Fluoridated salt for caries prevention and control - a 2-year field study in a disadvantaged community.

BACKGROUND: Salt fluoridation is considered a cost-effective community strategy for reducing caries. AIM: To evaluate the effect of school-based and domestic distribution of F-salt to schoolchildren residing in a disadvantaged community. DESIGN: Seven hundred and thirty-three schoolchildren (12-14 years), attending two public schools, were enrolled; one was assigned to intervention (IS), whereas the other served as reference (RS). Subjects in IS were given access to F-salt (250 ppm F) in marked jars at school lunch and through free supply for domestic use. The 2-year caries increment and progression rate, assessed from bitewing radiographs, was scored. Information on diet, oral hygiene, and fluoride exposure was collected through a baseline questionnaire. RESULTS: The dropout rate was high (IS 27%; RS 18%). At baseline, the IS children displayed more unfavourable risk factors and a higher caries experience than RS children. There were no significant differences in total caries increment or proximal progression rate between the two schools. A negative correlation (r = -0.29; P < 0.05) between the amount of delivered salt and the caries progression rate was, however, noted. No side effects were reported. CONCLUSIONS: F-salt was not effective in this setting. Still, the findings indicate that salt may be a beneficial source of fluoride in schoolchildren provided that compliance can be secured.

Prevalence of dental fluorosis in children taking part in an oral health programme including fluoride tablet supplements from the age of 2 years.

AIM: To investigate the prevalence of dental fluorosis in children who had participated in an oral health programme between the ages 2-5 years, including fluoride tablets from the age of 2 years. DESIGN: The study group consisted of 135 10- to 11-year-old children who had participated in the programme, including parent education, tooth-brushing instruction and prescribed fluoride tablets (0.25 mg NaF) (2-3 years: 1 tablet/day; 3-5 years: 2 tablets/day). The prevalence of dental fluorosis in the study group was compared with that in a nonintervention reference group consisting of 129 children of the same ages. The analysis was based on photos of the permanent maxillary front teeth using the Thylstrup & Fejerskov (TF) Index. RESULTS: No statistically significant difference in prevalence of dental fluorosis was seen between the two groups. Forty-three percent of the children in the study group and 38% in the reference group had fluorosis, the majority of a mild nature (TF-score 1). None had a TF score above 2. The pattern was the same after correction for parent reported intake of tablets at 3 and 5 years of age. CONCLUSION: Introduction of fluoride tablets at the age of 2 years did not result in increased prevalence of dental fluorosis.

Cost-analysis of an oral health outreach program for preschool children in a low socioeconomic multicultural area in Sweden.

The aim was to calculate the total and the net costs per child included in a 3-year caries preventive program for preschool children and to make estimates of expected lowest and highest costs in a sensitivity analysis. The direct costs for prevention and dental care were applied retrospectively to a comprehensive oral health outreach project for preschool children conducted in a low-socioeconomic multi-cultural urban area. The outcome was compared with historical controls from the same area with conventional dental care. The cost per minute for the various dental professions was added to the cost of materials, rental facilities and equipment based on accounting data. The cost for fillings was extracted from a specified per diem list. Overhead costs were assumed to correspond to 50% of salaries and all costs were calculated as net present value per participating child in the program and expressed in Euro. The results revealed an estimated total cost of 310 Euro per included child (net present value) in the 3-year program. Half of the costs were attributed to the first year of the program and the costs of manpower constituted 45% of the total costs. When the total cost was reduced with the cost of conventional care and the revenue of avoided fillings, the net cost was estimated to 30 Euro. A sensitivity analysis displayed that a net gain could be possible with a maximal outcome of the program. In conclusion, the estimated net costs were displayed and available to those considering implementation of a similar population-based preventive program in areas where preschool children are at high caries risk.

Caries prevalence in 3-year-old children living in a low socio-economic multicultural urban area in southern Sweden.

The aim of this study was to investigate the prevalence of dental caries in 3-year-old children living in a multi-cultural low socio-economic urban area of Malmö, Sweden, and to establish its relationship to some medical, oral and behavioural factors associated with caries risk. All 238 children that became 3 years of age between July and December 2000 were invited to participate and 94% showed up for examination. The parents completed a structured questionnaire concerning social and ethnic background, medical history and oral health behaviour and a clinical examination of the child was performed in optimal light with a mirror and probe. Visible plaque, gingival health and occurrence of initial and manifest caries lesions, extractions and fillings (defs) were scored. The prevalence of caries was 85% with a mean defs value of 4.4 +/- 4.3. Of those with caries, 55% had manifest lesions while 45% exhibited lesions that were limited within the enamel. The variables significantly associated with caries were frequent intake of meals (odds ratio, OR = 6.0), gingivitis (OR = 3.7), presence of visible plaque (OR = 3.2) and compromising medical conditions (OR = 2.7). Children without fluoride supplements or fluoridated toothpaste had significantly (p < 0.05) more caries that those with a daily intake of fluoride (mean defs 7.2 +/- 5.3 vs 4.0 +/- 4.0). In conclusion, a high prevalence of caries was found in a low socio-economic multi-cultural population in an urban area of Malmö, Sweden. Thus, early childhood caries may still be a public health problem in certain groups, which calls for collective preventive measures to be re-instituted.

Outcome of an oral health outreach programme for preschool children in a low socioeconomic multicultural area.

BACKGROUND: Despite a significant reduction in the prevalence of dental caries, childhood tooth decay is still a public health problem in both developed and developing countries. OBJECTIVE: The aim of this study was to evaluate the caries preventive effect of an oral health programme for preschool children living in a low socioeconomic multicultural area in the city of Malmö, Sweden. METHODS: Eight hundred and four 2-year-old children were enrolled and recalled every third month between ages 2 and 3 and semi-annually between ages 3 and 5 years. From an outreach facility, parents were instructed on oral health with a focus on toothbrushing and diet, and provided fluoride tablets free of charge. Participants completed a clinical examination and a structured interview at age of 5 years, at which point 651 children (81%) remained in the programme. The results of the intervention group were compared with a non-intervention reference group consisting of 201 5-year-old children from the same district. RESULTS: In the intervention group, 96% attended four or more of their scheduled appointments, and mean caries prevalence was significantly lower than in the reference group (5.4 deft vs. 6.9 deft; P < 0.001). The prevented defs fraction was 27%. Parents' daily assistance with toothbrushing and administering fluoride tablets was significantly better in the intervention group than in the reference group (P < 0.05). CONCLUSION: This study demonstrated that the early start of oral health programme had a significant beneficial effect on caries prevalence after 3 years.

Caries-preventive effect of an oral health program for preschool children in a low socio-economic, multicultural area in Sweden: results after one year.

The aim of this study was to evaluate the caries-preventive effect of an oral health program for preschool children living in a multicultural, low socio-economic area. In total, 804 2-year-old children were invited and recalled every 3rd month to an outreach facility for parent education and toothbrushing instruction. In addition, fluoride tablets (0.25 mg/day) were provided free of charge. A clinical examination and questionnaire were completed at baseline and at age 3 years. The results of the intervention were compared with a non-intervention Reference group of 3-year-old children (n=217) from the same area. In the Intervention group, the 1-year attrition rate was 8.2%, and more than 90% of the children attended at least 4 of their scheduled appointments. The parents' daily assistance with toothbrushing and the use of fluoride toothpaste and tablets improved significantly during the intervention. Compared with the Reference group when the children were 3 years old, the number of children in the Intervention group who consumed frequent in-between meals and sweet drinks at night was significantly lower. Caries prevalence at age 3 was significantly lower in the Intervention group than in the Reference group (3.0 deft versus 4.4 deft; p<0.01). The number of caries-free children after the 1-year intervention was 37% in the Intervention group compared with 15% in the Reference group. The relative risk (RR) was calculated to be 2.5 (95% CI 1.8-3.4) and the number needed to treat (NNT) 4.6. In conclusion, this study demonstrated that the oral health program significantly affected the prevalence of caries and various risk factors for caries development.