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HYGIENE TRIBUNE
The World’s Dental Hygiene Newspaper · U.S. Edition
February 2012 — Vol. 5, No. 2
www.dental-tribune.com
Fluoridated salt used in
global fight against caries
Aide Odontologique Internationale is working in developing nations
to simultaneously address iodine deficiency disorders and dental caries
By Patricia Anne Walsh, RDH, BS
Most dental professionals in the United
States are unaware that globally, fluoridated salt has significantly reduced the caries rate in many developing nations. Full
effectiveness relies on the salt reaching
consumers by several different channels.
Fluoride salt can be used in homes, but it
is also distributed to restaurant kitchens,
school canteens, hospitals, bakeries and
large bread factories. Fluoridation of salt
destined for human consumption has
been used in Switzerland since 1955. Since
1986 an increasing number of countries,
now approximately 15 and mainly in Europe, have adopted salt fluoridation strategies.
Farmers in Southeast Asia make salt on
fields that have been used for centuries.
The brine (saltwater) is poured on fields
and left for several days until much of
the water has evaporated and salt crystals
remain. The crystals are then scraped up
and carried to warehouses, typically constructed of wood, which hold an average
of 2,000 tons of salt. In large production
plants where continuous processing of
salt is common, the procedure is to spray
a dosed concentrated fluoride solution
through a nozzle onto the salt passing on
the conveyor belt below. In some countries one-ton mixers (customarily used for
mixing animal feed) are used to add the
fluoride.
The University of Health Sciences Laos
Patricia Walsh, RDH,
BS, has been a clinical
dental hygienist for
more than 20 years.
She is a graduate of the
Fones School of Dental
Hygiene, University of
Bridgeport (Conn.). She
has an extensive history in international volunteer work in oral
health. She was instrumental in the creation
of The Thailand Dental
Project, a volunteer
program focused onproviding educational,
preventive and restorative dental care to children in a
tsunami affected region of Thailand. She may be contacted at pwalshrdh@uberhygienist.com.
launched an iodine fluoride program this
past April. Health officials have estimated
that the addition of iodine and fluoride
would contribute to the prevention of iodine deficiency disorders and prevent dental caries.
Aide Odontologique Internationale (AOI)
is a non-governmental organization working with dentists in Laos and Cambodia. In
developing nations, AOI seeks to improve
oral health by working concurrently with
ministries of health, the World Health Organization and UNICEF.
Iodine is an essential micronutrient that
is necessary for the normal functioning
and development of the brain and body.
Children born into households where io-
dized salt is not consumed are at risk of developing mental and physical disabilities.
Major challenge in Cambodia
Dental caries is a major public health
threat in Cambodia. Unfortunately, there
are serious issues of quality control and
sustainability that, to date, have prevented the availability of fluoridated salt to
Cambodian consumers. One study, found
the Cambodian childhood caries experience to be very high. Only 36 percent of
children aged 1–4 years and 4 percent of
those aged 5–6 years were caries free. Only
15 percent of mothers reported bottle” See SALT, page C2
Latest 'Pros in the Profession' winner named
Kareen Wilson, RDH, recognized for exceptional daily service at home and on international missions
Crest® Oral-B® congratulates Kareen
Wilson, RDH, of Bloomfield, Conn., as
the third winner of the brands’ second
annual Pros in the Profession® award
program, which honors registered dental hygienists who go above and beyond
the call of duty every day. After careful
consideration of a pool of qualified candidates, a panel of judges selected Wilson for the award based on her commitment to the oral health of not only her
patients, but also those in countries who
do not have access to proper oral health
care.
Wilson has been practicing dental hygiene for more than 15 years, holding a
Bachelor of Science degree from Loma
Linda University. She is part-owner of
the family practice where her husband
practices dentistry.
Starting in 2004, Wilson realized her
true calling when she first joined mission trips to the Dominican Republic and
Peru with several other medical professionals, witnessing the drastic need for
better oral health care in these countries
and other parts of the world. Driven by
that experience, Wilson helped start the
Bethesda Medical Mission (BMM), a nonprofit organization dedicated to offering
free health services to enrich the lives of
Kareen Wilson, RDH Photo/Crest Oral-B
global citizens who are less fortunate.
Serving an active role on the Board of
Directors of BMM, Wilson joins a band
of pediatricians, psychologists and general practitioners who facilitate mission
trips to territories covering the Caribbean, Africa, Central America and South
America. This year, Wilson will be joining BMM on its second mission trip to
Haiti.
Wilson’s passion for improving oral
health in foreign countries is carried
with her each day in her profession as
well. She is committed to educating her
patients about whole-body wellness
and the correlation between their oral
health and overall health. With the help
of some of her favorite dental products,
Wilson strives to keep her patients bacteria-free and is always thrilled to see
the results of her work in patients both
inside her dental practice and in other
parts of the world.
Throughout the year, three other deserving professionals will join Wilson,
Donna Caminiti of Springfield, Ill., and
Julie Wells Kroeker of McAllen, Texas, as
this year’s Crest Oral-B Pros in the Profession winners.
Winners will receive a $1,000 monetary prize, recognition at a special
award cocktail reception at RDH’s Under
One Roof 2012 in Las Vegas, a recognition plaque, tribute in dental trade media news announcements and on the
website www.dentalcare.com, and an
exclusive trip to Proctor and Gamble
headquarters. So those who know worthy “Pros” like Wilson should help give
those individuals the recognition they
deserve by nominating them today.
Nominations will be accepted through
April 2012 at www.prosintheprofession.
com or at the Crest Oral-B booth at upcoming dental conventions.
Nominations should be submitted by
dentists, fellow hygienists, dental assistants, professional colleagues and other
collegiate colleagues.
Submitted nominations should convey why the nominee is a true pro. Nominees must meet the following criteria:
• Registered dental hygienists with
two-plus years of practice experience
after graduation from dental hygiene
school.
• Registered dental hygienists with
community service involvement.
• General volunteer/non-oral healthspecific examples are welcome, but oral
health-related volunteer experience is
preferred.
• Registered dental hygienists with
examples of work that go above and beyond the call of duty. Examples include:
excellent patient relations/special care/
retainment; involvement in research
and/or clinical experience; published
work(s); and the ability to generate additional business for their practice.
To learn more about Wilson, the other
winners and the Pros in the Profession
program — including how to nominate a
Pro for consideration — visit the website
www.prosintheprofession.com.
(Source: Crest Oral-B)
[2] =>
c2
News
Hygiene Tribune U.S. Edition | February 2012
'Give Kids A Smile' turns 10 H
YGIENE TRIBUNE
The American Dental Association (ADA)
shines a light on dental health for children
during February, marking the 10th anniversary of its Give Kids A Smile program as
well as its annual National Children’s Dental Health Month.
Give Kids A Smile is the ADA’s signature
access program designed to encourage parents, health professionals and policymakers to address the year-round need for oral
health care for all children.
Every year, jthousands of dentists and
their dental team members provide free
oral health care services to children from
low-income families across the country.
“The ADA thanks and celebrates all of the
dentists and dental team members who
donate their time to host or participate
in Give Kids A Smile programs, but we all
know that the real celebration can’t begin
until the epidemic of untreated dental disease is cured,” said ADA President Dr. William R. Calnon. “More than 16 million children have tooth decay, which is 16 million
too many.
The Give Kids A Smile program would not
be possible without volunteers and continued generous support of sponsors Henry
Schein Dental, which donated professional
dental products, Colgate-Palmolive Co.,
which donated consumer dental products,
and DEXIS, which donated the use of its
digital X-ray systems and the expertise of
its staff to assist dental schools, state dental
associations and large-group dental practices with their Give Kids A Smile events.
For more information about Give Kids
A Smile, visit www.givekidsasmile.ada.org,
and for the latest news, visit the Facebook
page, www.facebook.com/GiveKidsASmile.
(Source: American Dental Association)
Publisher & Chairman
Torsten Oemus t.oemus@dental-tribune.com
Chief Operating Officer
Eric Seid e.seid@dental-tribune.com
Group Editor
Robin Goodman r.goodman@dental-tribune.com
Editor in Chief Dental Tribune
Dr. David L. Hoexter d.hoexter@dental-tribune.com
Managing editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Managing Editor
Sierra Rendon s.rendon@dental-tribune.com
Managing Editor
Robert Selleck r.selleck@dental-tribune.com
Managing Editor Show Dailies
Kristine Colker k.colker@dental-tribune.com
◊ SALT, page C1
feeding, but 70 percent of such mothers
used sweetened canned milk in the bottle.
Oral hygiene was rated as poor in 80 percent of children and only 10 percent were
reported to use a toothbrush. Forty three
percent of children were reported to have
experienced toothache, but only 5 percent
had been to a dentist.
Dr. Francois Courtel, AOI director in
Cambodia, said, “In Cambodia, a feasibility study in 2010 showed that the situation was not favorable for starting salt
fluoridation. The main association of salt
producers is not willing to start fluoridation because they have to deal with iodine
and realize that it is more costs for them.
There are many small artisanal producers and boilers; the technology they use
for mixing salt and iodine is not safe and
professional. It was decided by the ministry of health not to start introduction of
fluoride at this time. Maybe in the future,
if the situation improves, that will be reconsidered.”
Fluoridation of water supplies has proven to be an effective preventive measure
for dental caries. Many developing countries in the Americas have multiple water
systems rather than centralized sources.
Struggling economies may not permit the
viable application of this fluoridation approach.
Some of the highest dental caries prevalence in the world is evident in the Americas. Fluoridated salt was considered as a
potential solution because of the urgent
need for dental caries prevention in millions of people with limited access to routine dental services.
Early success in Columbia
A fluoridated salt trial was initiated in Columbia (1963) and upon successful completion with preventive results comparable to water fluoridation, the approach
was introduced to other countries and
was supported by resolutions of the World
Health Organization, the Pan American
Health Organization, regional health
groups and the World Dental Federation.
The procedures for addition of fluoride
were comparable to those for iodization.
Result, based on addition of F ion at 200–
250 mg/kg salt, indicated caries prevalence reductions in 12 year olds ranging
from 84 percent in Jamaica and 73 percent
in Costa Rica to 40 percent in Uruguay at
an average cost of US$0.06/capita/year.
Prior to establishing a salt fluoridation
program, health workers determine if
there is any naturally occurring fluoride
Farmers in Southeast
Asia make salt on
fields that have been
used for centuries.
Product & Account Manager
Mark Eisen m.eisen@dental-tribune.com
Marketing Manager
Anna Kataoka-Wlodarczyk
a.wlodarczyk@dental-tribune.com
Sales & Marketing Assistant
Lorrie Young l.young@dental-tribune.com
Photos by Aide
Odontologique
Internationale
C.E.Manager
Christiane Ferret c.ferret@dtstudyclub.com
Dental Tribune America, LLC
116 West 23rd St., Ste. #500
New York, N.Y. 10011
(212) 244-7181
One of the two
fluoridated-salt
trucks in Laos,
operated by Aide
Odontologique
Internationale,
replete with
advertising.
in the water supply via sample collection.
In addition to maintaining important
sanitary considerations, the consistency
of proper levels of fluoride added to the
salt must be monitored as well. Sodium
fluoride or potassium fluoride is added
in accordance with whether a dry or wet
production method is used. Standardized
epidemiological surveillance is needed
after the fluoridated salt is made available to the public. Both open-mouth and
urinary fluoride evidence has been used
in the past to monitor a program’s safety
and efficacy.
We can conclude that individuals in developing nations are at a far greater risk
for debilitating dental disease then they
are for fluorosis after the implementation
of fluoridated salt usage. Salt is a naturally
occurring part of our human existence. It
is essential to our health and development.
Universally consumed, its risk of overdose
is minimal as everyone eats a predictable
amount. Additional additives are being
looked at by the World Health Organization to prevent malaria and other infectious disease in impoverished nations.
When addressing the problem of increasing dental disease in developing nations, it is obvious that strengthening the
local health structure is required first. We
then need to ask ourselves how to have
the maximum effect in these low-income
countries. Fluoride toothpaste, rinses, varnish applications and supplements may
have proven themselves in the West, but
they are not universally affordable.
While Laos has seen fluoridated salt
Published by Dental Tribune America
© 2012 Dental Tribune America, LLC
All rights reserved.
The Aide Odontologique
Internationale/UNICEF
quality seal for fluoridated
salt.
production for a year now, its neighbor
Cambodia has not yet found the financial
means to assist in reducing the suffering
from dental disease. The rural children
of Cambodia are extremely poor. In this
country, one in 14 individuals is an orphan. There is little food to eat, and there is
a complete lack of basic sanitation, medical/dental services and education. Child
exploitation and child labor are the norm.
Fluoride salt production assists sustainable economic development and is an effective management of natural resources.
When I travelled from Thailand to Cambodia the difference in household wealth
was hugely apparent in the rural areas. My
cheery ‘tuk tuk’ (taxi driver) spoke enthusiastically about how oil was just found
off the Cambodian shore. He was gleeful
that soon prosperity would be coming to
his nation. My thoughts turned to all the
sovereignty and political disputes over
islands in the South China Sea. I hoped
he was right. I prayed he was right. But I
would rather have taken what he said with
a grain of fluoridated salt.
˙
1.
2.
3.
4.
5.
6.
References
International Dental Journal (2005)
55,351–358 TM Marthaler, PE Petersen
Ibid
UNICEF Media advisory 16 Oct 2003
Int J Paediatr Dent 1994 Sep 4(3) 173–8 PMID
7811672
PAHO Tool-kit for decision makers, health
planners, legislators, epidemiologists and
health care workers
Kidservices.org, Dr. Robert Renner, KIDS International Dental Services
Dental Tribune strives to maintain the utmost accuracy in its news and clinical reports. If you find a
factual error or content that requires clarification,
please contact Managing Editor Robert Selleck at
r.selleck@dental-tribune.com.
Dental Tribune cannot assume responsibility for the
validity of product claims or for typographical errors.
The publisher also does not assume responsibility for
product names or statements made by advertisers.
Opinions expressed by authors are their own and
may not reflect those of Dental Tribune America.
Editorial Board
Dr. Joel Berg
Dr. L. Stephen Buchanan
Dr. Arnaldo Castellucci
Dr. Gorden Christensen
Dr. Rella Christensen
Dr. William Dickerson
Hugh Doherty
Dr. James Doundoulakis
Dr. David Garber
Dr. Fay Goldstep
Dr. Howard Glazer
Dr. Harold Heymann
Dr. Karl Leinfelder
Dr. Roger Levin
Dr. Carl E. Misch
Dr. Dan Nathanson
Dr. Chester Redhead
Dr. Irwin Smigel
Dr. Jon Suzuki
Dr. Dennis Tartakow
Dr. Dan Ward
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