Dental Caries Among Young Children With Special Health Care Needs

Objectives: 1) Document the prevalence of dental caries among a sample of preschool age children with special health care needs, 2) Assess caries-risk (streptococcus mutans (MS) colonization, prescription medication use) and caries-protective factors (use of fluoridated toothpaste and topical fluoride varnish), and 3) compare these factors and dental caries among children with and without functional limitations.

Methods: Participants were part of an observational study of the dental health needs of children with disabilities or chronic medical conditions. The data were obtained by parent interview and a clinical exam. Decayed, missing and filled teeth (dmft) were identified based on WHO criteria and the presence of MS was detected through Dentocult SM Strip mutans testing. MS colonization was defined as a culture of >10⁶ CFU. Associations between risk and protective factors: MS colonization, use of prescription medications, fluoride toothpaste, number of fluoride varnish applications, and caries experience were examined by logistic regression. Likelihood ratio tests were used to test whether there was effect modification of the relationship between the risk and protective factors and caries experience by functional limitation.

Results: Eighty-seven children ages 24 to 62 months were examined.  More than half were under 3 years old (55.2%), male (66.7%), and Non-Hispanic White (60.9%).  Nearly one-quarter (24.1%) had caries; the mean dmft was 1.3 (SD=3.43). Sixty-two children (71%) had a functional disability. Functional disability was not associated with a higher prevalence of caries. Fluoride exposure did not show a protective effect. Children with a MS culture  >10⁶ CFU were 3.6 times more likely to have caries (AOR 3.6 (1.1, 11.9) p<0.03).

Conclusions: Caries preventive efforts for this vulnerable population are warranted. Routine MS identification is recommended as it is a strong early predictor of dental caries.