Baltimore Dental Study Offers Model Program To Reduce Tooth Decay In Urban Children

Researchers at the University of Maryland Dental School conducted a 26-month study of 219 children, ages six to 27 months, at the University’s Pediatric Ambulatory Care Center, a pediatric primary care clinic serving mostly low-income residents. Oral conditions of very young children were compared with those of older children at their first visit.

A “prevention group” of 109 children, ages six to 15 months, showed more than eight times less cavity-causing oral bacteria and significantly less cavities at their final dental visit, than did a control group of 110 children, ages 18 to 27 months at their first visit who had not received previous preventive care. Each child in the younger group received assessments of dental caries, monitoring of oral bacteria levels, fluoride varnishing, dental health counseling, periodic recalls, and referral to a dentist.

The study showed that if infants and toddlers can be provided with some preventive care, their oral health will be much better at the age of two years old than if they did not receive preventive care, says study leader and Dental School professor Glenn Minah, DDS, PhD.

Outcome measures included number of decayed tooth surfaces, oral counts of cavity-causing bacteria, and caregiver responses to a questionnaire about the child’s diet and home care.

Children who needed immediate treatment for caries were referred for treatment and those with high microbial counts were considered high risk and recalled for additional prevention.

Tooth decay can begin as soon as the first teeth emerge in toddlers, Minah says. And the study confirmed that children with early childhood dental caries are at higher risk for developing new carious lesions at a later age. Early childhood caries is a $3 billion problem annually, according to the researchers.

The desired improvements in dental care for young urban children can happen “by working with the physicians to assess children for caries-risk, screening them for early caries, referring them to dentists, and applying topical fluoride varnish,” says Minah.

He said that the success of the study was made largely possible by placing a full-time nurse or dentist with pediatric experience at the clinic solely dedicated to oral care, and the use of microbial screenings as a primary caries-risk indicator for the study. The risk assessments and screenings helped the staff identify low-risk subjects and children who were experiencing caries-promoting conditions.

Norman Tinanoff, DDS, MS, program director of the School’s Department of Pediatric Dentistry, says that dental caries in preschool is a big program now and a “rather ignored” program until 10 years ago. The problem was referenced in only two separate sentences in the 2000 report of the Health and Human Services Department (HHS) Surgeon General’s report on the nation’s health. “Now it has bloomed as a public health problem and a research problem,” Tinanoff says. Dental caries is now recognized by HHS as the most widespread chronic disease and most common unmet health care need of childhood.

The study identified potential drawbacks of the model, such as added costs for laboratory equipment for analysis of the microbial screenings and recalling the young children for follow-up preventive measures.

A more cost-efficient model suggested by the study may be one that assumes every enrolled child is at high risk for tooth decay, providing fluoride varnish at the first visit and at six-month intervals, referring each child for dental treatment when cavities appear, re-examining them for oral problems at each or most medical visits, and emphasizing dental education at each visit. The study is published in the journal Pediatric Dentistry, vol. 30, no. 6.