Kazunari Kimoto * 1, 2 1 Division of Oral Health, Department of Health Science,

1. 30. Nov. 2006, Main Hall, Okayama University 50th Anniversary Hall 7th Congress of AAPD: Symposium II Part II: Spreading school-based fluoride mouth rinsing program (S-FMR) National survey on the school-based fluoride mouth rinsing program in Japan- Regional spread conditions in various kinds of schools - Kazunari Kimoto* 1, 2 1 Division of Oral Health, Department of Health Science, Kanagawa Dental College, Japan 2 Non-profit Japanese Conference on the Promotion of the Use of Fluoride in Caries Prevention, Japan (NPO-JPUF)

2. Background Background Sapporo Total population: 127,756,000 Children: 13,114,000 4-5 years old: 2,234,000 6-11 years old: 7,194,000 12-14 years old: 3,626,000 Sendai Niigata Tokyo Okayama Yokosuka Number of Dentists: 95,157(04 From Minister of Health, Labor and Welfare) To one million population by746 Dentists Number of Dental Hygienists: 79,695(04 From Minister of Health, Labor and Welfare) To one million population by624 Dental Hygienists Okinawa

3. Background Background Sapporo The mean DMFT at 12-year-old in 05 1.82 DT : 0.60, MT : 0.03, FT : 1.19 from Minister of Education, Culture, Sports and Technology Japan FT : 1.19 Sendai Niigata Tokyo Okayama Yokosuka In Japan, medical expenses insurance is on a piece-rate basis, national dental expenses/national income is 0.7%; ¥ 2,538 billion,04. The dental expenses insurance was included slightly preventive care. Unfortunately, certain dentists and dental hygienists give priority professional care in clinic and self care in home over public care. Okinawa

4. OtherfluorideusesatpresentinJapan: 1) Community water fluoridation; none except some natural areas (06) 2) Professional topical fluoride application in 1-14 years old; 59% (05 From Minister of Health, Labor and Welfare) 3) Fluoridated dentifrice in market share; 88% (05 From Lion Foundation of Dental Health) 4) Number of children in FMR at home in 4-14 years old (estimated data);347,000 (02 From Ando,et al) 5) FMR agents as over the counter drug (OTC); none for sale at present (30.Nov.06)

5. Thegoalsto2010inJapanbyNPO-JPUF: 1) Community water fluoridation; realizing in some areas 2) S-FMR;Number of children will be increased to 1,000,000 3) Fluoridated dentifrice in market share; more than 90% (88% in 05) ⇨realized ?! 4) Professional topical fluoride application; more than 60% (59% in 05) ⇨realized ?!

6. Purpose 1) Follow up the spreading conditions of the school- based fluoride mouth rinsing program (S-FMR) since 1970. 2) Estimate the total number of schools and children participating in the S-FMR for proposition regard- ing final assessment of Healthy Japan 21 in 2010. 3) Set up the next goal, and promote the fluoride uses throughout Japan.

7. Materials and Methods Data were collected by questionnaire regarding the schools and children participatingintheS-FMR,fi-nancial support for the S-FMR, frequencyofrinsing, mouthrinsingagentandfluorideconcentrationinthe rinsing solution. Questionnairesweresenttothekeypersonsand dentists of NPO-JPUF by mail or e-mail nearly every two years. Additionally, the estimating number in 2010 were determinedusingsimple regression analysis and/or polynominal regressionanalysisonthe basisof thedatafrom 1994 to 2002, by Stat View 5.0.

8. Table 1 The contents of the questionnaire for the S-FMR in Japan 1)Numberofschoolsparticipatingbygradelevel 2)Numberofchildrenparticipatingbygradelevel 3)Sources of financial support 4)Frequency of rinsing per week 5)Type of rinsing solutions (Mouth rinsing agent for use) 6)Fluoride concentration of rinsing solution

9. Year Number of prefectures Year Number of prefectures Year Number of prefectures 1970 1 1982 18 1994 35 1972 3 1983 20 1996 38 1974 6 1985 23 1998 39 1976 10 1987 26 2000 38 1978 15 1990 29 2002 40 1980 16 1992 32 2004 45 Table 2 Number of prefectures adopted the S-MFR during the past 35 years 200547

10. (Schools) 10,000 8,000 6,000 4,000 2,000 0 Number of schools Number of children (Children) 600,000 400,000 200,000 0 Fig. 1 The changes on the number of schools and children in the S-FMR by nearly every two year ◆ Children Schools  83  85  87  90  92  94  96  98  00  02  04  06

11. (Schools) (Children) 800 600 400 200 0 80,000 60,000 40,000 20,000 0 (Children) (Schools) (Children) (Schools) The 1st: Niigata Pref. The 2nd:Aichi Pref. The 3rd: Shizuoka Pref. The 4th: Saga Pref. 50% 80% * * ** ** 58 1518 47 1 Rank of Prefecture (according to number) Fig. 2 Number of schools and children in the S-FMR in 2006 (Regional difference in 47 prefectures)♯♯These data must be adjusted by difference of prefectural population, attending to 2 profiles were not adjusted in this figure. * Total number of rank from the tothe5th(orthe 8th) amounts to 50% of the precedence. **Total number of rank from the tothe15th(orthe18th)amounts to 80%oftheprecedence. 1st 1st

12. 2nd phase (2002 - 2006)1st phase (1983 - 2000) 00 The turning point: 2000 - 2002 1999: The Synthetic opinion of fluoride application by Japanese Association for Dental Science 2000: The Recommend of fluoride application in Healthy Japan 21 by Minister of Health and Welfare Japan The Technological support for community water fluoridation by Minister of Health and Welfare Japan The Strategy of regional project in prefectural Healthy Japan 21 2002:The Scientifically support for fluoride application by Japanese Society for Dental Health 2003:The Guideline for fluoride mouth rinse by Minister of Health, Labor and Welfare Japan (reorganization:01) Publication of The fluoride mouth rinse practical manual for caries prevention by research meeting of fluoride application

13. Table 3 Number of schools and children participating, therateoffinancialsupportintheS-FMRbygradelevel Number of Number of Financial support schools children Governmentsetc.*/The others** Grade level 3,313 (9.1%)***143,413 (6.4%)****84.1 % / 15.9 % 1,528 (6.6%) 300,912 (4.2%)89.2 % / 10.8 % 262 (2.4%) 45,508 (1.3%) 90.7 % / 9.3 % 28 (2.8%) 1,501 (2.7%) 34.8 % / 65.2 % 5,131 (7.2%) 491,334 (3.8%) 85.5 % / 14.5 % Nursery school & Kindergarten Primary school Secondary school Special school, etc. ♯ Total * The prefectural or municipal governments and/or educational committee ** The others (School, Parent, Dental Association, Jointed combination, etc.) 　 *** Number of schools in the S-FMR / Total schools by grade level in Japan 　 　 **** Number of children in the S-FMR / Total children by grade level in Japan ♯ The school for physically handicapped or mentally related children and the others

14. Table 4 Outline of the rinsing-methods in the questionnaire for the S-FMR by grade level (%) Frequencyperweek*Fluorideconcentration*S-FMRagentforuse 5 times / once 225ppmF / 450ppmF / 900ppmF Reagents / Medicaments Grade level Nursery school & Kindergarten Primary school Secondary school Special school, etc.♯ Total 58.0 / 26.4 48.4 / 27.7 / 17.3 38.9 / 61.0 6.1 / 91.1 5.1 / 24.1 / 69.5 67.6 / 32.4 8.5 / 87.3 4.7 / 17.5 / 76.876.2 / 23.8 41.7 / 37.5 15.8 / 36.8 / 42.1 48.0 / 52.0 40.9 / 47.8 33.2 / 26.2 / 35.9 48.9 / 51.1 *These are not the approximate value, because the rinsing-methods in the S-FMR are different by regional distinction. ♯ The school for physically handicapped or mentally related children and the others

15. In Japan, anti-fluoridationists commonly want to apply a statement in the WHO technical report. Go ahead !! Announcing by NPO-JPUF, “ Beginning of fluoride mouth rinse is recommended for Japanese(or Asian) children in 4-5 years old.” Tending to mislead by WHO statement “ FMR was not recommended for children below 6 years old, as it might contribute to the risk of dental fluorosis ??????????????? ” (Fluoride and Oral Health, WHO, 1994)

16. USA, Canada, South America, Australia, Europe and Asia (Malaysia, Singapore, Hong Kong, Korea, Thailand, China, Laos and the others) where fluoride is enough supply In Japan, fluoride use is limited to topical application, none Community Water Fluoridation S-FMR ( only 3.8% of children ) + Fluoridated dentifrice ( 88% of market share ) Community Water fluoridation (or Salt fluoridation, Milk fluoridation Fluoride supplements) + Fluoridated dentifrice Fluoride application in home use; self-applied fluoride Professional topical fluoride application

17. Conclusion These results suggest that cooperation among dental organizations, dental schools and municipal corporations can play an important role in order to correct at regional differences in the S-FMR in Japan. We propose that a goal, the item with regarding to caries prevention, for the S-FMR should be adopted in Healthy Japan 21at the final assessment in 2010. Some public health measures based on the health promotion should be provided in order to make a big jump for the S-FMR in the future.

18. だれにでもできる 小さな努力で 確かな効果 Fluoride;Community Water Fluoridation and Fluoride Mouth Rinse Lets gain everyones successful, to surely efficacy, by minimum effort. I appreciate your attention and interest. Thank you very much.