| کلیدواژههای انگلیسی مقاله |
Dental caries, Fissure sealants, Health plan, Implementation Iran, Topical fluorides, IntroductionIran&apos,s Health Reform Plan (IHRP) is a national program approved and started in May 2014 to improve accessibility and quality of state health services comprehensively [ 1, ]. It started with focus on general health promotion, prevention, and hygiene. Given the close relationship between oral health and general health and the impact of oral health on general health [ 2, - 5, ], the Oral Health Reform Plan (OHRP) was added to the IHRP at the beginning of 2015 [ 6, ]. OHRP intend to improve oral health by providing education, prevention, and treatment services to target groups. Children under 14 years of age, pregnant women, and lactating mothers were the main groups to receive packages of dental services. Thousands of dentists, dental hygienists, and other trained auxiliaries were recruited to provide these services in two levels. Fluoride therapy, fissure sealant for first permanent molars, and restorative treatments for primary school children were part of these services and were provided free [ 7, , 8, ]. The first level was provided in ",Health Houses", in rural areas and ",Health Posts", in urban areas, and the next level services were provided in ",Health Centers",, all being part of Primary Health Care (PHC) Network [ 9, ].Tooth decay is one of the most common oral diseases and has serious consequences for individuals and society, such as pain, dysfunction of the oral system and a decrease in the quality of life, the cost of treatment for the community and the loss of productivity of the individuals [ 10, ]. Studies conducted in different regions of Iran indicate a high prevalence of dental caries among young children and its significant differences among different regions of the country and between rural and urban areas [ 9, - 11, ]. The DMFT (decayed teeth, missing teeth due to caries, and filled teeth due to caries) Index of 12-year-old children was reported as 2.09 in 2012. The DMFT Index for age groups of 5-6, 15, 35-44, and 65-74 year olds were 5.16, 3.29, 13.20 and 25.71, respectively [ 9, ]. Scientific evidence shows that performing fluoride therapy and fissure sealant therapy are effective ways to prevent and stop dental caries [ 12, , 14, ]. These two services were highly appreciated by the OHRP authorities. The main outcome of the OHRP was reported to be the reduction of dental caries among primary school children due to the application of fissure sealant and topical fluoride. Department of Oral Health of the Iran&apos,s Ministry of Health has reported that the DMFT Index of 12-year-old children in Iran declined from 2.09 in 2012 to 1.84 in 2016, after implementation of OHRP [ 15, ].Regular assessment of the OHRP is essential for assessing its efficiency and effectiveness, and helps identify the strengths and weaknesses of this program. In addition, the evaluation of this program can provide valuable evidence for health-care providers to take measures such as the continuation of the program or making corrective changes in the program. In this regard, a one-year evaluation of the fissure sealant program was conducted by the dental public health department of Shiraz Dental School in 2016 [ 16, ]. The success rate of fissure sealant in this one-year evaluation was low (only 47%) and many factors affected the quality of fissure sealants including the type of clinicians who applied the fissure sealant and the type of fissure sealant materials. The authors suggested the necessity of quality and quantity assessment of the program to achieve better results regarding the reduction of dental caries [ 16, ]. On the other hand, the increasing costs of health systems around the world have become one of the main concerns of managers and decision makers of health systems. The health system of Iran, like other countries, is faced with the challenge of rising costs. The implementation of the IHRP has led to an increase of about two times the tariffs for health care services, which put a large financial burden on health insurance organizations [ 17, ]. High cost is a major challenge to health promotion [ 18, ]. In OHRP, a large budget has been spent for infrastructure reconstruction of state dental centers, provision of equipment and dental materials, and the supply of human resources.So far, little evidence exists regarding the efficacy and the effectiveness of the OHRP on the reduction of dental caries. The current study was designed to assess the possible changes in DMFT among six-grade primary school children of Shiraz two years after implementation of OHRP. Shiraz is the largest and most populated city in the south of Iran and has been one of the main centers of OHRP. Materials and MethodA repeated cross-sectional study was conducted on sixth grade school children of the city of Shiraz in 2015 and 2017. Children were selected by cluster randomization sampling. The schools were randomly selected from three socioeconomically different types of schools including private schools, state schools in affluent areas, and state schools in deprived areas. Schools for children with special needs were not included. Ethical permission was obtained from the Ethical Committee of Shiraz University of Medical Sciences (SUMS) (# 1396-01-03-16434) and the educational head office of Fars province (# 97/2450793). In each selected school, all children aged between 12 years and zero months to 12 years and 11 months were included. The process of choosing schools and children was continued until 400 children were selected in 2015 and the same was repeated in 2017. Written consent forms were sent to their parents ahead of the examination day. Children whose parents did not provide written consent, or did not cooperate during the examinations, and those identified with systemic syndromes or diseases that could affect the DMFT Index were excluded from the study. Examinations were conducted in schools, in rooms other than the classroom (usually Health or Nursing Room) by a group of six calibrated final year dental students under supervision of a university lecturer. Students were called to the examination room one by one and were given the necessary explanations. The students were examined on a regular seat while their head was leaning against the back of the chair or wall, using headlight, disposable mirror, tongue blade, and disposable gloves. World Health Organization&apos,s recommended chart and criteria to record DMFT for screening studies were used [ 19, ]. After descriptive assessment of the DMFT Index and its components (D, decayed tooth, M, missing due to caries, F, filling due to caries), one-way ANOVA test was used to assess the possible differences among the three socioeconomically groups. This was done in each assessment year separately. In addition, Poisson regression tests were used to assess the changes in DMFT, DT, MT, and FT from 2015 to 2017. The IBM SPSS Software (version 22) was used for data analysis. The significance level was set at &,alpha = 0.05.ResultsA total of 363 six-grade schoolchildren were included in the final analysis in 2015 (response rate= 91%), and 398 were included in 2017 (response rate= 99%). The descriptive statistics of DMFT and its components are given in Table 1,.YearSchool typeDTMTFTDMFT2015Private0.99 (&,plusmn 1.30)1.14 (&,plusmn 1.61) p*,=0.0520.00 (&,plusmn 0.00)0.02 (&,plusmn 0.25) p*,=0.030&,dagger 0.37 (&,plusmn 0.96)0.31 (&,plusmn 0.88) p*,=0.016&,dagger 1.35 (&,plusmn 1.55)1.47 (&,plusmn 1.83) p*,=0.647State in affluent areas0.87 (&,plusmn 1.55)0.10 (&,plusmn 0.56)0.54 (&,plusmn 1.00)1.49 (&,plusmn 2.04)State in deprived areas1.35 (&,plusmn 1.82)0.01 (&,plusmn 0.11)0.19 (&,plusmn 0.73)1.55 (&,plusmn 1.96)2017Private0.54 (&,plusmn 1.20)0.81 (&,plusmn 1.51)p*,=0.1410.00 (&,plusmn 0.00)0.03 (&,plusmn 0.22) p*,=0.1290.54 (&,plusmn 1.17)0.46 (&,plusmn 1.01) p*,=0.013&,dagger 1.09 (&,plusmn 1.68)1.29 (&,plusmn 1.79) p*,=0.278State in affluent areas0.86 (&,plusmn 1.50)0.02 (&,plusmn 0.17)0.54 (&,plusmn 1.07)1.42 (&,plusmn 1.79)State in deprived areas0.95 (&,plusmn 1.75)0.06 (&,plusmn 0.38)0.19 (&,plusmn 0.62)1.20 (&,plusmn 1.91)Significance level Comparing 2015 and 2017p**,&,lt 0.001&,dagger ,p**,=0.782p**,=0.002&,dagger ,p**,=0.048&,dagger ,*p, Significance level of the difference among three socioeconomically different schools **p, Significance level of the difference between 2015 and 2017 measurements &,dagger ,Statistically significant at &,alpha = 0.05 |