Strengthening of oral health systems: oral health through primary health care

Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care.

Primary oral health care

The aim of this review was to describe the background and evolution of primary oral health care (POHC), including the development of an oral health policy, by identifying the resources necessary for oral health services, reviewing the evidence of the effectiveness of oral health promotion and education, providing essential oral health care, and establishing evidence of the benefits of regular dental visits for effective POHC. At present, evidence for the effectiveness of oral health education and regular dental visits is very weak. Nevertheless, POHC needs to be developed as an integral part of primary health care (PHC). Therefore, a need exists to increase financial investment, resources and workforce in PHC to lower the prevalence of dental caries and periodontal disease in the Middle-East using the POHC approach.

Probiotics and oral health: an update

Probiotics are micro-organisms, principally bacteria, which, when ingested, confer health benefits beyond basic nutrition. Probiotics have been extensively studied for their health promoting effects. The main feld of research has been focussed on the gastro-intestinal tract. However, in the past few years probiotics have also been investigated from an oral health perspective and their use has shown promising results with respect to control of chronic conditions, such as dental caries, periodontitis, halitosis and candidial infections. Despite the immense potential of probiotics, hardly any randomised, controlled trials have been conducted on their action and application and studies on their effects on oral health are still in early stages. Hence, more research is needed before any evidence-based conclusions can be drawn. This paper considers some recent literature and insights on which further investigations could be based.

The crisis of women and at-risk populations needing dental care in Tennessee: challenges and engagement efforts

Women's health issues are receiving increased attention, including the differences in their dental needs and experiences. Biological and social factors are strong determinants of physical and dental health along the entire life spectrum. Socio-environmental place also contributes significantly to some of the barriers to quality and quantity of health care received, placing population groups who have less access to care at risk. Considerable disparities exist in who receives dental care and what type of dental treatment is received among different segments of the population. Greater illumination of these issues in all discussions related to healthcare of women and at-risk populations continues to be a needed focus of concern. The plight of women and at-risk populations and problems influencing access to care are addressed.

Epidemiology, control and prevention of tobacco induced oral mucosal lesions in India

Oral cancer is one of the leading causes of human morbidity and mortality especially in developing countries like India. Tobacco consumption in smokeless and smoking form along with alcohol is considered as the primary risk factors. Tobacco is a major health challenge with various tobacco products available for use which are known to have deleterious effects on the oral mucosa. The oral lesions caused by tobacco are inclusive of those that are less likely to progress to cancer; lesions with increased tendency to develop into cancer and cancerous lesions. Prevention and control of tobacco induced oral mucosal lesions is the prime requisite currently and mainly involves measures undertaken at primary, secondary and tertiary levels. Primary prevention plays a pivotal role in tobacco induced lesions and steps can be taken at policy level, community as well as individual level. This review paper focuses on the epidemiological data of tobacco induced oral mucosal lesions in India available in the literature with an overview on various strategies for their prevention and control.

Deletion syndrome 22q13: what the dentist should know to manage children with Phelan-McDermid syndrome effectively

Deletion Syndrome 22q13 (or Phelan-McDermid Syndrome) is a very rare genetic disorder characterized by general neonatal hypotonia, absent to delayed speech, and global developmental delays. With only 600 cases reported worldwide, the disease remains largely under-diagnosed, but diagnosis is on the rise. Current thinking suggests that 22q13 Deletion Syndrome may be one of the principal causes of idiopathic mental retardation. Patients with Phelan-McDermid Syndrome, especially children, can be a challenge for dental professionals, as it is often associated with autism. Dentists see patients with all kinds of special needs, developmental conditions and disabilities. Children with Phelan-McDermid Syndrome need dental care just like every other child. As with other autism-related disorders, children with Phelan-McDermid Syndrome need sameness and continuity in their environment. The dental literature, however, offers very little information to aid the dentist in the management of these children. This article aims to make dentists aware of the disorder and provides tips and recommendations that dentists may find helpful to manage Phelan-McDermid children more effectively.

[Using Mexidol Dent for prevention of oral mucosa disorders in patients with xerostomia]

The aim of the study was to evaluate clinical efficiency of oral hygiene agents Mexidol Dent (Farmasoft) for prevention of oral mucosa diseases. Eighty-three xerostomia patients (55 female and 28 male) aged 44 to 62 years were included in the study and divided in 4 groups according to oral hygiene agents: toothpaste Mexidol Dent Fito (20 patients), mouthwash Mexidol Dent Professional (23 patients), both toothpaste and mouthwash (21 patients) and control group of 19 patients who were free to choose their own oral hygiene means. After one year of the study in the experimental groups oral mucosa disorders were revealed in 9.6% of cases, which is 2.7 times lower than in control group.

The complication of oral piercing and the role of dentist in their prevention: a literature review

OBJECTIVES. The work report about the complications of oral piercing and the role of dentist in their prevention. MATERIALS AND METHODS. The authors conducted a systematic review of the literature through the Medline database by entering "oral piercing", "piercing and complications", "piercing and hygiene" as keywords. Articles published between 1988 and 2012 were considered. RESULTS. Oral piercing is linked to several potential complications. Many of them are due to scarce awareness of the risk, bad habits and inadequate oral care. CONCLUSIONS. The dentist should motivate patients with oral piercing to maintain a good oral care, provide instructions and conduct periodic inspections to secure their understanding and implementation in order to prevent complications.

[Oral management for cancer patients]

Chemotherapy and radiotherapy administered to cancer patients can be harmful because of their effect on normal cells as well as cancer cells, and cause many adverse events. The oral cavity is one of the sites most vulnerable to the direct and indirect effects of cancer therapy. Severe adverse events of the oral cavity can not only reduce a patient's QOL, but also disrupt cancer treatment. We discuss the concept of oral management by maintenance of the oral environment.

Effects of radiotherapy to the jaws. 2: Potential solutions

Dental maintenance and rehabilitation of head and neck cancer care is becoming more important as the outcome of cancer treatment improves. The management of these patients can be very difficult for a number of reasons as discussed in part one of this two-part series. This second part attempts to suggest possible solutions for the management of the major oral health problems encountered by these patients during and after their cancer treatment.

Effects of radiotherapy to the jaws. I: The scale of the problem

Cancer care has become one of the main targets of the National Health Service in England and with cancer patients surviving longer, it is likely that head and neck cancer patients will make up a large proportion of patients seen within secondary care settings in the future. The management of these patients can be very difficult for a number of reasons. Part one of this paper attempts to highlight the major oral health problems encountered by these patients during and after their cancer treatment and supported by the current literature. Part two of this series will address the dental management of head and neck oncology patients undergoing radiotherapy with particular attention of possible improvement to current management strategies for these patients.

[Current attitudes to the elimination of infection foci from the oral cavity of adult patients qualified for allogeneic hematopoietic stem cell transplantation]

Oral cavity is often the source of local and/or general complications in patients treated by allogeneic hematopoietic stem cell transplantation (alloHSCT). According to the literature dental treatment of an adult patient prior to transplantation is based on empiric protocols elaborated by oncological clinics for their individual needs. Suggested rules often differs between each other. I this article we present different attitude to the important problem of either removing or leaving the potential dentogenic foci of infection. The analysis of the literature suggest that the most appropriate procedure is to eliminate all potential and existing sources of infection before transplantation, as long as it is possible by the amount of time remaining before beginning the conditioning chemo/radiotherapy and by the general condition of a patient. In another case dental treatment should be postponed until the posttransplantation period.

Integrating oral and general health screening at senior centers for minority elders

Racial/ethnic and socioeconomic disparities regarding untreated oral disease exist for older adults, and poor oral health diminishes quality of life. The ElderSmile program integrated screening for diabetes and hypertension into its community-based oral health activities at senior centers in northern Manhattan. The program found a willingness among minority seniors (aged ≥ 50 years) to be screened for primary care sensitive conditions by dental professionals and a high level of unrecognized disease (7.8% and 24.6% of ElderSmile participants had positive screening results for previously undiagnosed diabetes and hypertension, respectively). Dental professionals may screen for primary care-sensitive conditions and refer patients to health care providers for definitive diagnosis and treatment. The ElderSmile program is a replicable model for community-based oral and general health screening.

[Prevention of oral diseases]

Oral health is essential to general health and quality of life. Ever more people are affected with oral diseases. Dental caries, gingivitis and periodontitis are the most common oral diseases and they can be prevented. Oral health promotion and oral disease prevention programs should be incorporated in national health strategies. Inability to understand health information can be a profound disadvantage to patients when asked to take responsibility for their health. Increasing the level of oral health literacy and improvement of communication between patients and dentists by avoiding the usage of professional dental terminology should be included in each oral prevention program.

Public policy and legislation for oral health: a convergence of opportunities

The first surgeon general's report regarding oral health, Oral Health in America, called for a national effort to improve oral health among Americans and raised awareness of the importance of oral health; however, many Americans continue to experience poor oral health and are unable to access oral health care. Renewed national interest in oral health and access to oral health care through recent public policy documents and legislation presents a convergence of opportunities for the dental hygiene profession to continue to serve as a strong voice for the prevention of oral disease and the promotion of oral health for all segments of the population.