Background: Early childhood caries is considered one of the most prevalent diseases in childhood, affecting almost half of preschool-age children globally. In the Netherlands, approximately one-third of children aged 5 years already have dental caries, and dental care providers experience problems reaching out to these children. Objective: Within the proposed trial, we aim to test the hypothesis that, compared to children who receive usual care, children who receive the Toddler Oral Health Intervention as add-on care will have a reduced cumulative caries incidence and caries incidence density at the age of 48 months. Methods: This pragmatic, 2-arm, individually randomized controlled trial is being conducted in the Netherlands and has been approved by the Medical Ethics Research Board of University Medical Center Utrecht. Parents with children aged 6 to 12 months attending 1 of the 9 selected well-baby clinics are invited to participate. Only healthy children (ie, not requiring any form of specialized health care) with parents that have sufficient command of the Dutch language and have no plans to move outside the well-baby clinic region are eligible. Both groups receive conventional oral health education in well-baby clinics during regular well-baby clinic visits between the ages of 6 to 48 months. After concealed random allocation of interventions, the intervention group also receives the Toddler Oral Health Intervention from an oral health coach. The Toddler Oral Health Intervention combines behavioral interventions of proven effectiveness in caries prevention. Data are collected at baseline, at 24 months, and at 48 months. The primary study endpoint is cumulative caries incidence for children aged 48 months, and will be analyzed according to the intention-to-treat principle. For children aged 48 months, the balance between costs and effects of the Toddler Oral Health Intervention will be evaluated, and for children aged 24 months, the effects of the Toddler Oral Health Intervention on behavioral determinants, alongside cumulative caries incidence, will be compared. Results: The first parent-child dyads were enrolled in June 2017, and recruitment was finished in June 2019. We enrolled 402 parent-child dyads. Conclusions: All follow-up interventions and data collection will be completed by the end of 2022, and the trial results are expected soon thereafter. Results will be shared at international conferences and via peer-reviewed publication. Trial Registration: Netherlands Trial Register NL8737; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8737

There is growing evidence for the beneficial effects of starting oral health prevention early in life. Preventing dental caries in very young children requires considerable investment from parents. Therefore, this cross-sectional study aimed to explore parents’ willingness to pay (WTP) and willingness to invest in time (WTIT) for primary oral health prevention in preschool children and describe whether these are related to the parents’ demographic, socio-economic and behavioural characteristics. In a convenience sample of parents of preschool children aged six months to four years (n = 142), data were collected with questionnaires. On average, parents were willing to pay EUR15.84 per month, invest time for 1.9 dental visits per year, and spend 2.4 min per day brushing their child’s teeth. A higher education level of the mother and having a child older than two were associated with a higher WTIT in brushing minutes per day (p = 0.03). In addition, parents who brushed their child’s teeth more frequently were also more willing to invest in brushing minutes (p < 0.01) and money (p < 0.01). Findings emphasise the importance of early oral health interventions and the need to increase awareness of primary prevention’s importance in maintaining healthy teeth and reducing possibly oral health inequalities.

Samenvatting: Inleiding: Het doel van dit vragenlijstonderzoek was om de attitude, kennis, informatiebehoefte en uitvoering van mondgezondheidsbevordering door jeugdartsen en jeugdverpleegkundigen op het consultatiebureau in kaart te brengen. Methode: Tien jeugdgezondheidszorginstanties hebben een digitale vragenlijst over kennis, attitude en uitvoering van mondgezondheidsbevordering binnen hun organisatie verspreid. Jeugdartsen en jeugdverpleegkundigen werden gevraagd de vragenlijst in te vullen. Informatie werd verzameld over: 1) demografische kenmerken; 2) kennis over cariësrisicofactoren; 3) attitude ten opzichte van mondgezondheid; 4) uitvoering van mondgezondheidsbevordering tijdens consulten bij kinderen tot vier jaar; en 5) informatiebehoefte. De antwoorden van jeugdartsen en jeugdverpleegkundigen worden apart gepresenteerd. Resultaten: Er zijn 146 vragenlijsten van 61 verschillende consultatiebureaus geanalyseerd. Respondenten hadden een positieve attitude en een meerderheid heeft voldoende basale kennis over cariësrisicofactoren. Tijdens een consult verwijst een minderheid (45%) actief naar een mondzorgprofessional voor preventie; 62% kijkt wel eens in de mond van een kind en 36% vindt dat er onvoldoende aandacht is voor mondgezondheidsbevordering op het consultatiebureau. Als reden daarvoor worden tijdsdruk, prioritering van te bespreken onderwerpen en gebrek aan kennis het meest genoemd. Conclusie: Ondanks een positieve attitude en basale kennis over cariësrisicofactoren krijgt mondgezondheidsbevordering onvoldoende aandacht op het consultatiebureau. Mondgezondheidsbevordering op consultatiebureaus vraagt om een hogere prioriteit.

Introduction: This study evaluated the Toddler Oral Health Intervention (TOHI) for preventing early childhood caries (ECC) by 48 months. TOHI, an add-on to standard care in well-baby clinics (WBCs), aims to reduce ECC incidence and severity. Methods: Dyads were randomised into TOHI (added to care as usual) or care as usual (CAU). The primary outcome was ECC (incidence and severity); secondary outcomes included plaque and pufa scores, and oral health behaviour changes. TOHI combined Non-Operative Caries Treatment and Prevention, Motivational Interviewing, and the Health Action Process Approach. Oral health coaches applied TOHI from enrolment (age 6–12 months) to 48 months. Data were collected at baseline, 24, and 48 months through questionnaires and clinical assessments. Blinding was maintained for clinical assessment and analysis. Intention-to-treat analysis used a Negative Binomial Hurdle Model with one-sided statistical testing. Results: Of the 402 enrolled dyads, 353 (88%) completed the study (TOHI: 176/205, 86%; CAU: 177/197, 90%). At 48 months, 61% of TOHI toddlers and 54% of CAU toddlers remained free of any caries lesions (ICDAS ≥1). Among toddlers with caries, TOHI reduced dmfs scores by 40% (RR: 0.60; UL95% CI: 0.98, p = 0.04). For cavitated lesions (ICDAS ≥3), TOHI reduced dmfs scores by 53% (RR: 0.47; UL95% CI: 1.04, p = 0.06), and 84% of TOHI toddlers remained free of cavitated lesions versus 78% in CAU. Conclusion: TOHI, added to usual care at WBCs, modestly reduced ECC incidence and severity at 48 months. Further research is needed to assess long-term impacts and cost-effectiveness.

Objective: This scoping review aims to identify complex health interventions (CHI’s) to prevent early childhood caries (ECC), explore the level of complexity of the identified CHI’s, and explore the details of their development, evaluation, and implementation. Introduction: Many interventions to prevent ECC have multiple interacting components and can be seen as CHI’s. Recent reviews on these interventions have found inconclusive effects, which may be due to differences in the development, evaluation, and implementation of CHI’s. Inclusion criteria: This scoping review will consider clinical trials reporting CHI’s to prevent ECC that starts during pregnancy or in the first year of life. Studies in the English language will be included regardless of the country of origin, sociocultural setting, or context. Methods: This review will follow the Joanna Briggs Institute methodology for scoping reviews. An initial search of PubMed identified keywords and Medical Subject Headings terms. A second search of PubMed, Embase, Clarivate Analytics/Web of Science Core Collection, ClinicalTrials.gov, and the Wiley/Cochrane Library will follow. Two independent reviewers will perform title and abstract screening, retrieve and re studies, and extract data. The reference lists of all included sources will be screened for additional CHI’s or relevant publications about a specific CHI. Data charting will be utilised based on study characteristics and intervention complexity. A 39-item instrument will be used to explore the details in the description of the CHI’s development, evaluation, and implementation. The results will be presented in tables, visual outputs, and a narrative summary in response to the review questions. Discussion: The proposed review will generate evidence which may provide a direction for the future design of studies on CHI’s to prevent ECC and more complete information for those who want to adopt successful interventions to prevent ECC.

Epidemiological oral health data are essential for informing public health policy and evaluating care. In the Netherlands, OrangeForce and the Oral Health Monitor seek to resume data collection by extracting information from dental practices using both automated (ie, software-based extraction) and manual (ie, user-entered in web-based forms) methods. As the success of these methods depends on cooperation from providers, this study aimed to explore the perspectives of Dutch dentists on collecting oral health data from practices, focussing on automated and manual data collection. Thirteen dentists were individually interviewed between May-December 2024 using a predefined topic list. The initial three participants were purposively sampled; others were approached to ensure variation in background characteristics. The interviews were thematically analysed using Atlas.ti. The dentists - assisted by a dental assistant - recorded most data directly during check-ups. Recorded data varied considerably in both content and method of documentation. Although the dentists generally supported data collection, they noted that more consistent and structured recording would be required for automated methods. Manual collection was perceived as time-consuming, although clear instructions could mitigate this. Eventually, the decision to participate in manual data collection largely depended on the required workload and time investment. Benchmark feedback could serve as a key incentive but is informative only with sufficiently large samples per dentist. Dutch dentists widely acknowledged the importance of epidemiological oral health data collection but identified several practical challenges. Currently, manual data collection via web-based forms seems more feasible than automated registration, which requires technical improvements and workflow changes. Clear instructions and the involvement of oral care providers in the development of the data collection procedures are necessary to improve data quality and manage research burden. Further advancement of dental software systems is needed to facilitate structured data collection in the future.