Kose Nehan Oral Health Program KN -Aileu 6 subdistrict schools - - PowerPoint PPT Presentation

Kose Nehan Oral Health Program

KN -Aileu

• 6 subdistrict schools
• 1 part time employee
• Tooth brushing
• Health promotion
• SDF

History

✓ 2008 Friends of Aileu ✓ 2009 Situational analysis ✓ 2010 - 12 1 school (pilot) ✓ 2013 – 15 3 schools ✓ 2016 - 18 KN 6 schools ✓ 2019 - ??

Partner or Perish

✓ Loc Local

• District Administration
• District Health
• District Education

MOH Other Health Providers ADETIL

✓ Australia ian

• Donors
• Friendship groups
• Professional associations
• Organisational
• Universities
• Personal contacts

National OH Plan 2015 -20

✓ Primary health ✓ Prevention ✓ Young people ✓ School curriculum ✓ Oral health materials ✓ Fluoride toothpaste in schools ✓ Capacity building - dental nurses ✓ Capacity building - teachers ✓ Integration of oral health promotion

Kose Nehan Focus on Prevention

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Education

T

• oth Brushing

https://www.livrutimor.org/book/kose-nehan/

OH Resources

Data

✓ 2016 2016 bas baseline surv survey

• 75% 6 year dmft = 4.17
• 51% 12 year DMFT = 1.32
• Activity 84%
• Impact of nutrition?

SDF Disease Management

Silver Diamine Fluoride

✓ Colorless liquid pH 10 ✓ 38% SDF ammonia solution - 5% F, 25% Ag ✓ 40% Aqueous solution ✓ Cheap ~40c/child = 10c/tooth ✓ Primary teeth

Products

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Actions, Dose & Safety

✓ 85% 85% les esio ions s ar arrested

• Ag bacteriocidal
• F remineralises enamel & dentine
• Preserves collagen ?

✓ Dose Dose

• 1 drop/10kg child = ~4 teeth
• SDF F < 0.25 ml fluoride varnish

✓ Sa Safety

• Oral LD50 = 520mg/kg
• 1 (20uL) drop = 9.5mg F in a 10kg

child at 100% absorption = 0.95mg/kg 400 x safety margin acute toxicity

• No reported adverse effects

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Application

✓ Remove gross debris ✓ Vaseline for gingiva ✓ Isolate and dry with cotton rolls/gauze ✓ Pre dispense ✓ Microbrush ✓ Excess: gauze, cotton roll, or cotton pellet ✓ Apply SnF or KI - new brush ✓ Continue to isolate up to ???

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Build an enabling information technology platform

Contraindication

✓ Symptomatic tooth ✓ Black staining ✓ Messy on clothes desks etc ✓ ? Anteriors ✓ Protect eyes ✓ Silver allergy ✓ Gingival irritation

Use in T-L

✓ Restorative option impractical ✓ Atraumatic ✓ Cheap ✓ It works ✓ Reduce pain and suffering ✓ Powerful indirect prevention ✓ Easy ✓ Minimal training ✓ Parental acceptance ✓ Benefits far outweigh risks

✓ Prevention & early intervention ✓ Reducing risk of cancer ✓ Increase data ✓ Employment ✓ Training ✓ Codesign

Opportunities

✓ Prioritisation - prevention /pain relief ✓ Shift decision making to the community ✓ General Health

• Rheumatic fever!
• Malnutrition
• Sustainability ($) and Logistic

Challenges

2

Kose Nehan Thank you

✓ American Academy of Pediatric Dentistry 2017

The SDF panel supports the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program

✓ Journal of Dental Research 2018, Vol. 97(2) 171–178. Chu, CH et al RCT using placebo and SDF 12% 38% on 888 kindergarten children 3790 lesions 66.9% and 75.7% in 38% group over 30 mths ✓ Advances in Health Science Research, vol8 2017. Durward, C et al 2x/year application SDF effective in management of v high risk caries population

OH Resources