1. TEETHING BELIEFS: CHLLENGES FOR PARENTS KNH/UoN Oral Health Symposium Theme: Oral Health as an Integral part of General Health Friday 4 th July, 2014

2. Dr Regina J. Mutave BDS(Nbi), Mres (St. Andrews –UK), PGDip-RM (Nbi) Dept. Periodontology/Community & Preventive Dentistry, University of Nairobi

3. Outline  Introduction  Summary of beliefs about teething  Challenges to healthcare system  Rationale for involvement  Conclusion

4. Introduction  Defining teething  Oral health professional  Biological expression of tooth movement  Predominantly axial direction  From the tooth’s developmental position within the jaws  To the emergence in the oral cavity’ Hulland SA, Lucas JO, Wake MA and Hesketh KD. Paediatric Dentistry. 2000;

5. Introduction  Other’s perspective  Period of illness for child  Fever  Diarrhoea  Vomiting  Cough

6. Teething: Summary of beliefs  98% mother expected child to experience illnesses Diarrhoea Fever 93% 95% Vomiting Loss of appetite 80% 83.5% Mutave RJ, Kiarie J. PGDRM 2011

7. Teething: Summary of beliefs AuthorStudy DesignDiarrhoeaFeverSleep disturbance Wake et al (1999) Community survey 36%70%78% Wake et al (2000) Prospective cohort – 21 children from 3 day care centres over 2067 days 33%48%71% Barlow et al (2002) Survey – paediatricians, paediatric dentists, and parents in IOWA 56.7%74.6%86.7% Owais et al (2010) Survey among 958 parents attending maternity and child health clinics - Jordan 71.8%84.9%80.8% Cunha et al (2004) Records of 1813 children aged 0-3 years 35%46%39%

8. Challenges to parents  Uncertainty  Conflicting information even from Healthcare workers  Persistent cultural practices  Myths Bankole oo, 2004, Denloye et al 2005, Markman L 2009, Owais AI 2010, BarlowBS et al 2002, Hassanali et al 1995, Mosha HJ et al 1983

9. Evidence Todate  Cohort studies  No association between teething and systemic illnesses  New evidence identifies lack of exclusive breastfeeding with increased childhood illness  Poor and early weaning practices to blame too  Poor sanitation, living conditions Wake et al 2000,

10. Challenges to Healthcare system Infant teething beliefs Delay seeking treatment Over the counter medication High infant mortality Traditional practices Anaesthetic Analgesics MCH clinic nurse

11. Challenges to Healthcare system  Traditional practices  Herbal use  Canine tooth bud enucleation (IOM) Edwards et al 2008

12. Challenges to Healthcare system

13. Canine toothbud enucleation: Consequences  Haemorrhage  Septicaemia  Infectious diseases  Death  Dentition  Poor jaw bone development  Hypodontia  Hypoplasia  Malocclusion Mosha et al 1983, Johnson et al 2005

14. Getting involved: Rationale  Oral health workers:  Custodians of tooth development knowledge  Other health professionals not well informed  ‘CREATE OPPORTUNITIES TO SHARE THE KNOWLEDGE’

15. Getting involved  Integration of oral health in various stages  Training curricula of other health professionals  Target MCH clinics with relevant information

16. Missed opportunities Content not specific to assisting mothers with information

17. Getting involved in time EARLY IS BETTER THIS COULD BE TOO LATE!!!

18. Conclusion  Explore the opportunities  Share the knowledge  Improve lives of populations

19. References  Hulland SA, Lucas JO, Wake MA and Hesketh KD. Eruption of the primary dentition in human infants: a prospective study. Paediatric Dentistry. 2000; 22(5): 415-421  Johnson NL PJ Riordan PJ. Tooth follicle extirpation and uvulectomy. Austr Dent J 2005;50:(4):267-272  Hassanali J, Amwayi P, Muriithi A. Removal of deciduous canine tooth buds in Kenyan rural Maasai. East Afr Med J 1995;72:207-209.  Mosha HJ. Dental mutilation and associated abnormalities in Tanzania. Odontostomatol Trop 1983;6:215-219.  Markman L. Teething : Facts and fiction. Pediatr. Rev. 2009;30;e59-e64  Owais AI, Zawaideh F, Bataineh O. Challenging parents’ myths regarding their children’s teething. Int. J. Dent. Hygiene. 2010; 8: 28-34  Wake M, Hesketh K, Lucas J. Teething and tooth eruption in infants: a cohort study. Pediatrics 2000; 106: 1374–1379.  Barlow BS, Kanellis MJ, Slayton RL Tooth eruption symptoms: a survey of parents and health professionals. J Dent Child. 2002; 69: 148-150.

20. THANK YOU