**7. Study design**

372 Contemporary Approach to Dental Caries

fluoride gel, showed that the preventive program had been effective and had a clear

The six months evaluation of a comprehensive preventive care from dental hygienists implemented in children at six Massachusetts elementary schools, grades 1 through 3, with pupil populations at high risk of developing caries indicates that this care model relatively quickly can overcome multiple barriers to care and improve children's oral health. If widely implemented, comprehensive caries prevention programs could accomplish national health

To increase access to care, improve oral health and reduce disparities in oral health care for children, treatments must be safe, effective, efficient, personalized, timely and equitable. This program can be implemented locally and can reduce the incidence of dental caries in

Sealants application programs have been suggested as an effective measurement for caries prevention. Khurshid reported that preventive oral health care as measured by the presence of dental sealants can significantly reduce the occurrence of dental caries in Hispanic children in underserved areas such as the US–Mexico border in Texas. The study confirms the strong effect of low house hold income and lack of health insurance in increasing the likelihood of dental caries in children. The old adage that prevention is better than cure

In Mexico, a school-based caries preventive program was established in the 1970's in the State of Mexico; it was a pioneer program, and later in 1988 the program of salt fluoridation was implemented for the first time as a pilot program in the state. The program was carried out with technical support from the Pan American Health Organization (PAHO) and financial from W.K. Kellogg. Then, the salt fluoridation program is positioned as a nationwide policy in 1992. Because in the country there are five states and other municipalities with concentrations of fluoride in drinking water above the optimum amount, steps were

The preventive educational program developed in preschool and primary school nationwide currently includes various activities, constituted in the "basic scheme of oral health" prevention that consists of 14 applications of sodium fluoride 0.2%, 4 detections of plaque, 4 brushing technique instructions, 4 flossing instructions (from 8 years old) and 4 educational talks. All the activities are developed in every school year; in addition, there is a

Great efforts have been made for the abatement of oral diseases of highest incidence and prevalence and major achievements have been accomplished, but it is necessary to strengthen the activities implemented with the purpose to achieve caries-free communities program so the action 2001-2006 oral health includes in its coverage of 4 to 15 years of age

In Mexico State, the coverage of preventive educational program is around 75%, yet there are limited healing care facilities for school children; only a few dental schools have these

applies to dental health as much as to any other public health issue (Khurshid, 2010).

protective effect on permanent teeth (Tapias, et al., 2001).

goals and reduce the need for new care providers and clinics.

school-aged children (Niederman, et al., 2008).

**6. Dental programs in Mexico** 

taken to prevent consumption in these regions.

curative care program that is not always free.

(Secretaria de Salud, 2011).

The present study is a 3-year longitudinal analysis of a school-based caries prevention program. The study protocol was reviewed and approved by the Research and Ethics Committee of Autonomous University of the State of Mexico (UAEM from its initials in Spanish). The inclusion criteria were children without orthodontic treatment and all children whose parents signed an informed consent form prior to the examinations. The sample was selected by a convenience non-probability sampling method, and included 145 schoolchildren (66 boys and 79 girls), 6-7 years of age, who attended from the first to the third school year in four public elementary schools at Toluca city, where the School of Dentistry of the Autonomous University of the State of Mexico is responsible for the implementation of the program. The program included 20 minute sessions of oral health education for children and teachers (five per school year), and parents (one per school year). The curriculum included information about caries etiology and prevention (oral hygiene, diet counseling, fluorides, pit and fissures sealants), 0.2% NaF mouth rinse (fourteen per school year), toothbrushing technique instructions (four per school year), flossing instructions in children up to 8 years old, and disclosing solution application (four per school year).

To motivate the children, oral health educational material was designed and adapted to their chronological age, using a puppet theater among other resources. The oral examination was performed on site (public elementary schools) in daylight conditions by two examiners, who used a dental mirror and a WHO/CPITN-type E probe (World Health Organization, 1997). No radiographs were taken. To ensure satisfactory inter-examiner reproducibility, the examiners were calibrated twice a week during the six months previous to the start of sampling (Kappa 0.95) by examining the same group of people and comparing their findings.

The oral health of children was evaluated by using deft/s and DMFT/S index. A tooth or surface was considered carious (D) if there was visible evidence of a cavity, including untreated dental caries and filled teeth with recurrent caries. The M component included missing teeth and / or decayed teeth with indication for extraction due to caries, or teeth missing as a result of caries. The F component was filled teeth; the sum of the three figures forms the DMFT/S-value. For primary dentition, deft/s index was used, where e indicates extracted teeth. Cumulative incidence was expressed as the proportion of new children with caries over the 3 years period. For caries incidence data were collected on DMFT and deft recording forms. Information to the parents about the oral health status of the children was provided by means of an advice/referral letter.
