Kathryn A. Plonka

A controlled, longitudinal study of home visits compared to telephone contacts to prevent early childhood caries

BACKGROUND Home visits (HV) provide excellent opportunities for health promotion. AIM This longitudinal study compared the effects of HV and telephone contacts (TC) in preventing early childhood caries (ECC) and colonisation of mutans streptococci (MS) and lactobacilli (LB) from 0 to 24 months. DESIGN A total of 325 children were recruited from community health centres at mean age of 42 days, and randomly assigned to receive either HV or TC. A total of 188 children completed three, 6 monthly HV, and another 58 had three, 6 monthly TC. An additional 40 age-matched children from childcare facilities served as reference controls (RC). At 24 months, all groups were examined at a community dental clinic. RESULTS At 24 months, three HV children of 188 (1.5%) had caries, compared to four TC of 58 (6.8%) and nine RC of 40 (22.5%) (P < 0.001 for HV versus RC; P = 0.05 for HV versus TC and P = 0.03 for TC versus RC). There were also more children with MS in the TC (47%) and RC (35%) compared to HV (28%) group (P = 0.01 and P = 0.02). CONCLUSIONS Home visits and telephone contacts conducted 6 monthly from birth are effective in reducing ECC prevalence by 24 months.

Increased traffic exposure and negative birth outcomes: a prospective cohort in Australia

BackgroundPregnant women exposed to traffic pollution have an increased risk of negative birth outcomes. We aimed to investigate the size of this risk using a prospective cohort of 970 mothers and newborns in Logan, Queensland.MethodsWe examined two measures of traffic: distance to nearest road and number of roads around the home. To examine the effect of distance we used the number of roads around the home in radii from 50 to 500 metres. We examined three road types: freeways, highways and main roads.ResultsThere were no associations with distance to road. A greater number of freeways and main roads around the home were associated with a shorter gestation time. There were no negative impacts on birth weight, birth length or head circumference after adjusting for gestation. The negative effects on gestation were largely due to main roads within 400 metres of the home. For every 10 extra main roads within 400 metres of the home, gestation time was reduced by 1.1% (95% CI: -1.7, -0.5; p-value = 0.001).ConclusionsOur results add weight to the association between exposure to traffic and reduced gestation time. This effect may be due to the chemical toxins in traffic pollutants, or because of disturbed sleep due to traffic noise.

A Longitudinal Study Comparing Mutans Streptococci and Lactobacilli Colonisation in Dentate Children Aged 6 to 24 Months

This longitudinal study aimed to investigate variables associated with colonisation of mutans streptococci (MS) compared with lactobacilli (LB) colonisation in a cohort of children (n = 214) from the time of first tooth eruption at approximately 6 months until 24 months of age. Repeated plaque and salivary samples were collected from the same infants at 6, 12, 18 and 24 months and assayed for MS and LB using a microbiological culture kit. Children having both MS and LB increased from 4% at 6 months to 13% at 12 and 18 months to 20% at 24 months (p = 0.004). LB presence at 6 months was correlated with MS presence at 12, 18 and 24 months (r = 0.21 to r = 0.46, p = 0.02), while MS presence at 6 months correlated with LB presence at all other times (r = 0.19 to r = 0.31, p = 0.03). At 6 and 12 months, the key variables for MS colonisation included unrestored dental cavities in the mother (p = 0.03), mother not persisting with toothbrushing (p = 0.001) and bottle taken to bed at night (p = 0.033), while the only significant variable for LB colonisation was natural birth (p = 0.01). At 24 months, the significant variables for MS colonisation were condiments added to pacifier (p = 0.022) and child being uncooperative for toothbrushing (p = 0.025), while the significant variables for LB colonisation were pregnancy problems (p = 0.028) and child being uncooperative for toothbrushing (p = 0.013). The ages 6–12 months thus represent a time period when key variables may be controlled to reduce MS and LB colonisation.

Cost-effectiveness of a telephone-delivered education programme to prevent early childhood caries in a disadvantaged area: a cohort study

Objectives Early childhood caries is a highly destructive dental disease which is compounded by the need for young children to be treated under general anaesthesia. In Australia, there are long waiting periods for treatment at public hospitals. In this paper, we examined the costs and patient outcomes of a prevention programme for early childhood caries to assess its value for government services. Design Cost-effectiveness analysis using a Markov model. Setting Public dental patients in a low socioeconomic, socially disadvantaged area in the State of Queensland, Australia. Participants Children aged 6 months to 6 years received either a telephone prevention programme or usual care. Primary and secondary outcome measures A mathematical model was used to assess caries incidence and public dental treatment costs for a cohort of children. Healthcare costs, treatment probabilities and caries incidence were modelled from 6 months to 6 years of age based on trial data from mothers and their children who received either a telephone prevention programme or usual care. Sensitivity analyses were used to assess the robustness of the findings to uncertainty in the model estimates. Results By age 6 years, the telephone intervention programme had prevented an estimated 43 carious teeth and saved £69 984 in healthcare costs per 100 children. The results were sensitive to the cost of general anaesthesia (cost-savings range £36 043–£97 298) and the incidence of caries in the prevention group (cost-savings range £59 496–£83 368) and usual care (cost-savings range £46 833–£93 328), but there were cost savings in all scenarios. Conclusions A telephone intervention that aims to prevent early childhood caries is likely to generate considerable and immediate patient benefits and cost savings to the public dental health service in disadvantaged communities.