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 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

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 Estonia

in thousands of Euros

2009 2010 2011 2010 prognosis

13 976

Changes compared to 2010

2% Dental treatment for children Prevention In children 14 477 408 Orthodontics TOTAL 2 753 Emergency Treatment for adults 716 18 354 14 222 409 2 711 750 18 092 363 2 842 657 17 838 14 231 391 2 989 657 18 268 8% 5% 0% 2%

Number of treatment cases

2009 factual 2010 budget 2010 prognosis

Dental treatment cases in children 299 081 Prevention in children 28 109 Orthodontics Ewmergency treatment in adults TOTAL 36 409 17 260 380 859 298 983 28 711 36 963 18 465 383 122 303 047 25 440 39 464 17 664 384 615

2011 budget

297 601

Changes compared to 2010

-2% 26 974 40057 17 489 382 121 6% 4% -1% -1%

Target groups for prevention of dental diseases

Born in (1988) • 1999 • 2002 • 2004 • 2005 Number of children 22442) 12431 13091 13973 14000 2008 No of visits for treatment 403 333 (1,5 visits per child)

Year

No of visits for prevention

No of visits No of children % 2003 2004 2005 2006 2007 2008 2011 151 148 148 308 115 296 116 759 115 016 113796 190 480 198 780 194 980 198 730 202 860 201 120 271 868 79,35 74,61 59,13 58,75 56,69 56,58

Budget per child

• Prevention 2009 2010 actual 14,51 Eur 14,26 2011 budget 14,49 • Dental treatment (children) 1 case 2009 2010 2011 48,40 46,11 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

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)

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”

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

3

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 2011

Contract 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