public health services saskatoon health region oral health ......of visit to a dentist office,...

Public Health Services

Saskatoon Health Region

Oral Health Program

Dental Health Screening Program Report

Grade One and Grade Seven

2008-2009

1

Acknowledgements ------------------------------------------------------------------------------------------------------------ Dental Health Screening Advisors Dr. Johnmark Opondo- Deputy Medical Health Officer Jill Werle- Manager, Healthy Growth and Development Leslie Topola- Supervisor, Oral Health Program Dr. Carol Nagle- Public Health Dentist Examiners and Data Collection The following Dental Health Educators participated as examiners and recorded the results: Cynthia Ostafie Julie Laberge-Lalonde Data Analysis Vinay K. Pilly, M.P.H. Practicum Student (U of S) Writing Vinay K. Pilly, M.P.H. Practicum Student (U of S) Leslie Topola- Supervisor, Oral Health Program Editing Vinay K. Pilly, M.P.H. Practicum Student (U of S) Joyce Birchfield- Administrative Assistant GIS Analyst Tracy Creighton Office Administration Mary Scheidl- Office Administration Assistant Bob Toso-IT Department Sponsor College of Dentistry, University of Saskatchewan

This report is dedicated to Bev Barber

Dental Assistant and Community Dental Health Coordinator 1994-2006

2

Table of Contents ------------------------------------------------------------------------------------------------------------ Acknowledgements ........................................................................................................... 1 Table of Contents .............................................................................................................. 2 Message from Deputy Medical Health Officer ............................................................... 7 Message from the Public Health Dentist ......................................................................... 8 Message from the Supervisor ........................................................................................... 9 Preface .............................................................................................................................. 11 Executive Summary ........................................................................................................ 12 Introduction ..................................................................................................................... 16 Methods ............................................................................................................................ 19 Results .............................................................................................................................. 21

Participation ................................................................................................................ 21 Location ....................................................................................................................... 21 Gender .......................................................................................................................... 22 Age ................................................................................................................................ 22 Water Fluoridation ..................................................................................................... 23 Dental Health Assessment .......................................................................................... 23

Optional Information ...................................................................................................... 34 Tobacco Usage: ............................................................................................................ 34 Dental Insurance: ........................................................................................................ 34 Dental Visit: ................................................................................................................. 35 Sealants: ....................................................................................................................... 37 Others: .......................................................................................................................... 37

Dental Health Trends in Saskatoon Health Region, 2008-09 ...................................... 38 Comparison with Past Screening ............................................................................... 38

Canadian Oral Health Strategy (COHS) Guidelines for 2010 .................................... 42 Dental Health Disparities ............................................................................................... 43

Dental Health Disparity by Neighbourhood Income ............................................... 46 Epidemiological studies .................................................................................................. 49 Discussion ......................................................................................................................... 53 Recommendations ........................................................................................................... 57 Appendices ....................................................................................................................... 58

Appendix 1: Dental Screening Program Definitions ............................................... 59 Appendix 2: List of Schools in Saskatoon Health Region, 2008-2009 .................... 62 Appendix 3: Dental Screening Advance Information Letter, 2008-2009 ............... 66 Appendix 4: Dental Screening Results Letter (MoH, Govt. of SK) ........................ 67 Appendix 5: Dental Health by School (Grade One Students), Saskatoon Health Region, 2008-2009 ....................................................................................................... 68 Appendix 6: Dental Health by School (Grade Seven Students), Saskatoon Health Region, 2008-2009 ....................................................................................................... 72

3

Appendix 7: Preventive Dental Care Services in Each Health Region in Saskatchewan, 2008-2009 ........................................................................................... 77 Appendix 8: SHR Communities with Access to Water Fluoridation .................... 78

References ........................................................................................................................ 79

4

List of Figures ------------------------------------------------------------------------------------------------------------ Figure 1: Percentage of All Students Screened by Location of Schools, Saskatoon Health Region, 2008-2009 ............................................................................................................ 21

Figure 2: Percentage of Children with Dental Health Needs, Grade One and Grade Seven Students, Saskatoon Health Region, 2008-2009 ............................................................... 24

Figure 3: Comparison of Grade One Students Dental Health Needs, Saskatoon Health Region, 2003-2004 and 2008-2009. .................................................................................. 25

Figure 4: Proportion of Grade One Students by Number of Affected Quadrants, Saskatoon Health Region, 2008-2009 ............................................................................... 26

Figure 5: Proportion of Grade Seven Students by Number of Affected Quadrants, Saskatoon Health Region, 2008-2009 ............................................................................... 27

Figure 6: Grade One and Grade Seven Students ‘deft’ Components, Saskatoon Health Region, 2008-2009 ............................................................................................................ 29

Figure 7: Grade One and Grade Seven Students ‘DMFT’ Components, Saskatoon Health Region, 2008-2009 ............................................................................................................ 31

Figure 8: Percentage of Saskatoon Health Region Grade One Students Screened who were Cavity-free during Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009 ................................................................................................................................... 38

Figure 9: Percentage of Saskatoon Health Region Grade One Students Screened who had Cavities during Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009 . 39

Figure 10: Percentage of Saskatoon Health Region 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 ......................................................................................................... 39

Figure 11 : Percentage of Saskatoon Health Region Grade One Students with Early Childhood Caries at the time of Dental Screening, 1993-1994, 1998-1999, 2003-2004 and 2008-2009 ......................................................................................................................... 40

Figure 12: Percentage of Saskatoon Health Region Grade One Students Screened who had No Evidence of Care, 1993-1994, 1998-1999, 2003-2004 and 2008-2009 ............... 40

Figure 13: Dental Health by Urban/Rural School Location, Saskatoon Health Region, 2008-2009 ......................................................................................................................... 44

Figure 14: Dental Health by Community Water Fluoridation, Saskatoon Health Region, 2008-09 ............................................................................................................................. 45

Figure 15 : Dental Health by Neighbourhood Income Status, City of Saskatoon, 2008-2009 ................................................................................................................................... 47

5

List of Tables ------------------------------------------------------------------------------------------------------------ Table 1: Participation in the Saskatoon Health Region Dental Health Screening, 2008-2009 ................................................................................................................................... 21 Table 2: Students Screened by Location of School, Saskatoon Health Region, 2008-2009 ........................................................................................................................................... 22 Table 3: Gender of All Students Screened by Grade, Saskatoon Health Region, 2008-2009 ................................................................................................................................... 22 Table 4: Grade One and Seven Students Dental Health Needs, Saskatoon Health Region, 2008-2009 ......................................................................................................................... 24 Table 5: Prevalence of Early Childhood Caries (ECC) and ECC+, Saskatoon Health Region, 2008-2009 ............................................................................................................ 25 Table 6A: Grade One Students with Decay, Saskatoon Health Region, 2008-2009 ........ 26 Table 6B: Grade Seven Students with Decay, Saskatoon Health Region, 2008-2009 .... 26 Table 7A: Grade One Students ‘deft’ Components, Saskatoon Health Region, 2008-2009 ........................................................................................................................................... 27 Table 7B: Grade One Students ‘deft’ Scores, Saskatoon Health Region, 2008-2009 ...... 28 Table 8A: Grade Seven Students ‘deft’ Components, Saskatoon Health Region, 2008-2009 ................................................................................................................................... 28 Table 8B: Grade Seven Students ‘deft’ Scores, Saskatoon Health Region, 2008-2009 ... 28 Table 9A: Grade One Students ‘DMFT’ Components, Saskatoon Health Region, 2008-2009 ................................................................................................................................... 30 Table 9B: Grade One Students ‘DMFT’ Scores, Saskatoon Health Region, 2008-2009 . 30 Table 10A: Grade Seven Students ‘DMFT’ Components, Saskatoon Health Region, 2008-2009 ......................................................................................................................... 30 Table 10B: Grade Seven Students ‘DMFT’ Scores, Saskatoon Health Region, 2008-2009 ........................................................................................................................................... 31 Table 11A: Grade One Students Dental Health Status, Saskatoon Health Region, 2008-2009 ................................................................................................................................... 32 Table 11B: Grade Seven Students Dental Health Status, Saskatoon Health Region, 2008-2009 ................................................................................................................................... 32 Table 11C: Grade One and Seven Students Dental Health Status, Saskatoon Health Region, 2008-2009 ............................................................................................................ 33 Table 12A: Grade One Students Priority Scores, Saskatoon Health Region, 2008-2009 33 Table 12B: Grade Seven Students Priority Scores, Saskatoon Health Region, 2008-2009 ........................................................................................................................................... 33 Table 13A: Comparison between Grade One and Grade Seven Students regarding Dental Insurance, Saskatoon Health Region, 2008-2009 ............................................................. 34 Table 13B: Comparison of the Dental Health measures between Students who answered either Yes/No regarding Dental Insurance, Saskatoon Health Region, 2008-2009 .......... 35

6

Table 13C: Comparison between Grade One and Grade Seven Students regarding History of Visit to a Dentist Office, Saskatoon Health Region, 2008-2009 .................................. 35 Table 13D: Comparison of the Dental Health measures between Students who answered either Yes/No regarding History of Visit to a Dental Office, Saskatoon Health Region, 2008-2009 ......................................................................................................................... 36 Table 13E: Comparison between Grade One and Grade Seven Students regarding History of Pit and Fissure Sealant Application, Saskatoon Health Region, 2008-2009 ................ 37 Table 13F: Comparison of the Dental Health measures between Students who answered either Yes/No regarding History of Pit and Fissure Sealant Application, Saskatoon Health Region, 2008-2009 ............................................................................................................ 37 Table 14: Grade One Dental Health by Screening Year, Saskatoon Health Region ........ 41 Table 15: Grade Seven Dental Health by Screening Year, Saskatoon Health Region ..... 41 Table 16: COHS Guidelines for 2010: Goal 2 (Grade One/Age 6), Saskatoon Health Region, 2008-2009 ............................................................................................................ 42 Table 17: Canadian Oral Health Strategy (COHS) Guidelines for 2010: Goal 2(Grade Seven/Age 12), Saskatoon Health Region, 2008-2009 ..................................................... 43 Table 18: Dental Health by Urban/Rural School Location, Saskatoon Health Region, 2008-2009 ......................................................................................................................... 44 Table 19: Dental Health by Community Water Fluoridation, Saskatoon Health Region, 2008-2009 ......................................................................................................................... 45 Table 20: Dental Health by Neighbourhood Income Status, City of Saskatoon, 2008-2009 ........................................................................................................................................... 46 Table 21: Comparison of Dental Health Status of Children who attended Schools located in Low Income Neighbourhoods in the City of Saskatoon for the school years 2003-2004 and 2008-2009 .................................................................................................................. 47 Table 22: Calculation of Relative Risk for being Cavity-free between Saskatoon Health Region and rest of Saskatchewan, 2008-2009 .................................................................. 49 Table 23: Calculation of Odds Ratio for being Cavity-free between Urban and Rural communities in Saskatoon Health Region, 2008-2009 ..................................................... 49 Table 24: Calculation of Relative Risk for being Cavity-free between Low Income Cut-off Neighbourhood in the City of Regina and Low Income Cut-off (LICO) Neighbourhood in the City of Saskatoon, 2008-2009 ...................................................... 50 Table 25: Calculation of Odds Ratio for being Cavity-free between Low Income (LICO) Cut-off Neighbourhood School and Non-Low Income Cut-off (LICO) Neighbourhood School in Saskatoon Health Region, 2008-2009 .............................................................. 50 Table 26: Calculation of Relative Risk for being Cavity-free between Schools that have access to community water fluoridation (CWF) in Saskatoon Health Region and rest of Saskatchewan, 2008-2009 ................................................................................................. 51 Table 27: Calculation of Odds Ratio for being Cavity-free between Schools that have access to Community Water Fluoridation (CWF) and Schools that do not in Saskatoon Health Region, 2008-2009 ................................................................................................ 51

7

Message from Deputy Medical Health Officer Public Health Services

I am pleased to present the Saskatoon Health Region (SHR) report on the Dental Health Screening Report, 2008 - 2009. The oral health program in SHR has established a baseline for monitoring oral disease trends in the region, and continues to provide region-wide assessments of the oral health status of first grade and seventh grade students attending public schools during the 2008-2009 academic year. This report summarizes the findings of the survey, which indicate that things are improving for the oral health of children in the region with fewer children experiencing dental decay. Increasing access to fluoridated water and dental sealants have proven to be a beneficial approach to prevent childhood caries.

We cannot however rest on current success as good oral health is not evenly shared by all children in our community. Significant disparities in oral disease persist between children who live in low-income neighbourhoods, when compared to their peers in wealthier neighbourhoods. Access to dental care also remains a challenge for some members of our community. The good news is that oral disease is preventable. As highlighted by the discussion section of this document, many strategies can be implemented to address the chronic condition of oral disease. Action requires an understanding of the condition, and I hope that this document will provide an overview of the problems with oral health in the Saskatoon Health Region and suggest what we can do about them. The solutions to the burden of oral disease lies in the collaborations and partnerships of government agencies and officials, private industry, foundations, consumer groups, health professionals, educators, and researchers to address the problem. I thank everyone who contributed to this document and invite all stakeholders, advocates and partners in oral health to join me in improving the oral health for all who belong to the Saskatoon community. Dr. Johnmark Opondo, M.B. Ch.B., MPH Deputy Medical Health Officer Saskatoon Health Region

8

Message from the Public Health Dentist Public Health Services-Oral Health Program Some of these, in part, are such things as: lower socioeconomic status and poverty, low birth weight and preterm babies, mothers and siblings with oral disease, risk taking behaviour, oral hygiene and diet. We know there are measures that help reduce and prevent childhood oral disease such as fluoride, sealants, a healthy diet and proper oral hygiene. Early identification and intervention are cost effective and lead to better outcomes. Within the Saskatoon Health Region, Public Health strives to integrate oral health programming that implements these strategies. These initiatives and programs help promote better oral health. They also promote general health and well-being in our community for not only children but for everyone. Carol Lynn Nagle BSP, DMD, MD, MSc

Childhood oral disease continues to be a significant health problem for many children in the Saskatoon Health Region and within Saskatchewan. Childhood oral disease is completely preventable. In spite of this, childhood oral disease continues to be a major health problem. This continues to present a great cost to society and our health care system both in morbidity and funding. Children with the greatest dental needs are those that come from high risk environments. There are many social determinants and variables that are correlated with childhood oral disease.

9

Message from the Supervisor Oral Health Program Public Health Services

The results of the 2008-2009 dental screening are the fourth in fifteen years. In 1993-1994 when the first dental screening was undertaken, only the World Health Organization had Oral Health Goals for the Year 2000 for children. Now in Canada we are fortunate to have the Canadian Oral Health Strategy (COHS) Guidelines for 2010. The COHS guidelines cover several categories, and include specific measurements for age groups. Six of these measurements relate to reduction of dental decay for children age 6 (2 goals) and age 12 (4 goals.)

The Saskatoon Health Region meets all six of the COHS Goals for children age 6 and 12. This occurs in a health region where 86% of the population has access to community water fluoridation, including children attending schools in communities with access to fluoridated water. Children in the Saskatoon Health Region are more likely to be cavity-free than anywhere else in the province. Community water fluoridation is one of the reasons the Saskatoon Health Region has met these goals. Results indicate that the targeted approach used by the Oral Health Program is beginning to improve oral health in core neighbourhoods. Since 2003-2004 additional fluoride varnish clinics with dental screening and referral for treatment have been implemented in core neighbourhoods. Since 2004, Early Childhood Caries (ECC) has been decreased by 13%, no evidence of care has decreased by 10%, and the deft/DMFT1 ratio has decreased by 0.15. This is good news! There is still much work to do! Children in low income neighbourhoods have a deft/DMFT almost double that of children in non–low income neighbourhoods. In addition, the presence of tooth decay is 2.5 times higher, ECC is 3 times higher, pain and infection is 2% higher, and the percentage of children who are cavity-free is 26% lower in low income communities. 1 deft/DMFT is a universal measurement of the number of decayed, extracted and filled deciduous teeth, and the number of decayed, missing, and filled permenant teeth.

10

Access to care remains a concern, with 17% of parents reporting that their child has not seen a dentist in over a year, and 12% of families reporting they have no dental coverage. Self-reports show that 38% of children age 6 and 12 have not had dental sealants – even though these are the ideal ages for applying sealants. The Oral Health Program will continue to focus on improving oral health for people who currently experience poor oral health. This approach is equitable and achieves results! Leslie Topola, SDT Supervisor, Oral Health Program

11

Preface ------------------------------------------------------------------------------------------------------------ Public Health Services (PHS), Saskatoon Health Region, 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 and to identify children with

unmet dental needs and to refer those in obvious need of dental treatment. Public Health

Services, Saskatoon Health Region, will continue to use the screening results to develop

strategies to decrease the number of children experiencing tooth decay. Since tooth decay

is 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 Saskatoon Health Region website. To obtain

additional copies of the report, to make suggestions, or to request further information,

please contact:

Oral Health Program Public Health Services Saskatoon Health Region 101-310 Idylwyld Drive North Saskatoon, Saskatchewan S7L 0Z2 Phone: (306) 655-4462 Website: http://www.saskatoonhealthregion.ca/index.htm

http://www.saskatoonhealthregion.ca/index.htm

12

Executive Summary ------------------------------------------------------------------------------------------------------------

A dental health screening was conducted in the Saskatoon Health Region during the

2008-2009 school year to assess oral health status, monitor the trends, identify children

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 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 marks the fourth of these

screening surveys. One hundred and fifty schools and 5917 children across the health

region participated in the screening, for a response rate 86.7% (See Table 1)

The screening recorded the proportion of children screened by location (See Table 2),

gender distribution (See Table 3), mean age of student for Grade One and Grade Seven

and proportion of schools that have access to community water fluoridation. The

proportion of children with Malocclusion, Staining, Gingivitis and Calculus were

included under Dental Health Needs. The results indicate that the Dental Health Needs

are higher among the Grade Seven students. (See Table 4-A, B, C)

Early Childhood Caries (ECC), defined as decay on primary anterior teeth, was

experienced by 5.9% (219) of Grade One children. This percentage has decreased

considerably since 2003-2004 screenings. (See Table 5)

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

Grade Seven students. In Grade One, 4.07% (116) of the children were found to have

urgent dental treatment needs. In Grade Seven, 0.8% (26) of the children were found to

have urgent dental treatment needs. In Grade One, 15.3% (437) of the children were

13

referred to see their dentist for treatment as soon as possible. In Grade Seven, 5.7 % (174)

of the children were referred to see their dentist for treatment as soon as possible (See

Table 12).

Optional information collected included tobacco usage for Grade Seven students,

information regarding any form of dental insurance coverage, visit to a dental office,

history of dental sealants done and usage of mouthguards was collected from all students.

For children in Grade One, tooth decay in the primary dentition remains a significant

childhood problem, equally so for children in Grade Seven, tooth decay in the permanent

dentition. The results of the 2008-2009 screening showed that children in Grade One, in

the Saskatoon Health Region are experiencing more dental decay than in the 2003-2004

screening year. In 2008-09, 19.2 % of Grade One children had dental caries compared to

16.6% in 2003-2004. (See Table 14)

The prevalence of Early Childhood Caries (ECC) was recorded only for Grade One

students, 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; individual components to gauge barrier

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), Early Childhood Caries (ECC), and the presence of

Pain and/ or Infection (See Appendix 1).

In Grade One, 50.8% of the students were cavity-free and 19.4% had unmet dental needs.

These findings meet the Canadian Oral Health Strategy guidelines (2010) for Grade One.1

In Grade Seven, 74.8% (close to 75%) of the students have never experienced decay in

14

their permanent dentition, unmet dental needs were 6.5%, Average ‘DMFT’ was 0.6 and

the Significant Caries Index (SIC) was 1.81. These findings meet the Canadian Oral

Health Strategy Guidelines (2010) for Grade Seven1. (See Table 16, 17

Dental health trends were identified, by comparing results from previous screening years

for Grade One students only, as Grade Seven students are included in the analysis for the

first time. Dental health measurements were done between urban and rural school

children, children attending schools that have access to community water fluoridation and

in schools located in low-income neighbourhoods.

Children from rural schools, low income neighbourhood schools and schools with no

access to community water fluoridation were more likely to experience caries, pain or

infection; show no evidence of care (NEC) and at the same time are less likely to be

cavity-free.

In 2008-2009, dental health disparities were noted between children attending schools

located in urban and rural communities. The average ‘deft/DMFT’ per child attending a

school in an urban community was 1.60 compared to 1.51 for a child attending a school

in a rural community. Also, 59.3% of children attending schools in urban communities

were caries-free compared to 58.5% of children attending schools in rural communities.

(See Table 18)


with community water fluoridation and schools without access to community water

fluoridation. The average deft/DMFT per child attending a school with community water

fluoridation was 1.54 compared to 1.82 for a child not attending a school with community

water fluoridation. Also, 71.8% of children attending schools with community water

fluoridation were caries-free compared to 65.0% of children attending schools without

community water fluoridation. (See Table 19)

15


located in low-income neighbourhoods and schools not located in low-income

neighbourhoods in the City of Saskatoon. The average deft/DMFT per child attending a

school in low-income neighbourhood was 2.97 compared to 1.53 for a child not attending

a school in low-income neighbourhood. Also, 34.1% of children attending schools

located in a low-income neighbourhood were caries-free compared to 59.8% of children

attending schools not located in a low-income neighbourhood. (See Table 20)

Epidemiological studies include relative risk and odds ratio for being cavity-free in

comparison with other health regions, within the health region and Saskatchewan as a

whole.

16

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 (Drum,

Chen & Duffy, 1998).4

Early Childhood Caries (ECC) is one of the most destructive diseases affecting primary

teeth that can have a negative impact on oral health of infants and children, which is

preventable, by proper education, counselling, prevention and anticipatory guidance

(AAPD, 2004). Lack of dental health education, dental health insurance and barrier to

access dental health care are some of the social variables contributing to prevalence of

ECC.4

Research has shown that fluoride in optimal levels in drinking water is the most cost-

effective community based preventive strategy for dental caries. Apart from that, fluoride

can be obtained from mouthrinse, toothpaste, and from professionally applied

fluorides. Long term exposure to optimal levels of fluoride results in diminishing levels

of caries in both children and adult populations.5

There is a clear co-relation between community socio-economic status and childrens’

dental health. Caries observed in primary teeth was significantly higher in children

from low socio-economic status communities. Also, the proportion of untreated caries in

primary teeth and permanent teeth, dental treatment priority needs and incisor trauma was

higher in children from low socio-economic status communities.6

17

Poor oral health and untreated tooth decay is a huge economic burden that surpasses most

other health conditions. The burden is disproportionately greater for 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, whereas rates for First

Nations and Inuit people for all age groups ranged from 3 to 5 times higher than for non-

aboriginal population.1

This report describes the methodology used to conduct the 2008-2009 dental screening

and the findings. The findings will be shared with policy makers, dental fraternity and

stakeholders.

18

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

U.S., 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 Canadian Pubic Health Association states that

fluoridation is one of the twelve public health milestones of the past 100 years. 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 fluoride is a basic human right.11

In April 2008, Health Canada made public the findings and recommendations from an

expert panel consisting of 6 members13. The panel concluded that 0.7mg/L ppm of

fluoride in drinking water protects teeth against decay while minimizing risk of dental

fluorosis2. Further, the panel found no health risks due to mild dental fluorosis and noted

that prevalence of moderate fluorosis in Canada is on a decline. Despite this, community

water fluoridation remains a controversial issue.11

Based on the Provincial and Territorial estimates for community water fluoridation

coverage in 2007, the percentage of Canadian population with fluoridated water was

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

2 Fluorosis is an abnormal condition caused by excessive intake of fluorides, characterized in children by discoloration and pitting of the teeth and in adults by pathological bone changes.

19

Methods ------------------------------------------------------------------------------------------------------------ Dental screening was offered to all Grade One and Grade Seven students who attended

schools in the Saskatoon Health Region between September 2008 and June 2009 (See

Appendix 2).

Dental Health Educators (licensed Saskatchewan Dental Therapists) assessed the child’s

oral health by a visual examination, using a mouth mirror and LED flashlight. Oral health

indicators collected were: the presence of sealed permanent molars (represents access to

preventive dental services), filled/ restored teeth (represents access to dental care) and

cavitated lesions/ untreated tooth decay (represents barrier to dental care).

Parents/Guardian’s were advised of the dental screening via a ‘Dental Screening Advance

Information Letter’ (See Appendix 3.) Students were assessed for possible dental health

needs, and these were communicated to parents/caregivers via a ‘Dental Screening

Results Letter’, 2008-2009 (See Appendix 4.) Each student was provided with basic

recommendations for oral hygiene, including illustrations of proper flossing and brushing

techniques.

Screening data, including basic demographic information for each child was entered into

an Access database. Data was exported to Excel and into SPSS 17.0 for analysis. Data

was cleaned and if anomalous or missing values could not be resolved by examining the

original data, it was excluded from the analysis.

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, children were classified

20

either as ‘urban’ or ‘rural’. Based on the school access to community water fluoridation,

children were classified into ‘fluoridated’ or ‘non-fluoridated’. Based on the location of a

school, children were classified either into ‘low-income cut off’ and ‘non-low income cut

off’ categories 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.

21

Results

------------------------------------------------------------------------------------------------------------

Participation The total number of Grade One and Grade Seven students screened in Saskatoon Health Region for this period was 5917. Table 1: Participation in the Saskatoon Health Region Dental Health Screening, 2008-2009

Location This analysis includes 5917 students who were screened. Of this number, 70.5 % (4171) attended urban schools and 29.5 % (1746) attended rural schools. Figure 1: Percentage of All Students Screened by Location of Schools*, Saskatoon Health Region, 2008-2009

*Selected locations had a population equal to or greater than 5000 people.

Grade Total Enrollment

Number Screened (%)

Number Refused (%)

Number Absent (%)

Grade One 3219 2849 (88.5) 198 (6.2) 172 (5.3) Grade Seven 3605 3068 (85.1) 310 (8.6) 227 (6.3)

22

Table 2: Students Screened by Location of School, Saskatoon Health Region, 2008-2009

Location of School Number (%) Saskatoon 4154 (70.2) Martensville 167 ( 2.8) Humboldt 108 ( 1.8) All Others 1488 (25.1) Gender There seems to be an equal distribution of male and female students screened. Among Grade One students screened, 50.6 % (1443) were male, and 49.2 % (1401) were female. Among Grade Seven students, 51.4 % (1577) were male, and 48.3 % (1483) were female. Table 3: Gender of All Students Screened by Grade, Saskatoon Health Region, 2008-2009

Grade Male Number (%)

Female Number (%)

Grade One 1443 (50.6) 1401 (49.2) Grade Seven 1577 (51.4) 1483 (48.3) Gender not recorded for 0.2% (5) Grade One students. Gender not recorded for 0.3% (8) Grade Seven students. Age Student’s date of birth and date of examination were entered into the screening database. The mean age of a child was calculated using their age as of June 30th 2009. For Grade One students, the mean age as of June 30th 2009 was 7.07 years For Grade Seven students, the mean age as of June 30th 2009 was 13.1 years

23

Water Fluoridation Of the students screened, 87.2% attended schools with water fluoridation. The following are the communities that have access to community water fluoridation (CWF) in Saskatoon Health Region. Out of 150 schools that participated in screening, 112 had access to CWF. The communities are listed below, followed by the number of schools in the community:

Allan (1) Annaheim (1) Bellevue (1) Bruno (1) Clavet (1) Cudworth (1) Dalmeny (2) Hague (2) Humboldt (3) Lake Lenore (1) Martensville (2)

Muenster (1) Osler (2) Quill Lake (1) Saskatoon (83) Wadena (2) Wakaw (1) Warman (2) Watson (2) Wynyard (2)

Dental Health Assessment The basic measures of dental health included assessment of outstanding treatment needs, and both past and present dental caries experience. Decay experience includes decayed teeth, filled teeth, or teeth that were extracted due to decay. There were 151 (5.3 %) Grade One students screened who participated in a regular fluoride mouthrinse program at school. Existing fillings that required treatment were present in 180 (6.3%) students. A recommendation for sealants application was sent home for 1855 (65.1%) students. Of the Grade Seven students screened, 89 (2.9%) participated in a regular fluoride mouthrinse program at school. Fifty students (1.6%) had existing fillings that required treatment. A recommendation for sealants application was sent home for 2420 (78.8%) students. Additional factors to assess Dental Health Needs included malocclusion, staining, gingivitis and presence of calculus (see Figure 2.)

24

Definitions: Malocclusion: Crooked or crowded teeth and/or poor bite Staining: Suspicious areas (possible decay), tartar or frank surface staining Gingivitis: Bleeding gums, early signs of gum disease Calculus: Hardened plaque on teeth Figure 2: Percentage of Children with Dental Health Needs, Grade One and Grade Seven Students, Saskatoon Health Region, 2008-2009

Table 4: Grade One and Seven Students Dental Health Needs, Saskatoon Health Region, 2008-2009 Dental Health Need

Malocclusion Number (%)

Staining Number (%)

Gingivitis Number (%)

Calculus Number (%)

Grade 1 797 (27.9) 87 (3.0) 5 (0.2) 22 (0.8) Grade 7 1695 (55.2) 165 (5.3) 109 (3.6) 56 (1.8) Combined 2492 (42.1) 252 (4.3) 114 (1.9) 78 (1.3)

25

Figure 3: Comparison of Grade One Students Dental Health Needs, Saskatoon Health Region, 2003-2004 and 2008-2009.

The proportion of Grade one children with Malocclusion as a dental health need has risen when compared with 2003-2004 screening results. Early Childhood Caries Students were classified as presenting with Early Childhood Caries (ECC) if the Dental Health Educator identified decay in the deciduous anterior central or lateral teeth. This classification was scored as ‘ECC+’ if pain or infection was present with caries. 5.9 % of (169/2849) Grade One students had evidence of Early Childhood Caries, with or without pain or infection. Table 5: Prevalence of Early Childhood Caries (ECC) and ECC+, Saskatoon Health Region, 2008-2009 Deciduous Caries

ECC Number (%)

ECC+ Number (%)

164 (5.7) 5 (0.2)

26

Children were assessed for visible, current tooth decay and scored on the number of quadrants of the mouth (0-4) affected by decay. For the following assessments, a childs mouth is considered to have 4 quadrants, upper right and left, as well as lower right and left. Of the 501 (17.6%) Grade One students who had visible tooth decay at the time of examination; the extent is illustrated in Table 6A and Figure 4. Table 6A: Grade One Students with Decay, Saskatoon Health Region, 2008-2009 Decay None

Number (%) 1 Quadrant Number (%)

2 Quadrants Number (%)



2348 (82.4) 253 (8.9) 124 (4.4) 56 (1.9) 68 (2.4) Figure 4: Proportion of Grade One Students by Number of Affected Quadrants, Saskatoon Health Region, 2008-2009

Of the 195(6.3%) Grade Seven students who had visible tooth decay at the time of examination; the extent is illustrated in Table 6B. Table 6B: Grade Seven Students with Decay, Saskatoon Health Region, 2008-2009

Decay

None Number (%)

1 Quadrant Number (%)




2873 (93.6) 132 (4.3) 42 (1.4) 10 (0.3) 11 (0.3)

27

Figure 5: Proportion of Grade Seven Students by Number of Affected Quadrants, Saskatoon Health Region, 2008-2009

The ‘deft’ is an index used to measure disease experience in dental screening. It measures not just current dental disease, but a history of tooth decay as evidence by fillings or extractions. The prevalence of dental caries for primary teeth was measured using ‘deft’ score, a cumulative index, measuring the number of primary teeth that are decayed (d), extracted (e) or filled (f) due to caries. Table 7A: Grade One Students ‘deft’ Components, Saskatoon Health Region, 2008-2009 Number of affected teeth

Decayed Number (%)

Extracted Number (%)

Filled Number (%)

None 2317 (81.3) 2505 (87.9) 1769 (62.1) 1-3 401 (14.1) 304 (10.7) 493 (17.3) 4-6 88 (3.08) 37 (1.3) 361 (12.7) 7+ 43 (1.51) 3 (0.1) 226 (7.9) Of the Grade One students screened, 37.9% had at least one filled primary tooth. There were 18.7% with at least one decayed primary tooth and the proportion with at least one extracted tooth as a result of dental caries was 12.1% (Tooth fatality rate).

28

Table 7B: Grade One Students ‘deft’ Scores, Saskatoon Health Region, 2008-2009 ‘deft’ Score Number (%) 0 1451 (50.9) 1-3 586 (20.6) 4-6 391 (13.7) 7+ 421 (14.8) The average (mean) ‘deft’ score among Grade One students was 2.31 The prevalence of dental caries (morbidity) in primary dentition among Grade One students who were screened in Saskatoon Health Region, 2008-2009, was 49.1%. Table 8A: Grade Seven Students ‘deft’ Components, Saskatoon Health Region, 2008-2009 Number of affected teeth

Decayed Number (%)

Extracted Number (%)

Filled Number (%)

None 2972 (96.8) 3062 (99.8) 2744 (89.4) 1-3 93 (3.0) 6 (0.2) 284 (9.2) 4-6 3 (0.1) 0 (0.0) 37 (1.2) 7+ 0 (0.0) 0 (0.0) 3 (0.1) Of the Grade Seven students screened, 10.6% had at least one filled primary tooth. About 3.2% had at least one decayed primary tooth and the proportion with at least one extracted tooth as a result of dental caries was 0.2% (Tooth fatality rate). Table 8B: Grade Seven Students ‘deft’ Scores, Saskatoon Health Region, 2008-2009 deft Score Number (%) 0 2685 (87.5) 1-3 329 (10.7) 4-6 50 (1.6) 7+ 4 (0.13) The average (mean) ‘deft’ score among Grade Seven students was 0.25 The prevalence of dental caries (morbidity) in primary dentition among Grade Seven students in Saskatoon Health Region, 2008-2009, was 12.5%

29

Figure 6: Grade One and Grade Seven Students ‘deft’ Components, Saskatoon Health Region, 2008-2009

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

30

Table 9A: Grade One Students ‘DMFT’ Components, Saskatoon Health Region, 2008-2009 Number of affected teeth

Decayed Number (%)

Extracted/Missing Number (%)

Filled Number (%)

None 2818 (98.9) 2849 (100.0) 2805 (91.4) 1-3 29 (1.0) 0 (0.0) 36 (1.1) 4-6 2 (0.07) 0 (0.0) 8 (0.3) 7+ 0 (0.0) 0 (0.0) 0 (0.0) Of the Grade One students screened, 1.4% had at least one filled permanent tooth, 1.07% had at least one decayed permanent tooth, and none had any extracted tooth as a result of dental caries. Table 9B: Grade One Students ‘DMFT’ Scores, Saskatoon Health Region, 2008-2009 ‘DMFT’ Score Number (%) 0 2776 (97.4) 1 36 (1.3) 2 20 (0.7) 3 7 (0.2) 4+ 10 (0.4) The average (mean) ‘DMFT’ score among Grade One students was 0.05. The prevalence of dental caries (morbidity) in permanent dentition among Grade One students in Saskatoon Health Region, 2008-2009, was 2.6%. Table 10A: Grade Seven Students ‘DMFT’ Components, Saskatoon Health Region, 2008-2009 Number of affected teeth

Decayed Number (%)

Extracted/Missing Number (%)

Filled Number (%)

None 2957 (96.4) 3008 (98.0) 2395 (78.1) 1-3 100 (3.2) 48 (1.6) 530 (17.3) 4-6 6 (0.2) 12 (0.4) 131 (4.3) 7+ 5 (0.2) 0 (0.0) 12 (0.4) Of the Grade Seven students screened, 22.0% had at least one filled permanent tooth. Over 3.6% had at least one decayed permanent tooth and the proportion with at least one extracted tooth as a result of dental caries was 2.0% (Tooth fatality rate).

31

Table 10B: Grade Seven Students ‘DMFT’ Scores, Saskatoon Health Region, 2008-2009 ‘DMFT’ Score Number (%) 0 2296 (74.8) 1 292 (9.5) 2 205 (6.7) 3 89 (2.9) 4+ 186 (6.1) The average (mean) ‘DMFT’ score among Grade Seven students was 0.60 The prevalence of dental caries (morbidity) for permanent dentition among Grade Seven students in Saskatoon Health Region, 2008-2009, was 25.2%. Figure 7: Grade One and Grade Seven Students ‘DMFT’ Components, Saskatoon Health Region, 2008-2009

32

Abbreviations used in the following tables are: NDE = No decay, fillings or extractions evident CCC = All decayed teeth appear to have been treated PCC = Some teeth treated, but decay still evident NEC = Decay with no evidence of past or present treatment Grade One students were shown to have caries experience with 9.8% having partial caries care (PCC) and 9.3% of the students had no evidence of care (NEC). The results are indicated in the Table 11A. Table 11A: Grade One Students Dental Health Status, Saskatoon Health Region, 2008-2009 Classification NDE

Number (%) CCC Number (%)

PCC Number (%)

NEC Number (%)

1449 (50.8) 850 (29.8) 280 (9.8) 264 (9.3) Status was not recorded for 6 (0.2%) students. Grade Seven students were shown to have caries experience with 2.9% partial caries care (PCC) and 3.6% of the students had no evidence of care (NEC). The results are indicated in the Table 11B. Table 11B: Grade Seven Students Dental Health Status, Saskatoon Health Region, 2008-2009 Classification

NDE Number (%)

CCC Number (%)

PCC Number (%)

NEC Number (%)

2045 (66.6) 818 (26.7) 90 (2.9) 110 (3.6) Status not recorded for 5 (0.16%) students.

33

Table 11C: Grade One and Seven Students Dental Health Status, Saskatoon Health Region, 2008-2009 Classification

NDE Number (%)

CCC Number (%)

PCC Number (%)

NEC Number (%)

3494 (59.0) 1668 (28.1) 370 (6.3) 374 (6.3) 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 Table 12A: Grade One Students Priority Scores, Saskatoon Health Region, 2008-2009 Priority

1 Number (%)

2 Number (%)

3 Number (%)

116 (4.07) 437 (15.3) 2296 (80.6) Table 12B: Grade Seven Students Priority Scores, Saskatoon Health Region, 2008-2009 Priority

1 Number (%)

2 Number (%)

3 Number (%)

26 (0.8) 174 (5.7) 2868 (93.5) Unmet dental needs are a combination of Priority 1 and 2. The percentage of unmet dental needs among Grade One students in Saskatoon Health Region is 19.4%. Fewer Grade Seven students in Saskatoon Health Region had unmet dental needs, at 6.5%.

34

Optional Information The following information was requested of students. Screening was still provided if this information was not shared. Tobacco Usage: Out of 3068 Grade Seven students screened, 2926 (95.4%) were asked regarding tobacco usage, 2835 (92.4%) answered ‘No’, 8 (0.3%) students did not respond or the Dental Health Educator forgot to ask the question, 83 (2.7%) responded ‘Yes’ for tobacco usage. Of which, 76 (2.5%) used cigarettes and the rest 7 (0.2%) used cigars, pipes or spit tobacco. Dental Insurance: Out of 5917 students screened, 3236 (54.7%) responded to the question regarding their personal or family dental insurance plan (See Table 13A). Some form of dental coverage was held by 2439 (75.4%) students, 394 (12.2%) students did not have any dental coverage, and 403 (12.4%) were not sure if they have dental insurance or not. Table 13A: Comparison between Grade One and Grade Seven Students regarding Dental Insurance, Saskatoon Health Region, 2008-2009 Dental Insurance Yes

Number (%) No Number (%)

Not Sure Number (%)

Grade One 1346 (41.6) 212 (6.55) 199 (6.15) Grade Seven 1093 (33.8) 182 (5.6) 204 (6.3) Total 2439 (75.4) 394 (12.2) 403 (12.4)

35

Table 13B: Comparison of the Dental Health measures between Students who answered either Yes/No regarding Dental Insurance, Saskatoon Health Region, 2008-2009 Dental Insurance Yes


Total

Cavity-free* 1497 (61.5) 232 (58.9) 1729 NEC* 122 (5.0) 30 (7.6) 152 Pain/Infection 43 (1.7) 8 (2.0) 51 ECC 61 (2.5) 15 (3.8) 76 Current Caries 254 (10.4) 62 (15.7) 316 Priority (Scores 1 and 2) 261 (10.7) 64 (16.2) 325 Total- Response 2439 394 2833 *Status recorded for only 2433 students who responded ‘Yes’ for Insurance. Dental health measures and the proportion of unmet dental needs are better among students who had some sort of dental coverage. Dental Visit: Out of 5917 students screened, 3236 (54.7%) responded to the question, if they had visited the dentist in the past year (See Table 13C). It was found that 2408 (74.4%) students had visited the dentist in the past year, 543 (16.8%) had not seen a dentist in the past year, and 285 (8.8%) were not sure if they had visited the dentist in the past year. Table 13C: Comparison between Grade One and Grade Seven Students regarding History of Visit to a Dental Office, Saskatoon Health Region, 2008-2009 Dental Visit Yes


Not Sure Number (%)

Grade One 1293 (39.9) 336 (10.4) 128 (3.9) Grade Seven 1115 (34.5) 207 (6.4) 157 (4.9) Total 2408 (74.4) 543 (16.8) 285 (8.8)

36

Table 13D: Comparison of the Dental Health measures between Students who answered either Yes/No regarding History of Visit to a Dental Office, Saskatoon Health Region, 2008-2009 Dental Visit Yes


Total

Cavity-free* 1429 (59.5) 349 (64.3) 1778 NEC* 92 (3.8) 78 (14.4) 170 Pain/Infection 42 (1.7) 17 (3.1) 59 ECC 66 (2.7) 16 (2.9) 82 Current Caries 237 (9.8) 111 (20.4) 348 Priority (Scores 1 and 2) 247 (10.3) 111 (20.4) 358 Total- Response 2408 543 2951 *Status recorded for only 2403 students who responded ‘Yes’ for Seen Dentist. Dental health measures and the proportion of unmet dental needs are better among students who had visited the dentist before except for the proportion of children being cavity-free, which was higher among those who had not visited the dentist before.

37

Sealants: Out of 5917 students screened, 3236 (54.7%) responded to the question regarding sealant application (See Table 13E). 947 (29.3%) had sealants placed before, 1252 (38.7%) did not have sealants placed before and 1037 (32.0%) were not sure if they had sealants placed or not. Table 13E: Comparison between Grade One and Grade Seven Students regarding History of Pit and Fissure Sealant Application, Saskatoon Health Region, 2008-2009 Sealants Yes


Not Sure Number (%)

Grade One 329 (10.2) 914 (28.2) 514 (15.9) Grade Seven 618 (19.1) 338 (10.5) 523 (16.1) Total 947 (29.3) 1252 (38.7) 1037 (32.0) Table 13F: Comparison of the Dental Health measures between Students who answered either Yes/No regarding History of Pit and Fissure Sealant Application, Saskatoon Health Region, 2008-2009 Pit and Fissure Sealants Yes


Total

Cavity-free* 550 (50.1) 847 (67.6) 1397 NEC* 25 (2.6) 109 (8.7) 134 Pain/Infection 12 (1.3) 31 (2.5) 43 ECC 28 (2.9) 25 (2.0) 53 Current Caries 87 (9.2) 155 (12.4) 242 Priority (Scores 1 and 2) 88 (9.3) 160 (12.8) 248 Total- Response 947 1252 2199 *Status recorded for only1248 students who responded ‘No’ for Sealants. Dental health measures and the proportion of unmet dental needs are better among students who had sealant application before except for the proportion of children being cavity-free, which was higher among those who did not have sealants placed before. Others: Out of 5917 students screened, 14 (0.2%) had restored fractures, 35 (0.6%) had non-restored fractures and 12 (0.2%) were using mouthguards. * Only 1 Dental Health Educator recorded the information regarding usage of mouth guards.

38

Dental Health Trends in Saskatoon Health Region, 2008-2009 Comparison with Past Screening Similar dental health screenings were carried out in 1993-1994, 1998-1999 and 2003-2004 for Grade One students. Since previous data is not available for Grade Seven students, it is not possible to carry out historical comparisons for this age group. Figure 8: Percentage of Saskatoon Health Region Grade One Students Screened who were Cavity-free during Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

Figure 8 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 53.9% in 2003-2004 to 50.8% in 2008-2009, which is the lowest in the past two decades.

39

Figure 9: Percentage of Saskatoon Health Region Grade One Students Screened who had Cavities during Dental Screenings, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

The proportion of students with cavities increased from 16.6% in 2003-2004 to 19.2% in 2008-2009 among Grade One students (See Figure 9) Figure 10: Percentages of Saskatoon Health Region 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 students in need of urgent dental care due to pain and/or infection increased from 2.7% in 2003-2004 to 4.0% in 2008-2009 among Grade One students (See Figure 10).

40

Figure 11 : Percentage of Saskatoon Health Region 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 decreased from 6.8% in 2003-2004 to 5.9% in 2008-2009 (See Figure 11). Figure 12: Percentage of Saskatoon Health Region Grade One Students Screened who had No Evidence of Care, 1993-1994, 1998-1999, 2003-2004 and 2008-2009

The percentage of Grade One Students Screened who had No Evidence of Care, decreased from 10.3% in 2003-2004 to 9.3% in 2008-2009 (See Figure 12)

41

Table 14: Grade One Dental Health by Screening Year, Saskatoon Health Region

Screening Year

Number of children screened

Average ‘deft/DMFT’

% with Cavities

% with No Evidence of Dental Care

% with ECC

% with Pain and or Infection

% Cavity-free

1993-1994 3963 3.13 17.3 8.2 0.9 6.0 51.6 1998-1999 3960 2.45 20.5 10.0 0.4 3.3 53.8 2003-2004 3085 2.15 16.6 10.3 6.8 2.7 53.9 2008-2009 2849 2.36 19.2 9.3 5.9 4.0 50.8

Table 15: Grade Seven Dental Health by Screening Year, Saskatoon Health Region Screening Year

Number of children screened

Average ‘deft/DMFT’

% with Cavities

% with No Evidence of Dental Care

% with Pain and or Infection

% Cavity-free

2008-2009* 3068 0.85 6.4 3.6 0.9 66.6 * As Grade Seven students are included in the analysis for the first time, comparisons with other years are not available.

42

Saskatoon Health Region used the following standards from the Canadian Oral Health Strategy1 to examine and analyze our screening results. Interpretation of Average ‘deft/DMFT’ ratio according to the WHO scale of severity2: Less than1.2 Very low risk for dental caries 1.2-2.6 Low risk for dental caries 2.7-4.4 Moderate risk for dental caries Greater than 4.4 High risk for dental caries Canadian Oral Health Strategy (COHS) Guidelines for 2010: Goal 2

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, a Average ‘DMFT’ of 1.0 or less. At age 12, a ‘Significant Caries Index’, ‘DMFT’ of 3.0 or less.

Table 16: COHS Guidelines for 2010: Goal 2 (Grade One/Age 6), Saskatoon Health Region, 2008-2009

COHS 50% of children have never experienced dental decay

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

SHR 2008-2009

50.8%

19.4%

The COHS1 guidelines for Grade One students are met as 50.8% of students have never experienced dental decay and 19.4% of students have unmet dental treatment needs.

43

Table 17: Canadian Oral Health Strategy (COHS) Guidelines for 2010: Goal 2(Grade Seven/Age 12), Saskatoon Health Region, 2008-2009

COHS 75% of children have never experienced decay in their permanent teeth

No more than 10% of children have unmet dental treatment needs

Average ‘DMFT’ of 1.0 or less

‘Significant ‘Significant Caries Index’, ‘DMFT’ of 3.0 or less.

SHR, 2008-2009

74.8%

6.5

0.6

1.81

The COHS guidelines for Grade Seven students are met as 74.8% (close to 75%) of students have never experienced dental decay in their permanent teeth, 6.5% of students have unmet dental treatment needs, Average ‘DMFT’ is 0.6 and the ‘Significant Caries Index’ is 1.81. Significant Caries Index (SiC) 3: Grade Seven, Saskatoon Health Region, 2008-2009 SiC for Grade Seven, Saskatoon Health Region, 2008-2009: 1.81 Relevant details related to SiC include:

New goal set by WHO. New goal set by the Canadian Oral Health Strategy guidelines for Grade Seven/

children who are twelve years of age. For countries, who still did not achieve the WHO/FDI 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 rd of the population with

highest ‘DMFT’ scores.

Dental Health Disparities: Table 18 illustrates the results from the comparative analysis between urban and rural dental health screening indicators in Saskatoon Health Region, 2008-2009. Overall it appears that rural school children in Saskatoon Health Region have better oral health when compared with urban school children. This is evident from the average ‘deft/DMFT’ value which is statistically significant. Furthermore, urban school children had slightly higher proportions with current caries, ECC and being cavity-free, lesser proportion showing No Evidence of Dental Care which is statistically insignificant. Rural

44

school children have a lesser proportion with pain/infection, which is statistically significant. Table 18: Dental Health by Urban/Rural School Location, Saskatoon Health Region, 2008-2009 Dental Health Measure School Location

p-value Total

Urban

Rural

Average ‘deft/DMFT’ b 1.60 1.51 <0.0001 1.57 With Current Caries a 540 (12.9) 205 (11.7) 0.20 745 (12.6) No Evidence of Dental Care a 263 (6.3) 111 (6.4) 0.94 374 (6.3) ECC present a 125 (2.9) 45 (2.6) 0.38 170 (2.9) Cavity-free a 2473 (59.3) 1021 (58.5) 0.56 3494 (59.1) Pain and Infection a 116 (2.8) 27 (1.5) 0.005 143 (2.4) Total Screened 4171 (70.5) 1746 (29.5) 5917 a Chi-square test b t-test Figure 13: Dental Health by Urban/Rural School Location, Saskatoon Health Region, 2008-2009

45

Table 19 illustrates the results from the comparative analysis of oral health between children studying in schools that have access to community water fluoridation and children studying in schools that do not have access to community water fluoridation in Saskatoon Health Region, 2008-2009 Table 19: Dental Health by Community Water Fluoridation, Saskatoon Health Region, 2008-2009 Dental Health Measure

Community Water Supply p-value Total Fluoridated/ Optimally adjusted

Non-Fluoridated/ Not Optimally adjusted

Average ‘deft/DMFT’ b

1.54 1.82 <0.0001 1.57

With Current Caries a

631 (14.6) 114 (18.6) 0.032 745 (12.6)

No Evidence of Dental Care a

306 (7.1) 68 (11.1) 0.001 374 (6.3)

ECC present a 149 (3.5) 21 (3.4) 0.846 170 (2.9) Cavity-free a 3095 (71.8) 399 (65.0) <0.0001 3494 (59.1) Pain and Infection a

131 (3.04) 12 (1.95) 0.107 143 (2.4)

Total Screened 5157 (87.2) 760 (12.8) 5917 a Chi-square test b t-test Figure 14: Dental Health by Community Water Fluoridation, Saskatoon Health Region, 2008-2009

46

Overall it appears that children attending schools that have access to optimally adjusted fluoridated water, have better oral health when compared with children attending schools that do not have access to optimally adjusted fluoridated water. This is evident from the average ‘deft/DMFT’ value which is statistically significant. In addition, schools with access to optimally adjusted fluoridated water had lesser proportions with current caries, showing no evidence of care and higher proportion being cavity free which is statistically significant. Furthermore, schools that have access to fluoridated water had a higher proportion with ECC and pain/infection, which is statistically insignificant. Dental Health Disparity by Neighbourhood Income According to Statistics Canada, a neighbourhood is designated as low-income (or high poverty) when more than 30% of the families in the neighbourhood meet the definition of low-income cut off (LICO).14 Low-income cut off is a set dollar value and based on the 2001 Statistics Canada Census, a household earnings is considered low-income when the annual income of the household is $30,429 or less.14 Table 20 illustrates the results from the comparative analysis of oral health between children attending schools that are located in Low Income Neighbourhoods and children attending in schools that are not located in Low Income Neighbourhoods in the city of Saskatoon, 2008-2009. Table 20: Dental Health by Neighbourhood Income Status, City of Saskatoon, 2008-2009 Dental Health Measure School Location p-value Total

LICO Non-LICO Average ‘deft/DMFT’ b 2.97 1.53 <0.0001 1.57 With Current Caries a 51 (30.5) 694 (12.1) <0.0001 745 (12.6) No Evidence of Dental Care a 21 (12.6) 353 (6.1) 0.001 374 (6.3) ECC present a 14 (8.4) 156 (2.7) <0.0001 170 (2.9) Cavity-free a 57 (34.1) 3437 (59.8) <0.0001 3494 (59.1) Pain and Infection a 7 (4.2) 136 (2.4) 0.13 143 (2.4) Total Screened 167 (2.8) 5750 (97.2) 5917 a Chi-square test, b t-test

47

Figure 15 : Dental Health by Neighbourhood Income Status, City of Saskatoon, 2008-2009

Overall it appears that children attending schools that are not located in Low Income Neighbourhoods, have better oral health when compared with children attending schools that are located in Low Income Neighbourhoods. This is evident from the average ‘deft/DMFT’ value which is statistically significant. In addition, schools that are located in Low Income Neighbourhoods had higher proportions with Current Caries, ECC and showing No Evidence of Care which is statistically significant. Furthermore, schools that are not located in Low Income Neighbourhoods had higher proportion being cavity-free, which is statistically significant and lower proportion with pain/infection which is statistically insignificant. Table 21: Comparison of Dental Health Status of Children who attended Schools located in Low Income Neighbourhoods in the City of Saskatoon for the school years 2003-2004 and 2008-2009 Dental Health Measure 2008-2009 2003-2004 Average ‘deft/DMFT’ 2.97 3.12 With Current Caries 51 (30.5) 106 (25.3) No Evidence of Dental Care (NEC) 21 (12.6) 96 (22.9) Early Childhood Caries (ECC) 14 (8.4) 91 (21.7) Cavity-free 57 (34.1) 165 (39.4) Pain & / Infection 7 (4.2) 15 (3.6) Total Screened 167 419 Overall it appears that oral health status in the low income neighbourhoods in the city of Saskatoon have improved since the previous screening, evident from the Average ‘deft/DMFT’ score. Based on the 2008-2009 screening results, the proportion of children

48

with current caries and pain/ infection has risen and children being cavity free has dropped. Dental health measures of NEC and ECC have improved. The significant reduction in NEC (by 10.3%) and ECC (by 13.3%) can be 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 Saskatoon.

49

Epidemiological studies ------------------------------------------------------------------------------------------------------------ Table 22: Calculation of Relative Risk for being Cavity-free between Saskatoon Health Region and rest of Saskatchewan, 2008-2009 Relative Risk Not Cavity-free (+) Cavity-free (-) Total Saskatoon Health Region (+) 2423 3494 5917 Rest of Saskatchewan (-) 6678 5319 11997 Total 9101 8813 17914 Relative Risk: 0.73 (p- value: <0.0000001) As the value is less than 1, the risk of not being cavity-free (having caries) is less when a student (either Grade One or Grade Seven) resides in Saskatoon Health Region, than when the student resides elsewhere in Saskatchewan. Table 23: Calculation of Odds Ratio for being Cavity-free between Urban and Rural communities in Saskatoon Health Region, 2008-2009 Odds Ratio Not Cavity-free (+) Cavity-free (-) Total Urban (+) 1698 2473 4171 Rural (-) 725 1021 1746 Total 2423 3494 5917 Odds ratio: 0.96 (p-value: 0.28) As the value is less than 1, a student (either Grade One or Grade Seven), who resides in a rural community in Saskatoon Health Region, has a higher chance of not being cavity-free (having caries), than if they reside in an urban community.

50

Regina Qu’Appelle Health Region and Saskatoon Health Region are similar in population and many traits. The following section compares the relative risk for being cavity free for LICO neighbourhoods in the cities of Regina and Saskatoon. Table 24: Calculation of Relative Risk for being Cavity-free between Low Income Cut-off Neighbourhood in the City of Regina and Low Income Cut-off (LICO) Neighbourhood in the City of Saskatoon, 2008-2009 Relative Risk Not Cavity-

free (+) Cavity-free (-)

Total

LICO_Regina Qu’ Appelle Health Region (+) 303 188 491 LICO_Saskatoon Health Region (-) 110 57 167 Total 413 245 658 Relative Risk: 0.93 (p-value: 0.16) As the value is less than 1, the risk of not being cavity-free (having caries) is less when a student (either Grade One or Grade Seven) attends a school located in a low income cut-off neighbourhood in the City of Regina, than when the student attends a school located in a low income cut-off neighbourhood in the City of Saskatoon. Table 25: Calculation of Odds Ratio for being Cavity-free between Low Income (LICO) Cut-off Neighbourhood School and Non-Low Income Cut-off (LICO) Neighbourhood School in Saskatoon Health Region, 2008-2009 Odds Ratio Not Cavity-free (+) Cavity-free (-) Total LICO (+) 110 57 167 Non-LICO (-) 2313 3437 5750 Total 2423 3494 5917 Odds ratio: 2.86 (p-value :< 0.0000001) As the value is greater than 1, a student (either Grade One or Grade Seven), who attends a school located in a low income cut-off neighbourhood is at a higher odds for not being cavity-free (having caries), than when a student who attends a school located in a non-low income cut-off neighbourhood, in the city of Saskatoon.

51

Adequate community water fluoridation (CWF) has long been known to improve dental health. This section provides a comparison between communities in Saskatoon Health Region and the rest of Saskatchewan with CWF. Table 26: Calculation of Relative Risk for being Cavity-free between Schools that have access to community water fluoridation (CWF) in Saskatoon Health Region and rest of Saskatchewan, 2008-2009 Relative Risk Not Cavity-free (+) Cavity-free (-) Total CWF_Saskatoon Health Region (+) 2062 3095 5157 CWF_ Rest of Saskatchewan (-) 1097 1222 3159 Total 3159 4317 7476 Relative risk: 0.84 (p-value: <0.0000001) As the value is less than 1, a student (either Grade One or Grade Seven), who attends school that has access to community water fluoridation in Saskatoon Health Region, is at a lower risk for not being cavity free (having caries), than when a student who attends a school elsewhere in Saskatchewan that has access to CWF. Comparing dental health for children by access to CWF also increases our understanding of the factors contributing to dental health in Saskatoon Health Region. Table 27: Calculation of Odds Ratio for being Cavity-free between Schools that have access to Community Water Fluoridation (CWF) and Schools that do not in Saskatoon Health Region, 2008-2009 Odds ratio Not Cavity-free (+) Cavity-free (-) Total CWF (+) 2062 3095 5157 No-CWF (-) 361 399 760 Total 2423 3494 5917 Odds Ratio: 0.73 (p-value: 0.00004) As the value is less than 1, a student (either Grade One or Grade Seven), who attends school that has access to community water fluoridation, is at a lower odds for not being cavity-free (having caries), than when a student who attends school that does not have access to community water fluoridation in Saskatoon Health Region, 2008-2009.

52

Interpretation for both Relative Risk (RR) and Odds Ratio (OR): RR / OR Interpretation If RR / OR = 1 No association If RR / OR >1 Positive association; possibly causal If RR / OR <1 Negative association; possibly protective

53

Discussion ------------------------------------------------------------------------------------------------------------ The participation rate for Grade One and Grade Seven students was 88.5% and 85.1%

respectively and the overall participation rate was 86.7%. In total 13.3% of enrolled

students either refused screening or were absent on the day of screening. This proportion

of students not screened represents hidden morbidity, as they may be suffering from

dental caries. The number of Grade One students screened was the lowest since the 1993-

1994 screening and also the number of Grade One students screened declined over the

past two decades at an attrition rate of 7.6% compared to the previous screening in 2003-

2004.

Nearly 87.2% of children screened attended schools that had access to CWF in Saskatoon

Health Region during the screening year 2008-2009. This access to CWF is also the

highest among all the health regions in Saskatchewan. This compliments the statement

that the relative risk for a child (either Grade One or Grade Seven) who attends a school

in Saskatoon Health Region is at a lower risk for having caries than a child (either Grade

One or Grade Seven) who resides elsewhere in Saskatchewan. Also, the caries prevention

fraction was higher for the students who attend schools that had access to CWF (0.72)

compared to children who do not attend schools that have access to CWF (0.65).

The factors malocclusion, staining, gingivitis and presence of calculus were included to

assess other dental health needs. These needs are higher among the Grade Seven children

than the Grade One children.

Malocclusion can lead to poor facial appearance and related psychological disturbances,

increased risk for caries due to malaligned teeth due to difficulty maintaining oral

hygiene, predisposition to gingivitis and periodontitis due to plaque/calculus

accumulation and abnormalities in mastication of food, deglutition (swallowing),

phonetics (speech), etc. The proportion of children experiencing malocclusion was

54

55.2% of Grade Seven students, compared to only 27.9% of Grade One students. More

than one in every other child screened in the health region is experiencing malocclusion

There is a need to improve understanding by parents and others of preventive

orthodontics. This calls for a shift in the balance from interceptive orthodontics to

preventive orthodontics as there are only seven practicing orthodontists in the health

region. The screening did not record the severity of the malocclusion, which would have

established the need to take immediate action.

The percentage of children with ECC decreased from 6.8% in 2003-2004 to 5.9% in

2008-2009, a decrease of 0.9%. The improvement was notably evident in the Low

Income Cut-off neighbourhoods, in the City of Saskatoon. The percentage of children

with ECC decreased from 21.7% in 2003-2004 to 8.4% in 2008-2009. The significant

reduction in ECC (by 13.3%) can be 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 Saskatoon.

For children in Grade One, tooth decay in the primary dentition remains a significant

childhood problem. Equally also for children in Grade Seven, tooth decay in the

permanent dentition is a problem. The results of the 2008-2009 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.

Optional information collected included dental insurance, history of visit to a dental

office and application of dental sealants. Dental health measures were found to be better

among the children who had some form of dental insurance, visited the dentist in the past

year and had a dental sealant placed. Social health insurance which was designed to be

the cornerstone of Canada’s health care system is not totally universal and does not

55

provide dental coverage. Based on the 2008-2009 screening results, more than 75% of

children screened had some form of dental insurance. The information collected

regarding dental insurance was standardized based on location, and it was found that a

higher proportion of urban school children (42.0%) had some sort of dental insurance

compared to rural school children (39.3%). Overall, more than one in every other child

(either Grade One or Grade Seven) in Saskatoon Health Region either do not have any

sort of dental insurance or are not sure about it. Access to the Saskatoon Health Region

Public Health Services Dental Clinic, or other free clinical services, must be expanded to

meet the needs of children without dental insurance.

Dental office visits are vital to maintaining good oral health. Based on the 2008-2009

screening results, nearly 75% of children visited the dentist in the past year. However, the

reason for the dental visit was not recorded, so detailed information on services accessed

such as preventive, fluoride, diagnostic check-up or therapeutic (treatment) is not

available. The time 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. There is a need to build an oral health coalition, including private dental

practitioners with the purpose of advocating for improved oral health for vulnerable

populations.

Based on the 2008-2009 screening results, dental sealants utilization was only 29.3%,

10.2% among Grade One students and 19.1% among Grade Seven students respectively.

The reason for the lower utilization of dental sealants requires further exploration when

65.1% of Grade One and 78.8% of Grade Seven students received a recommendation to

have dental sealants placed. Possible reasons for low utilization of sealants could be due

to lack of public knowledge, insurance companies restricting dental sealants,

reimbursement issues, or concerns about sealing over dental caries.

56

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 Bias 12: 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.

For the data collected regarding community water fluoridation (CWF), students were

grouped under CWF, if they attended a school that has access to CWF. But, a child who

attends a school that has access to CWF might be residing in a community that does

not have access to CWF and vice-versa.

57

Recommendations ------------------------------------------------------------------------------------------------------------

Healthy public policy to support the maintenance and implementation of adequate Community Water Fluoridation.

Support initiatives to provide the necessary infrastructure for communities which are planning to adopt community water fluoridation.

Orient and train public health nurses, nurse clinicians and other health professionals to provide fluoride varnish for infants and preschoolers who are at high risk for dental caries.

Increase number of fluoride varnish and screening referral programs to include children in Pre-Kindergarten, preschool, and daycares in core communities.

Increase access to dental sealants for Kindergarten, Grade 1, 2, 6 and 7 children by expanding Seal-A-Smile Program to schools where oral health status is poor.

Improve access to oral care (preventive and treatment) for pregnant women and

their children in core neighbourhoods.

Continue to work in partnership with White Buffalo Youth Lodge and College of Dentistry to improve the oral health status of children in their designated schools.

Continue to encourage children without any sort of dental insurance to utilize the services offered by the Public Health Dental Clinic.

Continue oral health surveillance based on Canadian Oral Health Strategy Goals.

Build oral health coalition, involving private dental health care providers, to help

improve oral health of vulnerable populations

Explore the reasons for the low utilization of dental sealants.

Emphasis on preventive orthodontics measures by dental health professionals to support timely diagnosis and allow prompt referral.

Advocate for a Dental Health Officer, who is a public health dentist and who can communicate with the appropriate authorities to address oral health needs and goals.

58

Appendices

59

Appendix 1: Dental Screening Program Definitions ‘deft/DMFT’:

index used to measure disease experience. It is the count of the number of decayed, missing(due to caries), and filled teeth of an individual.

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.

Attrition Rate:

The rate of decline in the number or size.

60

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:

infection visible (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.

61

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 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.

62

Appendix 2: List of Schools in Saskatoon Health Region, 2008-2009

Aberdeen Composite School Allan Composite School Allegro Montessori School Inc. Alvin Buckwold School Annaheim School Bishop Filevich Bishop Klein School Bishop Pocock School Bishop Roborecki School Borden School Brevoort Park School Brownell School Bruno School Brunskill School Buena Vista School Cardinal Leger School Caroline Robins School Caswell Community School Christian Centre Academy Clavet Composite School

Clear Springs Hutterite School College Park School Colonsay School Confederation Park Community School Cudworth School Cyber School Dalmeny High School Delisle Composite School Delisle Elementary School Dr. John G. Egnatoff School Drake School Dundonald School Dundurn School Ecole canadienne-francaise de Saskatoon Ecole Providence Ecole St. Isidore Englefeld School Fairhaven School Father Robinson School

63

Father Vachon School Forest Grove School Georges Vanier School Greystone Heights School Hague Elementary School Hague High School Hanley Composite School Henry Kelsey School Hepburn School Hillcrest Hutterite School Holliston School Howard Coad School Hugh Cairns VC School Humboldt Public School James L. Alexander School John Dolan School John Lake School King George Community School Laird School Lake Lenore School Lakeridge School

Lakeside Colony School Lakeview School Langham Elementary School Lanigan Elementary School Lawson Heights School Leroy School Lester B. Pearson School Lord Asquith School Mayfair Community School McClellan School Montgomery School Muenster School Nokomis School North Park Wilson School Osler School Pike Lake School Pleasant Hill Community School Pope John Paul II School Prairie View School Prince Philip School Princess Alexandra Community School

64

Queen Elizabeth School Quill Lake School River Heights School Riverbend Hutterite Colony School Riverview Hutterite School Roland Michener School Rosthern Elementary School Rosthern High School Saskatoon Christian School Saskatoon French School Saskatoon Misbah School Seventh-day Adventist Christian School Silverspring Elementary Silverwood Heights School Sion Middle School Sister O'Brien School South Corman Park School St. Alphonse School St. Angela School St. Anne School St. Augustine School – Humboldt

St. Augustine School – Saskatoon St. Bernard School St. Dominic School – Humboldt St. Dominic School – Saskatoon St. Edward School St. Frances School St. George School St. Gerard School St. Goretti School St. John School St. Luke School St. Marguerite School St. Mark School St. Mary Community School St. Matthew School St. Michael School St. Paul School St. Peter School St. Philip School St. Volodymyr School Stobart Community High School

65

Stobart Elementary Community School

Sutherland School

Swanson Christian School

Three Lakes School

Valley Christian Academy

Valley Manor Elementary School

Vanscoy School

Venture Heights Elementary School

Victoria School

Vincent Massey School

Viscount Central School

W.P. Bate Community School

Wadena Composite School

Wadena Elementary

Wakaw School

Waldheim School

Walter W. Brown High School

Warman Elementary School

Warman High School

Watrous Elementary School

Watson Elementary School

Watson High School

Westmount Community School

Wildwood School

William Derby School

Wynyard Composite High School

Wynyard Elementary School

66

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

67

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

68

Appendix 5: Dental Health by School (Grade One Students), Saskatoon Health Region, 2008-2009 School Name

%Cavity-free

%Unmet Dental Needs

% Current Cavities %NEC %ECC

% Pain/ Infection

Aberdeen Composite School 50.0 13.6 13.6 0.0 4.5 0.0 Allan Composite School 11.1* 11.1 11.1 0.0 0.0 0.0 Allegro Montessori School Inc. 60.0 10.0 10.0 0.0 0.0 10.0 Alvin Buckwold School 70.0 10.0 10.0 0.0 5.0 0.0 Annaheim School 12.5* 50.0* 50.0 25.0 25.0 0.0 Bishop Klein School 32.1* 32.1* 39.3 25.0 17.8 10.7 Bishop Pocock School 57.1 21.4* 21.4 14.3 7.1 7.1 Bishop Roborecki School 45.4* 54.5* 54.5 45.4 18.2 18.2 Borden School 25.0* 50.0* 50.0 50.0 0.0 25.0 Brevoort Park School 70.0 15.0 15.0 5.0 5.0 5.0 Brownell School 41.7* 25.0* 25.0 12.5 0.0 8.3 Bruno School 12.5* 12.5 12.5 0.0 0.0 0.0 Brunskill School 45.0* 20.0 20.0 5.0 10.0 0.0 Buena Vista School 66.7 20.8* 20.8 8.3 4.2 0.0 Cardinal Leger School 58.9 17.9 17.9 10.3 7.7 5.1 Caroline Robins School 33.3* 33.3* 33.3 23.8 19.0 4.7 Caswell Community School 26.1* 39.1* 39.1 21.7 8.7 4.3 Christian Centre Academy 100 0.0 0.0 0.0 0.0 0.0 Clavet Composite School 47.6* 23.8* 23.8 14.3 4.7 0.0 Clear Springs Hutterite School 0.0* 50.0* 50.0 0.0 0.0 0.0 College Park School 42.1* 31.6* 31.6 10.5 15.8 5.3 Colonsay School 30.0* 30.0* 30.0 20.0 10.0 0.0 Confederation Park Community School 18.2* 54.5* 54.5 30.3 24.2 18.2 Cudworth School 20.0* 40.0* 40.0 20.0 20.0 0.0 Delisle Elementary School 64.7 17.6 11.8 5.9 5.9 5.9 Dr. John G. Egnatoff School 71.7 4.3 2.2 0.0 2.2 2.2 Drake School 75.0 25.0* 25.0 0.0 25.0 0.0 Dundonald School 72.2 7.4 7.4 1.8 0.0 0.0 Dundurn School 20.0* 33.3* 33.3 20.0 0.0 0.0 Ecole canadienne-francaise de Saskatoon 65.0 20.0 20.0 5.0 5.0 0.0 Ecole Providence 44.4* 11.1 11.1 0.0 11.1 0.0 Ecole St. Isidore 71.4 0.0 0.0 0.0 0.0 0.0 Englefeld School 50.0 0.0 0.0 0.0 0.0 0.0 Fairhaven School 54.5 27.3* 27.3 18.2 18.2 9.1 Father Robinson School 56.1 14.6 12.2 7.3 0.0 2.4 Father Vachon School 50.0 18.7 18.7 6.3 0.0 18.7 Forest Grove School 30.9* 19.0 14.3 2.3 2.3 7.1 Georges Vanier School 62.1 17.2 17.2 6.9 3.4 3.4

69

School Name

%Cavity-free

%Unmet Dental Needs

% Current Cavities

%NEC

%ECC

% Pain/ Infection

Greystone Heights School 55.5 38.9* 44.4 27.8 16.7 5.5 Hague Elementary School 45.0* 35.0* 35.0 20.0 10.0 0.0 Hanley Composite School 11.1* 44.4* 33.3 22.2 11.1 11.1 Henry Kelsey School 50.0 4.5 4.5 4.5 4.5 0.0 Hepburn School 40.0* 10.0 10.0 5.0 0.0 0.0 Hillcrest Hutterite School 0.0* 0.0 0.0 0.0 0.0 0.0 Holliston School 57.1 25.7* 22.8 5.7 2.8 5.7 Holy Family School/ Bishop Filevich 43.7* 37.5* 37.5 25.0 12.5 6.3 Howard Coad School 46.7* 6.7 13.3 0.0 0.0 0.0 Hugh Cairns VC School 40.0* 33.3* 33.3 26.7 6.7 13.3 Humboldt Public School 50.0 12.5 12.5 12.5 6.3 6.3 James L. Alexander School 60.0 0.0 0.0 0.0 0.0 0.0 John Dolan School 50.0 0.0 0.0 0.0 0.0 0.0 John Lake School 57.9 26.3* 26.3 21.1 5.3 10.5 King George Community School 14.3* 71.4* 85.7 42.8 28.6 14.3 Laird School 71.4 0.0 0.0 0.0 0.0 0.0 Lake Lenore School 60.0 20.0 20.0 0.0 0.0 0.0 Lakeridge School 53.5 20.9* 18.6 9.3 13.9 6.9 Lakeside Colony School 100 0.0 0.0 0.0 0.0 0.0 Lakeview School 63.4 9.7 9.7 4.9 2.4 0.0 Langham Elementary School 45.8* 20.8* 16.7 8.3 4.2 0.0 Lanigan Elementary School 33.3* 20.0 20.0 20.0 6.7 6.7 Lawson Heights School 55.0 15.0 15.0 5.0 5.0 5.0 Leroy School 25.0* 50.0* 50.0 50.0 0.0 0.0 Lester B. Pearson School 56.5 17.4 13.0 8.7 0.0 0.0 Lord Asquith School 50.0 22.2* 22.2 22.2 5.5 0.0 Mayfair Community School 27.3* 13.6 36.4 13.6 9.1 9.1 McClellan School 50.0 0.0 0.0 0.0 0.0 0.0 Montgomery School 64.3 7.1 14.3 7.1 0.0 0.0 Mother Teresa School 50.0 11.7 8.8 5.9 2.9 2.9 Muenster School 42.8* 21.4* 21.4 14.3 14.3 0.0 Nokomis School 40.0* 40.0* 40.0 0.0 0.0 20.0 North Park Wilson School 68.0 4.0 4.0 0.0 4.0 0.0 Osler School 69.6 8.7 8.7 4.3 4.3 0.0 Pike Lake School 50.0 33.3* 33.3 16.7 16.7 33.3 Pleasant Hill Community School 18.7* 37.5* 37.5 25.0 0.0 12.5 Prairie View School 70.7 12.2 12.2 4.9 4.9 4.9 Prince Philip School 38.1* 28.6* 19 9.5 0.0 9.5 Princess Alexandra Community School 7.1* 71.4* 71.4 14.3 35.7 7.1 Queen Elizabeth School 66.7 22.2* 22.2 22.2 11.1 11.1 Quill Lake School 58.3 16.7 16.7 8.3 0.0 0.0 River Heights School 75.0 0.0 3.1 3.1 0.0 0.0

70

School Name

%Cavity-free

%Unmet Dental Needs

% Current Cavities

%NEC

%ECC

% Pain/ Infection

Riverbend Hutterite Colony School 100.0 0.0 0.0 0.0 0.0 0.0 Riverview Hutterite School 0.0* 100.0* 100.0 0.0 100 0.0 Roland Michener School 33.3* 50.0* 50.0 41.7 8.3 8.3 Rosthern Elementary School 71.4 14.3 14.3 9.5 4.7 4.7 Saskatoon Christian School 55.5 22.2* 11.1 11.1 0.0 11.1 Saskatoon French School 53.1 18.7 15.6 3.1 6.3 3.1 Saskatoon Misbah School 60.0 10.0 20.0 0.0 10.0 0.0 Seventh-day Adventist Christian School 100 0.0 0.0 0.0 0.0 0.0 Silverspring Elementary 72.0 0.0 2.0 2.0 0.0 0.0 Silverwood Heights School 69.2 0.0 0.0 0.0 0.0 0.0 Sister O'Brien School 67.7 0.0 0.0 0.0 0.0 0.0 South Corman Park School 64.7 5.9 11.7 5.9 5.9 5.9 St. Alphonse School 50.0 50.0* 50.0 50.0 0.0 0.0 St. Angela School 64.3 14.3 14.3 0.0 7.1 0.0 St. Anne School 62.5 0.0 0.0 0.0 0.0 0.0 St. Augustine School(Saskatoon) 34.6* 15.4 15.4 11.5 3.8 0.0 St. Augustine School(Humboldt) 37.5* 25.0* 25.0 6.3 18.7 6.3 St. Bernard School 58.3 25.0* 16.7 16.7 0.0 8.3 St. Dominic School(Humboldt) 38.1* 33.3* 33.3 14.3 14.3 4.7 St. Dominic School(Saskatoon) 68.2 4.5 4.5 4.5 4.5 4.5 St. Edward School 37.5* 25.0* 25.0 12.5 6.3 12.5 St. Frances School 17.6* 41.2* 41.2 23.5 5.9 0.0 St. George School 42.8* 19.0 14.3 4.7 0.0 0.0 St. Gerard School 33.3* 24.1* 24.1 7.4 9.3 3.7 St. Goretti School 21.7* 39.1* 34.8 13.0 13.0 4.3 St. John School 31.6* 31.6* 36.8 10.5 5.2 15.8 St. Luke School 48.7* 15.4 15.4 5.1 7.7 10.3 St. Marguerite School 55.3 14.9 14.9 12.7 0.0 4.3 St. Mark School 50.0 25.0* 25.0 10.7 10.7 0.0 St. Mary Community School 21.4* 50.0* 50.0 7.1 14.3 0.0 St. Matthew School 58.0 16.0 16.0 4.0 2.0 6.0 St. Michael School 31.6* 26.3* 26.3 15.8 5.3 5.3 St. Paul School 88.9 0.0 0.0 0.0 0.0 0.0 St. Peter School 60.4 5.7 5.7 1.9 1.9 0.0 St. Philip School 40.9* 40.9* 36.4 9.1 18.2 4.5 St. Thomas /Pope John Paul II School 57.1 28.6* 28.6 28.6 0.0 14.3 St. Volodymyr School 69.6 4.3 4.3 2.2 2.2 0.0 Stobart Elementary Community School 11.1* 48.1* 51.8 22.2 14.8 11.1 Sutherland School 47.6* 28.6* 28.6 9.5 9.5 4.8 Swanson Christian School 50.0 0.0 0.0 0.0 0.0 0.0 Three Lakes School 0.0* 66.7* 66.7 55.5 11.1 0.0 Valley Christian Academy 72.2 11.1 11.1 0.0 5.5 0.0

71

School Name

%Cavity-free

%Unmet Dental Needs

% Current Cavities %NEC %ECC

% Pain/ Infection

Valley Manor Elementary School 64.0 8.0 8.0 2.0 2.0 4.0 Vanscoy School 22.2 0.0 11.1 11.1 0.0 0.0 Venture Heights Elementary School 60.0 3.3 3.3 0.0 3.3 0.0 Victoria School 67.7 9.7 9.7 3.2 3.2 0.0 Viscount Central School 100.0 0.0 0.0 0.0 0.0 0.0 Vincent Massey School 29.4* 35.3* 35.3 5.9 23.5 11.7 W.P. Bate Community School 38.5* 19.2 26.9 11.5 15.4 0.0 Wadena Elementary 15.8* 36.8* 36.8 21.0 15.8 10.5 Wakaw School 37.5* 12.5 12.5 0.0 0.0 12.5 Waldheim School 29.4* 35.3* 41.2 23.5 5.9 0.0 Warman Elementary School 67.4 12.6 11.6 6.3 1.1 4.2 Watrous Elementary 41.7* 20.8* 20.8 12.5 4.2 0.0 Watson Elementary School 50.0 25.0* 0.0 0.0 0.0 25.0 Westmount Community School 15.4* 38.5* 38.5 15.4 7.7 7.7 Wildwood School 50.0 12.5 12.5 0.0 0.0 0.0 William Derby School 27.3* 54.5* 45.4 27.3 9.1 9.1 Wynyard Elementary 60.0 8.0 8.0 4.0 0.0 0.0

*Note: Red* font in ‘percentage cavity-free’ and ‘percentage unmet oral/dental health needs’ indicates schools that do not meet the Canadian Oral Health Strategy guidelines (2010) for Grade One Students having ‘50% and above caries-free’ and ‘ no more than 20% with unmet oral/dental health needs’ respectively.

72

Appendix 6: Dental Health by School (Grade Seven Students), Saskatoon Health Region, 2008-2009

School Name % Cavity-free

% Unmet Dental Needs

% DMFT=0

Avg. DMFT

% Current Cavities

%NEC % Pain & Infection

Aberdeen Composite School 79.2 8.3 75.0 0.58 8.3 8.3 0.0

Allan Composite School 76.9 7.7 84.6 0.15 7.7 7.7 0.0

Alvin Buckwold School 79.2 0.0 87.5 0.25 0.0 0.0 0.0

Annaheim School 50.0 0.0 100.0 0.0 0.0 0.0 0.0

Bishop Klein School 42.8 25.0* 53.6* 1.6* 25.0 7.1 3.6

Bishop Pocock School 65.4 11.5* 69.2* 0.7 11.5 7.7 0.0

Bishop Roborecki School 53.8 17.9* 56.4* 1.38* 15.4 2.6 0.0

Borden School 42.8 14.3* 42.8* 1.3* 14.3 14.3 0.0

Brevoort Park School 71.4 28.6* 71.4* 2.0* 28.6 14.3 0.0

Brownell School 65.4 3.8 76.9 0.34 3.8 0.0 0.0

Bruno School 77.8 0.0 88.9 0.1 0.0 0.0 0.0

Brunskill School 83.3 3.33 86.7 0.4 3.33 0.0 0.0

Buena Vista School 60.0 12.0* 68.0* 0.8 12.0 0.0 0.0

Cardinal Leger School 68.2 4.5 72.7* 0.66 6.8 4.5 0.0

Caroline Robins School 56.0 0.0 64.0* 0.8 0.0 0.0 0.0

Caswell Community School 80.5 5.5 83.3 0.7 5.5 2.8 2.8

Christian Centre Academy 100.0 0.0 100.0 0.0 0.0 0.0 0.0

Clavet Composite School 67.4 10.9* 76.1 0.6 10.9 8.7 0.0 Clear Springs Hutterite School 0.0 66.7* 0.0* 4.0* 66.7 33.3 0.0

College Park School 60.0 7.5 65.0* 0.65 7.5 5.0 0.0

Colonsay School 77.8 0.0 100.0 0.0 0.0 0.0 0.0 Confederation Park Community School 37.2 27.9* 46.5* 1.5* 27.9 23.2 0.0

Cudworth School 70.0 0.0 80.0 0.0 0.0 0.0 0.0

Dalmeny High School 71.8 0.0 79.5 0.4 0.0 0.0 0.0

Delisle Composite School 66.7 4.2 79.2 0.5 4.2 4.2 0.0

Dr. John G. Egnatoff School 62.5 7.8 76.6 0.6 7.8 4.7 1.6

Drake School 44.4 11.1* 88.9 0.3 11.1 0.0 0.0

Dundonald School 66.7 5.5 77.8 0.5 5.5 1.8 0.0 Ecole canadienne-francaise de Saskatoon 85.7 9.5 95.2 0.2 9.5 4.8 0.0

73


%Unmet Dental Needs

% DMFT=0

Avg. DMFT

% Current Cavities

%NEC

% Pain & Infection

Ecole Providence 57.1 0.0 57.1* 1.0 0.0 0.0 0.0

Ecole St. Isidore 70.0 0.0 80.0 0.0 0.0 0.0 0.0

Englefeld School 55.5 0.0 66.7* 1.1* 0.0 0.0 0.0

Fairhaven School 51.7 3.4 62.1* 1.24* 3.4 0.0 0.0

Father Robinson School 59.3 3.7 68.5* 0.56 3.7 1.8 0.0

Father Vachon School 50.0 9.1 63.6* 0.8 9.1 0.0 0.0

Forest Grove School 61.1 11.1* 63.9* 1.39* 11.1 8.3 5.5

Georges Vanier School 67.6 0.0 82.3 0.5 0.0 0.0 0.0

Greystone Heights School 70.8 9.2 75.4 0.51 10.8 7.7 0.0

Hague High School 56.5 17.4* 69.6* 0.6 17.4 8.7 0.0

Hanley Composite School 58.6 6.9 68.9* 1.03* 6.9 3.4 0.0

Henry Kelsey School 85.2 3.7 81.5 0.33 3.7 0.0 0.0

Hepburn School 76.5 0.0 94.1 0.1 5.9 5.9 0.0

Hillcrest Hutterite School 100.0 0.0 100.0 0.0 0.0 0.0 0.0

Holliston School 70.0 0.0 90.0 0.33 6.7 3.3 0.0 Holy Family School/ Bishop Filevich 60.0 20.0* 80.0 0.2 20.0 20.0 0.0

Howard Coad School 40.0 0.0 40.0* 1.0 0.0 0.0 0.0

Hugh Cairns VC School 69.4 11.1* 72.2* 0.61 11.1 2.8 2.8

Humboldt Public School 56.3 0.0 68.7* 0.4 0.0 0.0 0.0

James L. Alexander School 47.6 4.7 57.1* 1.24* 9.5 9.5 0.0

John Dolan School 100.0 0.0 0.0* 0.0 0.0 0.0 0.0

John Lake School 52.6 0.0 57.9* 1.2* 5.3 0.0 0.0 King George Community School 70.0 0.0 80.0 0.4 0.0 0.0 0.0

Laird School 85.7 0.0 85.7 0.4 0.0 0.0 0.0

Lake Lenore School 33.3 16.7* 66.7* 1.3* 16.7 0.0 0.0

Lakeridge School 60.4 11.3* 79.2 0.4 9.4 7.5 1.9

Lakeside Colony School 50.0 50.0* 50.0* 1.0 50.0 0.0 0.0

Lakeview School 74.4 9.3 76.7 0.5 9.3 6.9 0.0

Lanigan Elementary School 36.7 23.3* 56.7* 1.37* 23.3 6.7 0.0

Lawson Heights School 73.1 0.0 84.6 0.27 0.0 0.0 0.0

Leroy School 28.6 14.3* 57.1* 0.86 14.3 14.3 0.0

74


%Unmet Dental Needs

% DMFT=0

Avg. DMFT

% Current Cavities

%NEC

% Pain & Infection

Lester B. Pearson School 65.7 2.8 71.4* 0.86 2.8 0.0 2.8

Lord Asquith School 75.0 0.0 78.6 0.8 0.0 0.0 0.0

Mayfair Community School 58.8 11.7* 76.5 0.6 11.8 0.0 5.9

McClellan School 83.3 0.0 83.3 0.4 0.0 0.0 0.0

Montgomery School 64.7 5.9 64.7* 1.05* 0.0 0.0 5.9

Mother Teresa School 64.8 5.4 81.1 0.4 5.4 2.7 0.0

Muenster School 57.1 7.1 57.1* 1.0 7.1 0.0 0.0

Nokomis School 40.0 20.0* 75.0 0.8 20.0 20.0 0.0

North Park Wilson School 73.9 0.0 82.6 0.43 0.0 0.0 0.0

Osler School 94.7 5.3 94.7 0.1 5.3 5.3 0.0 Pleasant Hill Community School 33.3 50.0* 66.7* 0.67 50.0 16.7 0.0

Prince Philip School 75.0 5.0 85.0 0.15 5.0 5.0 0.0 Princess Alexandra Community School 16.7 33.3* 50.0* 0.67 33.3 33.3 16.7

Queen Elizabeth School 60.0 20.0* 60.0* 0.8 20.0 10.0 20.0

Quill Lake School 72.7 0.0 81.8 0.2 0.0 0.0 0.0

River Heights School 86.5 0.0 91.9 0.13 0.0 0.0 0.0 Riverbend Hutterite Colony School 66.7 0.0 66.7* 0.67 0.0 0.0 0.0

Riverview Hutterite School 100.0 0.0 100.0 0.0 0.0 0.0 0.0

Roland Michener School 68.7 12.5* 81.3 0.3 6.3 0.0 12.5

Rosthern High School 70.8 4.2 70.8* 0.6 4.2 4.2 0.0

Saskatoon Christian School 80.0 5.0 90.0 0.3 5.0 5.0 0.0

Saskatoon French School 88.9 0.0 100.0 0.0 0.0 0.0 0.0

Saskatoon Misbah School 28.6 0.0 71.4* 0.28 0.0 0.0 0.0 Seventh-day Adventist Christian School 25.0 25.0* 25.0* 1.5* 25.0 0.0 0.0

Silverspring Elementary 80.9 1.6 85.7 0.4 1.6 1.6 0.0

Silverwood Heights School 72.7 0.0 81.8 0.2 0.0 0.0 0.0

Sion Middle School 60.0 20.0* 80.0 0.6 30.0 0.0 0.0

Sister O'Brien School 82.1 3.6 96.4 0.1 3.6 0.0 0.0

St. Alphonse School 0.0 100.0* 0.0* 1.0 100.0 100.0 0.0

St. Angela School 90.9 4.5 90.9 0.1 4.5 4.5 0.0

75


%Unmet Dental Needs

% DMFT=0

Avg. DMFT

% Current Cavities


St. Anne School 74.3 11.4* 85.7 0.3 5.7 5.7 5.7

St. Augustine School(Humboldt) 64.7 5.9 70.6* 0.4 5.9 5.9 5.9

St. Augustine School(Saskatoon) 72.5 7.5 85.0 0.3 7.5 5.0 2.5

St. Bernard School 69.7 0.0 78.8 0.6 0.0 0.0 0.0

St. Dominic School(Humboldt) 72.7 0.0 72.7* 0.4 0.0 0.0 0.0

St. Dominic School(Saskatoon) 81.3 0.0 87.5 0.2 0.0 0.0 0.0

St. Edward School 68.4 5.2 73.9* 0.5 5.2 5.2 0.0

St. Frances School 50.0 10.0 50.0* 1.9* 10.0 0.0 10.0

St. George School 81.8 4.5 90.9 0.1 0.0 4.5 0.0

St. Gerard School 75.8 3.4 79.3 0.5 3.4 3.4 0.0

St. Goretti School 52.4 9.5 52.4* 1.43* 4.7 0.0 4.7

St. John School 50.0 15.0* 55.0* 0.9 20.0 25.0 10.0

St. Luke School 62.8 11.4* 77.1 0.3 11.4 0.0 0.0

St. Marguerite School 53.8 2.6 53.8* 1.07* 2.6 0.0 0.0

St. Mark School 62.5 4.2 62.5* 1.2* 4.2 4.2 0.0

St. Mary Community School 57.1 14.3* 57.1* 0.7 14.3 7.1 0.0

St. Matthew School 75.6 10.8* 83.8 0.3 10.8 5.4 2.7

St. Michael School 66.7 8.3 66.7* 0.5 8.3 8.3 0.0

St. Paul School 64.3 14.3* 85.7 0.3 7.1 0.0 0.0

St. Peter School 60.8 4.3 71.7* 0.6 4.3 0.0 2.2

St. Philip School 69.7 3.0 84.8 0.3 3.0 3.0 0.0 St. Thomas / Pope John Paul II School 57.1 9.5 61.9* 0.9 9.5 4.7 0.0

St. Volodymyr School 87.5 0.0 93.7 0.1 0.0 0.0 2.1 Stobart Community High School 58.6 6.9 65.5* 1.0 3.4 3.4 3.4

Sutherland School 70.6 11.8* 76.5 0.52 17.6 5.9 0.0

Swanson Christian School 100.0 0.0 100.0 0.0 0.0 0.0 0.0

Three Lakes School 36.4 36.4* 45.4* 1.1* 36.4 27.3 0.0

Valley Christian Academy 83.3 4.2 95.8 0.2 4.2 0.0 0.0 Valley Manor Elementary School 85.7 0.0 85.7 0.3 0.0 0.0 0.0

Vanscoy School 53.3 0.0 53.3* 1.2* 0.0 0.0 0.0

76


%Unmet Dental Needs

% DMFT=0

Avg. DMFT

% Current Cavities


Venture Heights Elementary School 77.3 0.0 77.3 0.7 0.0 0.0 0.0

Victoria School 42.8 14.3* 71.4* 0.3 0.0 0.0 14.3

Vincent Massey School 60.0 0.0 53.3* 0.87 0.0 0.0 0.0

Viscount Central School 66.7 0.0 100.0 0.0 0.0 0.0 0.0 W.P. Bate Community School 54.5 0.0 63.6* 0.82 0.0 0.0 0.0

Wadena Composite School 46.4 7.1 57.1* 1.4* 7.1 3.5 0.0

Wakaw School 70.0 0.0 80.0 0.6 0.0 0.0 0.0

Waldheim School 63.2 0.0 73.7* 0.47 0.0 0.0 0.0 Walter W. Brown High School 63.3 0.0 70.0* 0.8 0.0 0.0 0.0

Warman High School 84.3 0.0 88.6 0.2 0.0 0.0 0.0

Watrous Elementary 83.9 3.2 87.1 0.3 3.2 3.2 0.0

Watson High School 76.9 0.0 76.9 0.2 0.0 0.0 0.0 Westmount Community School 36.8 15.8* 42.1* 1.16* 15.8 10.5 5.3

Wildwood School 66.7 8.3 77.7 0.67 8.3 0.0 8.3

William Derby School 50.0 5.0 80.0 0.35 5.0 5.0 0.0 Wynyard Composite High School 66.7 3.33 66.7* 0.6 3.33 0.0 0.0

*Note: Red* font in ‘percentage unmet oral/dental health needs’, ‘percentage DMFT=0 and Average ‘DMFT’ indicates those schools that do not meet the Canadian Oral Health Strategy guidelines for Grade Seven Students having ‘ no more than 10% with unmet oral health needs’, ‘percentage DMFT=0 greater than 75%’ and the ‘Average DMFT less than or equal to 1’ respectively.

77

Appendix 7: Preventive Dental Care Services in Each Health Region in Saskatchewan, 2008-2009

Services Health Regions

Fluoride Mouthrinse

Fluoride Varnish

Pit and Fissure Sealants

Public Health Dental Clinic

Cypress HR Yes Yes No No Five Hills HR Yes No No No Heartland HR Yes No No No Kelsey Trail HR Yes Yes No No Keewatin Yatthe HR Yes Yes Yes Yes Mamawetan Churchill River HR

Yes Yes Yes Yes

Prince Albert Parkland HR Yes Yes Yes Yes Prairie North HR Yes Yes No No Regina Qu’Appelle HR Yes Yes No No Saskatoon HR Yes Yes Yes Yes Sun Country HR Yes Yes No No Sunrise HR Yes Yes No No

78

Appendix 8: SHR Communities with Access to Water Fluoridation

- 79 -

References ------------------------------------------------------------------------------------------------------------

1. The Canadian Oral Health Strategy, August 2005. Data retrieved from the

website: http://www.fptdwg.ca/assets/PDF/Canadian%20Oral%20Health%20Strategy%20-%20Final.pdf

2. The oral health status of children aged 12 years in Seychelles in the years 1994-

2000, Kathline Ernesta,SMDJ Seychelles Medical and Dental Journal, Special Issue, Volume 7,Number 1,November 2004.

3. WHO Oral Health Country/ Area Profile Programme. Data retrieved from the website:

http://www.whocollab.od.mah.se/expl/sic.html

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

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

6. Community socio-economic status and children’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 in dental caries in U.S. children and the effect of water fluoridation. J Dent Res 1990; 69(spec no): 723-727.

9. Fluoride: Nature’s tooth decay fighter. J Am Dent 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 and Present. Danielle Rabb-Waytowich,

JCDA, July/August 2009, Volume 75, No. 6

12. Epidemiology. Leon Gordis, fourth edition, Saunders Elsevier publication, 2008. 13. Findings and Recommendations of the Fluoride Expert Panel (January 2007). Data retrieved from the website: http://www.hc-sc.gc.ca/ewh-semt/pubs/water-eau/2008-fluoride-fluorure/index-eng.php

http://www.fptdwg.ca/assets/PDF/Canadian%20Oral%20Health%20Strategy%20-%20Final.pdf

http://www.whocollab.od.mah.se/expl/sic.html

http://www.ncbi.nlm.nih.gov/pubmed/18158522

http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm

http://www.hc-sc.gc.ca/ewh-semt/pubs/water-eau/2008-fluoride-fluorure/index-eng.php

- 80 -

14. Health Disparity by Neighbourhood Income. Mark Lemstra; Cory Neudorf; Johnmark Opondo. Canadian Journal of Public Health; Nov/Dec 2006; 97, 6; ProQuest Nursing and Allied Health Source, pg. 435.

15. Public Health Agency of Canada. Data retrieved from the website: http://www.phac-aspc.gc.ca/dca-dea/publications/hbsc_07-eng.php 16. Water fluoridation. Parnell C, Whelton H, O’ Mullane D; European archives of paediatric dentistry [1818-6300] Parnell yr: 2009 vol:10 iss:3 pg:141 -148 17. Based on the dental directory of the College of Dental Surgeons of Saskatchewan. Data retrieved from the website: http://www.saskdentists.com/a-z.asp . 18. Findings and Recommendations of the Fluoride Expert Panel (January 2007). Data retrieved from the website:http://www.hc-sc.gc.ca/ewh-semt/pubs/water-eau/2008 -fluoride-fluorure/index-eng.php.

http://www.phac-aspc.gc.ca/dca-dea/publications/hbsc_07-eng.php

http://www.saskdentists.com/a-z.asp

- 81 -

Public Health Services – Oral Health Program

#101 – 310 Idylwyld Drive North

Saskatoon, SK S7L 0Z2

Telephone: (306) 655-4462

HGD# 810 (05/10) ©2010, Saskatoon Health Region

public health services saskatoon health region oral health ......of visit to a dentist office,...

Documents