Dietary habits of the primary to secondary school population and implications for oral health.

Surveys have shown increases in dental caries in young persons in Kuwait. Intake of sugar and carbohydrates has increased, as has the incidence of obesity. The objective of this study was to identify dietary practices and the potential for dental disease in primary, intermediate, and secondary school students in a health region. A random sample of 600 students aged 8, 13, and 17 yrs in 12 schools (6 boys' schools and 6 girls' schools) received a questionnaire. Responses were analyzed by age group, gender, and dietary practices at home and in school. The dietary composition of meals tended to be similar at all ages and in both genders. A total of 97% of 8-yr-old, 96% of 13-yr-old, and 92% of 17-yr-old students reported snacking at school. Sugar intake from identified snacks alone was calculated as 193.8 g/day or the estimated equivalent of 746 calories, and daily fat intake was 70.17 g. A total of 88.6% of respondents (56.6% of all children) used fluoridated toothpaste; 44.4% of all children (22.6% of 8-yr-old, 14.1% of 13-yr-old, and 7.7% of 17-yr-old students) reported brushing their teeth three times per day. Use of school snacks increased with age, while use of a toothbrush decreased. Fundamental oral hygiene procedures such as brushing and use of fluoridated toothpaste appear to have been implemented. Health workers need to provide new and pertinent oral health messages, nutrition counseling, attention to diet, and reinforcement with parents, food preparers, health facilities, and intermediate and secondary schools.

Cost aspects of salt fluoridation.

The cost of salt fluoridation in a given country depends primarily on the number of salt factories and on the technical level available in the country. Equipment required may cost U.S. dollars 400,000 for large plants producing at least 20,000 tons/year providing salt for populations of several millions. Reliable batch mixers have been built locally for U.S. dollars 3000 to U.S. dollars 10,000, with one such mixer capable of producing 10 batches of one metric ton/day or 2000 to 3000 tons a year for a population of 350,000 to 500,000. Frequently 85-90% of the costs are devoted to infrastructure; in combination with salt iodization, the cost for fluoride equipment is 30-50% less. loIization is promoted by WHO, UNICEF, other international organizations and national aid agencies which can indirectly support salt fluoridation. With respect to running costs, the expense for the fluoride chemical is the major factor in small plants producing for example 6000 tons of salt, i. e U.S. dollars 0.015 to 0.03 per year and capita. The cost for personnel necessary for addition of fluoride and quality control is approximately U.S. dollars 0.008/capita/year in small plants and even less in large ones. With adequate implementation, salt fluoridation affords a cariostatic effectiveness equal to that of water fluoridation. When its cost is compared to that of water fluoridation, there may not be much difference regarding initial cost for equipment except in the case of small salt factories where local production of batch mixers may lower initial expenses substantially. Running costs for salt fluoridation are 10 to 100 times lower because the amount of fluoride chemical needed and its handling are up to 100 times less than with water fluoridation. In practice, the cost of salt fluoridation is often so low that many producers did not raise the price of fluoridated salt; this has been the case in Switzerland since 1955 and also in several countries in the Americas today.

Development of salt fluoridation in the Americas.

Fluoridation of water supplies has proven to be an effective preventive measure for dental caries. Many developing countries in the Americas have multiple water systems and economies that do not permit the viable application of this approach. Some of the highest dental caries prevalence in the world was evident in the Americas. Fluoridated salt was considered as a potential solution on account of the urgent need for dental caries prevention to millions of people with limited access to routine dental services. A fluoridated salt trial was initiated in Colombia (1963) and upon successful completion with preventive results comparable to water fluoridation, the approach was introduced to other countries and was supported by resolutions of WHO, PAHO, regional health groups and the FDI. The procedures for addition of fluoride were comparable to those for iodization and the two elements were compatible. In the period 1972-2004, ten countries introduced national or localized programmes and five more initiated programmes. Results, based on addition of F ion at 200-250 mg/kg salt, indicated caries prevalence reductions in 12 year olds ranging from 84% in Jamaica, 73% in Costa Rica to 40% in Uruguay at an average cost of 0.06 U.S. dollars /capita/year. This paper provides a background to the situation in the Americas, illustrates the approaches and feasibility of implementing viable fluoridated salt programmes in countries, and demonstrates the results obtainable at minimum cost.