[Early prevention of oral diseases]

Considering the intensivity of growth and development of the child in its first year, we might say that this is very dramatic period. Very complex processes of development of orofacial structures occur in the first year. Based on series of investigations, contemporary dental medicine is paying full attention to prevention of oral diseases. New attitude is that preventive measures should be undertaken as early as in the first year of the child's life. Prevention of oral diseases in infancy consists of parental education, adequate diet, oral hygiene and fluoridation. It is important to stress that a attending of dentist at the age of 12 months should not be missed, for there is a lot of important instructions for parents to get, considering future oral health of their child. This means that the children in their first year are very desirable patients for the dentist and preventive measures undertaken at this age will have significant effects on their oral health through their whole life.

Oral health promotion and prevention for older adults

An oral health promotion and prevention program customized to individual needs begins with a thorough assessment of function and risk profile for dental diseases. Toothbrushes and interproximal cleaners can be selected or adapted to meet special needs of older adults. Fluoride use based on caries risk is an important adjunct to any prevention program. Other preventive agents such as chlorhexidine rinses and xylitol gum supplement the program as risk factors increase or when health and disability limit the ability to effectively perform oral hygiene procedures. Oral cancer screening examination is advocated on a regular basis for all older persons.

Management of dry mouth

Dry mouth is a common complaint and, when associated with salivary gland dysfunction, a significant problem. Accurate and complete diagnosis of the patient with complaints of xerostomia is essential. Management should be directed to relief of symptoms, control of oral disease, and improvement in salivary function. With a systematic approach and aggressive management, most dry mouth patients can achieve oral comfort and adequate oral function.

The unique oral health needs of an aging population

Over the last century, the number and percentage of older adults has increased dramatically. In the last 30 years, the percentage of older edentulous adults has declined significantly but the total number is expected to remain constant at 9 million until the year 2020. The increasing number of and percentage of dentate adults will have more teeth at risk for caries and periodontal disease. Many of these adults will have multiple medical problems and be taking various pharmacotherapies which will complicate oral disease and its treatment. New concepts in prevention of oral disease will be required, as will more accurate diagnostic procedures, especially to identify the at-risk older adults.

Research revisited: Gunnar Rølla's contribution to oral health

Gunnar Rølla's contributions to oral science cover an enormous range. They include research into the basic understanding of pellicle and plaque formation, to mechanisms for the prevention of oral diseases. Rølla has collaborated with over 100 persons from many different countries and thus his influence on dental research has been global.

Oral health implications in children with inborn errors of intermediary metabolism: a review

Children with inborn errors of metabolism form an important group of children at risk of oral pathology. Their management includes dietary therapies which aim to promote normal growth and development but which are often highly cariogenic. It is important for paediatricians, dietitians and paediatric dentists to liaise closely in the management of these children. This paper reviews these disorders and the limited literature that exists on the oral health implications of those conditions that rely on dietary manipulation for their management, and presents suggestions for their dental care.

Optimal recall intervals in child dental care

A favorite quote from John Fowles can be applied to the debate over the optimal recall intervals for children: "Total sight or all else is desolation." Piecemeal considerations such as the patient's caries prevalence or the rate of progression of a carious lesion, on their own, are insufficient to determine the optimal time for a recall examination. Only a regular, comprehensive examination permits the dentist to understand and apply the ecological model--how best to reduce the incidence of a oral disease and how best to care for or alleviate a disease process. This knowledge permits a practitioner to customize, to individualize his decisions with respect to frequency of examination, and when and where to apply preventive and/or treatment regimens. This applies to the management of dental caries, periodontal conditions, and growth and development problems of the dental/oral-facial complex. A practitioner can only manage the whole patient-as opposed to just the disease entity-by individualizing the frequency of recall examinations. Similarly, we can only implement optimal preventive measures-and ethically postpone invasive procedures-by individualizing recall examinations.

[Oral-dental health in the national health system of Burkina Faso]

Oral health has a low priority in the health care and national health policies of Burkina Faso because of the high mortality rate and the occurrence of endemic and epidemic diseases. However, Burkina Faso, like other developing countries, is now having to cope with increases in the incidence of oral diseases. The World Health Organization has emphasized the need to develop national oral health plans into integrated general health plans based on primary health care, to achieve its "Health for All" targets by the year 2000. The aim of this paper is to highlight the political, administrative and economic constraints involved in implementing oral health policies within the framework of primary health care in this country. The organization of oral health services, understanding and compliance with a multidisciplinary approach by oral health care staff and the promotion of oral health in a community-based approach are vital for the integration of oral health care into the general health plan.

Oral lesions in organ transplant patients

Patients who have undergone organ transplantation can present with a variety of oral lesions that appear to be related either directly to their medication or arise as a consequence of drug-induced immunosuppression. Such lesions include hairy leukoplakia, an increased propensity to both fungal and viral infections and a high incidence of malignant change, especially lip cancer. Cyclosporin remains the immunosuppressant of choice in most transplant patients. Gingival overgrowth is the main unwanted oral effect associated with cyclosporin. Some 30% of dentate transplant experience this problem, which is further compounded by concomitant medication with a calcium channel blocker. This review appraises the various oral problems that can arise in this group of patients and emphasises the importance of regular oral screening and the establishment of links with the various transplant teams.

Periodontal considerations in the management of the cancer patient. Committee on Research, Science and Therapy of the American Academy of Periodontology

This position paper on periodontal considerations in the management of the cancer patient was prepared by the Research, Science and Therapy Committee of The American Academy of Periodontology. It is intended to provide information regarding the effects of head and neck radiation, total body radiation, chemotherapy, and bone marrow transplantation on the oral tissues. In addition, the paper offers suggestions for the prevention and treatment of periodontal and oral side effects of cancer therapy. Reliance on this position paper for patient management will not guarantee a successful outcome. Cancer therapy may be associated with complex problems. Ultimately, decisions regarding the diagnosis and treatment of oral disease in an individual patient must be made by the treating practitioner in light of the specific facts presented by that patient and in consultation with the patient's physician.

Promoting oral health in older people

Dental health can be a neglected area in the care of older people. This article considers some of the common dental problems experienced in older age and discusses strategies for treatment and prevention.

The development of patient information leaflets. Care of the mouth after radiotherapy

OBJECTIVES

Describe the methodology used to produce a patient leaflet on care of the mouth after radiotherapy.

DESIGN

Prospective study to design a patient information leaflet.

SETTING AND SUBJECTS

Patients undergoing radiotherapy for oral cancer.

INTERVENTION

After a review of the relevant literature, a patient questionnaire was produced. This was then completed by patients undergoing radiotherapy treatment and gave an indication of the problems being encountered. Healthcare professionals were surveyed for their views. A leaflet was then produced according to published guidelines. It was taken back to another group of patients and a further version produced after input from a health promotion group.

RESULTS

A leaflet was produced after wide consultation and survey.

CONCLUSIONS

Considerable effort must to be put into the production to patient information leaflet. It must be discussed with patients in the target group if it is to be sensitive, understood and find acceptance among its users.

Oral condition of patients with leukemia and lymphoma

Different oral manifestations, the most prominent characteristics of the different oral symptoms, and oral colonization by Candida albicans were studied in 97 patients with leukemia and lymphoma. Oral manifestations usually occurred in both leukemias and lymphomas. The most common manifestation in both diseases was mucosal pallor. Oral colonization by Candida albicans in all patients was determined by the use of Sebouraud's agar plates and quantitative estimation of the colonization was made on a scale of +1 to +4 according to its presence in the four quadrants of the agar plates. Oral colonization by Candida albicans was between +1 and +4 in the patients with leukemia and was between +1 and +3 in the patients with lymphoma. Professional dental follow-up should be integrated into the medical follow-up. This is important not only for diagnosis of the disease, but also for prevention and treatment of complications during subsequent treatment.

Clinical dentistry in the 21st century

What will oral health care be like in the 21st century? During the 20th century, American dental education evolved from freestanding and often proprietary schools to become an integral part of research-intensive university professional education. This evolution provided a formidable scientific basis for diagnosis, therapeutics, disease prevention, and health promotion. The development of clinical skills coupled with advanced dental materials and therapeutics has truly been remarkable. And now we approach the 21st century as a nation of changing demographics. By 2010, nearly 40 million Americans will be 65 years old or older. Expectations for "quality of life" now punctuate American values. In 1900, the human life span was 45 years, but today it approaches 80 years. Although in 1900, the primary causes of mortality and morbidity were acute infectious diseases, today our challenges include complex viral-infectious as well as neoplastic and chronic disabling diseases (e.g., chronic facial pain, musculoskeletal degeneration, osteoporosis, osteoarthritis, and cerebrovascular and coronary diseases and disorders). In fact, one American dies every hour from oral cancer. Changes in the practice of clinical dentistry in the 21st century will: (1) integrate dental practice into comprehensive health care; (2) become increasingly proactive for health promotion; (3) represent an increased knowledge-base and computer-assisted technology approach for diagnostics and therapeutics; and (4) use novel strategies for oral health care ranging from gene-mediated therapeutics to community-based health promotion.

Oral health education for medical students

With a view to improving oral health in Oman, particularly in the interior of the country where dental services are very scarce, medical students have been receiving a grounding in this field since 1988. The results achieved so far have proved encouraging.

Graft-vs.-host disease

Bone marrow transplantation (BMT) is the treatment of choice for many leukemias, lymphomas, bone marrow failure syndromes, and immunodeficiency disorders, and is the primary and salvage therapy for many solid malignancies. With the establishment of national and international marrow banks, unrelated allogeneic BMT is being performed with increasing frequency. Graft-vs.-host disease (GVHD) remains a major complication of allogeneic BMT, occurring in 25% to 70% of patients despite GVHD prophylaxis, with the skin, gastro-intestinal tract, and liver as primary target organs. Oral findings are seen in both acute and chronic GVHD. In acute GVHD, the oral lesions are often painful, erythematous, ulcerative, and desquamative. In chronic GVHD, they are lichenoid with associated erythema and ulcerations; additionally, they may be associated with a sicca syndrome characterized by xerostomia and progressive salivary gland atrophy. General principles of BMT are discussed, as are systemic and local therapeutic options for oral GVHD.

Radiotherapy and oral sequelae: preventive and management protocols

The purpose of this paper is to provide background information on radiotherapy, and to present dental hygiene protocols for the treatment of head and neck radiation patients. These patients experience specific oral complications or sequelae that require specialized care. To assist the treating dental hygienist in understanding the genesis of these complications, a brief history of the use of radiotherapy and its effects on mammalian tissue is included. Complications may include mucositis, candidiasis, xerostomia, loss of taste, trismus, severe caries, nutritional deficit, and osteoradionecrosis. Management protocols are presented for the prevention and treatment of these complications. Maximum protocol effectiveness and long-term success may only be attained by education of and communication with the patient. As the number of head and neck radiation patients increases daily, a thorough understanding of the disease and treatment process is becoming more necessary for all oral healthcare providers.

Orthodontic appliances in relation to nickel hypersensitivity. A review

Nickel hypersensitivity is an increasing problem in adolescents, especially in girls, with a prevalence of up to 30%. The presence of nickel in orthodontic appliances and the possibility of causing nickel hypersensitivity has been discussed in case reports. A review of the literature concerning nickel hypersensitivity in relation to orthodontic appliances has shown that the risk is very low for patients who are not nickel hypersensitive at the start of the treatment. A patient who is already nickel hypersensitive at the start of orthodontic treatment may in rare cases show adverse reactions induced by the appliance. The slow long-term release of nickel from orthodontic appliances may induce tolerance to nickel in individuals who are not hypersensitive at the start of orthodontic treatment.

Treating restorative dentistry to health

The concepts that underpin much of dental practice need refocusing so as to accommodate the many scientific advances that have been made in recent years in understanding oral disease processes and their management. "Treatment' should come to mean what it says, namely the curing of diseases- and much of this can only be accomplished by non-invasive means. Restorative procedures should be seen simply as prosthetic, making up for lost tissues. The sequence of events with respect to caries should usually be diagnosis followed by treatment, and then the option of restoration if appropriate. In order to achieve this state of affairs for the whole population, I believe it will be necessary to stream dental undergraduates so that, while a portion learn restorative techniques and become licensed to practise them, the remainder concentrate on the non-restorative aspects of dentistry, having a special emphasis on the prevention and non-invasive "treatment' of oral and dental diseases, including caries, on a community scale. This latter group of dentists would not be licensed to undertake restorative procedures.