Cárie na primeira infância: fatores associados e o efeito de intervenções educativas

Abstract

Early childhood caries (ECC) remains as the most common chronic disease of childhood, leading to a debilitating effect on general health and quality of life. Educational strategies can lead to important benefits for children’s oral health, because oral health behavior begins to form in early childhood. However, the evidence pertaining the effectiveness of oral health educational interventions remain controversial. The aim of this study was to systematically review the effectiveness of oral health educational interventions in preventing caries in primary teeth; to assess the effectiveness of an oral health educative intervention targeting mothers in preventing ECC by a cluster randomized controlled trial (RCT); to describe and evaluate knowledge and beliefs from mothers about ECC; and to assess the children’s caries experience, oral health hygiene practices and associated risk factors. The systematic review searched in electronic databases (PubMed, Cochrane-Central, EMBASE) and included RCT and controlled clinical trials, with dental caries as primary outcome, in 0- to -5-year-old children. Studies were selected and data extracted. Study quality was assessed and meta-analysis was conducted. In the cluster RCT, 24 public health centers were randomly assigned into 2 groups, intervention group (IG), in which mothers of children aged 0- to 12-month-old received an educational intervention by means of pamphlet and verbal instructions, and control group (CG, no intervention). Socioeconomic and demographic variables were collected by interview. In GI baseline (2010) an interview was used to assess the knowledge of mothers about ECC. After one year (2011), children were examined to determine caries and dental plaque status. Children with at least one noncavitated surface and/or at least one cavitated surface were considered as presenting ECC. In the CG, in 2011, to collect data on oral hygiene practices an interview was used. In the review 18 trials were included. Verbal and written information were the educational modalities most widely used. Meta-analysis of four RCTs suggests that educational intervention significantly reduces ECC (OR 0.18, CI 95% 0.08–0.40). In the RCT, of 533 mother-child pairs enrolled, 445 completed the follow-up (IG 174, CG 271). After the adjustment for number of teeth the odds of caries was 80% higher for the CG (p=0.037). In the study of mothers’ knowledge sugar intake and lack of hygiene were the most frequently mentioned causes of ECC. Most of the mothers were aware of the need to begin toothbrushing during their children’s first year. Mothers who had more children were more likely to not know the correct age for the first dental visit. Relative to oral hygiene practices and caries, of the 262 children examined, 42 (16.0%) presented dental caries. Low maternal education and low income were associated with higher odds of having caries, children presenting dental plaque and mothers not reporting oral hygiene (P<0.05). Preventive programs are needed for young children and the results suggested that educational intervention has an effect in preventing ECC. However, further RCTs are needed, with greater methodological quality to provide a definitive answer.