In India among the 1027 million populations about 72% people live in rural areas

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2 INTRODUCTION 2

3 In India among the 1027 million populations about 72% people live in rural areas India produces 9000 dentists per annum-dentist population ratio is 1:30,000 Only 10%of the dentists are available for rural population-negligence in rural oral health In 1994, WHO introduced ORAL HEALTH FOR HEALTHY LIFE to prevent the rising trend of dental diseases The method used fro primary prevention includes primary prevention of dental caries, periodontal diseases and oral cancers 3

4 In West Bengal Standard Treatment Protocol is needed which should include Community Health Service Function of the dental surgeon- mass education, training the volunteers, making the children aware of brushing habits and oral hygiene maintenance Habit of brushing should begin at family level-parents should encourage Anganwadi workers should be included in this programe for developing healthy habits 4

5 STANDARD TREATMENT PROTOCOL Proper and thorough examination oral structures of the oral and para- using: Bright light Mouth mirror Dental probe Tweeszers It includes the following observations 5

6 CHANGE IN PIGMENTATION : MELANOMA 6

7 ULCERATION: TRAUMATIC OR MALIGNANT 7

8 ULCERATION, SCAR MARK TUBERCULAR ULCER PEMPHIGUS 8

9 INTRA-ORAL EXAMINATION 1) TEETH 2)ORAL MUCOSA 3)PERIODONTIUM 4)EFFECT OF DIFFERENT DELITARIOUS HABITS 9

10 EXAMINATION OF TEETH DENTAL CARIES FRACTURED TEETH 10

11 EXAMINATION OF TEETH ENAMEL HYPOPLASIA FLUROSIS 11

12 EXAMINATION OF TEETH SWELLING AROUND TEETH IMPACTED TEETH 12

13 EXAMINATION OF TEETH EXTRINSIC STAIN INTRINSIC STAINTETRACYCLINE STAINING 13

14 EXAMINATION OF ORAL MUCOSA WHITE LESIONLEUKOPLAKIA PIGMENTED LESIONLICHENOID REACTION 14

15 EXAMINATION OF ORAL MUCOSA TONGUE- WHITE PATCH TONGUEDEPAPILLATION 15

16 EXAMINATION OF ORAL MUCOSA TONGUE- CANDIDIASIS GEOGRAPHIC TONGUE 16

17 EXAMINATION OF ORAL MUCOSA TONGUE- ULCERATION LINGUAL THYROID NODULE 17

18 EXAMINATION OF PERIODONTIUM GINGIVITIS PERIODONTITIS 18

19 EFFECT OF DELITARIOUS HABITS IN ORAOSAL MUCOSA ORAL SUBMUCOUS FIBROSIS LEUKOPLAKIA 19

20 EFFECT OF DELITARIOUS HABITS IN ORAOSAL MUCOSA SMOKER S PALATE ERYTHOPLAKIA 20

21 Awareness of the patients should be done at this level for prevention of disease rather than giving emphasis on curative aspect/treatment 21

22 PATIENT EDUCATION BY 1)MASS MEDIA 2)COMMUNITY HEALTH CHECK UP PROGRAMME 3)SCHOOL HEALTH CHECK UP PROGRAMME 4)THROUGH LEAFLETS AND HOARDINGS 22

23 SCHOOL HEALTH CHECK UP PROGRAMME IMPLICATION Importance of proper brushing Importance of regular dental check up Preliminary information of dental diseases Practicing good oral habits 23

24 PRIMARY PREVENTION FLUORIDE APPLICATION SCALING CALCULUS REMOVAL PIT AND FISSURE SEALANT RESTORATION OF DECIDUOUS TEETH BRUSHING PLAQUE CONTROL EXTRACTION- IF INDICATED 24

25 Includes1) TREATMENT OF DENTAL CARIES 2) TREATMENT OF PERIODONTAL DISEASES 3) TREATMENT OF MALALIGNED TEETH 4) TREATMENT OF PARTIALLY OR COMPLETELY EDENTULOUS PATIENT 5) TREATMENT OF ORAL PRE-CANCER AND CANCER 25

26 TREATMENT OF DENTAL CARIES Restoration/Filling Root Canal Treatment Grossly Mutilated- Extraction 26

27 TREATMENT OF PERIODONTAL DISEASES 1)AWARENESS FOR IMPROVEMENT OR ORAL HYGIENE AND MAINTENANCE 2)ORAL PROPHYLAXIS SCALING 27

28 BY ORTHODONTIC CORRECTION TREATMENT OF EDENTULOUS PATIENT BY FABRICATION OF- PARTIAL DENTURE COMPLETE DENTURE 28

29 TREATMENT OF ORAL PRECANCEROUS PATHOLOGIES 1) Identification of the disease at an early stage 2) Motivation to quit habit 3) Rounding off sharp edges of teeth or prosthesis 4) Extraction if needed 5) Therapeutic treatment- antioxidants, vitamin B complex TREATMENT OF CANCER Radical Surgery Radiotherapy Chemotherapy 29

30 1) Dental chair with unit and light 2) Suction apparatus 3) Electrical sterilizer 4) Autoclaves and drums 5) Instrument trolley or table 6) Forceps for dental extraction 7) Scaling set or ultrasonic scalar 8) Air compressor and its attachment like air rotor, air motor, burs etc. 9) Micro-motor 10)Instruments used for restoration 11)Instruments for making prosthesis 12)Surgical instruments 13)Instruments fro biological waste disposal 30

31 FOR INVESTIGATION Eg: to evaluate any extensive tumor or growthorthopantomogram Advanced radiological investigations like CT Scan MRI 31

32 SEROLOGICAL AND BIOCHEMICAL TESTS- facilities which are not available in primary health centers FOR TREATMENT- Extensive space occupying lesion of the jaw Unfavourable fractures Patients suffering from hematological disorders Road traffic accidents REFERRAL FOE SPECIALIZED DENTAL PROCEDURES like crown, bridges, esthetic dentistry, endodontic procedures etc. REFERRAL FOR TREATMENT OF ORAL CANCER TO SPECIFIC CENTERS 32

33 Treatment of Dental ailments expected from a Medical Officer P.H.C (Where there is no Dental Surgeon) Toothache :a) Dental Caries Look for a cavity in the involved tooth with a prove, see whether the pulp chamber is exposed or not exposed. Exposed tooth requires R.C.T. or extraction (Refer to a Dental Surgeon) if pulp chamber is not exposed the cavity can be filled (by Dental Surgeon). Temporaty measure given by an M.O. a) Prescribed analgesic Tablet b) Local anodyne - Paintex/cloves oil In case of exposed tooth if the tooth is tender on percussion give Antibiotics -- e.g. Amoxycillin in usual dose. 33

34 Cont. b) Periodontal Disease -- The gum is swollen, there may be abcess give Amoxycillin + Metronidazole Ref to DS for Scaling Recommend Tooth Brushing Trauma -- There is history of Trauma, the tooth may be factured or mobile --Give Analgesic Referred to Dental Surgeon 34

35 Gum bleeding Examine the nature of bleeding a) If the gum bleeds on provocation, the oral hygiene is poor --- recommend tooth brushing, prescribe antiseptic mouth wash and antibiotic like Amoxicillin + Metronidazole in usual dose. Referred to Dental Surgeon b) If the bleeding is spontaneous, the oral hygiene is usually good, there is generalised, the gum is usually not much inflammed --Suspect systemic disease do a routine haemogram and referred to a hematologist, if required. 35

36 c) Non-erruption of Teeth -Ask the patient age, each tooth erupts at a specific age. One can wait for six month from the specific date of eruption time. See the nutritional status of the patient, if you suspect malnutrition prescribe Calcium Tonic. It it does not erupt after six month advise one Intra-oral periodical x-ray of the involved tooth. If the tooth germ is present it will erupt, if it is not present then tell the patient that it will not erupt. 36

37 Ulcer present in Oral Cavity It may be a benign ulcer or a malignant ulcer a) If you suspect malignancy refere to an Oncology deptt. of any Medical College. b) In case of a benign ulcer i) The ulcer may be due to deficiency of Vitamin B-Complex or Iron --- prescribe Vitamin BComplex and Iron Tonic. ii) Traumatic Ulcer -- due to sharp tooth or denture appliances refer to a dental surgeon. iii) Habit of chewing tobacco, betal nut or leaf, PANPARAG, GUTKHA, may cause oral ulcer --advise -- stoppage of habits. 37

38 Cont. iv) Ulcer may be due to non-specific bacterial infection from bacteria of resident flora prescribe antibiotic like Amoxicillin in usual dose or ulcer may be cause by some specific bacteria like tuberculosis in that case it secondary to some primary focus of infection look for the primary focus and treat accordingly. v) Ulcer of Herpetic Infection -- It is of viral origin usually infents are affected by primary infection adult patient suffer from herps labialis, the intencity of which is less severe prescribe routine broad spectrum antibiotic like tetracycline Re-enforce oral hygine measure In some rare cases prescribe ACYCLOVIR ointment. vi) Fungal Infection There is formation of Pseudomembrane in Candidiasis prescribe commonly used topital antifungal ointments. vii) For pre-cancerous lesions Refere to a Dental Surgeon. 38

39 Cellulitis of Dental Origin Examine the oral cavity for the offending tooth which is tender, give semisynthetic Penicillins or cephalosporin + Metronidazole. Refere to a Dental Surgeon for extraction of the offending tooth. 39