1. INAUGURAL LECTURE ELIZABETH OBALOWU SOTE Professor of Paediatric Dentistry HEAD, DEPT. OF CHILD DENTAL HEALTH COLLEGE OF MEDICINE OF THE UNIVERSITY OF LAGOS 12 th March,2008 BY

2. PAEDIATRIC DENTISTRY: GIVING LASTING SMILE FROM BIRTH THROUGH CHILDHOOD TO ADOLESCENCE TITLE

3. 3 INTRODUCTION Children are a distinct group Differ from adults in many ways Children go through the primary, mixed, and permanent dentition stages Their teeth serve to nurture the entire body physically and emotionally This ensures optimum physical growth and development of personality

4. 4 OBJECTIVES OF LECTURE Create or enhance oral health awareness of audience Share research and clinical experience Highlight contribution to dentistry Emphasis is on paediatric dentistry

5. 5 FUNCTIONS OF TEETH IN THE CHILD Mastication-chewing Aesthetics Maintenance and promotion of alveolar bone growth Guidance of permanent teeth Communication such as in speaking and smiling WEAPON OF DEFENSE OR ATTACK- not recommended (Matthew 5: 38-39)

6. 6 COMMON ORAL HEALTH PROBLEMS IN CHILDREN An individual below 16 years of age is a child in Paediatric Dentistry. A host of oral health problems is commonly found in this age group. Only the highlights are intended in this presentation.

7. 7 COMMON ORAL HEALTH PROBLEMS DENTAL CARIES: severe early childhood caries can be very tormenting to child, parent, and care provider Severe early childhood caries Dento-alveolar abscess

8. 8 COMMON ORAL HEALTH PROBLEMS (CONT’D) GINGIVITIS: bleeding gum Another common condition featuring in children is chronic marginal gingivitis ( bleeding gum). Globally, most children have signs of gingivitis (Petersen, 2004). The gums are inflamed and bleed readily with or without irritation as a result of poor oral hygiene. Gingivitis can be prevented by maintaining a good oral hygiene.

9. 9 COMMON ORAL HEALTH PROBLEMS (CONT’D) TRAUMA: injuries to teeth and tooth supporting structures. Fractures and luxation injuries including tooth loss can result.

10. 10 Tooth Fracture COMMON ORAL HEALTH PROBLEMS (CONT’D)

11. 11 Intrusion COMMON ORAL HEALTH PROBLEMS (CONT’D)

12. 12 Avulsion COMMON ORAL HEALTH PROBLEMS (CONT’D)

13. 13 COMMON ORAL HEALTH PROBLEMS (CONT’D) TOOTH DISCOLOURATION: extrinsic or intrinsic in nature, genetic or environmentally acquired Discoloured Teeth

14. 14 COMMON ORAL HEALTH PROBLEMS (CONT’D) DISORDERS OF DEVELOPING DENTITION: dental anomalies, irregularities during tooth eruption and exchange, crowding, premature loss of teeth etc

15. 15 DENTAL AND CRANIOFACIAL ANOMALIES Talon cusps Cleft lip and palate Natal teeth

16. 16 INFECTIONS OF ORAL SOFT TISSUES Candidiasis Acute ulcerative gingivitis

17. 17 Excessive consumption of acidic foods and drinks is the main culprit in the child. All acids, whether from within the body or from external sources, are capable of demineralizing tooth tissue and therefore of causing erosion. Examples of extrinsic sources include carbonated soft drinks popularly called “minerals”, some fresh fruit juices, alcohol, some medications (such as aspirin and vitamin preparations in chewable tablets and lozenges) and some proprietary mouthwashes (WHO,2003; Auad and Moynihan,2007). TOOTH WEAR: DENTAL EROSION, ATTRITION, ABRASION

18. 18 Abrasion due to faulty use of the tooth brush and the chewing stick is another common cause of tooth wear. Tooth wear is a leading cause of tooth sensitivity, leading to pain, and discomfort. TOOTH WEAR: DENTAL EROSION, ATTRITION, ABRASION (CONT’D.)

19. 19 TEETHING IS NOT A PROBLEM It is a physiological process that results in eruption of teeth It is not the cause of diarrhoea, respiratory infections, malaria, and other illnesses frequently experienced by children It can be associated with some systemic conditions

20. 20 RESEARCH HIGHLIGHTS Started in 1980 at the University of California, Los Angeles (UCLA), USA Three main areas covered in today’s lecture are: 1.Preventive oral health care in children 2.Attitude and behaviour of children in dental practice 3.Special care dentistry

21. 21 PREVENTIVE ORAL HEALTH CARE IN CHILDREN Laboratory (in-vitro) studies on traditional oral hygiene methods using the chewing sticks Aqueous extracts of eight nigerian chewing sticks were tested on growth and adherence of streptococcus mutans Glass and saliva-coated hydroxyapatite beads were used as surfaces for bacterial attachment Growth was determined by ph changes and total radioactive bacteria count

22. 22 RESULTS Most plant extracts reduced adherence and growth of S. mutans to glass or saliva-coated hydroxyapatite beads S. warneckei (MEYINRO) was particularly inhibitory comparable to chlorhexidene F. xanthoxyloides (ORIN ATA) had no significant inhibitory effect By chemical and spectra analysis we identified high molecular weight polyphenolic tannin as active constituent What a breakthrough that was!

23. Table 1: Effect of 1% aqueous plant extracts on sucrose-mediated growth and adherence of S. mutans 6715-wt 13 to glass (mean + SEM) Sote,1982; Wolinsky & Sote, 1983

24. Table 2. Effect of 1% aqueous chewing stick extracts upon the adsorption of S. mutans 6715-wt13 to saliva- treated hydroxyapatite (means+ SEM) Sote, 1982; Wolinsky & Sote, 1984.

25. Table 3. Effect of pre-treating S. mutans 6715-wt13 cells and saliva-coated hydroxyapatite with 1% aqueos extracts of Nigerian Chewing stick (means + SEM) Wolinsky & Sote,1984

26. Figure 1. Effect of varying percentages of the aqueous extract of S. warneckei on growth and adherence of S. mutans 6715-wt to glass Sote, 1982; Wolinsky & Sote 1983.

27. 27 EFFECT OF CHEWING STICK EXTRACTS ON PERIODONTOPATHIC MICROORGANISMS Porphyromonas Gingivalis Prevotella Intermedia Fusobacterium Nucleatum Eikenella Corrodens Campylobacter Rectus

28. 28 AQUEOUS EXTRACTS OF FIVE CHEWING STICKS Inhibitory properties of the plant extracts at 10mg/ml were investigated At Eastman Dental Institute, UK As a Commonwealth Research Fellow Spectra of activity of the extracts against the tested microbes was determined for

29. 29 RESULTS All the plants tested except M. acuminata (PAKO JEBU) exhibited varying growth inhibitory potentials on the bacteria T. glaucescens (ORIN IDI) showed widest spectrum of activity by inhibiting four bacteria except P. gingivalis

30. Table 4: Spectra of activity of plant extracts on five periodontopathic bacteria at MIC=10mg/ml. Sote and Wilson, 1995.

31. 31 Most of the plants used traditionally for cleaning the teeth have potent antibacterial properties against common microorganisms that cause caries and periodontal diseases in addition to their mechanical cleansing potentials SUMMARY OF IN-VITRO STUDIES

32. 32 TRADITIONAL ORAL HYGIENE METHODS (IN-VIVO STUDIES): Comparison of relative effectiveness of chewing sticks and toothbrush & paste on plaque removal Impact of oral health education and oral hygiene knowledge on gingival health using the chewing sticks and toothbrush & paste

33. 33 RESULTS No significant difference between mean plaque scores of both the toothbrush & paste and chewing stick groups Higher proportion of males than females had gingivitis confirming better oral hygiene in females Only oral health education and oral hygiene knowledge may not effect positive change in oral hygiene habits The familiar oral hygiene method was more effective

34. * t = 3.038; df = 14; P<0.05 **t = 0.6843; df = 14; P>0.05 Table 5: Mean plaque score in each division of the tooth surface. Sote, 1987

35. Figure 2: Frequency of Gingivitis Incidence within the Four Groups by Sex Type at Final Examination Sote, 1991 A = Control B = ToothbrushC = S. warneckeiD = M. acuminata

36. Figure 3: Frequency of Scores 2 and 3 on the various Gingival Surfaces of Posterior Index Teeth of the Study at Final Examination of the Four Groups Sote, 1991

37. Figure 4: Plaque Distribution on the Four Gingival Surfaces of the Anterior Index Teeth of the Study at Final Examination of the Four Study GroupsFigure 4: Plaque Distribution on the Four Gingival Surfaces of the Anterior Index Teeth of the Study at Final Examination of the Four Study Groups Figure 4: Plaque Distribution on the Four Gingival Surfaces of the Anterior Index Teeth of the Study at Final Examination of the Four Study Groups Sote, 1991

38. 38 CONCLUSION FROM STUDIES Chewing stick can be as effective as the toothbrush provided the correct technique is used Some chewing stick constituents do play an important role in inhibiting plaque accumulation Effective use of the sticks confers both mechanical and anti-plaque benefits Thus, incidence of caries and periodontal diseases can be reduced among users

39. 39 USE OF FLUORIDE In child dental practice other caries preventive methods frequently used include fluoride in various forms, and clinical application of pit and fissure sealants. Systemically ingested fluoride gets incorporated into developing enamel to produce fluorapatite which is more resistant to acid dissolution by bacteria. Topical fluoride exerts its cariostatic effect through the dynamic de- and re- mineralization processes. Fluoride also inhibits metabolism of plaque bacteria in various ways thereby inhibiting cariogenesis.

40. 40 Fluoride containing toothpastes are common sources of topical fluoride and are therefore recommended for everyday oral hygiene maintenance. However, toothpastes containing reduced fluoride content are recommended for children to prevent the inherent risks associated with excess fluoride ingestion such as enamel opacities and fluorosis (Andlaw and Rock,1993; Sote,1998). To date, no toothpaste formulated and packaged solely for children is produced in Nigeria. USE OF FLUORIDE (CONT’D)

41. 41 ATTITUDE AND BEHAVIOUR OF CHILDREN IN DENTAL PRACTICE Ultimate goal is to instill and promote positive attitude to dentistry Attendance at the clinic is important both for preventive and restorative care Cooperative ability is crucial Negative attitudes result in lack of cooperation Fears, ignorance, incorrect information are common causes of negative attitudes

42. Figure 5: Showing Sources of Information about Dentistry Cited by Lagos School Children Sote & Sote, 1988

43. 43 CLINICAL DENTAL PRACTICE Treatment and alleviation of oral health problems in children is a major preoccupation of Paediatric dentists. All the aforementioned oral health problems can be very tormenting and agonizing to sufferers, be it a child or an adult. In order to enhance good quality of life in children and adolescents today’s inaugural lecturer engaged in several clinical studies as well as treating the problems.

44. 44 Dental treatment in children is very rewarding. Expectedly, treatment procedure varies a great deal depending on the type and severity of the problems. The group of children affected also influences treatment plan and strategy. A retrospective study on trends of dental treatment of children over 11-year period in our clinics at the Lagos University Teaching Hospital shows the diversity of the procedures (Sote, 2003). CLINICAL DENTAL PRACTICE (CONT’D)

45. 45 SPECIAL CARE DENTISTRY This subspecialty deals with oral health care of persons with disability and the medically compromised Little attention is given to their oral health problems by parents or care-givers because of the primary concern for the medical condition or disability itself They suffer unduly from severe oral diseases and their oral health care is frequently jeopardized

46. 46 SPECIAL CARE DENTISTRY (CONT’D) BEFORE TREATMENT AFTER TREATMENT

47. 47 SPECIAL CARE DENTISTRY (CONT’D) BEFORE TREATMENT AFTER TREATMENT

48. 48 SPECIAL CARE DENTISTRY (CONT’D) BEFORE TREATMENT AFTER TREATMENT

49. 49 SOTE,1993 Institutionalized female juvenile delinquents 91% had poor oral hygiene, 48.4% gingivitis, 40.8% discoloured teeth, 25.8% dental caries, 14% malocclusion, and 7.5% fractured teeth No ready access to dental care even when in pain

50. 50 SOTE, 1999 Jan. 1991 – Dec. 1998, only 40 persons with special healthcare needs presented in our clinics at LUTH Dental caries was commonest oral disease (30.4%) Scaling and polishing, tooth extraction most frequent treatment (28.3%; 21.7% respectively).

51. 51 CHILDREN WITH HIV/AIDS AND THE ORPHANED Special healthcare needs required Effective infection control Positive attitude of dentists in providing oral health care has increased compared to previous reports (Sote, 1992; 1993) Skills required and challenges of special care dentistry as a guide provided (Sote, 1999)

52. 52 MY CONTRIBUTION TO PAEDIATRIC DENTISTRY IN NIGERIA From 1990 to 1993 today’s lecturer was only academic lecturer on ground in the department of Child Dental Health discharging duties and responsibilities of the four paediatric dentists (including a professor) that had exited to greener pasture. As result I was honoured with the Long and Distinguished Service Award of the University of Lagos in 2007.

53. 53 WHY A LASTING SMILE? A smile is an expression of happiness, joy, satisfaction and fulfillment Smile is recognized even by babies Human beings need smiles. Smiling is not just a way of life it can be a necessity in life Sometimes one smile means more than a dozen roses A smile adds impetus to life The type of smile says a lot about the personality of the individual It is hard not to respond positively to someone who is smiling regardless of the type of smile

54. 54 A genuine, Duchenne smile is a beautiful thing and can reveal the innermost personality A fake, Pan-American smile simply stretches the mouth but never reaches the eyes (Hoggard, 2005) Do persons with fractured, discoloured, missing teeth not tend to have a closed-lip, half-hearted smile? Can an individual having a toothache or discomfort smile readily more so when eating is impaired? Is a hungry man not an angry man? WHY A LASTING SMILE? (CONT’D)

55. 55 This is why in Paediatric dentistry we promote lasting smile by preventing, making early diagnosis, treating, and correcting these oral health problems. Thus a confident, lasting smile is guaranteed from birth through childhood to adolescence WHY A LASTING SMILE? (CONT’D)

56. 56 SO, WHICH OF THESE IS A LASTING SMILE?

57. 57 CONCLUSION All children need adequate oral health care. This care should be provided for both those children who are able-bodied and those who have special needs be they physical, mental, medical, social or emotional. The society, parents and guardians owe the responsibility to provide all children with the same care that they themselves do enjoy. A concerted effort by both governmental and non- governmental organization is required to improve on the current state. Preventive oral health care and timely presentation for treatment are advocated for all children to avert damaging consequences so that they can smile into the future with confidence.

58. 58 RECOMMENDATIONS Compulsory, free, oral/dental check for pre-shool children Free dental treatment for children up to the age of five years Children of all ages with any form of disability should have ready access to free dental treatment in order to enhance their quality of life Oral health surveys to assess oral health needs of children to be conducted in every state and the fct Manufacturers of dental products should package products suitable for children.

59. 59 THANK YOU FOR LISTENING