Program Penjagaan Kesihatan Pergigian untuk Anak-anak Pelajar Pra-Sekolah.

INTRODUCTION

Pre-school children are one of the major target groups under the primary oral healthcare programme of the Ministry of Health. Oral healthcare for  pre-school children is given due priority as their oral health will determine the oral health status of future generations.

Several large-scale dental epidemiological surveys of 5 to 6-year-old children have been conducted in Malaysia. Findings show that caries prevalence in this group of children remains high although the rate is  declining. In the latest studies, caries prevalence of 87.1% was noted among 5-year-olds while in 6-year-olds, 80.6% had at least one or more  carious teeth in the deciduous dentition. For both groups, there was a  very high level of unmet treatment needs.

A structured pre-school programme has been in place in Malaysia since 1984. This programme focuses on preventive and promotive activities for pre-school children attending kindergartens (Taman Didikan Kanak-Kanak or tadika). A systematic referral system is also in place for the referral of children requiring curative care to the nearest government clinic.

In 1992, strategies and guidelines to implementation of all oral health programmes and activities were outlined in the document entitled “Strategi Ke Arah Perkhidmatan Pergigian Yang Cemerlang dan Bermutu” .

In view of the many changes that have taken place since then, there is a need to review the existing pre-school programme and to formallydocument the guidelines for the implementation of this programme. This would also facilitate planning of resources for the programme.

BACKGROUND

Since its launch in 1984, the pre-school programme has been mainly a preventive and promotive programme, with the objective of creating awareness and inculcating positive oral health habits and attitudes.

Through three visits to identified kindergartens or pre-schools, dental nurses and other auxiliaries carry out activities, which include dental health talks and tooth brushing drills. For a pleasant and fun introduction to the clinical aspects of oral healthcare, role-play is also carried out on the third visit. Through the years, implementation of the pre-school programme has seen some modifications. A kindergarten was previously considered “covered” when three visits were made. However, due to resource constraints, this was reduced to two visits in certain locales. This was supported by a local study, which found no difference in effectiveness between a two–visit and a three-visit programme.

In recent years, some districts took it a step further by undertaking the task

of treating pre-school children as an outreach programme. Treatment has been made more acceptable to these younger children with the development of the minimally invasive technique of Atraumatic Restorative

Treatment (commonly referred to as ART). This pre-school outreach programme was further facilitated with the establishment of pre-school  teams under the 7th Malaysia Plan (1996 - 2000).

In August 2000, the Oral Health Division, Ministry of Health, organised a seminar on “Atraumatic Restorative Treatment in The Management of Dental Caries” in Kota Bharu, Kelantan. Participants, comprising dental officers and nurses, were trained to undertake ART in concurrent workshop sessions in local kindergartens. The guidelines to implementation of the ART programmewere adhered to. Similar workshops were organised at state level.

Through the pre-school programme, nearly 100% of government-aided kindergartens and pre -schools registered with the Ministry of Education are “covered” each year.

extracted from Guidelines on Oral Health Care for Pre School Children by Bahagian Kesihatan Pergigian, Kementerian Kesihatan Malaysia.