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 -
I am grateful to President of this congress, Professor Tatsuo Watanabe and to Moderator of this session, Professor Seigo Kobayashi for inviting me to be here and to speak today.
　 I am going to talk about this presentation. My title is “National survey on the school-based fluoride mouth rinsing program in Japan”.
And, in this presentation, “school-based fluoride mouth rinsing program” is abbreviated “FMR” for short.
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. Okayama Background Total population: 127,756,000 Background Tokyo
Children: 13,114,000
Sapporo
4-5 years old: 2,234,000
6-11 years old: 7,194,000
12-14 years old: 3,626,000
Niigata
Sendai
In Japan, total population is 128 million, and total children from 4 to 14 years old is 13 million.
Number of dentists is 95 thousands, and number of dental hygienists is
80 thousands.
Tokyo
Okayama
Yokosuka
Number of Dentists: 95, (04 From Minister of Health, Labor and Welfare)
To one million population by 746 Dentists
Number of Dental Hygienists: 79,695 (04 From Minister of Health, Labor and Welfare)
To one million population by 624 Dental Hygienists
Okinawa

3. Background Okayama Background 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
Sapporo
FT : 1.19
Sendai
Niigata
Tokyo
At 12 year old, the mean DMFT is 1.82, DT is 0.6, MT is 0.03 and FT is 1.19, so FT is higher than DT.
In Japan, medical expenses insurance is on a piece-rate basis, national dental expenses per national income is 0.7%; about 2 thousands 5 hundreds billion yen.
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.
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. Other fluoride uses at present in Japan:
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)
Other fluoride uses at present in Japan, community water fluoridation is none except some natural areas.
Professional topical fluoride application is 59%.
Fluoridated dentifrice in market share is 88%.
Estimated data, Number of children in FMR at home is 2 thousands 5 hundreds.
FMR agents as OTC is none for sale.

5. The goals to 2010 in Japan by NPO-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 ?!
Then, we announced in 2002 that the goals to 2010 in Japan by NPO-JPUF.
Community water fluoridation is realizing in some areas.
In the FMR, number of children will be increased to 1 million.
Fluoridated dentifrice in market share is more than 90%.
Professional topical fluoride application is more than 60%.
The 3rd and the 4th goals are mainly 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.
The purpose of this presentation is to follow up the spreading conditions of the FMR in Japan, since 1970.
And to estimate the total number of schools and children participating in the FMR for proposition regarding final assessment of Healthy Japan 21 in 2010.
Furthermore, to 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 participating in the S-FMR, fi-nancial support for the S-FMR, frequency of rinsing, mouth rinsing agent and fluoride concentration in the rinsing solution. Questionnaires were sent to the key persons and dentists of NPO-JPUF by mail or nearly every two years. Additionally, the estimating number in were determined using simple regression analysis and / or polynominal regression analysis on the basis of the data from 1994 to 2002, by Stat View 5.0.
Data were collected by questionnaire regarding the schools and children participating in the FMR.
Questionnaires were sent to the key persons and dentists of NPO-JPUF by mail or nearly every two years.
Additionally, the estimating number in 2010 were determined using simple and/or polynominal regression analysis on the basis of the data from 1994 to 2002.

8. 1) Number of schools participating by grade level
Table The contents of the questionnaire 　　　　
for the S-FMR in Japan
1) Number of schools participating by grade level
2) Number of children participating by grade level
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
This slide shows the contents of the questionnaire,
number of schools and children,
financial support for the FMR,
frequency of rinsing per week,
mouth rinsing agent for use
and fluoride concentration in the rinsing solution.

9. Table 2 Number of prefectures adopted the S-MFR during the past 35 years45
2004 32
1992 16
1980 40
2002 29
1990 15
1978 38
2000 26
1987 10
1976 39
1998 23
1985 6
1974
1996 20
1983 3
1972 35
1994 18
1982 1
1970
Number of
prefectures
Year
In this survey, the results show about number of prefectures adopted the FMR during the past 35 years, started from 1970 to last year.
In last year, the FMR increased to all of 47 prefectures in Japan.

10. (Schools)
10,000
8,000
6,000
4,000
2,000
Number of schools Number of children
(Children)
600,000
400,000
200,000 ◆
Children
Schools
It shows the increasing number and trend of schools and children in the FMR.
Both the increasing profiles have two phases, 1st phase is from 1983 to n phase is from 2000 to 2006.
And both the turning points show in 2002, changing increase tendency.
   87     96      06
Fig The changes on the number of schools and children in the S-FMR by nearly every two year

11. (Schools)
(Children)
800
600
400
200
80,000
60,000
40,000
20,000
(Children)
(Schools)
(Children)
(Schools)
The 1st: Niigata Pref.
The 2nd: Aichi Pref.
The 3rd: Shizuoka Pref.
The 4th: Saga Pref.
50%
80%
This slide is explained about number of schools and children in this year. The champion is Niigata prefecture. In the children, total number of rank from the 1st to the 5th amounts to 50% of the precedence, and in the schools, total number of rank from the 1st to the 8th amounts to 50% of the precedence. And similarly, in the children, total number of rank from the 1st to the 15th amounts to 80% of the precedence, in the schools, total number of rank from the 1st to the 18th amounts to 80% of the precedence.
Although the number of schools and children implementing the FMR is increasing gradually, it is still modest and the regional differences in 47 prefectures are expanded. * * ** ** 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 to the 5th (or the 8th) amounts to 50% of the precedence.
** Total number of rank from the to the 15th (or the 18th) amounts to 80% of the precedence.
1st
1st

12. 2nd phase (2002 - 2006) 1st phase (1983 - 2000) 00
The turning point:
2nd phase ( ) st phase ( ) 00
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
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
This slide shows main factors of the turning points in Japan.

13. Table 3 Number of schools and children participating, the rate of financial support in the S-FMR by grade level
Number of Number of Financial support
schools children Governments etc.* / The others**
Grade level
3,313 (9.1%)*** 143,413 (6.4%)**** % / 15.9 %
1,528 (6.6%) ,912 (4.2%) % / 10.8 %
262 (2.4%) ,508 (1.3%) % / %
28 (2.8%) ,501 (2.7%) % / 65.2 %
5,131 (7.2%) ,334 (3.8%) % / 14.5 %
Nursery school
& Kindergarten
Primary school
Secondary school
Special school, etc. ♯
Total
In 2006, the total number of schools and children participating in the FMR were 5 thousands, and 4 hundreds 91 thousands, respectively. Number of schools is more preschool than primary school. But number of children is more primary school than preschool. Adding to number of children in FMR at home, they are estimated nearly 8 hundreds 38 thousands. Unfortunately, the estimating number of schools and children participating in the FMR in 2010 are approximately 8,497 and 787,320, respectively. It shows that the rate by the total schools in the nation is 9% of nursery school and kindergarten, 7% of primary school, 2% of secondary school and 3% of special school, respectively. Furthermore, the number of children represents about 4% of the same aged population in Japan.
The FMR is supported by public funds of the prefectural and municipal governments and/or educational committee in 84% of nursery school and kindergarten, 89% of primary school, 91% of secondary school, 35% of special school and 86% of total schools, which shows an increase tendency compared with 71% reported in 1994.
* 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 (%)
Frequency per week* Fluoride concentration* S-FMR agent for use
5 times / once ppmF / 450ppmF / 900ppmF Reagents / Medicaments
Grade level
Nursery school
& Kindergarten
Primary school
Secondary school
Special school, etc.♯
Total
58.0 / / 27.7 / / 61.0
6.1 / / 24.1 / / 32.4
8.5 / / 17.5 / / 23.8
41.7 / / 36.8 / / 52.0
40.9 / / 26.2 / / 51.1
Of the frequency with the FMR, 58% conducted 5 times per week in nursery school and kindergarten, while 91% and 87% adopted weekly rinse in primary and secondary school, respectively.
In nursery school and kindergarten, 48% of the participating children adopted the daily rinse using mainly 225ppmF solution.
In primary and secondary school, respectively 70% and 77%, adopted the mainly weekly rinse using nearly 900ppmF solution.
The FMR agent for use is mainly medicaments in nursery school and kindergarten, and reagents in primary and secondary school.
* 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. Announcing by NPO-JPUF, children in 4-5 years old.”
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.”
I would like to insist loudly, announcing by NPO-JPUF, beginning of FMR is recommended for Japanese children in 4 and 5 years old, so may be Asian children.
Next speaker, Dr. Sakuma will explained in this point.
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. + Fluoridated dentifrice
In Japan, fluoride use is limited to topical application, none Community Water Fluoridation
USA, Canada, South America, Australia, Europe and Asia (Malaysia, Singapore, Hong Kong, Korea, Thailand, China, Laos and the others) where fluoride is enough supply
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
　　 In the other hand,
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 21 at 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.
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 FMR in Japan.
We propose that a goal, the item with regarding to caries prevention, for the FMR should be adopted in Healthy Japan 21 at 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 FMR in the future.

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