DENTAL HEALTH PROGRAM

Oral disease continues to be a serious public health problem in the Philippines. The prevalence of dental caries on
permanent teeth has generally remained above 90% throughout the years. About 92.4% of Filipinos have tooth decay
(dental caries) and 78% have gum diseases (periodontal diseases) (DOH, NMEDS 1998). Although preventable,
these diseases affect almost every Filipino at one point or another in his or her lifetime.

 
           Table 1: Prevalence of the Two Most Common Oral Diseases by Year, Philippines

Prevalence
YEAR
Dental Caries Peridontal Disease
1987 93.9% 65.5%
1992 96.3% 48.1%
1998 92.4% 78.3%

           The oral health status of Filipino children is alarming. The 2006 National Oral Health Survey (Monse B. et al,
NOHS 2006) investigated the oral health status of Philippine public elementary school students. It revealed that
97.1% of six-year-old children suffer from tooth decay. More than four out of every five children of this subgroup
manifested symptoms of dentinogenic infection. In addition, 78.4% of twelve-year-old children suffer from dental
caries and 49.7% of the same age group manifested symptoms of dentinogenic infections. The severity of dental
caries, expressed as the average number of decayed teeth indicated for filling/extraction or filled permanent teeth
(DMFT) or temporary teeth (dmft), was 8.4 dmft for the six-year-old age group and 2.9 DMFT for the twelve-year-old
age group (NOHS 2006).

          Table 2 - Dental caries Experience (Mean DMFT/dmft), per age groups, Philippines

Age in Years NMEDS 1982 NMEDS 1987 NMEDS 1992  NMEDS 1998  NMEDS 2006
6 8.4 dmft
12 6.39 5.52 5.43 4.58 2.9
15-19 8.51 8.25 6.3
35-44 14.18 14.82 14.42 15.04

               Filipinos bear the burden of gum diseases early in their childhood. According to NOHS, 74% of twelve-year-
old children suffer from gingivitis. If not treated early, these children become susceptible to irreversible periodontal
disease as they enter adolescence and approach adulthood.

              In general, tooth decay and gum diseases do not directly cause disability or death. However, these
conditions can weaken bodily defenses and serve as portals of entry to other more serious and potentially dangerous
systemic diseases and infections. Serious conditions include arthritis, heart disease, endocarditis, gastro-intestinal
diseases, and ocular-skin-renal diseases. Aside from physical deformity, these two oral diseases may also cause
disturbance of speechsignificant enough to affect work performance, nutrition, social interactions, income, and self-
esteem.            Poor oral health poses detrimental effects on school performance and mars success in later life. In
fact, children who suffer from poor oral health are 12 times more likely to have restricted-activity days (USGAO 2000).
In the Philippines, toothache is a common ailment among schoolchildren, and is the primary cause of absenteeism
from school (Araojo 2003, 103-110). Indeed, dental and oral diseases create a silent epidemic, placing a heavy
burden on Filipino schoolchildren.
          VISION:             Empowered and responsible Filipino citizens taking care of their own personal oral health for
an         
enhanced quality of life

          MISSION:         The state shall ensure quality, affordable, accessible and available oral health care delivery.

          GOAL:               Attainment of improved quality of life through promotion of oral health and quality oral health
care.     

OBJECTIVES AND TARGETS:

1.      The prevalence of dental caries is reduce         

Annual Target : 5% reduction of the prevalence rate every year

2.      The prevalence of periodontal disease is reduced

Annual Targets : 5% reduction of the prevalence rate every year

3.      Dental caries experience is reduced

Annual Target : 5% reduction of the mean dmft/DMFT for 5/6 years old and 12 years old children every year

4.      The proportion of Orally Fit Children (OFC) 12-71 months old is increased                       

Annual Targets : Increased by 20% yearly        

            The national government is primarily tasked to develop policies and guideline for local government units. In
2007, the Department of Health formulated the Guidelines in the Implementation of Oral Health Program for Public
Health Services (AO 2007-0007). The program aims to reduce the prevalence rate of dental caries to 85% and
periodontal disease by to 60% by the end of 2016. The program seeks to achieve these objectives by providing
preventive, curative, and promotive dental health care to Filipinos through a lifecycle approach. This approach
provides a continuum of quality care by establishing a package of essential basic oral health care (BOHC) for every
lifecycle stage, starting from infancy to old age.

            The following are the basic package of essential oral health services/care for every lifecycle group to be
provided either in health facilities, schools or at home.

TYPES OF SERVICE
LIFECYCLE
(Basic Oral Health Care Package)
 Oral Examination
 Oral Prophylaxis (scaling)
Mother(Pregnant
Women) **  Permanent fillings
 Gum treatment
 Health instruction
 Dental check-up as soon as the first tooth erupts
Neonatal and Infants
under 1 year old**  Health instructions on infant oral health care and advise
on exclusive breastfeeding
Children 12-71 months  Dental check-up as soon as the first tooth appears and
 every 6 months thereafter
 Supervised tooth brushing drills
 Oral Urgent Treatment (OUT)

              - removal of unsavable teeth

old     **               - referral of complicated cases

              - treatment of post extraction complications

              - drainage of localized oral abscess

 Application of Atraumatic Restorative Treatment    (ART)

 Oral Examination
 Supervising tooth brushing drills
School Children (6-12  Topical fluoride theraphy
years old)  Pits and Fissure Sealant Application
 Oral Prophylaxis
 Permanent Fillings
 Oral Examination
Adolescent and Youth  Health promotion and education on oral hygiene, and
(10-24 years old)** adverse effect on consumption of sweets and sugary
beverages, tobacco and alcohol
 Oral Examination
Other Adults (25-59  Emergency dental treatment
years old)  Health instruction and advice
 Referrals
 Oral Examination
 Extraction of unsavable tooth
Older Person (60 years
old and above)**  Gum treatment
 Relief of Pain
 Health instruction and advice

STRATEGIES AND ACTION POINTS:

1.  Formulate  policy and regulations to ensure the full implementation of OHP

     a. Establishment of effective networking system (Deped, DSWD, LGU, PDA, Fit for School, Academe and others)

     b. Development of policies, standards, guidelines and clinical protocols 

          - Fluoride Use

          - Toothbrushing

          - Other Preventive Measures

2. Ensure financial access to essential public and personal oral health services

      a. Develop  an outpatient benefit package for oral health under the NHIP of the government
      b. Develop financing schemes for oral health applicable to other levels of care ( Fee for service, Cooperatives,
Network with HMOS)

      c. Restoration of oral health budget  line item in the GAA of DOH Central Office

3. Provide relevant, timely and accurate information management system  for oral Health.

      a. Improve existing  information system/data collection (reporting and recording dental services and
accomplishments )

           - setting of essential indicators

           - development of IT system on recording and reporting oral health service accomplishments and indices

           - Integrate oral health  in every family health information tools, recording books/manuals

      b. Conduct Regular Epidemiological Dental  Surveys – every 5 years 

4. Ensure access and delivery of quality oral health care servicesa.

      a. Upgrading of facilities, equipment, instruments, supplies

      b. Develop packages of essential care/services for different groups (children, mothers and marginalized groups)  

           -revival of the sealant program for school children

          - toothbrushing program for pre-school children

          - outreach programs for marginalized groups

      c. Design and implement grant assistance mechanism for high performing LGUs 

          - Awards and incentives

          - Sub-allotment of funds for priority programs/activities

       d. Regular conduct of consultation meetings, technical updates and  program implementation reviews with
stakeholders

5. Build up highly motivated health professionals and trained auxilliaries to manage and provide quality oral
health care

       a. Provision of adequate dental personnel

       b. Capacity enhancement programs for dental personnel and non-dental personnel

Current FHSIS Indicators/parameters:

             a)      Orally Fit Child (OFC)– Proportion of children 12-71 months old and are orally fit during a given point
of time. Is defined as a child who meets the following conditions upon oral examination and/or completion of
treatment a) caries- free or carious tooth/teeth filled either with temporary or permanent filling materials, b) have
healthy gums, c) has no oral debris, and d) No handicapping dento-facial anomaly or no dento-facial anomaly that
limits normal function of the oral cavity

            b)      Children 12-71 months old provided with Basic Oral Health Care (BOHC)

            c)      Adolescent and Youth (10-24 years old) provided with Basic Oral Health care (BOHC)

            d)      Pregnant Women provided with Basic oral Health Care (BOHC)

            e)      Older Persons 60 years old and above provided with Basic Oral Health Care (BOHC)

Policy/Standards/Guidelines formulated/developed:

             a.      AO. 101 s. 2003 dated Oct. 14, 2003 – National Policy on Oral Health

             b.      AO 2007-0007 – Dated January 3, 2007 Guidelines In The Implementation Of Oral Health Program For
Public Health Services In The Philippines

             c.       AO 4-s.1998 – Revised Rules and Regulations and Standard Requirements for Private School Dental
services in the Philippines

             d.      AO 11-D s. 1998 – Revised Standard Requirements for Hospital Dental services in the Philippines

             e.      AO 3 s. 1998 - Revised Rules and Regulations and Standard Requirements for Occupational Dental
services in the Philippines

             f.        AO 4-A s. 1998 – Infection Control Measures for Dental Health Services

Trainings/Capacity Enhancement Program:

a.      Basic Orientation Course on Management of Public Health Dentist

      The training program was designed with the Public Health Dentists (PHDs) as the main recipients of the Basic
Course on the Management of Oral Health Program.  The training is expected to provide an in-depth understanding
of the different roles and functions of the PHDs in the management and delivery of Public Health Services. A training
module was developed for the basic course.

Researches:

a.      National Monitoring Evaluation Dental Survey (NMEDS).

The Department of Health (DOH) has been conducting nationwide surveys every five years (1977, 1982, 1987, 1992,
and 1998) to determine the prevalence of oral diseases in the Philippines. Data gathered provide continuous
information that enables planners to update data used in planning, implementation and evaluation of existing oral
health programs. The latest NMEDS was conducted in 2011. Results will be available on the 1st quarter of 2012.

 
Existing Working Group for Oral Health:

              National Technical Working Group (TWG) on Oral Health (DPO 2005-1197)

              Member Agencies:     Department of Health (NCDPC, HHRDB, NCHP)

                                    DOH- Center for Health Development for NCR, Central Luzon and Calabarzon

                                    Philippine Dental Association

                                    Department of Education

                                    Up- College of Public Health

                                    Department of Interior and Local Government

                                    Department of Social Welfare and Development

                                    Local Government Units ( Makati, Quezon City)

Print materials:

1.      Leaflets (Malakas ang dating Buo ang Ngipin) for Children, Adolescent, Pregnant Women and Older Person

2.       Training Module on Basic Course on Management of Oral Health Program

Non-Government Organization Major Partners:

                Philippine Dental Association

                Fit for School, Inc.

Program Managers/Coordinators:

                Dr. Anthony P. Calibo

               OIC-Division Chief, cHILD hEALTH  Development dIVISION

 Ms. . Lita Orbillo

               National Oral Health Program Coordinator

               Disease Prevention and Control Bureau

               Department of Health

               Manila, Philippines

               (632) 651-7800  loc. 1726-1728

               E-Mail : [email protected]