Dental programs for caries prevention

Oral Health is fundamental to general health and well-being. A healthy mouth enables and individual to speak, eat and socialize without experiencing active disease, discomfort or embarrassments. Children who suffer from poor oral health are 12 times more likely to have restricted-activity days than those who do not. More than 50 million school hours are lost annually because of oral health problems which affect children's performance at school and success in later life (Kawan, et al., 2005).

Basically, erupting teeth are healthy. The first carious lesion and the first restoration in a tooth means the start of series of treatments that during the tooth's lifetime will end up in more and more complicated restorations or treatments if the caries process is not controlled. Today there is enough scientific knowledge about factors that might interfere in this process in order to develop preventive strategies. Operative treatment per se will never control caries. (Koch & Poulsen, 2006).

Minimal intervention is a key phrase in today's dental practice. Minimal intervention dentistry (MID) focuses on the least invasive treatment options possible in order to minimize tissue loss and patient discomfort. Concentrating mainly on prevention and early intervention of caries, MID's first basic principle is the remineralization of early carious lesions, advocating a biological or therapeutic approach rather than traditional surgical approach for early surface lesions. One of the key elements of a biological approach is the usage and application of remineralizing agents to tooth structure (enamel and dentin lesions). These agents are part of a new era of dentistry aimed at controlling the demineralization/remineralization cycle, depending upon the microenvironment around the tooth (Rao & Malhotra, 2011).

School provide man effective platform for promoting oral health because they reach over 1 billion children worldwide. The health and well-being of school staff, families and community members can also be enhanced by programs based in schools. Oral health messages can be reinforced throughout the school years, which are the most influential stages of children's lives, and during which lifelong beliefs, attitudes and skill are developed (Kwan, et al., 2005).

After caries decline of about 80% in children in Western Europe and other industrialized countries, there should be a critical debate about the best way for future caries prevention (Splieth, et al., 2004).

In Europe and Asia, positive results have come from implementing supervised toothbrushing programs in kindergartens and providing free fluoridated toothpaste to high risk children from underprivileged and multicultural groups. Furthermore, a comprehensive staged dental health program and professional fluoride varnish applications proved the possibility of a reduction in early childhood caries in vulnerable groups (Wennhall, et al., 2008).

Multiple fluoride use played an important role in caries reductions achieved in the 1980s and 1990s, but it also resulted in a polarization of lesion distribution in young people: the majority consists of low caries or even lesion-free individuals, while a minority is a so-called high caries risk group which seems not to be open to preventive programs. Last decade studies indicate that frequent fluoride applications (>6 times/year) in conjunction with effective plaque removal can be a successful approach for effective future caries prevention in high caries risk groups. Health promotion programs that are merely educational and do not provide fluoride do not seem to be effective. Alternatively, preventive measures could be performed at home or in a private practice, but only minimal compliance is reached in high risk groups compared with out-reaching group programs. Thus, group programs are instrumental in providing effective and efficient caries-preventive measures in children. The more expensive time of a dental practice team should be limited to procedures where costly equipment is needed (professional tooth cleaning, sealants, etc.). For efficient caries prevention, measures formerly targeted specifically at either populations, groups, or individuals should be remodeled and aimed to interact in order to achieve optimal oral health in children at a reasonable cost (Splieth, et al., 2004).

School dental screening is a popular public health intervention in many countries throughout the world. In the United Kingdom, school dental screening is a statutory function of local National Health Service (NHS) bodies and has been a feature of children's dental services for the past hundred years (Education Act, 1918).

The process involves a visual dental examination of children in the school setting to identify the presence of dental disease and conditions; parents of children who are screened positive are informed and encouraged to take their child to primary care services for further investigation. The WHO has recently endorsed dental screening of children in the school setting, stating that, "Screening of teeth and mouth enables early detection, and timely interventions towards oral diseases and conditions, leading to substantial cost savings. It plays an important role in the planning and provision of school oral health services as well as health services." Due to the long history of school dental screening in the UK, the aims of this cluster-randomized controlled trial conducted in the UK failed to show that the intervention used in a national school dental screening program significantly reduces active dental caries levels or increases dental attendance rates at the public health level. Milsom, et al. reported that school dental screening delivered according to 3 different models in the northwest of England children aged 6-9 years derived little benefit in terms of attending the dentist, and receiving treatment for their carious permanent teeth. The current method of school dental screening is no longer tenable, alternative ways to ensure that vulnerable children receive adequate dental care need to be explored (Milsom, et al., 2006).

Oral health education program in Belgian primary schoolchildren has been effective in improving reported dietary habits and the proper use of topical fluorides and resulted in a higher care index.

The implemented yearly based extra oral health promotional program did not result in a significant reduction of caries prevalence. The effectiveness on plaque level and gingival health was inconclusive. However, the favorable reported behavioral changes and the increased restoration level together with the educational responsibility of the profession justify the efforts and costs of this program (Vanobbergen, et al., 2004).

In the same way, supervised daily toothbrushing using fluoridate toothpaste in schools and intensive oral hygiene instructions sessions program was successful in controlling dental caries in children, as reported by Al-Jundi, et al. in a school-based caries preventive program in children from Jordan over a period of 4 years ( Al-Jundi, et al., 2006).

The evaluation of caries incidence after 7.5 years of follow-up, in an infant population under a dental health preventive program in Mostoles (Madrid), which consisted of preventive measures included health education, a weekly mouth rinse using sodium fluoride (NaFl) at 0 -2% concentration, fissure sealants to first permanent molars and topical application of fluoride gel, showed that the preventive program had been effective and had a clear protective effect on permanent teeth (Tapias, et al., 2001).

The six months evaluation of a comprehensive preventive care from dental hygienists implemented in children at six Massachusetts elementary schools, grades 1 through 3, with pupil populations at high risk of developing caries indicates that this care model relatively quickly can overcome multiple barriers to care and improve children's oral health. If widely implemented, comprehensive caries prevention programs could accomplish national health goals and reduce the need for new care providers and clinics.

To increase access to care, improve oral health and reduce disparities in oral health care for children, treatments must be safe, effective, efficient, personalized, timely and equitable. This program can be implemented locally and can reduce the incidence of dental caries in school-aged children (Niederman, et al., 2008).

Sealants application programs have been suggested as an effective measurement for caries prevention. Khurshid reported that preventive oral health care as measured by the presence of dental sealants can significantly reduce the occurrence of dental caries in Hispanic children in underserved areas such as the US-Mexico border in Texas. The study confirms the strong effect of low house hold income and lack of health insurance in increasing the likelihood of dental caries in children. The old adage that prevention is better than cure applies to dental health as much as to any other public health issue (Khurshid, 2010).

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