Oral health status of children in the Philippines
A recent National Oral Health Survey (Department of Education, Health and Nutrition Center 2008)1 showed that 97% of Grade I students (6 ± 1 year) and 82% of Grade VI students (12 ± 1 year) surveyed suffered from tooth decay. The Grade I / Grade VI students had an average of 9 / 3 decayed teeth; 40% / 41% of the decayed teeth had progressed into decay with pulpal involvement caries (Monse et al. 2009).2

The prevalence of Grades I and VI students with pulpally involved teeth (i.e., odontogenic infections) was 85% and 56%, respectively (Monse et al. 2009).3 Odontogenic infections in Grade I and VI students in the Philippines are associated with low body-mass index (Department of Education 2008).4 Chronic inflammation from odontogenic infection may affect metabolic pathways leading to anemia (Means 2003).5

A total of 20% of the Grade I students and 16% of the Grade VI students reported having toothaches during the examination for the National Oral Health Survey. Toothaches negatively impact food intake because eating is painful (Acs et al. 1999).6 They also have an effect on sleep and quality of life (Low et al. 1999).7 Toothaches are a major cause of school absenteeism in the Philippines (Araojo 2003).8

International policies
The World Health Organization (WHO) and the FDI World Dental Federation clearly state that: (1) prevention of tooth decay by using fluoride is the most realistic way of reducing the burden of tooth decay in populations; (2) fluoride toothpaste remains the most widespread and significant form of fluoride used globally and the most rigorously evaluated vehicle for fluoride use; (3) fluoride toothpaste is safe to use; and (4) promoting the use of effective fluoride toothpaste twice a day is strongly recommended (World Health Organization, Beijing Declaration 2007).9

A resolution on oral health, adopted by the 60th World Health Assembly of WHO in 2007, urges governments “to promote oral health in schools, aiming at developing healthy lifestyles and self care practices in children” (WHO 2007).10 By implementing the above international recommendations, substantial return in terms of reduced morbidity, improved growth, and improved educational outcomes can be achieved (WHO 2006).11

Evidence for Intervention
A Cochrane review has confirmed the anti-caries efficacy of daily use of fluoride toothpaste (Marinho et al. 2003).12 A two-year school-based fluoride-toothbrushing program in high-risk school children in Scotland showed a reduction in caries increment of 56% (Curnow et al. 2002).13 Long-lasting effects were evidenced by the fact that a 39% reduction in caries increment was still observed four years after the termination of program (Pine et al. 2007).14 In Indonesia, a three-year school-based fluoride-toothbrushing program resulted in up to 40% reductions in caries for different age groups (Adyatmaka et al. 1998).15 In the Philippines, daily school-based fluoride toothbrushing in pilot school studies have resulted in 40% caries reduction and in 60% reduction of caries progression into the pulp (Monse, unpublished data 2009).16

References

    1. Department of Education, Health and Nutrition Center. 2008. National Oral Health Survey 2006. Manila, Philippines.
    2. Monse, B., Heinrich-Weltzien, R., Benzian, H. et al. 2009. PUFA – An index of clinical consequences of untreated dental caries. Community Dent Oral Epidemiol.
    3. Ibid.
    4. Department of Education, Health and Nutrition Center. 2008.
    5. Means, R. T. 2003. Recent developments in the anemia of chronic disease. Curr Hematol Rep 2003; 2(2):116–21.
    6. Acs, G., Shulmann, R., Ng, M. W. et al. 1999. The effect of dental rehabilitation on the body weight of children with early childhood caries. Pediatr Dent 1999; 21(2):109–113.
    7. Low, W., Tan, S., Schwartz, S. 1999. The effect of severe caries on the quality of life in young children. Pediatr Dent 1999; 21(6):325–326.
    8. Araojo, J. R. 2003. Philippine Country Report on School Health Promotion Programme. 2nd Asian Conference on Oral Health Promotion for School Children: Prospectus for our Future Generation; 2003; Thammasat University, Ayyuthaya, Thailand. p. 103–110.
    9. World Health Organization. Beijing Declaration. Call to Action to Promote Oral Health by Using Fluoride in China and Southeast Asia. [Internet] [2007]. Available from: http://www.who.int/oral_health/events/oral%20healthc.pdf
    10. World Health Organization. Oral Health: Action Plan for Promotion and Integrated Disease Prevention. Report by the Secretariat. Document A60/16. [Internet] [2007]. Available from: http://www.who.int/gb/ebwha/pdf_files/WHA60/A60_16-en.pdf
    11. World Health Organization. 2006. Preventive Chemotherapy in Human Helminthiasis. Coordinated use of Anti-Helminthic Drugs in Control Interventions – Guidelines for Health Professionals and Program Managers. WHO; Geneva, Switzerland; 2006. p. 62.
    12. Marinho, V. C. C., Higgins, J. P. T., Logan, S. et al. 2003. Fluoride gels for preventing dental caries in children and adolescents (Cochrane Review). In: The Cochrane Library, Issue 3.
    13. Curnow, M. M. T., Pine, C. M., Burnside, G. et al. 2002. A randomised controlled trial of the efficacy of supervised toothbrushing in high-caries-risk children. Caries Res 2002; 36(4):294–300.
    14. Pine, C. M., Curnow, M. M. T., Burnside, G. et al. 2007. Caries Prevalence Four Years after the End of a Randomised Controlled Trial. Caries Res 2007; 41(6):431–436.
    15. Adyatmaka, A., Sutopo, U., Carlsson, P. et al. School-Based Primary Preventive Programme for Children: Affordable Toothpaste as a Component in Primary Oral Health Care. Experiences from a field trial in Kalimantan Barat, Indonesia. [Internet] [1998]. Available from: http://www.whocollab.od.mah.se/searo/indonesia/afford/whoafford.html
    16. Monse, B. 2009. Unpublished data.