Category: Dental Care

Health care workers are at the greatest risk — they can encounter diseases and infections daily and typically work in close proximity to one another and their patients. Many are already under quarantine because of exposure to the virus. Need of the hour is to prevent certain viral infections.

The ADA recommends following standard precautions with all patients, at all times. While treating patients keep following points into mind. These are:

ISOLATION & IDENTIFICATION

As Dental health care personnel is commonly exposed to oral cavity , he/she should be alert. Identify patients with an acute respiratory illness. Take proper medical history. Ask every patient about their travel history or being in contact with such person having a travel history. Patient’s body temperature should be checked using a non-contact forehead thermometer or with cameras having infrared thermal sensors . Patients who present with fever (>100.4°F = 38°C) and/or respiratory disease symptoms, should have elective dental care deferred for at least 2-3 weeks.

Dental professionals, including endodontists, may encounter patients with suspected or confirmed SARS-CoV-2 infection. They will have to be careful while providing & at the same time prevent nosocomial spread of infection. There is a potential for transmission of COVID-19 via aerosol, fomites or fecal-oral route that may contribute to nosocomial spread in the dental office setting

INFECTION CONTROL MEASURES

To help prevent the transmission of all respiratory infections proper infection control measures should be taken such as: Perform hand hygiene. Wash your hands often with soap and water for at least 20 seconds. 60% alcohol based senitizers should be used Offering face masks to patients who are coughing. Isolate them in a single-patient room with the door kept closed to limit their contact with other patients and personnel. These patients should wear masks outside their rooms. Offices also should follow routine cleaning and disinfection strategies used during flu season.

SELF PROTECTION

Dental personnel assessing a patient in case of emergency with a flu- like or other respiratory illness should wear a disposable surgical face mask, nonsterile gloves, head cap, gown and eye wear to prevent exposure which should be worn once and discarded. The CDC recommends all health care workers, including dentists and staff, receive the flu vaccine, and personnel experiencing a flu-like illness should not report to work. To avail more information regarding COVID-19 , ADA suggests checking for updates on the CDC’s coronavirus infection control page for health care professionals. Dental personnel who are concerned about the supply of personal protective equipment to monitor the CDC’s health care supply of personal protective equipment webpage for updated guidance.

POSTPONE ELECTIVE DENTAL PROCEDURES

According to The CDC’s Guidelines for Infection Control in Dental Health-Care Settings—2003 , dental personnel may consider postponing nonemergency or elective dental procedures until a patient is no longer contagious with diseases that can be transmitted through airborne, droplet or contact transmission. In case of emergency, both dental personnel and medical health care providers should work together to determine the appropriate .

PHARMACOLOGIC MANAGEMENT

In suspected or confirmed cases of COVID-19 infections, patients requiring emergency dental care such as tooth pain and/or swelling, antibiotics and/or analgesics should be given as an alternative for symptomatic relief This will provide dental professionals some time to develop a plan to deliver dental care with all appropriate measures in place to prevent the spread of infection.

On March 17, 2020, the British Medical Journal recommended the use of acetaminophen for analgesia and not ibuprofen in treating COVID-19 infected patients, as ibuprofen may interfere with immune function . This recommendation was endorsed by the World Health Organization (WHO) on March 18, 2020.

In certain cases such as dentoalveolar trauma or any fascial space infection requiring emergency dental intervention, dentists should be aware of the following recommendations: Dentists should follow standard, contact, and airborne precautions including the appropriate use of personal protective equipment (PPE) and hand hygiene practices 23.

Dentists should use a rubber dam to minimize splatter generation (of course, for non-surgical endodontic treatment). It may be advantageous to place the rubber dam so that it covers the nose. The actual procedure should minimize generation of aerosol. For example, ultrasonic instruments may impose a greater risk of generating contaminated aerosols. In addition, dentists should reduce the use of high-speed handpieces and three-way syringes.

Negative pressure treatment room/Airborne infection isolation rooms (AIIRs): It is worth noting that patients with suspected or confirmed COVID-19 infection should not be treated in a routine dental practice setting. Instead, this subset of patients should only be treated in negative pressure rooms or AIIRs. Therefore, anticipatory knowledge of health care centers with provision for AIIRs would help dentists to provide emergent dental care if the need arises (23).

Human coronavirus can survive on inanimate surfaces up to 9 days at room temperature, with a greater preference for humid conditions (27). Therefore, clinic staff should make sure to disinfect inanimate surfaces using chemicals recently approved for COVID-19 and maintain a dry environment to curb the spread of SARS-CoV-2 (28).

REFERENCES

1. Mary Beth Versaci. ADA releases coronavirus handout for dentists based on CDC guidelines : (24 Feb 2020) ADA News
2. Michael Day Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists 2020 BMJ page. 1
3. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 2020 Feb 19. pii;3099(20)30120-1. Available from: http://dx.doi.org/10.1016/S1473-3099(20)30120-1
4. Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol 2020 Mar 5. doi: 10.1002/jmv.25748. http://dx.doi.org/10.1016/S1473-3099(20)30120-1
5. Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC [Internet]. [cited 2020 Mar 9]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html
6. Eggers M, Koburger-Janssen T, Eickmann M, Zorn J. In Vitro Bactericidal and Virucidal Efficacy of Povidone-Iodine Gargle/Mouthwash Against
7. Respiratory and Oral Tract Pathogens. Infect Dis Ther 2018;7:249–59.
8. Kariwa H, Fujii N, Takashima I. Inactivation of SARS coronavirus by means of povidone-iodine, physical conditions, and chemical reagents. Jpn J Vet Res 2004;52:105-12.
9. Hokett SD, Honey JR, Ruiz F, Baisden MK, Hoen MM. Assessing the effectiveness of direct digital radiography barrier sheaths and finger cots. J Am Dent Assoc 2000;131:463-7.
10. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents. J Hosp Infect 2020;104:246–51.
11. UNITED STATES ENVIRONMENTAL PROTECTION AGENCY WASHINGTON, D.C. 20460 OFFICE OF CHEMICAL SAFETY AND POLLUTION PREVENTION List N: EPA’s Registered Antimicrobial Products for Use Against Novel Coronavirus SARS-CoV-2, the Cause of COVID-19.
12. ADA Calls Upon Dentists to Postpone Elective Procedures. Available at: https://www.ada.org/en/press-room/news-releases/2020-archives/march/ada-calls-upon-dentists-to-postpone-elective-procedures. Accessed March 16, 2020, n.d.

A profession is defined as “a vocation with a body of knowledge and skills put into service for the good of others; the welfare of society” (Van Mook et al., 2009). Medicine and dentistry are recognized by the public as the archetype of professionalism (Bloom, 2002). Professionalism is demonstrated through three key foundational elements: clinical competence, communication skills, and ethical/legal understanding. Building upon these foundations, a professional applies the principles of professionalism: excellence, humanism, accountability, and altruism. A professional aspires to demonstrate these principles in their behaviours and wisely resolves situations in which these values may be in conflict (Arnold &Stern, 2006).

The dental professional strives for excellence and is committed to competence in knowledge and technical skills, communication and ethics. Dental professionals should not be satisfied in providing the minimum standard of care and should place a conscientious effort towards providing care that goes beyond ordinary standards (Arnold & Stern, 2006). Inherent in the principle of excellence is a commitment to lifelong learning and improvement. In an Interview with Dr. Woo (MBBS), he emphasized the importance of continued learning as patients would expect their health care provider to be up to date, providing treatment based on the best available information. He mentioned that excellence in medicine is also expressed through effective collaboration with other health professionals to help improve the quality and delivery of health care. Promotion of scientific knowledge and maintaining the integrity of that knowledge are also professional obligations (Arnold & Stern, 2006). Dr. Woo stated that good practice involves public health advocacy to improve health outcomes of patients and communities, especially those that face significant health disparities.

Humanism emphasizes the sincere concern and value of human beings and it is a core principle that guides the dentist-patient interaction. Humanism encompasses values such as compassion, empathy, respect, and honor and integrity (Arnold & Stern, 2006). Respect is a personal commitment to honor the choices and rights of others regarding themselves and their medical care (ABIM, 1989). Having respect for cultural and societal differences includes a sensitivity towards a person’s age, culture, gender, and disabilities (Beach et al., 2007). A genuine effort should be placed in adapting one’s practice to improve engagements with patients from a variety of backgrounds (Dental Board of Australia). Dentist are obligated to respect patient privacy and confidentiality and provide informed consent. Empathy is the ability to understand the patient’s perspective and feelings (Arnold & Stern, 2006). Empathy is a key factor in the dentist-patient relationship and is positively associated with negotiated treatment plans, treatment adherence, patient satisfaction and reduced dental anxiety (Jones & Huggins, 2014). Communication skills are important in conveying empathy towards the patient. It may often involve the observation and use of non-verbal cues and body language (Arnold & Stern, 2006). Empathy and compassion drive the professional to act in beneficence. However, it is advised to refrain from getting too emotionally involved in order to preserve one’s objectivity and professional responsibility (Arnold & Stern, 2006).

Accountability refers to reliability, talking responsibility for one’s actions, and a responsibility to answer to those who place trust in the dental professional (Levinson, 2014). Accountability is demonstrated by taking responsibility for one’s mistakes, full disclosure, correcting errors and apologizing to parties involved. Medical professionals are accountable for quality of care, upholding principles, and reporting conflicts of interest (Arnold & Stern, 2006). Conflicts of interests do occur in medicine such as financial arrangements with pharmaceutical companies. While such conflicts are difficult to avoid completely, professional organizations recommend disclosure and management of such arrangements to make sure that patient and peer perceptions are not negatively influenced (Arnold & Stern, 2006). Accountability also involves the protection of confidential information that patients share in trust and is stated in the code of law. However, unintentional breaches of patient confidentiality do occur such as discussing patient information in a crowded area (Levinson, 2014). Dr. Woo stated that professionalism involves abiding by a certain code of ethics in patient care and being someone that patients can trust with their health and confidential information. It is unprofessional to risk a potential breach of confidentiality and it undermines the trust patients have in their health care providers. Dr. Woo emphasized that a professional is a representative of the profession. In relation to his statement, accountability and professional behaviour also extend into online and social media presence as well as personal appearance. Due to the public and potentially permanent nature of the internet, digital unprofessionalism may be significantly damaging to confidentiality, and the patients’ perception of the professional and the profession (Levinson, 2014). Medical associations provide guidelines in forming professional relationships and boundaries with patients. For example, friendships with patients are generally considered as undesirable in order to ensure that the patient’s medical needs remain a priority. However, it is argued that context does matter such as in cases where the individual is the only practicing dentist in a rural town and inevitably forms some friendships with patients (Levinson, 2014).

Altruism incorporates many professional principles including a commitment to providing the best care, selfless behaviour, and avoiding self interest. Altruism is defined as the duty of the medical professional to place patient welfare ahead of one’s own and recommending what is in the best interest of the patient (Arnold & Stern, 2006). Altruism is exercised by providing the best and most appropriate treatment for patients, avoiding highly profitable treatments if they are unjustified, avoiding overtreatment, and abiding to ethical and legal financial/business practices (Dental Board of Australia). Dr. Woo affirms the privileged relationship health care professionals have with their patients. “Doctors are privileged in their ability to have tangible effects on peoples’ health and lives. Patients have the right to expect that their best interests come first”.

Professional dental organizations exist to provide policies and guidelines and help dentists meet their professional obligations. The Australian Dental Association provides support to its members through enhancing their ability to provide high-quality oral health care, public health advocacy and promotion of ethics (ADA). The ADA also holds conferences that discuss the latest knowledge, develop collegial relationships, and refine professional identity. The Dental Board of Australia provides policies and guidelines on a range of issues. Resources are provided in continuing professional development which is required by dental professionals to further their knowledge and professional qualities (Dental Board of Australia). Dr. Woo further develops his skills and professional identity by attending events and tutorials in oral and maxillofacial surgery as well as CPD events such as surgical skills and trauma courses.

Dental professionalism is signified through clinical skills and knowledge, communication skills and ethics that lay the foundation of public trust in the profession. Upon these foundations, the dental professional strives for excellence, humanism, accountability, and altruism. Guidelines for medical professionalism seem to be in continuous discussion and evolution, especially in response to contemporary socio-economic issues and the rise of technology and digital media.

Dentistry is going Green?

There are a number of eco-friendly disruptions brought on by socially minded groups that are happening in dentistry that are highlighting my dental practice’s competitive vulnerabilities, while at the same time representing opportunities to turn those vulnerabilities into sustainable competitive advantages for many years to come. As of late, there has been a tremendous debate in dentistry in the area of sustainability. This debate has brought together dental professionals from all aspects of the industry, including academia and clinical practice, along with members of public health, regulatory, and government sectors to propagate to the dental world the importance of sustainability. Our dental regulatory college, the Royal College of Dental Surgeons of Ontario, is considering regulatory changes to encourage the adoption of sustainable practices and a push towards development of technology to facilitate these changes. This disruption is also exacerbated by the fact that a younger generation of dentists and millennials are concerned about the environment and global warming, and want to actively pursue more sustainable practices.

Why Green Dentistry?

Dentistry is a very competitive industry and the latest buzz word used by many dentists to promote their clinics and differentiate themselves from other clinics is “Green Dentistry”. Green dentistry helps dentists identify gaps which need to be addressed in the area of sustainability, in order to promote and help dentists make impactful changes. Most of these concepts are foreign to the older generation of dentists. The introduction of green dentistry has also brought on debates of sunk costs involved to move towards this type of practice and perceived ongoing financial burdens. Proponents of green dentistry argue that sustainable practice conserves money and time by reducing waste, conserving energy, and decreasing pollution.

In healthcare, dentists usually have the tendency to not adopt new technologies or concepts as quickly as other healthcare professionals. This is usually due to the fact that small changes in dentistry can cost a great deal, and given that our fixed and variable expenses are already higher compared to many of the other healthcare professions, change comes about slowly. This, coupled with the fact that climate change, until recently, was never mentioned in dentistry, makes this a foreign concept to many dentists. Green dentistry aims to teach the dental industry how dentists can take better care of the planet while at the same time running a successful business. The main priority for dentists has always been their patients and being green has not been at the forefront of many dentists’ minds. This is because dentists are usually so busy running from one room to another putting quality first, while at the same time paying close attention to the strict sterilization and safety guidelines that we have to adhere to, which were further tightened by new Public Health policies last year. Figuring out how to deal with these regulations in a sustainable way is a big challenge for dentists.

Green dentistry is forcing dentists to take responsibility for meeting the demands of society to reduce their impact on the environment. I believe that the only way for mass adoption of sustainability in dentistry is for dental bodies to develop guidelines and a framework for dentists to implement these concepts on an ongoing basis. If dentists turn a blind eye to the impact that their clinics have on the environment, then we will never identify opportunities to intervene. Sustainability needs to be engraved in every dentist’s mind and should be incorporated in dental school curriculums. National authorities and scholars should encourage research on the environmental impact of dental practices, and integrate the concept of sustainability into their continuing dental education programs. Such sustainable frameworks, specific to dentistry, are not yet available to provide leadership in converting the concept of green dentistry into a daily routine.

Green Dentistry and the Dental Team

I also believe that dentists should take time out of their busy schedules to educate their teams on concepts of green dentistry, in the form of office meetings and training sessions. These meetings should stress to the staff that whenever possible, the goal should be to reduce the consumption of energy, water, any materials which could be harmful to the environment. The reason why I stated “whenever possible” is because we should not forget that as healthcare professionals our ethical and moral standards should always be to the patient, and those lines should never be blurred.

Green Dentistry and Stakeholders

In addition to the oral health team, sustainability in dentistry involves many stakeholders who all have a role to play, including the government, educators, manufacturers, suppliers, dental equipment technicians, and waste removal companies. Green dentistry means rethinking dentistry, starting from processes, administration, all way to the design of our offices. This re-thinking sometimes has to start from the dental supply manufacturers since they are few in number and operate nationally. Such engagement is important as without manufacturers and suppliers seeking to reduce their carbon emissions, it makes mass adoption difficult. Dental product companies should be pressured to offer more sustainable, environmentally friendly, and socially responsible products, which will indirectly lead to dentists having no choice but to use these products, thus reducing the environmental impact.

Barriers to Adopting Green Dentistry

There is limited priority given to sustainability in dentistry due to lack of awareness, few drivers to influence change, and the various perceived barriers. Dentists need to realize that in sustainable businesses, long-term profitability takes precedence over short-term gains. Hence, dentists need to develop office policies and manuals with these concepts in mind. For a lot of practices, these manuals and policies have not been updated since the dentist started practicing, which means that any change will seem like a major change and barrier to their daily routine. These attitudinal issues stem as a barrier from the dentist towards going green since there is little motivation to do so. Barriers to the shift to green dentistry also include perceptions that being sustainable increases costs. Dentistry in Canada is already perceived as expensive to most patients. A lot of dentists feel like these costs will lead to increased expenses and ultimately increased costs to the patients, which can lead to them losing patients. However, in reality, adopting a green mentality for the office lowers expenses, leading to increased profits. As green technologies mature and become more readily accessible, costs for going green will ultimately decrease. I believe that going green will eventually be the only financially advantageous option in the highly saturated dental market.

As mentioned above, redevelopment of a mindset to incorporate green policies requires a shift in thinking that our responsibility as healthcare professionals to our patients is matched by our responsibilities as citizens to the world that we live in. Since there is a lack of appropriate guidance by our regulatory bodies towards sustainable dentistry, dentists have to take their own initiatives and ownership. This means that it is a matter of choice for dentists to choose green products and practices, and to realize that change is not always easy, but that even one practice can make a difference. The impact can be made greater as more dentists join the green dentistry movement and help make the world a cleaner place.

Dental Practice Waste

Four main processes are responsible for most dental practice waste:

• Sterilization and cleaning methods (disposable barriers and toxic chemicals).
• Conventional x-rays create toxic chemicals and waste. Even though digital x-rays have been around for a few years, older generation dentists don’t see the “benefits” since it comes with a higher price tag compared to conventional x-rays.
• Conventional suction systems use a tremendous amount of water. Dry suction systems use no water but usually cost more than double the conventional systems.
• Major mercury release to the environment comes from use of amalgam in dental restorations. For the older generation dentists, amalgam restorations were the only direct restoration material they were thought to use.

Green Dentistry and Marketing Benefits

A green dentistry approach can help reduce waste and save water, energy, and time. As these benefits become more publicized, more dental practices will ultimately have no choice but to move towards a sustainable approach to cater towards consumers who care about the planet. Sustainability is a priority for modern patients, particularly the millennials. This means that a green dental practice is a marketable dental practice which can actually be good for your bottom line. These types of patients tend to be loyal to the practice and the great cause, and are likely to share their positive experiences with other patients, increasing word-of-mouth referrals. Hence, green dental policies will eventually lead to a booming practice that is not easy to replicate, giving the dentist a sustainable competitive advantage.

Green Dentistry and the Role of Technology

Almost every high-technology innovation in dentistry seems to also have environmental benefits, thus amplifying the opportunities in this disruption by using high-tech innovations to differentiate a practice from the rest. These new technologies can be profitable and boost the financial success of a dental practice. For example, an important innovation in dentistry was the introduction of computer-aided technology/computer-aided manufacturing (CAD/CAM) technology. Over the years, improvements in digital impressions have made it more practical for day-to-day use. CAD/CAM technology is very convenient as it helps in completion of restorations that would normally take a two week span in a single appointment, lowering carbon emissions because of reduced patient travel to the office. CAD/CAM systems also eliminate the need for disposable impression materials, packaging, storage, and shipping of these impressions back and forth between the dental lab and the office, while significantly increasing accuracy and productivity. In addition to CAD/CAM technology, the following high-tech innovations are also part of green dentistry that should be adopted by all dentists:

• Digital X-rays.
• Steam sterilizers that eliminate use of toxic chemicals.
• Digital patient charts, reducing paper waste.
• Digital marketing, reducing paper flyers and the shipping carbon emissions.

Internal Hurdles to High-Tech Green Dentistry

A barrier to this technology and an internal hurdle that I face when wanting to implement this technology in my offices is cost. New technologies in dentistry are typically expensive and there has to be a financial justification for upgrading a procedure or machine that in my teams’ staff eyes is already working well. Staff are also not fund of the learning curve that a new technology needs in order to be adopted efficiently. For example, a typical CAD/CAM machine (called a CEREC machine) for a single practice has a price tag of $150,000, meaning that the patients in that clinic must not only have a high dental IQ, they must also have a green mindset to not mind paying a little more for something that is better for the environment and saves them time. To stay ahead of the competition, I purchased a CEREC for one of my clinics two years ago and the productivity improvements and patient “wow” factor has been outstanding, not to mention the environmental benefits. However, I have also had to deal with the mindset by my staff that if the office can afford a new machine for $150,000, then the office can afford to increase their salaries. They also had to go through two weeks of training which meant breaking the routines that they were used to. These internal hurdles mean that until technologies like this become more mainstream and mass adoption does not happen, the “don’t fix it if it isn’t broke” mentality in dentistry seems to be prevailing. For me to get over this hurdle, I have had to invest time, money, and resources to educate my staff in the benefits of the technology, not only for them but also for their patients and the planet.

Conclusion

As a practicing dentist, my leadership for my clinics has always been geared towards optimal and quality dental care for our patients. Yet unbeknownst to myself, and most dentists, our practices contribute significantly to global pollution and warming. So now, as a healthcare professional, I believe it is our duty to do something by our own will, not because we are forced to, to make the world a better place for the next generations to come. Building a green dental office is not just an investment in a clean future , it is also an excellent, ethical, business decision.

The aging population has significantly escalated in Australia thus increasing the number of senior citizens in the residential facilities. According to Hibbert et al., (2019, p.01) most of these elderlies have dementia therefore, most of the residence are faced with challenges associated with this degenerative disease. One of the problems includes maintaining good oral health. This report will discuss three problems of providing dental health in RACFs in Australia such as obstacles related to finance, barriers related to availability and barriers associated training and awareness. It will then analyze solutions and recommendations to improve the dental health.

The main reason for lack of oral health care is due to the cost associated with the treatment and the care. Most people who live in residential facilities are retired senior citizens. They are left with few funds to support themselves after paying for their stay in these facilities to make dental care a priority (Hearn & Slack- Smith, 2015, p. 447). They would rather save the little they have for other medical emergencies and challenges that may occur in the future. In addition, their private insurance hardly covers the oral health care and most of the residence believed that they are old and dental care is not a necessity (Villarosa et a., 2018, p.180) Some of their family members also agreed with them and mentioned that dental diseases were expected with old age and it was not a matter of urgency ((Lewis, Wallace, Deutch, & King, 2015, p.97). Villarosa et al., (2018, p. 182) suggested some solutions to ease this problem of finance residents with free dental care. It is recommended to include the residence’s family members in training and awareness so that they can make dental care a matter of importance and therefore be able to provide funds for their elderly relatives. These elderlies will not have to depend on their pension for treatment and care. Furthermore, Wright, Law, Chu, Cullen & Le Couteur (2017, p.424) mentioned a solution whereby residents who were not qualified for public oral care were assessed by a specialist through an agreement that was made between the resident or family members onsite.

The second reason for insufficient dental health care is because of unavailable resources and shortage of medical staff. Because of shortage of caregivers, priority is given to other task that are regarded as pleasant such as bathing and providing meals rather than daily oral care and they is an excessive demand of those other task for few caregivers (Hearn& Slack-Smith,2014, p.152). One care giver added that “… a big issue that I find is when residents have their own teeth, they are sometimes very hard to perform the oral health on” (Hoang, Barnett, Maine& Crocombe, 2018, p.274). Therefore, this continuously put a strain on the limited staff. In addition, some residential facilities do not have dentist onsite so they have to transport the elderly which results in the limited attendance of residences for their yearly checkups for those with this degenerative disease (dementia). It is difficult for them to cooperate and some caregivers are reluctant to keep persisting because they are in short supply and some of them do not have knowledge on how to handle those situations. According to Lewis et al., (2015, p.98) it would be advisable to implement dental equipment that is portable to the residential sites to avoid the need to move residence from one destination to the other. This could improve the number of residences that are assessed regularly and increase the chances of better dental care. Any emergency situations that mat arise are easily identified before they cause damage which will later lead to other diseases such as cardiovascular.

The last reason for absence of dental care in residential facilities is lack of knowledge and negative perception towards the care. Dentist are in high demand so they would rather go to other amenities where there are more opportunities for them than in residential facilities (Hearn &Slack-Smith, 2014, p.151). This resulted in having less experienced care givers who were willing to attend to the elderly and most of them supported the need for training. According to Villarosa et al., (2018, p.181) there is need for further formal training for them to be able to provide adequate oral care. Another care giver also supported the need for training by saying that “I started there in 2010 as a carer I can vaguely remember people coming back and giving education around the mouth.” (Hoang et al., 2018, p.273). In addition, dental care in the past was always regarded as the dentist main priority (Lewis et al., 2015, p.97). Care givers however were reluctant to share the responsibilities with them to work as a team thus having less focus on residences dental daily care. According to Lewis et al., (2015, p.99) it is therefore recommended that dental students take their placements in residential facilities so that they get acquitted with the elderly on daily bases. This is a way for these students to acquire more knowledge and gain experience in the field especially with residents who have dementia. Hearn and Slack-Smith (2015, p.450) also believed that the exposure will alter their insights and approaches and they will also be able to provide dental care materials for education purposes to the residents.

In summary, this report has discussed the setbacks that are being experienced in RACFs regarding dental care. The costs of getting oral care were mentioned as a huge problem as it discourages the less privileged residents to get the care. There is also lack of necessary resources and transportation to professionals which contributes to the problems. It also discussed possible solutions of having free dental health programs to help, as well as providing adequate training and providing on site care to avoid the need to travel for care.

In an era where technological advancements in medicine are rapidly growing, one may think that more people are receiving better healthcare. However, this is not the case since access to adequate healthcare is limited for many, especially the older generation. This is seen particularly in dental care, where a large portion of the elder population is still affected by dental problems due to limited access to preventive dental care. Approximately one in four seniors aged 65 and over have not visited a dentist in the past 5 years, according to the National Institute of Dental and Craniofacial Research. As a result, approximately 70% of elders aged sixty-five and older have developed periodontitis, or gum disease. In another ten years, approximately a quarter of the population will be older adults who are sixty five or older due to decreasing mortality rates as seen in the demographic transition. Therefore, this is a problem that needs to be addressed immediately since oral health has a direct correlation to one’s overall physical health, and our goal is to provide the best quality of life possible for older adults.

Gum disease increases the risk of developing certain chronic diseases, and it can also worsen the symptoms of preexisting chronic diseases. Gum disease is linked to diabetes, a significant chronic disease among elders, since it is harder to maintain healthy blood sugar levels with infected/damaged gums. Likewise, older people with gum disease eat foods that are easier to chew, but these foods have high saturated fats and cholesterol levels, which leads to obesity and risk of developing heart disease. Additionally, gum disease has been found to worsen brain function in those affected by Alzhimer’s, the leading chronic disease found amongst elders. Elders affected by periodontitis also have a higher risk of developing dementia.

Greater access to dental care for elders will result in fewer cases of periodontitis among elders, and this will improve many aspects of life. This will have major economic benefits since good oral health can prevent/ reduce the medical costs associated with chronic diseases such as Alzhimer’s, diabetes, and heart disease. Also, as the younger generation, we have a responsibility to promote active aging and enhance the quality of life for the older generation. We are currently failing in this responsibility by not providing adequate dental care and allowing elders to easily develop periodontitis. Likewise, we are trying to compress morbidity, and this will become easier if we can prevent gum disease from developing in the first place through regular dental checkups. Even though gum disease itself is not deadly, as I mentioned before, it increases the risk of developing/worsening deadly chronic diseases that are prevalent among the older population such as diabetes, heart disease, and Alzhimer’s.

As of now, there are no health insurance programs or policies that address this issue. Only one third of those who qualify for Medicare have dental coverage. The other 60% of medicare recipients do not have dental coverage. This is an issue because approximately 50% of medicare recipients have at least three chronic diseases, which can become worse due to poor oral hygiene. Yet, Medicare Part B doesn’t cover dental benefits such as dental care, procedures, or dental devices that are necessary to maintain good oral hygiene and prevent oral diseases from developing due to a statutory exclusion in the Social Security Act. Medicare Part A only covers certain inpatient dental services. This includes emergency dental services, dental treatments needed for a patient preparing to undergo radiation treatment as a result of jaw related diseases, and dental checkups needed before kidney transplant or heart valve replacement. Some advantage plans offered under Medicare Part C offer dental coverage, but the benefits range based on the plan and you have to live in the plan’s service area to qualify.

Providing Dental benefits are optional for state Medicaid programs, but many states do provide dental benefits. Right now, 37 states offer dental benefits, but this varies each year depending on the amount of funding received. Also, many states place limits on how many times certain dental services will be covered in a year. Furthermore, only 38% of dentists accept Medicaid so access to dental care is still limited for Medicaid recipients even though many state Medicaid programs provide dental benefits.

Under the Affordable Care Act, insurers are not required to offer adult dental coverage but dental care is included in some marketplace health plans.. However, the dental expenses are only covered after you meet your deductible, and deductibles can range from approximately 6,000 – 12,000 dollars. You can also get dental care through stand alone plans, but you have to pay additional premium.

Nigeria is struggling with many health, infrastructural, economic and political challenges. But the most challenging of these issues is that “major issues seem to be treated as minor issues and minor issues seem to be treated as major issues”. As nationals and dental professionals that should uphold health we are asked to answer the varying questions that hold back on our oral health and oral hygiene. Not many people bother about oral health in Nigeria and not many seem to care either, we basically lack adequate blog posts and media sensitization about the oral health of the citizenry and its varying debilitating diseases.

Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases (World Health Organization). Hygiene is the science of health, it’s promotion and preservation.Oral hygiene are the activities carried out by an individual to make the oral environment free of dental diseases. Oral hygiene can also be said to be the practices that result in the oral cavity smelling and looking healthy.

Struggles of Nigerians Towards Their Oral Hygiene

The pressing issue for us therefore as Nigerians are to find or discover our problems and struggles whilst proposing sustainable and dependable solutions to the struggles.

1. CODEH (Committee On Dental Education & Health). Nigeria, as a nation is still growing in its oral health awareness and exposure of its nationals to this sensitive area of medicine and health and as such many community dental outreaches have been held during various dental health weeks and yearly during the World Oral Health Day (WOHD). These outreaches being held are most often than not done within and around “urban communities and its environs”, rarely are these outreaches done for the rural community dwellers whom I suppose are the least educated concerning their oral hygiene, its benefits and consequences when not properly carried out. As much as this outreaches help society and the Nigerian state, they are capital intensive.
2. Funding. Nigerians are yet to really appreciate the value of six-monthly visit to the dentist as part of lasting and preventive solutions to their dental health hygiene and disease at large, mostly because of the cost and impoverished nature of some nationals. An interview to some Abuja residents on the last WOHD (World Oral health day) 2018. Say Ahh’ showed this in large numbers, most nationals are concerned and educated about their oral health but since the visit to the dentist is expensive especially at private practice level and the public practice, though affordable and accessible are usually overcrowded and as such perceived low patient care and attention to detail becomes a challenge and struggle to the citizenry.
3. Trado-medical curation. At most bus stops or junctions in Nigeria today we have traditional medicine peddlers, offices, centres and buyers claiming all sorts of cure to dental health challenges and selling some non-fluoridated toothpaste and tooth powders at highly affordable something cheaper prices. These trado-medical healers which I may say would be of use in future if regulated properly like in the case of China today, in the Nigerian state currently are causing more harm than good to Nationals and oral hygiene at large.
4. Availability of dental clinics in rural areas. The inaccessibility of dental doctors and dental practice has hampered on the free flow of dental awareness, oral hygiene education and propagation of health on Nigerians. Its accessibility to locals and affordability are one of the major strains and struggles of nationals.
5. Dental education. The number of dental educators and professionals in our nation today also plays a role in the dental hygiene of nationals, people are talking about health on other levels but we tend to forget the ‘window to the body’, where most medical diagnosis can be done on examination. The number of dental doctors goes a long way to buttressing the challenges oral hygiene and it’s education face in Nigeria. Illiteracy and misinformation about the role of dental professionals and importance are major problems facing Nigeria and the Nigerian with poor oral hygiene.

The above mentioned struggles are to mention but a few challenges oral hygiene faces in Nigeria as civilized nation in 21st century.

Sustainable Solutions to the Nigerian Struggle

1. CODEH. The outreaches I propose should be taken not only to the Urban communities as it were but to the rural communities where little or nothing has been taught to the rural dwellers both on formal and informal levels in the current society. And these outreaches should continue and become a routine for ages to come for sustenance of oral health awareness in Nigeria.
2. Government Policies. Enactment of policies by the Nigerian state and full implementation of such policies that encourage oral/dental care there by affecting the oral hygiene of the citizenry.
3. Funding. Being that dental health, education and service are capital intensive. Public and private partnership projects and fund raisers that are geared towards oral health education and care of citizens. More health funding on the part of all levels of government especially the federal government increasing the quota geared towards health in its yearly budgets, and full implementation and usage by ministry of health on all sectors of health as they bother on the nation.
4. Dental Education. Oral health education especially in the rural communities and environs via formal and informal means be commenced and enforced in most basic education institutions. Talking an educating more on preventive care in all societies rather than cure to citizens be carried out by health professionals.

The effects of a poor oral hygiene can not be overemphasized because those who currently suffer from its consequences can attest to the fact of its excruciating and disabling pains if and when not treated properly.

Major Causes of Poor Oral Hygiene in Nigeria

• Unhealthy diet especially diets high in sugar found in biscuits, sweets, etc lacking in nutrients and minerals for healthy gums.
• Dehydration which can lead to bad breath and gum diseases.
• Use of non-fluoridated toothpaste, powders and mouth wash.
• Tobacco smoking which can lead to periodontal diseases and Oral cancers.
• Non and irregular visit to the dentist for dental care.

Lasting Solutions to The Major Causes of Poor Oral Hygiene

• Deliberate and regular consumption of fruits and vegetables which are rich in essential vitamins and minerals for healthy gums and teeth.
• Brushing with fluoride rich toothpaste which are usually NAFDAC and NDA approved.
• Hydration which should be adequate for weight and on a regular.
• Regular and consistent visit to the dentist, six monthly visit highly recommended
• Using mouth wash along side brushing twice and flossing.
• Watching out for toothache, tooth sensitivity and other symptoms.
• Avoidance and stoppage of tobacco smoking.

Effects Of Poor Oral Hygiene

• Psychological effects. Especially on an individual’s self esteem and behaviour towards others.
• Social effects. Any issue affecting any individuals self esteem in the long run affects his social behaviour and relations with other humans in his environment.This may go a long way in affecting the individuals speech, eating and drinking habits and life style in a whole.
• Dental Diseases. Diseases such as periodontal diseases which are largely caused by poor oral hygiene of an individual leading to more debilitating diseases for an individual.

In conclusion, the need for education on oral hygiene as a major and sustainable solution cannot be overemphasized above all else. As we continue to celebrate the world oral health day let us continue to uphold the tenets of the dental profession as we hope to achieve sustainable and dependable solutions to our Nigerian state as a whole.

References

1. Definition of oral hygiene : American Dental Association.
2. Definition of oral health : Nigerian Dental Association.
3. Definition of Oral Hygiene :Dr. SEYE LOGEDE (Vice President NADS, ABUJA).
4. Abuja residents report : Punch Newspaper publication for 21st March, 2018.
5. Tips for oral hygiene : AMERICAN UNIVERSITY OF NIGERIA PUBLICATION in November, 2018.

The oral cavity is increasingly becoming recognised as a window to general health. Hepatitis is a heterogeneous inflammatory liver disease which manifests in the oral cavity and has important implications in the dental setting. Dentists and oral health workers must be aware of the full spectrum of signs and symptoms, as well as how the disease is transmitted, in order to provide safe and effective dental care.

Hepatitis A, B and C (HVA, HBV and HCV, respectively) are separate entities each with unique disease characteristics and varying modes of transmission, pathogenesis, treatment and preventive measures. HVA is transmitted by faecal-oral route through contaminated food and water, shared drug equipment, sexual activity within the homosexual male community and poor hygiene and sanitation practices (1, 2). Therefore, thorough hand hygiene practices, avoidance of sharing food and drinks, provision of vaccinations for high risk groups and safe sex practice are preventive measures to reduce the risk of spreading the disease (1). While HVA has a low prevalence in Australia, it has a higher prevalence in countries where sanitation and hygiene are poor. Nevertheless, travelling to endemic areas is the highest risk factor for contracting the disease (3). Symptoms of HVA include fatigue, fever and jaundice (4). HBV is the most common liver infection and can lead to liver failure, cancer or cirrhosis if untreated (5). It is transmitted through bodily fluids such as blood, semen and breast milk, syringe-sharing and sexual intercourse (6). Preventive recommendations include vaccination, practicing safe sex and the use of more general infection control measures such as disposible PPE, sterilisation and hand hygiene (7). There is a higher incidence rate in children than in adults (8) and high-risk infections from population migration from endemic countries (9). Patients are often asymptomatic in the acute phase, however chronic infections may present with symptoms similar to HVA and may be prolonged and severe (8). HCV is transmitted through infected needles, contaminated medical equipment and sexual activity (10). Although there are no vaccinations for HCV, similar HAV and HBV prevention practices are used with special attention to the use of new and sterile syringes to decrease the risk of HCV (11). Infected patients may report flu-like symptoms, which can be followed by more specific hepatic or haematologic symptoms over the following years. If left untreated, it can lead to chronic disease, liver cirrhosis and hepatocellular carcinoma (8). Furthermore, HCV can induce insulin resistance, oxidative stress and liver steatosis (12).

In order to minimize liver damage and improve the quality of life of patients, early diagnosis is extremely important. Prevention methods, risk reduction of spread and vaccinations for higher risk populations are critical (13). Serology tests are non-invasive procedures used for diagnosis and are able to identify the specific viral strain (14). Coordination of care and effective communication between the full multidisciplinary healthcare team is paramount, to ensure the best patient outcome during both treatment and recovery. This is done through specific patient education on their own viral strain and risks and prevention methods to reduce the spread of the disease (15).

Sexual activity plays a significant role in the transmission of the hepatitis viruses, particularly hepatitis A and B. Oro-genital sex is common in both heterosexual and homosexual couples of all sexual orientations (16), and it is common for young people to consider oral sex safer than vaginal sex, however this is not entirely true. Oro-anal contact is likely the most important risk factor for transmission of hepatitis B from anus to mouth, and may occur from faeces or asymptomatic rectal bleeding in homosexual men (17, 18). Hepatitis B can also be transmitted through fellatio and cunnilingus and virus particles that are found in semen, stool, saliva and blood (19). Hepatitis A is an enteric pathogen and so it is unsurprising that it is more prevalent in homosexual males who report having oro-anal sex. Epidemic outbreaks of hepatitis A affecting homosexual men have been reported in the literature (19, 20). Sexual transmission of hepatitis C is uncommon and cofactors such as the presence of HIV and hepatitis B may be necessary for transmission (21, 22). Maintaining good oral health has an underestimated role in protecting at risk groups from oral transmission of hepatitis A and B infection. Limiting exposure to sexual fluids as well as maintaining good oral health – free from bleeding gums, broken skin, lip sores and cuts which serve as a gateway for entry of infection from oral cavity to circulation – markedly reduces the risk of infection during unprotected oral sex (23). Once trust and rapport have been established, dentists are in a unique position to reduce a patient’s risk of acquiring and transmitting hepatitis through the oral cavity by preventive treatments, education and health promotion.

Oral health workers need to protect themselves adequately while maintaining a professional-patient relationship free from discrimination and prejudice. All patient’s body fluids must be treated as a potential portal to infection. Oral health practitioners are recommended to be vaccinated against HBV prior to performing dental treatment and to uphold appropriate standard precautions such as hand hygiene practices, the use of personal protective equipment (PPE), appropriate handling of sharps, and equipment sterilisation (24, 25). Transmission of HBV and HCV are more likely to occur in a dental setting as dental procedures are invasive and generate contaminated aerosols, which are suspended in the dental environment for up to five days (26). Prior to high risk procedures, antiseptic mouthwash for the patient reduces contamination along with antibiotic prophylaxis (27, 28). Although such measures may reduce the risk of contamination, the success in preventing the spread of disease lies within consistent and appropriate use of infection control practices for all patients without the need for adopting excessive measures for patients who identify with hepatitis. For example, changing the infection protocol for patients with hepatitis, such as through double gloving, can easily be viewed as discriminatory according to the Australian Dental Journal. Sharp injuries such as needle stick injuries leads to blood virus transmission, and the correct disposal of sharps provides protection rather than double-gloving (25). Patients who feel discriminated against would be less likely to disclose their hepatitis status and be discouraged from seeking appropriate healthcare due to the stigma associated with infections, and as there are no legal obligations to disclose their status (28). Dental health practitioners need to be aware of any discriminatory actions towards hepatitis patients (29).

Dental practitioners must be aware of potential complications and the medical management of patients with hepatitis. All patients should have their medical history reviewed before a clinical examination (30). Patients identified to have a history of hepatitis should undergo additional review of liver function and medications. Disclosure of this information is vital for the clinician to deliver safe treatment (30). Unless in an emergency situation, patients with active hepatitis should not undergo any dental treatment and need to be referred to their general physician for care (31). When emergency dental treatment cannot be delayed liaisons with the patient’s physician is required and clinicians must strongly abide with standard precautions and ensure all precautions are followed such as decreasing aerosol production. Hepatitis can interfere with haemostasis, therefore prothrombin and bleeding time must be measured and extra precautions should be followed to decrease surgical trauma as excessive bleeding may occur during surgery (32). Management of a patient with a history of hepatitis will depend on several factors. It is important to obtain complete blood count, coagulation tests, hepatic serology, viral load and liver function status before treatment of a patient with a history of hepatitis (33). Patients with a history of hepatitis with normal liver function can receive dental treatment (32). As patients may be hepatotoxic, certain sedatives and NSAIDS should not be used (28, 31). Clinicians can also consider limiting treatment to one quadrant per visit when managing patients with a history of hepatitis and associated impaired liver function, which minimizes the use of local anaesthetic and the possibility of complications arising (33). Post treatment follow-up is essential to ensure that there are no physical complications or patient concerns (31).

Hepatitis has the potential to manifest as oral diseases. There is evidence that suggests hepatitis affects the salivary glands (34). Consequently, patients with hepatitis have a higher risk of reduced saliva flow, which may lead to a condition known as Xerostomia(34). Hepatitis may increase the risk of Sjogren’s syndrome, but the literature supporting this is limited (35). The treatment for HCV also leads to Xerostomia (36). Saliva has a plethora of properties including reducing caries, an antibacterial role, lubrication, and speech articulation (37, 38). Dry mouth can be alleviated by consuming more water, chewing sugarless gum, celery, avoid alcohol mouthwashes and bicarbonate mouthwash (28). Hepatitis patients have a higher chance of periodontal disease. As a result, a strong preventative program must be implemented (28).

Around 27% of HCV-affected patients also suffer from Oral Lichen Planus (OLP). While there is a high correlation between OLP and HCV, the underlying pathophysiology is poorly understood (38). Due to this correlation, a new presentation of OLP in the dental setting could be used as a trigger to test for HCV infection, especially in higher risk patients. OLP is an immunological and inflammatory disease which affects the buccal mucosa, tongue and gingiva in the oral cavity and causes painful bleeding (39). The pain that is associated with OLP can compromise the ability to carry out oral hygiene routines as a result leading to poor oral health outcomes (40).

Oral healthcare workers are in a prime position to assist in the identification, education, management and recovery of patients with hepatitis infections. Effective communication between the dentist and the patients’ general practitioner or specialist could significantly improve patient outcomes, by ensuring the dentist has a thorough understanding of the patients treatments, latest bloods and symptoms. The dentist should invest time to build a strong professional relationship with the patient such that they feel supported and comfortable discussing all aspects of their disease. The dentist should approach topics such as fecal-oral and sexual transfer of hepatitis in a sensitive yet confident manner, leading the conversation in such a way that the patient does not feel disparaged or belittled. Undertaking targeted continuing professional development activities to maintain a high level of knowledge on hepatitis, as well as other infectious or sexually-transmitted diseases, can assist in arming the dentist with all the information they require to effectively diagnose, treat and most importantly communicate with all patients, regardless of disease status.

References

1. Franco E, Meleleo C, Serino L, Sorbara D, Zaratti L. Hepatitis A: Epidemiology and prevention in developing countries. World journal of hepatology. 2012;4(3):68-73.
2. Linder KA, Malani PN. Hepatitis A. Jama. 2017;318(23):2393.
3. Ward K, McAnulty J. Hepatitis A: who in NSW is most at risk of infection? N S W Public Health Bull. 2008;19(1-2):32-5.
4. Harris E WK, Lamps LW. Acute and Chronic Infectious Hepatitis Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas. 2nd ed2009.
5. Lin KW, Kirchner JT. Hepatitis B. Am Fam Physician. 2004;69(1):75-82.
6. Baumert TF, Thimme R, von Weizsäcker F. Pathogenesis of hepatitis B virus infection. World J Gastroenterol. 2007;13(1):82-90.
7. Elimination of Perinatal Hepatitis B: Providing the First Vaccine Dose Within 24 Hours of Birth. Pediatrics. 2017;140(3).
8. Ryan KJ RC. Medical Microbiology Fourth ed2003.
9. MacLachlan JH, Allard N, Towell V, Cowie BC. The burden of chronic hepatitis B virus infection in Australia, 2011. Aust N Z J Public Health. 2013;37(5):416-22.
10. Basu D, Sharma AK, Gupta S, Nebhinani N, Kumar V. Hepatitis C virus (HCV) infection & risk factors for HCV positivity in injecting & non-injecting drug users attending a de-addiction centre in northern India. Indian J Med Res. 2015;142(3):311-6.
11. Abdelwahab KS, Ahmed Said ZN. Status of hepatitis C virus vaccination: Recent update. World J Gastroenterol. 2016;22(2):862-73.
12. Irshad M, Mankotia DS, Irshad K. An insight into the diagnosis and pathogenesis of hepatitis C virus infection. World J Gastroenterol. 2013;19(44):7896-909.
13. Strauss E, Dias Teixeira MC. Quality of life in hepatitis C. Liver Int. 2006;26(7):755-65.
14. Alter MJ, Kuhnert WL, Finelli L. Guidelines for laboratory testing and result reporting of antibody to hepatitis C virus. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2003;52(Rr-3):1-13, 5; quiz CE1-4.
15. Kathryn M McDonald M, Vandana Sundaram, MPH, Dena M Bravata, MD, MS, Robyn Lewis, MA, Nancy Lin, ScD, Sally A Kraft, MD, MPH, Moira McKinnon, BA, Helen Paguntalan, MS, and Douglas K Owens, MD, MS. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies: Rockville (MD): Agency for Healthcare Research and Quality (US); June 2007.
16. Stone N, Hatherall B, Ingham R, McEachran J. Oral sex and condom use among young people in the United Kingdom. Perspect Sex Reprod Health. 2006;38(1):6-12.
17. Schreeder MT, Thompson SE, Hadler SC, Berquist KR, Zaidi A, Maynard JE, et al. Hepatitis B in homosexual men: prevalence of infection and factors related to transmission. J Infect Dis. 1982;146(1):7-15.
18. Reiner NE, Judson FN, Bond WW, Francis DP, Petersen NJ. Asymptomatic rectal mucosal lesions and hepatitis B surface antigen at sites of sexual contact in homosexual men with persistent hepatitis B virus infection. Ann Intern Med. 1982;96(2):170-3.
19. Edwards S, Carne C. Oral sex and the transmission of viral STIs. Sex Transm Infect. 1998;74(1):6-10.
20. Henning KJ, Bell E, Braun J, Barker ND. A community-wide outbreak of hepatitis A: risk factors for infection among homosexual and bisexual men. Am J Med. 1995;99(2):132-6.
21. Melbye M, Biggar RJ, Wantzin P, Krogsgaard K, Ebbesen P, Becker NG. Sexual transmission of hepatitis C virus: cohort study (1981-9) among European homosexual men. Bmj. 1990;301(6745):210-2.
22. Tor J, Llibre JM, Carbonell M, Muga R, Ribera A, Soriano V, et al. Sexual transmission of hepatitis C virus and its relation with hepatitis B virus and HIV. British Medical Journal. 1990;301(6761):1130.
23. Kumar T, Puri G, Aravinda K, Arora N, Patil D, Gupta R. Oral sex and oral health: An enigma in itself. Indian J Sex Transm Dis AIDS. 2015;36(2):129-32.
24. Ammon A, Reichart PA, Pauli G, Petersen LR. Hepatitis B and C among Berlin dental personnel: incidence, risk factors, and effectiveness of barrier prevention measures. Epidemiol Infect. 2000;125(2):407-13.
25. Leao JC, Teo CG, Porter SR. HCV infection: aspects of epidemiology and transmission relevant to oral health care workers. Int J Oral Maxillofac Surg. 2006;35(4):295-300.
26. Samaranayake L. Essential Microbiology for Dentistry. 4th Edition ed2011 28th September 2011.
27. De Rossi SS, Glick M. Dental considerations for the patient with renal disease receiving hemodialysis. J Am Dent Assoc. 1996;127(2):211-9.
28. Therapeutic Guidelines Oral and Dental Version 2. 2nd Edition ed: Therapeutic Guidelines Limited 2012.
29. Temple-Smith M, Jenkinson K, Lavery J, Gifford SM, Morgan M. Discrimination or discretion? Exploring dentists’ views on treating patients with hepatitis C. Aust Dent J. 2006;51(4):318-23.
30. DePaola LG. Managing the care of patients infected with bloodborne diseases. J Am Dent Assoc. 2003;134(3):350-8.
31. Falace JLCMNRD. Little and Falace’s Dental Management of the Medically Compromised Patient 8th edition ed: Elsevier; 2012 21st March 2012
32. Dahiya P, Kamal R, Sharma V, Kaur S. ‘Hepatitis’ – Prevention and management in dental practice. J Educ Health Promot. 2015;4:33.
33. Ganda K. Dentist’s Guide to Medical Conditions, Medications and Complications. 2nd Edition ed: Wiley Blackwell; 2013.
34. Delaleu N, Jonsson R, Koller MM. Sjogren’s syndrome. Eur J Oral Sci. 2005;113(2):101-13.
35. Carrozzo M. Oral diseases associated with hepatitis C virus infection. Part 1. sialadenitis and salivary glands lymphoma. Oral Dis. 2008;14(2):123-30.
36. Mortazavi H, Baharvand M, Movahhedian A, Mohammadi M, Khodadoustan A. Xerostomia due to systemic disease: a review of 20 conditions and mechanisms. Ann Med Health Sci Res. 2014;4(4):503-10.
37. Pedersen AML, Sorensen CE, Proctor GB, Carpenter GH, Ekstrom J. Salivary secretion in health and disease. J Oral Rehabil. 2018;45(9):730-46.
38. Stookey GK. The effect of saliva on dental caries. J Am Dent Assoc. 2008;139 Suppl:11s-7s.
39. Stoopler ET, Sollecito TP. Oral lichen planus. Cmaj. 2012;184(14):E774.
40. Price SM, Murrah VA. Why the general dentist needs to know how to manage oral lichen planus. Gen Dent. 2015;63(1):16-22.

The importance of aligning education with career choice cannot be underestimated. Given the importance of passion for work, it seems much easier to develop passion by being successful and being a good person. Choosing a career that you enjoy can ultimately focus your attention on pursuing your career path. While choosing a degree major that aligns with my personality, my career dreams and vison, the university also play an important role in providing coursework, support and creating a learning environment that is conducive for both student social and academic development. An academic plan at TSU will help me cultivate the social, political, and or cultural skills that I will need to be successful in my career. The major filed of my career is public health specializing in dental health. Dental public health is a program that focuses on scientific research on dental disease prevention and management, community dental health promotion, and prepares dentists and public health professionals to act as dental health professionals (Dussault & Dubois). It includes education in preventive dentistry, oral disease and health and quality of life relationships, patient and practitioner behavior, dental epidemiology, nutrition and dental health, dental care policy and delivery, oral health program planning and management, biostatistics and research methods (Dal Poz, Quain, O’Neil, McCaffery, Elzinga & Martineau). Public health is a field for those who think of the greater interests of humans. A program we study at university does not only impact our career choices but it will also have an impact on the community we live in.

History of the Major

The field of public health is constantly evolving in response to the needs of communities and populations around the world. The fundamental mission of public health is to improve conditions and behaviors that affect health so that everyone can reach health. Its mission has always included not only the implementation of public health policy, but also the study of public health issues and the education of future leaders who will ultimately turn that research into practices and policies aimed at improving the health of people in the region, country and around the world (Dubois & McKee). Public health has always been a discipline that has a real and lasting positive impact on people. This is because it helps to create a healthy environment, and it is a moral and ethical obligation.

Public health initiatives affect people every day, everywhere in the world. It addresses a wide range of issues that can affect the health and well-being of individuals, families, communities, populations, and societies now and to the next generation (Macdonald). Due to this discipline, there is increased life expectancy, mortality is decreasing worldwide, and there is eradication or reduction of many communicable diseases.

Career

My chosen career is to be a public health dentist. Public health dentists are dental professionals working in the public sector, typically focusing their skills and expertise on population-based dentistry instead of treating patients one at a time. The ultimate focus of public health dentists is generally to improve the oral health of people within the community or state. By increasing the population’s overall level of dental health, public health dentists can reduce the number of untreated dental problems by combining treatment, education, and policy changes (Larson).

Public health dentists handle a variety of tasks and rarely treat patients one-on-one. Instead, they research current oral health trends and community needs to determine areas for improvement. They also develop new oral health policies to improve dental health and implement and monitor policies to ensure correct results. In addition, they develop and provide programs and services that improve oral health problems.

I chose this career because I have a specific set of skills and unique traits that can help me improve my ability to perform tasks as expected. Good education and proper training will help me to develop my skills so that I can be successful in this career, and professional experience that I will acquire during internship and projects will also help. In addition, I also possess the following traits that can also have a major impact on my success as a public health dentist.

• Superior Analytical Skills-A key part of the job is collecting data and conducting research to determine which aspects of public dental health need improvement and how to improve. Therefore, my strong analytical skills are essential.
• Good Communication-Discussing policy with a legislator or others in the public health sector is just as one of the key parts of the job. I also posses written and oral communication skills which are essential for public health dentists.
• Attention to detail – It is important for public health dentists to pay attention to the details as the little ones can have a major impact on the overall dental health of the public. I possess attention to detail skills which makes me suitable for the career.

Academic Preparation for Future Career.

My coursework at TSU plays an important role in preparing me for my future career. This includes what I will learn in this course. For example, I will the academic course and field experience will prepare me for the planning, implementation and operation of dental public health programs and provides an understanding of the process by which health policy is developed and regulated. Through the following coursework, I will acquire the technical skills needed to take on leadership roles in public health.

For example, the marketing and communication course will help me to develop health education initiatives and market them. Human resources course will help me to work with various employees from different backgrounds. Financial management will help me to come up with public health dental program budgets and advocacy building will help me in building alliance with community members. Information management course will help me to analyze data and use technological systems to m market initiatives, analyze data and implement technologies in program implementation. A course in quality assurance and risk management will help me to minimize risk in program implementation.

A key component of the program is original research. Combining coursework and research will allow me to take advantage of public health studies to launch the academic oral health capstone projects required for the program. Completing these projects will give me an opportunity to network with dental public health professionals which will help me gain practical knowledge of my career. In addition, dental education courses will give me the knowledge I need to keep your patients healthy and happy. As new treatments are developed in the dental world, coursework will be incorporated with these which prepares me to educate people on the most recent effective techniques. Continuing dental education will help me acquire essential skills in the healthcare industry. This include courses such as

• OSHA
• Treatment protocol for medically impaired patients
• Enhancing patient safety and infection control
• CPR
• Handling medical emergencies and understanding vitals
• Cultural competency
• Knowledge of dental hygiene equipment

Therefore coursework not only improves my professional skills, but also allows me to meet other like-minded people in the dental industry. Building a network of dental professionals is a valuable benefit of participating in dental continuing education courses. Internships offered at the university during a summer break can teach students me more about what I must do in the practical job. Real experience often happen when someone starts working in the ideal workplace. Internships are a unique opportunity to test different locations to see which rides students like the most (Johnson, Larkin & Saks). I will take advantage of summer breaks to intern in a variety of roles and organizations to identify roles that can excite and have knowledge of my future career. At the same time, I must be able to apply research and bring experience I brought from internship to bring my academic progress to fruition. This was supported by (Davies) who said that ultimately, students should be able to apply what they learn to their path to career success. There is no substitute for learning by experience. The practical application of knowledge gained from coursework provides a solid foundation for any educational or career path. The development of critical thinking, problem solving, communication and teamwork skills during coursework is critical to my success in public dental health.

Social Preparation for Future Career

TSU offers a unique and innovative social environment that increases retention, enriches students’ intellectual, ethical and social development. It also provides public relations to the community and provides opportunities to improve leadership skills and learning opportunities. The following areas: enrolled student clubs and organizations, student government and leadership, fraternity and sorority life, late-night and weekend programs, intercultural affairs, student activities and service, homecoming and special events can help me to develop social skills that will be useful in my future career. This is because the following skills are developed through interaction, liaising and being involved with other students and social activities at the university.

Emotional Intelligence

The social environment at TSU will help me to develop emotional intelligence through practicing empathy and paying attention to the emotion’s others are feeling. This includes having productive conversation skills by listening to other people’s perspectives and asking good questions during discussions, volunteering activities and so forth. Staying in touch with classmates and professors can build relationships. These relationships can be key to career opportunities.

Cultural intelligence development

To understand the modern market, it is necessary to develop sensitivity and openness to diversity and multicultural differences. A career in public health requires me to engage and work effectively across cultures. The university is usefull of students with diverse cultures. Working in various projects and attending classes with people from different backgrounds will help me develop cultural competency that is important for my career.

Getting an internship

The best way to succeed after graduation is to gain experience working in the industry before graduation. Internships are the best way to gain that experience and potentially step into the door of a company. Even if your internship is unpaid, the skills you can build up can make an effective resume (Davies). The ability to get an internship while I am still studying at the university is a great opportunity for me to develop social skills for my career. This is because the industry will allow me to develop social networking skills outside the school environment that enhances my career.

Serving the Community

Dentistry offers many opportunities, challenges, and rewards. It’s a fast-changing and expanding job. The Doctor of Dental Medicine is a member of the primary healthcare profession at the forefront of disease prevention, intervention and health promotion which is crucial in serving the community and networking with other professionals. My career will be beneficial to the community because dentists are often the first medical professionals to recognize and identify a variety of diseases ranging from high blood pressure to oral cancer. They diagnose and treat problems that affect teeth, gingival tissue, tongue, lips, and jaw. These oral diseases often indicate other health problems that may require follow-up from the patient’s attending physician.

In the era of modern healthcare, dentists utilize new and advanced technologies such as computers, digital radiography, cone beam computed tomography and magnetic resonance imaging to diagnose patients. Dentists provide services that improve the appearance and confidence of patients through a variety of cosmetic dental procedures. These services can make patients feel good about their smile. To repair, restore, and maintain dentition (teeth), gums (gum), and oral tissues that are lost or damaged due to an accident or disease, dentists perform trauma surgery, dental implants, tissue transplants and laser surgery. This will benefit the community by improving the gnarl health and smiles of the public. In addition, the dentist’s job extends beyond the dental chair. Patient education is just as important as a real dental procedure as a dentist teaches good oral habits to promote good health. Dentists educate the general public about the importance of oral health and disease prevention. They interact with people of all ages, cultures, and personalities.

As a public health professional, I will be dedicated to protecting and improving the health of people and communities. This work is achieved by encouraging a healthy lifestyle, researching disease and injury prevention, and of course responding to infectious diseases such as the novel coronavirus. Good dentists also have creative talents. The dentist is an artist, and to brighten one tooth or realign the entire jaw, the dentist must have an artistic flair to envision the aesthetic result so that the patient looks at its best. Part of this work will require collaboration with other professional teams such as nurses. This will help to expand the professional community.

Dentists provide essential health care services. They are highly respected within the community. Dentists are skilled, conscientious and citizen-oriented individuals who work with community leaders, educators, and other healthcare professionals and government officials. They often serve school health programs and elderly, disabled or poor citizens, and show selflessness that is characteristic of their professionalism.

The CDC says chronic illness is one of the leading causes of death and disability in the United States (Dubois CA, McKee M, Nolte). Here are some statistics on chronic diseases in our country today.

• Half of American adults have chronic illnesses (Dubois CA, McKee & Nolte).
• One in three Americans has high blood pressure.
• 2 million heart attacks and strokes each year.
• 7 out of 10 Americans are caused by chronic conditions.
• Every dollar you spend on healthcare, 75 cents are spent on chronic diseases and factors that increase your risk.

Dental public health profession is important in that it identifies these chronic illnesses before they reach a detrimental stage. Patients will then be advised to seek medical attention at an early stage.

Of course, failure to maintain public health within the community can lead to a variety of medical problems. The chronic diseases such as diabetes and heart disease increase when the overall health and well-being of the community is neglected. The CDC reports that 90% of annual medical bills nationwide are for people with chronic health conditions. This reinforces the simple fact that public health professionals are important to our country’s health and well-being. TSU offers the academic and the social environment that will help me enhance my skills in this field. In a nutshell, when you get a public health degree, you don’t invest in the future, you also invest in the future of the people you serve.

From the times that we were kids, we have heard our parents talking about the importance of dental care. We were denied too many sweets and were threatened by cavities and tooth decay. Later, we got into the habit of brushing and flossing like any other regular activity. Tooth care is absolutely essential and it is important that we teach hygiene to our children in a way that they become habituated by the time they do all the activities on their own. In spite of so many books and journals about dental care, people still do not follow it properly and it results in tooth decay. However, falling of teeth can be due to many other natural reasons too for example old age.

With the development of science and technology, healthcare has reached the skies and there is a solution for almost every problem. Since teeth are a vital part of the body and help a lot in natural food processing and in turn the digestion process. It also enhances your looks and smile. Initially, the development in dental sciences brought in the discovery of dentures and bridges. With more and more development and changing times, the most recent invention in this category is of dental implants.

The meaning of dental implants or implantation is the procedure of replacing tooth roots. Dental implantation gives you a removable or fixed replacement with a strong base. The replacement teeth match your real teeth like a mirror image. There are experts who know this procedure and implant dentists are most of the time different than regular dentists.

It is obvious that any new discovery will have its own set of pros and cons. In this article, we will discuss the pros and cons of dental implants. Let us go through the pros first.

Pros of dental implants

1. Better appearance

Teeth are a vital part of your overall appearance and dental implants enhance the beauty. They are designed in such an expert manner that they blend with your bones perfectly. Besides becoming permanent, they look so real that there is not even a 1% chance of anyone understanding otherwise.

2. Comfortable Speech

You may be surprised to know that your teeth play an important role in how clearly you speak. One problem may occur if there are missing teeth and if that is solved another problem may occur which is of loose or improper implantation. If your replacement teeth are not designed properly, there will be a chance of it coming out loose inside your mouth. This may restrict clear speech. You need to make sure that you get them fixed only by the best dentist in town to avoid such problems.

3. More comfortable Than Simple Dentures

Traditional dentures are easily removable and hence can wear out with regular use. They can become loose after a period of time. However, that is not the case with permanent implants. They fix to your bones so well that there is hardly a risk of loosening. Therefore, these are much more comfortable than earlier solutions.

4. Makes Eating Easier

Traditional dentures can become loose and slide into your mouth with overuse. If you are trying to eat something a little hard or chewy, wearing temporary dentures can be really painful. On the other hand, getting permanent implantation means you can chew food comfortably and in a painless way just the same way as it was with your real teeth.

5. Boosts Confidence

As said earlier, the smile is an important part of the face, overall looks and also your personality. Losing such a vital part of your personality will affect your confidence and self-esteem. Get your set of dental implants done and you will get back your confidence and self-esteem.

6. Better Oral Health

In case of fixing bridges, your neighboring teeth needs to get extracted to make way for the new ones. In case of permanent implantation, nothing of this sort is required. If you are going for individual implantation, the rest of your teeth will be left intact and a space between them will be created. In this way, there will be much lesser pain and leaving the real teeth intact means your oral health will not get disturbed.

7. Relax for a long time

As discussed earlier, modern teeth implants are a permanent solution for missing teeth. Therefore, you can invest at once and remain relaxed for quite some time after that. It may even last you a complete lifetime.

8. More Convenient

If you are wearing temporary dentures, you will have to remove them every now and then and it may be an embarrassing situation for you. In case of permanent implants, you can avoid such odd situations and also not go through the trouble of bearing messy and sticky adhesives used for fixing dentures.

The rate of success with dental implants is as high as 98%. The rate may, however, be different, depending on the position in which they are to be fixed. As said, dental implants can last you a lifetime if you take proper care of them. Now that you know all the benefits or pros of dental implants, let us get on with the cons.

Cons of Dental Implants

1. Expensive

The fact that modern dental implantation is quite expensive, especially if you put it in comparison with temporary dentures and bridges. This is the most common problem that restricts a lot of people from undergoing this procedure. The cost of sinus graft, implant crown or the overall procedure is high.

Moreover, this is a complicated procedure that needs expert knowledge. It is like fixing or replacing a part of your body and it may go completely wrong if you let anybody do it just to save a little money. Therefore, the better the doctor, usually the more the fees of a session. There are however more affordable options if you do the correct research.

2. Dental Insurance Coverage is Limited

Health insurance has been revised well in the USA except for the part that covers dental insurance. When it comes to your dental insurance, it is better that you do not rely on it to cover all or even a major part of this procedure. Most of the dental insurance will cover to a maximum of $1,500 for the whole year which is very less if at all there is any coverage.

Some dental insurances, on the other hand, will only cover the cost of the canal or the sinus graft or a similar small part of the whole procedure. Ultimately, most of the money goes from your pocket and this can be a little difficult for some people.

3. Surgery Required

The procedure of dental implants includes a surgery which may come along with additional risks. The risk rate can be 1% and can level up to 5% in some cases. Surgery risks cannot be anticipated and you have to be ready for such risks. The risks of dental surgery include excessive bleeding, oral bone fracture, damage caused to other teeth and surrounding nerves and more.

4. Probable Replacement

Although, there is a guaranty that the implantation procedure is permanent but it may need some fixing after a while. This is not the common case, but 100% success is yet to be achieved. The porcelain covering can get a little chipped or there may be a problem with the fixing measurement and more. You have to be ready to bear such problems if at all needed.

5. Bone loss

Over time, there remains a risk of losing bone density in the surrounding areas in which implantation has been performed. This can be a little painful and this can also be avoided till a certain extent by taking good care of the implants.

Here are all the necessary points to take into consideration while deciding whether you want implantation or not. Now you are aware of all the major pros and cons of dental implantation.

Dental Hygiene: Past and Present

• 1907- Irene Newman became the first dental hygienist, trained by her cousin, Dr. Alfred Fones, a dentist in Connecticut.
• 1913- Dr. Alfred Fones established the first dental hygiene school in Bridgeport, Connecticut. Dr. Fones coined the term, “dental hygienist” after “dental nurses” had failed. He believed since they were instructing children on how to prevent diseases and instruct on oral hygiene habits, “dental hygienist” fit the description better.
• June 6, 1914- The first graduating class of dental hygiene students.
• 1917- Irene Newman becomes the first “licensed dental hygienist”.
• 1923-ADHA was established with 46 members.
• 1935-The ADHA implemented specific requirements for program acceptance; made it mandatory to have a high school diploma for licensure.
• 1940- to become a licensed hygienist, a 2-year course study program was implemented. Also in 1940, the ADHA adopted the label, “registered dental hygienist, RDH.”
• 1945- Dr. Clayton Gracey developed the Gracey curettes
• 1950’s- The ultrasonic scaler was created/introduced and fully reclining
• dental chairs were made.
• 1960- Dr. Esther Wilkins, RDH, DMD, published the first edition, “Clinical Practice of The Dental Hygienist.”
• April 1962- The first national board exam was given.
• The 1970s- The ADHA began implementing continuing education courses and establishing guidelines for these courses.
• The 1980s- The state of Washington became the first to fulfill the duties in the unsupervised practice of dental hygienists in specific settings.
• May 13, 2009- Senate File 2083 was signed by Minnesota Governor Tim Pawlenty to implement Advanced Dental Therapy into law. Minnesota was the first state to implement dental therapists. ADHP, Advanced Dental Hygiene Practitioner, is the medical version of a nurse practitioner and is a midlevel entry. ADHPs work collaboratively with a dentist but are able to go out to other areas in the communities to provide dental care without the supervision of a dentist.
• 2012- The state of Florida passes the law allowing dental hygienists to administer local anesthesia.
• May 3, 2019- Senate Bill 649 failed for the state of Florida to implement dental therapists. In 2014, Florida had the lowest rate of any state for Medicaid dental participation (Floridians for Dental Access, 2019).

Denturist-someone who makes dentures

There are many roles of a dental hygienist and are not just limited to clinical practice. According to the American Dental Hygiene Association’s website (2019), “dental hygienists provide clinical, educational, and consultative services…”

Hygienists can provide a variety of services whether in an office-type setting or business-related. The following are a range of areas in which a dental hygienist can perform roles: clinician, corporate, public health, researcher, educator, administrator, and entrepreneur (ADHA, 2019).

There is controversy regarding dental therapists (ADHP) because the opponents believe there isn’t adequate training and could potentially put patients at risk. The state of Florida has tried to pass the law to implement dental therapy but failed. There are currently 4 states and 50 countries allowing the practice of dental therapists. Florida is in great need because of the shortage of dentists in almost every county which leads to no dental care or emergency visits. If this law passes, it would allow more people, children, and adults, to receive dental care.

Whitening in the mall is legal but has many controversies. The kiosks that offer to whiten look appealing to the consumer because it’s less expensive than purchasing through a dental office, it’s convenient and time efficient. The controversy regarding mall whitening is there aren’t any dental professionals on staff to ensure safe treatment and they’re most likely franchised own with no dental supervision. Whitening can produce tooth or gingival sensitivity, and if not properly used or explained, can lead to further complications.

Cultural competency is important for an individual to have because it allows for knowledge and awareness of other cultures. Possessing competency for different cultures shows respect and patience which has the ability to reduce communication issues.

An ethical issue is when there is a conflicting issue of something right versus wrong and can usually be corrected quickly. An ethical dilemma on the other hand is two or more conflicting problems and one may affect the other in a way in which it can’t be resolved.

The educational requirements and legal process necessary to become a dental hygienist are as follows: must be 18 years old; graduated from a dental hygiene school or any school/college accredited by the Commission on Accreditation of the American Dental Association (Florida Board of Dentistry, 2019); can be a graduate of an unaccredited school, but must have 4 years of postsecondary graduation with a degree comparable to a DMD or DDS; must complete the “National Board Dental Hygiene Examination, ADEX Dental Hygiene Licensing Exam and Florida Laws and Rules Examination” (Florida Board of Dentistry, 2019).

The dental profession and environment are constantly changing with education and technology. As the need for dental care increases, the profession and environment do, as well; this is one of the main reasons to pass the laws necessary for dental therapists, especially in areas where there are shortages of dentists, like Florida.

References

1. American Dental Hygiene Association (2019). Professional Roles of the Dental Hygienist. Retrieved from https://www.adha.org/resourcesdocs/714112_DHiCW_Roles_Dental_Hygienist.pdf
2. Hakes, H., & Hakes, H. (2018, May 12). The History of Dental Hygiene: Development through the Years. Retrieved from https://www.todaysrdh.com/the-history-of-dental-hygienedevelopment-through-the-years/.
3. Florida Board of Dentistry (2019). Dental Hygienist. Retrieved from https://floridasdentistry.gov/licensing/dental-hygienist/Floridians for Dental Access (2019). Retrieved from http://floridiansfordentalaccess.com/solution/