A randomized trial of the effectiveness of home visits in preventing early childhood caries.
OBJECTIVE
Assess the effectiveness of home visits for advising mothers about breast feeding and weaning on early childhood caries (ECC) at the age of 12 months.


METHODS
A randomized field trial was conducted in mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo (intervention group = 200; controls = 300). The intervention group received the advice 10 days after the child's birth, monthly up to 6 months, at 8, 10 and 12 months, based on the 'Ten Steps for Healthy Feeding', a Brazilian national health policy for primary care, based on WHO guidelines. Both groups had research assessment at 6 and 12 months, with dental caries investigated in this last assessment; 122 children were lost in the 1-year follow-up; 378 were assessed for caries: two predentulous children were excluded from the analysis. Mann-Whitney U was used to test if the average number of decayed surfaces (DS; white spots and cavities) differed between the intervention and control groups, and logistic regression to estimate the effects of the intervention on the odds of ECC. Chi-square test was used to test for differences between the intervention and control groups in the distribution of feeding behaviours tackled by the dietary intervention.


RESULTS
10.2% of the children in the intervention group and 18.3% of the controls had caries. The odds of caries was 48% lower for the intervention group, adjusted for number of teeth (OR = 0.52, 95% CI = 0.27-0.97). Mean DS were lower for the intervention group (0.37) when compared with the control group (0.63), (Mann-Whitney U, P = 0.03). The intervention group had significantly longer duration of exclusive breast feeding (P = 0.000), later introduction of sugar (P = 0.005), and smaller probability of ever having eaten biscuits (P = 0.000), honey (P = 0.003), soft drinks (P = 0.02), fromage-frais (P = 0.001), chocolate and sweets (P = 0.001).


CONCLUSIONS
ECC is a public health problem in that population. The home visits for dietary advice appear to help reducing dental caries in infants. Greater efforts are needed to tackle cariogenic dietary behaviours even further, as a relevant proportion of children of the intervention group were shown to present with dental caries. Further studies should examine the effect of the intervention in the longer term.
Feldens
Carlos Alberto
CA
Department of Paediatric Dentistry, Lutheran University of Brazil, Canoas, Brazil. feldens@brturbo.com.br
Vítolo
Márcia Regina
MR
Drachler
Maria de Lourdes
Mde L
D000293:Adolescent; D000328:Adult; D001939:Bread; D001942:Breast Feeding; D002099:Cacao; D002182:Candy; D002253:Carbonated Beverages; D002611:Cheese; D003376:Counseling; D004245:DMF Index; D003731:Dental Caries / Q000517:prevention & control*; D019422:Dietary Sucrose / Q000008:administration & dosage; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006722:Honey; D006801:Humans; D007223:Infant; D007224:Infant Care; D008297:Male; D008875:Middle Aged; D014886:Weaning
D019422:Dietary Sucrose