A 5-year school-based comprehensive preventive program in Michigan, U.S.A.

The objectives were to demonstrate that a combination of preventive regimens could significantly reduce dental disease in a school population, to demonstrate the feasibility of a school-based program in relation to sustained benefits. There were 1286 students in 1st and 6th grades enrolled in the study. Subjects were stratified by grade, sex, and race and randomly placed in a treatment or education group. Procedures included ingestion of fluoridated water, oral hygiene education program, dental examinations, prophylaxis, acidulated phosphate fluoride gel (1.23%) applied in trays, pit and fissure sealants (bis-GMA) on occlusal surfaces of all eligible posterior teeth, and provision of all restorative care. Fluoride and sealant procedures were repeated at 6-month intervals. After 3 years the treatment group was randomly divided to provide a group that would not continue with treatment and serve as a comparison. The study population was enrolled in 18 schools and clinical procedures were provided on-site, using mobile dental vans. Five-year results indicate high degree of success with fall-off of benefits to those for whom treatment was terminated. This pilot program gives strong evidence for the possibility of implementing school-based dental programs. The study also indicates that prevention programs must be comprehensive and continuous for maximum benefit to occur.