Community-based assessment and intervention for early childhood caries in rural El Salvador

Abstract

Objective: The objectives were to assess early childhood caries (ECC) in rural areas of El Salvador and to investigate the changes in caries and mouth pain in the presence of community-based interventions. Methods: This study was a retrospective analysis of de-identified and anonymous data obtained from baseline and four annual follow-up visits that focused on the preventive oral health intervention and nutrition in a convenience sample of children 0-6 years of age. The decayed, missing and filled teeth (dmft) index for primary teeth was used as the survey tool. Caries was defined as a cavitated lesion. Descriptive statistics were used to describe the prevalence of ECC in the sample in relation to age and dmft score. Linear mixed model analysis of variance (ANOVA) and generalised linear mixed effects models were used to compare the pre-intervention and post-intervention outcomes. Results: The prevalence of caries was 58%. Incorporation of a community oral health education and fluoride supplementation programme contributed to significant reductions in caries experience (from 74% to 61%) and mouth pain (from 58% to 39%), in children 3-6 years of age. Conclusions: ECC is a common public health problem in rural El Salvador. In an established community-based maternal-child health programme in El Salvador, there appears to be an association between the incorporation of preventive oral health intervention and improvement in children's oral health and quality of life over time.

Effectiveness of fluoride varnish in preventing early childhood caries in rural areas without access to fluoridated drinking water: A randomized control trial

“…Importantly, this research was conducted in a caries‐vulnerable population due to its rural location, low socioeconomic status, difficulty accessing dental care and lack of fluoridated water. As such, 53% of our initial sample was excluded due to the presence of cavitated caries lesions; this rate of caries rate is high but consistent with previous studies conducted on populations with similar sociodemographic characteristics . Furthermore, although we included only children without caries, more than half of the population developed caries during the 48‐month follow‐up period.…”

“…As such, 53% of our initial sample was excluded due to the presence of F I G U R E 1 Flow diagram from baseline to the 24-month follow-up assessment cavitated caries lesions; this rate of caries rate is high but consistent with previous studies conducted on populations with similar sociodemographic characteristics. 2,4,18,19 Furthermore, although we included only children without caries, more than half of the population developed caries during the 48-month follow-up period.…”

Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective

“…Community programmes for managing ECC generally target high‐risk, low socioeconomic, disadvantaged communities using established caries prevention methods. Programmes that are culturally competent with community‐based participation and alignment with community cultures have been successful in reducing ECC in indigenous, low‐income, and migrant communities worldwide . Similarly, personal approaches such as home visiting and telephone contacts can reduce ECC by increasing caregivers’ health literacy and self‐efficacy to change behaviours to improve their infants’ oral health .…”

“…Programmes that are culturally competent with community-based participation and alignment with community cultures have been successful in reducing ECC in indigenous, low-income, and migrant communities worldwide. [44][45][46][47] Similarly, personal approaches such as home visiting and telephone contacts can reduce ECC by increasing caregivers' health literacy and self-efficacy to change behaviours to improve their infants' oral health. [48][49][50] Knowledge increases, however, may not improve oral health behaviours or reduce caries increment.…”

A Qualitative Study of Child Nutrition and Oral Health in El Salvador

“…In addition, El Salvador has experienced a drastic increase in child obesity, with the prevalence of overweight children below the age of five rising by 50% over the past decade [12]. Latin American countries, including El Salvador, have a high rate of early childhood caries or tooth decay—affecting over 50% of young children—which can cause chronic infection, inflammation, and mouth pain, and further contribute to malnutrition, poor development and school performance, and reduced quality of life [13,14].…”