Impact of an oral health intervention on pre-school children < 3 years of age in a rural setting in Australia.

AIM: Australian pre-school children living in rural areas experience higher levels of dental caries than those in metropolitan areas. This may be because of a lack of community water fluoridation. The aim of this study was to evaluate the effectiveness of a community-based intervention to improve the oral health of children in non-fluoridated rural Victoria, Australia. METHODS: The study was conducted across three local government areas in Victoria, with two receiving the intervention and one remaining with standard care. Although multifaceted, the primary strategy of the intervention was the promotion of early exposure to fluoridated toothpaste, including the distribution, by maternal and child health nurses (MCHNs), of an oral health starter kit including toothpaste, toothbrush and information to parents at their child's 7-8-month health check. Children were followed up annually to the age of three. RESULTS: Infants in the intervention arm experienced less caries (cavitated and pre-cavitated lesions included) than infants in the control arm at the first and second examinations (3.1% with caries in the intervention vs. 6.9% in the control group at exam 1 (adjusted P= 0.07) and 10.8% vs. 19.5% at exam 2 (adjusted P= 0.11), respectively). However potential benefits disappeared at the third examination (29.5% vs. 28.9%, adjusted P= 0.67). CONCLUSIONS: This study suggests that an oral health promotion intervention delivered via local MCHNs promoting early exposure to fluoride may be successful in reducing caries in the second year of life but less so in older children when participants have less contact with MCHNs.

Parental experiences and genetic counsellor roles in Pierre Robin sequence.

Pierre Robin sequence (PRS) is a craniofacial abnormality comprising micrognathia, glossoptosis and airway obstruction, which can impair the newborn's feeding and breathing. While there has been much research around the cause of PRS and most appropriate methods of care, understanding the psychosocial aspects of a PRS diagnosis from the parents' perspective is lacking. The aim of this study is to understand parental experiences of having a child diagnosed with PRS, as well as the role of genetic counselling in PRS. Fourteen semi-structured interviews were conducted with parents of children diagnosed with isolated PRS between 2 and 5 years prior. From these 14 interviews, eleven transcripts were analysed to find common themes and experiences. The diagnosis was confusing and overwhelming for participants during emotionally sensitive periods and little was understood about the cause of their child's PRS. Those participants who did recall experiences with genetic services reported that they were minimal and uninformative. According to participant recollection, genetic counselling was rarely offered, despite there being a potential for this service in PRS. Genetic counselling would be a valuable source of information and support for parents both at the time of antenatal diagnosis, and potentially 6 to 12 months later in the outpatient environment when these children are all routinely reviewed by their clinical care team.

Genetic and Early-Life Environmental Influences on Dental Caries Risk: A Twin Study.

OBJECTIVES: To explore the relative contributions of genetic and environmental influences on dental caries risk and to investigate fetal and developmental risk factors for dental caries. METHODS: We recruited children from 250 twin pregnancies midgestation and collected demographic, health, and phenotypic data at recruitment, 24 and 36 weeks' gestational age, birth and 18 months, and 6 years of age. 25-hydroxyvitamin D was quantified in mothers at 28 weeks' gestation and in infants at birth. Dental caries and enamel defects were measured at six years of age. We compared concordance for the presence of any caries and advanced caries in monozygotic and dizygotic twin pairs. To investigate environmental risk factors for caries, we fitted multiple logistic regression models using generalized estimating equations to adjust for twin correlation. RESULTS: A total of 345 twins underwent dental assessment, with 111 (32.2%) showing signs of any caries and 83 (24.1%) having advanced caries. There was no evidence of higher concordance in monozygotic twins compared with dizygotic twins, with a difference of 0.05 (95% confidence interval -0.14 to 0.25; P = .30) and 0.00 (95% confidence interval -0.26 to 0.26; P = .50) for any caries and advanced caries, respectively, suggesting that environmental factors, rather than genetics, are the predominant determinant of caries risk. After adjusting for potential confounders, lack of community water fluoridation, hypomineralized second primary molars, dichorionic placenta, and maternal obesity were associated with caries. CONCLUSIONS: Environmental rather than genetic factors drive dental caries risk and arise as early as prenatal life.

Dental erosion: part 1. Aetiology and prevalence of dental erosion.

Non-carious tooth tissue loss due to abrasion, attrition, abfraction and erosion has become a significant problem, occurring in up to 80 percent of children and in up to 43 percent of adults. Dental erosion is now recognised as an important cause of tooth tissue loss in both children and adults. It is caused by the presence of intrinsic or extrinsic acid of non-bacterial origin in the mouth. Intrinsic sources of acid include vomiting, regurgitation, gastro-oesophageal reflux or rumination. Extrinsic sources of acid are most commonly dietary acids. Medications, a patient's lifestyle choices and environment can also increase the risk of dental erosion. In this article we identify the prevalence of dental erosion and its main causative factors, and in Part II we will discuss the management of dental erosion.

The impact of participation in genetic research for families with cleft lip with and without cleft palate: a qualitative study.

Despite being the most common congenital facial anomaly, little is understood about the genetic contribution to isolated clefts of the lip with or without cleft palate (CL/P). 'OzCleft', a family-based genotype/phenotype study, is investigating this further. Participation for families involves various clinical investigations of the child with the cleft, and their unaffected sibling(s) and parents. Informal feedback from individuals involved in OzCleft suggested that participation in this research programme had benefits for families. Taking a qualitative approach, this study sought to investigate this hypothesis further. Semi-structured in-depth interviews were conducted with nine parents who had participated in OzCleft. All parents described participation as a positive experience for themselves and their families. Perceived benefits included a greater appreciation of the cleft treatment experience by unaffected family members. Being involved in a genetic study raised issues for parents regarding the cause of clefting in their child. While some parents found the possibility of a genetic component reassuring, it also raised questions about the potential implications for future generations. Parents were largely unsure about how to communicate this information to their children and the predictive value of this information. This study suggests a lack of genetic understanding and/or perceived value of genetic information by parents of children with CL/P that, in turn, highlights the need for increased support from genetic health professionals in this area.

Transmission electron microscope characterisation of molar-incisor-hypomineralisation.

Molar-incisor-hypomineralisation (MIH), one of the major developmental defects in dental enamel, is presenting challenge to clinicians due, in part, to the limited understanding of microstructural changes in affected teeth. Difficulties in the preparation of site-specific transmission electron microscope (TEM) specimens are partly responsible for this deficit. In this study, a dual-beam field emission scanning electron microscope (FESEM)/focused ion beam (FIB) milling instrument was used to prepare electron transparent specimens of sound and hypomineralised enamel. Microstructural analysis revealed that the hypomineralised areas in enamel were associated with marked changes in microstructure; loosely packed apatite crystals within prisms and wider sheath regions were identified. Microstructural changes appear to occur during enamel maturation and may be responsible for the dramatic reduction in mechanical properties of the affected regions. An enhanced knowledge of the degradation of structural integrity in hypomineralised enamel could shed light on more appropriate management strategies for these developmental defects.