Original Articles COMMUNITY DENTISTRY EFFECTIVENESS OF SCHOOL-BASED FLUORIDE MOUTH RINSING PROGRAM IN SCHOOL CHILDREN FROM KANDY DISTRICT, SRI LANKA… [629681]

Stomatology Edu Journal
Original Articles COMMUNITY DENTISTRY
EFFECTIVENESS OF SCHOOL-BASED FLUORIDE MOUTH
RINSING PROGRAM IN SCHOOL CHILDREN FROM
KANDY DISTRICT, SRI LANKA
Chandra Herath1a , Tharanga Nandasena2b , Kaung Myat Thwin3c* , Anushka Abeysundara2d ,
Sampath Ratnayake4e , Hiroshi Ogawa3f , Hideo Miyazaki3,5g , Takeyasu Maeda6h
1Department of Community Dentistry, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
2Department of Basic Science, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
3Division of Preventive Dentistry, Department of Oral Health Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
4Army Hospital, Sri Lanka Army, Sri Lanka
5Department of Dental Hygiene and Welfare, Meirin Junior College, Niigata, Japan
6Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
aBDS, MD, Professor
bBDS, PhD, Professor
cBDS, PhD, FICD, Assistant Professor
dBSc, Senior Technical Officer
eBDS, MSc, Doctor
fDDS, MDSc, PhD, Professor
gDDS, PhD, Professor
hDDS, PhD, Professor
Introduction: Dental caries is still epidemic and a significant public health
problem in developing countries. No research on a fluoride mouth rinsing
program has been conducted in Sri Lanka yet. Therefore, the purpose of this
study was to evaluate the effectiveness of a supervised school-based 0.2%
sodium fluoride mouth rinsing program among 6 year-old Sri Lanka school
children.
Material and Methods: This study was conducted on 415 school children from
the Yatinuwara educational zone of the Kandy district, Sri Lanka from January
2011 to January 2014. The children were allocated into two groups by adjusting
their socio-demographic background and the fluoride level in drinking water
at school level; Group 1 received 0.2% sodium fluoride mouth rinses weekly,
and Group 2 was the control group. A clinical oral examination and oral health
education were performed at baseline and annual follow-ups.
Results: At the baseline, the mean age of school children in the intervention
group and the control group were 6.17 ± 0.41 years and 6.08 ± 0.50 years,
respectively. Almost all of the children (>90%) used fluoride toothpaste in
both groups. After the fluoride mouth rinsing program, the intervention group
(77.8%) showed higher caries free proportion than the control group (63.1%),
although no statistically significant difference occurred. The mean DMFT and
DMFS indices in the intervention group were significantly lower than those in
the control group.
Conclusion: The school-based fluoride mouth rinsing program indicated a
significant tendency of preventing future caries incidence among children with
permanent dentition.
Keywords: Fluoride mouth rinsing; Dental caries; 6 year-old; School children;
Sri Lanka.ABSTRACT
OPEN ACCESS This is an Open Access article
under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Herath C, Nandasena T, Thwin KM,
Abeysundara A, Ratnayak S, Ogawa H, Miyazaki H,
Maeda T. Effectiveness of school-based fluoride mouth
rinsing program in school children from Kandy District,
Sri Lanka. Stoma Edu J. 2020;7(1):xxx-xxx
Received: November 04, 2019
Revised December 02, 2019
Accepted: January 09, 2020
Published: January 28, 2020
Corresponding author:
Dr. Kaung Myat Thwin, BDS, PhD, FICD, Assistant Professor,
Division of Preventive Dentistry, Department of Oral
Health Science, Graduate School of Medical and Dental
Sciences, Niigata University; 2-5274, Gakkocho-dori,
Chuo-ku, Niigata 951-8514, Japan;
Tel: +81-25-227-2858; Fax: +81-25-227-0807;
e-mail: kaung@dent.niigata-u.ac.jp
Copyright: © 2019 the Editorial Council for the
Stomatology Edu Journal.
1

Stoma Edu J. 2020;7(1): http://www.stomaeduj.comEFFECTIVENESS OF SCHOOL-BASED FLUORIDE MOUTH RINSING PROGRAM IN SCHOOL CHILDREN FROM
KANDY DISTRICT, SRI LANKAOriginal Articles 1. Introduction
Dental caries is still epidemic and a significant public
health problem in many developing countries [1]. Sri
Lanka is one of developing countries in South Asia,
and the children’s oral health is in poor condition
[2-4]. According to the 2015-16 National Oral Health
Survey , the prevalence of dental caries in 5 year-old
children was 63.1%, and the prevalence of untreated
active caries was 60.7%. Out of 5-year-olds who
had experienced dental caries, 96.2% of them had
active caries. Further more, as early as the age of 5-6
years old, some children already had caries on their
newly erupted permanent teeth [5]. It is considered
as a significant public health problem in Sri Lankan
children. It has become a burden not only to the
bearers and their families but also to the country [6].
Moreover, it has a great impact on the health policy
makers [7]. This increasing burden might be mainly
due to the increased rate of sugar consumption and
inadequate exposure to fluoride [7-9].
In a region of Sri Lanka, the fluoride levels in water
bases showed a great variation from less than 0.05
to 5 ppm [10]. These are very high altitude areas
that are exposed to heavy rain throughout the year,
and showed very low fluoride levels in drinking
water, namely 0.05 to 0.001 ppm. It is the area where
our study sample originated. Only 14.7% of the Sri
Lankan population get the desired level of fluoride
concentration of around 1mg/liter through natural
drinking water supplies [11].
The evidence-based preventive methods such as
topical fluoride applications, fluoride mouth rinsing,
diet modifications and good oral hygiene practices
are widely used for public caries prevention [2,12].
Daily use of fluoride toothpaste and school-based
fluoride mouth rinse programs are recommended
to control dental caries in children and adolescents,
especially for communities in low fluoridated areas
[13]. According to oral health report of the World
Health Organization (2013), a reduction in level of
caries can be achieved through a joint action of the
community, professionals and individuals [14]. The
weekly use of fluoride mouth rinse is practiced as a
group activity at community levels because it is safe
and effective [15]. The effect of fluoride mouth rinses
on the incidence of dental caries in children has
been extensively investigated, and its effectiveness
has been demonstrated for 15%-45% in reducing
dental caries over a period of 2-5 years [15-18].
The Ministry of Health, Nutrition and Indigenous
Medicine, Sri Lanka has started school dental
services since 1953. The school dental therapists
of the primary health care team had the main
responsibility to provide preventive oriented oral
health services for school children aged 3-13 years
old [19]. However, no research on fluoride mouth
rinsing program has been conducted in Sri Lanka
yet. Therefore, the purpose of this study was to
evaluate the effectiveness of the School-based Fluoride Mouth Rinsing (S-FMR) program among
6 year old Sri Lankan school children.
2. Materials and Methods
2.1. Study population
This study was carried out in the Yatinuwara
educational zone of the Kandy district, Sri Lanka
from January 2011 to January 2014. The six schools
came from urban, semi-urban and rural areas and
were randomly selected based on the probability
proportional to size sampling method.
Via the school authorities, an elaborative explanation
on the background, objectives, methods and
significance of the study was presented to children
aged 6 years and to their parents or guardians
gathered in large forums. Following the explanation,
the written consent was obtained from the schools,
participating children and their parents or guardians.
The S-FMR program started with a total of 415 school
children in the study (Figure. 1). During the 3 years
of fluoride mouth rinsing program, there was no
drop out since none of the participants moved
to any other school, or quit the school during the
period. Although there were a number of additional
entries to the schools, they were not included in
the statistical analysis and so the final number of
children who completed the study was 415.
2.2. Study setting
Basic socio-demographic information (gender,
age, school category, frequency of tooth brushing,
usage of tooth paste with fluoride, frequency of
intake of sweet food, parents who brush children
teeth, income of the family, father’s and mother’s
education levels, and knowledge on factors that
influence tooth decay) of school children were
taken at the baseline. Fluoride concentrations were
estimated in the sources of drinking water (deep
wells, tube wells, steams, and running tap water)
of each student participating in the study and the
mean fluoride level was 0.078 ppm. There were no
significant differences in the fluoride level among
the six schools. The participants were instructed
and obliged to use fluoridated tooth paste at the
baseline and the annual follow-ups. Further more,
parents and children were methodically educated on
oral health including frequency of tooth brushing,
usage of tooth paste with fluoride, frequency of
intake of sweet food, parents’ involvement during
tooth brushing, the knowledge of factors that
influence tooth decay, information about nutrition
intake and eating habits at the baseline of the
study and then annually in order to minimize the
different confounding factors and adjust the socio-
demographic factors in the sample. The children of
the six schools were divided into two groups by
adjusting their socio-demographic background and
fluoride level in drinking water at school level: an
intervention group (FMR) and a control group.
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Stomatology Edu Journal
Original Articles EFFECTIVENESS OF SCHOOL-BASED FLUORIDE MOUTH RINSING PROGRAM IN SCHOOL CHILDREN FROM
KANDY DISTRICT, SRI LANKA
2.3. Clinical oral examination
All the clinical oral examinations were performed by
two trained examiners. The calibration of the two
dentists was carried out prior to the study. Linear
weighted Kappa values for intra-examiner and inter-
examiner variability were 0.85 and 0.80, respectively.
A clinical oral examination was conducted to assess
dentition status at the baseline and annual follow-
ups based on WHO criteria for dental caries [20]. The
school children were examined using plane mouth
mirrors and metallic periodontal probes under good
day light to record Decayed (D), Missing (M) and
Filled (F) teeth. The findings were recorded using the
DMFT index and DMFS index.
2.4. Fluoride Mouth Rinsing
0.2% sodium fluoride (NaF) (900 ppmF, Wako
Product Number 196-01975, USA) was used for the
intervention in this study. The children were trained
for mouth rinsing using normal water for three
months to avoid the swallowing of fluoride solution.
After obtaining the standard practice without
swallowing and leaving solutions in cups, the
prepared 0.2% NaF solutions were provided weekly to
the schools by investigators. A teacher was allocated
to distribute fluoride solution to each class in each school. The class teacher distributed the plastic cups
containing 10 ml of fluoride solution to participating
children according to the schedule. Children rinsed
for a minute according to the teacher’s instructions.
The class teachers directly supervised the mouth
rinsing program and maintained the records for
three years. The final assessment of caries risk was
done to evaluate the effectiveness of the program in
January 2014. The control group was also intervened
as ‘placebo’ and so they performed regular mouth
rinse activity with drinking water. Furthermore, they
were repeatedly and annually educated on oral
health including the frequency of tooth brushing,
usage of tooth paste with fluoride, frequency of
intake of sweet food, parents’ involvement during
tooth brushing knowledge on factors that influence
tooth decay, information about nutrition intake and
eating habits.
2.5. Statistical analysis
The expected outcome of the study was that the
mean DMFT and DMFS in the intervention group
would be at a lower value than the control group
after the weekly exposure to fluoride mouth rinsing.
Therefore, the variables of study were exposure and
no exposure of six year-old schoolchildren to 0.2%

Baseline Partici pants (n = 416)
Clinical Oral Examination
Oral Health Education
Excluded (n= 1)
S-FMR group
(n = 198) Control group
(n = 217) 6 schools
Participants (n = 415)
3 schools 3 schools
Start 0.2% NaF

1-year f ollow -up
2-year follow -up
3-year follow -up
(Final assessment) Stop 0.2% NaF
Clinical Oral Examination
Oral Health Education

Clinical Oral Examination
Oral Health Education

Clinical Oral Examination
Oral Health Education
S-FMR group
(n = 198) Control group
(n = 217) Socio -demographic background
Fluoride Level in Drinking Water

Figure 1. Flow chart of the study design.
n: number of participants, NaF: Sodium Fluoride,
S-FMR: School-based Fluoride Mouth Rinse
program.
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Stoma Edu J. 2020;7(1): http://www.stomaeduj.com
Original Articles
fluoride mouth rinse for three years and DMFT level
and DMFS level in permanent dentition.
A statistical analysis was carried out using the
statistical software SPSS 23.0 (SPSS, Chicago, IL,
USA). Chi-square, independent t-test and ANOVA
tests were performed between the mean differences
between the intervention group and the control
group at the baseline and the annual follow-ups.
The level of statistical significance for all tests was set
at p<0.05.
2.6. Ethical approval
The study design was approved by the Research
Committee and Ethical Review committee of the
Faculty of Dental Sciences, University of Peradeniya,
Sri Lanka (Ethical clearance No. FDS-RERC/2009/13/
Herath2). The study permission was also obtained
from the Zonal Education Authority of Kandy District,
Central Province of Sri Lanka.3. Results
Four hundred and sixteen school children at age 6
were initially recruited for the study. However, one
child was excluded from the study due to the absence
of the consent form. Therefore, 415 school children
were finally included in the study. Out of them,
198 children (male: 101, female: 97) were recruited
for the intervention group and 217 children (male:
111, female: 106) for the control group. As shown
in Figure 1, their socio-demographic background
and fluoride level in drinking water were adjusted
in both groups. Then, the intervention group was
introduced to 0.2% NaF mouth rinse under the
supervision of school teachers for consecutive
three years. There were no dropouts from the study
during the study. Although there was a number of
additional lateral entries to the S-FMR program, they
were not included into the study. During the three
years of the program, a clinical oral examination and EFFECTIVENESS OF SCHOOL-BASED FLUORIDE MOUTH RINSING PROGRAM IN SCHOOL CHILDREN FROM
KANDY DISTRICT, SRI LANKA
Table 1. Socio-demographic background at baseline between two groups.
FMR: Fluoride Mouth Rinse, n: number of participants, Family income: average monthly income of the Kandy district, 1 US $ = Rs. 100, by X2 test (p<0.05) FMR, n=198
n (%) Control, n=217
n (%)
Gender
Male
Female
Location
Urban
Sub-urban
Rural
Father’s education level
University level
High school level
Below high school level
Mother’s education level
University level
High school level
Below high school level
Family’s income
High (> Rs. 20000)
Middle (Rs. 10000 – 20000)
Low (< Rs. 10000)
Frequency of tooth brushing
Once a day
Twice a day
Three times and above a day
Use of fluoride toothpaste
Yes
No
Don’t know101 (51.0)
97 (49.0)
70 (35.4)
100 (50.5)
28 (14.1)
28 (14.1)
125 (63.2)
45 (22.7)
29 (14.6)
134 (67.7)
35 (17.7)
23 (11.3)
72 (36.9)
103 (51.8)
27 (13.6)
151 (76.3)
20 (10.1)
185 (93.4)
3 (1.5)
10 (5.1)111 (51.2)
106 (48.8)
83 (38.3)
109 (50.2)
25 (11.5)
45 (20.8)
122 (56.2)
50 (23.0)
40 (18.4)
148 (68.2)
29 (13.4)
29 (13.4)
59 (29.2)
129 (57.4)
34 (15.7)
155 (71.4)
28 (12.9)
201 (92.6)
5 (2.3)
11 (5.1)
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Stomatology Edu Journal
Original Articles oral health education (basic knowledge about dental
diseases and oral hygiene care) were performed in
both groups annually.
The socio-demographic background of the study
population at the baseline between the two groups
is summarized in Table 1. At the baseline, the mean
ages of school children in the FMR group and the
control group were 6.17 ± 0.41 years and 6.08 ±
0.50 years, respectively. There were no significant
differences in mean age, proportions of male and
female, and other socio-demographic data between
the two groups. Over 75% of students in both groups
show that their parents have above high school level
education; 77.3% (father) and 72.3% (mother) in the
FMR group and 77.0% (father) and 86.6% (mother)
in the control group. However, the family income
for the majority of the students shows low level in
both groups. All school children brushed their teeth
at least once a day. Yet , the frequency of tooth
brushing twice a day was 76.3% in the FMR group
and 71.4% in the control group, which is the standard
and recommended practice. Almost all school
children (>90%) used fluoride toothpaste in both
groups. The results of the percentage of caries-free
in the FMR and control groups for consecutive four
visits are shown in Table 2. The percentage of caries-
free school children was calculated with permanent
dentitions; if DMFT is equal to zero, this child was
considered as a caries-free . No significant differences
were observed in proportion of caries-free in both
groups during the program. The caries-free level in
the FMR group, which was less comparative to the
control at the baseline and 1st visit, was higher than
the control group since the 2nd visit. When compared
after the FMR program, the intervention group
(77.8%) shows higher percentage of caries-free than
the control (63.1%). Table 3 shows the comparison
of the FMR and the control groups based on DMFT
and DMFS. At the baseline, the DMFT index in FMR
and control groups were 0.03 ± 0.22 and 0.11 ± 0.47,
where the DMFS level in the FMR and control groups
were 0.04 ± 0.31 and 0.13 ± 0.54, respectively. There
were no significant differences in mean DMFT and
DMFS between the two groups at the baseline and
1st visit. The mean number of DMFT and DMFS in the FMR group was significantly lower than that in the
control group at the 2nd visit and 3rd visit. As within
groups, the mean DMFT and DMFS were significantly
increased from baseline to the 3rd visit in the FMR
group. In the control group, there was no significant
difference from baseline to the 1st visit whereas there
were significant differences during the 2nd and 3rd
visits.
4. Discussion
Dental caries caused by multi-etiological factors is
largely preventable with evidence-based preventive
methods. However, the prevalence of dental caries
among children has risen in developing countries in
recent years because there are very frail preventive
care projects compared with developed countries.
Beside the increased burden of dental caries in Sri
Lanka, the evidence-based fluoride mouth rinsing
program in school has not been implemented yet.
This is the first intervention study to evaluate the
anti-caries effect of school based fluoride mouth
rinsing (S-FMR) program among 6 years old Sri
Lankan school children. The present study included
6 year-old 198 school children in the S-FMR program
and 217 children who did not receive any fluoride
application. Table 2 included the timely caries-free
status of permanent dentition in school children of
both groups. The FMR group showed less reduction
of the caries-free proportion than the control group,
although there were no statistical differences
between the two groups during the program. A
higher proportion (77.8%) of the children in the FMR
group remained caries-free at the end of the study
compared to the control group (63.1%). This implies
that the caries level in the FMR group was 22.2%
and 36.9% in the control group. Furthermore, it is
less than the reported prevalence of dental caries
for 12 year-old Sri Lankan population which is 30.4%
and the Kandy district population which is 35% [5].
Even though the present study did not carry out
the computation of percentage reduction of dental
caries due to S-FMR program, when compared with
the results of a systematic review [22], it showed a
comparable level of caries reduction which would
be observed in permanent dentition ranging from
15% to 67%. When compared to the study carried
out in Sarawak which was 24.2% [11], the caries-
free percentage was very high in the present study
as 77.8%. At the baseline, the mean DMFT and
DMFS values in both groups were not statistically
significant due to adjusting nearly equal recruitment
of school children into the study from urban, semi-
urban and rural areas. Moreover, they all were from
geographically comparable background, which
reported to have very low fluoride level in the natural
drinking water (0.078 ppm F) [11]. The previous
studies also recommended that school based
fluoride mouth rinsing should be implemented in
areas of fluoride-deficient communities [10,21].
Furthermore, a study on a school based fluoride EFFECTIVENESS OF SCHOOL-BASED FLUORIDE MOUTH RINSING PROGRAM IN SCHOOL CHILDREN FROM
KANDY DISTRICT, SRI LANKA
Table 2. Percentage of school children with caries free in two groups.
FMR: Fluoride Mouth Rinse, n: number of participants, by independent
t-test (p<0.05)VisitsFMR, n=198
n (%)Control, n=217
n (%)
Baseline 178 (89.9) 205 (94.5)
1th visit 165 (83.3) 194 (89.4)
2nd visit 149 (75.3) 143 (65.9)
3rd visit 154 (77.8) 137 (63.1)
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Stoma Edu J. 2020;7(1): http://www.stomaeduj.com
Original Articles EFFECTIVENESS OF SCHOOL-BASED FLUORIDE MOUTH RINSING PROGRAM IN SCHOOL CHILDREN FROM
KANDY DISTRICT, SRI LANKA
mouth rinsing program in Japan concluded that
community-oriented health measure should be
contributed to caries prevention of the permanent
teeth in areas where water fluoridation is not
available [22]. According to the National Oral Health
Survey in 2015-16 [5], the FMR group in this study
even though showed a similar DMFT level with
12-year-old Sri Lankan population which was 0.6
(1.6) it rather less than the Kandy district population
(0.8). Furthermore, when compared to the study
carried out in Sarawak [10], the DMFT value at the
end of the program was significantly less. The mean
DMFT and DMFS were significantly decreased in the
FMR group than in the control group during the 2nd
and 3rd visits, respectively. This finding supported
the previous studies which were performed in
several communities [10,24,25]. In accordance with
our findings, the present study demonstrated that
weekly use of 0.2% NaF (900 ppm F) has a significant
caries-preventive effect in children. Therefore, the
S-FMR programs are regarded as a highly effective
caries-preventive strategy. A previous systematic
review concluded that supervised regular use of
fluoride mouth rinse in daily or weekly or fortnightly
basis with 0.05% NaF (230 ppm F) or 0.2% NaF (900
ppm F) in children and adolescents could achieve
a satisfactory caries reduction in tooth surfaces
[25]. On the other hand, Jagan et al reported that
the effectiveness of fluoride mouth rinse with low
concentration (0.05% NaF) is not significant on
caries reduction [26]. Furthermore, its effectiveness
is said to be more significant in caries prevention
with the early introduction of fluoride mouth rinses
to children [22]. In this study, children aged 6 years
participated in the S-FMR program, as they are the
age group that start to attend primary schools. The
previous studies concluded that fluoride mouth
rinsing programs should start at a younger age, and
continue up to the age of 12 years in order for more
children to remain caries-free through their school
years [25]. The measurements for FMR uses among
preschool children were performed in Japan, and
reported FMR could be performed by preschool
children safely and efficiently [22]. This suggests that
the S-FMR program should start at a younger age,
such as the preschool period to further enhance the impact of the caries-preventive effects.
In this study, basic knowledge of oral hygiene care
such as the use of fluoridated toothpaste with correct
tooth brushing was delivered via the oral health
education in both groups during the follow-up visits.
Low levels of oral health knowledge will hinder the
sound understanding of oral health care, and result
in a poor oral health outcome [27]. The previous
review studies reported that daily use of fluoridated
toothpaste had a significant caries-preventive effect
in children [12,28,29]. The oral health situation
would be enhanced by a combination of the S-FMR
program together with provision of oral health
education for further impressive results.
The limitation of this study includes the assignment
of subjects to test and control groups which was
known to the examiners, which is common to
studies. Nevertheless, this study could provide useful
information about school-based weekly fluoride
mouth rinsing programs in fluoride-deficient areas.
The positive benefit of weekly sodium fluoride
mouth rinses on caries reduction would be a major
population-based strategy to improve the oral
health situation in Sri Lankan children. In addition,
to get the maximum impact on caries prevention,
the school-based fluoride mouth rinsing program
could be combined with other additional preventive
activities including reinforced use of fluoride
toothpaste and supervised tooth brushing through
oral health education to parents, guardians, school
teachers as well as school children to further caries
reduction.
5. Conclusion
Based on the findings of this study, we have found
evidence that weekly NaF mouth rinse had a
significant tendency of preventing future caries
incidence among children in permanent dentition.
Author Contributions
CH: Proposal writing, program organizing, clinical
examination, DMFT calculation, manuscript writing;
TN: Concept, data gathering and recording DMFT
calculation, data entry, manuscript writing; KT:
Data analysis, manuscript writing, critical review
of manuscript; AA: Mouth wash preparation, Table 3. Mean number of DMFT and DMFS in two groups.
DMFT (SD)p-valueDMFS (SD)p-valueFMR Control FMR Control
Baseline
1st Visit
2nd Visit
3rd Visit0.03 (0.22)
0.32 (0.74)*
0.44 (0.83)*
0.64 (0.89)*0.11 (0.47)
0.19 (0.62)
0.76 (1.01)*
0.90 (1.02)*0.965
0.067
0.03
0.070.04 (0.31)
0.40 (0.96)*
0.54 (1.06)*
0.85 (1.25)*0.13 (0.54)
0.26 (0.92)
1.06 (1.48)*
1.32 (1.61)*0.992
0.191
0.04
0.07
FMR: Fluoride Mouth Rinse, n: number of participants, DMFT: decayed, missing, and filled permanent teeth, DMFS: decayed, missing, and filled permanent
tooth surfaces, SD: Standard Deviation.
Mean values within each row are analyzed by using ANOVA test (p<0.05), NS: statistically not significant.
Mean values within each column are analyzed by using one way repeated ANOVA test (p<0.05), (*): statistically significant.
6

Stomatology Edu Journal
Original Articles EFFECTIVENESS OF SCHOOL-BASED FLUORIDE MOUTH RINSING PROGRAM IN SCHOOL CHILDREN FROM
KANDY DISTRICT, SRI LANKA
mouthwash distribution, data recording, data entry;
SR: Clinical examination, DMFT calculation, data
recording, data entry; HO: Data analysis, manuscript
writing, critical review of manuscript; HM: Concept,
protocol, proposal writing, data analysis, critical
review of manuscript; TM: Concept, protocol, critical
review of manuscript.
Acknowledgement
This study was supported by the Niigata University
and the University of Peradeniya Cooperation Agency Partnership Program and the Sri Lanka
Dental Association – under the 2010 grant . The
authors thank all participating school children,
parents or guardians, school authorities and teachers
who provided their fullest cooperation during the
program.
Conflict of Interest
The authors declare no conflict of interest.
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7

Stoma Edu J. 2020;7(1): http://www.stomaeduj.comQuestions
1. Which of the following method is more cost-effective to the developing country to
carry out the school-based study to prevent dental caries?
qa. Water fluoridation method;
qb. Use of fluoride mouth rinses;
qc. Use of fluoride toothpastes;
qd. Milk fluoridation method.
2. What is the effect of fluoride on teeth?
qa. Demineralize the enamel;
qb. Discolor the enamel;
qc. Remineralize the enamel;
qd. No effect on enamel.
3. What is the optimal level of fluoride in the fluoride mouth rinses to be used once a
week?
qa. 100-300 ppm;
qb. 300-500 ppm;
qc. 800-1000 ppm;
qd. > 1500 ppm.
4. What is not an advantage of fluoride mouth rinsing program in school?
qa. Cost effective;
qb. Time consuming;
qc. Can practice at community level;
qd. Less attention by participants.
CV
Chandra Herath, is a Professor in Paedodontics. She joined the Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
in 1997 and obtained her Fellowship in Paediatric Dentistry from the Royal College of Surgeons, England in 2003. She has
published over 15 research papers in local and international journals. She is the President elect of the Association of Specialists
in Restorative Dentistry, Sri Lanka and the Joint Secretary of the South Asian Academy of Paediatric Dentistry.
Her research interests are related to early childhood caries, dental trauma, developmental anomalies of teeth and children
with special health care needs. She has immensely contributed to upgrading Paediatric Dentistry in Sri Lanka by developing
undergraduate and postgraduate curricula, conducting workshops and delivering lectures for health care professionals and
the general public.Chandra HERATH
BDS, MS (Rest), FDS (Paed), RCS (Eng), Professor
Department of Community Dentistry
Faculty of Dental Sciences
University of Peradeniya
Peradeniya, Sri LankaOriginal Articles EFFECTIVENESS OF SCHOOL-BASED FLUORIDE MOUTH RINSING PROGRAM IN SCHOOL CHILDREN FROM
KANDY DISTRICT, SRI LANKA
8