„Oral Health Care Program“ Dr. Klaus de Cassan , Dentist – Foundation of German Dentists (HDZ) ©: KdeC. - 2015

Introduction to Oral Health Care Program Dr. Klaus de Cassan , Dentist – Foundation of German Dentists (HDZ) ©: KdeC. - 2015

Introduction to Oral Health preventive aspects and dental hygiene My native language is German and I don’t speak the English language every day. Excuse me therefore for the mistakes I would make during my speech. My name is Dr. Klaus de Cassan, I’m in my main profession a German dentist and have together with my partner a dental office in the south of Germany, near the Swiss border. Besides I have trained over 20 years dental students at a German University (Freiburg). Dr. Klaus de Cassan , Dentist – Foundation of German Dentists (HDZ) ©: KdeC. - 2015

The program, which I would like to introduce you, has been developed in the last century under my use in Germany, and there has led to a significant reduction of oral diseases. ©: KdeC. - 2015 ©: KdeC. - 2015

Since 2009 it is successfully deployed on many islands of the Philippines and parts of Argentina ©: KdeC. - 2015

I am here on behalf of the most importand German Dental Aid Organization – the name is HDZ - in order to give you some information about dentistry, preventive aspects and dental hygiene. ©: KdeC. - 2015

-- We currently serve over 70 projects around the world -- All our projects are under the motto “Helping People Help Themselves" ©: KdeC. - 2015

Introduction to Oral Health preventive aspects and dental hygiene Note: healthy teeth are a determinant factor for quality of life Bad teeth and diseased gums are not a destiny - are not inborn! They are the result of a lack or improper dental hygiene, wrong dietary habits and lack of minerals (fluorides). And it is easy and inexpensive to prevent these illnesses Dr. Klaus de Cassan , Dentist – Foundation of German Dentists (HDZ) ©: KdeC. - 2015

Introduction to Oral Health preventive aspects and dental hygiene If damaged teeth are present, we have several common problems: -- A dentist can treat the destroyed teeth - usually this means an extracting. Dental conservation measures by a dentist are in all countries very expensive and with an inadequate oral hygiene they are of limited duration. -- There are far too few dentists in Your country to fix all the damage, even if patients have enough money -- The consequence is, that in general dental treatment for pain solely means an extraction of the sore tooth (teeth), as we see in the next pictures If damaged teeth are present, we have several common problems: -- A dentist can treat the destroyed teeth - usually this means an extracting. Dental conservation measures by a dentist are in all countries very expensive and with an inadequate oral hygiene they are of limited duration. -- There are far too few dentists to fix all the damage, even if patients have enough money -- The consequence is, that in general dental treatment for pain solely means an extraction of the sore tooth (teeth), as we see in the next pictures Dr. Klaus de Cassan , Dentist – Foundation of German Dentists (HDZ) ©: KdeC. - 2015

Introduction to Oral Health preventive aspects and dental hygiene If damaged teeth are present, we have several common problems: -- A dentist can treat the destroyed teeth - usually this means an extracting. Dental conservation measures by a dentist are in all countries very expensive and with an inadequate oral hygiene they are of limited duration. -- There are far too few dentists in the Philippines to fix all the damage, even if patients have enough money -- The consequence is, that in general dental treatment for pain solely means an extraction of the sore tooth (teeth). Dr. Klaus de Cassan , Dentist – Foundation of German Dentists (HDZ) ©: KdeC. - 2015

Introduction to Oral Health preventive aspects and dental hygiene Dental diseases are not an isolated Zimbabwe problem, like a slice of the world map shows. But why have on this card, for example the countries of China, Australia and New Zealand only a few diseases? Answer: because they have government-controlled prevention programs. Dr. Klaus de Cassan , Dentist – Foundation of German Dentists (HDZ) ©: KdeC. - 2015

Introduction to Oral Health preventive aspects and dental hygiene But why have the people of Papua New Guinea, which have no state programs, healthy teeth? Answer: here live primitive peoples, which were yet not overrun by the Western civilization (Candys, Coca-Cola, McDonalds, etc.). Now it is an illusion to think, that we could return without these harmful foods. Maybe some people would follow this advice. The majority, however, would continue as usual food and drink - it tastes too good! Therefore we have to think of other ways to reduce tooth decay. Dr. Klaus de Cassan , Dentist – Foundation of German Dentists (HDZ) ©: KdeC. - 2015

Introduction to Oral Health preventive aspects and dental hygiene This is the reason of my visit: I would like to show You a way we have chosen several years ago in other countries of the world („Oral Health Care Program“), and so far has been very successful there. ©: KdeC. - 2015

What do we need for our planned “Oral Health Care Program"? Persons (“Volunteers”, “Oral-Health-Workers”), who are willing to teach children and young people, and later perform prophylactic measures. The role of oral health workers is to promote oral health through education, as well as to screen, coordinate and administer referral when needed. Persons who are willing to teach children and young people, and later perform prophylactic measures. We call them “Volunteers”. Another term is used to describe them as “Oral-Health-Workers“. The role of oral health workers is to promote oral health through education, as well as to screen, coordinate and administer referral when needed. This type of health worker has been widely used around the world for diverse activities in promotion, including oral health in areas when health professionals are not readily available. Even though oral health workers are not formal oral health team members, they may play an important support role to the professionals and also for the population. Because I will teach these volunteers and later control, they should speak English reasonably well. Often the volunteers are women. But there are no objections, if men also report themselves as volunteers. ©: KdeC. - 2015 ©: KdeC. - 2015

What do we need for our planned “Oral Health Care Program"? Depending on the size of the participating children / young people would be 4-8 volunteers optimally in one group. ©: KdeC. - 2015 ©: KdeC. - 2015

What do we need for our planned “Oral Health Care Program"? a simple treatment option for the prophylactic benefits A simple treatment option for the prophylactic benefits. The dental-chair of the illustration is from the Army. This "dental-unit" is constructed very simply, but perfectly adequate for our needs. Because of the low weight, it is easy to transport. Alternatively, we can also work on a simple chair and as light source a headlamp. However, this equipment is not professional and thus has negative effects on patients. ©: KdeC. - 2015 ©: KdeC. - 2015

What do we need for our planned “Oral Health Care Program"? Dental screening instruments such as probe, tweezers, dental mirror, wooden spatula and gloves. And a way to sterilize (disinfect) them. -- Dental screening instruments such as probe, tweezers and dental mirror. And a way to sterilize (disinfect) them. -- Wooden spatula -- Gloves ©: KdeC. - 2015 ©: KdeC. - 2015

What do we need for our planned “Oral Health Care Program"? Toothbrush, toothpaste, toothbrush holder (beaker, glastumbler), Teeth Brushing Timers Toothbrush, Toothpaste, Toothbrush tumbler, Teeth Brushing Timers (!) ©: KdeC. - 2015 ©: KdeC. - 2015

C-O-I Magic Formula - Video “C-O-I Magic Formula” - an effective and easy-to-learn dental cleaning method detailed video - Ausführliches Video ©: KdeC. - 2015 ©: KdeC. - 2015

What do we need for our planned “Oral Health Care Program"? Plaque disclosing tablets to stain the plaque If possible: Plaque disclosing tablets to stain the plaque. Disclosing agents (plaque disclosing agents) can visualize very well uncleaned districts. The patient then knows where he cleans and where he does not clean. They may be in either a liquid or tablet form. The dye is a natural substance, well-tolerated and can be removed again by thorough cleaning. The chewable tablet or the liquid disclosant should remain in the mouth for 15 to 30 seconds and then expectorated. Home use of disclosants by the patients should be encouraged to permit self-evaluation of the effectiveness. ©: KdeC. - 2015 ©: KdeC. - 2015

What do we need for our planned “Oral Health Care Program"? Fluorides I must give you now a longer explanation, so that you can understand why this salt is extremely important for our prevention-program: We have a big problem in our program: Especially the people who have a lot of tooth decay, have a poor oral hygiene and often no money to let repair the damage of the caries. We must therefore look for a solution to help these people – if they want help. Now we have known for many decades, that there are regions in the world, in which the residents have only a light tooth decay. Why? If they eat the same as their neighbors in other areas, which have a lot of tooth decay? Science has long inquiry into the causes and eventually found, that the drinking water showed in poor caries areas a higher fluoride content than in the neighboring areas. The magic word for these people who do not or are difficult to get used to an oral hygiene is, "Fluorides“. Fluorides are salts of the hydrofluoric acid and with our daily table salt chemically closely related. In controlled doses, they have a strong potential to prevent the development of caries. As a consequence of this knowledge, in many countries since the middle of last century, has been created the opportunity to feed the body artificially with fluorides. However the following should be observed: Any substance which we feed the body, must be correctly proportioned to act and to do no harm. A so-called "fluoride history" - especially the fluoride content of our drinking water - should be done before! ©: KdeC. - 2015 ©: KdeC. - 2015

What do we need for our planned “Oral Health Care Program"? Most commonly, fluoride is applied topically (means: on the surface) to the teeth using gels, varnishes, toothpaste/dentifrices or mouth rinse. Systemic (means: through the body) delivery involves fluoride supplementation using water, salt, tablets or drops which are swallowed. -- Best known is the supplementation with the ingredients of Toothpaste. But: this type of use have no effect to this people, who do not brush their teeth regulary or never. -- Fluoride tablets: in the right dose, and regularly applied, they are a good method for caries prevention. The problem is mainly, that they are not regularly or wrong (too much, too little) used - poisoning by overdose is possible. And: children at an early age learns the regular intake of pills - the path to capture harmful pills (drugs) in the future is traced. In many industrialized countries, this method is no longer practiced. -- Water fluoridation: in principle a good method because the quantity as the amount of drinking water for each person is about the same. Drinking fluoridated water remains one of the most effective ways to receive systemic and topical fluoride protection. But: only a small portion of the water is used for drinking. Most water is used for other purposes (e.g. washing, cleaning) - fluorides get useless in the environment. In addition, a good infrastructure must be available - in many areas of the world, the water comes from a fountain in front of the house. Water fluoridation is then not possible. For me, there is still a further and serious disadvantage: Everyone needs to take fluorides, whether he likes it or not! We speak of a ”obligatory or forced medication”. -- fluoridation of table salt: This method (250 mg Fluoride / 1 kg Salt) is, in my opinion, the solution to the most problems. Since the daily salt requirement of every human being from the 3rd years - depending on weight - is similar, is the daily fluoride intake optimal by this salt, poisoning by overdose is impossible for a healthy human. No one is forced to eat this special salt – you then can buy and eat a normal salt. This method is popular in many states. In Germany, for example, buy 80% of all households this specific salt. In many countries we have with this salt only one problem: Nobody knows it, it is to buy anywhere. Therefore, we import it from Europe and distribute it to you in household quantities. Use it therefore please only for cooking and in your salt shakers. Again, this is a voluntary but very effective method of caries prevention, which we offer additional with our preventive program. ©: KdeC. - 2015 ©: KdeC. - 2015

What do we need for our planned “Oral Health Care Program"? Overdosing of fluorides during tooth formation can have cumulative effects leading to fluorosis of teeth, characterised by opaque patches or demineralization on the teeth. The risk of dental fluorosis is highest during the period of enamel maturation, from 1 to 3 years of age. Fluoride poisoning (toxicity of fluoride) are extremely rare in the world and require such a high dose, you can’t eat: So is the probable toxic dose (PTD) in young children and vulnerable older people with 5 mg / kg body weight specified. After this value, a 10 kg weighing child would need to consume the quantity of 100 g of children's toothpaste (fluoride concentration 0.05% or 500 ppm) or during brushing accidentally swallow - the therapeutic use when brushing your teeth is in this age group 2 g / day with a children's toothpaste. On the Internet you can read on some sites, much nonsense about the side effects of fluorides. These things, written by sectarian opponents of fluoride, have no evidence from the perspective of science, if fluorides are dosed correctly. The criticism of fluorides is highest in countries where a water fluoridation exist (= opposition against ”obligatory or forced medication”) - this is for me understandable. All of well-known organizations recommend fluoridation when there is a lack of natural fluorides. ©: KdeC. - 2015 ©: KdeC. - 2015

What do we need for our planned “Oral Health Care Program"? Fluoride varnish (e.g. Duraphat®) contains 2.5 or 5% fluoride ion. The actual amount of fluoride used per treatment is 5-11 mg. The volume of fluoride varnish per treatment (0.2 – 0.5 ml) is significantly less than the probable toxic value for a 10 kg child (2.0 ml). The plasma fluoride concentration after varnish application is barely measurable. Therefore, fluoride varnish is very safe for use on infants’ teeth! +: extremely effective -: very expensive, teeth must be cleaned before ©: KdeC. - 2015 ©: KdeC. - 2015

What do we need for our planned “Oral Health Care Program"? ©: KdeC. - 2015 ©: KdeC. - 2015

What do we need for our planned “Oral Health Care Program"? Another (and cheaper) form of fluoride application is the use of fluoride-gels using a toothbrush or a splint. Not suitable for young children – ingestion. -- 1 to 2 times weekly instead of a normal paste a Fluoride jelly is used to brush the teeth (before going to bed). After this cleaning the mouth should be rinsed briefly. -- Splint: fill a fluoride gel in a splint (tray) and the patient can wear this splint for some time. Make sure that the teeth are clean and only so much gel is in the splint, that the gum is not wetted. After ~ 4-5 minutes rinse your mouth. This method can be performed at the dentist office or at home. +: effective, good price / performance ratio -: teeth must be cleaned before ©: KdeC. - 2015 ©: KdeC. - 2015

Notes ©: KdeC. - 2015 ©: KdeC. - 2015