|Year : 2017 | Volume
| Issue : 2 | Page : 62-66
Consensus statement of the Makkah symposium on the prevention of dental caries: Common goals to prevent dental caries in Saudi Arabia
Abdullah R AlShammery1, Abdullah Al-Dosari2, Adel Al-Rusayes3, Asim Al-Ansari4, Hassan Halawany5, Helal Sonbul6, Mishari AlOtibi7, Sharat Pani8
1 Riyadh Colleges of Dentistry and Pharmacy, Senior Consultant in Restorative Dentistry, Riyadh, Saudi Arabia
2 Vice President of Postgraduate Studies and Scientific Research, Professor of Oral Medicine, University of Hail, Hail, Saudi Arabia
3 Senior Registrar in Pediatric Dentistry, Supervisor of Preventive Dental Programs, General Directorate of Dental Services, Ministry of Health, Dammam, Saudi Arabia
4 Associate Professor of Dental Public Health, Vice Dean of Academic Affairs, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
5 Associate Professor of Preventive Dentistry, Chairman, Dental Caries Research Chair, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
6 Assistant Professor and Chairman of Restorative Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
7 Makkah Dental Conference, Security Forces Hospital, Makkah Region, Saudi Arabia
8 Assistant Professor of Pediatric Dentistry, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
|Date of Web Publication||25-Jul-2017|
Abdullah R AlShammery
Riyadh College of Dentistry and Pharmacy, P.O. Box: 84891, Riyadh 11681
Source of Support: None, Conflict of Interest: None
Dental caries levels in the Kingdom of Saudi Arabia have been a cause of concern to public health planners for sometime. The dental caries symposium of the 14th Makkah Dental Conference brought together leaders from the different academic and clinical stakeholders in the provision of dental health care in the Kingdom of Saudi Arabia. The aim of the symposium was to establish consensus on the role of different public health measures to be implemented in the Kingdom of Saudi Arabia that could help reduce the overall dental caries rate. This consensus statement summarizes the key findings of the panel and presents a consensus statement on six major topics: (1) water fluoridation, (2) dental health care provision by the Ministry of Health, (3) cost-effectiveness of preventive dental care, (4) caries risk assessment, (5) evidence-based recommendations for the prevention of dental caries, and (6) the role of the dental academic sector in the prevention of dental caries. These six factors were discussed in the background of international best practices in caries prevention and how these practices could be adopted in the Kingdom of Saudi Arabia.
Keywords: Dental caries, oral health promotion, prevention
|How to cite this article:|
AlShammery AR, Al-Dosari A, Al-Rusayes A, Al-Ansari A, Halawany H, Sonbul H, AlOtibi M, Pani S. Consensus statement of the Makkah symposium on the prevention of dental caries: Common goals to prevent dental caries in Saudi Arabia. Saudi J Oral Sci 2017;4:62-6
|How to cite this URL:|
AlShammery AR, Al-Dosari A, Al-Rusayes A, Al-Ansari A, Halawany H, Sonbul H, AlOtibi M, Pani S. Consensus statement of the Makkah symposium on the prevention of dental caries: Common goals to prevent dental caries in Saudi Arabia. Saudi J Oral Sci [serial online] 2017 [cited 2018 Jul 16];4:62-6. Available from: http://www.saudijos.org/text.asp?2017/4/2/62/211564
| Introduction|| |
Dental Caries has been recognized by the World Health Organization as an infectious noncommunicable disease that could impact the physical, social, and emotional well-being of children. Since the first studies on the prevalence of dental caries in the Kingdom of Saudi Arabia were carried out in the 1990s, the severity of the disease and the impact it has had, and continues to have on children has been documented in detail.,,, Prevention of dental disease is a critical part of dentistry in the 21st century, both reducing cost to the patient and improving practice for the dentist. While prevention has traditionally been seen as a field that is far removed from dental practice, this is no longer true. With greater emphasis being placed on concepts such as “minimal intervention,” the modern dentist cannot ignore the role that prevention plays in modern dental practice. This consensus statement seeks to look at the evidence of the success of existing strategies for the prevention of dental disease and makes evidence-based recommendations to promote oral health in Saudi Arabia.
| Water Fluoridation|| |
Fluorides have been termed as one of the greatest public health achievements of the 20th century. Several attempts have been made to map and identify fluoride levels and its impact on the levels of caries in the Kingdom of Saudi Arabia., No water fluoridation program exists in the Kingdom of Saudi Arabia; however, there have been several efforts made to study the impact of water fluoride levels on the occurrence of dental caries in the Kingdom of Saudi Arabia.
Several initial studies have shown significantly reduced caries rates in children residing in areas where the fluoride concentration has been >1.5 ppm.,, Extensive fluoride mapping of the Kingdom of Saudi Arabia has revealed that in most regions, the fluoride levels are below the minimum of 0.6 ppm that is necessary in hot climates. Despite the fact that large proportion of the urban population today drinks bottled water, there are still large areas in the Kingdom of Saudi Arabia that are dependent on naturally occurring water sources. The fact that desalinated water constitutes a large part of the water supply makes water fluoridation technically feasible. Based on the available evidence, and the feasibility of the process, the following recommendations are made:
- The relationship between optimal water fluoride levels and reduction in dental caries has been shown in certain areas of the Kingdom of Saudi Arabia
- The potential for optimal fluoridation of desalinated water needs to be recognized
- Water fluoridation could be used as a cost-effective measure to augment existing dental prevention mechanisms
- Optimal fluoridation of public water sources, especially desalinated water should be actively promoted to the planning authorities
- The Ministry of Health should follow up the fluoridation of the general drinking water.
| Role of the Ministry of Health in Providing Oral Health Care|| |
The Ministry of Health is the single largest healthcare provider in the Kingdom of Saudi Arabia and accounts for 40% of the healthcare professionals employed in the Kingdom of Saudi Arabia. The Ministry of Health, being the largest healthcare provider at the Kingdom of Saudi Arabia, has a long history of implementing preventive dental programs. The Ministry recognizes the challenges and continues to strengthen its preventive programs, alongside curative services, throughout the Kingdom of Saudi Arabia. Recently, the Ministry of Health has begun to place more emphasis on oral health preventive programs in both educational and clinical procedural aspects. In this regard, many programs, initiatives, and campaigns have been launched in an effort to tackle the underlying risk factors of dental caries.
- Given the workforce and logistical advantages of the Ministry of Health, it is recommended that the Ministry of Health will continue to be the backbone of preventive care within the Kingdom of Saudi Arabia
- The recent trend of increasing preventive programs and outreach into schools should be encouraged with greater expansion of these programs
- The Ministry of Health should work with the Ministry of Education to implement a curriculum of oral hygiene and prevention of oral disease in the first six grades of schools with a program for follow-up
- A greater role must be found for dental hygienists and auxiliaries in providing preventive dental care.
| Cost-Effectiveness of Preventive Dental Care|| |
There is a lack of understanding of the true cost of preventive care and its true benefits. The burden of dental care in Saudi Arabia is borne not just by the Ministry of Health but also by private practitioners. While there have been attempts made recently in developed countries to identify the cost and benefit of preventive dental care,, such data in the developing world in general  and Saudi Arabia in particular are lacking.
Preventive dental care is based on the concept of regular dental visits and incremental dental treatment. Such an approach is said to not only reduce the quantum of dental care in a visit but also reduce the severity of the dental intervention and helps reduce pain and the number of dental visits required for a particular procedure. The necessity of preventive dental care such as pit and fissure sealants, oral hygiene instruction, and regular topical fluoride application in the Saudi Population and the motivation of dentists to enforce such care have been previously emphasized.,
- There is a need for cost-effectiveness studies across the different sectors (both private and governmental) to collect reliable cost-effectiveness data from across the Kingdom of Saudi Arabia
- The role of third-party payment options (insurance) either as private insurance companies or as government subsidized health vouchers should be explored in preventive dental care
- There is a need to improve public awareness of the direct and indirect costs of dental caries
- The role of dental economics needs to be explored in preventive dentistry so that preventive programs will be in keeping with the “vision 2030” of the Kingdom of Saudi Arabia.
| Caries Risk Assessment|| |
Dental caries results from an ecological imbalance in the equilibrium between tooth minerals and oral biofilms. Several factors can influence the microbial metabolic activity in the dental biofilm. These factors include but not limited to plaque composition, cariogenic bacteria, and diet content and frequency as risk factors. The flow rate, buffer capacity of saliva, and presence of fluoride are risk inhibitors providing protection from caries. The multifactorial caries entity makes risk assessment and the prediction of caries development a complex process.
There is growing evidence to suggest that individualized caries risk assessment tools such as Cariogram and Caries Management by Risk Assessment are an evidence-based approach to evaluate patient's caries risk in daily practice, to prevent or to treat caries at early stages.
- Emphasis needs to be given to training the dental workforce in the advances in caries risk assessment
- Include application to measure caries risk assessment as a part of dental curriculum in dental schools
- Policies for the implementation of caries risk assessment as an integral part of patient treatment in the Kingdom of Saudi Arabia need to be promoted.
| Evidence-Based Recommendations for Caries Prevention in the Kingdom of Saudi Arabia|| |
The role of evidence-based guidelines for preventive dentistry as well as preventive clinical practice has recently gained popularity. While it is understood that preventive measures such as topical fluorides, pit and fissure sealants, and water fluoridation all contribute toward the reduction of dental caries, there is a need to review the existing literature in the Kingdom of Saudi Arabia to formulate specific preventive guidelines for each country.,
There have been targeted interventions and school programs conducted on a small scale in various settings across Saudi Arabia., The evidence from these studies suggested that the maintenance of sugar diaries in school served to reduce sugar intake as well as improve oral hygiene., However, later studies have documented that the awareness of school children regarding oral hygiene remains poor.,,, Even among older individuals, use of preventive methods is not prevalent and it can be improved by more intensive efforts to increase the awareness of these methods, primarily through dentists. Despite the presence of many studies in the Kingdom of Saudi Arabia, not all of them meet the standards of evidence-based medicine. It is therefore essential to ensure that all studies conducted in the country follow the highest reporting standards.
- Establish a working group with official identity to put clinical practice guidelines for all branches of dentistry
- Promote the evidence-based practice as a system to be implemented in most of our work through social media
- Putting evidence-based practice into the curriculum of dental schools in Saudi Arabia
- To make public and community preventive projects as an essential part of the curriculum not only by the volunteers.
| The Role of the Academic Sector in Caries Prevention|| |
The dental workforce in Saudi Arabia has undergone a rapid expansion. The establishing of many new dental schools in the Kingdom of Saudi Arabia means that there is likely to be an annual addition of approximately 500 new dentists to the workforce each year. The challenge is to utilize this emerging workforce in the promotion of preventive dental care.
Dental schools and their associated hospitals have been shown to be the ideal setting to implement programs that focus on caries risk assessment and individualized preventive care. Studies have shown that there remains little interest in pursuing dental public health or preventive dentistry as a specialty among dental students., There is a need to utilize the talent available across the established and new dental schools in the Kingdom of Saudi Arabia to improve dental caries prevention methods.
- Establishment of national preventive workshops and collaborative symposia for the training of faculty and students in the clinical aspects of preventive dentistry
- Promotion of preventive dental research among the different dental schools across the Kingdom of Saudi Arabia
- Stress needs to be placed on the promotion of preventive dentistry at the undergraduate level, with increasing the credit hours allotted to the community participation of students
- There is a need for educational institutions to cooperate with primary service providers like the Ministry of Health to ensure that academic research in preventive dentistry augments the delivery of preventive dental care.
| International Advances and Their Applicability to Saudi Arabia|| |
In an era of digitalization and web connectivity, there have been several international advances in the field of preventive dentistry that have blended these new technologies with traditional approaches. The use of mobile phone applications and online database systems has been shown to improve the interaction between dentists and the population. The use of web or mobile phone applications has also been used to ensure equitable distribution of resources and to facilitate cooperation between the public and private sectors.
School health programs have been around for more than six decades. The successful application of preventive measures such as fluorides and pit and fissure sealants have been demonstrated across the United States. Several of these projects such as the presence of school programs have already been initiated in parts of the Kingdom of Saudi Arabia. There is a need for cooperation between the different stakeholders in Saudi Arabia to ensure the implementation of these international advances across all parts of the Kingdom of Saudi Arabia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Akpata ES, al-Shammery AR, Saeed HI. Dental caries, sugar consumption and restorative dental care in 12-13-year-old children in Riyadh, Saudi Arabia. Community Dent Oral Epidemiol 1992;20:343-6.
al Shammery A, el Backly M, Guile EE. Permanent tooth loss among adults and children in Saudi Arabia. Community Dent Health 1998;15:277-80.
Alamoudi N, Salako NO, Massoud I. Caries experience of children aged 6-9 years in Jeddah, Saudi Arabia. Int J Paediatr Dent 1996;6:101-5.
al-Shammery AR, Guile EE, el-Backly M. Prevalence of caries in primary school children in Saudi Arabia. Community Dent Oral Epidemiol 1990;18:320-1.
Al-Shammery AR. Preventing orodental diseases is still better and cheaper than treating them. Saudi J Oral Sci 2017;4:1.
Akpata ES, Fakiha Z, Khan N. Dental fluorosis in 12-15-year-old rural children exposed to fluorides from well drinking water in the Hail region of Saudi Arabia. Community Dent Oral Epidemiol 1997;25:324-7.
Al Dosari AM, Wyne AH, Akpata ES, Khan NB. Caries prevalence and its relation to water fluoride levels among schoolchildren in Central Province of Saudi Arabia. Int Dent J 2004;54:424-8.
AlDosari AM, Akpata ES, Khan N. Associations among dental caries experience, fluorosis, and fluoride exposure from drinking water sources in Saudi Arabia. J Public Health Dent 2010;70:220-6.
al-Khateeb TL, Darwish SK, Bastawi AE, O'Mullane DM. Dental caries in children residing in communities in Saudi Arabia with differing levels of natural fluoride in the drinking water. Community Dent Health 1990;7:165-71.
Chi DL, van der Goes DN, Ney JP. Cost-effectiveness of pit-and-fissure sealants on primary molars in medicaid-enrolled children. Am J Public Health 2014;104:555-61.
Bertrand E, Mallis M, Bui NM, Reinharz D. Cost-effectiveness simulation of a universal publicly funded sealants application program. J Public Health Dent 2011;71:38-45.
Mariño R, Fajardo J, Morgan M. Cost-effectiveness models for dental caries prevention programmes among chilean schoolchildren. Community Dent Health 2012;29:302-8.
Togoo RA, Al-Rafee MA, Kandyala R, Luqam M, Al-Bulowey MA. Dentists' opinion and knowledge about preventive dental care in Saudi Arabia: A nationwide cross-sectional study. J Contemp Dent Pract 2012;13:261-5.
Al-Kheraif AA, Al-Bejadi SA. Oral hygiene awareness among female Saudi school children. Saudi Med J 2008;29:1332-6.
Sonbul H, Al-Otaibi M, Birkhed D. Risk profile of adults with several dental restorations using the cariogram model. Acta Odontol Scand 2008;66:351-7.
Lee GH, McGrath C, Yiu CK. Developing clinical practice guidelines for caries prevention and management for pre-school children through the ADAPTE process and Delphi consensus. Health Res Policy Syst 2016;14:44.
Lee GH, McGrath C, Yiu CK. Evaluating the impact of caries prevention and management by caries risk assessment guidelines on clinical practice in a dental teaching hospital. BMC Oral Health 2016;16:58.
Wyne AH, Al-Ghorabi BM, Al-Asiri YA, Khan NB. Caries prevalence in Saudi primary schoolchildren of Riyadh and their teachers' oral health knowledge, attitude and practices. Saudi Med J 2002;23:77-81.
Gandeh MB, Milaat WA. Dental caries among schoolchildren: Report of a health education campaign in Jeddah, Saudi Arabia. East Mediterr Health J 2000;6:396-401.
Wyne A, Darwish S, Adenubi J, Battata S, Khan N. The prevalence and pattern of nursing caries in Saudi preschool children. Int J Paediatr Dent 2001;11:361-4.
Wyne AH. The bilateral occurrence of dental caries among 12-13 and 15-19 year old school children. J Contemp Dent Pract 2004;5:42-52.
Wyne AH, Chohan AN, Jastaniyah N, Al-Khalil R. Bilateral occurrence of dental caries and oral hygiene in preschool children of Riyadh, Saudi Arabia. Odontostomatol Trop 2008;31:19-25.
Al-Ansari A. Awareness, utilization, and determinants of using oral diseases prevention methods among Saudi adults – A clinic-based pilot study. Int J Health Sci (Qassim) 2016;10:77-85.
Halawany HS. Career motivations, perceptions of the future of dentistry and preferred dental specialties among Saudi dental students. Open Dent J 2014;8:129-35.
Halawany HS, Binassfour AS, AlHassan WK, Alhejaily RA, Al Maflehi N, Jacob V, et al.
Dental specialty, career preferences and their influencing factors among final year dental students in Saudi Arabia. Saudi Dent J 2017;29:15-23.