Objectives Early childhood caries is a challenging public health problem in the United States and elsewhere; however, there is limited information concerning risk factors in very young children. The purpose of this study was to assess baseline risk factors for 18-month caries prevalence as part of a longitudinal study of high-risk children. Methods 212 children 6–24 months of age were recruited from a rural community in Iowa. Subjects were enrolled in the WIC program, which provides nutritional support for low-income families with children. Dental examinations using d1d2-3 criteria were conducted at baseline and after 18 months. Caries prevalence was determined at the frank decay level (d2-3 or filled surfaces), as well as at the non-cavitated level (d1), and combined (d1, d2-3 or f surfaces). Risk factor data were collected at baseline and after 9- and 18- months. These data included beverage consumption data, presence of visible plaque, and use of fluoride toothpaste for children as well as mutans streptococci (MS) levels of mothers and children and family socio-demographic factors. Results 128 children (60%) remained in the study after 18 months. Among these children, prevalence of d-1d2-3/f level caries increased from 9% to 77%, while d2-3/f level caries increased from 2% to 20%. Logistic regression models for baseline predictors of d2-3f caries at the 18-month follow-up found presence of MS in children (OR=4.4; 95% CI: 1.4, 13.9) and sugar-sweetened beverages (OR=3.0; 95% CI: 1.1, 8.6) to be the only significant risk factors. Socio-demographic factors and use of fluoride toothpaste were not significant in these models. Conclusions Results suggest that early colonization by MS and consumption of sugar-sweetened beverages are significant predictors of early childhood caries in high-risk populations.

It is ten years since the first paper on the Hall Technique was published in the British Dental Journal and almost 20 years since the technique first came to notice. Dr Norna Hall a (now retired) general dental practitioner from the north of Scotland had, for many years, been managing carious primary molar teeth by cementing preformed metal crowns over them, with no local anaesthesia, tooth preparation or carious tissue removal. This first report, a retrospective analysis of Dr Hall's treatments, caused controversy. How could simply sealing a carious lesion, with all the associated bacteria and decayed tissues, possibly be clinically successful? Since then, growing understanding that caries is essentially a biofilm driven disease rather than an infectious disease, explains why the Hall Technique, and other 'sealing in' carious lesion techniques, are successful. The intervening ten years has seen robust evidence from several randomised control trials that are either completed or underway. These have found the Hall Technique superior to comparator treatments, with success rates (no pain or infection) of 99% (UK study) and 100% (Germany) at one year, 98% and 93% over two years (UK and Germany) and 97% over five years (UK). The Hall Technique is now regarded as one of several biological management options for carious lesions in primary molars. This paper covers commonly asked questions about the Hall Technique and speculates on what lies ahead.

Objectives-Dental caries in early childhood is an important public health problem. Previous studies have examined risk factors, but they have focused on children during the later stages of the disease process. The purpose of this study was to assess the factors associated with caries in children aged 6 to 24 months as part of a cross-sectional analysis.Methods-Two hundred twelve mothers with children 6 to 24 months of age were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children clinic sites in southeastern Iowa for participation in a longitudinal study of dental caries. Baseline assessments included detailed questions regarding the children's beverage consumption, oral hygiene, and family socioeconomic status. Dental caries examinations using the d 1 d 2-3 f criteria and semiquantitative assessments of salivary mutans streptococci (MS) levels of mother and child were also conducted. Counts of the number of teeth with visible plaque were recorded for maxillary and mandibular molars and incisors.Results-Of the 212 child/mother pairs, 187 children had teeth. Among these children, the mean age was 14 months, and 23 of the children exhibited either d 1 , d 2-3 , or filled lesions. Presence of caries was significantly associated with older age, presence of MS in children, family income < $25,000 per year, and proportion of teeth with visible plaque.Conclusions-Results suggest that not only microbial measures, including MS and plaque levels, are closely associated with caries in very young children, but that other age-related factors may also be associated with caries. Continued study is necessary to more fully assess the risk factors for caries prevalence and incidence in preschool children.

Objectives The “optimal” intake of fluoride has been widely accepted for decades as between 0.05 and 0.07 mg fluoride per kilogram of body weight but is based on limited scientific evidence. The purpose of this paper is to present longitudinal fluoride intake data for children free of dental fluorosis in the early-erupting permanent dentition and free of dental caries in both the primary and early-erupting permanent teeth as an estimate of optimal fluoride intake. Methods Data on fluoride ingestion were obtained from parents of 602 Iowa Fluoride Study children through periodic questionnaires at the ages of 6 weeks, 3, 6, 9, 12, 16, 20, 24, 28, 32 and 36 months, and then at 6-month intervals thereafter. Estimates of total fluoride intake at each time point were made by summing amounts from water, dentifrice, and supplements as well as other foods and beverages made with or containing water. Caries data were obtained from examinations of children at ages 5 and 9 years, while fluorosis data were obtained from examinations only at age 9. Results The estimated mean daily fluoride intake for those children with no caries history and no fluorosis at age 9 was at or below 0.05 mgF/kg bw for nearly all time points through the first 48 months of life, and this level declined thereafter. Children with caries had generally slightly less intakes, while those with fluorosis generally had slightly higher intakes. Conclusions Given the overlap among caries/fluorosis groups in mean fluoride intake and extreme variability in individual fluoride intakes firmly recommending an “optimal” fluoride intake is problematic.

Objective Very few studies have examined the relationship between timing of fluoride intake and development of dental fluorosis on late-erupting permanent teeth using period-specific fluoride intake information. This study examined this relationship using longitudinal fluoride intake information from the Iowa Fluoride Study. Methods Participants’ fluoride exposure and intake (birth to 10 years) from water, beverages, selected food products, dietary fluoride supplements and fluoride toothpaste was collected using questionnaires sent to parents at 3- and 4- month intervals from birth to age 48 months, and every six months thereafter. Three trained and calibrated examiners used the Fluorosis Risk Index (FRI) categories to assess 16 late-erupting teeth among 465 study participants. A tooth was defined as having definitive fluorosis if any of the zones on that tooth had an FRI score of 2 or 3. Participants with questionable fluorosis were excluded from analyses. Descriptive and logistic regression analyses were performed to assess the importance of fluoride intake during different time periods. Results Most dental fluorosis in the study population was mild, with only 4 subjects (1%) having severe fluorosis (FRI Score 3). The overall prevalence of dental fluorosis was 27.8%. Logistic regression analyses showed that fluoride intake from each of the individual years from age 2 to 8 years plays an important role in determining the risk of dental fluorosis for most late-erupting permanent teeth. The strongest association for fluorosis on the late-erupting permanent teeth was with fluoride intake during the sixth year of life. Conclusion Late-erupting teeth may be susceptible to fluorosis for an extended period from about age 2 to 8 years. Although not as visually prominent as the maxillary central incisors, some of the late-erupting teeth are esthetically important and this should be taken into consideration when making recommendations about dosing of fluoride intake.