Early childhood caries and associated risk factors among preschool children in Ras Al-Khaimah, United Arab Emirates.

AIM: To investigate the prevalence and contributing factors of early childhood caries (ECC) in preschool children of Ras Al-Khaimah (RAK), United Arab Emirates (UAE). STUDY DESIGN: Cross-sectional. METHODS: The sample consisted of 540 healthy preschool children between four and six years of age attending 10 nursery schools in RAK, UAE. A structured questionnaire was distributed to the mothers of children who gave consent for their children to be included in the study. The questionnaire was used to collect information regarding child and mother's demographic data, children's feeding and dietary habits, oral hygiene practices and frequency of dental visits. The dental examination of children was conducted by one investigator using a mouth mirror and a torch light source. RESULTS: Five hundred and forty children with a mean age of 5.1 (SD = 0.71) years were included in the study. The prevalence of ECC was 74.1%, the mean dmft was 3.07 ± 0.135. The significant caries index (SiC) was very high (13.3) and the care index was very low (3.8%). A high proportion of caries-free children and those with ECC were either never or only visited dentists when in pain. However, the difference in frequency of dental visits was statistically highly significant (p < 0.001). There was also a statistically significant difference in frequency of tooth brushing between children with and without caries and more than two-thirds of children with ECC spent less than two minutes when brushing their teeth. The difference in sweet consumption was not statistically significant. CONCLUSION: The prevalence of dental decay and the mean dmft were high and the care index was extremely low. There is a great need for prospective studies and community preventive programs to solve the problem of ECC and set plans to treat open cavities in RAK preschool children.

Comparison of residual salivary fluoride retention using amine fluoride toothpastes in caries-free and caries-prone children.

AIM: This was to compare the salivary fluoride levels following tooth brushing with amine fluoride toothpastes containing three different concentrations of F (250 ppm F, 500 ppm F and 1250 ppm F) and to evaluate the effect of rinsing with water on the oral fluoride levels up to 90 min. METHODS: A double blind randomised six-arm crossover study was conducted with 32 child participants. Patients were divided into two groups depending on their caries experience with caries-free group (n = 17, mean age = 72.9 months) and caries-prone group (n = 15, mean age = 69.6 months, mean dmfs = 12.3). Each participant brushed their teeth with a smear of dentifrice containing (250 ppm, 500 ppm and 1250 ppm F toothpastes) for 60 s. After spitting out the dentifrice/saliva slurry, participants either rinsed with water or did not rinse at all. Samples of whole mixed unstimulated saliva were collected at 0 (baseline), 1, 15, 30, 45, 60 and 90 mins post-brushing/rinsing. RESULTS: After completing the study on residual fluoride concentration it was found that caries was not a significant variable (p = 0.567) while every other variable was (all p values <0.001). Time, toothpaste F concentration and rinse had significant effects (p < 0.001). In general, higher residual salivary F concentrations were found with increased F concentration in toothpastes and when no rinsing was performed after brushing. CONCLUSION: The results of this study support the current recommendation of using toothpastes with >1000 ppm F concentration in children with an increased caries risk in addition to spitting excess toothpaste with no rinsing following brushing.

Severity of early childhood caries in preschool children attending Al-Ain Dental Centre, United Arab Emirates.

AIM: To investigate the severity of and contributing factors of early childhood caries (ECC) in preschool children presented to a paediatric dentistry department in Al-Ain Dental Centre, United Arab Emirates; to study the level of any previous dental care provided to these children and to establish a baseline database for further research and the resources required for serving preschool children in Al-Ain (UAE). STUDY DESIGN: Cross-sectional prospective. METHODS: The sample consisted of all healthy children below 5 years of age who presented for their initial visits to the Department of Paediatric Dentistry during a 3-month period. A structured questionnaire was used to obtain information regarding demographic data, feeding history and dietary habits, and oral hygiene practices. The dental examination of children was conducted by the investigator with the help of a mouth mirror and Sirona dental unit light source. RESULTS: One hundred and seventy six children with a mean age of 3.7 years were included in the study and 78 (44 %) children were still bottle-fed on demand at the time of examination. More than half of the children consumed sweets more than once/day and 58 % either never or rarely brushed their teeth. Only one child was given fluoride. Two-thirds of children had never visited a dentist before and 63 % had poor oral hygiene. The mean dmft and dmfs scores were 10.9 and 32.1, respectively. The care index was very low (6.4 %). CONCLUSION: The high level of dental decay could be attributed to on-demand bottle feeding, high sweet consumption, poor oral hygiene, lack of use of fluoride prevention and lack of regular dental visits. There is a great need for prospective studies and community preventive programmes to solve the continuing problem of ECC.

Cost-effectiveness of a long-term dental health education program for the prevention of early childhood caries.

AIM: To evaluate the benefit-cost (B/C) and cost-effectiveness (C/E) of a long-term dental health education program to prevention early childhood caries (ECC) through home visits. METHODS: The data collected over a three year period in a dental health education programme (DHE), previously reported [Kowash et al., 2000] for infants aged 8 months at start were analysed for B/C and C/E. Dental caries indices (BASCD) for dmft and dmfs were used. Costs were based on British National Health Service (UK) fees for treating children by general dental practitioners and salaries for community dental officers in the Community Dental Services in the UK. Comparisons were made for B/C and C/E with results from a clinical trial of a slow releasing fluoride device (SRFD), community water fluoridation (CMF) and a school based fissure sealant program (FSP) using the hypothetical community of Niessen and Douglass, [1984]. RESULTS: The cavities, as ECC, saved over the three year period indicated a B/C ratio for the DHE of 5.21 compared with SRFD of 4.17; CWF of 1.15 and FSP of 0.42. The C/E results were 1.92, 2.40, 8.66 and 23.74 respectively. CONCLUSION: A dental health education program of home visits with mothers of young infants to prevent early childhood caries and starting at 8 months of age, gave better benefit-costs and costs effectiveness ratios than other preventive programs.

Association of salivary Streptococcus mutans with caries in young children: effect of dental health education on salivary levels.

AIM: This study aimed to determine the effect of a long-term dental health education (DHE) for mothers with young children on the level of salivary Streptococci mutans (SM) and their association with caries in young children. METHODS: A randomly selected cohort of 228 children born between 1 January and 30 September 1995, in a low socioeconomic high caries suburb of Leeds (UK), was divided into the following groups: A) DHE focused on diet; B) DHE focused on oral hygiene instruction (OHI) using fluoride toothpaste; C) DHE by a combined diet and OHI message. DHE was given using an interview and counselling for at least 15 minutes in each child's home, every three months for the first two years and twice a year in the third year of the study. A fourth group D was given diet and OHI, at home, but once a year only. The children in a fifth group E (control), received no DHE and were never visited, but examined at three years of age only. All children and mothers were examined for caries using the BASCD criteria. The levels of salivary SM were determined by sampling of bacteria from the oral cavity with a 1.8 cm wide wooden spatula, after giving the mother a paraffin pellet to chew for a minute and in children using unstimulated saliva. Bacteria were plated out and counted using image analysis for counting colonies. RESULTS: At three years of age the difference in the level of salivary SM between groups was not statistically significant. However, in group E there was a statistically significant relationship (p<0.05) between salivary SM and caries in children. CONCLUSION: The difference in the level of salivary SM between groups given various programs of dental health education was not statistically significant. There was a statistically significant (p<0.05) relationship between salivary MS and caries in children.

Enamel demineralization in situ with various frequencies of carbohydrate consumption with and without fluoride toothpaste.

There is little information in the literature on the relationship among the frequency of carbohydrate consumption, the use of fluoride toothpaste, and enamel demineralization. The aim of this investigation was to compare the extent of demineralization of enamel slabs in situ, with a sugar-based solution, consumed in constant amounts but with various frequencies in subjects both with and without the use of fluoride (F) toothpaste. Eight subjects wore removable mandibular appliances carrying an enamel slab cut from white-spot lesions. The subjects were required to drink 500 mL of a 120-gm/L sugar solution either once, 3, 5, 7, or 10 times/day for 30 sec on each occasion, for a period of 5 days while brushing their teeth twice daily with either a F (1450 ppm NaF) or a F-free toothpaste. Mineral analysis revealed that when the subjects used a F toothpaste, net demineralization was evident only with the seven- and 10-times/day regime (ns). When F-free toothpaste was used, statistically significant demineralization was observed when the frequency exceeded 3 times/day. This study demonstrates the importance of F-containing toothpaste in enamel re-/demineralization by varying the frequency of carbohydrate challenge

Effectiveness on oral health of a long-term health education programme for mothers with young children.

AIM: To determine the effect of dental health education (DHE) on caries incidence in infants, through regular home visits by trained DH Educators over a period of 3 years. METHOD: A randomly selected cohort of 228 children born between 1st January and 30th September 1995, in a low socioeconomic/high caries suburb of Leeds (UK) were divided into the following groups: A) DHE focused on diet; B) DHE focused on oral hygiene instruction (OHI) using fluoride toothpaste; and C) DHE by a combined diet and OHI message. DHE was given using an interview and counselling for at least 15 minutes at home every 3 months for the first 2 years and twice a year in the third year of the study. A fourth group D was given diet and OHI, at home, once a year only. All children and mothers were examined for caries and oral hygiene. A fifth group E (control) received no DHE and were never visited but examined at 3 years of age only. RESULTS: In the groups of children visited regularly only two developed caries and three had gingivitis (all in group A). In group E, however, 33% of children had caries and nine (16%) had gingivitis. The differences in caries levels and caries risk factors between study and control groups were statistically significant (P < 0.001). Mothers of the study groups also showed an improvement in their own levels of gingivitis, debris and calculus scores by the second and third examinations (P < 0.001). CONCLUSION: Regular home visits to mothers with infants, commencing at or soon after the time of the eruption of the first deciduous teeth, was shown to be effective in preventing the occurrence of nursing caries.