Effects of Application of Sealant and Fluoride Gel Application Program for Elementary School Children in Laos for 3 Years

Transcription

1 Original Article Int J Clin Prev Dent 2018;14(1):81-88 ㆍ ISSN (Print) ㆍ ISSN (Online) Effects of Application of Sealant and Fluoride Gel Application Program for Elementary School Children in Laos for 3 Years Nitthasack Phommavongsa 1, Woo-Ryung Park 2, Na-Young Kim 2, Eun-Joo Na 3, Mi-Hae Yun 3, Seung-Chul Shin 4, Ja-Won Cho 4 1 Department of Pediatric Dentistry, Faculty of Dentistry, University of Health Science, Vientiane, Laos, 2 Department of Oral Health, Graduate School, Dankook University, Cheonan, 3 Department of Dental Hygiene, Daejeon Health Institute of Technology, Daejeon, 4 Department of Preventive Dentistry, College of Dentistry, Dankook University, Cheonan, Korea Objective: This study conducted oral health program with the fluoride topical and sealant application in elementary school in Laos for 3 years in order to estimate the effect of prevention for the program on school oral health in Laos. Methods: Three primary schools were selected as an experimental group and the comparison group. 1.23% APF gel was applied 3 times every year and sealant was applied on the permanent 1st Molar for grade 1 to 5 in experimental group and caries experience was examined by use of DSRL camera photo taking and image analysis technique. The data was compared with the experimental and comparison group for 3 years. Results: Fluoride topical application and sealant in children with mixed dentition showed no difference in dft and dfs index (p>0.05). and also not so much different between two as DMFT or DMFS index in permanent dentition (p>0.05). Caries prevention effect was estimated as showed 41.4% in third grade, 15.0% in forth grade, 20.9% in fifth grade in DMFT index and the prevention effect of DMFS index was 56.1% in third grade, 38.2% in forth grade and 31.9% in fifth grade. Conclusion: It would be a more effective for prevention for the caries in case of the continuous performing the fluoride and sealant application as one of the school oral health program in Laos. Keywords: pit and fissure sealants, topical fluorides, oral health Introduction Corresponding author Ja-Won Cho Department of Preventive Dentistry, College of Dentistry, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: , Fax: , priscus@dku.edu Received January 19, 2018, Revised February 24, 2018, Accepted February 25, 2018 Laos is the only inland country on the Indochina Peninsula. Its official name is the Lao People s Democratic Republic and is not adjacent to the sea of the Indochina Peninsula [1,2]. Laos shares borders with Thailand, Cambodia, China, Myanmar and Vietnam. The per capita GDP of the Lao people is about $ 1660, one of the underdeveloped countries. The total population of Laos is about 7 million, with the population under 20 years accounting for 49.1% of the total population. Previous studies re- Copyright c Korean Academy of Preventive Dentistry. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 81

2 International Journal of Clinical Preventive Dentistry ported the deplorable conditions of oral health status in Laos [2,3]. Currently no public oral health services are available for students or the public in Laos. Oral care programs are under way, supported by foreign aid to students at a few institutions [4-10]. Vientiane, the capital of Laos, is home to about 500 elementary schools. Lao Elementary Education is compulsory, and the academic career begins at 6 years of age and lasts 5 grades in total [10,11]. Oral health, which is considered part of overall health, refers to the state of oral tissues that are not affected by other diseases, and which do not interfere with mental and social life. Thus, oral health is an essential element of health. Dental caries and periodontal diseases threaten oral health. Dental caries is a multi-factorial disease [12]. Dental caries is an oral disease, which accounts for the highest percentage of cases associated with tooth loss [13]. This type of dental caries is common in children of elementary school age, and dental caries developed once accumulates over a lifetime and cannot be restored to its natural state [12,13]. At the FDI World Dental Federation, the prevalence of dental caries was determined by several factors [5] including geographical and social factors, and access to dental clinics. In particular, social influences had the greatest effect on the prevalence of dental caries [5,6]. In order to prevent dental caries, public oral health programs in the community are in progress, and should incorporate dental caries prevention for the population below poverty line, for economic and social progress [12,13]. Among these public oral health projects, the primary oral health project is carried out as part of elementary school education in an effort to improve and maintain the oral health of elementary students more efficiently. The oral health projects in the elementary school are designed to develop children s oral health knowledge, attitude and behavior changes. In addition, oral health projects in the elementary school are among the most effective and basic public health projects supposed to raise the oral health level of all citizens [12,13]. The purpose of this study is to confirm the combined effect of 1.23% APF fluoride gel and sealant. Toward this end, tooth filling was performed on the occlusal surface of the permanent teeth of a few elementary school children in Laos, Vientiane, from May 2013 to February 2016, by applying 1.23% APF fluoride gel three times annually. We investigated the degree of contribution to prevention of caries, confirmed the prophylactic effect, and used it as a standard of reference to conduct Laos elementary school oral health project. Materials and Methods 1. Subject This project was carried out in collaboration with Korea International Cooperation Agency (KOICA) in Korea. In cooperation with the Lao Health Ministry and Healthcare and Hope Alliance (HHA) in Korea, three projects were selected among the elementary schools in Vientiane, the capital of Laos. We carried out oral health care business for three years from 2013 to 2016 [10]. Based on the number of students, 1 elementary school (Huayhong school) in the experimental group and 2 control schools (Bornangua school, Nongping school) in the control group were selected. Table 1 shows the number of students who became business targets. 2. Methods Students at one elementary school (Huayhong school) in the experimental group and at two elementary schools (Bornangua school, Nongping school) in the control group were examined orally before the project (May 2013), and annually in February of 2014, 2015, and The student s examination was carried out in parallel with the oral and indirect oral examinations. These direct and indirect oral examinations were carried out after the Lao dentist and the Korean preventive team were trained in the same oral examination methods and standards. Table 1. Experimental subject (n) Control Subtotal Control Subtotal Control Subtotal Experimental Experimental Experimental Experimental Control Subtotal Total Vol. 14, No. 1, March 2018

3 Nitthasack Phommavongsa, et al:effects of Application of Sealant and Fluoride Gel Application Program The experimental and the control groups were both subjected to the same brushing demonstration training every year. In the experimental group, pit and fissure sealants for permanent tooth dentition and topical fluoride application using 1.23% APF gel were used in parallel. 1) Approval of IRB The study was approved by the IRB of the Graduate School of Dentistry of Kyung Hee University (IRB: KHUSD ). 2) Composition of the research team This project was carried out in cooperation with KOICA. The research team consisted of the Laos Health Authority, the Lao Dentist Association, the Members of HHA in Korea, and a team of medical corps of the preventive dentistry and dental health departments of Dankook University. A total of 25 members consisted of dentists, dental hygienists, and dental technicians from the Korean Service Team, dentists from the Lao Dental Association, administrative support and international cooperation personnel (Table 2). 3) Research schedule The schedule for the investigation from May 4, 2013 to February 19, 2016 is as follows (Table 3). Table 2. Composition of research team Manpower Number Responsibilities Korean dentist 9 Dental preventive care Korean dental hygienist 6 Taking of oral photo Korean dental technician 1 Lao dentist 6 Dental preventive care Healthcare and hope alliance 2 Administrative support, international cooperation, supplies support Other 1 Interpretation, etc. 4) Research protocol Students at a single elementary school (Huayhong school) in the experimental group and at two elementary schools (Bornangua school, and Nongping school) in the control group conducted oral health education programs using the same oral examination, educational video and vocal procedures. In one experimental group, a sealant and fluoride topical application with 1.2% to 3% APF gel was applied. (1) Direct and indirect oral examinations: Dental investigations were carried out by direct and indirect oral examinations, based on WHO standards and after obtaining informed Conseco of the participants. Direct oral examinations were performed by directly examination of the subjects using dental mirrors, tongue blade, and portable penlights, by a Korean dentist team. An indirect oral examination was carried out after preliminary consultation and training. The equipment used to obtain oral pictures used dental solution and a mouth photo mirror (FF-PHOTO; Osung, Seoul, Korea) equipped with D-SLR camera (EOS 40D; Canon Co., Tokyo, Japan) containing a 60 mm macro lens (Canon EF-S 60 mm F2.8 Macro USM; Canon Co.) and ring fresh (Canon MR-14 EXII Ring Fresh; Canon Co.) [14,15]. Maxillary and mandibular occlusal views, as well as anterior and lateral views of the subject were obtained in the basic oral photographs. Additional photography was performed as deemed necessary. The oral photographs were analyzed by a single dentist and recorded on a chart. (2) Oral health education and brushing lessons: Oral health education and brushing lessons were conducted in the experimental and the control groups using materials produced in Korea. Oral health education was carried out using a beam projector and screen. Toothbrushing education was conducted by distributing toothbrushes to the subjects in the field, and conducting a pilot education directly using the educational tooth Table 3. Schedule of Laos project Year Period Experimental group (Huayhong) Control group (Bornangua/Nongping) 1st Oral examination, oral health education, pit & fissure Oral examination, oral health education sealant fluoride gel application 2nd Pit & fissure sealant fluoride gel application Oral examination, oral health education, pit & fissure Oral examination, oral health education sealant fluoride gel application Pit & fissure sealant fluoride gel application 3rd Pit & fissure sealant fluoride gel application Oral exam, pit & fissure sealant fluoride gel application Oral examination Pit & fissure sealant fluoride gel application 4th Pit & fissure sealant fluoride gel application Oral exam, pit & fissure sealant fluoride gel application Oral examination 83

4 International Journal of Clinical Preventive Dentistry model (PE-STP002; Nissin Dental Products Inc., Tokyo, Japan) and the education toothbrush model (P3-TB; Nissin Dental Products Inc.). These oral health education and brushing lessons were conducted once a year. (3) Sealant: First, sealants were applied to first permanent molar teeth of 1st, 2nd, and 3rd grade students among the experimental school children in May. In the second year, the target was a school group containing grades 1, 2, 3, and 4 students. In the third and fourth years, sealants were used among all the grades 1, 2, 3, 4, and 5 (Table 4). At this time, Denfil TM etchant-37 R (37% phosphoric acid solution; Vericom, Seoul, Korea) was used as an etchant, and tooth filling was performed with Seal it R (Pit and fissure sealant; Spident, Seoul, Korea), a photopolymerization vehicle. (4) Fluoride topical application: Fluoride topical application was carried out using a 1.23% APF gel (60 Second taste Gel; Pascal International Inc., Bellevue, WA, USA) 3 times a year Table 4. The number of teeth to which the sealant is applied during the program Total 1st year 2nd year 3rd year 4th year Total Values are presented as number only. Table 5. Dental caries experience of primary tooth Year Number dft index dfs index Expe Cont Expe Cont p a Expe Cont p a M SD M SD M SD M SD M SD M SD M SD M SD M SD M SD M SD M SD dft index: decayed and filled primary tooth index, dfs index: decayed and filled primary tooth surface index, Expe: experimental group primary school, Cont: control group primary school, M: mean, SD: standard deviation. a p-value by 2 samples t-test. 84 Vol. 14, No. 1, March 2018

5 Nitthasack Phommavongsa, et al:effects of Application of Sealant and Fluoride Gel Application Program in experimental students, during February, May, and October every year. (5) Statistical analysis: This study recorded oral examinations using MS excel 2016 (Microsoft. Co., Redmond, WA, USA). The IBM SPSS ver (IBM Co., Armonk, NY, USA) for Windows, was used to compare and analyze the caries expe- Table 6. Dental caries experience of permanent tooth Year Number DMFT index DMFS index Expe Cont Expe Cont p a Expe Cont p a M SD M SD M SD M SD p b M SD M SD M SD M SD p b M SD M SD M SD M SD p b M SD M SD M SD M SD p b M SD M SD M SD M SD p b DMFT index: decayed, filled and missing permanent tooth index, DMFS index: decayed, filled and missing permanent tooth surface index, Expe: experimental group primary school, Cont: control group primary school, M: mean, SD: standard deviation. a p-value by 2 samples t-test. b p-value by 2 samples t-test between 2013 and

6 International Journal of Clinical Preventive Dentistry rience status according to each group and grade. A two-sample t-test (p=0.05) was performed to determine the significance of the mean values between the experimental and control groups. In addition, the percentages of caries prevention annually in the experimental school were calculated as shown in the table below. Caries prevention rate= A B 100(%) A A=Caries experience index of control school B=Caries experience index of experimental school Results 1. Dental caries experience of primary tooth Table 3 shows the results of the primary tooth caries experience. There was no significant difference in dft and dfs indices of the primary tooth caries experience between the experimental and the control groups among the lower grades of Laos between 2013 and 2016 (p>0.05) (Table 5). 2. Dental caries experience of permanent tooth The DMFT index of the experimental group was 0.55±0.62 and the DMFS index was 0.58±0.71 in the third grade students, The DMFT index of the control group was 0.93±1.14 and the DMFS index was 1.13±2.03, and there was a statistically significant difference in the DMFS index (p<0.05) (Table 6). The DMFT index of the experimental group was 1.02±0.93 and the DMFS index was 1.08±1.02 in the 4th grade students, The DMFT index of the control group was 1.20±1.13 and the DMFS index was 1.75±2.14, and there was a statistically significant difference in the DMFS index (p<0.05) (Table 6). In the 5th grade students, the DMFT index of the experimental group was 1.12±1.05 and the DMFS index was 1.55±1.54. The DMFT index of the control group was 1.42± 1.50 and the DMFS index was 2.27±3.04, indicating that the experimental group had lower cure experience than the control group, but not statistically significant (p>0.05) (Table 6). 3. Effect of caries prevention on permanent tooth Table 7 shows the caries prevention effect in the experimental school children in 2016 compared with the control school. In terms of DMFT index, the caries prevention rate was 41.4% among the 3rd grade, 15.0% among the 4th grade, and 20.9% in the 5th grade students. The DMFS index was 56.1% in the 3rd grade, 38.2% in the 4th grade, and 31.9% in the 5th grade. Discussion Dental caries is a disease caused by various factors, including a combination of host-specific, pathogen-related, and environmental factors [12,13]. In recent years, the prevalence of dental caries has risen in developing countries where there is a lack of preventive care or public health projects compared with advanced countries with well-developed social security services. The 12-year-old DMFT index of Southeast Asian countries surveyed by the World Dental Federation was 1.1 in Cambodia in 2007, 0.2 in Myanmar in 2009, 1.3 in Thailand during 2012, and Laos scored 1.8 in 2006 suggesting that Laos is higher than neighboring countries in terms of public health services [2,5]. The World Health Organization (WHO) has introduced the principles of preventive care, and minimum medical care in dental care as a guideline for the management of oral diseases. However, poor dental conditions in Laos interfere with appropriate preventive measures. Dental caries developing in the elementary school period and associated with mixed dental arch containing a mixture of primary and permanent teeth, and in permanent dental arch due to exchange of primary and permanent teeth, is characterized by progressive disease throughout life. Therefore, appropriate oral health care during the elementary school period prevents oral Table 7. Prevention effect (%) According to DMFT index According to DMFS index According to Dft index According to Dfs index Mean Mean Mean Mean P.E.R. P.E.R. P.E.R. Expe Cont Expe Cont Expe Cont Expe Cont P.E.R DMFT index: decayed, filled and missing permanent tooth index, DMFS index: decayed, filled and missing permanent tooth surface index, Expe: experimental group primary school, Cont: control group primary school, P.E.R.: prevention effect rate. 86 Vol. 14, No. 1, March 2018

7 Nitthasack Phommavongsa, et al:effects of Application of Sealant and Fluoride Gel Application Program disease [16,17]. The school oral health project is based on the 4-stage dental caries prevention method, which prevents the occurrence and progress of dental caries based on brushing education, fluoride application and sealant usage [16,17]. Lim et al. [10] reported that long-term school oral health projects improved the effectiveness of dental caries prevention, rather than short-term preventive care programs via 1.23% APF gel application and sealants for two years in Laos school-age children. The purpose of this study was to investigate the preventive effect of oral health projects on dental caries via application of sealants and fluoride gel in Laos elementary school children for 3 years, and to establish long-term and ongoing oral health projects for elementary school students in Laos. DMFT index of the group of students in the target schools in the comparison of the 3rd grade students were investigated by 0.55±0.62, DMFS index was 0.58±0.71, and the DMFT index of the control group, compared to school students was 0.93±1.14 and the DMFS index was 1.13±2.03. There was a statistically significant difference in the DMFS index (p<0.05). DMFT index of the control group in the comparison of the 4th grade students was 1.20±1.13 and the DMFS index was 1.75±2.14. The DMFT index was 1.02±0.93 and the DMFS index was 1.08, and DMFS index were statistically significant (p<0.05). DMFT index of the control group in the comparison of the 5th grade students was 1.12±1.05 and the DMFS index was 1.55±1.54. It appeared to DMFS index 2.27±3.04, and determined that the low degree of dental caries experience than the control group, were not investigated as not statistically significant. The dental caries prevention rate in terms of DMFT index for 3 years was 41.4% for grade 3, 15.0% for 4th grade, and 20.9% for 5th grade. Park et al. [6] analyzed the effects of fluoride ion application project in Laos children and found that fluoride ion application method using 2% NaF was effective, and Yun et al. [9] reported that the DMFS index was decreased in the three-year evaluation of the fluoride ion application in Laos. Kim et al. [8] reported that the rate of prevention of dental caries in the DMFS index was 29.3% in the 3rd grade, 16.5% in the 4th grade, and 30.8% in the 5th grade using sealants among Laos school children for three years. However, the effect of fluoride application and sealants alone on the business was affected by a number of variables. In the case of the sealant, the degree of cleanliness of the tooth surface and dietary habits affect the maintenance period. Also, fluoride ion application was influenced by the degree of electric current of fluorine ion pre-application and the electrode. Compared with 2 years of sealant usage and 1.23% APF gel application by Lim et al. [10], which resulted in an increased prevention of dental caries, the prevention rate of DMFS index caries was 30% or more. Therefore, it is expected that school dental health projects including fluoride application, sealant and oral health education programs will have a higher dental caries prevention effect. As a result, continuous and ongoing application of sealants and fluoride gels in dental health projects among Laos elementary school children was evaluated to demonstrate the dental caries preventive effects. Conclusion To evaluate the effectiveness of oral health care programs in elementary school, the Laotian Primary School students in Vientiane City applied sealant for permanent teeth over a period of 3 years and a topical application of 1.23% APF fluoride gel from May A total of four oral examinations were conducted among the elementary school students of the target school along with a comparative evaluation in May 2013, February 2014, February 2015, and February Analysis of the data yielded the following conclusions: 1. Among students in the third grade of 2016, the DMFT index of the experimental group was 0.55 (±0.62) and the DMFS index was 0.58 (±0.71), the DMFT index of the control group was 0.93 (±1.14) and the DMFS index was 1.13 (±2.03), and there was a statistically significant difference in the DMFS index (p<0.05). 2. DMFT index 1.02 (±0.93) and DMFS index 1.08 (±1.02) in the experimental group were compared in the fourth grade students in 2016, The DMFT index of the control group was 1.20 (±1.13) and the DMFS index was 1.75 (±2.14), and there was a statistically significant difference in the DMFS index (p<0.05). 3. The DMFT index of the experimental group was 1.12 (±1.05) and the DMFS index was 1.55 (±1.54) in the 5th grade students of the year 2016, the DMFT index of the control group was 1.42 (±1.50) and the DMFS index was 2.27 (±3.04). The experimental group showed lower dental caries compared with the control group, without any statistical significance. 4. In terms of DMFT index, the dental caries prevention rate was 41.4% for 3rd grade, 15.0% for 4th grade, and 20.9% for 5th grade. The DMFS index was 56.1% in the 3rd grade, 38.2% in the fourth grade, and 31.9% in the 5th grade students. Thus, implementation of continuous oral health care projects including sealant and fluoride gel application programs among elementary school students is necessary to promote systematic oral health care by effectively preventing dental caries. 87

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