School Oral Health

SCHOOL ORAL HEALTH PROGRAM
KUWAIT-FORSYTH

Introduction:

Oral diseases over the years have been fluctuating with changing lifestyles. Many of the oral diseases or conditions are associated with unhealthy lifestyles. Hence, modifying the lifestyle of an individual is a better way of controlling oral disease.

School children are the best targets for any preventive oral health program. Also it is in these young children that we can cultivate healthy lifestyles for a better tomorrow.

School Oral Health Program, Kuwait-Forsyth is a comprehensive oral health program serving to the oral health needs of Kuwaiti school children. It is program with Preventive, Treatment and Health Educational components. The main area of concentration is Primary Prevention that is prevention of the disease before its onset.

This program is one of the rare national school-based program in the world and only one of its kind in the middle-east where the need for this kind of a program is immense.

Other Links:

	Program Goal and Objectives
	Brief History about School Oral Health Program, Kuwait
	Functioning of the program
	Manpower structure
	Our Target population and services rendered to them
	Results of oral health survey conducted during 2003-2004
	Research Department
	Program Accomplishments
	Program Productivity during 2002-2007
	Contact

GOAL & OBJECTIVES:

Goal:
To achieve optimum oral health to the maximum number of children by a comprehensive oral care approach - education, prevention and treatment.

Objectives:

Increase the proportion of children benefiting from our Program every year
Increase the proportion of children receiving preventive oral health care every year to achieve 90% coverage with prevention by the year 2010
Increase awareness about the importance of oral health among school children, parents and teachers
Reduce the proportion of children with untreated dental decay to minimal
Increase the proportion of caries free children in permanent and primary dentitions

Brief History about School Oral Health Program, Kuwait:

1982- Forsyth Research Institute was invited by MOH, Kuwait to study the oral health needs of Kuwaitis
1983- Subsequently Forsyth Research Institute was asked to plan a model school oral health program catering to the oral health needs of Kuwaiti school children of Capital governorate.
Subsequently, in the same year 10 Kuwaiti dentists were trained at Forsyth Research Institute and later worked in the Program at Capital region.
1986- After the initial success of Capital program, MOH decided to expand the wings of the School oral health program by signing a contract with Royal Dental College, University of Copenhagen, Denmark to start a similar program catering to the dental needs of Kuwaiti School children of Ahmadi Governorate
1990-1992- Program activities were suspended because of war
1994- MOH decided to have the program started in all the governorates catering to the dental needs of all the Kuwaiti School children
Subsequently, MOH asked Kentucky University to start a program in Hawally governorate, Forsyth Research Institute to start a program in Jahra governorate and Royal Dental College, University of Copenhagen, Denmark to start another program at Farwaniya governorate. Thus all the five regions of School Oral Health Program came into existence.
1999-2000 MOH asked Forsyth Research Institute to take over the programs at Ahmadi, Farwaniya and Hawally. Thus during this year all the programs came under a single banner.
2002- Four dental clinics started functioning at Schools with special needs, serving to the dental needs of around 2500 children with special needs.
2003- New centre started functioning at Mubarak Al Kabeer governorate.

Functioning of School Oral Health Program:

School Oral Health Program is located at all the 6 governorates of Kuwait and the structure of functioning is the same in all the governorates.

School Oral Health program is a comprehensive program for Kuwaiti school children rendering Preventive, Treatment and Health Educational services. These services are rendered through:

1. Center based clinics. (Morning and afternoon) 67 clinics.
2. School based clinics, 58 clinics.
3. Mobile clinics, 48 (25 Sealant teams and 23 Fluoride Varnish teams).
4. School oral health program for the disabled, 4 clinics.

1. Center-based clinics:
This is a system of polyclinics comprising of around 10-15 clinics at a centre located in each program. In the morning, few clinics are reserved for prevention, few for emergency, few for curative procedures and few for endodontics. They work from 8AM to 8PM. In the evening session more emphasis is paid on curative procedures. Also the offices of the co ordinators and supervisors are located in these centers. Emergency clinics work on all the days throughout the year.

2. School-based clinics:
These are dental clinics located within the schools. Most of these clinics are located in primary schools and they are well equipped clinics. A dentist and 2 assistants work in each school clinic and provide comprehensive oral health care to all the children of that school throughout the school year.

3. Mobile clinics:
These are preventive teams comprising of dentists, Hygienists and assistants which move from school to school and perform preventive procedures like, Sealant placement and Fluoride application. They go to schools that do not have school clinics and work throughout the academic year. There are separate teams for applying sealants and fluoride varnish. Sealant team comprises of a dentist and 2 dental assistants whereas a fluoride varnish team comprises of a Dental Hygienist and a dental assistant.

4. School oral health program for the special needs:
In the year 2002 dental clinics were started at schools for children with special needs, and these clinics serve the dental needs of the children at a complex of 12 schools meant for children with special needs. This is composed of 3 school based clinics and 1 mobile team in addition to one educational team, this team is well trained in dealing with the children with special needs.

The procedures that are performed under this comprehensive program are:

A. Health education and promotion:

All the students will get at least one oral health education lesson with supervised tooth brushing exercise during every school year.
Oral health education sessions are organized for parents and pregnant mothers.
Parents are made aware of various preventive programs and the importance of brushing their child's teeth at least twice a day with fluoride tooth paste
Dental health education programs are conducted for school teachers.
Attending oral health exhibitions in co-ordination with oral health department.
Participating with school activities.

Participating in the community activities in public places.

	Hawally Activities		Capital Activities
	Jahra Activities		Farwaniya Activities
	Ahmady Activities		Mubarak Al-Kabeer Activities

B. Preventive measures:

Twice a year application of Fluoride Varnish to all the children. We started replacing gel with Fluoride varnish since 2005 and from the academic year we'll be using only fluoride Varnish.
Sealants targeting newly erupted permanent molars and pre molars.
Oral Prophylaxis.

C. Treatment measures:

Examination & charting for all children at the beginning of the academic year.
Emergency treatment for all children.
Treatment of primary and permanent dentition for all the students.
More emphasis on 1st permanent molars
Undertake prophylaxis & scaling when indicated.
Restorations of primary & permanent teeth. (Glass-ionomers, compomers &composites).
Pulpotomies and the use of SS crowns when needed
Extractions of teeth as required.
Endodontic treatment for permanent teeth under the supervision of a specialist.
Interceptive orthodontic procedures.
All the school children seen in the year are recalled annually.

Manpower Structure:

1. Superintendent of oral health
2. Director of the program
3. Program coordinators: 6 dentists.
4. Clinical Supervisors 10 dentists
5. Prevention Team Leaders: 6 dentists
6. Health Education In charges: 6 dentists
7. Dentists: 160
8. Hygienists: 20
9. Dental assistants: 288.
10. Infection control supervisors 2 Nurses.

Our Target population and services rendered to them:

For Nurseries, only educational services are provided.
For KG students (2 grades, age group of 4-6 years) comprehensive educational and preventive services are provided.
For Primary school students (5 grades, age group of 6-11 years), all services are offered upon consent, they are our area of concentration.
For part of Intermediate school students (4 grades, age group of 11-15 years), all services are offered upon consent.

The overall strength of these school children is around 300,000 and our main focus of

concentration are primary school children with strength of around 160,000.

Research and Training Departments:

School Oral Health Program has a full fledged Research and Training departments.
Training department is responsible for training of new staff and for organizing Continuing Dental Education programs during an academic year.
Research department provides scientific evidence for oral health care administration.
They help to plan, impl ement and evaluate the program from time to time.
Many researches have been done, presented and published in international dental journals and conferences.
Some research works that were presented from our program at various IADR meetings are being presented here:

1. Varnish in preventing caries in partially erupted permanent first molars:
This clinical trial evaluated the efficacy of Duraphat (5% NaF) and 1.23% APF gel in combination in comparison with 1.23% APF gel alone. This research showed that when Duraphat and APF gel were used together there were 4.2 times more chances of the tooth remaining sound after 2 years.

2. Sealant retention with or without use of primer and bond:
This clinical trial tried to evaluate the effectiveness of sealants with and without primer and bond This study showed that if a proper technique is employed for sealant placement, after 2 years primer and bond does not enhance sealant retention

3. To evaluate the retention and effectiveness of fissure sealants in permanent first molars:
This trial on sealant evaluated the retention of sealants when placed with rubber dam and when placed only with cotton roll isolation This study showed that if a proper technique is employed for sealant placement, after 2 years, 75% of the sealants were completely retained and also the retention of the sealants is the same whether placed with rubber dam isolation or with cotton rolls as isolation.

4. Sealant Retention Using Rubber Dam and Cotton Roll Isolation:
This clinical trial was conducted to evaluate the effectiveness of sealants isolated with rubber dam and cotton roll.

A total of 2538 sealants were applied. In two years, in teeth sealed using cotton rolls, 74.5% were completely retained, 3.2% partially lost, 9.1% completely lost, and 13.2% resealed or restored. In teeth sealed using rubber dam, 75.2% were completely retained, 2.8% partially lost, 6.6% completely lost, and 15.3% resealed or restored. There was no difference in sealant retention (p=0.82) and caries (p=0.08) in teeth isolated by rubber dam or cotton roll. After controlling for arch and surface, still no differences in sealant retention were seen in teeth isolated by rubber dam or cotton roll.

Results of oral health survey conducted during 2003-2004:

Outcome evaluation of our program is done once in 3-4 years in the form of oral health surveys. Last oral health survey among Kuwaiti school children was conducted during the year 2003-2004.

6636 children were examined with equal no of males and females. The oral examination was performed by five trained and calibrated teams using portable equipment.

In permanent dentition, 58.7% of the children examined had caries, and 41.3% were caries free. 44.3% of the children examined had untreated decay, 28.2% of the children had restorations, 1.1% had missing teeth, and 7.7% had sealants.

In primary dentition, 69.6% of the children examined had caries, and 30.4% were caries-free. 56% of the children examined had untreated decay, 40% of the children had restorations, 27% had missing teeth, and 7.7% had sealants.

The mean DMFT was 1.9 ± 2.5 and the mean DMFS was 2.7 ± 3.9. The mean deft was 3.8 ± 3.7 and the mean defs was 10.1 ± 11.6

Females had higher caries in permanent dentition with higher DMFT and DMFS whereas males had higher caries in primary dentition.

Age wise comparison shows that DMFT in 12 year olds was 2.8 and deft in 6 year olds was 6.2 which has stabilized over the years.

Also % of filled teeth among 12 year olds was 37% which has been increasing every year.

Program Accomplishments:

School Oral Health Program has come a long way and it is 25 years old now. It has stood the test of time and has come out with flying colors each time.

This is basically a service program which serves to the oral health needs of Kuwaiti school children
We evaluate our program from time to time and make changes accordingly
Quality evaluation is done by monthly and yearly productivity of our dentists and other staff
Outcome evaluation and monitoring of our program is done by conducting oral health surveys every 3 to 5 years
The success of our program can be measured from the fact that. There is increased oral health awareness and knowledge among children, teachers and parents, as demonstrated by the increasing number of parents that bring their children to our centers for treatment.
The increasing trends in the disease level previously seen have been stabilized.

So much has been done already and much needs to be done in future if we are to maintain the standard we have set.

Productivity of School Oral Health Program, Kuwait-Forsyth during 2002-2007:

Contact:

Email: info@smilekw.com | schooloralhealth@yahoo.com