Caries in children results in major health, financial and social burdens to the community. In the low socioeconomic district of Logan-Beaudesert, 6 year old children have a mean decayed, missing, filled, teeth (dmft) index of 4.9, two and a half times that of Australian’s average. This thesis aims at evaluating different caries prevention strategies targeted at children in a low socio-economic, high caries risk community.
The first study in this thesis assessed the effectiveness of home visits and telephone contacts in preventing early childhood caries in 5 year old children. The study was a 5 year follow-up examination of a randomised birth cohort who received home visits or telephone contacts at the ages of 6, 12, 18, 30 and 42 months and examined at the community dental clinic at 2, 3 and 4 years. In addition to daily brushing with toothpaste (0.304% sodium monofluorphosphate), the children were randomly assigned to use either chlorhexidine gel (0.2%), casein phosphoprotein amorphous calcium phosphate cream (CPP-ACP10%) or toothpaste only. A matched control group of 5 year old children from the same community dental clinic was used as comparison. The results found that the home visit and telephone contact groups had a lower dmft score of 1.47 and 1.45 respectively when compared to the control children (dmft of 3.76). The chlorhexidine gel and CPP-ACP cream did not provide any additional benefits.
The second study of this thesis assessed the cost-effectiveness of home visits and telephone contact interventions aimed at preventing early childhood caries. A Markov statistics model was used to assess the costs, quality adjusted life years gained and number of caries prevented in children. The results of this study found that for every group of 100 children, home visits and telephone contacts would save the public health system AUD 258,000 and AUD 224,000 respectively over 5.5 years when compared to no intervention.
The third study of this thesis evaluated the effects of water fluoridation on the caries experience of 4-9 year-old children living in the Logan-Beaudesert community using clinical and bitewing radiographic data. Water fluoridation was introduced to the district in December 2008. The clinical and radiographic data of 201 pre-fluoridation children (mean age 6.95 ± 1.05 years) and 256 post-fluoridation children (mean age 7.19 ± 1.23 years) who attended routine visits to the Logan-Beaudesert public oral health program were selected and assessed for caries. The dental records of children with no exposure to water fluoridation (1998 to 2008) was compared to children who experienced at least 24 months of water fluoridation (January 2011). The post-fluoridation children exhibited a significant decrease of 0.88 (19%) in the mean dmft when compared to the pre-fluoridation children. The caries prevalence in children before water fluoridation was 87 percent, which decreased to 75 percent in the post-fluoridation children.
The results of the studies from this thesis lead to several recommendations for preventing caries in a high-risk low socioeconomic community. Home visits and telephone contact interventions aimed at improving oral hygiene and motivation should be provided to high-risk children as a cost-effective measure to reduce caries experience. The water fluoridation program should have increased support in low socioeconomic communities as a method for reducing caries experience and prevalence.