Toothbrushing & Dental Care in Sri Lanka

SUPERVISED TOOTHBRUSHING PROGRAMME IN PRIMARY SCHOOLS -A PILOT PROJECT IN JAFFNA DISTRICT

DR.S.BALAKUMAR Regional Dental Surgeon, Jaffna

PROBLEM STATEMENT Caries prevalence rate of Grade 1 students in Jaffna District is very high when compared to children in Grade 1 in other parts of the country

MOTIVATION • Dental caries has a massive impact on the child’s development.

• Dental caries prevalence rate in Grade 1 (6yrs) students: National level: 65.5% mean dmft: 3.5 Jaffna district: 84.7% mean dmft: 7.2 (2011) • Most of the children used to clean their teeth with tooth powder and finger. In order to train them to use tooth brush and a fluoridated tooth paste which can reduce the dental caries incidence rate.

MEETING TO INTRODUCE MY PROJECT TO THE EDUCATION AUTHORITY • I conducted a meeting with the Department of Education officials, school principals and teachers to get maximum support from the education side • Dr.N.Sivarajah (WHO coordinator Jaffna), Dr.A.Ketheswaran (RDHS Jaffna) attended the meeting

APPROACH It is well known that even individuals who use brush and fluoridated tooth paste to clean their teeth developed caries. So I did a derivation to analyze the mistakes they do during brushing and found five mistakes every person who brush their teeth with tooth brush and tooth paste. To validate the findings we started the SUPERVISED TOOTH BRUSHING as a pilot project in selected schools with a control group in the Grade 1 students in each MOH divisions in 2011. They did the brushing after the afternoon meal in the school under the supervision of trained teachers. The School Dental Therapists did all the necessary routine treatments for the children. The SDTs recorded the oral heath status to both study and control groups.

THE MISTAKES EVERYBODY MAKES WHILE BRUSHING • Wetting the brush if we take tooth paste on a wet brush it will activate the foaming agent thus more spitting makes fluoride waste • After taking the tooth paste, putting the brush into the oral cavity This will result in applying the paste on one side of the quadrant. So I asked to tap the brush on the hand so that the paste will move into the brush so that tooth paste will be dispensed all over mouth

• After brushing rinsing the mouth several times The fluoride is drawn onto the tooth by adsorption theory (surface adhesion) if we rinse the mouth several times it will get washed away. It needs at least 30 minutes for the fluoride to penetrate into the tooth

WHAT DOES FLUORIDE DO? • Amazingly, the new tooth mineral that's created during remineralization when fluoride is present is actually "harder" than the tooth was originally. • Teeth are generally composed of the minerals hydroxyapatite and carbonated hydroxyapatite. The tooth mineral that is created during the remineralization process when fluoride is present is fluorapatite. • Fluorapatite is "harder" than other tooth minerals, in the sense that it is more resistant to damage caused by acids (demineralization). So, astoundingly, not only does fluoride promote the tooth's remineralization but it also helps to create a tooth surface that is even more resistant to the formation of tooth decay

FLUORIDE HELPS TO INHIBIT ACID CREATION Dental researchers have found that fluoride acts to inhibit the rate at which the bacteria living in dental plaque are able to produce acids This is because fluoride disrupts the bacteria's ability to metabolize sugars. And the less sugar that the bacteria can consume, the less acidic tooth-demineralizing waste products they will produce.

DETAILS OF SCHOOLS SELECTED No

Name of the School Dental Therapist & MOH area

Base/ Feeder school

No of students

Principal’s name

1

Mrs.Shobana Thayaparan MOH Chavakachcheri

B: J/Dreiberg College,Chavakachcheri F: J/Ladies College, Chavakachcheri

65(2 Div) 60(2 Div)

Mr.K.Arunthvapalan Mrs.S.Sivanathan

2

Mrs.Nanthini Uthayakumar MOH Karaveddy

B: J/Udupiddi Girls College F: J/

60(2 Div) 70(2 Div)

Mrs.T.Joseph Mrs.S.Tharmalingam

3

Mrs.Nalinasany Rajadurai MOH Sandilipay

B: J/Sothi vembadi M.V,Manipay F: J/Vivekanantha M.V,Maipay

40(1 Div) 40(1 Div)

Mrs.Sivakumar

4

Mrs.Gowry Paraparan

B: J/Kondavil CCTMS F: j/Kondavil Hindu M.V

40(1 Div) 60(2 Div)

Mr.Shanmugakumar

5

Mrs.Pushpavathi Kanagaratnam

B:J/RamanathanCollege,Maruthanarmadam F: J/Inuvil Central College

60(2 Div) 60(2 Div)

Mrs.A.Sivagnanasudar am

6

Mrs.Nagarani Sothiroopan

B: J/Central College, F: J/Holy Family Convent,

140(4 Div) Mr.Ongaramoorthi 140(4 Div)

B: J/Arunothaya College, Alaveddy F: J/Alaveddy RC School

60(2 Div) 25(1 Div)

Mr.Ketheeswaran

B: J/Velanai Saraswathy Vidyalayam F: J/Velanai Iyanar Vidyalayam

30(1 Div) 40(1 Div)

Mrs.Nanthini Panchalingam Mrs.P.Rajanayagam

B: J/Vaddu Hindu College F: J/Sithankerni Sri Ganesha Vidyalayam

30(1 Div) 35(1 Div)

Mr.S.Sivashanmugasu ndaram MrsJ.Jeyarani

MOH Nallur

MOH Uduvil

MOH Jaffna

7

Mrs.Anesta Gnanachandran MOH Tellipalai

8

Mrs.S.Elilarasi MOH Kayts

9

Mrs.Mansuladevi Pansalingam MOH Chankanai

INTRODUTION TO THE PROGRAMME AT A SCHOOL • Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level

PARENTS ATTENDING THE INTRODUCTION • Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level

PARENTS ATTENDING THE INTRODUCTION • Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level

INTRODUCING THE TECHNIQUE • Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level

CHILDREN BRUSHING THEIR TEETH • Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level

CHILDREN BRUSHING THEIR TEETH • Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level

CHILDREN BRUSHING THEIR TEETH • Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level

NAMED TOOTH BRUSHES • Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level

TOOTH BRUSH HOLDER AT SCHOOL

• Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level

A PARENT ACKNOWLEDGING THE MEETING • Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level

RESULTS After two years (2011-2012) we checked the Dental caries incidence for both the study and the children in the control group of students. It was shown that the control group developed more dental caries when compared to the study group The study group developed 7% & the control group developed 30% at the end of 2 years . We should carry out this project for at least three years to get a final result

CONCLUSION We can reduce Dental caries by proper bushing which is cost effective and can be carried out at home rather than doing Fluoride varnish application or Fluoride gel application which are costly treatments

DRAWBACKS ENCOUNTERED • Some schools in the villages did not have tap Bourne water and water scarcity (MOH Kayts).

• During the rainy season the children did not have a place to do brushing.

OTHER CONSIDERATIONS But after I started this project I came to know that the schools have syllabus which have to be completed and various other activities. So now I have started a pilot project in the Pre schools (Kinder garden) as Oral Health Promoting Pre schools which include proper healthy foods, no cool drinks or fizzy drinks to be brought in the drink bottles (only boiled cooled water), proper hand washing and proper brushing. This approach is supported by the Oral Health Division, Ministry of Health, Sri Lanka

ACKNOWLEDGEMENT I wish to thank the CMDDA (Canada) for funding this project and make it a success And I also thank Dr.Jayanthi (Director WHO collaborating center, Sweden) for giving me technical advices

I WISH TO THANK THE INTERNATIONAL MEDICAL HEALTH ORGANIZATION USA FOR INVITING ME TO THE 10TH ANNUAL CONVENTION.

Thank you