An international Delphi Study of Fluoride-based Caries Prevention in Nursery and Primary Schools

Aim: The aim of this study was to develop an international expert consensus on fluoride-based interventions in early-years education settings (nursery and primary schools) for reducing Early Childhood Caries (ECC), a recognised global public health challenge which has substantial impact on child wellbeing and healthcare system expenditure. Methods: A systematic overview of systematic reviews, trials, and observational studies was performed to identify and critically appraise the available evidence on the effectiveness and cost-effectiveness of fluoride-based interventions in early-years education settings to prevent ECC. This was followed by a three stage Delphi panel study (n= 21) consisting of round 1, an online survey to gather opinion on overview findings, round 2 an online survey to present collated group opinion and gather feedback and round 3 an online workshop with presentations and facilitated in-depth, recorded group discussions. Results: There was high consensus that supervised toothbrushing delivered in nurseries (kindergartens) or primary schools should be supported, it shows greater benefit to most disadvantaged children, helps child social development, and is feasible in low/middle-income countries. There was more moderate support for fluoride varnish application in this setting in terms of preventive effectiveness (especially where fluoride toothbrushing is in place) and cost-effectiveness. It was agreed that policy makers should target at-risk groups where resources are limited, and that systemic fluoride interventions in this setting are no longer a priority. Conclusion: In the population studied, toothbrushing with fluoridated toothpaste is internationally agreed as the most effective and cost-effective caries-prevention measure for children, providing the opportunity for universal population coverage including in low/middle-income countries

Mapping Early Childhood Caries Prevention Programmes in Scotland and South-Eastern Europe

Background: Early Childhood Caries (ECC) is a recognised global public health challenge, and the World Health Organisation (WHO) has set out preventive approaches in an implementation manual. Scotland has an established information-sharing partnership with countries in South-Eastern Europe, where the ECC burden is substantial. Aim: This project aimed to map ECC and preventive programmes in Scotland and South-Eastern Europe against WHO criteria and to facilitate discussion, drawing from recent research and assessment of international consensus, to agree on priority interventions. Methods: A dedicated pro-forma gathered structured information on: population statistics; disease burden; workforce capacity; interventions in dental practice, early years education and the community. A recorded online workshop involved presentations and discussions of policy and practice in relation to current and future ECC prevention plans. Workshop discussions were transcribed and analysed using thematic theory-based implementation frameworks, facilitated by QSR NVivo12.0 software. Results: Data were received from Albania, Bulgaria, Croatia, Romania, Scotland and Serbia. The child population and birth rate are generally declining. In 2019, ECC prevalence among 5–6-year-olds was 80% to 84% in South-Eastern Europe countries, while in Scotland, less than a third (26%) of those children had obvious decay experience in their primary teeth in 2020, compared with more than half (55%) in 2003. A key barrier for implementing ECC prevention is a lack of political prioritisation and funding. Further barriers identified included a lack of integration of public and private preventive programmes, low engagement of professional dental associations, and a lack of population knowledge/awareness of the issue. Implementation might be facilitated through wider universal child health initiatives (e.g. vaccination and maternal health programmes). Conclusion: Mapping disease and oral health prevention activities in Scotland and South-Eastern Europe has allowed for assessment of progress and identified barriers and facilitators for future implementation in line with WHO ECC prevention guidelines

Maternal and Child Oral Health Interventions in Middle East and North Africa Regions:a rapid review

Objectives: To conduct a rapid review to identify any maternal and/or child oral health interventions implemented and/or tested in Middle East and North Africa (MENA) countries generally, and Lebanon, Palestine and Syria specifically, and to compile information on the relative effectiveness of these interventions. Methods: A systematic search was conducted for primary and secondary literature indexed in five online databases, and the websites of the World Health Organisation (WHO), the International Union for Health Promotion and Education (IUHPE), the United Nations Children’s Fund (UNICEF), United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), and the United Nations Refugee Agency (UNHCR). Results: Two independent researchers reviewed 1,180 records from the online databases, and 3,120 reports from the WHO, UNRWA, UNICEF and UNHCR. Four unique studies were included and conducted in Syria, Saudi Arabia and Iran. No systematic reviews were found for targeted interventions in MENA regions. However, interventions using fluoridated toothpaste (Syria), preventive treatment and fluoridated chewing gum (Saudi Arabia), and oral health education with oral health reminders (Iran) were significantly effective in reducing early child caries (ECC) experience. In Syria and Iran, mother and child oral health promotions integrated into ongoing vaccination programmes were effective in reducing ECC. These interventions formed part of WHO and Ministry of Health programmes. Conclusion: Further investigation is essential to verify the effectiveness of incorporating multi-disciplinary, theory-driven oral health interventions into ongoing WHO maternal and child health programmes in MENA countries to assist in promoting oral health and wellbeing

Dietary behaviours and dental fluorosis among Gaza Strip children ‫غزة‬ ‫قطاع‬ ‫يف‬ ‫األطفال‬ ‫لدى‬ ‫بالفلور‬ ‫األسنان‬ ‫م‬ ُّ ‫وتسم‬ ‫الغذائية‬ ‫م‬ ُ ‫ُظ‬ ‫الن‬ ‫حيث‬ ‫من‬ ‫السلوكيات‬ Comportements alimentaires et fluorose dentaire chez des enfants de la

ABSTRACT A high prevalence of dental fluorosis has been identified among children in the Gaza Strip. This study aimed to determine the history of breastfeeding and dietary behaviours among children in the Gaza Strip and to examine potential associations with the prevalence and severity of dental fluorosis. A cross-sectional study recruited a stratified cluster random sample of 350 children aged 12-18 years and their mothers. Data about dietary behaviours in the first 7 years of life were collected by interview questionnaire. Dental fluorosis was determined using the Thyllstrup-Fejerskov index. A majority of children were breastfed exclusively in the first 6 months (82.9%) but 98.1% were given tea in the first year of life. The prevalence of dental fluorosis was 78.0%. Both intake of animal proteins and plant proteins were negatively associated with the prevalence and severity of dental fluorosis. Further studies to investigate fluoride intake is required to plan preventive interventions. Comportements alimentaires et fluorose dentaire chez des enfants de la Bande de Gaza RÉSUMÉ Une prévalence élevée de fluorose dentaire a été observée chez des enfants de la Bande de Gaza. La présente étude visait à déterminer les antécédents d'allaitement au sein et les comportements alimentaires chez des enfants de la Bande de Gaza puis à examiner les associations possibles avec la prévalence et la sévérité de la fluorose dentaire. Une étude transversale a recruté 350 enfants âgés de 12 à 18 ans et leurs mères, formaient un échantillon randomisé et stratifié en grappes. Les données sur les comportements alimentaires au cours des sept premières années de vie ont été recueillies par questionnaire lors d'un entretien. La fluorose dentaire a été déterminée à l'aide de l'indice Thylstrup-Fejerskov. Une majorité des enfants avait été nourrie exclusivement au sein au cours des six premiers mois de vie (82,9 %) mais 98,1 % avaient consommé du thé pendant leur première année. La prévalence de la fluorose dentaire était de 78,0 %. Les apports en protéines animales et végétales étaient négativement associés à la prévalence et la sévérité de la fluorose dentaire. Des études supplémentaires évaluant l'apport en fluor sont requises pour prévoir des interventions préventives