ORDINANCE NO. 2023-041

AN ORDINANCE INSTITUTIONALIZING THE MASS FLUORIDIZATION PROGRAM AMONG EDUCARE PUPILS IN NAGA CITY AND APPROPRIATING FUNDS THEREOF:-

Authors: Hon. Jessie R. Albeus, DMD
Hon. Gilda Gayle R. Abonal-Gomez, PhD, RPsy

EXPLANATORY NOTE

Art. II, Sec. 15 of the 1987 Constitution provides that the State shall protect and promote the right to health of the people and instill health consciousness among them. Thus, it is the policy of the State to ensure quality, affordable, accessible and available oral health care among its citizens.

According to the Department of Health, oral disease continues to pose a serious public health problem in the Philippines. Based on the 2011 National Monitoring and Epidemiological Dental Survey (NMEDS) about 87.4% of Filipinos have tooth decay or dental caries and 48.3% have gum or periodontal diseases.

Periodontal or gum disease are mainly the result of infections and inflammation of the gums and bone that surround and support the teeth. According to the World Health Organization, more than one billion adults or 14% of the global adult population suffers from severe periodontal diseases. The main causes of periodontal disease are poor oral hygiene and tobacco use.

Tooth decay, on the other hand, is one of the most common microbiological infectious diseases worldwide, making it a major oral health problem globally suffered by almost 2 billion people with permanent teeth and 520 million children with primary teeth. The World Health Organization (WHO) estimated that 60% to 90% of all children of school age have experienced dental caries. Dental caries is a multifactorial disease affecting both children and adults that leads to demineralization of the tooth structure. The main causative factors include the presence of endogenous cariogenic bacteria, frequent consumption of fermentable carbohydrates, and a susceptive tooth and host.

Although dental caries can progress if left untreated, it can be prevented, reversed, or arrested at its initial stages. Prevention and minimal intervention treatment following early detection of the lesion are becoming the new philosophy for managing dental caries. In children and young adults, dental caries is most likely to occur at occlusal surfaces from the early eruptive stages of the tooth. About 80% to 90% of dental caries cases in children are occlusal caries. First molars are the most susceptible teeth to caries, followed by second molars.

In the City of Naga, Ordinance No. 2019-052, entitled “An Ordinance Strengthening the Oral Health Program of the City Government of Naga, Establishing Guidelines in the Implementation Thereof, Institutionalizing the Oral Health Service Center in the City Health Office, Appropriating Funds Thereof, and for other purposes”, also known as “The Oral Health Services Ordinance of Naga City”, provided the scope of services, measures, and interventions of the City in the implementation of various oral health programs and projects. However, there is a need to institutionalize the program on mass fluoridization to effectively combat the prevalence of dental caries in school-age children of the City of Naga.

Effective 2024, the supply of Fluoride Varnish coming from the Department of Health will no longer be available to the LGU, particularly to the City Health Office. In order for the continuity of the Fluoridization Program for the Educare pupils of this City, this legislative measure is essential.

For this purpose, the use of Fluoride Varnish is chosen due to its benefits and effectiveness particularly in slowing down the development of decay by stopping demineralization, making the tooth enamel more resistant to acid attack, and speeds up remineralization. Thus, the passage of this ordinance is earnestly sought.

NOW THEREFORE, be it ordained by the Sangguniang Panlungsod of Naga in session assembled, that:

SECTION 1. TITLE. This ordinance shall be known as “The Ordinance Institutionalizing the Mass Fluoridization Program among Educare Pupils in Naga City and Appropriating Funds Thereof”.

This ordinance may be known and cited as “The Fluoridization Ordinance of Naga City”.

SECTION 2. DEFINITION OF TERMS. As used in this ordinance, the following words and phrases shall have the meaning ascribed to them:

(a) DENTAL CARIES – also known as ‘tooth decay’, is defined by the American Dental Association (ADA) as a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues. If left untreated, dental caries can lead to dental cavity and loss of tooth support;

(b) DENTAL RECORD – is an official document containing all the details of the diagnosis, health history, clinical notes, treatments performed, and patient-related communications;

(c) EDUCARE PUPILS  – are students from nursery to kindergarten who attend the School for Early Education Development (SEED), daycare centers, and/or public schools in any barangay in Naga City;

(d) FLUORIDE VARNISH – is defined as a highly concentrated form of fluoride which is applied to the tooth’s surface, by a dentist, dental hygienist or other health care professional, as a type of topical fluoride therapy that prevents new cavities and slows down or stops decay from getting worse;

(e) FLUORIDIZATION – is the therapeutic process of using fluoride to decrease the incidence of dental caries or tooth decay, as by topical application of fluoride agents to the teeth;

SECTION 3. IMPLEMENTING AGENCY. The Oral Health Service Center of the City Health Office shall be the lead agency in partnership with the following:

3.1. Non-government Organization, particularly the Philippine Dental Association Camarines Sur.

SECTION 4. FLUORIDIZATION PROCESS. Provided by this Ordinance, fluoridization will be mass implemented for educare pupils in the City of Naga. As defined in Sec. 2 (c) of this Ordinance, fluoridization is “a highly concentrated form of fluoride which is applied to the tooth’s surface, by a dentist, dental hygienist or other health care professional, as a type of topical fluoride therapy that prevents new cavities and slows down or stops decay from getting worse.”

The enamel of the tooth is exposed to various demineralization-remineralization cycles throughout the day. The balance between remineralization processes and demineralization processes regulates whether dental caries remain static, progress, or are reversed. Demineralization of teeth is caused by acids from foods and drinks and microbial attack of bacteria. These acids lead to plaque pH reduction and subsequent chemical dissolution of both the organic and inorganic matrix and mineral loss of the enamel.

Fluoride is available in two forms: a systemic form and a topical form. Topical fluoride systems are available for use at home with a low concentration of fluoride or professionally with a high concentration of fluoride. While systemic fluoride is available via water fluoridation or can be taken in through the diet or fluoride supplements.

High-concentration topical fluoride, which is available in the form of a fluoride varnish will be used to slow down the development of dental decay to stop demineralization and enhance remineralization. Topical fluorides increase the availability of fluoride ions in saliva and enhance the formation of fluorapatite. Fluorapatite is strongly resistant to acid attacks and demineralization. Additionally, increasing the concentration of fluoride may inhibit bacterial metabolism.

Fluoride Varnish (FVs) slows down the release of active substances such as chlorhexidine, oxidative agents from bleaching systems, and fluoride. They are usually applied two or four times per year depending on an individualized caries risk assessment of a child. This varnish can stick to the tooth surfaces for a relatively long time, thus releasing fluoride in an efficient and effective way. Thus, mass application of Fluoride Varnish is now the trend to combat the increasing incidence of dental caries among educare and elementary students.

The process involves painting a varnish containing high levels of fluoride onto the surface of the tooth every 6 months to prevent decay. It works by strengthening tooth enamel, making it more resistant to decay. Fluoride varnish is an effective product to stop the progression of enamel carious lesions in both primary and permanent teeth, protecting the teeth for several months. It works best if it is reapplied every three to six months. When applied, the varnish will harden on the teeth to offer that layer of protection.

SECTION 5. TARGET BENEFICIARIES. The target beneficiaries are the educare pupils of the School for Early Education Development (SEED), daycare centers, and/or public schools in all barangays in Naga City.

SECTION 6. IMPLEMENTATION PHASE. The Fluoridization Program on educare pupils shall run every six (6) months per identified beneficiary. All beneficiaries of the program shall be provided with a Dental Record which will be kept at the respective educare center, SEED, and/or public school clinic.

SECTION 7. FUNDING AND APPROPRIATION. The amount of Seven Hundred Thousand Pesos (P700,000.00) shall be appropriated for the purchase of Fluoride Varnish and other supplies, chargeable against City Health Office (P500,000.00) and Children’s Fund (P200,000.00) effective January 2024;

SECTION 8. EFFECTIVITY. This Ordinance shall take effect on January 2024;

ENACTED: May 9, 2023

WE HEREBY CERTIFY to the correctness of the foregoing ordinance.

GIL A. DE LA TORRE
Secretary to the
Sangguniang Panlungsod

CECILIA B. VELUZ-DE ASIS
City Vice Mayor
& Presiding Officer

APPROVED:

NELSON S. LEGACION
City Mayor