Areca use among adolescents in Yap and Pohnpei, the Federated States of Micronesia.

OBJECTIVE: Areca (Betel Nut) is the fourth most commonly used psychoactive drug throughout the world and is legal in U.S. It is carcinogenic. Within a health program in the Federated States of Micronesia we surveyed use among adolescents. METHODS: One hundred 7th and 8th graders in Yap and Pohnpei were surveyed and clinical oral examinations conducted. The questionnaire included items on Areca: age first used Areca, whether peers or family members used Areca, frequency of use, whether tobacco was used, and source of Areca. Questions also assessed anxiety and depression. Two scales assessed getting along with other kids and adaptation to school. RESULTS: 61.5-71.4% of adolescents had ever used Areca and 54.7-68.6% used it at least once in the last month. CONCLUSION: Most adolescents surveyed in Yap and Pohnpei used Areca, which may place these youth at increased risk for cancer and health disparities.

Topical iodine and fluoride varnish combined is more effective than fluoride varnish alone for protecting erupting first permanent molars: a retrospective cohort study.

OBJECTIVE: This communication examines the combined effect of topical polyvinylpyrollidone (PVP)-iodine plus fluoride varnish in the prevention of tooth decay in erupting first permanent molars in an ongoing public health program. METHODS: The evaluation employed a retrospective cohort design with two groups of children 60-83 months. Cohort 1 (2004-05) received three times per school year topical fluoride varnish, and Cohort 2 (2008-09) received topical application of 10 percent PVP-iodine followed at each visit with topical fluoride varnish. The children were examined clinically at the beginning and end of the school year. RESULTS: The proportion of children with caries-free first permanent molars in Cohort 2 (PVP-iodine plus fluoride varnish) was 0.883 and was greater than that in Cohort 1 (varnish), which was 0.785 (Chi-square = 1.000E1, df 1, P < 0.002). CONCLUSIONS: This evaluation of an ongoing dental public health program adds evidence that topical antiseptics applied at the same time as fluoride varnish are more effective than varnish alone. Randomized trials are needed.

Evaluation of Pacific Islands Early Childhood Caries Prevention Project: Republic of the Marshall Islands.

OBJECTIVES: This communication reports an outcomes evaluation of the Pacific Islands Early Childhood Caries Prevention Project. METHODS: The evaluation includes children in three conditions: a) topical fluoride varnish three times per school year; b) varnish plus twice-per-day toothbrushing; and c) intervention 2 plus three-times-per-day xylitol containing gummy bear snacks at school and home visits to encourage parental involvement. For this evaluation, groups 2 and 3 have been combined. RESULTS: One year after project implementation, mean decayed, extracted, or filled primary teeth was 10.3 [standard deviation (SD)= 4.3] teeth for group 1, and 8.2 (SD = 4.0) teeth for the combination of groups 2 and 3 (P < 0.05). Twenty-four percent of group 1 had cavitated lesions in any permanent molar versus 12.8 percent in groups 2 and 3 combined (P > 0.05). CONCLUSION: Evaluation confirms the outcome of a program including both in-school twice-daily toothbrushing with fluoridated toothpaste and frequent applications of fluoride varnish.

Topical iodine and fluoride varnish effectiveness in the primary dentition: a quasi-experimental study.

PURPOSE: Combining fluorides with antimicrobials may be of value because fluorides alone do not provide complete protection. The purpose of this quasi-experimental study was to compare the effectiveness of combined topical treatment with 10% polyvinyl-pyrollidone iodine (PVP-I) and 5% sodium fluoride varnish (FV) with FV alone. METHODS: One hundred seventy-two 12- to 30-month-old children received either combined or single therapy in Majuro, Republic of the Marshall Islands, between June 2008 and March 2009. The children received a mean of 2.5 treatments in the PVP-I combined group (range=2-3) and 2.8 treatments in the FV group (range=2-4) and were then examined. RESULTS: The percentage of children with any new decayed primary teeth was 41% (n=81) in the PVP-I combined group and 54% (n=90) in the FV group. Multivariate log-binomial regression was used to compare the rate of any new decay between groups, controlling for the number of teeth at baseline and the number of treatment visits. The risk ratio for treatment is 0.69 (95% confidence interval [CI]=0.51-0.94). No adverse effects were observed. CONCLUSION: Combined treatment with 10% polyvinylpyrollidone iodine and 5% sodium fluoride varnish reduced the rate of new tooth decay by 31% over fluoride varnish alone.

Xylitol pediatric topical oral syrup to prevent dental caries: a double-blind randomized clinical trial of efficacy.

OBJECTIVES: To evaluate the effectiveness of a xylitol pediatric topical oral syrup to reduce the incidence of dental caries among very young children and to evaluate the effect of xylitol in reducing acute otitis media in a subsequent study. DESIGN: Double-blind randomized controlled trial. SETTING: Communities in the Republic of the Marshall Islands. PARTICIPANTS: One hundred eight children aged 9 to 15 months were screened, and 100 were enrolled. Intervention Children were randomized to receive xylitol topical oral syrup (administered by their parents) twice a day (2 xylitol [4.00-g] doses and 1 sorbitol dose) (Xyl-2 x group) or thrice per day (3 xylitol [2.67-g] doses) (Xyl-3x group) vs a control syrup (1 xylitol [2.67-g] dose and 2 sorbitol doses) (control group). MAIN OUTCOME MEASURES: The primary outcome end point of the study was the number of decayed primary teeth. A secondary outcome end point was the incidence of acute otitis media for reporting in a subsequent report. RESULTS: Ninety-four children (mean [SD] age, 15.0 [2.7] months at randomization) with at least 1 follow-up examination were included in the intent-to-treat analysis. The mean (SD) follow-up period was 10.5 (2.2) months. Fifteen of 29 of the children in the control group (51.7%) had tooth decay compared with 13 of 32 children in the Xyl-3x group (40.6%) and eight of 33 children in the Xyl-2x group (24.2%). The mean (SD) numbers of decayed teeth were 1.9 (2.4) in the control group, 1.0 (1.4) in the Xyl-3x group, and 0.6 (1.1) in the Xyl-2x group. Compared with the control group, there were significantly fewer decayed teeth in the Xyl-2x group (relative risk, 0.30; 95% confidence interval, 0.13-0.66; P = .003) and in the Xyl-3x group (0.50; 0.26-0.96; P = .04). No statistical difference was noted between the 2 xylitol treatment groups (P = .22). CONCLUSION: Xylitol oral syrup administered topically 2 or 3 times daily at a total daily dose of 8 g was effective in preventing early childhood caries.

Dental manpower development in the Pacific: case study in the Republic of the Marshall Islands.

This case study reports the ongoing progress and results of a manpower development program to expand indigenous dental personnel at four levels in the Republic of the Marshall Islands. The program was designed to: 1) increase the number of Marshallese students who successfully complete dentistry training; 2) recruit and train a group of Marshallese high school graduates in dental assisting for service in new preventive outreach programs within the community; 3) enhance the dental training of health assistants providing primary medical care to outer islands away from the main population centers of Majuro and Ebeye; and 4) provide in-service training on tooth decay prevention for Head Start teachers. The program resulted in the training of one Marshallese dentist and two Marshallese dental therapist, 16 primary care health aides who received oral health training for work in the outer island dispensaries, and 200 Head Start and kindergarten teachers who completed in-service training in oral health. Additional expertise was shared with other United States Affiliated Pacific Islands (USAPI) to enhance the dental workforce throughout the Pacific.

Republic of the Marshall Islands: planning and implementation of a dental caries prevention program for an island nation.

The Republic of Marshall Islands (R.M.I.) is an island state in eastern Micronesia with a landmass of 70 square miles scattered across 750,000 square miles of the western Pacific Ocean with a national population of approximately 51,000. In a 2002 children's oral health survey, 85 percent of six year old children in the R.M.I. capital of Majuro were found to have had at least one carious tooth and 65 percent had 5 or more affected teeth. The mean caries prevalence among primary (or baby) teeth was 5.79 decayed or filled teeth (dft), a caries prevalence rate close to three times the U.S. national mean. While 12.3 percent were caries-free, 65.0 percent had experienced 5 or more affected teeth (rampant caries). Of these, less than 1 percent had received any form of dental treatment. Comparably remarkable early childhood dental disease rates were also observed on other populated islands and atolls. In response to the rampant dental disease shown to be affecting young children, the R.M.I. Ministry of Health has proposed the implementation of a strategy targeting the pre-natal / pen-natal environment, young parents, pre-school and elementary school children.