Download When the Body Turns On Itself

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Sally Simpson
Julie Rosse
 BSDHT
 Philips
 Mhari Coxon


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Maria Perno Goldie, RDH, MS
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August 14-17, 2017 Capetown, South
Africa
 ORAL HEALTH – VITAL LINK IN ACHIEVING
TOTAL HEALTH

 Overview
 Systemic Lupus Erythematosus
 Rheumatoid Arthritis (RA)
 Scleroderma
 Pregnancy
 Sjögren's Syndrome (SS)
 Product
7

http://cancerhelp.cancerresearchuk.org
/about-cancer/cancerquestions/autoimmune-disease-andcancer
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What are Autoimmune Disorders?
The Hidden Link that all Autoimmune
Disorders share
 The Immune System
 Genetics and Research
 Autoimmune Disorders and Depression
 Latest Medical News
 Links to other Websites


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http://www.coeliac.org.uk/healthcareprofessionals/associated-conditions-andcomplications/other-autoimmunedisorders
 Coeliac disease
 Autoimmune thyroid disease
 Autoimmune hepatitis
 Primary biliary cirrhosis
 Addison's disease
Review
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
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NICE (2009) Coeliac Disease:
Recognition and assessment of coeliac
disease.
 www.nice.org.uk

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Maria Perno Goldie, RDH, MS
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The Immune System
Understanding The
Immune System
Markers of Self
Bacteria
Parasite in red blood cell
SARS virus
Fungus
Markers of Non-Self
Bacteria
Epithelial
cell
SARS virus
Muscle cell
Epitope
Antigen
Antibody
Leukocyte
Non-self nerve cell
Non-self leukocyte
Nerve
cell
Antigen
Epitope
Class I MHC protein
Class I MHC self-marker protein
Major Histocompatibility Complex
Antibody
self-tolerance
Organs of the Immune System
Lymphatic System
Lymphocytes
Tonsils and adenoids
Lymph nodes
Lymphatic vessels
Thymus
Lymph nodes
Spleen
Peyer’s patches
Appendix
Lymph nodes
Bone marrow
Lymphatic vessels
Lymph node
Lymphatic vessel
Maria Perno Goldie, RDH, MS
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Immunity: Active and Passive
Active immunity
Passive immunity
T cells and B cells
are
activated, some
become
“memory” cells
Naturally acquired
“Privileged” Immunity
Chorionic villi
Naturally acquired
Artificially acquired Artificially acquired
*
Immunodeficiency
• Too little
*
Hypersensitivity
• Too much
*
Autoimmunity
• Misdirected
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Maria Perno Goldie, RDH, MS
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Women are 2.7 times more likely than men
to acquire an autoimmune disease.3
 Women have enhanced immune systems
compared to men, which increases
women’s resistance to many types of
infection but also makes them more
susceptible to autoimmune diseases.4

Autoimmune diseases are the third most
common major illness in the U.S. after
cancer and heart disease .1
 Autoimmune diseases are the eighth
leading cause of death for women aged
15 to 84.2


1. Rose, Noel R. “The autoimmune diseases: United they stand.” The Bridge: Quarterly
Newsletter of the Thyroid Foundation of America, Inc. 15 (3): 1-2, Fall 2000.

2. Walsh, S.J., Rau L.M. Autoimmune diseases: a leading cause of death among young
and middle-aged women in the United States. Am J Public Health. 2000: 90(9):14631466.
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
3. Jacobson, Denise L., Gange, StephenJ., Rose, Noel R., and Graham, Neil M.H. “Short
analytical review: Epidemiology and the estimated population burden of selected
autoimmune diseases in the United States.” Clinical Immunology and
Immunopathology. 84 (3): 223-39, September 1997.

4. Cannon, J.G., St. Pierre, B.A. Gender Differences in host defense mechanisms. J
Psychiatr Res. 1997: 31(1): 99-113.
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Maria Perno Goldie, RDH, MS
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
Organ Specific
 More
common among pregnant
women
 Abnormal antibodies can cross
the placenta and affect the fetus
 Pregnancy affects autoimmune
diseases in different ways
• Insulin dependent diabetes mellitus (IDDM) •
•
•
•

Type I
Graves’ disease
Goodpasture’s syndrome
Myasthenia gravis
Multiple sclerosis
Systemic
• Systemic lupus erythematosus
• Rheumatoid arthritis
• Sjogren’s syndrome
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
Thyroid Disease
32

› Graves’ Disease
› Hashimotos’ Disease


Crohn’s Disease
 SLE
 Myasthenia Gravis
 Immune Thrombocytopenic Purpura
 Rheumatoid Arthritis
 Pemphigoid Gestationis




Occurs in 5-10% of all pregnancies
May occur after delivery or pregnancy loss
May decrease milk volume
Transient hyperthyroidism followed by
transient hypothyroidism
May recur in subsequent pregnancies
Risk may be reduced by selenium
supplements
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Heat Sensitivity
Sweating
 Fine Brittle Hair
 Weakness In Your
Muscles
 Light Menstrual
Periods










Tiredness
Depression
Sensitivity To Cold
Weight Gain
Muscle Weakness And Cramps
Dry Hair
Tough Skin
Constipation
Sometimes There Are No Symptoms







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Weight Loss
Without Dieting
Irritability
Insomnia
Bulging Eyes
Shaky Hands
Sometimes There
Are No Symptoms
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Maria Perno Goldie, RDH, MS
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Goiter
 Comparable
to effect of
moderate smoking
 Increased risk of preterm delivery
and IUGR
 Higher risk if disease active at
conception
 Careful monitoring during
pregnancy
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 They
are estimated to cost the
nation $86 billion a year1
Type I diabetes
 Multiple sclerosis
 Scleroderma
 Lupus
 Rheumatoid arthritis
 Pemphigus Vulgaris
 Sjögren’s syndrome
 And others…


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1. “Autoimmune Diseases: A Major Women’s Health Issue.” American Autoimmune Related Diseases Association,
Inc. www.aarda.org
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Maria Perno Goldie, RDH, MS
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
The Office of Research on Women’s
Health, a unit of the National Institutes of
Health (NIH), has named autoimmunity
and autoimmune diseases one of the
priority women’s health issues for the 21st
century.1
In about 2% of cases, the body’s immune
system goes awry and fails to recognize
its own parts as “self,” which results in an
attack on healthy cells
 This can occur from before birth, as in
type 1 diabetes, into old age

1. U.S. Department of Health and
Human Services, Public Health
Service, National Institutes of Health.
Agenda for Research on Women’s
Health for 21st Century. Report of the
Task Force on the NIH Women’s Health
Research Agenda for the 21st
Century. Vol. 2. Bethesda, MD. NIH
Publication No. 99-4399.
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
Discoid (DLE) form affects the skin
› Chronic, erythematous scaly plaques on
head region
› Rare to have systemic manifestations

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Systemic (SLE) form affects multiple
organ systems including skin, heart, lungs,
kidneys, neurological system
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An inflammation of the connective
tissues, SLE can afflict every organ system
 It is up to nine times more common in
women than men
 It strikes black women three times as
often as white women
 The condition is aggravated by sunlight

Systemic lupus
erythematosus
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Diseases: A Major Women’s Health Issue. American Autoimmune
Related Diseases Association, Inc. www.aarda.org.
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Maria Perno Goldie, RDH, MS
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Also more common in Hispanic women
Common complications include
psychiatric problems, infections, CAD,
osteonecrosis
 5 year survival rate 90% and 10 year
survival rate 80%

Malaise, fatigue, fever, weight
loss, butterfly rash across nose
and cheeks
 Migratory arthritis, oral ulcerations,
recurrent pharyngitis
 Renal failure best clinical indicator
of patient’s prognosis
 Raynaud‘s phenomenon


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Vasculitis
“Hitch-hiking thumb
Neuropsychiatric problems include
psychosis, seizures, movement disorders,
high risk of stroke
 Pulmonary risks include pleuritis, edema,
hypertension
 Cardiac risks include pericarditis,
endocarditis, valvular abnormalities

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Antinuclear antibody
(ANAs) test has 95%
specificity
 Patient’s may have
hemolytic anemia,
leukopenia, lymphopenia,
and thrombocytopenia
 Also risk for elevated PTT
time, may have clotting
abnormalities

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Maria Perno Goldie, RDH, MS
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
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No cure, not an infection
Treatment is palliative
 Avoid sun –exposure may exacerbate
disease
 NSAID’s,COX2 inhibitors, aspirin
 Antimalarials
In general, clotting should occur
between 25 to 35 seconds
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
LUPUS: The Disease with a Thousand
Faces
 http://www.lupuscanada.org/english/livi
ng/1000faces.html


› Hydroxychloroquine or quinacrine
Corticosteroids
 Immunosuppressive drugs

› Imuran & Methotrexate

Rituximab - monoclonal antibody
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Antibiotic prophylaxis according to AHA
guidelines due to high risk of heart valve
irregularities
 Leukopenia may make patient more at
risk for infection along with steroid use
 May need to supplement steroids for
high stress procedures

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High risk for altered drug metabolism due
to renal disease (nephritis)
 Patient’s may be at high risk for excessive
bleeding, a coagulation profile should
be obtained

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Maria Perno Goldie, RDH, MS
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Seen in 5-25% of patients
 May resemble lichen planus or leukoplakia
 Oral lesions are increased with sun exposure
 Erythematous lesions with white spots can
be seen on the lips, palate, and on the
insides of their cheeks in 5-25% of patients,
not associated with active disease

Red ulcers surrounded by a white halo
and white radiating lines, more typical
"discoid" lesions
 May or may not be sore
 Also Burning
 Xerostomia

› Meds
› Salivary gland disease
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
NSAIDs and COX-2 inhibitors
 Antimalarial drugs
 Calcium channel blockers
 ACE inhibitors
 Cholesterol lowering agents
 Rituximab
 Cyclosporine

Changes in pigment of the lining of the
mouth
› Common side effect of antimalarial drugs
Drug reaction to medication
 Opportunistic oral infection

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 Herpes
simplex virus infection occurs in
80-90% of the general public
 Candidiasis,
caused by fungal
organisms, can develop secondary to
dry mouth, diabetes, and dentures
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Treat with appropriate antifungals,
antivirals, and antibiotics
 Disinfection of dentures with
chlorhexidine
 Referral not necessary unless
patient does not respond

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Maria Perno Goldie, RDH, MS
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Medical for Dentures disinfects and
cleans without causing corrosion or
discoloration or distortion all types of
removable dentures made of acrylic,
silicon, nylon and elastomer
 Every day for 2 weeks
 After, use Medical Interporous twice per
week as part of the denture cleansing
routine


http://www.msi-lab.com/
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Orabase Paste Overview
– Indication
• Oral irritations / Mouth sores
– Active Ingredient
• 20% benzocaine
– Benefits
• Maximum strength pain relief
• Shields wound from further irritation
• ADA approved and alcohol-free
Source: Pharmacy Times OTC Supplement, 2007.
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http://www.aphthasol.net/professional/
99% of toothbrushes are contaminated
with micro-organism biofilm
 Worse if stored in the bathroom in the
open air

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Maria Perno Goldie, RDH, MS
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


Lupus Guide to Dental Care
by Heather Galusha-Phillips
http://www.niams.nih.gov/H
ealth_Info/Lupus/Lupus_Gui
de/lupus_guide.pdf
Boutonnière deformity
Hyperextension at the metacarpophalangeal joint, flexion at the
proximal interphalangeal joint, and hyperextension at the distal
interphalangeal joint
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A systemic disorder in which immune
cells attack and inflame the membrane
around joints
 Of the estimated 2.1 million Americans
with rheumatoid arthritis, approximately
1.5 million (71 percent) are women

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Peak incidence: young adults and
premenstrual women
 Common (1-2% of population) severe
inflammatory disorder which can affect
men and women of all ages
 Marked by variable course, with
exacerbations and remissions

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Maria Perno Goldie, RDH, MS
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Many patients have chronic progressive
course resulting in severe morbidity and
mortality
 Main target organ is synovium

› Inflammation vasculitis
› Edema
› Infiltration by lymphocytes and
macrophages
› Synovial proliferation and cartilage erosion
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
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Inflamed and/or deformed joints, loss of
strength, swelling, pain
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 Rest
and exercise
 Anti-inflammatory drugs when
necessary
 Drug treatment includes:
In the morning generally
lasts longer than 45
minutes
 Other symptoms
include fatigue,
anemia, weight loss,
and low-grade fever

› Analgesics for pain;
› Anti-inflammatory drugs
› Disease-modifying drugs (DMARDS)
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Maria Perno Goldie, RDH, MS
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Can be a secondary reaction to
rituximab and ACE-inhibitors, used to
treat hypertension
 This reaction can also be a result of antiseizure medications and
immunosuppressants, such as calcium
channel blockers

Inflammation of the temporomandibular
joint
 Secondary Sjögren’s syndrome

› Xerostomia treatment (43%)
Michael A. Weber and Franz H. Messerli . Angiotensin-Converting Enzyme
Inhibitors and Angioedema: Estimating the Risk. Hypertension. 2008;51:
1465-1467; published online before print April 14 2008,
doi:10.1161/HYPERTENSIONAHA.108.111393
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Colgate® PreviDent 5000 Plus®
Active Ingredient
• 1.1% sodium fluoride (5,000 ppm)
Before application
Benefits
• Significantly remineralizes caries in 3 months*
• Helps prevent decay
• One step brushing
• Safe for ceramic crowns
Following application
Patient Problems
• High caries risk/rate
• Crown and bridge work
• Xerostomia
• Soda pop syndrome
*Baysan, A. et al. Reversal of primary root caries using dentifrices containing 5,000 and 1,000 ppm fluoride.
Caries Res 2001;35:41-46.
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 Chlorhexidine
Gluconate 0.12%
oral rinse - 16oz
Narrowed joint
spaces
 Flattened condyles
Severely destroyed
 Erosions
rheumatoid GH joint
 Subchondral sclerosis
 Cysts
 Osteoporosis

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Note the narrowing of the joint spaces and
the increased density around the joints due
to the subchondral sclerosis (black arrows).
Flattened Condyles
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Maria Perno Goldie, RDH, MS
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
Patients with RA may
require antibiotic
prophylaxis
 http://www.ada.org/
prof/resources/pubs/
jada/reports/report_
prophy_statement.p
df

Difficulty brushing and flossing
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Scleroderma is an activation of immune
cells which produces scar tissue in the
skin, internal organs, and small blood
vessels
 It affects women three times more often
than men overall, but increases to a rate
15 times greater for women during
childbearing years, and appears to be
more common among black women

93
From the Greek words skleros for hard,
and derma for skin, it literally means hard
skin
 Chronic; often disabling; potentially life
threatening

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Localized scleroderma affects the skin
and underlying tissue, hardening or
tightening the skin
 Systemic scleroderma affects the skin
and internal organ systems
 Both forms can cause debilitating
physical changes

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Maria Perno Goldie, RDH, MS
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Approximately 300,000 Americans
80 percent are women
 Between the ages of 25 and 55
 Scleroderma can strike anyone at any
age


Currently, there is no cure for
scleroderma
 The Scleroderma Foundation and the
National Institutes of Health fund
research to find answers and a cure
 As this is a complex disease, more
research lies ahead

97

Common symptoms include:
98

› Hands or feet overly sensitive to the cold,
with pain and color changes
› Thickening of the skin
Also known as systemic sclerosis, is a
disorder that leads to thickening,
hardening and tightening of the skin and
connective tissue
› Shortness of breath
› Trouble swallowing
› Stiffness of the hands
› Joint or bone pain
› Fatigue
99

Localized scleroderma, the damage is
confined to the skin and the tissue just
beneath it
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Calcinosis
Calcinosis
 Reynaud’s
 Esophogeal dysfunction
 Sclerodactyly
 Telangiectasia

Telangiectasia.
Sclerodactyly &
Reynaud’s
Sclerodactyly
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Maria Perno Goldie, RDH, MS
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The drug D-penicillamine has been shown
to decrease skin thickening (Cuprimine and
Depen)
 Symptoms involving other organs such as
the kidneys, esophagus, intestines, and
blood vessels are treated individually

›
›
›
›
›
›
›
103
Hematopoietic stem-cell transplantation
can be an effective treatment in
patients with refractory systemic sclerosis
 The dermal sclerosis improved
immediately after transplantation, but
thrombocytopenia and Graves’ disease
developed

n engl j med 357;26 www.nejm.org 2736 december 27, 2007

104
Tell the dental hygienist that you have
scleroderma
 Schedule short exam and care
appointments for one area at a time or
one tooth at a time
 Schedule appointments for the best time
of day for you
 Wear gloves and bring a blanket in case
the office is cold

105
The appointment can be made more
comfortable by:
› Mouth prop
› Rubber dam
› Patience of both parties
Calcium channel blockers
Prostaglandins
Antidepressants
Phosphodiesterase enzyme inhibitors
Histamine H2 antagonists
Proton-pump inhibitors
Antihypertensive agents
106
Lips and tongue can become rigid and
the mouth narrows
 The folds of skin around the mouth
disappear, giving the face a masklike
appearance

› Short appointments and/or breaks
Living a legacy: 1953-2002
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Maria Perno Goldie, RDH, MS
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Mask-like or “mouse” facies
Widened palpebral fissures
 Xerophthalmia
 Xerostomia



Claw like form of her
hands

109
110
111
112
Resorption of the
condyles and
mandibular ramus
bilaterally
Gastroesophageal reflux disease
 Thickened periodontal ligament and
blunting of mandibular angles on dental
radiographs
 Microstomia
 Poor oral hygiene
 Pathologic mandibular fracture

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Maria Perno Goldie, RDH, MS
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
Tongue blade exercise
Antimicrobial rinses
 Scaling and root planing
 Surgery
 Local antibiotic administration
 Extraction as needed

115

TMJ, Temporomandibular Joint
Dysfunction
116

http://www.myoacademy.com/
117
118
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Maria Perno Goldie, RDH, MS
20
121

122
Chronic, slowly progressing inability to
secrete saliva and tears
Incidence
Women
Men
123
ANA (Anti-Nuclear Antibody)
RF (Rheumatoid FactorSS-A (or Ro) and
SS-B (or La): Marker
 Antibodies for Sjögren’sESR (Erythrocyte
Sedimentation Rate)
 IGs (Immunoglobulins
124




125
Schirmer test: Measures tear production
Rose Bengal and Lissamine Green: Use
dyes to examine the surface of the eye
for dry spots
126
Maria Perno Goldie, RDH, MS
21
Salivary flow: Measures the amount of
saliva produced over a certain period of
time
 Salivary scintigraphy: A nuclear medicine
test that measures salivary gland
function
 Salivary gland biopsy (usually in the lower
lip): Confirms lymphocytic infiltration of
the minor salivary glands



It can occur alone or
with rheumatoid
arthritis, scleroderma,
or systemic lupus
erythematosus
Nine out of 10 cases
occur in women,
most often at or
around mid-life
Sjögren's Syndrome
127
The most serious condition associated
with Sjögren's syndrome (SS) is malignant
lymphoma
 The risk of developing lymphoma is up to
44 times higher for patients with primary
SS than for age- and sex-matched
controls

Interventions to keep the mouth and
eyes moist include drinking a lot of fluids
and using eye drops, as well as good
oral hygiene and eye care
131
Men
128
Dryness of the eyes and mouth
Swollen neck glands
 Difficulty swallowing or talking
 Unusual tastes or smells
 Thirst
 Tongue ulcers
 Severe dental caries


129

Women
130
Loss of saliva results in the loss of the
antibacterial and antifungal capacities
of saliva, as saliva keeps the oral soft
tissue moist and healthy, and buffers the
oral environment, helping to neutralize
acids that cause dental decay
 Destruction of the salivary glands inhibits
that buffering effect

132
Maria Perno Goldie, RDH, MS
22
2% sodium fluoride (NaF) gel for four
minutes in a tray
 5% sodium fluoride varnish applied
directly to the teeth, four times a year

Daily five-minute application of 1.1%
sodium fluoride in a custom tray
 Daily 0.05% NaF rinse for one minute
 Use of extremely high-fluoride-content
toothpaste once daily
 Many xerostomic patients complain that
the flavors of mint or cinnamon are too
spicy

› Consider using products with gentler taste
profiles such as vanilla, melon, chocolate, or
fruit
133

134
“Currently, there is no cure for Sjögren's
syndrome, and treatment is mainly
palliative”
135
136
Moisturizes the mouth, locks in moisture
 Helps protect from dryness
 Enamel-safe pH, mild mint flavor
 Sugar-free, alcohol-free, and contains no
known allergens
 Available OTC

137
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Maria Perno Goldie, RDH, MS
23

Salese is a sustained release product that
delivers active ingredients efficiently and
continuously in small doses
Ingredients:
• Xanthan gum
• Essential oils
• Xylitol
• Sodium Bicarbonate
• Zinc


139
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142
5000 ppm fluoride
Prescription-strength
Includes acidic, bitter, or sour foods and
beverages that are known to stimulate
salivary flow
 These should be limited because low pH
foods and beverages promote mucosal
soreness, dental erosion, and dental
caries

http://www.alignpharma.com/
143
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Maria Perno Goldie, RDH, MS
24
Use of sugar free chewing gum to
stimulate saliva
 Lozenges of anhydrous crystalline
maltose also stimulate saliva in dry
mouth patients
 http://www.xlear.com/

Xylitol
 Stevia Leaf Extract (Rebaudioside A)
 Kettle Cooked & Over Stirred
 Made in the USA
 Magnolia Bark Extract
 Natural Flavors

http://www.puredentgum.com
146
145
Eight to 10 8-oz glasses of water per day
promotes adequate hydration
 Sip water frequently to replace, at least
in part, the missing saliva
 Using a cool air humidifier during sleep,
especially during winter months, can be
helpful

Electrical stimulation can also increase
salivary flow
 Electrical stimulation with a TENS
(transcutaneous electrical nerve
stimulator) unit is used to stimulate
salivary flow

› The humidifier should be turned on
approximately 1 hour prior to bedtime and
left on all night, and cleaned frequently
147
Acupuncture increases salivary flow,
ability to eat and speak, and improved
sleep in patients affected with Sjogren’s
syndrome
 Acupuncture points on hands and ears
are used to increase salivation

149
148
Limit between-meal ingestion of
fermentable carbohydrate
 Use noncariogenic sweetening agents
such as acesulfame K, aspartame,
saccharin, sorbitol or xylitol

150
Maria Perno Goldie, RDH, MS
25
MS is a Demyelinating Disease
The nerve damage is
caused by inflammation
 The body's own immune
cells attack the nervous
system
 Repeated episodes of
inflammation can occur
along any area of the
brain, optic nerve, and
spinal cord

Blood vessel
Inflammation
Myelin – provides
insulation to nerve
processes (axons)
Blood vessel
Inflammation
Blood vessel
Inflammation
152
151
Risk of Developing MS and Region
of Origin
 Risk
is modified by
Environmental factors
› Sunlight
› Diet (e.g., vitamin D)
› Other lifetime experiences
(infections?)
153
154
A chemical messenger has been shown
to have a previously unknown major role
in autoimmune diseases like arthritis and
lupus
 Investigators found interleukin 17 plays a
major role on shaping B cells' ability to
create more and more disease-causing
antibodies, which may generate new
ideas in the ongoing search for better
drug targets

Fibromyalgia is a common syndrome in
which a person has long-term, body-wide
pain and tenderness in the joints, muscles,
tendons, and other soft tissues
 Fibromyalgia has also been linked to
fatigue, sleep problems, headaches,
depression, and anxiety

Nature Immunology, Jan 2008
155
156
Maria Perno Goldie, RDH, MS
26
 Alopecia
areata
 Antiphospholipid
antibody
syndrome (aPL)
 Autoimmune
hepatitis
 Celiac disease
 Guillain-Barre
syndrome
 Hemolytic
anemia
 Inflammatory
myopathies
 Primary biliary
cirrhosis
 Psoriasis
 Vitiligo
American Autoimmune Related Diseases
Association (AARDA), Inc.
Phone: 586-776-3900; 800-598-4668 (for
literature requests)
 National Heart, Lung, and Blood Institute
(NHLBI), NIH, HHS
Phone: 301-592-8573
 National Institute of Allergy and
Infectious Diseases (NIAID), NIH, HHS
 Phone: 866-284-4107

157
158
OHASA
National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS),
NIH, HHS
Phone: 301-495-4484; Toll-Free: 877-226-4267
 National Institute of Diabetes and Digestive
and Kidney Diseases, NIH, HHS
Phone: 301-496-3583
 National Institute of Neurological Disorders
and Stroke (NINDS), NIH, HHS
Phone: 800-352-9424
The Oral Hygienists’
Association of South Africa
presents:

159
HOUSE OF DELEGATES MEETING 2013
Pre-congress HOD
meeting
 Date:
 12-13th August 2013
 Venue:
 The Lord Charles Hotel
 Town:
 Somerset West, CT
IFDH Governing body
tri-annual meeting
 The official meeting of
the house of delegates of
the IFDH member
countries
 Elections of new
Executive Council
members
 Forming IFDH policies
and procedures
As one of the top ten
tourist destinations in the
world, Cape Town is no
ordinary city. So it stands
to reason that the CTICC
would be no ordinary
convention centre—IT IS
WORLD CLASS
Widely regarded as one of
the leading convention
centres in the southern
hemisphere
GREEN CONFERENCE
INITIATIVE
[email protected]
Congress Venue:
The Cape Town Convention Centre
CTICC
Maria Perno Goldie, RDH, MS
27
WELCOME RECEPTION &
OPENING CEREMONY 19TH
ISDH 2013
THIS EVENT WILL TAKE PLACE IN THE CAPE TOWN
INTERNATIO NAL CONVENTION CENTRE (CTICC)
THE SOUND OF THE AFRICAN DRUMS WILL CALL IN ALL
DELEGATES FROM AROUND THE WORLD TO TAKE PART IN
THIS PRESTIGIOUS EVENT
GALA DINNER
M
SPIER
O
WINE
Y
ESTATE
O
Stellenbosch
 Date: 16/08/2013
 Time: 19:00 hrs



A unique
destination for a
sophisticated
African experience
AVOID DISAPPOINTMENTBOOK NOW!
VISIT US AT
:http://www.embassyconferences.co.za/portfolio/present/19thinternational-symposium-on-dental-hygiene/10

Sponsored by
Sunstar
Foundation
KEYNOTE SPEAKER PROPOSALS 19TH ISDH 2013
 Please submit the attached ‘Keynote Speaker Proposal Form’ not
later than 31 st October 2012 to:
CALL FOR ABSTRACTS
19TH ISDH 2013

 Marie Ferreira, Chair Scientific Committee
.
PLEASE SU B MIT T H E ‘A B STRACTS SU B MISSION FORM’ B Y
3 1 ST O C T O B E R 2 0 1 2 T O :
 Postal Address:
 206 Kings Terrace
Brooks Hill Drive
 Humewood
 Port Elizabeth
 6001
MA RIE FERREIRA CH A IR SCIEN TIFIC COMMITTEE
POSTAL A D D RESS: 206 KINGS TERRACE
BROOKS HILL DRIVE
H U M E WOOD
PORT ELIZABETH 6001
SOUTH AFRICA
South Africa
 Email Address: [email protected]
 We welcome your proposal, support and participation.
E M A IL A D D RE SS: M A R IE FE [email protected]
REGISTRATION FOR 19TH ISDH 2013
PROFESSIONAL
CONGRESS ORGANIZER
 VISIT US AT
:http://www.embassy
conferences.co.za/port
folio/present/19thinternationalsymposium-ondental-hygiene/10
Save the date !
 Please join us for
this once in a
lifetime African
congress
experience
[email protected]
[email protected]
 www.ifdh.org
Maria Perno Goldie, RDH, MS
28
Maria Perno Goldie, RDH, MS
29