Objectives: Early childhood caries (ECC) constitutes a serious public health issue, especially in communities without water fluoridation. We assessed the effectiveness of biannual fluoride varnish applications to prevent ECC in children from nonfluoridated rural areas.Methods: A triple-blind randomized control trial with two parallel arms was conducted with 275 two-to three-year-old children without cavitated carious lesions from 28 rural public preschools in Chile. The preschools were located in areas of low socioeconomic status without access to fluoridated water. An oral health education component was administered to children, parents and educators. A new toothbrush and toothpaste for each child was delivered to the parents at baseline and at four follow-up visits. The participants were randomly allocated to receive fluoride varnish or placebo applications every six months. Trained, calibrated dentists blind to the treatment arm performed visual dental assessments at 6, 12, 18 and 24 months. The primary endpoint was the development of cavitated carious lesions in children during the 24-month follow-up period using WHO criteria, and the secondary outcomes were an increase in caries measured as a change in the index of decayed, missing or filled teeth (dmft) since the beginning of the study and the development of adverse effects. An intention-to-treat (ITT) approach was used for the primary analysis.Results: We included 131 participants in the intervention group and 144 participants in the placebo group; of these children, 89 (67.9%) in the intervention group and 100 (69.4%) in the control group completed the protocol. The comparative ITT analysis of caries incidence after 24 months of follow-up showed a between-group prevention fraction of 18.9% (À2.9%-36.2%). Caries incidence was 45.0% for the experiment group and 55.6% for the control group (P = .081), with a mean dmft of 1.6 (SD = 2.4) and 2.1 (SD = 2.5), respectively. No adverse effects were reported. Conclusions:In conclusion, biannual fluoride varnish application is not effective in preschool children from rural nonfluoridated communities at a high risk of caries. K E Y W O R D Searly childhood caries, fluoride varnish, preschool children, randomized controlled trial

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Introduction: Early Childhood Caries (ECC) is a serious public health concern worldwide, especially in communities without water fluoridation. Objective:To determine the prevalence of ECC in 2 and 3 year old children attending rural daycare centers without access to water fluoridation. Methods: A cross-sectional study at community level was performed during 2012. The eligible population was composed of 2 and 3 year-old children from rural daycare centers located in nonfluoridated areas in regions La Araucanía, Los Ríos, and Los Lagos, Chile. Four calibrated examiners (ICC=0.83) measured the prevalence of dental caries based on criteria proposed by the WHO. Data were analyzed using chi-square test, t-test and logistic regression models. Results: The study sample consisted of 587 children; two-year-olds accounted for 53.32%, and 52.47% were female. Prevalence of ECC was 51.62% with a mean dmft index of 2.53. Region de la Araucanía had the highest ECC prevalence (52.79%). Variables that showed association were age, OHI-S and type of health insurance coverage (p<0.05). Conclusion: A high prevalence of ECC was found in areas with a non-fluoridated water supply.

Chile is a country where the geography and territorial distribution of the population make healthcare a constant challenge. Despite a reported improvement on oral health indicators, some levels of inequality are still noted in terms of access to healthcare services. In this context, teledentistry has been considered an effective tool to respond to the population's healthcare needs. The aim of this paper is to present the current state of teledentistry in Chile. This paper describes the initiatives and programmes of teledentistry developed in Chile, the ethical and legal aspects, financing sources and pending challenges for its consolidation. It is expected that teledentistry will contribute toward an increase in coverage and access to specialists, improve the appropriateness of referrals and reduce costs of specialist care.