Dental caries in three-year-old preschool children in Lima, Peru assessed according to the CAST instrument / Caries dental en niños prescolares de 3 años en Lima-Perú evaluados con el instrumento CAST

ABSTRACT The aim of this study was to determine the caries situation of three-year-old preschool children residing in low socioeconomic status districts in Lima, Peru. The study is a crosssectional analysis of the caries situation of suburban areas of Lima. A stratified sampling procedure by geographical distribution, considering healthcare centers with a motherand- child health clinic and surrounding preschools as factors, identified 45 randomly selected preschools, of which 17 accepted to participate. Children from 3-year-old classrooms were examined by two independent calibrated dentists using the Caries Assessment Spectrum and Treatment (CAST) instrument at their premises using artificial light, sterile examination mirrors and gauze for drying each tooth before evaluation. ANOVA and the Tamhane method were used to analyze the data. 308 children, mean age 3.4 years (min: 3 years; max: 3 years, 7 months), were examined. The sample prevalence of enamel and dentine carious lesions (CAST code 3-7) was 91.2% while the prevalence of dentine carious lesions (CAST code 4-7) was 58.8%. The mean number of teeth with cavities that had reached the pulp and those that had an abscess or fistula were 2.0% and 0.5% respectively. The majority of enamel and dentine carious lesions were observed in molars. The CAST severity score was 7.0. Mean examination time was 57 seconds. The burden of dental caries of the children at this young age was high.

RESUMEN El objetivo del presente estudio fue determinar la prevalencia de caries dental en niños en edad preescolar de 3 años residentes en áreas suburbanas de Lima, Perú. Se trata de un análisis transversal de la situación de caries de áreas periféricas de Lima. Un procedimiento de muestreo estratificado por distribución geográfica consideraba a los centros de salud materno-infantiles y centros educativos preescolares de la jurisdicción como factores, identificando 45 centros prescolares aleatoriamente, de los cuales 17 aceptaron la invitación para participar del presente estudio. Dos odontólogas independientes, calibradas examinaron a los niños de las aulas de 3 años utilizando el instrumento Caries Assessment Spectrum and Treatment (CAST) en las instalaciones de cada jardín de infancia, utilizando luz artificial, instrumental estéril y gasas para el secado de las superficies a evaluar. Los datos fueron analizados utilizando ANOVA y el método Tamhane. Se evaluaron 308 niños, quienes tenían una edad media de 3.4 años (min: 3 años; max: 3 años, 7 meses). La prevalencia de lesiones de caries de esmalte y dentina (código CAST 3-7) fue del 91,2%, mientras que la prevalencia de lesiones de caries en dentina (código CAST 4-7) fue de 58,8%. El número promedio de dientes afectados por caries dental con compromiso pulpar y que tenían un absceso o fístula fue de 2.0% y 0.5% respectivamente. La mayoría de las lesiones de caries en esmalte y dentina se observaron en los molares. La valoración de severidad CAST fue 7.0. El tiempo promedio de examinación fue de 57 segundos. La carga de la enfermedad caries dental a estas edades tan tempranas ya es alta en la infancia suburbana de Lima.

Tendencia y factores asociados a la frecuencia de cepillado dental en menores de doce años, Perú 2013-2018 / Trend and factors associated with the frequency of tooth brushing in children under twelve years old, Peru 2013-2018

RESUMEN Objetivos. Determinar la tendencia y factores asociados al cepillado de dos o más veces por día en niños menores de doce años entre el 2013 y 2018 en Perú. Materiales y métodos. Se realizó un estudio transversal mediante análisis secundario de datos reportados por la Encuesta Demográfica y de Salud Familiar. Se consideró la información de niños con al menos un cepillado al día, considerando como «Adecuada Frecuencia de Cepillado Dental¼ (AFC) para quienes reportaban de dos a más; se generaron medidas porcentuales por ámbito geográfico, características sanitarias, de vivienda y hogar. Se determinaron los factores asociados a la AFC mediante regresión logística binaria para encuestas complejas, la variabilidad de la tendencia se identificó mediante regresión joinpoint con un 95% de confianza. Resultados. En el 2013, la AFC fue del 79,0% con un aumento a 83,9% para el 2018; se identificó que cuatro de 25 espacios geográficos se mantuvieron sin variación de AFC, y otros cuatro disminuyeron. Todas las características sanitarias mostraron favorecer el cepillado, destacándose que el no compartir el cepillo generó un OR de 2,30, IC 95%: 1,46 a 3,60. La región natural, el tipo de lugar de residencia y el quintil de riqueza afectaron la AFC; la AFC fue mayor según se incrementa el grupo etario. Conclusiones . El porcentaje de AFC ha aumentado en los últimos años, siendo influenciado favorablemente por los aspectos sanitarios; a nivel rural este porcentaje es significativamente menor, algo que también se evidencia en la región sierra.

ABSTRACT Objetivos. To determine the trend and factors associated with brushing two or more times per day in children under twelve years of age between 2013 and 2018 in Peru. Materials and Methods. A cross-sectional study was conducted by secondary analysis of data reported by the Demographic and Family Health Survey (ENDES). Information on children with at least one brushing per day was taken into account, considering as an "Adequate Toothbrushing Frequency" (ATF) for those who reported brushing two to more times per day. Percentage measures were generated by geographical area, health, housing, and household characteristics. Factors associated with an ATF were determined by using binary logistic regression for complex surveys, trend variability was identified by joinpoint regression with a 95% confidence. Results. In 2013, the ATF was 79.0%, increasing to 83.9% by 2018. Four out of 25 geographic areas were identified as having no variation on the ATF, and four others decreased. All sanitary characteristics showed favoring brushing, emphasizing that not sharing the toothbrush generated a 2.30 OR, 95% CI: 1.46 to 3.60. The natural region, type of place of residence, and wealth index quintile affected the ATF. The ATF was higher as the age group increased. Conclusions. The percentage of ATF has increased in recent years, being favorably influenced by health aspects; in rural areas, this percentage is significantly lower, something that is also evident in the Highland region.

Oral Health Advices and Illustrations Card for Use in Mother-and-Child Health Clinics: Face and Content Validity.

Background: The prevalence of Early Childhood Caries (ECC) in Peruvian children is very high especially in sub-urban areas. The dental profession is unable to solve this problem alone. Nurses have close contact with mothers and young children through the mother-and-child health clinics. Educating nurses in providing oral health advises to parents and inspecting teeth of the children regularly might reduce the prevalence of ECC. Supportive educational materials need to be developed and validated to facilitate their counselling actions. Objective: To develop and validate an oral health advisory card and related illustrations for face and content. Methodology: The infant oral health guidelines from the Peruvian Association of Dentistry for Infants (ASPOB) were adapted into statements and related illustrations, and assessed during a focus group meeting. Using the RAND modified e-Delphi consensus method, 60 panel members, covering (non-) dental professionals from 6 Latin-American countries, assessed 14 statements and illustrations for face and content, using a Likert scale (1-9). Consensus was obtained at the 90% mark point. The statements and illustrations were then field tested with 30 parents from a public school to guarantee the understanding of words and graphics used. Results: Two assessment rounds were needed. The response rates were 66.7% and 50%, for round 1 and 2, respectively. At the end of round 1, full agreement on 6 statements and illustrations was obtained. At the end of round 2, the mode value of agreement was 95.2% and concerned 8 statements and illustrations. The maximum value of 100% agreement was reached for 5 statements and illustrations. Consensus was reached for all 14 statements and illustrations. Parents approved the oral health advisory card and related illustrations. Conclusion: The newly developed oral health advisory card and related illustrations were validated for face and content and were accepted by parents.

Impact of Health Centre Nurses on the Reduction of Early Childhood Caries in Lima, Peru.

Background: The prevalence of early childhood caries (ECC) among 36-47 months-old children in Lima, Peru, is 65.5%. Dentists have no easy access to see infants but nurses do. If nurses will be trained on oral health behaviours and early recognition of signs of ECC in infants, they could assist parents in keeping infant teeth healthy, during their regular well-child visits, using an oral health advisory and control cards and by referring infants to the health centre dentist earlier. Aims: The primary aim of the study is to reduce the prevalence of ECC. Nurses will be trained in educating mothers on oral health behaviour and in detecting signs of ECC in infants. They will assist parents in keeping infant teeth healthy with assistance of an oral health advisory card during regular well-child controls and referring infants with ECC risk to the health centre dentist. Study Design: The study is a three-arm randomized clinical trial. (A) Active intervention group: nurses will receive training in oral health education and in detecting carious lesions, supported by validated oral health advisory and control cards. (B) Passive intervention group: nurses will receive the oral health advisory and control cards together with written instructions, while nurses in the (C) control group will be lectured once on good oral health behaviours. In the three groups, knowledge of nurses will be evaluated, using a validated questionnaire, pre- and post-training. The pattern of referrals and treatments will be obtained from records available in the office of the health centre dentist. The ECC status among three year olds will be assessed at baseline and after three years, as will the quality of life of the infants. Place and Duration of the Study: The study will be carried out in three districts in Lima, Peru between September 2014 and September 2017.