national survey on school-based fluoride mouth rinsing program in japan - regional spread conditions...

National Survey on School-based Fluoride National Survey on School-based Fluoride Mouth RinsingMouth Rinsing Program in Japan Program in Japan

- Regional Spread Conditions in Various Kinds of Schools -- Regional Spread Conditions in Various Kinds of Schools -

Kazunari KimotoKazunari Kimoto * * 11, Katsuhiko Taura, Katsuhiko Taura 22, Akihiro Yoshihara, Akihiro Yoshihara

33, Satoru , Satoru HaresakuHaresaku

44, Yuichi Ando, Yuichi Ando 55, Hirohisa Arakawa, Hirohisa Arakawa

11 and Osamu Sakai and Osamu Sakai 66

1 Division of Oral Health, Department of Health Science, Kanagawa Dental College, Japan1 Division of Oral Health, Department of Health Science, Kanagawa Dental College, Japan 2 Dental Care Center attached to Tohoku University Hospital, Miyagi, Japan2 Dental Care Center attached to Tohoku University Hospital, Miyagi, Japan 3 Division of Preventive Dentistry, Department of Oral Health Science, Graduate school of Medical 3 Division of Preventive Dentistry, Department of Oral Health Science, Graduate school of Medical & Dental Sciences, Niigata University, Japan& Dental Sciences, Niigata University, Japan 4 Preventive & Public Health Dentistry, Department of Public Health & Human Science, Fukuoka4 Preventive & Public Health Dentistry, Department of Public Health & Human Science, Fukuoka Dental College, JapanDental College, Japan 5 Department of Oral Health, National Institute of Public Health, Japan5 Department of Oral Health, National Institute of Public Health, Japan 6 Non-profit Japanese Conference on the Promotion of the Use of Fluoride in Caries Prevention6 Non-profit Japanese Conference on the Promotion of the Use of Fluoride in Caries Prevention (NPO-JPUF)(NPO-JPUF)

The 9th World Congress on Preventive DentistryThe 9th World Congress on Preventive Dentistry

#: 123#: 123

September 9, 2009, at Hilton Phuket Arcadia September 9, 2009, at Hilton Phuket Arcadia Resort & Spa, Grand Ballroom Resort & Spa, Grand Ballroom

8. Theme III: Fluoride and Health (Poster)8. Theme III: Fluoride and Health (Poster)

Fluoride mouth rinsing (FMR) is safe, effective and easy Fluoride mouth rinsing (FMR) is safe, effective and easy to learn and do by preschool and school children. It is to learn and do by preschool and school children. It is relatively inexpensive caries-preventive measure with public relatively inexpensive caries-preventive measure with public health.health. In Japan, school-based fluoride mouth rinsing program In Japan, school-based fluoride mouth rinsing program (S-FMR) started in a single prefecture in 1970, and spread (S-FMR) started in a single prefecture in 1970, and spread to all of 47 prefectures by 2005 (Table 1). to all of 47 prefectures by 2005 (Table 1).

The purposes of this study were as follows;The purposes of this study were as follows;

ObjectiveObjective

1)1) to clarify the spread conditions of the school-based to clarify the spread conditions of the school-based fluoride mouth rinsing program (S-FMR) since fluoride mouth rinsing program (S-FMR) since 1983.1983.

2) to set up the next S-FMR goal in 2010 and promote 2) to set up the next S-FMR goal in 2010 and promote it throughout Japan to health for all (Fig. 1).it throughout Japan to health for all (Fig. 1).

Table 1 Number of prefectures adopted S-FMR during the pastTable 1 Number of prefectures adopted S-FMR during the past 38 years 38 years

YearYear Number ofNumber of

prefecturesprefectures YearYear Number ofNumber of

prefecturesprefectures YearYear Number ofNumber of

prefecturesprefectures

19701970 11 19831983 2020 19981998 3939

19721972 33 19851985 2323 20002000 3838

19741974 66 19871987 2626 20022002 4040

19761976 1010 19901990 2929 2004 2004 4545

19781978 1515 19921992 3232 20052005 4747

19801980 1616 19941994 3535 20062006 4747

19821982 1818 19961996 3838 20082008 4747

1) S-FMR;1) S-FMR; Number of children will be increased toNumber of children will be increased to

　　　　 1,000,000 in 20101,000,000 in 2010 　　　　 2,000,000 in 20202,000,000 in 20202)2) Community water fluoridation; Community water fluoridation; realizing in some areasrealizing in some areas (none except some natural areas in 2009)(none except some natural areas in 2009)

3)3) Market share ofMarket share of fluoridated dentifrice; fluoridated dentifrice; more than 90%more than 90% (89% in 2007)(89% in 2007)

4)4) Experienced person of professional topical fluoride application; Experienced person of professional topical fluoride application; more than 60%more than 60% (59% in 2005)(59% in 2005) ・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・

・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・

** Other fluoride uses at present in Japan Other fluoride uses at present in Japan : : ・・ FMR agents as over the counter drug (OTC); FMR agents as over the counter drug (OTC); none for sale at present (in 2009)none for sale at present (in 2009)

・・ Number of children in FMR at home in 4-14 years old; Number of children in FMR at home in 4-14 years old; 347,000 (estimated data in 347,000 (estimated data in 2002)2002) Fig.1 Fig.1 The goals of S-FMR and others in Japan by NPO-JPUFThe goals of S-FMR and others in Japan by NPO-JPUF

* * Other fluoride uses at present in JapanOther fluoride uses at present in Japan

Subjects and MethodsSubjects and Methods

Data were collected by questionnaire surveys regarding Data were collected by questionnaire surveys regarding the schools and children participating in S-FMR. The other the schools and children participating in S-FMR. The other contents of questionnaire for S-FMR are frequency of rinse, contents of questionnaire for S-FMR are frequency of rinse, used agent for mouth rinsing, fluoride concentration of the used agent for mouth rinsing, fluoride concentration of the rinsing solution and source of financial support for S-FMR. rinsing solution and source of financial support for S-FMR. Questionnaires had been sent to the key persons and Questionnaires had been sent to the key persons and dentists of NPO-JPUF by mail or e-mail every two years. dentists of NPO-JPUF by mail or e-mail every two years. The latest survey, a joint with 8020 Promotion The latest survey, a joint with 8020 Promotion Foundation, WHO Collaborating Center for Translation of Foundation, WHO Collaborating Center for Translation of Oral Health Science and NPO-JPUF, was conducted in Oral Health Science and NPO-JPUF, was conducted in 2008. Questionnaires were sent to manager of oral health in 2008. Questionnaires were sent to manager of oral health in all 47 prefectures.all 47 prefectures.

Furthermore, the number of children participating in S-Furthermore, the number of children participating in S-FMR program corresponds to about 5.1% of the same aged FMR program corresponds to about 5.1% of the same aged population (Table 2).population (Table 2).

In 2008, the total number of schools and children In 2008, the total number of schools and children participating in the program were 6,433 and 674,141, participating in the program were 6,433 and 674,141, respectively. respectively. (recovery rate 100%). (recovery rate 100%). The ratio by the total The ratio by the total number of schools and children in Japan were 9.0 % and number of schools and children in Japan were 9.0 % and 5.1 %, (nursery schools and kindergartens 11.1 % and 7.0 5.1 %, (nursery schools and kindergartens 11.1 % and 7.0 %, primary schools 9.1 % and 6.3%, secondary schools 2.7 %, primary schools 9.1 % and 6.3%, secondary schools 2.7 % and 1.5%, and schools for special needs education; % and 1.5%, and schools for special needs education; physically handicapped and mentally retarded children 3.1 physically handicapped and mentally retarded children 3.1 % and 2.7 %), respectively.% and 2.7 %), respectively.

The number of children in S-FMR by prefectures in 2006 The number of children in S-FMR by prefectures in 2006 and 2008 is drawn map, which showed in increasing and 2008 is drawn map, which showed in increasing among prefectures (Fig. 2; red and pink prefectures). among prefectures (Fig. 2; red and pink prefectures).

Results Results (1)(1)

Fig.2Fig.2 The map on the number of children in S-FMR The map on the number of children in S-FMR by 47 prefectures in 2006 and by 47 prefectures in 2006 and 2008.2008.

30,000 30,000 ～～10,000 10,000 ～～ 5,000 5,000 ～～ 1,000 1,000 ～～less than 1,000less than 1,000

** Lower left sideLower left side : Survey in 2006 with NPO-JPUF : Survey in 2006 with NPO-JPUF **** Upper right sideUpper right side : Survey in 2008, a joint with NPO-JPUF, : Survey in 2008, a joint with NPO-JPUF,

8020 Promotion Foundation and WHO Collaborating8020 Promotion Foundation and WHO Collaborating Center for Translation of Oral Health ScienceCenter for Translation of Oral Health Science

20082008 ****

20062006 **

Table 2 Number of schools and children participating, the rate of Table 2 Number of schools and children participating, the rate of

financial support in S-FMR by school class in 2008 financial support in S-FMR by school class in 2008Number of Number of Financial supportNumber of Number of Financial support

schools children schools children GovernmentsGovernments etc.etc.** // The othersThe others****

Nursery schoolNursery school & Kindergarten& Kindergarten Primary schoolPrimary school Secondary schoolSecondary school Special school, etc. Special school, etc. ♯♯

TotalTotal

Various kinds Various kinds

of schoolof school

* The prefectural or municipal governments and/or educational committee * The prefectural or municipal governments and/or educational committee ** ** 　　 The others (School, Parent, Dental Association, Jointed combination, etc.) The others (School, Parent, Dental Association, Jointed combination, etc.) 　　 *** Number of schools in S-FMR / Total schools in Japan *** Number of schools in S-FMR / Total schools in Japan 　　　　 **** Number of children in S-FMR / Total children in Japan **** Number of children in S-FMR / Total children in Japan 　　 ♯ ♯ The school for physically handicapped or mentally related children and the othersThe school for physically handicapped or mentally related children and the others

4,049 (11.1%)4,049 (11.1%)****** 170,177 (7.0%)170,177 (7.0%)******** 69.2 %69.2 % / 30.8 % / 30.8 %

2,053 (9.1%) 2,053 (9.1%) 447,579 447,579 (6.3%)(6.3%) 84.2 %84.2 % / 15.8 % / 15.8 %

300 (2.7%) 54,794 (1.5%) 300 (2.7%) 54,794 (1.5%) 87.9 %87.9 % / 12.1 % / 12.1 %

31 (3.1%) 1,591 (2.7%) 31 (3.1%) 1,591 (2.7%) 100.0 %100.0 % / / 0.0 %0.0 %

6,433 (9.0%) 6,433 (9.0%) 674,141674,141 (5.1%) 80.4 % (5.1%) 80.4 % / 19.6 %/ 19.6 %

Figure 3 shows the increasing number of schools and Figure 3 shows the increasing number of schools and children in S-FMR by nearly every two yearchildren in S-FMR by nearly every two year (1983-2008), (1983-2008), and goal of children in 2010 (and goal of children in 2010 (●●).). In nursery schools and kindergartens, 59.2 % and 47.0 In nursery schools and kindergartens, 59.2 % and 47.0 % of the participating children adopted the daily rinsing-% of the participating children adopted the daily rinsing-method, respectively. In primary and secondary schools method, respectively. In primary and secondary schools 95.7 % and 95.4% of the participating children adopted 95.7 % and 95.4% of the participating children adopted the weekly rinsing-method, respectively. In nursery the weekly rinsing-method, respectively. In nursery schools, kindergartens and special needs education, schools, kindergartens and special needs education, children used more medicaments for FMR than a reagent children used more medicaments for FMR than a reagent of Sodium Fluoride and in primary and secondary schools, of Sodium Fluoride and in primary and secondary schools, children used more a reagent than medicaments.children used more a reagent than medicaments.

Results Results (2)(2)

0

2000

4000

6000

8000

10000

1983 1985 1987 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

0

20

40

60

80

100

120

** Survey in 2008, a joint with NPO-JPUF, 8020 Promotion Foundation and Survey in 2008, a joint with NPO-JPUF, 8020 Promotion Foundation and WHO Collaborating Center for Translation of Oral Health ScienceWHO Collaborating Center for Translation of Oral Health Science

Nu

mb

er of child

renN

um

ber of ch

ildren

’83 ’85 ’87 ’90 ’92 ’94 ’10’96 ’98 ’06 ’08 ’04’02’00

10

8

6

4

2

0

120

100

80

60

40

20

0

The turning point The turning point in Japanin Japan

●●

（（ ×10 ×10 44 ））（（ ×10 ×10 33 ））

Fig.3 The changes on the number of schools and children in S-FMR Fig.3 The changes on the number of schools and children in S-FMR by nearly every two year (1983 - 2008), and goal of children ( by nearly every two year (1983 - 2008), and goal of children (●●).).

Nu

mb

er of schools

Nu

mb

er of schools

**

Table 3 Outline of the rinsing-methods in the questionnaire Table 3 Outline of the rinsing-methods in the questionnaire for S-FMR by grade level (%) for S-FMR by grade level (%)

FrequencyFrequency perper weekweek** FluorideFluoride concentrationconcentration** SS--FMRFMR agentagent forfor useuse

5 times / once 250ppmF / 450ppmF / 900ppmF Reagents / Medicaments5 times / once 250ppmF / 450ppmF / 900ppmF Reagents / Medicaments

Nursery schoolNursery school & Kindergarten& Kindergarten Primary schoolPrimary school

Secondary schoolSecondary school

Special school, etc.Special school, etc.♯♯

TotalTotal

** These are not the approximate value, because the rinsing-methods in S-FMR are These are not the approximate value, because the rinsing-methods in S-FMR are 　　 d different by regional distinction.d different by regional distinction.

♯ ♯ The school for physically handicapped or mentally related children and the othersThe school for physically handicapped or mentally related children and the others

55.0 55.0 / 27.4 / 27.4 42.5 42.5 / 26.5 / 13.4 35.9 // 26.5 / 13.4 35.9 / 64.1 64.1

3.2 /3.2 / 95.7 95.7 3.1 / 30.5 /3.1 / 30.5 / 63.8 52.5 63.8 52.5 / 47.3/ 47.3

4.2 / 4.2 / 95.495.4 4.5 / 27.3 / 4.5 / 27.3 / 64.164.1 67.867.8 / 32.2 / 32.2

32.1 / 32.1 / 41.741.7 16.3 / 16.3 / 41.041.0 / 24.2 / 24.2 22.4 /22.4 / 66.8 66.8

16.4 /16.4 / 78.3 78.3 13.2 / 29.2 /13.2 / 29.2 / 51.1 51.1 49.5 /49.5 / 50.4 50.4

Various kinds Various kinds of schoolof school

S-FMR is useful public health method. Both the increasing S-FMR is useful public health method. Both the increasing profiles have two phases, profiles have two phases, ““first phasefirst phase”” was increased from was increased from 1983 to 2000. Then, 1983 to 2000. Then, ““Second phaseSecond phase”” was increasing from was increasing from 20022002 to 2008. It would be considered that factors of turning to 2008. It would be considered that factors of turning points were “The Synthetic opinion of fluoride application” points were “The Synthetic opinion of fluoride application” by Japanese Association for Dental Science (1999) and by Japanese Association for Dental Science (1999) and announcement of guideline for FMR by Minister of Health, announcement of guideline for FMR by Minister of Health, Labor and Welfare Japan (2003) etc..Labor and Welfare Japan (2003) etc.. We have recognized a We have recognized a big regional differences even though the number of schools big regional differences even though the number of schools and children implementing FMR was increasing. and children implementing FMR was increasing.

We need the cooperation among dental organizations, We need the cooperation among dental organizations, dental schools and municipal corporations to achieve the dental schools and municipal corporations to achieve the goals and to lesson in regional differences in S-FMR.goals and to lesson in regional differences in S-FMR.

We propose that a goal, the item with regarding to caries We propose that a goal, the item with regarding to caries prevention, for S-FMR should be adopted for the final prevention, for S-FMR should be adopted for the final assessment of Healthy Japan 21.assessment of Healthy Japan 21.

DiscussionDiscussion

東京

福岡

京都

札幌

仙台新潟

那覇

・

・

・・

・

・・

OkinawaOkinawa

SapporoSapporo

SendaiSendaiNiigataNiigata

Number of Dentists: 97,198Number of Dentists: 97,198 ((06 From 06 From Minister of Health, Labor and WelfareMinister of Health, Labor and Welfare))

To one million population byTo one million population by 761 Dentists761 Dentists Number of Dental Hygienists: 86,939Number of Dental Hygienists: 86,939 ((06 From 06 From Minister of Health, Labor and WelfareMinister of Health, Labor and Welfare))

To one million population byTo one million population by 680 Dental Hygienists680 Dental Hygienists

Total population: 127,773,000Total population: 127,773,000

Children: 13,248,000Children: 13,248,000

BackgroundBackground

KyotoKyoto

4-5 years old: 2,433,0004-5 years old: 2,433,000



TokyoTokyo

東京

福岡

京都

札幌

仙台新潟

那覇

・

・

・・

・

・・

OkinawaOkinawa

SapporoSapporo

SendaiSendaiNiigataNiigata

In Japan, medical expenses insurance is on a piece-rate basis, In Japan, medical expenses insurance is on a piece-rate basis, national dental expenses/national income is 0.5%; ¥ 25,766 national dental expenses/national income is 0.5%; ¥ 25,766 billion, in billion, in 05. The dental expenses insurance was included 05. The dental expenses insurance was included slightly preventive care. Unfortunately, certain dentists and slightly preventive care. Unfortunately, certain dentists and dental hygienists give priority professional care in clinic and dental hygienists give priority professional care in clinic and self care in home over public care.self care in home over public care.

* * The mean DMFT at 12-year-old in The mean DMFT at 12-year-old in 0707

1.631.63 DT : 0.59, MT : 0.03, FT : 1.01DT : 0.59, MT : 0.03, FT : 1.01

from from Minister of Education, Culture,Minister of Education, Culture, Sports and Technology JapanSports and Technology Japan

FTFT :: 1.191.19

KyotoKyoto TokyoTokyo

OtherOther fluoridefluoride usesuses atat presentpresent inin JapanJapan::

1) Community water fluoridation;1) Community water fluoridation; none except some natural areas (none except some natural areas (09)09) 2) Topical fluoride application in 1-14 years old;2) Topical fluoride application in 1-14 years old; 59% (59% (05 05 From From Minister of Health, Labor and WelfareMinister of Health, Labor and Welfare)) 3) Fluoridated dentifrice in market share;3) Fluoridated dentifrice in market share; 89% (89% (07 07 From From Lion Foundation of Dental HealthLion Foundation of Dental Health)) 4) Number of children in FMR at home in 4-14 years 4) Number of children in FMR at home in 4-14 years old (estimated data);old (estimated data); 347,000 (347,000 (02 02 From From Ando,Ando, et alet al)) 5) FMR agents as over the counter drug (OTC);5) FMR agents as over the counter drug (OTC); none for sale at present none for sale at present ((20th.20th. July.July. 0909))

1999: 1999: The Synthetic opinion of fluoride applicationThe Synthetic opinion of fluoride application by Japanese Association for Dental Scienceby Japanese Association for Dental Science

2000: 2000: The Recommend of fluoride application in Healthy Japan 21The Recommend of fluoride application in Healthy Japan 21 by Minister of Health and Welfare, Japanby Minister of Health and Welfare, Japan

The Technological support for community water fluoridationThe Technological support for community water fluoridation by Minister of Health and Welfare, Japan by Minister of Health and Welfare, Japan

TheThe StrategyStrategy ofof regionalregional projectproject inin HealthyHealthy JapanJapan 21 21

2002:2002: The Scientifically support for fluoride applicationThe Scientifically support for fluoride application by Japanese Society for Dental Healthby Japanese Society for Dental Health

2003:2003: The Guideline for fluoride mouth rinseThe Guideline for fluoride mouth rinse by Minister of Health, Labor and Welfare, Japanby Minister of Health, Labor and Welfare, Japan

Publication of The fluoride mouth rinse practical manual for Publication of The fluoride mouth rinse practical manual for caries prevention caries prevention by research meeting of fluoride applicationby research meeting of fluoride application

ChronologicalChronological opinionopinion aroundaround thethe turningturning pointpoint inin

JapanJapan

In Japan, anti-fluoridationists commonly want to In Japan, anti-fluoridationists commonly want to apply a statement in the WHO technical report.apply a statement in the WHO technical report.

Tending to mislead byTending to mislead byWHO statementWHO statement

“ “ FMR was not recommended for children FMR was not recommended for children below 6 years old, as it might contribute to below 6 years old, as it might contribute to the risk of dental fluorosis ?the risk of dental fluorosis ???????????????????????????? ”? ”

(Fluoride and Oral Health, WHO, 1994)

Go ahead !!Go ahead !!

Announcing by Announcing by NPO-JPUFNPO-JPUF,, “ “ Beginning of FMRBeginning of FMR is recommended is recommended

for for JapaneseJapanese (or Asian)(or Asian) children children in in 4-5 years old4-5 years old.”.”

USA, Canada, South America, USA, Canada, South America, Australia, Europe and AsiaAustralia, Europe and Asia ( (Malaysia, Malaysia,

Singapore, Hong Kong, Korea, Singapore, Hong Kong, Korea, Thailand, China, Laos and the othersThailand, China, Laos and the others), ),

where fluoride is enough supplywhere fluoride is enough supply

In JapanIn Japan, fluoride use is limited , fluoride use is limited to topical application, none to topical application, none

Community Water FluoridationCommunity Water Fluoridation

S-FMRS-FMR( only 5.1% of children )( only 5.1% of children )

++Fluoridated toothpasteFluoridated toothpaste(89% of market share )(89% of market share )

Community Water fluoridationCommunity Water fluoridation(or Salt fluoridation, Milk fluoridation(or Salt fluoridation, Milk fluoridation

Fluoride supplement)Fluoride supplement)++

Fluoridated toothpasteFluoridated toothpaste

LetLet s gain everyones gain everyones successful,s successful,to surely efficacy,to surely efficacy,

by minimum effortby minimum effort..

Fluoride:Fluoride:Community Water FluoridationCommunity Water Fluoridation

andand Fluoride Mouth Rinsing ProgramFluoride Mouth Rinsing Program

national survey on school-based fluoride mouth rinsing program in japan - regional spread conditions...

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