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Health Promotion and Prevention of Early Childhood Caries

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Health Promotion and Prevention of Early Childhood Caries Health promotion and prevention of early childhood caries A thesis submitted for the degree of Doctor of Philosophy Dental School The University of Adelaide South Australia by Kamila Plutzer May 2005 Supervised by Professor A John Spencer Australian Research Centre for Population Oral Health (ARCPOH) HEALTH PROMOTION AND EARLY CHILDHOOD CARIES Dental School, The University of Adelaide Contents List of tables OIlOO.O.I/I$.e ••• 0.!)G"IJ~O$lJ& •• /lI •••• 1J ••••• O.O.O •••• O ••••••••••••••••••••••••••••••••••••••••••••••••••• vii List of figureso.~o ... o •• oo.oll' ...... oo.lt.oo~.".II •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• x Ab brevia tio ns ".0.00"0 "",., •••••••• 0 ••••• 0 •••• 0 ••••• 0 ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• xi Abstract 08.0 •• 9" ••••• 00 ...... 011 ••••••••••••••••• 0.01 •••••••••••• G ••••••••••••••••••••• ••••••••••••••••••••••••••••• xii Declara tio n ." •.• ., •.••• \11001'00$ ••• e •••••••• ,,411' ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• xiv Ackllowledgements .............................................•.....................................•..•• xv Chapter 1. Introduction ............................................................................ 1 1.1 History of the disease and terminology .................................................................... 3 1.2 Definition of early childhood caries ........................................................................ .4 1.3 Prevalence of early childhood caries ........................................................................ 5 1.4 Clinical appearance of early childhood caries ......................................................... 6 1.4.1 Susceptibility of primary teeth to caries ..................................................... 6 1.4.2 Clinical appearance ofECC ................................................... · ...... ·· ............ 7 1.5 Significance of early childhood caries ..................................................................... 7 1.5.1 Influence on a child's quality of life ........................................................... 8 l.5.2 Risk factors for future dental caries ............................................................ 9 1.5.3 Adverse effect of hospitalisation ................................................................ 9 1.5.4 Cost oftreatment. ................................................... · ........ · .. ·........................ 9 1.6 Aetiology of early childhood caries ....................................................................... 10 1.6.1 Cariogenic microorganisms ...................................................................... 11 l.6.2 Tooth surface and host factors .................................................................. 11 1.6.3 Substrate - femlentable carbohydrates ..................................................... 12 1.7 Social and behavioural issues in the development of nursing caries ..................... 13 1.8 Conceptual framework of societal intluence on child's oral health ....................... 13 l.9 Overview of interventional preventative programs and their significance to the current study ........................................................................................................... 17 1.10 Overview of the current study ................................................................................ 22 1.11 Hypothesis .............................................................................................................. 25 1.12 Rationale for the study ........................................................................................... 25 1.13 Purpose of the study ............................................................................................... 25 1.14 Aims of the study ................................................................................................... 25 1.15 References to Chapter 1 ......................................................................................... 27 Chapter 2. Methods ............................•...........................................•..•..... 36 2.1 Research design: Randomised Controlled TriaL ................................................... 36 2.1.2 Subject allocation ................................................................... · .................. 39 2.1.3 Justification of the sample size ................................................................. 39 11 HEALTH PROMOTION AND EARLY CHILDHOOD CARIES 2.1.4 Hospitals selection ." ... , ............. " .............................................................. 40 2.2 Ethical considerations ....................... " ................................................................... 40 2.2.1 Privacy protection ..................................................................................... 42 2.3 Pilot testing ............................................................................................................ 42 2.4 Methods of health promotion intervention ................................................... · ...... ··.43 2.4.1 Mailed written health information .......................................................... .44 2.4.2 Telephone intervention ............................................................................ 45 2.5 Data collection ...................................................................................................... 45 2.5.1 Questionnaires .......................................................................................... 46 2.5.2 Medical history ........................................................................................ 55 2.5.3 Telephone intervention ............................................................................. 55 2.5.4 The clinical dental examination ................................................................ 56 2.5.4.1 Diagnostic criteria ................................................................... 57 2.5.4.2 Recording of present caries ..................................................... 57 2.5.4.3 Counselling ............................................................................. 57 2.6 Criteria for age calculation ..................................................................................... 58 2.7 Data management. .................................................................................................. 58 2.8 Data analysis .......................................................................................................... 59 2.9 Missing values ........................................................................................................ 60 2.10 Sponsorship .............................................................................. · .... · ...... · .... · .. · ........ · 60 2.11 References to Chapter 2 ......................................................................................... 61 Chapter 3. Results ................................................................................... 68 3.1 Overview of presentation of results ...................................................................... 68 3.2 Enrolment, allocation and characteristics of subjects ........................................... 72 3.2.1 Recruitment of subjects ............................................................................ 72 3.2.2 Exclusions ................................................................................................. 72 3.2.3 Refusals ..................................................................................................... 72 3.2.4 Enrolll1ent of subjects ............................................................................... 75 3.2.5 Random allocation of participants to test and control groups ................. 77 3.3 Baseline data analysis ........................................................................................... 78 3.3.1 Demographic factors ................................................................................ 79 3.3.2 Self-assessment of health .......................................................................... 84 3.3.3 Sources and frequencies of non-alcoholic drinks .................................... 85 3.3.4 Oral hygiene habits ................................................................................... 87 3.3.5 Harmful health habits ................................................................................ 89 3.3.6. Other variables .......................................................................................... 91 3.3.6.1 Planned / unplanned pregnancy .............................................. 91 3.3.6.2 Importance of healthy baby teeth ............................................ 92 3.4 18 months follow - up details ................................................................................. 93 3.4.1 Reasons of participants' loss to follow up ................................................ 93 111 HEALTH PROMOTION AND EARLY CHILDHOOD CARIES 3.4 .1.1 Exclusions from the study ....................................................... 93 3.4.1.2 Other reasons for the loss of participants ................................ 97 3.4.2 Retention of participants in test and control group according to the mothers' demo graphic characteristics ...................................................... 99 3.5 Comparability of examined children in the test and control groups .................... 107 3.6 Comparability of Test A and Test B groups after the
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