Dental health of preschool children after two-years of a supervised tooth brushing program in Southern Israel.

BACKGROUND: Supervised tooth brushing is an important part of leading national oral health improvement programs in different countries. With the cessation of water fluoridation in 2014, a new program was immediately required to provide community-based caries prevention, especially amongst young children. The aim of this study was to determine whether a supervised tooth brushing program (STBP) in kindergartens could reduce dental caries amongst preschool children, when compared with children from the same community who did not participate in the program. The study was performed 2 years after the start of the program. METHODS: Two Jewish and two Arab local authorities (one participating and one control) were randomly chosen. In each local authority, 4 kindergartens (children aged 5) were randomly chosen, giving a total of 16 kindergartens. Children in the intervention group brushed once daily at kindergartens, with fluoridated toothpaste, for two school- years. All the children were examined using the WHO Oral Health Survey Methods Ed.4. RESULTS: Two hundred eighty-three five-year-old children were examined, 157 of them Jewish (86 participants in STBP, 71 non-participants) and 126 Arab (59 vs 67 respectively). Among Jewish children, the fraction of untreated decayed teeth was 61% in the participant group and 65% for non-participants, and amongst the Arab children 69% vs. 90% respectively. The fraction of treated decayed teeth for the participant group was 37% compared to 29% for the non-participants among Jewish children, whilst for the Bedouin group it was 23% vs. 8% respectively. CONCLUSIONS: After 2 years, supervised tooth brushing with fluoride toothpaste shows a favorable effect. This study suggests that dental health of children participating in STBP was better than the control group. Fewer carious teeth and more treated carious lesions were recorded in this group. This program can be applied to low SES communities nationwide. Guidelines for fluoride concentration in toothpaste for children should be re-considered based on high caries levels.

An assessment of the dental health of chronic institutionalized patients with psychiatric disease in Israel.

Many institutionalized patients with psychiatric disease have been discharged into the community and the patients who remain hospitalized are at a particularly high risk for dental disease. This study assessed the oral health and treatment needs of chronically hospitalized patients with psychiatric disease in Israel. A random sample of 301 patients hospitalized for more than 1 year in 14 of 18 psychiatric institutions in Israel was drawn from the National Psychiatric Hospitalization Registry, and 84.4% of them were examined. Their dental status was evaluated using decayed, missing, filled teeth (DMF-T) index and demographic and medical data were retrieved from the patients' files. Of the 254 patients examined, 4 (1.6%) were caries-free, 176 (69%) patients had only a partial natural dentition, while 66 (26%) were edentulous. The average DMF-T score was 23.8. The caries component accounted for 2.7 of the DMF-T, the missing teeth component was 20, and the restored teeth component was only 1.1. There was a negative correlation between age and treated caries, and a positive correlation between age and missing teeth. Not all edentulous patients had dentures. These findings confirm the need to improve the oral health of chronic psychiatric inpatients and the need for dental treatment. The existing policy should be adjusted to integrate the currently separated delivery of the dental services for institutions and community settings. Dental professionals in the health service should be rewarded to restore teeth in this population rather than just to extract them.

Effect of implementing dental services in Israeli psychiatric hospitals on the oral and dental health of inpatients.

OBJECTIVE: Psychiatric disorders (schizophrenia, mood disorders, and organic brain disorders) and their treatment may lead to oral diseases, but assessment of dental status and oral care needs among patients with these disorders is lacking. This study reports changes in dental health and oral care needs of psychiatric inpatients after 1998, when psychiatric hospitals in Israel were required to provide regular dental examinations and treatment for every inpatient hospitalized longer than a year. METHODS: Two epidemiological cohorts from 1997 and 2006 representing long-term psychiatric inpatients before (N=431) and after (N=254) the reform of dental services were compared on the standardized criteria of the Decayed, Missing, and Filled Teeth (DMFT) index scores and DMFT component scores, as well as on the use of and need for dentures. RESULTS: Compared with the prereform cohort, the postreform cohort had fewer decayed teeth and lower DMFT index scores. These differences were independent of gender and clinical diagnosis. No between-cohort differences were found in the use of and need for dentures. On-site dental services were more effective than outsourced services in improving dental health. CONCLUSIONS: The results suggest a substantial improvement in the dental health of this at-risk population after the dental reform in psychiatric hospitals. However, oral health needs are still not fully met, and therefore, additional organizational efforts for further prevention and treatment of dental diseases are required.