Kamila Plutzer

Bio: Kamila Plutzer is an academic researcher from University of Adelaide. The author has contributed to research in topics: Early childhood caries & Randomized controlled trial. The author has an hindex of 8, co-authored 11 publications receiving 420 citations.

Efficacy of an oral health promotion intervention in the prevention of early childhood caries.

Abstract: – Objective: Despite a marked improvement in oral health of Australian children over the last 30 years, severe early childhood caries (S-ECC) affects up to 17% of 2- to 3-year-old children with some requiring hospitalization and invasive treatment. This provided a compelling rationale to develop and test an oral health promotion programme which aimed to reduce this unnecessary suffering. The purpose of this study was to test the efficacy of an oral health promotion programme for the parents of infants, starting during the pregnancy, using a randomized controlled trial. Methods: A programme was developed around the provision of anticipatory guidance to nulliparous women (women expecting their first child) in Adelaide. Mothers in the test group received oral health promotion information during pregnancy, and later when the child reached 6 and 12 months of age. After the second round of information the test group mothers were randomized again. The information was reinforced in one of the test subgroups through a telephone consultation. There was no contact with mothers in the control group after enrolment. At the age of 20 ± 2.5 months all test and control group children were examined by a dentist. The case definition of an incidence of S-ECC was one or more upper incisor teeth being carious at the level of a cavitated or noncavitated lesion. The differences in S-ECC incidence between the test and control groups, and the test subgroups were analysed. Results: Of 649 women enroled in the programme (test group 327, control group 322), 441 had their child examined at follow-up. The incidence of S-ECC in the test group was 1.7% and in the control group 9.6% (P < 0.001). Conclusion: An oral health promotion programme based on repeated rounds of anticipatory guidance initiated during the mother’s pregnancy was successful in reducing the incidence of S-ECC in these very young children.

Women's attitudes to and perceptions of oral health and dental care during pregnancy.

Abstract: Aims: To assess pregnant women’s opinions on and perceptions of oral health and their relationship to oral hygiene and dental care practices. Methods: Questionnaire survey on perceived oral health, oral hygiene and utilization of dental services among 649 nulliparae attending for antenatal care at all public antenatal clinics in Adelaide, South Australia. Results: Women rated their general health significantly better than their oral health (P-0.001) and attributed more importance to healthy teeth for their baby than for themselves (P-0.001). Only 35% had dental care during pregnancy; 35% had no dental visit for at least two years and 27% reported cost as a major deterrent. Eighteen percent had experienced gingival bleeding before pregnancy and 41% during pregnancy. Gingival bleeding outside pregnancy was clearly related to perceived oral health (P-0.001), but this was less so for bleeding during pregnancy. The latter was not related to age, level of education, employment, marital status, or smoking habits. Only 38% of women with gingival bleeding in pregnancy had a dental care visit in pregnancy and 28% considered their oral health as very good. Conclusions: Many pregnant women do not perceive gingival bleeding as indicating inflammatory disease and seek no professional help for it. Maternity care providers need to devote more attention to oral health in antenatal clinics and antenatal education.

Reassessment at 6–7 years of age of a randomized controlled trial initiated before birth to prevent early childhood caries

Abstract: Plutzer K, Spencer AJ, Keirse MJNC. Reassessment at 6–7 years of age of a randomized controlled trial initiated before birth to prevent early childhood caries. Community Dent Oral Epidemiol 2012; 40: 116–124. © 2011 John Wiley & Sons A/S Abstract – Objectives: To assess whether the effect of providing mothers with guidance during pregnancy and when the child was 6 and 12 months old, which had drastically reduced the prevalence of early childhood caries at 20 months of age, would be sustained at 6–7 years of age. Methods: Children, whose mothers had been enrolled in a randomized controlled trial during pregnancy and a comparison group of similar school children, were examined for the presence of caries by the South Australian School Dental Services (SA SDS) at 6–7 years of age. Results: Of 625 eligible trial participants, 277 (44%) participated in the follow-up and dental records were available for 187 of them (30%). Loss to follow-up and reasons for it were similar in the intervention and control groups. At 6–7 years of age, 33% of children in the trial had caries compared with 42% in the SA SDS comparison group (n = 263). All measures of caries severity (d3mft, d3mfs and SiC30) were lower, but not significantly so, in the intervention than in the control group. Children in the comparison group of school children had more severe caries than those in the trial (P < 0.01) and in the intervention group especially (P < 0.005). Children in both randomized groups suffered significantly less toothache than those in the comparison group (P < 0.001). Conclusions: Providing new mothers with guidance on caries prevention helps to reduce early childhood caries and has a sustainable effect up to school age.

Incidence and prevention of early childhood caries in one- and two-parent families

Abstract: Background Since the mid-1990s, there has been an increase in early childhood caries (ECC) in Australia and an increase in children living in one-parent families. Objective To examine whether single parenthood (mother only) affects the effectiveness of an oral health promotion programme to prevent ECC in their child. Methods First-time mothers were enrolled in a randomized controlled trial of anticipatory guidance to prevent ECC. The intervention was applied during pregnancy and when the child was 6 and 12 months old. Mothers in the control group received no intervention. The presence of ECC was assessed at 20 months of age and compared between children from one- and two-parent families. Results Of 649 women enrolled, 441 brought their child for dental assessment. Eighty-seven (19.7%) had a one-parent family. Children from one-parent families had a 2.3 times higher incidence of ECC than children from two-parent families. The intervention reduced the frequency of ECC from 8.1% to 1.1% in two-parent families (relative risk: 0.14) and from 16.3% to 4.5% (relative risk: 0.28) in one-parent families. One case of ECC was prevented for every nine single mothers receiving anticipatory guidance compared with one case per 15 partnered mothers. Despite a greater reduction in the absolute risk of ECC in children from one-parent families, the intervention reduced their ECC experience only 3.5-fold compared with sevenfold in children from two-parent families. Conclusion The intervention produced a greater reduction in the frequency of ECC in children from one-parent families than in those from two-parent families. This did not reduce their disadvantage, though, as they still had a four times higher risk than children from two-parent families. Mothers and children in one-parent families need substantially more attention and support than those in two-parent families to eliminate their disadvantage in suffering ECC.

How first-time mothers perceive and deal with teething symptoms: a randomized controlled trial.

Abstract: Background Teething, especially in their first child, continues to be a daunting problem for parents. Objective The objective of this paper was to assess the effects of providing first-time mothers with information about symptoms commonly associated with teething and ways to manage these. Methods In a randomized controlled trial to decrease the incidence of early childhood caries, we included information on teething as another issue in a child's oral health. Mothers in the intervention group received three rounds of printed information: at enrolment during pregnancy and when the child was 6 and 12 months old. Information on teething arrived when a child reached 6 months of age. Outcome assessment was at 20 ± 2.5 months of age. Data were complemented with a systematic search for evidence on teething symptoms and how to alleviate them in other populations. Results Of 649 expectant mothers enrolled in the study, 441 completed the ‘Child's oral health’ questionnaire. There were no significant differences in teething symptoms reported by mothers in the intervention (n= 232) and control (n= 209) groups. However, mothers in the intervention group were less likely to use topical and oral medications to manage teething problems (P < 0.03) and relied more on rubbing the gums to ease discomfort (P < 0.005) than mothers in the control group. Conclusions Providing mothers with information on how to address teething symptoms markedly reduced the use of medications for symptom relief. There is still need for better evidence, first, on what symptoms can or cannot be attributed to teething and, second, on what is effective in alleviating them.

The Role of Bacteria in the Caries Process: Ecological Perspectives

Abstract: Dental biofilms produce acids from carbohydrates that result in caries. According to the extended caries ecological hypothesis, the caries process consists of 3 reversible stages. The microflora on clinically sound enamel surfaces contains mainly non-mutans streptococci and Actinomyces, in which acidification is mild and infrequent. This is compatible with equilibrium of the demineralization/remineralization balance or shifts the mineral balance toward net mineral gain (dynamic stability stage). When sugar is supplied frequently, acidification becomes moderate and frequent. This may enhance the acidogenicity and acidurance of the non-mutans bacteria adaptively. In addition, more aciduric strains, such as ‘low-pH’ non-mutans streptococci, may increase selectively. These microbial acid-induced adaptation and selection processes may, over time, shift the demineralization/remineralization balance toward net mineral loss, leading to initiation/progression of dental caries (acidogenic stage). Under severe and p...

School Interventions–based Prevention of Early-Childhood Caries among 3–5-year-old children from very low socioeconomic status: Two-year randomized trial

Abstract: OBJECTIVES To assess the effectiveness of school-based interventions to prevent early childhood caries (ECC) among preschool children from very low socioeconomic background over a period of 2 years. MATERIALS AND METHODS Four hundred and twenty preschool children between the ages of 3-5 years participated in this double blind, three parallel arm clinical trial. School only interventions such as prohibition of sugary snack consumption in school, teacher supervised daily brushing using fluoridated toothpaste, and oral health education were implemented with regular follow-up at 6 months, 1, and 2 years. The study group had all three interventions, in active control-tooth brushing and oral health education, and in negative control, only oral health education. Decay at d1/d2 using World Health Organization criteria, visible plaque and gingival inflammation were assessed at all follow-ups. The value of P < 0.05 was considered significant. RESULTS Absolute caries risk reduction in the study group was 20 percent and 12 percent when compared to active, negative controls after 2 years. Mean caries increment in the study group was 0.4 for d1/d2, for the active control group was 0.9 and negative control 0.8. The effect of interventions to prevent ECC in each group was calculated using the Cohen's d, and the study group had a score of 0.6 when compared with active controls and 0.9 in comparison to the negative control group. CONCLUSIONS Prohibition of sugary snacking in school and daily supervised tooth brushing, with or without oral health education is effective in preventing ECC among preschool children with health neglect in very low-resource settings.

Assessing the relationship between children's oral health status and that of their mothers.

Abstract: Background The authors conducted a study to describe the relationship between the oral health of young children and that of their mothers. Methods Using data from the Third National Health and Nutrition Examination Survey and a related birth certificate–linked file, the authors compiled a sample of 1,184 mother/child pairs for children aged 2 through 6 years. The authors performed logistic and cumulative logistic regression analyses by using children's caries experience and untreated caries status as dependent variables. They evaluated the mothers' untreated caries status and tooth loss status along with other covariates, including age, race/ethnicity and poverty status. Results Children of mothers who had high levels of untreated caries were more than three times as likely (odds ratio [OR], 3.5; 95 percent confidence interval [CI], 2.0–6.2) to have higher levels of caries experience (treated or untreated dental caries) compared with children whose mothers had no untreated caries. A similar relationship was observed between mothers' tooth loss and caries experience among their children. The children of mothers with high levels of tooth loss were more than three times as likely (OR, 3.3; 95 percent CI, 1.8–6.4) to have higher levels of caries experience compared with children of mothers with no tooth loss; for mothers with moderate tooth loss, the OR was 2.3 (95 percent CI, 1.5–3.5). Conclusions Mothers' oral health status is a strong predictor of the oral health status of their children. Practice Implications Preventive plans for children should be based on a caries risk assessment. The results of this study demonstrate that basic information obtained from the child's mother regarding her oral health status is valuable in helping the dentist determine the child's caries risk.

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

Abstract: Feldens CA, Giugliani ERJ, Duncan BB, Drachler ML, Vitolo MR Long-term effectiveness of a nutritional program in reducing early childhood caries: a randomized trial Community Dent Oral Epidemiol 2010; 38: 324–332 © 2010 John Wiley & Sons A/S Abstract – 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 (d1+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 ClinicalTrialsgov, 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 (693%) controls but only 76 (539%) intervention children had early childhood caries, home counseling reduced incidence by 22% (RR 078; 95% CI 065-093) Severe early childhood caries incidence was reduced by 32% (RR 068; 95% CI 050-092) The mean number of affected teeth was lower for the intervention group (325) compared with the control group (415) (Mann Whitney U-test; p=0023) 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

Women's attitudes to and perceptions of oral health and dental care during pregnancy.

Abstract: Aims: To assess pregnant women’s opinions on and perceptions of oral health and their relationship to oral hygiene and dental care practices. Methods: Questionnaire survey on perceived oral health, oral hygiene and utilization of dental services among 649 nulliparae attending for antenatal care at all public antenatal clinics in Adelaide, South Australia. Results: Women rated their general health significantly better than their oral health (P-0.001) and attributed more importance to healthy teeth for their baby than for themselves (P-0.001). Only 35% had dental care during pregnancy; 35% had no dental visit for at least two years and 27% reported cost as a major deterrent. Eighteen percent had experienced gingival bleeding before pregnancy and 41% during pregnancy. Gingival bleeding outside pregnancy was clearly related to perceived oral health (P-0.001), but this was less so for bleeding during pregnancy. The latter was not related to age, level of education, employment, marital status, or smoking habits. Only 38% of women with gingival bleeding in pregnancy had a dental care visit in pregnancy and 28% considered their oral health as very good. Conclusions: Many pregnant women do not perceive gingival bleeding as indicating inflammatory disease and seek no professional help for it. Maternity care providers need to devote more attention to oral health in antenatal clinics and antenatal education.