Background

Early childhood caries (ECC) is a public health problem associated with impaired oral health-related quality of life and high costs for families as well as for society. There are numerous biological, medical, behavioural, psychological, cultural, and life-style factors associated with the disease but in spite of extensive research over the years, there are knowledge gaps concerning its prevention and management [1]. Fluoridated toothpaste and fluoride varnish are currently the most effective strategies to prevent ECC [2]. Therefore, such community oral health programs have been launched for vulnerable children with increased caries risk [3–6]. Little is however known on the long-term impact of such fluoride-based programs on oral bacteria. It is generally thought that a low-fluoride exposure can interact with the consecutive cycles of de- and remineralization while higher fluoride concentrations may hamper bacterial acid production [7, 8]. A reduced pH-drop would favour the growth of health-associated bacteria that prefer pH values around neutrality rather than the acid-producing and acid-tolerating species associated with caries [9]. Fluoride varnish contains typically 5% sodium fluoride (22, 600 ppm F) and after application, fluoride is slowly released to the oral biofilm over a period of several weeks. Since it is not fully clear whether or not this sustained fluoride release has an influence on the bacterial composition of biofilm, it was thought of interest to apply this research question in a current community oral health project [10]. The primary aim of the present study was to compare the oral microflora in preschool children participating in an extended preventive program with semi-annual fluoride varnish applications with children receiving a standard program with no varnish applications. The null hypothesis was that no differences would be obtained between the groups. A secondary aim was to investigate the microbial composition in children who had developed early childhood caries at the age of 3 years versus those that remained caries free.

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