One of the main results achieved by our project was to increase the number of children using toothbrush and toothpaste specific for the age group. Regarding toothpaste, we had a statistically significant increase in children using one containing fluorine. The use of fluorine is the principal factor that reduces the prevalence of caries (3, 17). Fluoride is known to prevent caries by inhibiting demineralization enhancing remineralization and inhibiting bacterial growth (18). In fact, the national guidelines for the promotion of oral health and the prevention of oral pathologies in developmental age (14) indicate that from 6 months to 6 years of age (age group in which our children fall), fluoroprophylaxis can be carried out through the use of a toothpaste containing at least 1000 ppm of fluorine, 2 times a day, in a pea-size dose.
The National Guidelines for the Promotion of Oral Health and the Prevention of Oral Diseases in Developmental Age (13) also emphasize that since the eruption of the first deciduous tooth, the teeth must be thoroughly cleaned with gauze or rubber finger. The use of the toothbrush with a small-head soft brush should be started as soon as possible (19) to familiarize the child with it.
The analysis of the data also report an increasing trend in the number of daily washes, both in the evening and in the morning. The removal of soft deposits from oral surfaces is important for the maintenance of dento-periodontal health (14). However, there is only a weak relationship between the frequency of brushing and the reduction in the incidence of caries: it is, in fact, difficult to distinguish between the preventive effect given by the mechanical removal of the plaque and the effect offered by the fluorine contained in the toothpaste (5, 14). The Italian guidelines report that the correct brushing of the teeth, at least twice a day, prevents gingivitis; there is scientific evidence that the correct oral hygiene habits must be acquired during childhood (19), to be strengthened later during adolescence. Our data highlight another important fact, our educational intervention has reduced the number of children who brush their teeth independently without any parental support. In fact, it is strongly suggested that oral hygiene for children from 0 to 3 years should be complete parents responsibility (5, 20, 21); also it is important that parents set a good example: the child who sees parents brushing their teeth daily several times a day is spontaneously led to imitate them (1, 2, 13).
Unfortunately, our data report that there was no increase in the number of children who made their first dental visit, a topic that we had instead emphasized during the parents’ meeting. In fact, it is known that the first dental visit should be made around 18/24 months regardless of the presence or absence of dental problems (3, 22). Moreover that patients under 6 years of age with low risk of developing caries should carry out check-ups every 12 months in case the dentist evaluates a greater risk, the visits will be more frequent (14).
As for the development of caries, it must be emphasized that there are various carbohydrates that can be effectively fermented by bacteria. In addition to sucrose, in order of cariogenicity, there are glucose, maltose, fructose and lactose (23). Therefore, the intake of drinks and foods containing simple carbohydrates is not recommended outside main meals (6, 17, 19, 24). In this regard, we have observed only a slight trend in the reduction of children who snack at night. The use of sweetened pacifier and the non-nutritional use of the bottle containing sugary drinks must be strongly discouraged (13, 14) especially at night, when the salivary flow is greatly reduced. In this regard, during the meetings, we suggested to the parents to continue, at least for a certain period of time, bottle feeding at night, if this was used to aid sleep, but only with water (13).
School-based educational programs held by health professionals may offer the best opportunities for implementing useful and sustainable interventions that are effective in both children and adolescents (12). Contento defined nutrition education as “any combination of educational strategies, accompanied by environmental supports, designed to facilitate voluntary adoption of food choices and other food- and nutrition-related behaviors conducive to health and well-being” (25). For successful nutrition education interventions it is important to study the specific characteristics of effective nutrition education programs and to identify the aspects of nutrition education that are essential for the age group considered (26). We hypothesized that the success of the food education intervention is due to the strategy adopted: engaging neo-parents, generally more likely to improve, organizing face-to-face sessions in order to use appropriate and effective communication, identifying specific behaviors to be modified, and the support of teachers.
Our project has ambitious goals for the future such as involving a larger number of individuals, expanding the geographical range of interest and structuring increasingly appropriate meetings.