Using chlorhexidine varnish to prevent early childhood caries in American Indian children

Abstract

Objectives: To test the efficacy of 10% chlorhexidine (CHX) dental varnish applied to the mothers' dentition in preventing caries in American Indian children. Methods: This was a placebo‐controlled, double‐blind, randomized clinical trial. Mother–child pairs were enrolled when the child was 4.5‐6.0 months. Mothers received 4 weekly applications of the study treatment (CHX or placebo) followed by single applications when her child was age 12 and 18 months. Children received caries examinations at enrollment, 12, 18 and 24 months. Analyses were limited to the intent‐to‐treat (ITT) group: children whose mothers received the first study treatment and who received at least one post‐baseline exam. The outcome variable was the number of new carious surfaces (NNCS) at the child's last visit. Wilcoxon nonparametric and Fisher's exact tests were used to test differences between the active and placebo groups. Results: We randomized 414 mother–child pairs, with 367 (88.6%) included in the ITT group (active = 188, placebo = 179). The proportion of children caries‐free at their final exam was 51.1% and 50.8% for the active and placebo groups (P > 0.99). The mean NNCS for the active and placebo groups was 3.82 (standard deviation [SD] = 8.18) and 3.80 (SD = 6.08), respectively (P = 0.54). The proportion with NNCS > 6 was 18.1% for active children versus 27.9% for placebo (relative risk [RR] = 0.65, P = 0.03). The number needed to treat to shift one child from NNCS > 6 to a lower severity was 10.2. Conclusions: In this population CHX varnish did not reduce the mean NNCS or proportion of children with caries, but did reduce the proportion with severe caries.

Prevalence and risk factors of caregiver reported Severe Early Childhood Caries in Manitoba First Nations children: results from the RHS Phase 2 (2008–2010)

“…Community-based initiatives that rely on community development principles are appropriate (11,12,50). While some clinical trials involving Indigenous children have used chemotherapeutic agents to prevent or arrest caries, they alone do not appear to be the silver bullet (2,51). Rather, multi-pronged approaches that also address determinants of health may offer hope (4).…”

“…Potential strategies to consider include motivational interviewing, improving access to early visits, access to fluoridated water and nutritious food choices, along with antimicrobials and applying remineralizing agents to existing caries lesions (4,11,36,47,52). Regardless, we need to find an appropriate metric, like monitoring the volume of children requiring dental surgery, to measure the success of such interventions for these children (2). …”

“…Indigenous children around the globe are disproportionately affected by ECC and a more aggressive form of the disease, termed Severe Early Childhood Caries (S-ECC). The prevalence of caries is high among American Indian and Alaska Natives (AIAN), Australian Aboriginals and the Maori (2–6). This reality also exists in Canada where the prevalence of caries in Aboriginal children is staggering (7–12).…”

Reducing Alaska Native paediatric oral health disparities: a systematic review of oral health interventions and a case study on multilevel strategies to reduce sugar-sweetened beverage intake

“…While a number of studies focus on the oral health of American Indian children in the continental US (26, 27), there are fewer observational studies and no randomised clinical trials on Alaska Native children. There are 3 possible reasons.…”

A novel staging system for caries severity in the primary dentition

“…CIPD is the quintessential age‐dependent disease: children are not born with carious teeth, nor are the teeth carious at eruption. Yet in the highest risk children, caries often begins within two years after birth progresses inexorably in severity into cavitation in multiple surfaces and teeth , and continues until affected teeth receive restorations or are extracted. In addition, longitudinal studies have shown that CIPD is also a risk factor for caries in the permanent teeth .…”