Page 35 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
th
11 National QA Convention, 4 – 6 October 2022
OP-21

Reducing the Percentage of Fissure-filled Teeth Failure among Primary Schoolchildren
in Perlis

Nuranida HR , Nur Izanti MS , Anis EAR , Amalina MZ , Idham HS , Husna H , Sumayyah MS , Mabel Mun
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YC , Mohamad Hafizal H 5
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1 Klinik Pergigian Kuala Sanglang, Perlis
2 Klinik Pergigian Kangar, Perlis
3 Klinik Pergigian Arau, Perlis
4 Pejabat Timbalan Pengarah Kesihatan (Pergigian) Perlis, Perlis
5 Klinik Pakar OMFS, Hospital Tuanku Fauziah, Perlis
SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Fissure sealant covers tooth fissures to prevent caries in children. A verification study showed that only 15.6%
of fissure-filled teeth were intact after six months of application among primary schoolchildren in Perlis.
Failure of fissure sealant leads to caries of vulnerable teeth and worsening clinical outcomes.

KEY MEASURES FOR IMPROVEMENT:
The key indicator for improvement was measured using the percentage of fissure-filled teeth failure after six
months of application among primary schoolchildren. A standard of 15% was set based on expert consensus.

PROCESS OF GATHERING INFORMATION:
Data were collected from January 2018 to December 2020 involving three phases: i) verification study, ii)
implementation of remedial measures (2 cycles) and iii) re-evaluation post-intervention (2 cycles). The study
population includes primary schoolchildren in Perlis. Data were collated from clinical oral examination and
patient records.

ANALYSIS AND INTERPRETATION:
The pre-remedial study showed that 84.4% of fissure-filled teeth failed after six months of application. Potential
contributing factors include improper isolation technique (30.8%), use of inferior retention material (81.5%),
2-handed dentistry practice (30.8%) and incorrect tooth selection (49.2%).

STRATEGIES FOR CHANGE:
Remedial measures include a checklist designed for fissure sealant application procedure, conducting continuous
dental education (CDE) and chair-side training on proper sealant application techniques, redistribution of
portable suction to the dental school team, and the introduction of our innovative product – a dental suction
anchorage instrument (Suction Anchorage Utility Holder – SAUH) to aid in 2-handed dentistry in a limited-
resource setting.

EFFECT OF CHANGE:
The first cycle of evaluation observed an inadequate percentage reduction of fissure-filled teeth failure from
84.4% to 43.1%. Upon implementing the SAUH project and redistribution of portable suction, further reduction
to 10.8% was achieved, exceeding the standard set of ≤ 15%.

THE NEXT STEP:
The developed procedural guideline and training module will be continued at the state level. We aim to have
our SAUH project replicated at the national level to benefit facilities with limited resources in providing high-
quality dental care.

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