DIET

The goal of diet therapy is to obtain an ideal body weight by consuming the desired amount of calories, ideal body weight & body mass index

Ideal Body Weight (in kg) = (Height in cms – 100) x 0.9

Body Mass Index = Weight in kg / (Height in Metres ) squared

BMI

Normal = 17-27 (in male)

= 17-25 (in female)

Lean (under weight) < 17

Overweight > 27-32

Obesity > 32

Encourage

Whole food high in fibre

Low animal fat intake

No added salt

Avoidance of sweets

World Health Organisation recommendation

CARBOHYDRATES : Allowance: 60-65% of total calories

Sources:

a) Cereals and cereal products (mainly from whole grain cereals)

b) Pulses

c) Beans

d) Fresh fruits

e) Vegetables

A diabetic patient can also take rice in the right amount preferably mixed with dahl or rajmah and green vegetables in consultation with physician.

FIBRES

TYPE-1 FIBRES :

These are water insoluble fibers-cellulose, hemi cellulose & lignin.

SOURCE: Cereals and millets.

BENEFITS: Decrease the intestinal transit time, increase the fecal bulk and therefore this is useful in constipation.

TYPE-II FIBRES:

These are water soluble fibres- pectin, gums and mucilage.

SOURCE: Vegetable, fruits & legumes.

BENEFITS: 1. These are more effective in controlling blood glucose and triglycerides.

2. These provide Omega 3 (W3) fatty acids and antioxidants.

FRUITS

Fruits are must for a diabetes patient and should be included in a meal plan.

However bananas, mangos, grapes and jackfruits are not recommended for a diabetic patient.

Fruit allowance: one fruit of one variety in the recommended amount at a time. Fruit juice is not recommended.

VEGETABLES

Green leafy vegetables are good source of vitamins. Seasonal green vegetables are good source of Vitamin B complex and minerals.

Vegetables provides

Vitamins, Minerals, Antioxidants, Fibres, Low calories (Carbohydrate) etc.

FATS: ALLOWANCE- 15-25% of total calories. 3-4 TSF per day.

FAT SOURCES

Visible Fats,

Invisible Fats,

Saturated Fats,

Unsaturated Fats – sources are mainly Mono-Unsaturated Fatty Acid(MUFA) or Poly-Unsaturated Fatty Acid (PUFA) and do not have any deleterious effect on lipid profile if consumed in moderate amount..

Artificial sweetening agents

Caloric (fructose, sorbitol, manitol, xylitol, hydrogeneted, starch hydroplysates) should be avoided and non caloric saccharine, aspartame play a dominant role.

Spices and condiments

Fenugreek seeds : Provides soluble fibre, W3FA , Triglyceride and Cholesterol

Clove (long) & Turmeric (Haldi) : Antioxidant activity controlling free oxygen radical damage.

Garlic : 1-3 gms per day, fibrinolytic activity.

Onion : 20-30gms per day, decrease platelet aggregation, decrease blood sugars and lipids.

PROTEINS :

Allowance – 15 to 20% of total caloric consumption per day and an adult needs 0.8 per kg weight of protein per day.

SOURCES:

1. First class proteins (Animal proteins)

a. Non-Vegetarian- eggs, mutton, chicken, fish, pork.

b. Vegetarian – Milk, curd, paneer.

2. Second class proteins- soybeans, grams, dahls, peas, beans, nuts (dry fruits)

3. Third class proteins:- Cereals – oats, barley, ragi, wheat and rice.

Meat had got high fat content while dahl has got high protein content.

Protein intake should be reduced in renal failure while increased during pregnancy stage.

SODIUM : < 6 g/day

hypertensive diabetic, < 3 g/day

RECOMMENDATIONS

ALCOHOL : In moderation; restricted entirely in insulin induced hypoglycaemia, neuropathy, hyperlipidaemia.

SMOKING & TOBACCO : Avoid.

VITAMINS : Supplements unnecessary.

MANAGING YOUR DIABETES

Exercise regularly to stay healthy.

About 2500 yrs ago, ancient Indian physician Shushruta stressed upon the importance of exercise in the treatment of diabetes. Shortly after the discovery of insulin in 1922, it was shown that exercise potentiates the effect of insulin.

Exercise in association with balanced diet remained an important tool in the management of type-2 diabetics because of its beneficial effect on insulin sensitivity & hypoglycaemia.

Benefits of exercise

Helps in long term glycaemic control.

Reducing body weight.

Reducing requirement of OHA and/or Insulin.

Improvement in hypertension.

Improvement in lipid profile.

Improvement in cardio-vascular function.

Increase body fitness and stamina.

Increase sense of well-being.

Improves quality of life.

It has a special role to play in the prevention of atherosclerosis and ageing.

EXERCISE & INSULIN

EXERCISE CAUSES:

Increase in sensitivity of muscles to Insulin.

Increase in Insulin action by increasing :

In insulin binding receptors sites in the muscle and increasing the number of receptors.

In cytoplasmic and mitochondrial activity.

In muscles, capillary density.

In GLUT-4 protein & mRNA.

Response To Exercise Depends On

DIABETIC STATUS OF THE PATIENT.

BLOOD GLUCOSE LEVEL.

AVAILABILITY OF INSULIN.

STATE OF HYDRATION.

Evaluation Of The Patient Before Exercise

Careful screening for the presence of macrovascular & microvascular complications is needed that may be worsened by the exercise.

Fair control of diabetes is to be ensured.

History of drug intake & its effect on exercise is to be kept in mind.

Time Of Exercise

Ideal time is morning, if this is not possible then the evening or both.

Have an empty stomach or take small snacks before exercise (to prevent hypoglycaemia).

Exercise after meals to be avoided.

Risk Of Exercise

HYPERGLYCAEMIA : In poorly controlled diabetes patient.

KETOACIDOSIS

HYPOGLYCAEMIA : In tightly controlled diabetics.

HEART ATTACK : Sudden Myocardial Infarction in patient with silent Myocardial Ischaemia.

SUDDEN BLINDNESS : In diabetics with Proliferative Diabetes Retinopathy due to vitreous haemorrhage.

FOOT CARE

Regular foot care is a must in diabetes to avoid amputations.

PRACTICAL TIPS: For Patients

Never walk with bare feet – indoors or outdoors

Use clean socks/stockings that absorb sweat. Avoid nylon

Footwear should neither be very tight nor very loose

Before wearing shoes, look & feel inside for rough surfaces & pebbles (In diabetic neuropathy the pain sensation often is dulled and diabetics have been known to walk for days with nails or pins stuck in the feet).

INSPECT FEET

Look for breaks in skin, cuts, scratches, blisters, sores

If need be use a magnifying glass (especially if retinopathy is present)

Check for temperature changes

Medical attention needed, if foot injuries do not heal within 2-3 days

Strong medicines, corn caps, warts removers should be used except under medical supervision

Regularly wash feet every evening

Use mild soap

Soak feet in tepid water (not hot) for not more than 5 minutes

Pay special attention to the skin between the toes and dry them properly with a soft towel

Apply a moisturising cream or lotion to keep your skin supple

Good preventive foot care can save a leg from amputation

Treatment of diabetes in modern medicine

Lifestyle management

Oral hypoglycaemic agents

Insulin therapy

Exercise

Major used Homoeopathic medicines in Diabetes

Liver complications

Natrum sulph, Leptandra, Chionanthus, Ceanothus, Carduus marinus, Carlsbad,

Lycopodium, Chelidonium, Kali brom, Magnesia carb, Kali carb, Natrum phos

Podophyllum etc.

Pancreatic drugs

Iris ver, Pancreatin, Phosphorus, Baryta mur, Natrum sulph, Cortisone

Malnutrition in utero

Secale cor, Calc phos, Baryta carb

Amyloid disease

Tubercullinum, Syphillinum, Carcinosin, Cortisone etc.

Hypertension

Syzigium jambolium, Rauwolfia serpentine, Glycerinum, Uranium nitricum

Secale cor

Diabetic neuropathy

Helonias, Secale cor, Hypericum, Ashwagandha, Kali. phos

Diabetic retinopathy

Secale cor, Hypericum

Vitreous haemorrhage

Arnica mont, Belladona, Crotalus horridus, Lachesis, Merc cor

Peri vascular diseases

Arnica Montana, Conium maculatum, Cuprum ars, Kreosotum, Lachesis

Merc sol, Proteus

Diabetic nephropathy

Asparagus, B. coli, Candida albicans, Lycopodium, Lyco. Vir, Eup. Purp, Phaseolus

Phosphorus, Salicylic acid, Sulphur, Medorrhinum, Cuprum met, Terebinth

Impotency

Acon nap, Cannabis sat, Coca, Conium mac, Cuprum met, Eup purp, Helonias, Kali carb

Moschus, Sulphur , Phosphoric acid

Other complications and homoeopathic treatment

Prostatomegaly : eup purp, Phaseolus

Caries teeth : Ac. sulph

Spongy gums : Syz. jamb

Psoriasis : Mang. acet

Cataract : Saccharum alb

Amblyopia : Sacch. alb

Muscular cramps : Chin. sulph

Sciatica : Kreos

Sweet smelling urine : Ferr. iod

Gout : Lact ac, Nat sulph, Phase, Phos

Gall stones : But.ac

Arteriosclerosis : Aur, Chlorpr , Plum ,Syz

Black spots : Ars, Kreos, Kres, Secale cor

Hyperthyroidism: Kali iod

Ankle swelling : Arg met , Sacch alb

Dropsical scrotal swelling : Arg met

Family history of diabetes

Carcinosin

Saccharum officinalis

Thuja occidentalis

Natrum sulph

To be remembered:

Homoeopathic medicines are applied particularly on the basis of totality of symptoms.

Proper exhaustive case taking should be done.

The totality of symptoms must be the ultimate guide and the physician must be strictly unprejudiced. According to condition of patient and the stage of the disease proper potency may be given.

There is no fixed miasmatic condition responsible for the development of Diabetes mellitus. It is the patient’s individuality, miasmatic background and accessory circumstances which will decide what type of symptom will produce in one patient at one time. So, if the patient is psoric or psoric predominance is noted, then the psoric symptomatology of the Diabetes may be observed, in that patient and just like that the syphilitic and sycotic patient, will produce the syphilitic and sycotic symptomatology of the disease respectively.

Proper anamnesis of the patient may give the right direction to the path of similimum.

Constitutional Homoeopathic treatment is the mandatory way to treat the patient along with the proper management. If palliation is needed then homoeopathic palliation after short case taking will prove more beneficial. If there is not a single characteristic found (the indications), even after very careful and exhaustive case taking, then it may be assumed that the case is totally incurable.

In the Insulin dependent Diabetes never stop the insulin suddenly without going through the regular monitoring of the blood sugar level. Glycosalyted Hb1Ac will give you the prognostic view of the disease in a better manner. Along with the Homoeopathic constitutional treatment you can continue insulin in case of

Type – I diabetes (IDDM). If you think patient is improving then you can refer the patient to his allopathic physician to decrease the insulin if necessary.

Acknowledgments:

Dr. Shubhamoy Ghosh.M.Sc, BHMS,BMCP, HEAD, Dept of pathology

M.B.Homeopathic Medical College & Hospital, Govt. of West Bengal.

VOMITING IN PREGNANCY | Cause, Prevention & Homeopathy

VOMITING IN PREGNANCY | Cause, Prevention & Homeopathy

Morning sickness and emesis gravidarum are the other names for it. Nausea and vomiting can be one of the first signs of pregnancy and usually begins around the 6th week of pregnancy. It can occur at any time of the day, and for most women it seems to stop around the 12th week of pregnancy.

 I have seen in some weak women with nausea and vomiting till the last trimester of pregnancy without any harmful effect to the baby.

"Nausea and vomiting are the commonest symptoms experienced in the first trimester of pregnancy, affecting 70-85% of women"

There is nothing to be worried about this vomiting at all till it turns in to Hyperemesis gravidarum which is a severe form of it where the patient should be hospitalized.

Why do pregnant women suffer from nausea and vomiting?

The exact cause for this is not known. Some doctors believe it as due to imbalance in blood glucose level.

Many midwives and doctors believe that morning sickness is more common in women carrying twins or triplets

Family history of hyperemesis gravidarum is seen in some cases.

Sudden increase in estrogen and hCG (a pregnancy hormone) can be another cause for this as nausea and vomiting ceases when these hormones decrease.

Will this vomiting affect my baby?

          Obviously it will not affect your baby at all. It is a normal symptom of pregnancy. You should replace the water and energy that you lost by vomiting by eating fruits and small snacks. If it becomes severe and exhausting, the women should get hospitalized. I have seen some ladies who have been vomiting till the last month of their pregnancy and they have given birth to healthy babies weighing more than 3 Kg.

How can I prevent or reduce these symptoms?

·         Take your own time when you get up. Don’t get up quickly from bed.

·         Eat something small when you go to sleep.

·         Reduce stress and anxiety.

·         Enjoy light music and sit calm.

·         Eat some Dry snacks when you get up from bed.

·         Eat small meals at frequent intervals.

·         Make sure that you take plenty of water regularly.

·         Avoid caffeine.

·         Some women find ginger tea helps a lot.

·         Give some physical rest after eating. Sit upright position for a little time after food.

·         Fresh open air can help to reduce the symptoms

·         Avoid triggering factors like Bad smell, Spicy Food, sudden movements, fatty food and very hot food.

Homeopathy for vomiting in pregnancy

There are many good medicines in homeopathy which will help you to reduce your vomiting in pregnancy. Some particular desires and aversion to food can determine your remedy. You should avoid those triggering factors along with homeopathic medicines. As I have explained, it is a normal physiological symptom of pregnancy as you don’t need a medication for it. When the symptoms disturb your daily activities, you will need a medical attention on it.  I am giving some important homeopathic medicines here for vomiting in pregnancy which should be taken on your homeopaths advice.

Colchicum:

Horrible nausea that is worse from the sight and smell of food (especially eggs or fish) often indicates this remedy. The woman retches and vomits, and has a sore and bloated feeling in the abdomen. She has trouble eating anything — although she often craves things, when she tries to eat them they make her sick. She is likely to feel ill from many smells that others don’t even notice.

Argentum Nitricum:

It is indicated when there is very considerable flatulence accompanying the nausea and vomiting. There is frequently a craving for sugar and sweet foods, and a panicky nervousness is characteristic. All forms of heat are abhorrent and cool fresh air is sought.

Bryonia:

Any movement triggers the nausea, even rolling over in bed. The lips are dry, the mouth is dry, there is a lot of thirst, but she is afraid of the movement that it will take to get a drink. She has the typical “bear‐like” foul mood of the Bryonia type. This woman wants to be left alone in quiet.

Carbolic Acid:

Vomiting of pregnant women, with frantic headache and irritability

Nausea early in morning; dull aching, uneasy feeling in stomach; torpor of bowels.

Nux vomica:

     Nausea, especially in the morning and after eating, may respond to this remedy—especially if the woman is irritable, impatient, and chilly. She may retch a lot and have the urge to vomit, often without success. Her stomach feels sensitive and crampy, and she may be constipated

Pulsatialla:

Variable kind of nausea, with intolerance of heat or of anything greasy or fatty. The symptoms often come on in the afternoon or evening but are typically changeable.

There is an absence of thirst and in general only cold acidic drinks are acceptable. There is often a thick whitish‐yellow coating on the tongue, and the general mood is one of tearful passivity, often craving sympathy. She has

belches and the taste of food stays in her mouth a long time after eating them. Seeks out open air even though it makes her chilly.

Sepia:

 Gnawing, intermittent nausea with an empty feeling in the stomach suggests a need for this remedy. It is especially indicated for a woman who is feeling irritable, sad, worn out, and indifferent to her family. She feels worst in the morning before she eats, but is not improved by eating and may vomit afterward. Nausea can be worse when she is lying on her side. Odors of any kind may aggravate the symptoms. Food often tastes too salty. She may lose her taste for many foods, but may still crave vinegar and sour things.

Tabacum:

This remedy can be helpful to a woman who feels a ghastly nausea with a sinking feeling in the pit of her stomach. She looks extremely pale, feels very cold and faint, and needs to lie very still and keep her eyes closed. If she moves at all, she may vomit violently—or break out in cold sweat and feel terrible.

Psorinum

It will be useful in obstinate cases of vomiting in pregnancy and when above medicines fails to act.

Symphoricarpus:

 Persistent vomiting of pregnancy. Adverse to all food. Nausea from motion. She may be constipated and often has serious debilitating nausea and vomiting. Bitter taste in the mouth, feels best lying on her back. Often used where there are no other indications, or when the indicated remedy fails

Sources:-

www.medicalnewstoday.com

www.americanpregnancy.org

www.netdoctor.co.uk

www.onlymyhealth.com

www.olivehomeopathy.blogspot.in

Blood Orange Grapefruit Juice Recipe

Grapefruits are believed to aid weight loss.

As well as helping to surpress hunger, grapefruit and grapefruit juice is also said to help our body metabolise blood sugar so that it is less likely to be stored as fat.

The only problem is that many of us don’t like its taste.

Mixing grapefruit juice with blood oranges makes this drink much more palatable, gives it a lovely red colour and makes it very high in Vitamin C.

Recipe Serves:

This Recipe Serves 1.

Recipe Ingredients:

• 3 blood oranges, (peeled)
• 1 medium grapefruit, (peeled)

Recipe Method:

1. Place blood oranges & grapefruit in a food processor or juicer & blend until fruits resemble juice.
2. Serve immediatley in your favorite glass, with ice if desired.

International Dental Journal (2007) 57, 187-194

Objective: To assess the oral hygiene practices, current use of and knowledge about
fluoride toothpaste among schoolchildren, parents, and schoolteachers; to describe the
attitudes of parents and schoolteachers in relation to improving schoolchildren’s oral health.
Design: Cross-sectional study. Participants: 1,557 schoolchildren, 1,132 parents, and
352 schoolteachers were recruited by multistage stratified sampling procedure in a district
of Beijing, China. Methods: Self-completed questionnaire. Results: The percentage of
schoolchildren, parents, and schoolteachers who actually used fluoride toothpaste was
88%, 86%, and 87%, respectively, and 74-78% of the respondent groups brushed their
teeth twice a day or more. 64% of schoolchildren, 73% of parents, and 74% of schoolteachers
confirmed the caries preventive effect of fluoride toothpaste. Toothpaste recommended
by oral health professional organisations was preferred by respondents - particularly by
schoolchildren - when purchasing toothpaste (86%). 93% of parents and 56% of schoolteachers
recognised their important role in promoting children’s oral health; however, their
lack of knowledge seemed to be a major obstacle in fulfilling this role. Conclusions: The
use of fluoride toothpaste in Beijing appears to have increased during the past decade. In
addition to mass communication comprehensive school-based oral health programmes are
needed to continuously promote the use of fluoride toothpaste among schoolchildren.

© 2007 FDI/World Dental Press
0020-6539/07/03187-08

Changing use and knowledge of fluoride toothpaste by schoolchildren, parents and school teachers in Beijing, China

Key words: Dental caries, fluoride toothpaste, oral health behaviour, school oral health

During the past two decades, many industrialised countries
have experienced a dramatic decline in the prevalence
and severity of dental caries among children and
adolescents1-4. Although the reasons for this are complex,
the consensus view is that the greater availability
of fluoride through automatic fluoridation (i.e. water,
salt, milk) and an increasing use of fluoride toothpastes
are the most significant factors for improved control
of dental caries5-7. A recent systematic review revealed
that daily use of fluoride toothpaste may reduce the
DMFT 3-year increment by 25% 8. WHO continues to
emphasise as an important public health measure the
need to strengthen the effective use of fluoride for the
prevention of dental caries in the 21st century, and highly
recommends the introduction of affordable fluoride
toothpastes in developing countries9-11. In China, the
dental caries experience in primary teeth is high while
children show relatively low and less severe dental caries
patterns in their permanent teeth11. However, an
increasing level of caries in permanent teeth has been
observed recently in some areas of China partly because
of the growing consumption of sugars and inadequate
exposure to fluoride12,13. The availability and use of
dental services in China are rather limited13-18 and professionally
applied fluoride would thus have minimal public
health impact. Promoting oral self-care capacity and the
188
International Dental Journal (2007) Vol. 57/No.3
use of fluoride toothpaste is therefore an appropriate
strategy for the control of dental caries in China.
Previous studies showed that the use of fluoride
toothpaste among Chinese children and adolescents was
relatively low, particularly in rural areas13,18,19. Chinese
society has changed rapidly during the past decade and
fluoride toothpastes are now more commonly available
on the market, especially in urban areas. In addition, oral
health education programmes, such as the ‘Love Teeth
Day’ mass campaign20,21, have been implemented at
province and community levels throughout the country
since 1989, and the regular use of fluoride toothpaste is
highly recommended by these programmes. However,
no recent data are available which could elucidate the
changing use of fluoride toothpaste in children and
adolescents. In a life cycle perspective, childhood and
adolescence are crucial periods for the development of
health practices. Both parents and schoolteachers have a
great potential to influence this process. As a platform,
school can provide both a supportive environment for
promoting oral health and important networks to the
local community and families22. Thus, the objectives of
the present study were to describe the oral hygiene practices,
current use and knowledge of fluoride toothpaste
among schoolchildren, parents and schoolteachers, and
to describe the attitudes of parents and schoolteachers
in relation to improving schoolchildren’s oral health.
The results may be helpful in the orientation of school
oral health programmes towards promoting healthy
lifestyles.
Study population and methods
Study population
This investigation took place in Haidian district, Beijing
in January 2004. Schoolchildren were recruited by a
multistage stratified sampling procedure. Three strata
consisting of primary schools (grades 4 to 6), secondary
schools (grades 7 to 9), and high schools were identified
based on the actual education system of China. Schools
within each stratum were chosen through a probability
sampling procedure (proportional to size) and schoolchildren
were then chosen by simple random sampling
within each sampled school. All schoolteachers responsible
for training of the sampled schoolchildren were
selected together with the mother or father of these
schoolchildren. In all, 1,557 schoolchildren (response
rate 87%, mean age ± SD: 13±2.1 yrs), 1,132 parents
(response rate 64%, mean age ± SD: 37±9.2 yrs), and
352 schoolteachers (response rate 89%, mean age ± SD:
52±23.0 yrs) participated in the study.
Questionnaires
For each respondent group, a self-administered structured
questionnaire was used to collect information
about oral self-care practices, use of toothpaste, consumer
preferences, fluoride knowledge, and dental visiting
habits. The wording of the questions was identical
to provide valid comparisons of the responses given
by schoolchildren, parents and schoolteachers. Items
addressing attitudes towards promoting schoolchildren’s
oral health were included in the questionnaires for parents
and schoolteachers. The participants were asked to
provide the brand name of the toothpaste used at time
of the study. Whether or not the reported toothpaste
contained fluoride was collected through information
available from the manufacturer or the market and the
result was recorded as ‘actual use’. Furthermore, the
participants were asked to report the type of toothpaste
(fluoridated, non-fluoridated, do not know) currently
being used and the answers were recorded as ‘self-reported
use’. The highly structured questionnaires were
tested and validated prior to the study. The present study
received ethical approval from the Education Commission
of Haidian District, Beijing city.
Statistical analysis
Data from the questionnaires were processed and analysed
by means of the Statistical Package for the Social
Sciences (SPSS 14.0). Description and analysis of the
data were carried out by frequency distributions. Bivariate
frequency distributions were computed and the
differences in proportions were evaluated by the Chisquare
test. The measurement of fluoride knowledge
was based on seven component items. Cronbach’s Alpha
was used to evaluate the internal reliability of these
items and the results for schoolchildren, parents, and
schoolteachers were 0.83, 0.78, and 0.77, respectively.
A correct answer to a statement on fluoride knowledge
was coded as a 1 and an incorrect answer as a 0. Composite
variables of fluoride knowledge were then constructed
based on additive indices and the scales were
subsequently categorised into three levels according to
empirical distributions: low level (scores 0-2); middle
level (scores 3-5); and high level (scores 6-7). Spearman
correlation coefficients confirmed moderate to strong
associations between the final composite variables and
the original component variables.
Results
Toothbrushing practices
The responses of primary, secondary, and high school
students with regard to tooth brushing practices, use of
fluoride toothpaste, fluoride knowledge, and consumer
preferences were combined since no substantial differences
were found. Table 1 summarises the toothbrushing
habits of schoolchildren, parents and schoolteachers.
The vast majority of the respondents reported having
brushed their teeth every day during the past week and
189
Liu et al.: Fluoride toothpaste in Beijing, China
three quarters of these claimed to have brushed their
teeth two times or more on the previous day. Most of
the respondents answered that they tried carefully to
clean every tooth surface and that they rinsed their
mouth with a large amount of water from a beaker
after brushing. Rinsing the mouth without a beaker
after tooth brushing was indicated by very few persons
only. The amount of toothpaste used each time varied
markedly among all the respondents.
Use of fluoride toothpaste
Nearly 90% of the schoolchildren, parents and schoolteachers
actually used fluoride toothpaste and these
percentages were much higher than the self-reported
use (Table 2). Nearly half of the schoolchildren and
schoolteachers were not able to judge correctly whether
their toothpaste contained fluoride; the likelihood of a
correct answer was somewhat higher for parents (69%,
p<0.001).
Fluoride knowledge
Most schoolchildren, parents and schoolteachers claimed
that they had heard about the concept of fluoride
toothpaste (Table 3); however, only one third of them
confirmed the statement that “fluoride toothpaste is
a kind of toothpaste which contains fluoride”. Two
thirds of schoolchildren and three fourths of parents
and schoolteachers reported that brushing the teeth
with fluoride toothpaste can prevent dental caries, and
similar figures were found for the item that fluoride
toothpaste can strengthen resistance of tooth surfaces.
Meanwhile, the statement “fluoride toothpaste
can reverse early-stage caries” was confirmed by less
than half of the respondents. Around 60-70% of the
respondents reported that a proper amount of fluoride
is helpful, whereas an excess amount of fluoride may
be harmful to dental health. About half of the parents
and four out of ten schoolteachers answered that the
amount of fluoride toothpaste should be less than peasize
for children 3-7 years of age. The differences of
Table 1 The distribution (%) of schoolchildren, parents and schoolteachers with different tooth brushing practices
Schoolchildren Parents Schoolteachers
Tooth brushing everyday during the past week 95 98 99
Frequency of tooth brushing yesterday
No brushing 1 1 1
Once 24 23 22
2 times or more 74 76 78
Try carefully to brush all surfaces of every tooth 82 87 83
Post-brushing behaviour
Rinsing with beaker and much water 78 83 81
Rinsing with beaker but little water 17 14 16
Rinsing without beaker 6 3 3
Amount of toothpaste used for brushing (fraction of the head of toothbrush)
Less than 1/4 6 7 9
1/4-1/3 22 22 28
1/2 30 33 28
More than 1/2 29 25 24
Full head of a toothbrush 13 13 12
Table 2 The percentages of respondents who used different types of toothpaste by “actual use” and “selfreported
use”
*** p<0.001
Schoolchildren Parents Schoolteachers
Actual type of toothpaste
Fluoridated 88 86 87
Non-fluoridated 6 8 7
Uncertain 6 6 7
Self-reported type of toothpaste
Fluoridated 52 66*** 53
Non-fluoridated 11 19 18
Don’t know 37 15 29
Use of fluoride toothpaste correctly reported 52 69*** 54
190
International Dental Journal (2007) Vol. 57/No.3
fluoride knowledge among schoolchildren, parents and
schoolteachers are also shown in Table 3, and the additive
index on the level of fluoride knowledge confirmed that
schoolchildren scored somewhat lower than did parents
and schoolteachers.
Sources of fluoride information
With regard to sources of fluoride information, mass
media were most frequently reported by all respondents,
oral health education programmes being the second
most often reported (Table 4). One fifth of the schoolchildren
had learned about fluoride from their parents.
The percentages of primary school students and secondary
school students whose knowledge of fluoride
derived from dentists were much higher than those of
high school students (p<0.001). Oral health education
included in the school curriculum was reported by one
sixth of schoolchildren (Table 5). High school students
(20%) had more often received fluoride information
from teachers than had primary and secondary school
students (p<0.01). About half of the schoolchildren
wished to know how to prevent dental disease effectively
and how to promote oral health in school; this
attitude was particularly frequent among primary school
students (74%).
Attitudes towards promoting schoolchildren’s
oral health
The percentage of parents who recognised that they
have an important role in promoting children’s oral
health was 93%; however, 32% of parents felt that
they had not done their best. Lack of knowledge (46%)
was frequently reported by parents as an obstacle in
promoting children’s oral health. In all, 56% of schoolteachers
thought that they were important in promoting
schoolchildren’s oral health while 66% did not want to
recommend that schoolchildren use fluoride toothpaste,
as their knowledge in this regard was insufficient.
Table 3 The percentages of participants who responded differently to statements on fluoride knowledge and the distribution (%) of
participants by additive index of fluoride knowledge level
*** p<0.001
Schoolchildren Parents Schoolteachers
Heard about the word ‘fluoride toothpaste’ Yes 81 92 97***
Fluoride toothpaste is a kind of toothpaste which contains
fluoride
Right 26 38 38***
Wrong 30 26 24
Do not know 44 36 38
Tooth brushing with fluoride toothpaste can prevent caries Right 64 72 73***
Wrong 6 8 5
Do not know 30 20 22
Tooth brushing with fluoride toothpaste can reverse earlystage
caries
Right 48 50*** 43
Wrong 14 21 22
Do not know 38 29 35
Tooth brushing with fluoride toothpaste can strengthen resistance
of tooth surfaces
Right 65 74 76***
Wrong 5 6 3
Do not know 30 20 21
Proper amount of fluoride is helpful, but excess amount of
fluoride may be harmful to health
Right 58 64 68**
Wrong 9 9 6
Do not know 33 27 26
The amount of fluoride toothpaste should be less than peasize
for 3-7 year old children
Right -- 48** 42
Wrong -- 11 8
Do not know -- 41 50
Fluoride knowledge level
Low (score 0-2) 31*** 23 24
Medium (score 3-5) 41 45 47
High (score 6-7) 28 32 29
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Liu et al.: Fluoride toothpaste in Beijing, China
Table 4 The percentages of respondents who reported certain sources of fluoride information (more than one response allowed)
** p<0.01 *** p<0.001 Indicate differences among primary, secondary, and high school children
Schoolchildren Parents Schoolteachers
Primary school Secondary school High school Total
Mass media 65 75 77*** 72 76 78
Oral health education programme 58 58 61 58 60 60
Dentist 40*** 40 26 37 33 17
Parents 22 22 16 21 -- 1
Friends or relatives 25 35** 30 31 34 32
Table 5 The percentages of schoolchildren who have gained oral health information from school according to type of school
Primary school Secondary school High school Total
Have oral health education classes 18 16 13 16
Teachers have told me about fluoride 11 12 20** 13
Want to know how to protect teeth in school 74*** 52 32 54
** p<0.01 *** p<0.001
Table 6 The percentages of schoolchildren, parents and schoolteachers who considered different factors when buying toothpaste
(more than one response allowed)
** p<0.01 *** p<0.001 Indicate differences among schoolchildren, parents, and schoolteachers.
Schoolchildren Parents Schoolteachers Total
Toothpaste recommended by professional organisations 86*** 77 73 81
Taste 74 73 81** 74
Brand 73*** 66 71 70
Effects advertised by the toothpaste factories 66 66 62 65
Whether it contains fluoride or not 58 61*** 46 58
Price 42 49** 45 45
Table 7 The percentages of respondents using fluoride toothpaste and having a high level of fluoride
knowledge according to whether they were concerned that toothpaste contains fluoride (Yes) or not (No)
** p<0.01 *** p<0.001 Indicate differences within respondent groups
Schoolchildren Parents Schoolteachers
Yes No Yes No Yes No
Use of fluoride toothpaste 88 89 89** 82 85 89
High knowledge level about fluoride 35*** 17 37*** 22 37** 22
Consumer preferences
Toothpaste recommended by professional oral health
organisations was most frequently considered by schoolchildren
and parents when purchasing toothpaste and
it was the second most common consideration among
schoolteachers (Table 6). Whether or not the toothpaste
contained fluoride was of less concern to all respondents
than the taste, brand, or commercial advertisements
of the toothpaste. In addition, nearly half of the
respondents took into account the price of toothpaste.
The consumer concern as to whether the toothpaste
contains fluoride was positively associated with fluoride
knowledge level, but did not relate to actual use of fluoride
toothpaste (Table 7). Moreover, the use of fluoride
toothpaste was irrespective of the fluoride knowledge
level for the three groups.
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International Dental Journal (2007) Vol. 57/No.3
Dental visiting habits
The answers to questions on dental attendance and the
reasons for the last dental visit of the respondents are
summarised in Table 8. The percentage of individuals
who claimed to have seen a dentist during the previous
year was somewhat higher in schoolchildren than in
parents and schoolteachers. Experience of dental symptoms
rather than a check-up was a prominent reason
for the last dental visit. Relatively more schoolchildren
went to see a dentist for a check-up while parents and
schoolteachers often sought a dentist because of problems.
Dental visits and dental check-ups were more often
reported by primary and secondary school students
than by high school students. With the exception of
schoolteachers, respondents who visited a dentist during
the past year seemed to have higher level of fluoride
knowledge. However, the use of fluoride toothpaste was
not associated with dental visiting habits in the three
groups (Table 9).
Discussion
The aim of the study was to describe the current use
of and knowledge about fluoride toothpaste among
schoolchildren, parents and schoolteachers, and to assist
in the formulation of appropriate strategies for the
continuous promotion of the use of fluoride toothpaste
targeted at schoolchildren in China. School-based oral
health promotion programmes have been introduced
in certain urban communities in China over the past
years23,24. Notably, such a programme had not yet been
established in the present study area and these programmes
are still greatly needed in most communities
throughout the country. The participants were strictly
sampled by proportional sampling procedures and the
response rates for the three study groups were high.
The validity of the questionnaires was evaluated in
pre-tests and by an expert panel of public oral health
researchers prior to the investigation25. The Cronbach’s
Alpha values indicated that the internal consistencies of
items within the three questionnaires were satisfactory25.
Overall, the present study may give an overview of the
use of and knowledge about fluoride toothpaste among
schoolchildren, parents, and schoolteachers in an urban
community in China, even though the present data are
not representative in purely statistical terms.
In light of previous studies13,15,17,18,26, growing proportions
of urban Chinese appear to have adopted healthy
lifestyles in terms of regular oral hygiene practices. A
major finding of the present study is that substantially
more schoolchildren used fluoride toothpaste compared
with previous studies13,18,19,26,27. The use of fluoride
Table 8 The percentages of schoolchildren, parents and schoolteachers who visited a dentist during the past year and the reasons for last
dental visit
Schoolchildren Parents Schoolteachers
Primary school Secondary school High school Total
Have seen a dentist during the past year 53††† 52 33 49*** 42 32
The reason for the last dental visit (only for dental visitors )
Problems/need for care 50 51 65† 59 71 84***
Dental check-up 50† 49 35 41*** 29 16
† p<0.05 ††† p<0.001 Indicate differences among primary, secondary, and high school children;
* p<0.05 *** p<0.001 Indicate differences among schoolchildren, parents, and schoolteachers.
Table 9 The distribution (percentage) of participants by level of fluoride knowledge
and use of fluoride toothpaste according to whether or not they saw a
dentist during the past year
*** p<0.001 Indicates differences within respondent groups
Saw a dentist during past year or not
Schoolchildren Parents Schoolteachers
Yes No Yes No Yes No
Fluoride knowledge level
Low 24 36*** 20 26 23 24
Middle 45 39 41 48 45 48
High 31 25 39*** 26 32 28
Use of fluoride toothpaste
Yes 89 87 88 85 85 87
No 4 7 6 9 8 6
Uncertain 7 6 6 6 7 7
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Liu et al.: Fluoride toothpaste in Beijing, China
toothpaste by 12-year-old children as reported in the
present study was 90%, which was more than twice the
level (38%) found for children of the same age group
living in Beijing in 199513. The use of fluoride toothpaste
by parents and schoolteachers was also greater than observed
in earlier studies of schoolteachers and middleaged
adults living in urban areas of China15,17,26,27. This
trend may relate to several factors. Firstly, more fluoride
toothpastes have been made available on the market
during the past decade, especially in urban areas. The
second reason for the greater use of fluoride toothpaste
observed may relate to different data collection methods.
Previous studies13,15,17-19,26,27 were based on declared
use of fluoride toothpaste rather than actual use of
verified fluoride toothpastes. The latter approach, applied
in the present study, may have provided data with
less information bias, which may be helpful to explain
why the self-reported use of fluoride toothpaste in the
present study was very similar to the finding (48%, age
group 11-15 yrs) of a survey19 conducted in 2003 in
eight main cities of China, including Beijing.
According to the actual results most of the participants
were not particularly clear about the concept of
fluoride toothpaste and a high proportion of them did
not know whether their toothpaste actually contained
fluoride. Thirdly, the implementation of oral health
education programmes has increased over time in China.
In urban areas this is due particularly to the launch in
1989 of the annual ‘Love Teeth Day’ campaign20,21.
The greater use of fluoride toothpaste and the fact that
significant proportions of schoolchildren, parents, and
schoolteachers reported having gained information
about fluoride from oral health education programmes
may reflect a positive impact of these programmes.
Remarkably, only a few respondents indicated having
obtained fluoride information from a dentist. This,
however, corresponds to their low utilisation of dental
services and the symptoms-oriented dental visiting
habits.
The availability of fluoride toothpaste on the market
may be an important reason for its greater use in China.
People were apparently not significantly motivated by
health concerns while buying toothpaste as they seldom
considered the content of fluoride. Toothpastes recommended
by professional oral health organisations were
preferred. The accreditation of products by professional
oral health organisations, informing about the clinical
effect of fluoride toothpaste, may contribute to effective
promotion of the use of fluoride toothpaste. Meanwhile,
several domestic products are labelled fluoride
toothpaste but have none or little efficacious fluoride
content28 and establishment of appropriate quality assurance
mechanisms is urgently needed.
Mass media and large scale oral health education
programmes may be powerful in health communication.
Based on the present study, knowledge about fluoride
must be continuously improved among schoolchildren,
parents, and schoolteachers. The majority of parents
recognised their responsibilities in promoting their
children’s oral health. However, lack of knowledge
restricts their function and the involvement of parents
in translation of information to children was low. Most
importantly, the dissemination of oral health messages
in school was also poor and about half of the
schoolteachers did not sufficiently understand their
role in promoting children’s oral health. Children spend
considerable time in school and health education may
target children at an age when their health habits are
being formed. Only a few schoolchildren had received
information from teachers about the benefits of fluoride
even though most of them were eager to know
more about how to prevent dental disease and how to
promote oral health in school. Both schoolteachers and
parents have a great potential to influence the oral health
behaviour of children22. Comprehensive school-based
oral health programmes are greatly needed and will
provide a unique context for promoting the use of fluoride
toothpaste. Moreover, when the Health Promoting
Schools approach is applied the target population
may include not only schoolchildren but also parents
and schoolteachers22. The parents and schoolteachers,
however, need proper training and practical support in
health education from dentists experienced in public
health, and should also be provided with relevant educational
material.
Acknowledgement
The study obtained technical assistance from the WHO
Collaborating Centre for Community Oral Health Programmes
and Research, University of Copenhagen,
Denmark, and the Danish International Agency for
Development (DANIDA).
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Correspondence to: Dr. Ling Zhu, Peking University, School and
Hospital of Stomatology, Department of Preventive Dentistry, Beijing,
China. Email: zhuling@ncoh.cn