Caries Prevention in High-risk Preschool Children in the United States

Dental caries is a common infectious disease affecting young children living in low-income families in the United States. Efficacious, safe, feasible and cost-effective caries prevention methods for these children are essential. Several studies have shown the efficacy of fluoride varnish and xylitol to improve the oral health of children. The efficiency of caries prevention programs including the use of fluoride varnish or xylitol chewing gum in early childhood has not been well documented in communities with private dental services. The purpose of this study was to determine the caries prevalence and distribution in the primary dentition, and to evaluate the effectiveness of two prevention programs, including applications of fluoride varnish and the use of xylitol chewing gum in randomized groups of preschool children attending Head Start school programs in Northern Florida. The caries preventive effect of fluoride varnish in the primary dentition was evaluated in a sample of 4–6 year-old Head Start schoolchildren in Alachua, Florida (n = 142). Caries progression after nine months was analyzed using dmf(s/t) and ds values. A modified caries scoring system, which differentiates between active and inactive carious lesions, was used to evaluate the effect of fluoride on early noncavitated enamel lesions. The effect of xylitol gum was evaluated by measuring the levels of salivary mutans streptococci before and after a three week chewing period in 3–5 year-old children attending the Head Start school in Starke, Florida (n = 61). This study is in line with earlier reports that caries prevalence is high in Head Start preschool children. This study showed that active noncavitated enamel lesions were common in the primary dentition and that applications of fluoride varnish may offer an effective means of arresting these early enamel lesions. Chewing the xylitol gum reduced the levels of salivary mutans streptococci, thereby possibly reducing the risk for dental caries in these children. While the detection and monitoring of early enamel lesions is critical in determining effectiveness of prevention therapy, this study suggests that fluoride varnish applications may offer an efficient, non-surgical treatment for decay in children. Also, the prevention program with xylitol may provide an additional method to be used in situations where other prevention methods are difficult to implement.