Oral Health in Toddlers Attending a Postnatal Home Visiting Programme

Objective: To evaluate caries development in 18-month-old children attending an extended postnatal home visiting programme in a disadvantaged area in Stockholm, Sweden.

Methods: All children and parents in Sweden are offered regular planned contact with the Child Health Service from birth until the age of six. This includes one home visit around two weeks after birth. In addition to the regular Child Health Program all first-born children in the interventions area was offered five extra home visits by a child nurse and a parental advisor from social services before the age of 15 months. Different themes were discussed during each home visit. To stimulate tooth-brushing with fluoridated toothpaste they provided the parents with a toothbrush and toothpaste from the public dental service at infant’s age around 6 months.

Caries development in a cohort of 18-month-old children participating (n =73) in the extended postnatal home visiting programme was compared with a non-intervention comparison group (n=100) of children matched for age and gender living in a comparable disadvantaged area in Stockholm. Two calibrated dentists examined the children in knee-to-knee position using the ICDAS II criteria. Parents also answered a structured interview concerning dental background, dental trauma, dietary habits and tooth-brushing.

Results: The mean number of decayed teeth (ICDAS 3-6) was compared using the independent samples t-test and was significantly lower (p=0.013) in the intervention group than in the comparison group. For non-decayed caries lesions (ICDAS 1-2) there was no significant difference. Parents` assistance with tooth brushing twice daily was compared using Pearson Chi-Square test. Parent’s in the intervention group brushed their children’s teeth significantly more (P=0.045) than in the comparison group.

Conclusion: This study demonstrates that an extended postnatal home visiting programme in this cohort of toddlers have a beneficial effect on caries prevalence and tooth brushing habits at 18-months of age.