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Dental Health International Nederland
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Basic Package of Oral Care
Jo E. Frencken
Christopher J. Holmgren
Wim H. van Palenstein Helderman
WHO Collaborating Centre for Oral Health Care Planning and Future Scenarios
Chapter 2 - Oral Urgent Treatment (OUT) for the emergency
management of oral pain, infection and trauma
This chapter discusses services targeted at the emergency relief of oral pain, management of oral infection and dental trauma through Oral Urgent Treatment (OUT). Access to this component of basic oral care is a fundamental right for everyone. Therefore, governments must take the responsibility to establish and maintain a functional OUT service that is accessible and acceptable to the entire population.
What is OUT?
Oral Urgent Treatment (OUT) is an on-demand service providing basic emergency oral care. An OUT service must be tailored to the perceived needs and treatment demands of the local population. Thus the precise content of an OUT service will differ from country to country and possibly from district to district within the same country.
The three fundamental elements of OUT comprise:
• Relief of oral pain;
• First aid for oral infections and dento-alveolar trauma;
• Referral of complicated cases.
It is anticipated that an OUT service would be able to manage the majority of cases requiring basic emergency oral care. The main treatment modalities would include:
• Extraction of badly decayed and severely periodontally involved teeth under local anesthesia;
• Treatment of post-extraction complications such as dry sockets and bleeding;
• Drainage of localized oral abscesses;
• Palliative drug therapy for acute oral infections;
• First aid for dento-alveolar trauma;
• Referring complicated cases to the nearest hospital.
Why is there a need for OUT?
Although most oral diseases are not life-threatening, they constitute an important public health problem. Their high prevalence, public demand for treatment, and their impact on the individual and society in terms of pain, discomfort, functional limitation and handicap affect the quality of life. In addition, the social and financial impact of oral diseases on the individual and community can be very high.
Pain relief
In under-served populations, the most common oral health problems and the use of oral health services are strongly related to pain and discomfort. The relief of pain is considered the predominant treatment demand in many population groups. Dental decay is the main cause of toothache. In these circumstances pain relief is achieved through extracting badly decayed teeth. Despite treatment of dental decay through tooth extraction, a high percentage (>90 %) of decayed teeth are left untreated in many countries.
In order to stop oral pain, people usually resort to medicines. Large sums of money are spent on pharmaceutical painkillers, antibiotics and traditional medicines. Often the use of medicines is not followed up by treatment of the source of the pain. The combination of palliative drug therapy and operative treatment should be emphasized in a proper OUT situation.
It is important to note that the inappropriate use of antibiotics for oral infections, such as localized abscesses, carries the risk of seriously affecting the efficacy of these medicines when used in life-threatening situations. A report entitled `Antibiotic use in Dentistry', from the American Dental Association (1997), pointed to the alarming increase in microbial resistance to antibiotics. It cautioned dental professionals against the overuse of antibiotics. A number of studies carried out in various countries on antibiotic use in dentistry determined that antibiotics were prescribed unnecessarily in 22 to 74 percent of cases.
First aid for oral infections and dento-alveolar trauma
Oral infections
The most common oral infection that requires assistance in an OUT situation is the localized dental abscess. This condition usually results from untreated dental decay and/or periodontal disease. Health personnel should be able to provide first aid to people with oral infections.
Dento-alveolar trauma
The second most common reason for children to visit the dental clinic for emergency care is the management of dental trauma. The most frequent types of dental trauma include enamel and enamel-dentine fractures. Studies investigating the prevalence of untreated dental trauma among children up to age 15 ranged from 7 to 50 percent, depending on age and location. These data show that there is a need for organized care to manage dental trauma within the government medical health services. It is known that late complications of dental injuries may lead to pulp death, root resorption and loss of alveolar bone.
Until recently, traffic accidents were the most frequent cause of dental and facial trauma in EME countries. Currently (domestic) violence and sports accidents are the leading cause. However, in most non-EME countries, traffic accidents remain the major reason for dental and facial trauma. Reduction in dental and facial trauma is attributed to stronger legislation on alcohol restrictions for drivers, the compulsory wearing of seatbelts, safety requirements for vehicles and better road conditions.
Referral of complicated cases
In line with the referral system in use in a country's health infrastructure, complicated cases require referral to specialists. OUT personnel should be adequately trained in the circumstances that require referral to an oral health professional.
Conclusion
Emergency oral care that is easily accessible for all should be the first priority in any oral health program. OUT should be integrated into the PHC system at a sub-district level and should make use of PHC facilities in both urban and rural areas.
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