Abstract
Background: Fluoride has been shown to strengthen and protect teeth, therefore preventing dental caries. The 2017 Vanuatu National Oral Health Survey (NOHS) reported that almost 70% of children aged 5-7 years old had dental decay; the prevalence of dental caries was higher in urban centres compared to rural areas. Although some information on diet was collected in the NOHS, it was limited. Water fluoride levels in Vanuatu vary widely, from very low levels on some islands, to very high levels on other islands.
Objective: The aim of this study was to measure the nutrient intakes and oral health of Ni-Vanuatu children aged between 6 and 12 years of age living in Port Vila, the largest city on the island of Efate, and Tanna, an island with high water fluoride due to an active volcano.
Design: This was an observational study investigating the nutrient intakes and oral health of children aged 6-8 and 10-12 years living in Port Vila on Efate island; due to the Covid-19 pandemic, data was not obtained from children on Tanna. The WHO Oral Health Assessment Form for Children and WHO Oral Health Assessment Form for Children by Tooth Surface was used to assess the oral health of children. For children aged 10-12 years, diet was assessed using an interactive, multiple-pass 24-hour diet recall; repeat recalls were obtained from 10% of children. Recalls were entered into a nutrient analysis programme and the multiple source method was used to estimate usual intakes. Food consumed each day was also categorised using the South Pacific Community dietary guidelines.
Results: A convenience sample of children (n=57) from two primary schools near the village of Pango, Port Vila, Efate were included in the study. Almost a quarter of the children often experienced toothache or discomfort due to their teeth. The majority of children had never received dental care or visited a dentist. Although most (90%) of children brushed their teeth, ~40% cleaned their teeth once a day and ~40% cleaned their teeth less frequently. It was common for children to drink hot water with ~2tsp added sugar (i.e., “tea”) at least once in day. In children aged 6-8 years, the mean dmft (decayed, missing, and filled primary teeth) was 3.90 and the dmfs (decayed, missing, and filled primary tooth surface) was 11.05, which is higher than the mean dmfs of 10.92 for children in the NOHS. In children aged 10-12 years, the mean DMFT (Decayed, Missing, and Filled Permanent Teeth) was 2.5.
The mean dietary energy intake of children aged 10-12 years old was 7.0 MJ/day which was higher in boys (7.8 MJ/day) than girls (6.2 MJ/day). Recommended energy intakes for children of this age are 8.5-10.5 MJ/day. Carbohydrate contributed ~63% of total energy in the diets of these children. Protein intakes of both boys and girls were 60 g/day and 47 g/day, respectively; ~3% of children had an inadequate intake of protein. Following the South Pacific Guidelines, energy foods made up 58% of the diet, which was primarily rice, bread and sugar sweetened beverages, followed by body-building foods (23%) and then protective foods (20%); children consumed less vegetables and fruit than recommended. Their mean intake of dietary fibre intake was 11g/day. The fluoride content of water in Port Vila is 0.1 mg/L (i.e. ppm), below the WHO recommended range of 0.5 to 1.5 mg/L, and below the New Zealand Ministry of Health recommendation for fluoridation of 0.7 to 1.0 ppm.
Conclusion: In conclusion, this sample of Ni-Vanuatu children living in Port Vila had poor oral health with many children requiring urgent intervention. This is likely the result of a diet high in refined carbohydrate and infrequent tooth brushing. At the same time, the fluoride concentration of water was low. The high cost of living in Port Vila makes it difficult for parents or guardians to prioritise dental health and purchase fluoridated toothpaste, toothbrushes, and nutritious food. Fluoridating municipal water and supplying free school lunches are economical strategies that the government could implement to improve the health of these children.