Dental Health International Nederland
Training of basic oral health workers
Part 2 - Prevention of dental diseases
Prevention of dental diseases teaches us how we can maintain our mouth, teeth and gums healthy. As we realise how important a healthy mouth is for our general health and for our good looks, we understand why prevention is so important. A big problem with prevention is that WE may feel that prevention is very important, but someone who has never experienced toothache may think: I never had a toothache, so I care well enough.
We always have to realise that in order to make people understand our message, we should have a good story to tell.
Preventive dental care consists of 3 issues:
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1. The understanding of courses of dental diseases.
2. The knowledge and skills to communicate
a. with groups
b. with individuals
3. Follow-up on whether teaching on prevention has been successful.
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THE UNDERSTANDING OF CAUSES OF DENTAL DISEASES.
From chapter 1 we have learned how caries and gingivitis develop.
Caries develops when dental plaque is present for some time.
The bacteria which grow in the plaque take sugar from the food and transform it into acid which dissolves the enamel.
As we understand we realise that there are 2 targets for prevention of caries.
One target is to reduce the plaque and
The second target is to minimise the intake of sugar or sweet food.
Gingivitis develops when dental plaque is present for some time along the gums. The gums get irritated and will get inflamed.
Removal of plaque is therefore important in the prevention of gingivitis.
How to reduce the plaque.
Plaque can be reduced by brushing the teeth. Brushing the teeth removes the plaque and therefore reduces the amount of bacteria
which may form acid. Many people do not see the need for brushing their teeth. They forget to clean their teeth on a regular basis.
The first aim of our teaching therefore should be to make people clean their teeth regularly. At best teeth are cleaned two times
a day.
Plaque can be removed in various ways.
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- tooth brush
- chewing stick/twig
- finger with ash or salt
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 Figure 11. Chewing stick and toothbrush.
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As bristles have the best cleaning results, we prefer a toothbrush or a chewing stick. The bristles also clean in between
the teeth while your finger will not. Teeth should be cleaned regularly and thoroughly; preferably after every meal but at least twice a day. The best times are after breakfast and before going to bed. Cleaning should be a routine to make sure that all the teeth are
brushed and none are missed out.
For example:
Starting in the upper left jaw, first clean the outside from left to right. After this the biting surfaces need to be cleaned. The
lower jaw can be cleaned in the same way; first outside left to right, then inside left to right followed by the biting surfaces.
Figure 12. Placing and movement of the brush.
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How to minimise the use of sugar and sweet foodstuffs.
This is a difficult issue. People like sweet food. Children like sweeties, people like their tea best with plenty of sugar. We
should try to convince people that they take risks by eating sweet food. People will not listen when we tell them not to eat
sugar anymore, therefore we should encourage them to reduce the number of times they take sweet food. It is better to take much
sweet food at once than to take through the day. Remember every time sugar is in the mouth, acid will be formed.
THE KNOWLEDGE AND SKILLS TO COMMUNICATE.
Our aim with teaching is to make people aware of their teeth and gums and to assist them in keeping their mouth healthy. Our
teaching is therefore aimed at CHANGE OF BEHAVIOR. People who don't clean their teeth should start doing so; people who eat
much sweet food should reduce this. Only if a change in BEHAVIOR results we have a successful talk.
How to teach individuals.
When we teach a person who visits us with toothache we may start from there.
Questions like:
Do you know how the pain is caused?, Do you clean your teeth? etc. may be the start to a good explanation of the causes of the
toothache and a change in BEHAVIOR. We should always listen very well to questions of the patient. We have to avoid difficult
language. It looks impressive when we tell the patient about gingivitis, plaque, molars etc., but if the patient fails to understand the meaning of these words he will not understand anything at all. We should talk simple and clear.
How to teach a group.
First of all we should consider what group we address. We may address groups like:
-ante-natal clinic
-under 5 clinic
-patients in the waiting room
-out-patients department
-primary/secondary school
When addressing a group the following points are important:
- always be friendly and respect your patients. They will listen better if they realise that you are not telling them off,
but are instead trying to help them.
- do not use difficult terms when telling people about the prevention of dental diseases, as they will not understand.
For example: as a health worker you know that gingivitis is caused by plaque. The patient will only understand: my gums
will get ill if there is dirt on the teeth.
- try to use examples from day-to-day life.
For example: you want to emphasise that good cleaning means that each and every tooth should be cleaned; you can ask
whether a room is swept well if the centre is swept but the corners are forgotten.
- take your time and stimulate the patient to ask you questions. Usually patients are shy to talk to you. If you ask them a
simple question like: "What do we use our teeth for?", they might start talking more easily. If there are questions
during your talk you can be sure that it has been a good talk.
The talk on oral hygiene and prevention could start with questions like:
- have you ever met somebody with toothache?
- do many people suffer from toothache?
- do you know what causes a toothache?
During the talk we should at least discuss the following topics:
- what is the function of the teeth?
- why is it important to keep our teeth and gums healthy?
- what is good/bad for the teeth and gums?
- what can we do to care properly for our teeth and gums?
- how should we brush our teeth?
FOLLOW-UP ON THE RESULTS OF OUR TEACHING.
This again is a difficult issue. At our clinics we usually see patients only once or twice so that we are unable to check whether people have changed their bad habits into good habits. After teaching we always can ask questions to our audience to see whether they have understood everything, but we cannot actually check in the mouth. When we address schoolchildren or antenatal/U-5 clinics we are able to see these persons on a regular basis. We should try to find out whether our teaching did have a good result. If not we should ask ourselves why we failed.
PREVENTIVE PROGRAM
In order to start a preventive program we need to know what group of people we aim at. A program for schoolchildren may be quit
different from a group of mothers attending U-5 clinic The aims of the program are to be defined in a realistic way.
Examples:
Group. Schoolchildren Standard 1,4,8.
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Group: Ante natal clinic
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Aims: 1 - Regular visits (once a month)
2 - Teaching of principles of oral hygiene
3 - Teaching on the visible structures in the mouth
(teeth, gums, etc. (standard 8)
4 - Principles of dental diseases (standard 8)
5 - Examination of the mouth
6 - If necessary giving treatment
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Aims: 1 - Regular visits
2 - Teaching of principles of oral hygiene
3 - Teaching of principles of dental diseases
4 - Special attention on the relation
dental diseases <-> pregnancy
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We should be careful to define our aims so that we are able to achieve them.
Of course it will be nice to aim at the complete prevention of toothache, but this is unrealistic at first.
Therefore we have to limit ourselves. If our program is successful it is easy enough to aim at a higher standard of oral care.
The keywords to a successful preventive program are:
-continuity
-sound knowledge and teaching capacities