Dental Health Report · Dental Health Education Program added a screening component to be repeated on a five year interval basis. The 2008-2009 screening marks the fourth of these

Design byMedical Media Services9566-2010-Don Heenan

Population and Public Health Services

Dental Health Screening Program Report

Grade One and Grade Seven

2008-2009

page 2

Acknowledgements 5Message from the Medical Health Officer and the Executive Director 6Preface 7Executive Summary 8Key Findings 9Introduction 11Water Fluoridation in Canada 13Methods 14Results 15

Participation 15Location 15Gender Distribution 16Age 16Water Fluoridation 16Dental Health Assessment 17Early Childhood Caries 19Priority Scores 25

Dental Health Trends in the Regina Qu’Appelle Health Region, 2008-2009 26Canadian Oral Health Strategy (COHS) Guidelines for 2010: Goal 2 31Signi -8002 ,RHQR ,neveS edarG )CiS( xednI seiraC tnac if 2009 32Dental Health Disparities 33 Dental Health Disparity by Neighbourhood 33Discussion 35Limitations of the study 37Recommendations 38 Healthy Public Policy 38 Building Capacity 38 Enhanced Patient Care 39 Health Surveillance 39 Additional Research 39Appendices 40

Appendix 1: Dental Screening Program Definitions 40Appendix 2: List of Schools in RQHR participating in the dental screening 2008-2009 43Appendix 3: Dental Screening Advance Information Letter, 2008-2009 45

Appendix 3A: Dental Screening Advance Information Letter, 2008-2009 46Appendix 4: Dental Screening Results Letter (Ministry of Health, Govt. of SK) 47

References 49

Contents Notes

Notes

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Figure 1: Dental Health Care Needs, Grade One and Grade Seven Students, RQHR, 2008-2009Figure 2 : Percentage of Grade One Students by Number of Affected Quadrants, RQHR, 2008-2009Figure 3: Grade One and Grade Seven Students ‘deft’ Components, RQHR, 2008-2009Figure 4: Grade One and Grade Seven Students ‘DMFT’ Components, RQHR, 2008-2009Figure 5: Percentage of RQHR Grade One Students Screened who were Cavity-free during Dental Screen-ings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009Figure 6: Percentage of RQHR Grade One Students Screened who had Cavities during Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009Figure 7: Percentages of RQHR Grade One Students Screened who had Pain and/or Infection at the time of Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009Figure 8: Percentage of RQHR Grade One Students with Early Childhood Caries at the time of Dental Screening, 1993-1994, 1998-1999, 2003-2004 and 2008-2009Figure 9: Percentage of RQHR Grade One Students Screened who had No Evidence of Care, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

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List of Figures

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Table 1: Participation in the RQHR Dental Health Screening, 2008-2009

Table 2: Students Screened by Location of Schools, RQHR, 2008-2009

Table 3: Gender of Students Screened, RQHR, 2008-2009

Table 4: Communities with Fluoridated Water and Students Screened, RQHR, 2008-2009Table 5: Grade One Students Dental Health Care Needs, RQHR, 2008-2009

Table 6: Grade Seven Students Dental Health Care Needs, RQHR, 2008-2009

Table 7: Grade One and Seven Students Dental Health Care Needs, RQHR, 2008-2009

Table 8: Prevalence of Early Childhood Caries (ECC) and ECC+, RQHR, in Grade One Students2008-2009

Table 9: Percentage of Grade One Students by Number of Quadrants Affected by Dental Caries, RQHR, 2008-2009

Table 10: Percentage of Grade Seven Students by Number of Quadrants Affected by Dental Caries, RQHR, 2008-2009

Table 11: Grade One Students ‘deft’ Components, RQHR, 2008-2009

Table 12: Grade One Students ‘deft’ Scores, RQHR, 2008-2009

Table 13: Grade Seven Students ‘deft’ Components, RQHR, 2008-2009

Table 14: Grade Seven Students ‘deft’ Scores, RQHR, 2008-2009

Table 15: Grade One Students ‘DMFT’ Components, RQHR, 2008-2009

Table 16: Grade One Students ‘DMFT’ Scores, RQHR, 2008-2009

Table 17: Grade Seven Students ‘DMFT’ Components, RQHR, 2008-2009

Table 18: Grade Seven Students ‘DMFT’ Scores, RQHR, 2008-2009

Table 19: Grade One Students Dental Health Status, RQHR, 2008-2009

Table 20: Grade Seven Students Dental Health Status, RQHR, 2008-2009

Table 21: Grade One Students Priority Scores, RQHR, 2008-2009

Table 22: Grade Seven Students Priority Scores, RQHR, 2008-2009

Table 23: Grade One Dental Health by Screening Year, Regina Qu’Appelle Health Region

Table 24: Canadian Oral Health Strategy (COHS) Guidelines for 2010: Goal 2 (Grade One/Age 6), RQHR, 2008-2009

Table 25: Canadian Oral Health Strategy (COHS) Guidelines for 2010: Goal 2 (Grade Seven/Age 12), RQHR, 2008-2009

Table 26: Dental Health by Urban/Rural School Location, RQHR, 2008-2009

Table 27: Dental Health by Neighbourhood Income Status, City of Regina, 2008-2009

Table 28: Comparison of Dental Health Status of Students who attended Schools located in Low

Income Neighbourhoods in the City of Regina for the school years 2003-2004 and 2008-2009

List of Tables

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References

1. The Canadian Oral Health Strategy, August2005. Data retrieved from the website:http://www.fptdwg.ca/assets/PDF/Canadian%20Oral%20Health%20Strategy%20-%20Final.pdf

2. Promoting Oral Health from birth throughchildhood: Prevention of Early Childhood Caries. Jennnifer Yost & Yihong Li, MCN,Volume 33, January/February 2008. http:// www.ncbi.nlm.nih.gov/pubmed/18158522

3. U.S. Department of Health and HumanServices (HHS). Oral Health in America:A Report of the Surgeon General. Rockville, MD: HHS, National Institutes of Health, National Institute of Dental andCraniofacial Research, 2000.

4. Proceedings. NIH Consensus DevelopmentConference: Dental Sealants in the Prevention of Tooth Decay. Journal ofDental Education 48(2) (Suppl.),1984.PubMed; PMID 6583262

5. World Health Organization: Fluorides &Oral Health. WHO technical report series #846, Geneva, 1994.

6. Community socio-economic status andchildren’s dental health. James Gilchrist,David E. Brumley, Jennifer U. Blackford,JADA, Volume 132, February 2001.

7. Newbrun E. Effectiveness of water fluoridation. J Public Health Dent 1989;49(5 spec no.): 279-289

8. Brunelle JA, Carlos JP. Recent trends indental caries in U.S. children and the effectof water fluoridation. J Dent Res 1990;69(spec no): 723-727.

9. Fluoride: Nature’s tooth decay fighter. J AmDent Assoc 2009; 140; 126

10. Center for Disease Control and Prevention.Data retrieved from the website :http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm

11. Water Fluoridation in Canada: Past andPresent. Danielle Rabb-Waytowich, JCDA,July/August 2009, Volume 75, No. 6

12. Findings and Recommendations of theFluoride Expert Panel (January 2007). Dataretrieved from the website:http;//www.hc-hc-sc.gc.ca/ewh-semt/pubs/water-eau/2008-fluoride-fluorure/iondex-eng.php.

13. WHO Oral Health Country/ Area ProfileProgramme. Data retrieved from the website: http://www.whocollab.od.mah.se/expl/sic.html

14. Epidemiology. Leon Gordis, fourth edition,Saunders Elsevier publication, 2008.

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Appendices

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Dental Health Screening Advisors

Dr. Tania Diener, Medical Health Officer, Population and Public Health ServicesBob Layne, Executive Director, Population and Public Health Services Anna Engel, Manager, Health Promotion, Population and Public Health Services

Examiners and Data Collection

The following Dental Health Coordinators participated as examiners and recorded the results:Rosemary HenricksenBarb IngMelanie LemieuxCharlene McConnellJudy Tejszerski

Data Analysis

Vinay K. Pilly, M.P.H. Practicum Student (U of S), Saskatoon Health RegionZahid Abbas, Epidemiologist, Population and Public Health Services

Writing and Editing

Dr Tania DienerVinay K. PillyZahid AbbasAnna EngelRosemary HenricksenBarb IngCharlene McConnellJudy Tejszerski

Sponsor

College of Dentistry, University of Saskatchewan

The Population and Public Health Services, Dental Health Promotion Program and the Regina Qu'Appelle Health Region also gratefully acknowledge all the schools who participated in the Dental Health Screening.

Acknowledgements

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Message from the Medical Health Officer and the Executive Director Population and Public Health Services

Dear Reader,

We are pleased to share with you the Dental Health Screening Report, 2008-2009. This report presents the results of a screening survey reviewing the dental health status and treatment needs of Grade One and Grade Seven students. The survey was conducted by the Dental Health Coordinators, Population and Public Health Services, Regina Qu’Appelle Health Region, in 2008-2009.

The information obtained from this screening is extremely valuable to Population and Public Health Services as we continue to plan and address the oral health needs of our children. Oral health, in particular tooth decay, is the most common unmet health need and is a major problem for our young children, left untreated it can lead to chronic pain, delayed growth, and impaired speech which can ultimately affect the child’s ability to learn and thrive.

The report indicates disparities in oral health needs in our communities and neighbourhoods, highlighting the need to focus our efforts on vulnerable children and their families and to advocate for improved oral health through Healthy Public Policy, Building Capacity andEnhanced Patient Care.

The information provided in this report will help mobilize efforts to improve the oral health of our children. Improving the oral health of our children at the community level is a collaborative process, and we invite you to join us in a concerted effort to create healthy communities throughout the Regina Qu’Appelle Health Region.

Dr. Tania Diener, MBChB, MMed, (Com Health), MPA, DTM, MFTM RCPS (Glasg)Medical Health Officer

Bob Layne BSc (Hon), MPAExecutive Director

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Appendix 4: Dental Screening Results Letter(Ministry of Health, Govt. of SK)

Appendices

page 46

Appendices

Appendix 3A: Dental Screening Advance Information Letter, 2008-09

page 7

Population and Public Health Services (PPHS), Regina Qu’Appelle Health Region (RQHR), conducted an oral health screening of Grade One and Grade Seven students in

the region during the 2008-2009 school year.

The purpose of this screening was to assess oral health needs, to identify students with unmet dental needs and to refer those in obvious need of dental treatment. Population and

Public Health Services, RQHR, will continue to use the screening results to develop strate-gies to decrease the number of students experiencing tooth decay. Since tooth decay is largelypreventable, we collaborate with early childhood programs by enhancing oral health content in pre-natal, post-natal and parenting programs.

This report is also available on the Regina Qu’Appelle Health Region website. To obtain additional copies of the report, to make suggestions, or to request further information,

please contact the:

Dental Health Promotion ProgramPopulation and Public Health ServicesRegina Qu’Appelle Health Region1080 Winnipeg StreetRegina, SaskatchewanS4R 8P8Phone: (306) 766-6320Website: http://www.rqhealth.ca/programs/comm_hlth_services/pubhealth/pubhealth_dental.shtml

Preface

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Executive Summary

Adental health screening was conducted in the Regina Qu’Appelle Health Region during the 2008-2009 school year to assess

oral health status, monitor the trends, identify students with unmet dental needs, locate schools that are at high risk for caries, gauge the effectiveness of preventive dental programs and to provide needs-based appraisal data for the health region. Following the termination of the Saskatchewan Children’s Dental Plan in 1993, the Saskatchewan Health Dental Health Education Program added a screening component to be repeated on a five year interval basis. The 2008-2009 screening marks the fourth of these screening surveys.

The screening recorded the participation rate (Table 1), proportion of students screened by location (Table 2), gender distribution (Table 3)

mean age of students for Grade One and Grade Seven and proportion of schools that have access to community water fluoridation (Table 4). The proportion of students with malocclusion, staining, gingivitis and calculus were included under Dental Health Care Needs (Table 5 to Table 7).

The prevalence of Early Childhood Caries (ECC) was recorded for Grade One students only, whereas decay by the number of affected

quadrants (occlusal/interproximal) was recorded for both Grade One and Grade Seven students. The screening assessed the past and present dental caries experience by a measure of cumulative indices for both primary (deft) and permanent (DMFT) dentition, as well as individual components to gauge barriers to access dental care (d/D component) and access of dental care (m,f/M,F components). Additional information collected included: No Evidence of Dental Care (NEC), No Decay Evident (NDE) (no fillings/extractions/decay obvious), Early Childhood Caries (ECC), and the presence of pain and/or infection (Appendix 1).

Unmet dental needs were measured based on Priority scores for both Grade One and Grade Seven students.

This report is divided into the following parts:

1 Executive Summary

2 Introduction

3 Methods

4 Results

5 Discussion

6 Limitations of the study

7 Recommendations

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Appendix 3: Dental Screening Advance Information Letter, 2008-09

Appendices

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McLurg School*McNaughton High School - Moosomin*Milestone School*Montmartre SchoolMorning Star Christian Academy*North Valley High School - Lemberg*Pense School*Pilot Butte School*Punnichy Elementary School*Raymore SchoolRegina Christian SchoolRegina Huda School*Robert Southey School - Southey*Rocanville SchoolRosemont SchoolRuth M. Buck SchoolSacred Heart Community School*Schell School - Holdfast*Sedley School*South Shore School – Regina BeachSt. Angela Merici SchoolSt. Augustine Community School*St. Augustine School - WilcoxSt. Bernadette SchoolSt. Catherine SchoolSt. Dominic Savio SchoolSt. Francis Community School

St. Gabriel SchoolSt. Gregory SchoolSt. Jerome SchoolSt. Joan of Arc SchoolSt. Josaphat SchoolSt Luke SchoolSt. Marguerite Bourgeoys SchoolSt. Mary SchoolSt. Matthew SchoolSt. Michael Community SchoolSt. Pius X SchoolSt. Theresa SchoolSt. Timothy School*Stewart Nicks School – Grand CouleeThomson School*Vibank SchoolW.F. Ready SchoolW.H. Ford SchoolW.S. Hawrylak SchoolWalker School*Wapella SchoolWascana Elementary School*White City School*Whitewood SchoolWilfred Hunt SchoolWilfred Walker School*Wolseley High School

* denotes rural school** there were ten schools in the RQHR that did not participate for various reasons

Appendices

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Key Findings

One hundred and nine schools and 4,044 students across the health region participated in the screening, for a response rate of 82.8% (4,044/4,888)

(Table 1 and Appendix 2).

Early Childhood Caries (ECC), defined as any decay evident in the deciduous centrals and laterals, was experienced by 10.1% (205) of Grade One students.

This percentage has increased considerably from 6.9% recorded during 2003-2004 screenings (Table 8 and Table 23).

In Grade One, 5.3% (108) of the students were found to have urgent dental treatment needs. In Grade Seven, 1.3% (26) of the students were found to have

urgent dental treatment needs (Table 21 and Table 22).

In Grade One, 26.6% (540) of the students were referred to see their dentist for treatment as soon as possible. In Grade Seven, 13.7 % (276) of the students

were referred to see their dentist for treatment as soon as possible (Table 21 and Table 22).

For students in Grade One and Grade Seven in the RQHR tooth decay remains a significant childhood problem. The results of the 2008-2009 screening

showed that students in Grade One, in RQHR are experiencing more dental decay than in the 2003-2004 screening year. In 2008-2009, 33.5 % of Grade One students had dental caries compared to 24.3% in 2003-2004 (Table 23). Since this survey was a screening and not a full dental exam with radiographs tooth decay is likely to be underestimated.

In Grade One, 42.9% of the students were cavity-free and the percentage of unmet dental needs was 33.1%. These findings do not meet the Canadian Oral

Health Strategy guidelines (2010) of 50% for never having experienced tooth decay and 20% for unmet dental need for Grade One1 (Table 24).

For students in Grade Seven, only 62.7% have never experienced decay in their permanent dentition, unmet dental needs were 15.4%, the average ‘DMFT’

was 1.05 and the ‘Significant Caries Index’ (SiC) was 3.04. These findings do not meet the Canadian Oral Health Strategy guidelines (2010) of 75% of students age 12 not having experienced decay in their permanent teeth, no more than 10% have unmet dental needs, an average DMFT of 1.0 or less and a SiC of 3 or less1

(Table 25).

Continued

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In 2008-2009, dental health disparities were noted between students attending schools located in urban and rural communities. The average ‘deft/DMFT’ per

student attending a school in an urban community was 2.32 compared to 2.52 for a student attending a school in a rural community. Also, 52.6% of students attending schools in urban communities were cavity-free compared to 43.1% of students attending schools in rural communities (Table 26).

In 2008-2009, dental health disparities were noted between students attending schools located in low-income neighbourhoods and schools in higher income

neighbourhoods in the City of Regina. The students attending low income neighbourhood schools were more likely to be experiencing caries, pain or infection, show no evidence of care (NEC) and at the same time are less likely to be cavity-free. The average ‘deft/DMFT’ per student attending a school in a low-income neighbourhood was 4.95 compared to 2.09 for a student attending a school in higher-income neighbourhood. Also, 23.1% of students attending schools located in a low-income neighbourhood were cavity-free compared to 55.7% of students attending schools located in a higher-income neighbourhood (Table 27).

Of the 109 schools in the RQHR, 73 (67%) schools had 20% or more of their Grade One and Grade Seven students with visible decay. These schools are

designated as having high risk for dental need. Twenty-five (23%) schools had 10% or more, but less than 20% of their Grade One and Grade Seven students with visible decay. These schools are designated as having medium risk for dental need. Eleven (10%) schools had less than 10% of their Grade One and Grade Seven students with visible decay. These schools are designated as having low risk for dental need, (Individual school data not included).

Key Findings

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Appendices

Appendix 2: List of Schools in RQHR participating in the dental screening 2008-09

Albert School Arcola SchoolArgyle School*Arm River Hutterite SchoolAthabasca School*Balcarres Community School*Broadview SchoolCentennial School*Clive Draycott School - BethuneConnaught Community SchoolCoronation Park School*Cupar SchoolDavin SchoolDieppe SchoolDouglas Park SchoolDr. A.E. Perry SchoolDr. George Ferguson School*Dr. Isman School - WolseleyDr. L.M. Hanna SchoolEcole St. AndrewElsie Mironuck SchoolEthel Milliken School*Fort Qu'Appelle Elementary Community School*George Gordon Education Centre - PunnichyGeorge Lee SchoolGladys McDonald SchoolGlen Elm School

Grant Road School*Grenfell Elementary School*Grenfell High SchoolHarvest City Christian AcademyHaultain SchoolHenry Braun SchoolHenry Janzen SchoolHoly Rosary Community SchoolImperial Community School*Imperial School - Imperial*Indian Head Elementary School*Indian Head High SchoolJack Mackenzie Elementary School*James Hamblin School – Qu’AppelleJudge Bryant School*Kelliher SchoolKen Jenkins SchoolKitchener Community School*Lajord Colony SchoolLakeview School*Lipton School*Lumsden Elementary SchoolM.J. Coldwell School*MacLeod Churchill Elementary School - MoosominMarion McVeety SchoolMassey SchoolMcDermid School*McLean School

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Early Childhood Caries+:• pain and/or infection present with anterior caries on deciduous centrals and laterals.

Supernumerary Teeth:• supernumerary teeth are not counted. You must decide which tooth is the legitimate occupant of the space.

Over Retained:• where both primary and permanent teeth occupy the same tooth space only the permanent tooth is considered.

Non-Vital Teeth:• are to be scored as if they are vital.

Treatment Priorities:

Priority 1:• pain and/or infection present, in teeth distal to deciduous laterals.• early childhood caries+.• urgent, requires immediate attention.

Priority 2:• visible decay in 1-4 quadrants in teeth, distal to deciduous laterals.• treatment required as soon as possible.

Priority 3:• no visible decay.

Oral Health Status:

NDE:• indicates that no decay, fi llings or extractions are evident.CCC:• indicates that all decayed teeth appear to have treated.PCC:• indicates that some teeth have been treated, but decay is still evident.NEC:• indicates that there is decay but no evidence of past or present dental treatment.

Appendices

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Introduction

“…oral health and general health should not be interpreted as separate entities”-Surgeon General’s Report on Oral Health of America, 2000

Oral health is an inseparable and essential part of total health and contributes to overall well being, and has the potential to impact a person’s health status,

affecting the ability to eat and speak properly, quality of life, self-esteem and levels of usual activity.2

Poor oral health and untreated tooth decay is a huge economic burden that exceeds most other health conditions. The burden is disproportionately more

on lower income people and aboriginal populations. These disparities were emphasized in the Canadian Oral Health Strategy guidelines for 2010, which states that in Canada, people with low income had 2.5 to 3 times higher treatment and decay rates, where as rates for First Nations and Inuit people for all age groups ranged from 3 to 5 times higher than the non-aboriginal population.1

Dental caries is the most common chronic disease affecting children, occurring 5-8 times more frequently than asthma, which is the second most common

chronic disease among children.3

Early Childhood Caries (ECC) is one of the most destructive forms of dental caries affecting primary teeth that can have a negative impact on the oral

health of infants and children, which is preventable, by proper education, counselling, prevention and anticipatory guidance.

Lack of dental health education, sweetened pacifiers, improper feeding practices in which a child is put to bed with either milk or food in the oral cavity,

improper oral hygiene practices in which a child is put to bed without cleaning the oral cavity, lack of dental health insurance and barriers to access dental health care are some of the factors contributing to the prevalence of ECC.2, 4

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Research has shown that fluoride at optimal levels in drinking water is the most cost-effective community based preventive strategy for dental

caries. Fluoride can also be obtained from mouthrinse, toothpaste and from professionally applied fluorides. Long term exposure to optimal levels of fluorideresults in diminishing levels of caries in both children and adult populations.5

Dental sealants if placed on permanent teeth which are not at high risk for dental caries but might be susceptible, would prevent most of the tooth decay in children.4

There is a clear correlation between community socio-economic status and children’s dental health. Caries experience in primary teeth was signiflcantly

higher in students from low socio-economic status. Also, the proportion of untreated caries in primary teeth and permanent teeth, dental treatment priority needs and incisor trauma was higher in students from low socio-economic status.6

The dental health surveys have been tracking patterns and trends of the dental health indicators in Regina Qu’Appelle Health Region since 1993-1994.

Introduction

Although Grade One Students have been included in all previous surveys; the 2008-2009 report is the first to feature information regarding Grade Seven students in epidemiological studies and additional optional information questions.This report describes the methodology for conducting the 2008-2009 dental screening and the results, which will be shared with policy makers, dental fraternity and stakeholders.

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Attrition Rate:• The rate of decline in the number or size.

Caries Prevention Fraction:• Proportion of caries prevented due to exposure to community water fl uoridation.

Morbidity:• A measure of sickness, which could be either incidence rate or prevalence.

Hidden Morbidity:• An undiagnosed or a missed measure of sickness.

Tooth Fatality Rate:• Tooth fatality rate represents the potential for a tooth to be lost due to dental caries.

Recurrent Decay:• when a tooth has a visible recurrent decay then it is marked as decayed even though it may have a restoration in place.

Pain:• pain as a result of tooth decay, injury, periodontal disease, or over retention.

Infection:• visible infection (abscess).

Broken/Fractured/Lost:• a tooth that has been restored where the restoration (i.e.: crown, amalgam) has failed and there is no obvious decay.

Restored/Fractured:• fracture of the crown involving the dentin. The tooth is restored.

Non- Restored/ Fractured:• fracture of the crown involving the dentin. The tooth is not restored or the restoration has been lost.

Early Childhood Caries:• any decay evident in the deciduous anterior centrals and laterals.

Appendices

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Appendices

Appendix 1: Dental Screening Program Defi nitions

deft/DMFT:• index used to measure the caries experience of a population. It is the count of the number of decayed, missing (due to caries), and fi lled teeth of a group of individuals.

The term ‘deft’ refers to decay, extracted and fi lled primary teeth

decay:• visual or obvious decay of primary teeth.• discolouration or loss of translucency typical of undermined or de-mineralized enamel.• the tooth may not be restorable.

extracted:• the primary teeth that have been extracted because of dental caries. Teeth missing for other reasons (i.e.: orthodontic, trauma, heredity) are not recorded.

fi lled:• a primary tooth with a permanent or temporary restoration as a result of caries• if the tooth has a defective restoration without evidence of decay.

The term ‘DMFT’ refers to decay, missing and fi lled permanent teeth

Decay:• visual or obvious decay of permanent teeth.• discolouration or loss of translucency typical of undermined or de-mineralized enamel.• the tooth may or may not be restorable.

Missing:• the permanent teeth that have been extracted as a result of dental caries. Teeth lost for other reasons (i.e.: orthodontic, trauma, heredity) are not recorded.

Filled:• a permanent tooth with a permanent or temporary restoration as a result of caries.• if the tooth has a defective restoration without evidence of decay.

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Water Fluoridation in Canada

Community water fluoridation is the most cost-effective means of preventing tooth decay. A reduction of 20-40% of decay can be achieved with water

fluoridation.7, 8 In the US, the American Dental Association, Center for Disease Control and Prevention and the American Academy of Pediatric Dentistry support water fluoridation as safe and effective based on evidence.9 The Center for Disease Control and Prevention hails water fluoridation as one of the ten great public health achievements of the 20th century 10 and the World Health Organization believes access to fl uoride is a basic human right.11

In Canada, during April 2008, Health Canada made public, the findings and recommendations from the fluoride expert panel consisting of six members12.

The panel concluded that 0.7mg/L ppm of fluoride in drinking water protects teeth against decay, while minimizing risk of dental fluorosis. Further, the panel found no health risks due to mild dental fluorosis and noted that the prevalence of moderate fluorosis in Canada is on a decline. Despite this, community water fluoridation remains a contentious issue.11

Based on the Provincial and Territorial estimates for community water fluoridation coverage in 2007, the percentage of the Canadian population

with fluoridated water was 45.1%, and in Saskatchewan it was 36.8%, which is below the national percentage. 11

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Methods

Dental screening was offered to Grade One and Grade Seven students who attended schools in the Regina Qu’Appelle Health Region in the 2008-2009

school year (Appendix 2).

Dental Health Coordinators (licensed Saskatchewan Dental Therapists)assessed the student’s oral health by a visual examination, using a mouth

mirror and LED (Light-emitting diode) flashlight. Oral health status indicators collected were filled/restored teeth (represents access to dental care) and cavitated lesions/untreated tooth decay (represents barrier to dental care).

Parents/Guardians were advised of the dental screening via a ‘Dental Screening Advance Information Letter’ (Appendix 3). This letter was modified during

the school year at the request of a school division (Appendix 3A). Students were assessed for dental health needs, and these were communicated via a ‘Dental Screening Results Letter’ (Appendix 4). All students were provided with basic recommendations for oral hygiene, including illustrations of proper flossing and brushing techniques.

Screening data, including basic demographic information about each student was entered into an Access database by the regional Dental Health

Coordinators. Data was exported to Excel and into SPSS 17.0 (SPSS Inc. 2009, Chicago, Ill.) for analysis. Data was cleaned and compared to the original database where anomalies or missing values which were not resolvable, were excluded from analysis.

The student’s date of birth and date of examination were entered into the screening database. The mean age of a student was calculated using their age

at the time of exam. For the purpose of dental health disparity, both Grade One and Grade Seven students were analyzed together. Based on the postal code of the school, students were classified into either ‘urban’ or ‘rural’. Based on the school access to community water fluoridation, students were classified either into ‘fluoridated’ or ‘non-fluoridated’. Based on the location of a school in a low-income neighbourhood, students were classified either into ‘low-income cut off’and ‘non-low income cut off’ categories respectively and analysed accordingly.

Epidemiological studies, involving odds ratio and relative risk for being cavity-free, for comparisons within the health region, with other health regions and

Saskatchewan as a whole, were calculated using the software OpenEpi, Version2.3 (2009, Emory University, USA). An agreement was signed for the sharing of data for a provincial report.

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Enhanced Patient Care

• Continue to promote the benefi ts of dental sealants as a preventative service for students at their dental offi ce.

• Increase the number of evidence based fl uoride varnish and screening programs for children in Pre-Kindergarten, preschool and daycares in core neighbourhoods.

• Continue to build working relationships with private dental health care providers, the College of Dental Surgeons of Saskatchewan and the College of Dentistry through information sharing and oral health up-dates.

• Explore tertiary prevention in particular Alternative Restorative Technique (ART) to arrest tooth decay and prevent/delay hospitalization.

• Examine opportunities to increase oral health services (screening and varnishes) through community health centers including the Regina Community Clinic, Open Door Society, Four Directions and the Food Bank.

• Explore opportunities to enhance services targeting immigrant school age students and preschoolers.

Health Surveillance

• Continue oral health surveillance based on the Canadian Oral Health Strategy Goals through on going dental screening in high needs schools and the provincial 5- Year screenings.

Additional Research

• Further examine the attrition rate in the number of children screened and the barriers that exist in achieving higher response rate.

• Explore the reasons for low utilization rates of dental sealants.

Recommendations:

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Recommendations:

Observation from the Dental Health Screening Report Grade One and Grade Seven 2008-2009 indicates that oral health for children is a priority in the Regina Qu’Appelle Health Region.

The following recommendations have been made:

Healthy Public Policy

• Support the maintenance and implementation of adequate Community Water Fluoridation.

• Dissemination of the Dental Health Screening Report to stakeholders to advocate for improved oral health in schools and communities.

• Provide information and education to the public with respect to accessing dental health care coverage.

• Continue to advocate for an oral health safety net component to be included in the context of primary health care initiatives.

Building Capacity

• Promote and facilitate implementation of additional fl uoride mouthrinse programs in high risk schools.

• Enhance Public Health Nursing prenatal packages and Child Health Clinic protocols with current oral health information and recommendations.

• Provide oral health information and resources for the Maternity Home Visiting Program to share with new mothers.

• Examine partnership opportunities with SIAST Dental Division to support RQHR community Dental Health Programs.

page 15

Results

Participation

The total Grade One and Grade Seven student population screened in the Regina Qu’Appelle Health Region for this period was 4,044 (Table 1).


Grade TotalEnrolment

ScreenedNumber (%)

RefusedNumber (%)

AbsentNumber (%)

Grade One 2,370 2,030 (85.7) 143 (6.0) 197 (8.3)Grade Seven 2,518 2,014 (80.0) 274 (10.8) 230 (9.1)

Location

Of the 4,044 students screened, 3,063 (75.7%) were from schools in the City of Regina, 71 (1.8%) from Fort Qu’Appelle, 59 (1.5%) from Indian Head, 56 (1.4%) from Moosomin, 53 (1.3%) from Pilot Butte and the rest 742 (18.3%) were from other communities in the RQHR (Table 2).


tnecreP rebmuN loohcS fo noitacoL 7.57 360,3 anigeR 8.1 17 elleppA’uQ troF 5.1 95 daeH naidnI 4.1 65 nimosooM 3.1 35 ettuB toliP 3.81 247 srehtO 0.001 440,4 latoT

page 16

Results

Gender Distribution

There is almost an equal distribution of males and females among Grade One and Grade Seven students (Table 3).


elameFelaMedarGNumber Percent Number Percent

Grade One 1,023 50.4 1,007 49.6 Grade Seven 1,011 50.2 1,003 49.8

Age

The mean age for Grade One students was 6.1 years and for Grade Seven students it was 12.2 years.

Water Fluoridation

Only two communities (Table 4) in the Regina Qu’Appelle Health Region who participated in the dental screening receive fluoridated water. Most students screened did not attend schools with water fl uoridation.

Table 4: Communities with Fluoridated Water and Students Screened, RQHR, 2008-2009

tnecreP rebmuN ytinummoCMoosomin 4.1 65Indian Head 5.1 95

*Balgonie has community fluoridated water but the students attending school there were not screened.

The number of students screened with access to fl uoridated water is not enough for statistical comparisons.

page 37

Limitations of the study:

Hidden Morbidity: The screening was conducted using a mouth mirror and LED fl ashlight. Caries not detected visually might have been detected using a radiograph. Not all students enrolled in the study were screened, either due to lack of consent, absentia on the day of screening or delay in receiving the consent forms from the parents/guardians. This represents the proportion of cases that were missed being detected or diagnosed.

Misclassifi cation Bias14: This occurs when the method for collecting information about a subject is inadequate. Due to which some of the information gathered regarding disease and/or exposure might be incorrect.

For the data collected regarding Low Income Cut-off information (LICO), students were grouped under LICO, if they attended a school located in low-income neighbourhood. But, a child who attends a school located in low-income neighbourhood might reside in a high or medium income neighbourhood and vice-versa.

page 36

Discussion

Optional information collected included dental insurance, history of visit to a dental office and dental sealants. Only 55.3% of those screened responded to the optional

questions. Universal Health Insurance which was designed to be the cornerstone of Canada’s health care system is not totally universal and does not provide dental coverage. Based on the 2008-09 screening results, more than 80% of the students screened who returned their forms with the optional questions answered had some sort of dental insurance. The information collected regarding dental insurance was not standardized based on location, so it is difficult to ascertain if more urban school students or rural school students had any sort of dental insurance. Nearly, one in every five students’parents/guardians (either Grade One or Grade Seven) who responded to the optional questions in Regina Qu’Appelle Health Region either do not have any sort of dental insurance or are not sure about it. The possibility of establishing a public health dental clinic must be explored to serve children without dental insurance.

Dental office visits are vital to maintaining good oral health. Based on the 2008-09 screening results, nearly 80% (of those who responded to the optional question)

had visited the dentist before. However, the reason for the dental visit was not recorded, if it was for preventive (routine check-up), diagnostic or therapeutic (treatment). Thetime since the last visit which was not noted, could have revealed any waiting time that might have existed or may be the reason for the gap in the time between the visits. Thereis a need to build an oral health coalition, where in private dental practitioners advocate preventive dental health education to their patients.

Based on the 2008-09 screening results, self reported , dental sealants utilization was only 30.2%, (of those who responded to the optional question), 12.4% among Grade

One students and 17.8% among Grade Seven students respectively. The reason for the lower utilization of dental sealants require further exploration when 39.2% of Grade One and 37.7% of Grade Seven students received a recommendation to have dental sealants placed. This could be due to lack of public knowledge, insurance companies reluctant to consider dental sealants as a restoration, reimbursement issues, or concerns not detecting dental caries before deciding to place the sealants.

page 17

Results

Dental Health Assessment

The basic measures of dental health included assessment of outstanding treatment needs, as well as past and present dental caries experience. Decay experience includes decayed teeth, filled teeth, or teeth that were extracted due to decay.

There was 399 (19.6%) of the Grade One students screened that participated in a regular fluoride mouth rinse program at school. Forty-four students (2.2%) had existing fillings that required treatment. Seven hundred and seven students (39.2%) were sent home with a recommendation to receive sealants.

There was 244 (12.1%) of the Grade Seven students screened who participated in a regular fluoride mouth rinse program at school. Twenty-three (1.1%) students had existing fillings that required treatment. Seven hundred and fifty-nine students (37.7%) were sent home with a recommendation to receive sealants.

The factors malocclusion, staining, gingivitis and presence of calculus were in-cluded to assess the other Dental Health Care Needs, the extent of which is illus-trated in (Figure 1 and Table 5 to Table 7).

5.7

6.9

0.2 0.1

13.813.83.814.3

2.7

1.1

0

2

4

6

8

10

12

14

16

18

20

suluclaCsitivigniGgniniatSnoisulccolaM

Dental Health Care Needs

Perc

ent

Grade One Grade Seven

Figure 1: Dental Health Care Needs, Grade One and Grade Seven Students, RQHR, 2008-2009

page 18

Results

Definitions:

Malocclusion: Crooked or crowded teeth and/or poor biteStaining: Suspicious areas (possible decay), tartar or frank surface stainingGingivitis: Bleeding gums, early signs of gum diseaseCalculus: Hardened plaque on teeth

Table 5: Grade One Students Dental Health Care Needs, RQHR, 2008-2009

Dental Health Needs

Malocclusion Staining Gingivitis Calculus

Number 115 141 4 2 Percent 5.7 6.9 0.2 0.1


Dental Health Needs


Number 278 289 54 22 Percent 13.8 14.3 2.7 1.1


Dental Health Needs


Number 393 430 58 24 Percent 9.7 10.6 1.4 0.6

page 35

Discussion

The participation rate for Grade One and Grade Seven students was 85.7% and 80.0% respectively and the overall participation rate was 82.8%. In total 17.2% of enrolled

students either refused screening or were absent on the day of screening or the student did not turn in the signed consent forms from their parents/guardians in time. This proportion of students not screened may represent hidden morbidity, as they might be suffering from dental caries. The number of Grade One students screened was the lowest since the 1993-94 screening and also the number of Grade One students screened declined over the past two decades at an attrition rate of 16.8% compared to the previous screening in 2003-04. There is a need to understand the barriers that exist which might have prevented an enrolled student from not getting screened.

The factors malocclusion, staining, gingivitis and presence of calculus were included to assess the other dental health needs. These needs are higher among the Grade

Seven students than the Grade One students, especially, the proportion of children experiencing malocclusion and gingivitis.

The percentage of students with ECC increased from 6.9% in 2003-04 to 10.1% in 2008-09, an increase of 3.2%. However there was an improvement among the

students attending schools in the Low Income Cut-off neighbourhoods, in the City of Regina. The percentage of students with ECC decreased from 21.3% in 2003-04 to 16.9% in 2008-09. The signifi cant reduction in ECC (by 20.7%) can be partially attributed to the success of preventive dental programs such as targeted fl uoride varnish application, dental screening and referral for treatment in the Low Income neighbourhoods in the City of Regina.

For students in Grade One, tooth decay in the primary dentition remains a signifi cant childhood problem, equally also for students in Grade Seven, tooth decay in the

permanent dentition. The results of the 2008-09 screening showed that for primary dentition tooth fatality rate, prevalence of dental caries (morbidity) and the average ‘deft’ score was higher among the Grade One students. Also for permanent dentition tooth fatality rate, prevalence of dental caries (morbidity) and the average ‘DMFT’ score was higher among the Grade Seven students.

page 34

Dental Health Disparities

Table 27: Dental Health by Neighbourhood Income Status, City of Regina, 2008 - 2009

Dental Health Measure School Location

LICO Number (%)

Non-LICO Number (%)

Average ‘deft/DMFT’ 4.95 2.09 With current caries 131 (54.1) 625 (22.8) No evidence of dental care 66 (27.3) 338 (12.3) ECC present 41 (16.9) 142 (5.2) Cavity-free 56 (23.1) 1,530 (55.7) Pain and Infection 26 (10.7) 81 (2.9) Total screened 242 (8.1) 2,746 (91.9)

Table 28: Comparison of Dental Health Status of Students who attended Schools located in Low Income Neighbourhoods in the City of Regina for the school years 2003-2004 and 2008-2009

Dental Health Measure 2003-2004 2008-2009 Average ‘deft/DMFT’ 4.98 4.95 With Current Caries 183 (42.4) 131 (54.1) No Evidence of Dental Care 115 (26.9) 66 (27.3) ECC present 92 (21.3) 41 (16.9) Cavity-free 138 (31.9) 56 (23.1)Pain and /Infection 44 (10.2) 26 (10.7) Total Screened 432 242

Overall it appears that oral health status in the low income neighbourhoods in the city of Regina have improved since the previous screening, evident from the average ‘deft/DMFT’ score. Based on the 2008-09 screening results, the percentage of students with current caries, ECC, NEC and pain/infection have declined and students being cavity-free had increased.

page 19

Results

Early Childhood Caries

Students were classified as presenting with Early Childhood Caries (ECC) if the dental health coordinator identified decay in the deciduous anterior central orlateral teeth. This classification was scored as ‘ECC+’ if pain or infection was present with caries. There were 10.1% (205/2030) of Grade One students that had evidence of Early Childhood Caries, with or without pain or infection (Table 8).

Table 8: in Grade One Students, 2008-2009

Prevalence of Early Childhood Caries (ECC) and ECC+, RQHR

Early Childhood Caries ECC ECC+Number 51091Percent 7.04.9

Students were assessed for visible, current tooth decay and scored on the number of quadrants of the mouth (0-4) affected by decay.

At the time of examination, 636 (31.3%) Grade One students had visible tooth decay. This is illustrated in Table 9 and Figure 2.

Table 9: Percentage of Grade One Students by Number of Quadrants Affected by DentalCaries, RQHR, 2008-2009

Decay None 1 Quadrant 2 Quadrants 3 Quadrants 4 QuadrantsNumber 1,394 227 193 71 145 Percent 68.7 11.2 9.5 3.5 7.1

Figure 2: Percentage of Grade One Students byNumber of Affected Quadrants, RQHR, 2008-2009

68.7%

11.2%

9.5%

3.5%7.1%

None

1 Quadrant

2 Quadrants

3 Quadrants

4 Quadrants

page 20

Results

At the time of examination 15% (303/2014) of Grade Seven students had visible tooth decay (Table 10).

Table 10: Percentage of Grade Seven Students by Number of Quadrants Affected by DentalCaries, RQHR, 2008-2009

Decay None 1 Quadrant 2 Quadrants 3 Quadrants 4 Quadrants

Of the Grade One students screened, 40.1% had at least one filled primary tooth, 32% had at least onedecayed primary tooth and 14.2% had at least one extracted primary tooth as a result of dental caries(Table 11).

Number 1,711 137 92 37 37 Percent 85.0 6.8 4.6 1.8 1.8

The ‘deft’ is an index used to measure disease experience in primary teeth in dental screenings. It measures not just current dental disease, but a history of tooth decay as evidencedby fi llings or extractions.


Number of Affected Teeth

decayed extracted filled

Number Percent Number Percent Number Percent None 1,380 68.0 1,742 85.8 1,216 59.9 1-3 389 19.2 211 10.4 343 16.9 4-6 170 8.4 61 3.0 273 13.4 7+ 91 4.5 16 0.8 198 9.8

page 33


Table 26: Dental Health by Urban/Rural School Location, RQHR, 2008 - 2009

Dental Health Measure School Location Urban

Number (%) Rural

Number (%) Average ‘deft/DMFT’ 2.32 2.52 With current caries 756 (25.3) 241(22.8) No Evidence of Dental Care 404 (13.4) 84 (8.0) ECC present 183 (6.1) 26 (2.5) Cavity-free 1,579 (52.6) 450 (43.1) Pain and/ Infection 103 (3.4) 24 (2.3) Total screened 2,999 (74.1) 1,044 (25.8)

Dental Health Disparity by Neighbourhood

The percentage of population living under the Statistics Canada low-income cut-off (LICO) was used as a measure of “low income cut-off neighborhoods. LICO is an income threshold below which a family will likely devote a larger share of its income on the necessities of food, shelter and clothing than the average family. Cut-off points are adjusted for family size, population of city or area of residence, urban/rural differences and consumer price index. A neighbourhood was designated low income when more than 30% of the families in the neighbourhood meet the defi nition of low income cut-off. We obtained the percentage of population living below LICO from the 2006 census.

When stratifi ed by school location, signifi cant differences in oral health status were observed. Compared to non-LICO neighbourhood schools, students in low income neighbourhoods were signifi cantly more likely to have a history of caries, dental decay, pain and infection and absence of dental care (Table 27).

Table 26 illustrates the results from the comparative analysis between urban and rural dental health screening indicators in the Regina Qu’Appelle Health Region, 2008-2009. The students in urban schools have significantly higher prevalence of early childhood caries, dental decay and no evidence of dental care. The students in rural schools, however, have a significantly higher average deft/DMFT value.

page 32

Signifi cant Caries Index:

• New goal set by WHO (World Health Organization).• New goal set by the Canadian Oral Health Strategy guidelines for Grade Seven/ students who are twelve years of age.• For countries, who still did not achieve the WHO/FDI (Fédération dentaire international) global health goal of ‘DMFT’ less than or equal to 3, this goal is an urgent priority.• Ideally ‘SiC’ should be less than 3, by the year 2015.• Calculated by recording the mean ‘DMFT’ scores of 1/3 of the population with highest ‘DMFT’ scores.

The polarization of dental decay rates makes overall percentages less relevant.It over states the decay rates of the majority of children who are at low risk of

decay and understates the children who are at high risk of decay. To overcome this discrepancy some jurisdictions also measure the “Signifi cant Caries Index” (SiC index- Bratthall, 2000) which involves two measurements; the average DMFT of the population at a given age as well as the DMFT of 1/3 of the sample group with the highest decay rates.

Signifi cant Caries Index for Grade Seven, RQHR, 2008-09: 3.04

Signifi cant Caries Index (SiC) 13:Grade Seven, RQHR, 2008-2009

page 21


‘deft' Score Number Percent 1.14 538 enoN

2.02 114 3-1 5.61 533 6-4 1.22 944 +7

Average (mean) ‘deft’ score for Grade One was 3.26

The prevalence of dental caries (morbidity) for primary dentition among Grade One students in RQHR, 2008-2009, was 58.9% (Table 12).



decayed extracted filled Number Percent Number Percent Number Percent

None 1,923 95.5 1,999 99.3 1,802 89.5 1-3 87 4.3 14 0.7 177 8.8 4-6 4 0.2 0 0.0 26 1.3 7+ 0 0.0 1 0.0 9 0.4

Of the Grade Seven students screened, 10.5% had at east one filled primary tooth. Over 4% had at least one decayed primary tooth and the proportion with at least one extracted tooth as a result of dental caries was less than 1% (Table 13).

Table14: Grade Seven Students ‘deft’ Scores, RQHR, 2008-2009

tnecreP rebmuN erocS 'tfed‘ 9.58 037,1 enoN 9.11 932 3-1 6.1 33 6-4 6.0 21 +7

Average ‘deft’ score for Grade Seven was 0.32

Results

page 22

The prevalence of dental caries (morbidity) for primary dentition among Grade Seven students in RQHR, 2008-09, was 14.1% (Table 14).

The ‘deft’ score is lower for the Grade 7 students as this is a score of primary teeth only and by Grade 7 most of the primary teeth have been replaced with permanent teeth.

Results

Figure 3: Grade One and Grade Seven Students ‘deft’ Components, RQHR, 2008-2009

0

5

10

15

20

'deft' Components

Per

cent

1-3 19.2 4.3 10.4 0.7 16.9 8.8

4-6 8.4 0.2 3.0 0.0 13.4 1.3

7+ 4.5 0.0 0.8 0.0 9.8 0.4

decayed-Gr-1 decayed-Gr-7 extracted-Gr-1 extracted-Gr-7 filled-Gr-1 filled-Gr-7

The prevalence of dental caries for permanent teeth was measured using the‘DMFT’ score, a cumulative index, measuring the number of permanent teeth that are decayed (D), missing (M) or fi lled (F) due to caries.



Decayed Extracted/Missing Filled


Of the Grade One students screened, 1.5% had at least one fi lled permanent tooth and 4% had atleast one decayed permanent tooth (Table 15).

page 31

Canadian Oral Health Strategy (COHS) Guidelines for 2010:

Goal 2

The purpose of the COHS is to raise the overall oral health of Canadians.

2.2: Reduction of Dental decay• At age 6, 50% of children have never experienced dental decay.• At age 6, no more than 20% of children have unmet dental treatment needs.• At age 12, 75% of children have never experienced decay in their permanent teeth.• At age 12, no more than 10% of children have unmet dental treatment needs.• At age 12, an average ‘DMFT’ of 1.0 or less.• At age 12, a ‘Signi? cant Caries Index’, ‘DMFT’ of 3.0 or less.

Table 24: Canadian Oral Health Strategy (COHS) Guidelines for 2010: Goal 2 (Grade One/Age 6), RQHR, 2008-2009

COHS 50% of students have never experienced dental decay

No more than 20% of students have unmet dental treatment needs

RQHR,2008-09 42.9% 33.1%

The Canadian Oral Health Strategy (COHS) Guidelines for Grade One students are not met as only 42.9% of students have never experienced dental decay and 33.1% of students have unmet dental treatment needs.


COHS 75% of students have never experienced

decay in their permanent teeth

No more than 10% of students have

unmet dental treatment needs

Average‘DMFT’ of 1.0 or less

‘Significant Caries Index’,

‘DMFT’ of 3.0 or less.

RQHR,2008-09

62.7% 15.4% 1.05 3.04

The Canadian Oral Health Strategy (COHS) Guidelines for Grade Seven students are not met as only 62.7% of students have never experienced dental decay in their permanent teeth, 15.4% of students have unmet dental treatment needs, the average ‘DMFT’ is 1.05 and the ‘Significant Caries Index’ is 3.04.

page 30

10.0

12.1

13.2

16.6

0

5

10

15

20

1993-1994 1998-1999 2003-2004 2008-2009

Screening Year

Per

cen

t

The percentage of Grade One Students Screened who had No Evidence of Care, increased from 13.2% in 2003-04 to 16.6% in 2008-2009, which is the highest, recorded in the past two decades.


Screening Year

Number of

StudentsScreened

Average‘deft/

DMFT’

%with

Cavities

% with No

Evidence of Dental

Care

%with ECC

% with Pain and

orInfection

%Cavity-

free

1993-94 3,286 3.85 21.1 10.0 3.4 6.4 45.0 1998-99 3,202 3.87 22.9 12.1 6.2 4.3 48.0 2003-04 2,441 2.93 24.3 13.2 6.9 3.4 51.4 2008-09 2,031 3.34 33.5 16.6 10.1 5.3 42.9

Figure 9: Percentage of RQHR Grade One Students Screened who had No Evidence of Care, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

Dental Health Trends Continued

page 23


‘DMFT' Score Number Percent

Of the Grade Seven students screened, 29.9% had at least one filled permanent tooth, 12.6% had at least one decayed permanent tooth and 1.7% had at least one extracted tooth as a result of dental ca . .)71 elbaT( seir


‘DMFT’ Score Number Percent

5.49819,1enoN4.7951-30.8174-60.007+

Average ‘DMFT’ score for Grade One was 0.11

The prevalence of dental caries (morbidity) for permanent dentition among Grade One students in RQHR, 2008-209, was 5.4% (Table 16).



Decayed Extracted/Missing Filled Number Percent Number Percent Number Percent

None 1,760 87.4 1,980 98.3 1,411 70.1 1-3 209 10.4 33 1.6 461 22.9 4-6 35 1.7 1 0.0 129 6.4

7+ 10 0.5 0 0.0 13 0.6

0 1,264 62.7 1 213 10.6 2 179 8.9 3 124 6.2 4+ 233 11.6

Average ‘DMFT’ score for Grade Seven was 1.05

The prevalence of dental caries (morbidity) for permanent dentition among Grade Seven students in RQHR, 2008-2009, was 37.3% (Table 18).

Results

page 24

Figure 4: Grade One and Grade Seven Students ‘DMFT’ Components, RQHR, 2008-2009

0

5

10

15

20

25

'DMFT' Component

Per

cent

1-3 3.4 10.4 0.1 1.6 1.4 22.9

4-6 0.6 1.7 0.0 0.1 0.1 6.4

7+ 0.0 0.5 0.0 0.0 0.0 0.6

Decayed-Gr-1 Decayed-Gr-7 Extracted-Gr-1 Extracted-Gr-7 Filled-Gr-1 Filled-Gr-7

Grade One students were shown to have caries experience with 16.5% partial caries care (PCC)and 16.6% of the students had no evidence of care (NEC). The results are indicated in Table 19.


Classification NDE CCC PCC NECNumber 871 487 335 337 Percent 42.9 24.0 16.5 16.6

Results

page 29

3.4

6.2

6.9

10.1

0

2

4

6

8

10

12

1993-1994 1998-1999 2003-2004 2008-2009

Screening Year

Per

cen

t

Figure 8: Percentage of RQHR Grade One Students with Early Childhood Caries at the time of Dental Screening, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

The percentage of Grade One students with ECC increased from 6.9% in 2003-2004 to 10.3% in 2008-2009, which is the highest, recorded in the past two decades.


page 28

Figure 7: Percentages of RQHR Grade One Students Screened who had Pain and/or Infection at the time of Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

The percentage of Grade One students with pain and/or infection increased from 3.4% in 2003-2004 to 5.3% in 2008-2009.

6.4

4.3

3.4

5.3

0

2

4

6

8

1993-1994 1998-1999 2003-2004 2008-2009

Screening Year

Per

cen

t


page 25

Grade Seven students were shown to have caries experience with 7.9% partial caries care (PCC) and 7.5% of the students had no evidence of care (NEC). The results are indicated in the Table 20.


Classification NDE CCC PCC NECNumber 1,180 524 159 151 Percent 58.6 26.0 7.9 7.5

Priority Scores

Students were scored for priority, depending on the urgency of their dental health needs.

Priority 1 = Urgent (pain or infection) requiring immediate treatment.Priority 2 = Treatment required as soon as possible.Priority 3 = No immediate treatment indicated.

Results


Priority 1 2 3 Number 108 540 1,382 Percent 5.3% 26.6% 68.1%



An unmet dental need is a combination of Priority scores 1 and 2.

The percentage of unmet dental needs among Grade One students screened in the Regina Qu’Appelle Health Region is 31.9% (Table 21).

The percentage of unmet dental needs among Grade Seven students screened in the Regina Qu’Appelle Health Region is 15% (Table 22).

page 26

Dental Health Trends in the Regina Qu’Appelle Health Region, 2008-2009

Comparison with Past Screenings

Similar dental health screenings were carried out in 1993-1994, 1998-1999 and 2003-2004 school years.

Figure 5: Percentage of RQHR Grade One Students Screened who were Cavity-free during Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

The percentage of Grade One students who were cavity-free decreased from 51.4% in 2003-2004 to 42.9%in 2008-2009, which is the lowest in the past two decades.

45.0

48.0

51.4

42.9

1993-1994 1998-1999 2003-2004 2008-2009

Screening Year

page 27

Figure 6: Percentage of RQHR Grade One Students Screened who had Cavities during Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

21.1

22.924.3

33.5

0

10

20

30

40

1993-1994 1998-1999 2003-2004 2008-2009

Screening Year

Per

cen

t

The percentage of Grade One students with cavities increased from 24.3% in 2003-04 to 33.5% in 2008-2009, which is the highest, recorded in the past two decades.


page 26

Dental Health Trends in the Regina Qu’Appelle Health Region, 2008-2009

Comparison with Past Screenings

Similar dental health screenings were carried out in 1993-1994, 1998-1999 and 2003-2004 school years.

Figure 5: Percentage of RQHR Grade One Students screened who were Cavity-free during Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

Figure 5 compares the percentages of Grade One students who were cavity-free during the past screenings.The percentage of Grade One students who were cavity-free decreased from 51.4% in 2003-2004 to 42.9% in 2008-2009, which is the lowest in the past two decades.

45.0

48.0

51.4

42.9

1993-1994 1998-1999 2003-2004 2008-2009

Screening Year

page 27

Figure 6: Percentage of RQHR Grade One Students Screened who had Cavities during Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

21.1

22.924.3

33.5

0

10

20

30

40

1993-1994 1998-1999 2003-2004 2008-2009

Screening Year

Per

cen

t

The percentage of Grade One students with cavities increased from 24.3% in 2003-2004 to 33.5% in 2008-2009, which is the highest, recorded in the past two decades.


page 28

Figure 7: Percentages of RQHR Grade One Students Screened who had Pain and/orInfection at the time of Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

The percentage of Grade One students with pain and/or infection increased from 3.4% in 2003-2004 to 5.3% in 2008-2009.

6.4

4.3

3.4

5.3

0

2

4

6

8

1993-1994 1998-1999 2003-2004 2008-2009

Screening Year

Per

cen

t


page 25

Grade Seven students were shown to have caries experience with 7.9% partial caries care (PCC) and 7.5% of the students had no evidence of care (NEC). The results are indicated in the Table 20.


Classification NDE CCC PCC NEC Number 1,180 524 159 151 Percent 58.6 26.0 7.9 7.5

Priority Scores

Students were scored for priority, depending on the urgency of their dental health needs.

Priority 1 = Urgent (pain or infection) requiring immediate treatment.Priority 2 = Treatment required as soon as possible.Priority 3 = No immediate treatment indicated.

Results





An unmet dental need is a combination of Priority scores 1 and 2.

The percentage of unmet dental needs among Grade One students screened in the Regina Qu’Appelle Health Region is 31.9% (Table 21).

The percentage of unmet dental needs among Grade Seven students screened in the Regina Qu’Appelle Health Region is 15% (Table 22).

page 24

Figure 4: Grade One and Grade Seven Students ‘DMFT’ Components, RQHR, 2008-2009

0

5

10

15

20

25

'DMFT' Component

Per

cent

1-3 3.4 10.4 0.1 1.6 1.4 22.9

4-6 0.6 1.7 0.0 0.1 0.1 6.4

7+ 0.0 0.5 0.0 0.0 0.0 0.6

Decayed-Gr-1 Decayed-Gr-7 Extracted-Gr-1 Extracted-Gr-7 Filled-Gr-1 Filled-Gr-7

Grade One students were shown to have caries experience with 16.5% partial caries care (PCC)and 16.6% of the students had no evidence of care (NEC). The results are indicated in the Table 19.

Defi nitions:

NDE = No decay, fi llings or extractions evident.CCC = All decay teeth appear to have been treated.PCC = Some teeth treated, but decay still evident.NEC = Decay with no evidence of past or present treatment.


Classification NDE CCC PCC NEC Number 871 487 335 337 Percent 42.9 24.0 16.5 16.6

Results

page 29

3.4

6.2

6.9

10.1

0

2

4

6

8

10

12

1993-1994 1998-1999 2003-2004 2008-2009

Screening Year

Per

cen

t

Figure 8: Percentage of RQHR Grade One Students with Early Childhood Caries at the time of Dental Screening, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

The percentage of Grade One students with ECC increased from 6.9% in 2003-2004 to 10.1% in 2008-2009, which is the highest, recorded in the past two decades.


page 30

10.0

12.1

13.2

16.6

0

5

10

15

20

1993-1994 1998-1999 2003-2004 2008-2009

Screening Year

Per

cen

t

The percentage of Grade One Students Screened who had No Evidence of Care, increased from 13.2% in 2003-04 to 16.6% in 2008-2009, which is the highest, recorded in the past two decades.


Screening Year

Number of

StudentsScreened

Average‘deft/

DMFT’

%with

Cavities

% with No

Evidence of Dental

Care

%with ECC

% with Pain and

orInfection

%Cavity-

free

1993-1994 3,286 3.85 21.1 10.0 3.4 6.4 45.0 1998-1999 3,202 3.87 22.9 12.1 6.2 4.3 48.0 2003-2004 2,441 2.93 24.3 13.2 6.9 3.4 51.4 2008-2009 2,031 3.34 33.5 16.6 10.1 5.3 42.9

Figure 9: Percentage of RQHR Grade One Students Screened who had No Evidence of Care, 1993-1994, 1998-1999, 2003-2004 and 2008-2009


page 23


‘DMFT' Score Number Percent 5.49 819,1 enoN 7.4 59 3-1 8.0 71 6-4 0.0 0 +7

Average ‘DMFT’ score for Grade One was 0.11

The prevalence of dental caries (morbidity) for permanent dentition among Grade One students in RQHR, 2008-09, was 5.4% (Table 16).



Decayed Extracted/Missing Filled Number Percent Number Percent Number Percent

None 1,760 87.4 1,980 98.3 1,411 70.1 1-3 209 10.4 33 1.6 461 22.9 4-6 35 1.7 1 0.0 129 6.4

7+ 10 0.5 0 0.0 13 0.6

Of the Grade Seven students screened, 29.9% had at least one filled permanent tooth. Over 12.6% had at least one decayed permanent tooth and the percentage with at least one extracted tooth as a result of dental caries was just 1.6% (Table 17)..


‘DMFT’ Score Number Percent 0 1,264 62.7% 1 213 10.6% 2 179 8.9% 3 124 6.2% 4+ 233 11.6%

Average ‘DMFT’ score for Grade Seven was 1.05

The prevalence of dental caries (morbidity) for permanent dentition among Grade Seven students in RQHR, 2008-09, was 37.3% (Table 18).

Results

page 22

The prevalence of dental caries (morbidity) for primary dentition among Grade Seven students in RQHR, 2008-09, was 13.9% (Table 14).

The ‘deft’ score is lower for the Grade 7 students as this is a score of primary teeth only and by Grade 7 most of the primary teeth have been replaced with permanent teeth.

Results

Figure 3: Grade One and Grade Seven Students ‘deft’ Components, RQHR, 2008-2009

0

5

10

15

20

'deft' Components

Per

cent

1-3 19.2 4.3 10.4 0.7 16.9 8.8

4-6 8.4 0.2 3.0 0.0 13.4 1.3

7+ 4.5 0.0 0.8 0.0 9.8 0.4

decayed-Gr-1 decayed-Gr-7 extracted-Gr-1 extracted-Gr-7 filled-Gr-1 filled-Gr-7

The prevalence of dental caries for permanent teeth was measured using the‘DMFT’ score, a cumulative index, measuring the number of permanent teeth that are decayed (D), missing (M) or fi lled (F) due to caries.



Decayed Extracted/Missing Filled


Of the Grade One students screened, 1.5% had at least one fi lled permanent tooth and 4% had at least one decayed permanent tooth (Table 15).

page 31

Canadian Oral Health Strategy (COHS) Guidelines for 2010:

Goal 2

The purpose of the COHS is to raise the overall oral health of Canadians.

2.2: Reduction of Dental decay• At age 6, 50% of children have never experienced dental decay.• At age 6, no more than 20% of children have unmet dental treatment needs.• At age 12, 75% of children have never experienced decay in their permanent teeth.• At age 12, no more than 10% of children have unmet dental treatment needs.• At age 12, an average ‘DMFT’ of 1.0 or less.• At age 12, a ‘Significant Caries Index’ of 3.0 or less.

Table 24: Canadian Oral Health Strategy (COHS) Guidelines for 2010: Goal 2 (GradeOne/Age 6), RQHR, 2008-2009

COHS 50% of students have neverexperienced dental decay

No more than 20% of students have unmet dental treatment needs

RQHR,2008-2009 42.9% 33.1%

The Canadian Oral Health Strategy (COHS) Guidelines for Grade One students are not met as only 42.9% of students have never experienced dental decay and 33.1% of students have unmet dental treatment needs.


COHS 75% of students have never experienced

decay in their permanent teeth

No more than 10% of students have

unmet dental treatment needs

Average‘DMFT’ of 1.0 or less

‘Significant Caries Index’,

‘DMFT’ of 3.0 or less.

RQHR,2008-2009 62.7% 15.4% 1.05 3.04

The Canadian Oral Health Strategy (COHS) Guidelines for Grade Seven students are not met as only 62.7% of students have never experienced dental decay in their permanent teeth, 15.4% of students have unmet dental treatment needs, the average ‘DMFT’ is 1.05 and the ‘Significant Caries Index’ is 3.04.

page 32

Significant Caries Index13:

• New goal set by WHO (World Health Organization).• New goal set by the Canadian Oral Health Strategy guidelines for Grade

Seven/ students who are twelve years of age.• For countries, who still did not achieve the WHO/FDI (Fédération dentaire

international) global health goal of ‘DMFT’ less than or equal to 3, this goal is an urgent priority.

• Ideally ‘SiC’ should be less than 3, by the year 2015.• Calculated by recording the mean ‘DMFT’ scores of 1/3 of the population

with highest ‘DMFT’ scores.

The polarization of dental decay rates makes overall percentages less relevant.It over states the decay rates of the majority of children who are at low risk of

decay and understates the children who are at high risk of decay. To overcome this discrepancy some jurisdictions also measure the “Significant Caries Index” (SiC index- Bratthall, 2000) which involves two measurements; the average DMFT of the population at a given age as well as the DMFT of 1/3 of the sample group with the highest decay rates.

Significant Caries Index for Grade Seven, RQHR, 2008-2009 is 3.04 (Table 25)which is greater than the goal of 3 set by the World Health Organization.

Significant Caries Index (SiC)Grade Seven, RQHR, 2008-2009

page 21


‘deft' Score Number Percent 1.14 538 enoN 2.02 114 3-1 5.61 533 6-4 1.22 944 +7

Average (mean) ‘deft’ score for Grade One was 3.26

The prevalence of dental caries (morbidity) for primary dentition among Grade One students in RQHR, 2008-2009, was 58.9% (Table 12).



decayed extracted filled Number Percent Number Percent Number Percent

None 1,923 95.5 1,999 99.3 1,802 89.5 1-3 87 4.3 14 0.7 177 8.8 4-6 4 0.2 0 0.0 26 1.3 7+ 0 0.0 1 0.0 9 0.4

Of the Grade Seven students screened, 10.5% had at east one filled primary tooth. Over 4% had at least one decayed primary tooth and the proportion with at least one extracted tooth as a result of dental caries was less than 1% (Table 13).

Table14: Grade Seven Students ‘deft’ Scores, RQHR, 2008-2009

tnecreP rebmuN erocS 'tfed‘ 9.58 037,1 enoN 9.11 932 3-1 6.1 33 6-4 6.0 21 +7

Average ‘deft’ score for Grade Seven was 0.32

Results

page 20

Results

At the time of examination 15% (303/2014) of Grade Seven students had visible tooth. This is illustrated in Table 10 and Figure 4.


Decay None 1 Quadrant 2 Quadrants 3 Quadrants 4 Quadrants Number 1,711 137 92 37 37 Percent 85.0 6.8 4.6 1.8 1.8

The ‘deft’ is an index used to measure disease experience in primary teeth in den-tal screenings. It measures not just current dental disease, but a history of tooth decay as evidenced by fi llings or extractions.



decayed extracted filled


Of the Grade One students screened, 40.1% had at least one filled primary tooth. Thirty-two percent had at least one decayed primary tooth and the percentage with at least one extracted tooth as a result of dental caries was 14.2% (Table ). 11

page 33


Table 26: Dental Health by Urban/Rural School Location, RQHR, 2008 - 2009

Dental Health Measure School LocationUrban

Number (%)Rural

Number (%)Average ‘deft/DMFT’With current cariesNo Evidence of Dental CareECC presentCavity-freePain and/ InfectionTotal screened

2.32 756 (25.3) 404 (13.4) 183 (6.1) 1,579 (52.6) 103 (3.4) 2,999 (74.1)

2.52 241 (22.8) 84 (8.0) 26 (2.5) 450 (43.1) 24 (2.3) 1,044 (25.8)

Dental Health Disparity by Neighbourhood

The percentage of population living under the Statistics Canada low-income cut-off (LICO) was used as a measure of “low income cut-off neighborhoods. LICO is an income threshold below which a family will likely devote a larger share of its income on the necessities of food, shelter and clothing than the average family. Cut-off points are adjusted for family size, population of city or area of residence, urban/rural differences and consumer price index. A neighbourhood was designated low income when more than 30% of the families in the neighbourhood meet the defi nition of low income cut-off. We obtained the percentage of population living below LICO from the 2006 census.

When stratifi ed by school location, signifi cant differences in oral health status were observed. Compared to non-LICO neighbourhood schools, students in low income neighbourhoods were signifi cantly more likely to have a history of caries, dental decay, pain and/or infection and absence of dental care (Table 27).

Table 26 illustrates the results from the comparative analysis between urban and rural dental health screening indicators in the Regina Qu’Appelle Health Region, 2008-2009. The students in urban schools have significantly higher prevalence of early childhood caries, dental decay and no evidence of dental care. The students in rural schools, however, have a higher average deft/DMFT value.

page 34


Table 27: Dental Health by Neighbourhood Income Status, City of Regina, 2008 - 2009

Dental Health Measure School Location

LICONumber (%)

Non-LICONumber (%)

Average ‘deft/DMFT’ 4.95 2.09With current caries 131 (54.1) 625 (22.8)No evidence of dental care 66 (27.3) 338 (12.3)ECC present 41 (16.9) 142 (5.2)Cavity-free 56 (23.1) 1,530 (55.7)Pain and Infection 26 (10.7) 81 (2.9)Total screened 242 (8.1) 2,746 (91.9)

Average ‘deft/DMFT’ 4.98 4.95With Current Caries 183 (42.4) 131 (54.1)No Evidence of Dental Care 115 (26.9) 66 (27.3)ECC present 92 (21.3) 41 (16.9)Cavity-free 138 (31.9) 56 (23.1)Pain and /Infection 44 (10.2) 26 (10.7)Total Screened 432 242

Table 28: Comparison of Dental Health Status of Students who attended Schools located in Low Income Neighbourhoods in the City of Regina for the school years 2003-2004 and2008-2009

Dental Health Measure 2003-2004 2008-2009

Overall it appears that oral health status in the low income neighbourhoods in the city of Regina have improved since the previous screening, evident from the average ‘deft/DMFT’score. Based on the 2008-09 screening results, the percentage of students with current caries, ECC, NEC and pain and/or infection have declined. The percentage of cavity-free studentshas increased. The improvement may be because Grade Seven students were not included inthe 2003-2004 dental screening.

page 19

Results

Early Childhood Caries

Students were classifi ed as presenting with Early Childhood Caries (ECC) if the dental health coordinator identifi ed decay in the deciduous anterior central or lateral teeth. This classifi cation was scored as ‘ECC+’ if pain or infection was present with caries. There were 10% (205/2030) Grade One students that had evidence of Early Childhood Caries, with or without pain or infection (Table 8).

Table 8: Prevalence of Early Childhood Caries (ECC) and ECC+, RQHR, 2008-2009

Early Childhood Caries ECC ECC+ Number 51 091Percent 7.0 4.9

Students were assessed for visible, current tooth decay and scored on the number of quadrants of the mouth (0-4) affected by decay.

At the time of examination, 636 (31.3%) Grade One students had visible tooth decay. This is illustrated in Table 9 and Figure 3.


Decay None 1 Quadrant 2 Quadrants 3 Quadrants 4 Quadrants Number 1,394 227 193 71 145 Percent 68.7 11.2 9.5 3.5 7.1

Figure 2: Percentage of Grade One Students byNumber of Affected Quadrants, RQHR, 2008-2009

68.7%

11.2%

9.5%

3.4%7.1%

None

1 Quadrant

2 Quadrants

3 Quadrants

4 Quadrants

page 18

Results

Defi nitions:

Malocclusion: Crooked or crowded teeth and/or poor biteStaining: Suspicious areas (possible decay), tartar or frank surface stainingGingivitis: Bleeding gums, early signs of gum diseaseCalculus: Hardened plaque on teeth


Dental Health Needs


Number 115 141 4 2 Percent 5.7 6.9 0.2 0.1


Dental Health Needs


Number 278 289 54 22 Percent 13.8 14.3 2.7 1.1


Dental Health Needs


Number 393 430 58 24 Percent 9.7 10.6 1.4 0.6

page 35

Discussion

The participation rate for Grade One and Grade Seven students was 85.7% and 80.0% respectively and the overall participation rate was 82.8%. In total 17.2% of enrolled

students either refused screening or were absent on the day of screening or the student did not turn in the signed consent forms from their parents/guardians in time. This proportion of students not screened may represent hidden morbidity, as they might be suffering from dental caries. The number of Grade One students screened was the lowest since the 1993-94 screening and also the number of Grade One students screened declined over the past two decades at an attrition rate of 16.8% compared to the previous screening in 2003-04. There is a need to understand the barriers that exist which might have prevented an enrolled student from not getting screened.

The factors malocclusion, staining, gingivitis and presence of calculus were included to assess the other dental health needs. These needs are higher among the Grade

Seven students than the Grade One students, especially, the proportion of children experiencing malocclusion and gingivitis.

The percentage of students with ECC increased from 6.9% in 2003-04 to 10.1% in 2008-09, an increase of 3.2%. However there was an improvement among the

students attending schools in the Low Income Cut-off neighbourhoods, in the City of Regina. The percentage of students with ECC decreased from 21.3% in 2003-04 to 16.9% in 2008-09. The significant reduction in ECC can be partially attributed to the success of preventive dental programs such as targeted fluoride varnish application, dental screening and referral for treatment in the Low Income neighbourhoods in the City of Regina.

For students in Grade One, tooth decay in the primary dentition remains a significantchildhood problem, equally also for students in Grade Seven, tooth decay in the

permanent dentition. The results of the 2008-2009 screening showed that for primary dentition the rate of tooth loss, prevalence of dental caries (morbidity) and the average ‘deft’ score was higher among the Grade One students. Also for permanent dentition the rateof tooth loss, prevalence of dental caries (morbidity) and the average ‘DMFT’ score was higher among the Grade Seven students.

page 36

Discussion

Optional information collected included dental insurance, history of visit to a dental office and dental sealants. Only 55.3% of those screened responded to the optional

questions. Universal Health Insurance which was designed to be the cornerstone of Canada’s health care system is not totally universal and does not provide dental coverage. Based on the 2008-09 screening results, more than 80% of the students screened who returned their forms with the optional questions answered had some sort of dental insurance. The information collected regarding dental insurance was not standardized based on location, so it is difficult to ascertain if more urban school students or rural school students had any sort of dental insurance. Nearly, one in every five students’parents/guardians (either Grade One or Grade Seven) who responded to the optional questions in Regina Qu’Appelle Health Region either do not have any sort of dental insurance or are not sure about it. The possibility of establishing a public health dental clinic must be explored to serve children without dental insurance.

Dental office visits are vital to maintaining good oral health. Based on the 2008-09 screening results, nearly 80% (of those who responded to the optional question)

had visited the dentist before. However, the reason for the dental visit was not recorded, if it was for preventive (routine check-up), diagnostic or therapeutic (treatment). Thetime since the last visit which was not noted, could have revealed any waiting time that might have existed or may be the reason for the gap in the time between the visits. Thereis a need to build an oral health coalition, where in private dental practitioners advocate preventive dental health education to their patients.

Based on the 2008-09 screening results, self reported , dental sealants utilization was only 30.2%, (of those who responded to the optional question), 12.4% among Grade

One students and 17.8% among Grade Seven students respectively. The reason for the lower utilization of dental sealants require further exploration when 39.2% of Grade One and 37.7% of Grade Seven students received a recommendation to have dental sealants placed. This could be due to lack of public knowledge, insurance companies reluctant to consider dental sealants as a restoration, reimbursement issues, or concerns not detecting dental caries before deciding to place the sealants.

page 17

Results

Dental Health Assessment

The basic measures of dental health included assessment of outstanding treatment needs, as well as past and present dental caries experience. Decay experience includes decayed teeth, fi lled teeth, or teeth that were extracted due to decay.

There was 399 (19.6%) of the Grade One students screened that participated in a regular fl uoride mouth rinse program at school. Forty-four students (2.2%) had existing fi llings that required treatment. Seven hundred and seven students (39.2%) were sent home with a recommendation to receive sealants.

There was 244 (12.1%) of the Grade Seven students screened who participated in a regular fl uoride mouth rinse program at school. Twenty-three (1.1%) students had existing fi llings that required treatment. Seven hundred and fi fty-nine students (37.7%) were sent home with a recommendation to receive sealants.

The factors malocclusion, staining, gingivitis and presence of calculus were in-cluded to assess the other Dental Health Care Needs, the extent of which is illus-trated in (Figure 1 and Table 5 to Table 7).

5.7

6.9

0.2 0.1

13.814.3

2.7

1.1

0

2

4

6

8

10

12

14

16

18

20

suluclaCsitivigniGgniniatSnoisulccolaM

Dental Health Care NeedsPe

rcen

t

Grade One Grade Seven

Figure 1: Dental Health Care Needs, Grade One and Grade Seven Students, RQHR, 2008-2009

page 16

Results

Gender Distribution

There is almost an equal distribution of males and females among Grade One and Grade Seven students (Table 3).


elameF elaM edarGNumber Percent Number Percent

Grade One 1,023 50.4 1,007 49.6 Grade Seven 1,011 50.2 1,003 49.8

Age

The mean age for Grade One students was 6.1 years and for Grade Seven students it was 12.2 years.

Water Fluoridation

Only two communities (Table 4) in the Regina Qu’Appelle Health Region who participated in the dental screening receive ? uoridated water. Most students screened did not attend schools with water fl uoridation.

Table 4: Communities with Fluoridated Water and Students Screened, RQHR, 2008-2009

tnecreP rebmuN ytinummoCMoosomin 4.1 65Indian Head 5.1 95

*Balgonie has community fluoridated water but the students attending school there were not screened.

The number of students screened with access to fl uoridated water is not enough for statistical comparisons.

page 37

Limitations of the study:

Hidden Morbidity: The screening was conducted using a mouth mirror and LED flashlight. Caries not detected visually might have been detected using a radiograph. Not all students enrolled in the study were screened, either due to lack of consent, absentia on the day of screening or delay in receiving the consent forms from the parents/guardians. This represents the proportion of cases that were missed being detected or diagnosed.

Misclassification Bias14: This occurs when the method for collectinginformation about a subject is inadequate which could mean some of the information gathered regarding the disease and/or exposure might be incorrect .

For the data collected regarding Low Income Cut-off information (LICO), students were grouped under LICO, if they attended a school located in low-income neighbourhood. But, a child who attends a school located in low-income neighbourhood might reside in a high or medium income neighbourhood and vice-versa.

page 38

Recommendations:

Observation from the Dental Health Screening Report Grade One and Grade Seven 2008-2009 indicates that oral health for children is a priority in the Regina Qu’Appelle Health Region.

The following recommendations have been made:

Healthy Public Policy

• Support the maintenance and implementation of adequate Community WaterFluoridation.

• Dissemination of the Dental Health Screening Report to stakeholders to advocatefor improved oral health in schools and communities.

• Provide information and education to the public with respect to accessing dental health care coverage.

• Continue to advocate for an oral health safety net component to be included in the context of primary health care initiatives.

Building Capacity

• Promote and facilitate implementation of additional fluoride mouthrinse programsin high risk schools.

• Enhance Public Health Nursing prenatal packages and Child Health Clinic protocols with current oral health information and recommendations.

• Provide oral health information and resources for the Maternity Home VisitingProgram to share with new mothers.

• Examine partnership opportunities with SIAST Dental Division to support RQHRcommunity Dental Health Programs.

page 15

Results

Participation

The total Grade One and Grade Seven student population screened in the Regina Qu’Appelle Health Region for this period was 4,044 (Table 1).


Grade Total Enrolment

Screened Number (%)

Refused Number (%)

AbsentNumber (%)

Grade One 2,370 2,030 (85.7) 143 (6.0) 197 (8.3) Grade Seven 2,518 2,014 (80.0) 274 (10.8) 230 (9.1)

Location

Of the 4,044 students screened, 3,063 (75.7%) were from schools in the City of Regina, 71 (1.8%) from Fort Qu’Appelle, 59 (1.5%) from Indian Head, 56 (1.4%) from Moosomin, 53 (1.3%) from Pilot Butte and the rest 742 (18.3%) were from other communities in the RQHR (Figure 1 and Table 2).


tnecreP rebmuN loohcS fo noitacoL 7.57 360,3 anigeR 8.1 17 elleppA’uQ troF 5.1 95 daeH naidnI 4.1 65 nimosooM 3.1 35 ettuB toliP 3.81 247 srehtO 0.001 440,4 latoT

page 14

Methods

Dental screening was offered to Grade One and Grade Seven students who attended schools in the Regina Qu’Appelle Health Region 2008-2009 school

year (Appendix 2).

Dental Health Coordinators (licensed Saskatchewan Dental Therapists) assessed the student’s oral health by a visual examination, using a mouth

mirror and LED (Light-emitting diode) fl ashlight. Oral health status indicators collected were fi lled/restored teeth (represents access to dental care) and cavitated lesions/untreated tooth decay (represents barrier to dental care).

Parents/Guardians were advised of the dental screening via a ‘Dental Screening Advance Information Letter’ (Appendix 3). This letter was modi? ed during

the school year at the request of a school division (Appendix 3A). Students were assessed for dental health needs, and these were communicated via a ‘Dental Screening Results Letter’ (Appendix 4). All students were provided with basic recommendations for oral hygiene, including illustrations of proper fl ossing and brushing techniques.

Screening data, including basic demographic information about each student was entered into an Access database by the regional Dental Health

Coordinators. Data was exported to Excel and into SPSS 17.0 (SPSS Inc. 2009, Chicago, Ill.) for analysis. Data was cleaned and compared to the original database where anomalies or missing values which were not resolvable, were excluded from analysis.

The student’s date of birth and date of examination were entered into the screening database. The mean age of a student was calculated using their age

at the time of exam. For the purpose of dental health disparity, both Grade One and Grade Seven students were analyzed together. Based on the postal code of the school, students were classifi ed into either ‘urban’ or ‘rural’. Based on the school access to community water fl uoridation, students were classifi ed either into ‘fl uoridated’ or ‘non-fl uoridated’. Based on the location of a school in a low-income neighbourhood, students were classifi ed either into ‘low-income cut off’ and ‘non-low income cut off’ categories respectively and analysed accordingly.

Epidemiological studies, involving odds ratio and relative risk for being cavity-free, for comparisons within the health region, with other health regions and

Saskatchewan as a whole, were calculated using the software OpenEpi, Version 2.3 (2009, Emory University, USA). An agreement was signed for the sharing of data for a provincial report.

page 39

Enhanced Patient Care

• Continue to promote the benefits of dental sealants as a preventative service for students at their dental office.

• Continue to promote rof smargorp gnineercs dna hsinrav edirou lf desab ecnedive children in Pre-Kindergarten, preschool and daycares in core neighbourhoods.

• Continue to build working relationships with private dental health care providers, the College of Dental Surgeons of Saskatchewan and the College of Dentistry through information sharing and oral health up-dates.

• Explore tertiary prevention in particular Alternative Restorative Technique (ART)to arrest tooth decay and prevent/delay hospitalization.

• Examine opportunities to increase oral health services (screening and varnishes) through community health centers including the Regina Community Clinic, Open Door Society, Four Directions and the Food Bank.

• Explore opportunities to enhance services targeting immigrant school age students and preschoolers.

Health Surveillance

• Continue oral health surveillance based on the Canadian Oral Health Strategy Goals through on going dental screening in high needs schools and the provincial 5- Year screenings.

Additional Research

• Further examine the attrition rate in the number of children screened and the barriers that exist in achieving higher response rate.

• Explore the reasons for low utilization rates of dental sealants.

Recommendations:

page 40

Appendices

Appendix 1: Dental Screening Program Definitions

deft/DMFT:• index used to measure the caries experience of a population. It is the count

of the number of decayed, missing (due to caries), and filled teeth of a group of individuals.

The term ‘deft’ refers to decay, extracted and filled primary teeth

decay:• visual or obvious decay of primary teeth• discolouration or loss of translucency typical of undermined or de-mineralized

enamel• the tooth may not be restorable

extracted:• the primary teeth that have been extracted because of dental caries. Teeth

missing for other reasons (i.e.: orthodontic, trauma, heredity) are not recorded.

filled:• a primary tooth with a permanent or temporary restoration as a result of caries• if the tooth has a defective restoration without evidence of decay

The term ‘DMFT’ refers to decay, missing and filled permanent teeth.

Decay:• visual or obvious decay of permanent teeth• discolouration or loss of translucency typical of undermined or de-mineralized

enamel• the tooth may or may not be restorable

Missing:• the permanent teeth that have been extracted as a result of dental caries. Teeth lost

for other reasons (i.e.: orthodontic, trauma, heredity) are not recorded.

Filled:• a permanent tooth with a permanent or temporary restoration as a result of caries• if the tooth has a defective restoration without evidence of decay

page 13

Water Fluoridation in Canada

Community water fl uoridation is the most cost-effective means of preventing tooth decay. A reduction of 20-40% of decay can be achieved with water

fl uoridation.7, 8 In the US, the American Dental Association, Center for Disease Control and Prevention and the American Academy of Pediatric Dentistry support water fl uoridation as safe and effective based on evidence.9 The Center for Disease Control and Prevention hails water fl uoridation as one of the ten great public health achievements of 20th century 10 and the World Health Organization believes access to fl uoride as a basic human right.11

In Canada, during April 2008, Health Canada made public, the fi ndings and recommendations from the ? uoride expert panel consisting of six members12.

The panel concluded that 0.7mg/L ppm of fl uoride in drinking water protects teeth against decay, while minimizing risk of dental fl uorosis. Further, the panel found no health risks due to mild dental fl uorosis and noted that the prevalence of moderate fl uorosis in Canada is on a decline. Despite this, community water fl uoridation remains a contentious issue.11

Based on the Provincial and Territorial estimates for community water fl uoridation coverage in 2007, the percentage of the Canadian population

with fl uoridated water was 45.1%, and in Saskatchewan it was 36.8%, which is below the national percentage. 11

page 12

Research has shown that fl uoride in optimal levels in drinking water is the most cost-effective community based preventive strategy for dental

caries. Fluoride can also be obtained from mouthrinse, toothpaste as well from professionally applied fl uorides. Long term exposure to optimal levels of fl uoride results in diminishing levels of caries in both children and adult populations.5

Dental sealants if placed on permanent teeth which are not at high risk for dental caries but might be susceptible, would prevent most of the tooth decay in children.4

There is a clear correlation between community socio-economic status and children’s dental health. Caries experience in primary teeth was signifl cantly

higher in students from low socio-economic status. Also, the proportion of untreated caries in primary teeth and permanent teeth, dental treatment priority needs and incisor trauma was higher in students from low socio-economic status.6

The dental health surveys have been tracking patterns and trends of the dental health indicators in Regina Qu’Appelle Health Region since 1993-19994.

This 2008-2009 report features information regarding Grade Seven students, epidemiological studies and additional optional information questions for the fl rst time. This report describes the methodology for conducting the 2008-09 dental screening and the results, which will be shared with policy makers, dental fraternity and stakeholders.

Introduction

page 41

Attrition Rate:• the rate of decline in the number or size

Caries Prevention Fraction:• proportion of caries prevented due to exposure to community water fluoridation

Morbidity:• a measure of sickness, which could be either incidence rate or prevalence

Hidden Morbidity:• an undiagnosed or a missed measure of sickness

Tooth Fatality Rate:• tooth fatality rate represents the potential for a tooth to be lost due to dental

caries

Recurrent Decay:• when a tooth has a visible recurrent decay then it is marked as decayed

even though it may have a restoration in place

Pain:• pain as a result of tooth decay, injury, periodontal disease, or over retention

Infection:• visible infection (abscess)

Broken/Fractured/Lost:• a tooth that has been restored where the restoration (i.e.: crown, amalgam)

has failed and there is no obvious decay

Restored/Fractured:• fracture of the crown involving the dentin. The tooth is restored

Non- Restored/Fractured:• fracture of the crown involving the dentin. The tooth is not restored or the

restoration has been lost

Early Childhood Caries:• any decay evident in the deciduous anterior centrals and laterals

Appendices

page 42

Early Childhood Caries+:• pain and/or infection present with anterior caries on deciduous centrals and

laterals

Supernumerary Teeth:• supernumerary teeth are not counted. You must decide which tooth is the

legitimate occupant of the space.

Over Retained:• where both primary and permanent teeth occupy the same tooth space only the

permanent tooth is considered

Non-Vital Teeth:• are to be scored as if they are vital

Treatment Priorities:

Priority 1:• pain and/or infection present, in teeth distal to deciduous laterals• early childhood caries+• urgent, requires immediate attention

Priority 2:• visible decay in 1-4 quadrants in teeth, distal to deciduous laterals• treatment required as soon as possible

Priority 3:• no visible decay

Oral Health Status:

NDE:• indicates that no decay, fillings or extractions are evidentCCC:• indicates that all decayed teeth appear to have treatedPCC:• indicates that some teeth have been treated, but decay is still evidentNEC:• indicates that there is decay but no evidence of past or present dental treatment

Appendices

page 11

Introduction

“…oral health and general health should not be interpreted as separate entities”-Surgeon General’s Report on Oral Health of America, 2000

Oral health is an inseparable and essential part of total health and contributes to overall well being, and has the potential to impact a person’s health status,

affecting the ability to eat and speak properly, quality of life, self-esteem and levels of usual activity.2

Poor oral health and untreated tooth decay is a huge economic burden that exceeds most other health conditions. The burden is disproportionately more

on lower income people and aboriginal populations. These disparities were emphasized in the Canadian Oral Health Strategy guidelines for 2010, which states that in Canada, people from low income had 2.5 to 3 times higher treatment and decay rates, where as rates for First Nations and Inuit people for all age groups ranged from 3 to 5 times higher than non-aboriginal population.1

Dental caries is the most common chronic disease affecting children, occurring 5-8 times more frequently than asthma, which is the second most common

chronic disease among children.3

Early Childhood Caries (ECC) is one of the most destructive forms of dental caries affecting primary teeth that can have a negative impact on the oral

health of infants and children, which is preventable, by proper education, counselling, prevention and anticipatory guidance.

Lack of dental health education, sweetened pacifi ers, improper feeding practices in which a child is put to bed with either milk or food in the oral cavity,

improper oral hygiene practices in which a child is put to bed without cleaning the oral cavity, lack of dental health insurance and barriers to access dental health care are some of the factors contributing to the prevalence of ECC.2, 4

page 10

In 2008-2009, dental health disparities were noted between students attending schools located in urban and rural communities. The average ‘deft/DMFT’ per

student attending a school in an urban community was 2.32 compared to 2.52 for a student attending a school in a rural community. Also, 52.6% of students attending schools in urban communities were caries-free compared to 43.1% of students attending schools in rural communities (Table 26).

In 2008-2009, dental health disparities were noted between students attending schools located in low-income neighbourhoods and schools in higher income

neighbourhoods in the City of Regina. The students attending low income neighbourhood schools were more likely to be experiencing caries, pain or infection, show no evidence of care (NEC) and at the same time are less likely to be cavity free. The average ‘deft/DMFT’ per student attending a school in a low-income neighbourhood was 4.95 compared to 2.09 for a student attending a school in higher-income neighbourhood. Also, 23.1% of students attending schools located in a low-income neighbourhood were caries-free compared to 55.7% of students attending schools located in a higher-income neighbourhood (Table 27).

Of the 109 schools in the RQHR, 73 (67%) schools had 20% or more of their Grade One and Grade Seven students with visible decay. These schools are

designated as having high risk for dental need. Twenty-fi ve (23%) schools had 10% or more, but less than 20% of their Grade One and Grade Seven students with visible decay. These schools are designated as having medium risk for dental need. Eleven (10%) schools had less than 10% of their Grade One and Grade Seven students with visible decay. These schools are designated as having low risk for dental need.

Key Findings

page 43

Appendices

Appendix 2: List of Schools in RQHR participating in the dental screening 2008-2009

Albert SchoolArcola SchoolArgyle School*Arm River Hutterite SchoolAthabasca School*Balcarres Community School*Broadview SchoolCentennial School*Clive Draycott School - BethuneConnaught Community SchoolCoronation Park School*Cupar SchoolDavin SchoolDieppe SchoolDouglas Park SchoolDr. A.E. Perry SchoolDr. George Ferguson School*Dr. Isman School - WolseleyDr. L.M. Hanna SchoolEcole St. AndrewElsie Mironuck SchoolEthel Milliken School*Fort Qu'Appelle Elementary Community School*George Gordon Education Centre - PunnichyGeorge Lee SchoolGladys McDonald SchoolGlen Elm School

Grant Road School*Grenfell Elementary School*Grenfell High SchoolHarvest City Christian AcademyHaultain SchoolHenry Braun SchoolHenry Janzen SchoolHoly Rosary Community SchoolImperial Community School*Imperial School - Imperial*Indian Head Elementary School*Indian Head High SchoolJack Mackenzie Elementary School*James Hamblin School – Qu’AppelleJudge Bryant School*Kelliher SchoolKen Jenkins SchoolKitchener Community School*Lajord Colony SchoolLakeview School*Lipton School*Lumsden Elementary SchoolM.J. Coldwell School*MacLeod Churchill Elementary School - MoosominMarion McVeety SchoolMassey SchoolMcDermid School*McLean School

page 44

McLurg School*McNaughton High School - Moosomin*Milestone School*Montmartre SchoolMorning Star Christian Academy*North Valley High School - Lemberg*Pense School*Pilot Butte School*Punnichy Elementary School*Raymore SchoolRegina Christian SchoolRegina Huda School*Robert Southey School - Southey*Rocanville SchoolRosemont SchoolRuth M. Buck SchoolSacred Heart Community School*Schell School - Holdfast*Sedley School*South Shore School – Regina BeachSt. Angela Merici SchoolSt. Augustine Community School*St. Augustine School - WilcoxSt. Bernadette SchoolSt. Catherine SchoolSt. Dominic Savio SchoolSt. Francis Community School

St. Gabriel SchoolSt. Gregory SchoolSt. Jerome SchoolSt. Joan of Arc SchoolSt. Josaphat SchoolSt. Luke SchoolSt. Marguerite Bourgeoys SchoolSt. Mary SchoolSt. Matthew SchoolSt. Michael Community SchoolSt. Pius X SchoolSt. Theresa SchoolSt. Timothy School*Stewart Nicks School – Grand CouleeThomson School*Vibank SchoolW.F. Ready SchoolW.H. Ford SchoolW.S. Hawrylak SchoolWalker School*Wapella SchoolWascana Elementary School*White City School*Whitewood SchoolWilfred Hunt SchoolWilfred Walker School*Wolseley High School

* denotes rural school** there were ten schools in the RQHR that did not participate for various reasons

Appendices

page 9

Key Findings

One hundred and nine schools and 4,044 students across the health region participated in the screening, for a response rate of 82.8% (4,044/4,888)

(Table 1 and Appendix 2).

Early Childhood Caries (ECC), defi ned as pain and/or infection present with anterior caries on deciduous centrals and laterals, was experienced by 10.1%

(205) of Grade One students. This percentage has increased considerably from 6.9% recorded during 2003-2004 screenings (Table 8 and Table 23).

In Grade One, 5.3% (108) of the students were found to have urgent dental treatment needs. In Grade Seven, 1.3% (26) of the students were found to have

urgent dental treatment needs (Table 21 and Table 22).

In Grade One, 26.6% (540) of the students were referred to see their dentist for treatment as soon as possible. In Grade Seven, 13.7 % (276) of the students

were referred to see their dentist for treatment as soon as possible (Table 21 and Table 22).

For students in Grade One and Grade Seven in the RQHR tooth decay remains a signi? cant childhood problem. The results of the 2008-2009 screening

showed that students in Grade One, in RQHR are experiencing more dental decay than in the 2003-2004 screening year. In 2008-2009, 33.5 % of Grade One students had dental caries compared to 24.3% in 2003-04 (Table 23). Since this survey was a screening and not a full dental exam with radiographs tooth decay is likely to be underestimated.

In Grade One, 42.9% of the students were cavity-free and the percentage of unmet dental needs was 33.1%. These fi ndings do not meet the Canadian Oral

Health Strategy guidelines (2010) of 50% for never having experienced tooth decay and 20% for unmet dental need for Grade One1 (Table 24).

For students in Grade Seven, only 62.7% have never experienced decay in their permanent dentition, unmet dental needs were 15.4%, the average ‘DMFT’

was 1.05 and the ‘Signifi cant Caries Index’ (SiC) was 3.04. These fi ndings do not meet the Canadian Oral Health Strategy guidelines (2010) of 75% of students age 12 not having experienced decay in their permanent teeth, no more than 10% have unmet dental needs and average DMFT of 1.0 or less or SiC of 3 or less for Grade Seven students1 (Table 25).

Continued

page 8

Executive Summary

Adental health screening was conducted in the Regina Qu’Appelle Health Region during the 2008-2009 school year to assess

oral health status, monitor the trends, identify students with unmet dental needs, locate schools that are at high risk for caries, gauge the effectiveness of preventive dental programs and to provide needs-based appraisal data for the health region. Following the termination of the Saskatchewan Children’s Dental Plan in 1993, the Saskatchewan Health Dental Health Education Program added a screening component to be repeated on a fi ve year interval basis. The 2008-2009 screening marks the fourth of these screening surveys.

The screening recorded the participation rate (Table 1), proportion of students screened by location (Table 2), gender distribution (Table

3), mean age of students for Grade One and Grade Seven and proportion of schools that have access to community water fl uoridation (Table 4). The proportion of students with malocclusion, staining, gingivitis and calculus were included under Dental Health Care Needs (Table 5 to Table 7).

The prevalence of Early Childhood Caries (ECC) was recorded for Grade One students only, whereas decay by the number of affected

quadrants (occlusal/interproximal) was recorded for both Grade One and Grade Seven students. The screening assessed the past and present dental caries experience by a measure of cumulative indices for both primary (deft) and permanent (DMFT) dentition, as well as individual components to gauge barriers to access dental care (d/D component) and access of dental care (m,f/M,F components). Additional information collected included: No Evidence of Dental Care (NEC), No Decay Evident (NDE) (no fi llings/extractions/decay obvious), Early Childhood Caries (ECC), and the presence of pain and/ or infection (Appendix 1).

Unmet dental needs were measured based on Priority scores for both Grade One and Grade Seven students.

This report is divided into the following parts:

1 Executive Summary

2 Introduction

3 Methods

4 Results

5 Discussion

6 Limitations of the study

7 Recommendations

page 45

Appendix 3: Dental Screening Advance Information Letter, 2008-2009

Appendices

page 46

Appendices

Appendix 3A: Dental Screening Advance Information Letter, 2008-2009

page 7

Population and Public Health Services (PPHS), Regina Qu’Appelle Health Region (RQHR), conducted an oral health screening of Grade One and Grade Seven students in

the region during the 2008-2009 school year.

The purpose of this screening was to assess oral health needs to identify students with unmet dental needs and to refer those in obvious need of dental treatment. Population and

Public Health Services, RQHR, will continue to use the screening results to develop strate-gies to decrease the number of students experiencing tooth decay. Since tooth decay is largely preventable, we collaborate with early childhood programs by enhancing oral health content in pre-natal, post-natal and parenting programs.

This report is also available on the Regina Qu’Appelle Health Region website. To obtain additional copies of the report, to make suggestions, or to request further information,

please contact the:

Dental Health Promotion ProgramPopulation and Public Health ServicesRegina Qu’Appelle Health Region1080 Winnipeg StreetRegina, SaskatchewanS4R 8P8Phone: (306) 766-6320Website: http://www.rqhealth.ca/programs/comm_hlth_services/pubhealth/pubhealth_dental.shtml

Preface

page 6

Message from the Medical Health Offi cer and the Executive Director Population and Public Health Services

Dear Reader,

We are pleased to share with you the Dental Health Screening Report, 2008-2009. This report presents the results of a screening survey reviewing the dental health status and treatment needs of Grade One and Grade Seven students. The survey was conducted by the Dental Health Coordinators, Population and Public Health Services, Regina Qu’Appelle Health Region, in 2008-2009.

The information obtained from this screening is extremely valuable to Population and Public Health Services as we continue to plan and address the oral health needs of our children. Oral health, in particular tooth decay, is the most common unmet health need and is a major problem for our young children, left untreated it can lead to chronic pain, delayed growth, and impaired speech which can ultimately affect the child’s ability to learn and thrive.

The report indicates disparities in oral health needs in our communities and neighbourhoods, highlighting the need to focus our efforts on vulnerable children and their families and to advocate for additional resources for oral health and fl uoridation of water in our communities.The information provided in this report will help mobilize efforts to improve the oral health of our children. Improving the oral health of our children at the community level is a collaborative process, and we invite you to join us in a concerted effort to create healthy communities throughout the Regina Qu’Appelle Health Region.

Dr. Tania Diener, MBChB, MMed, (Com Health), MPA, DTM, MFTM RCPS (Glasg) Medical Health Offi cer

Bob Layne BSc (Hon), MPA Executive Director Population and Public Health Services

page 47

Appendix 4: Dental Screening Results Letter(Ministry of Health, Govt. of SK)

Appendices

page 48

Appendices

page 5

Dental Health Screening Advisors

Dr. Tania Diener, Medical Health Offi cer, Population and Public Health ServicesBob Layne, Executive Director, Population and Public Health Services Anna Engel, Manager, Health Promotion, Population and Public Health Services

Examiners and Data Collection

The following Dental Health Coordinators participated as examiners and recorded the results:Rosemary HenricksenBarb IngMelanie LemieuxCharlene McConnellJudy Tejszerski

Data Analysis

Vinay K. Pilly, M.P.H. Practicum Student (U of S), Saskatoon Health RegionZahid Abbas, Epidemiologist, Population and Public Health Services

Writing and Editing

Dr Tania DienerVinay K. Pilly, M.P.H.Practicum Student (U of S), Saskatoon Health RegionZahid AbbasAnna EngelRosemary HenricksenBarb IngCharlene McConnellJudy Tejszerski

Sponsor

College of Dentistry, University of Saskatchewan

The Population and Public Health Services – Dental Health Promotion Program and the Regina Qu'Appelle Health Region also gratefully acknowledge all the schools who participated in the Dental Health Screening.

Acknowledgements

page 4




Table 4: Communities with Fluoridated Water and Students Screened




Table 8: Prevalence of Early Childhood Caries (ECC) and ECC+, RQHR, 2008-2009






Table 14: Grade Seven Students ‘deft’ Scores, RQHR, 2008-2009










Table 24: Canadian Oral Health Strategy (COHS) Guidelines for 2010: Goal 2(Grade One/Age 6), RQHR, 2008-2009

Table 25: Canadian Oral Health Strategy (COHS) Guidelines for 2010: Goal 2(Grade Seven/Age 12), RQHR, 2008-2009

Table 26: Dental Health by Urban/Rural School Location, RQHR, 2008-2009

Table 27: Dental Health by Neighbourhood Income Status, City of Regina, 2008-2009

Table 28: Comparison of Dental Health Status of Students who attended Schools located in Low

Income Neighbourhoods in the City of Regina for the school years 2003-2004 and 2008-2009

List of Tables

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page 49

References

1. The Canadian Oral Health Strategy, August2005. Data retrieved from the website:http://www.fptdwg.ca/assets/PDF/Canadian%20Oral%20Health%20Strategy%20-%20Final.pdf

2. Promoting Oral Health from birth throughchildhood: Prevention of Early Childhood Caries. Jennnifer Yost & Yihong Li, MCN,Volume 33, January/February 2008. http:// www.ncbi.nlm.nih.gov/pubmed/18158522

3. U.S. Department of Health and HumanServices (HHS). Oral Health in America:A Report of the Surgeon General. Rockville, MD: HHS, National Institutes of Health, National Institute of Dental andCraniofacial Research, 2000.

4. Proceedings. NIH Consensus DevelopmentConference: Dental Sealants in the Prevention of Tooth Decay. Journal ofDental Education 48(2) (Suppl.),1984.PubMed; PMID 6583262

5. World Health Organization: Fluorides &Oral Health. WHO technical report series #846, Geneva, 1994.

6. Community socio-economic status andchildren’s dental health. James Gilchrist,David E. Brumley, Jennifer U. Blackford,JADA, Volume 132, February 2001.

7. Newbrun E. Effectiveness of water fluoridation. J Public Health Dent 1989;49(5 spec no.): 279-289

8. Brunelle JA, Carlos JP. Recent trends indental caries in U.S. children and the effectof water fluoridation. J Dent Res 1990;69(spec no): 723-727.

9. Fluoride: Nature’s tooth decay fighter. J AmDent Assoc 2009; 140; 126

10. Center for Disease Control and Prevention.Data retrieved from the website :http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm

11. Water Fluoridation in Canada: Past andPresent. Danielle Rabb-Waytowich, JCDA,July/August 2009, Volume 75, No. 6

12. Findings and Recommendations of theFluoride Expert Panel (January 2007). Dataretrieved from the website:http;//www.hc-hc-sc.gc.ca/ewh-semt/pubs/water-eau/2008-fluoride-fluorure/iondex-eng.php.

13. WHO Oral Health Country/ Area ProfileProgramme. Data retrieved from the website: http://www.whocollab.od.mah.se/expl/sic.html

14. Epidemiology. Leon Gordis, fourth edition,Saunders Elsevier publication, 2008.

Notes

page 3

Figure 1: Dental Health Care Needs, Grade One and Grade Seven Students, RQHR, 2008-2009Figure 2 : Percentage of Grade One Students by Number of Affected Quadrants, RQHR, 2008-2009Figure 3: Grade One and Grade Seven Students ‘deft’ Components, RQHR, 2008-2009Figure 4: Grade One and Grade Seven Students ‘DMFT’ Components, RQHR, 2008-2009Figure 5: Percentage of RQHR Grade One Students screened who were Cavity-free during Dental Screen-ings, 1993-94, 1998-99, 2003-04 and 2008-2009Figure 6: Percentage of RQHR Grade One Students Screened who had Cavities during Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009Figure 7: Percentages of RQHR Grade One Students Screened who had Pain and/or Infection at the time of Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009Figure 8: Percentage of RQHR Grade One Students with Early Childhood Caries at the time of Dental Screening, 1993-1994, 1998-1999, 2003-2004 and 2008-2009Figure 9: Percentage of RQHR Grade One Students Screened who had No Evidence of Care, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

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List of Figures

page 2

Acknowledgements 5Message from the Medical Health Offi cer and the Executive Director 6Preface 7 Executive Summary 8Key Findings 9Introduction 11Water Fluoridation in Canada 13Methods 14Results 15 Participation 15 Location 15 Gender Distribution 16 Age 16 Water Fluoridation 16 Dental Health Assessment 17 Early Childhood Caries 19 Priority Scores 25 Dental Health Trends in the Regina Qu’Appelle Health Region, 2008-09 26 Canadian Oral Health Strategy (COHS) Guidelines for 2010: Goal 2 31 Signifi cant Caries Index (SiC) 15: Grade Seven, RQHR, 2008-09 32 Dental Health Disparities 33 Dental Health Disparity by Neighbourhood 33 Discussion 35 Limitations of the study: 37 Recommendations: 38 Healthy Public Policy 38 Building Capacity 38 Enhanced Patient Care 39 Health Surveillance 39 Additional Research 39Appendices 40 Appendix 1: Dental Screening Program Defi nitions 40 Appendix 2: List of Schools in RQHR participating in the dental screening 2008-09 43 Appendix 3: Dental Screening Advance Information Letter, 2008-09 45 Appendix 3A: Dental Screening Advance Information Letter, 2008-09 46 Appendix 4: Dental Screening Results Letter (Ministry of Health, Govt. of SK) 47 References 49

Contents Notes

Design byMedical Media Services9566-2010-Don Heenan

Population and Public Health Services

Dental Health Screening Program Report

Grade One and Grade Seven

2008-2009

Documents

Dental Health Report · Dental Health Education Program added a screening component to be repeated on a five year interval basis. The 2008-2009 screening marks the fourth of these