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Background: Early childhood caries remains an unsolved problem in children under three worldwide. Midwives are important health care persons around birth and can shape behavior. They possibly can play a positive role in preventing early childhood caries in young children. Objective: to assess how involved midwives are in early childhood caries prevention, what preventive measures they recommend and what knowledge they have about early childhood caries, as well as to study the potential differences between the various federal states or due to their work experience. Materials and Methods: An online survey targeted midwives in Germany regarding their knowledge about early childhood caries as well as the preventive measures they recommended. Participants were members of the German Association of Midwives (DHV). The survey invitation was published with the monthly newsletter and in the association journal of the DHV. Data was collected anonymously. Results: 191 midwives nationwide responded to the questionnaire. Most midwives were aware about ECC prevalence, consequences, causes and the teeth mainly affected. Midwives gave excellent recommendations regarding diet, oral hygiene and avoiding prolonged bottle feeding. However, only 40.8% of midwives recommended the first dental visit with the eruption of the first tooth. 71.7% recommended a fluoride tooth paste with the eruption of the first tooth. The rest advised a later use or non-fluoridated toothpaste. Regional differences were minimal. Conclusion: Midwives have good oral health knowledge, but there is some variability in recommendations on the first dental visit and the use of fluoride toothpaste which reflects an inconsistency of professional recommendations delivered by different health care institutions in Germany.
Background: Despite of the remarkable caries reduction in permanent dentition, caries levels of primary teeth has stagnated in Germany. Early Childhood Caries (ECC) or also known as baby bottle tooth decay is the most vulnerable form of caries in young children, but minimal data and information from different German states are available to determine the appropriate preventive programs. Aim: The purpose of the current study is to find the prevalence of ECC among young children in the state of Mecklenburg-Vorpommern (North-East Germany) and to optimize an intervention on ECC prevention in a community setting. In addition to education, fluoride varnish is evaluated on young children with active ECC. Design: In this cross-sectional study, a total of 4283 children living in the state of Mecklenburg-Vorpommern were examined. Four age groups - with an accuracy of one day - were formed as follows: less than one year (n=8), one year (n=293), two years (n=1618) and three years (n=1888). The examination was carried out by community dental service’s examiners whom are calibrated to ECC diagnostic criteria of Robke and Buitkamp (2002), and dmf-t values for caries diagnosis. These data are compared by those of children (n=5355) of same age group for the year 2011-2012. In addition, a structured questionnaire on the starting preventive programme on ECC was filled out by the community dentists and for the city of Greifswald, fluoride varnish (Duraphat®, 5% NaF = 2.26%F, Colgate-Palmolive, Germany) was applied for 32 children previously diagnosed with active ECC (ECC1: n=15, ECC2: n=17). Lesions are identified as active or non active according to texture and luminosity, and oral hygiene index (OHI-S) is measured and re-evaluated at three months follow up. Results: The percentage of children under three years old in 2012-2013 with ECC was comparatively low (4%) which possibly reflects the very young age of the children and a restriction for ECC on the upper incisors. The overall caries prevalence in Mecklenburg-Vorpommern varied from 9% to 15%. Most cavitated lesions are untreated. These results are comparable with the results from other German counties. The interventions of the ECC programme vary considerably among the different counties. There was no significant difference in the oral hygiene index (OHI-S) prior and post fluoride varnish application (p-value = 0.25). The use of fluoride varnish resulted in an 81%, statistically significant decrease of active ECC lesions in Greifswald (p < 0.001). Conclusion: The prevalence of caries among young children was considerable in Mecklenburg-Vorpommern. A preventive intervention in nurseries and fluoride varnish applications for active ECC lesions seems to be a feasible approach in controlling caries in early childhood. However, further quality management and standardization of the program should be reinforced.