There have been numerous clinical trials to explore the effect of various preventive approaches in pre-school children, such as sealants, fluorides, diet modification, antimicrobials, mineral trioxide, xylitol, and preventing maternal transfer of mutans streptococci.  So far the most favorable results have been found with fluoridated toothpaste, fluoride varnish, and adjusting drinking water to optimal fluoride levels.

The role of tooth brushing in the prevention of tooth decay has long been considered self-evident. Yet there is little evidence to support the notion that tooth brushing per se reduces caries. However, there is convincing evidence for the decay-preventing benefit of tooth brushing when used with a fluoride-containing toothpaste.  Studies have shown that daily tooth brushing with fluoride toothpaste in 3-6 year olds significantly reduces caries incidence.  To prevent fluorosis from excessive swallowing of toothpaste, children’s brushing should be supervised with dispensing only a “pea-sized” amount for children over three years old, and a “smear” for children under age three. 

Fluoride varnish is ideally suited for topical applications to the teeth of preschool children because of ease of use, acceptability to young children and reduced risk of over ingestion of fluoride.  Although fluoride varnish has been widely used in Europe for more than 30 years, it was not introduced into the United States until 1991.  The efficacy of fluoride varnish to reduce caries in primary teeth has been shown in several studies (see table on the right). 

If the fluoride content of the child’s drinking water is unknown, a sample of the water should be analyzed for fluoride content, and subsequently systemic fluoride supplementation can be recommended considering the fluoride content of the water, the child’s age, as well as the child’s caries risk.  Data from over 20 clinical trials show caries reduction in primary teeth of 30-80% from fluoride supplements, provided that they are started close to birth and continued for five or more years.  However, there also is a growing body of literature showing that children, whether living in a fluoridated or non-fluoridated area, ingest sufficient quantities of fluoride from dentifrice, beverages and foods, and there is an association of dental fluorosis in the permanent teeth with fluoride supplement use.  Therefore, recent recommendations suggest that fluoride supplements only should be prescribed to children residing in non-fluoridated communities, who are identified as being at high caries risk.

A multitude of clinical trials during the past several decades have shown that dental sealants are safe and highly effective in preventing pit and fissure caries.  Despite their effectiveness, however, sealant utilization has remained low in preschool children because practitioners are not convinced of its efficacy in primary teeth, difficulty in placing them in preschool children, and sealants placement in primary teeth is not a reimbursable in most dental insurance plans, including Medicaid.  





Mineral Trioxide Paste


Preventing Maternal Transmission