Research Reports first published in the journal Tuith Online

Targeted caries prevention in pre-school children

The aim of the Generalisable Evidence-based Targeted Caries Prevention for Pre-school Children by Integrated Primary Care Teams (GETCaPPP) study was to evaluate the effects of an intensive caries prevention regime targeted at children assessed as high caries risk at age 13 months. Consented children were randomly assigned to an Intervention or a Control group.

How the study was carried out?

Around the time of the child's 8 month developmental screening, the health visitor explained the study to the parent and asked if they would like to take part. Those who agreed are then randomly assigned either to the test or control group.

At the age of about 13 months, the parents of the children in the test group were given a questionnaire by their health visitor. The health visitor also filled in a questionnaire based on her/his knowledge of the family. Questionnaires were then analysed, using the previously determined model, to assess if the child was at high or low risk of caries.

Parents of the children in the test group were required to register with a dentist of their choice: virtually all of the dental practices in Dundee took part, as did the CDS and the Dental Hospital. Dentists in nearby towns also agreed to participate at the special request of parents who were registered with them.

Children identified as being at high risk of caries were required to register with a dentist and attend every 3 months for a regime of intensive, preventive care. This regime included:

1. Flossing
2. Prophylaxis
3. Application of a fluoride (FluorProtector) or Chlorhexidine/ thymol (Cervitec) varnish at alternate appointments
4. Dietary advice
5. Oral hygiene instruction
6. Free toothpaste and toothbrush

Children assessed as being at low risk of caries were required to attend the dentist annually, when they were given dietary advice and oral hygiene instruction.

Throughout the study the dentist retained full clinical responsibility for the child and also provided any other treatment that he/she considered appropriate.

The health visitors were trained to carry out a clinical caries risk assessment and looked at the children in the low risk group when they were 2 and 3½ years old to assess if they had been correctly identified. If the health visitor then considered them to be at risk of caries, the child was enrolled into the high risk preventive programme.

Parents of the children in the control group made their normal arrangements for dental care which, in some cases, may have meant that they did not attend for dental treatment at all during their pre-school years.

The study dentist examined all the children in the study at ages 3½ and 4½ years and the caries prevalence of the two groups was compared.

Progress and desired outcomes

At age 4½ years the children were dentally examined by a calibrated examiner, who did not know their group allocation.

Factors which made a statistically significant difference were any intervention, even a one-off, early registration and frequent attendance, and appropriate application of prevention regimes by dental teams. Contact through nursery schools emerged as a positive alternative to counteract poor attendance at dental practices.

If it is judged that the study has been both successful in reducing caries and cost-effective, then it suggested that this will aid the management of the dental health of young children at risk of caries throughout the whole of Scotland.