Developmental delays and dental caries in low-income preschoolers in the USA: a pilot cross-sectional study and preliminary explanatory model

Abstract Background Anecdotal evidence suggests that low-income preschoolers with developmental delays are at increased risk for dental caries and poor oral health, but there are no published studies based on empirical data. The purpose of this pilot study was two-fold: to examine the relationship between developmental delays and dental caries in low-income preschoolers and to present a preliminary explanatory model on the determinants of caries for enrollees in Head Start, a U.S. school readiness program for low-income preschool-aged children. Methods Data were collected on preschoolers ages 3–5 years at two Head Start centers in Washington, USA (N = 115). The predictor variable was developmental delay status (no/yes). The outcome variable was the prevalence of decayed, missing, and filled surfaces (dmfs) on primary teeth. We used multiple variable Poisson regression models to test the hypothesis that within a population of low-income preschoolers, those with developmental delays would have increased dmfs prevalence than those without developmental delays. Results Seventeen percent of preschoolers had a developmental delay and 51.3% of preschoolers had ≥1 dmfs. Preschoolers with developmental delays had a dmfs prevalence ratio that was 1.26 times as high as preschoolers without developmental delays (95% CI: 1.01, 1.58; P < .04). Other factors associated with increased dmfs prevalence ratios included: not having a dental home (P = .01); low caregiver education (P < .001); and living in a non-fluoridated community (P < .001). Conclusions Our pilot data suggest that developmental delays among low-income preschoolers are associated with increased primary tooth dmfs. Additional research is needed to further examine this relationship. Future interventions and policies should focus on caries prevention strategies within settings like Head Start classrooms that serve low-income preschool-aged children with additional targeted home- and community-based interventions for those with developmental delays

Socio-behavioral factors influence prevalence and severity of dental caries in children with primary dentition

The aim of this study was to analyze the influence of socio-behavioral variables on the prevalence and severity of dental caries in 4- to 6-year-old children. A cross-sectional study was performed on a sample of 1993 children enrolled in 58 public preschools from Araçatuba City, São Paulo State, Brazil, during 2010. The exams were made using the decayed, missing, and filled teeth index (World Health Organization methodology) and detection criteria for non-cavitated lesions. A tested, self-administered questionnaire was sent to parents to obtain information about their socio-behavioral characteristics. Standardization was performed to verify concordance among examiners (kappa = 0.84). The prevalence of cavitated caries lesions was 41.2% (821), and the prevalence of both, cavitated and non-cavitated caries lesions, was 43.9% (875). The means ± standard deviations of the decayed, missing, and filled teeth index for children aged 4, 5, and 6 years were 1.18 ± 2.45, 1.65 ± 2.67, and 1.73 ± 2.77, respectively. Caries were significantly more prevalent in children from families with low incomes and low educational levels. The presence of dental caries was associated with access to dental services (p < 0.05). The associations between both, cavitated and non-cavitated dental caries lesions, and the frequency of oral hygiene were statistically significant. The prevalence of dental caries in preschoolers was strongly associated with factors related to the children's parents. Therefore, information about parents' socio-economic status, behaviors, and attitudes in relation to oral health should be considered when planning prevention and educational programs for the oral health of preschool children

O uso de vernizes fluoretados e a redução da incidência de cárie dentária em pré-escolares: uma revisão sistemática Fluoride varnishes and decrease in caries incidence in preschool children: a systematic review

O objetivo desta revisão sistemática foi verificar se existe evidência conclusiva de que o verniz fluoretado reduz a incidência de cárie dentária em pré-escolares. Foram feitas buscas nas bases eletrônicas BBO, LILACS, MEDLINE e Cochrane para identificar ensaios clínicos controlados que avaliassem o desenvolvimento de lesões cavitadas de cárie em crianças com até seis anos de idade. Dois pesquisadores analisaram criticamente os trabalhos selecionados para inclusão. Foram encontrados 513 artigos e oito foram incluídos. Esses estudos apresentaram problemas quanto ao desenho e, além disso, eram heterogêneos quanto à experiência prévia de cárie dos participantes, ao tipo de intervenção administrada ao grupo controle, à exposição das crianças a outras fontes de fluoretos, e ao intervalo entre as aplicações de verniz. As diferenças absolutas entre as incidências de cárie nos grupos controle e teste e as frações prevenidas variaram de 0,30 a 1,64 e de 5 a 63%, respectivamente. O verniz fluoretado parece ser efetivo para reduzir a incidência de cárie dentária em pré-escolares, mas outros ensaios clínicos de melhor qualidade metodológica são necessários para se obter evidência conclusiva a esse respeito.<br>The objective of this systematic review was to evaluate whether there is conclusive evidence that the professional application of fluoride varnish decreases the incidence of dental caries in preschool children. We searched the BBO, LILACS, MEDLINE and Cochrane electronic databases to identify controlled clinical trials that evaluated the development of cavitated caries lesions in children up to six years of age. Two researchers performed a critical appraisal of the studies selected for inclusion. Five-hundred and thirteen articles were found, but only eight met our inclusion criteria. Most of these eight studies were of poor methodological quality. They were also heterogeneous in relation to participants' previous caries experience, type of intervention performed on the control group, children's exposure to other sources of fluoride, and varnish application interval. The absolute differences between caries incidences in the control and test groups ranged from 0.30 to 1.64 and the preventive fractions varied from 5% to 63%. Fluoride varnish may be effective to decrease the incidence of dental caries in preschoolers, but more randomized clinical trials with better methodological quality are necessary to provide conclusive evidence in this respect