Dental public Health Programmes conducted by the Population Oral Health Unit (Community Dental Unit), Dental Institute, Colombo, Sri Lanka

by Irosha Perera

Introduction

In Sri Lanka, Public Oral Health care services are provided closely linked to existing public health infrastructure. These services come under the purview of Dr Jayasundara Bandara, Deputy Director General (DDG) Dental Services, Ministry of Health, Sri Lanka.

Colombo, Sri Lanka

The Dental Institute, Colombo is one of the premier multidisciplinary (outpatient care, oral & maxillofacial surgery, orthodontics, restorative dentistry and public health dentistry) public sector tertiary care dental hospitals in Sri Lanka where comprehensive dental care is provided free of charge at the point of service delivery and is administered by Dr PH Sumith Ananada as the Deputy Director of the Institute.

The Population Oral Health Unit (Community Dental Unit), Dental Institute, Colombo, headed by Dr Irosha Perera, aims to develop self-empowering, targeted, best practice models in resource constrained settings for reducing the high burden of caries and periodontal disease, among disadvantaged population groups in Colombo, Sri Lanka. A series of activities are conducted in the Population Oral Health Unit, to achieve this objective:

1. Oral health promotion for socially disadvantaged, culturally diverse preschool children in the Colombo Municipal Council (CMC)-Division 1.(Forbes Lane, Colombo 10)
2. Conducting a Preventive Dental Clinic for toddlers and children aged 1 year to 10 years in the Dental Institute, Colombo.
3. Oral health promotion for pregnant mothers in the Colombo Municipality antenatal clinics at Forbes Lane (Colombo 10) and Modera (Colombo 15).
4. Conducting oral health promotion programmes for diverse population groups in different settings such as schools, child development centres, occupational settings, Homes for elders, social events on health and oral health promotion, Health camps etc.in Colombo.
5. Capacity building of preschool teachers and health workers for oral health promotion among high risk groups in Colombo area.

1. Oral health promotion for socially disadvantaged, culturally diverse preschool children in the Colombo Municipal Council (CMC)-Division 1 – (Forbes Lane, Colombo 10)

Background
ECC (Early Childhood Caries) among the preschool children aged 3-5 years of our target area Forbes Lane in Colombo Municipality was 63% with a mean of 6 decayed teeth in 2012. These children are from very low socioeconomic backgrounds with highly cariogenic dietary patterns, poor tooth brushing habits and low value placed on oral health.

Programme Outline
Preschool oral health programme is organized liaising with Health Instructors of the Medical Officer of Health (MOH) office of the CMC-division 1. This programme consists of:

• an interactive oral health awareness programme for parents/primary care givers of children, and children themselves,
• advice for teachers on oral health promotion activities e.g.- mid-day meal policy, brushing drills,
• screening of children for oral diseases and referral to the preventive dental clinic.
• Mothers are invited to bring other children and toddlers in the family too for oral health care.

Achievements

• Ten programmes have been conducted in pre-schools in this area in 2012.
• Total number of preschool children screened was 1002 for the year 2012, of them 633 (63.2%) were referred for dental care.

2. Conducting Preventive Dental Clinic for toddlers and children aged 1-10 years, Dental Institute, Colombo.

Background
This caters to preschool children referred from our preschool oral health programmes and from Outpatient Department of the Dental Institute, Colombo. All these toddlers and children are at high risk for ECC.

Programme Outline

• An attractive child friendly environment has been set up for behavioural management thus making the child willingly corporate with dental care.
• Risk assessment is conducted for each child.
• The procedures include oral hygiene instructions, dietary counselling, fluoride varnish and gel application, simple restorations with Glass Ionomer Cements (GIC), application of fissure sealants and referral for pulp therapy.
• Depending on the risk status monthly, 3-monthly follow up visits are done aimed at zero caries increment, optimal plaque control and healthy dietary pattern.

Achievements

• For the year 2012, 2221 toddlers/children have received care from preventive dental clinic (14.7% from preschool programme and 85.3% from OPD referrals).

3. Oral health promotion for pregnant mothers in the CMC antenatal clinics at Forbes Lane (Colombo 10) and Modera (Colombo 15)

Background
As oral health care has been incorporated into the existing National Maternal and Child health care package in Sri Lanka, this programme is conducted monthly along with the Lactation Management programmes in the Colombo 10 and 14 Municipalities.

Urban and rural antenatal women in Sri Lanka carry a high burden of oral disease. The prevalence of dental caries and periodontal disease, among pregnant mothers of the two antenatal clinics is 71% (1).

Programme Outline
Oral health programme consists of:

• an interactive oral health awareness session
• screening for oral diseases, mainly caries and periodontal diseases
• referral to near-by CMC primary care dental clinics for those who need care

Achievement

• In 2012, 19 awareness sessions were conducted.
• Total of 524 pregnant mothers were screened for the year 2012, of them 370 (70.6%) were referred for dental care.

4. Conducting oral health promotion programmes for diverse population groups in diverse settings, Colombo

Background
Population Oral Health Unit, Dental institute, Colombo also conducts oral health programmes in diverse settings and among diverse target groups such as: street children, Home for the Elderly, school children and occupational groups: SANASA Development Bank staff, Institution of Construction Training & Development (ICTAD), Colombo.

Programme Outline
A vibrant population oral health approach is practiced thus making use of Social Marketing Events aimed at promoting healthy lifestyles where oral health promotion is showcased as an essential component in out-door health fiestas. Child Development Centres, Homes for the Elders, Occupational settings and Health camps conducted for urban-underprivileged kids are the other venues used for oral health promotion activities by the unit.

Achievements
16 such programmes were conducted for the year 2012:

• 5 programmes for occupational groups
• 1 outdoor social marketing event integrated to a health fiesta
• 8 programmes in child development centres/day care centres/ underprivileged kids in Colombo suburbs
• 1 programme in home for elders
• 1 programme for year 3 children in an international school

5. Capacity building of preschool teachers, health workers for oral health promotion among high risk groups

Preschool teachers have a great potential to be harnessed for promoting oral health status of preschool children. Periodic capacity building programmes are conducted for preschool teachers of CMC-Division 1 to compliment the preschool oral health programme conducted by the Unit. Moreover, Similar programmes are conducted for middle and junior oral health care workers attached to Dental Institute and health workers of Volunteer Organizations in order to address their knowledge gap in oral health promotion among high risk groups.

Conclusion

Poor compliance to referrals and being corporative to dental care are common problems among high risk groups of children from disadvantaged social backgrounds. Population Oral Health Unit, Dental Institute Colombo was able to improve the compliance for referrals from 52% to 74%. Moreover, 71% of uncooperative children during the first visit to became corporative for preventive dental care during the second visit, by employing behavioural management techniques such as explaining procedures in child-friendly phrases, positive, modelling, rewarding and assertiveness.

Reference

Karunachandra NN, Perera IR, Fernando G, Oral health status during pregnancy: rural urban comparisons of oral disease burden among antenatal women in Sri Lanka. Rural and Remote Health 2012; 1902 (online). (http://www.rrh.org.au).