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ORAL HEALTH DIVISION, MOH, MALAYSIA 1 Datin Dr Norain binti Abu Talib Pengarah Kanan Kesihatan Pergigian Kementerian Kesihatan Malaysia Symposium Pengurusan.

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Presentation on theme: "ORAL HEALTH DIVISION, MOH, MALAYSIA 1 Datin Dr Norain binti Abu Talib Pengarah Kanan Kesihatan Pergigian Kementerian Kesihatan Malaysia Symposium Pengurusan."— Presentation transcript:

1 ORAL HEALTH DIVISION, MOH, MALAYSIA 1 Datin Dr Norain binti Abu Talib Pengarah Kanan Kesihatan Pergigian Kementerian Kesihatan Malaysia Symposium Pengurusan dan Peroditan Industri Air November 2009 SACC, Shah Alam, Selangor Norain AT, Norlida ANorain AT, Norlida A

2 Penyakit karies gigi Penyakit kronik paling meluas di dunia terutama di kalangan kanak-kanak Negara-negara perindustrian, 60-90% kanak- kanak sekolah mengidap penyakit karies – miskin dan minoriti (Selwitz et al. (2007), Petersen & Lennon, 2004) Apabila berlaku karies gigi proses rawatan akan berulang. Contoh Jangka hayat tampalan amalgam 9-14 tahun (Griffin et al. (2001) ORAL HEALTH DIVISION, MOH, MALAYSIA2

3 3 masa Permukaan gigi makanan Plak bacteria Etiologi karies gigi

4 Primary intervention of dental caries Type of intervention Challenges Tooth structureEnsure strong enamel structure Good oral hygiene (Dental Health education) Knowledge and practice How many of us brush and floss our teeth at least 2 times a day effectively everyday through out our life? BacteriaNo available vaccine yet FoodsHigh consumption of sugar (Malaysian consume about 40 kg/capita/year) FluorideSafe and effective vehicles for delivery ORAL HEALTH DIVISION, MOH, MALAYSIA4

5 Cara penyampaian Fluorida ORAL HEALTH DIVISION, MOH, MALAYSIA5 Air minum (1945) garam(1950) susu(1959 ) pil/titisan(1960) Air minum (1945) garam(1950) susu(1959 ) pil/titisan(1960) larutan (1943) Ubat gigi(1945) Kumur mulut (1946) Gels(1967) Varnishes(1968) larutan (1943) Ubat gigi(1945) Kumur mulut (1946) Gels(1967) Varnishes(1968) Systemik Topikal

6 World Health Assembly,2007 (WHA 60.17) The sixtieth World Health Assembly urges member states:…(4) for those countries without access to optimal levels of fluoride, and which have not yet established systematic fluoridation programmes, to consider the development and implementation of fluoridation programmes, giving priority to equitable strategies such as the automatic administration of fluoride, for example, in drinking water, salt or milk and the provision of affordable toothpaste. ORAL HEALTH DIVISION, MOH, MALAYSIA6

7 Pengunaan fluorida diMalaysia Pendekatan melalui penduduk (systemik ) Pendekatan topikal pemfluoridaan bekalan air minum boleh dimenafai oleh rakyat yang menerima bekalan air berfluorida. Ubat gigi berfluorida ( ppm) – memerlukan pengawasan orang dewasa jika digunakan oleh kanak-kanak Kumuran Berfluorida- memerlukan pengawasan personel kesihatan sapuan gel, buih dan varnish flluorida(Fluoride gel/foam/varnish) – sapuan perlu dibuat oleh doktor atau jururawat pergigian ORAL HEALTH DIVISION, MOH, MALAYSIA7

8 8 satu kaedah perawatan bekalan air awam di mana fluorida di tambah supaya mencapai paras optimum ke dalam bekalan air terawat di loji perawatan bekalan air Tujuannya adalah untuk mengawal penyakit karies di kalangan masyarakat yang menerima bekalan air tersebut

9 Benefits of Fluoride Epidemiological studies in 1930s in the USA established the relation between concentration of fluoride in water and caries experience Water fluoridation began in the USA in Now reaching 355 million people in 31 countries in addition to at least 50 million receiving optimal fluoride levels in water naturally 1940s onwards – development of other ways of delivering fluoride Water fluoridation recognized as one of the ten great public health achievements of the 20th century in the U.S (MMWR, October 22, 1999 /48(41); ) ORAL HEALTH DIVISION, MOH, MALAYSIA9

10 Geographical areas with high natural fluoride levels (> 1.5 mg/l) ORAL HEALTH DIVISION, MOH, MALAYSIA10

11 Percentage of population receiving fluoridated water, including both artificial and natural fluoridation ORAL HEALTH DIVISION, MOH, MALAYSIA11 80–100% 60–80% 40–60% 20–40% 1–20% <1% unknown

12 Optimum level varies for different countries according to climate, temperatures and consumption WHO (1984) - maximum concentration of 1.5 ppm fluoride in drinking water to avoid dental fluorosis The US Environmental Protection Agency (EPA) maximum primary contaminant level (MCL) of 4 ppm fluoride for drinking water, based on the avoidance of skeletal, but not dental fluorosis - An MCL of 2 ppm fluoride was set to protect against moderate to severe dental fluorosis. ORAL HEALTH DIVISION, MOH, MALAYSIA12 ppm = mg/l USA – 0.7 – 1.2 ppm Australia – 0.6 – 1.1 ppm Hong Kong – 0.6 ppm Singapore – 0.6 ppm Malaysia – 0.5 ppm

13 Dmf Teeth Per Child Nine Years After Fluoridation, Grand Rapids, Michigan ORAL HEALTH DIVISION, MOH, MALAYSIA AGE AURORA (Natural fluoridation) GRAND RAPIDS (before fluoridation) DMF TEETH PER CHILD GRAND RAPIDS (9 years after fluoridation)

14 ORAL HEALTH DIVISION, MOH, MALAYSIA14 dmf TEETH PER CHILD SARNIA, BRANTFORD AND STRATFORD SARNIA - NO FLUORIDE BRANTFORD - FLUORIDATED SINCE 1945 STRATFORD - NATURALLY FLUORIDATED AGE : YEARSAGE : YEARS SARNIA BRANT- FORD STRATFORD STRAT- FORD BRANT- FORD SARNIA DMF TEETH PER CHILD

15 Current Development USA 2010 Healthy People – 75% received fluoridated water( %) Oct 2007: Southern California begins water fluoridation Australia 80% population coverage in all states except Queensland (5%) Major change – Queensland starts Fluoridation UK South Central Strategic Health Authority agreed to implement fluoridation in Southampton in 2010 Malaysia Reinstitution of fluoridation programme in Kelantan (2006) Reinstitution of Fluoridation programme in Terengganu (2008) ORAL HEALTH DIVISION, MOH, MALAYSIA 15

16 Evidence Basis Water fluoridation…. reduce caries prevalence Still effective with use other fluoride sources reduces caries for all social classes may reduce the oral health gap between social classes withdrawal of water fluoridation indicates that caries prevalence increases no association between adverse effects and water fluoridation has been established except dental fluorosis remains a relevant and valid choice as a population measure for the prevention of dental caries technically feasible and culturally acceptable, A Systematic Review of Public Water Fluoridation. NHS Centre for Reviews and Dissemination, University of York, 2000 Australian Government. National Health and Medical Research Council. A Systematic Review of the Efficacy and Safety of Fluoridation, June 2007 Parnell C, Whelton H, O'Mullane D. Eur Arch Paediatr Dent Sep;10(3): NHMRC 1985 review of the safety and effectiveness of water fluoridation (NHMRC 1985) The 1991 report The effectiveness of water fluoridation (NHMRC 1991) Review of Water Fluoridation and Fluoride Intake from Discretionary Fluoride Supplements (National Health and Medical Research Council, 1999) World Health Organization (WHO, 2006) American National Academies of Science (NAS, 2006) reports on fluoride in drinking- water International Programme of Chemical Safety (IPCS, 2002) report on fluoride. ORAL HEALTH DIVISION, MOH, MALAYSIA 16

17 Other benefits of water fluoridation Kumar JV. Is water fluoridation still necessary? Adv Dent Res 20:8-12, July, 2008 Halo effect - persons in non-fluoridated areas also receive fluoride through beverages and foods processed in fluoridated areas –diminished difference in caries observed between fluoridated and non-fluoridated communities in recent years However, there is still a noticeable difference in dental caries between fluoridated and non-fluoridated communities despite the ubiquitous presence of fluoride in food, water, and dental products ORAL HEALTH DIVISION, MOH, MALAYSIA17

18 There are other intangible benefit: the progression of caries is delayed in the presence of fluoride, thereby providing more time for undertaking restorative treatment, when compared with 50 years ago the disease in children is also now less complex to treat, since most of the lesions are in pits and fissures the benefits continue into adulthood ORAL HEALTH DIVISION, MOH, MALAYSIA18 Other benefits of water fluoridation Kumar JV. Is water fluoridation still necessary? Adv Dent Res 20:8-12, July, 2008

19 Dental Fluorosis Hypomineralisation of tooth enamel or dentin produced by ingestion of above- optimum amounts of fluoride when teeth are developing However, it has not been shown to pose any health risks beyond the possible esthetic concern ORAL HEALTH DIVISION, MOH, MALAYSIA19

20 The severity is directly related to the age of the child at exposure, and the type, level and duration of the exposure. individual response, and nutritional and other factors ORAL HEALTH DIVISION, MOH, MALAYSIA20 Dental Fluorosis

21 Subjects perception of fluorosis 21 p<0.05 Source: Oral Health Division, MOH. Fluoride Enamel Opacities in 16-year-old Schoolchildren, 2000

22 ORAL HEALTH DIVISION, MOH, MALAYSIA22

23 Policy statement Fluoridation of public water supplies be instituted in West Malaysia as soon as possible and further recommends that an optimum level of 0.7 ppm fluoride be maintained in the reticulation system (MOH,1971) ORAL HEALTH DIVISION, MOH, MALAYSIA23

24 History of fluoridation in Malaysia YearEvent 1957first introduced in state of Johore 1959 Penang 1962 Sarawak 1964 Johor Study ( ) -reduction of dental caries 60% 1969 MOH appointed committee to look on fluoridation of PWS 1972 Cabinet approval (optimum level-0.7 ppm) 1974 nationwide fluoridation 1995 discontinuation of fluoridation in Kelantan (about 50% coverage) 1999 discontinuation of Fluoridation in Terengganu (about 80% coverage) 2004 optimum level reviewed to 0.5 ppm 2005 Implementation of optimum level ppm 2006 reinstitution of fluoridation in Kelantan (Pasir Mas and Machang District – 17.7% population coverage) 2008 reinstitution of fluoridation in Terengganu (Setiu District – 4.3% population coverage) ORAL HEALTH DIVISION, MOH, MALAYSIA24

25 Why water fluoridation in Malaysia? Caries is the most prevalence chronic disease and affect all ages Good public water supply system where it reaches 95% of the population fluoride level in natural water is less than the optimum level(0.5ppm) Evident as safe and effective public health approach in reducing caries Equitable benefits to the population Recommended by World Health Organization Recognized by large number of prominent national and international organizations ORAL HEALTH DIVISION, MOH, MALAYSIA 25

26 ORAL HEALTH DIVISION, MOH, MALAYSIA 26 Achievement after 35 years of Fluoridation

27 Estimated population received fluoridated water, 2008 ORAL HEALTH DIVISION, MOH, MALAYSIA27

28 Number of Water treatment Plant with and without Fluoridation System, 2008 ORAL HEALTH DIVISION, MOH, MALAYSIA28

29 Per Capita Cost/Year 18 Sept 1972 – recurrent expenditure at 16 cents per head of population served per year Malaysia RM ORAL HEALTH DIVISION, MOH, MALAYSIA 29 Loh KH (2004). Cost Estimation Study of Water Fluoridation Programme in Johor. This study found that the estimated per capita cost of fluoride compound for fluoridating community water supply at the recommended level of 0.7 ppm in Johor is RM0.18 (S.D. 0.12) per year.

30 Incremental Improvement Attributed To Appropriate Use Of Fluorides And School Dental Programme ORAL HEALTH DIVISION, MOH, MALAYSIA30 However…… year-old12-year-old16-year-old Age group Mean DMFT

31 However, Caries Prevalence Remain High Among Children ORAL HEALTH DIVISION, MOH, MALAYSIA31 AgeYear Caries Prevalence (%) Pen. M'sia SarawakSabahMalaysia 5 years years years years Oral Health Division, Ministry of Health Malaysia. National oral health survey of preschool children 2005 (NOHPS 2005), 2006 Oral Health Division, Ministry of Health Malaysia. Oral Health Status 2008, Dec 2008 WHO goal 50%

32 Caries Severity in Children < 18 Years from Several Surveys in Malaysia ORAL HEALTH DIVISION, MOH, MALAYSIA32 Mean dft 5 years1995na years years Mean DMFT 12 years years Oral Health Division, MOH, Various surveys

33 ORAL HEALTHCARE UTILISATION 15 years and above ORAL HEALTH DIVISION, MOH, MALAYSIA33 Surveys % utilise in last 1 year % utilise in last 2 years PublicPrivateOthersNever visited NOHSA (2000) %46.4%50.0%43.0%0.5%6.5% NHMS III (2006) %26.5%41.7%50.7%7.6%- 1.Oral Health Division, Ministry of Health Malaysia. The National Oral Health Survey of Adults 2000 (NOHSA 2000). November Institute for Public Health, Ministry of Health Malaysia. The Third National Health and Morbidity Survey 2006 (NHMS III). Oral Health. Jan 2008

34 Dental Caries Prevalence among Malaysian Adults from Various Surveys ORAL HEALTH DIVISION, MOH, MALAYSIA 34

35 Inequalities persist ORAL HEALTH DIVISION, MOH, MALAYSIA Age Group Mean DMFT

36 Caries Experience among Adults of Different Age Groups between Selected Countries ORAL HEALTH DIVISION, MOH, MALAYSIA 36 CountryAge groupYear Dental Caries PrevalenceMean DMFT Malaysia Singapore Indonesia Thailand Philippines Malaysia Singapore Indonesia Thailand Philippines Hong Kong Malaysia Singapore Indonesia Thailand Hong Kong Source: WHO Oral Health Country/Area Profile Programme

37 ORAL HEALTH DIVISION, MOH, MALAYSIA 37

38 98.0% 88.3% 97.9% 96.3% 99.9% 100% 95.0% 98.0% 96.7% 81.6% 4.3% 17.7% 4.7% 68.1% 98.0% Water Fluoridation Programme Population Coverage, 2008 Source: Oral Health Division, MOH ORAL HEALTH DIVISION, MOH, MALAYSIA38

39 Inequalities Persist By Location ORAL HEALTH DIVISION, MOH, MALAYSIA39 Age GroupUrbanRural 5 years (2005)69.3%85.6% 12 years55.6%66.5%

40 Differences in Dental Caries Experience (DMFT) among 16- year-old Schoolchildren between Fluoridated (F) and Non- Fluoridated (NF) Areas Oral Health Division, Ministry of Health Malaysia. National oral health survey of school children 1997 (NOHSS 97), 1998 Oral Health Division, Ministry of Health Malaysia. Fluoride enamel opacities in 16-year- old school children, June 2001 ORAL HEALTH DIVISION, MOH, MALAYSIA 40

41 Penutup Pemfluoridaan bekalan air minum masih relevan dan terbukti sebagai kaedah yang kos efektif dalam mencegah karies gigi diMalaysia. –Karies gigi dental caries is very common –Ketidaksamaan Kesihatan pergigian berterusan –>95% of the population menerima bekalan air paip –Paras fluorida dalam air yang belum dirawat adalah rendah Walaubagaimanapun semua agensi perlu memainkan peranan dan memberi sokongan padu untuk menjalankan program ini supaya dapat meningkatkan kesihatan pergigian serta kualiti hidup masyarakat. -Menentukan paras optimum fluorida -Pastikan liputan masyarakat pertingkatkan -Pastikan fluorida dapat dikekalkan diretikulasi ORAL HEALTH DIVISION, MOH, MALAYSIA 41

42 Syor Jawatankuasa Khas 1971 Strongly recommends that fluoridation of public water supplies be instituted in West malaysia as soon as possible and further recommends that an optimum level of 0.7 ppm fluoride be maintained in the reticulation system ORAL HEALTH DIVISION, MOH, MALAYSIA42

43 25 April 1972 Jemaah Menteri bersetuju bahawa Kementerian Kesihatan boleh melancarkan rancangan membuboh floraid kepada bekalan air dengan segera dengan tidak payah menerima persetujuan daripada Kerajaan-Kerajaan Negeri. Walau bagaimana pun, Kerajaan-Kerajaan Negeri patut juga diberitahu di atas tindakan yang demikian. ORAL HEALTH DIVISION, MOH, MALAYSIA 43

44 44 A lifetime of healthy smiles!

45 ORAL HEALTH DIVISION, MOH, MALAYSIA 45


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