Randomized trial of a photography-aided behavioral intervention to reduce risk factors for caries and malocclusion in high-risk infants.

OBJECTIVE To assess the efficacy of a photography-aided behavioral intervention in reducing risk factors for dental caries and malocclusion in high-risk infants. MATERIALS AND METHODS In this randomized trial conducted in a maternity hospital, 55 mothers of recently born infants at high-risk of developing oral diseases were allocated to either the intervention (n=28) or usual care (n=27). The intervention arm received the same usual care plus an enhanced, behavior-oriented, photography-aided, two-stage (0 and +6 months) educational program addressing nutritional, behavioral, lifestyle and familial factors that affect child's oral health. The primary outcome was the proportion of children classified as being at a "low risk" of developing dental caries at the age of 12 months using a modified score based on the Caries-risk Assessment Form of the American Academy of Pediatric Dentistry. Secondary outcomes included risk factors for malocclusion, such as duration of exclusive breastfeeding, pacifier use, and bottle-feeding and/or sippy cup usage. RESULTS At 12 months, the proportion of children considered at low risk for dental caries was significantly higher in the intervention group compared to usual care (71% vs 15%, respectively, relative risk=4.82, 95% confidence interval=1.89-12.3, P<0.001). The median duration of exclusive breastfeeding in the intervention group was 1.7 times higher than in the control arm: 5 months vs 3 months, P=0.03). CONCLUSION Altogether, our findings provide evidence that a low-cost, two-stage preventive strategy using photographs to deliver a stronger visual impact might significantly reduce the incidence of risk factors for dental caries and malocclusion in 12-month old children.