Download inaugural lecture - University of Lagos

INAUGURAL LECTURE
UNIVERSITY OF LAGOS
12th March,2008
BY
ELIZABETH OBALOWU SOTE
Professor of Paediatric Dentistry
HEAD, DEPT. OF CHILD DENTAL HEALTH
COLLEGE OF MEDICINE OF THE
UNIVERSITY OF LAGOS
TITLE
PAEDIATRIC DENTISTRY:
GIVING LASTING SMILE FROM BIRTH THROUGH
CHILDHOOD TO ADOLESCENCE
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
3
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
4
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 ATTACKnot recommended (Matthew 5: 38-39)
5
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.
6
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
7
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.
8
COMMON ORAL HEALTH
PROBLEMS (CONT’D)
TRAUMA: injuries to teeth and tooth supporting
structures. Fractures and luxation injuries
including tooth loss can result.
9
COMMON ORAL HEALTH
PROBLEMS (CONT’D)
Tooth Fracture
10
COMMON ORAL HEALTH
PROBLEMS (CONT’D)
Intrusion
11
COMMON ORAL HEALTH
PROBLEMS (CONT’D)
Avulsion
12
COMMON ORAL HEALTH
PROBLEMS (CONT’D)
TOOTH
DISCOLOURATION:
extrinsic or intrinsic in
nature, genetic or
environmentally
acquired
Discoloured Teeth
13
COMMON ORAL HEALTH
PROBLEMS (CONT’D)
DISORDERS OF
DEVELOPING
DENTITION: dental
anomalies,
irregularities during
tooth eruption and
exchange, crowding,
premature loss of
teeth etc
14
DENTAL AND CRANIOFACIAL
ANOMALIES
• Talon cusps
• Cleft lip and palate
• Natal teeth
15
INFECTIONS OF ORAL SOFT TISSUES
Acute ulcerative gingivitis
Candidiasis
16
TOOTH WEAR: DENTAL EROSION,
ATTRITION, ABRASION
• 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).
17
TOOTH WEAR: DENTAL EROSION,
ATTRITION, ABRASION (CONT’D.)
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.
18
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
19
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
20
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
21
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!
22
Test Agent
pH of Culture
Adherent Radioactive
Total Radioactive
Bacteria (tubes +
Bacteria for Culture
rods) % of control
% of Control
None
4.49+0.03
100+1.1
100+2.1
F. xanthoxyloides
4.36+0.04
83.5+2.1
94.5+2.1
P. africana
4.36+0.05
24.0+0.0
86.0+6.5
T. glausescens
4.65+0.13
36.5+9.2
53.0+12.7
G. kola
4.66+0.02
22.5+3.1
63.0+5.7
A. schimperi
6.21+0.97
11.3+7.5
21.6+2.4
M. accuminata
5.18+0.08
49.4+3.5
80.5+2.1
S. warnecki
7.29+0.07
1.0+0.3
1.3+0.6
P. kotschyi
4.37+0.01
12.8+3.5
49.9+13.1
Chlorhexidine
7.42+0.07
0.83+0.11
0.97+0.06
Growth was determined from the percent of the total radioactive bacteria recovered and/or the
mean pH of the actual media determined after a 24-hour growth. Chlorhexidine concentration was
1.0x10-4M.
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
Test agent added
Number of S.mutans
adsorbed(x10+5)relative to
buffer control/20mgHA beads
2.43 + 0.12
%adsorption relative to buffer
control
1% tannic acid
0.34 + 0.07
14
1% G.kola
1.84 + 0.12
76
1% S.warneckei
0.38 + 0.14
15
1% P.africana
0.36 + 0.21
16
1% M.acuminata
2.09 + 0.70
86
1% F.zanthoxyloides
2.50 + 0.75
103
1% T.glaucescens
0.95 + 0.15
39
1% P.kotschyi
0.34 + 0.10
14
1% A.schimperi
0.36 + 0.04
15
None
100
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.
Pretreatment
Condition
Buffered KCl
Pretreatment of S. mutans cells
Number of S.
% relative to
mutans adsorbed buffer
(x10+5)/20 mg SHA
2.38 + 0.18
100
Pretreatment of S-HA
Number of S.
% relative to
mutans adsorbed buffer
(x10+5)/20 mg SHA
2.20 + 0.14
100
1% tannic acid
0.39 + 0.02
16
1.12 + 0.10
51
1% G.kola
1.86 + 0.10
73
1.87 + 0.21
85
1% S.warnecki
0.42 + 0.06
15
0.94 + 0.09
43
1% P.africana
0.39 + 0.06
16
0.90 + 0.15
41
1% M.acuminata
1.71 + 0.25
72
1.98 + 0.44
91
1% F.zanthoxyloides
2.85 + 0.81
120
2.31 + 0.90
105
1% T.glaucescens
0.90 + 0.15
38
1.21 + 0.43
55
1% P.kotschyi
0.36 + 0.06
15
1.18 + 0.15
54
1% A.schimperi
0.31 + 0.04
13
0.83 + 0.20
38
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
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.
EFFECT OF CHEWING STICK EXTRACTS ON
PERIODONTOPATHIC MICROORGANISMS
•
•
•
•
•
Porphyromonas Gingivalis
Prevotella Intermedia
Fusobacterium Nucleatum
Eikenella Corrodens
Campylobacter Rectus
27
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
28
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
29
Names of Plants
Yoruba Names of Plants
Names of Bacteria______________
A. schimperi
Ayin
C.rectus, P.gingivalis
F. zanthoxyloides
Orin Ata
C.rectus, F.nucleatum, E.corrodens
G. kola
Orogbo
F.nucleatum, P.gingivalis, P.interm.
M. acuminata
Pako Jebu
-
P. Africana
Orin Ayan
C.rectus, F.nucleatum, P.intermedia
P. kotschyi
Emigbegi
E.corrodens
S. warneckei
Meyinro
P.gingivalis
T. glaucescens
Orin Idi
C.rectus, E.corrodens, F.nucleatum
-
-
Table 4: Spectra of activity of plant extracts on five periodontopathic bacteria at MIC=10mg/ml.
Sote and Wilson, 1995.
SUMMARY OF IN-VITRO STUDIES
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
31
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
32
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
33
TOOTH AREA
Gingival 1/3 of
TOOTHBRUSH & PASTE
CHEWING STICK
Mean Score
Mean Score
% Frequency
% Frequency
2.8
22.6
2.4
23.1
0.93
7.5
1.1
10.6
0.0
0.0
0.0
0.0
* Distal area
4.6
37.0
4.8
46.1
** Mesial area
4.1
33.0
2.1
20.2
12.43
100.1
10.4
100
middle area
Middle 1/3 of
middle area
Incisal 1/3 of
middle area
TOTAL
* 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
Figure 2: Frequency of Gingivitis Incidence within the Four Groups by Sex Type at Final
Examination Sote, 1991
A = Control B = Toothbrush
C = S. warneckei
D = M. acuminata
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
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
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
38
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 remineralization processes. Fluoride also inhibits
metabolism of plaque bacteria in various ways
thereby inhibiting cariogenesis.
39
USE OF FLUORIDE (CONT’D)
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.
40
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
41
Figure 5: Showing Sources of Information about Dentistry Cited by Lagos School
Children Sote & Sote, 1988
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.
43
CLINICAL DENTAL PRACTICE (CONT’D)
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).
44
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
45
SPECIAL CARE DENTISTRY (CONT’D)
BEFORE TREATMENT
AFTER TREATMENT
46
SPECIAL CARE DENTISTRY (CONT’D)
BEFORE TREATMENT
AFTER TREATMENT
47
SPECIAL CARE DENTISTRY (CONT’D)
BEFORE TREATMENT
AFTER TREATMENT
48
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
49
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).
50
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)
51
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.
52
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
53
WHY A LASTING SMILE? (CONT’D)
• 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?
54
WHY A LASTING SMILE? (CONT’D)
• 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
55
SO, WHICH OF THESE IS A
LASTING SMILE?
56
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 nongovernmental 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.
57
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.
58
THANK YOU FOR
LISTENING
59