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By Professor Omar Hasan Kasule Sr.
1.0 OVERVIEW
1.1 Untreated dental disease is associated with several complications including masticatory difficulties leading to malnutrition, impairment of speech, and disfigurement that leads to social stress.
1.2 The main oral disorders are: dental caries, periodontal disease, malocclusion and dento-facial abnormalities, oral mucosal disease, and oral malignancies.
1.3 Dental caries are due to decalcification of the enamel by action of organic acids produced when oral bacteria act on sucrose. Only a few of the oral normal flora are cariogenic the most important being strep mutans, actinomyeses spp, and lactobacillus spp. Saliva helps buffer the acids and has minerals (calcium, phosphorus, and fluorine) that help in remineralization.
1.4 Periodontal disease starts as gingivitis which progresses to periodontitis. The infection is due to microorganisms in the plaque that colonize the gingival crevice. The primary pathogens are actinobacillus, actinomycetes spp, porphyromonas gingivalis, provotella intermedia, eikelnella corrodens, and fusobactarium nucleotum.
2.0 EPIDEMIOLOGICAL MEASURES OF ORAL DISEASE
2.1 The DMF index is used to indicate D = number of decayed teeth, M= number of missing teeth, F= number of filled teeth. The Oral Hygiene Index (OHI) and the Plaque Index (PI) are used to assess periodontal health. Gingivitis is assessed using the gingival index, the periodontal disease index, and the community periodontal Index of Treatment Need (CPITN).
3.0 INCIDENCE AND MORTALITY
3.1 Diseases of the teeth and surrounding structures have a high prevalence. Dental caries became prevalent in the 19th and 20th centuries due to increasing consumption of refined foods and sugar. Dental caries' incidence is increasing worldwide.
3.2 The incidence of caries is higher in developed countries with peaks in childhood and adolescence but is falling due to awareness. It is rising in developing countries as dietary practice changes with material development. Caries are found more in the low SES due to delay is seeking treatment.
3.3 Periodontal disease occurs more in rural than urban areas. Males are affected more than females. Periodontal disease is prevalent in developing countries. Its severity increases with age. It is associated with poor oral hygiene. It is more common in rural areas. Males are affected more than females. The uneducated and users of tobacco have higher prevalence.
3.4 The following are encountered as craniofacial malformations: cleft lip, cleft palate, jaw deformities, dental anomalies, too wide spacing of teeth, too narrow spacing of teeth, facial asymmetry, and the fetal alcohol syndrome.
4.0 RISK FACTORS
4.1 Low salivary flow is a risk factor for dental caries.
4.2 The main risk factors of dental caries are dietary; taking refined food with high sugar content.
4.3 Poor oral hygiene is the main risk factor for periodontal disease.
4.4 The risk factors for cleft lip are thought to be environmental insults in pregnancy (maternal disease, chemotherapy, radiation, alcohol, excess retinoic acid, and anti-convulsant therapy) or genetic factors.
4.5 About 90% of oral malignancies are squamous cell carcinoma whose risk factors are tobacco and alcohol. It is suspected that viruses such as EBV, CMV, and HPV are involved.
5.0 PREVENTION
5.1 Dental caries are prevented by use of fluoride. It can be added to community water supplies, milk, salt can be given as topical fluoride or as fluoride supplements. Fluoride makes the enamel more resistant to caries. Occlusal sealants help prevent contact of the tooth enamel with the careous acids.
5.2 Good oral hygiene involves plaque removal, regular brushing, and flossing.
5.3 Dietary modifications involve decreasing fermentable carbohydrates, increasing the amount of fiber in the diet, and taking adequate phosphorus and calcium.
5.4 Care must be taken to avoid damaging salivary glands during operations on the mouth. Where salivary flow is inadequate, artificial saliva can be used.
5.5 Periodontal disease is prevented by oral hygiene, professional tooth cleaning every 6 months, and mechanical plaque removal done by the patient or a dental hygienist.
6.0 PROPHETIC TEACHINGS ON ORAL HYGIENE
6.1 Oral hygiene was emphasized by the Prophet. He taught two methods of maintaining oral hygiene: rinsing the mouth during wudhu, madhmadhat[i]; and using the tooth-pick, siwaak.
6.2 Use of the toothpick, siwaak, was especially emphasized[ii]. The prophet would have ordained it for every salaat were it not for fear of over-burdening people[iii]. The prophet emphasized regular use of the toothpick to maintain oral hygiene and prevent infection. It is recommended to use the toothpick in the following cases: entering the mosque, reading Qur'an, after eating, before salat, and on waking up at night. The toothpick must be washed between uses.
7.0 WATER FLUORIDATION STUDY
7.1 The benefit of fluoridation of community water supplies was shown in classical community intervention studies in the US (J Amer Dent Asoc 52:314-325 1956; J Amer Dent Assoc 65:581-588 1962).
7.2 A community intervention study is designed to test whether a certain public health intervention such as health education or water fluoridation has an effect on a given outcome measure. Two or more similar communities are randomly allocated to receive different interventions and the outcome is then measured. The intervention is carried out at a community-wide level. Random allocation ensures comparability. The population in which the intervention is undertaken is called the intervention population. The reference population serves as controls. In a community-based intervention study, the random allocation is based on the community and not the individual. This is considered a quasi-experimental design with less statistical power than allocation based on individuals. For best results it is best to restrict the study to certain age groups. Sometimes it is not feasible to assess outcome on all members of the intervention and reference populations. A sample survey of both populations before and after intervention may have to be done in such cases.
[i] Buloogh al maraam #48
[ii] Bukhari 1:245, Bukhari 1:246)
[iii] Buloogh al maraam #29