School-based Fluoride Mouthrinse Program Research Articles

Associations between school-based fluoride mouth-rinse program, medical-dental expense subsidy policy, and children's oral health in Japan: an ecological study.

Dental caries are a common non-communicable disease among children. As a public health measure at the prefectural level, school-based fluoride mouth-rinse (S-FMR) program, medical/dental expense subsidy policies, and other factors may reduce the incidence of dental caries and tooth loss. Prefectures focusing on promoting oral health policies may promote both, but the interaction effect of implementing both subsidy policies and S-FMR at the prefectural level on caries prevention has not yet been examined. We conducted an ecological study using two-wave panel data, prefecture-level aggregated data in Japan for 2016 and 2018. Coefficient and 95% confidence intervals (CI) were calculated for the dependent variables for oral health using mixed-effects linear regression analysis adjusted for possible confounders. Two dependent variables were used; the standardized claim ratio (SCR) of deciduous tooth extraction and 12-year-olds' decayed, missing, or filled permanent teeth (DMFT). Four independent variables were S-FMR, the SCR of dental sealants, prefectural income per person, and subsidy policy in three models: co-payment until children enter elementary school (n = 23), no co-payment until children enter elementary school (n = 7), and co-payment continuing beyond elementary school (n = 17). The effects of six interaction terms, each representing a unique pairing from the four independent variables, were individually calculated. S-FMR was negatively associated with the SCR of deciduous tooth extractions and DMFT (coefficient = -0.11, 95% CI -0.20; -0.01 and coefficient = -0.003, 95% CI -0.005; -0.001, respectively). No co-payment until children enter elementary school was positively associated with the SCR of deciduous tooth extraction compared to co-payment until children enter elementary school(coefficient = 11.42, 95% CI 3.29; 19.55). SCR of dental sealants was positively associated with the SCR of deciduous tooth extractions (coefficient = 0.12, 95% CI 0.06; 0.19) but negatively associated with DMFT (coefficient = -0.001, 95% CI -0.003; -0.0001). Per capita prefectural income was positively associated with the SCR of deciduous tooth extractions(coefficient = 0.01, 95% CI 0.001; 0.02). No interaction was found between S-FMR and the subsidy policy at both outcomes. High S-FMR utilization and no co-payment until children enter elementary school were associated with fewer deciduous tooth extractions. Also, S-FMR and dental sealant were associated with decreased DMFT.

Marginalized zero-inflated Poisson models with missing covariates.

Unlike zero-inflated Poisson regression, marginalized zero-inflated Poisson (MZIP) models for counts with excess zeros provide estimates with direct interpretations for the overall effects of covariates on the marginal mean. In the presence of missing covariates, MZIP and many other count data models are ordinarily fitted using complete case analysis methods due to lack of appropriate statistical methods and software. This article presents an estimation method for MZIP models with missing covariates. The method, which is applicable to other missing data problems, is illustrated and compared with complete case analysis by using simulations and dental data on the caries preventive effects of a school-based fluoride mouthrinse program.

小学校におけるフッ化物洗口が中学生の永久歯う蝕経験歯面数(DMFS)に与える影響

小学校におけるフッ化物洗口が中学生の永久歯う蝕経験歯面数(DMFS)に与える影響

日本における集団応用でのフッ化物洗口に関する実態調査 : 「健康日本21」における2005年中間評価に向けて

日本における集団応用でのフッ化物洗口に関する実態調査 : 「健康日本21」における2005年中間評価に向けて

School-Based Fluoride Mouth-Rinse Program Dissemination Associated With Decreasing Dental Caries Inequalities Between Japanese Prefectures: An Ecological Study

BackgroundDental caries inequalities still severely burden individuals’ and society’s health, even in countries where fluoride toothpastes are widely used and the incidence of dental caries has been decreasing. School-based fluoride mouth-rinse (S-FMR) programs, a population strategy for dental caries prevention, might decrease dental caries inequalities. This study investigated the association between S-FMR and decreasing dental caries prevalence and caries-related inequalities in 12-year-olds by Japanese prefecture.MethodsWe conducted an ecological study using multi-year prefecture-level aggregated data of children born between 1994 and 2000 in all 47 Japanese prefectures. Using two-level linear regression analyses (birth year nested within prefecture), the association between S-FMR utilization in each prefecture and 12-year-olds’ decayed, missing, or filled permanent teeth (DMFT), which indicates dental caries experience in their permanent teeth, were examined. Variables that could explain DMFT inequalities between prefectures, such as dental caries experience at age 3 years, dentist density, and prefectural socioeconomic circumstances, were also considered.ResultsHigh S-FMR utilization was significantly associated with low DMFT at age 12 (coefficient −0.011; 95% confidence interval, −0.018 to −0.005). S-FMR utilization explained 25.2% of the DMFT variance between prefectures after considering other variables. Interaction between S-FMR and dental caries experience at age 3 years showed that S-FMR was significantly more effective in prefectures where the 3-year-olds had high levels of dental caries experience.ConclusionsS-FMR, administered to children of all socioeconomic statuses, was associated with lower DMFT. Utilization of S-FMR reduced dental caries inequalities via proportionate universalism.

Marginalized zero-inflated negative binomial regression with application to dental caries.

The zero-inflated negative binomial regression model (ZINB) is often employed in diverse fields such as dentistry, health care utilization, highway safety, and medicine to examine relationships between exposures of interest and overdispersed count outcomes exhibiting many zeros. The regression coefficients of ZINB have latent class interpretations for a susceptible subpopulation at risk for the disease/condition under study with counts generated from a negative binomial distribution and for a non-susceptible subpopulation that provides only zero counts. The ZINB parameters, however, are not well-suited for estimating overall exposure effects, specifically, in quantifying the effect of an explanatory variable in the overall mixture population. In this paper, a marginalized zero-inflated negative binomial regression (MZINB) model for independent responses is proposed to model the population marginal mean count directly, providing straightforward inference for overall exposure effects based on maximum likelihood estimation. Through simulation studies, the finite sample performance of MZINB is compared with marginalized zero-inflated Poisson, Poisson, and negative binomial regression. The MZINB model is applied in the evaluation of a school-based fluoride mouthrinse program on dental caries in 677 children.

Effect of School-Based Fluoride Mouth Rinsing Program in a Socially Deprived Community

Purpose: The objective of this study was to evaluate the caries prevention effect of school-based fluoride mouth rinsing (FMR) program implemented in the Hanuul district of Mongolia, which has a very low socioeconomic status and extremely poor infrastructure for oral health. Materials and Methods: One hundred and seventy children aged from 6 to 8 years of the FMR school and 187 children aged from 6 to 8 years of the control school completed the baseline survey. Children from the FMR school rinsed with 0.05% sodium fluoride everyday under supervision, while those from the control school did not. Adjusted caries preventive fraction (CPF) for 2 years were calculated to evaluate the effect of the FMR program. Result: After 2 years, 288 schoolchildren remained in the study. Decayed, missing or filled permanent teeth (DMFT) and index of the FMR and the control schools at baseline were 0.11 and 0.12, respectively, and the average DMFT increment of the FMR and the control schools after 2 years were 0.35 and 0.65, respectively. The adjusted CPF of DMFT was 48.5%. Conclusion: These findings show that a school-based FMR is an effective caries preventive program in a socially deprived community with poor infrastructure for oral health.

Effect of school-based fluoride mouth-rinsing on dental caries incidence among schoolchildren in the Kingdom of Tonga

Since 1998, the authors have been working to improve the oral health of children at kindergartens and primary schools in the Kingdom of Tonga (Tonga). Our primary activity has been a school-based fluoride mouth-rinsing (FMR) program. FMR is performed using 7-10 mL of a 0.2% NaF solution for 1 min once per week at each school. In the present study, we evaluated the effect of school-based FMR on dental caries incidence among Tongan schoolchildren. A total of 109 children aged 10 years were evaluated at six primary schools on Tongatapu Island. The FMR group comprised 46 children who had participated in the school-based FMR program for at least 5 years 6 months; the control group comprised 63 children who had participated in the school-based FMR program for 1 year or less. During standardized dental examinations, decayed, missing, and filled teeth were counted by a single dentist at each school. The school-based FMR program effectively decreased the number of dental caries. A school-based FMR program may thus be very beneficial in preventing caries among children in Tonga.

Effectiveness of a School-based Fluoride Mouthrinse Program

The aims of this study were to estimate the caries-preventive effects of a school-based weekly fluoride mouthrinse (FMR) program and to determine whether its effectiveness varied by school-level caries risk. We used clinical and parent-reported data for 1,363 children in grades 1 through 5 from a probability sample of North Carolina (NC) schoolchildren. Children’s caries experience was measured using decayed and filled primary (d2,3fs) and total (d2,3fs+D2,3MFS) tooth surfaces. Program participation was quantified using ‘FMR years’. To estimate caries risk at program entry, children were matched with NC kindergarten-surveillance data representing school-level mean untreated decay (low-risk school: < 1 and high-risk school: ≥ 1 untreated carious teeth). Mean d2,3fs was 4.1 [95% confidence limits (CL) = 3.7, 4.5]. Overall, each ‘FMR year’ was associated with weak reduction of caries prevalence in the primary [prevalence ratio (PR) = 0.98; 95% CL = 0.90, 1.06] and the mixed dentition (PR = 0.98; 95% CL = 0.91, 1.05). We found a trend toward a larger caries-preventive benefit among children in high-risk schools compared with those in low-risk schools (i.e., 55% vs. 10% caries reduction for 5 to 6 yrs of FMR participation compared to none). Although this difference was not confirmed statistically, our results indicate that children in high-risk schools, as identified by school-level surveillance data, may experience substantial caries-preventive benefits from long-term FMR participation.

Long-term Caries Preventive Effects of a School-Based Fluoride Mouth Rinse Program in Adulthood

The purpose of this study was to evaluate the long-term caries preventive effects of school-based fluoride mouth rinse (FMR) program in adults aged 20 years and older. 637 mothers aged from 20 to 39 years were surveyed. Clinical examinations were carried out for subjects to obtain data on dental caries prevalence when they visited local health centers to take their children for medical and dental check-ups at 1.5- or 3-years old. We also obtained information regarding the FMR program: the duration that the subjects participated between nursery school and junior high school. When analyzing data, subjects were divided into 4 groups: FMR from nursery to junior high school group (N-JH group, n=22), FMR limited to the elementary school group (El group, n=62), FMR no-experience group (n=545), and other subjects whose FMR experience is not clear (n=8). For evaluation of the FMR program effect, multiple regression analysis was used. As independent variable, the FMR program patterns were converted into dummy data, and mean DMFT was used as dependent variable. The results of multiple regression analysis between mean DMFT and FMR program patterns showed that the N-JH group and El group were negatively associated with the mean DMFT (ß=-0.20, p<0.001 for N-JH group and ß=-0.11, p=0.003 for El group).The positive caries preventive effects of school-based FMR program from nursery school to junior high school can continue in adults aged 20 years and older.

Economic Evaluation of a School-based Combined Program with a Targeted Pit and Fissure Sealant and Fluoride Mouth Rinse in Japan

Background:In Niigata prefecture, Japan, a system has been developed based on a school-based fluoride mouth rinse program as follows; students with caries susceptible teeth are screened in a school dental examination, and encouraged to receive sealant placement in local dental clinics. However, the cost-effectiveness of sealant application in the public health has been questioned. The aim of this study was to estimate of the cost-effectiveness and cost-benefit ratio for a school-based combined program with fluoride mouth rinse and targeted fissure sealant in children residing in non-fluoridated areas in Japan.Participants:The analysis was based on comparing an intervention group with two cohorts in the 8-year-old (n=66) and 11-year-old (n=58) participating in the combined program for four and seven years, respectively, with a control group of the same grades (n=43 and n=54 respectively). Methods:The study measured mean differences in number of decayed and filled teeth (DFT) between the study groups and a combined program cost per child during study periods. The cost-effectiveness ratio was expressed as an individual annual program cost per DFT averted. In the cost-benefit ratio the mean difference in treatment cost between groups (program benefit) was compared to program cost. Results:The mean reduced DFT differences between groups were 1.44 in 8-year-old and 3.17 in 11-year-old children. The cost-effectiveness ratio was ¥ 493 in the 8-year-old and ¥ 202 in the 11-year-old, respectively. The cost-benefit ratio was 1.84 in 8-year-old children and 2.42 in 11-year-old. Conclusion:This combined program indicated acceptable cost-effectiveness and cost –benefit ratio.

日本における集団応用でのフッ化物洗口に関する実態調査 : 施設別,都道府県別の普及状況(2008)

日本における集団応用でのフッ化物洗口に関する実態調査 : 施設別,都道府県別の普及状況(2008)

Examination of Factors Related to Participation in a School-based Fluoride Mouth Rinsing Program for Children

Examination of Factors Related to Participation in a School-based Fluoride Mouth Rinsing Program for Children

National Survey on the School-based Fluoride Mouthrinsing Program in Japan : Part 2 : Regional Spread Conditions in Various Kinds of Schools

National Survey on the School-based Fluoride Mouthrinsing Program in Japan : Part 2 : Regional Spread Conditions in Various Kinds of Schools

Preventive Effectiveness of School-based Fluoride Mouthrinsing Program in a Community in Wakayama Prefecture, Japan, in an Era of Decreased Caries Prevalence

Preventive Effectiveness of School-based Fluoride Mouthrinsing Program in a Community in Wakayama Prefecture, Japan, in an Era of Decreased Caries Prevalence

フッ化物洗口プログラム終了後のう蝕予防効果 洗口経験年数による比較

The purpose of this study was to evaluate the effects of a fluoride mouth-rinsing program (FMR) on dental health after the FMR program was completed. The state of dental health, including caries prevalence, was examined under blind recording conditions concerning participation in the FMR for 11th grade students in 10 public high schools, from 11 municipalities in Niigata Prefecture. The procedures of the FMR were carried out in these areas weekly, with 0.2% NaF, or daily, with 0.05% NaF, supervised by the classroom teachers in each school. The subjects, 321 in total, were classified into 3 rinse groups, each of which participated in the FMR for different periods of time, and a control group. The results of the statistical analysis showed increasing benefits in relation to increasing periods of participation. The reduction rate of caries prevention was the highest in the F11-group, subjects who participated in the program for 11 years from 4 to 14years of age. The F11-group was 56.0% lower in the mean DMFT and 81.8% lower in the mean number of highly progressed carious teeth than the control group, with statistical significance in both cases. The percentage of students who had toothaches or who were absent from school in order to visit a dentist was lower in the rinse groups than in the control group. We conclude that, in countries such as in Japan where caries prevalence is relatively high, a school-based FMR program throughout the school years is profoundly effective in preventing the occurrence and the progression of caries, and it could be the foundation of lifelong dental health care.

Evaluation of a school‐based fluoride mouthrinsing and clinic‐based sealant program on a non‐fluoridated island

For many years the children of Guam have experienced a high prevalence of dental caries. Surveys conducted on the fluoride-deficient island found that caries levels were double those of US mainland children. In 1976 a school-based fluoride mouthrinse program was initiated involving over 22,000 children in grades kindergarten through eight in weekly rinses with 0.2% neutral NaF. A clinic-based dental pit and fissure sealant program was added in 1984 to the fluoride mouthrinse program. Over 15,000 children participated annually in the sealant program where more than 75,000 teeth were sealed the first year. After 8 yr of fluoride mouthrinsing (1976-1984) mean DMFS scores were 1.79 surfaces per child lower compared to baseline, a decrease of 0.22 DMFS per child per year. During this period proximal DMFS scores decreased 61%, buccal-lingual surfaces 31%, and occlusal surfaces 7%. After 2 yr of fluoride mouthrinsing and sealant application combined overall DMFS scores decreased an additional 2.34 surfaces per child, a reduction of 1.17 DMFS per child per year. Most of this decline took place on pit and fissure surfaces. For the 10-yr period a reduction of 4.13 DMFS per child was seen--a decline from 7.06 DMF at baseline to 2.93 DMF surfaces per child in 1986. This long-term evaluation indicates that dental sealants when used in combination with fluoride mouthrinse were particularly effective in lowering the prevalence of dental caries. Schoolchildren in participating grades on Guam now have dental caries rates close to those of US schoolchildren.

Posttreatment benefits from participation in a school-based fluoride mouthrinsing program: results after up to 7 years of rinsing.

The caries prevalence of 7th- to 9th-grade junior high school students (approximate age 12–15 years) who had previously participated in a weekly 0.2% neutral NaF mouthrinsing program as elementary school children was compared with that of similarly aged children from the same schools who were examined before the mouthrinsing program began. After participation in the program for 5–7 years, the mean DMFS score for children in these grades had decreased from 7.37 to 3.89, a reduction of 47.2%. The greatest reduction, 78.9%, occurred in proximal surfaces. The inception of an effect only after the program was instituted, the dose-related response, and the specificity of the response to treatment support the conclusion that a posttreatment fluoride effect is responsible for the declining caries prevalence.

Attitudes of school personnel and parents toward a school-based fluoride mouthrinse program.

A study was conducted to assess the attitudes of school personnel and parents toward a school-based fluoride mouthrinse (FMR) program. The responses were obtained by administering a questionnaire to school personnel and parents of an urban school system. The responses of the school personnel indicate that they support the FMR program as it is currently structured; they perceive that the program does not interfere with the education of the students and they have willingly participated in the program. The school personnel do not oppose governmental participation in such a program, but they believe that parents should be responsible for their children's oral health. Parents are supportive of the FMR program as a means of preventing dental problems and improving children's oral health. The parents do not object to governmental involvement and funding of the program. They do not perceive the cost of operating the program as excessive in relation to the expected benefits.

Supervised weekly rinsing with a 0.2 percent neutral NaF solution: final results of a demonstration program after six school years.

The results of a school-based fluoride mouthrinsing program in the elementary schools of a Long Island, New York community (F less than or equal to 0.1 ppm) was described. Children enrolled in this continuing program rinse once a week for 60 seconds with a 0.2 percent neutral NaF solution. Kindergarteners rinse with 5.0 ml.; children in the first through sixth grade rinse with 10 ml. Program personnel mix and distribute the rinse to the classrooms. Rinsing is supervised by homeroom teachers. A random sample of 125 children from each grade level (approximately 750 children) annually receive visual-tactile caries examinations from the same examiner. Mean caries prevalence scores after participation in the rinsing program are compared to the caries prevalence of children that were examined in 1975, before the program began. There has been 170 scheduled rinse sessions during six years. By the sixth-year examinations, first graders rinsed for one year (as kindergarteners), second graders for two years, etc. All children who were examined began participation in the program as kindergarteners. The findings after six years of the rinsing program included: 1. There was a 54.1 percent reduction in the mean DMFT caries prevalence score and a 55.2 percent reduction in the mean DMFS score. 2. The greatest percentage caries reduction, 68.8 percent, occurred for proximal surfaces, and the greatest absolute reduction occurred for occlusal surfaces. 3. The percentage of children with a caries-free permanent dentition increased from 43.5 percent to 66.3 percent. Of those children with caries, more were in the low caries category (DMFS = 1-4) compared to children who were examined before the rinsing program began.