EFFECT OF INTENSIFIED PREVENTION ON DENTAL HEALTH OF CHILDREN DEPENDING ON SES

Abstract

This study aimed to ascertain whether the dental health of primary school children can be improved by introducing a group prevention program based on applications of fluoride gel and supervised tooth-brushing, following intensive preventive care in kindergarten.

Method: Twenty schools in Northern Hesse, Germany were chosen by lot to be included in the intensified prevention based on tooth- brushing with fluoride gel (fluoride content 12,500 ppm) under supervision of a dental assistant at intervals of three weeks during school session (test group). Pupils in 23 other primary schools (control) received instruction on tooth brushing three to four times a year from specially trained dental assistants and were given free toothpaste for home use (basic prevention). The test and control subjects (total n=1079) were further classed into three groups based on the preventive care received in kindergarten (intensive prevention, basic prevention or no organised prevention in kindergarten). The study was approved by the Ethics Committee of the Faculty of Medicine, University of Marburg and written consent was obtained from parents. The study was performed from September 2010 to June 2012. Caries ex- perience and increment from second grade (7- year-olds) to fourth grade (9-yearolds) were recorded by one trained and calibrated examiner (A.L.). A standardised questionnaire was used to record independent variables. Socioeconomic status (SES) was collected through parents schooling, occupational training and occupational status. To compare the caries scores of subgroups, non-parametric tests were used.

Results: While second-graders without professionally supported daily tooth-brushing in kindergarten exhibited an average d3- 6mft of 2.17, in those who had enjoyed intensive dental prevention the value was 19% lower, (d3- 6mft=1.74). The caries increment was significantly lower mainly among children who had received the maximum of group prevention (intensive prevention in kindergarten and gel program at school) compared to the group with basic prevention in kindergarten and no fluoride gel at school (p=0.039). A significant difference was found in the mean DMFT depending on socioeconomic status (no prevention in kindergarten, fluoride gel at school with low SES DMFT=0.47 vs. with high SES DMFT=0.18; p=0.023). Class-specific differences were no longer visible among children who had taken part in a basic preventive program.

Conclusions: The results show that intensified preventive programs in kindergartens and schools, based mainly on supervised tooth brushing, have a positive effect on the dental health of primary school children.