Learning objectives
At the end of this lecture student will be able to : 1-Identify common dental health problems among children . 2-Determine essential elements for dental carries development . 3-Discuss epidemiology of dental carries in developed & developing countries . 4-Describe preventive measures for dental carries . 5-Specify activities of school health services in Iraq . To a level accepted to the accreditation standard of the College .Oral –Dental Health ۞Dental health problems are usually preventable . Tooth decay among children is a preventable disease.۞The development of dental carries is depending upon the critical inter–relationship between the tooth surface , dietary carbohydrates and specific oral bacteria.۞The frequency of carbohydrates consumption is more important than the actual quantity of carbohydrates consumed.
Epidemiology
۞In developed countries the prevalence and severity has been declined markedly during the last two decades.۞It is a common health problem and a common cause of high morbidity among school age children.۞The prevalence of dental carries shows marked variations among different countries and at different time periods.WHO weighted DMFT (Decayed ,missed and filled permanent teeth) .A mean of 3 is expected to be present in developed countries ; in comparison to 2.2 in developing countries among the age group 12 years and above.۞The explanation could be changes in the consumption of refined sugar despite the expected improvements in :Dental Hygiene Water Fluoridation
Preventive Measures : A/Fluoridation 1.Of communal water supply to 1.00 PPM. 2.Dietary fluoride supplements (in deficient areas). 3.Flouride prescription. 4.Topical fluoride application (specially for risky children).
B/Oral Hygiene ۞Through daily brushing and flossing of teeth helps in preventing dental carries and periodontal diseases.۞Parents should receive professional instructions about proper hygienic techniques for their children.۞Several studies revealed a deficient eye–hand coordination which is essential for optimal oral hygiene in children less than 10 years old.
C/Diet۞Decreasing the frequency of carbohydrates ingestion.۞Avoiding between meals snakes that contain carbohydrates .۞Using with precaution of gum, candy and soft drinks is an effective approach for the child with “ sweet tooth”.۞Bottle fed infants need to be weaned by completing one year of age in order to avoid nursing bottle carries , in addition it is better to give water containing nursing bottles at bed time after completing 1 year.
D/Dental fissures sealants ۞Specially useful in preventing pit and fissure carries.۞Sealants are plastic coatings that are professionally applied to the occlusal surface of posterior teeth.۞Children who develop smooth surface lesions need dental restoration placement and sealants removal.
E/High Risk Patients Identification۞Intact salivary glands function is the major host defense against dental carries :1.Pateints with Sgogreni syndrome Mikulicz disease ,chronic graft–versus–host disease and patients receiving long term therapy of drugs causing Xerostomia.2.Pateints with gastro–esophageal reflux, bulimia, rumination ,mental retardation.۞On the other hand, patients with hereditary fructose intolerance found having a reduced incidence of dental carries because they avoid fructose containing diet.
School Health Services
۞It is one of the important health care services that are provided by primary health care centers to all schools and teaching institutions in the catchments area. Activities include :-1.Examination of:a- All children in kinder gardens twice / each academic year (clinical & opthalmological & nutritional status assessment) .
b- All first year students at primary ,intermediate & secondary schools (clinical & opthalmological ) again twice a year .c- All newly enrolled students in nursing schools (clinical & opthalmological examination) .2.Detection and management of communicable diseases :a. Giving sick leaves .b. Re–examining patients after treatment.c. Epidemiological investigations to detect source of out break.d. Protection of contacts.
3.Periodic dental follow up of students. 4.Conductiong stool examination for students looking for intestinal parasites and managing infected ones. 5.Giving prophylactic vitamin A to 1st year primary school students (twice /academic year). 6.Vaccination a. All newly enrolled children in kinder gardens or primary schools according to vaccination schedule(DPT) . b. All girls 12 years old (German measles vaccine) .
7.Early detection and diagnosis of slow learning ,weak hearing and improper vision for a more comprehensive management. 8.Treating acute conditions among students and teaching staff. 9.Performing a supervisory health visits for schools and general institution within the catchments area. 10.Introducing essential health educational information and advices regarding common health problems and dental health.
11.Periodic examination of auxiliary personnel (X–ray , stool exam ,throat & nose swab and supplying them with health certificates) . 12.Training of at least one teacher per school in primary health care including eye care.13. Conduction of health statistical studies .