(By Dr. Joseph D. Lim and Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI)
FLUORIDE toothpaste as a hygiene commodity and as a product that prevents tooth decay has not received the public policy attention that could lead to innovative interventions.
One such intervention, encouraged by the findings of the WHO Global School-based Student Health Survey, has worked in the Philippines.
The survey, conducted in collaboration with the US Centers for Disease Control and Prevention, analyzed data from 75 low- and middle-income countries. It revealed that 35 percent to 94 percent of 12-15-year-olds say they brush their teeth between one and three times a day, while 2 percent to almost 38 percent indicated not brushing their teeth at all.
“The Philippines are amongst the countries with the highest prevalence of dental caries in children,” states Dr. Maria Corazon Dumlao, Chief of the Health Division of the Health and Nutrition Center at the Department of Education (DepEd), recalling the situation back in 2008. “Toothache, infections, dental impairment, impacted nutritional intake, and school absenteeism are some of the consequences. With the available resources to address oral diseases, a curative approach was neither realistic nor ethically appropriate.”
At that time, only regular preventive interventions in key institutionalized settings, such as schools, were identified as realistic to address the silent epidemic of dental caries in the Philippines.
Enter the Regional Fit for School Program of the DepEd, the German Development Cooperation, and the German Federal Ministry of Economic Cooperation and Development. They facilitated the integration of daily group toothbrushing with fluoride toothpaste as part of the Essential Health Care Program, along with other school health and water, sanitation and hygiene interventions.
Supervised by teachers or older students, this approach of simple, effective interventions allowed schools to manage toothbrushing efficiently for a large number of students. It ensured that basic hygiene and exposure to fluoride are accessible on a daily basis for students, irrespective of their socioeconomic background.
The procurement of toothpaste and toothbrushes was financed by the DepEd, and agreements were made with a local manufacturer to simplify bulk procurement of affordable, high-quality fluoride toothpaste.
Research showed that, depending on implementation quality, daily group toothbrushing with fluoride toothpaste prevented up to 38 percent of new caries lesions and reduced the days of absence from school.
“The integration of oral health into a broader approach to establish healthy learning environments is a great success. Water, sanitation and hygiene programs in schools and other common, yet preventable child diseases are pressing problems in many countries, and effective collaboration between health, education and local governments can have a big impact,” says Dr. Noel Vallesteros, DOH Chief Dental Officer.
(The DOH Guidelines on the Implementation of School Dental Health Care Program includes distributing dental care supplies to children from kindergarten to Grade 6 and applying fluoride varnish to all kindergarten and Grade 3 students.
In 2009, DepEd, the League of Provinces of the Philippines, and Fit for School Inc. implemented a nationwide Essential Health Care Program which focuses on dental caries, infectious diseases (respiratory tract infections and diarrhea), and worm infestations, as the most basic hygiene deficiency-related infectious diseases in public schools due to lack of water and functional sanitary facilities. The program included daily toothbrushing with a fluoridated toothpaste.)
It is time for innovative approaches such as these. The need is urgent.
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Dr. Joseph D. Lim, Ed. D., is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; Honorary Life Member of the Thai Association of Dental Implantology; and Founding Chairman of the Philippine College of Oral Implantologists. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines, College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate Professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Fellow, Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com./PN
