Family-Centered Oral Health Promotion in Preventing Early Childhood Caries

Abstract

Objectives: To evaluate the effectiveness of a family-based oral health promotion to parents in a non-dental-setting in preventing early childhood caries (ECC) in children at 3 years old. Methods: This study was conducted by recruiting first-time pregnant women (10th- 22nd gestational week) and their husbands during a prenatal visit and randomly allocated into two groups. Test group received a 30-minute face-to-face individualized counselling, explanation of oral health education (OHE) pamphlets and oral hygiene instructions both on adults and babies, with guidance to prevent ECC. Reinforcements were implemented in the 3rd-trimester of pregnancy (prenatal visit), 6-month postpartum (messaging), and when the child reached 1 and 2 years of age (home visit). Control group received the same OHE pamphlets only. ECC was recorded using the ICDAS index. Results: At baseline, 580 families (test: 294; control: 286) were recruited and 436 (75%) families were followed till the children were aged 3 years. Prevalence of white spot lesions was lower in the test group than in control group at the 1-year and 2-year follow-up (6.3% vs 14.2%, p=0.006; 12.6% vs 24.6%, p=0.001). In the 3-year follow-up, 21.2% of the control group children had experienced caries into dentin and their mean dmft score was 0.5±1.1 while the corresponding figures in the test group were 4.4% and 0.1±0.7 (p<0.001), respectively. Prevalence of severe-ECC was higher among the control than the test children (16.3% vs 4.4%, p<0.001). Negtive binomial regression analysis showed that, by age 3, children in the control group (IRR=3.7, p<0.001) and consumed candies more than once daily (IRR=3.3, p<0.001) had higher chance to develop dentin caries, while children whose mother with higher self-efficacy regarding child oral health (IRR=0.8, p=0.001) had a lower chance. Conclusions: This simple, low-intensity and family-based intervention in a non-dental setting implemented at an early stage of pregnancy with annual reinforcement was effective in preventing ECC.