Please activate JavaScript!
Please install Adobe Flash Player, click here for download

Hygiene Tribune Middle East & Africa Edition No.1, 2018

C2 HYGIENE TRIBUNE Dental Tribune Middle East & Africa Edition | 1/2018 “The prevalence of caries and other oral diseases is a worrying trend” Interview with Corrie Jongbloed-Zoet on caries By DTI One of the primary ways in which oral health can impact the quality of life is through its economic burden. In Europe, traditional curative treat- ment accounts for 5–10 per cent of total public health expenditure. The Platform for Better Oral Health in Europe forecasts that the total cost will rise from €54 billion 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 ap- propriate care. the The prevalence of caries and other oral diseases is a worrying trend, especially given increased knowledge of how oral health can be maintained through twice-daily brushing with a fluoridated tooth- paste, a healthy diet and regular den- tal check-ups. In the Netherlands, for example, a commonly implemented programme to prevent caries among children involves twice-yearly check- ups that are often accompanied by an application of fluoride and the sealing of all visible fissures. This pro- gramme 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 disincentive. In spite of this progres- sive and egalitarian approach, the proportion of Dutch youths with- out any caries experience 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 needed to be tested. Working from the basis of a study conducted in Denmark, a group of dental research- ers in the Netherlands trialled a non- operative caries treatment and pre- vention (NOCTP) programme with a pool of 6-year-old children. This programme, which promoted recall intervals 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 International Federation of Dental Hygienists (IFDH), about how the principles of these scientific stud- ies are applied to a programme implemented by Dutch society for the promotion of oral health ‘Ivoren Kruis’(Ivory Cross) and the impact these studies may have on approaches to caries prevention throughout Europe. What are the principles upon which the NOCTP approach is founded, and how do these differ from conventional car- ies prevention approaches? NOCTP is based on individual risk as- sessment, extensive oral hygiene in- struction and education, and paren- tal home care. In contrast, we have the regular (Dutch) protocol that is based on dental check-ups twice a Corrie Jongbloed-Zoet, The Netherlands. President-elect of the International Federation of Dental Hygienists (IFDH) year, fluoride application and seal- ants and if necessary restoration of caries on the dentine threshold. The protocol is based on the under- standing that caries is a localised process that can be prevented by brushing with a fluoride toothpaste. Extensive oral hygiene instruction and education 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 per- manent molars and carious activ- ity affecting the occlusal surfaces of the first permanent molars. Unfor- tunately, we see a great deal of very progressive carious activity in pri- mary dentition and in first molars, especially among young emigrant children and in lower socio-econom- ic 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 dentist or a dental hygienist and is followed by a demonstration of vis- ible plaque and education and train- ing in plaque removal by the patient and motivational interviewing. After professional plaque removal, a di- agnosis is made and the treatment continued. In the case of no caries progression, a risk and interval as- sessment is determined. In the case of caries progression, treatment, education and training are followed by fluoride application, sealing or restoration. tient is ready to change, he or she is instructed—through explaining, showing and doing—and motivated and coached, with the intention that he or she will change his or her atti- tude towards oral health and his or her behaviour. Step 1 During the first visit, the patient and his or her parents are informed about the programme and asked about their motivation to partici- pate, problems, previous experienc- es, fear, stress, etc. Step 6 If necessary, fluoride is applied on white spots or areas difficult to reach with a toothbrush. If the patient is not able to reach erupting molars with a toothbrush, sealants are ap- plied to these and only if necessary. Step 2 After disclosing of the plaque, the level of oral hygiene and self-care is noted—plaque index—followed by information and instruction. The pa- tient or his or her parent is asked to remove the plaque him- or herself. Step 3 The next step in the NOCTP protocol is professional cleaning. Step 4 A very important factor for risk as- sessment is the diagnosis of carious activity: small pits and severe caries Step 5 The next step is motivational inter- viewing, which is the key to success. The patient is prepared for imple- menting change and this might need multiple sessions. If the pa- When it comes to the pre- vention of caries in children, what role do parents’ atti- tudes play? The programme focuses on behav- ioural change: the patient and/or his or her parents are encouraged to take responsibility for his or her oral health. In the study, the par- ents’ attitude turned out to be a de- cisive factor. There are parents who are conscious and responsible, but there also parents who are trivialis- ing and fatalistic, appearance-driven and open-minded, knowledgeable but defensive, or conscious and con- cerned. The health care providers are trained over several days to be fa- miliar with these differences and to consider them in their approach to- wards the patient’s parents. After in- formed consent has been obtained, parents are asked to fill in a ques- tionnaire to provide information on socio-economic circumstances, oral hygiene habits, oral health history, dietary habits, self-care routines and knowledge on dental topics. What role does the IFDH play in the promotion of oral health in Europe? The IFDH is an international non- governmental organisation reg- istered in the US. It unites dental hygienist associations from around the world (32 countries) in their com- mon goal of promoting oral health and preventing oral disease. The fed- eration represents approximately 85,000 dental hygienists. All Euro- pean countries where dental hygien- ist associations exist are members of the IFDH and of the European Den- tal Hygienists Federation (EDHF). The IFDH and EDHF work together towards their common goal of im- proving oral health worldwide with partners like the Alliance for a Cavi- ty-Free Future, the Global Child Den- tal Fund and the Platform for Better Oral Health in Europe. References 1. European Platform for Better Oral Health, The State of Oral Health in Europe (2012), http://www.oral- healthplatform.eu/wp-content/up- loads/2015/09/Report-the-State-of- Oral-Health-in-Europe.pdf, accessed 20 Jul. 2017. 2. Zorginstituut Nederland, Signale- ment Mondzorg 2016: Mondg- ezondheid en Preventief Tand- heelkundig Gedrag van Jeugdigen (2016), https://www.zorginstitu- utnederland.nl/binaries/zinl/docu- menten/rapport/2016/07/06/ signalement-mondzorg-2016/sig- nalement-mondzorg-2016.pdf, ac- cessed 20 Jul. 2017. 3. Vermaire, J.H., “Optimizing Oral Health: Towards a Tailored, Effective and Cost-Effective Dental Care”, the- sis, University of Amsterdam, Stom- petoren, 2013. 4. Ekstrand, K.R. & Christiansen, M.E.C., “Outcomes of a non-opera- tive caries treatment programme for children and adolescents”, Caries Research, 39/6 (2005), 455–67. 5. Vermaire, J.H., Poorterman, J.H.G., Van Herwijenen, L., Van Loveren, C., “A three-year randomized controlled trial in 6-year-old children on caries- preventive strategies in a general dental practice in the Netherlands”, Caries Research, 48/6 (2014), 524–33. Editorial note: The interview was originally published in Prevention In- ternational Magazine for Oral Health 1/2017

Pages Overview