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«Chapter 24 Assorted Errands in Prevention of Children’s Oral Diseases and Conditions H.S. Mbawala, F.M. Machibya and F.K. Kahabuka Additional ...»

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When bacteria feed on the sugars in the food they produce acids responsible for tooth demineralization. All people carry bacteria in their mouth which make them susceptible to tooth decay. In particular, risks for caries development include physical, biological, environ‐ mental, behavioural, and lifestyle-related factors such as poor oral hygiene, inappropriate methods of feeding infants, diet high in sugars, high numbers of bacteria, and frequent use of medications containing sugar or causing dry mouth, insufficient fluoride, malnutrition including vitamin and mineral deficiencies and some medical conditions, such as Sjogren's syndrome, that decreases the flow of saliva in the mouth. The teeth are susceptible to caries throughout lifetime, though host factors including tooth structure and saliva modify the progression of the disease. Children are susceptible to aggressive tooth decay of primary teeth known as early childhood caries.

Treatment of dental caries: Some initial dental caries process may stop if prevention actions (like oral hygiene improvement) are put in place. Nevertheless, treatment options for more severe caries include dental fillings. When decay reaches the dentin but not yet in the pulp, it can be treated by removing the decay using rotary or hand instruments; the cavity is then cleaned and filled with dental materials of choice. When the lesion extends into the pulp and/or root canal of the tooth, it is treated by root canal treatment procedure. The procedure involves preparation of an access cavity followed by removal of dead tissue, blood vessels and nerves from the canal and finally cleaning of the root canal(s). Biocompatible materials are filled in the cavity and the canals. When indicated, a crown is placed on the tooth to strengthen the restored tooth crown.

Tooth Extraction: Removal of the tooth is opted if the extent of tooth decay and/or tooth infection is beyond repair with filling or root canal treatment. When the tooth is extracted, it can be replaced with dental implant, partial bridge or denture.

7.2. Periodontal diseases

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negative, anaerobic bacteria growing in subgingival areas. The persistent inflammation due to host response to pathogens causes the destruction of periodontal tissues, leading to clinical manifestations of the disease [24]. In general, most children and adolescents worldwide have signs of gingivitis. An aggressive periodontitis affects about 2% of young individuals during puberty and may lead to premature tooth loss.

Causes of periodontal diseases: Periodontal diseases are caused by bacteria in dental plaque-a sticky substance that forms on tooth surface, but other factors influence the disease progres‐ sion. In reaction to bacterial invasion, the body immune system releases substances that inflame and damage the connective tissues of the gingiva, periodontal ligament or even the alveolar bone. This leads to swollen, bleeding gums which are signs of gingivitis. Further damage involving cementum, alveolar bone with periodontal pockets indicates severe form of periodontal disease. Some genetic and environmental factors put the host susceptible to periodontal diseases. Rare syndromes affecting phagocytes, the structure of the epithelia, connective tissue, or teeth, could have severe periodontal manifestations. For some disorders, the responsible gene or tissue defect has been identified.

Haim-Munk and Papillon-Lefèvre syndromes are rare autosomal recessive disorders associ‐ ated with periodontitis onset at childhood and early loss of both deciduous and permanent teeth [25, 26].

Tobacco and alcohol use: Tobacco use is clearly a risk factor for periodontal disease. In contrast, a small but significant association exists between alcohol consumption and loss of periodontal support [27].

Infection like HIV and AIDS: An infection process impairs the immune response thereby lowering the gingival protection from local infection.

Nutrition: Historically, specific, overt nutritional deficiencies have been associated with periodontal disease. Vitamin C deficiency leads to scurvy with decreased formation and maintenance of collagen, increased periodontal inflammation, haemorrhage, and tooth loss.

Diabetes: The relation between periodontal health and diabetes has been described as bidir‐ ectional; although periodontitis is a potential complication of diabetes, evidence suggests that treatment of periodontal infections in diabetics could improve glycaemic control [28].

Stress: Emotional and psychosocial stresses clearly are factors in periodontal disease, but their precise role in the pathogenesis of this disease is unknown [29].

Impaired immune response: Severe periodontal disease and loss of tooth-supporting tissues often occurs if the individual’s host response or immune function is impaired. Various systemic diseases such as leukaemia and thrombocytopenia could be associated with increased severity of periodontal disease.

Treatment for periodontal diseases: The foundation of periodontal therapy is anti-infective nonsurgical treatment aimed at controlling the bacterial plaque and other prominent risk factors.

Proper tooth brushing can prevent and treat initial stages of bacterial induced gingivitis.

However, scaling and root planning is indicated for treating advanced periodontal disease.

552 Emerging Trends in Oral Health Sciences and Dentistry Dental plaque and calculus can be removed from tooth-crown and root surfaces (scaling and root planing) by use of various manual or powered instruments. Special attention is devoted to biofilm debridement in periodontal pockets combined with improved personal oral hygiene.





Additional use of local antibiotics, local antiseptic drugs, and systemic antibiotics provides some extra benefit compared with debridement alone.

7.3. Dental trauma

Dental trauma is any injury to the mouth, including teeth, lips, gums, tongue, and jawbones.

About one third of 5 years old children have sustained traumatic dental injuries involving primary teeth mostly tooth luxation: boys have slightly higher frequency than girls. A prevalence of 5–12% has been found in children aged 6–12 years in the Middle East. A significant proportion of dental trauma relates to falls, sports, unsafe playgrounds or schools, road accidents and violence [30].

An important predisposing factor for dental trauma is large maxillary overjet and incomplete lip closure. Other risk factors associated with incisors injury in elementary school children are playing without mouthguard and/or faceguard and sociobehavour factors including gender (MaleFemale) and increased participation in sport activities [31, 32].

Treatment of dental trauma varies according to the type or extent of injury like fracture, avulsion and luxation (tooth displacement). Tetanus booster and antibiotics should be administered whenever a dental injury is at risk for infection. Arrangements should be made for prompt follow-up with a dentist or an oral and maxillofacial surgeon [33, 34]. Specific procedural details of each type of fracture is beyond the scope of this chapter

7.4. Dental malocclusion

Malocclusion is not a disease but rather a set of dental deviations which in some cases can influence quality of life and interfere with oral functions. The prevalence of different traits of malocclusions varies with age, ethnicity and geographical location. The reported incidence ranges from 32 to 93 percent [35].

The causes of malocclusion include hereditary transmission, oral habits such as thumb sucking, tongue thrusting, pacifier use, prolonged use of a bottle early loss of teeth, impacted teeth, or abnormally shaped teeth, misalignment of jaws due to fractures after a severe injury, tumours of the mouth and jaw, congenital and acquired jaw deformities and abnormal orofacial muscle function.

Treatment: Every dentist who treats children practices orthodontics, whether knowingly or not. It is not enough to think of orthodontics as being solely concerned with appliances.

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7.5. Oral mucosal lesions There are many mucosa lesions occurring in the mouth. Some are local due to local derange‐ ment, while others occur in the mouth manifesting systemic diseases like HIV/AIDS. Of the oral mucosa lesions, Leukoplakia is the most frequent form of oral precancer and appears in the oral cavity as a white patch that cannot be rubbed off [37]. Oral lesions may be in form of a swelling, blisters, cyst, ulcers and mucosa coulour change or mucosa plaque.

Oral manifestations of systemic diseases: Many systemic disease manifests with oral signs and symptoms, hence, the mouth is considered as the mirror of the general body health. Some oral lesions (e.g. Koplik’s sport) are very specific thus are used in confirming diagnosis of some diseases. Some lesions appear at the initial stage of systemic diseases that should alert clinician to speculate and work for early diagnosis of particular systemic conditions. Before the introduction of Highly Active Antiretroviral Therapy (HAART), approximately 40–50% of people who were HIV-positive had oral disease caused by fungal, bacterial or viral infections that often occur early in the course of the disease [38]. The common systemic diseases with oral lesions include; HIV, Sickle cell anaemia, Hodgkin's lymphoma, Sjögren's syndrome, drugs side effects, Herpes simplex, Varicella-zoster, measles, oral hairy leukoplakia and syphilis.

Congenital anomalies: There are many orofacial conditions occurring congenitally. Of the developmental disorders, congenital diseases of the enamel or dentine, problems related to the number, size and shape of teeth, and craniofacial birth defects such as cleft lip and/or palate are most important [39].

8. Basic principles of prevention of oral diseases in children

WHO Global Oral Health Programme for public health has set down basic principle ap‐ proaches underlying effective oral disease prevention namely; acting on socio-determinants of health, working as one through the common risk factor approach and implementation of multiple strategies of prevention in different settings.

Socio-determinants of health: It is now apparent that individual behaviours such as oral hygiene practices, dietary patterns and attendance for dental care, which are the bases for prevention of oral diseases and conditions are largely influenced by family, social and community factors, as well as political and economical measures [40]. Therefore, WHO recommends that oral disease prevention strategies (public health strategies) need to be directed at underlying sociodeterminants of health. They include; socioeconomic and political context, social position and health care system [41].

Thecommon risk factors approach as one of the underlying strategies for public health approach recognizes that chronic non-communicable diseases such as obesity, cancers, diabetes and oral diseases share a set of common risk conditions and factors. Hence providing a rationale for partnership in disease prevention which is particularly applicable in countries with limited numbers of oral health personnel.

554 Emerging Trends in Oral Health Sciences and Dentistry The multiple strategies of prevention: The other underlying principle is the multiple strategies to be implemented in different settings. There should be a mix of complementary public health approaches that focus both on assisting individuals and communities to avoid disease and on the other hand to create supportive environments that are conducive to sustain good health.

In the prevention of oral diseases, the high-risk approach has been largely dominant. Finally, the WHO now increasingly acknowledges that the best preventive strategy for public health approach is a combination of the high-risk and directed population approaches, [42].

9. Available prevention approaches for specific oral diseases and their effectiveness Evidence base of oral health interventions from systematic reviews and effectiveness studies conducted between 1994 to 2005 reveal that there are several approaches for diseases preven‐ tion [43]. Water fluoridation and use of topical flourides as toothpaste, mouthrinses and varnishes were effective in reducing caries prevalence of 14 to 46% respectively. Whereas fissure sealants are reported to have caries reduction of up to 86% in 12 months and 57% in 48 months time. Dental health education provided a short term improvement in oral health knoweledge and had limited effects on oral health behaviours. While the effectivenes of dieatary control on reducing caries was not revealed. Table 2 below, summarizes the preven‐ tion approaches for specific oral diseases and their effectiveness.

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10. Different stakeholders responsible for children’s oral health There are diverse stakeholders for children’s oral health who vary in accordance to the child’s age or place where the child is located on a specified period of time. Another category is the overall universal stakeholder.

The stakeholders in accordance to the child’s age are presented for three age groups namely;

birth to three years, four to seven years and eight to twelve years.

10.1. From birth to three years At birth children do not have teeth. Usually the mothers are the fundamental persons in charge of the children’s oral health. Under special circumstances, for example a very sick mother or a mother who pass away after delivery, caretakers may become principally accountable.

Whether the mother is available or not, more carers come in as the child grows to one year and further to three years. They include; fathers, siblings, helpers and other family members. Other important responsible groups for prevention of oral diseases in young children are the professionals that is; Medical personnel (Medical doctors and nurses) and Dental personnel (Dentists, Dental Hygienists, Dental Nurses).

10.2. Four to seven years

As children grow they also assume responsibility on their health issues. Thus the stakeholders for children aged four to seven years are the mothers, fathers, children themselves, siblings, helpers, other family members and nursery/school teachers. The Medical personnel (Medical doctors and nurses) and Dental personnel (Dentists, Dental Hygienists, Dental Nurses) are accountable in prevention of oral diseases in this age group.

10.3. Eight to twelve years



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