Evaluating the provision of oral health education material in Schools in Finland.

INTERVENTIONS: The Finnish Dental Association donated new oral health education material (OHEM) to all upper comprehensive schools in 2008. OBJECTIVE: The aim of this study was to determine whether that OHEM was noticed, received and used in schools, and whether oral health teaching and teachers' attitudes towards oral health changed after distribution of the OHEM. METHODS: Surveys were conducted using online questionnaires for all health education teachers in upper comprehensive schools in Finland. Schools response rates were 39% in 2008, and 40% in 2009. Statistical significances between the teachers and between the schools according to background variables were analysed using a Pearson's Chi-square test for nominal data and Mantel-Haenszel Chi-square test for ordinal data. Changes between 2008 and 2009 were evaluated using percentage change and confidence intervals. RESULTS: Of the responding teachers, 46% reported that they had received the OHEM and 33% had used it in their teaching. The number of teachers teaching oral health did not change after the OHEM, but teachers who taught oral health reported teaching all oral-health-related topics more frequently than they did before. Female teachers more often reported having received the OHEM (48% vs 32%, p=0.011) and having used it (36% vs 22%, p=0.017) than did male teachers. CONCLUSIONS: The OHEM may not lead more teachers to teach oral health, but it provides them with the resources to teach the subject more comprehensively. The OHEM must be planned in close co-operation between schools and local dental health care professionals, to make it better known and accepted among teachers, especially male teachers.

Effect of national recommendations on the sale of sweet products in the upper level of Finnish comprehensive schools.

INTERVENTIONS: In 2007, the Finnish National Board of Education (FNBE) and the National Public Health Institute (KTL) recommended to schools that they quit regular selling of candies and soft drinks. OBJECTIVE: The aim of this study was to determine how and why such selling changed from 2007 to 2008 after the national recommendation. METHODS: Surveys were conducted using online questionnaires to all upper comprehensive schools in Finland. In 2007, 480 (49%) and in 2008, 507 (51%) schools answered the questionnaire; 319 (32%) schools participated in both studies. Schools were asked whether they sold candies, soft drinks or other sweet products and, if theyhad changed the selling of these products, why. The changes in selling were analyzed by using McNemar's test. RESULTS: Of the responding schools, 56% (n=267) and 46% (n=233) sold sweet products in 2007 and 2008, respectively. Of the schools responding both years, 56% reported selling sweet products in 2007 and 50% in 2008. Selling had decreased by 11% among the schools that took part in both studies. The main reasons stated for quitting selling these products were concern about pupils' health (40%) and the recommendation of the FNBE and KTL (38%). CONCLUSIONS: The national recommendation was followed by some decrease in sale of sweet products. For further progress, new actions, both policy measures and broader public involvement, may be needed.

Pit and fissure sealants versus fluoride varnishes for preventing dental decay in children and adolescents.

BACKGROUND: The majority of the detected increment in dental caries is confined to pit and fissure surfaces of first molars. Application of pit and fissure sealants and topical fluorides are widely used procedures in the prevention of decay, and their effectiveness in caries prevention has been proved by systematic reviews. OBJECTIVES: The objective of this study was to compare the effectiveness of pit and fissure sealants with fluoride varnishes in the prevention of dental decay on occlusal surfaces. SEARCH STRATEGY: Electronic searching was performed on the following databases: the Cochrane Oral Health Group's Trials Register (last update November 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4), MEDLINE (from 1966 to December 2005), EMBASE (from 1974 to November 2004), SIGLE (from 1976 to December 2004), SCISEARCH, CAplus, INSPEC, JICST-EPLUS, NTIS, PASCAL (last update December 2004), DARE, NHS EED and HTA (last update November 2005). Reference lists from articles that fulfilled the inclusion criteria in this review and from review articles based on the search of MEDLINE were searched for additional relevant articles. Conference abstracts published as books or journals and handsearched by the Cochrane Oral Health Group were also included. SELECTION CRITERIA: The inclusion criteria for study selection were: random or quasi-random allocation study design; sealants versus fluoride varnish or sealants and fluoride varnish combination versus fluoride varnish alone; included studies included caries documentation on occlusal surfaces of permanent molars and the subjects were under 20 years of age. Both parallel and split-mouth study designs were accepted. The primary outcome of interest was the increment in the numbers of carious occlusal surfaces of premolars and molars. A study was excluded if sealants and fluoride varnish were not compared with each other. DATA COLLECTION AND ANALYSIS: Two review authors carried out the baseline searches, selecting the papers on the basis of the title, keywords and abstract and making decisions about the eligibility and data extractions. The same review authors assessed the methodological quality of all included studies: for example, the allocation concealment, blinding, and completeness of follow up. Authors of the studies were contacted for additional information. Risk ratios (RR) as effect estimates were calculated for the differences in whether surfaces were carious or not in the treatment groups, along with the appropriate standard errors and 95% confidence intervals (CI). No data could be combined or meta-analyses undertaken due to the clinical and methodological diversity between study designs. MAIN RESULTS: Four studies were eligible for inclusion in the review. Three of the four studies compared the effectiveness of sealants with fluoride varnish application, and one study compared the effectiveness of sealants and fluoride varnish combination with fluoride varnish alone. Results of two studies revealed the effectiveness of pit and fissure sealants to be statistically significantly higher than an application of fluoride varnish every 6 months in preventing occlusal decays of first molars at 23 months (RR 0.74, 95% CI 0.58 to 0.95) and at 9 years follow up (RR 0.48, 95% CI 0.29 to 0.79). One of these studies was classed as at low risk of bias, one of moderate to high risk. One small study at moderate to high risk of bias failed to find a statistically significant difference between sealants and fluoride varnishes. One study of low risk of bias found a statistically significant difference in favour of the sealants and fluoride varnish combination compared with merely fluoride varnish at 24 months follow up with RR 0.36 (95% CI 0.21 to 0.61). The age of children in the included studies was 5 to 9 years. Allocation concealment was classified adequate in two of these four studies. AUTHORS' CONCLUSIONS: There was some evidence of the superiority of pit and fissure sealants over fluoride varnish application in the prevention of occlusal decays. However, it remained unclear to what extent there is difference between the effectiveness of pit and fissure sealants and fluoride varnishes. Therefore, more high quality research is needed. No recommendations for the clinical practice could be given and the benefit of pit and fissure sealants and fluoride varnishes should be considered locally and individually.

Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents.

BACKGROUND: Fissure sealants used on occlusal tooth surfaces were introduced in the 1960s for protecting pits and fissures from dental caries. Although sealants have demonstrated to be effective in preventing caries, their efficacy may be related to the background caries prevalence in the population. OBJECTIVES: The primary objective of this review was to evaluate the caries prevention of resin based pit and fissure sealants and glass ionomer cements or sealants in children and adolescents. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (last update December 2002), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2002), MEDLINE via OVID (1966 to December 2002), EMBASE (1974 to February 2002), SCISEARCH, SIGLE, CAplus, INSPEC, JICST-EPLUS, NTIS, PASCAL (February 2002) and DARE, NHS EED, HTA (March 2002). Reference lists from included articles and review articles were searched for additional relevant articles. All relevant studies in most languages were considered and translated. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials of at least 12 months in duration in which sealants were used for preventing caries in children and adolescents under 20 years of age were included. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars. DATA COLLECTION AND ANALYSIS: In the first phase, two reviewers independently examined whether a given study was likely to be relevant on the basis of the title, key words and abstract. In the second phase, four of the reviewers independently classified studies to be included in final analyses. Study authors were contacted for additional information. In the split-mouth studies relative risk ratios were calculated for the paired differences of tooth surfaces being carious or not. In studies comparing resin based sealant with no treatment, fixed effect meta-analyses were used to combine the estimates of relative risk ratios. In one parallel group study, the mean DFS data as continuous data, the effect estimate being the difference in mean DFS, was calculated from data of occlusal surfaces of teeth included in the test and control groups. MAIN RESULTS: Eight trials were included in this review of which seven trials were split-mouth studies and one a parallel group study. Six studies provided data for comparing sealant with no treatment and three studies for comparing glass ionomers with resin based sealants. The overall effectiveness of resin based sealants in preventing dental decay on first molars was high. Based on five split-mouth studies with 5 to 10 year old children there were significant differences in favour of the second-generation resin sealant compared with no treatment with pooled relative risk values of 0.14, 0.24, 0.30, 0.43 at 12, 24, 36 and 48 to 54 months respectively. The reductions in caries therefore ranged from 86% at 12 months to 57% at 48 to 54 months. The 24 month parallel group study comparing second-generation resin sealant with control in 12 to 13 year old children found also significantly more caries in the control group children with DFS = 0.65 (95% CI 0.47 to 0.83). Allocation concealment was classified adequate in three of these six studies. However the information on background levels of caries in the population was insufficient to conduct further analyses to estimate the effectiveness of resin based sealants related to baseline caries prevalence. Only one study provided data for the comparison between glass ionomer sealant and control. Based on this, there is not enough information to say whether ionomer sealants are effective, or not. The results of three studies comparing resin sealants with glass ionomer sealants were conflicting and the meta-analyses were not carried out. REVIEWERS' CONCLUSIONS: Sealing with resin based sealants is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars. However, we recommend that the caries prevalence level of both individuals and the population should be taken into account. In practice, the benefit of sealing should be considered locally and specified guidelines for clinicians should be used. The methodological quality of published studies concerning pit and fissure sealants was poorer than expected.