The Jerusalem oral health program for schoolchildren 1992-2008

Background: A public health program for the promotion of oral health among schoolchildren in Jerusalem has been focused on preventive dentistry since 1992. An initial survey had established that over 90% of caries in permanent teeth among 1st to 4th grade children was situated in the fissures of first permanent molars. The program therefore was concentrated on the placement of pit and fissure sealants. Objectives: To review the program, to evaluate the retention and effectiveness of the sealants, to examine the caries trend, and to assess the satisfaction of the public. Methods: Monitoring and evaluation were achieved via surveys conducted every 2-3 years, which determined caries levels, sealants' retention and parents' satisfaction. Results: The number of children, who participated in the program, increased from 2,225 to 16,540 and the number of sealants from 1,044 to 25,405, from 1992 till 2008. Levels of successful sealant treatment (complete retention, no caries), two years after placement, ranged between about 50% and 70%. Caries levels, despite sealant placement, two years after placement, ranged between about 3% and 19%. A significant negative association was revealed between number of sealants placed and DMFT (p<0.001). DMFT levels had decreased from 1.91 in 1993 to 1.04 in 2005 among 4th grade children. Parents of children who participated in the program reported higher levels of satisfaction regarding pre-treatment explanations, access, cost, and treatment safety, as compared to those whose children were treated by private dentists. Conclusions: Based upon these results, enhanced recall of sealants was encouraged. The continuation of the program has been advocated as an important component of the municipal public health efforts.