Long-term effectiveness of a nutritional program in reducing early childhood caries: a randomized trial

Objectives: To investigate the effectiveness of home visits advising mothers about healthy feeding practices during the first year of life on the occurrence of early childhood caries and severe early childhood caries at 4 years of age. Methods: We conducted a parallel randomized trial of mothers of single, full-term children with birthweight >= 2500g in Sao Leopoldo, Brazil. The intervention group received monthly advice up to 6 months and then at 8, 10 and 12 months by undergraduate nutrition students, based on the ``Ten Steps for Healthy Feeding'', a Brazilian national health policy for primary care based on World Health Organization guidelines. The primary outcome was the occurrence of early childhood caries at age four. Secondary outcomes included the occurrence of severe early childhood caries and the number of affected teeth: decayed (white spots and cavities), missing and filled teeth (d(1+)mft). Blinded observers ascertained feeding habits in the home and one blinded dentist performed dental examinations in a municipal clinic. This study is registered with ClinicalTrials.gov, number NCT00629629. Results: Of 500 mother-child pairs (200 intervention, 300 control) enrolled, 340 (141 intervention, 199 control) completed 4 year follow-up. As 138 (69.3%) controls but only 76 (53.9%) intervention children had early childhood caries, home counseling reduced incidence by 22% (RR 0.78; 95% CI 0.65-0.93). Severe early childhood caries incidence was reduced by 32% (RR 0.68; 95% CI 050-0.92). The mean number of affected teeth was lower for the intervention group (3.25) compared with the control group (4.15) (Mann Whitney U-test; p=0.023). No adverse effects were noted. Conclusions: Home nutritional advice during the first year of life decreases caries incidence and severity at four years of age in a low income community.