Dental Immunisation: Evaluation of a Community-Driven Strategy for Addressing Caries Burden in Indonesian School Children

ABSTRACT

Background

The World Health Organization (WHO) has long emphasized the significance of oral health as a key component of overall health and well-being. Global oral health disparities, often exacerbated by a lack of access to essential dental care, present a challenge that resonates on a worldwide scale.

Aims

This study explores how community-driven strategies can actively support the global oral health goals set forth by the WHO.

Methods

The RE-AIM framework was applied to evaluate a “Dental Immunisation” program in Bali, Indonesia. An evaluation of the Reach, Effectiveness, Adoption, Implementation, and Maintenance of the program was conducted.

Results

Dentists collaborated with local communities to co-create oral health initiatives targeting school children and their families. A total of 210 children from two schools were enrolled in the program, with a mean age of 9.4 years. Collaborative oral health workshops with local staff and families amplified the impact of school-based initiatives with 50 parents and teachers also participating in oral health promotion activities. At baseline, 60% of Grade 1 children presented with carious lesions, averaging 2.3 affected teeth per child. No children had previously received any restorative care. Post-intervention, 150 teeth were restored using ART, with all participants receiving toothbrushes and application of fluoride varnish.

Conclusion

The “Dental Immunisation” program demonstrates a potential paradigm shift in community-based dental care and prevention strategies. By bridging local practices with global objectives, a more interconnected and collaborative approach to tackling oral health disparities may be achieved. Ongoing longitudinal studies will be essential to validate and expand on the findings from this project.

KEYWORDS:

• Dental immunisation
• dental caries
• Indonesia
• children
• atraumatic restorative treatment
• community oral health promotion

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Irene Adyatmaka

Irene Adyatmaka, born in Papua, graduated in dentistry in 1995 and excelled in dental public health and now manages services for over 10,000 students from 1996 to 2011. She pioneered the Atraumatic Restorative Treatment (ART) approach in Indonesia, completing 2,000+ restorations, and collaborated with WHO’s Prof. Douglas Bratthall on translating the Cariogram into Indonesian. Her research with Mediteam Sweden focused on Carisolv, and she oversaw oral health in 22 government schools. She earned a record-breaking Ph.D. in dental public health within 22 months, receiving cum laude honors and setting an Indonesian record. As a senior researcher at Universitas Indonesia, she developed a nationally adopted school oral health program, UKGS Innovative. Her co-authored book with Dr. Bruce Donoff, “Dental Immunization,” showcases her expertise. Dr. Adyatmaka is also a lecturer in research methodology and GC Indonesia’s Country Manager.

Jilen Patel

Jilen Patel, is a specialist paediatric dentist, senior lecturer at the University of Western Australia and a consultant at Perth Children’s Hospital. For over a decade, Jilen has been involved with providing volunteer dental services to remote Aboriginal communities and has been involved in adapting models of dental care to address areas of unmet need among vulnerable communities. Jilen’s research interests include dental public health and cariology, and he is the clinical lead for the West Australian Early Childhood Dental Program a state-wide initiative aiming to provide universal access to dental care to children under four years of age. His PhD created an evidence-based quality improvement framework for dental care to Indigenous communities and studied the impact of volunteer services to remote communities. He was recently awarded the Australian Dental Association’s outstanding young dentist award for his contributions to the profession.