***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background This survey was intended to investigate prevalence and severity of early childhood caries ( ECC ) in a sample of children in Southern Italy and to identify factors that may be related to this condition . Methods The study was design ed as a cross-sectional survey . The study population ( children aged 36–71 months ) attending thirteen kindergartens was r and omly selected through a two-stage cluster sampling procedure . Parents/guardians of all eligible children were invited to participate filling out a structured self-administered question naire , and after having returned the informed consent form an oral examination of the child was performed at school . The question naire included information on : socio-demographics about parents/guardians and child , pregnancy and newborn characteristics , oral hygiene habits of child , eating habits particularly on consumption of sweets , access to dental services , and infant feeding practice s. The WHO caries diagnostic criteria for deciduous decayed , missing and filled teeth ( dmft ) and surfaces ( dmfs ) were used to record ECC and severe-ECC ( S-ECC ) . Univariate and multiple logistic regression analyses were conducted to evaluate statistical associations of social demographics , infant feeding practice s , oral hygiene habits , and access to dental services to ECC , S-ECC , dmft and dmfs . Results 515 children participated in the study . 19 % had experienced ECC , and 2.7 % S-ECC , with a mean dmft and dmfs scores of 0.51 and 0.99 , respectively . Mean dmft was 2.68 in ECC subjects , and 6.86 in S-ECC subjects . Statistical analysis showed that prevalence of ECC significantly increased with age ( OR = 1.95 ; 95 % CI = 1.3 - 2.91 ) and duration of breastfeeding ( OR = 1.26 ; 95 % CI = 1.01 - 1.57 ) , whereas it was significantly lower in children of more educated mothers ( OR = 0.64 ; 95 % CI = 0.42 - 0.96 ) , and higher in those who had been visited by a dentist in the previous year ( OR = 3.29 ; 95 % CI = 1.72 - 6.33 ) . Conclusions Results of our study demonstrate that even in Western countries ECC and S-ECC represent a significant burden in preschool children , particularly in those disadvantaged , and that most of the known modifiable associated factors regarding feeding practice s and oral hygiene are still very spread in the population OBJECTIVE To demonstrate the effectiveness of a dental caries prevention program on the primary dentition of Chilean rural children , using fluori date d powdered milk and milk derivatives . METHODS Fluori date d milk and milk-cereal was given to about 1000 preschool children in Codegua , a rural community located in the 6th Region of Chile , using the st and ard National Complementary Feeding Program ( PNAC ) . The daily fluoride dose from fluori date d powdered milk was estimated at 0.25 mg for infants ( 0 - 2 years old ) , 0.5 mg for children aged 2 - 3 years and 0.75 for children aged 3 - 6 years . Cross-sectional sample s of children aged 3 - 6 years were taken from Codegua ( study community ) from 1994 to 1999 and from La Punta ( control community ) from 1997 and 1999 . RESULTS Significant reductions ( 72 % ) were observed in the dmfs indices in the 3 - 6-year-old groups in Codegua , when comparing 1999 with 1994 data . In 1999 , children in the study community showed significantly lower dmfs than children in the control community ( 41 % ) . The proportion of caries-free children in the study community increased after 4 years of program implementation ( from 22.0 % to 48.4 % ) . CONCLUSION Under Chilean rural conditions , fluoridation of powdered milk distributed through the PNAC is an effective caries prevention alternative for areas where water fluoridation might not be feasible Objectives The purpose of this study is to investigate the contribution of selected variables to the occurrence of  severe early childhood caries ( S-ECC ) in 3- to 5-year-old kindergarten children . Methods A cross-sectional study was conducted in 2010 in 30 r and omly selected kindergartens in the German Rhein-Neckar district . After informed consent , parents were asked to complete a question naire . The oral examinations took place in the selected kindergartens and the WHO methods as well as the criteria proposed by the American Academy of Pediatric Dentistry were followed . Logistic regression was applied to explore the main factors contributing to S-ECC in a multivariate model . Results In all , 1,007 children aged 3 to 5 years with an average age of 4.1 ( SD = 0.8 ) years were examined . Five variables were associated significantly with the occurrence of S-ECC : breastfeeding for more than 12 months ( OR = 3.27 ) , use of the nursing bottle in bed  ( OR = 3.08 ) , start of tooth brushing after the first anniversary  ( OR = 2.42 ) , regular visits at the dentists ( OR = 0.14 ) and mother with immigration background ( OR = 4.05 ) . Prevalence rate of S-ECC was 9.5 % . The mean d3 + 4mft values were 5.69 ( S-ECC group ) and 0.23 ( non-S-ECC group ) . Conclusion These results show that occurrence of S-ECC is a complex interaction between socioeconomic , psychological and behavioural factors of parents . New and specific ways to provide preventive dental care for toddlers and infants of caries risk groups have to be developed . Clinical relevance Parents of newborn children have to receive information about timely start of tooth brushing and adequate use of nursing bottles The purpose of this study was to describe the dietary habits of infants and toddlers living in Sweden with special reference to caries prevalence at 2 and 3 years of age and to immigrant status . The study was design ed as a prospect i ve , longitudinal study starting with 671 children aged 1 year . At 3 years , all children were invited to a further examination . A total of 298 individuals , r and omly selected from the original group , were also examined at 2 years . The accompanying parent was interviewed about the child 's dietary habits . Children with caries at 2 and 3 years of age and immigrant children had , when they were 1 year old , consumed caries-risk products and been given nocturnal meals and sweetened liquid in a feeding bottle more often than caries-free 2- and 3-year-olds and non-immigrant children . Although a great variation in dietary habits was found in infants and toddlers , the use of sugar-containing products is widespread in Sweden even in early childhood OBJECTIVES To evaluate the significance of variables such as oral hygiene , dietary habits , socio-economic status and medical history of a child in assessing the level of caries risk and to generate a caries prediction model for pre-school Saudi children . DESIGN Cross-sectional study of pre-school children . SETTING Clinics and schools in Riyadh , Saudi Arabia . SAMPLE AND METHODS A sample of 446 Saudi pre-school children , 199 males and 247 females , with a mean age of 4.13 years , were selected at r and om from clinics and schools . Selection was limited to subjects who either had no caries ( dmft = 0 ) or who had high caries experience ( dmft > 8) . Each child was examined for caries experience and oral hygiene status . Their mothers were interviewed through a st and ardized question naire for information about oral hygiene habits of the children , diet history , childhood illness and socio-economic status . RESULTS There was a highly significant difference between the two groups in : debris index ( P < 0.0001 ) , aged child started tooth brushing , ( P < 0.0001 ) , age breastfeeding was stopped ( P < 0.005 ) , nocturnal bottle feeding with milk formula ( P < 0.001 ) , use of sweetened milk ( P < 0.0001 ) , frequency of use of soft drinks ( P < 0.0005 ) , frequency of consumption of sweets ( P < 0.0001 ) , and age at first dental visit ( P < 0.0001 ) . A caries prediction model developed through stepwise multivariate Logistic Regression ( LR ) analyses showed debris index , use of sweetened milk in bottle , frequency of consumption of soft drinks , frequency of intake of sweets and child 's age at the first dental visit to be significant . Predictive probability of the model was 86.31 % with a sensitivity of 90.1 % and a specificity of 80.6 % . CONCLUSIONS Risk factors for dental caries have been identified and a caries prediction model has been developed for Saudi pre-school children . The prediction model , if verified , may provide with guidance in identifying high caries risk Saudi preschool children as targets for preventive programmes OBJECTIVE Despite a marked improvement in oral health of Australian children over the last 30 years , severe  early childhood caries ( S-ECC ) affects up to 17 % of 2- to 3-year-old children with some requiring hospitalization and invasive treatment . This provided a compelling rationale to develop and test an oral health promotion programme which aim ed to reduce this unnecessary suffering . The purpose of this study was to test the efficacy of an oral health promotion programme for the parents of infants , starting during the pregnancy , using a r and omized controlled trial . METHODS A programme was developed around the provision of anticipatory guidance to nulliparous women ( women expecting their first child ) in Adelaide . Mothers in the test group received oral health promotion information during pregnancy , and later when the child reached 6 and 12 months of age . After the second round of information the test group mothers were r and omized again . The information was reinforced in one of the test subgroups through a telephone consultation . There was no contact with mothers in the control group after enrolment . At the age of 20 + /- 2.5 months all test and control group children were examined by a dentist . The case definition of an incidence of S-ECC was one or more upper incisor teeth being carious at the level of a cavitated or noncavitated lesion . The differences in S-ECC incidence between the test and control groups , and the test subgroups were analysed . RESULTS Of 649 women enroled in the programme ( test group 327 , control group 322 ) , 441 had their child examined at follow-up . The incidence of S-ECC in the test group was 1.7 % and in the control group 9.6 % ( P < 0.001 ) . CONCLUSION An oral health promotion programme based on repeated rounds of anticipatory guidance initiated during the mother 's pregnancy was successful in reducing the incidence of S-ECC in these very young children PURPOSE The purpose s of this r and omized controlled trial were to : ( 1 ) test motivational interviewing ( MI ) to prevent early childhood caries ; and ( 2 ) use Poisson regression for data analysis . METHODS A total of 240 South Asian children 6 to 18 months old were enrolled and r and omly assigned to either the MI or control condition .  Children had a dental exam , and their mothers completed pretested instruments at baseline and 1 and 2 years postintervention . Other covariates that might explain outcomes over and above treatment differences were modeled using Poisson regression . Hazard ratios were produced . RESULTS Analyses included all participants whenever possible . Poisson regression supported a protective effect of MI ( hazard ratio [HR]=0.54 (95%CI=035 - 0.84)-that is , the M/ group had about a 46 % lower rate of dmfs at 2 years than did control children . Similar treatment effect estimates were obtained from models that included , as alternative outcomes , ds , dms , and dmfs , including " white spot lesions . " Exploratory analyses revealed that rates of dmfs were higher in children whose mothers had : ( 1 ) prechewed their food ; ( 2 ) been raised in a rural environment ; and ( 3 ) a higher family income ( P<.05 ) . CONCLUSIONS A motivational interviewing-style intervention shows promise to promote preventive behaviors in mothers of young children at high risk for caries Fluori date d milk reduced caries increment by about 70 % OBJECTIVES Assess the effectiveness of home visits for advising mothers about breast feeding and weaning on  early childhood caries ( ECC ) at the age of 12 months . METHODS A r and omized field trial was conducted in mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo ( intervention group = 200 ; controls = 300 ) . The intervention group received the advice 10 days after the child 's birth , monthly up to 6 months , at 8 , 10 and 12 months , based on the ' Ten Steps for Healthy Feeding ' , a Brazilian national health policy for primary care , based on WHO guidelines . Both groups had research assessment at 6 and 12 months , with dental caries investigated in this last assessment ; 122 children were lost in the 1-year follow-up ; 378 were assessed for caries : two predentulous children were excluded from the analysis .  Mann-Whitney U was used to test if the average number of decayed surfaces ( DS ; white spots and cavities ) differed between the intervention and control groups , and logistic regression to estimate the effects of the intervention on the odd 
    Output:
    
Conclusion : The best available evidence indicates that breastfeeding up to 2 y of age does not increase ECC risk .
Providing access to fluori date d water and educating caregivers are justified approaches to ECC prevention .