Evaluation of the child oral health promotion 'MaliMali' Programme based on schools in the Kingdom of Tonga.

INTRODUCTION: The South Pacific Medical Team (SPMT) has supported oral health care for Tongan juveniles since 1998. This voluntary activity, named the MaliMali ('smile' in Tongan) Programme, is evaluated in detail in this paper. METHODS: This evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. The objectives were to explore: (i) whether the programme was accessible to Tongan schoolchildren (Reach); (ii) the impact of the programme on decayed, missing and filled teeth (DMFT) scores and toothbrushing habits (Effectiveness); (iii) factors that affected the adoption of the programme (Adoption); (iv) whether implementation was consistent with the programme model (Implementation); and (v) the long-term sustainability of the programme (Maintenance). RESULTS: The MaliMali Programme has grown into an international project, has spread countrywide as a uniform health promotion and is reaching children in need. Following implementation of this programme, the oral health of Tongan juveniles has improved, with a decrease in the mean DMFT index and an increase in toothbrushing. To provide training that will allow Tongans to assume responsibility for the MaliMali Programme in the future, dental health education literature was prepared and workshops on oral hygiene and the MaliMali Programme were held frequently. At present, the programme is predominantly managed by Tongan staff, rather than by Japanese staff. CONCLUSIONS: This evaluation found the MaliMali Programme to be feasible and acceptable to children and schools in the Kingdom of Tonga. The programme promotes oral health and provides accessible and improved oral health care in the school setting, consistent with the oral health-promoting school framework.

Effect of school-based fluoride mouth-rinsing on dental caries incidence among schoolchildren in the Kingdom of Tonga.

Since 1998, the authors have been working to improve the oral health of children at kindergartens and primary schools in the Kingdom of Tonga (Tonga). Our primary activity has been a school-based fluoride mouth-rinsing (FMR) program. FMR is performed using 7-10 mL of a 0.2% NaF solution for 1 min once per week at each school. In the present study, we evaluated the effect of school-based FMR on dental caries incidence among Tongan schoolchildren. A total of 109 children aged 10 years were evaluated at six primary schools on Tongatapu Island. The FMR group comprised 46 children who had participated in the school-based FMR program for at least 5 years 6 months; the control group comprised 63 children who had participated in the school-based FMR program for 1 year or less. During standardized dental examinations, decayed, missing, and filled teeth were counted by a single dentist at each school. The school-based FMR program effectively decreased the number of dental caries. A school-based FMR program may thus be very beneficial in preventing caries among children in Tonga.

Associations between oral health behavior and anxiety about water fluoridation and motivation to establish water fluoridation in Japanese residents.

Since 1972, community water fluoridation programs have not been practiced in Japan. Risk perception among the population plays an important role in the implementation of water fluoridation programs. The oral health behavior of Japanese children has changed, especially due to recent increases among children in the use of fluoridated products and fluoride applications by dentists. The purpose of this study was to examine the associations between oral health behavior, risk perception, and the desire to implement water fluoridation among Japanese residents. We distributed a questionnaire survey (response rate: 92.8%) to mothers with children aged two or three years (n = 573). There was a correlation between anxiety and level of motivation to implement water fluoridation (Spearman coefficient: 0.355, P < 0.001). Exposure to various fluoride experiences was higher in the "not anxious" group. The motivation level was significantly higher in subjects who had a better understanding of the effectiveness of fluoride, those who used fluoride tooth paste, and those whose children received fluoride applications from dentists. We conclude that increased knowledge of and experience with fluoride might help decrease the perception of risk and increase motivation for implementing water fluoridation among the general public.

Economic Evaluation of a School-based Combined Program with a Targeted Pit and Fissure Sealant and Fluoride Mouth Rinse in Japan.

BACKGROUND: In Niigata prefecture, Japan, a system has been developed based on a school-based fluoride mouth rinse program as follows; students with caries susceptible teeth are screened in a school dental examination, and encouraged to receive sealant placement in local dental clinics. However, the cost-effectiveness of sealant application in the public health has been questioned. The aim of this study was to estimate of the cost-effectiveness and cost-benefit ratio for a school-based combined program with fluoride mouth rinse and targeted fissure sealant in children residing in non-fluoridated areas in Japan. PARTICIPANTS: The analysis was based on comparing an intervention group with two cohorts in the 8-year-old (n=66) and 11-year-old (n=58) participating in the combined program for four and seven years, respectively, with a control group of the same grades (n=43 and n=54 respectively). METHODS: The study measured mean differences in number of decayed and filled teeth (DFT) between the study groups and a combined program cost per child during study periods. The cost-effectiveness ratio was expressed as an individual annual program cost per DFT averted. In the cost-benefit ratio the mean difference in treatment cost between groups (program benefit) was compared to program cost. RESULTS: The mean reduced DFT differences between groups were 1.44 in 8-year-old and 3.17 in 11-year-old children. The cost-effectiveness ratio was ¥ 493 in the 8-year-old and ¥ 202 in the 11-year-old, respectively. The cost-benefit ratio was 1.84 in 8-year-old children and 2.42 in 11-year-old. CONCLUSION: This combined program indicated acceptable cost-effectiveness and cost -benefit ratio.

Associations among distributions of dental postgraduate residents, dentists and clinical training facilities in Japan.

The purpose of this study was to evaluate the correlation and distribution of dental postgraduate residents, dentists and clinical training facilities in each prefecture to analyze the regional distribution and supply of dentists in Japan. The results were also compared with referential data for medicine. The coefficient of correlation between the dentist index and dental postgraduate resident index was r = 0.76 (P < 0.001) in 2006. The distribution (coefficient of variation) was greatest for the dental postgraduate resident index. The numbers of dentists per 100,000 population in prefectures with dental colleges were significantly higher in 1986, 1996 and 2006 for each comparison (P < 0.001). Coefficients of correlation between dentist index and dental postgraduate resident index were r = 0.65 (P < 0.01) in prefectures with dental colleges and r = 0.11 in those without dental colleges in 2006. The prefectures with high level of numbers of cooperative-type clinical training facilities had dental colleges.

A vicious cycle in the oral health status of schoolchildren in a primary school in rural Cambodia.

OBJECTIVE: To investigate the oral health status and the risk factors contributing to dental caries and gum disease of schoolchildren in Cambodia. METHODS: A cross-sectional survey was conducted in a primary school in the Puok District, Siem Reap Province of Cambodia. An oral examination and self-reported questionnaire were used to evaluate oral health status of schoolchildren, ranging in age from 6-16. Of the 512 children that were enrolled in first through sixth grade at the primary school, 332 children (62.8%) participated. RESULTS: Of the schoolchildren that were involved in this study, the prevalence of dental caries in permanent dentition was 53.5% and gum disease was present in 46.2%. Among the participants 80% had plaque, 68.6% suffered from tooth pain and only 44.2% of the schoolchildren owned their own toothbrush. There was an association between the schoolchildren that suffered from tooth pain and those that had dental caries (P < 0.03). Plaque was related to dental caries in permanent dentition (P < 0.003), calculus (P < 0.0001) and gum disease (P < 0.0001) and was linked to the schoolchildren who did not own a toothbrush (P < 0.03) and who suffered from tooth pain (P < 0.03). CONCLUSION: The following sequence of events may result in a vicious cycle in the oral healthcare of schoolchildren in rural Cambodia: the lack of a personal toothbrush leads to plaque buildup, which may increase the incidence of dental caries, which has been linked to tooth pain and gum disease. Ultimately, this poor oral healthcare impacts an individual's quality of life and can lead to more serious health issues later in life.