I am sure most of us have memories of dental clinic vans pulling up in our school compounds, followed by nurses in crisp white uniforms loading portable dental chairs and instruments into assigned treatment rooms. Not long after that, one of the nurses would uninvitingly appear in our classrooms, calling us to go to the treatment room to get our teeth checked. How many of us had feigned toilet visits shortly after that?
Now that we have grown up and have children of our own, sometimes we are reminded of that dental-nurse-with-a-huge-syringe memory when our children bring home green coloured treatment cards for us to sign our consent for dental treatment. With more than 31% of the Malaysian population below the age of twenty, oral healthcare for school children in our nation remains a priority for the Ministry of Health.
From the historical perspective, the government dental services began as a school dental service shortly after independence. The government dental services have now expanded to include a wider range of population such as pre-school children, pregnant mothers, children with special needs, adults and the elderly population. The government school dental service is modelled after the School Dental Service (SDS) in New Zealand, which was established in 1921 and made free in 1945 when the Department of Health began to completely reimburse school dental clinics for their operating expenditures. This unique SDS model has then been successfully emulated in other countries including Malaysia, Hong Kong, Australia and to a certain extent, United Kingdom.
Why is school dental program important? As the famous Malay saying goes, “melentur buluh biarlah daripada rebungnya.” The school dental program aims to achieve and maintain optimal oral health amongst children, and to empower them to take responsibility for their own oral health. It provides a perfect mechanism to carry out early clinical preventative initiatives on school children, and to educate them with sufficient knowledge to foster oral health habits early in their lives. Schools are also provided with health education curriculum to heighten oral health awareness beyond the dental clinic environment. Our current approach is geared toward coordinated involvement of individuals, families and the community that will lead to improved health outcome.
Dental treatment for school children is delivered via several modes. For schools which enrolments are more than 1000 pupils, a dental clinic is established at the schools in a room provided with necessary modification. In schools with less number of pupils or situated in rural areas, oral health personnel travel to the schools by land or river. Upon arrival at the school, a temporary dental clinic is set up using portable dental chairs and instruments in a suitable room provided by the school for that purpose. There are also mobile dental clinics used to deliver oral healthcare as well as for community outreach programs. Each mobile clinic is attached to a prime mover, which gives it the appearance of a container or trailer clinic.
Treatment provided by school dental program ranges from scaling, clinical preventative initiatives and basic restorative treatment, as well as health education. Through lectures or talks, school children are armed with knowledge necessary to individually maintain their oral health beyond the dental clinic environment. This will hopefully cultivate proper oral hygiene habits that will last through their lifetimes. School children are also taught hands-on on the proper way of brushing teeth through toothbrushing drills (Latihan Memberus Gigi (LMG)). LMG can also be carried out by the schools on a daily or weekly basis without supervision of oral health personnel as a part of health promotion program.
School dental service also presents as an efficient mechanism for clinical prevention initiatives. After the initial examination and diagnosis session, if a child is determined to have high risk for dental caries in the future (e.g. already existing caries in other teeth or teeth with deep fissures), prevention steps such as fissure sealant could be taken early. Fissure sealant is a procedure to seal deep grooves and fissures on teeth that are likely to entrap dental plaque and subsequently contract dental caries. As long as the fissure sealant remains intact on the teeth, the possibility of getting dental caries is greatly reduced.
Furthermore, school dental service provides an opportunity for early interceptive treatment. The earliest a treatment is initiated, the better is the outlook (prognosis). For instance, dental caries that is caught early and treated could save the tooth for a lifetime when accompanied by proper oral hygiene care. Even though the primary providers of school oral healthcare comprise of dental officers and nurses who mainly handle basic dental treatment, complex cases seen are referred to specialists for further management. Referral of complex cases such as those for orthodontic treatment (braces) is made easier now that there is increasing availability of specialist care throughout the country.
In conclusion, school dental program has brought tremendous increase in improving oral healthcare in school children in Malaysia. By establishing school dental clinics and other outreach initiatives, more children are benefiting from early treatment provided by oral healthcare personnel. With the increasing school-going population and constraints in resources, school-based oral healthcare program is still a cost-effective way to encourage the practice of good oral health habits that can last a lifetime. Coordinated action from every level is needed so that our young population is orally fit and able to maintain quality of life throughout their lifetimes.
Dr. Husna Razak (BDS) (KLE VK) is a dental officer working in the Kelantan. Know more about her in The Team page.
Oral Healthcare For School Children in Malaysia (2006), Oral Health Division, Ministry of Health Malaysia.