Interview: “Around 50 per cent of children have cavities by 6 years of age” / I love it! A personal story by Dubai dental hygienist Raheleh Mahtabpour / Effective School Dental Health Program - step towards making “Little Oral Health Champions” #YearOfGiving
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DTMEA_No.2. Vol.7_HT.indd
www.dental-tribune.me
PUBLISHED IN DUBAI
March-April 2017 | No. 2, Vol. 7
Interview: “Around 50 per cent of children
have cavities by 6 years of age”
By Brendan Day, DTI
With recent studies showing that
more than four out of ten Australian
children aged 5–10 have caries affecting their primary dentition, it is clear
that good oral health habits need to
be practised from a very early age.
Given that oral disease can cause
potentially permanent damage, a
preventative approach is essential.
Dental Tribune Online spoke with
Prof. David Manton, Chairman of
the Australian Dental Association’s
Oral Health Committee, about the
importance of dental check-ups for
children and why recent legislative
changes in Australia may negatively
affect this.
Dental Tribune Online: Prof.
Manton, how many times
should children be visiting
the dentist each year?
Prof. David Manton: The regularity of visiting the dentist for children depends on their oral health.
To start with, a child should visit a
dentist within six months of the
eruption of the first tooth, so around
12 months of age. This is to allow
the dentist to examine the child’s
mouth and discuss with the parents
how to maintain their child’s oral
health. This would include issues
such as diet and oral hygiene. After
that, the time between visits usually
varies between six and 12 months,
although some children may visit
more frequently, such as a child at
high risk of dental caries.
What are some of the main
contributors to the poor oral
health of Australian children?
The main factor affecting oral heath
in children is dental caries. Around
50 per cent of children have cavities
by 6 years of age. The main causative factor is diet—primarily the
regular consumption of sugars in
the diet. These sugars can be obvious, like sugary sweets and lollies,
but can also be hidden in food and
drinks, such as soft drinks, dried and
processed fruits, soy drinks and flavoured milk. The sugars encourage
the overgrowth of decay-causing
bacteria in the plaque on the teeth,
and these produce acids that weaken
the teeth and lead to caries.
Brushing teeth with fluoridated
toothpaste decreases the amount
of decay that occurs and improves
gingival health, so a lack of brushing can lead to the opposite. Around
one sixth of children will have teeth
affected by developmental defects
that may lead to an increased risk
of decay, so early detection of these
defects can help prevent caries developing.
ÿPage C2
[2] =>
DTMEA_No.2. Vol.7_HT.indd
C2
HYGIENE TRIBUNE
Dental Tribune Middle East & Africa Edition | 2/2017
◊Page C1
The Child Dental Benefits
Schedule (CDBS), which enables eligible recipients to
access dental care for their
children, has recently been
lowered from a subsidy of
A$1,000 per child over two
years to A$700. Who will the
changes to the CDBS primarily affect?
These changes to the CDBS mean
that one in five children will not
be able to have all their treatment
needs met. For children with high
dental care needs, this will mean that
their parents will be out of pocket
in many cases and may lead to children not receiving the care they deserve. While the Australian Dental
Association was supportive of an
adjustment to the cap based on the
findings in the Report on the Third
Review of the Dental Benefits Act
2008, there seems to be no evidence
supporting a 30 per cent drop. It is
not clear what will happen to children who need treatment costing
more than A$700 over two years.
Processes need to be put in place to
ensure these children do not end up
being part of long dental waiting lists
in the public dental system.
How important is prevention
in seeking a lifetime of good
oral health?
The maintenance of oral health is
a vital part of overall health. Oral
diseases such as dental caries and
periodontal disease often have irreversible effects on the teeth and
gingivae. That is why early detection
of disease risk and prevention before
such damage occurs is so important.
Once a tooth develops caries, it will
be weaker, even after the caries is
treated. Deep lesions may lead to
problems with the dental pulp and
result in root canal therapy or extraction. Periodontal disease that is
allowed to progress will lead to the
destruction of the supporting bone
of the tooth and may eventually lead
to the loss of the tooth.
Preventative care includes the establishment of a healthy diet, regular
brushing of teeth with a fluoridated
toothpaste, flossing, application of
pit and fissure sealants, professional
cleaning of teeth if required, application of concentrated fluoride varnishes and scheduled dental examinations to detect disease early. This is
why establishment of a home orientated to dental health by 12 months
of age and development of healthy
eating and oral hygiene habits are so
important in children, as they lead
to healthy habits that can last a lifetime.
Researchers find link between oral bacteria,
cerebral microbleeds and stroke
By DTI
KYOTO, Japan: Cerebral microbleeds
(CMBs) have attracted attention as
an important predictive marker of
stroke in several studies. Research
further suggests that cnm-positive
Streptococcus mutans, a type of oral
bacteria associated with dental caries, is involved in the development
of CMBs. Seeking to clarify the connection, a team of Japanese researchers has now found evidence that
cnm-positive S. mutans is a novel
factor of cognitive impairment associated with CMBs and therefore may
be linked to disorders such as stroke
and dementia.
Aiming to understand the clinical significance of CMBs and the
mechanisms of their production,
researchers from Kyoto Prefectural
University of Medicine examined
279 patients (average age of 70)
for the presence or absence of the
collagen-binding surface Cnm protein expressed on cnm-positive S.
mutans in the saliva. In addition,
cognitive function, dental health
status and the prevalence of CMB
were assessed. Oral examination
included the number of remaining
teeth, presence or absence of dental
caries, and periodontal status of the
participants.
In the study group, 94 per cent tested positive for S. mutans and 33 per
cent for cnm-positive S. mutans, and
25 per cent showed collagen-binding
activity associated with S. mutans.
Magnetic resonance imaging of the
brain detected CMBs in 73 participants (26 per cent). As for the dental
examination, 31 per cent of the participants had dental caries and 28 per
cent scored a Code 3 or higher on the
Community Periodontal Index of
Treatment Needs. The mean number
of remaining teeth was 22.7 ± 7.5.
The analyses showed that cnm-positive S. mutans was detected more
often among participants with CMBs
than those without. Furthermore,
the percentage of dental caries patients was significantly higher in the
collagen-binding activity group, the
study found.
According to the researchers, the
findings suggest a molecular mechanism for the interaction between
chronic oral infections and geriatric
disorders, such as stroke and cognitive impairment. In order to clarify
the causality, an intervention study
focused on oral care and the microbiota in CMB subjects would be of
interest, they emphasised. As the
current data supports the important
influence of the oral microbiota on
neurological disease, they further
called for improved collaboration
between dental and medical researchers.
The study, titled “Oral cnm-positive
Streptococcus mutans expressing
collagen binding activity is a risk factor for cerebral microbleeds and cognitive impairment”, was published
online on 9 December in the Scientific Reports journal.
Interview: “Communities without fluoridated
water have a higher incidence of dental caries”
By DTI
CAIRNS, Australia: Once a mandatory measure, the fluoridation of local water supply in Queensland is no
longer compulsory due to legislative
measures put in place between 2012
and 2014. Due to pressure from antifluoridation campaigners, many local councils have chosen to abandon
the addition of fluoride to water,
despite its proven health benefits.
Professor John Abbott is the Director
of Clinical Dentistry at Cairns’ James
Cook University and he recently
spoke with Dental Tribune International about this on-going issue.
DTI: What prompted the
Queensland Government to
make the fluoridation of water supply non-compulsory?
Professor Abbott: On 5 December 2007, the Labor government’s
Premier, Anna Bligh, made it mandatory that all water supply in Queensland be fluoridated. However, in
November 2012 the Liberal Party
government reversed this decision.
The reversal seemed to stem from
consideration of the greater area that
is called regional Queensland. There
are many communities in Queensland, including far north Queensland, that never had fluoride in their
water supply and there was quite a
bit of unrest that water fluoridation
had been forced onto these communities.
What benefits does water
fluoridation present?
Fluoride in the water supply is considered by tertiary dental schools to
be a very good public health initiative. There is clear evidence that longterm exposure to an optimal level of
fluoride results in diminishing levels
of dental caries in both child and
adult populations. The level of fluoride in drinking water supplies is also
just 1-1.5 parts per million (ppm).
Which groups does
non-fluoridated water
affect most?
Simply put, communities without
fluoridated water have a higher incidence of dental caries.
Evidence has repeatedly shown that long-term exposure to optimally fluoridated water results in decreased levels of dental caries in
both children and adults. (Photograph: kruszyzna0/pixabay)
There has been some discussion centring on ‘alternative
solutions’ to compulsory water fluoridation. What type
of solutions would these be
and what limitations do they
have?
Alternatives to fluoridated water
include toothpaste and fluoride
added to bottled water. The best-case
scenario is the actual incorporation
of fluoride into developing teeth inutero, by the mother drinking fluoridated water. This enables fluoride to
be incorporated into the developing
teeth so that, on eruption, they are
strongly protected against acid attack and dental caries.
Bottled fluoridated water could be
used in schools, but would require
extensive management of the programme, which may be costly. Fluoridated toothpaste from the supermarket contains around 1000ppm
of fluoride, but most of this is washed
down the sink with vigorous rinsing
of the teeth after brushing.
Are there currently any incentives for councils to fluoridate
their water supply?
As far as I am aware, there are currently not any incentives for councils to do this.
Professor Abbott, thank you for
speaking with us.
[3] =>
DTMEA_No.2. Vol.7_HT.indd
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References:
BY DENTISTS
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[4] =>
DTMEA_No.2. Vol.7_HT.indd
C4
HYGIENE TRIBUNE
Dental Tribune Middle East & Africa Edition | 2/2017
I love it! A personal story by Dubai dental
hygienist Raheleh Mahtabpour
I have been a dental hygienist for
over 14 years. Originally from Iran, I
started working in a clinic specialising in implantology and periodontics. After a while, I moved to Dubai
to work at the Department of Health
and Prevention in the UAE. I was with
them for almost five years, gained
excellent experience and worked
with students. But I wanted a change,
so I moved to the largest dental clinic
in Dubai.
After six years of working in a private
clinic, I decided to take a short break,
so moved to Canada for a while and
experienced motherhood. I came
back to Dubai with a new addition to
the family.
Rahleh Mahtabpour (Photograph: Marc Chalupsky, DTI)
By Marc Chalupsky, DTI
I have always been very passionate
about dental hygiene education and
spreading oral health and hygiene
awareness in schools in Dubai. Not
only do I love the interaction with
my patients, but I also continue to
learn from them and with them every day. One topic has been of particu-
lar importance to me: individually
trained oral prophylaxis. A healthier and happier life can be achieved
through proper oral hygiene—if one
knows how to do it.
Madrid, Spain
29 August - 1 September 2017
I finished my degree in Iran 16 years
ago. Iranians are hungry for new
things related to dental hygiene and
dentistry. Programmes there range
from two to three years. After that,
dental hygienists need to spend at
least two years in the hospital before becoming a qualified professional. The schools in Iran ensure
that we gain a great deal of exposure
to patients. This might sound a bit
biased, but when I came to Dubai, I
saw myself as being a little bit more
prepared than the other hygienists I
met. Patient interaction and experience have always been very important.
Dental hygiene treatment in Iran is
not different than in the rest of the
world. We do the scaling, polishing,
whitening and charting. In fact, we
care about charting a great deal. We
usually work with periodontists and
our profession is truly appreciated.
Oral hygiene does not only affect
one’s teeth, it also influences a person’s overall physical and emotional
health. By imparting good oral hygiene habits, we help patients live
healthier and happier lives.
Today, I work at Dr. Michael’s Dental
Clinic in the heart of Dubai. I think
that the clinic is one of the most
beautiful private practices. We have
three clinics, one for orthodontics,
one for general dentistry and one for
paediatrics. Our clinic is surrounded
by gardens; we have a beautiful atmosphere in the clinic. All of our patients feel welcome immediately.
My daily morning fun
Daily work starts at 8 a.m. in the
morning. I take my daughter to kindergarten and then go to the clinic. I
start preparing my brushes and my
room. When the first patient comes
in, I immediately begin discussing
oral hygiene.
Bringing the World together
to improve oral health
THE BIGGEST INTERNATIONAL
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I love it!
I love the daily interaction with
my patients. I have learnt so much
from my patients and made many
new friends. At the same time, I do
www.world-dental-congress.org
2017_WDC-ad-A4.indd 1
The session starts with photographs.
I then do the overall check-up and
cancer screening, checking for anything abnormal and informing the
dentists if necessary. After that, I perform 15–20 minutes of ultrasound
scaling and follow with hand scaling
and polishing. Appointments usually last 1 hour. In fact, I might do the
probing and charting in a separate
appointment. The hygienist and
dentist work closely together, discussing cases and referring patients
to each other.
28/09/16 18:22
my best to teach them about oral
hygiene and how it can affect their
health. I enjoy seeing my patients
smile.
This is especially rewarding, as a
large number of patients in the UAE
do not know how to floss and brush
properly. Even worse, many patients
are referred from dentists who advised them to buy a medium toothbrush. I then show them the benefits
of a soft toothbrush and explain that
failure to use the correct brushing
technique leaves plaque around the
teeth, leading to caries and even gingival infection. One of my favourite
pieces of information continues to
be: “Yes, you can remove bacteria
and biofilm with a soft toothbrush.”
In Iran, many patients only go to
the clinic when they already have a
dental problem. In the UAE, there are
many patients with poor oral health.
Furthermore, there are many smokers, and judging from the oral health
of many patients, they certainly like
to eat sweets and drink sugary beverages. Patients usually come when it
is too late. This is even the case with
children.
That is why I usually see my patients
twice a year, because most insurance
covers those visits. Sometimes, I see
my patients again after two months
or two weeks. I then ask them to
bring their toothbrushes, which we
will check together.
I am still in love
About ten years ago, I started ordering many toothbrushes and interdental brushes from the Swiss brand
CURAPROX and introduced them to
my patients. One day, a representative approached me and told me
more about individually trained
oral prophylaxis (iTOP). I attended
the initial training programme—
and loved it! After attending four
more iTOP seminars in Prague in
the Czech Republic, I am still in love.
I feel every dentist and hygienist can
benefit from this. In the second iTOP
programme, I practised brushing,
but I continued to use a little bit too
much pressure. It was evident to me
that we as dental hygienists need to
continue to train. Through attending
the iTOP courses, I learnt the right
technique and now know that soft
toothbrushes are the best products
for proper cleaning.
ITOP teaches the following: interdental brushes first, then dental flossing.
Many of my patients do not like to
floss; they see bleeding and stop. Interdental brushing, however, is easier and more convenient. One has to
help one’s gingivae become clean. Almost all of my patients have gingival
bleeding—and most of them think it
is normal!
Today, I am a proudly certified iTOP
instructor and will continue to travel
to Prague to learn more for the benefit of my colleagues and patients. I
simply love being a dental hygienist and dental educator. Please let us
spread the word together.
[5] =>
DTMEA_No.2. Vol.7_HT.indd
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[6] =>
DTMEA_No.2. Vol.7_HT.indd
Dental Tribune Middle East & Africa Edition | 2/2017
C6
HYGIENE TRIBUNE
Effective School Dental Health Program, step
towards making “Little Oral Health Champions”
#YearOfGiving
By Dr. Aparna Sharma, UAE
diseases or injuries can suffer from
inadequate nutritional intake, impaired growth and development,
speech problems from missing
teeth, or poor self-esteem.
Introduction
Good dental health habits in our
children can give them a lifetime
of better health. Schools can play a
key role in preventing or identifying
children’s oral problems before they
become serious and helping families
obtain dental care services that are
accessible and affordable.
Planned Services to be offered in School-based Dental
Program
Little Smile Officers are in real
need…
Children with severe untreated
dental decay often are in pain, can’t
sleep at night, can’t concentrate and
get poor grades. Young children and
children with special needs often are
unable to communicate about their
oral problem or pain. Teachers may
notice a child having difficulty while
completing tasks by showing the effects of pain – anxiety, fatigue, irritability, depression and withdrawal
from normal activities. Children
who have a toothache when they
take tests are unlikely to score as well
as children who are not distracted
by pain. When children’s acute oral
health problems are treated and
they are not experiencing pain, their
learning and school attendance records improve.
Children and adolescents with special health care needs compared to
all other health care services, oral
health care is the most prevalent
unmet health care need. Unmet oral
health care needs affect about twice
as many children and adolescents
as unmet mental health care needs.
According to parents, children and
adolescents with special health care
needs without insurance and from
families with low incomes are more
likely not to receive the health care
services they need. More than half of
dental schools provide students with
less than 5 hours of classroom instruction, and less than 5 percent of
clinical time, related to children and
adolescents with special health care
needs. Hands-on educational experiences in dental school significantly
impact dentists’ perceptions of barriers to care for children and adolescents with special health care needs.
WHO Child Oral Health
Fact File:
Dental cavities
Worldwide, 60–90% of school chil-
Assimilating factors of productive “Oral Health Program”
dren and nearly 100% of adults have
dental cavities, often leading to pain
and discomfort.
Oro-dental trauma
Across the world, 16-40% of children
in the age range 6 to 12 years old are
affected by dental trauma due to
unsafe playgrounds, unsafe schools,
road accidents, or violence.
Noma
Noma is a gangrenous lesion that
affects young children living in extreme poverty primarily in Africa
and Asia. Lesions are severe gingival
disease followed by necrosis (premature death of cells in living tissue) of lips and chin. Many children
affected by noma suffer from other
infections such as measles and HIV.
Without any treatment, about 90%
of these children die.
Cleft lip and palate
Birth defects such as cleft lip and palate occur in about one per 500–700
of all births. This rate varies substantially across different ethnic groups
and geographical areas.
Impact of poor oral health on
physical, social and emotional health
Tooth decay is an infection caused by
bacteria that are transmitted via saliva. Without proper care, the infection progresses to become a cavity
and maybe an abscess, thus not just
affecting the tooth but the rest of the
mouth and even the rest of the body,
leaving the child prone to many other childhood infections such as ear or
sinus infections.1 Oral injuries often
occur during childhood and adolescence, and the teeth most frequently
affected are the highly visible front
teeth. Nearly 3% of children ages 6–8,
11% of children ages 9–11, 18% of adolescents ages 12–15, and 23% of adolescents ages 16–19 experience oral
injuries. Emergency room admission studies reveal that more than
50% of oral injuries are the result of
a fall. Trauma to the head and mouth
can occur during school-sponsored
physical activities, especially contact
sports, as well as on the playground
from accidents or fights. Studies
indicate that about 33% of all dental injuries and about 19% of head
and face injuries are sports related.
Loss of primary (baby) teeth from
injuries or severe dental decay can
result in permanent teeth that are
crooked, trapped under other teeth
or over-crowded, making them more
susceptible to decay and periodontal
(gum) disease. A single injury to a
tooth may not heal completely and
may create expensive, long-term
problems.
Children who have untreated oral
In school-based dental programs preventive care services can be offered
at the school. Programs may provide services in school clinics with
stationary equipment, in a room in
the school building using portable
equipment, or in mobile vans parked
at the school. Four common schoolbased dental service models include:
1. Dental screening programs:
Students in any grade level may be
seen. No treatment is provided at the
school; thus, students with dental
needs can be referred to a local dental clinic.
2. Dental sealant programs:
Dental screenings are done and sealants are placed on students in selected grades (typically 2nd and 6th
grade) to reach children at a time
when the first or second molars typically erupt.
3. Dental preventive services
program:
The provided services include
screening, prophy (cleaning), fluoride treatment, and sealants. This
type of program will generally serve
and benefit students in all grades.
4. Basic preventive and restorative
dental services program:
This type of program would include
the full range of preventive services
along with restorative services, such
as basic fillings and simple extractions. Students in all grades are offered services.
Follow-up and case management handling
There are many questions, being
asked by the school when will we
plan to conduct an Oral Health pro-
gram. Will the program be provided
by the program or will the school
be responsible for this? Who will address parent questions or concerns
after treatment has been provided?
All programs will encounter children who need restorative care. Case
manager’s duty should be helping
children and families find a dental
home, locate dental clinics that will
provide services to students. Also
for uninsured students, ensure that
appointments are made and kept,
and will make sure treatment plans
are completed. All programs need to
synchronize with dental offices so
students can quickly receive needed
care. Case management is important
to ensure the child receives necessary restorative care.
The program should have a plan for
following up on students with dental decay. It is important to have a
clear understanding regarding who
ultimately has the responsibility of
following up with students and/or
parents on needed dental care. In
addition, once the program has finished providing services at school,
there should be established protocol
for how parents’ questions or concerns will be addressed.
How often and for how long
will the program be at school
site– for instance, once a year,
once a week, or some other
arrangement?
For better impact the program
should be conducted at least once
every year. The program’s length
at the school can vary based upon
the number of students needed to
be seen. To ensure that all children
who sign up for the program receive
treatment, we must present paperwork to the school looking for words
such as “if time allows” or “as time
permits.” These words often indicate
that the program is scheduled to be
at the school for a set number of days
even if not all the children who are
signed up for care can be seen.
Children are the future pillars of our
nation. As a healthcare provider we
should always contribute for a betterment of society. With this positive
step we can improve awareness in
our children and give them a happy
and healthy smile.
5 stages of Adoption, as part of Effectual School Health Program
Participants wanted for trial testing to explore
painless caries treatment
By DTI
BIRMINGHAM, Ala., USA: The Uni-
local anesthesia or drilling, which is
conventionally unavoidable to access the cavity.
versity of Alabama at Birmingham
School of Dentistry has announced
that it will be offering patients with
interdental caries a new, less painful
treatment option as part of a new
clinical trial. The new treatment,
which entails infiltrating a preparation gel and then a liquid resin
through a perforated plastic sheet
between the teeth, allows dentists to
treat cavities without administering
The resin infiltration system is a
commercially available product
made in Germany and approved by
the Food and Drug Administration,
but is mostly being used only in clinical trials in the U.S. The university’s
clinical research center is conducting
the largest U.S. clinical trial of this
product, enrolling 150 patients in the
study.
“When we develop cavities between
teeth, sometimes we have to go
through the tooth, and we end up
damaging healthy tooth structure,”
said Dr. Augusto Robles, assistant
professor and director of the operative dentistry curriculum at the
university. “This new system allows
us to skip the drilling and helps us
preserve that structure.”
With the new procedure, the cavity
is first cleaned by pushing a gel that
prepares the surface to accept the
resin infiltrant through the perforated sheet. The tooth is then filled
by pushing a liquid resin through
the perforated sheet. Finally, a dental curing light is then applied to the
tooth to cure the resin.
Despite the apparent simplicity of
the procedure, the treatment works
only in between teeth or on smooth
surfaces with small cavities. Some
large lesions or those on the occlusal
surfaces are not suited for this kind
of system because the liquid resin
cannot be used to build up shapes.
Therefore, its application has to be
very specific, Robles highlighted.
Dentists with patients interested in
participating can advise their patients to make an appointment for
a free 20-minute radiographic and
screening assessment by email. Participation is free of charge.
[7] =>
DTMEA_No.2. Vol.7_HT.indd
International Magazines
ortho
international magazine
of orthodontics
www. dental-tribune.com
Vol. 1 • Issue 1/2016
issn 1868-3207
ortho
international magazine of
orthodontics
1
2016
EUR 22 per year (2 issues per year; incl. shipping and VAT for customers in Germany) and EUR 23
per year (2 issues per year; incl. shipping for customers outside Germany).
Your subscription will be renewed automatically every year until a written cancellation is sent to Dental
Tribune International GmbH, Holbeinstr. 29, 04229 Leipzig, Germany, six weeks prior to the renewal date.
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[8] =>
DTMEA_No.2. Vol.7_HT.indd
WHY JUST MASK SENSITIVITY?
SEE THE DIFFERENCE COLGATE
MAKES FOR PATIENTS
®
Repairs sensitive areas of the teeth and is 2X more effective.*1
MASKING LIMITS RELIEF
Potassium-based toothpastes mask pain by desensitising
the nerve, but leave dentin exposed
REPAIRING IS SUPERIOR WITH
COLGATE® SENSITIVE PRO-RELIEF™
• Unique Pro-Argin™ technology works upon
contact with saliva to build a calcium-rich layer
• Instant relief and 2X more effective*1
Most patients who use Colgate® Sensitive Pro-Relief™
are able to enjoy life sensitivity-free†
For more information, visit colgateprofessional.com/cspr
Reference: 1. Ayad F, Ayad N, Delgado E, et al. J Clin Dent. 2009;20(Spec Iss):115-122.
*vs potassium-based toothpaste. †Patient Experience Study, EU 2015, IPSOS.
)
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