Comparación del desempeño técnico-asistencial en programas escolares con diferentes modalidades de implementación / Comparison of technical-assisstance performance in school programs with different implementation modalities

Se comparó el desempeño técnico-asistencial de 2 programas de atención odontológica con iguales protocolos de atención y diferente modalidad de implementación. Ambos programas se caracterizaron por un perfil preventivo-promocional; uso de protocolos validados según riesgo biológico, atención odontológica adaptada a sedes no convencionales, recursos asignados por método de necesidades; ejecución por recurso humano pre-profesional supervisado y modulación por altas. La modalidad de implementación difirió en la densidad/concentración de las actividades realizadas: en el Programa Extensivo (PE) las acciones se implementaron con frecuencia semanal; en el Programa Intensivo (PI) las acciones se concentraron en una semana en el año. Cobertura anual: PE = 120 escolares de 6 a 9 años de edad; PI = 180 escolares y preescolares de 3 a 12 años de edad. Se midió la cantidad de prestaciones, sesiones y tiempo -en minutos- hasta alcanzar el Alta Básica Operativa (ABO). Para comparar grupos (PI y PE) se utilizaron los tests: U de Mann Whitney, t de Student para mues-tras independientes, chi cuadrado y comparación de proporciones. La razón de prestaciones/sesión fue significativamente mayor (p=0,000) en el programa intensivo. El número de prestaciones hasta el alta (ABO) y la razón tiempo/sesión no mostraron diferencias entre programas (p=0,8 p=0,087), mientras que se evidenció una mayor razón tiempo/prestación y tiempo en alcanzar el alta (ABO) en la modalidad extensiva (p=0,000). La modalidad intensiva mostró mayor eficiencia en el desempeño técnico asistencial que la extensiva (AU)

Aim: To compare technical-care performance of 2 dental care programs with the same care protocols and different implementation modalities. Both programs shared the following features: preventive-promotional profile; use of validated clinical protocols according to biological risk, dental care adapted to non-conventional settings, allocation of resources by needs method; supervised pre-professional human resource and modulation by discharges. The implementation mode differed in the density/concentration of the activities: in the extensive program (EP) the actions were implemented on a weekly basis along the year; in the intensive program (IP) the actions were concentrated in one week in the year. Annual coverage of the programs: 180 schoolchildren and preschoolers (3 -12 years old); EP = 120 schoolchildren (6 - 9 years old). We measured the following variables: the number of dental services performed, the number of sessions and the time, in minutes, to reach the basic operating discharge (BOD). We used the following tests to compare groups (IP and EP): Mann Whitney U; Student's t for independent samples, chi square and comparison of proportions test. The action per session ratio was significantly higher (p=0.000) in the intensive program. The number of actions performed until discharge (BOD) and the time per session ratio did not show differences between programs (p=0.8 p=0.087). In the extensive mode, compared to intensive mode, it took longer to reach discharge (BOD) (p=0.000) The program implemented with intensive modality (PI) showed greater efficiency regarding technical-care performance when compared to the extensive mode (AU)

Ambiente escolar como cenário de um estágio em atenção primária: análise político-pedagógica de vivências experimentadas / School environment as a stage of an internship in primary care: political-pedagogical analysis of experiences

Objetivo: analisar as significâncias político-pedagógicas de vivências experimentadas por estagiários de um curso de Odontologia em um ambiente escolar. Metodologia: estudo qualitativo transversalmente estruturado sob estratégia narrativo-descritiva e moldado à técnica argumentativa. Resultados: o "Estágio de Clínica Integrada em Atenção Primária" foi didaticamente sistematizado em dois períodos: "Pré-intervenção" e "Intervenção". Do primeiro, desvendaram-se duas ações: "Contextualização dos acadêmicos estagiários" e "Estruturação, ambientalização e levantamento de necessidades do ambiente de trabalho". Já o segundo foi guiado pelo instrumento "TPC" (Teorizar-Praticar-Criticar), em que todas as ações programadas seguiram a lógica ativa do planejamento estratégico, ou seja, contextualizadas às realidades do cenário de prática (ambiente escolar). Conclusão: das experimentações vivenciadas, algumas inferências se destacaram: a efetividade do instrumento "TPC" no direcionamento dos acadêmicos estagiários no planejamento estratégico de atividades de educação em saúde; o reconhecimento do ambiente escolar como território fértil para o desenvolvimento de ações promotoras de saúde; a importância de se disseminar, em espaços científicos, os aprendizados advindos de experimentações práticas de estágios.(AU)

Objective: to analyze the political-pedagogical significance of experiences experienced by trainees of a dentistry course in a school environment. Methodology: qualitative study transversely structured under narrative-descriptive strategy and molded to the argumentative technique. Results: the "Internship of Integrated Clinic in Primary Care" was didactically systematized in two periods, "Pre-intervention" and "Intervention". From the first, two actions were unveiled: the "Contextualization of the Interns" and the "Structuring, Environmentalization and Survey of Work Environment Needs". The second was guided by the instrument "TPC" (Theorize- Practice-Criticize), where all programmed actions followed the active logic of strategic planning, contextualized to the realities of the practice scenario (school environment). Conclusion: from the experiments experienced some inferences stood out: the effectiveness of the "CPT" instrument in guiding the trainee academics in the strategic planning of health education activities; the recognition of the school environment as a fertile territory for the development of health promoting actions; the importance of disseminating, in scientific spaces, the learning that comes from practical experimentation of internships.(AU)

School dental screening programmes for oral health.

BACKGROUND: School dental screening refers to visual inspection of children's oral cavity in a school setting followed by making parents aware of their child's current oral health status and treatment needs. Screening at school intends to identify children at an earlier stage than symptomatic disease presentation, hence prompting preventive and therapeutic oral health care for the children. This review evaluates the effectiveness of school dental screening in improving oral health status. It is an update of the original review, which was first published in December 2017. OBJECTIVES: To assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 4 March 2019), the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Register of Studies, to 4 March 2019), MEDLINE Ovid (1946 to 4 March 2019), and Embase Ovid (15 September 2016 to 4 March 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases; however, the search of Embase was restricted to the last six months due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL. SELECTION CRITERIA: We included randomised controlled trials (RCTs) (cluster or parallel) that evaluated school dental screening compared with no intervention or with one type of screening compared with another. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included seven trials (five were cluster-RCTs) with 20,192 children who were 4 to 15 years of age. Trials assessed follow-up periods of three to eight months. Four trials were conducted in the UK, two were based in India and one in the USA. We assessed two trials to be at low risk of bias, two trials to be at high risk of bias and three trials to be at unclear risk of bias.None of the trials had long-term follow-up to ascertain the lasting effects of school dental screening.None of the trials reported the proportion of children with untreated caries or other oral diseases, cost effectiveness or adverse events.Four trials evaluated traditional screening versus no screening. We performed a meta-analysis for the outcome 'dental attendance' and found an inconclusive result with high heterogeneity. The heterogeneity was found to be, in part, due to study design (three cluster-RCTs and one individual-level RCT). Due to the inconsistency, we downgraded the evidence to 'very low certainty' and are unable to draw conclusions about this comparison.Two cluster-RCTs (both four-arm trials) evaluated criteria-based screening versus no screening and showed a pooled effect estimate of RR 1.07 (95% CI 0.99 to 1.16), suggesting a possible benefit for screening (low-certainty evidence). There was no evidence of a difference when criteria-based screening was compared to traditional screening (RR 1.01, 95% CI 0.94 to 1.08) (very low-certainty evidence).In one trial, a specific (personalised) referral letter was compared to a non-specific one. Results favoured the specific referral letter with an effect estimate of RR 1.39 (95% CI 1.09 to 1.77) for attendance at general dentist services and effect estimate of RR 1.90 (95% CI 1.18 to 3.06) for attendance at specialist orthodontist services (low-certainty evidence).One trial compared screening supplemented with motivation to screening alone. Dental attendance was more likely after screening supplemented with motivation, with an effect estimate of RR 3.08 (95% CI 2.57 to 3.71) (low-certainty evidence).Only one trial reported the proportion of children with treated dental caries. This trial evaluated a post screening referral letter based on the common-sense model of self-regulation (a theoretical framework that explains how people understand and respond to threats to their health), with or without a dental information guide, compared to a standard referral letter. The findings were inconclusive. Due to high risk of bias, indirectness and imprecision, we assessed the evidence as very low certainty. AUTHORS' CONCLUSIONS: The trials included in this review evaluated short-term effects of screening. We found very low-certainty evidence that is insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria-based screening, we found low-certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening, there is no evidence of a difference in dental attendance (very low-certainty evidence).We found low-certainty evidence to conclude that personalised or specific referral letters may improve dental attendance when compared to non-specific counterparts. We also found low-certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) may improve dental attendance in comparison to screening alone. For children requiring treatment, we found very-low certainty evidence that was inconclusive regarding whether or not a referral letter based on the 'common-sense model of self-regulation' was better than a standard referral letter.We did not find any trials addressing possible adverse effects of school dental screening or evaluating its effectiveness for improving oral health.

Silver diamine fluoride versus therapeutic sealants for the arrest and prevention of dental caries in low-income minority children: study protocol for a cluster randomized controlled trial.

BACKGROUND: Dental caries is the most prominent childhood disease in the world. In the United States, more than 50% of children have experienced caries. Untreated caries can have negative impacts on quality of life, academic performance, and school attendance. To reduce oral health disparities, multiple organizations recommend school-based caries prevention. METHODS/DESIGN: A longitudinal, cluster randomized, non-inferiority trial will be conducted in low-income children from primarily Hispanic/Latino backgrounds currently enrolled in public elementary schools in New York City, New York, United States, from 2018 to 2023. The primary objective is to compare the non-inferiority of silver diamine fluoride and fluoride varnish versus glass ionomer therapeutic sealants and fluoride varnish in the arrest and prevention of dental caries. Secondary objectives are to evaluate differences in effectiveness when care is provided by nurses versus dental hygienists and assess the impact of prevention on oral health-related quality of life and educational outcomes. Caries arrest will be evaluated after 2 years, and caries prevention and secondary outcomes will be assessed at the completion of the study. Data analysis will follow intent-to-treat, and statistical analyses will be conducted using a two-sided significance level of 0.05. DISCUSSION: The comparative effectiveness of alternative caries prevention delivery models is considered to be one of the highest research priorities in the United States. Many treatments are currently available to prevent and arrest dental caries. The simplicity and affordability of silver diamine fluoride may be a viable alternative for the prevention of dental caries in high-risk children. TRIAL REGISTRATION: U.S. National Library of Medicine, www.clinicaltrials.gov , ID: NCT03442309 . Registered on 22 February 2018.

Effectiveness of school dental screening on dental visits and untreated caries among primary schoolchildren: study protocol for a cluster randomised controlled trial.

BACKGROUND: Dental caries is one of the most common diseases affecting children in Saudi Arabia despite the availability of free dental services. School-based dental screening could be a potential intervention that impacts uptake of dental services, and subsequently, dental caries' levels. The purpose of this study is to evaluate the effectiveness of two alternative approaches for school-based dental screening in promoting dental attendance and reducing untreated dental caries among primary schoolchildren. METHODS: This is a cluster randomised controlled trial comparing referral of screened-positive children to a specific treatment facility (King Saud University Dental College) against conventional referral (information letter advising parents to take their child to a dentist). A thousand and ten children in 16 schools in Riyadh, Saudi Arabia, will be recruited for the trial. Schools (clusters) will be randomly selected and allocated to either group. Clinical assessment for dental caries will be conducted at baseline and after 12 months by dentists using the World Health Organisation (WHO) criteria. Data on sociodemographic, behavioural factors and children's dental visits will be collected through structured questionnaires at baseline and follow-up. The primary outcome is the change in number of teeth with untreated dental caries 12 months after referral. Secondary outcomes are the changes in the proportions of children having untreated caries and of those who visited the dentist over the trial period. DISCUSSION: This project should provide high level of evidence on the clinical benefits of school dental screening. The findings should potentially inform policies related to the continuation/implementation of school-based dental screening in Saudi Arabia. TRIAL REGISTRATION: ClinicalTrials.gov , ID: NCT03345680 . Registered on 17 November 2017.

Prevalencia y algunos factores de riesgo de caries dental en el primer molar permanente en una población escolar de 6 a 12 años de edad / Incidence and risk factors of tooth decay on the first permanent molar in a schoolchildren population aged 6 to 12 years old

Introducción: La Organización Mundial de la Salud reporta que la caries en México afecta a 48 por ciento de los menores de 5 años y que 93 por ciento de los niños de 15 años la padecen. En conjunto se estima que 99 por ciento de la población ha tenido caries y que esta enfermedad es la causa más importante de la pérdida de dientes antes de los 35 años de edad. La pérdida principal la constituyen los primeros molares permanentes, estos órganos dentales acompañan a la dentición primaria en la boca de un niño transformando la oclusión de la primera dentición a la dentición mixta. El propósito de este trabajo fue identifi car la prevalencia y algunos factores de riesgo de caries en el primer molar permanente en una comunidad escolar del municipio de Tultitlán, Estado de México. Métodos: Estudio observacional, prolectivo, transversal y descriptivo en una población de 560 escolares con una media de edad de 9.0 (± 2.0), mediana de 9.0 (6-12 años). Se valoró la presencia de placa dentobacteriana con el índice O’Leary y la experiencia de caries con los índices CPOD y CPOS. Resultados: La prevalencia de caries en el primer molar permanente en la población de estudio fue de 25.6 por ciento, el valordel índice CPOS fue de 1.6 ± 2.7; CPOD de 1.0 ± 1.4; los más afectados son los molares inferiores en 30.6 por ciento (n = 343) con un CPOS 1.0 (± 1.7) vs. los superiores 20.5 por ciento (n = 226) con un CPOS de 0.6 (± 1.4). De los riesgos analizados, el factor tiempo de exposición a la PDB medido a través de la edad mostró que los escolares ≥ 8 años tienen 7.1 veces más riesgo de presentar caries en el PMP que los menores de esa edad, siendo esta diferencia clínica estadísticamente significativa (RM = 8.1; IC95 por ciento 4.4-14.7, p < 0.0001). Conclusiones: Nuestra población de estudio muestra una similitud en los índices de caries en la dentición permanente con la literatura científica.

Introduction: The World Health Organization reports that tooth decay inMexico aff ects 48% of children under 5 years of age and 93% of childrenunder 15. Overall it is estimated that 99% of the population has hadtooth decay and that this disease is the most important cause of tooth lossbefore age 35. The greatest loss is of the fi rst permanent molars, thesedental organs represent the primary dentition in the mouth of a child,transforming with its presence the primary occlusion in mixed. Therefore,the purpose of this study was to identify the prevalence and some risk factorsfor tooth decay in the fi rst permanent molar in a school community in themunicipality of Tultitlan, State of Mexico. Methods: An observational,prolective, transverse and descriptive study in a population of 560 studentswith a mean age of 9.0 (± 2.0), median of 9.0 (6-12 years), the presenceof dental plaque (biofi lm) was assessed with the O’Leary index and theexperience of tooth decay with the DMFT and DMF indexes. Results:The prevalence of tooth decay in the fi rst permanent molar in the studypopulation was 25.6%, the value of the DMF index was 1.6 ± 2.7; DMFTof 1.0 ± 1.4; the most aff ected were the lower molars with 30.6% (n = 343)with a DMF 1.0 (± 1.7) vs. the upper ones with 20.5% (n = 226) with aDMF of 0.6 (± 1.4). Of the risks analyzed, the factor «time of exposure toPDB¼ measured through age showed that, schoolchildren ≥ 8 years of ageare 7.1 times more likely to have tooth decay in the fi rst molar than childrenunder that age, this diff erence is clinically and statistically signifi cant (RM= 8.1, IC95% 4.4-14.7, p < 0.0001). Conclusions: Our study populationshows a similarity in the tooth decay indexes in permanent dentitionwith the one indicated in the scientifi c literature; of the risks analyzed,the exposure time to dental plaque (biofi lm) was the one that showed astatistically signifi cant diff erence.

Evaluation of School-Based Dental Sealant Programs: An Updated Community Guide Systematic Economic Review.

CONTEXT: A recently updated Community Guide systematic review of the effectiveness of school sealant programs (SSPs) still found strong evidence that SSPs reduced dental caries among schoolchildren. This follow-up systematic review updates SSP cost and benefit information from the original 2002 review. EVIDENCE ACQUISITION: Using Community Guide economic review methods, the authors searched the literature from January 2000 to November 20, 2014. The final body of evidence included 14 studies-ten from the current search and four with cost information from the 2002 review. Nine studies had information on SSP costs; six on sealant benefit (averted treatment costs and productivity losses); four on SSP net cost (cost minus benefit); and three on net cost to Medicaid of clinically delivered sealants. The authors imputed productivity losses and discounted costs/outcomes when this information was missing. The analysis, conducted in 2015, reported all values in 2014 U.S. dollars. EVIDENCE SYNTHESIS: The median one-time SSP cost per tooth sealed was $11.64. Labor accounted for two thirds of costs, and time to provide sealants was a major cost driver. The median annual economic benefit was $6.29, suggesting that over 4 years the SSP benefit ($23.37 at a 3% discount rate) would exceed costs by $11.73 per sealed tooth. In addition, two of four economic models and all three analyses of Medicaid claims data found that SSP benefit to society exceeded SSP cost. CONCLUSIONS: Recent evidence indicates the benefits of SSPs exceed their costs when SSPs target schools attended by a large number of high-risk children.

Nationwide 2.5-Year School-Based Public Health Intervention Program Designed to Reduce the Incidence of Caries in Children of Grenada.

UNLABELLED: This paper describes an innovative public health intervention, called 'Smile Grenada', targeting the oral health of children in Grenada utilizing the resources of a US dental school, several oral health care companies, local governmental and public health authorities, and Grenadian school personnel. METHODS: Preintervention visual/tactile caries examinations were collected from 1,092 schoolchildren (mean age 9.9 years, standard deviation, SD = 3.7) in 2010. The intervention included: (1) classroom-based toothbrushing with fluoridated toothpaste, (2) fluoride varnish applied by trained dental students, teachers and local providers 3 times a year and (3) glass ionomer sealants placed on first permanent molars in children aged 6-8 years. Postintervention data were collected in May, 2013 (n = 2,301, mean age 9.8 years, SD = 3.7). Decayed and demineralized surfaces were examined for the whole sample and decay/demineralization and sealant retention on 6-year molars were examined separately (ages 6-8 in 2013 cohort). RESULTS: The number of decayed/demineralized surfaces declined across all age groups. The average number of decayed surfaces dropped from 9 at baseline to just over 6 (F1, 3,393 = 69.8, p < 0.0001) and the average number of demineralized surfaces dropped from 6 to less than 2 (1.8 surfaces; F1, 3,393 = 819.0, p < 0.0001). For children aged 6-8 years, there were statistically significantly fewer decayed surfaces (t1, 2,086 = 12.40, p < 0.0001; mean baseline 0.93, SD = 1.75; mean follow-up 0.23, SD = 0.83) and demineralized surfaces (t1, 2,086 = 19.7, p < 0.0001; mean baseline 2.11, SD = 2.74; mean follow-up 0.50, SD = 0.97) on 6-year molars. The Smile Grenada program successfully demonstrated a locally sustainable model for improving oral health in children in a developing country.

The BBaRTS Healthy Teeth Behaviour Change Programme for preventing dental caries in primary school children: study protocol for a cluster randomised controlled trial.

BACKGROUND: Oral health behaviours such as establishing twice-daily toothbrushing and sugar control intake need parental self-efficacy (PSE) to prevent the development of childhood dental caries. A previous study has shown that behaviour change techniques (BCTs) delivered via a storybook can improve parental self-efficacy to undertake twice-daily toothbrushing. OBJECTIVE: to determine whether an intervention (BBaRTS, Bedtime Brush and Read Together to Sleep), designed to increase PSE; delivered through storybooks with embedded BCTs, parenting skills and oral health messages, can improve child oral health compared to (1) an exactly similar intervention containing no behaviour change techniques, and (2) the BBaRTS intervention supplemented with home supply of fluoride toothpaste and supervised toothbrushing on schooldays. METHODS/DESIGN: A 2-year, three-arm, multicentre, cluster randomised controlled trial. PARTICIPANTS: children (estimated 2000-2600) aged 5-7 years and their families from 60 UK primary schools. INTERVENTION: Test group 1: a series of eight children's storybooks developed by a psychologist, public health dentist, science educator, children's author and illustrators, with guidance from the Department for Education (England). The books feature animal characters and contain embedded dental health messages, parenting skills and BCTs to promote good oral health routines focused on controlling sugar intake and toothbrushing, as well as reading at bedtime. Books are given out over 2 years. Test group 2: as Test group 1 plus home supplies of fluoride toothpaste (1000 ppmF), and daily supervised toothbrushing in school on schooldays. Active Control group: series of eight books with exactly the same stories, characters and illustrations, but without BCTs, dental health messages or parenting skills. Annual child dental examinations and parental questionnaires will be undertaken. A sub-set of participants will be invited to join an embedded study of the child's diet and salivary microbiota composition. PRIMARY OUTCOME MEASURE: dental caries experience in permanent teeth at age 7-8 years. DISCUSSION: A multi-disciplinary team was established to develop the BBaRTS Children's Healthy Teeth Programme. The books were developed in partnership with the Department for Education (England), informed by a series of focus groups with children, teachers and parents. TRIAL REGISTRATION: ISRCTN21461006 (date of registration 23 September 2015).

School-based intervention for improving the oral health of children in southern Thailand.

OBJECTIVE: A two-year study assessed the benefit of an enhanced oral health promotion program combined with a closely supervised tooth brushing program in schools, using toothpaste containing 1,450 ppm F- and 1.5% arginine, on oral health and dental caries. METHODS: 15 southern Thailand schools and 3,706 pre-school children were recruited: 8 schools with 1,766 children as controls; 7 schools with 1,940 children in the intervention groups. Of the intervention schools five were classified as cooperative school and two as non-cooperative schools, based on the criteria of 80% participation in the prescribed tooth brushing activities. RESULTS: The DMFT and DMFS increments ("enamel and dentine") were 1.19 and 1.91 for the control group and 1.04 and 1.59 for the intervention groups. These represent 12.6% and 16.8% reductions in caries respectively. The DMFT and DMFS increments ("dentine threshold") were 0.26 and 0.44 for the control group and 0.19 and 0.29 for the intervention group, representing 26.9%, and 34.1% reductions in caries incidence respectively. For the more cooperative schools the benefits were greater: up to a 40.9% reduction in caries for DMFS ("dentine threshold"). At the 24 month examination there were significant improvements in dental plaque scores with greater improvements seen in the intervention group, greater still in the cooperative schools. CONCLUSIONS: This study documents the positive effect from use of fluoridated toothpaste (1,450 ppm F- and 1.5% arginine) administered by schoolteachers and undertaken via an enhanced school oral health program. Optimising oral health interventions for young children in Thai schools may have a significant impact on caries incidence resulting in reductions of up to 34% reductions in caries for all schools included in the study and up to 41% for the most cooperative.

[Evaluation of an Intensified Dental Preventive Programme Aimed at Children with Increased Caries Risk]. / Evaluation eines zahnmedizinischen Präventionsprogramms für Kinder mit erhöhtem Kariesrisiko.

Our study investigated the effect of a selective intensive prevention (SIP) programme on dental health of pupils in comparison to a control group. While no differences were observed in respect to dental health of first graders, the DMF-T values of fourth and 6 graders participating in SIP were significantly lower. Concerning the psychometric variables only few differences were found. The fourth and 6 graders in the test group reported less dental fear than the pupils in the control group.

Caries-preventive effectiveness of fluoride varnish as adjunct to oral health promotion and supervised tooth brushing in preschool children: a double-blind randomized controlled trial.

OBJECTIVES: To evaluate the effect of biannual fluoride varnish applications in preschool children as an adjunct to school-based oral health promotion and supervised tooth brushing with 1000ppm fluoride toothpaste. METHODS: 424 preschool children, 2-5 year of age, from 10 different pre schools in Athens were invited to this double-blind randomized controlled trial and 328 children completed the 2-year programme. All children received oral health education with hygiene instructions twice yearly and attended supervised tooth brushing once daily. The test group was treated with fluoride varnish (0.9% diflurosilane) biannually while the control group had placebo applications. The primary endpoints were caries prevalence and increment; secondary outcomes were gingival health, mutans streptococci growth and salivary buffer capacity. RESULTS: The groups were balanced at baseline and no significant differences in caries prevalence or increment were displayed between the groups after 1 and 2 years, respectively. There was a reduced number of new pre-cavitated enamel lesions during the second year of the study (p=0.05) but the decrease was not statistically significant. The secondary endpoints were unaffected by the varnish treatments. CONCLUSIONS: Under the present conditions, biannual fluoride varnish applications in preschool children did not show significant caries-preventive benefits when provided as an adjunct to school-based supervised tooth brushing with 1000ppm fluoride toothpaste. CLINICAL SIGNIFICANCE: In community based, caries prevention programmes, for high caries risk preschool children, a fluoride varnish may add little to caries prevention, when 1000ppm fluoride toothpaste is used daily.

Effects of information dissemination using video of indigenous language on 11-12 years children's dental health.

BACKGROUND: Videos as a medium of health education are useful tools. This study evaluated the effectiveness of a dental health education video in the Yoruba language (spoken in southwestern Nigeria) targeted at children from the lower socioeconomic class. METHODS: An interventional study was conducted among 120 children aged 11 and 12 years, randomly selected from three public primary schools in Ibadan, Nigeria. Participants were assigned into three study groups: group 1 watched the video, group 2 received verbal dental health education in the Yoruba language and group 3 were the control. Following this, each participant received a full mouth prophylaxis, and six weeks later, their oral hygiene was assessed using the Simplified Oral Hygiene Index of Greene and Vermillion. RESULTS: A mean debris score of (1.11), (1.04) and (1.57) was recorded for the video, verbal and control groups respectively (p<0.001). The mean calculus index score was lowest among the verbal group (0.56), followed by the video group (0.75) and highest among the control (1.16) (p<0.001). However, multivariate analysis, controlling for child's age and fathers education, revealed that oral hygiene of the participants in the video group was significantly better by 28.6% compared to the control group while in the verbal education group there was an improvement of 23.4 % in contrast to the control. CONCLUSION: This study demonstrated that a culturally appropriate video in an indigenous language can significantly improve oral hygiene among school children from the lower socioeconomic group in Nigeria.

Preliminary evaluation of a serious game for the dissemination and public awareness on preschool children's oral health.

This article presents the preliminary evaluation by dentists, teachers and parents of a serious game for dissemination of public awareness on preschool children's oral health. In this game, the player keeps a victory condition, while your tooth remains whole. Preliminary evaluation was performed in two parts. The first part was a questionnaire designed to evaluate the applicability of this technology and the opinions on the effectiveness of games in education and in oral health promotion. In the second part, the game is presented and an evaluation questionnaire of it is applied. This study had the participation of 115 persons. There was 80% approval which suggested that the game is an alternative for the prevention of dental awareness. Furthermore, the study perceives that teachers can work together with dentists in order to perform dental prevention.

National supervised toothbrushing program and dental decay in Scotland.

We aimed to assess the association between the roll-out of the national nursery toothbrushing program and a reduction in dental decay in five-year-old children in a Scotland-wide population study. The intervention was supervised toothbrushing in nurseries and distribution of fluoride toothpaste and toothbrushes for home use, measured as the percentage of nurseries participating in each health service administrative board area. The endpoint was mean d(3)mft in 99,071 five-year-old children, covering 7% to 25% of the relevant population (in various years), who participated in multiple cross-sectional dental epidemiology surveys in 1987 to 2009. The slope of the uptake in toothbrushing was correlated with the slope in the reduction of d(3)mft. The mean d(3)mft in Years -2 to 0 (relative to that in start-up Year 0) was 3.06, reducing to 2.07 in Years 10 to 12 (difference = -0.99; 95% CI -1.08, -0.90; p < 0.001). The uptake of toothbrushing correlated with the decline in d(3)mft (correlation = -0.64; -0.86, -0.16; p = 0.011). The result improved when one outlying Health Board was excluded (correlation = -0.90; -0.97, -0.70; p < 0.0001). An improvement in the dental health of five-year-olds was detected and is associated with the uptake of nursery toothbrushing.

School-based strategies for oral health education of adolescents--a cluster randomized controlled trial.

BACKGROUND: Oral health education (OHE) in schools has largely been imparted by dental professionals. Considering the substantial cost of this expert-led approach, the strategies relying on teachers, peer-leaders and learners themselves have also been utilized. However the evidence for comparative effectiveness of these strategies is lacking in the dental literature. The present study was conducted to compare the effectiveness of dentist-led, teacher-led, peer-led and self-learning strategies of oral health education. METHODS: A two-year cluster randomized controlled trial following a parallel design was conducted. It involved five groups of adolescents aged 10-11 years at the start of the study. The trial involved process as well as four outcome evaluations. The present paper discusses the findings of the study pertaining to the baseline and final outcome evaluation, both comprising of a self-administered questionnaire, a structured interview and clinical oral examination. The data were analyzed using Generalized Estimating Equations. RESULTS: All the three educator-led strategies of OHE had statistically higher mean oral health knowledge (OHK), oral health behavior (OHB), oral hygiene status (OHS) and combined knowledge, behavior and oral hygiene status (KBS) scores than the self-learning and control groups (p<0.001). The mean OHK, OHS and KBS scores of the three educator-led strategies did not differ significantly. The peer-led strategy was, however, found to have a significantly better OHB score than the respective score of the teacher-led strategy (p<0.05). The self-learning group had significantly higher OHB score than the control group (p<0.05) but the OHK, OHS and KBS scores of the two groups were not significantly different. CONCLUSIONS: The dentist-led, teacher-led and peer-led strategies of oral health education are equally effective in improving the oral health knowledge and oral hygiene status of adolescents. The peer-led strategy, however, is almost as effective as the dentist-led strategy and comparatively more effective than the teacher-led and self-learning strategies in improving their oral health behavior. SRCTN39391017

Gingivitis and plaque scores of 8- to 11-year-old Burmese children following participation in a 2-year school-based toothbrushing programme.

AIM: The present study assessed whether gingivitis and plaque scores of 8- to 11-year-old school children who participated in a SBTB programme for 2 years were lower than those of children who did not participate in the programme. MATERIAL AND METHODS: The present study was performed using an examiner-blind, parallel group design and was performed in Burma (Myanmar) in 2006. Three of the five schools where daily SBTB programmes took place after lunch and which were performed under teacher supervision were randomly selected; three non-participating schools (non-SBTB) from the same area were assigned as controls. Twenty-five children per school were examined for gingivitis (bleeding on marginal probing) and plaque (Quigley & Hein). RESULTS: In total, 150 8- to 11-year-old children participated, with 75 children in either group. The test group (SBTB) exhibited an overall mean bleeding score of 0.76. For the control group (non-SBTB), this score was 0.83. With respect to the overall mean plaque scores, the test group exhibited a score of 2.93, whereas the control group exhibited a score of 2.91. No statistically significant differences between the test and the control group were observed. CONCLUSION: The present study did not reveal a statistically significant effect of daily SBTB programmes in 8- to 11-year-old school children with respect to gingivitis and plaque scores.

Improving access to preventive dental services through a school-based dental sealant program.

PURPOSE: The lack of access to preventive dental services, such as dental sealants, can be a major barrier to optimal dental health. School-based dental sealant programs can serve as programs to improve access to preventive dental services. METHODS: This school-based dental sealant program managed by a Boston dental school with collaborating partners in the metro west area of Massachusetts provides free dental sealants to second grade children. The number of second grade children having dental sealants was tracked for 6 school years and compared with the Healthy People 2010 objective of 50% of all children aged 8 years to have at least 1 dental sealant. RESULTS: From school years 2003 to 2004 through 2008 to 2009, 1,609 dental screenings were provided for second grade children. Of those, 1,189 received dental sealants. To determine whether or not the Healthy People 2010 objective was met, the number of children who received dental sealants from the school-based program was added to the number of children who already had their permanent first molars sealed by their own dentist at the time of the dental screening, plus children with sealants per parent report. In total, the aggregate second grade enrollment having sealants during the designated school years was 54%. CONCLUSION: The specific Healthy People 2010 objective was achieved over the designated time period. School-based dental sealant programs can help to decrease or eliminate barriers for access to preventive dental services by increasing the number of children who receive dental sealants.

Techniques for assessing tooth surfaces in school-based sealant programs.

BACKGROUND: The authors reviewed the evidence supporting current guidelines for the detection of cavitated carious lesions. Currently, cavitation is the point at which sealants are not placed in school-based programs. TYPES OF STUDIES REVIEWED: The authors did not perform a formal systematic review. However, they examined existing systematic reviews of caries detection and diagnosis, including those presented at the 2001 National Institutes of Health Consensus Conference on Management of Caries, published evidence related to the International Caries Detection and Assessment System criteria and other peer-reviewed publications. Where the authors found ambiguity or uncertainty in the evidence, they consulted with fellow members of an expert work group. RESULTS: Visual examination is appropriate and adequate for caries assessment before placing sealants. The clinician should not use an explorer under force. Radiographs are not indicated solely for the placement of sealants, and the use of magnification and caries detection devices is not necessary to determine cavitation. CLINICAL IMPLICATIONS: This report focuses on tooth assessment, in particular the detection of carious lesion cavitation in school-based sealant programs. These recommendations must be balanced with the dentist's expertise, available treatment options, the patient's preferences and access to care.