Oral HealthPromotion and Fluoride

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 What’s our oral health problem?

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What is the oral health condition of
children in Europe ?
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How the world measures oral health status ?

DMFT of 12 year-olds
D = decayed teeth
M = missing due to caries
F = filled/ restored
eg.
D =1, M = 1, F = 1 (DMFT = 3)
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DMFT of an adult could be 0 – 32

DMFT 0 = healthy / caries free
Higher DMFT = Poorer oral health
 Background and rationale

D = 0, M = 0, F = 0……DMFT = 0
D = 1, M = 0, F = 0 …...DMFT = 1
D = 0, M= 0, F = 1 …….DMFT = 1
D = 0, M = 1, F = 0 ……DMFT = 1
If a person got one carious tooth, and
even good dentists gave any kind of
treatment ……DMFT still remains 1
Not completely healthy
 Background and rationale

 DMFT is irreversible
 If we do not have any effective
preventive measure a
person / country’s DMFT will
increase
 Poor Oral Health
 Background and rationale

What instrument can prevent DMFT 0

would not change into DMFT 1, 2, 3,
4…….32 ?
 Strategy for Achieving Oral Health in SEA

The recent remarkable technological progress in

dentistry with the development of sophisticated
equipment, better dental material and orthodontic
treatment techniques is not accompanied by overall
improvement of oral health in countries of the SEA
Region

The overemphasis on curative dentistry contributes to

growing oral health inequalities
SEA Strategy for Achieving Oral Health for All (Draft as of 14 Aug 2008)
Dental caries is considered by many
politicians and health decision makers
as an unpleasant disorder but not as a
life threatening health condition and
therefore does not receive much
attention or prioritization in the national
health policy
These conditions pose a serious threat to children’s
general health because they may develop into life
threatening conditions.
Furthermore, the accompanied toothache alters eating
and sleeping habits that impact on growth and health.
Untreated dental caries does not only impact on the
physical condition but also on the cognitive
development of children.
It impedes education of a nation’s children because
toothache is the principal reason for absenteeism from
schools.
 How to cope with???

Limited manpower

Limited financial
resources
Global consultation on oral health through fluoride
17-19 November 2006, Geneva

Prevention of caries by using fluoride is the

only realistic way of reducing this burden in
populations
 Sixtieth World Health Assembly, May 2007
WHO resolution

For those countries without access to optimal

levels of fluoride, to consider the development and
implementation of fluoride programs
 Beijing Declaration
18 & 19 September 2007

Call to action to promote oral health by using

fluoride in China and Southeast Asia

Fluoride toothpaste remains the most widespread and

significant form of fluoride used globally and the most
rigorously evaluated vehicle for fluoride use

Fluoride toothpaste is safe to use irrespective of low,

normal or high fluoride exposure from other sources

Promoting the use of effective fluoride toothpaste twice a

day for prevention of tooth decay
 Background and rationale

Fluoride
Fluoride is the only tool to prevent
dental caries
Toothbrushing with efficacious fluoride
toothpaste is the most practical self care
measure to control dental caries,
periodontal diseases and crowding due to
early loss
 Background and rationale

 Daily Fluoride Toothbrushing

= self immunization against major oral
diseases
To get the best benefits from fluoride (F-)
toothpastes
 F and dental caries

The safety and efficacy of F in preventing

dental decay has been consistently
demonstrated throughout the world over
50 years of extensive research

FDI Statement
Adopted by FDI General Assembly
 Limitations of water fluoridation
Municipal water supply is not always possible
in developing communities, as well as-high
installation & maintenance cost
Water fluoridation is not always possible even
in developed countries and it was necessary
to develop easier and effective ways to
protect dental caries with F-
Then came- salt fluoridation, topical
applications, F- tablets,
F toothpastes
 F toothpaste ; when and how it was
started ?

 1945-Bibby
 1953-Winkler et. al.,
 1955-Muhler et. al.
 1961 Keyes et. al.

All clinical trials hadn’t found anti-caries

effect as they all had expected!
 So, what is the problem?
 1961- Ericsson

The fluoride in the toothpaste was inactivated

by calcium carbonate or dicalcium phosphate
from the abrasives and it’s desired anti-caries
action was diminished.
How to choose the correct formula
F toothpastes contain NaF or SMFP
NaF 0.02% =1000 ppmF
SMFP 0.76% =1000 ppmF
Na F is not compatible with Ca CO3 or dicalcium
phosphate
SMFP with Ca CO3 or Dicalcium phosphate
stays efficacious only for short time, gradually
efficacy diminishes
Na F & SMFP is compatible with silica gel
Gel formulas are generally better than cream
pastes (b/c silica gel is a must)
 New research findings

•It is not that important that the F- ions had to

be incorporated in the enamel crystals to resist
acid attack
•Studies indicated that F- even at very low
concentration, if stays in the mouth, can protect
decay---interfere de-mineralisation and/or
promote re-mineralisation of enamel
• (0.2 ppmF)
 New research findings

•Topical effect of F- is more than the

systemic to prevent dental caries
 Primary Oral Health Care
MoH/ WHO joint project
Community oral health care services
1) Basic & emergency oral health care
2) Oral health screening & referral
3) Oral health education & promotion
4) School-based after-lunch toothbrushing
programs
1st Message on Toothbrushing with
Fluoride toothpaste
1992 Primary Oral Health Care Project, Oral
Health Unit, DoH
Declares
“ A Toothpaste without fluoride is just for
cosmetic”
and this message was disseminated to the
profession, some decision makers, project
participants & community
1st Message on Toothbrushing with
Fluoride toothpaste
1992 Primary Oral Health Care Project, Oral
Health Unit, DoH distributes IEC materials
• To use F toothpaste to prevent dental
caries
• Establish school toothbrushing programs
introducing fluoride toothbrushing
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 Step 3 in Advocacy process

Invitational Meeting on Fluoride

Exposure and Oral Health Care for
Myanmar, July-2002

Multi-sectorial participated meeting:

Decision makers, Dental & Medical profession/
Manufacturers, NGO's, relevant sectors

Ko Ko Maw, 2004
 Major outcomes of the Meeting

Permission to conduct F Toothpaste and Dental

Fluorosis issues as an Oral Health Project in
Myanmar from the Health Ministry

Production and marketing of F toothpaste from

the factory of The Ministry of Industry 1 in Nov.
2002
"Pepsodent with fluoride"
Free ionisable F = 780 ppm F
Retail price = 313 Ks/ 100 Gm

Ko Ko Maw, 2004
Consumption of local-made F toothpaste
with >700ppm

Brand name Year Type of Retail price

Fluoride for 100 Gms
Fresh Up 2002 SMFP 466 Ks

Fresh Up 2003 SMFP 413 Ks

Pepsodent 2002 SMPF 313 Ks

With F
Pepsodent 2003 SMFP 313 Ks
With F

Ko Ko Maw & Wim van Palenstein Helderman, 2004

Myanmar Times Feb 3-9, 2003
 2005 Toothpaste survey
More local manufacturers
15 local brands
4 (26%) local brands showed desirable
efficacy i.e. >700 free available fluoride
None had user-instruction in Myanmar
language
 Step 4 in Advocacy Process
2006 Consultative Advocacy Meeting for
Development of Affordable & Effective
Fluoride Toothpaste for Myanmar
 Step 4 in Advocacy Process
Accreditation Criteria
and user-instruction
draft shown to the
professional groups
Participants
Local/ International
Dental, Medical, Health,
MDA, MAMS & local
manufacturers
Thank you