1. PREVENTABLE DENTAL DISEASES

2. DENTAL CARIES (TOOTH DECAY). GINGIVITIS (GUM DISEASES). PERIONDONTITIS (Diseases affecting the supporting structures of the teeth-bone, gum and periondontal ligament). And many others too numerous to mention.

3. DENTAL CARIES (TOOTH DECAY) DEFINITION DESTRUCTION OF THE TOOTH SURFACE DUE TO THE ACTION OF BACTERIA ON REFINED CARBOHYDRATE. Food + Bacteria = Acid Acid + Tooth =Caries Commonest cause of tooth loss in children.

4. AETIOLOGY/CAUSES 1. Bacteria 2. Refined Carbohydrate e.g. snacks, sweets, biscuits.(frequency more likely cause than quantity) 3. Susceptible teeth e.g. deep pits & fissures, tight contact areas.

5. SIGNS AND SYMPTOMS Initially symptomless-incipient caries. Frank Hole on the tooth. Pains with cold/ warm water with dentine exposure. When the pulp/nerves becomes exposed: Pains at night and with chewing. Unstimulated pains.

6. TREATMENT Use of amalgam (Silver)fillings). Use of composite (white)fillings Root canal therapy Extraction

7. COMPLICATIONS OF UNTREARED TOOTH DECAY Dental abscess Cellulitis /Ludwigs Angina Osteomyelitis

8. prevention Good oral hygiene habits through brushing with fluoride containing tooth paste at least twice daily. Use medium tooth brush with upward & downward movements. Avoid eating in between meals. Avoid frequent snacking, sticky food Brush orRinse after each meal. Fluoridated public water supply 1ppm should be encouraged.

9. PERIONDONTAL DISEASES (Gingivitis and Periondotitis)-Gum disease Definition: Disease affecting the supporting structures of the teeth: Gingiva (gums), bone, periodontal ligament/fibres. Aetiology/Associated factors Poor oral hygiene Smoking Stress

10. SIGNS AND SYMPTOMS OF GINGIVITIS REDNESS OF THE GUMS SWELLING OF THE GUMS BLEEDS EASILY LITTLE OR NO PAIN INITIALLY

11. WARNING SIGNS/SYMPTOMS OF PERIONDONTAL DISEASE BLEEDING OF THE GUMS REDNESS OF THE GUMS PAINS SORENESS OF THE GUMS POCKETING HALITOSIS /FOUL BREATH PUS FROM THE GUMS TEETH MOBILITY DRIFTING OF TEETH

12. MANAGEMENT OF GINGIVITIS Scaling and polishing Good oral home care

13. GENERAL PRINCIPLES OF PREVENTION AND MANAGEMENT OF PERIONDONTITIS 1. SCALING AND POLISHING 2X IN A YEAR. 2. ESTABLISH EFFECTIVE ORAL HYGIENE HABITS 3.SURGERY

14. HALITOSIS Oral malodour, breath odour, mouth odour, foul breath, fege bosta, fetor oris, fetor ex ore or most commonly, bad breath. Definition : Unpleasant odour coming from the mouth when breathing whether the source is from mouth or not. True halitosis or False halitosis ( halitophobia). Third most frequent reason for seeking dental care following Dental caries (tooth decay) and periodontal disease. GENERALAETIOLOGY/CAUSES 85-90% originates from the mouth. Intensity during the day depends on what is consumed e.g. garlic, onions, meat, fish and cheese. Obesity, smoking and alcohol consumption also implicated.

15. HALOTOSIS (CONT) Halitosis ( morning breath) worse in the morning. May be temporary and disappear after eating, brushing, flossing or following mouth rinses. May also be persistent ( chronic ). 25% of population may be affected.

16. HALITOSIS (cont) MOUTH >600 Types of bacterial in an average mouth. Odours produced thru anaerobic break down of proteins into individual amino acids, followed by further breakdown of certain amino acids to produce detectable foul gases e.g. the breakdown of cysteine and methionine produce hydrogen sulphide and methyl mercapatan. Other parts of the mouth in descending order may also contribute to foul breath: Back of the tongue, inter dental and subgingival niches, faulty dental work. Food-impaction areas, unclean dentures and abscesses.

17. HALITOSIS (cont) TONGUE Most common location for mouth-related halitosis. Large colonies of bacteria on posterior dorsum of the tongue where they thrive on food deposits, dead epithelial cells, and post nasal drip. When left on the tongue, the anaerobic respiration of such bacteria can produce offensive odours. CLEANING THE TONGUE Commonest reason for cleaning the tongue is to control bad breath. Mouth deodorants only give temporary relief because they do not remove the cause of bad breath. A tongue cleaner or tongue scraper can be used to clean the tongue.

18. GINGIVITIS Subgingival plaque have a foul smelling odour. NOSE 2 nd Major source of bad breath. May be due to sinus infection or foreign bodies. TONSILS Due to small bits of calcified matter called tonsilloliths which smells extremely foul when released and can cause foul breath. STOMACH In belching, reflux, or fistula between the stomach and oesophagus

19. SYSTEMIC DISEASES Generally INFREQUENT in the general population. Fetor hapticus Lower respiratory tract infections(Bronchial and lung infections). Renal infections and renal failure. Carcinoma. Trimethylaminuria (fish odour syndrome). Diabetes mellitus. Metabolic dysfunction. Individuals suffering from the above conditions often show more diagnostic conclusive symptoms than bad breath.

20. HALITOSIS (CONT) DIAGNOSIS Self diagnosis/Home diagnosis Professional Diagnosis. Halimeter- Used to test for level of sulphur emissions. Gas chromatography- Measures hydrogen sulphide, methyl mercaptan and dimethyl sulfide. It produces visual results in graph form via computer interface. BANA test-Measures salivary level of an enzyme indicating the levels of certain halitosis related bacteria. B-galactose test- salivary levels of this enzyme were found to be correlated with halitosis. THE MOST RELIABLE TEST (THE GOLD STANDARD) IS THE ACTUAL SNIFFING AND SCORING OF THE LEVEL AND TYPE OF THE ODOUR CARRIED OUT BY TRAINED EXPERTS (ORGANOLEPTIC MEASUREMENTS). THE LEVEL OF THE ODOUR IS USUALLY ASSESSED ON A 6 POINT INTENSITY SCALE.

21. HOME CARE AND TREATMENT Chronic halitosis not well understood by most physicians and dentists, hence, effective treatment is not always easy to find. 6 strategies may be suggested: 1 Gently cleaning the surface of the tongue 2x dly. Use tongue cleaner/brush/inverted teaspoon..

22. HOME CARE AND TREATMENT (cont) 2.Eating a healthy breakfast with rough food helps to clean the back of the tongue. 3.Chewing gum- to improve salivary flow. 4.Gargling before bed time with an effective mouth wash 5.Maintaining good oral hygiene. 6.Maintain water levels in the body

23. RECEEDING GUMS(GINGIVAL RECESSION). Exposure of the root surface due to shrinkage of the gums. Aetiology/Causes – Overaggressive brushing – Poor oral hygiene – Periodontal disease – Bruxism/Grinding of the teeth – Adult orthodontic movement of teeth. – Sensitivity of the teeth to Sodium Lauryl Sulphate(SLS), an ingredient of most commercial toothpastes

24. RECEEDING GUMS (CONT.) Signs and Symptoms Sensitive teeth 2 heat/cold,aweet, sour or spicy foods. Teeth may appear longer than normal. Exposed & visible roots. The tooth feels notched the gum line. Change in tooth colour because of the difference in colour between enamel & cementum Spacing between the gums Cavities/holes below the gum line.