Evaluation eines interdisziplinären Präventionsprogramms zur Vermeidung der Frühkindlichen Karies bei Dormagener Kleinkindern

Evaluation of an interdisciplinary prevention program for avoiding Early Childhood Caries in young children in Dormagen Scientific investigations of the last years have shown that, in contrast to older children, there is only slight or no reduction of caries prevalence in primary dentition. Further-more, this type of caries only affects a small group of children. Already established preventive measures such as individual care and preventive dental examinations are initiated too late in a child’s life. Because the initiative of the family is required to take part in those programs (“Come-structure”), these measures provide low effectiveness on high-risk groups. The pilot project which was conducted in this study intended to evaluate if repeated information-units during pregnancy, after birth and in early childhood can influence behavior patterns to help prevent the onset of Early Childhood Caries (ECC). The program was focused on an interdisciplinary teamwork of gynaecologists, midwives, paediatricians, dentists and the youth welfare- and health- offices in the City of Dormagen. The focus of the project was to reach families with low socioeconomic status using home-visiting components and barrier-free offers. The study was conducted as a “historical comparison”. For this purpose, we compared the dental health and the dental health-related behavior of a group of 3-4 year old children born before the start of the project (between 06/2007 and 12/2008, n=661/control-group) to a group of 3-4 year old children (born between 03/2011 and 09/2012) who participated in the program (n=706/prevention-group). The dental-health-status was recorded by two dentists of the health-office in the kindergartens according to ICDAS-collapsed. In addition a standardized questionnaire was distributed to the parents to compensate for independent variables (nutrition and prophylaxis). The focus of the study was the evaluation of the caries experience (d3-6mf-t) and the caries prevalence. The Mann-Whitney-U-Test was used to assess our primary hypothesis, which dictates that the d3-6mft-Index should be lower in the prevention-group than in the control-group. The categorical variables for each test were evaluated by contingency tables using the respective test according to Fisher. The results showed a significant improvement of the dental health of the prevention-group: The mean d3-6mf-t in the prevention-group (0,46) was half of the control-group (0,92). Additionally, the proportion of children with S-ECC in the prevention-group (7,9 %) was half as high as in the control-group (14,5 %).The caries prevalence was clearly decreased from 21,2 % in the control-group to 13,7 % in the prevention-group. The questionnaire-evaluation showed significant changes in dental health related behavior: In comparison with the control-group, fewer children of the prevention-group got a feeding-bottle with cariogenic/erosive drinks during the day as well as at night beyond the age of 8 months. Prevention-group children started earlier with dental hygiene, brushed their teeth more often before sleeping and their first visit to the dentist occurred more commonly during their first year of life. After comparison with neighboring municipalities we can exclude that the results follow a general national trend. Rather, the comparison showed that the caries decline is a direct consequence of the introduced prevention program. The results of this study prove a clear reduction of ECC and S-ECC and an improvement of dental-health-related behavior due to the newly introduced interdisciplinary prevention program, which was based on home-visiting components and barrier-free offers. Therefore this program is an effective concept of collective measures to contain Early Childhood Caries and can be considered a model to be used in the future for other regions.