the use of xylitol to decrease mother-childtransmission of mutans streptococci Xylitol promotes mineralization non-fermentable by oral bacteria decreases counts of mutans streptococci (MS)as well as the amount of plaque
Some MS strains are inhibited by xylitol MS cells are thought to incorporate xylitol asxylitol-5-phosphate through the major routeof sugar transport ―Xylitol effects‖: 5-7 g xylitol/day, 3 times/day
S.mutans :a major etiological agent of dentalcaries the study, xylitol chewing gum consumptionwas compared with fluoride andchlorhexidine varnish treatmentscolonization percentagesXylitol 10%CHX 29%F 49%
xylitol preventedenrichment of S.mutans, while sorbitolhad the opposite effect
a decrease in the amount of plaque inassociation with habitual xylitolconsumption xylitol gum has been found to be superiorto sorbitol gum in retarding regrowth ofsupragingival plaque Xylitol doses decreasing MS counts alsoreduce the amount of plaque ―effective‖ doses of xylitol may not reduceplaque in individuals with very poor oralhygiene
Several studies have shown thatxylitolreduces dental plaque as well as thenumber of mutans streptococci. Xylitol-based caries prevention may be worthit.
Despite being one of the United States‘ 10 greatest publichealth achievements of the 20th century (Centers forDisease Control and Prevention, 2000), community waterfluoridation receives only qualified endorsement fromsome systematic reviews of its effectiveness in preventingdental caries. Children→ effective, but reluctant to quantify the effect.(∵poor quality of many studies) Adults→ lack of evidence.⇒ it hampers the development of health policy.ex) economic evaluation → no caries-preventive benefit.
Before 1990 (now outdated)→ fluoridated water was effective onlywhen ingested prior to tooth eruption Will potential benefits be limited to peopleborn after implementation of fluoridation, ormight there be additional benefits for peopleborn before implementation?
Effects were compared between the pre-fluoridationcohort born before 1960 (n=2,270) and the cohort bornbetween 1960 and 1990 (n=1,509). Residential history questionnaires determined thepercentage of each person‘s lifetime exposed tofluoridated water. Examiners recorded decayed, missing, and filled teeth(DMF-Teeth) and decayed and filled tooth surfaces (DF-Surfaces). Socio-demographic and preventive dental behaviors wereincluded in multivariable least squares regression modelsadjusted for potential confounding.
The exposure of interest was proportion of lifetimeexposure to fluoridated drinking water. The fluoridation database (Australian Research Centrefor Populaiton Oral Health) registers fluorideconcentarations for 99.4% of the Australianpopulation. <0.3 ppm F = 00.3 ~ 0.7 ppm F = 0.5≥0.7 ppm F = 1.0 The number of years at each concentration wasmultiplied by the concentration.
M. Bravo, J. Montero, J.J. Bravo, P. Baca and J.C. Llodra16번 김은혜
Little is known about the effect ofdiscontinuation of sealant or fluoride varnish. The purpose of this study was to comparesealant with fluoride varnish in the preventionof occlusal caries in permanent first molars ofchildren over a nine-year period: 4 yrs forprogram evaluation plus 5 yrs ofdiscontinuation.
Results of the active period of the project at both24 and 48 mos indicated that both treatmentswere effective, and that the sealants performedbetter than the varnish. Furthermore, the caries reduction figures up to48 mos were within the published range ofpooled preventive fractions in available meta-analyses. The same conclusions apply to the nine yearresults, with a higher loss in preventive effect forvarnish (43.9% at 4 yrs and 27.3% at 9 yrs) vs.sealant (76.3% at 4 yrs and 65.4% at 9 yrs).
The long-term success, measured byretention and caries prevention, of second-generation (chemically cured) fissure sealantshas been well-documented. However, to our knowledge, 9 yrs is thelongest follow-up period to date in a study ofcaries reduction with a third-generation(visible-lightcured) sealant or fluoride varnish,although comparisons of varnish with otherstudies should be interpreted with cautionbecause of the 5 yrs of discontinuation
Main journal7조 44번 이시은Inlernalional Dental Journal (2001) 51,399406
The Vipeholm studies were publishedshowing that sugar eaten in the form of largetoffees between meals resulted in severedamage to the teeth. However, consumption of sugar even at highlevels was not importantly associated withincreased damage when the sugar was takenup to four times a day with meals. It was also concluded that carious lesionsoccurred despite avoidance of sugar.
Another study showed the importance of thelength of time that is given to the teeth toremineralise as a determinant of the amountof caries which develops. Bowen concluded that it is not necessarily thefrequency of ingestion of sugars that isrelated to development of caries, but theduration that sugars are available tomicroorganisms in the mouth.
The report mentioned that populationanalyses suggest that less than 18kg perperson per year of sucrose intake is linked tolower rates of dental disease.
It is impossible to see a threshold level inthese data.
These data do suggest that there is a declineof caries prevalence in Japan, concomitantwith the increase of the use of fluoridetoothpaste
The steep increase in the number of cariesfree children occurred when fluoride becameavailable. In this period, sugar consumption wascontinuously high.
Retention of food, food impaction, thepresence of fluoride and the age of dentalplaque are all strongly related to oral hygiene.
Bratthal proposed three factors, bacteria, dietand susceptibility to disease contributing tothe development of caries. most of the criteria are not easily diagnosed,cannot be influenced and are not site-specific.
Caries prevalence in many EU countries hasdeclined, while the sugar consumption perperson per year has remained approximatelystable. The decrease in caries prevalence is primarilyattributed to increased exposure to fluorides(toothpastes) and improved oral hygienetechniques
Numerous chemical factors, such as pH,titratable acidity, degree of saturation, kindof acid, and chelating properties, have beenidentified to influence the erosive potential ofacids.
However, compared with the chemical factors,limited information exists about the effects ofthe physical or physico-chemical aspects ofthe acid on dental erosion.
Therefore, the aim of this in vitro study wasto investigate the effects of viscosity changesof different acidic solutions on dental erosion.The null hypothesis was that the erosivity ofcitric acid and phosphoric acid at different pHvalues is not affected by their viscosity.
Citric acid (CA) and phosphoric acid (PA)solutions at pH levels of 2.5, 3.0, and 3.5were used. CA solutions at pH 2.5, 3.0, and 3.5 wereobtained by the addition of 2.81, 3.3, and4.17 g/L (Fluka, Buchs, Switzerland),respectively, to de-ionized water.
PA solutions at the respective pH values wereobtained by the addition of 30.5, 109.3, and110.3 mL/L, respectively from a 3 mol/Lstock solution (Merck, Darmstadt, Germany)to de-ionized water.
The kinetic viscosities of the acidic solutionswere adjusted to 1.5, 3, 6, 12, and 24mm2/sec, respectively, by the addition ofhydroxypropyl cellulose (HPC, Grade LM, HPC,Nippon Soda Company, Tokyo, Japan) atdifferent concentrations.
The respective acidic solutions were droppedfrom a reservoir into an inclined (45°) channelwhich was made from polyvinyl chloride (8mm in length) at a flow rate of 1 mL/min,which directed the acidic solutions over thesurface of an enamel specimen (Fig. 1).
Figure 1. Flow inclineallowing for rinsing 8specimens in parallel. (a) Plastic tubesattached to the pump(internal diameter, 3mm). (b) Acid drops. (c) Inclined U-formchannel (depth, 0.68mm; width, 2.00 mm). (d) Enamel sample
Enamel loss by CA and PA at different viscosities.
We have shown that the erosive potential ofacids is dependent not only on variouschemical properties, such as pH, but also onthe viscosity of the acidic solution.
Since the erosive enamel loss decreased withincreasing viscosity, it can be assumed thatthe relative stickiness of the acid solutionswith higher viscosity decreased the ionexchange and clearance of dissolutionproducts.
At a higher viscosity, this static layer mightbe thicker and less undersaturated, so thatenamel erosion decreased.
Effects of an Oral HealthPromotion Program in Peoplewith Mental IllnessJournal of Dental Research, Jul 29, 2009745번 권오인폴리클 7조F. Almomani, K. Williams, D. Catley and C.Brown
I. Introduction751. 장애인들은 구강질환에 대해 더 많은 주의가 필요하다.1) 중증 정신장애인들의 약물치료는구강건조증, 치아우식, 치주질환, 치아수복, 발치 등을초래할 수 있으며,(Kenkre and Spadigam, 2000; Friedlander and Marder, 2002)2) avolition을 동반한 중증 정신장애인은구강위생유지 의욕을 상실할 수도 있다.3) 또한, 구강건조증을 피하기 위해 이용하는 사탕이나 껌, 음료수 등은치아 우식을 유발할 수 있다.따라서, 중증 정신장애인들에게는 예방적인 구강건강교육이 특별히중요하다.
I. Introduction762. 중증 장애인에게, 구강건강교육의 효과는 분명 긍정적이다.(Almomani et al., 2006),- 하지만 그 효과는 약하고 오래가지 못한다. (Kay and Locker, 1996)3. 구강건강교육은 개인의 동기를 유발시킬 때 효과가 커질 수 있다.- 동기면담(MI ; motivation interviewing)은건강에 대한 태도를 광범위하게 변화시키는 데에 동기를 부여해주며(Resnicow et al., 2002; Burke et al., 2003, 2004; Hettema et al.,2005; Rubak et al., 2005),- 이는 특히, 구강위생에도 잘 적용된다(Weinstein et al., 2004).
I. Introduction774. MI는- 개인들은 바꾸도록 설득하는 외적(external) 이유를 제공하기 보다는,- 자발적 조절에 대한 개인들의 내적(internal) 동기를 유발할 수 있는특별한 방법을 사용한다. (Ryan and Deci, 2000;Williams et al., 2000).
I. Introduction78※ MI(motivation interviewing; 동기면담) 이란?- 동기면담은 (1) 협동성(Collaboration), (2) 유발성(Evocation), 그리고 (3) 자율성(Autonomy)의 세 가지기본 정신(Spirit)에 기초하고 있다(Arkowitz, 2009).- 동기면담에서는1) 치료자가 환자와 협동적이어야 하며, 권위적인 자세를 피하며,환자를 치료자와 대등한 위치의 조력자로 대함(협동성).2) 환자를 직접적으로 설득하고 특정한 방향으로 교육하는 대신에치료자가 환자의 관심과 생각을 자발적으로 이끌어내는 데 초점맞춤(유발성)3) 치료자가 환자의 행동에 대해서 즉각적인 선택을 하도록 몰아가지 않으며,환자의 행동 변화를 유발하는 힘과 동기는개인 안에 내재한다고 믿는다(자율성)Ref : [건강 검진 후 상담에서 동기면담의 활용], 서울아산병원 건강증진센터 정신과, 서울대학교병원 헬스케어시스템 강남센터 정신과1, 순천향대학교병원 건강증진센터 영상의학과2, 김병수․윤대현1․한내진2의료커뮤니케이션 제 4 권 제 2 호 pp 98～106, 2009
I. Introduction795. 연구의 목적1) 구강건강교육을 시작하기 직전에 간단한 MI를 제공하는 것이교육 효과를 증가시킬 수 있는지를 조사하는 것이다.2) 4주에서 8주동안① 구강건강교육만 하는 것과② 구강건강교육과 MI를 병행하는 것을 비교하면,- 후자의 경우가plaque index를 낮추고,Oral health knowledge를 증가시키며,자발적인 self-regulation을 증가시킬 것이라고 가정했다.
II. Methods80연구방법1. 60명의 지원자들에게 동의를 얻어 실험을 시행했으며, 56명이 완료(탈락자는 이사를 가거나, 입원을 했음)- 완료 시점에서,- MI 집단은 27명 (여자12, 남자15)- 구강교육 집단은 29명 (여자18, 남자 11)
II. Methods81연구방법2. 모든 수치는시작 시점을 baseline으로 잡고4주, 8주 간의 following intervention으로 얻었다.(1) Plaque accumulation- Quigley-Hein plaque index를 측정하여, 평균을 냈음.(2) Oral health knowledge- 15개의 질문을 만들어서, 3명의 전문가가 직접 면담함(3) Self – regulation- Treatment Self-regulation Questionnaire(TSRQ)를 사용, 정기적으로 칫솔질을 하는 것에 대하여, ‗자발적으로‘ 인지 ‗관리를 받아서‘인지
II. Methods82연구방법3. MI를 활용한 개입(1) MI전문가들과의 15분~20분 가량의 짧은 면담이 실행- 성과를 평가하고, 피드백을 제공(2) MI는 구강교육을 받기 전에 시행되었으며,- 매일 행하는 칫솔질과 구강건강과 관련한 개인수치를 측정하여,장단점과 동기, 자신감 등을 평가하였다.(장단점이란, 구강을 건강하게 유지했을 때의 장단점)(3) 모든 참가자들은 기계적 잇솔질과 알림 기능, 주 단위의 전화 알림등을 함에 있어서 필요한 팜플렛을 두 개씩 받았다.
III. Data & Results852. Oral health knowledge 결과
III. Data & Results863. Oral health knowledge 결과- 두 그룹의 차이가 크지 않음!
IV. Discussion871. 이 실험 결과는 구강교육을 함에 있어, MI를 병행하는 것이 매우유용하다는 것을 뒷받침한다.- plaque index : 1.7 감소 vs 0.8 감소2. 예상치 못했던 결과는,MI병행 그룹에서 oral health knowledge가 크게 증가한 것이다.- MI 병행 그룹은 MI 상담에 의해 동기가 부여됐기 때문에,이어지는 구강교육에 더욱 적극적으로 임하였기 때문으로 생각
IV. Discussion883. oral health knowledge의 증가는 MI그룹의 낮은 plaque index에도기여했으리라 여겨진다.- 4주, 8주의 oral health knowledge와 plaque index score의 변화가비슷한 양상을 보임
IV. Discussion893. oral health knowledge의 증가는 MI그룹의 낮은 plaque index에도기여했으리라 여겨진다.- 4주, 8주의 oral health knowledge와 plaque index score의 변화가비슷한 양상을 보임- self-care의 어려움은 병과 치료에 대한 지식의 부족을 반영한다는연구 결과도 있음 ((Skaret et al., 2003; Weinstein et al., 2004).
IV. Discussion904. MI병행은 자발적인 규제에 큰 향상을 주리라 가정했는데,실험 결과는 가정과 다소 차이가 있었지만,- external 이나 autonomous한 규제보다는introjective에 다소 더 영향을 주었다.- 이 결과는 선천적 정신질환자의 천성을 반영할 수도 있고,항정신병약물치료가 동기를 저하시켜 개인들이 내적인 규제를 지켜가는 것에 지장을 주는 것으로도 생각할 수 있다.
IV. Discussion915. 이 실험의 가장 큰 한계는, follow-up 기간의 부족이었다.- 8주보다 더 긴 시간 동안 추적을 하지 못했음이 유감이다.6. 또 다른 한계는, 실험의 설계에 있어서MI 그룹이 구강건강과 관련해서 더 많은 시간을 보냈다는 점이다.- 이것 자체가 MI 그룹의 교육효과를 더 높였을 수도 있다.
V. Implication921. 이 실험 결과는, 정신장애인들에게 구강위생 관리가 매우 필요함을 보여주고 있다.- 정신 장애인의 plaque index는 3.5, 비장애인은 0.9~1.9 (Quigleyand Hein, 1962; Williford et al., 1967; Van Der Weijden et al.,1998).2. 구강건강 교육 뿐만 아니라, 동기부여가 병행된 교육은구강건강 수치를 크게 개선시킬 수 있다.3. 구강건강교육 전에 짧은 MI 상담을 병행함으로써,구강위생을 크게 개선시킬 수 있으며,이는 장애인뿐만 아니라, 비장애인들에게도 적용될 수 있을 것이다.
(1) What are the minimum dose andfrequency for the use of xylitol-containingchewing gum for significantly loweringmutans streptococci levels? (2) Can delivery vehicles be produced that areapplicable in settings where chewing gum orsimilar confections might be permitted?
Total Area Under theCurve (AUC) for the2 products did not differsignificantly (pellet gum— 63.0 ng.min/mL, syrup— 59.0 ng.min/mL).
A controlled study of complex design withxylitol-containing candies and gum wasconducted in children about 10 yrs old(Thisage group was targeted because of the potential to protecterupting second permanent molars) (xylitol-maltitol or xylitol-polydextrose) orgum at 5 grams per day Result: 35 to 60% reductions in cariesincidence in the test groups relative tothe control individuals, and no differencebetween xylitol delivery vehicles
brushing twice daily with fluoride toothpastewith 10% xylitol or fluoride toothpaste alone,reported a 12% reduction in decayed/filledsurfaces (DFS) and an 11% reduction indecayed/filled buccal and lingual surfaces(DFS-BL)
is possible that frequent lower-doseexposure to xylitol is beneficial without theeffort of maintaining special programs.
In spite of the considerable evidence that xylitolis an effective caries-preventive and cariostaticagent, an effective delivery system for xylitol,especially for children, demanding minimaladherence yet safe, has not been developed(5 to 6 grams and 3 exposures) the xylitol toothpaste studies suggesting thatlower doses and less-frequent exposures mightbe effective, but the synergistic effects of xylitoland fluoride or triclosan cannot be ruled out. Studies of new vehicles for xylitol, such as axylitol-releasing dummy and a pediatric syrup,have been conducted.
This study aimed to appraise clinicalevidence and its risk from bias regarding theeffects of xylitol in comparison with sorbitol A number of review of clinical trialscomparing xylitol with sorbitol is published
Systemic search strategy: on the basis of their listed title and abstract,article from the research result were selected Inclusion criteria- Tested caries-related primary outcome- Compared the effects of xylitol with those ofsorbitol- Included rest and control group- Used a prospective group Extraction of data from accepted trials Statistical analysis
Literature search- Out of nine article, eight article were accepted Dataset extraction-chewing 10.5g of gum containing 100% xylitolfive times daily for 5 min per time is associatedwith a 3.5-times greater rehardening of softbrownish discoloured carious lesion(vs sorbitolgum)-chewing 10.5g of gum containing 100% xylitolfor 5 min five times deaily for 2 years with 50-70% fewer caries lesion after 5 year (vs sorbitolgum)
For all other dataset, the informationreported on the number of participant lost tofollow up at the time of assesement wasinsufficient to enable sensitivity analysis It would lead to different conclusion if worst-case scenario were assumed
The chewing of 65% xylitol gum five times perday was observed to have a preventive effectagainst caries after 40 month, but not after20 months(chewing time was twice) -> timefactor* Chewing gum containing 589mg sorbitolover a 2year period was observed to be moreeffective in preventing caries than chewing589mg xylitol gum
However, 589mg xylitol gum was observed tobe more preventive than sorbitol after 3 year The three timed per day intake of 2.67gxylitol syrup over 10.5 months was no moreeffective in preventing caries than a twicedaily intake of 4.0g-> time, dosage important!
Xylitol has been assumed to have specificanticariogenic properties The result of this systematic search indicateageneral lack trial covering this topic The evidence found in support of xylitol oversorbitol is contradaictory, contains a high riskfor selection and attrition bias and may belimited
Effect of xylitol versus sorbitol: a quantitativesstematic review of clinical trial, steffenmickednausch, internaional dentaljournal2012;62;175-188
It seems reasonable to assume that the use of afluoride dentifrice is likely to increase plaquefluoride concentrations significantly for up to 12hrs in areas where the water contains fluorideclose to 1.0 ppm, but not in areas with above-optimum fluoride levels in the drinking water. Plaque calcium and fluoride concentrations werepositively related under each of the 4 conditions.Thus, considering that most people do notcompletely remove dental plaque after toothbrushing, the amount of fluoride retained inplaque can play an important role in cariescontrol.
S.O. Griffin, E. Oong, W. Kohn, B. Vidakovic, B.F. Gooch, J. Bader,J. Clarkson, M.R. Fontana, D.M. Meyer16번 김은혜
A barrier to providing sealants is concernabout inadvertently sealing over caries. The purpose of this meta-analysis is toexamine the effectiveness of dental sealantsin preventing the progression of carieslesions in the pits and fissures of permanentteeth.
We searched electronic databases forcomparative studies examining cariesprogression in sealed permanent teeth. We used a random-effects model to estimatepercentage reduction in the probability ofcaries progression in sealed vs. unsealedcarious teeth.
Our outcome measure was the percentage ofcaries lesions progressing, where progressionwas defined as demineralization or loss oftooth structure. To measure effectiveness, we calculated therelative risk ratio (RR) and its 95% confidenceinterval (CI).R = % lesions progressing (SEALED)% lesions progressing (NOT SEALED)
In conclusion, the evidence supports theplacement of sealants over non-cavitatedcaries lesions in the pits and fissures ofpermanent teeth in children, adolescents, andyoung adults. Despite variations in study design andconduct, subgroup and sensitivity analysesfound the effect to be consistent in size anddirection.
Major improvements in the oral health statusof the general public have been observed inmany parts of the world as is shown by thecontinuous decline in caries prevalence inchildren and adolescents. This is generally ascribed to better oralhygiene and use of fluoride toothpaste.
Dr. Anne Nordblad, STAKES, NationalResearch and Development Centre for Welfareand Health (SF) and Dr. Jos van den Heuvel,Ministry of Health, Welfare and Sport (NL), co-presidents of the FDI Public Health Section,chaired the symposium. Chief dental officers and key representativesof various fields of dentistry from all over theworld attended the symposium.
The percentage of caries-free 5 to 6-year-oldchildren has increased to more than 50percent. The caries prevalence in adolescents (1 2-year-olds) in Europe decreased from high ormoderate levels in the 1980s to a low level inthe 1990s.
This decrease occurred despite theunchanged diet of the population and hasbeen attributed to regular mechanical toothcleaning using fluoridated toothpaste.
Diet plays a role in the development of cariesand erosion but not in periodontal disease. The association between sugar/sucroseconsumption and caries vanishes whenfluoride toothpaste becomes generally usedat population level. Thus, regular plaque removal with a fluoride-containing toothpaste is more effective incaries control than dietary restrictions
The use of fluoride toothpaste has resulted ina decrease in the prevalence of dental carieseven though no significant change in theconsumption of fermentable carbohydrateshas taken place. If the teeth were brushed twice a day with afluoride containing toothpaste, foodsidentified as cariogenic became a risk to theteeth only when consumed more than seventimes a day.
Current and expected future improved oralhygiene and the use of fluoride containingtoothpaste have made recommendations oncariogenic foods less necessary at populationlevel
The aim of this study was to estimate theprevalence of periodontal disease andtreatment needs in a population with the aidof the CPITN index, to discover cases ofperiodontal disease and recommendtreatment. The study was also designed to bea first step for monitoring the changes in thedisease status over time in the studiedpopulation.
The examination included 214 subjects, aged18 to 60, 84 women (39.25 per cent) and 130men (60.75 per cent). The subjects were factory workers in a textilemill and comprised a representative sampleof workers and staff members from a list of1500 employees chosen by a simple randomsampling technique.
All examinations were conducted under thesame conditions, in a dental chair by a singleexaminer to avoid inter-examiner variability.
The periodontal examination estimated thenumber of healthy sextants (score 0), thenumber of sextants with gingival bleeding(score 1), the number of sextants withcalculus (score 2) and the number of sextantswith periodontal pockets (score 3 [4-5mm] or4 [>6mm])
Of 214 examined subjects, 20 (9.34 per cent)had no signs of periodontal disease (code 0);46 (21.49 per cent) presented gingivalbleeding after gentle probing (code 1); 40(18.69 per cent) had supra- or subgingivalcalculus (code 2); 70 (32.71 per cent)presented pathologic pockets 4-5mm deep(code 3); 38 (17.76 per cent) had pathologicpockets 6mm or deeper (code 4).
Subjects were classified into differenttreatment need categories, according to thehighest score recorded during theexamination, as follows: 0 (no treatment) - subjects with code 0 I (improvement in personal oral hygiene) –subjects with code 1 II (I + scaling) - subjects with code 2 andcode 3. III (I+I1 +complex treatment) - subjects withcode 4.
The aim of the study was to determine theprevalence of periodontal disease and thetreatment needs in a population of 214factory workers in Romania. Of thoseexamined, 9.34 per cent were in periodontalhealth (code 0), 21.49 per cent had gingivalbleeding (code l), 18.69 per cent had supra-or subgingival calculus (code 2), 32.71 percent presented with pathological pockets 4-5mm deep (code 3) and 17.76 per cent hadpathological pockets 6mm or deeper (code 4).
The distribution of these subjects among thetreatment need categories revealed that30.83 per cent would need improvement inpersonal oral hygiene (I), 51.40 per cent fromthe subjects would need treatment (I) +scaling (XI) and 17.76 per cent would needtreatment (I + I I) + complex treatment (I I I).
Results of oral health and hygieneeducationin an institution for multiplehandicappedchildren in IndonesiaAdi S.A.W. AdiwosoJakarta, IndonesiaTaco PilotGieten, The NetherlandsInternational Dental Journal (1999)49, 82-891475번 권오인폴리클 7조
I. summary148In a collaboration between the Dutch and Indonesian Dental Associationsa system for oral health care for multiple handicapped children wasinitiated in a large care and rehabilitationinstitution in Jakarta, Indonesia. Part of the project was to develop aprogramme for oral health and hygiene education (OHE), with a specificplaque control component.This programme was aimed not only at the handicapped children but alsoat their parents and the teaching and (para) medical staff of the institution.A study to investigate the feasibility, acceptability and effectiveness of theOHE programme was carried out over aperiod of 2% years. The programme was well accepted, effective and ofclinical significance. It is probably one of the first of its kind in adeveloping country.
II. Introduction1491. children with such handicaps often have different patterns of dentalcaries andmissing teeth. Plaque control, gingival and periodontal health arefrequentlypoor compared to children of the same age without handicaps.2. These specific problems have received attention in a number ofindustrialisedcountries and special oral health care for the handicapped is nowactivelypromoted.
III. Materials and Methods1501. The participants
III. Materials and Methods1512. The programme1) OHE material was designed and adjusted to the parents‘ educationlevel. The parents were grouped according to the educational level of themother and each group consisted of not more than seven persons.OHE lectures were also given to the teachers and to the therapistsworking at the institution, to increase general knowledge, create supportfor the programmeand better understanding of the physical conditions and the special careneeded for the handicapped children.2) At the first visit children were taken to the dental clinic, they wereaccompanied by the persons who were responsible for the oral cleaning.At the dental clinic children were seated on the dental chair or remainedseated in their wheelchair. Instruments used for the plaque scoringconsisted of an operating light, mouthmirror, explorer, disclosing solution, cotton buds and a special piece of
III. Materials and Methods1522. The programme3) Tooth brushing instruction according to the Bass technique wasdemonstrated.4) a fluoride gel was applied with a cotton bud on the teeth surfaces andleft in place for 20-30 minutes before the patients were allowed to rinse.5) The children returned a week after the first visit together with thepersons who were responsible for the oral hygiene. A review andevaluation of oral cleaningwas then conducted and if the oral hygiene was not adequate, trainingand teaching of toothbrushing was repeated.
III. Materials and Methods1533. Examination and Calibration1) The plaque scores were taken and noted according to Albertson30.- Scores:0 = no plaque present;1 = plaque covering 1/3 of the surface;2 = plaque covering more than 1/3,but less than 2/3 of the exposed tooth surface.3 = plaque covering more than 2/3 of the exposed tooth Surface;2) The plaque score was taken of each child every 4-6 months leading to8 scores taken over a period of 32 months.
IV. Results1541. Inquiries revealed the following reasons for non-participation:the parents of 27 children preferred their own family dentist and/or theyknew already about oral health education2. The results of the oral health education and plaque control programme,as expressed in the mean plaque scores (between 0 and 18) arepresented in Table 3.
IV. Results1551. Inquiries revealed the following reasons for non-participation:the parents of 27 children preferred their own family dentist and/or theyknew already about oral health education2. The results of the oral health education and plaque control programme,as expressed in the mean plaque scores (between 0 and 18) arepresented in Table 3.
V. Discussion1561. It can be concluded that specially designed oral health education andplaque control programmes can be developed gradually, gaining moresupport of the staff of the institute and the parents. The participation rateat the start of the project was relatively low. However, this was notunexpected as it was a completely new activity at YPAC and in fact, inIndonesia as a country.2. The decrease in mean plaque scores in the present study over 32months seems to be somewhat smaller than the results obtained byBrown over a three year period% and by Nicolaci and Tessini over an 18months period26, but greater than reported by Shaw and Shaw over twoyears2‘. However, as in the present study all showed a gradual decrease inplaque scores over time. Comparisons remain difficult because ofdifferences in study groups, OHE methods and plaque recording.
V. Discussion1573. One of the reasons for the continuing decrease in plaque scoresobtained in this study might have been the tailored approach to all partiesconcerned. Oralhygiene and the specific procedures were not left to the individualhandicapped person, but taken as a compulsory part of their general carecarried out by mother,nurse or maid or under very close supervision at home, and repeatedly re-enforced by professional personnel at the YPAC institute.4. In conclusion, the specially designed oral health and hygieneprogramme for handicapped children involving staff and therapists of theinstitute, and parents and carers, is effective and of clinical significance. Itis probably one of the first of its kind in a developing country, and wassuccessfully developed by an initiative for collaboration between theIndonesian and the Dutch Dental Associations.