Evaluation of a dental preventive program for Danish chocolate workers

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Abstract
The purpose of the present study was to develop and evaluate a preventive dental program at two Danish chocolate fatories. The program was undertaken within the setting of an occupational health service in order to control oral occupational disease. Eighty-nine persons (80%), 19-61 yr of age, participated in a 2-yr follow-up study. Preventive care was offered to the workers by a dental hygienist. Clinical prophylaxis was given at four visits the first year and two visits the second year. Health education was based on active involement of the participants and safety committee or safety group members in order to stimulate self-care activities at the factories. The outcome of the program was evaluated by clinical recordings of visible plaque index (VPI), gingival bleeding (GB), calculus index (CI), and DMFS. Data on dental conditions were recorded at baseline, after 12, and after 24 months. Questionnaires were completed by the workers each time in order to obtain data on dental knowledge, attitudes, dental health behavior, social network activities, and perceptions of the process. The results showed improvement in dental health in terms of stepwise reduction in VPI, GB, CI, and DS. For example, mean GB decreased from 36% of the teeth scored at baseline to 9% at 24 months and mean DS decreased from 2.3 to 0.7. Positive developments of dental behaviour were observed. The proportion of workers reporting daily toothbrushing at work increased from 6% to 24% during the program and the proportion of workers using dental floss regularly increased from 24% to 47%. However, the changes in dental knowledge and attitudes were rather diffuse. The majority of the workers (73%-81%) was satisfied with scaling their teeth, flouride treatment, isntructions and advice in preventive care, and regular control of dental health status. After 12 and 24 months, qualitative inteviews were made with the managment, the workers of the safety committees, and the occupational health personnel. Passive as well as active activities should be considered casual with respect to the positive outcome of the program.