1. Status of Prevention of Dental Diseases in Estonia Mare Saag

2. From the Guidelines for family doctors and other cooperating health care workers Decree of the Minister oh Social affairs 17.01.2010 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

3. 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

4. Changes Up to 2003 all the children belonged to the target group for prevention 2003-2008 6-12 years old children were covered

5. Budget for oral health care in Estonia in thousands of Euros 20092010 prognosis 2011Changes compared to 2010 Dental treatment for children 14 47714 22213 97614 2312% Prevention In children 4084093633918% Orthodontics2 7532 7112 8422 9895% Emergency Treatment for adults 716750657 0% TOTAL18 35418 09217 83818 2682%

6. Number of treatment cases 2009 factual2010 budget2010 prognosis 2011 budgetChanges compared to 2010 Dental treatment cases in children 299 081298 983303 047297 601-2% Prevention in children 28 10928 71125 44026 974 6% Orthodontics36 40936 96339 46440057 4% Ewmergency treatment in adults 17 26018 46517 66417 489-1% TOTAL380 859383 122384 615382 121-1%

7. Target groups for prevention of dental diseases Born in-Number of children (1988) 22442) 199912431 200213091 200413973 200514000 2008No of visits for treatment 403 333 (1,5 visits per child)

8. No of visits for prevention YearNo of visits No of children % 2003 151 148 190 48079,35 2004148 308 198 78074,61 2005 115 296 194 98059,13 2006116 759198 73058,75 2007115 016202 86056,69 2008 113796 201 12056,58 2011271 868

9. Budget per child Prevention 200914,51 Eur 2010 actual 14,26 2011 budget14,49 Dental treatment (children) 1 case 200948,40 201046,11 201147,81

10. 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

11. History Projects 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)

12. 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

13. History “Dental passport” 3 This document was meant for registration of dental health situation and performed treatment and preventive measures for the child.

14. 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

15. Dental health in children Health promotion project 2011 Contract No 2-21/49 Estonian Sick Fund Estonian Dental Association Estonian Society of Oral Hygienists

16. 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

17. 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“

18. 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

19. 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.

20. 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

21. 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

22. 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