Programmes of
Oral Health
Oral health programmes
Aim of each oral health programme is prevention of dental caries and that of
periodontium - fig. 3,4.
Collective programmes – training of tooth brushing and fluoridation (rinses)
in schools
There is no programme of that character in Czech republic –only educative
Educative programmes-information, demonstration
Individual programme – is offerred to the child in the dental surgery
Ways of child examination: fig. 5, 17
Possibilities of tooth brushing. fig. 6,7
Early childhood caries (ECC) fig. 8-12 – Result of inproper attitude of mother:
no oral hygiene, – teeth covered by the dental plaque, frequent sugar intake,
no fluoridation
Tooth brushing training in the dental surgery: fig. 18-20
Table 9-VIII. Information on dental diseases including dietary counselling.
Age group Method
Pregnancy Maternity welfare center information on rearing of the new-born child
6-10 months Child health center information on dietary habits (sweetened beverages)
fluoride tablets and pacifiers
15-18 months Child health center information on dietary habits, fluoride tablets and oral
hygiene
3-6 years Information to parents and child in connection with yearly dental treatment,
informative and motivating lecture at pre-school
7-16 years Motivating lecture at school every year and individual information in
connection with early dental treatment
Table 9-IX. Plaque control
Age group Method
6-10 months Child health center information on the start of regular toothbrushing at the
age of 12 months. Instruction in toothbrushing
18 months Demonstration of toothbrushing
3-6 years Demonstration of plaque to parents by use of disclosing solution yearly at
regular treatment. Instruction in toothbrushing
7-16 years Use of disclosing solution and training in toothbrushing twice a year at the
dental clinic or in groups at school. Occasional instruction in flossing for
proximal cleaning
Table 9-X. Fluoride program
Age group Method
0-6 years Recommendation to use supplementary fluoride tablets. Fluoride
dentifrice from the age of 4 years. Topical application at regular,
yearly visits to the dental care clinic from the age of 3 years.
7-16 years Collective mouthrinses every week or every second week with 0.2 per
cent sodium fluoride solution. Fluoride dentifrice. Topical application
(sodium fluoride solution or fluoride varnish) yearly at regular visits at
the dental care clinic.
Tooth brushing training
in the dental surgery
Tooth brushing twice a day
Fluor containing tooth paste, rinses, gels
• home care
• care in the dental surgery
Fluoridation in the surgery, gel in the tray
Fluoridation in surgery
Table 9-XV. Preventive dental care program
Intended for Activities Dental care personnel and time
required
Mothers of
newborn babies in
maternal health
care center
In the maternity welfare center the mother is
informed on diet, use of pacifiers etc. If this
information cannot be given in the maternity ward it
may be given in the antenatal clinic etc.
Information is given by dentist,
dental hygienist or preventive
dentistry assistant. Time: about 45-
60 min per session and group
Mothers of 6- and
18-months-old
babies at the child
health center
Child and parents are invited to the dentist in
connection with the medical examinations at the
child health center. The dentist informs on diet, oral
hygiene and fluorides. The child receives a
toothbrush free of charge at the 18-month
examination
If required these tasks can be
delegated to a dental hygienist or a
preventive dentistry assistant, then
in close co-operation with the dentist
connected to the child health centre.
Time:15 min per child
Table 9-XV. Preventive dental care program
Intended for Activities Dental care
personnel and time
required
Children at parttime
preschools
(2-6 years of age)
The preventive dentistry assistant gets in touch with the
preschool and the parents are informed by means of a
pamphlet about the extent of the preventive dental care
activities in the preschool personnel are informed that the
preventive dental care personnel are pleased to take part in
parent-teacher meetings. The assistant tries to activate
children and personnel in accordance with Birns model which
means group activities in visualization teeth, dental decay,
prevention etc. To motivate the personnel at the preschool they
are offered oral hygiene procedures by the dental assistants.
The assistant visits the preschool 4times/year. At each visit a
„lecture“(play) on preventive dental care is given modified to
the age of the children. Individual toothbrushing instructions
are given monitored by disclosing solutions. At most
preschools the personnel daily helps the children to practice
toothbrushing
Preventive dentistry
assistant Time:45
min.2 hours per
session
Table 9-XV. Preventive dental care program
Intended for Activities Dental care
personnel and time
required
Parents and children
3years of age (first
appointment with the
Public Dental Service)
The parents and child are invited to a preventive dentistry
assistant 3-4 weeks before the first regular visit to the dentist.
The assistant motivates and informs the parents by means of
slides, models and pamphlets. In the meantime the child is
given informative material to play with. Then the childs teeth
are painted with a disclosing solution and the assistant shows
the plaque and gives instructions on how to brush the teeth
properly. If the child refuses disclosing and toothbrushing
he/she is called again 3 months later. All children are treated
with fluoride varnish either at the informative session or in
connection with the visit to the dentist
Preventive dentistryassistant.
Time:30-45
min per child
Parents and children
4-5 years of age (2nd
and 3rd appointment
with the Public Dental
Service)
These children receive information about dental health care at
the yearly appointments with the dentist. Children at risk are
to be referred to a preventive dentistry assistant for further
information and instructions
Dentist, preventive
dentistry assistant
Table 9-XV. Preventive dental care program
Intended for Activities Dental care personnel
and time required
Schoolchildren and
adolescents aged 7-16
years: Basic program
Mouthrinsing once per week with 0,2 NaF solution is
performed as a basic fluoride program throughout the
whole school period. In addition, all children should be
treated with fluoride varnish at the yearly check-ups at
the dentist. Parents of children who are about to start
their first year at school are informed by personnel in
preventive dental care at the parent-teacher meeting
before school starts. The parents are encouraged to
continue to give the children fluoride tablets untill they
are 12 years old. If further information on oral disease
prevention is required the preventive care personnel
are pleased to help. Such information should
preferably be given at parent-teacher meetings in the
third class.
Preventive dentistry
assistant
Table 9-XV. Preventive dental care program
Intended for Activities Dental care personnel
and time required
Children 7 years of age
(first class)
At the beginning of the autumn term the preventive
dentistry assistant and her helper visit school to inform
about fluoride mounthrinsing. Children and parents are
invited to the clinic and preventive dentistry assistant
for information and instruction in
toothbrushing(preferably in connection with dental
examination). The preventive dentistry assistant visits
school once during the spring term to inform about the
toothbrushing session which are to start. Then there is
at least one session of practice with disclosing solution
and toothbrushing in front of a mirror. This session is
also intended to be a check-up of the effect of previous
preventive activities. If necessary, child and parent are
invited to see the assistant for further information and
instruction.
Preventive dentistry
assistant with helper
Time:20 min Preventive
dentistry assistant
Time:40-60 min per
group(3-5 children) In
each class a preventive
dentistry assistant and a
prophylaxis helper work
together Time:5 min per
child per session and
about 20 min during the
joint information.
Table 9-XV. Preventive dental care program
Intended for Activities Dental care personnel
and time required
Children 8-13 years
(2nd-6th classes)
During the second year at school 6 individual
toothbrushing session are held including use of disclosing,
instruction and brushing in front of a mirror. When
necessary, the prophylaxis assistant may visit the class
another 1-2 times. On the other hand, she may decide to
decrease the frequency of session in a well motivated and
competent class. One preventive dentistry assistant and
one helper or two prophylaxis helpers work together. At
one session per year the assistant gives lecture on
preventive dental care to the whole class(20-40 min)
Preventive dentistry
assistant with helper
Time: 5 min per child and
session
Adolescents aged
14-16 years (7th-9th
classes)
The preventive dentistry assistant visits the classes once
per year and gives a lecture on preventive dental care. The
dentist uses disclosing solution and fluoride varnish in
connection with yearly examinations. The school pupil is
then called after ½ year to the prophylaxis assistant of the
clinic for information, toothbrushing instruction and fluoride
varnish treatment
Preventive dentistry
assistant Time: 20 min
per class Dentist,
preventive dentistry
assistant Time: 20-30 min
per pupil
Table 9-XV. Preventive dental care program
Intended for Activities Dental care personnel
and time required
Children and
adolescents 0-16 years
of age. Individualized
additional program
To children and adolescents in need of special
prophylactic measures an individually modified
program is applied in addition to the basic program.
The additional program includes activities that are
considered appropriate for the individual situation
Dentist, dental hygienist
and assistant in
preventive dentistry
 Dental caries
 Differences between children
 10 – 20% - high caries prevalence
 Basic programme
 to 80 – 90% of children
 Additional programme
 to 10 – 20% of children
 Not suitable for all children – too expensive
In addition to collective programmes – individual programme for
every child
Basic programme intended for 80-90% of
children
 Cooperation
 gynecology
 pediatrics
 nurses
 pedagogists
 parents
 Coordination
 dentists
 (specialists in
pedodontics)
Table 9-XII. Clinical criteria which might indicate
application of an additional preventive program
(gingivitis=according to Gingival Bleeding Index system)
Age group Clinical finding
0-2 years Carious lesions, gingivitis
3 years Several manifest carious teeth, extensive initial carious lesions, gingivitis around
several teeth
4-5 years More than 2 new proximal manifest carious lesions in molars, new manifest
carious lesions on buccal and lingual surfaces, extensive new initial carious
lesions, gingivitis around several teeth
6-16 years More than 2 new proximal manifest carious lesions, extensive new initial carious
lesions, several new proximal carious lesions, gingivitis around several teeth,
pocket formation, more than 4mm, marginal bone loss
í
Fig. 35
Neglected care for oral hygiene – extremely high caries prevalence,
pronounced gingivitis
Table 9-XIII. Additional preventive program for children with high
caries activity. Each appointment requires 30-45 minutes
Appointment Procedure Comments
I Information
Salivary tests: secretion
rate and buffering capacity
Bacteriological tests:
Lactobacilli and
Streptococcus mutans
counts
Dietary and medication
history
Oral hygiene control
Oral hygiene instructions
and recommendations
Professional toothcleaning
including topical fluoride
application
Aims at presenting the reasons for performing and addiotional
preventive program and gives condensed information about etiology
and prevention of caries.
These tests are mostly used in teen-agers. Simple methods have
been developed for clinical use(Dentobuff, Orion, Diagnostica).A
secretion rate below 1ml/min and a buffering capacity measured as
titration (Ericson 1959) below pH 4,5 should be looked upon as low
and indicate high caries risk.
A simple clinical method of determining the number of Lactobacilli in
saliva has been developed(Dentocult, Orion, Diagnostica).A high
number of Lactobacilli indicates frequent consumption of
carbohydrates and the test could be used as a basis for the dietary
recommendations.
Streptococcus mutans count may be indicated in severe cases in
order to monitor the use of antibacterial agents.
24-hour recall in order to find a basis for dietary counselling(See
appointment II)
Bacterial plaque visualized with disclosing solution.
Toothbrushing training. In cases with several proximal carious
lesions in permanent teeth flossing is demonstrated.
Table 9-XIII. Additional preventive program for children with high
caries activity. Each appointment requires 30-45 minutes
Appointment Procedure Comments
II One week
later
Oral hygiene control
Dietary counselling
Audiovisual program
Professional toothcleaning
including topical fluoride
application
See appointment I
Based on the dietary habit history taken at appointment I
recommendations are given in an attempt to reduce the number of
consumptions to 5-6 per day. Special habits such as frequent intake
of sweetened beverages, extensive snack and candy consumption,
cough syrup etc. are noted and recommendations made in an effort
to change the habits.
AV-program about etiology and prevention of caries, adapted to the
age of the child is presented
III One week
later
Gingival index
Dietary habit control
Institution of intensified
fluoride program
To control the oral hygiene measures recommended. An
improvement of at least 60 is required.
From the age of about 8 years a fluoride gel program can be carried
out at home. A 0.2 per cent NaF gel applied in trays is used for 5
minutes every day for one month. As an alternative daily
mouthrinsing and in younger children toothbrushing with an 0.2 per
cent NaF solution for one month can be performed. Flossing is
performed in the permanent dentition immediately before fluoride
application.
Table 9-XIII. Additional preventive program for children with high
caries activity. Each appointment requires 30-45 minutes
Appointment Procedure Comments
IV one month
later
Evaluation
Gingival index
Dietary habit control
Oral hygiene control
Bacteriological tests
Professional toothcleaning
including topical fluoride
application
See appointment III
See appointment I
Exceptionally. Lactobacilli test may be used to control the change of
dietary habits.
Fluoride varnish application
V Six months
later
Follow-up See measures, appointment IV
Table 9-XIV Additional preventive progam for children with extensive
gingival inflammation. Each appointment requires about 30 minutes
Appoint
ment
Procedure Comments
I Information
Gingival index: according
to gingival bleeding index
system
Oral hygiene control
Oral hygiene instructions
and recommendations
Professional
toothcleaning
Aims at presenting the reasons for performing an additional
preventive program and gives condensed information about the
etiology and prevention of gingivitis.
Bacterial plaque visualized with disclosing solution
Toothbrushing training including interproximal cleaning
II One
week
later
Oral hygiene control and
reinstruction
Audiovisual program
Professional
toothcleaning
See appointment I
AV-program about etiology and prevention of gingivitis
Table 9-XIV Additional preventive progam for children with extensive
gingival inflammation. Each appointment requires about 30 minutes
Appoint
ment
Procedure Comments
III One
week
later
Gingival index
Oral hygiene control
Professional
toothcleaning
An improvement of at least 60 per cent should have been
achieved. If not, a daily gel, toothbrushing or mouthrinsing
program with a 0.1 per cent chlorhexidine preparation could be
instituted during the following month.
See appointment I
IV one
month
later
Evaluation
Gingival index
Oral hygiene control
Professional
toothcleaning
Now an improvement of more than 75 per cent should have
been achieved compared with appointment I.
See appointment I
V Two
months
later
Follow-up See measures, appointment IV