title: Failure of intense preventive efforts to arrest early childhood and rampant caries: three case reports.
abstract: This report presents the first three children who developed dental caries despite being enrolled in a randomized, control trial to test methods to prevent early childhood caries. The children's caretakers received education on decreasing frequent and prolonged feeding with a nursing bottle and other sugar containing foods, as well as brushing the children's teeth daily with 0.4% SnF2 gel. One of the child's caretaker additionally received training sessions to improve confidence in eliminating the child's nursing bottle habit and in performing daily tooth brushing. The two other children received monthly topical fluoride treatments with 2% NaF. Despite these intensive preventive efforts, these three children developed dental caries. Two of the children had mutans streptococci colonization at the time of initial visit, (12 and 14 months of age, respectively). All had high mutans streptococci levels at the time that caries was detected. Incorrigible, high-frequency sugar consumption from a bottle or from solid foods was suggested in all three cases. In one case, dental caries was associated with defects of the tooth enamel. Conceivably, the cariogenic challenge and harmful behaviors in certain children may be so extreme that they can overwhelm even extraordinary preventive efforts.
authors.affiliation: Department of Pediatric Dentistry, University of Connecticut Health Center, USA.
authors.forename: N
authors.initials: N
authors.lastname: Tinanoff
authors.forename: N S
authors.initials: NS
authors.lastname: Daley
authors.forename: D M
authors.initials: DM
authors.lastname: O'Sullivan
authors.forename: J M
authors.initials: JM
authors.lastname: Douglass
mesh_terms: D001903:Bottle Feeding / Q000009:adverse effects; D002327:Cariostatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018890:Chemoprevention; D015169:Colony Count, Microbial; D003731:Dental Caries / Q000382:microbiology / Q000517:prevention & control*; D003743:Dental Enamel / Q000002:abnormalities; D004040:Dietary Carbohydrates / Q000008:administration & dosage / Q000009:adverse effects; D005459:Fluorides / Q000008:administration & dosage / Q000627:therapeutic use*; D005460:Fluorides, Topical / Q000008:administration & dosage / Q000627:therapeutic use; D006267:Health Education, Dental; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D012969:Sodium Fluoride / Q000008:administration & dosage / Q000627:therapeutic use; D013295:Streptococcus mutans / Q000254:growth & development; D014002:Tin Fluorides / Q000008:administration & dosage / Q000627:therapeutic use; D014099:Toothbrushing; D014100:Toothpastes / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D002327:Cariostatic Agents; D004040:Dietary Carbohydrates; D005460:Fluorides, Topical; D014002:Tin Fluorides; D014100:Toothpastes; D012969:Sodium Fluoride; D005459:Fluorides