Abstract

1. ASSESSMENT OF THE PREVALENCE AND PREDICTORS OF DENTAL CARIES AND LOSS TO FOLLOW-UP: MICHIGAN DEPARTMENT OF COMMUNITY HEALTH FLOURIDE VARNISH APPLICATION PROGRAM Nivedita Akarte BDS, MPH1, Steven Korzeniewski MA, MSc1, Sheila Vandenbush, Ph.D1,Violanda Grigorescu MD, MSPH1, Susan Deming RDH, RDA, BS1 ,Lisa M. Joseph, RDH, BS, MHR1Michigan Department of Community Health, Division of Genomics, Perinatal Health and Chronic Disease Epidemiology Lansing, MI Table .1 : Demographic Associations between demographic characteristics and occurrence of caries and likelihood of repeat varnish applications Abstract Objective: The MDCH Oral Health Program implemented the Fluoride Varnish program from October 2007-2008. Children from 13 selected Early Head Start and Head Start programs were examined to evaluate the prevalence of oral disease and provide up to four fluoride varnish applications, education to parents and school staff, and referral for dental care. This study assesses the prevalence and predictors of oral disease and predictors of failure to obtain repeat varnish applications. Methods: This is a cross-sectional study. Data were obtained by trained dental hygienists, dentists and a nurse. Several children not receiving a varnish application were excluded. Univariate, bivariate, and multivariate results are reported. We assessed caries likelihood at inception, whether urgent treatment was needed, prevalence of caries overall and newly developed, and the rate of repeat varnish application. Bivariate analyses included assessment by age and race. Multivariate analyses included factors significantly associated in bivariate analyses and study site. Results: The program reached 7391 children; nearly 7% initially screened at risk of early childhood caries, 7% were determined in need of urgent dental care during the study period, 9.5%.had at least one carious lesion. Of children screened repeatedly (n=1,534), 5.5% had caries detected only after the first screen. After adjustment, Hispanic/Latinos (OR 0.5, 95% CI 0.370 -0.606) and multi-racial children (OR 0.6, 95% CI 0.510- 0.684) were determined to be at less risk of caries at the first screen compared to Whites. Children age three to five years and those of Hispanic/Latino ethnicity had a greater likelihood of caries in both crude (OR 1.7, 95% CI 1.256-2.186) and adjusted models (OR 1.6, 95% CI 1.159-2.121) relative to younger children and those of White race respectively. New carries likelihood did not vary significantly by age, although children of Hispanic/Latino ethnicity (OR 2.7, 95% CI 1.745-6.522) or of Black race (OR 1.7, 95% CI 1.051 -3.352) were at greater risk compared to Whites after adjustment. Whites were significantly more likely to obtain a repeat varnish application in both crude and adjusted models. The likelihood of needing urgent treatment was greater in older relative to younger children after adjustment (OR 8.6, 95% CI 3.545-20.991).Treatment urgency did not vary by race/ethnicity. Conclusion: While caries likelihood at first screen and rate of new caries did not statistically differ by age, older children were 11 times more likely to have a carious lesion and nine times more likely to be in need of urgent treatment after adjustment. Early intervention is necessary to reduce the prevalence of oral disease. While Black and Hispanic/Latino children were less likely to receive a repeat screen/varnish application (lower eligibility for new caries detection), they were more likely to develop new caries relative to Whites. Culturally tailored interventions are recommended. Methods Study Population: 7391children from 13 selected Early Head Start (0-3yrs) and Head Start programs (3-5yrs) in Michigan were examined to evaluate the prevalence of oral disease. Study Design: This is a cross-sectional study where data was obtained by trained dental hygienists, dentists and a nurse. Univariate, bivariate, and multivariate results are reported. Primary Exposure (Varnish Application): The program was conducted from October 07-08 and aimed to provide at least four fluoride varnish applications and screens at an interval of 2-3 months. Analysis: We assessed caries likelihood at inception, whether urgent treatment was needed, prevalence of caries overall and newly developed, and the rate of repeat varnish application. Bivariate analyses included assessment by age and race. Multivariate analyses included factors significantly associated in bivariate analyses and study site. Results: Among the 7391 children, 7% were determined in need of urgent dental care during the study period, 9.5%.had at least one carious lesion. Of children screened repeatedly (n=1,534), 5.5% had caries detected only after the first screen. After adjustment, Hispanic/Latino children (OR 0.5, 95% CI 0.370 -0.606) and multi-racial children (OR 0.6, 95% CI 0.510- 0.684) were determined to be at less risk of caries at the first screen compared to Whites. Children age three to five years and those of Hispanic/Latino ethnicity had a greater likelihood of caries in both crude (OR 1.7, 95% CI 1.256-2.186) and adjusted models (OR 1.6, 95% CI 1.159-2.121) relative to younger children and those of White race respectively. New carries likelihood did not vary significantly by age, although children of Hispanic/Latino ethnicity (OR 2.7, 95% CI 1.745-6.522) or of Black race (OR 1.7, 95% CI 1.051 -3.352) were at greater risk compared to Whites after adjustment. Whites were significantly more likely to obtain a repeat varnish application in both crude and adjusted models. The likelihood of needing urgent treatment was greater in older relative to younger children after adjustment (OR 8.6, 95% CI 3.545-20.991).Treatment urgency did not vary by race/ethnicity. Background: The Michigan Department of Community Health Oral Health Program in collaboration with Delta Dental (funding agency) administered the 07-08 Varnish! Michigan program to Head Start and Early Head Start children by using providers through local public health departments, dental schools, PA 161 dental hygienists and community dental clinics. The application of fluoride varnish on a very young population can significantly reduce dental disease in this group. National and international studies demonstrate a 40-75% reduction in dental caries with the application of fluoride varnish. Finding this group of children a “dental home” for future dental care needs and providing oral health education to parents and Head Start staff is the focus of the program. Limitations: The primary limitation of our study is attrition, or loss to follow-up. While it was intended to provide up to four varnish applications, virtually all of the study participants did not receive more than two applications. Thus, our ability to evaluate the impact of varnish applications is accordingly hindered. Our results may be impacted by missing or inaccurate data; however, there is no indication that reporting of demographics or treatment data was differential by the number of varnish applications or risk profile. Public Health Implication: This study helped us understand that early intervention is necessary to reduce the prevalence of oral disease among high risk infants and children before oral disease causes dental decay, pain and suffering and culturally tailored programs are required to provide these services.