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 ✓ Australia Local ian • • District Administration Donors • • District Health Friendship groups • • District Education Professional associations • MOH Organisational • Other Health Providers Universities • ADETIL Personal contacts

National OH Plan 2015 -20 ✓ Primary health ✓ Fluoride toothpaste in schools ✓ Prevention ✓ Capacity building - dental nurses ✓ Young people ✓ Capacity building - teachers ✓ Integration of oral health promotion ✓ School curriculum ✓ Oral health materials

Kose Nehan Focus on Prevention

Education Build an enabling information technology platform

T ooth Brushing

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

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

Actions, Dose & Safety ✓ 85% ✓ Sa 85% les esio ions s ar arrested Safety • • Ag bacteriocidal Oral LD50 = 520mg/kg • • F remineralises enamel & dentine 1 (20uL) drop = 9.5mg F in a 10kg child at 100% absorption = • Preserves collagen ? 0.95mg/kg ✓ Dose Dose 400 x safety margin acute toxicity • 1 drop/10kg child = ~4 teeth • No reported adverse effects Build an enabling • SDF F < 0.25 ml fluoride varnish information technology platform

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

Build an enabling information technology platform

Build an enabling information technology platform

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

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

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

Challenges ✓ Prioritisation - prevention /pain relief ✓ Shift decision making to the community ✓ General Health • Rheumatic fever! • Malnutrition • Sustainability ($) and Logistic

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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