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, MHR 1Michigan 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 (n1,534), 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 7391 children 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 (n1,534), 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.