Stopping the Rot Early

Surveys have revealed that early childhood caries (ECC) is prevalent in Hong Kong, with more than half the children aged under five experiencing oral health problems. Professor Chu Chun-hung, Associate Dean (External Relations) of the Faculty of Dentistry, puts this down to lack of parental attention to good oral health, saying: “Children suffering from ECC often snack frequently and have not been taught effective oral hygiene practices. They are too young to brush their teeth properly, and their parents fail to assist them to brush. Many parents do not realise the importance of oral health and overlook the consequence of ECC.”

Left untreated, ECC will lead to serious tooth decay causing pain and infection, which starts locally but can spread systemically and affect the nutrition, general health, growth and development of the child. To tackle the situation, the Faculty of Dentistry launched the ‘Jockey Club Children Oral Health Project’, an outreach community programme sponsored by the Hong Kong Jockey Club Charities Trust.

“The service is free of charge and aims to promote oral health in infants by providing outreach dental services to more than 180,000 preschool children in more than 1,000 kindergartens in Hong Kong,” said Professor Chu. “It provides oral health education, dental screening and silver diamine fluoride (SDF) therapy to arrest – that is, stop and harden – ECC in kindergarten children.

“SDF solution effectively helps slow down tooth decay, and is safe to use in children causing no significant impact on general health. When SDF is applied to cavities it turns black, indicating that the active decay has been stopped successfully. It is widely used in countries such as the US, Australia and Japan.”

COVID-19 has hampered the team’s efforts a little. But, despite the suspension of kindergartens several times during 2019– 2020, the Faculty was able to deliver the service to 137 kindergartens. In 2020–2021, more than 700 schools have agreed to participate in the service.

Professor Chu is leading the project, alongside Professor Edward Lo Chin-man, Tam Wah- Ching Professor in Dental Science, and Professor Cynthia Yiu Kar-yung. “Professor Lo is a specialist in community dentistry. Professor Yiu is a specialist in paediatric dentistry and I am a specialist in family dentistry,” said Professor Chu. “We use our expertise to develop and monitor the service, while project manager Dr Tammy Duangthip, who has extensive clinical and administrative experience, works with eight full-time dentists and other supporting staff to implement it.”

Annual screening

With parental consent, the team provide annual dental screening, and topical application of SDF on caries of the children. An individual report on each child’s oral condition is sent to his/her parents after the dental screening, and each kindergarten receives a summary report about the general dental health of the children in their care.

“In addition, we educate the parents on oral health,” said Professor Chu. “Our dentists highlight the common dental problems of preschool children and the findings of the child’s oral health status. If a child has severe tooth decay, we arrange an individual consultation with the parents, aiming to help them improve the oral health of their child.”

The team also provide training for the kindergarten teachers through lectures and hands-on workshops to empower them to talk to the children about oral health. “It is important to involve kindergarten teachers and parents because they are important stakeholders in this service,” said Professor Chu.

All kindergartens invited

The Faculty of Dentistry began to develop the ‘Jockey Club Children Oral Health Project’ in September 2019, and in 2019–2020 invited selected kindergartens to participate. Then in September 2020, they made the decision to invite all kindergartens in Hong Kong to participate.

“Our team did an oral health survey in 2016, which found that over 55 per cent of five-year-old children had tooth decay,” said Professor Chu. “Similar to previous surveys, we found that more than 90 per cent of ECC went untreated. The prevalence and severity of the condition revealed that an outreach dental service was urgently needed to manage ECC in preschool children.

“We hope that the project will not only help with the immediate problem of remedying ECC in children, but also act as an introduction for these youngsters to dental services and be the starting point for a new mindset in Hong Kong’s communities, namely, to ensure lifelong oral health you must start from a very young age.”