Oral Health Care All what you have to know about your oral health.Its impact on physical, social & psychological well being is considerable.Financial costs of treating these conditions are enormous But they are easily preventable. Lets see how.

1. Oral Health Care
Yapa Wijeratne
Faculty of Medicine,
University of Peradeniya
This lecture note was prepared based on
the lecture given from Faculty of Dental
Science, University of Peradeniya

2. Oral Health Care
Area of dentistry today
1. Teeth & related structure
2. Perioral tissues
3. Temporomandibular joint
4. Oral mucous membranes
5. Facio-maxillary complex
Importance of Oral health
1. Oral health is an integral part of general health
2. Oral manifestations of systemic diseases-HIV/AIDS, diabetes, leukemia
3. Systemic implications of oral diseases-↓birth weight, preterm births, CVD
4. Oral diseases- work loss (impact on economy)
5. Doctors role in early diagnosis, advise, referral
6. Doctors’ role in screening & prevention
7. Doctors may have to work with dentists
8. Dental services are part of medical services
9. Management of hospitals with dental clinics
Basic specialties in dentistry
1. Oral & maxillofacial surgery
2. Oral medicine
3. Restorative dentistry- filling
4. Prosthetic dentistry- artificial appliances, dentures
5. Periodontology- supporting structures of the tooth
6. Orthodontics – braces, correction of mal-aligned teeth
7. Children’s dentistry – Paedodontics
8. Dental public health
9. Oral pathology & microbiology
Provision of Oral Health Care
1. Dental specialists or consultants
2. Dentists
3. Dental ancillaries/ auxiliaries – person who helps the dentist to provide dental care but not
considered as professional.
Types of Oral Health Care specialists in Sri Lanka
1. Oral maxillofacial surgeons
2. Consultants in restorative dentistry
3. Consultants orthodontists
4. Consultants in dental public health
Types of dental ancillaries (by WHO)
1. Operating type
a. Dental hygienist
b. Dental therapist
c. New Zealand type school dental nurse
2. Non- operating type
a. Dental surgery assistants
b. Dental laboratory technicians
c. Dental receptionist

3. Types of dental ancillaries in Sri Lanka
1. Operating type
a. School dental nurse
b. School dental therapist
They function independently & works in school dental clinics, provide oral health care (prevention &
treatment both) to children between 3-13 yrs & conduct outreach activities.
2. Non- operating type
a. Dental surgery assistants
b. Dental laboratory technicians
c. Dental receptionist
Oral Health Care services in Sri Lanka
1. Hospital dental service
2. School dental service includes adolescent dental clinics (by dentists) & school dental clinics
(by School dental therapist)
3. Dental services in the armed forces & police
4. Private dental care
Organization of government dental services in Sri Lanka
Central government
Director General of Health Services DDHS → Deputy Director General of Dental Services
DDGDS
Provincial health administration
1. Curative section (hospitals) - dentists
2. Preventive section - School dental therapist
3. Administrative section –regional dental surgeon, supervising School dental therapist
In addition some hold administrative positions. E.g. Regional director of health services
WHO index age groups for oral health surveys
1. 5 yrs
2. 12 yrs
3. 15 yrs
4. 35-44 yrs
5. 65-74 yrs
Oral diseases of public health significance
Criteria to consider as public health problem
o High prevalence
o Impact on the individual
o Impact on the society
o Could be prevented & treatment available
Common oral diseases
o Affect↑ # of people -↑ prevalence
o Impact on physical, social & psychological well being is considerable.
o Financial costs of treating these conditions are enormous
o But they are easily preventable.
E.g.
1. Dental caries
2. Periodontal disease
3. Oral cancer & pre cancer
4. Dental fluorosis
5. Oro facial trauma

4. 6. Tooth loss (really the end result of disease)
7. Cleft lip & palate
8. Malocclusion (not strictly a disease)
Oral pre cancer – leukoplakia (white patch which cannot be removed)
Pre cancerous lesion- a morphologically altered tissue in which oral cancer is more likely to occur.
E.g. leukoplakia, erythroplakia
Pre cancerous condition- a generalized state associated with ↑ risk of oral cancer.
E.g. submucous fibrosis, lichen planus, actinic keratosis, syphilis, siderogenic dysphagia
Ways of expressing the problem
% of all cancers
Crude incidence
E.g. oropharyngeal cancers in SL in 1995
Crude incidence % of all cancers Rank
Male 11/100,000 29% 1
Female 4/100,000 10% 4
Pre cancer prevalence is 4%
Prevention of common oral diseases
o Affect a large # of people – increase prevalence
o Impact on physical, social & psychological well being
o Financial costs of treating conditions are enormous – no free dental services
o Epidemiological indication: strong socio behavioural basis –> life style-smoking
1. Dental caries
2. Periodontal disease
3. Oral cancer & pre cancer
4. Dental fluorosis
1. Dental caries
o Bacteria (microflora), Sugar (substrate)- sucrose
o Chronic condition
o Depends on behavior, human biology (pH of saliva, amount of bacteria), environment
(fluoride in water ↓ dental caries), life style (how much sugar in diet), health services
Plaque bacteria (Streptococcus mutans, Lactobacillus) convert fermentable carbohydrates (sucrose,
glucose, fructose) into organic acids (lactate), which attack tooth enamel by destroying dental
minerals. Therefore balance between demineralization & remineralization (by saliva & fluoride) of
tooth is lost.
Prevention
1. Diet – control of non milk extrinsic sugars (NMES) in diet.
2. Fluoride utilization-
a. Systemic method- any fluoride swallowed (milk, water)
b. Topical method- we don’t swallow – local action-for self use (F- tooth paste, F- mouth
rinses) & for professional use (F- gel & F- varnishes)
3. Fissure sealants (molar teeth) –prevent contact of acid-tooth

5. Role of diet
Dietary sugars
Intrinsic sugar (sugar
Extrinsic sugar (sugar
molecules within cell)
molecules outside the cell)
vegetables,fruits milk sugar-lactose
NMES-sugar added by us to
meal (contribute to caries)
Dried fruits & fruit juices are cariogenic because during the process sugar within cells comes out.
Strategy for control of dietary sugars
1. Education strategy
2. Regulatory strategy-laws
3. Substitution strategy-diabetes-artificial sweetness is used.
4. Pricing strategy-↑ sugar price
Education strategy
1. Limit intake of NMES to meal time
2. ↓ Consumption & specially frequency of intake of foods/ drinks containing NMES-limit to 4
times per day.
3. Use of sugar free snacks
4. Use of sugar substitutes
5. NMES should provide only 10% of total energy intake in diet.
Regulatory strategy
1. Use of legal measures to modify sugar consumption behavior- food labeling
2. Working with other partners in food chain
a. E.g. food labeling, ban addition of sugar to baby foods-paerdiatrics
3. Drugs
4. Control advertising
Substitution strategy
1. Use of artificial sweetness- E.g. sorbitol, mannitol
Pricing strategy
1. Taxation
2. ↑ Price of sugar
Use of F-
1. Community water fluoridation
2. School water fluoridation
3. Milk fluoridation
4. Salt fluoridation
5. Fluoride tablets & drops

6. 2. Periodontal disease
Risk factors
1. Dental plaque-Main etiological factor
2. Smoking
3. Stress
4. Genetic disorders
5. Systemic infection- diabetes/ HIV/AIDS
6. Puberty / pregnancy – due to hormonal changes
Prevention
1. Rigorous daily personal oral hygiene –
a. Effective brushing (tooth brush, traditional chewing sticks) - replace brush when
bristles are splayed.
b. Anti plaque, anti calculus tooth paste
c. No harsh abrasions- use of floss, wood points, tooth picks
2. Disclosing solutions to disclose plaque
3. Social, economic & cultural transformation
4. Poverty reduction
5. Rising educational & living standards
3. Oral cancer
Leukoplakia
Risk factors
 Smoking tobacco
 Chewing tobacco/oral snuff
 Chewing betel with tobacco, arecanut
 Heavy consumption of alcohol
 Presence of potentially (pre) malignant lesions
 Syphilis
Strongly suggestive-
 Sunlight
 Radiation
Possible factors-
 Dietary deficiencies (Vit. A,C,E & Fe)
 Genetic predisposition
 Viral infection-Human Papilloma Virus-HPV
Strategies for Prevention
1. Health education
2. Screening
3. Policy formulation
4. Health promotion
Health education
 ↓ of if possible stop habit of chewing betel, tobacco, arecanut
 Rinse mouth after every chew of betel
 Stop chewing tobacco
 Stop smoking
 Don’t go to bed with guid in mouth
 Consume alcohol in moderation
 Self identification of early sign-non healing ulcer, white & red patches
 In fair skinned people protection against UV sunlight

7. Screening for Oral cancer
 Systematically screen all sections of oral mucous membrane of all adults.
 PHC workers also can do a good job
 Every health worker must play a role
 Referred to specialized units if lesions are detected.
 Opportunistic screening
Policy formulation
 Banning manufacture, sale, advertisement & distribution of tobacco production
 Reduction of tar/nicotine levels in tobacco products.
 ↑ tax on tobacco & alcohol
 Regulation of alcohol sale & consumption
 Action to discourage betel industry
 Prevent people starting to use tobacco
 Mandatory screening with incentives
4. Dental fluorosis
Caused by excessive intake of fluoride during developmental stages of the tooth.
Risk factors
1. ↑[F-] in drinking water
2. Use of F- dietary supplements
3. Early use & ingestion of F- toothpaste
4. Consumption of tea in early childhood (<7 yrs) (?)
5. High altitude (?) (↑fluorosis is seen in high altitudes of African countries)
Prevention
1. Defluoridation of drinking water- by national water supply
a. Defluoridation technique
i. Bone char
ii. Alum
iii. Laterine (bricks)-SL
iv. Activated carbon
v. Activated alumina & lime (Nalgonda technique)
2. Rain water harvesting
Malocclusion
o 10% of 12 & 15 yrs of SL.
o Moderate → severe
o Caused due to environmental (sucking) & genetic factors.