The effectiveness of a tooth brushing programme for children in the Ehlanzeni district Mpumalanga and the relationship between body mass index (BMI) and odontogenic infections

Abstract

1. Introduction Dental caries is the most frequently occurring non-communicable disease world-wide and the most common disease found in children. Although dental caries in South Africa reduced significantly during the last 3 decades, the high levels of untreated caries in all age groups is an alarming cause for concern. Experts are of the opinion that the dramatic decline in caries is mostly due to the use of fluoride toothpaste. Whilst water fluoridation had been proven as effective in reducing caries prevalence and severity and promoted as a major public health intervention by the World Health Organisation (WHO), no water fluoridation schemes exist in South Africa. There is little evidence that caries in South African children is addressed adequately through policy and service provision efforts. Due to persistent oral health inequalities in access to care the South African public sector is under constant strain to deliver equitable, cost effective primary oral preventive services. As children spend a considerable proportion of their lives in education, schools can play a significant role in promoting children's health and oral health. Although several studies indicated that caries prevalence and severity can be reduced by brushing programmes, very little is known on the effectiveness of such interventions in the South African public school set up. Odontogenic infections may influence the ability of a child to ingest food which in turn could have a negative impact on the development of the child. Despite the pandemic character of dental decay, particularly in children, there are only a few studies that have examined the relationship between the severity of dental decay and the Body Mass Index (BMI). Rob Ferreira Hospital, Dental Department, under supervision of the author of this dissertation, introduced the Colgate Bright Smile Bright Future tooth brushing programme in low socio-economic areas in the Ehlanzeni district of Mpumalanga for children in Grades R to three in June 2012. Teachers supervised children that participated in the programme to ensure they brushed daily at school according to the prescribed methods. This provided an ideal opportunity to evaluate the effectiveness of a three year tooth brushing programme in primary schools (community trial) in a South African public school setup and to evaluate the relationship between odontogenic infections and BMI of the children. 2. Objective The purpose of the study was to evaluate the effectiveness of the tooth brushing programme in a community trial in the Ehlanzeni district of Mpumalanga. The idea was to evaluate the impact of this programme on dental caries by comparing the caries status of children who took part in a brushing programme since 2012, with the caries status of a comparable group of children from the same district who did not take part in the brushing programme, in the three years prior to the survey. The purpose of the second part of the study was to investigate the relationship between odontogenic infections and BMI of eight to ten year old children. 3. Study methodology Two samples of 250 children each, in the age group eight to ten years old, were randomly selected from children in Grade three. The first sample was drawn from children who took part in the brushing project and only the six schools that were part of the brushing project since the commencement of the project in 2012, were included. The second sample was drawn from children in six schools, in the same district, who did not participate in the brushing programme, but who were in the proximity of the intervention schools. DMFT/dmft index was used to measure caries experience and PUFA/pufa index used to measure odontogenic infections due to untreated dental caries according to standard procedures. Anthropometric measurements were performed and this information was used to compute the BMI. PUFA outcome was assessed using logistic regression while the data analysis for the evaluation of the effectiveness of tooth brushing compared intervention versus nonintervention groups using independent samples T-tests.