Topical antimicrobial therapy in the prevention of early childhood caries

Early childhood caries (ECC) is microbiologically characterized by heavy infection of mutans streptococci (ms) on dental surfaces. Accordingly, it is reasonable to speculate that suppression of dental ms levels would decrease risk for ECC. On this basis, randomized double blind, placebo controlled pilot study was performed to test this concept.

The study population consisted of 31 subjects (age: 12 to 19 mos; sex: 18F/13M) who were clients of a Women, Infants, and Children (WIC) clinic in Puerto Rico. Inclusion criteria included: (1) unremarkable medical history; (2) presence of 4 maxillary primary incisors (PMI) with no visible defects; (3) clinically caries free; (4) use of a nursing bottle at naptime and/or bedtime which contained a cariogenic substrate; (5) two consecutive ms positive cultures (utilizing Mitis-Salivarius-Bacitracin (MSB) agar) from pooled PMI plaque. The subjects were randomized into 2 groups. The 15 subjects in the experimental group and the 16 subjects in the control group were evaluated every 2 months during the study period. At each evaluation, the subjects had 10% povidone iodine (experimental group) or placebo (control group) applied to their dentition. The placebo was commercial instant tea (without lemon or sweetener) and deionized water. Treatment failure was defined as the appearance of a white spot lesion(s) on any of the PMI during the study period.

The mean duration of observation to treatment failure was 155 days; the mean duration of observation for treatment success was 217 days. Five of the 16 control subjects and 0 of the 15 experimental subjects experienced treatment failure (Fisher's exact test: P = 0.04). The Kaplan-Meier estimate for incidence of treatment failure in the placebo group was 48% over 357 days (P = 0.02).

These observations suggest that topical antimicrobial therapy reduces risk for the development of ECC in high-risk children.