ORAL HEALTH

COURSE CODE: CHE 232

DURATION: 30 HOURS (2 HOURS)

UNIT: 2

COURSE DESCRIPTION

Sound oral health is a vital aspect of total health.

Oral health programs should provide Community
Health Extension Workers with the knowledge and
tools they need to understand basics of good oral
health practices which can prevent many oral
health problems and lessen the long-term effects
of existing ones.

GOAL:
This course is designed to equip the students with the
knowledge and skills necessary to promote community
oral health and prevent oral diseases.

OBJECTIVES:
1.0 Explain oral health

2.0 Describe how to identify and manage

common oral health problems in the
clinic and in the community

3.0 Describe how to Mobilize the

Community to Promote Positive Oral
Health Habits.
UNIT: 1-in oral health

TOPIC: ORAL HEALTH

INSTRUCTIONAL MATERIALS: -

 Maker
 Whiteboard
 Card board paper
 Models

TEACHING METHODS: -

 Lecturehabit

 Demonstration
 Group discussion

TYPES OF ASSESSMENT: -

 MCQ
  Essay

LEARNING OBJECTIVES: -

At end of the lesson, the learners should be able to:

 Define oral health

 Draw and Describe the anatomy of the buccal cavity
 Identify the types of teeth
 Discuss the stages of teeth eruption

CONCEPT OF ORAL HEALTH

Introduction:

Oral health has been given less priority in Africa, because of other health problems of the continent which
are life threatening and communicable. In the past all Africans were assumed to have good teeth, therefore
the need for oral health was not given priority. According to WHO, dental caries is a problem of growing
concern to most African countries.

Practicing good oral hygiene has nearly limitless benefits. When our mouth, gums, or teeth are not healthy,
our bodies may be more susceptible to serious disease, so taking care of the mouth is just as important as
taking care of the body. Oral health is integral to general health and wellbeing of an individual’s, the mouth
is a gateway into the healthiness of the body.

Oral health is an important aspect of general health and wellbeing. Oral hygiene if adopted properly can
help get rid of oral diseases, many studies have proved that better knowledge in oral health practices and
their attitude are linked to good habits with healthier oral cavity. Oral diseases are major public health
concern due to high prevalence and its impact on quality of life. Many studies have shown that lack of
knowledge among rural people and negligent behavior among urban people are causes of dental diseases.
Oral hygiene is compromised.

Oral health could be a manifestation of general health because systemic diseases can have oral symptoms
and signs and oral diseases can present in other parts of the body system. A competent community health
worker should be able to prevent ad care for the most common oral health problems and refer appropriately
as required and also mobilise the community members to take responsibility for their own oral health by
heeding to simple habits and stopping some harmful cultural and personal habit that relate to oral health.

1.1 DEFINITION ORAL HEALTH

Oral health can be define as all practices that are involved in providing and improvement of the
healthy teeth, and other oral structures of an individual’s, family or a community.

Oral hygiene is an important part of a daily routine. It is the practice of keeping one's mouth clean and
free of disease, by regular brushing and cleaning in between the teeth.

Stomatology is the study of the morphology, structure, function and diseases of the contents and
lining of the oral cavity.

Dentistry is the science and art of preventing, diagnosing, and treating, diseases, injuries and
malformations of the teeth, jaws and mouth and of replacing lost or absent teeth and associated
structures.
 Importance of Oral Health

Oral health is essential to general health and quality of life. It is a state of being free from mouth and
facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay,
tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing,
smiling, speaking, and psychosocial wellbeing.

The human body is comprised of a complex system which are interconnected with other parts. Because
of the way, the human body is made, one area of the body can have an impact on different parts of the
body. For example, take the mouth and teeth. If you have problem with your teeth and gum, this can
pose problems with other areas. Poor oral hygiene can lead to problems with diabetes, heart disease
and other health issues.

Therefore the importance of Oral Health includes:

1. Good Dental Hygiene Keeps the Teeth and Gums Healthy - Although genetics play a large
role in whether you get cavities, regular brushing and preventative dental care help keep your
teeth and gums healthy. Brushing removes the plaque that causes tooth decay and stimulates
your gums to help prevent gum disease.
2. Regular Visits to Dentist Lead to Early Disease Detection - A key component to proper oral
hygiene is regular visits to your dentist. Do you go every six months? You should! Your dentist
can detect a whole lot more than cavities from looking in your mouth. Among the problems and
diseases dentists can discover with a thorough examination are:
i. Vitamin deficiencies
ii. Acid reflux
iii. Tooth grinding
iv. Diabetes
v. Osteoporosis
vi. Heart problems
vii. Dementia
viii. Mental health issues
ix. Oral cancers
3. Good Dental Hygiene Prevents Certain Diseases - Infections that start in your mouth can
lead to even worse health concerns. For example, gingivitis is a common inflammation of the
gums. It can develop into periodontitis, a much more serious infection that can cause tooth loss.
Infections that start in your mouth have even been linked to such complications and disease as:
i. Asthma
ii. Arthritis
iii. Premature births
iv. Low birth babies
v. Respiratory problems
vi. Coronary artery disease
vii. Stroke
viii. Untreated tooth and gum disease can even lead to death!

1.2 THE ANATOMY OF THE BUCCAL CAVITY

In the chapter the muscles, blood supply, innervation of oral structures like the lip, teeth, palate, oral
mucosa, gum which are pertinent to the course will be overviewed by the following figure.
The mouth is an opening on lower part of the human face used for taking in food, making sounds and
speech. On the outer part of the mouth are two lips (the upper and the lower). On both sides of the mouth
are the cheeks. The inside of the mouth consists of the tongue and the teeth. The mouth can be regarded as
a mirror to the rest of the body as many systemic diseases have oral manifestations

The importance of Anatomy and Physiology of the Mouth

i. Oral structures are essential in reflecting local and systemic health

ii. Oral anatomy: a fundamental of dental sciences on which the oral health care provider is based.
iii. Oral anatomy used to assess the relationship of teeth, both within and between the arches

The Parts of the Buccal cavity

1. The Lips - The lips form the outer border and opening of the mouth and are used to hold food in the
mouth and to form words during speech. They are used to form facial expression (such as smiling,
frowning, yawning and whistling). In a physiological state both lips should come in contact with each
other without exerting force a phenomenon known as LIP COMPETENCE.

2. The Cheeks - The cheeks form the sides of the mouth. They also assist in holding food in the mouth,
chewing and making speech.
3. The Palate - The roof of the mouth is called the palate. It separates the mouth from the nasal
passage. The front part of the palate is called the hard palate while the back part is called the soft
palate. The palate prevents food from getting to the nasal passage. The palate is divided into two
equal halves (right and left sides) by the MID PALATINE RAPHAE
4. The Teeth - They are found in the alveolar bone of both the upper and lower jaws and are used for
biting and chewing food. They also give the month its shape.
5. The Floor - The tongue is attached to the floor of the mouth except at the front where it is freely
mobile.
6. The Gum - The gum is also referred to as the gingival. It covers the jaw bones and supports the teeth
in the bones. It is c o r a l pink in colour in health state but may be brown in dark skinned healthy
individuals. It may be blackish, reddish or whitish in unhealthy individuals. The part of the gum in-
between the tooth is called the gingival papilla.
7. The Salivary Glands - There are three pairs of salivary glands - the sublingual, submandibular and
parotid glands which open into the oral cavity. These glands secrete watery fluid called saliva which
lubricates the food and contains enzymes which help in food digestion. It also contains minerals and
proteins that protect the teeth.
8. The Tongue - It a muscular tissue, flexible used for eating/chewing, swallowing and talking/making
speech and other sounds. The tongue also contains taste buds responsible for the sense of taste. It is
attached to the floor of the mouth extending from the bone at the back of the mouth upwards and
forwards. The upper surface, borders and the front part of the lower surface are free. The upper
 surface is covered with tiny projections called papillae that give the tongue its rough texture. The
colour is usually pinkish-red but gets discoloured by various diseases.

Blood Supply and Venous Drainage

The mouth and the contents are supplied with oxygenated blood via the lingual, facial, palatine arteries. The
venous drainage is also along corresponding veins.

Nerve Supply

These are the lingual nerve, facial nerve, inferior alveolar nerve and their branches.

The Anatomy and Physiology of the Teeth

The teeth are located in the gum and jaw in the floor; and the roof of the mouth through their roots.

1.3 TYPES OF TEETH

There are four major types of teeth names and their functions.

1. Incisors - They are located in the front part of the mouth. They are fan-shaped and majorly used for
cutting food. The upper ones are bigger than the lower ones. There are a total of eight (four upper and
four lower) incisors in the complete human secondary dentition

2. Canines - They are pointed teeth at the corner of the lips, strong and used for tearing food. There are
a total of four canines (two upper and two lower) incisors in the complete human secondary dentition.
3. Premolars - They resemble the molars except that they are smaller. They have a narrow table surface
with two projections. There are a total of eight premolars in the human dentition. (Two in each
quadrant of the mouth). The primary dentition does not have premolars.
4. Molars - They are large and at the back of the mouth. They have a wide table surface and three
projections. They are used in grinding food. There are a total of twelve molars in the complete
secondary human dentition. (Three in each quadrant of the mouth)

Structure of the Teeth

Teeth are hard and bony structures in the mouths. They are the hardest and most durable organ. Teeth
have been found to be preserved long after the flesh and bones have decayed. They are invaluable in
phoresy.

The tooth consists of several layers of tissue. The outermost part which is the hardest part is called the
enamel. The enamel, about 16mm thick is the visible part of the teeth seen above the gum. It protects
 the other inner layers from bacteria and changes in the temperature from hot and cold food. Directly
under the enamel is another bone-like layer called the dentin. It is also harder than the bone.

https://cdn.britannica.com/28/116228-050-C6456E92/Cross-section-human-molar.jpg

The core of the tooth is known as the pulp which is in turn protected by the dentin. The pulp contains the
blood vessels which carry oxygen and nutrients to the tooth and also contain the nerves which transmit pain
and temperature sensation to the brain. The part of the tooth that is visible is the crown while the portion
that lies beneath the gum is the root. There is a hard tissue known as the cementum surrounding the tooth
root made up of a thin layer of bony tissue that covers the dentin from the root to the neck of the tooth.
There are tough tissues that help to hold the tooth root in place and cushion the tooth against the gum and
the jaw called the periodontal ligament.
 Model of Teeth

Types of Dentition

Two sets of teeth erupt during a man’s life time: These are:

1. Primary Dentition or Milk Dentition - They develop from between 6 months and 2½
years of age. The complete set is made up of about 20 teeth (5 in each quadrant - 2
incisors, 1 canine and 2 molars). They are usually smaller, whiter, more rounded than the
permanent teeth.
2. Secondary Dentition or Permanent Dentition - As described in arrangement below.

Arrangement of the Teeth

There are 32 permanent teeth in human (adult) equally distributed on the 4 dental arches (upper left;
lower left; upper right and lower right). Eight teeth are found on each of the dental arches. There are 4
different types of teeth with different shape and functions. These are;

i. The incisors (2),

ii. Canine (1),
iii. Premolars (2) and
iv. Molars (3).
Up jaw = 3. 2. 1. 2. 2. 1. 2. 3
Lower jaw = 3. 2. 1. 2. 2. 1. 2. 3

The color and morphology of the structures may vary with genetic patterns and age
1.4 Discuss the Stages of Teeth Eruption

Development of the Teeth

Humans are diphyodont—that is, they develop two sets of teeth during their lives. The first set of teeth
is the deciduous teeth, these are 20 small teeth also known as baby teeth or milk teeth. Deciduous
teeth start developing about two months after conception and typically begin to erupt above the gum-
line when a baby is between 5 and 7 months old.

Occasionally a baby may be born with one or more deciduous teeth at birth, known as natal teeth. By
the time a child is six years old, a second set of 32 larger teeth, called permanent teeth, start to erupt,
or push out of the gums, eventually replacing the deciduous teeth. Human tooth development occurs
in stages. The hard tissue of the deciduous teeth, or the dentin, forms while the fetus is in the womb.
After the child is born, tooth enamel develops in stages. Front tooth enamel, for example, is usually
complete around one month after birth, while the enamel on the second molars is not completely
developed until a child is about a year and a half old. When the enamel is fully developed the tooth
erupts. Front teeth usually erupt when a child is between 6 and 12 months of age, second molars at
about 15 months old, and canines usually erupt at 18 months. The final stage of tooth development is
root completion, a slow process that continues until the child is more than 3 years old.

Around the age of 6 years, the roots of deciduous teeth slowly resorb as the developing permanent
teeth start to push them out. Deciduous teeth eventually fall out and are replaced by the erupting
permanent teeth. This begins a transitional phase of tooth development that takes place over the next
15 years. As baby teeth are pushed out by permanent teeth, the entire mouth and jaw transform from
their childhood shape to a more pronounced, adult-like structure. From age 6 to age 10, a child’s
permanent incisors, canines, and first molars erupt. The third molars also called the wisdom teeth
usually erupt between the age of 18 and 21 years.

It should be noted that a child’s first permanent molar is the first permanent tooth to erupt.
 Abnormalities of the Development of the Teeth

1. Congenital Absence of Teeth. This includes: Total anodontia in which case there is complete
absence of the teeth. It is very rare and is often associated with other diseases or congenital defects of
other organs of the body. Partial anodontia which is more common. It may be symmetrical when a
particular teeth or groups of teeth are involved or it May be haphazard when there is no particular
pattern. There are racial differences in the prevalence of missing teeth. Ectodermal dysplasia is a
common congenital anomaly associated with congenital absence of teeth.
2. Supernumerary Teeth - Just as there can be absence of some teeth, there can also be additional
teeth above the normal set of teeth. These usually develop along any tooth bearing area. They also
usually occur with other abnormalities such as cleft palate. They are usually single and unusual in the
deciduous dentition.
3. Disturbances of the Size of the Teeth - This is usually the size of the teeth in proportion to that of
the jaw both of which are determined by genetic factors. It is known that large variations occur in the
ratio of the tooth size to the jaw size in people. The terms macrodontia and microdontia are used to
describe situation when the teeth are larger or smaller than normal respectively. It may involve the
entire dentition or selective teeth. It may also be associated with other defects such as Down’s
syndrome or congenital heart disease.
4. Other Disturbances - There are also disturbances in the form, structure or arrangement of the teeth.
Furthermore, there may be problems with premature eruption, retarded eruption, premature loss,
persistence of milk teeth, discolouration of the teeth, etc.

STUDENTS ACTIVITY

TOPIC: Oral health

At the end of this lesson, the

STUDENT learner will be able to:

 Define oral health

 Draw a well label diagram of buccal

OUTCOME cavity
 Identify types of teeth
 Discuss the state of teeth eruption

TASK:

 Brain storming on steps involves in mobilizing & community out-reach

 Demonstrate on community mobilization
 Role play
UNIT: 2

COMMON ORAL HEALTH PROBLEMS AND THEIR MANAGEMENT

INSTRUCTIONAL MATERIALS: -

 Whiteboard
 Maker
 Card board paper
 Models

TEACHING METHODS: -

 Lecture
 Demonstration
 Group discussion

TYPES OF ASSESSMENT: -

 Essay questions
 MCQ
 Assignments

LEARNING OBJECTIVES: At the end of this unit the learner should be able to:

 List diseases associated with oral cavity

 Describe the diseases of the oral cavity
 Discuss harmful cultural practices that affect
the health of the oral cavity
 Explain the preventive and control measures
of mouth infection
 Manage oral health according to standing
2.1 DISEASES ASSOCIATED
order WITH ORAL CAVITY

Introduction
The mouth contains a number of different tissues which we have already discussed in earlier units.
Different diseases and malformations can occur in any of these structures of the oral cavity. Certain
diseases are more common among younger age group while others are more common at older age
group. Similarly some are more common in developing Countries with low socio-economic groups and
certain habits

Classification of Oral Diseases

1. Infection - There are millions of bacteria that live in the mouth. Most of these bacteria are harmless
and are referred to as normal flora; and in fact, they are necessary for normal functioning of the
 body for example those that assist in digestion. However, they may become harmful when the
individual’s body immunity is lowered due to illness or other factors. The infection may affect the
alveolar bone, teeth, the gum or other supporting structures of the mouth called the periodontal
structures.
2. Trauma - The lips, cheeks, teeth, tongue, periodontal tissues, and bony structures can suffer from
different injuries. These can result from fall; fight, road traffic accidents which may result into
fracture, tear, and crush of the tissues concerned in addition to bleeding that may accompany the
injury.
3. Decay - This is commonly referred to as dental caries. It is the most common reason for
presentation at the dental clinic and the most common cause of tooth loss in humans.
4. Degeneration - These are diseases that arise as a result of old age such as natural tooth loss. Also,
decreased salivary flow could predisposed to dry mouth which results in dental caries.
5. Developmental/Deformities - There may be deformities in the developmental process which may
predispose to other diseases. These include naturally missing and supernumerary teeth in which
cases one or two teeth never erupt at all or an individual may have an extra teeth.
6. Neoplasm - Tumor or new abnormal growth can also affect the mouth and contents. These may or
may not be malignant (cancerous). Causes are not known but risk factors have been determined by
epidemiological associations. Common risk factors or habits are cigarette smoking or tobacco
chewing, excessive alcohol consumption, etc.
Epidemiology of Common Oral Diseases
Epidemiology refers to the study of the distribution, determinants and deterrents of diseases or health
related events and the application of the knowledge to solve health problems or proffer solutions. It is
concerned with the pattern of the diseases and their distribution which answers the questions - what,
distribution (who, where, when), determinants (why and how) and then deterrents (what is the way
forward?).
i. What: This refers to the diseases being discussed. Appropriate and correct oral diagnosis must
be made through history taken, careful general and specific examination (not only of the oral
cavity but of other systems too) and applicable laboratory and radiological investigations.
ii. Who: In terms of age, dental caries is found in all age groups but more common among children
and adolescents but there are both early onset (<35 years) and adult periodontitis (>35years),
NOMA developed in under 5 children and oral cancers are found in the older adults and young
elderly. Apart from age; distribution can also be in terms of sex, socio-economic status, immune
status, occupation, other disease conditions (e.g. diabetic, hypertensive, HIV patients) and habits
(e.g. smokers).
iii. Where: This refers to geographical distribution, e.g. home/resident, place of employment or
school (occupational exposure to possible risks); developing or developed countries; rural or
urban areas, etc.
iv. When: Some oral diseases are more likely at a period of day or a season of the year. In dental
caries for example, it is known that the bacteria causing this disease are most virulent at night
when there is decreased salivary flow.
v. Why: This involves the causative agents, risk or associated factors in the environment and the
host factors. Most oral diseases as in other diseases also require multi-factorial determinants for
establishment of such diseases. This also explains why some individuals with certain habits
develop some diseases why others may not. The mere presence of the disease agent without a
conducive environment and susceptible/vulnerable host may not result in a disease condition.
vi. How: This refers to the mode of transmission in case of infection or the mode of pathology
(disease formation) and how the structures are affected. It refers to how the damages have
occurred.
vii. What Next/What Way Forward: This is concerned with what can be done to bring relief,
restore normal health, reverse further damage, and support the sufferer.
2.2 THE DISEASES OF THE ORAL CAVITY

 Dental caries (tooth decay)

 Periodontal diseases (gum diseases)
 Non-Communicable Diseases of the Mouth
i. Oral Cancer
ii. Oral Trauma
iii. Cleft Lip and Palate

1. DENTAL CARIES (TOOTH DECAY)

Definitions:
Is a localized post-eruptive pathological process of external origin involve and softening the hard
tissues of a tooth and proceed to form a cavity.[WHO]
Dental caries can also be defined as a slow bacterial destruction of the crown or root of a tooth

Courses of Dental Caries

 Bacteria
 Refine carbohydrate
 Susceptible tooth
 Time
 Frequency

Development of Dental Caries

Dental Caries, a bacterial infection, may be defined as a post eruptive pathological process of
external origin, involving the softening of the hard dental tissues and proceeding to a hole or
cavity formation. (E.S Akpata et al 1997). The process involves continuous demineralization of
the tooth due to the by-products of microorganisms on fermentable carbohydrate in the person’s
diet and reduced remineralization. Some bacteria in the dental plaque are able to turn the sugar
(especially sucrose and glucose and less commonly fructose and lactose) we eat into acid. As the
acid is slowly released, it dissolves the tooth - first from the enamel within 3 min in which case
the tooth surface looks whitish. Later, the dentine is affected which leads to the formation of a
hole and pain especially after a cold food or drink. Finally, the pulp is affected which will result
into more severe pain. The hole usually appears as a dark spot when the mouth is opened.

Picture of Dental caries at Superior surface

Picture of Dental caries at the anterior surface

Epidemiology of Dental Caries

Place: It occurs worldwide, i.e. pandemic. Between 90-95 per cent of a population is affected by
dental caries in both developing and developed countries although it is more in the developed
than in the developing countries; and more in the urban than in the rural areas.

Person: It was initially commoner among the people with high socio- economic status but now it
is more among the low socioeconomic status in industrialised nations because sweets are cheap
and victims have no money for early treatment. Similarly, the prevalence was high among whites
than the blacks but presently, the reverse is the case. Dental caries begins at early age and
increases with age – the older the person, the more the caries experience. There is high activity
rate in the first 20 years of life.

Signs and Symptoms of Dental Caries

The symptoms or presenting complaints are;

 Teeth not as white as others;

 Wearing away of the teeth;
 Pains at an advanced stage;
 Dark spots on the teeth.
 If there are complications, it may also come with fever (if infection spreads to other parts
of body - i.e. Becomes systemic);
 Swelling (if there is collection of pus – abscess);
 Hole or complete loss of teeth;
 Bad odour from the mouth.

Factors Affecting the Development of Dental Caries

1. Dental caries can only be formed in the presence of three factors:

i. Food (sweet/sugary - the frequency and quality is more important than the
quantity),
ii. Bacteria (in plaque) and
iii. Tooth type (strong or weak).
2. Salivary Secretion. Factors that reduce salivary flow will lead to increased formation of
dental caries. For example, people with high bow-shaped upper lip which does not cover
the upper incisors will have increased evaporation of saliva; similarly, the night time
favour’s development of dental caries due to reduced secretion and also drugs that cause
dry mouth. (E.g. Oral hypoglycaemic drugs and some antihypertensive drugs).
3. Past caries experience have strong association with new caries.
4. Presence of very deep pits and fissures in teeth show a high risk to development of caries.
5. Poor exposure to fluoride in water of other forms also has a strong association to
development of caries.
 6. Teeth malocclusion and genetic difference have weak association.However malocclusion
leads to difficulty in proper cleaning of the mouth which could enhance the development of
dental caries and periodontal (gum) disease.

Treatment of Dental Caries

1. Conservative dentistry
2. Root canal therapy
3. Extraction

Primary Prevention of Dental Caries

i. Good Oral Hygiene - This involves regular brushing of teeth - last thing at night and after
breakfast or every meal and also early in the morning. It also involves school and day care
centre visits.
ii. Good Eating Habits - This involves avoidance of refined carbohydrates or sugars
especially “syrups”, sweets, chocolates, cakes, etc. rinsing the mouth with water after
sweet food, drinks or snacks including sweet drugs.
iii. Fluoridation - Municipal water should ideally be fluoridated. Topical fluoride in toothpaste
and in fortified food (salt, milk, table water) is another means.
iv. Use of Fissure Sealant - This involves the use of thin plastic like coatings applied to
chewing surfaces of the teeth with grooves, e.g. molars.

This is commonly done for children with the primary or deciduous dentition.
v. Regular Dental Check-Up - This may be for professional cleaning of hidden parts. This is
called scaling and polishing and should be done by every individual at least twice (i.e.
every 6 months) by either a dentist or a dental therapist

Secondary Prevention/Treatment of Dental Caries

i. Early diagnosis and prompt treatment - This can occur during the routine check-ups.
ii. There may be filling of carious teeth or restoration of lost teeth by artificial ones.
iii. Analgesics may be given for pains.

Summary of Prevention of Dental Caries

 Minimized the use of refine carbohydrate

 Brush the mouth after each meal with fluoridated tooth past
 Visit dental centre or clinic at least two[2]times a year
 Fluoridation

Complication of Dental Caries

i. Pulpitis
ii. Pulp Necrosis
iii. Periapical Abscess

3 PERIODONTAL DISEASE

Introduction
Periodontal refers to tissues around the tooth, it relates to the gum and other surrounding
structures. The early stage is called gingivitis (soft tissue only) while the more advanced stage is
known as periodontitis (when both soft tissues and bone are involved).

Definition
Periodontal disease is a chronic progressive destruction of the supporting structures of a tooth
(Periodontium) these tissues are; Gingival (gum), Cementum, Alveolar bone and periodontal
fibres.

Picture of Periodontal Disease

Picture of Periodontal Disease (Gingivitis)

Development of Periodontal Disease
When plaque is allowed to settle in the mouth for up to 7 – 12 days, some bacteria in tooth
plaque multiply close to the gums and produce certain toxic substances which irritate the gums.
This leads to inflammation of the gum which makes the gum look deep red, swollen and bleed
easily from gentle touch or pressure. If not treated on time, the disease progresses to involve the
deeper structures such as the bones and ligament around the tooth.

Epidemiology of Periodontal Disease

Between 10 and 40% of the world’s population are highly susceptible to some form of destructive
periodontal disease. These vary from the early and milder form to the late severe form. The
prevalence also tends to increase with age which is mainly due to accumulation of untreated
cases rather than new cases occurring at older age.

Signs and Symptoms of Periodontal Disease

The early form known as gingivitis is characterized by;
1. Superficial swelling,
2. Redness and
3. Pain around the gum. It is usually progressive.
4. There may also be easy bleeding from the site,
5. Itching,
6. Bad breathe and
7. Bad taste.
8. The tooth may eventually become loose and fall out when the disease involve the bone.
9. Ulcers may be found on the gum papillae and
10. There may be fever and general weakness in acute cases.

Complications may include Stomatitis, periodontal abscess, cancrum oris (noma).

Factors Responsible for periodontal disease and its Complications

1. Presence of calculus (hardened plaque): When plaque is not removed, damage to the gums
progresses until a pocket is formed. Plaque and calculus collect in the pockets and worsen
the condition which subsequently dissolves the jawbone and causes the tooth to become
loose and fall out known as periodontis. This process takes a long time and ordinarily,
people do not start losing their teeth until their middle age. In unusual circumstances, the
loss of teeth may begin early (< 30 years) especially in puberty in which case it is called
juvenile periodontis.
2. Tooth fillings which are not well placed – overhanging amalgam fillings.
 3. Sugary and empty calorie foods
4. Poor oral hygiene
5. Diminished immunity due to malnutrition in children

Causes of Periodontal Disease

There are many courses of periodontal disease but classified into local and general factors.
Local Factors
 Malocclusion
 Dental plague
 Faulty dental restoration

General Factors
 Hypovitaminosis
 Drug toxicity
 Endocrine disturbances
 Chronic debilitating diseases

Preventive Measures of Periodontal Diseases

 Proper brushing and flossing

 Using antibacterial toothpaste and mouthwash to kill bacteria
 Biannual dental visits for cleanings and checkups

Treatment of Periodontal Disease

Treatment includes professionally cleaning the pockets around teeth to prevent damage to
surrounding bone. Advanced cases may require surgery.

4 NON-COMMUNICABLE DISEASES OF THE MOUTH AND ORAL CAVITY

Non-communicable diseases refer to those diseases which cannot be transmitted from person to
person directly or indirectly. However, some person to person activities can serve as risk factors
for its development. These diseases are usually multi-factorial, i.e. due to several events all at
the same time. The most common non-communicable diseases are oral trauma and oral cancer.

i. Oral Trauma
ii. Oral Cancer
iii. Cleft Lip and Palate

TRAUMA

Epidemiology and Control of Dental Trauma

Dental trauma is a pathological condition caused by injury to the tooth, its supporting tissues and
the skeletal bone.

Types of Injuries

Injury could be physical arising from:

i. Vigorous tooth brushing vigorous mastication (chewing)

ii. Accidents from falls, punch/blows, RTA
iii. It could also be chemical injury arising from:
  Corrosive agents, e.g. battery water, certain paints
 Acidic fruits - oranges, lime
 Medicines - mouth wash, Vitamin C, herbs (garlic).

Effects of the Injuries

Abrasion

This is a post-eruptive wearing away of the supporting tissue of the tooth due to abnormal
mechanical process such as over-zealous tooth brushing, washing the tooth with coal, white
sand, ashes or chewing stick. It usually affects the gingival and may be superimposed with
gingival recession.

Attrition

This is a post-eruptive wearing away of the tooth due to tooth contact. It is usually caused by
quality of diet, mastication especially the coarse kind of meals.

Erosion

This is a chemical process of removal of hard tissue by acid due to repeated gastric regurgitation,
prolonged contact with acidic fruits like oranges, acidic drinks (coke).

Complications of the Injuries

Complications could lead to;

i. Hypersensitivity of the dentine,

ii. Obliteration (Destruction),
iii. Necrosis (death), and
iv. Calcification of the pulp.
v. Aesthetic Challenges are also major complications.

Prevention of the Injuries

1. Health education on diet, nutrition, proper technique in brushing.

2. Restriction to the minimum of coarse foods.
3. Stopping of habits such as teeth grinding, chewing pins.
4. Avoidance of physical clashes and punches on the mouth.
5. Control of RTA.
6. Appropriate Treatment.

DENTAL CANCER

Definition

Is a disease in which abnormal cells divide uncontrollably and destroy oral tissues.

Epidemiology and Control of Dental Cancers

Oral cancer is one of the 10 most common diseases in the world.

Like other cancers, the causes are unknown but have established risk factors which are
preventable. Oral cancers also have early detection signals (pre-cancerous lesions) for early
treatment intervention.

Types of Oral Cancers:

Most oral cancers are squamous cell carcinoma.

Common Sites of Oral Cancers

The lower lip is the most frequent site. The tongue, them cheeks, the palate, the gingival and the
floor of the mouth are other common sites for oral cancers.

Common Signs

i. Abnormal hardness of a lesion when pressed with a finger.

ii. Ulceration of mucous membrane with yellowish centre.
iii. Whitish raised areas on the surface of lesion -cauliflower appearance.
iv. Part of lesion raised above surrounding mucus membrane.
v. Tissues that are abnormally freely mobile become fixed to underlying structures.
vi. Loosening of teeth without apparent cause.
vii. Rapid growth rate of the tumour or swelling.
viii. Differential warmth i.e. the temperature of the tumour is higher than the other parts of the
body.
ix. Anaesthesia (loss of sensation) and/or paraesthesia of the tumour or swelling.

Common Risk Factors

i. Age: most cancers occur between 60 and 65 years; 98 % occur in people over 40 years old.
ii. Sex: commoner in male than female at the ratio of 2:1.
iii. Heavy Tobacco use and alcohol use
iv. Human Papillomavirus (HPV) infection.

Ancestry

The incidence and mortality is higher in blacks than in whites.

Lifestyle

Chewing or smoking of tobacco (especially pipe or cigar) including heavy alcohol intake and
chewing of areca nuts

Occupation

Chemical industries with risk of exposure to coal tar derivatives.

Environment

Sunlight on fair skin can cause lip cancers.

Genetics

Oral Cancers have been found to occur more in individuals who have a genetic or familial history
of such cancers.

Prevention

Primary Prevention

Health education that people should abstain from tobacco or quit if already commenced should
be promoted. Those who cannot quit should reduce quantity and frequency of tobacco use. They
can also use nicotine substitutes.

Sun Screens should also be encouraged to prevent adverse exposure to sunlight.

Face and nose masks should be encouraged in chemical industries

National Prevention Programmes

i. Legislation to prohibit sales of tobacco to minors; and smoking in public places by adults.
ii. Increased tariffs on alcohol and products.
iii. Increased taxes on tobacco.
iv. Use of warning signs on tobacco.
v. Prohibit advertising of tobacco products.
vi. Regulate contents of tobacco products to decrease tars, nicotine and other carcinogenic
agents.

Secondary Prevention s

i. Early detection of pre-cancerous lesions through population screening of high risk group.
ii. Individuals to report early in hospital for any strange lesion. Routine examination of mouth
of patients.
iii. Regular checkups - oral and dental.
iv. Treatment and radiotherapy as appropriate.

Summary Treatment of Oral Cancer

i. Medications: (chemotherapy), kills cells that are growing or multiplying too quickly.
ii. Medical procedures: (radiation therapy) ;treatment that uses x-ray and other high energy
rays to kill abnormal cells.
iii. Surgery: which include:
 Laryngectomy surgical removal of all or part of the voice box (larynx) in the throat.
 Neck dissection surgical removal of lymph nodes in the neck.
 Glossectomy: surgical removal of all or part of the tongue.

Specialist
 Radiation Oncologist: Treat and manage cancer by prescribing radiation therapy.
 Dentist: Specialists in diseases of the oral cavity, especially the teeth.
 Otolaryngologist: Treat ear, nose and throat disorders.
 Oncologist: Specialists in cancer treatments

CLEFT LIP AND PALATE

Definition

Cleft lip and cleft palate are facial and oral malformations that occur very early in pregnancy,
while the baby is developing inside the mother. Clefting results when there is not enough tissue in
the mouth or lip area, and the tissue that is available does not join together properly.

A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a
narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base
of the nose and includes the bones of the upper jaw and/or upper gum.

A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard
palate (the bony front portion of the roof of the mouth), and/or the soft palate (the soft back
portion of the roof of the mouth).
 Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the
palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate
without a cleft lip, or both together.

Epidemiology and Control of Cleft Lip and Palate

This is a congenital malformation that affects about 1 in 750 live births. Cleft lip and palate
together constitute about 50 per cent of all clefts while cleft lip with affecting the palate is present
in only about 3 per cent of all clefts. The lesion occurs as a result of failure of fusion of the median
and lateral nasal processes and the maxillary process during the intra-uterine life. Patient has his
front teeth crooked with poor spacing. Correction is achieved by closure through surgery.

Causes of Clift Lip and Palate

1. In most cases, the cause of cleft lip and cleft palate is unknown. These conditions cannot be
prevented. Most scientists believe clefts are due to a combination of genetic and environmental
factors. There appears to be a greater chance of clefting in a newborn if a sibling, parent, or
relative has had the problem.
2. Another potential cause may be related to a medication a mother may have taken during her
pregnancy. Some drugs may cause cleft lip and cleft palate. Among them:
anti-seizure/anticonvulsant drugs, acne drugs containing Accutane, and methotrexate, a drug
commonly used for treating cancer, arthritis, and psoriasis.
3. Cleft lip and cleft palate may also occur as a result of exposure to viruses or chemicals while the
fetus is developing in the womb.
4. In other situations, cleft lip and cleft palate may be part of another medical condition.

Diagnosis of Cleft Lip and Cleft Palate

Because clefting causes very obvious physical changes, a cleft lip or cleft palate is easy to
diagnose. Prenatal ultrasound can sometimes determine if a cleft exists in an unborn child. If the
clefting has not been detected in an ultrasound prior to the baby's birth, a physical exam of the
mouth, nose, and palate confirms the presence of cleft lip or cleft palate after a child's birth.
Sometimes diagnostic testing may be conducted to determine or rule out the presence of other
abnormalities.

Treatment of cleft Lip and Cleft Palate

1. A cleft lip may require one or two surgeries depending on the extent of the repair needed. The
initial surgery is usually performed by the time a baby is 3 months old.
2. Repair of a cleft palate often requires multiple surgeries over the course of 18 years. The first
surgery to repair the palate usually occurs when the baby is between 6 and 12 months old. The
initial surgery creates a functional palate, reduces the chances that fluid will develop in the
middle ears, and aids in the proper development of the teeth and facial bones.
3. Children with a cleft palate may also need a bone graft when they are about 8 years old to fill
in the upper gum line so that it can support permanent teeth and stabilize the upper jaw.
About 20% of children with a cleft palate require further surgeries to help improve their
speech.
4. Once the permanent teeth grow in, braces are often needed to straighten the teeth.
 5. Additional surgeries may be performed to improve the appearance of the lip and nose, close
openings between the mouth and nose, help breathing, and stabilize and realign the jaw. Final
repairs of the scars left by the initial surgery will probably not be performed until adolescence,
when the facial structure is more fully developed.

The Outlook for Children With Cleft Lip and/or Cleft Palate
Although treatment for a cleft lip and/or cleft palate may extend over several years and require
several surgeries depending upon the involvement, most children affected by this condition can
achieve normal appearance, speech, and eating.

Dental Care for Children With Cleft Lips and/or Palates

1. Generally, the preventive and restorative dental care needs of children with clefts are the
same as for other children. However, children with cleft lip and cleft palate may have special
problems related to missing, malformed, or malpositioned teeth that require close monitoring.
2. Early dental care. Like other children, children born with cleft lip and cleft palate require
proper cleaning, good nutrition, and fluoride treatment in order to have healthy teeth.
Appropriate cleaning with a small, soft-bristled toothbrush should begin as soon as teeth erupt.
If a soft children's toothbrush will not adequately clean the teeth because of the modified
shape of the mouth and teeth, a toothette may be recommended by your dentist. A toothette
is a soft, mouthwash-containing sponge on a handle that's used to swab teeth. Many dentists
recommend that the first dental visit be scheduled at about 1 year of age or even earlier if
there are special dental problems. Routine dental care can begin around 1 year of age.
3. Orthodontic care. A first orthodontic appointment may be scheduled before the child has any
teeth. The purpose of this appointment is to assess facial growth, especially jaw development.
After teeth erupt, an orthodontist can further assess a child's short and long-term dental
needs. After the permanent teeth erupt, orthodontic treatment can be applied to align the
teeth.
4. Prosthodontic care. A prosthodontist is a member of the cleft palate team. He or she may
make a dental bridge to replace missing teeth or make special appliances called "speech
bulbs" or "palatal lifts" to help close the nose from the mouth so that speech sounds more
normal. The prosthodontist coordinates treatment with the oral or plastic surgeon and with the
speech pathologist.

HALITOSIS
This is also known as bad breath and it is a condition in which the oral cavity has a foul smell and
is more pronounced when the person talks or breathes. It is also known as Fetor oris. It
constitutes a problem to many people. The origin of the foul odour may be from

The oral cavity itself

Other related organs or tissues other systemic disorders.
The most common cause of bad breath is poor oral hygiene, untreated decayed tooth, long
standing periodontal disease, ulcers or wound in the mouth.
Other conditions include:
 Acute Ulcerative
 Gingivitis (ANUG),
 Noma, herpes,
 Oral thrush,
 Ulcers from cancers.
Other systemic and organ diseases that can give rise to bad smell in the mouth are;
 Diabetes mellitus,
 Diseases of the nose, ear and throat,
 Infections of the respiratory tract. Lastly,
 Some people have a feeling of halitosis without any of the stated conditions (psychogenic
halitosis) or Pseudo Halitosis.

DENTAL PLAQUE
Introduction
Everyone develops plaque because bacteria are constantly forming in our mouths. These
bacteria use ingredients found in our diet and saliva to grow. Dental plaque is the singular most
important factor in the development of dental caries and periodontal diseases.

Definition
Plaque can be defined as an adherent intercellular matrix consisting primarily of proliferating
micro-organisms. Plaque is made up of invisible masses of soft, white or yellow harmful layer of
germs that live in the mouth and stick to the surfaces of the teeth. Plaques are bacteria and not
food particles. Plaque grows in areas that cannot be easily reached by the tongue, lips or the
cheeks such as the necks of teeth; cracks/grooves on teeth and in-between two teeth. Plaque
may also be found on fixed and removable dental restorations. Some types of plaque cause tooth
decay while others cause gum disease. Red, puffy or bleeding gums can be the first signs of gum
disease. If the gum disease is not treated, the tissues holding the teeth in place are
Destroyed and the teeth are eventually lost. Plaque is found in every mouth but it accumulates
faster in some individuals.

Formation of Plaque
Plaques begin to grow on tooth surfaces soon after the tooth has been cleaned. Bacteria which
initially settle in the thin layer of saliva on the tooth with time multiply and grow in size and type.
When sugary food is eaten, bacteria in plaque convert this to acid which eventually begins to
destroy the teeth and the gum. When the plaque is not removed on time, minerals settle on it
and it becomes hardened. This hardened deposit is called calculus or tartar. (Calculus means
calcified plaque)

Signs and Symptoms of Dental Plaque

Dental plaque is difficult to see because it may be the same colour with the teeth but at times it
may be colored by the food which will make it visible. Otherwise, it is stained by chewing red
“disclosing tablets,” found at grocery stores and drug stores, or by using a cotton swab to smear
green food coloring on the teeth. The red or green color left on the teeth will show where there is
plaque.

Steps in Removing Dental Plaque

Step One: Floss
Use floss to remove germs and food particles between teeth and then rinse.
Step Two: Brush Teeth
Use any tooth brushing method that is comfortable, but do not scrub hard back and forth. Small
circular motions and short back and forth motions work well. To prevent decay, it’s what’s on the
toothbrush that counts. Use fluoride toothpaste. Fluoride is what protects teeth from decay.
Step Three: Brush the tongue for a fresh feeling! Rinse again.
Remember: Food residues, especially sweets, provide nutrients for the germs that cause tooth
decay, as well as those that cause gum disease. That’s why it is important to remove all food
residues, as well as plaque, from teeth. Remove plaque at least once a day - twice a day is
better; i.e. last thing at night and after breakfast. If you brush and floss once daily, do it before
going to bed.

HIV/AIDS AND ORAL HEALTH

Acquired Immunodeficiency Syndrome (AIDS) is a chronic infectious disease caused by a virus

known as the Human Immunodeficiency Virus (HIV). It is a multi-systemic disease complex. It
takes several years for someone with HIV to develop AIDS and when this occurs, the
manifestations include the oral involvement. Apart from the transmission through sexual means
and blood transfusion, dental surgery or procedure is a common means of transmitting HIV
infection via unsterilized instruments.

Magnitude of the Problem

The HIV/AIDS epidemic is one of the most serious to affect humanity. By the end of 2007, some
33 million people worldwide were living with HIV, and millions had died of AIDS. Many more
people are affected because their parents, other family members, friends and co-workers have
died from AIDS or are infected with HIV. HIV/AIDS is the fastest growing threat to development
today and the epidemic is particularly severe in sub-Saharan Africa and Asia. As the epidemic has
progressed, realisation of its complex causes and effects has increased. The greatest challenge
in responding to HIV/AIDS at present is to ensure that proven; gender sensitive strategies for
prevention and care are widely implemented to a level where there will be significant impact on
the epidemic. The WHO Oral Health Programme can make important contributions to the early
diagnosis, prevention and treatment of this disease. A number of studies have demonstrated that
about 40-50 % of HIV positive persons have oral fungal, bacterial or viral infections often
occurring early in the course of the disease.

Transmission of HIV

HIV can be transmitted through instruments used in dental surgery during procedures such as
tooth extraction, repair of cleft lip/palate, restorative surgery, and surgery involving mandibular
and maxillary bones. Also, sharing of tooth brush with a person infected with the virus is reported
especially if the person has ulcer in the mouth.

People who practice oral sex are also at risk of the infection through the oral route. In all these
ways, there is blood contact between the two. Although, HIV virus has been found in all body
fluid including the saliva, the transmission is not passed through the saliva and so ordinary
kissing does not pass the virus except deep kissing involving lip and tongue biting. HIV is also
transmitted from mother to child through childbirth.

Oral Symptoms of HIV/AIDS

1. Most of the oral lesions associated with HIV/AIDS are due to fungi because the body
immune response is damaged.
2. Oral lesions strongly associated with HIV infection are pseudo-membranous oral candidiasis
otherwise known as oral thrush,
3. Oral hairy leukoplakia,
4. HIV gingivitis and periodontitis,
5. Kaposi sarcoma,
6. Non-Hodgkin lymphoma, and
7. Dry mouth due to a decreased salivary flow.
8. Oral candidiasis is whitish creamy coating substance on the tongue or mucosa surface.
9. When scrapped, it usually reveals a bleeding or sore surface. There may be reddish spots,
blisters or irregular areas.
 Combating the Menace
The WHO Oral Health Programme has prepared a guide to provide a systematic approach to the
implementation of epidemiological studies of oral conditions associated with HIV infection; to
provide guidelines for the collection, analysis, reporting and dissemination of data from such
studies, and to facilitate comparison of findings from different studies. The programme consists
of sound health education on safe sexual practices, distribution of condom to high risk groups,
universal precaution in handling sharps, safe surgical procedures, and prevention of mother-to-
child transmission. It also aims to encourage oral health personnel and public health practitioners
to make oral health status an integral part of optimum case management and of surveillance
activities of the diseases associated with HIV infection.

2.3 HARMFUL CULTURAL PRACTICES THAT AFFECT THE HEALTH OF THE ORAL CAVITY

There are various traditional and cultural beliefs and practices in the African society, as it relates
to oral health, which is held on strongly to without any scientific bases. Some of these are
beneficial while some are harmful directly or indirectly and others yet are neither beneficial nor
harmful.

The Harmful Traditional practices include:

Teeth Cleaning
Teething is taken very seriously among the Yoruba communities. The moment a child is born
and the teeth begin to erupt, the care of the teeth and oral cavities begin. Some even have
preventive measures against possible associated problems with teething. Items used
traditionally to clean the mouth are stems of bitter leaf tree, Neem tree (dogon yaro), and table
salt in place of toothpaste.

Positive Aspect
School age children usually take over the cleaning of their own teeth. Use of chewing stick (orin
or pako) is common in rural communities not only because of the cleansing properties but also
due to the perceived antibacterial actions. Cleaning the mouth every morning before breakfast
is a must.

Negative Aspect
Some agents used may be corrosive and astringent e.g. unripe lime, charcoal, white sand, and
ash and these may cause traumatic injury. Some of the substances may actually introduce
germs due to the unhygienic method of collection and use. Some of the substances also may
make the mouth to feel fresh and tart but may not be able to remove plaque and stains.
Furthermore, the fluoride content in toothpaste is missed out.
Some Cultural Oral Practices and Reasons

S/ Materials used Purpose and Time of Use

No
1 Fresh tomato fruit + alum To clean gums and mucosa of
applied with cotton wool or babies before the eruption of
foam. teeth
2 Alum applied with foam. When bleeding from the gum
Alum mixed with lapalapa is observed.
sap.
Hydrogen peroxide applied
with cotton wool.
3 Alum mixed with atare and Regular use in infancy and
iyere and citrus lime. childhood.
4 Toothpaste on a piece of Regular use in infancy and
foam or cotton wool. childhood.
5 Chewing sticks. Time of school enrollment.

There is also the belief that the teeth should not be cleaned at night otherwise, the person will
lose his mother prematurely. This has a negative effect on oral hygiene and constitutes a major
public health problem.

Tooth Eruption
Teeth are believed to erupt between 5 and 6 months. Children born with teeth or whose teeth
erupt too early in life are believed to be evil and may be killed or a ritual made in which case the
tooth is forcefully extracted. This can endanger the life of the child; profuse bleeding and
infection are consequences. Similarly, when the upper incisors erupt before the lower, it is a bad
sign in some communities and the child with his family may be ostracised. In order to prevent
this embarrassment, the parents quickly seek to have the tooth extracted.

Teething
Different health effects have been attributed to teething in many parts of the world and
especially in Africa. Such health problems are fever, diarrhoea, cough and catarrh, skin rashes.
These are actually symptoms of other diseases and instead of seeking help from health facilities,
the children are left alone with the belief that the symptoms are normal or at best give some
herbal concoction or teething mixture.
This practice cut across all educational status. Sometimes the herbal mixtures for teething are
given as prophylaxis.

Nylon Tooth
In some East African countries, traditional practitioners deceive people that children have some
false teeth (nylon teeth) which need to be removed. This can have grave effect on the child.

Cosmetics
 Trimming or Sharpening Front Teeth
In some cultures, the front teeth are trimmed into a pointed shape at adolescence as cosmetic.
In this process, the enamel is removed exposing the dentine causing pains and sensations to
pressure, temperature (hot or cold). The teeth will likely get decay (carious) and the pulp easily
gets infected forming an abscess.

Removal of Certain Teeth

In some cultures, the lower front teeth are removed, in others, the front teeth of new brides are
removed forcefully. This procedure leaves a gap which can result into periodontal disease and
can also affect speech.

Making a Hole in the Upper Lip and Inserting an Ornamental Stick

This process destroys the upper front teeth, the surrounding gums and the jaw bone.

Others include using tooth as tools for;

 Intentional removal of tooth

 Habitual fingers sucking

Four domains that can shape peoples cultural beliefs and practices related to oral health are: -

 Health education
 Help seeking and preventive care
 Good Oral hygiene practice
 Beliefs about teeth and the oral cavity
 The use of folk remedies

2.4 PREVENTIVE AND CONTROL MEASURES OF MOUTH INFECTION

Levels of Prevention of Oral Disease

Before we describe some specific diseases that are of public health importance, we shall describe some
general levels at which oral diseases could be prevented. There are three basic levels - primary,
secondary and tertiary levels.

1. Primary Prevention

This is aimed at controlling the interaction between the agent, disease and the host, i.e.
prevention of the disease in an individual before it happens at all. This is through:

i. General health promotion,

 Health education,
 Health maintaining habits,
 Good nutrition e.g Vitamins of all variety.
 Oral hygiene e.g Washing of mouth with correct toothpaste, method of brushing etc
ii. Specific Protection such as;
 Chemoprophylaxis e.g Immunization against chronic diseases
 Food/water fortification, e.g fluoridation
 Protection from hazards,
 Stopping/quitting certain habits e.g Smoking cigarette, alcohol etc.
 Early referral of complicated cases to secondary level.
2. Secondary Prevention
This is aimed at halting the progress of disease at its early stage before serious or irreversible
damage occurs. This is done through early diagnosis and prompt treatment. This is also made
possible through:
i. Regular checkup when a disease state can be detected early
ii. Early Treatment of oral diseases either by drugs or surgery.
iii. Early referral to tertiary level when no improvement.

3. Tertiary Prevention

Sometimes bad damage would have occurred and what could be done are:

i. Limitation of the disability - e.g. counseling to quit tobacco or smoking or to desist from
frequent sugary consumption; fabrication of dentures.
ii. Rehabilitation: e.g. vocational, speech therapy.

Summary of Preventive and Control Measures of Mouth Infecti0n

 Good oral hygiene practice

 Brushing mouth after each meal
 Visiting dental centre
 Good brushing technique

GOOD ORAL HEALTH

Daily preventive care, including proper brushing and flossing, will help stop problems before they
develop and are much less painful, less expensive and worrisome than treating conditions that have
been allowed to progress.
These include:
1. Brushing thoroughly twice a day and flossing daily.
2. Eating a balanced diet and limiting snacks between meals.
3. Using dental products that contain fluoride, including toothpaste.
4. Rinsing with a fluoride mouthwash if your dentist tells you to.
5. Making sure that your children less than 12 drink fluoridated water or take a fluoride supplement
if they live in a non- fluoridated area.

Proper Brushing Procedure

1. An important part of good oral health knows how to brush and floss correctly.
2. Thorough brushing each day removes plaque.
3. Gently brush the teeth on all sides with a soft bristle brush using fluoride toothpaste.
4. Circular and short back-and-forth strokes work best.
5. Take the time to brush carefully along the gum line.
6. Lightly brushing your tongue also helps to remove plaque and food debris and makes your mouth
feel fresh.
7. In addition to brushing, using dental floss is necessary to keep the gums healthy.
8. Proper flossing is important because it removes plaque and leftover food that a toothbrush cannot
reach.
9. If brushing or flossing results in bleeding gums, pain, or irritation, there is the need to see a dentist
at once.
The mouth is normally teeming with bacteria and once it can be kept under control with good oral
health care, such as daily brushing and flossing, ill health can be avoided. Saliva is also a key defense
against bacteria and viruses. It contains enzymes that destroy bacteria in different ways. But harmful
bacteria can sometimes grow out of control and lead to periodontitis, a serious gum infection.
When the gums are healthy, bacteria in the mouth usually don't enter the bloodstream. However, gum
disease may provide bacteria a port of entry into your bloodstream. Sometimes, invasive dental
treatments can also allow bacteria to enter your bloodstream. Medications or treatments that reduce
saliva flow or disrupt the normal balance of bacteria in your mouth may also lead to oral changes,
making it easier for bacteria to enter your bloodstream. Some researchers believe that these bacteria
and inflammation from your mouth are linked to other health problems in the rest of your body.

Summary of Good Oral Hygiene

So what exactly is good dental hygiene and how do you make sure you’re doing all you can? Follow a
few basic rules of dental hygiene:
i. Eat healthy and avoid sugary snacks
ii. Don’t use tobacco products
iii. Rinse your mouth out after meals or chew sugarless gum
iv. Brush at least twice a day
v. Protect your teeth with a mouth guard during athletics
vi. Have your dentist apply sealant to your children’s teeth
vii. Get regular dental exams

Oral Health Care for the Elderly and Other Special Groups

With the numbers of elderly people (65 years of age and older) on the increase in Nigeria and
developing countries, their health will pose a great challenge. Among the many problems of the aged
are oral and dental degeneration related to years of chewing, smoking, trauma, and dysfunctional oral
habits. Many people believe that as people get older, they will naturally lose their teeth. It is now
known that this belief is not true. By following easy steps for keeping your teeth and gums healthy –
plus seeing your dentist regularly — you can have your teeth for a lifetime!

The Need for Special Oral Care among the Elderly

The need for oral care ranges from nearly none to extreme, depending on the many individual factors
influencing oral disease and the specific oral health experiences that have occurred during the
person’s life, and the aging process specific to the person. Poor oral care in the elderly can have
serious health consequences including increased risk of stroke, heart disease, and pneumonia.
Preventing the development of these diseases through appropriate oral care, and maintenance of oral
and general health is very important.

Deficit Oral Hygiene

Dementia in the elderly may cause oral hygiene problems and such people need specialized dental
care to maintain proper oral hygiene, optimal periodontal health, and control of the development of
carious lesions. Patients who have poor periodontal health and a high incidence of dental caries upon
diagnosis of dementia require a comprehensive dental exam and a specialised treatment plan. These
patients may have a decrease in digital abilities (use of fingers or hands), lack of personal motivation
and memory loss which often leads to inadequate oral hygiene. Oral dysfunction can be painful, and
have an acute impact on quality of life, affecting chewing, speaking, and social interactions.
 Steps to Improve Oral Health and Oral Health Care
i. Education of primary healthcare workers and geriatricians about oral disease and dysfunction.
ii. Provision of regular screening and preventive education for dental disease.
iii. Provision of oral health care education and training to daily caretakers (nurses, nursing
assistants).
iv. Assisting the dental community in recognizing the management of oral disease in the elderly.
v. Generation of new options for providing improved oral health care to the elderly.

Common Oral Problems of the Elderly Patient

These include an increase of difficulty to restore dental caries; decreased salivary flow; loss of natural
teeth; ongoing, unrecognized periodontal disease; excessive tooth wear; a desire to look better and
younger; Impaired oral hygiene due to medical problems; loss of bone in the jaw and impaired use of
dentures.

Potential Problems Associated with Poor Oral Care

These include dry, cracked, bleeding or chapped lips; cold sores on the lips; raised areas; swollen,
irritated, red, bleeding or whitish gums; loose, cracked, chipped, broken or decayed teeth; yellow filled
or red sores, such as canker sores inside the mouth; white spots inside the mouth; pus; coated or
swollen tongue; bad breath or fruity smelling breath; change in the ability to eat or drink; gagging or
choking; report of mouth pain.
Basic Oral Care Guidelines for the Elderly
1. Provide oral care (care for the mouth, teeth and gums) at least twice a day or more often if
needed.
2. Brush teeth with a soft bristled toothbrush for at least five minutes brush gums and the roof of
the mouth
3. Brush all sides and eating surfaces of the tongue for 30 seconds floss gently the space between
each tooth and gum
4. Clean dentures at least once a day monitor for signs of potential problems.
5. When administering oral care to an elderly, move slowly and explain what you are doing.
Encourage independence.
6. Adaptive devices may be necessary to maintain ones independence.
7. Always wear gloves when giving oral care.
8. Follow standard precautions and wash hands when you are finished assisting with oral care.
While providing oral care,
9. Community Health Practitioner should monitor the elderly patient for the above potential
problems and report these sign/symptoms to the nurse immediately.

Oral Care among the Disable

Similarly, the physically and mentally challenged also require special assistance in oral hygiene due to
the limitations they may experience.

2.5 MANAGEMENT OF ORAL HEALTH PROBLEMS ACCORDING TO STANDING ORDER

Definition
Standing Orders are set of specific guidelines arranged by age group, disease conditions, findings,
clinical judgments and actions, which define how clients should be cared for.

Application of Standing Orders in Management of Oral Condition

1. Create a good rapport with the client
2. Explain purpose and procedure to the clients
3. Obtain the bio-statistic or personal data of the client and a certain his age
4. Open the Standing Orders to the appropriate age group page
5. Obtain the chief complaint from the client and look at the content, then open to the appropriate
page of the condition.
6. Ask all questions as listed in the complaint Cullum
7. Wash your hand and dry with towel
8. Perform all examination as stated in the examination Cullum
9. Record all significance and non-significance findings
10. Make a clinical Judgement, using the significance finding.
11. Explain findings to the client and intended action to be taken.
12. Explain medication in detail to the client as prescript in the Standing Orders, and evaluate client
understanding of drugs instructions.
13. Perform any skill as required by the Standing Orders e.g. Ear syringing etc.
14. Append your signature, rank and date of treatment.
15. Prepare for referral where necessary and required
16. Follow-up visit is very important.

Summary of steps for Community Health Practitioner to use Standing Orders

1. Obtain good history taking of presenting and associating complains taking note of significance
information
2. Perform complete physical examination taking note of significance findings
3. Open to appropriate page of the Standing Orders using the following information;

i. Age group of the patient

ii. Significant information from history taking
iii. Significance findings during examination
4. Make a clinical Judgment
5. Manage the patient condition by taking appropriate action corresponding to the clinical
judgement
6. Append your signature appropriately and write the date.
 STUDENTS ACTIVITY

TOPIC: Diseases associated with oral cavity

At the end of this lesson, the

learner will be able to:
STUDENT
 List diseases associated with oral
cavity
 Describe the diseases of the mouth
 Discuss harmful cultural practice
OUTCOME that affect the health of the oral
cavity
 Explain the preventive and control
measures of the mouth infections
 Understand how to manage oral

TASK:

 Brain storming on steps involves in mobilizing & community out-reach

 Demonstrate on community mobilization
 Role play
 Essay and multiple choice questions
 Assignment

UNIT: 3

TOPIC: STEPS INVOLVED IN MOBILISING THE COMMUNITY IN PROMOTING POSITIVE ORAL HEALTH
BEHAVIOR

INSTRUCTIONAL MATERIALS: -

 Maker
 Card board paper
 Charts
 Model

TEACHING METHODS:

 Demonstration
 Group discussion

TYPES OF ASSESSMENT:
  MCQ

LEARNING OBJECTIVES:

At end of the lesson, the student should be able to:

 List steps that are involved in mobilizing the community in promoting positive oral health behavior

COMMUNITY MOBILIZATION ON ORAL HEALTH

Community: Is a group of people living together in geographical location, which may consist of sub-
group, sharing the same culture, religion and belief.

Mobilization: Is a process of encouraging, inspiring and arousing the interest of the community
members to become aware of their health problems, health needs, and health related needs and to
prepare for health actions.

Introduction

Community mobilization engages all sectors of the population in a community-wide effort to address a
health, social, or environmental issue. It brings together policy makers and opinion leaders, local,
state, and federal governments, professional groups, religious groups, businesses, and individual
community members. Community mobilization empowers individuals and groups to take some kind of
action to facilitate change. Part of the process includes mobilizing necessary resources, disseminating
information, generating support, and fostering cooperation across public and private sectors in the
community.

Anyone can initiate a community mobilization effort — the health providers, staff of local or state
health departments, or concerned physicians and other health professionals. All it takes is a person or
a group to start the process and bring others into it.

How can community benefit from community mobilization?

The most significant benefit is doing something to help address an issue impacting their community to
save valuable resources. By getting involved, community and faith-based organizations, health care
professionals, and policy makers will jointly take actions that should result in the elimination or
reduced the incidence of Oral Diseases (problems) in their community. Beyond the great satisfaction
and achievement of eliminating Oral Problems, community mobilization can position your organization
as a leader in the community, possibly bringing in new resources.

Community mobilization consists of:

 Community involvement: which is a process of making community members to be part and

parcel in finding their own health problems and provide solution to their identified problems
through community participation.

 Community participation: Is the process of making community members to be involved in

decision making in day to day running of the health facility, which include: planning, organizing,
implementing, monitoring, supervising and evaluating.

The characteristic of community participation

 Commitment: - Community members are to be self-committed to support Primary health care

activities in their community to prevent it from collapsing.

 Cost sharing: - community members are to share cost with Government in supporting PHC
activities in terms of funding. Government should be viewed as a partner rather than funding
 agency, because any programme emanating from the community is perceived as being their
own programme.

 Inter-sectoral collaboration: - Other sector of related importance to the effective health

development of community are being involved to support PHC activities e.g. Agriculture,
Education, works etc.

ORAL HEALTH PROMOTION AND HEALTH EDUCATION

Introduction

Early prevention strategies in the control of oral diseases involve health promotion and specific
protection. While it is pertinent to note that the healthcare providers and government are main
stakeholders in healthcare of the populace, the individual has a major role/responsibility to his/her
health. However, information needed by the individuals and community members must be provided by
the health workers while also providing the encouragement, motivation, mobilization and enabling
environment for the actualization and practice of such health information. Health education is the
major channel through which such information is communicated to community members.

Health Education Pathway

Informed decision making is a necessary principle in improved healthcare. Huchbauch principle of

acquiring habit and behavioural change is by an acronym “AKUBAH”.

Awareness Knowledge Understanding

Belief Attitude Habit IMPROVED STATE

Adequate awareness concerning certain health condition will give rise to increased knowledge and
better understanding which in turn will influence the person’s belief and result in an attitude change
and finally habit/behavioural change.

Objective of Health Education

The objective of health education is to make individuals and community members to take responsibility
of their own health.

Health education should make people to be committed and actively involved towards improving their
health condition and status. From the above pathway, it is seen that the people’s belief (culture,
religion, interest, etc) is important in behavioural change and not only the information.

Giving Correct Information on Oral Health

All health personnel (not only dentists or general practitioners) should receive additional training to
support the concept of primary oral healthcare. It should be known that new information should build
on existing one, i.e. one goes from the known to the unknown.

Therefore, the health educator has a need to have some idea of what the people knew before and build
on that. He/she also needs to have acquired adequate, correct and up-to-date information concerning
the aspect of oral healthcare concerned per time. Being knowledgeable is more than mere awareness,
so a step by step fashion in a language that is acceptable to the audience is imperative. Also, an
appropriate method and channel of health education must be utilized (health talk, drama, and
demonstration, action song) in order to make the message interesting and understandable.

The oral health educator must respect the people’s culture and religion even when the people have
wrong information (based on cultural/religious beliefs) detrimental to their oral health; the Manner and
technique of communication is important whether or not the information will be accepted. This will
determine whether they will believe, accept and change their attitude toward the concerned issue or
not.

Print and Audio-Visual Media’s role cannot be over-emphasized. The health educator can also make use
of the media in promoting oral health. Similarly, journalists should play their own role in educating the
public.

Diet and Nutrition: The effects of diet and nutrition on oral health have already been discussed in
previous units. Sugars are not only detrimental to oral health; they also have a negative impact on
other systems and general health. Thus, reduction of sugar consumption for dental health can also
benefit general health, e.g. reduced incidence of obesity, coronary heart disease, and diabetes.

Oral Hygiene: Obtaining good toothbrush and fluoridated toothpaste should be emphasized.
Appropriate technique in tooth brushing should be practically demonstrated. Advantages of tooth brush
over the chewing stick should be explained.

Environment: There should be education also to the government and other stakeholders on policies
and regulations through oral health promotion. For example, apart from fluoridated toothpaste,
municipal water can also be fluoridated.

Dental Services: Dental health facilities and services (promotive, preventive, curative and
rehabilitative) should be available. This is especially important in primary and secondary schools.

Health Seeking a n d Keeping Habits: Community members should be encouraged to adapt positive
attitude to seeking healthcare early before complication sets in. Some oral diseases are not painful
until there is severity. Smoking should be discouraged or stopped.

Challenges Encountered in Oral Health Promotion and Education

Poor Communication Skills: The objective may not be clear enough, the language may not be
appropriate, the chosen method may not be suitable, the planning may not be enough and the
community may not be carried along (community participation of all concerned groups and leaders).

Negative attitude of the community members: This may be due to long standing beliefs, cultural
practices; illiteracy, wrong priority.

Appropriate policy and environment for the effectiveness of the health education may not be provided.

Steps in Planning Community Mobilization

 Identify the community entry point e.g Community leaders etc

  Identify policy makers eg. Chairman LGA, Counselor representing ward, other influential people
in the community.
 Assess Community Resources needed for Oral Health promotion
 Identify Communications strategies in the community
 Advocate for support
Steps in Organizing/Implementing Community Mobilization

 Organize meeting with policy makers/leaders

 Outline major information to be passed
 Be sure of the subject matter
 Be precise and straight forward
 Allow questioning and answering
 Be punctual and smart in presentation
 Form support groups
 Advocate for funds to assist the needees
Summary of Community Mobilization for Oral Health

Building partnership between you and the community: This you will do by spending time listening to
the community. Learn as much as possible from the community; learn their values, habits, traditions,
attitudes towards diseases prevention and control.

Approach the community, through existing local leaders, and administration, village health community
or similar groups such as groups are composed persons representing various part of the community.

Obtain information to help adopt the diseases prevention and control method to the people you work
with.

The Basic steps in community mobilization involve the following features:

 Defining the problems

 Establishing a community mobilization group
 Designing strategies, setting objectives and selecting target groups
 Developing an action plan with a time line
 Building capacity
 Identifying partners

Health Education, Advocacy and Community Mobilization Module

 1
5.
Assess to
Supervise, Identify and
Monitoring and Prioritise need
Evaluation

4.
Organise for
Implementation

2.
Set Goals and
Objectives

3.
Develop
Strategies

STUDENTS ACTIVITY

TOPIC: Steps involve in mobilizing the community in promoting positive oral health behavior

At the end of this lesson, the

learner will be able to:
STUDENT
 Define Mobilization
 List the steps involved in mobilizing
the community
 Explain the steps involved in
OUTCOME community mobilization
 Identify methods of communication
in the Community

TASK:

 Brain storming on steps involves in mobilizing & community out-reach

 Demonstrate on community mobilization
 Role play
 Essay Questions
 Multiple Choice Questions
 Assignment