Study design

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The present study is a 3-year longitudinal analysis of a school-based caries prevention program. The study protocol was reviewed and approved by the Research and Ethics Committee of Autonomous University of the State of Mexico (UAEM from its initials in Spanish). The inclusion criteria were children without orthodontic treatment and all children whose parents signed an informed consent form prior to the examinations. The sample was selected by a convenience non-probability sampling method, and included 145 schoolchildren (66 boys and 79 girls), 6-7 years of age, who attended from the first to the third school year in four public elementary schools at Toluca city, where the School of Dentistry of the Autonomous University of the State of Mexico is responsible for the implementation of the program. The program included 20 minute sessions of oral health education for children and teachers (five per school year), and parents (one per school year). The curriculum included information about caries etiology and prevention (oral hygiene, diet counseling, fluorides, pit and fissures sealants), 0.2% NaF mouth rinse (fourteen per school year), toothbrushing technique instructions (four per school year), flossing instructions in children up to 8 years old, and disclosing solution application (four per school year).

To motivate the children, oral health educational material was designed and adapted to their chronological age, using a puppet theater among other resources. The oral examination was performed on site (public elementary schools) in daylight conditions by two examiners, who used a dental mirror and a WHO/CPITN-type E probe (World Health Organization, 1997). No radiographs were taken. To ensure satisfactory inter-examiner reproducibility, the examiners were calibrated twice a week during the six months previous to the start of sampling (Kappa 0.95) by examining the same group of people and comparing their findings.

The oral health of children was evaluated by using deft/s and DMFT/S index. A tooth or surface was considered carious (D) if there was visible evidence of a cavity, including untreated dental caries and filled teeth with recurrent caries. The M component included missing teeth and / or decayed teeth with indication for extraction due to caries, or teeth missing as a result of caries. The F component was filled teeth; the sum of the three figures forms the DMFT/S-value. For primary dentition, deft/ s index was used, where e indicates extracted teeth. Cumulative incidence was expressed as the proportion of new children with caries over the 3 years period. For caries incidence data were collected on DMFT and deft recording forms. Information to the parents about the oral health status of the children was provided by means of an advice/referral letter.

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