Health professionals delivering oral health interventions in early childhood: A scoping review of Australian and New Zealand literature.

ISSUE ADDRESSED: Dental caries is highly prevalent in very young Australian and New Zealand children. Health professionals other than registered dental professionals can help prevent early childhood caries, promoting oral health to assist families establish preventative oral health habits at a child's early age. This review identifies oral health promotion (OHP) delivered by nondental health professionals in Australia and New Zealand involving very young children. METHODS: Databases (MEDLINE, CINAHL, Embase, Emcare, Web of Science, Scopus, ProQuest, Google Scholar, TROVE) and digital libraries were searched between 2001 and 2021 for eligible studies and grey literature. Studies with a focus on preventative oral health strategies in a primary health care context were included. RESULTS: The review identified 76 studies. Seven met the inclusion criteria, and were conducted in Australia across metropolitan, rural, and remote settings. Studies that successfully engaged nondental health professionals to promote oral health to families reported a positive change in oral health practices among very young children. Delivering OHP during a child's early life stage positively influenced their oral health outcomes. CONCLUSIONS: Integration of dental and primary health care increased access to oral health care and advanced positive oral health outcomes for children. With adequate training, resources, and support mechanisms, nondental health professionals can deliver oral health strategies that facilitate behaviour change in parents to improve children's oral health. So What? Health promotion generates enabling conditions that support and empower families to improve and maintain their oral health. Nondental health professionals can play a crucial role promoting oral health for very young children and improving equitable access to preventative oral health care.

Relative cost-effectiveness of home visits and telephone contacts in preventing early childhood caries.

OBJECTIVES: To evaluate the cost-effectiveness of a home-visit intervention conducted by oral health therapists relative to a telephone-based alternative and no intervention. METHODS: A Markov model was built to combine data on dental caries incidence, dental treatments, quality of life and costs for a cohort of children from age 6 months to 6 years. The probabilities of developing caries and subsequent treatments were derived primarily from the key intervention study. The outcome measures were costs (US dollars), quality-adjusted life years (QALYs) and the number of carious teeth prevented. One-way and probabilistic sensitivity analyses were used to test the stability of the model. RESULTS: For every group of 100 children, the model predicted that having the home-visit intervention would save $167 032 and telephone contacts $144 709 over 5½ years relative to no intervention (usual care). The home visits and telephone intervention would prevent 113 and 100 carious teeth (per 100 children) relative to no intervention in a period of 5½ years. Sensitivity analysis showed that a lower rate of caries reduced the intervention's cost-effectiveness primarily through reducing general anaesthesia costs. The home visits and telephone interventions resulted in 7 and 6 QALYs, respectively, gained over the usual care group for the 100 children over 5½ years. Both interventions were 'dominant,' as they saved costs and produced health benefits over usual care. CONCLUSIONS: Both the home visits and telephone-based community interventions conducted by oral health therapists were highly cost-effective than no intervention in preventing early childhood caries.

Effects of water fluoridation on caries experience in the primary dentition in a high caries risk community in Queensland, Australia.

OBJECTIVES: In December 2008, artificial water fluoridation was introduced for the first time to the Logan-Beaudesert district in the state of Queensland, Australia. The aim of this study was to evaluate the effects of water fluoridation in the primary dentition in this community after a period of 36 months. METHODS: Children aged 4-9 years with clinical examinations and bitewing radiographs (BWs) taken before water fluoridation (pre-F) were randomly selected as comparison controls for age matched children who had been exposed to a mean period of 36 months of water fluoridation (post-F). A total of 201 sets of pre-F BWs from children (mean age 6.95 ± 1.05 years) and 256 sets of post-F BWs from children (mean age 7.19 ± 1.23 years) attending schools in the district were randomly selected. Caries experience in the primary dentition was determined as decayed, missing or filled teeth/surfaces (dmft/dmfs). RESULTS: The caries prevalence for the pre-F group was 87% compared to 75% in the post-F group (Odds ratio (OR): 0.44, 95% CI: 0.27-0.72). Overall, there was a 19 percent reduction of mean dmft from 4.54 in the pre-F group to 3.66 in the post-F group (p = 0.005). After fluoridation, the dmfs was reduced from 6.68 to 5.17 (p = 0.0056). The distal surfaces of maxillary first primary molars experienced the greatest reduction (26%) in caries experience after water fluoridation (p < 0.001). CONCLUSIONS: After only 36 months of water fluoridation there was a significant drop in caries prevalence from 87 to 75% and a 19% reduction in caries experience in a community with one of the highest caries rates in Australia.

Cost-effectiveness of a telephone-delivered education programme to prevent early childhood caries in a disadvantaged area: a cohort study.

OBJECTIVES: Early childhood caries is a highly destructive dental disease which is compounded by the need for young children to be treated under general anaesthesia. In Australia, there are long waiting periods for treatment at public hospitals. In this paper, we examined the costs and patient outcomes of a prevention programme for early childhood caries to assess its value for government services. DESIGN: Cost-effectiveness analysis using a Markov model. SETTING: Public dental patients in a low socioeconomic, socially disadvantaged area in the State of Queensland, Australia. PARTICIPANTS: Children aged 6 months to 6 years received either a telephone prevention programme or usual care. PRIMARY AND SECONDARY OUTCOME MEASURES: A mathematical model was used to assess caries incidence and public dental treatment costs for a cohort of children. Healthcare costs, treatment probabilities and caries incidence were modelled from 6 months to 6 years of age based on trial data from mothers and their children who received either a telephone prevention programme or usual care. Sensitivity analyses were used to assess the robustness of the findings to uncertainty in the model estimates. RESULTS: By age 6 years, the telephone intervention programme had prevented an estimated 43 carious teeth and saved £69 984 in healthcare costs per 100 children. The results were sensitive to the cost of general anaesthesia (cost-savings range £36 043-£97 298) and the incidence of caries in the prevention group (cost-savings range £59 496-£83 368) and usual care (cost-savings range £46 833-£93 328), but there were cost savings in all scenarios. CONCLUSIONS: A telephone intervention that aims to prevent early childhood caries is likely to generate considerable and immediate patient benefits and cost savings to the public dental health service in disadvantaged communities.

A controlled, longitudinal study of home visits compared to telephone contacts to prevent early childhood caries.

BACKGROUND: Home visits (HV) provide excellent opportunities for health promotion. AIM: This longitudinal study compared the effects of HV and telephone contacts (TC) in preventing early childhood caries (ECC) and colonisation of mutans streptococci (MS) and lactobacilli (LB) from 0 to 24 months. DESIGN: A total of 325 children were recruited from community health centres at mean age of 42 days, and randomly assigned to receive either HV or TC. A total of 188 children completed three, 6 monthly HV, and another 58 had three, 6 monthly TC. An additional 40 age-matched children from childcare facilities served as reference controls (RC). At 24 months, all groups were examined at a community dental clinic. RESULTS: At 24 months, three HV children of 188 (1.5%) had caries, compared to four TC of 58 (6.8%) and nine RC of 40 (22.5%) (P < 0.001 for HV versus RC; P = 0.05 for HV versus TC and P = 0.03 for TC versus RC). There were also more children with MS in the TC (47%) and RC (35%) compared to HV (28%) group (P = 0.01 and P = 0.02). CONCLUSIONS: Home visits and telephone contacts conducted 6 monthly from birth are effective in reducing ECC prevalence by 24 months.

A randomised, controlled clinical trial comparing chlorhexidine gel and low-dose fluoride toothpaste to prevent early childhood caries.

OBJECTIVES. This randomised, controlled trial compared the effectiveness of 0.12% chlorhexidine (CHX) gel and 304% fluoride toothpaste to prevent early childhood caries (ECC) in a birth cohort by 24 months. METHODS. The participants were randomised to receive either (i) twice daily toothbrushing with toothpaste and once daily 0.12% CHX gel (n = 110) or (ii) twice daily toothbrushing with toothpaste only (study controls) (n = 89). The primary outcome measured was caries incidence and the secondary outcome was percentage of children with mutans streptococci (MS). All mothers were contacted by telephone at 6, 12, and 18 months. At 24 months, all children were examined at a community dental clinic. RESULTS. At 24 months, the caries prevalence was 5% (3/61) in the CHX and 7% (4/58) in the controls (P = 0.7). There were no differences in percentages of MS-positive children between the CHX and control groups (54%vs 53%). Only 20% applied the CHX gel once daily and 80% less than once daily. CONCLUSIONS. Toothbrushing using 304% fluoride toothpaste with or without the application of chlorhexidine gel (0.12%) reduces ECC from 23% found in the general community to 5-7%. The lack of effect with chlorhexidine is likely to be due to low compliance.

A randomized controlled trial of a 10 percent CPP-ACP cream to reduce mutans streptococci colonization.

PURPOSE: The purpose of this study was to investigate the effectiveness of a 10 percent casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) cream to reduce mutans streptococci (MS) colonization and prevent early childhood caries. METHODS: The cohort was randomized at mean age of 11 days old to receive once-daily CPP-ACP cream (n=102) or no product (comparison group; n=89) from the time of first tooth eruption. All mothers were contacted by telephone at six, 12, and 18 months and advised to brush their children's teeth twice daily with low-dose fluoride toothpaste. At 24 months, all children were examined at a community clinic. RESULTS: At 24 months old, one out of 65 (2 percent) children in the CPP-ACP group had caries vs. four out of 58 (seven percent) in the comparison group (difference not statistically significant). There were fewer MS-positive children in the CPP-ACP group (26 percent) vs. the comparison group (47 percent; P=.02). A dose-response effect of CPP-ACP usage on MS was observed, where MS was present in eight percent of regular CPP-ACP users, 28 percent of irregular users, and 47 percent of non-users (P<.02). CONCLUSIONS: CPP-ACP reduced the percentages of mutans streptococci-positive 24-month-old children, although it did not reduce caries prevalence.