Preventing Early Childhood Caries among Children in Rural Maine

Background: Early childhood caries is an ongoing public health challenge in the United States, particularly in underserved areas where children are at higher risk for dental decay. Children in rural Maine experience higher risk for caries and greater barriers in access to care, demanding interventions that focus on prevention at the earliest age. NYU introduced silver diamine fluoride (SDF) to Washington County Children’s Program (WCCP) in 2016 to address the challenges to oral health. The aim of this study is to evaluate the effect of SDF application on dental caries prevention in this population.

Methods: A serial cross-sectional study was conducted in 74 children aged 0 to 6 years at baseline enrolled in WCCP from 2016 to 2018. The intervention had three stages: (1) placement of glass ionomer sealants on first permanent molars, (2) topical application of fluoride varnish and silver diamine fluoride biannually, and (3) annual clinical treatment. Caries prevalence was evaluated at baseline and once annually over 24 months through a standard oral examination performed by calibrated pediatric dentists. Data were analyzed to evaluate caries experience, caries incidence, and arrested lesions.

Results: Caries prevalence decreased significantly from 31% at baseline to 16% in 2018 (P<0.05). A total of 172 decayed tooth surfaces received SDF and fluoride varnish application. At the 24-month recall, there was a 60% reduction in decayed surfaces and a total of 69 new arrested lesions. Only 7% of children developed new caries in their primary molar teeth after two years, a significant difference from 28% at baseline (P<0.05).

Conclusion: The study documents the positive effect of a combined topical fluoride approach for arresting and preventing early childhood caries, particularly in children living in resource-poor settings. Optimizing community-based oral health programs for young children can be a critical tool in reducing caries at an early age.