Answer these questions based on the case below. Preventing dental caries in Jama

Question

Answer these questions based on the case below.

Preventing dental caries in Jamaica.

http://www.cgdev.org/page/case-18-preventing-dental-caries-jamaica

In order to evaluate the effects of salt fluoridation, an oral health survey was launched in 1995 to compare the caries scores with those observed in 1984. Thirty nine schools out of 800 were randomly selected and a total of 1113 children who were 6 to 15 years old were examined. Two dentists and 7 auxiliaries were calibrated as examiners and 9 dental assistants as recorders, in a 2-day training workshop. Data was collected according to the WHO Oral Health Surveys Manual.

Questions:

1. Are dental carries and dental health a global public health issue? Should dental health be a priority?

2. If you were health minister in Ethiopia, what proportion of your annual budget would you spend on dental health? What would you do?

3. What are the economic and social consequences of dental caries? Why might Jamaican children have particularly high prevalence of dental problems (before the salt fortification)?

4. Why was water fluoridation not the right approach in Jamaica, as it is in the United States? What would have been the consequences had the authorities chosen to fluoridate the water? Consider how improvements would have been seen only among children with access to publicly provided water—typically from wealthier families.

5. What are the arguments against community-level fortification interventions such as salt fluoridation? Do you agree or disagree with those arguments? What do you think it would take to convince those who believe that fluoridation of water or salt is a bad idea?

Explanation / Answer

1. Yes dental caries and dental health is a global public issue.

Dental caries, or tooth decay, is one of the most common chronic health problems of children. Untreated caries is painful and may affect diet, school attendance, and sleep. Tooth decay can have significant negative health and social consequences in later life.

2. If I were the health minister of Ethiopia, I would spend the estimated amount of budget( approx. $3000) for dental health programme. As per estimates, salt fluoridation in Jamaica costs around 6 cents per person annually. This is an even lower cost than water fluoridation, which may cost up to 90 cents per person per year, depending on the size of the community. In treatment costs alone, the return on investment in salt fluoridation is substantial, leaving aside any less easily measured benefits such as reduced absence from school or improved health in later life. It is estimated that for each $1 spent on salt fluoridation in Latin America and the Caribbean, about $250 will be saved in reducing the need for future dental treatment. This makes fluoridation of salt one of the most cost-effective interventions known to modern public health.

3.  Poor oral health can add significantly to the disadvantages a child faces, in terms of both personal health and life chances. Untreated caries is painful and may affect diet, school attendance, and sleep. Unresolved oral health problems can affect a child’s speech and language, as well as appearance, self-image, and even social functioning. Poor oral health can be lifelong and span many generations. Impaired eating habits and persistent oral infections can continue into adulthood and contribute to overall health. In fact, one study found that pregnant women with periodontal disease are seven times more likely to deliver a preterm or low birth weight baby, controlling for other factors.In short, although dental caries rarely makes it to the top of the health priority list, it merits attention as an important determinant of both child and adult health. In many populations, a disadvantaged minority of children suffer a much higher burden of caries than their more affluent peers and also are less likely to have received treatment. In the United States, for example, almost 37 percent of children aged 2 to 9 years living below the poverty level have at least one untreated carious tooth, compared with 17.3 percent of nonpoor children in this age group. A similar pattern is evident in other countries.

4. Water fluoridation is effective only if the water supply system is regulated and the majority of inhabitants have access to the piped water system. In the 1960s and early 1970s, a community trial of salt fluoridation was conducted in Colombia, supported by PAHO and the US National Institutes of Health. Two communities receiving fluoridated salt—fluoridated at the rate of 200 mg of fluoride per kilogram—experienced reductions of nearly 50 percent in dental caries, compared with no reduction in a third community that served as a control, and compared with a 60 percent reduction in a fourth community that received fluoridated water. Thus, while slightly less efficient than water fluoridation, salt fluoridation was shown to be highly beneficial. Because the introduction of fluoridated salt in Jamaica was a national-level community intervention, it is impossible to be certain that the fluoridated salt alone achieved the reduction in dental caries. Communities elsewhere in the world without access to fluoridated water or salt have also seen some modest reduction in dental caries in recent decades, usually attributed to the introduction of fluoride-containing toothpastes.

5. I think salt flouridation is cost effective and best intervention in Jamaica. It could prevent dental caries in community level with much less cost. Through its impact on the health and well-being of children from low-income households, and the demonstration effect that influenced other countries in the region, the Jamaican salt fluoridation program shows how much can be achieved with focused attention and creative problem solving.

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