Wendt, L. K., Hallonsten, A. L., Koch, G. and Birkhed, D.. Oral hygiene in relation to caries development and immigrant status in infants and toddlers. Scandinavian Journal of Dental Research. 1994:102;269-73.

Cohort Study

+

1 yr olds caries-free = 629 ; 2 year olds caries free = 298 ; 3 year olds caries free = 270

Pre-school children; community-based; Immigrant status = (a) Swed, i.e. at least one parent born in Sweden and (b) Immi, i.e. both parents born outside Sweden. Caries-free at 1 year of age.

Presence of caries + oral health habits

Presence or absence of dental caries, gingivitis and visible plaque.

3 years

Presence or absence of dental caries

Visible plaque at 1 year of age: 29% carious lesions by 2 years, + 54% carious lesions by 3 years.

General comments: Potential confounding factors not addressed, i.e. gender + heterogeneity of different ethnic groups. Not enough evidence to support a recommendation on its own.

Verrips, G. H., Kalsbeek, H., Van Woerkum, C. M., Koelen, M. and Kok-Weimar, T. L.. Correlates of toothbrushing in preschool children by their parents in four ethnic groups in The Netherlands. Community Dental Health. 1994:11;233-9.

Survey

+

614 children examined

476 parents interviewed

4 different ethnic groups / Selection by district and ethnic group / Community based

Questionnaire on parental attitudes/beliefs regarding toothbrushing - as predictors of caries risk

Risk factors for dental caries

1. Age at start of brushing as a risk factor: 29% of diff. In scores between Turkish grp. and Dutch and Surinamese (reference group) could be attributed to the role of all potential correlates, i.e. parental habits, attitudes, beliefs etc.

2. Frequency of brushing : Relatively strong relationship between freq. and attitudes and habits (i.e. 54% of difference attributed to these correlates.

General comments: Selection bias due to 67% of Moroccan respondents being illiterate. No details of how well terminology was explained, e.g. caries, molars etc. Possible recall bias. Importance of health education in advocating frequency of brushing more than once daily + commencement of brushing before 2 yrs. of age.

Sjogren, K., Birkhed, D. and Rangmar, B.. Effect of a modified toothpaste technique on approximal caries in preschool children. Caries Research. 1995:29;435-41.

RCT

++

Baseline = 369 Test groups x 2 = 131 Control groups x 2 = 150

4 to 7 year olds attending clinic

Instruction on use of F-paste with brushing technique

Between treatments + between treatment and control. Baseline and final radiographs

3 years

DMF(S)/ dmf(s)/ salivary F concentration/ + behavioural factors via questionnaire

Total mean dfs (Baseline and at end): Test Groups = 1.5 ; Control groups = 2.01) p<0.05. 2. Caries increment (new dfs) Test = 1.14/ Control = 1.55 p<0.05 3.Salivary fl. Concentration - mean = 1.8 times higher in test group than control group (p<0.01) + AUC value = 1.9 times higher (p<0.001)

Government. Toothpaste/brush manufacturers

General comments: Good ev for brushing with fluoride toothpaste (mechanical action) & importance of decreased use of rinsing water after brushing

Raitio, M., Mottonen, M. and Uhari, M.. Toothbrushing and the occurrence of salivary mutans streptococci children at day care centers. Caries Research. 1995:29;280-4.

RCT

++

Baseline 506; Follow-up 358 ; Took part in both examinations 345.

Age : 1-8 yrs Community-based : Municipal day care centres in Oulu, Finland

Mutans Strep. Tests + reported dental health habits

Before and after intervention + intervention (toothbrushing group) vs. control (no brushing) group

8 months

Positive MS tests. Diff. In dmf values between those with MS and those without.

RR for irregular brushing = 2.1; p<0.001 - MS counts for irregular brushers 64.9% vs 46.4% for regular brushers.

not stated

Assoc. of risk factors with occurrence of MS

MS increased with sweet consumption (p<0.01). MS reduced by fluoride tablets (p<0.02) MS count and older age (p<0.01) / Positive MS test and female sex associated (p<0.05).

not stated

General comments: Toothbrushing at day-care centres does not influence salivary MS counts. Incidental finding : Children who brushed irregularly at home had more risk of positive MS test than those brushing teeth daily at home. (MS considered to be most important bacteria involved in dental decay process).

Holtta, P. and Alaluusua, S.. Effect of supervised use of a fluoride toothpaste on caries incidence in pre-school children. International Journal of Paediatric Dentistry. 1992:2;145-9.

RCT

+

Test group = 87 ; Control group = 87

Community-based (2 nursery schools). Children aged 3-6 yrs from same residential area of average income families. All children receiving regular dental care at Dept. Pedodontics and Orthodontics, Uni. Of Helsinki.

Supervised use of fluoride toothpaste once a day in nursery school

Daily brushing with fluoride toothpaste vs. brushing with no toothpaste in low-caries population

Mean follow-up = 1.4 yrs

Difference in dfs + DFS (mean caries increments) between test and controls.

Mean dfs+DFS - 1.3 (test group) & 2.0 (control) (NS)

Number of new carious surfaces

No. of new carious surfaces - 13 children in test group & 25 in control group (p<0.05)

Number of caries-free children

Stat. significant diff. between test and control groups (X2 =4.55, p<0.05)

General comments: Even in low-caries groups, supervised brushing with fluoride toothpaste >1000ppmF offers benefits & increases no. of caries-free children. Some caution should be exercised in interpreting results of this study due to study design issues but it appears to support the argument for the use of fl. toothpaste in the prevention of dental caries.

Davies, G. M., Worthington, H. V., Ellwood, R. P., Bentley, E. M., Blinkhorn, A. S., Taylor, G. O. and Davies, R. M.. A randomised controlled trial of the effectiveness of providing free fluoride toothpaste from the age of 12 months on reducing caries in 5 4-year old children. Community Dental Health. 2002:19;131-6.

RCT

++

3731

All age 12 months at commencement/ all aged 5-6 yrs at primary school at clinical examination/ all from areas with high levels of dental caries. Community-based

Provision of free fluoride paste from age 12 mnths to 5.6 yrs.

Effectiveness of two concentrations of fluoride paste (440ppmF and 1450ppmF) + comparison between treatment and placebo

5 year follow-up

Dmft index

1450ppmF confers a 16% reduction in mean dmft compared with control (p<0.05). NS difference in mean dmft between 440ppmF group and controls.

Grant from former North Western RHA. 2 authors employed by Colgate-Palmolive

Prevalence of caries

Prevalence = 50% in 1450ppm group vs. 58% in 440ppm group and control group.

General comments: High drop out rate (7422 recruited). Importance of fluoride dose when recommending use of fluoride toothpaste.

Chestnutt, I. G., Schafer, F., Jacobson, A. P. and Stephen, K. W.. The influence of toothbrushing frequency and post-brushing rinsing on caries experience in a caries clinical trial. Community Dentistry & Oral Epidemiology. 1998:26;406-11.

Survey

2621 (No explanation of why 2621 in this study but 4294 in the 3 year trial).

Scottish adolescents (aged 11-12 yrs at outset). 54% male. Participants from non-affluent backgrounds. Setting : Area of generally high deprivation

Use of fluoride dentifrice containing either 1000 or 1500 ppm fluoride

Frequency of toothbrushing + method of post-brushing rinsing. (No comparison between different fluoride concentrations of toothpaste.)

3 years

Caries experience and caries increment, i.e. DMFS values. (+ data collection on oral health habits via questionnaire and interview of subjects at examination)

Association between caries experience and claimed brushing frequency at baseline : DMFS values of 9.66 (Group1), 8.12 (Group 2), 7.36 (Group 3) p<0.001.

Not stated but one author supported by Unilever Dental Research

Caries experience and caries increment, i.e. DMFS values. (+ data collection on oral health habits via questionnaire and interview of subjects at examination)

Assoc. between caries increment and brushing frequency (p<0.01)

Influence of post-brushing rinsing method (i.e. beaker vs. no beaker).

Caries increment with beaker 6.84 ; caries increment without beaker 5.84 (p<0.05).

General comments: Provides evidence of importance of frequency of brushing but study flawed as a result of being based on reported frequency by participants, i.e. could be misreported causing bias.