Professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries: Systematic review

OBJECTIVES

This systematic review aimed to review the safety and effectiveness of professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries (LMICs).

METHODS

Randomized controlled trials conducted in LMICs, in which professionally applied fluorides were compared with placebo/no treatment/health education only or usual care with a minimum one-year follow-up period, were included. Any topically applied fluoride agents such as sodium fluoride (NaF), acidulated phosphate fluoride, silver diamine fluoride (SDF), and nano silver fluoride (NSF) were included. Five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) were searched in May 2022. Meta-analysis was conducted using a random effect model.

RESULTS

This review included 33 studies for qualitative synthesis, encompassing 16,375 children aged between 1.5 and 14 years. Nevertheless, the meta-analysis focused on only 17 studies, involving 4067 children. Fourteen papers assessed potential adverse events, none of which was reported as major adverse events. SDF and NSF were identified as effective in arresting caries on primary teeth (p < 0.05) compared with a placebo or no treatment. Fluoride varnish and gel were identified as effective in reducing new caries development on primary teeth (p < 0.05) but not on permanent teeth (p > 0.05). The certainty of the generated evidence obtained is low.

CONCLUSION

The review provides valuable insights into the use of professionally applied fluorides in LMICs and contributes to recommendations for their use. However, the limited rigorous evidence suggests the need for further research to strengthen these findings and draw more robust conclusions.

Tobacco chewing and associated factors among a vulnerable youth population in Sri Lanka

BACKGROUND

Tobacco in any form kills millions of people every year. Tobacco addiction among youth shows an increasing trend while smokeless type is becoming more common. This study aimed to describe the lifestyle of chewing smokeless tobacco among a group of high-risk youth population in Sri Lanka.

METHODS

A descriptive cross-sectional study was conducted among a sample of 1431 youths aged between 15 to 24 years residing in urban slums in Colombo Sri Lanka, using a cluster sampling technique combined with probability proportionate to size technique. Data were collected using an interviewer-administered questionnaire. Chewing smokeless tobacco was assessed using betel quid chewing and commercially prepared tobacco and areca nut packet chewing. Current chewer was defined as who had the practice of chewing during past 30 days.

RESULTS

The mean age of the study sample was 17.53 (95% CI: 17.40-17.65). Of the 1431 respondents, 57% were males and 43% were females. The prevalence of current smokeless tobacco chewers was 44.9% and among them 90.8% were males and 9.8% were females. Around 31.3% did not have smokeless tobacco chewing practice (Male-5.9%, Female-64.9%). Among the current smokeless tobacco chewers 21.5% chew both types of smokeless tobacco products and all of them were males. Male gender (OR 17.9; 11.4 -27.9) and ever smoking lifestyle (OR 4.4; 2.9-6.6) were significant determinants of current smokeless tobacco chewing lifestyle.

CONCLUSION AND RECOMMENDATIONS

The study shows a high prevalence of smokeless tobacco use by youth aged between 15 to 24 years who were residing in urban slum areas in the district of Colombo, in Sri Lanka, highlighting this target group for early intervention to reduce the uptake and promote the quitting of this practice.

Preschool teachers as agents of oral health promotion: an intervention study in Sri Lanka

BACKGROUND

According to National Oral Health Survey reports and research, Early Childhood Caries has been identified as a serious public health problem in Sri Lanka. More than 65% of preschool-aged children have dental decay and only 2% of them have had treatment. With proper interventions and commitment from public health personnel and responsible community leaders this should be a largely preventable disease.

METHODS

An intervention study was conducted among preschool teachers in the District of Colombo, Sri Lanka, to assess their influence on oral health promotion in the school environment. All the available 52 preschools and all 72 teachers registered under a local government authority were involved in the study. Preschools were divided into intervention group and control group based on geographically defined areas. The intervention included training preschool teachers using a manual covering health education, health promotion, incorporation of oral-health-friendly activities into the preschool curriculum, and hands-on experience of oral examination. Pre- and post- assessments were conducted with a 6 month interval.

RESULTS

After 6 months, the median oral health knowledge score of the intervention group improved from 55 to 72 (p = 0.005) and the mean score for oral health related practices from 32 to 35 (p = 0.032). The variables: oral-health-friendly preschool environment (p = 0.02), availability of brushing facilities (p = 0.005) and availability of information, education and communication materials related to oral health (p = 0.004) were significantly different between the two groups after 6 months.

CONCLUSION

Oral health promotion activities can be effectively instilled in a pre-school environment by the education of teachers.