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EFFECTIVENESS OF SCHOOL-BASED FLUORIDE MOUTH
Original Articles
RINSING PROGRAM IN SCHOOLCHILDREN FROM
KANDY DISTRICT, SRI LANKA
Chandra Herath1a , Tharanga Nandasena2b , Kaung Myat Thwin3c* , Anushka Abeysundara2d ,
Sampath Ratnayake4e , Hiroshi Ogawa3f , Hideo Miyazaki3,5g , Takeyasu Maeda6h
1
Department of Community Dentistry, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
2
Department of Basic Science, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
3
Division of Preventive Dentistry, Department of Oral Health Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
4
Army Hospital, Sri Lanka Army, Sri Lanka
5
Department of Dental Hygiene and Welfare, Meirin Junior College, Niigata, Japan
6
Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
a
BDS, MD, Professor; e-mail: chk1719@yahoo.com; ORCIDiD: https://orcid.org/0000-0002-6570-3343
b
BDS, PhD, Professor ; e-mail: bgtln@yahoo.com; ORCIDiD: https://orcid.org/0000-0002-7712-8761
c
BDS, PhD, FICD, Assistant Professor; e-mail: kaung@dent.niigata-u.ac.jp; ORCIDiD: https://orcid.org/0000-0003-0350-7977
d
BSc, Senior Technical Officer; e-mail: anushkap12@yahoo.com; ORCIDiD: https://orcid.org/0000-0002-0267-6106
e
BDS, MSc, Doctor; e-mail: sampathratnayake@yahoo.com; ORCIDiD: https://orcid.org/0000-0001-8396-7302
f
DDS, MDSc, PhD, Professor; e-mail: ogahpre@dent.niigata-u.ac.jp; ORCIDiD: https://orcid.org/0000-0003-1070-2172
g
DDS, PhD, Professor; e-mail: hideomiy@dent.niigata-u.ac.jp; ORCIDiD: https://orcid.org/0000-0003-4032-9655
h
DDS, PhD, Professor; e-mail: maedat@dent.niigata-u.ac.jp; ORCIDiD: https://orcid.org/0000-0001-5317-7510
ABSTRACT https://doi.org/10.25241/stomaeduj.2020.7(1).art.1
Introduction Dental caries is still epidemic and a significant public health problem in developing countries.
No research on a fluoride mouth rinsing program has been conducted in Sri Lanka yet. Therefore, the
purpose of this study was to evaluate the effectiveness of a supervised school-based 0.2% sodium fluoride
mouth rinsing program among 6 year-old Sri Lanka school children.
Material and Methods This study was conducted on 415 school children from the Yatinuwara educational
zone of the Kandy district, Sri Lanka from January 2011 to January 2014. The children were allocated into two
groups by adjusting their socio-demographic background and the fluoride level in drinking water at school
level; Group 1 received 0.2% sodium fluoride mouth rinses weekly, and Group 2 was the control group. A
clinical oral examination and oral health education were performed at baseline and annual follow-ups.
Results At the baseline, the mean age of school children in the intervention group and the control group
were 6.17 ± 0.41 years and 6.08 ± 0.50 years, respectively. Almost all of the children (>90%) used fluoride
toothpaste in both groups. After the fluoride mouth rinsing program, the intervention group (77.8%) showed
higher caries free proportion than the control group (63.1%), although no statistically significant difference
occurred. The mean DMFT and DMFS indices in the intervention group were significantly lower than those
in the control group.
Conclusion The school-based fluoride mouth rinsing program indicated a significant tendency of preventing
future caries incidence among children with permanent dentition.
KEYWORDS
Fluoride Mouth Rinsing; Dental Caries; 6 Year-Old; Schoolchildren; Sri Lanka.
1. INTRODUCTION Sri Lanka is one of developing countries in South
Asia, and the children’s oral health is in poor
Dental caries is still epidemic and a significant public condition [2-4]. According to the 2015-16 National
health problem in many developing countries [1]. Oral Health Survey, the prevalence of dental caries in
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Herath C, Nandasena T, Thwin KM, Abeysundara A, Ratnayak S, Ogawa H, Miyazaki H, Maeda T. Effectiveness of school-based fluoride mouth
rinsing program in school children from Kandy District, Sri Lanka. Stoma Edu J. 2020;7(1):07-14.
Received: November 04, 2019; Revised: December 02, 2019; Accepted: January 09, 2020; Published: January 28, 2020
*Corresponding author: Dr. Kaung Myat Thwin, BDS, PhD, FICD, Assistant Professor, Division of Preventive Dentistry, Department of Oral Health Science,
Graduate School of Medical and Dental Sciences, Niigata University; 2-5274, Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan;
Tel: +81-25-227-2858; Fax: +81-25-227-0807;
e-mail: kaung@dent.niigata-u.ac.jp
Copyright: © 2020 the Editorial Council for the Stomatology Edu Journal.
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Herath C. et al.
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5 year-old children was 63.1%, and the prevalence of from January 2011 to January 2014. The six schools
Original Articles untreated active caries was 60.7%. Out of 5-year-olds came from urban, semi-urban and rural areas and
who had experienced dental caries, 96.2% of them were randomly selected based on the probability
had active caries. Further more, as early as the age proportional to size sampling method. Via the
of 5-6 years old, some children already had caries school authorities, an elaborative explanation on the
on their newly erupted permanent teeth [5]. It is background, objectives, methods and significance of
considered as a significant public health problem the study was presented to children aged 6 years
in Sri Lankan children. It has become a burden not and to their parents or guardians gathered in large
only to the bearers and their families but also to forums. Following the explanation, the written
the country [6]. Moreover, it has a great impact consent was obtained from the schools, participating
on the health policy makers [7]. This increasing children and their parents or guardians. The S-FMR
burden might be mainly due to the increased rate program started with a total of 415 schoolchildren
of sugar consumption and inadequate exposure to in the study (Fig. 1). During the 3 years of fluoride
fluoride [7-9]. In a region of Sri Lanka, the fluoride mouth rinsing program, there was no drop out since
levels in water bases showed a great variation none of the participants moved to any other school,
from less than 0.05 to 5 ppm [10]. These are very or quit the school during the period. Although there
high altitude areas that are exposed to heavy rain were a number of additional entries to the schools,
throughout the year, and showed very low fluoride they were not included in the statistical analysis and
levels in drinking water, namely 0.05 to 0.001 ppm. so the final number of children who completed the
It is the area where our study sample originated. study was 415.
Only 14.7% of the Sri Lankan population get the
desired level of fluoride concentration of around 2.2. Study setting
1mg/L through natural drinking water supplies [11]. Basic socio-demographic information (gender,
The evidence-based preventive methods such as age, school category, frequency of tooth brushing,
topical fluoride applications, fluoride mouth rinsing, usage of tooth paste with fluoride, frequency of
diet modifications and good oral hygiene practices intake of sweet food, parents who brush children
are widely used for public caries prevention [2,12]. teeth, income of the family, father’s and mother’s
Daily use of fluoride toothpaste and school-based education levels, and knowledge on factors that
fluoride mouth rinse programs are recommended influence tooth decay) of schoolchildren were
to control dental caries in children and adolescents, taken at the baseline. Fluoride concentrations were
especially for communities in low fluoridated areas estimated in the sources of drinking water (deep
[13]. According to oral health report of the World wells, tube wells, steams, and running tap water)
Health Organization (2013), a reduction in level of of each student participating in the study and the
caries can be achieved through a joint action of the mean fluoride level was 0.078 ppm. There were no
community, professionals and individuals [14]. The significant differences in the fluoride level among
weekly use of fluoride mouth rinse is practiced as a the six schools. The participants were instructed
group activity at community levels because it is safe and obliged to use fluoridated tooth paste at the
and effective [15]. The effect of fluoride mouth rinses baseline and the annual follow-ups. Various types
on the incidence of dental caries in children has of fluoridated toothpastes are available in local
been extensively investigated, and its effectiveness market, which is imported brands as well as locally
has been demonstrated for 15%-45% in reducing manufactured brands. The available fluoridated
dental caries over a period of 2-5 years [15-18]. toothpastes in Sri Lanka usually contain 850 - 1000
The Ministry of Health, Nutrition and Indigenous µg/gF in soluble form. Further more, parents and
Medicine, Sri Lanka has started school dental ser- children were methodically educated on oral health
vices since 1953. The school dental therapists of including frequency of tooth brushing, usage of tooth
the primary health care team had the main res- paste with fluoride, frequency of intake of sweet
ponsibility to provide preventive oriented oral food, parents’ involvement during tooth brushing,
health services for schoolchildren aged 3-13 years the knowledge of factors that influence tooth decay,
old [19]. However, no research on fluoride mouth information about nutrition intake and eating habits
rinsing program has been conducted in Sri Lanka at the baseline of the study and then annually in order
yet. Therefore, the purpose of this study was to to minimize the different confounding factors and
evaluate the effectiveness of the School-based adjust the socio-demographic factors in the sample.
Fluoride Mouth Rinsing (S-FMR) program among The children of the six schools were divided into
6 year old Sri Lankan schoolchildren. two groups by adjusting their socio-demographic
background and fluoride level in drinking water at
2. MATERIALS AND METHODS school level (which applied a comparison design)::
an intervention group (FMR) and a control group.
2.1. Study population
This study was carried out in the Yatinuwara 2.3. Clinical oral examination
educational zone of the Kandy district, Sri Lanka All the clinical oral examinations were performed by
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Original Articles
Figure 1. Flow chart of the study design.
n: number of participants, NaF: Sodium Fluoride,
S-FMR: School-based Fluoride Mouth Rinse
program.
two trained examiners. The calibration of the two A teacher was allocated to distribute fluoride
dentists whom trained by a public health expert solution to each class in each school. The class
using gold standard. Linear weighted Kappa values teacher distributed the plastic cups containing 10
for intra-examiner and inter-examiner variability ml of fluoride solution to participating children
were 0.85 and 0.80, respectively. A clinical oral according to the schedule. Children rinsed for a
examination was conducted to assess dentition minute according to the teacher’s instructions.
status at the baseline and annual follow-ups The class teachers directly supervised the mouth
based on WHO criteria for dental caries [20]. The rinsing program and maintained the records for
schoolchildren were examined using plane mouth three years. The final assessment of caries risk was
mirrors and metallic periodontal probes under good done to evaluate the effectiveness of the program in
day light to record Decayed (D), Missing (M) and January 2014. The control group was also intervened
Filled (F) teeth. The findings were recorded using as ‘placebo’ and so they performed regular mouth
the DMFT index and DMFS index. If at the point the rinse activity with drinking water. Furthermore, they
examiners noted the total of ‘zero’ DMFT/DMFS in were repeatedly and annually educated on oral
clinical oral examination, it defined as “caries free”. health including the frequency of tooth brushing,
usage of tooth paste with fluoride, frequency of
2.4. Fluoride Mouth Rinsing intake of sweet food, parents’ involvement during
0.2% sodium fluoride (NaF) 900 ppmF (Wako tooth brushing knowledge on factors that influence
Product Number 196-01975, USA) was used for the tooth decay, information about nutrition intake and
intervention in this study. The children were trained eating habits.
for mouth rinsing using normal water for three
months to avoid the swallowing of fluoride solution. 2.5. Statistical analysis
After obtaining the standard practice without The expected outcome of the study was that the
swallowing and leaving solutions in cups, the mean DMFT and DMFS in the intervention group
prepared 0.2% NaF solutions were provided weekly would be at a lower value than the control group
to the schools by investigators. after the weekly exposure to fluoride mouth rinsing.
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Original Articles Table 1. Socio-demographic background at baseline between two groups.
FMR, n=198 Control, n=217
n (%) n (%)
Gender
101 (51.0) 111 (51.2)
Male
97 (49.0) 106 (48.8)
Female
Location
70 (35.4) 83 (38.3)
Urban
100 (50.5) 109 (50.2)
Sub-urban
28 (14.1) 25 (11.5)
Rural
Father’s education level
28 (14.1) 45 (20.8)
University level
125 (63.2) 122 (56.2)
High school level
45 (22.7) 50 (23.0)
Below high school level
Mother’s education level
29 (14.6) 40 (18.4)
University level
134 (67.7) 148 (68.2)
High school level
35 (17.7) 29 (13.4)
Below high school level
Family’s income
23 (11.3) 29 (13.4)
High (> Rs. 20000)
72 (36.9) 59 (29.2)
Middle (Rs. 10000 – 20000)
103 (51.8) 129 (57.4)
Low (< Rs. 10000)
Frequency of tooth brushing
27 (13.6) 34 (15.7)
Once a day
151 (76.3) 155 (71.4)
Twice a day
20 (10.1) 28 (12.9)
Three times and above a day
Use of fluoride toothpaste
185 (93.4) 201 (92.6)
Yes
3 (1.5) 5 (2.3)
No
10 (5.1) 11 (5.1)
Don’t know
FMR: Fluoride Mouth Rinse, n: number of participants, Family income: average monthly income of the Kandy district, 1 US $ = Rs. 100, by X2 test (p<0.05)
Therefore, the variables of study were exposure and from the Zonal Education Authority of Kandy District,
no exposure of six year-old schoolchildren to 0.2% Central Province of Sri Lanka.
fluoride mouth rinse for three years and DMFT level
and DMFS level in permanent dentition. 3. RESULTS
A statistical analysis was carried out using the
statistical software SPSS 23.0 (SPSS, Chicago, IL, Four hundred and sixteen schoolchildren at age 6
USA). Chi-square, independent t-test and ANOVA were initially recruited for the study. However, one
tests were performed between the mean differences child was excluded from the study due to the absence
between the intervention group and the control of the consent form. Therefore, 415 schoolchildren
group at the baseline and the annual follow-ups. were finally included in the study. Out of them, 198
The level of statistical significance for all tests was set children (male: 101, female: 97) were recruited for
at p<0.05. the intervention group and 217 children (male: 111,
female: 106) for the control group. As shown in Figure
2.6. Ethical approval 1, their socio-demographic background and fluoride
The study design was approved by the Research level in drinking water were adjusted in both groups.
Committee and Ethical Review committee of the Then, the intervention group was introduced to 0.2%
Faculty of Dental Sciences, University of Peradeniya, NaF mouth rinse under the supervision of school
Sri Lanka (Ethical clearance No. FDS-RERC/2009/13/ teachers for consecutive three years. There were no
Herath2). The study permission was also obtained dropouts from the study during the study. Although
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DMFS level in the FMR and control groups were 0.04
Original Articles
Table 2. Percentage of caries free school children in the FMR and
control groups. ± 0.31 and 0.13 ± 0.54, respectively. There were no
significant differences in mean DMFT and DMFS
FMR, n=198 Control, n=217 between the two groups at the baseline and 1st visit.
Visits
n (%) n (%) The mean number of DMFT and DMFS in the FMR
group was significantly lower than that in the control
Baseline 178 (89.9) 205 (94.5)
group at the 2nd visit and 3rd visit.
As within groups, the mean DMFT and DMFS were
1th visit 165 (83.3) 194 (89.4) significantly increased from baseline to the 3rd visit
in the FMR group. In the control group, there was
2nd visit 149 (75.3) 143 (65.9) no significant difference from baseline to the 1st visit
whereas there were significant differences during
3rd visit 154 (77.8) 137 (63.1) the 2nd and 3rd visits.
FMR: Fluoride Mouth Rinse, n: number of participants, by independent
t-test (p<0.05) 4. DISCUSSION
there was a number of additional lateral entries to Dental caries caused by multi-etiological factors is
the S-FMR program, they were not included into largely preventable with evidence-based preventive
the study. During the three years of the program, a methods. However, the prevalence of dental caries
clinical oral examination and oral health education among children has risen in developing countries in
(basic knowledge about dental diseases and oral recent years because there are very frail preventive
hygiene care) were performed in both groups care projects compared with developed countries.
annually. The socio-demographic background of the Beside the increased burden of dental caries in Sri
study population at the baseline between the two Lanka, the evidence-based fluoride mouth rinsing
groups is summarized in Table 1. program in school has not been implemented
At the baseline, the mean ages of schoolchildren yet. This is the first intervention study to evaluate
in the FMR group and the control group were 6.17 the anti-caries effect of school based fluoride
± 0.41 years and 6.08 ± 0.50 years, respectively. mouth rinsing (S-FMR) program among 6 years old
There were no significant differences in mean age, Sri Lankan schoolchildren. The present study
proportions of male and female, and other socio- included 6 year-old 198 schoolchildren in the S-FMR
demographic data between the two groups. Over program and 217 children who did not receive any
75% of students in both groups show that their fluoride application.
parents have above high school level education; Table 2 included the timely caries-free status of
77.3% (father) and 72.3% (mother) in the FMR group permanent dentition in schoolchildren of both
and 77.0% (father) and 86.6% (mother) in the control groups. The FMR group showed less reduction of
group. However, the family income for the majority the caries-free proportion than the control group,
of the students shows low level in both groups. although there were no statistical differences
All schoolchildren brushed their teeth at least once a between the two groups during the program. A
day. Yet, the frequency of tooth brushing twice a day higher proportion (77.8%) of the children in the FMR
was 76.3% in the FMR group and 71.4% in the control group remained caries-free at the end of the study
group, which is the standard and recommended compared to the control group (63.1%). This implies
practice. Almost all schoolchildren (>90%) used that the caries level in the FMR group was 22.2% and
fluoride toothpaste in both groups. The results of 36.9% in the control group. Furthermore, it is less
the percentage of caries-free in the FMR and control than the reported prevalence of dental caries for 12
groups for consecutive four visits are shown in Table year-old Sri Lankan population which is 30.4% and
2. The percentage of caries-free schoolchildren was the Kandy district population which is 35% [5].
calculated with permanent dentitions; if DMFT is Even though the present study did not carry out
equal to zero, this child was considered as a caries- the computation of percentage reduction of dental
free. No significant differences were observed in caries due to S-FMR program, when compared with
proportion of caries-free in both groups during the the results of a systematic review [22], it showed a
program. The caries-free level in the FMR group, comparable level of caries reduction which would
which was less comparative to the control at the be observed in permanent dentition ranging from
baseline and 1st visit, was higher than the control 15% to 67%. When compared to the study carried
group since the 2nd visit. When compared after the out in Sarawak which was 24.2% [11], the caries-
FMR program, the intervention group (77.8%) shows free percentage was very high in the present study
higher percentage of caries-free than the control as 77.8%. At the baseline, the mean DMFT and
(63.1%). Table 3 shows the comparison of the FMR DMFS values in both groups were not statistically
and the control groups based on DMFT and DMFS. significant due to adjusting nearly equal recruitment
At the baseline, the DMFT index in FMR and control of schoolchildren into the study from urban, semi-
groups were 0.03 ± 0.22 and 0.11 ± 0.47, where the urban and rural areas. Moreover, they all were
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Original Articles Table 3. Mean number of DMFT and DMFS in two groups.
DMFT (SD) DMFS (SD)
p-value p-value
FMR Control FMR Control
Baseline 0.03 (0.22) 0.11 (0.47) 0.965 0.04 (0.31) 0.13 (0.54) 0.992
1st Visit 0.32 (0.74)* 0.19 (0.62) 0.067 0.40 (0.96)* 0.26 (0.92) 0.191
2nd Visit 0.44 (0.83)* 0.76 (1.01)* 0.03 0.54 (1.06)* 1.06 (1.48)* 0.04
3rd Visit 0.64 (0.89)* 0.90 (1.02)* 0.07 0.85 (1.25)* 1.32 (1.61)* 0.07
FMR: Fluoride Mouth Rinse, n: number of participants, DMFT: decayed, missing, and filled permanent teeth, DMFS: decayed, missing, and filled permanent
tooth surfaces, SD: Standard Deviation.
Mean values within each row are analyzed by using ANOVA test (p<0.05), NS: statistically not significant.
Mean values within each column are analyzed by using one way repeated ANOVA test (p<0.05), (*): statistically significant.
from geographically comparable background, continue up to the age of 12 years in order for
which reported to have very low fluoride level more children to remain caries-free through their
in the natural drinking water (0.078 ppmF) [11]. school years [25]. The measurements for FMR uses
The previous studies also recommended that school among preschoolchildren were performed in
based fluoride mouth rinsing should be implemented Japan, and reported FMR could be performed by
in areas of fluoride-deficient communities [10,21]. preschoolchildren safely and efficiently [22]. This
Furthermore, a study on a school based fluoride suggests that the S-FMR program should start at a
mouth rinsing program in Japan concluded that younger age, such as the preschool period to further
community-oriented health measure should be enhance the impact of the caries-preventive effects.
contributed to caries prevention of the permanent In this study, basic knowledge of oral hygiene care
teeth in areas where water fluoridation is not such as the use of fluoridated toothpaste with
available [22]. According to the National Oral Health correct tooth brushing was delivered via the oral
Survey in 2015-16 [5], the FMR group in this study health education in both groups during the follow-
even though showed a similar DMFT level with up visits. Low levels of oral health knowledge will
12-year-old Sri Lankan population which was 0.6 hinder the sound understanding of oral health care,
(1.6) it rather less than the Kandy district population and result in a poor oral health outcome [27].
(0.8). Furthermore, when compared to the study The previous review studies reported that daily
carried out in Sarawak [10], the DMFT value at the use of fluoridated toothpaste had a significant
end of the program was significantly less. The mean caries-preventive effect in children [12,28,29].
DMFT and DMFS were significantly decreased in the The oral health situation would be enhanced by
FMR group than in the control group during the 2nd a combination of the S-FMR program together
and 3rd visits, respectively. with provision of oral health education for further
This finding supported the previous studies which impressive results.
were performed in several communities [10,24,25]. The limitation of this study includes the assignment
In accordance with our findings, the present study of subjects to test and control groups which was
demonstrated that weekly use of 0.2% NaF (900 known to the examiners (not performed to single or
ppm F) has a significant caries-preventive effect double blind), which is common to studies. Further,
in children. Therefore, the S-FMR programs are the diagnostic criteria applied are based on those
regarded as a highly effective caries-preventive stated by WHO (1997), in which the initial lesions
strategy. A previous systematic review concluded (white sports) are not considered. In consequence,
that supervised regular use of fluoride mouth rinse there may be under-registration. Nevertheless,
in daily or weekly or fortnightly basis with 0.05% this study could provide useful information about
NaF (230 ppm F) or 0.2% NaF (900 ppm F) in children school-based weekly fluoride mouth rinsing pro-
and adolescents could achieve a satisfactory caries grams in fluoride-deficient areas.
reduction in tooth surfaces [25]. On the other hand, The positive benefit of weekly sodium fluoride
Jagan et al reported that the effectiveness of fluoride mouth rinses on caries reduction would be a
mouth rinse with low concentration (0.05% NaF) is major population-based strategy to improve
not significant on caries reduction [26]. the oral health situation in Sri Lankan children.
Furthermore, its effectiveness is said to be more In addition, to get the maximum impact on
significant in caries prevention with the early caries prevention, the school-based flu-
introduction of fluoride mouth rinses to children oride mouth rinsing program could be combined
[22]. In this study, children aged 6 years participated with other additional preventive activities including
in the S-FMR program, as they are the age group reinforced use of fluoride toothpaste and supervised
that start to attend primary schools. The previous tooth brushing through oral health education
studies concluded that fluoride mouth rinsing to parents, guardians, school teachers as well as
programs should start at a younger age, and schoolchildren to further caries reduction.
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5. CONCLUSION KT: Data analysis, manuscript writing, critical review of manuscript;
Original Articles
AA: Mouth wash preparation, mouthwash distribution, data
recording, data entry; SR: Clinical examination, DMFT calculation,
Based on the findings of this study, we have found data recording, data entry; HO: Data analysis, manuscript writing,
evidence that weekly 0.2% NaF mouth rinse had a critical review of manuscript; HM: Concept, protocol, proposal
significant tendency of preventing future caries writing, data analysis, critical review of manuscript; TM: Concept,
incidence among children in permanent dentition. protocol, critical review of manuscript.
ACKNOWLEDGEMENT
CONFLICT OF INTEREST
This study was supported by the Niigata University and the
The authors declare no conflict of interest. University of Peradeniya Cooperation Agency Partnership
Program and the Sri Lanka Dental Association – under the 2010
AUTHOR CONTRIBUTIONS grant . The authors thank all participating schoolchildren, parents
or guardians, school authorities and teachers who provided their
CH: Proposal writing, program organizing, clinical examination, fullest cooperation during the program.
DMFT calculation, manuscript writing; TN: Concept, data gathering
and recording DMFT calculation, data entry, manuscript writing;
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www.stomaeduj.com
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Chandra HERATH
BDS, MS (Rest), FDS (Paed), RCS (Eng), Professor
Department of Community Dentistry
Faculty of Dental Sciences
University of Peradeniya
Peradeniya, Sri Lanka
CV
Chandra Herath, is a Professor in Paedodontics. She joined the Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
in 1997 and obtained her Fellowship in Paediatric Dentistry from the Royal College of Surgeons, England in 2003. She has
published over 15 research papers in local and international journals. She is the President elect of the Association of Specialists
in Restorative Dentistry, Sri Lanka and the Joint Secretary of the South Asian Academy of Paediatric Dentistry. Her research
interests are related to early childhood caries, dental trauma, developmental anomalies of teeth and children with special health
care needs. She has immensely contributed to upgrading Paediatric Dentistry in Sri Lanka by developing undergraduate and
postgraduate curricula, conducting workshops and delivering lectures for health care professionals and the general public.
Questions
1. Which of the following method is more cost-effective to the developing country to
carry out the school-based study to prevent dental caries?
qa. Water fluoridation method;
qb. Use of fluoride mouth rinses;
qc. Use of fluoride toothpastes;
qd. Milk fluoridation method.
2. What is the effect of fluoride on teeth?
qa. Demineralize the enamel;
qb. Discolor the enamel;
qc. Remineralize the enamel;
qd. No effect on enamel.
3. What is the optimal level of fluoride in the fluoride mouth rinses to be used once a
week?
qa. 100-300 ppm;
qb. 300-500 ppm;
qc. 800-1000 ppm;
qd. > 1500 ppm.
4. What is not an advantage of fluoride mouth rinsing program in school?
qa. Cost effective;
qb. Time consuming;
qc. Can practice at community level;
qd. Less attention by participants.
14 Stoma Edu J. 2020;7(1): 07-14 pISSN 2360-2406; eISSN 2502-0285