Democratic and Popular Republic of Algeria
Ministry of Higher Education and Scientific Research
BADJI MOKHTAR UNIVERSITY – ANNABA
FACULTY OF MEDICINE
DEPARTMENT OF DENTAL MEDICINE
PERIODONTOLOGY DEPARTMENT
Oral health and at-risk populations
COURSE HANDOUT PREPARED AND PRESENTED BY
P r BOUDJELLEL
HYGIENE AND PREVENTION MODULE
2nd YEAR
2023/2024
Plan
I/ Introduction
II/ Definition of public health
III/ The different populations at risk
IV/ The different risk factors
V/ How to collect information
VI/ Importance of anamnesis
Conclusion
Further reading: WHO report November 2023
I/ Introduction
General health can have an impact on oral health and vice versa. Thus, for certain periods of life, such as during pregnancy, oral health is more fragile.
On the other hand, people who are affected by chronic diseases, such as diabetes or heart disease, need rigorous dental monitoring.
Finally, elderly people and people with motor or intellectual disabilities may need help with dental hygiene.
In these cases, we speak of populations at risk for oral health. (WHO 2023)
II/ Definition of public health
The WHO, in 1952, gave the following definition: “Public health is the science and art of preventing disease, prolonging life and improving the health and mental and physical vitality of individuals, through concerted collective action aimed at:
- Clean up the environment;
- Fight against diseases;
- Teach personal hygiene rules;
- Organize medical and nursing services for early diagnosis and preventive treatment of diseases;
- Implement social measures to ensure that each member of the community has a standard of living compatible with maintaining health.
Public health is today an autonomous discipline which deals with the health status of a community, the overall health of populations in all its aspects: curative, preventive, educational and social.
III/ The different populations at risk
WHO describes populations at risk or vulnerable populations: Pregnant women, infants and young children, people over 65, people suffering from cardiovascular diseases, heart or respiratory failure, people with asthma, etc.
It is therefore important to know that from a public health perspective, it is more effective to target groups rather than individuals at high risk of oral diseases.
Although all patients are exposed to food risk, some, through their behavior, are real “at-risk patients” and here again, it is important to know them well in order to better identify them.
Le problème peut être individuel : dans ce cas le patient est dépendant d’habitudes alimentaires incompatibles avec sa santé bucco-dentaire : Consommation fréquente de sucreries, addiction aux colas, boissons sucrées et acides, café, alimentation molle et collante, etc.
IV/ Les différents facteurs de risque
Le risque peut être lié :
-à son âge : jeune patient atteint d’un “syndrome du biberon”, ou simplement gros consommateur de sucreries, privilégiant les “sandwichs” aux vrais repas ;
-à un aspect psychologique : boulimie, anorexie mentale, état dépressif, problèmes psychoaffectifs avec habitudes alimentaires compensatoires.
-à un problème médical : la prise de certains médicaments (antidépresseur par exemple) peut entraîner une hyposialie, dans ce cas, même si l’alimentation est «saine», sa cariogénicité est aggravée.
C’est parfois la galénique même du traitement qui crée le risque : pastilles que l’on suce, sirop pris “au coucher”.
-à un problème de santé générale : La santé bucco-dentaire actuellement fait partie intégrante de la santé générale et du bien-être. Les personnes qui sont affectées par des maladies chroniques, comme les cardiopathies, le diabète, ont besoin d’un suivi dentaire rigoureux.
Le risque peut être lié à un style de vie
– Appartenance à un groupe social : Époques particulières de la vie pouvant amener une modification temporaire ou définitive de l’alimentation : adolescence, grossesse, période d’allaitement, 3ème et 4ème âge.
– Appartenance à un milieu professionnel particulier : métiers de l’alimentation où il faut “goûter” à tout instant bien sûr, mais aussi métiers de stress, métiers où l’on grignote “en attendant” : taxi, pompiers, chauffeurs-routiers, etc. Sportifs professionnels où les régimes alimentaires et énergétiques sont particulièrement dangereux pour les dents.
– Habitudes nocives : fumeurs qui veulent “masquer” ou compenser le tabac par des sucreries mentholées. Halitose que le patient cherche à masquer par des sucreries mentholées. Il faut faire attention aux petits bonbons “peu caloriques” mais cariogènes s’ils sont sucés à longueur de journée. Le grignotage est une source de caries et de maladies parodontales, surtout s’il est associé à un manque d’hygiène bucco-dentaire.
Autres facteurs importants
- La pauvreté et l’ignorance sont les indicateurs de risque les plus importants qui expliquent les différences de santé bucco-dentaire.
- Le niveau d’instruction et la malnutrition, étroitement liés à la pauvreté.
- In developing countries and in risk groups in industrialized countries, the role of sugar in the development of enamel caries is indisputable. In these countries, soft and sticky food outside the home (such as sandwiches, hamburgers, etc.) actively contributes to the development of periodontal diseases.
- Lack of twice-daily use of fluoride-containing toothpaste is a risk factor for oral diseases (caries and periodontal disease).
The role of mothers is essential, as they generally underestimate the importance of initiating or supervising the brushing of their children’s teeth during the first years of life. The age at which parents start brushing their children’s teeth and the frequency of brushing are also potential risk factors.
With indicators and risk factors for oral diseases identified, the question arises whether prevention efforts should be targeted and how prevention strategies might be more effective if they were addressed to previously identified at-risk individuals.
To achieve this goal, they may require additional information, a detailed oral examination and, if possible, information regarding the level of dental hygiene, prevention and dental care.
V/ How to collect information
It is therefore appropriate to develop strategies for the dental practice to discover these risky circumstances in the lives of these patients. Obviously, the usual communication, the dialogue will allow to question and better understand the lives of these patients.
It is often during the first appointments that the practitioner identifies or suspects “a particular problem”: the patient’s attitude, the practitioner’s clinical sense, the type of lesions, their location, will arouse his concern to go further.
VI/ Importance of anamnesis
Anamnesis should be performed at the first consultation, before any procedure is performed, in order to be aware of any possible risks that may exist in the patient. The patient should be questioned about their medical and surgical history, treatments, allergies, addictions, lifestyle habits and their socio-economic level in a more general manner.
Contact with the treating physician may complete this questioning, as well as a thorough clinical examination to enable the practitioner to identify certain elements useful for the continuation of the treatment.
CONCLUSION
Patients from at-risk populations require appropriate care, which involves taking certain precautions and therefore knowing the potential risks.
The course of action to be taken will be guided by numerous recommendations, but also by the experience of the practitioner, who will be responsible for making the decisions.
Further reading
WHO report November 2023
The World Health Organization (WHO) released a new status report on the state of global oral health last November. It provides the first-ever comprehensive picture of the burden of oral disease with data from 194 countries containing unprecedented information on key areas and markers of oral health.
According to the report, nearly half of the world’s population (45%, or 3.5 billion people) suffer from oral diseases, and three out of four people affected live in low- and middle-income countries. ” As evidence that many people lack access to prevention and treatment for oral diseases, there are one billion more cases than there were 30 years ago ,” WHO points out .
“ Oral health has long been the poor relation of global health, but many of its conditions can be prevented and treated with the cost-effective measures outlined in this report ,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.
The most common oral diseases are caries, severe periodontal disease, tooth loss and oral cancers. Untreated dental caries is the most common health problem worldwide, affecting approximately 2.5 billion people. Severe periodontal disease – a major cause of total tooth loss – is estimated to affect one billion people worldwide. In addition, approximately 380,000 new cases of oral cancer are diagnosed each year.
The report highlights inequalities in access to oral health services, with the most vulnerable and disadvantaged populations being by far the most affected by these diseases. People on low incomes, with disabilities, older people living alone or in residential care, people in remote and rural communities and people from minority groups are more heavily affected by oral diseases.
Improve oral health status
This pattern of inequality is similar to that of other noncommunicable diseases, such as cancers, cardiovascular disease, diabetes and mental disorders. Common risk factors for noncommunicable diseases, “ such as high sugar intake, all forms of tobacco use and the harmful use of alcohol, are all contributing to the global oral health crisis ,” WHO said in a statement.
The report presents several proposals for improving the state of oral health worldwide. These include planning oral health services as an integral part of national health and improving the integration of oral health services into primary health care as part of universal health coverage.
The report also proposes to “ redefine models for the oral health workforce to meet the needs of the population and expand the skills of other health workers to expand the coverage of oral health services .”
Oral health and at-risk populations
Early cavities in children need to be treated promptly.
Dental veneers cover imperfections such as stains or cracks.
Misaligned teeth can cause difficulty chewing.
Dental implants provide a stable solution to replace missing teeth.
Antiseptic mouthwashes reduce bacteria that cause bad breath.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush preserves enamel and gums.