Publicação da WHO decreta o fim da desconfiança que a amamentação pode causar cáries no lactente.
A OMS recomenda que os bebês sejam amamentados exclusivamente até seis meses de idade, após o qual a amamentação deve continuar de forma complementar até dois anos de idade ou mais por causa dos muitos benefícios à saúde para mãe e bebê, incluindo saúde bucal.
...
Uma nova revisão sistemática incluindo dados mais recentes mostrou que bebês amamentados com 2 anos de idade não têm maior risco de cárie infantil do que aqueles que foram amamentados até um 1 de idade."
Fonte: World Health Organization. (2019). Ending childhood dental caries: WHO implementation manual. World Health Organization. ISBN 9789240000056 English
Agora essa excelente publicação da OMS está em português:
O marketing faz parte do cotidiano, vivenciado por praticamente todos. No entanto, o marketing de fórmulas de leite infantis (leites de vaca ultraprocessados em pó) é diferente do marketing de itens de uso diário, como xampu, sapatos ou geladeiras. Os hábitos alimentares das crianças nos primeiros 3 anos de vida afetam profundamente a sua sobrevivência, saúde e desenvolvimento ao longo da vida. A decisão de como alimentamos nossos bebês e crianças deve, portanto, ser baseada nas melhores informações e evidências verdadeiras, influenciadas apenas pelo que é melhor para a criança e os pais e livre de interesses comerciais.
Que se cumpra o Código Internacional de Comercialização de Substitutos do Leite Materno de 1981.
E a NBCAL - Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças da Primeira Infância de 1988 com atualizações.
Prof. Marcus Renato de Carvalho
Um precioso capítulo do livro “Crescimento Crânio Facial” do Dr. Prof. Antonio de Padua Ferreira Bueno, Especialista em Ortodontia e Ortopedia Facial, um dos pioneiros no Brasil da Ortopedia Funcional dos Maxilares, Fundador da Associação Brasileira de Ortopedia dos Maxilares (ABOM)...
Nosso reconhecimento e gratidão ao
http://www.drpadua.com
Tive a honra de ter um exemplar autografado no lançamento em 1997. Apesar de mais de 2 décadas, esse capítulo merece atenção dos estudiosos do Manejo Clínico da Amamentação pelo enfoque fono-odontológico.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Many mothers to be often wonder, “What does pregnancy have to do with my oral health?”
Well, the answer is quite simple: quite a lot! In fact, dental health problems during pregnancy can be a sign of other health problems. Your oral health routine is of utmost importance during pregnancy, and should be seen as equally important as a healthy diet and regular check-ups with your dentist.
Agora essa excelente publicação da OMS está em português:
O marketing faz parte do cotidiano, vivenciado por praticamente todos. No entanto, o marketing de fórmulas de leite infantis (leites de vaca ultraprocessados em pó) é diferente do marketing de itens de uso diário, como xampu, sapatos ou geladeiras. Os hábitos alimentares das crianças nos primeiros 3 anos de vida afetam profundamente a sua sobrevivência, saúde e desenvolvimento ao longo da vida. A decisão de como alimentamos nossos bebês e crianças deve, portanto, ser baseada nas melhores informações e evidências verdadeiras, influenciadas apenas pelo que é melhor para a criança e os pais e livre de interesses comerciais.
Que se cumpra o Código Internacional de Comercialização de Substitutos do Leite Materno de 1981.
E a NBCAL - Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças da Primeira Infância de 1988 com atualizações.
Prof. Marcus Renato de Carvalho
Um precioso capítulo do livro “Crescimento Crânio Facial” do Dr. Prof. Antonio de Padua Ferreira Bueno, Especialista em Ortodontia e Ortopedia Facial, um dos pioneiros no Brasil da Ortopedia Funcional dos Maxilares, Fundador da Associação Brasileira de Ortopedia dos Maxilares (ABOM)...
Nosso reconhecimento e gratidão ao
http://www.drpadua.com
Tive a honra de ter um exemplar autografado no lançamento em 1997. Apesar de mais de 2 décadas, esse capítulo merece atenção dos estudiosos do Manejo Clínico da Amamentação pelo enfoque fono-odontológico.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Many mothers to be often wonder, “What does pregnancy have to do with my oral health?”
Well, the answer is quite simple: quite a lot! In fact, dental health problems during pregnancy can be a sign of other health problems. Your oral health routine is of utmost importance during pregnancy, and should be seen as equally important as a healthy diet and regular check-ups with your dentist.
Dental health during pregnancy and how to avoid common dental problems in pre...Dr. Rajat Sachdeva
Pregnancy is a beautiful phase in the life of women. It’s a harbinger of hope, joy and unbound excitement. So, naturally, the level of care is greater during the period to ensure smooth arrival of the baby. To some, it’s also a phase when lots of doubt surface seeking answers and asking caution on the part of pregnant ladies.
Whether or not a burning question comes in the mind of every pregnant women dealing with dental problems that is dental treatment safe during pregnancy, it is something that you must know to approach the most wonderful phase in life with aplomb. The answer is YES! There is no risk whatsoever in undergoing dental work when you’re pregnant. But then, the better your oral health during pregnancy the healthier you baby will be.
Things to Keep in Mind During Pregnancy :
Dental treatment is safe during pregnancy and you needn’t bother a bit about that.
You can get dental treatment done any time during pregnancy without any worry.
However, the period between weeks 14 through 20 is perhaps the best time to get done elective dental treatment during pregnancy.
Dental treatment during second trimester carries less risk of side effects than on other period.
Immediate treatment should be sought for oral pain or swelling without waiting for the right period during pregnancy.
It’s important to let the dentist know any prescription medications and over-the-counter drugs you are taking so that right type of medicine can be prescribed for you.
You should never worry about the safety of the numbing medications or anesthetic or anesthesia used by your dentist during the procedure as it will always be safe for you, and your baby.
And getting an x-ray will be safe during pregnancy
You can always consult a top oral surgeon queens if there is problem so that it does not aggravate
. #Dentalblogger #drrajatsachdeva #delhidentist #dentaleducation #dentalcare #analgesics #dentistryworld #dentalclinicdelhi #dentistrylife #blogging #dentistry #dentists #dentalcare #dentaleducation #dentalblogging #dentalblogger #dentalblog #oralhealth #oralcare #bloggers
#pregnancy
Oral Healthcare for Pregnant Women | Maneesh GuptaManeesh Gupta
It's essential for you to take excellent care of your tooth and gums while pregnant.Listed below are some guidelines to support you manage good oral health before, throughout, and after pregnancy.
Clínica Oralmed é uma empresa especializada em Medicina do Trabalho e Odontologia do Trabalho. Composta por profissionais altamente especializados para proporcionar a você e sua empresa o melhor em saúde ocupacional. A Clínica Oralmed realiza exames ocupacionais (ASO), admissionais, demissionais, periódicos e mudança de função, espirometria e audiometria, PCMSO. A Medicina do Trabalho bem como a Odontologia do Trabalho são instrumentos aliados do empresário, que entende que a Saúde Ocupacional garante a Qualidade de Vida, proporcionando ao seu quadro de colaboradores Saúde Integral, garantindo a empresa funcionários satisfeitos que farão com que aumente a produtividade e diminua o absenteísmo, esta é a principal função que a Medicina do Trabalho e a Odontologia do Trabalho da Clínica Oralmed podem oferecer a você e seus colaboradores. A Clínica Oralmed também conta com Consultas Médicas e tratamento odontológico, atendemos a vários convênios.
Oral health is linked to overall healthmanojitsingh
If any one know that how oral health is related to overall health, they will certainly start giving importance to maintain proper oral health which is not possible by brushing everyday. You need to Floss your teeth with easy to use Healthbuddy Dental Floss Pick which is available on Flipkart or Amazon or Ebay.
Hi, I am Dr Komal Ghiya, pediatric dentist by profession, I am here to share some of my own presentations for educational purposes. I hope a presentation on DIET AND DENTAL CARIES will be useful for all the dental and medical students. Comments are welcome if you like the presentations and if not please suggest some ways I could make them better for you. All the best
Early childhood caries (ECC) affects teeth of children aged under six years. According to the Global Burden of Disease Study in 2017, more than 530 million children globally have dental caries of the primary teeth. However, as primary teeth are exfoliated due to growth of the child, #ECC has previously not been considered important.
Dental caries can lead to abscesses and cause toothache, which may compromise ability to eat and sleep and restrict life activity of children.
Prevalence of ECC is increasing rapidly in low and middle-income countries, and dental caries is particularly frequent or severe among children living in deprived communities. In many countries, access to dental care is not equitable, leaving poor children and families underserved.
Esta nova Diretriz OMS: Aconselhamento de mulheres para melhorar as práticas de amamentação, é a primeira orientação baseada em evidências científicas para esta intervenção.
Complementa as iniciativas e orientações apresentadas em várias publicações anteriores da OMS:
Breastfeeding counselling: a training course, Infant and young child feeding counselling: an integrated course, Combined course on growth assessment and IYCF counselling, Integrated Management of Childhood Illness, Community management of at-risk mothers and infants under six months of age (C-MAMI) tool, Essential newborn care course, Caring for newborns and children in the community: a training course for community health workers, Guidelines on optimal feeding of low birth-weight infants in low- and middle-income countries, Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services, Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services – the revised Baby-friendly Hospital Initiative and Infant and young child feeding in emergencies. Operational guidance for emergency relief staf and programme managers.
Essa diretriz expande os detalhes de tempo, frequência, modo ou profissional ideal para o Aconselhamento para melhorar as práticas de aleitamento materno, com base nas revisões sistemáticas e narrativas mais recentes sobre o tema. Um documento de orientação anexo, complementa os detalhes de um programa de saúde pública de Aconselhamento em Amamentação.
Dra. Elsa Giuglini foi uma das consultoras dessa publicação que será muito útil para provarmos que o Aconselhamento é uma habilidade imprescindível.
Prof. Marcus Renato de Carvalho
Dental health during pregnancy and how to avoid common dental problems in pre...Dr. Rajat Sachdeva
Pregnancy is a beautiful phase in the life of women. It’s a harbinger of hope, joy and unbound excitement. So, naturally, the level of care is greater during the period to ensure smooth arrival of the baby. To some, it’s also a phase when lots of doubt surface seeking answers and asking caution on the part of pregnant ladies.
Whether or not a burning question comes in the mind of every pregnant women dealing with dental problems that is dental treatment safe during pregnancy, it is something that you must know to approach the most wonderful phase in life with aplomb. The answer is YES! There is no risk whatsoever in undergoing dental work when you’re pregnant. But then, the better your oral health during pregnancy the healthier you baby will be.
Things to Keep in Mind During Pregnancy :
Dental treatment is safe during pregnancy and you needn’t bother a bit about that.
You can get dental treatment done any time during pregnancy without any worry.
However, the period between weeks 14 through 20 is perhaps the best time to get done elective dental treatment during pregnancy.
Dental treatment during second trimester carries less risk of side effects than on other period.
Immediate treatment should be sought for oral pain or swelling without waiting for the right period during pregnancy.
It’s important to let the dentist know any prescription medications and over-the-counter drugs you are taking so that right type of medicine can be prescribed for you.
You should never worry about the safety of the numbing medications or anesthetic or anesthesia used by your dentist during the procedure as it will always be safe for you, and your baby.
And getting an x-ray will be safe during pregnancy
You can always consult a top oral surgeon queens if there is problem so that it does not aggravate
. #Dentalblogger #drrajatsachdeva #delhidentist #dentaleducation #dentalcare #analgesics #dentistryworld #dentalclinicdelhi #dentistrylife #blogging #dentistry #dentists #dentalcare #dentaleducation #dentalblogging #dentalblogger #dentalblog #oralhealth #oralcare #bloggers
#pregnancy
Oral Healthcare for Pregnant Women | Maneesh GuptaManeesh Gupta
It's essential for you to take excellent care of your tooth and gums while pregnant.Listed below are some guidelines to support you manage good oral health before, throughout, and after pregnancy.
Clínica Oralmed é uma empresa especializada em Medicina do Trabalho e Odontologia do Trabalho. Composta por profissionais altamente especializados para proporcionar a você e sua empresa o melhor em saúde ocupacional. A Clínica Oralmed realiza exames ocupacionais (ASO), admissionais, demissionais, periódicos e mudança de função, espirometria e audiometria, PCMSO. A Medicina do Trabalho bem como a Odontologia do Trabalho são instrumentos aliados do empresário, que entende que a Saúde Ocupacional garante a Qualidade de Vida, proporcionando ao seu quadro de colaboradores Saúde Integral, garantindo a empresa funcionários satisfeitos que farão com que aumente a produtividade e diminua o absenteísmo, esta é a principal função que a Medicina do Trabalho e a Odontologia do Trabalho da Clínica Oralmed podem oferecer a você e seus colaboradores. A Clínica Oralmed também conta com Consultas Médicas e tratamento odontológico, atendemos a vários convênios.
Oral health is linked to overall healthmanojitsingh
If any one know that how oral health is related to overall health, they will certainly start giving importance to maintain proper oral health which is not possible by brushing everyday. You need to Floss your teeth with easy to use Healthbuddy Dental Floss Pick which is available on Flipkart or Amazon or Ebay.
Hi, I am Dr Komal Ghiya, pediatric dentist by profession, I am here to share some of my own presentations for educational purposes. I hope a presentation on DIET AND DENTAL CARIES will be useful for all the dental and medical students. Comments are welcome if you like the presentations and if not please suggest some ways I could make them better for you. All the best
Early childhood caries (ECC) affects teeth of children aged under six years. According to the Global Burden of Disease Study in 2017, more than 530 million children globally have dental caries of the primary teeth. However, as primary teeth are exfoliated due to growth of the child, #ECC has previously not been considered important.
Dental caries can lead to abscesses and cause toothache, which may compromise ability to eat and sleep and restrict life activity of children.
Prevalence of ECC is increasing rapidly in low and middle-income countries, and dental caries is particularly frequent or severe among children living in deprived communities. In many countries, access to dental care is not equitable, leaving poor children and families underserved.
Esta nova Diretriz OMS: Aconselhamento de mulheres para melhorar as práticas de amamentação, é a primeira orientação baseada em evidências científicas para esta intervenção.
Complementa as iniciativas e orientações apresentadas em várias publicações anteriores da OMS:
Breastfeeding counselling: a training course, Infant and young child feeding counselling: an integrated course, Combined course on growth assessment and IYCF counselling, Integrated Management of Childhood Illness, Community management of at-risk mothers and infants under six months of age (C-MAMI) tool, Essential newborn care course, Caring for newborns and children in the community: a training course for community health workers, Guidelines on optimal feeding of low birth-weight infants in low- and middle-income countries, Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services, Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services – the revised Baby-friendly Hospital Initiative and Infant and young child feeding in emergencies. Operational guidance for emergency relief staf and programme managers.
Essa diretriz expande os detalhes de tempo, frequência, modo ou profissional ideal para o Aconselhamento para melhorar as práticas de aleitamento materno, com base nas revisões sistemáticas e narrativas mais recentes sobre o tema. Um documento de orientação anexo, complementa os detalhes de um programa de saúde pública de Aconselhamento em Amamentação.
Dra. Elsa Giuglini foi uma das consultoras dessa publicação que será muito útil para provarmos que o Aconselhamento é uma habilidade imprescindível.
Prof. Marcus Renato de Carvalho
Protegendo, promovendo e apoiando a Amamentação em maternidades - diretrizes atualizadas pela OMS.
Esta diretriz fornece recomendações globais e fundamentadas em evidências científicas sobre proteção, promoção e apoio à amamentação ideal em maternidades, como uma intervenção de saúde pública.
Pretende-se contribuir para discussões entre as partes interessadas ao selecionar ou priorizar as ações apropriadas em seus esforços para alcançar os Objetivos de Desenvolvimento Sustentável e as metas globais para 2025, conforme proposto no Plano Integral de Implementação de Nutrição Materna e Infantil, endossado pela 65ª. Assembléia Mundial da Saúde, em 2012, na resolução WHA65.6, a Estratégia Global para a saúde das mulheres, crianças e adolescentes (2016-2030) e a Estratégia Global para alimentação infantil e de crianças.
Ratifica a importância da implementação da IHAC – Iniciativa Hospital Amigo da Criança.
Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services
Guideline
Relatório apresenta uma análise do estado atual da BFHI - Baby-Friendly Hospital Initiative (No Brasil, IHAC – Iniciativa Hospital Amigo da Criança) em países ao redor do mundo.
Com base na 2 ª revisão da política global de nutrição, implementado pela OMS em 2016-2017, o documento apresenta a implementação da iniciativa, 25 anos após o seu lançamento.
O relatório descreve a cobertura do programa, o atual processo de designação, razões para rescisão em locais onde o programa foi descontinuado, integração dos dez passos para outras normas e políticas globais, e lições aprendidas. Além disso, o relatório fornece informação qualitativa em alguns dos países que enfrentaram desafios na implementação da BFHI.
Excelente publicação – o Brasil é citado várias vezes.
Number of pages: 60
Publication date: 2017
Languages: English
ISBN: 978 92 4 151238 1
Novas diretrizes da OMS e Unicef para maternidades, casas de parto e centros de nascimento:
Protecting, promoting and supporting Breastfeeding in facilities providing maternity and newborn services: the revised
BABY-FRIENDLY HOSPITAL INITIATIVE
OMS e Unicef relançam os 10 passos da IHAC/BFHI leia em http://www.aleitamento.med.br/amamentacao/conteudo.asp?cod=2358
At present at least 2.2 billion people around the world have a vision impairment, of whom at least 1 billion have a vision impairment that could have been prevented or is yet to be addressed. The world faces considerable challenges in terms of eye care, including inequalities in the coverage and quality of prevention, treatment and rehabilitation services; a shortage of trained eye care service providers; and poor integration of eye care services into health systems, among others. The “World report on vision” aims to address these challenges and galvanize action.
Produced at the request of Member States during a side event to the 70th World Health Assembly, and with the support of experts from around the world, the report provides evidence on the magnitude of eye conditions and vision impairment globally, draws attention to effective strategies to address eye care, and offers recommendations for action to improve eye care services worldwide. The key proposal of the report is for all countries to provide integrated people-centred eye care services which will ensure that people receive a continuum of eye care based on their individual needs throughout their lives.
•At least 2.2 billion people around the world are living with a vision impairment, according to the WHO’s first report on vision. Here’s what else you need to know:
•Projections: Some 95 million people will develop glaucoma by 2030, and nearly 245 million will develop any kind of age-related macular degeneration during the same time.
•Preventable conditions: Of the 1 billion living with untreated or preventable conditions, some 12% have some unaddressed refractive error, while more than 65 million have cataract problems.
•Disease burden: Unaddressed problems with distance vision is nearly four times as common in low- and middle-income regions than in high-income areas. Women, the elderly, and people with disabilities are also more likely to have vision impairment.
Finalmente saiu a atualização do manual da OMS sobre PARTO e NASCIMENTO. A 1a. edição foi publicada há mais de 20 anos atrás - 1996!
Desde então, tivemos no ano passado a publicação das diretrizes do Ministério da Saúde, para cesárea e parto normal, um trabalho colaborativo de grande porte, denso, em que muit@s de nós tivemos o privilégio de poder contribuir.
E esta semana saiu! Ainda está apenas em inglês, espero que em breve esteja acessível em outros idiomas. Incluindo o nosso!
Algumas coisas do que dá para perceber lendo o sumário a partir da página 3:
- o foco principal é na redução de intervenções sem indicação precisa
- inova ao incluir como resultado a mulher relatar o parto como uma experiência positiva
- adorei a proposta de um toque vaginal a cada 4h no primeiro estágio, fase latente
- recomenda banho do bebê só depois de 24 horas (afora contato pele-a-pele, amamentação na primeira hora etc)
- inclui cuidados com a mulher no pós-parto imediato
- esta versão integra recomendações provenientes de outros documentos da OMS
Bem - agora é ler, tomar conhecimento e adotar como referência, né?
Muito, muito bom!
Dizem que o ano começa, de verdade, após o carnaval - taí! começou bem!
Cordialmente,
Daphne Rattner
ReHuNa
Recomendações da OMS: Cuidados intra-parto para um
experiência de parto/nascimento positiva (baseada em evidências científicas).
Já se passaram mais de duas décadas desde que a Organização Mundial da Saúde (OMS) emitiu orientação técnica dedicada ao cuidado de gestantes saudáveis e seus bebês - Cuidados no parto normal: um guia prático.
O panorama global dos serviços de maternidade mudou consideravelmente desde que essa orientação foi publicada.
Mais mulheres estão dando à luz em instituições de saúde em muitas partes do mundo e, ainda assim, abaixo do ideal.
A qualidade dos cuidados continua a impedir a obtenção dos resultados desejados. Enquanto em algumas configurações também poucas intervenções estão sendo fornecidas tarde demais para as mulheres, em outros ambientes as mulheres estão recebendo muitas intervenções desnecessárias...
...
A nossa querida Profa. Melania Amorim foi uma das autoras dessa importante publicação.
Prof. Marcus Renato de Carvalho
Recomendações da OMS para o cuidado do recém-nascido prematuro ou de baixo peso
WHO recommendations for care of the preterm or low birth weight infant
Estima-se que 15 milhões de bebês prematuros todos os anos. Isso é mais de 1 em cada 10 bebês. Aproximadamente 1 milhão de crianças morrem a cada ano devido a complicações de parto prematuro. Muitos bebês sobreviventes enfrentam uma vida inteira de deficiência, incluindo dificuldades de aprendizagem e problemas visuais e auditivos.
No Dia Mundial da Prematuridade de 2022, 17 de novembro de 2022, o Departamento de Saúde Materna, Neonatal, Infantil e Adolescente e Envelhecimento da Organização Mundial da Saúde em Genebra está lançando novas recomendações com base em evidências recentes que podem melhorar o atendimento de recém-nascidos prematuros e/ou de baixo peso. Existem 25 recomendações que expandem substancialmente o “o que”, “onde” e “como” para melhorar a sobrevivência, saúde e bem-estar de bebês prematuros e de baixo peso ao nascer. Isso inclui a Metodologia MÃE CANGURU e o envolvimento das famílias no cuidado de seus bebês desde o momento do nascimento.
WHO Foresight Approaches in Public Health.pdfWendy Schultz
Suggestions for expanding futures research and foresight capabilities in an organization, with an emphasis on broad participation by stakeholders; includes examples of multiple futures methods and linked processes.
Oral health is fundamental to general health and well being. In this document guidelines are given on how to assist school and community leaders to improve health and education of children and young people. The schools can provide a supportive environment for promoting oral health; school policies and education for health are imperative in the attainment of oral
health and control of risk behaviours related to diet and nutrition, tobacco use and excessive alcohol consumption.
Este documento apresenta a posição conjunta e a visão de um grupo de trabalho especializado, global e multissetorial sobre a implementação da Metodologia Mãe Canguru (MCC) para todos os bebês prematuros ou com baixo peso ao nascer (BPN), como base para o cuidado de recém-nascidos prematuros e/ou doentes.
O documento resume as informações básicas, as evidências e a justificativa para disponibilizar o MMC para todos os recém-nascidos prematuros ou de BPN e busca mobilizar a comunidade internacional de saúde materna, neonatal e infantil e as famílias para se unirem para apoiar a implementação do MMC para todos os prematuros ou bebês com baixo peso ao nascer para melhorar a saúde e o bem-estar deles e de suas mães e famílias.
Este documento de posição destina-se a ser utilizado por gestores, parceiros de desenvolvimento, lideranças do pessoal de saúde, pediatras neonatologistas, lideranças da sociedade civil (por exemplo, organizações de pais e profissionais) e organizações de pesquisa envolvidos na pesquisa de implementação do MMC.
O MMC é uma intervenção que permite à mãe assumir um papel central em sua própria vida
e os cuidados do seu recém-nascido, revertendo assim a mudança de poder entre a mãe e o responsável pelos cuidados de saúde, prestadores ou sistemas de saúde. Humaniza os cuidados maternos e neonatais, capacitando e envolvendo
aqueles que mais cuidam do RN, em vez de focar predominantemente em soluções tecnológicas.
Assim, o MMC pode servir como ponto de partida para uma reformulação mais ampla do sistema de saúde e para a prestação de serviços,
transformação dos cuidados maternos e neonatais, e um modelo do que pode ser realizado quando
as partes interessadas relevantes têm o poder de desempenhar os papéis que lhes são naturalmente confiados no cuidado dos seus
recém-nascidos.
Esse documento mostra como o Cuidado Mãe-Canguru pode ser revolucionário na atenção neonatal.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Nova publicação da WHO: intervenções não clínicas para reduzir as cesarianas desnecessárias.
Cesariana é um procedimento cirúrgico que pode prevenir a mortalidade materna e recém-nascidos quando indicada por razões clínicas específicas.
No entanto, o nascimento por cesárea está associado a curto e longo prazo a maiores riscos que podem estender muitos anos.
Quando mal indicada, afeta a saúde da mulher, da criança, a amamentação e futuras gravidezes.
Altas taxas da seção cesariana são associadas a custos substanciais para os serviços de saúde.
Um documento espetacular que acaba de ser lançado pela Organização Mundial da Saúde.
Prof. Marcus Renato de Carvalho
Este Guia, “Alimentação complementar de bebês e crianças pequenas de 6 a 23 meses de idade”, substitui os Princípios Orientadores para Alimentação Complementar do Lactente Amamentado e princípios orientadores para alimentação crianças não amamentadas de 6 a 24 meses de idade.
A alimentação complementar saudável é definida como o processo de fornecimento de alimentos além do leite materno ou fórmula láctea quando por si só não são mais suficientes para atender necessidades nutricionais. Geralmente começa aos 6 meses de idade e continua até 24 meses de idade, embora a amamentação deve permanecer além deste período.
Essa etapa é um momento crítico para o desenvolvimento para as crianças aprenderem a aceitar alimentos e bebidas saudáveis a longo prazo. Também coincide com o período de pico para o risco de crescimento insuficiente e deficiências nutricionais.
As consequências imediatas, como a desnutrição durante estes anos de formação –
bem como no útero e nos primeiros 6 meses de
vida - incluem crescimento insuficiente significativo, morbidades e mortalidade e atraso motor, retardo do desenvolvimento cognitivo e sócio emocional.
Mais tarde, pode levar a um risco aumentado de doenças não transmissíveis (DNT). No
longo prazo, desnutrição na primeira infância causa redução da capacidade de trabalho e dos rendimentos e, entre as meninas, redução da capacidade reprodutiva. A Alimentação Complementar inadequada com alimentos ultra processados pode resultar em Obesidade, Diabetes tipo 2, hipertensão…
Os primeiros dois anos de vida também são um período crítico para o desenvolvimento do cérebro, a aquisição de linguagem e maturação das vias sensoriais para a visão
e audição, e o desenvolvimento de melhor desempenho das funções cognitivas.
Estas novas diretrizes estão atualizadas com evidências mais sólidas e têm muitos princípios em comum com o que preconiza o “Guia Alimentar para Crianças Brasileiras menores de 2 anos”. (Baixe aqui no nosso SlideShare).
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Existem cada vez mais evidências de que os setores de bebidas e alimentos ultra processados, fórmulas infantis, micronutrientes, pesticidas e manipulação genética de alimentos, além de atores associados, frequentemente tentam atrasar, enfraquecer, distorcer e/ou impedir o desenvolvimento de políticas e programas de alimentação e nutrição que possam contribuir efetivamente para sistemas alimentares mais saudáveis e sustentáveis.
Este documento estabelece um roteiro para introduzir e implementar, na Região das Américas, o Projeto de abordagem da OMS para a prevenção e gestão de conflitos de interesse na formulação de políticas e implementação de programas de nutrição no âmbito nacional, publicado pela OMS em dezembro de 2017.
Conflito de interesse segundo a OMS é uma situação em que o interesse primário de uma instituição pode ser indevidamente influenciado pelo interesse de um ator não estatal, de tal forma que afete (ou possa parecer afetar) a independência e objetividade do trabalho do governo no campo da saúde pública.
O projeto de abordagem da OMS é um processo decisório cujo objetivo é ajudar os Estados a identificar, prevenir e gerenciar potenciais conflitos de interesse quando da sua interação com atores não estatais (principalmente comerciais) nas políticas e programas de nutrição.
Considerando a complexidade do projeto de abordagem da OMS, este documento também fornece uma 'ferramenta de triagem' simplificada para apoiar e permitir sua aplicação.
Essa ferramenta de triagem foi desenvolvida pela OPAS, com o apoio de funcionários de ministérios da saúde e de organizações da sociedade civil.
Este roteiro tem como objetivos:
- apresentar os princípios fundamentais da abordagem da OMS aos tomadores de decisão das agências governamentais relevantes;
- adaptar e desenvolver formatos complementares da abordagem da OMS que se encaixem nos processos decisórios existentes em nível nacional;
- e complementar a ferramenta completa da OMS com uma ferramenta de triagem mais curta para aumentar a acessibilidade e possibilitar um envolvimento e uso mais efetivos na tomada de decisões relativas a potenciais interações com atores não estatais.
A publicação explica como esses objetivos podem ser abordados usando um método em 3 estágios. Ela também inclui anexos que cobrem estudos de caso, programas para oficinas e uma ferramenta de triagem para avaliar potenciais interações com atores não estatais: indústrias, comerciantes, empresas... Inclusive, no patrocínio de Congressos, Encontros, Reuniões científicas e apoio as Associações e Sociedades de profissionais de saúde.
Recomendamos!
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Promoção comercial dos ditos substitutos do leite materno:
Implementação do Código Internacional -
relatório de situação mundial em 2024
Esta publicação fornece informações atualizadas sobre o estado de implementação do Código Internacional de Comercialização de Substitutos do Leite Materno (de 1981) e subsequentes resoluções da Assembleia Mundial da Saúde (relacionadas com o “Código”) por países. Apresenta o estatuto jurídico do Código, incluindo até que ponto as disposições de recomendação foram incorporadas nas legislações nacionais.
O relatório centra-se na forma como as medidas legais delineiam processos de monitorização e aplicação para garantir a eficácia das disposições incluídas.
Também destaca exemplos importantes de interferência de fabricantes e distribuidores de substitutos do leite materno nos esforços para enfraquecer e atrasar a implementação de proteções contra o marketing antiético.
O Brasil aparece classificado como “substancialmente alinhado com o Código” devido à NBCAL – Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras, que está em constante atualização desde sua primeira versão de 1988.
Esse status no traz esperança de continuar avançando, principalmente contra o marketing digital perpetrado pelas redes sociais e pelas ditas “influenciadoras”.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Maternidade pública de Salvador lança caderneta específica para acompanhamento da gestação de Homens Trans. A Unidade de saúde da Universidade Federal da Bahia mantém ações de acolhimento à população transexual. Medida visa preencher lacuna do sistema de saúde.
A iniciativa foi idealizada e produzida pela Maternidade Climério de Oliveira da UFBA em Salvador.
“A caderneta tem como objetivo promover inclusão social, visibilidade e pertencimento, além de produzir dados qualitativos e quantitativos sobre gestações transmasculinas. O uso do instrumento pode contribuir na elaboração de políticas públicas que propiciem o acesso, o cuidado seguro e a garantia de direitos, conforme estabelecido nos princípios do SUS (universalidade, equidade e integralidade)”, disse Sinaide Coelho, superintendente da MCO-UFBA.
TRANSGESTA
Trata-se de uma iniciativa voltada às pessoas que se reconhecem e se declaram transexuais, travestis, transgêneras, intersexo e outras denominações que representam formas diversas de vivência e de expressão de identidade de gênero. Desde o início, o programa realizou o acompanhamento de 7 homens trans gestantes, que resultou no nascimento de nove bebês na maternidade.
Parabéns!
Todo o nosso apoio: essa Caderneta será citada no V Seminário online anual preparatório para a SMAM 2024 em www.agostodourado.com
Prof. Marcus Renato de Carvalho
www.aleitamento.com
ALIMENTAÇÃO DE LACTENTES E CRIANÇAS PEQUENAS EM SITUAÇÕES DE EMERGÊNCIA:
manual de orientações para a comunidade, profissionais de saúde e gestores de programas de assistência humanitária.
*Tema da SMAM 2009 e que abordaremos novamente no www.agostodourado.com desse ano.
As calamidades e emergências complexas têm um impacto devastador sobre a vida das pessoas. Repentinamente, elas perdem suas casas e são obrigadas a viver fora de seu local de origem, muitas vezes com a cisão abrupta da unidade familiar. O acesso aos serviços de saúde primários costuma ficar prejudicado ou completamente inviabilizado e os sistemas de saúde podem entrar em colapso. A água potável e os alimentos geralmente se tornam escassos, as condições de segurança precárias. Durante os desastres é preciso enfrentar o desafio de lidar com um grande número de pessoas em choque, muitas delas doentes, feridas ou traumatizadas por suas experiências. As mulheres e crianças são as vítimas que mais necessitam de cuidados. Muitas mulheres perdem seus maridos/companheiras, filhos, pais ou parentes e, mesmo assim, precisam iniciar imediatamente o trabalho de reconstruir seus lares, de organizar o espaço para continuar vivendo e de cuidar dos membros mais frágeis da família. O impacto sobre as mulheres pode ser imenso, tanto físico quanto emocional e social. Atenção extra e cuidados especiais precisam ser oferecidos às mulheres com crianças pequenas, órfãos e gestantes.
A Amamentação cruzada não é recomendada e as lactantes devem receber um acolhimento carinhoso para que possam continuar amamentando ou serem apoiadas para a relactação.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Você gostaria de saber mais sobre como ter uma amamentação prazerosa?
Tirar as principais dúvidas sobre aleitamento?
Como doar seu leite com segurança e ter apoio de um Bancos de Leite Humano?
Quais medicamentos pode tomar enquanto está amamentando?
Baixe agora o Aleitamento App!
O que você irá encontrar:
- dicas desde a gestação até a volta ao trabalho,
- espaço para crianças com dicas de livros,
- diário do bebê,
- rede de apoio / cuidado paterno e muito mais!
* Estamos sem patrocínio e precisamos do seu apoio para que essa ferramenta continue disponível gratuitamente.
=> Nosso aplicativo é sempre atualizado com informações baseadas em evidências científicas e notícias do universo da saúde materno-infantil.
É grátis e muito fácil baixar:
https://aleitamento.com.br/instalar/
ou acesse pelo celular o Google Play Store e na Apple Store, faça o download de “Aleitamento Lactare”
Programadora: Clara
Watanabe
Divulgação: aleitamento.com
Curadoria de conteúdo: Prof. Marcus Renato de Carvalho @marcus.decarvalho
Amamentação e desenvolvimento sensório psico-motor dos lactentes: “Trilhos anatômicos”, bases neurais da motricidade do sistema estomatognático e suas repercussões sistêmicas.
O lactente é preparado para a amamentação desde a décima segunda semana de gestação, quando inicia o ato reflexo de deglutir o líquido amniótico. A região do encéfalo responsável pela elaboração desses primitivos atos motores é o tronco encefálico. O RN adquire controle motor no sentido céfalo caudal. Isso se dá porque a deposição de mielina obedece à mesma direção. Acrescente-se o fato de o aumento expressivo dos prolongamentos de neurônios ocorrer, principalmente, até os 2 anos de idade. A amamentação, que deve ser mantida pelo menos até que o lactente complete 24 meses de vida, ou mais, funcionaria como uma forma de estimulação perfeita durante esse período crítico do desenvolvimento motor. No lactente, fase em que predominam as ações motoras do orbicular dos lábios e do bucinador (inervados pelo facial), a deglutição é visceral. Entre 7 e 8 meses de idade ocorre a erupção dos dentes incisivos decíduos. O contato inter incisal deflagra a mudança de dominância motora do facial para a do trigêmeo. O padrão de deglutição muda de visceral para somático. Os músculos masseter, pterigoideo medial e temporal (inervados pelo trigêmeo) fazem parte da linha profunda anterior e se comunicam com o occipto frontal (inervado pelo facial), limite cranial da linha superficial posterior. A atuação conjunta dessas duas linhas miofasciais permite que o lactente abandone sua postura flexora com o fortalecimento gradual da musculatura extensora. A amamentação promove, portanto, um adequado sincronismo das ações motoras estimuladas pelos nervos facial e trigêmeo, cujos núcleos se situam no tronco encefálico e estabelecem contato com diversas vias neurais importantes para a organização dos movimentos. Influência o tônus neuromuscular, a postura e o desenvolvimento motor do lactente.
Juliana de Magalhães Faria, Antonio de Padua Ferreira Bueno, Marcus Renato de Carvalho.
Publicado na Revista Fisioterapia Ser • vol. 18 - nº 4 • 2023.
Juliana é Fisioterapeuta em instituições públicas e/ou
privadas há 22 anos, onde adquiriu experiência na área da Saúde e Educação, Pediatria, Fisioterapia em reabilitação de bebês e crianças com problemas neurológicos, estimulação sensório psicomotora, correção postural, reabilitação de pacientes com limitações ortopédicas e neurológicas...
Especialista em Atenção Integral à Saúde Materno-infantil na Maternidade Escola da UFRJ onde iniciou esse artigo que começou com o seu TCC em 2006-7.
Os Princípios de Yogyakarta são um documento sobre direitos humanos nas áreas de orientação sexual e identidade de gênero, publicado em novembro de 2006 como resultado de uma reunião internacional de grupos de direitos humanos na cidade de Joguejacarta (em indonésio: Yogyakarta), na Indonésia.
Os Princípios foram complementados em 2017, expandindo-se para incluir mais formas de expressão de gênero e características sexuais, além de vários novos princípios.
Os Princípios, e sua extensão de 2017, contêm um conjunto de preceitos destinados a aplicar os padrões da lei internacional de direitos humanos ao tratar de situações de violação dos direitos humanos – LGBTQIA+ - de lésbicas, gays, bissexuais, transgêneros, intersexuais e demais expressões de gênero.
São 29 princípios:
1. Direito ao Gozo Universal dos Direitos Humanos
2. Direito à Igualdade e a Não-Discriminação
3. Direito ao Reconhecimento Perante a Lei
4. Direito à Vida
Direito à Segurança Pessoal
6. Direito à Privacidade
7. Direito de Não Sofrer Privação Arbitrária da Liberdade
8. Direito a um Julgamento Justo
9. Direito a Tratamento Humano durante a Detenção
10. Direito de Não Sofrer Tortura e Tratamento ou Castigo Cruel, Desumano e Degradante
11. Direito à Proteção Contra todas as Formas de Exploração, Venda ou Tráfico de Seres Humanos
12. Direito ao Trabalho
13. Direito à Seguridade Social e outras Medidas de Proteção Social
14. Direito a um Padrão de Vida Adequado
15. Direito à Habitação Adequada
16. Direito à Educação
17. Direito ao Padrão mais Alto Alcançável de Saúde
18. Proteção contra Abusos Médicos
19. Direito à Liberdade de Opinião e Expressão
20. Direito à Liberdade de Reunião e Associação Pacíficas
21. Direito à Liberdade de Pensamento, Consciência e Religião
22. Direito à Liberdade de Ir e Vir
23. Direito de Buscar Asilo
24. Direito de Constituir uma Família
25. Direito de Participar da Vida Pública
26. Direito de Participar da Vida Cultural
27. Direito de Promover os Direitos Humanos
28. Direito a Recursos Jurídicos e Medidas Corretivas Eficazes
29. Responsabilização (“Accountability”).
Fonte: Wikipedia + JusBrasil
"Amamentação, sistemas de primeira alimentação
e poder corporativo: um estudo de caso sobre o mercado e as práticas políticas da indústria
transnacional de alimentação infantil no Brasil"
Artigo original: Breastfeeding, first-food systems and corporate power: a case study
on the market and political practices of the transnational baby food industry in Brazil.
Métodos da pesquisa: Usamos um desenho de estudo de caso, extraindo dados de documentos e entrevistas com informantes-chave (N=10).
Resultados: As taxas de amamentação despencaram no Brasil para um mínimo histórico na década de 1970. O ressurgimento da amamentação a partir
de meados da década de 1980 refletiu o fortalecimento do compromisso para a política nacional e uma lei de proteção da amamentação, resultante, por sua vez, de ações coletivas levadas a cabo por coligações de amamentação, defensores e mães. No entanto, mais
recentemente, as melhorias na amamentação estabilizaram no Brasil, enquanto a indústria aumentou as vendas de CMF
( Fórmulas Lácteas Comerciais) no Brasil em 750% entre 2006 e
2020. À medida que as regulamentações se tornaram mais rigorosas, a indústria promoveu de forma mais agressiva os CMF para bebés mais velhos e crianças pequenas, bem como para produtos especializados. fórmulas. A indústria de alimentos para bebés é fortalecida através da associação com grupos industriais poderosos e emprega lobistas com bom acesso aos decisores políticos.
A indústria conquistou a profissão pediátrica no Brasil através de sua associação de longa data com a Sociedade Brasileira de Pediatria.
...
Parabenizamos os autores: Cindy Alejandra Pachón Robles, Mélissa Mialon, Laís Amaral Mais, Daniela Neri, Kimielle Cristina Silva e Phillip
Baker.
Tradução: Moises Chencinski
* Referência: Robles et al. Globalization and Health (2024) 20:12
https://doi.org/10.1186/s12992-024-01016-0
GLOBAL BREASTFEEDING SCORECARD 2023
As taxas de amamentação estão aumentando em todo mundo através da melhoria dos sistemas de promoção, proteção e apoio.
A amamentação é essencial para a sobrevivência e saúde infantil. O leite materno é um produto seguro, natural, nutritivo e sustentável. O padrão ouro para a alimentação dos lactentes. O leite materno contém anticorpos que ajudam a proteger contra muitas doenças infantis, como como diarreia e doenças respiratórias. Estima-se que o desmame precoce seja responsável por 16% das mortes infantis a cada ano.
As crianças amamentadas têm melhor desempenho em testes de inteligência e têm menos probabilidade de ter excesso de peso ou obesidade na vida adulta. As mulheres que amamentam também têm um risco reduzido de câncer e diabetes tipo II.
O “Global Breastfeeding Scorecard” examina as práticas atuais de amamentação em todo o mundo, considerando o momento de iniciação, exclusividade nos primeiros seis meses de vida e continuação até os dois anos de idade.
Além disso, documenta o desempenho nacional em indicadores-chave de como a amamentação é protegida e apoiada. Essa edição 2023 registra o progresso e os desafios na melhoria da amamentação. O relatório destaca histórias de sucesso em vários países que reforçaram as suas políticas e programas de amamentação.
Oito iniciativas fundamentais e seus impactos são analisadas:
1. Assegurar e ampliar o financiamento de políticas para aumentar as taxas de amamentação desde o nascimento até aos dois anos de vida dos lactentes;
2. Implementar integralmente o Código de Comercialização de Substitutos do Leite Materno (NBCAL no Brasil);
3. Garantir legalmente licença parentalidade (licença maternidade e paternidade) remunerada e políticas de apoio à amamentação no local de trabalho;
4. Implementar os Dez Passos para o Sucesso da Amamentação nas maternidades – a IHAC;
5. Melhorar o acesso as capacitações em Aconselhamento em amamentação;
6. Fortalecer os vínculos entre as unidades de saúde e as comunidades;
7. Fortalecer os sistemas de monitoramento que acompanham o progresso das políticas, programas de aleitamento, e o seu financiamento;
8. Apoio IYCF (Infant and Young Child Feeding / Alimentação de lactentes e pré-escolares) em Emergências
...
CONCLUSÃO
O Scorecard demonstra que há progressos na proteção e no apoio à amamentação. Mas, ainda temos desafios significativos no aleitamento materno. São necessários mais investimentos e ações políticas ousadas para melhorar os ambientes propícios à proteção, promoção e apoio à amamentação.
Essa importantíssima publicação é do GLOBAL BREASTFEEDING COLLECTIVE, um conjunto de dezenas de instituições e experts no tema com o apoio do UNICEF.
Tradução livre do Prof. Marcus Renato de Carvalho www.aleitamento.com
Workplace breastfeeding support for working women: A scale
development study
Artigo científico publicado no European Journal of Obstetrics & Gynecology and
Reproductive Biology: X
O objetivo deste estudo foi desenvolver uma escala para avaliar o apoio ao aleitamento materno no local de trabalho.
Métodos
O estudo foi realizado com 490 mulheres trabalhadoras que se inscreveram nos ambulatórios da mulher e da criança de um hospital na Turquia. Os dados do estudo foram coletados por meio de um 'Formulário de Informações Pessoais' e da 'Escala de Apoio à Amamentação no Local de Trabalho para Mulheres Trabalhadoras'. Os dados foram analisados nos softwares SPSS 25 e AMOS 21. No processo de desenvolvimento da escala; Utilizaram-se a validade de conteúdo, a análise fatorial exploratória, os métodos de correlação item escore total e o coeficiente alfa de Cronbach.
Resultados
O índice de validade de conteúdo da escala foi de 0,90 e o valor de alfa de Cronbach foi de 0,93. O valor da escala de Kaiser-Meyer-Olkin foi de 0,91, o teste de Bartlett foi χ2 = 11.573,924 e p < 0,000. De acordo com os resultados da análise fatorial exploratória para a validade de construto da escala, a escala foi composta por 31 itens e 6 fatores.
Conclusões
A escala desenvolvida pode ser utilizada para avaliar o apoio à amamentação no local de trabalho para mulheres trabalhadoras como um instrumento de medida válido e confiável.
Excelente instrumento: tema da SMAM 2023 - Amamentação / Direito da Mulher Trabalhadora.
Profa. Carla Taddei afirma nessa entrevista que a AMAMENTAÇÃO modula a MICROBIOTA, e, portanto, se sobrepõe ao parto normal na transmissão materno infantil de “bactérias do bem”.
E em outra pesquisa mostrou que os prematuros de UTI Neonatal que tomavam leite materno tinham menos tempo de internação, independentemente se receberam leite da própria mãe ou leite humano pasteurizado do Banco de Leite da maternidade.
Está comprovado cientificamente que a Amamentação dá resiliência para a microbiota e, mesmo que a criança precise de antibiótico ou que tenha alguma outra enfermidade, o Aleitamento humano vai garantir a estrutura daquela comunidade microbiana (que antigamente chamávamos de flora intestinal).
Dra. Carla Taddei é Professora Associada do Laboratório de Microbiologia Molecular do HU da USP.
Fonte: Super Saudável, Ano XXIII, número 100 – outubro a dezembro de 2023.
Leia mais sobre esse tema no nosso portal www.aleitamento.com
As bactérias do leite humano - Microbioma do leite materno tem um efeito protetor contra infecções.
Prof. Marcus Renato de Carvalho
Esse é o capítulo sobre políticas públicas de promoção, proteção e apoio ao aleitamento da 4ª edição do livro “Amamentação – bases científicas” – GEN Editora, 2017.
“Manejo Ampliado” é um conjunto de saberes que vão mais além dos conhecimentos biomédicos necessários para a assistência clínica ao binômio lactante-lactente.
É a capacitação de profissionais para elaborarem programas, políticas, eventos em prol da amamentação, com enfoque de gênero, interseccionalidade, diversidade e inclusão.
São apresentadas várias iniciativas internacionais e nacionais das ONGs e dos governos municipais, estaduais e federal.
Inclui um histórico das Semanas Mundiais de Aleitamento e dos Encontros Nacionais de Aleitamento desde 1991.
É o aleitamento pela ótica da saúde coletiva.
Mande suas críticas, sugestões e outras iniciativas não citadas.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Orientação sobre regulamentação de medidas destinadas a restringir o marketing digital de substitutos do leite materno (em tradução livre)
É urgente a proteção da amamentação nas redes sociais
"Guidance on regulatory measures aimed at restricting digital marketing of breast-milk substitutes".
As redes sociais se tornaram rapidamente a fonte predominante de exposição à promoção de substitutos do leite materno a nível mundial. O marketing digital amplifica o alcance e o poder da publicidade e de outras formas de promoção em ambientes digitais, e a exposição a promoção comercial digital aumenta a compra e a utilização dos ditos substitutos do leite materno.
À luz destas evidências, a 75ª. Assembleia Mundial da Saúde solicitou que a OMS desenvolvesse orientações para os Estados-Membros sobre medidas regulamentares destinadas a restringir a comercialização digital de substitutos do leite materno. Esta orientação aplica-se à comercialização de produtos abrangidos pelo Código Internacional de Comercialização de Substitutos do Leite Materno (NBCAL no Brasil), bem como a alimentos para lactentes e crianças pequenas que não sejam substitutos do leite materno.
Parabenizamos o nosso colega e amigo Cristiano Boccolini (Institute of Scientific and Technological Communication—ICICT, Oswaldo Cruz Foundation—Fiocruz, Brazil) um dos autores dessa inédita publicação.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Apresentamos a Carta do Recife: Por uma política pública de atenção integral aos homens na saúde para promoção da paternidade e do cuidado no Brasil que apresenta uma breve síntese das reflexões e discussões desenvolvidas ao longo do Seminário Nacional e Internacional "Paternidade e Cuidado" que aconteceu em Recife, entre 30 de agosto e 1º de setembro de 2023.
Nesta carta, apresentamos algumas notas e proposições a toda a sociedade brasileira, dialogando especialmente com gestores/as da União, estados e municípios, legisladores/as, órgãos do poder judiciário, empresas, empregadores/as, sindicatos, movimentos sociais, pesquisadores/as, entidades vinculadas ao controle social e à sociedade em geral.
Abraços,
Coordenação de Atenção à Saúde do Homem (COSAH/CGACI/DGCI/SAPS/MS)
Núcleo de Pesquisas Feministas em Gênero e Masculinidades - GEMA/UFPE
Núcleo GenSex/Fiocruz
Núcleo Tramas/UFPA
UFMT
Estivemos presentes e ratificamos essas análises e recomendações.
Prof. Marcus Renato de Carvalho
Representante do Parents in Science / Faculdade de Medicina - UFRJ
www.aleitamento.com
A Federação Internacional de Ginecologia e Obstetrícia (FIGO) reconhece a Amamentação
como uma prática protetora que pode salvar vidas e recomenda que seja iniciada dentro da 1ª hora de vida (conhecida como “hora mágica” ou "hora de ouro").
Através das recomendações do
melhores práticas, a OMS sugere que a amamentação “temprana” e oportuna na sala de parto pode trazer grandes benefícios para ambos – tanto para a mãe quanto para o bebê.
Alguns aspectos importantes da hora mágica, como o contato pele a pele e o início
no início do aleitamento materno, pode prevenir a hemorragia pós-parto, facilita a involução uterina e produz amenorreia lactacional, que é um método contraceptivo (LAM) útil.
A amamentação no início da vida traz benefícios a longo prazo para a mãe e para a criança.
...
Parabéns a FIGO!
Amamentação na primeira hora: proteção sem demora!
Prof. Marcus Renato de Carvalho
www.aleitamento.com
O atendimento ambulatorial de Puericultura é destinado à criança saudável, para a prevenção, e não para o tratamento de doenças. Sendo
assim, diante dos novos conceitos de programming
e epigenética, fica clara a necessidade da assistência à saúde da criança se iniciar antes
mesmo de seu nascimento.
A ANS em 2013, pela Resolução Normativa nº 338, incluiu o procedimento pediátrico “atendimento ambulatorial em puericultura” no rol de consultas, passando a valer desde janeiro de 2014. Uma vez incluído, o procedimento passou a fazer parte da cobertura assistencial mínima
obrigatória pelos planos privados de assistência
à saúde suplementar: operadoras, Unimed...
O atendimento pediátrico a gestantes (terceiro trimestre) foi contemplado pelo Código
nº 1.01.06.04-9 com indicação de remuneração pelo Porte 2B, lembrando aos pediatras a importância do preenchimento correto do código da ANS nas guias de consulta para o devido reembolso desse valor diferenciado.
Vamos incentivar as gestantes a marcarem uma Consulta Pediátrica Pré-Natal?
Prof. Marcus Renato de Carvalho
Este "Guia do Pré-Natal do Parceiro para Profissionais
de Saúde" foi originalmente publicado em 2016 para apresentar a Estratégia Pré-Natal do Parceiro (EPNP), que, em linhas gerais, visa orientar
profissionais e gestores(as) do SUS sobre a importância do envolvimento masculino em todo o ciclo gravídico-puerperal.
Mais recentemente, entre 2021 e 2023, este material passou por processo de revisão/atualização
conduzido pela Coordenação de Atenção à Saúde do Homem (Cosah/CGACI/DGCI/Saps/MS), com a participação de pesquisadores/as vinculados/
as a instituições públicas de pesquisa e formação acadêmica (Gema/UFPE; UFPA; UFMT e IFF/Fiocruz).
Esse processo contou também com diálogos e a apreciação de gestores(as), das Coordenações
Estaduais e Municipais de Saúde do Homem, das áreas técnicas da Secretaria de Atenção Primária à Saúde do Ministério da Saúde, além de
trabalhadores(as) da atenção primária à saúde (APS)
e representantes da sociedade civil.
Para ampliarmos a participação dos homens na APS é necessário que trabalhadores(as) e gestores(as) revejam práticas e ideias e estejam mais atentos(as)
às construções socioculturais de gênero e às singularidades das pessoas e dos territórios, a fim
de garantir espaços de reflexão sobre as práticas de cuidado em saúde.
Parabéns ao Ministério da Saúde e parceiros.
Notamos a falta de conteúdo da Amamentação - informações básicas devem ser dadas nessa fase gestacional para que mães e pais se preparem para esse ato de cuidado e proteção da infância.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
O Instituto de Medicina Integral Professor Fernando Figueira (IMIP) relançou na manhã desta quarta (30) o livro O Matador de Bebês – 3ª edição (2023).
O pediatra João Guilherme Bezerra Alves leu a carta publicada pela prestigiada revista científica The Lancet em que os profissionais do IMIP, destacam a luta do fundador desta casa na proteção da amamentação.
A coordenadora do Banco de Leite, Vilneide Braga, relembrou na sua fala o percurso do professor em prol da amamentação, da IHAC, do Cuidado Mãe-Canguru...
A obra teve impacto mundial por denunciar as consequências na saúde da população com a comercialização de fórmulas infantis e da mamadeira, em países do Terceiro Mundo.
Silvia Rissin concedeu o título de sócio honorário ao Professor Mike Muller, que se sentiu muito surpreso pela honraria e pelo interesse ao tema.
Estive presente e esse livro é muito impactante sobre a falta de ética dos produtores de fórmulas infantis que atuavam sem os limites do Código Internacional dos ditos Substitutos do Leite Materno.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Nesse Agosto Dourado, a Sociedade Brasileira de Pediatria - SBP publica um livro digital sobre direitos da mulher trabalhadora que amamenta.
É possível "conciliar" a amamentação com o trabalho? A Constituição Federal protege o aleitamento materno? Para esclarecer estas e outras questões, a SBP lança nesta semana a publicação “Os direitos da mulher trabalhadora que amamenta”.
Esse livro é parte das ações em comemoração ao Agosto Dourado, mês da campanha mundial de conscientização sobre a importância do aleitamento materno.
Como destaca o documento, para facilitar o processo de adaptação das relações de trabalho da mãe às necessidades de amamentação do filho, sobretudo nos primeiros meses de vida, é fundamental conhecer, de maneira prévia, quais direitos estão garantidos na lei brasileira.
Nossa observação: me incomoda o termo “conciliar” porque acaba virando uma sobrecarga para a mulher 😥
E aqui no Brasil, esse termo é pejorativo, os pelegos conciliam…
Prof. Marcus Renato de Carvalho
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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5. Contents
Acknowledgements iv
Glossary v
Abbreviations vii
Preface viii
1. Background 1
1.1 Early childhood caries is a highly prevalent global disease
of public health importance 1
1.2 Risk factors are known: they are diverse and, like most
noncommunicable diseases, related to social determinants of health 1
1.3 The primary care team is a key actor in prevention and
control of early childhood caries 4
2. Introduction 5
3. Definition of early childhood caries 7
4. Tackling early childhood caries 9
4.1 Early diagnosis 10
4.2 Control of risk factors: infant feeding and diet in young children 14
4.3 Control of risk factors: population-based fluoride exposure 18
4.4 Arresting carious lesions through application of sealants, fluoride
varnish and minimally invasive techniques for restoration 22
4.5 Health education and community engagement
for prevention of early childhood caries 28
4.6 Involvement of primary care teams, including community health
workers, in prevention and control of early childhood caries 32
4.7 Monitoring and evaluation 36
4.8 Building a supportive framework for integration of
early childhood caries prevention and control in
overall health initiatives 40
Annex 1 44
Review questions related to prevention of early childhood caries 44
Annex 2 45
Key interventions for preventing and controlling early childhood caries45
Annex 3 51
Useful materials 51
References 53
6. Ending childhood dental cariesiv
Acknowledgements
The development of this manual was led by Benoit Varenne, Dental Officer,
and Yuka Makino, Technical Officer, World Health Organization (WHO)
Headquarters, in collaboration with Poul Erik Petersen, Senior Consultant,
WHO Regional Office for Europe.
The manual was prepared under the general guidance of Faten Ben Abdelaziz,
Coordinator, Health Promotion Unit, Fiona Bull and Prasad Vinayak, Acting
Directors, Prevention of Noncommunicable Diseases, WHO Headquarters.
WHO would like to appreciate the contribution of all the experts involved in
the development of this manual.
Special thanks are due to the following, who supported development of the
content: Ramon Baez (University ofTexas Health Science Center, United States
of America), Edward Lo (University of Hong Kong, China), Paula Moynihan
(WHO Collaborating Centre, Newcastle University, United Kingdom of Great
Britain and Northern Ireland; and University of Adelaide, Australia), Hiroshi
Ogawa (WHO Collaborating Centre, Niigata University, Japan), Prathip
Phantumvanit (Thammasat University, Thailand), and Andrew Rugg-Gunn
(The Borrow Foundation, United Kingdom).
Thanks are also due to the following for their review of the content: Carlos
Alberto Feldens (Universidade Luterana do Brasil, Brazil), Ray Masumo (Ministry
of Health, United Republic of Tanzania), Nigel Pitts (King’s College London,
United Kingdom), Murray Thomson (University of Otago, New Zealand),
Norman Tinanoff (University of Maryland, United States; and Science Chair
of International Association of Paediatric Dentistry) and Richard Watt (WHO
Collaborating Centre, University College London, United Kingdom).
Finally, the following WHO staff members made valuable contributions to
reviewing the content: Kaia Engesveen, Laurence Grummer-Strawn, Jason
Montez and Chizuru Nishida.
Photo credits: Carlos Alberto Feldens (Universidade Luterana do Brasil, Brazil),
Prathip Phantumvanit (Thammasat University, Thailand), Yupin Songpaisan
(Suranaree University of Technology, Thailand), and Poul Erik Petersen (WHO
Regional Office for Europe).
Funding source: funds received from theWHO voluntary contributions from
The Borrow Foundation, United Kingdom and WHO Collaborating Centre,
Niigata University, Japan were used for the development of this manual.
7. Glossary v
Glossary
Atraumaticrestorativetreatment (ART)This is a minimally invasive technique
to treat existing dental decay and prevent further decay. ART can be used with
patients of all ages (e.g. children, adolescent, adults and elderly people). It
consists of two activities: The first is a procedure to treat decayed tooth cavities
by removing the decay using hand instruments; this is followed by filling the
cavities and any adjacent pits and fissures on biting surfaces of the teeth with
an adhesive material containing fluoride (glass-ionomer cement).The provision
of ART is not limited to dental clinics since it does not require a dental chair, drill,
piped water or electricity. Moreover, pain is rare during ART, virtually eliminating
the need for anaesthetic. Although ART is ideally delivered by an oral health
professionalorauxiliary,trainedprimarycareworkersarealsoabletodeliverART
effectively with the appropriate instruments and consumables.
Caries prevalence Proportion of population affected by dental caries.
Caries severity Mean number of teeth affected by caries per person in
the population.
Community health workers People who provide health education, referral
and follow-up, case management, basic preventive health care, and home
visiting services to specific communities. Community health workers provide
support and assistance to individuals and families in navigating health and
social services systems. Community health workers are known by many
different names in different countries, but in almost all cases they come from
the communities they serve.
Complementary foods Foods that should be added to a child’s diet when
breast milk is no longer enough to meet the child’s nutritional needs. The
transition from exclusive breastfeeding to family foods, referred to as
complementary feeding, typically covers the period from age 6 months to
18–24 months.1
Dental caries Dental decay. Destruction of teeth results when microbial
biofilm (plaque) formed on the tooth surface converts the sugars contained
in foods and drinks into acids, which dissolve tooth enamel and dentine
over time.
Early childhood caries Caries characterized by the presence of one or more
teeth affected by carious lesions or with white spot lesions in primary teeth,
loss of teeth due to caries, or filled tooth surfaces in affected teeth of a child
aged under six years. Children with early childhood caries have been shown
to have a high number of teeth affected by progressive disease.
Healthy foods Foods that contribute to a healthy diet if consumed in
appropriate amounts.2
Impact of early childhood caries Sequelae caused by early childhood caries
for the infant or child, family and community.
Infant A child aged under 12 months.
1
Complementary feeding. Geneva:World Health Organization (https://www.who.int/nutrition/
topics/complementary_feeding/en/).
2
Healthy diet. Fact sheet 394. Geneva:World Health Organization; 2015 (https://www.who.int/
nutrition/publications/nutrientrequirements/healthydiet_factsheet394.pdf).
8. Ending childhood dental cariesvi
Primary care A key process in the health system: first-contact, accessible,
continued, comprehensive and coordinated care. First-contact care is accessible
at the time of need; ongoing care focuses on the long-term health of a person
rather than the short duration of the disease; comprehensive care is a range of
services appropriate to the common problems in the respective population;
coordination is the role by which primary care acts to coordinate other specialists
that the person may need. Primary care is a subset of primary health care.3
Primary health care A whole-of-society approach to health and well-
being centred on the needs and preferences of individuals, families and
communities. It addresses the broader determinants of health and focuses
on the comprehensive and interrelated aspects of physical, mental and
social health and well-being. It provides whole-person care for health needs
throughout the lifespan rather than treating only a set of specific diseases.
Primary health care ensures people receive comprehensive care – ranging
from promotion and prevention to treatment, rehabilitation and palliative
care – as close as feasible to people’s everyday environment.4
Systemic fluoride Fluoride ingested and absorbed into the body.
Topical fluoride Fluoride applied directly on to teeth.
Unhealthy foods Energy-dense, nutrient-poor foods such as foods high in
saturated fats, trans-fatty acids, free sugars or salt.5
Universal health coverage Universal health coverage means that all
individuals and communities receive the health services they need without
financial hardship. It includes the full spectrum of essential good-quality
health services, from health promotion to prevention, treatment, rehabilitation
and palliative care. Universal health coverage enables everyone to access the
services that address the most significant causes of disease and death, and
ensures the quality of those services is good enough to improve the health
of the people who receive them.6
3
Main terminology. Geneva: World Health Organization (http://www.euro.who.int/en/
health-topics/Health-systems/primary-health-care/main-terminology).
4
Primary health care. Geneva: World Health Organization; 2019 (https://www.who.int/
news-room/fact-sheets/detail/primary-health-care)
5
Report of the Commission on Ending Childhood Obesity: implementation plan – executive
summary. Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/
handle/10665/259349/WHO-NMH-PND-ECHO-17.1-eng.pdf;jsessionid=9653E50F444A1698
3630CFE740689D72?sequence=1).
6
Universal health coverage. Geneva: World Health Organization; 2019 (https://www.who.int/
en/news-room/fact-sheets/detail/universal-health-coverage-(uhc).
9. Abbreviations vii
Abbreviations
ART Atraumatic Restorative Treatment
DHIS District Health Information System
ECC early childhood caries
NCD noncommunicable diseases
SDF silver diamine fluoride
WHO World Health Organization
10. Ending childhood dental cariesviii
Preface
Early childhood caries (ECC) affects teeth of children aged under six years. According to the
Global Burden of Disease Study in 2017, more than 530 million children globally have dental
cariesoftheprimaryteeth.However,asprimaryteethareexfoliatedduetogrowthofthechild,
ECC has previously not been considered important.
ECChassignificantinfluenceonindividuals,familiesandsocieties.Thediseaseaffectsprimary
teeth and permanent teeth and influences general health and quality of life across the entire
life course. ECC links with other frequent diseases of childhood, primarily due to risk factors
shared with other noncommunicable diseases (NCDs) such as high sugar intake, and the
disease relates to other health conditions such as obesity. Dental caries can lead to abscesses
and cause toothache, which may compromise ability to eat and sleep and restrict life activity
ofchildren.Severedentalcariesisassociatedwithpoorgrowth.Moreover,ECCisaneconomic
burden to the family and society; treatment of ECC under general anaesthesia for extensive
dental repair is especially costly.
PrevalenceofECCisincreasingrapidlyinlow-andmiddle-incomecountries,anddentalcaries
is particularly frequent or severe among children living in deprived communities. In many
countries,accesstodentalcareisnotequitable,leavingpoorchildrenandfamiliesunderserved.
Fortunately, ECC is preventable, with almost all risk factors modifiable. ECC differs from
dental caries in older children and adults in its rapid development, its diversity of risk factors,
and in the control of disease. As with most NCDs, both cause and prevention are strongly
determinedbysociobehavioural,economic,environmentalandsocietalfactors,knownasthe
social determinants of health. ECC is influenced strongly by health behaviours and practices
of children, families and caregivers.
ECCpreventionandcontrolapproachesrangefromchangingpersonalbehaviour,toworking
with families and caregivers, to public health solutions such as building health policies,
creating supportive environments, and health promotion and orientation of health services
towards universal health coverage. Building supportive environments for integration of ECC
prevention and control into general health activities is essential. In addition, primary care
teams, including community health workers, are key to successful programmes.
TheEndingChildhoodDentalCaries:WHOImplementationManualhasbeendevelopedto
serve different stakeholders in their work for better health of children; these stakeholders
include community agencies, ministries of health, academia, and nongovernmental and
professional organizations.
The manual is based on evidence from systematic reviews andWHO recommendations,
especially on nutrition, including breastfeeding, and primary care workers’programmes.
The current manual focus on tackling ECC in its global context defines the disease and
outlines known risk factors and approaches to prevention and treatment. It is intended
to inform and support:
• policy-makers on actions and rationales for ECC interventions;
• chief dental officers, ministry of health focal points and public health administrators
in the development and implementation of plans for ECC prevention and control,
using the primary health-care approach.
The manual may also be used in training activities to help primary care teams:
• understand ECC as a public health problem;
• recognize the essential risk factors for ECC, especially lack of exclusive breastfeeding,
consumptionoffreesugars,andinadequateexposuretofluorideinpreventionofdentalcaries;
• identify opportunities for intervention against ECC and its causes.
11. 1. Background 1
1. Background
1.1 Early childhood caries is
a highly prevalent global
disease of public health
importance
The first primary teeth erupt in infancy, at about age 6 months, and the primary
dentition of 20 teeth is complete by about age 30 months. In many children,
these teeth stay sound, contributing to the child’s health and well-being. But for
anunacceptablylargepercentageofchildren,theseteethdonotstaysoundbut
are ravaged and sometimes totally destroyed by dental caries (dental decay).
This is a preventable, global, noncommunicable disease (NCD) of medical,
social and economic importance. Early childhood caries (ECC) differs from
dental caries in older children and adults in its rapid development, its diversity
of risk factors and its control. As with most NCDs, the aetiology and prevention
of ECC are strongly determined by sociobehavioural, economic, environmental
and societal factors, known as the social determinants of health (1). Societal
and economic pressures often influence health behaviours and practices of
children and families – particularly the main caregivers – and typically lead
to poor oral health. The prevalence of ECC is increasing rapidly in low- and
middle-income countries (2,3).
Figure 1 Percentages of children aged 5 and 6 years affected by dental caries in 2017–2018
Source: Petersen PE. WHO Collaborating Centre for Community Oral Health Programme and Research, University of Copenhagen 2019.
12. Ending childhood dental caries2
Traditionally the prevalence and severity of dental caries are presented as
the percentages of people with dental caries and the mean number of teeth
affected by dental caries per person. Information collected by the World
Health Organization (WHO) Collaborating Centre for Community Oral Health
Programme and Research, University of Copenhagen is given in Figure 1,
which indicates that the burden of dental caries affects significant numbers
of children in all WHO regions. More recently, some surveys have recorded
sequelae of disease by recording gross infection caused by severe caries
involving pain and abscesses (4–7). Infection causes toothache, which can
result in the child being unable to eat and compromise sleep for the child and
their family. Severe dental caries is associated with poor growth (8).
1.2 Risk factors are known:
they are diverse and, like
most noncommunicable
diseases, related to social
determinants of health
Almost all risk factors for ECC are modifiable.They can be grouped into children,
family and community influences (Figure 2) (9). The relevant factors will be
considered elsewhere in detail.This is particularly the case with the importance
of the parents’ health (including nutritional status and oral health); family
beliefs and behaviours, such as infant feeding and choice of complementary
foods and drinks; and the ability, knowledge and will to purchase and provide
a healthy diet for the child. As with the causal factors of childhood obesity,
an appreciation of the effects of excessive and frequent consumption of free
sugars is essential in the understanding of the aetiology and control of ECC.
The importance of establishing good eating habits in childhood to minimize
the risk of ECC and obesity can not be overestimated. Since eating patterns
track from childhood to adulthood, establishing appropriate habits in the early
years is a major target.
13. 1. Background 3
Figure 2 Concept of childhood caries – child, family and community influences on oral health
outcomes of children
Social
environment
Child-Level Influences
Family composition
Socioeconomic
status
Social support
Physical safety
Health status
of parents
Family
function
Culture Health behaviors, practices,
and coping skills of family
Physical and demo-
graphic attributes
Biologic and genetic
endowment
Health behaviors
and practices
Dental
Insurance
Use of dental care Development
Dental care system
characteristics
Health care system
characteristics
Physical safety
Physical
environment
Community
oral health
environment
Microflora
Host and Teeth Substrate (diet)
Oral Health
Social capital
Culture
Community-Level Influences
Family-Level Influences Environment
Time
Source: adapted from Fisher-Owens SA, Gansky SA, Platt LJ, Weintraub JA, Soobader MJ, Bramlett MD, Newacheck PW. Influences on children’s
oral health: a conceptual model. Pediatrics. 2007;120:e510–20.
14. Ending childhood dental caries4
1.3 The primary care team is a
key actor in prevention and
control of early childhood
caries
Difficulties in tackling prevention and control of ECC include:
• identifying a key platform to deliver oral health promotion and
ECC prevention;
• identifying risk factors, including individual risk behaviours, culture
and environment.
For example, many countries have introduced effective school-based
programmes to improve the oral health of children (10,11).These programmes
usually involve toothbrushing with a fluoride-containing toothpaste. Although
such programmes are effective at developing healthy life skills, it is realized
that most problems of ECC occur before the child attends school and therefore
can not be impacted by these programmes.
ECC prevention and control interventions should be integrated into existing
primary care such as child and maternal health programmes alongside
vaccinations and general medical check-ups. This could lead to a continuing
programmeofinterventionsthatprovidereassurancetoparentsandcaregivers
and boost their knowledge of the need to attend health appointments (12).
Social context and cultural pressures within societies also influence ECC
by influencing families’ behaviours. Creating supporting environments for
families is an important element of oral health promotion.
Globally, there are relatively few trained oral health professionals, and
therefore it is unrealistic to rely on workforce models that require oral health
professionals to deliver prevention and treatment of ECC. Fortunately, the
majority of interventions related to ECC are proven, affordable and feasible
in the places where people normally live and can be carried out by non-oral
health professionals in the community or primary care facilities.
Therefore, primary care teams including nurses, midwives and community
health workers, who have worked in the community and primary care facilities
and advised and cared for families and communities, can contribute to
preventing and controlling ECC.
To this end, all sectors of the community should use primary care teams to
promote healthy behaviours at local and national levels.
15. 2. Introduction 5
2. Introduction
The Ending Childhood Dental Caries: WHO Implementation Manual has
been developed following the request by different stakeholders, including
countries, academia, and nongovernmental and professional organizations,
involved in the prevention and management of ECC.
The development process was initiated in January 2016 in Bangkok at theWHO
Expert Consultation on Public Health Intervention against Early Childhood
Caries.TheWHO Collaborating Centre for Oral Health Education and Research
at Mahidol University organized this consultation in collaboration with
the WHO Oral Health Programme, to agree on a set of key messages and
interventions for a future action plan (13).
The expert consultation discussed a number of research questions relevant
to the continuing work in the prevention of ECC, and the need for a new
systematic review on action programmes was recognized. Subsequently,
the WHO Collaborating Centre for Nutrition and Oral Health at Newcastle
University conducted a systematic review on the effect of modifiable risk
factors for ECC, focusing on 12 key questions (see Annex 1) (14).
This manual is based on updated evidence from systematic reviews andWHO
recommendations, especially on nutrition, including breastfeeding, and
community health workers’programmes.
After the manual was drafted, the contents were reviewed by experts in the
fields of oral health and nutrition, including a specialist in breastfeeding.
Experts assessed whether the manual is applicable for different resource
settings (high-, middle- and low-resource settings), practitioners, policy-
makers and academia staff from different countries.
The manual intends to inform and support policy-makers on actions and
rationales for ECC interventions. Oral health focal points in ministries of health
(e.g. chief dental officers) and public health administrators are considered
important in the development and implementation of plans for ECC prevention
and control using the primary health-care approach.The manual includes the
following elements:
• definition of ECC;
• tackling ECC:
– early diagnosis;
– control of risk factors: infant feeding and diet in young children;
– control of risk factors: population-based fluoride exposure;
– arresting carious lesions through application of sealants, fluoride
varnish and minimally invasive techniques for restoration such as
Atraumatic Restorative Treatment (ART);
– health education and community engagement for prevention of ECC;
– involving primary care teams, including community health workers,
in prevention and control of ECC;
– monitoring and evaluation;
– building a supportive framework for integration of ECC prevention
and control in overall health initiatives.
16. Ending childhood dental caries6
The manual may also be useful in training activities for primary care teams to
help them understand ECC as a public health problem, recognize the essential
risk factors for ECC, and identify opportunities for intervention against ECC
and its sequelae.
Key points
• ECC is a highly prevalent global disease.
• ECC is a noncommunicable disease of medical, social and economic importance.
• ECC risk factors are linked to family lifestyle and community norms.
• Prevention and control of ECC require a primary health-care approach.
• Building supportive environments for integration of ECC prevention and control into other
public health activities is crucial.
• Primary care teams, including community health workers, are key to successful programmes to
prevent ECC.
• Countries should develop and deliver strategies for prevention and control of ECC.
The misfortune of dental general anaesthetics for infants and young children
Extraction of infected carious teeth is often the only option – a traumatic experience for both child
and family. If facilities exist, these extractions are often carried out under general anaesthesia in a safe
environment, but this is expensive. It is of considerable concern that in several high-income countries,
dental extractions are among the most common reasons for hospital admission in infants and children.
In 2016–2017, a total of 30 238 children aged 0–9 years were admitted to hospital for extraction of
decayed teeth in England (population 53 million). This figure excludes extractions under general
anaesthetic in young children carried out by community dental services and private hospitals. Tooth
extraction was the most common reason for hospital admission for children aged five to nine years.
The average cost of admitting a child aged 5 years or under for tooth extraction is £800–900 (15–17).
Similarly high numbers of hospital admissions for dental extractions in young children have been
reported in Australia (18), the United States of America (19), Israel (20) and New Zealand (3).
Box 1
Box 2
17. 3. Definition of early childhood caries 7
3. Definition of early
childhood caries
Dental caries (tooth decay) is a disease that may affect the teeth of people
of all ages, including young children. It is the most common NCD among
children around the globe. The disease affects primary teeth (milk teeth) and
permanent teeth.
Cavitation occurs due to loss of tooth substance (enamel and dentine) by
acids formed by bacteria in dental plaque, which accumulates on the tooth
surface.This process is due to the bacterial metabolism of sugars derived from
dietary sugars.
Tooth decay is the destruction of the tooth, which is made from calcified tissue.
Undernormalcircumstances,thelossofcalcium(demineralization)iscompensated
by the uptake of calcium (remineralization) from the tooth’s microenvironment.
This dynamic process of demineralization and remineralization takes place more
or less continually and equally in a favourable environment of the mouth. In
an unfavourable environment, the remineralization rate does not sufficiently
neutralize the rate of demineralization, and caries occurs.
Early stages of dental caries are often without symptoms, while advanced
stages of dental caries may lead to pain, infections and abscesses, or even
sepsis. Advanced stages often result in tooth extraction (the tooth is pulled
out). The development of caries is influenced by the susceptibility of the
tooth, bacterial profile, quantity and quality of the saliva, level of fluoride,
and amount and frequency of intake of sugars.
Dental caries influences general health and quality of life. Dental caries links
with several frequent diseases of childhood, primarily due to common risk
factors. For instance, dental caries can co-occur with obesity, as both diseases
are related to diet and nutrition. Moreover, nutritional status affects teeth
pre-eruptively, although this is less important than the post-eruptive local
effect of diet. Undernutrition coupled with a high intake of sugars may
exacerbate caries.
Across the world, dental caries is particularly frequent or severe among
underprivileged and disadvantaged groups of children. Socioeconomic factors
also play a crucial role in the scope of services covered by primary oral health
care. In many countries, poor children are underserved by dental care since
access to dental care is not equitable.
18. Ending childhood dental caries8
ECC is characterized by the presence of one or more teeth affected by carious
lesions or with white spot lesions in primary teeth, loss of teeth due to caries,
or filled tooth surfaces in affected teeth of a child aged under six years. Those
children with ECC often have been shown to have a high number of teeth
affected by progressive disease. Consequences of ECC include a higher risk of
painordiscomfort,abscesses,cariouslesionsinboththeprimaryandpermanent
dentitions, risk for delayed physical growth and development, increased days
with restricted activity, and diminished oral health-related quality of life. The
aetiology is frequently linked with a high-frequent consumption of sugared
drinks or food, lack of breastfeeding, and/or poor oral hygiene. Additionally,
the disease often manifests in children from poor families or living in poor
environmental settings (21).
Photo credit: Petersen PE. Photo credit: Petersen PE.
Figure 3 Image of early childhood caries
21. 4. Tackling early childhood caries 11
Key message
• Detect early
caries lesions for
early intervention.
Background information
Because caries lesions progress faster in primary dentition than in permanent
teeth (22,23), the early detection of carious lesions is key to managing ECC and
preventing adverse problems associated with its occurrence; it is also likely to
be painless and less expensive.
Especially for children under six years of age, main caregivers assisted by health
professionals are the important entry point to detecting early caries lesions.
An oral health professional (dentist, dental therapist or nurse, dental hygienist)
will be able to diagnose ECC according to the WHO clinical criteria (24). In
addition, suspicious white spot lesions that may indicate the early process
of caries in teeth should be detected carefully. Primary care teams, if trained
appropriately, can also detect early caries lesions (25). A mouth mirror and
satisfactory lighting of the mouth cavity are required for careful examination
of all teeth present. Images of tooth conditions may help the identification
of lesions.
The images included in this section are intended to complement established
criteria for determining whether a child has existing or has had ECC (24).
Rationale for implementation of key interventions
Action Rationale
Early detection of carious lesions is key to
managing ECC. Main caregivers assisted by health
professionals are the important entry point to
detecting early caries lesions.
Caries lesions progress faster in primary dentition
than in permanent teeth.
Integrate oral health check-ups into primary care,
including community-based health interventions,
to encourage early diagnosis of ECC.
Children may be seen for vaccinations or
consultation for systemic health problems. Children
aged under six years may be seen frequently by
primary care staff or general health-care providers
and less often by oral health professionals.
Early detection of ECC and immediate intervention
offer the opportunity to manage ECC and prevent
associated problems.
22. 12 Ending childhood dental caries
Figure 4 Visual inspection of teeth
(a) Sound teeth in both jaws
(primary teeth)
Photo credit: Feldens CA. Photo credit: Phantumvanit P.
Photo credit: Feldens CA.
(d) Suspicious white spot lesions, which
may indicate early process of caries in
teeth of upper jaw (primary teeth)
(b) Sound teeth in upper jaw
(primary teeth)
(e) Tooth decay in front teeth of
upper jaw (primary teeth)
(g) Deep carious lesions in upper jaw
(primary teeth)
(c) Sound teeth in lower jaw
(primary teeth)
(f) Deep carious lesions in both jaws
(primary teeth)
(h) Deep carious lesions in lower jaw
(primary teeth)
Photo credit: Feldens CA.
Photo credit: Feldens CA.Photo credit: Feldens CA.
Photo credit: Feldens CA.Photo credit: Feldens CA.
25. 4. Tackling early childhood caries 15
Key messages
• Promote, protect and
support exclusive
breastfeeding up to age six
months, and introduction
of nutritionally adequate
and safe complementary
(solid) foods at age six
months together with
continued breastfeeding
up to two years of age
or beyond.
• Prevent the intake of free
sugars from drinks and
foods, and promote a
healthy balanced diet for
young children.
Background information
Infant feeding practices, complementary feeding practices and diet in
young children have immediate and long-lasting effects on child oral and
general health.
WHO recommends that infants are exclusively breastfed up to six months of
age, after which breastfeeding should continue alongside complementary
feeding up to two years of age or beyond because of the many health benefits
of breastfeeding for both mother and infant, including oral health (26). The
WHO Global Guidance on Ending the Inappropriate Promotion of Foods for
Infants andYoung Children states explicitly that commercial complementary
foods should not be advertised for infants aged under six months (27).
Evidence suggests that infants who are breastfed in the first year of life have
lower levels of dental caries than those fed infant formula (28). Breast milk
has a relatively higher concentration of lactose and a relatively lower content
of protective factors such as calcium and phosphorus compared with cow’s
milk and other milks that form complementary drinks (29). This has raised
concerns among the oral health profession about the risk breastfeeding poses
to dental caries. One systematic review suggested a higher risk of ECC when
breastfeeding extends beyond one year of age, but the data analysis did not
control adequately for important confounders such as intake of sugars from
other sources (30). A systematic review including more recent data has shown
that infants who are breastfed two years of age do not have a greater risk of
ECC than those breastfed up to one year of age (14).
Complementary feeding practices and dietary habits in the early years of
life may modify the risk posed by exposure to dietary free sugars. It is well
established that the amount of dietary free sugars consumed is the primary
causative factor for dental caries (31), and the amount of free sugars should
be no more than 5% of energy intake (32). Free sugars include all mono-
and disaccharides added to foods and drinks by manufacturers, cooks or
consumers, plus the sugars that are naturally present in honey, syrups, fruit
juice and fruit-juice concentrates. Free sugars do not include sugars naturally
present in milk and milk products or in whole fresh fruits and vegetables (32).
A systematic review has indicated that consumption of drinks containing
free sugars increases the risk of ECC, although the observational studies on
which this was based failed to control adequately for confounding factors (14).
Studies show that consumption of liquids containing free sugars from an infant
feeding bottle is independently associated with risk of ECC (14,33). Adding free
sugars to complementary foods is also associated with a higher risk of ECC,
although the data are limited (14,33).
Additionally, it is reported that some commercially produced complementary
foods include free sugars, leading to children exceeding the WHO
recommendation for sugar intake (34,35).
Children should be encouraged to eat a combination of different foods to help
them obtain the right amounts of essential nutrients and avoid a diet high in
free sugars. A good combination of different foods includes:
• staple foods, such as cereals (e.g. wheat, barley, rye, maize, rice) and starchy
tubers or roots (e.g. potato, yam, taro, cassava);
• legumes (e.g. lentils, beans);
• vegetables and fruits;
• foods from animal sources (e.g. meat, fish, eggs, milk) (36).
26. 16 Ending childhood dental caries
Rationale for implementation of key interventions
Action Rationale
Promote, protect and support exclusive
breastfeeding up to age six months and
introduction of nutritionally adequate and safe
complementary (solid) foods at age six months
together with continued breastfeeding up to two
years of age or beyond.
Breastfeeding is associated with better general health
and a lower risk of ECC in infants and children (14).
Limit consumption of liquids containing free sugars,
including natural unsweetened juices.
Consumption of free sugars increases risk of dental
caries, including ECC. Consumption of free sugars in
drinks, including from feeder bottles, increases risk of
ECC (14).
Limit consumption of complementary foods that
contain free sugars.
Consumption of free sugars increases risk of dental
caries, including ECC. Consumption of complementary
foods high in sugars increases risk of ECC (14).
Encourage a combination of different foods that is
high in fruits, vegetables and low in free sugars for
young children.
A combination of different foods that is high in fruits
and vegetables is associated with reduced risk of NCD
including dental caries. (14,36).
28. 18 Ending childhood dental caries
4.3
Control of risk
factors: population-
based fluoride
exposure
29. 4. Tackling early childhood caries 19
Key messages
• Effective use of fluoride is
an essential component of
any strategy to control ECC.
• There is substantial
evidence that the
appropriate use of fluoride,
principally through water
fluoridation and use
of fluoride-containing
toothpastes, reduces the
prevalence, severity and
impact of ECC.
Background information
Fluoride is a key agent in reducing the prevalence and severity of dental
caries (37). Effective use of fluoride is strongly supported by WHO (38–40).
There are two ways to use population-based fluoride to prevent dental caries:
systemic exposure and topical exposure.
For systemic exposure, fluoridation of drinking water is an effective, safe and
economically beneficial public health measure that is listed among the 10
greatest public health achievements of the twentieth century. Fluoridated
drinking water reaches about 350 million people worldwide (41–45).
A systematic review of the best available evidence pertaining to water
fluoridation from cohort studies showed consistent evidence of a protective
effect (14). Lack of piped drinking water precludes installation of water
fluoridation in many communities globally, but when possible it has great
advantages of reaching everyone without their effort, and being of low cost
to the community. A distinct advantage of fluoridation is that it benefits the
people who are most difficult to reach with other preventive programmes, and
very often the people with the greatest health burden (37,41–43).
The enrichment of dietary salt with iodine has provided an effective way of
preventing goitre. In parallel, adding fluoride to salt has been successful in
preventing dental caries in many countries, with an estimated 300 million
users of fluoridated salt worldwide (14,37). Where salt is used as a vehicle for
fluoride, the WHO guideline on sodium intake must be considered (46). Salt
intake at the country level should be monitored so that adjustments to the
levels of fluoride in salt can be made if required to ensure the population is
receiving optimum levels of fluoride exposure.
A third way of providing fluoride to communities is milk fluoridation. This
can be cost-effective if the community has a well-developed milk distribution
system, such as an existing school milk programme (14,47–51).
For topical exposure, toothbrushing twice a day with a fluoride-containing
toothpaste is the most effective preventive measure for ECC. Toothpastes
containing 1000–1500 μg/g (ppm) fluoride are effective in preventing dental
caries. Parents and caregivers should brush their young children’s teeth twice
a day (52). In several communities around the world, children are taught to
brush daily in nursery or school with an appropriate fluoride-containing
toothpaste (11). Since toothpaste is not intended to be swallowed, such
programmes can coexist with fluoridation of water, salt or milk, bringing
substantial added benefit (37,53).
For both systemic and topical fluoridation, the risk of adverse effects of
fluoridation, such as mild enamel fluorosis, is very low when the correct
dose of fluoride for caries prevention is considered carefully. The population
exposure to fluoride should be measured before programme implementation.
An adequate surveillance system through periodic urinary fluoride monitoring
in the child population should be considered. Assessment of enamel fluorosis
and the level of dental caries in the child population should be undertaken
regularly (54).
Although exposure to fluoride reduces the development of dental caries and
delays the onset of the cavitation process, it does not completely prevent
dental caries if implemented as an isolated action. Addressing the cause (free
sugars) is therefore essential in preventing and reducing dental caries (55).
30. 20 Ending childhood dental caries
Rationale for implementation of key interventions
Action Rationale
In communities where there is little fluoride
available naturally, fluoride-based community
programmes using water, salt or milk should
be introduced.
It was shown in the 1930s that dental caries prevalence and
severity are inversely related to fluoride concentration in
drinkingwater(37).Althoughsomepopulationsdrinkwater
naturally containing an adequate concentration of fluoride,
the majority of populations drink water with much lower
natural fluoride concentrations. Fluoride concentration in
drinking water was adjusted to the optimum level in 1945
in Grand Rapids in the United States (37); since then, at
least 78 studies globally have demonstrated that water
fluoridation prevents ECC (44). There have been fewer
studies of the effectiveness of fluoride added to salt or
milk, but these demonstrate effectiveness (37). There is no
contradiction to the WHO recommendation of reducing
the intake of salt, as only limited salt intake is needed
for achievement of the caries-preventive effect. These
methods of providing fluoride are low in cost and have
the advantage of benefiting the people who are the most
difficult to reach with other preventive programmes – very
often the people with the greatest health burden (40).
Brushing infants’ and children’s teeth with an
affordable, effective fluoride-containing toothpaste
should be routine.
Since fluoride was first added to toothpastes 70 years
ago, a very large number of trials have demonstrated
its effectiveness in caries prevention (52). Effectiveness
increases as the concentration of fluoride in the
toothpaste increases but, for infants and young children,
the concentration of fluoride is decided after considering
benefit and risk; in most countries, concentrations are in
the range 1000–1500 ppm.
Toothpaste manufacture is a skill. It is important that
added fluoride is available to provide its caries-preventive
effect and that the shelf-life of toothpaste is suitable; this
should be audited by national authorities. Authorities
should also take steps to ensure effective toothpastes are
affordable for the whole population, and that parents and
caregivers have adequate skills and motivation to brush
their children’s teeth.
Brushing twice a day is more effective than less frequent
brushing, as it maintains adequate fluoride around the
teeth for a greater proportion of the day (56).Toothbrushing
is a life skill; in many countries, it is part of school routines
aimed at improving health (40).
33. 4. Tackling early childhood caries 23
Key messages
• Application of fluoride
sealants and varnish with
glass-ionomer cement
by primary care teams
can help to prevent
deterioration of ECC-
affected dentition.
• Application of silver
diamine fluoride by primary
care teams can arrest
dental caries.
• If restoration of decayed
primary teeth is required,
minimally invasive
techniques such as
Atraumatic Restorative
Treatment (ART), can
be used by primary care
teams and oral health
professionals to stabilize
caries lesions.
Background information
Management of ECC should aim to reverse the disease process and to prevent
or slow down the progression of carious lesions to cavitation and tooth
destruction.Young children are usually apprehensive and may not cooperate
fully during dental treatment. The use of non-invasive or minimally invasive
treatment approaches is preferred because they are less resource-demanding,
are more efficient and cost-effective, and cause less discomfort than other
methods (57).
Placement of pit-and-fissure sealants in molar teeth can reduce the
development and progression of new carious lesions into dentine (58).
Different types of sealant material have their own merits, but glass-ionomer
sealants, which are less demanding on technique and moisture control, are
often suitable for use in young children and in community settings.
Systematic reviews have shown that regular application of 5% sodium
fluoride varnish can prevent the development of new caries in primary
teeth and can help remineralization of early enamel lesions (59–62). As the
health-care worker controls the amount of fluoride varnish being used, it is
regarded as an appropriate professionally applied topical fluoride agent of
choice. However, regular applications every three to six months are required
to maintain effectiveness.
Carious lesions that have progressed to cavitation should be stabilized in order
to preserve tooth structure and to prevent negative health consequences such
as pain and infection. Annual or semi-annual application of 38% silver diamine
fluoride (SDF) solution is effective in arresting the progression of cavitated
carious lesions in primary teeth and in hardening these lesions (63). The
effectiveness of SDF is greater with semi-annual application.This can minimize
discomfort and potential pulp damage, and help to keep the caries-affected
primary teeth symptomless and functional until their natural exfoliation.This
is a painless, simple and low-cost treatment that can be widely promoted as an
alternative to conventional invasive caries management techniques, especially
in populations and areas with low accessibility to dental care services.
Covering cavitated carious lesions with flowable fluoride-releasing glass-
ionomer cement may have outcomes similar to SDF application, but the
level of skill required by dental personnel is greater (64). In addition, daily
toothbrushing with a fluoride-containing toothpaste plays an essential role
in arresting ECC (64).
If restoration of decayed primary teeth is required, preference should
be given to the use of minimally invasive techniques such as ART using
adhesive materials such as glass-ionomer cement, especially when provided
in community settings. These techniques do not require a local anaesthetic
injection and, being less invasive, are more“child-friendly”. Survival of single-
surface ART restorations using high-viscosity glass-ionomer in primary teeth
is high (65) and can be comparable to that of restoration placed using a
conventional approach (66).
The oral health-care system of the country, the availability of dental personnel
and resources, the local community setting, the dental health status of the
child, the cooperation of the child, and the child’s preferences are among the
various factors that need consideration when choosing the most appropriate
method to manage and arrest ECC lesions in a population.
34. 24 Ending childhood dental caries
Figure 5 Application of sealants
Figure 6 Fluoride varnish
(a) Caries lesions on occlusal
surfaces of lower molars presented
as dentine shadows
Photo credit: Feldens CA.
(a) Active enamel lesions of early
childhood caries in anterior teeth
Photo credit: Feldens CA. Photo credit: Feldens CA.
(b) Lesions treated with fluoride
varnish
a
Photo credit: Feldens CA.
(c) Sealant being applied
c
Photo credit: Feldens CA.
(b) Acid etching
b
(d) After sealant application
Photo credit: Feldens CA.
d
a b
35. 4. Tackling early childhood caries 25
Figure 7 Silver diamine fluoride (SDF) application
(a) Cavitated lesions on upper incisors
Photo credit: Feldens CA. Photo credit: Feldens CA.
(b) SDF application with cotton pellet
Photo credit: Feldens CA.
(b) If microbrush is available, apply
SDF by microbrush
(c) Two weeks after SDF application
Photo credit: Feldens CA.
a
b
b
c
36. 26 Ending childhood dental caries
(b) Use spoon excavator to remove soft caries
from cavity of teeth
(c) Clean the cavities with
small cotton pellets damped
with water; dry the cavities
with dry cotton pellets
(f) Using finger, with thin
petroleum jelly press on
top of glass-ionomer
restoration over tooth
(d) Paint dentine
conditioner thoroughly
inside cavity; clean with
water and dry cotton
(g) ART is completed
(e) Press mixed glass-
ionomer from capsule
into cavity
Photo credit: Songpaisan Y. Photo credit: Songpaisan Y.
Figure 8 Atraumatic Restorative Treatment (ART)
(a) Cavitated lesion on
lower molar
Photo credit: Songpaisan Y.
Photo credit: Songpaisan Y.
Photo credit: Songpaisan Y.
Photo credit: Songpaisan Y.
Photo credit: Songpaisan Y.
Photo credit: Songpaisan Y.
a
c
f
b
d
g
e
37. 4. Tackling early childhood caries 27
Rationale for implementation of key interventions
Action Rationale
Application by primary care teams of sealant on pits
and fissures of primary molars that are deep or with
initial caries.
Compared with control with no sealant, placement
of resin or glass-ionomer sealant in primary molars
can reduce the development of new carious lesion
involving dentine (58).
Application by primary care teams of sodium
fluoride varnish to primary teeth in children with
ECC or teeth with signs of early caries.
Topical application of fluoride varnish two to
four times a year can reduce the development of
new carious lesions into dentine or the need for
restoration of teeth (59,60). Fluoride varnish can
reverse incipient carious lesions in primary teeth
and promote remineralization of early enamel
caries in children (61,62).
Keep carious lesions clean by daily toothbrushing
with a fluoride-containing toothpaste, with support
from caregivers.
Daily toothbrushing with a 1000–1500 ppm fluoride
toothpaste can arrest or slow down progression
of active carious lesions in primary teeth of young
children (64).
Application of SDF by primary care teams to carious
lesions that have extended into dentine.
Annual or semi-annual application of 38% SDF
solution is simple, inexpensive and highly effective
in arresting soft cavitated carious lesions in primary
teeth (63).
Use by primary care teams and oral health
professionals of flowable fluoride-releasing glass-
ionomer cement to cover surface of carious
dentine lesions.
Application of flowable fluoride-releasing glass-
ionomer cement to cover surface of carious dentine
lesions can arrest lesions in primary teeth (64).
If restoration of decayed primary teeth is required,
primary care teams and oral health professionals
can use minimally invasive techniques such
as ART using adhesive materials such as glass-
ionomer cement.
Placement of dental adhesive materials using
minimally invasive techniques does not require
a local anaesthetic injection and is suitable
for young children who may not cooperate
during treatment. Survival of single-surface ART
restorations using high-viscosity glass-ionomer in
primary teeth is high (65) and may be comparable
to that of restoration placed using a conventional
approach (66).
39. 4. Tackling early childhood caries 29
Key messages
• Advocate the importance
of primary teeth to parents
and caregivers, non-oral
health professionals and
the community by raising
awareness of the impact of
ECC on the quality of life of
young children.
• Engage parents and
caregivers, nursery staff and
school health personnel in
the prevention of ECC and
promotion of oral health.
• Target ECC prevention
and oral health
promotion towards low-
resource communities.
• Apply scientifically
sound oral health
education messages.
Background information
Although an intake of free sugars, poor oral hygiene and inadequate use of
fluoride are rightly given prominence as primary risk factors, reasons for these
unfavourable behaviours need to be understood if preventive strategies are to
be successful. A review of these aspects reported that rates of ECC are highest
among socially disadvantaged groups and indigenous and ethnic minorities;
for example, there is an association between low levels of education and low
family incomes with a high prevalence of ECC (67).
The family represents the child’s primary source of learning about health
and risk factors (68,69). Awareness of oral health and attentiveness to ECC
prevention among parents can be raised through health communication and
by providing them with sound information about disease and intervention. A
systematic review outlines the efficacy of behavioural interventions against
ECC as applied at the individual and family levels (70).
In addition to parents, caregivers such as kindergarten and nursery staff are
vital in young children’s health learning, and they may be instrumental in
development of viable health practices. They may carry out accompanying
ECC preventive actions, particularly by providing a healthy diet, organizing
regular toothbrushing with children, facilitating fluoride administration, and
contributing to early detection of dental caries (71,72).
In countries where formal education starts before the age of five years,
preschools and schools have great potential for influencing the health of
young children. Children may spend a large amount of time in preschool
and school and can be reached at a life stage when their health habits are
being formed. Health promotion may be conducted by preschool teachers
when they have adequate background and knowledge about health and
risk factors (10). Preschools also provide a convenient platform for training
children in regular toothbrushing and for administration of fluoride.
Mass communication through media such as television and radio, books,
pamphlets, flyers and posters is important in improving oral health knowledge
and practices of parents and caregivers specifically in relation to child oral
health (70). A systematic review summarized the evidence of the efficacy
of oral health educational programmes directed at pregnant mothers for
prevention of ECC in children (73). In general, such intervention programmes
may have a positive effect in the fight against ECC.
A range of public health interventions are shown to be beneficial in prevention
and control of dental caries among young children. Home visits and telephone
communication are important in outreach care (74); they are valuable in
engaging parents in prevention of poor oral health in children, and the
personal contact may raise parents’ understanding of oral health support
for infants. Community programmes based on the principles of motivational
interviewing have been used successfully for pregnant women, mothers
and other caregivers in avoiding dental caries and promoting oral health in
infants (72,75,76). A systematic review found that midwifes have an excellent
opportunity for oral health promotion during pregnancy (77).
Importantly, prevention of ECC also requires addressing the social and
economic factors that face many families affected by ECC in low-resource
communities. In particular, universal health coverage is vital for all people and
communities to receive the health care they need without suffering financial
hardship (78,79). Universal health coverage includes the full spectrum of
essential care, including health promotion, prevention, treatment, rehabilitation
and palliative care, and the experience of good-quality health services.
40. 30 Ending childhood dental caries
Rationale for implementation of key interventions
Action Rationale
Primary care teams, especially community health
workers, should advocate the importance of primary
teeth to parents, caregivers and the community at
large, and raise awareness of the impact of ECC on
quality of life of young children.
The adoption of durable health habits in childhood
begins at home with parents and main caregivers, as
they play an important role in forming the child’s oral
health behaviours.
Providing oral health education to parents and
caregivers on ECC risk factors may reduce the risk of
ECC (14,71,72).
Health education must be based on scientifically sound
information (80).
Relevant ministries and local municipalities must
establish oral health education programmes in
preschools, including toothbrushing with use of
fluoridated toothpaste.
Health education in preschools, including
toothbrushing programmes with toothpaste
containing fluoride 1000–1500 ppm, is effective in
reducing dental caries when activities are carried out
by preschool teachers (10,11).
Mass communication should be organized to
improve oral health knowledge and practices of
parents and caregivers.
Several media may be used to increase awareness
among parents and caregivers about ECC prevention,
diet and oral health practices (70).
Home visits and telephone communication should
be introduced in outreach care.
Personal contact with parents of children affected
by ECC is relevant for early detection of disease, ECC
prevention, and appropriate health care coverage
of children (74). Community health workers may
undertake this outreach activity.
Motivational interviewing of parents and pregnant
women by trained primary care workers and oral
health professionals is useful for avoiding dental
caries among children.
Community programmes including motivational
interviewing are useful in engaging mothers and
pregnant women in dental caries prevention
(72,75–77).
42. 4.6
Involvement of
primary care teams,
including community
health workers,
in prevention and
control of early
childhood caries
43. 4. Tackling early childhood caries 33
Key messages
• Primary care teams,
including community
health workers, are key
actors in the prevention
and control of ECC.
• An important function
of national and local
authorities is to advocate
and facilitate training on
ECC prevention and control
for all first-contact health
agents – that is, primary
care teams, including
community health workers,
nurses and midwives.
Background information
In most countries, children aged under five or six years are seen by primary
care teams including nurses, midwives and community health workers, and
less often by oral health professionals. Children may be seen for vaccinations
or consultation for systemic health problems.
Primary care teams are already trained to deliver a range of services (e.g.
child immunization, family planning, health promotion) and to treat minor
conditions and injuries, and they have the educational background and clinical
skills needed to learn about oral health promotion and control of ECC. Primary
care teams often have profound knowledge of the community, enabling
them to gather support from family, friends and organizations, and to offer
continuity of care (81).
Primary care workers should have a basic set of practical skills and knowledge
about oral disease prevention and oral health promotion.These should enable
them not only to advise and treat children affected by ECC when they first
seek help for oral health problems, but also to carry out outreach work in
schools and at health promotion sessions in various locations and settings
where community members gather. Such settings may include meeting
halls, religious sites, workplaces, and any other places that are appropriate
for information, education and communication activities aimed at modifying
behaviours and environments for good oral hygiene, a balanced diet and a
good nutritious status, and towards oral health and quality of life (81).
WHO has developed guidelines on health policy and system support to
optimize community health worker programmes (82).The preservice training
programme suggests that community health workers will gain the following
core competences:
• promotion and preventive services, and identification of family health and
social needs and risk;
• integration of work activities within the wider health-care system in relation
to the range of tasks to be performed in accordance with community health
workers’ roles, including referral for health care, collaboration with other
health workers in primary care teams, patient tracing, community disease
surveillance, monitoring, and data collection, analysis and use;
• consideration of the social and environmental determinants of health;
• providing psychosocial support;
• interpersonal skills related to confidentiality, communication, community
engagement and mobilization;
• personal safety.
Additionally, community health workers will gain competency in diagnostic
practices, treatment and care in alignment with expected roles.
Primary care workers, including community health workers, should be able to
play a role in the prevention and control of ECC by undertaking the following
activities (81):
• Promotion of oral health and prevention of ECC:
– conduct routine oral and dental examinations during outreach work;
– encourage regular general and oral hygiene;
– promote healthy nutrition and an active lifestyle;
– provide information, education and communication sessions about
toothbrushing with a fluoride-containing toothpaste;
44. 34 Ending childhood dental caries
– facilitate healthy environments with restricted access to sugars (e.g.
schools, marketplaces).
• Control of ECC:
– arrest ECC lesions through application of sealants, fluoride varnish and
minimally invasive techniques such as ART;
– avoid cross-infection by effective implementation of appropriate
hygiene and disinfection measures;
– recognize children who need to be referred to a higher level, and have
the connections and facilities to do so.
Rationale for implementation of key interventions
Action Rationale
Advocate and facilitate training for primary care
workers, including community health workers,
nurses and midwives.
Primary care teams are key actors in prevention and
control of ECC. In most countries, children aged
under five or six years are seen by primary care teams,
including nurses, midwives and community health
workers, and less often by oral health professionals.
Primary care teams often have profound knowledge of
the community, enabling them to work with support
from family, friends and organizations, and to offer
continuity of care (81).
47. 4. Tackling early childhood caries 37
Key messages
• Preschool children may be
included in national and
subnational oral health
surveys as part of regular
population surveillance
programmes. Such surveys
should be based on the
WHO Oral Health Surveys:
Basic Methods and include
assessment for risk factors.
• Promote evaluation,
surveillance and research,
including into cost-
effectiveness, for the
prevention of ECC in
different communities.
Background information
It is important that community programmes established for prevention of ECC
and health promotion are evaluated. Regular surveys every three years or so
may be organized at the local or national level by public health administrators
and health-care personnel in order to assess the adequacy, effectiveness and
acceptance of implemented programmes. At the local community level,
analysis of programme performance may be relevant annually. Surveillance
of ECC programmes will help health administrators to learn about experiences
and outcomes from interventions against ECC in very young children.
Moreover, when outcomes and costs of programmes (e.g. time, number of
staff, expenses) are measured concurrently, it may be possible to assess the
cost-effectiveness of alternate programmes.
The WHO STEPwise approach to health surveillance should be adopted and
put into practice (83). Step 1 focuses on self-assessment of oral conditions
and risk factors. The fifth edition of the WHO Oral Health Surveys: Basic
Methods is relevant for surveillance of preschool children and ECC programme
evaluation (24). This tool helps in collection of information on self-reported
severe tooth decay, painful teeth and discomfort, modifiable risk factors such
as consumption of sugars and dietary patterns, oral hygiene, quality of life, and
socioeconomic and environmental conditions. Information can be obtained
based on use of a WHO simplified oral health questionnaire about children
addressed to parents or caregivers.
The questionnaire is designed for self-completion or for use in interviews. Basic
requirements of anonymity, purpose of questions, clarity and length have to
be considered. If an interview mode is used, variation can occur due to intra-
or inter-interviewer variability. Similar questionnaires are prepared byWHO for
primary school teachers engaged in oral health education of young children.
The simplified questionnaires include core questions considered essential in
the surveillance of ECC; they should be adapted to local or national settings.
Step 2 implicates the collection of clinical oral health data. AWHO oral health
assessment form is used to record ECC lesions. Clinical examination conducted
by oral health professionals should include careful assessment of the teeth for
any signs of severe decalcification, location and number of affected teeth, and
any urgent need for immediate care of ECC. Other symptoms of ill-health are
likely to have been recorded by general health personnel when children are
brought to the health service facility.
In countries with a shortage of oral health professionals, children are not
examined clinically by oral health professionals. Primary care teams involved
in interventions for controlling and preventing ECC may use the photographs
for caries assessment shown in Section 4.1.
As suggested for regular oral health surveys conducted according to WHO
methods and criteria, examiners must be trained to make reliable clinical
judgements. Training will ensure uniform interpretation, understanding and
application by all examiners of the criteria and codes for ECC. Assistance in
calibration for consistency may be available from WHO.
48. 38 Ending childhood dental caries
Rationale for implementation of key interventions
Action Rationale
Preschool children may be included as a
target group in national and subnational oral
health surveys as part of regular population
surveillance programmes.
It is important that community programmes
established for prevention of ECC and health
promotion be evaluated. National or subnational
concerns may call for incorporation of preschool
children in oral health surveillance programmes (24).
50. Ending childhood dental caries
4.8
Building
a supportive
framework for
integration of early
childhood caries
prevention and
control in overall
health initiatives
51. 4. Tackling early childhood caries 41
Key messages
• Oral health focal points
in ministries of health
(e.g. chief dental officers)
are important in leading
development and
implementation of plans for
ECC prevention and control
using the primary health-
care approach.
• ECC prevention
intervention is linked to
other health intervention
initiatives such as
promoting, protecting and
supporting breastfeeding,
regulation of marketing
of foods and drinks high
in free sugars, and actions
against childhood obesity.
• For development of a
supportive environment,
it is important to integrate
ECC prevention and control
within primary care, such
as maternal and child
health programmes.
Background information
The aetiology of ECC is complex due to the multilevel web of factors that
direct risk mechanisms. Intervention approaches include changing personal
behaviours, working with families and caregivers, and instigating public health
solutions such as creating supportive environments that promote equity and
reduce inequalities.
Population-directed ECC interventions should target pregnant women, new
mothers and primary care teams with the aim of raising awareness about
the importance of breastfeeding and common risk factors, particularly the
addition of free sugars to drinks and foods (32).
Oral health focal points in ministries of health (e.g. chief dental officers)
are important to lead development and implementation of plans for ECC
prevention and disease control using the primary health-care approach.
Public health agencies and officers, community leaders and civil society
organizations have responsibilities for creating a supportive environment for
prevention and control of ECC through integrating ECC prevention and control
in overall health initiatives.
For example, ECC prevention and control should be integrated into public
health programmes such as:
• initiatives to promote, protect and support breastfeeding, and to ensure
regulation of food products that function as breast-milk substitutes (e.g.
infant formula, follow-up formula) (26,27);
• initiatives to promote safe drinking water to reduce the intake of sugar-
sweetened beverages (84);
• regulation of marketing of foods and drinks (including commercial
complementary food and drinks) to children, especially reducing both
the exposure of children to, and power of, marketing of foods high in free
sugars (85,86);
• taxation of foods and drinks high in free sugars (87);
• existing primary care such as child and maternal health programmes
alongside vaccinations and general medical check-ups;
• childhood obesity initiatives through control of common risk factors (e.g.
free sugars) (88).
Population-directed and individual fluoride administration for the prevention
and control of ECC are vital and should be integral components of existing
primary care systems and essential health services provided to children.
Additionally, it is important to consider the design of essential oral health
services packages – for example, the promotion of affordable fluoride
toothpaste to prevent dental decay; urgent treatment aimed at relief of oral
pain and providing emergency treatment; and minimally invasive techniques
for restoration to treat existing dental decay and prevent further decay (81).
This basic oral health package should be integrated into the existing primary
care system with consideration of health financing (general tax and health
insurance) towards universal health coverage whereby children can receive
the health services they need without suffering financial hardship.
Implementation of community ECC activities should be monitored according
to the District Health Information System (DHIS). Performance of oral health
work carried out by primary care teams should be assessed continuously for
identification of future roles of non-oral health professionals.
52. 42 Ending childhood dental caries
Responsible agencies must collaborate with related departments and ministries and cooperate with civil society and
public and private stakeholders in implementing ECC prevention and control, while avoiding potential conflicts of
interest. In addition, the responsible agencies should identify the most suitable policy approach given the national
circumstances and develop new or strengthen existing policies.
Rationale for implementation of key interventions
Action Rationale
Integrate ECC prevention within primary care
(e.g. child and maternal health programmes)
and ensure engagement of non-oral health
professionals in oral health work.
In most countries, children aged under five or six years
are seen by primary care teams, including nurses,
midwives and community health workers, and less often
by oral health professionals.
Promote, protect and support exclusive
breastfeeding up to age six months and
introduction of nutritionally adequate and safe
complementary (solid) foods at age six months
together with continued breastfeeding up to two
years of age or beyond.
Breastfeeding is associated with better general health
and a lower risk of ECC in infants and children (14).
Align ECC intervention with health promotion
initiatives against childhood obesity by avoiding
consumption of free sugars in foods and drinks,
including complementary foods and drinks.
Intake of free sugars has a negative impact on oral and
general health, such as dental caries, weight gain, obesity
and associated NCDs (32).
Increase efforts to ensure access to clean safe
drinking water to avoid unnecessary consumption
of sugar-sweetened beverages.
Intake of free sugars has a negative impact on oral and
general health, such as dental caries, weight gain, obesity
and associated NCDs (32).
Regulate marketing of foods and drinks (including
complementary food) to children, and especially
reduce exposure of children to, and power of,
marketing of foods high in free sugars.
Intake of free sugars has a negative impact on oral and
general health, such as dental caries, weight gain, obesity
and associated NCDs (32).
Introduce taxation policies on foods and drinks
high in free sugars.
Taxes or levies on sugar-sweetened beverages are
recommended by WHO as a measure to reduce
consumption of sugar-sweetened beverages (87).
Advocate appropriate use of fluoride for caries
prevention. This should provide guidance for both
public health interventions and health workers
advising individuals and caregivers.
Fluoride is a key agent in reducing prevalence of dental
caries (38–40). Because ECC severity and social, cultural
and economic conditions differ between countries, each
country should formulate and implement its own policy
on appropriate use of fluoride.
Integrate ECC surveillance into existing national
or subnational surveillance systems (e.g. DHIS).
It is important that national programmes established
for prevention of ECC and health promotion are
evaluated. National or subnational concerns may call
for incorporation of preschool children in oral health
surveillance programmes (24).
53. 4. Tackling early childhood caries 43
Action Rationale
Develop a national policy to encourage the
development of new skills and competencies
of primary care teams and ensure their initial
and continuing training for ECC prevention
and control.
It is essential that non-oral health professionals (primary
care teams, primary care workers) appreciate ECC as
a public health problem impacting on infants and
children, families and communities. This should be in
terms of pain, infection, child growth and development,
as well as the economic bearing of the disease. Health
professionals should understand the key risk factors for
ECC and how to identify them, and they should recognize
their responsibilities in the work against ECC.
54. Ending childhood dental caries44
Annex 1
Review questions related to
prevention of early childhood
caries
1. Does breastfeeding beyond one year increase the risk of early childhood
caries compared with breastfeeding until less than one year of age?
2. Does breastfeeding beyond one year increase the risk of early childhood
caries compared with consumption of cow’s (or similar) milk as the main
milk source from age one year?
3. Does breastfeeding beyond two years increase the risk of early childhood
caries compared with breastfeeding for less than two years?
4. Does breastfeeding beyond two years increase the risk of early childhood
caries compared with consumption of cow’s (or similar) milk as the main
milk source from age two years?
5. Does consumption of liquids that contain free sugars from an infant
feeding bottle increase the risk of early childhood caries?
6. Does consumption of complementary drinks that contain free sugars
increase the risk of early childhood caries?
7. Does consumption of complementary foods to which free sugars have
been added increase the risk of early childhood caries?
8. Does oral hygiene provided by a parent or caregiver reduce the risk of
early childhood caries?
9. Is oral health education for caregivers effective in preventing early
childhood caries?
10. Does an optimum concentration of fluoride in water reduce the risk of
early childhood caries?
11. Does consumption of fluoridated milk reduce the risk of early
childhood caries?
12. Does salt fluoridation reduce the risk of early childhood caries?
55. Annex 2 45
Annex 2
Key interventions for preventing and controlling
early childhood caries
Action Rationale
Early diagnosis Early detection of carious lesions is
key to managing ECC. Main caregivers
assisted by health professionals are an
important entry point to detect early
caries lesions.
Caries lesions progress faster in primary
dentition than in permanent teeth.
Integrate oral health check-ups into
primary care, including community-
based health interventions, to
encourage early diagnosis of ECC.
Children may be seen for vaccinations or
consultation for systemic health problems.
Children aged under six years may be seen
frequently by primary care staff or general
health-care providers and less often by oral
health professionals.
Early detection of ECC and immediate
intervention offer the opportunity
to manage ECC and prevent
associated problems.
Control of risk
factors: infant
feeding and diet in
young children
Promote, protect and support exclusive
breastfeeding up to age six months and
introduction of nutritionally adequate
and safe complementary (solid) foods
at age six months together with
continued breastfeeding up to two
years of age or beyond.
Breastfeeding is associated with better
general health and lower risk of ECC in
infants and children.
Limit consumption of liquids
containing free sugars, including
natural unsweetened juices.
Consumption of free sugars increases
risk of dental caries, including ECC.
Consumption of free sugars in drinks,
including from feeder bottles, increases
risk of ECC.
Limit consumption of complementary
foods containing free sugars.
Consumption of free sugars increases
risk of dental caries, including ECC.
Consumption of complementary foods
high in sugars increases risk of ECC.
Encourage a combination of
different foods that is high in fruits,
vegetables and low in free sugars for
young children.
A combination of different foods that is
high in fruits and vegetables is associated
with reduced risk of NCDs, including
dental caries.
56. Ending childhood dental caries46
Action Rationale
Control of risk
factors: population-
based fluoride
application
In communities where there is little
fluoride available naturally, fluoride-
based community programmes
using water, salt or milk should
be introduced.
It was shown in the 1930s that dental
caries prevalence and severity are
inversely related to fluoride concentration
in drinking water. Although some
populations drink water naturally
containing an adequate concentration of
fluoride, the majority of populations drink
water with much lower natural fluoride
concentrations. Fluoride concentration
in drinking water was adjusted to the
optimum level in 1945 in Grand Rapids
in the United States; since then, at least
78 studies globally have demonstrated
that water fluoridation prevents ECC.
There have been fewer studies of the
effectiveness of fluoride added to salt or
milk, but these demonstrate effectiveness.
There is no contradiction to the WHO
recommendation of reducing the intake
of salt, as only limited salt intake is needed
for achievement of the caries-preventive
effect. These methods of providing
fluoride are low in cost and have the
advantage of benefiting the people who
are the most difficult to reach with other
preventive programmes – very often the
people with the greatest health burden.
Brushing infants’and children’s teeth
with an affordable, effective fluoride-
containing toothpaste should
be routine.
Since fluoride was first added to
toothpastes 70 years ago, a very large
number of trials have demonstrated
its effectiveness in caries prevention.
Effectiveness increases as the
concentration of fluoride in the
toothpaste increases but, for infants
and young children, the concentration
of fluoride is decided after considering
benefit and risk; in most countries,
concentrations are in the range
1000–1500 ppm.
Toothpaste manufacture is a skill. It is
important that added fluoride is available
to provide its caries-preventive effect and
that the shelf-life of toothpaste is suitable;
this should be audited by national
authorities. Authorities should also take
steps to ensure effective toothpastes are
affordable for
57. Annex 2 47
Action Rationale
the whole population, and that parents
and caregivers have adequate skills and
motivation to brush their children’s teeth.
Brushing twice a day is more effective
than less frequent brushing, as it
maintains adequate fluoride around
the teeth for a greater proportion of the
day. Toothbrushing is a life skill; in many
countries, it is part of school routines
aimed at improving health.
Arresting carious
lesions through
application of
sealants, fluoride
varnish and
minimally invasive
techniques
Application by primary care teams
of sealant on pits and fissures of
primary molars that are deep or with
initial caries.
Compared with control with no sealant,
placement of resin or glass-ionomer
sealant in primary molars can reduce
the development of new carious lesion
involving dentine.
Application by primary care teams of
sodium fluoride varnish to primary
teeth in children with ECC or teeth with
signs of early caries.
Topical application of fluoride varnish
two to four times a year can reduce the
development of new carious lesions
into dentine or the need for restoration
of teeth. Fluoride varnish can reverse
incipient carious lesions in primary teeth
and promote remineralization of early
enamel caries in children.
Keep carious lesions clean by daily
toothbrushing with a fluoride-
containing toothpaste, with support
from caregivers.
Daily toothbrushing with a 1000–
1500 ppm fluoride toothpaste can
arrest or slow down progression of
active carious lesions in primary teeth of
young children.
Application of SDF by primary care
teams on to carious lesions that have
extended into dentine.
Annual or semi-annual application of 38%
SDF solution is simple, inexpensive and
highly effective in arresting soft cavitated
carious lesions in primary teeth.
Use by primary care teams and oral
health professionals of flowable
fluoride-releasing glass-ionomer
cement to cover surface of carious
dentine lesions.
Application of flowable fluoride-releasing
glass-ionomer cement to cover surface of
carious dentine lesions can arrest lesions
in primary teeth.
58. Ending childhood dental caries48
Action Rationale
If restoration of decayed primary teeth
is required, primary care teams and oral
health professionals can use minimally
invasive techniques such as ART using
adhesive materials such as glass-
ionomer cement.
Placement of dental adhesive materials
using minimally invasive techniques does
not require a local anaesthetic injection
and is suitable for young children who
may not cooperate during treatment.
Survival of single-surface ART restorations
using high-viscosity glass-ionomer
in primary teeth is high and may be
comparable to that of restoration placed
using a conventional approach.
Health education
and community
engagement for
prevention of ECC
Primary care teams, especially
community health workers, should
advocate the importance of primary
teeth to parents, caregivers and
the community at large, and raise
awareness of the impact of ECC on
quality of life of young children.
The adoption of durable health habits in
childhood begins at home with parents
and main caregivers, as they play an
important role in forming the child’s oral
health behaviours.
Providing oral health education to parents
and caregivers on ECC risk factors may
reduce the risk of ECC.
Health education must be based on
scientifically sound information.
Relevant ministries and local
municipalities must establish oral
health education programmes in
preschools, including toothbrushing
with use of fluoridated toothpaste.
Health education in preschools, including
toothbrushing programmes with
toothpaste containing fluoride 1000–
1500 ppm, is effective in reducing dental
caries when activities are carried out by
preschool teachers.
Mass communication should be
organized to improve oral health
knowledge and practices of parents
and caregivers.
Several media may be used to increase
awareness among parents and caregivers
about ECC prevention, diet and oral
health practices.
Home visits and telephone
communication should be introduced
in outreach care.
Personal contact with parents of children
affected by ECC is relevant for early
detection of disease, ECC prevention,
and appropriate health care coverage of
children. Community health workers may
undertake this outreach activity.
Motivational interviewing of parents
and pregnant women by trained
primary care workers and oral health
professionals is useful for avoiding
dental caries among children.
Community programmes including
motivational interviewing are useful in
engaging mothers and pregnant women
in dental caries prevention.
59. Annex 2 49
Action Rationale
Role of primary care
teams, including
community
health workers, in
prevention and
control
Advocate and facilitate training for
primary care workers, including
community health workers, nurses
and midwives.
Primary care teams are key actors in
prevention and control of ECC. In most
countries, children aged under five
or six years are seen by primary care
teams, including nurses, midwives and
community health workers, and less often
by oral health professionals.
Primary care teams often have profound
knowledge of the community, enabling
them to work with support from family,
friends and organizations, and to offer
continuity of care.
Monitoring and
evaluation
Preschool children may be included
as a target group in national and
subnational oral health surveys
as part of regular population
surveillance programmes.
It is important that community
programmes established for prevention of
ECC and health promotion be evaluated.
National or subnational concerns may call
for incorporation of preschool children in
oral health surveillance programmes.
Building a supportive
framework for
integration of ECC
prevention and
control into overall
health initiatives
Integrate ECC prevention within
primary care (e.g. child and maternal
health programmes) and ensure
engagement of non-oral health
professionals in oral health work.
In most countries, children aged under
five or six years are seen by primary care
teams, including nurses, midwives and
community health workers, and less often
by oral health professionals.
Promote, protect and support exclusive
breastfeeding up to age six months and
introduction of nutritionally adequate
and safe complementary (solid) foods
at age six months together with
continued breastfeeding up to two
years of age or beyond.
Breastfeeding is associated with better
general health and a lower risk of ECC in
infants and children.
Align ECC intervention with health
promotion initiatives against childhood
obesity by avoiding consumption
of free sugars in foods and drinks,
including complementary foods
and drinks.
Intake of free sugars has a negative
impact on oral and general health, such
as dental caries, weight gain, obesity and
associated NCDs.
Increase efforts to ensure access to
clean safe drinking water to avoid
unnecessary consumption of sugar-
sweetened beverages.
Intake of free sugars has a negative
impact on oral and general health, such
as dental caries, weight gain, obesity and
associated NCDs.
60. Ending childhood dental caries50
Action Rationale
Regulate marketing of foods and
drinks (including complementary food)
to children, and especially reduce
exposure of children to, and power of,
marketing of foods high in free sugars.
Intake of free sugars has a negative
impact on oral and general health, such
as dental caries, weight gain, obesity and
associated NCDs.
Introduce taxation policies on foods
and drinks high in free sugars.
Taxes or levies on sugar-sweetened
beverages are recommended by WHO as a
measure to reduce consumption of sugar-
sweetened beverages.
Advocate appropriate use of fluoride
for caries prevention. This should
provide guidance for both public health
interventions and health workers
advising individuals and caregivers.
Fluoride is a key agent in reducing
prevalence of dental caries. Because ECC
severity and social, cultural and economic
conditions differ between countries, each
country should formulate and implement
its own policy on appropriate use
of fluoride.
Integrate ECC surveillance into existing
national or subnational surveillance
systems (e.g. DHIS).
It is important that national programmes
established for prevention of ECC and
health promotion are evaluated. National
or subnational concerns may call for
incorporation of preschool children in oral
health surveillance programmes.
Develop a national policy to encourage
the development of new skills and
competencies of primary care teams
and ensure their initial and continuing
training for ECC prevention and control.
It is essential that non-oral health
professionals (primary care teams, primary
care workers) appreciate ECC as a public
health problem impacting on infants and
children, families and communities. This
should be in terms of pain, infection, child
growth and development, as well as the
economic bearing of the disease. Health
professionals should understand the key
risk factors for ECC and how to identify
them, and they should recognize their
responsibilities in the work against ECC.
61. Annex 3 51
Annex 3
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