Nursing caries is a distinct caries pattern that is most often ascribed to frequent, especially night time, bottle feeding. The seriousness and societal cost of this caries process is enormous. Estimates of the prevalence of nursing caries range from 6% to as high as 85% in certain Native American populations. Besides the impact of this disease on the primary maxillary anterior incisors, the condition usually progresses to rampant caries on the other teeth in a child's mouth. Dental treatment often involves general anesthesia or deep sedation because of the lack of cooperative behavior at such a young age. Such extensive therapy usually requires hospitalization and may present morbidity and mortality risks for young children. Current preventive efforts have been unsuccessful. This nursing caries intervention study will follow 400 high risk Infants and their parents from the Hartford and Newark WIC programs. Parents that report that their one year old child is using a feeding bottle at night will be recruited for the study. Subjects visit the W.l.C. programs monthly to receive food stamps, making it an ideal situation for the proposed interventions. Child/parent pairs will be assigned to either the control or one of the two interventions. The Control Group will receive annual education regarding the potential harm of frequent and prolonged feeding with a nursing bottle after age 1. The parents also will be given an infant size toothbrush and 0.4% SnF2 (1,000 ppm F). They will be instructed to use a pea sized amount of gel once daily on their child's teeth instead of dentifrice. Dental examinations will be performed at baseline and after 1 and 2 years. The Self-Efficacy Group will receive the same Instruction and examinations as the Control group. In addition parents will receive behavioral training, positive outcome expectancy, self-efficacy enhancement, and performance feedback, to improve their confidence in eliminating the nursing bottle habit and in performing their child's daily tooth brushing with fluoride gel. The High Frequency Professional Fluoride Group will received the same instruction and examinations as those in the Control group. In addition the children will receive monthly supervised professional topical fluoride treatment, 0.1 ml of 1.23% topical fluoride that is """"""""brushed-on"""""""" for one minute. Logistic regression and structural equation models will be designed to predict the development of more carious lesions. These approaches allow for the estimate of the effect of various independent variables on the dependent variable (e.g., the effect of mutans streptococci levels or continued nursing bottle usage on caries increment in the control and treatment groups). Logistic regression also offers a perspective for directly estimating expected costs and benefits of intervention. We will also measure differences in dental knowledge, and tooth brushing and bottle behavior between groups before and 1 and 2 years after instruction. This study, therefore, will examine the effect of parentally or professionally directed preventive treatments on caries progression in children at high risk for nursing caries. Effective prevention protocols should have immediate and Ion term effects on improving dental health and lessening health care costs in children from low-income families.
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