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Effects of a health promotion and fluoride varnish on dental caries among Australian aboriginal children
This study aimed to test the efficacy of a dental health program in preventing dental caries among Australian Aboriginal children living in the Northern Territory. Although the intervention targeted communities, families, and children of the Aboriginal population group, it is important to note that preschoolers aged between 18 and 47 months were the main target (N=666 at baseline; 543 after intervention). The study was informed by the fact that Australias Indigenous children experience excessively high rates of dental caries that could be effectively reduced through fluoride varnish application and parental counseling in diet and oral hygiene.
Hypothesis
The authors hypothesized that the dental health program (application of fluoride varnish on childrens teeth, water consumption, and routine tooth cleaning with toothpaste) provided had the capacity to reduce dental caries in preschool children.
Type of Study
The study used a quantitative research approach and a prospective, cluster-randomized controlled trial design to evaluate the effectiveness of the dental health program in reducing oral caries. The described research approach and design assisted the researchers in randomly allocating the participants selected from 30 communities to intervention and control groups (15 intervention communities and 15 control communities) for the two-year prospective study. It was also possible to follow the participants through the two-year period with the view to assessing how the intervention was working on the experimental group.
Exposure/Risk on Protective Factor
It is evident from the study that, twice per year for two years in the intervention group, fluoride varnish was applied to childrens teeth, water consumption and daily tooth cleaning with toothpaste were advocated, dental health was promoted in community settings, and primary health care workers were trained in preventive dental care (Slade et al., 2011, p. 29). No activities were undertaken in the control group during the two-year follow-up period.
Outcome
The expected outcome was the reduction of dental caries in the intervention group after exposure to the main components of the dental health program. It is important to note that the primary endpoint to determine the efficacy of the intervention was net dental caries increment (d3mfs), a child-level measurement (Slade et al., 2011, p. 37).
Statistical Tests Used
Descriptive tests were used to determine net caries increment (d3mfs) by comparing baseline data and follow-up data that were paired by child, tooth, and surface to calculate surfaces that had either a caries increment or decrement, while the two-tailed test of the null hypothesis and multi-level linear regression models were used to determine the efficacy of the intervention in reducing dental caries among the targeted population.
Statistical Results
The study found that the preventive dental intervention of twice-yearly fluoride varnish application combined with community health promotion significantly reduced the average number of tooth surfaces, per child, that developed caries in a 2-year period compared to the level observed in control communities (Slade et al., 2011, p. 40). Statistically, the study found that the intervention was effective as it was able to reduce dental caries by 2.3 to 3.5 surfaces per child (average of 3.0 surfaces per child at 95 percent confidence level) and prevented fractions of 24-36 percent (average of 31 percent).
Conclusion
The researchers concluded that the application of fluoride furnish is an effective strategy in preventing dental caries in preschoolers, particularly when the intervention is combined with community-based health promotion programs aimed at increasing oral hygiene in the population.
Limitations
The limitations acknowledged in the study include the inability of the trained health care workers to provide dental services planned for this study due to their heavy workload, high turnover of remote health staff in the selected communities, and the wrong impression created by the presence of the research team in these remote communities.
Bias/Confounding Variables
The concentration of fluoride in the toothpaste was a major confounding variable in efforts aimed at evaluating the efficacy of the oral health intervention in reducing dental caries.
Periodontitis: A future risk of acute coronary syndrome
This study aimed at confirming if there is any relationship between periodontitis and known cardiovascular diseases by investigating if the reappearance of the acute coronary syndrome (ACS) was in any way predicted by previous mental and periodontal conditions. The population for this study consisted of adults with recurrent ACS events as well as medically healthy adults. Overall, a sample of 165 participants with recurrent ACS events (intervention group) and 159 medically healthy participants (control group) was used.
Hypothesis
The researchers hypothesized that mental and periodontal conditions actively predicted the recurrence or reappearance of ACS events in the selected population.
Type of Study
The study employed a quantitative research approach and a prospective research design (not randomized) to evaluate the relationships between the various variables of interest to the study. This research design not only enabled researchers to study the participants for three years but also ensured that outcome measures could be compared across the intervention and control groups.
Exposure/Risk on Protective Factor
The main risk considered in the study was a periodontal disease, a common chronic oral disease in adults that was defined in the study by alveolar bone loss (Renvert, Ohlsson, Pettersson, & Persson, 2010).
Outcome
Subgingival samples taken from the participants were assessed using the checkerboard DNA-DNA hybridization technique to note shifts in outcome indicators including serum levels of high-density lipoprotein, creatinine, as well as white blood cells (WBC) counts (Renvert et al., 2010).
Statistical Tests Used
Descriptive and inferential tests (e.g., correlation analysis and general linear modeling multivariate analysis) were used to determine if recurrent or reappearing ACS events are predicted by mental and periodontal conditions as indicated by the outcome variables (serum levels, creatinine, and WBC counts)
Statistical Results
The main statistical results include (1) ACS was found to recur in 40 percent of participants in the intervention group, (2) the first ACS event was found in 4.4% of participants in the control group, (3) substantially high serum levels of high-density lipoprotein, creatinine and WBC counts were reported in participants with future ACS, and (4) periodontal condition was positively associated with the first event of ACS and the recurrence of ACS in the near future (Renvert et al., 2010).
Conclusion
These results led to the conclusion that recurrent ACS events are predicted by serum WBC counts, serum creatinine levels, and a diagnosis of periodontitis (Renvert et al., 2010, p. 992).
Limitations
It was difficult to achieve the preferred sample size due to the wide variations of ACS and low level of ACS knowledge among the participants. Additionally, the complex measurements and calculations of serum levels presented a challenge that could compromise the validity and reliability of the study findings.
Bias/Confounding Variables
To ensure that the results were reflective of the main issues of interest and were not influenced by other outside forces, the authors had to control for the age of participants as well as the prediction of a future ACS event.
References
Renvert, S., Ohlsson, O., Pettersson, T., & Persson, G.R. (2010). Periodontitis: A future risk of acute coronary syndrome? A follow-up study over 3 years.Journal of Periodontology, 8, 992-1000. Web.
Slade, G.D., Bailie, R.S., Roberts-Thomson, K., Leach, A.J., Raye, I., Endean, C.,&Morris, P. (2011). Effects of a health promotion and fluoride varnish on dental caries among Australian aboriginal children: Results from a community-randomized controlled trial.Community Dentistry and Oral Epidemiology, 39(1), 29-43. Web.
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