Status of Prevention of Dental Diseases in Estonia

Mare Saag

From the Guidelines for family doctors and other cooperating health care workers

Decree of the Minister oh Social affairs17.01.2010

• Family doctors must check oral health and advise parents to visit the dental clinic at the age of 12, 24 and 36 months

• Children should be checked by a dentist concerning oral health as a rule at the age 6,7,9,12,14,and 15 years

• School nurses also direct (motivate) children to visit the dentist annually

School health services - nurses

Work load: 40 hours a week for 600 pupils

Duties:

..........

Spreading evidence based information about health

Advising about diet

Cooperating with other health professionals and parents of the children

Changes

• Up to 2003 all the children belonged to the target group for prevention

• 2003-2008 6-12 years old children were covered

Budget for oral health care in Estoniain thousands of Euros

2009 2010 2010prognosis

2011 Changes compared to 2010

Dental treatment for children

14 477 14 222 13 976 14 231 2%

PreventionIn children

408 409 363 391 8%

Orthodontics 2 753 2 711 2 842 2 989 5%

EmergencyTreatment for adults

716 750 657 657 0%

TOTAL 18 354 18 092 17 838 18 268 2%

Number of treatment cases2009 factual 2010 budget 2010

prognosis2011 budget Changes

compared to2010

Dental treatment cases in children

299 081 298 983 303 047 297 601 -2%

Prevention in children

28 109 28 711 25 440 26 974 6%

Orthodontics 36 409 36 963 39 464 40057 4%

Ewmergency treatment in adults

17 260 18 465 17 664 17 489 -1%

TOTAL 380 859 383 122 384 615 382 121 -1%

Target groups for prevention of dental diseases

Born in- Number of children (1988) 22442)

•1999 12431

•2002 13091

•2004 13973

•2005 14000

2008 No of visits for treatment 403 333 (1,5 visits per child)

No of visits for prevention

Year No of visits No of children %

2003 151 148 190 480 79,35

2004 148 308 198 780 74,61

2005 115 296 194 980 59,13

2006 116 759 198 730 58,75

2007 115 016 202 860 56,69

2008 113796 201 120 56,58

2011 271 868

Budget per child

• Prevention

2009 14,51 Eur

2010 actual 14,26

2011 budget 14,49

• Dental treatment (children) 1 case2009 48,40

2010 46,11

2011 47,81

Project based prevention of diseases

• Financed by the Estonian Sick Fund or the Ministry of Social Affairs, sometimes by city councils

• Budget 6400 – 31640 Eur

• 1- year- projects

• No permanent general impact on the health care system

HistoryProjects 1996-2005

• Seminars, lectures, workshops for kindergarten- and schoolteachers in regions

• 3 conferences for dentists on prevention of dental diseases

• Methodological books, videos, info-pamphlets and sets of transparencies for teaching purposes have been prepared.

• A special one-month school program for 2nd classes in preliminary schools has been carried out in 1996-2005 (sponsored by Procter Gamble)

History Projects 1996-2005 2

• Programme for 4th classes sponsored by Colgate Palmolive

• Stickers designed to promote dental health

• TV talk shows about dental health

• Board game with messages about dental health

• In 2000 a preventive program for 5-6 years old children 20 000 children of this age all over Estonia were studied and preventive measures were performed

History“Dental passport” 3

• This document was meant for registration of dental health situation and performed treatment and preventive measures for the child.

Prevention 2011

• The child’s health development

concentrating upon the network around the child to develope good physical and psychological/social life, good environment for playing and studies

• Extensive project to promote dental health

Dental health in children

Health promotion project 2011Contract No 2-21/49

Estonian Sick Fund Estonian Dental Association

Estonian Society of Oral Hygienists

Budget & content of the project in 2011

Program director Dr. Marek Vink

Target group is 3 years old children, their parents, teachers in kindergartens, nurses

Total of 31960 Eur including expenses for:

1.Guidelines in internet for midwifes, nurses of family doctors, health promotion specialists, teachers in kindergartens

2.Illustrated manual „prevention of dental diseases in children“ for the health professionals

2011

• Poster „Sugar clock“for kindergartens, family doctors praxis,

• A smaller interactive teaching aid material with stickers

• Coloring book with 24 pages about dental health, also in Russian. Printed books are distributed to the 40 kindergartens participating in the project

• Animated drawings in internet

• A cartoon „Jänku-Jussi“

2011• Leaflets for nurses to distribute to the parents of 4,5

months old infant’s parents• Cooperation with the Society of Cardiologists• Establish links to the web-pages

perekool.ee/lastehammastetervis;

www.toitumine.ee

www.ut.ee/tervis/hambad • Courses for nurses (min 30) working with family doctors• Seminars for nurses (min 100) working with family doctors

Aim and expected results of the project

• Overall aim of the study is to start prevention of dental caries before being infected

• In case of turning the project  into system it is possible to raise a new caries-free generation

• Due to improved oral health all the health indicators of the population will improve leading to decreased expences on health care directly and indirectly. Life quality of the population  will change for better.

Minimal aim

Minimal aim of prevention of dental diseases is to reach the level of DMFT to the recommended by WHO level In West-Europe it means that 

o at least 80% of children are caries-free o Average DMFT index in 12-year-olds will be less

that 1,5

More distant aims

Oral hygienists and dental nurses participating in this project will provide a network to carry on the project in future

As many as possible, teachers and healthcare professionals and officials will be engaged in prevention of dental caries

What can you see today ?

Cartoons•  http://www.lastekas.ee/index.php?go=web&t=1&id=3902•  http://www.lastekas.ee/index.php?go=web&t=1&id=3936•  http://www.lastekas.ee/index.php?go=web&t=1&id=3938