Evaluation einer zahnmedizinischen Intensivprophylaxebei 12-jährigen mit erhöhtem Kariesrisiko

The polarization of caries experience in specific social groups makes it necessary to develop preventive strategies for socially deprived children. More than 10 years ago an intensified preventive programme was introduced in Marburg-Biedenkopf county. The programme includes health education, tooth-brushing instructions and fluoride varnish applications four times per year. The aim of this study was to evaluate the effect of the intensified preventive programme on the oral health of 12-year-olds. Furthermore, the International Caries Detection and Assessment System (ICDAS II) was verified in the course of this study. Patients and Methods: A cohort study design was chosen. The intervention group consisted of children attending 3 schools in socially deprived areas in the county of Marburg-Biedenkopf who had participated in the preventive programme for 6 years. Control group subjects were recruited from 34 schools in socially deprived areas in the county of Osnabrück. These 6th grade children only received conventional oral health instructions without topical fluoridation. The dental and psychometric examinations(including parent- and child questionnaires) were performed during the school year 2007/2008. Dental caries was recorded according to ICDAS II using a mirror and a ballended probe. The influencing variables nutrition, start and frequency of tooth-brushing, use of fluoride supplements, application of fluoride varnish or solutions and fissure sealants in the dental office, knowledge of dental health, socio economic status (SES) and ethnicity were analyzed regarding their effect on caries experience. Bivariate and multivariate analyses were performed. The D3-6MF-T-Index served as outcome variable. In order to compare oral health parameters (D3-6MF-T, D5,6MF-T, D3-6F-S, D1,2F-S, SiC, GI), control and intervention group were matched regarding age, gender, ethnicity and maternal education as an indicator of SES. Mann-Whitney-U-Tests were used to assess the differences between control and intervention group. Chi-Square-Test (Pearson) was applied to compare frequencies. The siginificance level was set at p < 0,05.Results: The response rate was 65.9%. A total of 925 12-year-olds were counted in the analysis. Bivariate analyses found ethnicity, SES, use of fluoride supplements in the past,start of tooth-brushing, application of fluoride varnish or solutions in the dental office,fissure sealents, knowledge of dental health and the application of fluoride varnish during group prevention to be significantly related to the outcome variable D3-6MF-T–IndexBinary logistic regression showed following factors as significant influencing variables: the amount of sealed teeth, nutrition (sugar index), early start of tooth-brushing and topical fluoridation. After the matching process the intervention and control group each comprised 210 12- year-olds to be compared. On average, the children of the intervention group had a meanof 0.88 D3-6MF teeth, whereas children in the control group had an average of 1.73 D3-6MF teeth (p< 0.005). The intervention group presented better values concerning the transitional stages of caries (ICDAS score 3 and 4), the Significant Caries Index and the Treatment Index. With respect to the presence of plaque and the GI no significant differences were shown. The participants of the intervention group however had more sealed fissures and received more topical fluoride applications at the dental office. Furthermore, toothbrushing was started at the age of 1 more often in the intervention group. No significant differences were shown regarding dental health knowledge and dietary habits (Sugar index). Discussion and Conclusions: The results of our study confirm a caries preventive effect of the intensified preventive programme (“Marburger Modell”). The intervention group showed better oral health in all outcome variables reviewed. For this reason, the “Marburger Modell” can serve as a basic model for whole Germany. Furthermore, theinhibition of initial lesions, which is typical for preventive programmes using fluoride varnishes, was confirmed by the differentiated assessment with ICDAS II. By using differentiated systems like ICDAS II the quality of studies evaluating preventive programmes can be improved. Both groups showed similar results regarding dietary habits, prophylaxis knowledge and oral hygiene. This leads to the conclusion that the effect of the preventive programme is primarily based on the application of fluoride varnish. The correlation between caries experience and certain risk factors can help to identify risk groups and include them intointensified preventive programmes.