Impact of a caries preventive intervention in remote Indigenous Australian children

Abstract

IMPORTANCE: The burden of dental caries in remote Indigenous communities in Australia is unacceptably high. OBJECTIVES: We tested the impact of an annual caries preventive intervention, delivered by a fly-in/fly-out professional team, on Indigenous children residing in a remote Australian community, involving selective fissure sealants, topical povidone iodine and fluoride varnish application. The outcome was caries increment at 12- and 24-month follow-up. DESIGN, SETTING, PARTICIPANTS: Around 600 Indigenous children aged 5 to 17 years were invited to participate at baseline, of which 408 had caregiver consent provided. Of these, 196 consented to both the study and the treatment arm and comprised the experimental group. Two hundred and twelve consented to the epidemiological examination only, and constituted the comparison group. INTERVENTION: The Big Bang intervention, which occurred annually, comprised placement of fissure sealants, and application of povidone-iodine and fluoride varnish, following completion of each childs dental treatment plan. Standard diet and oral hygiene advice was provided. MAIN OUTCOMES AND MEASURES: Caries increment (number of tooth surfaces with new dental caries) in both primary and permanent dentitions at 12- and 24-month follow-up. RESULTS: At 12-month follow-up, children in the experimental group had, on average, 5.05 (5.47) new carious lesions compared to 7.49 (6.94) in the comparison group (p=0.001). The preventive fraction was 33%. At 24-month follow-up, children in the experimental group had, on average, 6.47 (6.07) new carious lesions compared to 8.43 (5.83) in the comparison group (p=0.002). The preventive fraction was 23%. CONCLUSIONS AND RELEVANCE: Indigenous children exposed to the Big Bang caries intervention had significantly less increment in dental disease than those not exposed to the intervention. Benefits were demonstrated at both 12- and 24-month follow-ups, suggesting that the intervention is likely to be sustained if delivered across a childs life. The cost-effectiveness of this approach is being evaluated.

Predicting Dental Caries Increment Using Salivary Biomarkers in a Remote Indigenous Australian Child Population

“…This is consistent with our baseline study where caries experience was approximately twice in those with higher counts of salivary MS than those with lower counts [33], demonstrating that simple chair side assessment of microbial loads would assist in determining the risk for future caries. Furthermore, preventive interventions to reduce the bacterial loads were found to be equally effective in this community [34] and advanced investigations suggested that this could be due to a reduction of oral microbial diversity as a result of improved oral health of the children [23].…”