Effects of nursing bottle misuse on oral health. Prevalence of caries, tooth malalignments and malocclusions in North-German preschool children.

OBJECTIVE

Aim of this epidemiological study was to provide basic, representative data on the oral health of preschool children in northwestern Germany.

SUBJECTS AND METHODS

Clinically examined were the prevalence of caries, proportion of early childhood caries (ECC) due to nursing bottles--referred to as nursing bottle caries (NBC)--and the frequencies and extent of malocclusions in the primary dentition of 434 preschool children (50.5% male, 49.5% female) aged 2 to 6 years. To assess the children's dental status, the d(1-4)mf-s/t index was determined, and orthodontic findings were clinically assessed as sagittal, transversal, vertical single-arch, and occlusal. The examinations took place in kindergartens and child-care facilities.

RESULTS

Sixty-one percent of the examined preschool children had caries-free dentition, 25% had no tooth misalignments or malocclusions. The caries prevalence (dmf-t-value) amounted to 2.0. The high percentage of NBC in the 3-to 6-year-old children (20.3% manifest NBC, 9.0% initial NBC) indicated considerable deficits in terms of nutritional behavior and the frequent "misuse" of nursing bottles in infants. The NBC almost always correlated with extensive tooth damage, the dmf-t-value in this subpopulation amounted to 7.2. Initial carious lesions in infants were observed almost exclusively on the maxillary incisors. Primary crowding was the dominant malocclusion in 36.9%, followed by increased overjet in 30.6%. I observed a loss of maxillary incisors due to carious lesions in 7.6% of the children and a loss of the supporting zone in 9.9%. 16.1% of the children showed a deep bite, and 14.7% an open bite. Vertical discrepancies were apparent in 63.6% of the children with massive carious damage to the maxillary incisors (NBC).

CONCLUSIONS

The importance of starting caries prophylaxis early cannot be stressed highly enough in light of the high prevalence of ECC, in particular NBC. The implementation of interceptive, early treatment measures should be intensified due to the high number of malocclusions in primary dentition. An improved combined approach of preventive caries therapy and preventive orthodontic therapy would be a most welcome overall development.