Prathip Phantumvanit

Effect of CPP-ACP Paste on Dental Caries in Primary Teeth A Randomized Trial

This clinical trial tested the effect of daily application of 10% w/v calcium phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste for 1 yr when added to regular toothbrushing with fluoridated toothpaste to prevent dental caries in pre-school children. High-caries-risk children aged 2½ to 3½ yrs in a suburban area of central Thailand were assigned to receive either CPP-ACP (n = 150) or a placebo control (n = 146) in addition to fluoridated toothpaste. The International Caries Detection and Assessment System (ICDAS) was recorded at baseline, 6 mos, and 1 yr. At 1 yr, a significant increase in mean numbers of enamel and dentin caries lesions, as well as dmfs, was found in both groups (p < 0.001). No significant difference was observed between groups on these 3 outcome measures (p = 0.23, 0.84, and 0.91, respectively). The odds of enamel caries lesion transitions to a state of regression or stability, compared with progression from baseline, was also not different between groups [OR = 1.00, 95% CI (0.86, 1.17)]. This trial found that daily application of 10% w/v CPP-ACP paste on school days for 1 yr, when added to regular toothbrushing with a fluoride toothpaste, had no significant added effect in preventing caries in the primary dentition of these pre-school children (ClinicalTrials.gov number CT01 604109).

Perspectives in the Effective Use of Fluoride in Asia

Dental caries is the most prevalent chronic disease affecting human populations worldwide. The diverse disease patterns across and within countries are related to socio-behavioral determinants, demographic factors, environmental conditions, and the availability and accessibility of oral health services, in particular, exposure to disease prevention programs (Petersen, 2003, 2008a). Benefits of fluoride for caries prevention have been substantiated in many countries (Petersen and Lennon, 2004; Jones et al., 2005). In the second half of the 20th century, this focus shifted to the development and evaluation of fluoride toothpastes and rinses and, to a lesser extent, to alternatives to water fluoridation, such as salt and milk fluoridation. Most recently, efforts have been made to summarize this extensive database through systematic reviews of fluoride administration (McDonagh et al., 2000; Marinho et al., 2003; Australian Government, 2007). The Asian workshop held in Phan-Nga, Thailand, during March 22-24, 2011, aimed to discuss current information on fluoride and dental caries, as well as to try identifying barriers and opportunities that countries of Asia may have for implementing such programs. In addition, the intention was to give recommendations for including fluoride schemes within national public health programs.

Profile of the oral healthcare team in countries with emerging economies

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the worlds people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

Rationale for the prevention of oral diseases in primary health care: an international collaborative study in oral health education.

Ensuring that members of society are healthy and reaching their full potential requires the prevention of oral diseases through the promotion of oral health and well-being. The present article identifies the best policy conditions of effective public health and primary care integration and the actors who promote and sustain these efforts. In this review, arguments and recommendations are provided to introduce an oral health collaborative promotion programme called Live.Learn.Laugh. phase 2, arising from an unique partnership between FDI World Dental Federation, the global company Unilever plc and an international network of National Dental Associations, health-care centres, schools and educators populations.

LLL2: an international global level questionnaire on toothbrushing and use of fluoride toothpaste.

PURPOSE To determine the evolution of toothbrushing frequency and use of fluoridetoothpaste in the FDI-Unilever partnership Live.Learn.Laugh. phase 2 programme using a self-reported questionnaire. METHODS The study was conducted in 23 countries. The key focus of this partnership was to educate people about the benefits of twice-daily brushing with fluoride toothpaste and to support people in adopting this important oral health behaviour. The partnership offers a choice of four project options to the local partnership team of the National Dental Association and local Unilever-operating companies. A self-report questionnaire was used in all participating subjects in local projects to evaluate the brushing frequency, the brushing timing and the use of fluoride toothpaste. RESULTS After implementation of the project interventions, a clear improvement in the reported frequency of brushing twice a day, regardless of the type of project, was observed. Subjects also increased day and night brushing and the use of fluoride toothpaste. CONCLUSION The strategy of using mothers to increase healthy behaviours in oral health achieved the greatest increase in twice-daily toothbrushing, followed by the intervention in schools.

Toward Effective Use of Fluoride in Asia

prevention based on the effective use of fluoride. It is unfortunate, however, that, despite the availability of such programs, dental caries is still a major public health problem in most countries. The disease affects 60 to 90% of schoolchildren and the vast majority of adults, and dental caries has contributed to the extensive loss of natural teeth observed in older people. Dental caries is also the most prevalent oral disease in many countries of Asia and Latin America. The principal reasons for this increase appear to be high consumption of sugars and inadequate exposure to fluoride. Few lowand middle-income countries have large-scale fluoridation programs in operation. Some countries in Latin America have introduced water and salt fluoridation, but exposure to fluoride is still fairly limited. In the African region, salt fluoridation has been implemented in Madagascar with the support of the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO). In Asia, Thailand introduced toothpaste with fluoride, and demonstration programs on milk fluoridation have been established in schools. Currently, WHO facilitates the introduction of salt fluoridation in Laos and Viet Nam. In China, while the use of fluoride toothpaste is becoming more common, its use is not the norm, even among those who brush their teeth twice a day, and it is more likely to be used in urban than in rural communities. Locally produced fluoridated toothpastes often have insufficient levels of fluoride. Recently, a WHO symposium reviewed the Chinese experiences from fluoridation programs (Petersen et al., 2008). According to country reports (Siriphant and Srisawasdi, 2011), dental caries prevalence in 12-year-old children in Asia is moderate or high; for example, in the Korean Democratic Republic, it is 2.1; in the Philippines, 2.9; in Mongolia, 3.7; and in Brunei Darussalam, 4.8. In other countries of the region, dental caries severity is reportedly low; however, current data are not available. Evidently, population groups in several countries have not yet obtained the health benefit from community prevention programs, and dental caries continues to be a burden to society. The reasons for non-implementation of prevention programs may vary, ranging from lack of national policy for oral health to low awareness of oral disease. The need for an appropriate environment that would bring together public health administrators, oral health officers, researchers, and academicians is considered urgent for discussion of state-of-the-art information on fluoride. Such action would have to address key opportunities for implementation of community-oriented administration of fluoride, as well as the identification of important Extraordinary advancement in all areas of public health intervention has occurred during the past 100 years or so. The area of oral health has also enjoyed new successes; several methods are now available for prevention of the most common diseases, dental caries and periodontal disease, and new treatment modalities are available to restore the oral cavity complex to normal function. A breakthrough in oral disease prevention was the discovery of using fluoride for dental caries prevention; controlled addition of fluoride to drinking water supplies in communities that lacked it or where fluoride concentration was below optimal levels to have a cariostatic effect began in the 1940s and has been proven successful in dental caries reduction in many countries. Industrial production of fluoridated salt started in Switzerland in 1955, and its use has expanded to several countries in various regions of the world, with success similar to that achieved with water fluoridation. Research into using milk as a vehicle for administering fluoride started in the mid-1950s, and the first community-based scheme was introduced in 1988. Milk fluoridation has also been reported to be successful in dental caries prevention, particularly among children, and schemes have been developed based on school health programs. Since no special effort is required from the individual for ingesting fluoridated water, salt, or milk, these methods have been designated as automatic systems for dental caries prevention. Fluoride in toothpaste has also been available for decades and has been identified as a main contributor to the decline in dental caries observed among several industrialized countries; unfortunately, toothpastes are not universally used, due to the cost factor, which prevents poor population groups from accessing such preventive measures. Moreover, fluoride has been made available in products for professional application, including gels, varnishes, and restorative materials; finally, fluoride mouthrinses have also been used for decades with various degrees of success in caries prevention, especially in school health programs. Several industrialized and some developing countries have implemented successful national programs for dental caries P.E. Petersen1* and P. Phantumvanit2