 |
 |
||||||||||||||||||||||||
|
|||||||||||||||||||||||||
|
Baby Bottle Tooth Decay Not Prevented by Fluoride |
|
|
According to The Daily Apple, "Baby bottle tooth decay occurs when a child's teeth are exposed to sugary liquids, such as formula, fruit juices, and other sweetened liquids for a continuous, extended period of time. The practice of putting a baby to bed with a bottle, which the baby can suck on for hours, is the major cause of this dental condition. The sugary liquid flows over the baby's upper front teeth and dissolves the enamel, causing decay that can lead to infection. The longer the practice continues, the greater the damage to the baby's teeth and mouth." Maureen Jones, from Citizens for Safe Drinking Water, has compiled the following list of research on baby bottle tooth decay (BBTD). As she demonstrates, much of the research on BBTD shows that it is most prevalent amongst the poor and that fluoride does not prevent it. Findings summarized by Maureen Jones, Citizens for Safe Drinking Water, maureenj@pacbell.net . More detailed summaries included below. Von Burg MM et al. Baby Bottle Tooth Decay: A Concern for All Mothers. Pediatric Nursing; 21:515-519, 1995. "Data from Head Start surveys show the prevalence of baby bottle tooth decay is about three times the national average among poor urban children, even in communities with a fluoridated water supply." Barnes GP et al. Ethnicity, Location, Age, and Fluoridation Factors in Baby Bottle Tooth Decay and Caries Prevalence of Head Start Children. Public Health Reports; 107: 167-73, 1992. "Children attending centers showed no significant differences (in baby bottle tooth decay) based on fluoride status for the total sample or other variables." (Note: The key paragraph from this study's abstract was excluded from Medline/PubMed. Only on the original study can one read that there was "no significant difference based on fluoride status" for BBTD.) Weinstein P et al. Mexican-American parents with children at risk for baby bottle tooth decay: Pilot study at a migrant farmworkers clinic. J Dent for Children; 376-83, Sept-Oct, 1992. Overall, 37 of the 125 children (29.6 percent) were found to have BBTD. Compliance in putting fluoride drops in bottle once a day was identical between BBTD and non BBTD groups. Kong D. City to launch battle against dental 'crisis'. Boston Globe, Nov. 27, 1999. 18% of children 4 years old and younger seen in the pediatric program at Tufts University School of Dental Medicine in 1995 had baby bottle tooth decay. Treatment can cost up to $4,000 per child. About 90% of 107 Boston high school students needed dental treatment, and an unpublished 1996 study reported that the city's students had four times more untreated cavities than the national average. Boston was fluoridated in 1978. (Read article) Tang JMW et al. Dental Caries Prevalence and Treatment Levels in Arizona Preschool Children. Public Health Reports; 112:319-29, 1997. Although Head Start is mandated to provide dental care for all enrolled children, in approximately half of the 11 surveys of Head Start children, the percentage of decayed surfaces or teeth was greater than 50%. Approximately 70% of children residing in the 32 survey communities had access to public drinking water containing greater than 0.6 ppm of fluoride. Kelly M et al. The Prevalence of Baby Bottle Tooth Decay Among Two Native American Populations. J Pub Health Dent; 47:94-97, 1987. The prevalence of BBTD in the 18 communities of Head Start children ranged from 17 to 85 percent with a mean of 53%. The surveyed communities had a mixture of fluoridated and non fluoridated drinking water sources. Regardless of water fluoridation, the prevalence of BBTD remained high at all of the sites surveyed. Febres C et al. Parental awareness, habits, and social factors and their relationship to baby bottle tooth decay. Pediatric Dentistry; 19:22-27, 1997. Of 100 children in this study, 19 had BBTD on at least two maxillary incisors: Hispanic 13, Black 3, White 1. (Note: Houston was fluoridated in 1982.) Blen M et al. Dental caries in children under age three attending a university clinic. Pediatric Dentistry; 21:261-64, 1999. Of 369 children who attended the University of Texas-Houston Health Center (Houston is fluoridated), 56% between 2 and 3 years old had decay. Among the 3 year olds, 46% had more than three decayed teeth. The children without decay were weaned from the bottle at an average age of 10 months. Those with severe decay were weaned at 16.9 months. Pollick H et al. 1993-94 California Oral Health Needs Assessment. Unpublished. 33% of Head Start children and 13% of non-Head Start preschool children had BBTD. The California Department of Health Services omitted from their Summary of Findings their finding that BBTD was as high as 45% for Asian children in Head Start preschools in fluoridated urban regions. Instead, they reported only the 40% of Hispanic children who had BBTD and attended Head Start schools in non-fluoridated urban areas. The following are more detailed summaries on the studies listed above as well as others. Study summary by M. Jones: Dilley GJ et al. Prolonged Nursing Habit: A Profile of Patients and Their Families. J Dent Child; March- April, 1980. The purpose of this investigation was to describe a sample of children
with the pattern of decay associated with prolonged bottle/nursing-habit.
The sample of 75 children was obtained from children who presented
themselves for treatment at the University of North Carolina School
of Dentistry. 84% of the children presented with nursing-bottle
decay in at least two maxillary incisors. The most severely affected
teeth were the maxillary incisors and first primary molars. On the
average, 97 percent of the children were bottle-fed until 23.4 months
of age. Ninety-three percent of the parents gave their child a bottle
at bedtime during infancy and discontinued the practice at approximately
the same time all bottle feedings were stopped. Over 78 percent
of parents reported that they received no instructions for discontinuation
of the bottle. This would suggest that the health professions are
negligent in either their recognition of the problems of early decay
and prolonged nursing-habit or in their dispersal of information
to the public. Study summary by M. Jones: Thakib AA et al. Primary incisor decay before age 4 as a risk factor for future dental caries. Pediatric Dentistry; 19:37-41, 1997. This controlled study evaluated the relationship between incisor
caries and subsequent decay. This is of clinical relevance since
primary incisor caries in young children is associated with a diagnosis
of nursing caries or baby bottle tooth decay. In summary, initial
primary incisor caries is a risk factor for developing future carious,
extracted, and restored teeth. It is important to note that after
initial primary incisor caries were adjusted for risk factors (age)
and protective factors (recalls and sealants), initial primary incisor
caries continued to be a significant risk factor for future caries
in primary and permanent teeth, and in permanent first molars alone.
Data for this study were collected from a retrospective dental chart
review of all patients who received their initial dental care between
1985 and 1988 at the Pediatric Dental Clinic, School of Dentistry,
University of Minnesota. (Note: Minnesota is 93.4% fluoridated by
population.) The purpose of this investigation was to determine whether early childhood caries (ECC) is a risk factor for future dental caries. One hundred fifteen dental charts of children younger than 4 years of age when initially treated were reviewed and abstracted for primary incisor caries and age at the initial examination. In addition, the number of carious, extracted, and restored teeth (cert/CERT: primary/ secondary) at the last examination was determined. Children with ECC at their initial examination (n = 58) had a 93.0% cert rate, a 67.2% CERT rate, and a 60.3% CERT in first molars rate by their last dental examination. Non-ECC children at their initial examination (n = 57) had less than half the rate of each cert/CERT parameter (43.9%, 22.8%, and 26.3%, respectively) at their last dental visit. The odds ratios for each cert/CERT parameter posed by ECC status were 17.3 for cert, 7.0 for CERT, and 4.3 for CERT in first molars. When these odds were adjusted for other study parameters by a forward step-wise logistic regression analysis, ECC status continued to be a risk factor for each cert/CERT parameter. We conclude that 1) early childhood caries is a risk factor for future caries, 2) increased age is a risk factor for CERT, and 3) recalls and sealants are protective factors. (Pediatr Dent 19:37-41, 1997) Study summary by M. Jones: Duperon DF. Early Childhood Caries: A Continuing Dilemma. CA Dent Assoc J; 23:2, 15-25, 1995. ECC is the overall term describing three aspects of a 100 year
old problem; Baby Bottle Tooth Decay (BBTD), Breast Milk Tooth Decay,
(BMTD), and dental caries from the use of sweetened pacifiers. Caries
first occurs on the upper incisors, both on the labio-gingival and
on the lingual surfaces as early as 12 to 16 months of age. Soon
after the eruption of the first primary molars, the occlusal surfaces
become carious. The primary precipitating factor for ECC is prolonged
use of the bottle or breast past 9 to 12 months of age. Use of the
baby bottle as a device to reduce infant demands or to pacify the
child and cultures that favor a fat, quiet baby overshadow parental
knowledge that these practices could lead to early dental decay.
The occurrence of ECC appears to vary significantly with race, culture
and socioeconomic status. In North American Indians, an incidence
of 53 percent has been reported. Inuit (Eskimo) children have shown
a 60% to 65% incidence of BBTD and BMTD. In Mexican American migrant
farm workers, 30% of the children examined showed evidence of BBTD.
Among Anglo Saxon and African American children, a more common finding
ranged between 3% and 6%. Study summary by M. Jones: Kelly M et al. The Prevalence of Baby Bottle Tooth Decay Among Two Native American Populations. J Pub Health Dent; 47:94-97, 1987. Baby Bottle tooth decay is manifested as severe dental caries in
the primary dentition. The decay pattern begins with the maxillary
primary incisors followed by the primary molars, in order of eruption
(2-11). Maxillary incisors are thought to be affected because of
a pooling of liquid from the bottle nipple and a reduction in salivary
flow during sleep. In 1985, 514 Native American Head Start children,
232 in nine Alaskan villages and 282 in nine Oklahoma tribes, were
screened. Initially, the criteria for BBTD were defined as decay
affecting two of the four maxillary incisors. After some criticism
from the dental community, the data was recalculated using the criteria
of three of the four maxillary incisors. The prevalence of BBTD
in the 18 communities of Head Start children ranged from 17 to 85
percent with a mean of 53 percent. The surveyed communities had
a mixture of fluoridated and non fluoridated drinking water sources.
Regardless of water fluoridation, the prevalence of BBTD remained
high at all of the sites surveyed. Baby bottle tooth decay (BBTD) is a disease characterized by severe dental caries in the primary dentition that may have significant short-term and long-term implications for the health of children. Its prevalence and various etiologic factors have not been addressed fully in the dental literature. In 1985, 514 Native American Head Start children in Alaska and Oklahoma were screened to establish the prevalence of BBTD in those populations. The prevalence of BBTD ranged between 17 and 85 percent, with a mean of 53 percent. BBTD is clearly a significant health problem for this population group. Concerted intervention efforts to lower the prevalence of this preventable condition should be instituted and their effectiveness evaluated for potential utility among other affected groups. Study summary by M. Jones: Barnes GP et al. Ethnicity, Location, Age, and Fluoridation Factors in Baby Bottle Tooth Decay and Caries Prevalence of Head Start Children. Public Health Reports; 107: 167-73, 1992. The purpose of this study was to compare BBTD and caries prevalence
among 1,230 Head Start children who are members of four ethnic groups:
221 whites, 409 blacks, 449 Hispanics, and 151 Native American,
in five southwestern States (Region VI): Arkansas, Texas, Louisiana,
New Mexico, and Oklahoma. By either of the two criterion i.e., two
of the four maxillary incisors or three of the four maxillary incisors,
the rate for 5-year-olds was significantly higher than for 3-year-olds;
27.9% vs. 18.5% and 19.2% vs. 11.1%, respectively. The data suggest
that BBTD has a greater association with residence than with ethnicity.
The prevalence among rural children was more than double that of
non rural children for every ethnic group except whites. Initially,
it was thought that the primary reason for this difference was access
to optimally fluoridated water supplies, since 68 percent of the
non rural children consumed optimally fluoridated water as compared
with 15 percent of the rural residents. Separate analyses for rural
and non rural residents revealed no significant differences in the
rates of BBTD exhibited by optimally fluoridated water drinkers
and their counterparts. Baby bottle tooth decay (BBTD) is a term applied to a specific
form of rampant decay associated with inappropriate bottle or breast
feeding of infants and young children. Although the prevalence of
BBTD has been studied in individual ethic groups, comparison studies
are rare. Head Start children have frequently served as study subjects
for assessing the prevalence of BBTD. The purpose of this study
was to compare BBTD and caries prevalence among Head Start children
who are members of four ethnic groups in five southwestern States.
Age, residence, and fluoridation status were also compared for the
total sample and ethnic categories. The sampling process was a stratified
random site selection; it was used to obtain data on 1230 children.
This number constituted 3 percent of the children enrolled in Head
Start in Public Health Service Region VI (Arkansas, Louisiana, New
Mexico, Oklahoma, and Texas) where the study was conducted. The
criterion for determining the presence of BBTD was based on the
number of carious deciduous maxillary incisors observed. The severity
of the condition was reported as two of four and three of four of
the target teeth affected. Thus, two levels of severity are reported.
BBTD was prevalent in approximately 24 percent and 15 percent of
the total sample, depending on the severity criterion used. Native
American children had a significantly higher (P<0.05) prevalence
than Hispanic, white, and black subjects. Rural children had significantly
higher (P<0.05) prevalence of BBTD than nonrural children for
all ethnic groups except whites. The prevalence of decayed and filled (df) surfaces of primary dentition was significantly greater for all rural than for nonrual groups (P<0.05). Children attending centers showed no significant differences based on fluoride status for the total sample or other variables. BBTD and caries prevalence increased with age. Studies are needed to identify predisposing factors among the ethnic groups and residence status in order for more effective preventive regimens to be developed, implemented, and evaluated. Study summary by M. Jones: Watson MR et al. Caries conditions among 2-5-year-old immigrant Latino children related to parents' oral health knowledge, opinions and practices. Community Dent Oral Epid; 27:8-15, 1999. Although few studies have documented the oral health of preschool
American children, there is increasing recognition that early childhood
caries (ECC) is a significant problem - especially among children
from low-income families. Also, there is evidence that children
with caries in the primary dentition are more likely to develop
caries in the permanent dentition. A community health program was
begun in Mount Pleasant, an inner city Latino neighborhood of Washington
DC, which has been fluoridated since 1952, and is characterized
for being populated by recent Central American immigrants. A total
of 142 children between 2 and 5 years of age were examined. The
mean age was 3.4 years. Although 75 (53%) of the children examined
were caries free, 67 children (46%) had untreated decay at the time
of the examination. 18% were in need of immediate care because of
pain or tooth infection. The finding of 47% of the children having
experienced dental caries in their primary teeth (ranging from 1
to 17 dft) does not differ greatly with other studies of low socioeconomic
status and racial ethnic groups (22-34). Objectives: To collect baseline data prior to initiating a community-based, oral health promotion program in an inner city Latino community in Washington DC, populated by Central American immigrants. Methods: In 1995, an oral survey of a convenience sample of children 2-5 years of age (n = 142) and a survey of the knowledge, opinions and practices (KOP) of their parents (n = 121) were completed. Clinical data of children were matched with parent respondents of the KOP survey. Data were analyzed for statistical associations using univariate odds ratios, Fisher's exact tests, and multiple logistic regression. Results: Only 53% of the children were caries free. Eighteen percent of all children were in need of immediate dental care and 26% were in need of early or non-urgent dental care. Only 7% of the parents knew the purpose of sealants and 52% knew the purpose of fluorides. Further, only 9% thought that brushing with toothpaste can prevent tooth decay. The strongest predictors of dental caries in this population, after adjusting for child's age and mother's education, were recency of mother's residence in the United States and report of an uncooperative child when attempting toothbrushing. Conclusions: Regimens of caries prevention have been successful in reducing dental decay for a large segment of the US population, yet this disease remains prevalent especially among low socioeconomic groups. The oral health status of the children and the oral health KOP of the parents in this community are disturbingly deficient. Study summary by M. Jones: Weinstein P et al. Mexican-American parents with children at risk for baby bottle tooth decay: Pilot study at a migrant farmworkers clinic. J Dent for Child; p 376-83, Sept-Oct, 1992. Subjects for this pilot study were 125 children, eight months (one
of the youngest reported of having BBTD) to forty-seven months.
Their parents/caretakers were farmworkers of Mexican descent, many
of them recent immigrants, who were enrolled in a program for migrant
families in the Yakima Valley of central Washington. Children were
classified to have BBTD if two or more anterior teeth were decayed.
Overall, 37 of the 125 children (29.6 percent) were found to have
BBTD. BBTD babies were older (33.0 months) than non-BBTD babies
(25.3 months) and it was noted that with the wide age range, some
younger children in the non-BBTD group will acquire BBTD as they
mature. Parents were asked 44 questions regarding demographics,
baby care, baby and parent characteristics, dental questions, and
compliance with a range of recommendations to "help the baby
keep his or her front teeth from becoming decayed and toothachy."
In answer to "baby has own brush and own toothpaste",
the BBTD parents report a much greater rate than non-BBTD parents,
77.85% and 62.9% vs. 48.8% and 42% respectively. Compliance in putting
fluoride drops in bottle once a day was identical between BBTD and
non-BBTD groups. Study summary by M. Jones: Tang JMW et al. Dental Caries Prevalence and Treatment Levels in Arizona Preschool Children. Public Health Reports; 112:319-29, 1997. Most published studies on dental caries in U.S. preschool children
have looked at 3 to 5-year-old children enrolled in Head Start,
a Federally funded preschool education and child development program
for low-income children and families. Although Head Start is mandated
to provide dental care for all enrolled children, in approximately
half of the 11 surveys of Head Start children, the percentage of
decayed surfaces or teeth was greater than 50%. In this study, 5171
Arizona preschool children ages 5 months through 4 years were examined
for dental caries between February 1994 and September 1995. The
children were recruited from four types of settings: Head Start
programs, WIC programs, health fairs, and private day care centers.
Ethnicity was categorized as Native American, black, Hispanic, and
white. Approximately 70% of children residing in the 32 survey communities
had access to public drinking water containing greater than 0.6
parts per million of fluoride. Seventy-two percent of caries in
one-year-olds and 53% in 2-year-olds was located in maxillary anterior
(upper front) teeth, a condition often referred to as "nursing
bottle caries." Of the 994 one-year-old children examined,
6.4% had caries, nearly 20% of the 2-year-olds had caries, 35% of
the 3-year-olds had caries, and 49% of the 4-year-olds had caries.
Only 42% of the Head Start children with caries had received any
treatment. For those children covered by Medicaid, primarily the
Head Start and WIC children, access to care is affected by low provider
participation. Reasons given are; low fees, excessive paperwork,
and frequently missed appointments by patients. Objectives: To assess the prevalence of dental caries in a large group of preschool children, to determine the extent to which the children received dental treatment, to examine the association between demographic and socioeconomic factors and the prevalence of caries, and to compare these findings with those from previous studies of preschool populations in the United States. Methods: Dental caries exams were performed on 5171 children ages 5 months through 4 years, and a parent or other caregiver was asked to complete a questionnaire giving information about the child and her or his household. The children were recruited from Head Start programs; Women, Infants, and Children (WIC) nutrition programs; health fairs; and day care centers in a representative sample of Arizona communities with populations of more than 1000 people. Results: Of the 994 one-year-old children examined, 6.4% had caries, with a mean dmft (decayed, missing [extracted due to caries], and filled teeth) score of 0.18. Nearly 20% of the 2-year-olds had caries, with a mean dmft of 0.70. Thirty-five percent of the 3-year-olds had caries, with a mean dmft of 1.35, and 49% of the 4-year-olds had caries, with a mean dmft of 2.36. Children whose caregivers fell into the lowest education category had a mean dmft score three times higher than those with caregivers in the highest education category. Children with caregivers in the lowest income category had a mean dmft score four times higher than those with caregivers in the highest category. Children younger than age 3 had little evidence of dental treatment, and most of the children with caries in each age group had no filled or extracted teeth. Conclusions: The data show that dental caries is high prevalent in this preschool population, with little of the disease being treated. Timing of diagnostic examinations and prevention strategies for preschool children need to be reconsidered, especially for children identified as having a high risk of caries. Study summary by M. Jones: Bruerd B et al. Preventing Baby Bottle Tooth Decay: Eight-Year Results. Public Health Reports; 111:63-65, 1996. BBTD is a preventable dental disease characterized by a unique
pattern of dental decay that affects the upper primary incisors
followed by the primary molars (1-8). Bottle-feeding past the age
of 12 months and/or bottles containing formula, milk, and juice
at nap or bedtime can result in BBTD. Cost estimates are $1000 to
$2000 per child and may be doubled if hospitalization is necessary.
In 1986, a program to prevent BBTD was implemented in 12 Head Start
centers in 10 states. In three years BBTD decreased from 57% to
43%. Funding was discontinued in 1990. An assessment of 1319, 3
to 5-year-old new cohorts in 1994 found that at the five sites where
both one-to-one counseling and educational activities had continued
without funding, BBTD prevalence was reduced by 38% over the entire
eight year period. At the five successful sites activities included
counseling during well-baby clinic visits, computerized mailings,
smile contests, health fair booths, TV and radio public service
announcements, posters, newspaper articles and parenting workshops. Baby Bottle Tooth decay (BBTD) is a preventable dental disease that affects more than 50% of American Indian/Alaska Native (AI/AN) children. A community-oriented program to prevent BBTD was implemented in 12 AI/AN communities in 1996. In 1989, the overall prevalence of BBTD for the 12 sites combined decreased from 57% to 43% which represented a 25% reduction (P<.001). Funding for the formal program was discontinued in 1990. In 1994, the Indian Health Service Dental Program and Head Start funded an assessment of the current prevalence of BBTD and the level of program implementation at the 12 original sites. This paper describes the findings. At the five sites where both one-to-one counseling and community-based educational activities had continued, BBTD prevalence was reduced by 38% (P<.001) over the eight-year period. Study summary by M. Jones: Johnsen DC et al. Background comparisons of pre-3 1/2-year old children with nursing caries in four practice settings. Pediatric Dentistry; 6:50-54, 1984. The caries pattern associated with excessive bottle feeding is
distinctive with minor variations. Maxillary (upper) primary incisors
are carious in all descriptions of this affliction; more than one
incisor (of the four) is involved. Maxillary and mandibular first
primary molars are frequently carious with the occlusal surface
most commonly affected. The lesions are first noticed by the parents
at about 20 months. This study sample was made up of 134 children
with carious incisors and 90 caries-free children. Children were
included in the incisor caries group if three incisors had carious
lesions. The study was conducted at four sites: Baton Rouge, Louisiana;
non fluoridated, middle and upper middle class patients, Akron,
Ohio; fluoridated, middle and upper middle class patients; Cleveland,
Ohio, fluoridated, lower middle-class and Medicaid patients predominate,
Morgantown, West Virginia; fluoridated, patients from a University
dental clinic. Data on supplemental fluoride use were available
on three of the four sites. 70% of caries-free and 29% of BBTD parents
reported fluoride supplement use in fluoridated Akron. 65% of caries-free
and 32% of BBTD reported supplement use in non-fluoridated Baton
Rouge. Nursing caries appears to cut across practice settings and
geographic boundaries. A definitive profile of the child with nursing
caries remains elusive - a single profile probably does not exist. Background information was compared for children with carious primary incisors versus caries-free children in different geographic and practice locations: private practices in Baton Rouge, Louisiana, and Akron, Ohio, and university-affiliated clinics in Cleveland, Ohio, and Morgantown, West Virginia. In several respects nursing caries cuts across geographic boundaries and practice settings. Data were similar among study sites for: family size, age of the child when lesions were first noticed, mother's optimism about her own dentition, awareness of cariogenicity from sleeping with the bottle, and getting the child to accept water in the bottle. Data in this study are interpreted to support the notion that nursing caries frequently is related to parental overindulgence or lack of control. Study summary by M. Jones: Von Burg MM et al. Baby Bottle Tooth Decay: A Concern for All Mothers. Pediatric Nursing; 21:515-519, 1995. (All three authors are currently members of the Indiana Healthy
Mothers, Healthy Babies, Oral Health Subcommittee.) The Children's
Defense Fund (1991) reports that only 10% of dentists accept patients
enrolled in Medicaid. During the infant's early childhood, usually
12 to 24 months, the maxillary incisors and molars are usually the
first teeth affected by BBTD. The surfaces affected are the smooth
facial and chewing surfaces. Damage is often severe enough to cause
the loss of the child's front teeth by two to three years of age,
several years before they will be replaced with permanent teeth.
Data from Head Start surveys show the prevalence of baby bottle
tooth decay is about three times the national average among poor
urban children, even in communities with a fluoridated water supply.
New and expectant mothers must learn how they can help prevent this
costly condition ($2-$3,000) at relatively little or no cost. In
Indiana, the Oral Health Subcommittee provided Indiana hospitals
with a video tape and a brochure showing pictures of children with
the condition. (Note: Indiana is 98.6% fluoridated.) In 1990, the
Center for Disease Control began promoting the prevention of baby
bottle tooth decay as a nation- wide goal. Study summary by M. Jones: O'Sullivan DM et al. Dental Caries Prevalence and Treatment among Navajo Preschool Children. J Public Health Dent; 54:139-44, 1994. Data were analyzed for 2,003 Navajo children age three to five
years. All children were participants in Head Start programs from
more than 100 centers located in Arizona and New Mexico. Data were
also analyzed for 115 Navajo WIC (Women, Infants and Children program)
children who were younger than three years of age. The mean dmfs
in children <two years was 0.5; two-year-olds, 3.9; three-year-olds,
10.7; four-year-olds, 15.3; and five-year-olds, 18.9 (6.6 dmft),
a score among the highest contemporary dmfs means reported in the
world for this age group. Remarkably, about 70% of the dmfs in this
group comprise treated surfaces. Caries were categorized into three
disease patterns: 'maxillary anterior' pattern known as bottle or
nursing caries; 'fissure' pattern included all occlusal fissures,
buccal pits, and lingual grooves of the molars; and 'posterior proximal'
pattern of contacting surfaces between teeth. Prevalence of bottle/nursing
caries was 11% in <2-year-olds, 36% in two-year olds, 68% in
three-year-olds, 64% in four-year-olds, and 62% in five-year-olds.
Although the prevalence of bottle caries is high, the severity is
relatively low. Nearly 75 % of children with the proximal pattern
have the bottle caries pattern. This suggests that preventing the
development of bottle caries may significantly reduce 'between teeth'
caries. Fissure pattern caries was consistently greater than 'between-teeth
' caries, reaching 87% in the five-year-olds. (Note: The 1992 Fluoridation
Census shows Arizona as having three Indian schools and 109 Indian
water systems fluoridated: 67 adjusted and 42 natural, for a fluoridated
Indian population of 92,000. New Mexico shows eight Indian schools
and 76 Indian water systems fluoridated: 46 adjusted and 30 natural,
for a fluoridated Indian population of nearly 68,000.) Objectives: The purpose of this study was to assess the dental health of Navajo preschool children, a population about whom little dental information is published. Methods: Caries data were collected and analyzed for 2,003 Navajo children aged 3-5 years in the Head Start program, and for a convenience sample of 115 children younger than three years old from the Women, Infants and Children (WIC) program. Results: Each age group had an extremely high mean dmfs; however, as much as 70 percent of this index comprised treated surfaces. Maxillary anterior caries was observed in the WIC children under two years of age and posterior proximal caries was observed as early as two years of age. The prevalence of maxillary anterior caries reached a maximum of 68 percent in the three-year-old Head Start children, and may be associated with the high level of posterior caries in this population. Conclusions: Most children in this population may be considered at risk for developing caries. This Navajo preschool population has perhaps the earliest caries onset, among the highest caries prevalence, and among the highest level of treatment of any reported population. Study summary by M. Jones: Febres C et al. Parental awareness, habits, and social factors and their relationship to baby bottle tooth decay. Pediatric Dentistry; 19: 22-27, 1997. This study investigated the relationship between various social
and behavioral factors and the incidence of BBTD. The study group
of 100 children was selected from patients seeking care at the pediatric
dental clinic at Houston Medical Center, University of Texas. (Note:
Houston was fluoridated in 1982.) Children were between ages 12
and 42 months. Classification of BBTD was based on two or more maxillary
anterior teeth exhibiting caries. Racial composition was: Hispanic
43, Black 44, White 9, and Other 3. Of the 19 children found to
have BBTD: Hispanic 13, Black 3, and White 1. Of the 81 patients
without BBTD, 60 were weaned from the bottle between 12 and 14 months.
Dental health education in the Houston Hispanic population may not
be received early enough to prevent children from developing BBTD. The general objective of this study was to investigate the relationship between parental awareness, habits, and social factors in a particular parent population and the occurrence of baby bottle tooth decay (BBTD) in their children. The sample consisted of Hispanic, Black, and White families and included 100 parents with 100 children from the Pediatric Clinic and the Pediatric Dentistry Clinic at Houston Medical Center, University of Texas, Houston. Questionnaires including information related to demographic data, educational level, marital status, baby care, and knowledge and beliefs about BBTD were completed by the parents. Each child was examined with mouth mirror and tongue blade to determine the presence of BBTD. Overall, 19 of the children were found to have BBTD. The racial distribution of the children with and without BBTD was statistically significant (P = 0.03) with the Hispanic population being over-represented in the BBTD group (72.2% versus 37.0%) and Blacks under-represented (16.2% versus 50.6%). The ages at which babies with BBTD were weaned from the bottle were significantly (P < 0.001) higher than those with no BBTD, and those weaned after 14 months of age were more likely to have BBTD. The percentage of babies with BBTD weaned from the bottle after 14 months old was higher (36.8%) than babies without the condition (26.5%). Awareness of BBTD was generally lower among parents of the BBTD children than parents of children without BBTD, as reflected by the feeding patterns of their children and their responses to questions dealing with their knowledge of BBTD. (Pediatr Dent 19:22-27, 1997) Study summary by M. Jones: Blen M et al. Dental caries in children under age three attending a university clinic. Pediatric Dentistry; 21:4, 1999. The purpose of this retrospective study was to determine the rates
of dental caries and assess the restorative needs of children under
three years of age. Clinical charts of 369 children, aged 8-36 months,
who attended the University of Texas-Houston Health Science Center
dental clinic between 1993 and 1997 were used for the study. ( Note:
Houston was fluoridated in 1982.) Because of reported weekly fluctuation
of fluoride content of the water, fluoride supplements were recommended
as needed. The study population included African Americans (51%)
and Hispanics (34%), with a majority (92%) receiving dental benefits
through the state Medicaid program. 24% of the children has severe
decay (greater than three decayed teeth), 4% had moderate decay
(two or three teeth decayed) and 4% had mild (one decayed tooth).
56% of the children between 24-36 months had decay. Among the three-year-olds
with caries, 46% had more than three decayed teeth. There was a
statistically significant association between dental caries and
the age the child was weaned from the bottle. The average age of
the study population was 20 months and only one-half of the children
had been weaned from the bottle. The children without any dental
caries were weaned from the bottle at an average age of 10 months.
The children with severe dental caries were weaned at 16.9 months.
Of the 109 children who needed restorative treatment, 20% were treated
in the hospital operating room. Purpose: The aim of study was to determine the rates of dental caries and assess the restorative needs of children under three years of age attending an urban university clinic from 1993-1997. Methods: In this retrospective study, data were abstracted from patient records and included demographic information, caries experience, and restorative needs. Results: Gender distribution of the sample included 55% males and 45% females. The study population was predominantly African-American (51%) and Hispanic (34%), with a mean age of 20 months. A majority of the population had dental benefits through Medicaid (92%). Nearly one-third of the study population and as many as 56% of the children between 24 and 36 months had dental caries. Among those off the bottle (50%), children with severe dental caries had been weaned off the bottle at a significantly older age compared to those without any caries (16.9 vs. 10 months, P = 0.000). Conclusion: This study provides further validity to the early oral health exam and early dental treatment, not only for preventive measures but also for restorative needs. The relatively high prevalence of early childhood caries could have been prevented by appropriate primary preventive strategies. (Pediatr Dent 21: 262-265, 1999) Study summary by M. Jones: Tsubouchi J et al. A study of dental caries and risk factors among Native American infants. Journal of Dentistry for Children; 283-87, July-August 1995. Baby Bottle Tooth Decay (BBTD) is one of the most severe dental
problems in children, characterized by a distinctive rampant caries
pattern in the primary dentition, in which maxillary incisors and
frequently the maxillary and mandibular molars are affected. The
average cost of treating BBTD patients, using general anesthesia,
was $2140. The purpose of this study was to establish the prevalence
of caries among Native American infants and to identify risk factors
contributing to this disease. The subjects were 77 infants, twelve
to thirty-six months of age, and their parents/caregiver, who participated
in a Women Infant Children (WIC) program in Marysville, Washington.
The local water is not fluoridated. Less than 10 percent used fluoride
supplements and over 80 percent used fluoride toothpastes. The average
age of the children was 23.6 months and almost 50 percent continue
to use the nursing bottle. In the comparisons between children with
caries and those without caries, children using the bottle now were
significantly associated with having caries (63.9 percent vs. 29.3
percent). 55.6 percent in the 24-36 month group had caries experience.
We believe culturally appropriate preventive and early screening
efforts targeted and tailored to American Indian caregivers are
needed in order to reduce caries rates in these high risk populations. Study summary by M. Jones: Kong D. City to launch battle against dental 'crisis'. Boston Globe, Nov. 27, 1999. While Boston's water supply has contained fluoride since 1978, Boston officials say their current dental crisis reflects gaps in insurance coverage and access to dental-care providers. Public Health officials cited a complicated mix of people who are uninsured, people who are underinsured, a lack of providers willing to serve people on Medicaid, and inadequate reimbursement for health care providers. 18% of children 4 years old and younger seen in the pediatric program at Tufts University School of Dental Medicine in 1995 had baby-bottle tooth decay. Treatment can cost up to $4,000 per child. About 90% of 107 Boston high school students needed dental treatment. An unpublished 1996 study reported that the city's students had four times more untreated cavities than the national average. Of 88 elementary school students, 44% had obvious tooth decay and 11% had gum disease. Many of these children had Medicaid coverage but were likely unable to find a provider who would take the insurance. Recently a dental clinic that served 3,000 patients a year closed as a result of too-low insurance reimbursement rates. (Read article) |
Fluoride Action Network | 802-338-5577 | info@fluoridealert.org |