Dental caries in American Indian toddlers after a community-based beverage intervention

Gerardo Maupomé, Njeri Karanja, Cheryl Ritenbaugh, Tam Lutz, Mikel Aickin, Thomas Becker

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Objective/Setting: The Toddler Overweight and Tooth Decay Prevention Study (TOTS) was an overweight and early childhood caries (ECC) project in the Pacific Northwest. It targeted American Indian (AI) toddlers from birth, to effect changes in breastfeeding and sweetened beverage consumption. Design/Intervention/Participants: The intervention cohort was children born in three communities during 12 months; expectant mothers were identified through prenatal visits, and recruited by tribal coordinators. The local comparison cohorts were children in those communities who were aged 18-30 months at study start. A control longitudinal cohort consisted of annual samples of children aged 18-30 months in a fourth community, supplying secular trends. Outcome measures: d1-2mfs was used to identify incident caries in intervention, comparison, and control cohorts after 18-to-30 months of follow-up in 2006. Results: No missing or filled teeth were found. For d1t, all three intervention cohorts showed statistically significant downward intervention effects, decreases of between 0.300 and 0.631 in terms of the fraction of affected mouths. The results for d2t were similar but of smaller magnitudes, decreases of between 0.342 and 0.449; these results met the .05 level for significance in two of three cases. In light of an estimated secular increase in dental caries in the control site, all three intervention cohorts showed improvements in both d1t and d2t. Conclusion: Simple interventions targeting sweetened beverage availability (in combination with related measures) reduced high tooth decay trends, and were both feasible and acceptable to the AI communities we studied.

Original languageEnglish (US)
Pages (from-to)444-450
Number of pages7
JournalEthnicity and Disease
Issue number4
StatePublished - Sep 2010


  • American Indian
  • Caries
  • Child
  • Community intervention
  • Soft drinks
  • Sugared beverages

ASJC Scopus subject areas

  • Epidemiology


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