Brisbane Dental Hospital and Queensland University Dental College Building Alias The Palace: Heritage Listing.

The National Trust of Queensland placed the Brisbane Dental Hospital and Queensland College of Dentistry Building, alias The Palace, on the National Trust of Queensland Register in April 1997. This action generated no statutory consequences. Within days, the trust nominated The Palace for listing on the Queensland Heritage Register. Under the terms of the Queensland Heritage Act 1992, this nomination could have impeded an imminent $2-million redevelopment within The Palace. Two years later, the Queensland Heritage Council entered The Palace on the Queensland Heritage Register. This procedural delay was unusual and occurred in an era of post-Fitzgerald bureaucratic reform, federal cutbacks to funding for public dental services, tenuous political control of state government and widespread community support for heritage protection. The authors use historical methods to disclose and analyze hitherto inaccessible evidence relating to the delay in the listing. They argue that, against a backdrop of potential controversy, a small band of networked, organized and resolute administrators and Palace-based personnel, achieved the redevelopment. Astute tactics, concurrent rebuilding of health infrastructure, ministerial resolve, the nature of the act, public demand for dental services, the timing of the redevelopment and the political circumstances influenced the outcome.

Public Dental Services, Queensland, Australia: Charles Octavius Vidgen.

Charles Octavius Vidgen was the Superintendent of the Brisbane Dental Hospital, c1917-1945. Hitherto, commentators' reviews rely on imposing but narrow streams of evidence to either ignore Vidgen's influence on the dental profession or portray it as both peripheral and controversial. In this account, the authors use historical method to provide a revisionist account of Vidgen's professional profile and, to a lesser extent, a character resurrection. Vidgen was probably introverted. His orientation relating to dental education became obsolete, inappropriate and disruptive. Vidgen's actions, beliefs and values incurred sustained and organized opposition from academe, the Australian Dental Association Queensland Branch, the Odontological Society of Queensland and some private practitioners. The sociopolitical context, namely the Great Depression and affiliated reconstruction, the community's demand for government-administered dental services, World War II, twenty-five years of continuous Australian Labor Party government in Queensland, Edward Hanlon's authoritarianism and the emergence of a welfare state were also relevant to Vidgen's becoming a nonconformist, nonjoiner and an outcast. However, the authors posit that, for the socially disadvantaged and the regionally and remotely domiciled, Vidgen was a humanitarian and a quiet social reformer who, under Hanlon's authority and tutelage, pioneered enduring changes to the delivery of dental services across Queensland.

Public Dental Services, Queensland: Alan Thomas Robertson.

Alan Thomas Robertson's career as Assistant Superintendent Brisbane Dental Hospital [1927-1945] and Acting Superintendent [1945-1946] spanned difficult times. In Victoria, against a backdrop of family tragedy and World War I, Robertson achieved distinguished academic and war-service records. Following the move to Queensland, Robertson either experienced or witnessed the Great Depression, World War II and affiliated paradigm shifts in government policy, dental education and the system of the delivery of dental services. Within this context, the actions of Hanlon, Vidgen and Hoole overshadowed Robertson's brief but meaningful contribution to the Australian Dental Association Queensland Branch, his diligent nineteen years of service to the Brisbane Dental Hospital [BDH] and its patients, his pioneering of general anesthesia and his perennial commitment to undergraduate and continuing dental education. Robertson's career was neither financially lucrative nor acclaimed. Despite his overt patriotism, leadership potential, academic profile and experience, seniority and service, Robertson's appointment as Superintendent at the BDH was only an interim measure. A brief career in an entrepreneurial private practice ended in professional isolation followed by tragedy. The authors present a revisionist interpretation of Robertson's career. This narrative conveys messages for human resource managers in both academe and health departments.

Public Dental Services, Queensland: Alfred James Hoole.

Historians have given limited attention to the genesis and evolution of public dental services across Queensland. The Secretary [Minister] for Home Affairs and later Premier, Edward 'Ned' Hanlon, was the political architect of accessible public hospital and dental facilities. However it was administrator and dentist, Alfred James Hoole, who orchestrated the practical details in the field. Hoole developed an extensive and successful government-administered, hospital-based dental service that, in terms of reach and workforce, was the contemporaneous leader in Australia. These clinics and affiliated school dental services delivered treatment to a disproportionately high percentage of socially disadvantaged and remotely domiciled Queenslanders. Hoole's career progression from Superintendent of the Brisbane Dental Hospital to Director of Dental Services is remarkable for its achievements, consequences, competency and duration. It originated from a limited secondary education and traversed the bitter political split of 1957, changes of government, minister and fiscal policy, health adversity and opposition from private practitioners. Hoole, an anointed leader, a ministerial confidant and a pragmatist, served on authorities and institutions that shaped the future of dental education and dental practice across the state. Forty-five years after his death, Hoole's contribution to the administration of public dental services in Queensland remains unrivalled.

Public Dental Services, Queensland: Edward "Ned" Michael Hanlon.

Within the Australian context, commentators often portray the Queensland system of delivery of public dental services as state-specific. A poorly explored dimension within this narrative is the contribution from Ned Hanlon. The authors use historical methods to address this inadequacy in the literature. The implementation of Hanlon's vision of a statewide government-administered dental service required dentists and infrastructure; both implicated legislative and administrative changes to dental education, hospital organization and local authority. In this way, there was an inexorable link between the genesis and evolution of the public hospital and public dental systems. Hanlon's motive was initially humanitarian but later implicated pragmatism, state development and Queensland chauvinism. Hanlon's actions were autocratic, authoritarian and populist. He pursued regionalism, states rights and state development. The post-depression and post-war timing, together with the ubiquity of dental caries and the nature of the dental profession, facilitated Hanlon's success. A nascent and emerging dental profession was powerless, out of touch with public thinking and hindered by the legislative framework that controlled dentists' registration. The Hanlon-dentist encounters became an intersection of conflicting values; idealism and tradition versus pragmatism and innovation. Whatever the perceived inadequacies in Hanlon's methods, his contribution to public dentistry across Queensland remains remarkable.

Digital imaging in the immunohistochemical evaluation of the proliferation markers Ki67, MCM2 and Geminin, in early breast cancer, and their putative prognostic value.

BACKGROUND: Immunohistochemical assessment of proliferation may provide additional prognostic information in early breast cancer. However, due to a lack of methodological standards proliferation markers are still not routinely used for determining therapy. Even for Ki67, one of the most widely-studied markers, disagreements over the optimal cutoff exist. Improvements in digital microscopy may provide new avenues to standardise and make data more reproducible. METHODS: We studied the immunohistochemical expression of three markers of proliferation: Ki67, Mini-Chromosome Maintenance protein 2 and Geminin, by conventional light microscope and digital imaging on triplicate TMAs from 309 consecutive cases of primary breast cancers. Differences between the average and the maximum percentage reactivity in tumour cell nuclei from the three TMA cores were investigated to assess the validity of the approach. Time-dependent Receiver Operating Characteristic curves were utilized to obtain optimal expression level cut-offs, which were then correlated with clinico-pathological features and survival. RESULTS: High concordance between conventional and digital scores was observed for all 3 markers (Ki67: rs = 0.87, P < 0.001; MCM2: rs = 0.94, P < 0.001; and Geminin: rs = 0.86, P < 0.001; Spearman's rank). There was no significant difference according to the number of TMA cores included for either Ki67 or MCM2; analysis of two or three cores produced comparable results. Higher levels of all three proliferation markers were significantly associated with higher grade (P < 0.001) and ER-negativity (P < 0.001). Optimal prognostic cut-offs for percentage expression in the tumour were 8 %, 12 and 2.33 % for Ki67, MCM2 and Geminin respectively. All 3 proliferation marker cutoffs were predictive of 15-year breast cancer-specific survival in univariable Cox regression analyses. In multivariable analysis only lymph node status (HR = 3.9, 95 % CI = 1.79-8.5, P = 0.0006) and histological grade (HR = 1.84, 95 % CI = 1-3.38, P = 0.05) remained significantly prognostic. CONCLUSIONS: Here we show that. MCM2 is a more sensitive marker of proliferation than Ki67 and should be examined in future studies, especially in the lymph node-negative, hormone receptor-positive subgroup. Further, digital microscopy can be used effectively as a high-throughput method to evaluate immunohistochemical expression.

The Brisbane Dental Hospital Building: "The Palace" An Era Ends.

Constitutional, educational, humanitarian and political considerations underpinned the design and construction of the Brisbane Dental Hospital Building, often colloquially referred to as "The Palace." The Queensland Heritage Council's listing of the Brisbane Dental Hospital Building on The Queensland Heritage Register in 1999 confirms the cultural significance of Nowland's architectural signature, the historical importance of the Wickham Park precinct and prior students' connection with the building. Influences on decisions determining the location, grand design and timing of construction of the Brisbane Dental Hospital Building emanated from a far bigger and largely unrecorded political picture. The authors argue that the political context in two tiers of government, the timing and nature of the proposal, town planning issues, the exigencies of the caries epidemic and Forgan Smith's post-Depression economic reconstruction across Queensland underpinned the project. Hanlon's personal attributes and disdain for the autonomy of the dental profession, together with his desire to reform dental education and to establish statewide government-administred dental clinics, were also relevant. Accordingly, the BDHD portrayed aspiration, purpose, symbolism, and vision. This paper, essentially an integration of dental and mainstream history, assembles and analyzes hitherto scattered and unpublished evidence to fill a gap in the current literature.

Comparison of basal-like triple-negative breast cancer defined by morphology, immunohistochemistry and transcriptional profiles.

Basal-like invasive breast cancer is an important clinical group because of its association with a triple-negative phenotype defined by the lack of expression of estrogen, progesterone and human epidermal growth factor receptors 2, relative lack of therapeutic options and poor prognosis. However, depending on the method used to define these lesions, morphological assessment, immunohistochemical markers or gene expression, a different set of tumors is captured. The aim of this study was to investigate the consequences of using different methodological approaches to define basal-like lesions among triple-negative breast carcinomas with regard to their clinicopathological features and patient outcome. The cohort consisted of 142 invasive breast cancers with a triple-negative receptor status. First, each was reviewed histologically and those with morphological basal-like features were characterized as 'Path-Basal'. Second, the 'Core Basal' immunohistochemical lesions, defined as cytokeratin 5/6 and/or epidermal growth factor receptor 1 positive, within the triple-negative breast cancers were identified, and third their classification based on gene expression profiling was retrieved and those in the molecular 'PAM50 basal-like' subtype recorded. A total of 116 basal-like breast cancers were identified among the 142 triple-negative breast cancers by at least one of these three classifications (80%), but only 13 samples were defined as basal-like with all three methods. None of these 13 tumors were associated with lymphovascular invasion. The 34 morphological 'Path-Basal' lesions were significantly associated with a lack of nodal metastases. Comparing the estimates of death in the three classifications, the highest risk of death was seen for the 'Core Basal' group. In this study, we highlight that the definition of basal-like breast cancer based on different methodologies varies significantly and does not identify the same lesions. This incomplete overlap of cases emphasizes the need for consistent or new approaches to improve precise identification.

Design of the xylitol for adult caries trial (X-ACT).

BACKGROUND: Dental caries incidence in adults is similar to that in children and adolescents, but few caries preventive agents have been evaluated for effectiveness in adults populations. In addition, dentists direct fewer preventive services to their adult patients. Xylitol, an over-the-counter sweetener, has shown some potential as a caries preventive agent, but the evidence for its effectiveness is not yet conclusive and is based largely on studies in child populations. METHODS/DESIGN: X-ACT is a three-year, multi-center, placebo controlled, double-blind, randomized clinical trial that tests the effects of daily use of xylitol lozenges versus placebo lozenges on the prevention of adult caries. The trial has randomized 691 participants (ages 21-80) to the two arms. The primary outcome is the increment of cavitated lesions. DISCUSSION: This trial should help resolve the overall issue of the effectiveness of xylitol in preventing caries by contributing evidence with a low risk of bias. Just as importantly, the trial will provide much-needed information about the effectiveness of a promising caries prevention agent in adults. An effective xylitol-based caries prevention intervention would represent an easily disseminated method to extend caries prevention to individuals not receiving caries preventive treatment in the dental office. TRIAL REGISTRATION: ClinicalTrials.Gov NCT00393055.

Dental caries prediction to target high-risk individuals in community-based preventive programs is problematic.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Life course dental caries determinants and predictors in children aged 12 years: a population-based birth cohort. Peres MA, Barros AJ, et al. Community Dent Oral Epidemiol 2009;37:123-33. REVIEWER: John P. Brown, BDS, MS, PhD. PURPOSE/QUESTION: To define selected life course social, biological, and behavioral exposures as determinants and predictors of dental caries in children at 12 years of age. SOURCE OF FUNDING: Brazilian National Council for Scientific and Technological Development CNPq Grant No. 403362/2004-0. TYPE OF STUDY/DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 2: limited-quality patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Not applicable.

Epidemiologic survey of erosive tooth wear in San Antonio, Texas.

OBJECTIVES: To estimate the prevalence of erosive tooth wear in children aged 12-17 years in the southwest region of San Antonio, Texas, within Bexar County. METHODS: A convenience sample of 307 children aged 12-17 years was selected from two junior high schools. The population consisted predominantly of Hispanic Mexican Americans. The true prevalence of erosive tooth wear within the US is known from only one study, and then only for limited sectors of the population. The Tooth Wear Index, Screening for Oral Health using the Association of State and Territorial Dental Directors (ASTDD) criteria and oral health and dietary assessment questionnaires were used as survey parameters. The questionnaire included data on detailed dietary habits relating primarily to the consumption of acidic beverages and foods. RESULTS: The overall prevalence of erosion within our convenience sample was 5.5 percent. All affected children showed erosive tooth wear low in severity and confined to the enamel with no exposed dentin. A chi-square test was performed to test for associations between the presence of erosion and consumption level of certain acidic foods at a significance level of 5 percent. Few significant and consistent associations were found between erosive tooth wear and consumption frequency categories of groups of acidic foods and beverages using a non-validated food intake questionnaire on purported risk foods. Soda drinks were associated. Mexican acidic foods were not. CONCLUSION: This study indicated a low prevalence and low severity of dental erosion in a convenience sample of children aged 12-17 years in southwest San Antonio, Texas. Issues of sampling and response bias preclude these findings being generalized to other populations and regions.The results should be viewed with caution. Because the local consumption of some purported risk foods appears to be increasing, this study provides a base-line for future assessments of erosive tooth wear in this population.

Alpha-6 integrin is necessary for the tumourigenicity of a stem cell-like subpopulation within the MCF7 breast cancer cell line.

The identification of mammary epithelial stem cells raises the hypothesis that these cells may be crucial in the pathogenesis of breast cancer. To further support this, a highly tumourigenic sub-population of cancer cells has recently been identified in primary and metastatic breast cancer samples. In this study, a sub-population of cells displaying features normally attributed to stem cells was identified within the breast cancer cell line MCF-7. This sub-population is capable of growth in anchorage-independent conditions as spherical organoids, displays resistance to proapoptotic agents and significantly greater tumourigenicity than its parental line, with as few as 1,000 cells able to form tumours in immunodeficient mice. Cells within this sub-population can be enriched by serial passages in anchorage-independence, and are characterized by over-expression of the adhesion molecule alpha6-integrin. Alpha-6 integrin proves to be required for the growth and survival of these cells, as the knockdown of ITGA6 causes mammosphere-derived cells to lose their ability to grow as mammospheres and abrogates their tumourigenicity in mice. These findings support the existence of a highly tumourigenic sub-population in breast cancer cells. Furthermore, it shows alpha6-integrin as a potential therapeutic target aimed at tumour-generating subsets of breast cancer cells.

A novel CD11c monoclonal antibody effective in formalin-fixed tissue for the diagnosis of hairy cell leukemia.

OBJECTIVE: The diagnosis of hairy cell leukemia (HCL) and its distinction from other B-cell lymphomas can be difficult in formalin-fixed tissue. This is because the histology is not always classical, and despite having a characteristic phenotype, there are few relevant monoclonal antibodies with sufficient sensitivity and specificity that can be applied to fixed material. In this study, we assessed the utility of a newly developed antibody against a formalin-resistant CD11c epitope (5D11) for the diagnosis and monitoring of HCL in formalin-fixed tissue. METHODS: We performed immunohistochemical staining for CD11c expression in formalin-fixed and also decalcified tissue of 196 small B-cell lymphomas, including 104 cases of HCL showing extensive to minimal infiltrates. RESULTS: The CD11c antibody was both sensitive and specific for HCL, even in cases with minimal infiltration. CONCLUSION: We recommend that this CD11c antibody be added to a panel of antibodies for immunostaining of formalin-fixed material, for differentiation of HCL from other small B-cell lymphomas, and for detection of residual disease following therapy.

A new curriculum framework for clinical prevention and population health, with a review of clinical caries prevention teaching in U.S. and Canadian dental schools.

To fulfill the Healthy People 2010 Objective 1.7, "Increase the proportion of . . . health professional training schools whose basic curriculum for health care providers includes the core competencies in health promotion and disease prevention," the Healthy People Curriculum Task Force has developed a curriculum framework for clinical prevention and population health for all the health professions. This framework has four components: 1) evidence base for practice; 2) clinical preventive services, including health promotion; 3) health systems and health policy; and 4) community aspects of practice. Within these four common components are nineteen domains, for which each health profession is identifying its own educational objectives. An inventory of knowledge and skills is being developed. A prerequisite to promoting change in the teaching of dental prevention and population oral health is to better understand the current status. Sixty-six of sixty-eight U.S. and Canadian dental schools provided input on the teaching of one important aspect of this wider topic--dental caries prevention--before a December 2002 Clinical Preventive Dentistry Leadership Conference in Cincinnati, OH. In clinical teaching, 68 percent of dental schools included caries risk assessment and also reevaluated preventive outcomes, but while 65 percent included remineralization procedures, only 38 percent specifically reevaluated this outcome. Faculty members have commonalities in attitudes about the advantages and problems in improving teaching in clinical prevention, yet dental schools act individually in curricular design and implementation. The conference introduced a method of conceptualizing change, so that dental schools might address organizational barriers in clinical curriculum development. Even with the new common curriculum framework, other barriers to improved dental prevention and population oral health exist: these include organizational change in dental schools, dental practices, and dental clinics; reimbursement issues and incentives; and lack of accepted and explicit standards in dental care.

PAK4 promotes kinase-independent stabilization of RhoU to modulate cell adhesion.

P21-activated kinase 4 (PAK4) is a Cdc42 effector protein thought to regulate cell adhesion disassembly in a kinase-dependent manner. We found that PAK4 expression is significantly higher in high-grade human breast cancer patient samples, whereas depletion of PAK4 modifies cell adhesion dynamics of breast cancer cells. Surprisingly, systematic analysis of PAK4 functionality revealed that PAK4-driven adhesion turnover is neither dependent on Cdc42 binding nor kinase activity. Rather, reduced expression of PAK4 leads to a concomitant loss of RhoU expression. We report that RhoU is targeted for ubiquitination by the Rab40A-Cullin 5 complex and demonstrate that PAK4 protects RhoU from ubiquitination in a kinase-independent manner. Overexpression of RhoU rescues the PAK4 depletion phenotype, whereas loss of RhoU expression reduces cell adhesion turnover and migration. These data support a new kinase-independent mechanism for PAK4 function, where an important role of PAK4 in cellular adhesions is to stabilize RhoU protein levels. Thus, PAK4 and RhoU cooperate to drive adhesion turnover and promote cell migration.

The dynamic behavior of the early dental caries lesion in caries-active adults and implications.

OBJECTIVE: To describe the full range of behavior of the visible, noncavitated, early caries lesion in caries-active adults with substantial fluoride exposure, and to consider implications. METHODS: The data were from the Xylitol for Adult Caries Trial (X-ACT) collected annually for 33 months using condensed ICDAS caries threshold criteria. Individual tooth surfaces having a noncavitated caries lesion were included, and the patterns of transition to each subsequent annual clinical examination to sound, noncavitated or cavitated, filled or crowned were determined. The resulting sets of patterns for an individual tooth surface, looking forward from its first appearance as a noncavitated lesion, were combined into one of four behavior profiles classified as reversing, stable, oscillating, or continuously progressing, or were excluded if not part of the caries continuum. The distributions of profile types were assessed using the Rao-Scott chi-square test, which adjusts for clustering of tooth surfaces within teeth. RESULTS: Inter- and intra-examiner kappa scores demonstrated acceptable calibration at baseline and annually. 8084 tooth surfaces from 543 subjects were included. The distribution of profile types differed significantly between coronal and root surfaces. Overall, two-thirds of all coronal noncavitated lesions were first seen at baseline, half reversed, over a fifth were stable, 15% oscillated, and only 8.3% progressed to cavitation, filled, or crowned in 33 months or less (6.3% consistently Progressed plus 2.0% inconsistently, a subset of oscillating, which oscillated before progressing to cavitation). Approximal, smooth, and occlusal coronal surfaces each were significantly different in their individual distributions of profile types. Xylitol showed no significant and consistent effect on this distribution by tooth surface type. This was in keeping with the X-ACT's lack of effect of xylitol at the noncavitated plus cavitated lesion thresholds combined. CONCLUSIONS: This study demonstrated the full dynamic range of early caries lesion behavior. The great majority were not progressive, and few (8.3%) became cavitated over 33 months in caries-active adults using fluorides. Important caries management implications favoring recorded longitudinal monitoring, prevention of active risks, and minimal restoration only after direct visual determination of cavitation are discussed.

A multi-country comparison of caries-associated microflora in demographically diverse children.

OBJECTIVE: The aim of this formative international collaborative research on childhood dental caries was to undertake an initial investigation comparing the dental plaque of young children from diverse ethnic and socioeconomic backgrounds with and without dental caries. BASIC RESEARCH DESIGN: The following four null hypotheses were investigated. There were no differences in numbers of individual taxa when comparing plaque samples from: 1) caries-free children from deprived and non-deprived backgrounds; 2) children from deprived and non-deprived backgrounds with at least 3 decayed teeth; 3) children from non-deprived backgrounds who are caries free with those from similar backgrounds with at least 3 decayed teeth; and, 4) children from deprived backgrounds who are caries free with those from similar backgrounds with at least 3 decayed teeth. PARTICIPANTS: 277 children aged 3-4 years from 5 countries. MAIN OUTCOME MEASURES: A sample of interproximal plaque from anterior teeth was collected using sterile dental floss, and cultured according to accepted international standards. RESULTS: Analysis of the data found that the first null hypothesis was accepted and that the fourth was rejected. Unexpectedly, the second null hypothesis was rejected as the children with caries from deprived and non-deprived backgrounds had a different caries-associated flora. In particular, children living in deprivation harbored more caries-associated bacteria [mutans streptococci and lactobacilli]. This greater microbial challenge was associated with a higher level of cavitated carious lesions and with more frequent consumption of confectionery. Conclusions Children from deprived backgrounds with caries may be further disadvantaged by having higher levels of caries-associated microflora.

Developing explanatory models of health inequalities in childhood dental caries.

OBJECTIVE: Long-term aim is to determine optimum interventions to reduce dental caries in children in disadvantaged communities and minimise the effects of exclusion from health care systems, of ethnic diversity, and health inequalities. DESIGN: Generation of initial explanatory models, study protocol and development of two standardised measures. First, to investigate how parental attitudes may impact on their children's oral health-related behaviours and second, to assess how dentists' attitudes may impact on the provision of dental care. SUBJECTS: Core research team, lead methodologists, 44 consortium members from 18 countries. To complete the development of the questionnaire, the initial set of items was administered to parents (n = 23) with children in nursery schools in Dundee, Scotland and sent to the same parents one week later. A standardised measure examining barriers to providing dental care for children aged 3 to 6 years was developed. 20 dentists working in primary dental care in Scotland completed the measure on two different occasions separated by one week. RESULTS: Explanatory models were developed. Family questionnaire: test-retest reliability excellent (r = 0.93 p < or = 0.001) with very good internal reliability (alpha = 0.89). Dentists questionnaire: excellent test-re-test reliability r = 0.88, (alpha = 0.90). CONCLUSIONS: Interaction between consortium members enhanced the validity of the questionnaires and protocols for different cultural locations. There were challenges in developing and delivering this multi-centre study. Experience gained will support the development of substantive trials and longitudinal studies to address the considerable international health disparity of childhood dental caries.

Caries prevalence of children in an infant oral health educational program at a WIC clinic.

PURPOSE: The purpose of this study was to compare the prevalence of caries between children whose parents had previously participated in an infant oral health educational program (IOHEP) at a WIC clinic with those children whose parents had not participated previously. METHODS: One hundred and twenty children aged 1 to 5 years participated in the study. A single examiner previously standardized using the WHO diagnostic criteria for caries examined the children. RESULTS: One hundred and sixteen children were Hispanic (97%). Forty-one of the parents (34%) had previously participated in the IOHEP. Previous participation of the parents in the IOHEP was highly associated with fewer enamel carious lesions (P=.005) and lower dft (P=.043) scores. Children whose parents reported brushing their child's teeth with fluoride toothpaste had significantly lower prevalence of caries (P=.007). CONCLUSIONS: Infant oral health educational programs directed to parents at WIC can have a positive impact on caries prevention.