor for ECC, and the associations between ECC and other indicators related to SDG 16 targets.

Oral health during pregnancy: an analysis of interprofessional guideline awareness and practice behaviors among prenatal and oral health providers

BackgroundPoor oral health during pregnancy has significant implications across the life course, including increased risk for adverse pregnancy, birth outcomes, and the development of early childhood caries. In efforts to improve perinatal oral health in the United States, a set of national interprofessional guidelines were developed that include recommended practice behaviors for both oral health providers and prenatal providers. The purpose of this study was to examine guideline awareness, familiarity, beliefs, and practice behaviors among both provider types.MethodsPrenatal providers and oral health providers in Florida were recruited via random and convenience sampling to complete an online survey guided by the Consolidated Framework for Implementation Research (CFIR) and the Cabana Framework. The present analysis focused on the Individuals Involved domain (CFIR), awareness and familiarity with the guidelines (Cabana Framework), confidence, and practice behaviors as recommended by prenatal oral health guidelines (assess, advise, refer, share/coordinate). Data were analyzed using chi-square tests, independent samples t-tests, Pearson correlation coefficients, and one-way analysis of variance (ANOVA) and analyses were conducted in SPSS.ResultsPrenatal and oral health providers did not differ significantly in their awareness of the guidelines, but awareness was significantly associated with three of the four practice behaviors for prenatal providers. Familiarity with the guidelines was significantly higher among oral health providers and was associated with all four practice behaviors for both provider types. Five out of ten oral health belief items were significantly associated with practicing the guidelines among prenatal providers, but only two among oral health providers. Confidence in performing the practice behaviors was significantly associated with guideline implementation among both groups. Years in practice was significantly associated with performing practice behaviors for prenatal providers, but not for oral health providers.ConclusionsOur findings highlight the importance of professional organizations and the role of clinical guidelines on practice behaviors. Although provider education is a key implementation strategy, organizational and policy-level system changes could also be critical in supporting practice behaviors.

Presence of candida in the dental plaque and saliva of patients with severe early childhood caries and early childhood caries:a pilot study.

The aim of this study is to evaluate the presence of candida, which is one of the etiological factors contributing to early childhood caries (ECC) and severe early childhood caries (S-ECC), in the dental plaque and saliva of children aged 6 years and younger. Our study involved 60 participants who met the inclusion criteria. Based on clinical examinations, we divided them into three groups, each consisting of 20 children: S-ECC, ECC, and caries-free groups. We collected dental plaque and saliva samples from the children during clinic visits. In the laboratory, we assessed these samples for the presence of candida using the Liofilchem® - ChromaticTM Candida (Roseto degli Abruzzi, Italy) medium and identified Candida species. The presence of Candida in the saliva of children with S-ECC (40%) and ECC (30%) was statistically significant compared to children without caries (p<0.05). Observationally, we found a higher presence of candida only in the dental plaque of children with S-ECC (25%) and ECC (15%) compared to children without caries (p>0.05). In the S-ECC group, we detected Candida albicans, Candida glabrata, Candida krusei, and Candida tropicalis in saliva, while Candida albicans was found in dental plaque. In the ECC group, Candida albicans, Candida glabrata, and Candida krusei were detected, whereas Candida was not detected in children without caries. It is important to consider the presence of Candida in both saliva and dental plaque, as it potentially plays a role in the pathogenesis of ECC. These findings suggest that identifying and preventing Candida colonization may be valuable for individual risk assessment and could contribute to reducing ECC.

Early childhood caries – myths and misconceptions

Early childhood caries – myths and misconceptions

Evaluation of Factors Affecting Clinical Outcomes of Full Mouth Rehabilitation Under General Anaesthesia for Children With Early Childhood Caries: A Prospective Cohort Study.

This study was designed to evaluate the factors affecting the clinical outcomes of full mouth rehabilitation under general anaesthesia for children with early childhood caries (ECCs). A prospective cohort of 200 children with early childhood caries and requiring dental rehabilitation under general anaesthesia was evaluated and treated. Children were recalled at six-month intervals for a period of two years and evaluated for the recurrence of caries and the need for repeat treatment of failed cases. 86.5% of the patients adhered to the six-month recall visits for 24 months. An overall caries recurrence rate of 14.5% was seen. Children who did not adhere to the follow-up plan and visited ad hoc had the highest caries recurrence rate (88%). Good compliance with postoperative instructions after full mouth rehabilitation resulted in good oral hygiene and a limited recurrence of caries. Patients with poor compliance with recall visits and postoperative instructions had high rates of caries recurrence. Rehabilitation under general anaesthesia can be considered a viable treatment option for children diagnosed with early childhood caries.

Effectiveness of silver diamine fluoride versus sodium fluoride varnish combined with mother’s motivational interviewing for arresting early childhood caries: a randomized clinical trial

BackgroundSilver Diamine Fluoride (SDF) has gained attention as one of the minimally invasive modalities to manage ECC although it causes black staining of treated carious lesions. A possible affordable alternative may be Sodium Fluoride (NaF) varnish combined with good oral hygiene promoted by parental Motivational Interviewing (MI). The study compared the effectiveness of 38% SDF solution and 5% NaF varnish supported by parental MI in arresting ECC.Materials and methodsChildren aged ≤ 4 years old with at least one active carious lesion (ICDAS score ≥ 3) were randomly assigned to treatment by a single application of 38% SDF solution or a single application of 5% NaF varnish supported by two MI sessions for mothers at baseline and after three months. Chi-Squared test was used to compare groups and multilevel logistic regression analysis was used to assess the effect of the interventions on ECC arrest adjusting for confounders. The interaction between the type of intervention and baseline lesion severity, moderate (ICDAS 3/4) or advanced (ICDAS 5/6), was also assessed.ResultsThe study included 165 children with 949 active lesions. After 6 months, there were no significant differences between SDF and NaF/MI groups in overall caries arrest (63.7% and 58.1%, p = 0.08), and in moderate lesions (72.9% and 69.6%, p = 0.52). However, in advanced lesions, the arrest rate was significantly higher in the SDF than the NaF/ MI group (60.3% and 50.0%, P = 0.01). Multilevel multiple logistic regression showed no significant differences between the interventions (AOR = 1.56, P = 0.27) with significant interaction between the intervention and baseline lesion severity (p < 0.001). Moderate lesions treated with SDF (AOR = 3.69, P = 0.008) or NaF/MI (AOR = 3.32, P < 0.001) had significantly higher odds of arrest than advanced lesions treated with NaF/ MI with no difference between advanced lesions treated with SDF or NaF/ MI (AOR = 1.85, P = 0.155) in arrest rate.ConclusionNaF/ MI can be an alternative to SDF in arresting advanced and moderate ECC lesions without staining with stronger effect on moderate lesions (ICDAS 3/4).Trial registrationThe trial was retrospectively registered at clinicaltrial.gov registry (#NCT05761041) on 9/3/2023.

Nutritional Status, Prevalence of Early Childhood Caries, and its Association among Preschool Children in Northeast India.

Early childhood caries (ECC) is a common public health problem in developing countries. Children with severe decay can also have altered eating habits and preferences. Therefore, ECC can influence nutritional health. The aim is to find the prevalence of ECC and nutritional status and to evaluate its association among preschool children in Northeast India. This descriptive cross-sectional study was conducted among 384 preschool children aged 2-6 years. The sampling unit comprised the children attending the pediatric dentistry department of one dental college. Information regarding sociodemographic factors, child feeding habits, and child oral hygiene practices was obtained from the parents using a pretested questionnaire. Weight and height were evaluated to assess the nutritional status. The decay, missing, filled teeth index for primary teeth was used to determine the dental caries status. The mean value of carious teeth for 384 children aged 2-6 years was 5.6 ± 2.43. Most kids who had caries (74.7%) belonged to the moderate category (dmft >7), followed by the low sort, which was 16.7%, and then by those in the higher class (8.6%). The body mass index (BMI) for age revealed that 5.2% were overweight, 15.1% were thin, and 8.3% were obese. Most of those with high caries (i.e., dmft >7) were underweight or in the normal weight category. Pearson correlation showed no significant correlation between ECC with BMI-for-age (r = 0.04, P > 0.05). The prevalence of dental caries among children below the age of 5 years in Imphal was high. The risk factors for ECC included age, low maternal education, improper feeding, and oral hygiene habits. However, the results revealed no significant relationship between ECC and BMI.

Esthetic Management of Child with Severe Early Childhood Caries: Two Case Reports

This case report represents the esthetic management of child with severe early childhood caries (ECC). Early loss of primary anterior teeth is caused by severe ECC. The child’s speech gets affected as it interferes with the pronunciation of consonants which could lead to the development of parafunctional habit. Two case reports are discussed with different approaches for rehabilitation of severely decayed primary anterior teeth. In Case 1, the primary anterior teeth were severely decayed. Teeth were restored with intracanal retainers followed by full coronal coverage restoration. In Case 2, one of the primary anterior tooth was mobile and rest of them were severely decayed. The tooth was extracted and fiber-reinforced bridge was placed. The other teeth were restored with intracanal retainers followed by full coronal coverage restoration. Additive effect of intracanal retainers with full coronal coverage restorations and fiber-reinforced bridge presented esthetic and functional success.

A Systematic Review of The Relationship Between Parental Stress and Early Childhood Caries

Background: Until now, there has been a lack of comprehensive evaluation to establish the extent to which parental stress affects children's oral health, such as the occurrence of dental caries. This study aimed to explore the relationship between parental stress and early childhood caries (ECC). Objective: The objective of this review was to evaluate the association between ECC development and stress-related factors, including parental stress. Method: A comprehensive web-based search identified 12 studies that examined parental stress and Early Childhood Caries. Results: The research examined several areas related to parenting, including satisfaction with parenting, parenting-related stress, the parent-child relationship, and specific parenting practices. Out of 12 studies, 10 studies showed that there is a correlation between parental stress and the occurrence of early childhood caries, and 2 studies showed there is no association. Conclusions: The systematic review focuses on the work of researchers who have studied parental stress and how it is related to the occurrence of early childhood caries. A consistent association between parental attitude and oral health outcomes in children has been demonstrated by these studies. Despite several studies on the relationship between parental stress and early childhood caries (ECC), the overall literature is limited by methodological constraints that hinder the ability to establish a causal link between parental stress and ECC. Further study is also needed to advance our current understanding of the association of Early Childhood Caries and Parental Stress

Untreated Early Childhood Caries and Possible Links with Brain Development

Untreated early childhood caries (ECC) is a global public health concern. In the short term, untreated ECC can lead to pain, infection, and disrupted sleep, among other issues. In the long term, it is associated with poor oral health in later life, increased risk of caries in permanent teeth, and adverse effects on physical and psychological development. There may be a link between untreated ECC and adverse cognitive and neurodevelopmental outcomes in young children, although the exact pathways are not fully understood. One possible pathway is through the relationship between mastication and brain stimulation. Impaired masticatory function due to ECC can affect the hippocampus, a key region responsible for memory and learning. Furthermore, untreated ECC can cause chronic inflammation, leading to the release of pro-inflammatory cytokines that may damage the brain. Sleep disturbances resulting from ECC-related pain and discomfort can also impact brain development and cognitive functioning. Additionally, frequent use of antibiotics and analgesics to address ECC-related infections can disrupt the gut microbiome, potentially affecting the brain through the gut–brain axis. Untreated ECC can cause nutritional deficiencies and elevated nutritional risk, and can further hinder brain development. Addressing ECC comprehensively with early childhood health initiatives can help mitigate potential long-term consequences and promote optimal brain development in young children.

Dental management of a 3-year-old uncooperative child under general anaesthesia: a case report

Dental care is medically necessary for the purpose of eliminating and preventing orofacial disease, infection and pain, restoring the form and function of the dentition, and correcting facial disfiguration or dysfunction – American Academy of Pediatric Dentistry (AAPD). Lack of cooperation in young paediatric patients can be a confounding factor for dental rehabilitation procedures and even examination or radiographs. To complete necessary dental radiographs and/or treatment in young, uncooperative children general anaesthesia or deep sedation is often required. This article presents the case of a 3-year-old girl child with a complaint of sharp shooting pain in upper and lower left back tooth region and was extremely uncooperative. She was diagnosed with early childhood caries; full mouth rehabilitation was done under general anaesthesia. Clinical examination, classification and treatment plan are discussed based on the review of current literature available.

The number of erupted teeth as a risk factor for dental caries in eighteen-month-old children: a cross‑sectional study

BackgroundDental caries is one of the most common chronic diseases worldwide, affecting lifelong as well as children. Therefore, it is important to clarify factors related to early childhood caries (ECC) in a younger population in terms of caries prevention. However, the prevalence of ECC is low in developed countries in the twenty-first century and a large-scale survey is needed to clarify the risk factors. Furthermore, earlier tooth eruption is not taken into consideration in most studies of ECC, even though it may be a factor of ECC. The present study investigated the prevalence and risk factors of dental caries in children aged 18 months in a core city of Japan.MethodsFindings from a total of 7351 children aged 18 months were analyzed. Anthropometric measurements of height and weight, as well as an oral examination and a microbiological caries-risk test, were performed. Additionally, a structured interview sheet was provided to the parents or guardians. Findings of dental caries at 18 months of age were evaluated using a logistic regression model.ResultsOf the enrolled children, 1.2% had experienced dental caries. Multivariable logistic regression analysis results indicated a significant association with dental caries at 18 months of age for the following factors: second child (OR = 1.78; 95% CI:1.08–2.93, P < 0.05), third and later child (OR = 2.08; 95% CI:1.12–3.89, P < 0.05), 12 or fewer erupted teeth (OR = 0.47; 95% CI:0.24–0.96, P < 0.05), 17 or more erupted teeth (OR = 4.37; 95% CI:1.63–11.7, P < 0.01), Cariostat score (+ + +) (OR = 3.99; 95% CI:1.29–12.31, P < 0.05), daily eating before bed (OR = 2.62; 95% CI: 1.55–4.45, P < 0.001), three or more snacks per day (OR = 2.03; 95% CI:1.15–3.58, P < 0.05), and breastfeeding (OR = 3.30; 95% CI:2.00–5.44, P < 0.001).ConclusionsThese results suggest that the number of erupted teeth, as well as birth order, eating habits, and breastfeeding, are significant factors in dental caries occurrence at 18 months of age.

Knowledge, Attitudes, and Practices Towards ECC Prevention in Thai Medical Personnel

This study aimed to identify the knowledge, attitudes, and practices related to the prevention of early childhood caries (ECC) amongst medical personnel in well-baby clinics (WBC). Participants were 152 health care professionals, including public health officers, nurses, and physicians, working in WBC in Chonburi Province, Thailand. Participants completed a 6-part online questionnaire asking about demographic data, knowledge and attitudes related to ECC, ECC prevention practices, collaboration, referral systems, and suggestions for improving collaboration between dental and medical personnel in WBC. Whilst most participants had high levels of knowledge about oral care instructions, tooth brushing frequency, and cariogenic foods and beverages, they knew less about recommendations for timing of the first dental visit, fluoride concentration in toothpaste, and the time for exfoliation of primary teeth. There were significant differences in the proportions of correct answers to questions related to the first dental visit and bottle feeding and in total knowledge scores between physicians and other health care professionals. Most participants demonstrated a positive attitude towards ECC prevention. More than 70% of participants always advise parents on oral hygiene and nutrition related to ECC prevention, but only 29% always refer patients to see dental personnel. Attitudes, collaboration, and referral systems were significantly associated with ECC prevention practices, but not knowledge. This study demonstrates that attitudes, collaboration, and referral systems are key contributors to ECC prevention amongst Thai medical personnel. In addition to training programmes, consistent interprofessional policy and referral systems should be formulated, especially in primary care settings.

An interdisciplinary intervention program to prevent early childhood caries in the Dominican Republic.

The principal aim of this randomized clinical trial (RCT) was to test the effectiveness in the prevention of Early Childhood Caries (ECC) through an educational intervention program with the use of a printed guide for pediatricians and parents both designed by pediatric dentists. After ethical approval, the first step was to design the educational guides, which were based on the information obtained from a focus group with pediatricians (n = 3), phone interviews with mothers to toddlers' (n = 7), and the best evidence available about children's oral health. For the RCT, 309 parents with their 10-12 months old children were randomly allocated to either the intervention or the control group. Parents in the intervention group received oral health education from the pediatricians supported by the printed guides. Parents in both groups received an oral health kit with a toothbrush and toothpaste at the first visit as well as at each 6-month follow-up visit. After 18 months the children were evaluated using ICDAS criteria. At baseline, data were available from 309 children (49.8% girls). The mean age of the children was of 10.8 months (SD = 0.8) and 69.3% had not had their teeth brushed with toothpaste. After 18 months, a total of 28 (22%) children in the intervention group and 44 (24%) in the control group were clinically examined. Regarding the number of tooth surfaces with caries lesions, the children in the intervention group had a mean of 6.50 (SD = 6.58) surfaces, while the children in the control group had a mean of 5.43 (SD = 4.74) surfaces with caries lesions. This difference was not significant (p = 0.460). The RCT showed no effectiveness in caries-progression control. Despite this result, this study managed to identify barriers that do not allow pediatricians from offering parents adequate oral health recommendations. With this learning, it is possible to work on collaborative programs with pediatricians that over time likely will increase dental health by controlling for ECC.