Republic of the Marshall Islands: planning and implementation of a dental caries prevention program for an island nation.

The Republic of Marshall Islands (R.M.I.) is an island state in eastern Micronesia with a landmass of 70 square miles scattered across 750,000 square miles of the western Pacific Ocean with a national population of approximately 51,000. In a 2002 children's oral health survey, 85 percent of six year old children in the R.M.I. capital of Majuro were found to have had at least one carious tooth and 65 percent had 5 or more affected teeth. The mean caries prevalence among primary (or baby) teeth was 5.79 decayed or filled teeth (dft), a caries prevalence rate close to three times the U.S. national mean. While 12.3 percent were caries-free, 65.0 percent had experienced 5 or more affected teeth (rampant caries). Of these, less than 1 percent had received any form of dental treatment. Comparably remarkable early childhood dental disease rates were also observed on other populated islands and atolls. In response to the rampant dental disease shown to be affecting young children, the R.M.I. Ministry of Health has proposed the implementation of a strategy targeting the pre-natal / pen-natal environment, young parents, pre-school and elementary school children.