Evaluation of Guamanian dental caries preventive programs after 13 years

To address the high prevalence of dental caries in Guamanian children, a school-based fluoride mouthrinse program, a clinic-based pit and fissure sealant program, and community water fluoridation were phased in over a 13-year period. The purpose of this paper is to evaluate the impact of these programs on the prevalence of dental caries.

Cross-sectional samples representative of schoolchildren in grades 1 through 8 were selected in 1976, 1979, 1984, 1986, and 1989. These years include the starting years for each of the three interventions and varying follow-up periods for each. About 1,000 children in each of the survey years were examined to derive DMF surface scores.

After eight years of fluoride mouthrinsing, DMFS scores were reduced by 25.4 percent in 6-14-year-olds. With two additional years of fluoride mouthrinsing and with pit and fissure sealants, overall DMFS scores declined an additional 44.4 percent. In 1989, three years after community water fluoridation was initiated on the island and continuation of the other two programs, there was a further decline in overall DMFS scores of 34.5 percent. Over the entire study period--during which there were 13 years of fluoride mouthrinsing in the schools, five years of sealant application, and three years of community water fluoridation--DMFS scores declined 72.8 percent overall (5.14 surfaces per child) and 71.9, 71.0, and 78.8 percent for occlusal, buccal-lingual, and proximal surfaces, respectively.

An intensified preventive dentistry program introduced on an island with high caries prevalence twice that of the US mainland was successful, and contributed to a reduction in the prevalence of caries to a level equivalent to that of the United States at the end of the study period.