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Efficacy of chlorhexidine varnish applications in the prevention of early childhood caries.
Eur J Paediatr Dent. 2005 Sep;6(3):149-54.
Plotzitza B, Kneist S, Berger J, Hetzer G.
AIM: A prospective clinical study was conducted to evaluate the influence of 3-monthly
applications of the chlorhexidine- containing varnish Cervitec on the colonisation of
a child's oral cavity by mutans streptococci (MS) and on caries prevalence. METHODS:
200 children aged 11.7 +/- 0.7 months were examined. Children's caries risk was assessed
on the basis of their MS scores in saliva. Out of the 48 children in whom a high caries
risk (> or =10(5) CFU/ml) was expected, 23 were treated with Cervitec at 3-month
intervals (CHX group). The remaining 25 children of the high-risk group received no
treatment and served as controls (group C). All parents received detailed information
on the prevention of early childhood caries. 172 children had completed the study
after one year. RESULTS: During the course of the study the percentage of children
with visible plaque on their maxillary incisors increased from 17.8% to 40.1% and
the percentage of children given sweetened drinks in nursing bottles for the
night rose from 16.3% to 18.0%. At the closure of the study 26.2% of the
two-year-olds had salivary scores of MS > or =10(5) CFU/ml of saliva. The
mean d(1-4)mft value increased from 0.05 -/+ 0.4 to 0.8 -/+ 2.9 and the mean
d(1-4)mfs value rose from 0.08 -/+ 0.8 to 1.8 -/+ 5.9. No significant differences
were demonstrable between the two-year-olds in groups CHX and C for
colonisation of the oral cavity by MS or for d(1-4)mft values. In contrast
the d(1-4)mfs values were significant lower in the CHX group as in the group
C. CONCLUSION: Poor feeding habits and deficits
in oral hygiene cannot be compensated by the application of Cervitec.
Comparison of the cariogenicity of cola, honey, cow milk, human milk, and sucrose.
Pediatrics. 2005 Oct;116(4):921-6.
Bowen WH, Lawrence RA.
OBJECTIVE: The purpose of this study was to determine and compare the cariogenicity
of various fluids that are frequently fed to infants and toddlers. We chose to examine
sucrose, cola drink, honey, human milk, cow milk, and water because some of these have
been associated with development of early childhood caries, although direct experimental
evidence is lacking. METHODS: We used our desalivated rat model because the approach
mimics the situation found in infants, whereby the flow of saliva is interrupted
through mechanical effects of a nipple. The animals received basic nutrition by gavage,
and the fluids being tested were available ad libitum. Thus, the only substances
that came in contact with teeth were the test fluids. The investigation continued
for 14 days. RESULTS: Cola, sucrose, and honey were by far the most cariogenic.
In addition, cola and honey induced considerable erosion. Human milk was
significantly more cariogenic than cow milk probably because of its lower
mineral content and higher level of lactose. CONCLUSIONS: Our data show that
the use of honey, cola, and sucrose water in nursing bottles should be discouraged.
Although human milk is more cariogenic than cow milk, it is no more cariogenic
than are common infant formulas. Protracted exposure to human milk or formula
through allowing an infant to sleep on the nipple should be discouraged,
and the need for oral hygiene after tooth eruption should be emphasized.
A practical guide to infant oral health. (Free Full Text)
Am Fam Physician. 2004 Dec 1;70(11):2113-20.
Douglass JM, Douglass AB, Silk HJ.
Early childhood caries is the most common chronic disease in young children and may develop
as soon as teeth erupt. Bacteria, predominately mutans streptococci, metabolize simple
sugars to produce acid that demineralizes teeth, resulting in cavities. Physicians should
examine children's teeth for defects and cavities at every well-child visit. Any child
with significant risk factors for caries (e.g., inadequate home dental care and poor oral
hygiene, a mother with a high number of cavities, a high sugar intake, enamel defects,
premature birth, special health care needs, low socioeconomic status) should be referred
to a dentist by 12 months of age. Promoting appropriate use of topical and systemic
fluoride and providing early oral hygiene instruction can help reduce caries in young
patients, as can regularly counseling parents to limit their child's consumption of sugar.
Breastfeeding and early childhood caries: a critical review (Free Full Text)
J Pediatr (Rio J). 2004 Nov;80(5 Suppl):S199-210.
Ribeiro NM, Ribeiro MA.
OBJECTIVE: To find scientific evidence that can prove or refute the assumption that
nocturnal and on demand breastfeeding are associated with caries in infants and preschool
children. SOURCES OF DATA: MEDLINE, Lilacs, and SciELO articles were searched, as well
as important internet sites, technical books and consensus publications of national and
international organisms. The following keywords were used: "early childhood caries",
"dental caries", "dental decay" and "breastfeeding". References cited in the articles
selected were also included. SUMMARY OF THE FINDINGS: Studies associating caries with
breastfeeding invariably observe factors associated with how this disease develops,
letting aside those associated with breastfeeding. Many of these factors act as
confusing variables because in the same way as they interfere in breastfeeding,
they also influence the development of caries. Besides, current studies have already
demonstrated the cariogenic potential of some types of aliments given to children
against the non-cariogenic potential of the human milk. CONCLUSIONS: There is no
scientific evidence proving that human milk can be associated with the development
of caries. This is a complex relation to be established, as it is often blurred by too many variables.
Use of the Nd:YAG laser in the treatment of Early Childhood Caries.
Eur J Paediatr Dent. 2004 Jun;5(2):98-101.
Birardi V, Bossi L, Dinoi C.
AIM: This was to demonstrate that traditional therapy of Early Childhood Caries (ECC)
can be improved with the use of the Nd:YAG laser. METHODS: This investigation was
conducted on three 3 year-old children in which the four maxillary primary incisors
were affected by ECC. The teeth were treated with the Nd:YAG laser and one unrestorable
tooth for each child was extracted for investigation by scanning electron microscopy.
RESULTS: The laser therapy provided several clinical advantages (reduction of dentine
permeability and hypersensitivity, sterilization of the lased surface, and fluoride
penetration within the tooth). Good patient compliance was also achieved due to the
type of appliance and materials used, absence of noise and vibration, a lack of need
for local analgesia, and the reduced number of brief appointments. CONCLUSION: This
approach to treatment of ECC permits teeth to be retained in the dental arch and
delays the use of traditional methods to a later time when the
child has reached an age sufficient for cooperation with the practitioner.
Children's first dental visit: attitudes and practices of US pediatricans and family physicians.
Pediatr Dent. 2003 Sep-Oct;25(5):425-30.
Ismail AI, Nainar SM, Sohn W.
PURPOSE: The aim of the present study was to survey the recommendations and practices
regarding the first dental visit by young children, as reported by family physicians
and pediatricians in the United States. METHODS: A representative sample of family
physicians and pediatricians was surveyed in the year 2000. The initial survey was
mailed out to 1,500 family physicians and 1,000 pediatricians who were selected from
the AMA Masterfile. After the first mailing, 3 follow-up questionnaires and a postcard
reminder were mailed to the nonresponders within a period of 3 months. The questionnaire
described case scenarios of 2, 12-month-old children, one with low caries-risk and the
other at high risk with noticeable cavitation of the maxillary front teeth. RESULTS:
The response rate to the survey was 43% (622 out of 1,439) for family physicians
and 52% (493 out of 957) for pediatricians. When the case scenario of a child with
high caries risk was presented, more than 90% of the respondents recommended that
the child see a dentist as soon as possible. For the child with low caries-risk,
the proportion of respondents recommending early dental visit was significantly
lower: only about 19% of family physicians and 14% of pediatricians. For a child
at low risk for dental caries, about 40% of family physicians and 63% of
pediatricians recommended the first dental visit around the third birthday.
The majority of the respondents (pediatricians=91% and family physicians=77%)
reported frequent screening for gross tooth decay. However, only a minority
of them (pediatricians=33% and family physicians=19%) frequently checked for
early signs of tooth decay as part of their regular practice. CONCLUSIONS:
US physicians can decide on referral patterns based on the risk status of
a child. However, the majority of respondents
do not regularly screen for early signs of early childhood caries.
Prevention of early childhood caries in North Carolina medical practices: implications for research and practice. (Free Full Text)
J Dent Educ. 2003 Aug;67(8):876-85.
Rozier RG, Sutton BK, Bawden JW, Haupt K, Slade GD, King RS.
Early childhood caries is a significant public health problem in low-income children,
with important negative consequences for the child and the family. The purpose of
this paper is to describe the development, implementation, and preliminary outcomes
of preventive dentistry programs in North Carolina that target low-income children
from birth to thirty-five months of age. The focus is on Into the Mouths of Babes,
a statewide program in which pediatricians, family physicians, and providers in
community health clinics are reimbursed by Medicaid to provide preventive dental
services for
children (risk assessment, screening, referral, fluoride varnish application)
and caregivers (counseling). The provider intervention includes continuing medical
education lectures and interactive sessions, practice guidelines for the patient
interventions, case-based problems, practical strategies for implementation, a
toolkit with resource materials, and follow-up training. In the first two years
of the statewide program, 1,595 medical providers have been trained. The number
of providers billing for these services has steadily increased, and by the last
quarter of 2002, the number of visits in which preventive dental services were
provided in medical offices reached 10,875. A total of 38,056 preventive dental
visits occurred in medical offices in 2002. By the end of 2002, only sixteen of
the state's one hundred counties had no pediatrician, family physician, or local
health department participating. The preliminary results from this program
demonstrate that nondental professionals can integrate preventive dental
services into their practices. The program has increased access to preventive
dental services for young Medicaid children whose access to dentists is restricted.
Assessments of effectiveness and cost-effectiveness of both the provider
and patient interventions are under way.
Oral health risk assessment timing and establishment of the dental home. (Free Full Text)
Pediatrics. 2003 May;111(5 Pt 1):1113-6.
Hale KJ; American Academy of Pediatrics Section on Pediatric Dentistry.
Early childhood dental caries has been reported by the Centers for Disease Control
and Prevention to be perhaps the most prevalent infectious disease of our nation's
children. Early childhood dental caries occurs in all racial and socioeconomic groups;
however, it tends to be more prevalent in low-income children, in whom it occurs in
epidemic proportions. Dental caries results from an overgrowth of specific organisms
that are a part of normally occurring human flora. Human dental flora is site specific,
and an infant is not colonized until the eruption of the primary dentition at
approximately 6 to 30 months of age. The most likely source of inoculation of an
infant's dental flora is the mother or another intimate care provider, through
shared utensils, etc. Decreasing the level of cariogenic organisms in the mother's
dental flora at the time of colonization can significantly impact the child's
predisposition to caries. To prevent caries in children, high-risk individuals
must be identified at an early age (preferably high-risk mothers during prenatal care),
and aggressive strategies should be adopted, including anticipatory guidance,
behavior modifications (oral hygiene and feeding practices),
and establishment of a dental home by 1 year of age for children deemed at risk.
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