Oral health of and provision of dental care service to kindergarten children in Hong Kong

Abstract

The last oral health survey conducted by the government of Hong Kong in 2001 found that dental caries was common among the kindergarten children and that most of their dental caries was untreated. The overall aims of this research project were to find out the oral health status of the kindergarten children in Hong Kong and the outcomes of providing a private practice based dental service programme to these children.

To achieve the first aim, an oral health survey was conducted in 2007. Through stratified simple random sampling, 12 kindergartens in Hong Kong Island were selected. All children attending grades 1 to 2, aged 3 to 5 years, in the kindergartens were invited to participate. Children with parental consent were clinically examined by one of two calibrated examiners. A questionnaire on the child’s demographic background and oral health related behaviours was completed by the parents.

Response rate of the survey was 89% and 1,343 children were examined. Their mean age was 52 months (SD=7) and 51.5% were boys. Around one third (35.3%) of the children had experienced dental caries. The mean dmft score was 1.5, increasing from 1.2 at age 3 to 2.0 at age 5 (ANOVA, p=0.016). Soft, cavitated caries (dt) accounted for 90% of the dmft score. The prevalence and severity of dental caries in the children were associated with the children’s socio-demographic background, and their dietary and tooth-brushing habits.

To find out the feasibility of implementing a private clinic based dental service program for the preschool children a total of 245 children attending grade 1 in 9 kindergartens were invited to participate. Baseline information of the children was collected through a clinical examination and a parental questionnaire at April 2007. After baseline data collection, the study children were randomly allocated into the test or the control group. Children in the test group were offered free dental services at regular intervals in 3 private dental clinics. Evaluation took place in July 2009 after the completion of the 24-month intervention programme through conducting clinical examinations and a parental questionnaire.

After 24 months, 88% of the control and test group students remained in the study. The mean dental appointment attendance rate of the test group children was 53%. Individualized instructions on oral hygiene were provided to 82% of the children and 52% of the children had received topical fluoride application. Treatments were provided to more than 30% of the children and the mean number of dental fillings placed is 1.1. The mean total running cost per child was around HK$100 a year.

The kindergarten children who were covered by the study dental service programme had better oral health than that of the children who were not. The study programme was effective in preventing development of new dental caries and in reducing the amount of untreated caries among the test group children. However, it was not effective in improving the oral health related behaviours and oral hygiene status of the children. The study programme was acceptable to the kindergartens, the parents and the children by the satisfaction study. Consumer satisfaction was reasonable high.