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Salt Fluoridation Programme to Prevent Dental Caries

Salt Fluoridation Programme
to prevent dental caries in Jamaica



 Introduction

In 1987 Jamaica initiated a comprehensive island wide salt fluoridation programme. The Pan American Health Organization (PAHO) provided technical assistance in the design and implementation of this programme as well as training local personnel in salt fluoridation techniques. This presentation is based on the study by Estupinan-Day and co-workers published in 2001.


 Background and Rationale

A baseline caries prevalence study conducted in 1984 in Jamaica showed that the DMFT for the 12-year-olds was 6.7 which was far above the WHO goal of DMFT 3 or less. As it was not feasible to implement water fluoridation beyond the capital Kingston, salt fluoridation seemed to be the most suitable caries preventive programme for Jamaica.



salt fluoridation plant

Alkali Limited, producers of salt since 1963, designed and implemented the addition of KF (Potassium fluoride) solution to refined table salt just before the drying stage in the salt refining process. Same concentrations of KF in domestic salts as in Switzerland and France which was 250 mg KF/ kg, was added to salt in Jamaica. An average concentration of 180 mg/kg of KF was achieved in the salt, after initial variations.

An education campaign targeting the general public was launched in 1986 and 1987 through the mass media. Training workshops for the health professionals were held on salt fluoridation. PAHO took part in training local personnel in salt fluoridation techniques.

Fluoride toothpastes were available in Jamaica from 1972, which was maintained even after salt fluoridation commenced. Salt fluoridation was introduced in Jamaica in 1987.


salt and water fluoridation in the American Region
* Courtesy Estupinan-Day SR, 2001


 Project Outline

In order to evaluate the effects of salt fluoridation, an oral health survey was launched in 1995 to compare the caries scores with those observed in 1984.

Thirty nine schools out of 800 were randomly selected and a total of 1113 children who were 6 to 15 years old were examined. Two dentists and 7 auxiliaries were calibrated as examiners and 9 dental assistants as recorders, in a 2-day training workshop. Data was collected according to the WHO Oral Health Surveys Manual.


 Achievements


Caries experience of children examined in 1995 and 1984
Age 1995 1984
Number DMFT Number DMFT
6 years 121 0.2 420 1.7
7 years 139 0.5 - -
8 years 117 0.4 - -
12 years 359 1.1 400 6.7
15 years 377 3.0 400 9.6


The changes in caries experience among school children in Jamaica between 1984 (before salt fluoridation) and 1995 (after salt fluoridation) were striking. Reduction of caries experience was 69%, 84% and 87% in the 15, 12 and 6-year-olds, respectively. The higher percentage difference in caries experience for the 12-year-olds when compared to the 15-year-olds may be due to the longer exposure of the younger children's teeth to fluorides. The 15-year-old group was already 8 years of age when fluoridation started in 1987 while the 12-year-olds were only 4 years old thus their permanent teeth were exposed to fluorides from the time of eruption.

Ninety six percent of the children were fluorosis free, 4% had 'questionable' fluorosis and less than 1% had very mild to mild fluorosis. None of the children showed moderate or severe fluorosis.


 Conclusion

The reduction in caries experience in children between 1984 and 1995 was striking and may be a result of a combination of factors, the likeliest being the fluoridation of domestic salt. The continued availability of fluoride toothpastes may have contributed to this reduction though data are not available to measure this. Oral health education in schools did not reach majority of the children and there were only a limited school dental service in the island.


 Reference and Acknowledgement

Estupinan-Day SR, Baez R, Horowitz H, Warpeha R, Sutherland B and Thamer M. Salt fluoridation and dental caries in Jamaica, Community Dent Oral Epidemiol 2001; 29: 247-252.


 

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