Dental Public Health Programs implemented by Dental Service Department, Dubai Health Authority, Dubai, United Arab Emirates.
By Shiamaa Shihab AlMashhadani

Introduction

In the Emirate of Dubai, Community Dental Services (CDS) are linked to the Primary Oral Health care Centers. There are 14 health care centers spread all over Dubai providing multidisciplinary approach (Oral surgery, orthodontics, periodontics, conservative, restorative and community dentistry) where comprehensive treatment is available to the public, free of charge. The dental services department comes under the direct supervision of Dr Hamda AlMesmar, the Director of Dental Services Department in Dubai Health Authority.

The Community Dental Services (CDS) team supervised by Dr Shiamaa AlMashhadani, aims to fulfill the vision of Dubai Health Authority, which is Healthy, Safe and Happy community.

The Community Dental Health Services (CDS) team provides an oral diseases preventive program called Dubai Smiles Healthy, to tackle oral health problems of children through schools, health centers and contributing to a healthcare work force capable of tackling oral health problems.

Program outline

Dubai Smiles Healthy is a national oral disease preventive program designed to improve the oral health of children in Dubai. The program involves all the regions of Dubai (Deira, Bur Dubai, Hatta and Lusaily) and is based on the need for promotion and prevention of oral diseases. The main aims of this program is to decrease the caries prevalence, lower the level of (dmft) and increase oral health awareness of the young population of Dubai while targeting active intervention for the children when indicated.

It has three main components:

• Dubai Smiles Healthy School Practice
• Dubai Smiles Healthy Child Health
• Dubai Smiles Healthy School Nurse Training

Dubai Smiles Healthy- School Practice- Reaching children at their own schools and nurseries:

The results of the oral screening conducted on schoolchildren during the year 2013 in Dubai showed that children from different age groups have high levels of oral health problems. Children under the age of 7 had a caries prevalence of 65% with a dmft of 3.8.

These results required immediate action from the dental department targeting children within their school settings in an effective and developed way. In order to provide preventive dental care delivered in the nursery and school setting, a dental team was set to visit these schools with mobile dental vans. The dental team consisting of one dentist and 6 dental hygienists who are all trained and calibrated periodically to perform screening and oral preventive measures based on the WHO standards.

The dental team visits these schools and nurseries twice yearly for preventive measures which include routine dental check up of the teeth, filling referral forms for high risk patient sent to the guardians to complete their dental treatments with their local dentist and placement of topical fluoride varnish.

They also promote good oral health behaviour by emphasizing on four points:

1-Proper tooth brushing techniques and routine oral hygiene: Children get to have a hands on experience and demonstrate their skills in tooth brushing and flossing in front of each other with the guidance of the dental hygienist

2-Dietary advice: what are cariogenic foods vs. healthy foods (foods that make teeth sad and happy) Children get to sort out different kinds of food in to groups using models and pictures

3- Placement of fluoride varnish (making our teeth strong to fight cavities): Children get an application of fluoride varnish placed on their teeth and learn why this is placed and how it helps prevent the acid attack of sugar bugs.

4- Why we have to visit the dentist and what to expect on a dental visit: Children see an educational video; have hands on experience of a real dental clinic through the mobile dental van. They sit on the dental chair and are free to touch and ask the hygienist about their doubt. The feeling of fear is tackled since the children have the dental clinic within the school premises, which is a more comfortable and familiar setting.

Students are exposed to oral health promotion and dental check up twice yearly.

Achievements

433 students received dental checkups and fluoride application in 2015.

Dubai Smiles Healthy- Child health session:

These sessions are performed within the dental department in all primary health centers; they are newly introduced within the main centers during vaccination sessions. There are three sessions per week in the main large health centers and once a week in the smaller centers. It is free of charge and all the community is invited to attend these sessions. Children and their Parents or guardians are scheduled for appointments from the age of 6 weeks. Dental hygienists lead these sessions after they undergo proper training and educational sessions. There are set guidelines that the hygienists must follow to have a unified message sent to the public. A printed guide in a form of a flip chart is readily available for all hygienists in English and Arabic during their sessions to make them cover all necessary points with the parents and guardians during each session. Illustrations are used to help make the information more understandable to the parent or care giver.

Fig: a sample of printed child health guide.

Each session includes the following:

- How to care for your child’s dentition

- Dietary advice and the healthy way to feed your child

- Avoiding bad habits from childhood (thumb sucking, pacifiers, etc.…)

- Breast feeding verses bottle feeding

- Resources for families to look up at home

- Advise parents to talk to their children about dental visits in a positive way.

Children from six months of age receive oral checkups and fluoride application using the Lift the Lip technique, where the child sits in the lap of his/her parent and the hygienist is in-front of them lifting the lip with their finger and checking the teeth and placing fluoride varnish. Children with urgent needs are referred to the dentist within the Primary Health Care Centers in Dubai Health Authority for follow-up and intervention.

Dubai Smiles Healthy - School Nurse training:

In the Emirate of Dubai all schools have a school nurse available to the students to tend to their basic health needs. School nurses are located in the school clinic where children are received if they have simple accidents, fever and simple ailments. A visiting doctor is available in the school clinic once a week.

School nurses have a big role in medical screening, vaccination campaigns, reporting infectious diseases and routine medical check up.

School regulations require children to have a medical check up (weight, height and recording of medical history) at certain ages. New comers to a school, grade one students (5 years old), grade five students (10- years) and grade twelve students (17 years).

All information is recorded in students’ medical files. The regular dental or oral checkups and dental emergencies are all sent to dentists or parents are requested to pickup their children from schools to deal with these problems.

Therefore, the idea of involving school nurses in oral health education and empowering them to take control of such situations is a necessity in the school community. Our aim from this part of the program is to develop a school-nursing workforce with the competencies to prioritize oral disease prevention and oral health promotion in the schools. The overarching goal of this training is to create an educational infrastructure for the school nursing profession that advances’ nursing’s contribution to reducing oral health problems across Dubai schools.

In 2015, there were 290 nurses trained to conduct simple oral check ups, oral health promotion sessions which included three basic points of a healthy oral environment in their schools

• Maintaining routine oral hygiene
• Dietary advice
• Importance of routine visits to the dentist.

Conclusion

A better relationship with children and their caregivers were established within this program. Reaching children at a very young age was achieved by introducing oral health education to the vaccination clinics, which was an innovative approach in Dubai. Furthermore continuous reinforcement of oral health hygiene, dietary advice, referrals and professional preventive measures for the children in several environments (schools, home and dental centers) enforced the commitment from the parents and caregivers towards their children’s’ oral health. Introducing school nurse training for oral health education allows us to have a large workforce that support our goals within the schools and are effective key players within the school environment

References

1) Dubai Smiles Healthy School Practice
2) Dubai Smiles Healthy Child Health
3) Flip chart English
4) Flip chart Arabic
5) Dubai Smiles Healthy School Nurse Training