1. Oral Health and Disease Prevention in Adolescence
DMargaret Wandera BDS MSc PhD
Society of Adolescent Health in Uganda Fourth Clinical and Scientific Meeting
29-30th March, 2017

2. Overview of Presentation
Definition
Common Oral Diseases
Oral Disease and Adolescence
Oral disease status in Uganda Adolescence
Conclusion

3. Definition - Oral Health
Sheiham and Spencer (1997) stated, “Oral health is the ability to chew and eat the full range of foods native to the diet, to speak clearly, to have a socially acceptable smile and dento-facial profile, to be comfortable and free from pain and to have fresh breath.”

4. Definition - Oral Health
Oral health is multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex.
FDI definition

5. Definition - Oral Health
State of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual's capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing.
WHO defintion

6. Oral Disease
All pathological conditions in both the soft and hard tissues of the oral cavity.
 Are common in all societies with prevalence's ranging from 40% to 100% for some conditions
Two most common oral diseases are
Dental caries
Periodontal disease

7. Dental Caries Also referred to as TOOTH DECAY
is caused by the action of acids produced when sugars (mainly sucrose) in foods or drinks react with bacteria present in the plaque on the tooth enamel surface.
The resultant cavity (hole) impacts include
discomfort, pain, tooth abscess, tooth loss, broken teeth, chewing problems and serious infection.

8. Dental Caries Prevention
Limit consuming sugar, regular proper cleaning habit, Dentist application of preventive sealants
Treatment
The earlier the treatment the less complex
Dental filling
Root canal
Crowns
Extraction

10. Periodontal Disease
"Perio" means around, and "dontal" refers to teeth. 
Periodontal diseases are infections of the structures around the teeth
Periodontal disease is caused by Plaque
Simple infection may affect only the gums.
In more severe disease, all of the tissues are involved including the bone.

11. Periodontal Disease Prevention
is by regular cleaning and use of dental floss to clean between the teeth as means to control Plaque build up
Treatment
scaling and root planing (SRP)
Flap surgery
Grafts (gum or bone as required)

13. Periodontal Disease
 Other factors that may contribute and/or add to your risk of periodontal disease Include;
Misaligned teeth,
Medications, 
Diseases ,
Poor nutrition,
Smoking and tobacco use,
Genetics

14. Oral Diseases Other Oral Diseases include: Oral tumours Trauma
Tooth wear
Xerostomia (Dry mouth)
Mouth ulcers
Cold sores
Tooth sensitivity
Halitosis (bad breath)

15. Oral Health and Adolescence
OH of particular concern during Adolescence is in the areas of:
Population surveys

16. Population surveys - EXAMPLE OF DMFT OF 12YR OLDS IN 2004

17. Oral Health and Adolescence
OH of particular concern during Adolescence is in the areas of:
Population surveys
Orthodontic care/consideration
Habit forming
Drug initiation
Sports injuries

18. Oral health situation of Ugandan Adolescents
Dental Caries
Periodontal disease
Orthodontic care
Habit forming and Drug initiation (hygiene, fads e.t.c)

19. 1. Dental Caries Studies of Dental Caries in Uganda Children reveal
(Moller et al. Tiromwe et al. Wandera and Twa Twa, Muwazi et al, Kiwanuka et al, Batwala et al)
Increasing prevalence when cf. to earlier studies
- from as low as 0.2 DMFT in 1970 to 2.0 in 2000s
Increasing prevalence with Age
Urban children more affected than rural
More Decayed than treated teeth in DMFT scores reflecting ‘Unmet’ treatment need in the population

20. 2. Periodontal Disease
Studies continue to report Periodontal disease affecting 50 to 80% of Uganda populations.
Albandar et.al (2002) observed a high prevalence of Early onset Periodontitis in Ugandan children and recommended further investigation

21. 3. Orthodontic
Basis of Orthodontic treatments in Ugandan children is on existing information from other countries (Buwembo et al.2012)
Maloclussion seen in Adolescence may be due to the harmful practice of Infant Oral Mutilation in early childhood (ebinyo) (Bataringaya et al. 2005)

22. 4. Drug initiation/Habit forming
Limited literature on Uganda Adolescents
GYTS report of 2008 noted early initiation of smoking
Mpabulungi ( 2007) study of Secondary school children found
17.5% to have smoked tobacco with 37.9% having tried or started before age 10 yrs.
15-30% perceived that people who smoke had more friends than those who did not? )

23. Conclusion Adolescence is a time of unique health needs
In view of rising trends of some Oral disease it is important to Increase awareness to all, on Oral health, Oral disease and treatment needs
As well as to Involve other health personnel in Oral disease prevention to help address the existing low numbers of Dental personnel

24. References
Guideline on Adolescent Oral Health Care(2015) AMERICAN ACADEMY OF PEDIATRIC DENTISTRY
The Uganda Global Youth Tobacco Survey Report (2008) – Tobacco control policy implications
Bataringaya, A., M. Ferguson, et al. (2005). "The impact of ebinyo, a form of dental mutilation, on the malocclusion status in Uganda." Community Dent Health 22(3):
Batwala, V., E. M. Mulogo, et al. (2007). "Oral health status of school children in Mbarara, Uganda." Afr Health Sci 7(4):
Kiwanuka, S. N., A. N. Astrom, et al. (2004). "Dental caries experience and its relationship to social and behavioural factors among 3-5-year-old children in Uganda." Int J Paediatr Dent 14(5):
Kutesa, A., A. Kasangaki, et al. (2015). "Prevalence and factors associated with dental caries among children and adults in selected districts in Uganda." Afr Health Sci 15(4):
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Mpabulungi, L. and A. S. Muula (2004). "Tobacco use among high shool students in Kampala, Uganda: questionnaire study." Croat Med J 45(1):
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Muula, A. S. and L. Mpabulungi (2007). "Cigarette smoking prevalence among school-going adolescents in two African capital cities: Kampala Uganda and Lilongwe Malawi." Afr Health Sci 7(1):
Muwazi, L. M., C. M. Rwenyonyi, et al. (2005). "Prevalence of oral diseases/conditions in Uganda." Afr Health Sci 5(3):
Okullo, I., A. N. Astrom, et al. (2004). "Social inequalities in oral health and in use of oral health care services among adolescents in Uganda." Int J Paediatr Dent 14(5):
Rwenyonyi, C. M., L. M. Muwazi, et al. (2011). "Assessment of factors associated with dental caries in rural communities in Rakai District, Uganda." Clin Oral Investig 15(1):
Tirwomwe, J. F., C. M. Rwenyonyi, et al. (2007). "Oral manifestations of HIV/AIDS in clients attending TASO clinics in Uganda." Clin Oral Investig 11(3):
Wandera, M. and J. Twa-Twa (2003). "Baseline survey of oral health of primary and secondary school pupils in Uganda." Afr Health Sci 3(1):

25. Thank you for your attention!