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prevention International magazine for oral health No. 1, 2017

practical prevention | caries prophylaxis Corrie Jongbloed-Zoet : “The prevalence of caries and other oral diseases is a worrying trend“ AUTHOR: DENTAL TRIBUNE INTERNATIONAL / CORRIE JONGBLOED-ZOET of fluoride and the sealing of all visible fis- sures. This programme is covered by the country’s health insurance and is thus free for all children up to 18 years of age, ensuring that there is no financial disin- centive. In spite of this progressive and egalitarian approach, the proportion of Dutch youths without any caries experi- ence has not dropped over the last 30 years and has remained stable. It was clear from this that an alterna- tive approach to caries prevention need- ed to be tested. Working from the basis of a study conducted in Denmark, a group of dental researchers in the Netherlands tested a non-operative caries treatment and prevention (NOCTP) programme with a pool of 6-year-old children. This programme, which promoted recall inter- vals based on individual risk assessment, resulted in a 40–70 per cent reduction in caries for the group subjected to the NOCTP method. Prevention spoke with Corrie Jong- bloed-Zoet, President-elect of the Inter- national Federation of Dental Hygienists (IFDH), about how the principles of these scientific studies are applied to a pro- gramme implemented by Dutch society for the promotion of oral health ‘Ivoren Kruis’ (Ivory Cross) and the impact these studies may have on approaches to car- ies prevention throughout Europe. What are the principles upon which the NOCTP approach is founded, and how do these differ from conventional caries prevention approaches? NOCTP is based on individual risk assess- ment, extensive oral hygiene instruction and education, and parental home care. In contrast, we have the regular (Dutch) protocol that is based on dental check- ups twice a year, fluoride application and sealants and if necessary restoration of caries on the dentine threshold. The protocol is based on the under- standing that caries is a localised proc- ess that can be prevented by brushing with a fluoride toothpaste. Extensive oral hygiene instruction and educa- tion are given and recall intervals are made on an individual basis using the following criteria: the cooperation of the parents, the activity of carious lesions within the dentition, the eruption stage of permanent molars and carious activity affecting the occlusal surfaces of the first permanent molars. Unfortunately, we see a great deal of very progressive carious activity in primary dentition and in first molars, especially among young emigrant children and in lower socio- economic income groups. Could you please take us through the protocol of the Ivoren Kruis’s Gewoon Gaaf programme? The first appointment is made with a den- tist or a dental hygienist and is followed by a demonstration of visible plaque and education and training in plaque removal by the patient and motivational interviewing. After professional plaque removal, a diagnosis is made and the treatment continued. In the case of no Corrie Jongbloed-Zoet One of the primary ways in which oral health can impact the quality of life is through its economic burden. In Europe, traditional curative treatment accounts for 5–10 per cent of total pub- lic health expenditure. The Platform for Better Oral Health in Europe forecasts that the total cost will rise from €54 bil- lion in 2000 to €93 billion in 2020. Oral diseases are the fourth most expensive to treat, according to the World Health Or- ganization, and this financial aspect can hinder people of lower socio-economic standing in receiving appropriate care. The prevalence of caries and other oral diseases is a worrying trend, espe- cially given the increased knowledge of how oral health can be maintained through twice-daily brushing with a fluori- dated toothpaste, a healthy diet and regu- lar dental check-ups. In the Netherlands, for example, a commonly implemented programme to prevent caries among chil- dren involves twice-yearly check-ups that are often accompanied by an application 54 issue #1

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