Category: Dental Care

My name is Sharwari Kashid and I am a resident of India. I am applying to your esteemed University for admission to the Diploma in Dental Hygiene. Oral hygiene and dental health are crucial for everyone. One of my strongest motivations for choosing a Dental Hygiene program is it is a unique opportunity to positively impact the dental as well as oral health of every patient who comes into the dentist’s office. I am planning to seek a diploma program from your university because it provides a comprehensive learning and training experience in basic and advanced elements including behavioral sciences, biomedical sciences, oral health sciences, dental hygiene theory, and practice as well as clinical experience. I believe that my educational background has instilled in me the qualities required to meet the rigor of this demanding course. I would like to pursue this program to acquire a wide variety of skills and abilities relating to patient-oriented care, health promotion, prevention, and community advocacy which helps to serve the people and to keep smiles on their faces for a lifetime. I feel that being associated with this group would stand me in great stead throughout my career.

I have put up a sterling performance throughout my academic lifespan. I scored 9 CGPA in the 10th standard from Kolhapur Public School (CBSE), Kolhapur (2012), 73% in the 12th standard from Kolhapur Public School (2014), and 62% in Bachelor of Technology from Sinhgad Dental College and Hospital, Pune (2018). I have excellent English language skills. I have received a certification in JAVA programming.

Along with academics, I have worked as a Rotaract Club Member (2014-2018) where I was a Public Relations Officer (2015-16) and International Service Director (2017-2018). All these activities are confirmed by raising interest in preventive medicine, outcomes and effectiveness, and quality of care. I am a quiet, polite, empathetic person broad-minded person who handles all critical situations smoothly. In my extra-curricular activities, I am a National Fencing Player (2010-2011). I also actively participated in intra-college events. During my leisure time, I do public service which gives me the utmost satisfaction, and I engage myself in playing Table tennis.

My area of intrigue is in Diploma in Dental Hygiene. I was attracted to the dental health department because of its focus on oral or dental disease prevention as opposed to treatment and rehabilitation. The primary reason behind choosing this program is that it is applicable to several areas including preventative dentistry, pharmacology, radiology, oral health, anatomy, dental hygiene techniques, dental materials, and other subjects. This course gives me an opportunity to treat so many people and to change lives for the better. The Diploma in Dental Hygiene provides me adequate knowledge of oral science, clinical care, and professional practice and great job opportunities after completion of the course that I needed to succeed in the increasingly complex field of oral health.

The reason that motivates me to pursue a Diploma in Dental Hygiene from your esteemed university is it has talented and dedicated professional faculty with advanced degrees in dental hygiene. Considerable scholastic activities, practice-oriented methods of teaching, and excellent facilities in my field of intrigue inspired me to select this university. During the course, Students are imparted knowledge and training about oral hygiene and preventive dentistry. In addition to theoretical teaching, practical clinical teaching is given by treating patients under supervision. This full-time, two-year program in your college prepares me to be a health promotion specialist on an oral health care team as well as a competent clinician and community health advocate. Browsing through the information given on the Website, I am highly impressed with the teaching staff who are experienced, inspiring, and supportive of students’ individual journeys. I believe that this university can give me an unparalleled education in Dental Health at the policy and management level.

I have selected Canada as my destination for pursuing a Diploma in Dental Hygiene because the universities in Canada produce highly talented candidates in dental and oral health who are excelling in the Medical field. Also, the curriculum at these universities provides enough scope for research towards the latest technologies and developments in dental hygiene which closely resembles my career goals. Canada is often characterized as being progressive, diverse, and multicultural. The country is well-known for its ethnic background, and it welcomes migrants from all over the world that only remains the topmost reason that people across the globe prefer to study in Canada, thus, it has topped my chart of preference for pursuing. The Nation is a safe option to look for a promising lifestyle and steady growth in income if one chooses to work there. The country has augmented prospects for employment and individual betterment; it is a nation for those looking for an improved quality of life.

I would like to conclude by stating that, I am optimistic that I may be given admission to your graduate institute. I promise that I will work hard and efficiently to match the high criterion fixed by your college and carry out my duties in the most effective way and I will pursue the course with utmost diligence and pass the term with flying colors. I eagerly wait for your benevolent act of accepting me into your fold and granting me admission to my desired course.

Teeth are made of enamel which is the hard outer white layers, If you do not brush your teeth, they can wear down which can start to show the dentin, Dentin is the soft yellow inner layer which is what causes the teeth to get that yellow look, It has little holes which lead to the pulp of your tooth. since the pulp holds all of the nerves and when that happens you get to the cementum which is what holds all the nerves to the gum and so on and so forth.

Eggs are a perfect substitute for teeth since they have an outer layer which is like the enamel. They are both made of protein and when you eat or drink sugary drinks and snacks they can wear down enamel which causes cavities. We can stop that by using toothpaste which has properties that strengthen the enamel and prevent the wearing down of the tooth. If we dip the tooth(egg) in vinegar, the shell should start to dissolve. If we cover certain areas of the shell with toothpaste, the egg should be protected so there should be an area in which the shell remains intact.

Things that may help protect the tooth are eating less sugary things like sugar-free gum which can strengthen the jaw and also protect your tooth by scraping off the plaque. Plaque likes to slowly build up and eventually harden to become tartar which turns orange and is hard to get off and the minerals in your saliva can’t dissolve the tartar since it is made up of minerals.

One way to fix the tooth is to drink lots of water that contains fluoride which fluoride is good for teeth but things that contain a lot of acid are fruits and fruit juice like apple juice, orange juice, and lemon juice they are high in acid which is what can cause erosion. Lactic acid can also affect your teeth but the protein can build up the tooth and cause calculus build which is tartar but a very high buildup of it hardens and become a mineral stone on your tooth which has to be removed by a dentist you can’t brush it off. It is even worse with braces. You have to keep them extra clean since it builds up around the braces and can cause staining, which is permanent.

You may also want to watch out for because brushing your teeth too often can also be a bad thing it can cause tooth abrasion or tooth recession which is when the tooth starts to erode away from the bristles or brush which can expose the teeth to other harmful disease or bacteria.

Abfraction is when you lose chunks of teeth from grinding or just loss of enamel, although it is usually from bruxism or when you grind your teeth in your sleep.

You can get crowns or caps to help protect teeth that may be too weak or to help them heal but in rare cases, the rot has gotten so bad that it rots under the cap and you eventually lose the tooth.

Alcohol may also affect your teeth because of the high sugar content, but the main cause if from the drying properties which allow cavities to sit and eat away at your teeth.

You may also get periodontitis for plaque build up which causes swollen or red gums, bleeding gums or tender gums, pus from the gum line, and painful chewing. Periodontitis can open a very big door for other diseases to get in.

So in general for your safety take the little amount of time it takes to brush your teeth and brush daily so that you can protect yourself from bad diseases or symptoms that come with not brushing your teeth, you will have a better life and a better dental hygiene.

Service Outcome

Satisfaction with service. Participants reported varying levels of satisfaction with dental service. On a quantitative question, about 30% rated their satisfaction level as either “very dissatisfied” or “dissatisfied.” One participant with Medi-Cal expressed a high level of satisfaction with dental services:

I really like my dentist. She is like an angel. Her office is one of the few accepting patients with Medi-Cal in Koreatown. You don’t know how embarrassing it is to see a doctor with Medi-Cal, but she makes me feel comfortable. It is always a big concern to poor people like me if there is any extra cost for treatment. My dentist always checks the coverage before I ask. She makes sure that there is no unexpected cost at the end. God bless her! [female, 60]

This participant also shared her negative experience related to Medi-Cal in another clinic:

I am diabetic. It was diagnosed about two years ago. When I went to see a cardiac doctor, the nurse who saw my chart said that I should be tested for blood sugar. Then the other nurse said, ‘No, she is Medi-Cal.’ I was badly hurt when I heard that. I don’t deserve to have that simple strip test because I am Medi-Cal. I felt devalued and degraded. I hate going to clinics and showing my Medi-Cal card. [female, 60]

On a quantitative question, more than 36% of the participants reported having negative experiences in dental clinics (e.g., discrimination, unfriendliness, mistreatment, overtreatment), which seemed to contribute to their dissatisfaction with services. Participants particularly expressed a high level of dissatisfaction with cost and care quality. Some participants receiving medical benefits from social insurance programs seemed to have lowered their expectations:

I have no complaints. Everything is fine. I am very grateful for what they offer to me. How can I ask for more? [female, 93]

Areas for improvement. The main improvement that participants wanted to be related to affordability and accessibility:

I wish there are options for dental care that seniors can easily use without worrying about the cost. It would be wonderful if basic dental services is covered. [female, 74]

There are only a few Korean dentists who accept patients with Medi-Cal, and the option is becoming more limited every year. I don’t know what to do if my current doctor says she doesn’t receive Medi-Cal patients any longer. [female, 60]

Another area for improvement relates to patients’ informational and relational needs. Participants wanted to better understand their conditions and be able to make informed decisions:

I have never seen a dentist who is kind enough to explain the conditions and treatment options to patients. Doctors and nurses speak their medical jargon like special codes and ignore me. Even when I ask a question, they don’t respond well. They should respect their patients. [male, 82]

Also, participants noted the need for oral health education:

I realized the importance of oral health when I became old. I should have known it earlier. People should get educated when they are young so that they can build good lifelong habits. I have two grandkids. Every time I see them, I talk about the importance of brushing well. [male, 79]

Discussion

This qualitative study explored the oral health and dental care experiences among older Korean immigrants and identified contextual factors influencing their dental service use. Older Korean immigrants reported many oral health problems such as missing or broken teeth, gum problems, pain, poorly fitted dentures, and dry mouth. These problems negatively impacted various aspects of life, ranging from eating restrictions to low self-confidence. This finding is in line with previous research reporting poor oral health status among older immigrants.8-10 However, despite their poor oral health, there was a lack of perceived need for dental care. The fact that older ethnic minority adults tend to consider oral health care less important than other health care10 and tend to seek dental care only when urgently needed21 may explain this discrepancy. Given that the perceived need for dental care is one of the major driving forces of dental care service use,9,10 it is important to understand the potential mechanisms of the discrepancy and to identify ways to promote awareness of the importance of preventive dental care.

The study findings also identified four specific barriers to dental care services: (1) insurance and finance, (2) language, (3) social support, and (4) knowledge and beliefs. Many participants did not have dental insurance and had a high level of financial burden, and thus were not able to use dental care services despite their needs. These findings are consistent with previous research which identified lack of dental insurance and financial strain as significant barriers to the use and unmet needs of dental care services for older adults.7,9,10 Moreover, a considerable number of the study participants with Medi-Cal were not aware of its dental coverage. Such a lack of knowledge about insurance benefits serves as a barrier by discouraging individuals from using health services.22,23

Limited English proficiency was a barrier because it limited the available service options. Korean immigrants experienced difficulty in communicating with health professionals and thus preferred Korean dentists who shared language and culture. All study participants had, in fact, visited Korean-speaking dentists within the Korean community. Korean-speaking dentists are more available to older Korean immigrants in Los Angeles than in many communities; however, the options for dental care services and the sources for oral health information are still primarily limited to the Korean enclave and not readily available in the broader Los Angeles area.

Due to financial burdens and limited English proficiency, many older Korean immigrants depend on their adult children for support in seeking dental care. However, the older adults’ deep sense of burden and desire for independence served as barriers to care. For example, fear that they would cause concern and impose financial obligations on their adult children prevented many older Korean immigrants from using dental care services. This finding highlights the significant roles of social support and family network for older Korean immigrants relative to dental care. It also provides further insight into the impact of social support mechanisms on the use of dental services and calls for the need to enhance access to formal support (e.g., community organizations and agencies) to reduce the family burden and older individuals’ sense of dependency.

In addition to poor knowledge and beliefs about insurance benefits, participant responses reflected varying levels of knowledge and beliefs about appropriate preventive dental care measures and pessimistic views on dental care based on the belief that poor oral health is a natural process of aging. Consistent with previous research,10,21 they also placed a lower priority on dental care than on other health care and sought dental care services only for curative purposes, rather than preventive purposes. Although these findings warrant further exploration, knowledge and beliefs about oral health and dental care among older Korean immigrants seem culturally embedded and also closely interconnected with the language barrier. That is, older Korean immigrants obtain health information from informal and ethnically homogenous networks due to their limited English proficiency, and such information can be misleading, reinforce cultural norms and beliefs in specific health behaviors, and ultimately lead to inadequate health decisions.22,23

The structural and cultural barriers may also be associated with compromised care quality and patient safety. In fact, about 30% of study participants were dissatisfied with the dental service they had received, and over 36% reported that they had had negative experiences in dental clinics, such as mistreatment or overtreatment. The study identified several approaches for improving dental care use, including affordability, accessibility, and enhancement of oral health literacy through education. Multilateral efforts from diverse stakeholders—such as health policymakers, oral health service providers, and local ethnic community agencies—would be required to proactively address these areas for improvement.

One of the unique study findings was the interconnected nature of the three core categories: oral health needs, service barriers, and service outcomes. Challenges in each category exacerbated challenges in the other two, creating a vicious circle of poor dental care. For example, older Korean immigrants who experience multiple service barriers may experience poor service outcomes due to (1) limited service options, or (2) compromised care quality and aggravated oral health, or (3) a lower level of perceived need for dental care because they are discouraged about using dental care services. Poor service outcomes and a lower level of perceived need for dental care caused by multiple service barriers may then serve as subsequent barriers to service use. Service outcomes and oral health needs are also interconnected in that continued unsatisfactory service outcomes may discourage individuals and lower the level of their perceived needs for dental care, which may lead to aggravated oral health status. Thus, it is critical to understand the mechanisms through which the challenges of the three categories influence one another and to take a comprehensive approach to better address the varied challenges facing older Korean immigrants.

The study has several limitations. First, restricting the sample to older Korean immigrants who live in Los Angeles may limit the generalizability of the study findings. Older Korean immigrants who live in other, smaller Korean communities or who live outside of Korean enclaves may have different experiences than the study participants. Thus, future research should expand the scope of the target population to include diverse geographic locations. Second, the small purposive-based sample may not represent the larger population of older Korean immigrants. Third, despite our research team’s effort to ensure the trustworthiness of the study, each member’s biases and perceptions may have influenced the interpretation of data to some extent.

Despite the limitations, this study has several significant implications for policy and practice to promote optimal oral health and dental care. The discrepancy between the perceived and actual needs for dental care calls for action to raise older Korean immigrants’ awareness and understanding about the significance of preventive dental care. Also, a variety of services and programs that respond to the needs and barriers identified in the study need to be developed. For example, financial burden, lack of awareness of benefits covered by Medi-Cal, and language are major service barriers for some older Korean immigrants; therefore, developing a culturally and linguistically tailored education program about the dental care services covered by Medi-Cal would promote their use of dental care services. Taking a comprehensive and multilateral approach that includes policy-, community-, and individual-level efforts is also critical to better address the interconnected oral health and dental care challenges. By identifying oral health and dental care challenges in the areas of oral health needs, service barriers, and service outcomes, our study not only sheds light on the varied experiences of oral health and dental care among older Korean immigrants but also informs the development of services and programs responsive to the identified needs and barriers.

Traditionally many people regarded a Professional as an individual who dressed appropriately within their working environment, or by simply carried out a skilled task efficiently within their chosen job sector. Although these factors do contribute towards professionalism, there are many more requirements needed to become a competent skilled Dental Care Professional (DCP). To be registered as a Dental Care professional within the UK, a professional-approved qualification with in-depth training must be obtained; along with adhering to standards put in place and to help keep DCPs safe.

The concept of professionalism is sometimes used in the negative- which emphasizes on what is missing from someone’s behavior, with the most minimal ethical standards of a profession, when the person’s conduct is such that it is hard to think of the person acting like a member of that profession at all. (Ozar et al, 2018).

The General Dental Council has put together 9 core principles, which all registered members of the Dental team must adhere to at all times. These guidelines are put in place to guide the DCP on delivering the best possible care safely to patients, along with working within their specific Scope of Practice. Every patient needs to feel they can trust their DCP to make the correct ethical decisions, using a tailored approach that suits their individual needs. Once a registrant has completely gained their professional qualification at dental school; it is essential that they continue their professional development constantly throughout their career. This is to ensure that they stay refreshed with their specific skilled knowledge, and remain up to date with the expectations and care standards that they are required to deliver to every patient.

This essay will discuss the ethical issues which relate to the GDC standard 1:

To Put patients’ interests first whilst focusing on the topic of Mental Health Conditions and their Effects on the Oral Cavity. Principle 1.6 states that You must treat patients fairly, as individuals and without discrimination.

GDC standard 1.4.2 states You must provide patients with treatment that is in their best interests, providing appropriate oral health advice and following clinical guidelines relevant to their situations. You may need to balance their oral health needs with their desired outcomes (General Dental Council, 2013).

Therefore, it is essential that all patients including those with Mental health illnesses are treated with the best adequate care possible, from a Dental Hygienists’ perspective.

How do mental health conditions affect the oral cavity?

There are a variety of dental concerns for those suffering from mental health conditions which include:

Neglect

It is well established and supported by research, that individuals that suffer from Mental Health illnesses are more likely known to avoid making visits to a Dental Care Professional; which results in a neglected oral hygiene regime. Neglected Oral hygiene maintenance and care often lead to Dental Caries and poor Periodontal health.

This was demonstrated in a study of 334,503 individuals. The oral health status of people with anxiety and depressive disorders was recorded, using 19 research papers on depression andor anxiety, and 7 on dental phobiaanxiety= 26 combined. The psychiatric subjects were linked with increased dental caries with DMFT and DMFS scores, as well as increased tooth loss. Panic disorder was linked with periodontal disease.

Anxiety

Dental phobia is a condition that many people encounter. Due to the severity of anxiety felts towards dental care, this results in them not visiting a Dental Care Professional frequently enough, which in turn has a huge impact on oral health and general systemic health (Dental health.org, 2021).

Eating Disorders

People who suffer from eating disorders including bulimia are more at risk of developing tooth erosion, due to the acid attacks produced by the individual vomit. Calcium deficiencies are often present in those with bulimia, resulting in an increased risk of poor tooth health.

Those who are deprived of nutrients, and suffer from anorexia are more susceptible to osteoporosis; which affects the person’s bones and can result in tooth loss, due to the alveolar bones in the jaw becoming compromised and weak (Olliffe, 2020).

Medication

Patients with mental health illnesses will often be taking medication that may result in oral side effects. A lot of antidepressant antipsychotic medications produce unpleasant oral side effects such as Xerostomia (dry mouth), caused by the reduction of salvia.

Brushing actions and medication continued

Bipolar and similar mental health conditions can often result in a person over-brushing their teeth and gingiva too hard; creating tooth surface loss and gingival tissue destruction. Patients with Bipolar are often treated using Lithium medication. Whilst being effective at controlling mental health conditions, lithium does come with some dental side effects. Common oral side effects of taking Lithium include Xerostomia, which stops the soft tissues and teeth from being adequately hydrated and prevents the natural cleansing mechanism from occurring in the oral cavity. Those taking Lithium are more prone to dental disease due to reduced salivary flow, including caries and periodontal disease. Individuals suffering from bipolar are also known to overbrush their teeth resulting in excessive tooth wear and abrasion (Colgate, 2021). It is essential for Dental Care Professionals to be aware of the link between Mental Health and Oral Health.

The BDSH states that there are certain aspects to consider which will have an effect on an individual’s oral health; resulting in poor self-care and accessibility to the use of available health care including visiting oral health providers.

Many factors contribute to the ability to access oral health and including:

• What sort of mental illness, how severe it is, and at what point it is currently at.
• How is the patient’s mood, confidence and self worth at present
• How aware is the patient of their oral health status and oral problems
• Are they aware of their lifestyle and habits which contribute to their own oral health
• What environmental aspects can have an affect on negative self and dental care
• Deprivation area that the patient resides at, which may result in limited availability of health care choices
• Language barriers and cultural beliefs and standards
• Not enough knowledge is provided on accessing the information on Oral health services
• Medication taken that affects the oral cavity ie- Dry mouth Xerostomia
• Lack of knowledge of their own oral care and health care providers including dental care practitioners
• What is the awareness and knowledge, the dental care team has on Mental health illnesses
• The dental care professionals in the local area are not able to provide sufficient dental care (BSDH, 2000).

If either oral health or mental health is compromised in an individual, It is well known that if one is poor, the other will be affected in some form. Both Dental Care Professionals and Mental health care providers will gain prosperity on gathering knowledge on the relations between both; to be able to advise those with mental health conditions to take care of their own personal oral health and regime; which includes those taking certain medications for mental health conditions, along with knowledge of the side effects possible which can directly affect their oral health (Maple dental health, 2018).

Conclusion

Mental health conditions will continue to be an issue that surrounds us daily, as more and more people are being diagnosed with such illnesses. It is important that as Dental care professionals we are trained to effectively deal with a varied amount of oral conditions, which are made worse or exist due to patients’ illnesses. This is supported by the research evidence included above which discusses Psychiatric subjects were linked to increased dental caries on DMFT and DMFS scores, along with increased tooth loss and periodontal disease (Journal of affective disorders). The role of a dental care professional is not only to ensure that oral symptoms andor abnormalities are detected and treated; but equally important, it is to mention that the clinician is competently ensuring that every single patient is treated fairly with integrity and respect, despite what mental health condition they present with.

As a Dental nurse for nearly 10 years, and now as a Dental Hygiene student; I have cared for and treated many patients with a variety of mental health conditions.

It is essential not to stigmatize individuals that present with mental health issues; which has been the case for many years. It is equally important, that every patient is treated as though you wish to be treated. We have to demonstrate compassion, whilst being aware of professional limitations and ensure that the GDC`s standards are followed at all times, whether this is treating and caring for our patients in a general dental practice, hospital, or care home setting.

Oral health is defined as “a state of being free from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing.” (WHO, 2019) Unfortunately, access to oral health care in America is in a crisis and oral health is completely overlooked for most. Through articles and documentaries, I’ve learned about the current state of oral health care in America as well as the importance of oral health for one’s overall health.

The Frontline PBS documentary “Dollar and Dentist” provides a look into the limited world of dental care in America. It examines the long-lasting tension between the need of Americans for dental services and the lack of services available under the current system. The documentary emphasized the maldistribution of dentists in rural communities and its effects on many Americans. Low-income families who are the most vulnerable to oral problems have become the population that is the most neglected. In my opinion, dental care has become a luxury and one that most can’t afford or obtain. Although I was somewhat conscious of the current dental care situation in our country, I was saddened to see how to cooperate chains have turned dental care providers into sales representatives, making unjust decisions based off monetary incentives. It was very unsettling to watch doctors try to provide over-treatment to children. I believe it goes against the ethics and oaths we take when we decide to become healthcare providers. The vulnerable population that lacks of access to oral health care can result in delayed diagnosis, untreated oral diseases and conditions, compromised health status, and even death. An odontogenic infection is an infection that originates within a tooth or in the closely surrounding tissues and can spend through spaces and become increasingly dangerous in patients who are very young.(Bali, Sharma, Gaba, Kaur, & Ghanghas, 2015) Children are extremely vulnerable due to their dependency of a caretaker. The parents of these children typically work numerous hours just to make ends meat and do not have any oral health literacy. Furthermore, they are unable to equip their children with the information and tools need to practice good oral habits. This along with no dental care gives rise to early childhood caries, dental infections, pain, speech impairment, difficulty chewing, sleep disruption, and school absences. Children of the vulnerable population may develop the long-term effects of malocclusion, nutritional problems and dental anxiety of fear.(Bersell, 2017) Oral hygiene habits are developed early in life, it is very important that from day one children create and practice good oral hygiene habits to avoid the many effects of bad oral hygiene.

Dental care in my home country of the Dominican Republic is pretty similar to the one here in the United States. Where there is wealth there are dentists. In more rural areas of the Dominican Republic, you will not be able to encounter a dentist and or dental office. Therefore, poor and lower class don’t receive any dental care and are not educated one bit on oral home care. From my standpoint, since a young child, I’ve visited the dentist regularly for checkups and cleanings. Growing up close to the city I never had an issue with finding dental care which is why I was astonished when I learned that some Americans did not receive dental care because the services were not locally available to them. Furthermore, while discussing this topic with my classmates I learned that in Romania, a country in east central Europe dentistry is cheap but there is no preventive care. My classmate stated when she came to America she had no understanding of what a scaling, root canal or filling was because all they provide in her country are extractions and crowns. My other classmate shared how she is from Nigeria and she has never been to the dentist because in her country dentistry is almost nonexistent. After watching the documentary “Dollar and Dentist,” reading the article “Access to Oral Health Care: A National Crisis and Call for Reform,” and listening to my classmates share their stories and experiences my opinion on access to oral health care has definitely changed. I am now aware how difficult it is for people all over the world to have access to good quality preventive care or any type of oral care at all. I believe oral health is important to everyone’s overall health and should be more prevalent in all countries.

The factors that contribute to problems with access to oral health care are numerous and complex. These include social, cultural, economic, structural, and geographic factors, among others.(National Academies Press, 2011) Solutions to improving the dental care situation in America may be to place dentists in hospitals so that dental professionals are readily available to provide emergency services. Ultimately solving the issue of the maldistribution of dentists would give more Americans a chance to receive oral health care. Dental hygienists can contribute to improving the current dental care situation by lobbying together and gathering evidence to try to change policies to expand the spectrum of responsibility given to dental hygienists. Expanding the scope of care for dental hygienists can help decrease the vulnerable population of oral health.

Oral health literacy has been identified as a major internal barrier and personally, I would like to help break that barrier. I would like to start a blog to help educate our country on how important home care is to help disrupt the bacteria formation in the oral cavity and to help clarify any perceptions and/or misconceptions about preventive dental care. I would also like to inform parents on how they can instill good oral hygiene habits in the lives of their children. Ultimately, I would like to inform and educate everyone about oral health care in hopes that the information can steer someone in the right direction when it comes to oral health choices and potentially save a life.

Although Rome wasn’t built in a day I believe small changes and gestures can help our country rebuild our oral health care system so everyone has access to it. Oral health is not just important for the health of the oral cavity but the body as a whole. Everyone’s life can be improved by having access to oral care and knowledge about oral home care. Oral health care is not a privilege but a right and necessity for everyone and it can’t remain an optional extra in our health service.

The health, well-being and quality of life of human beings depend on good oral health throughout a lifetime, from infancy to adulthood. According to the World Health Organization (2018), oral health diseases such as dental caries (cavities) and periodontal disease, affect many people around the world and they are, for the most part, entirely preventable. Populations most vulnerable to these preventable diseases are youth, older adults, racial and ethnic minorities, individuals with intellectual and developmental disabilities (IDDs) and pregnant women, to name a few. It is important to understand why pregnant women of lower socio-economic status do not receive dental care throughout the entirety of their pregnancy to help develop appropriate interventions.

Oral Health Diseases

During pregnancy, physiological changes and fluctuating hormone levels can negatively affect the oral health of women (Steinberg, Hilton, Iida, & Samelson, 2013). These fluctuations in hormones can lead to an oral health disease called periodontal disease. Periodontal disease is a disease that affects the gums surrounding the teeth. Progression of periodontal disease can oftentimes lead to tooth loss among those affected. Poor pregnancy outcomes associated with periodontal disease are low birth weight, preeclampsia and gestational diabetes mellitus (Corbella et al., 2016; Hartnett et al., 2016; Wu, Chen, & Jiang, 2015).

In addition, the increased risk in periodontal disease is not the only poor oral health outcome pregnant women need to worry about. Tooth decay, due to dental caries, is a common disease that women may experience due to changes that occur during pregnancy. Considered a non-communicable disease by the World Health Organization (2018), tooth decay caused by dental caries is the most common disease affecting people worldwide. It is considered the most common chronic disease in children around the world (Pitts, et al., 2017; U.S. Department of Health and Human Services, 2000). Dental caries are the breakdown of tooth enamel due to bacteria-created acid (Pitts et al., 2017). Enamel is the white part of the tooth that protects against caries. Once the enamel is eaten away by the acid produced by bacteria in the mouth, holes form on the surface of teeth and can be very painful. If caries are left untreated, the infection can occur (Pitts et al., 2017).

Barriers to Accessing Dental Care

Many vulnerable populations may experience barriers to accessing quality and timely dental services due to a lack of insurance, education or being underinsured leading to unaffordable dental procedures. In addition to accessing dental services, vulnerable populations may also experience health disparities. Pregnant women are an example of a vulnerable population that may experience worse health outcomes due to being pregnant or based on their socio-economic status. According to the U.S. Surgeon General, preventative care for oral health during pregnancy should be considered a priority for improved health outcomes for both mother and child. (U.S. Department of Health and Human Services, 2000). Preventative care includes visiting the dentist at least twice a year and continuing regularly scheduled dental procedures as they are safe to perform (The American College of Obstetricians and Gynecologists, 2013). Regular dental procedures can include fillings, crowns and root canals. X-rays are also safe during pregnancy with proper use of equipment.

A study conducted by Azofeifa, Yeung, Alverson, and Beltran-Aguilar (2016), pregnant women experience a higher rate of dental caries than women who were not currently pregnant. This may be due to some dentists not wanting to treat pregnant women due to liability issues or obstetrician-gynecologists not stressing the importance of or educating about oral health during pregnancy, however, further research would be needed (Hartnett et al., 2016; National Maternal and Child Oral Health Policy Center, 2012). A study done by Marchi, Fisher-Owens, Weintraub, Yu, and Braveman (2010) found that a lack of a perceived need of dental care was also a barrier for pregnant women, specifically, accessing dental care. In addition to a lack of a perceived need of dental care during pregnancy, cultural beliefs might also limit a woman’s ability to receive dental care (Abiola et al., 2011; Ibrahim, Mudawi, & Ghandour, 2017). Another barrier to receiving dental care during pregnancy is the belief that procedures are unsafe (Marchi et al., 2010).

Tooth decay may not only cause someone physical pain, it may also lower the quality of life, especially of individuals of vulnerable populations like pregnant women. During pregnancy, women’s perceptions of themselves are lower compared to before they got pregnant (Geevarghese, Baskaradoss, & Sarma, 2017; Haas et al., 2005; McKee, Cunningham, Jankowski, & Zayas, 2001).

Health Belief Model

In order to understand why pregnant women do not seek dental care during pregnancy, the health belief model can be used to explain why. The health belief model (HBM) is a theory that can be used to help public health practitioners in explaining why or why not individuals choose to use health services (McKenzie, Neiger, & Thackeray, 2009, p. 173; Rosenstock, 1966). This theory can help explain why some women do not visit the dentist during pregnancy. For pregnant women, the HBM theorizes that if women feel susceptible to periodontal disease, they will seek dental care. Oral health education during pregnancy by obstetrician-gynecologists or dentists is a way to increase awareness of the importance of visiting the dentist during pregnancy. By a lack of information about the importance or oral health during pregnancy and how it may harm the child, the perception of the seriousness of oral health diseases is decreased. They will also seek care if they understand the severity of periodontal disease and its effects on their child. Education on the importance of visiting the dentist during pregnancy may increase a mother’s perceived severity. If pregnant women are aware that oral health diseases are entirely preventable, they might realize the benefits of receiving dental care during pregnancy. However, going to the dentist can be costly if an individual does not have dental insurance or if the dentist feels uncomfortable treating pregnant women. If a pregnant woman feels that the benefits outweigh the barriers to receiving dental care, this might increase the likelihood of taking action to prevent poor health outcomes for the mother and baby. Through creating awareness and removal of barriers, pregnant women can seek dental services and prevent adverse health outcomes due to oral health diseases.

Title of Essay: “Healthy mouth means happy life”. Discuss the effects of dental disease on the welfare of domestic cats. Include in your discussion the causes of dental disease in cats and how we, as owners, can contribute to promoting oral health and welfare in our pet felines.

Dental care involves the cleaning and maintaining of the teeth, gums and tongue. To begin with, dental health is one of the most neglected health issues in animals. Most people believe that animals can look after their own teeth and so, are not inclined to clean the teeth and surrounding areas themselves. Most animals also make it very difficult to access their teeth, discouraging owners from attempting to clean them. Unless the serious disease is identified in animals by veterinarians, most diseases go unnoticed due to the animal’s ability to mask the pain or illness related to the issue with dental health.

Dental health must be properly managed in animals to avoid any discomfort. Not looking after an animal’s dental health can lead to a lot of problems including trouble eating, tooth loss and pain. It is necessary to look after any pet’s dental health. In household cats, dental issues can be hard to distinguish as cats are known to hide any pain. As a result, dental problems can be hard to notice, however, regular trips to the veterinary clinic can avoid most of these problems. A basic understanding of dental and oral anatomy can also help to notice any unusual things in your animals’ mouths. The first and most basic step in attempting to improve dental care in a household is convincing owners on the devastating effects of ignoring dental health. I do not think many owners realize that serious dental problems can lead to many diseases, not just in the mouth but also in the stomach (Fraser Hale, 2010).

In this essay, I will discuss the causes of dental disease and how we can eliminate diseases present in domestic cats and prevent any other diseases from developing. I will explain the importance of dental care in animals and how it affects domestic cats in detail. I aim to suggest ways to convince domestic cat owners how to make sure their pets’ teeth are well looked after. I would like to establish the horrifying effects on owners and their pets if dental care is not taken into consideration when looking after your animals’ health.

Dental health is important in all animals, but we will discuss dental importance in cats. Domestic cats under the Animal Welfare Act are “protected animals”. Under this act, “creatures in the possession or under the control of a human being” must be looked after in a manner that safeguards it welfare (Animal Health and Welfare Act, 2013). Any neglect or failure to look after the animal’s welfare is an offense under this act. Legally, owning any animal means you are responsible for the animal itself and its welfare. This includes ensuring it has food, water and adequate shelter as well as taking all precautions to ensure no pain or suffering comes of the animal due to its health, which includes dental healthcare. It is illegal to fail to provide the correct medication for your animal when it happens to fall ill. Dental disease is a result of an owner failing to obtain proper dental care, making it illegal under this act. The penalties of this act are severe and there is no way of getting out of them. Buying a pet is taking on the responsibility of this animal, if people can’t look after animals properly, they shouldn’t own them.

Dental care is so important in all animals, not just cats. Like humans, teeth and gums are necessary to chew food to allow us to obtain the nutrients we need. Sore and bleeding gums will discourage animals from eating as its too painful. Without the necessary treatment, weight loss may become a problem as well as diseases. This is obviously a result of not obtaining a balanced diet. Nutrition is important in all animals. In cats, not eating properly results in serious diseases such as kidney disease, cat flu or hyperthyroidism. These diseases can be triggered by poor nutrition. A trip to the veterinarian for a dental cleaning to ensure they don’t develop these diseases because of their teeth would eliminate poor dental care as a cause. This would help the veterinarian to quickly move on to other possible causes of such diseases. Cats have a delicate immune system and any diseases that weaken their immune system could become fatal. Therefore, dental care is very important.

Adult cats, if they have all teeth, should have 30 teeth all together. They should have twelve incisors, four canines, ten pre-molars, and 4 molars. Fourteen of these are on the bottom and sixteen are on the top. At around three or four months of age, these teeth will have emerged.

Kittens have 26 teeth but by four months of age, cats should have their full set of adult teeth. Cats’ gums should be light pink in color if they are healthy gums. Red, bright pink or white gums is an indication of gum diseases such as gingivitis.

Other symptoms of dental diseases in cats include them grooming themselves less or not at all, bad breath or drooling (JaneA Kelly, 2018). Symptoms can be hard to recognize in domestic cats who live outside but it is important to keep an eye on your cat, just in case there is a problem.

A major symptom that something is wrong with your domestic cat is a change in behavior. Cats tend to be more at ease when they’re not in pain, as any animal or human is. Any increased sensitivity to touch if often related to pain. Many people assume scratching or biting is related to anger but if your cat doesn’t usually behave like that, make sure to take a trip to the veterinarian. It has been proven that cats and dogs have pain thresholds that are very similar to humans (Fraser Hale, 2010). Domestic cats often hide their pain and continue to eat, even though there is chronic pain whilst chewing their food, due to their poor dental care. A domestic cat, or any cat would be much happier in life with no pain in their teeth or gums.

The causes of poor dental health are numerous. Dental disease is one of the commonest diseases veterinarians see in animals (Jan Bellows, VCA Hospitals, 2013). The main cause of cat dental issues is, unfortunately, human error. Cat owners are responsible for looking after their animals and neglecting their health causes disease. Education on why dental health, especially in Ireland should be made more aware. A natural cause of dental problems in domestic cats is natural tooth alignment or misalignment. This is when the cat’s bite does not fit the way it is meant to. The top and bottom jaw do not fit into each other properly. This problem might not be obvious in kittens but as they grow and their teeth develop, the problem may worsen and become obvious to veterinarians and cat owners. Dental diseases such as periodontal and gingivitis are developed as it’s the body’s immune response to the plaque build-up in a cat’s mouth over time.

The two main diseases related to plaque build-up and lack of dental care include gingivitis, periodontal and stomatitis. These can have very serious effects on the cat’s teeth, gums and behavior. The commonest disease seen in veterinarian practices is periodontal disease ( Jessica Vogelsang, DVM, 2019 ). By the age of 3, most cats seem to show signs of periodontal disease or have it already. The cause of this disease developing is a build-up of plaque and tartar on the cat’s teeth. Similar to humans, not brushing cats’ teeth can lead to dental diseases such as this one. The filthy plaque that has built up around the teeth spreads into the gums causing inflamed gums, severe pain when eating and in some cases tooth loss. Plaque develops as bacteria are present on the teeth and it is these bacteria that work their way into the gums as well as destroy surrounding tissue (VetStreet, 2014). When cats with periodontal disease are brought into practice, the first step is a thorough dental clean. Antibiotics for the gums, crown restoration or root canal procedures can be done. If these cannot save the tooth, they would have to be removed. Even though the cat would be missing teeth at least its mouth and gums wouldn’t be sore to eat.

Gingivitis is also a very commonly seen dental disease in cats. Gingivitis is a part of periodontal disease but without any bit of tooth loss. It is a disease that affects the gums, causing inflammation, redness and pain. This disease is also caused by a build-up of plaque where the bacteria migrate into the gums, causing infection. The pathogens associated with this disease attack cells that protect the gums from the teeth. When it damages these, the pathogens can access the connective tissue underneath, causing the cats immune response to activating inflammation as a response. Gingivitis does not just develop because of poor dental disease but also because of Feline Leukaemia Virus, severe kidney diseases and many other diseases (Dr. Bruce Kornreich, 2017). Signs of gingivitis include bleeding, sore, swollen gums as well as drooling and bad breath. Prevention of gingivitis includes brushing your cats’ teeth using specified cat toothpaste or if they already have it, a course of antibiotics. Although bad breath, red gums and refusal to eat could sound like dental disease, we must consider it could be cancer. It can affect any part of the mouth and develops quickly, often being in the advanced stages before it is noticed.

Dental diseases need to be taken seriously and the advice veterinarians give their clients needs to be carried out as instructed. Unfortunately, in Ireland and in many countries, feline dental disease isn’t taken very seriously.

In my opinion, feline dental diseases are not taken seriously in Ireland. The first step to fixing this is making sure owners are informed of the effects it has on cats. Owners who have experienced a bad case of, for example, periodontal disease can have devasting effects. Tooth loss is if the disease has affected them so badly before they got to the veterinarian’s practice but refusal to eat can become more serious. Owners who fail to notice their cat no longer eats properly can lead to drastic weight loss and low immunity. To make sure people know how serious dental diseases can be, I would suggest having information leaflets left in consulting and waiting rooms in practices with photos included of the devasting effects dental diseases can have on cats. If they are informed of the results of neglecting dental care, they might take the initiative to do the dental care work before it gets too serious. Veterinarians doing dental check-ups when cats come in to the practice for an unrelated disease can become efficient. They can inform the owner politely, show them the effects of leaving it untreated and prescribe a suitable method to help cure it. Offering dental check-ups for free will encourage more people to say yes and help reduce the number of cats who develop dental-related diseases. According to studies, 50 and 90% of cats older than four years of age suffer from some form of dental disease (Dr. Bruce Kornreich, 2017).

It is common knowledge that people often listen to celebrities and other people who are capable of influencing others. Famous veterinarians such as Noel Fitzpatrick could influence cat owners by telling them the serious effects of dental disease. The most important thing to remember when trying to influence people is remembering not to insult them. People who get offended when you’re trying to explain the lack of dental care often to not follow up on your advice. A good way to advise people without being too personal is advertising. It would get the idea and importance of dental care across easily. Advertising is the non-paid, non-personal communication of information about a product through various media (William Murphy, 21st Century Business, 2016). With dental care being such a big problem and people not knowing about it, I think an informative advertising technique should be used. Through the internet to get the message across to young people, the television for people of all ages or newspapers, leaflets or magazines. Advertising is a good way of getting the message across. Pet owners could consult with veterinarians on the main information that needs to be put across and put an ad in the local radio or local newspaper.

Cat owners, once they are informed of the awful effects it can have and how much pain it causes their pets, I think they would act upon it. Veterinarians can offer the first dental clean for free and give a free toothpaste or toothbrush for the cat to encourage cat owners to continue the cleaning process. Cat owners inform others of how a daily dental clean at home can massively improve the health of a cat’s teeth. In Ireland, word of mouth is the fastest way news gets around anyway.

To conclude, I think that over time and a lot of work into dental care, it will become more aware in Ireland. The welfare of domestic cats is so important and should be taken very seriously and should be the most important thing concerning cats. Once cat owners know how important it is, I think the rate of periodontal diseases, gingivitis, etc. will decrease. Cat owners love their cats and would do anything to keep them happy. Keeping cats’ teeth will improve their quality of life by enabling them to eat properly and enjoy a pain-free life. Something so small as not brushing their teeth can lead to so many problems and pain. Some owners may not be able to access their cats’ mouths due to the cat being feisty but there are other methods of cleaning cats’ teeth without using a toothbrush. Dental gels are easily used to rid cats’ mouths of bacteria and plaque and are the next best thing to brush (Maris Munkevics, Signe Munkevica, 2014).

A smile can speak volumes and is a universal language in not only the human race but can be seen in some animals as well – chimpanzees, cats, and dogs amongst a few. When words fail, a simple smile can create and exemplify feelings of joy, happiness, confidence, care, and safety. A smile also has the simple power to connect people in unspoken deeper ways. So, what happens when someone cannot smile? Or what if someone has so much insurmountable pain in their mouth, it affects their daily life? Or what if someone does not have the funds to afford quality dental care? George Cuvier, a 19th-century naturalist once said: “Show me your teeth, and I will tell you who you are”.

Just as the power of a healthy mouth and smile can radiate positive qualities, the opposite is true of frowning and poor dental care. Poor dental hygiene in America today is not spoken about or corrected as it should be. Everything starts with the mouth – the three most important factors being communication, quality of life, and diet and nutrition. It is imperative that we began to stop compartmentalizing the mouth from the rest of the body. By changing the way, we look at dental care and hygiene, educating our youth, and making changes in accessibility, we then can be able to change the course of people’s overall health and well-being.

Bad Teeth

Unlike other medical conditions, people are held personally accountable for their poor dentition. Poor dental hygiene and the state of one’s teeth often become somewhat of an indication of the adversities of their life. We are living in a continuous and ongoing ‘silent epidemic’ of oral disease stated in a report by David Satcher, the U.S. Surgeon General. “Just as we now understand that nature and nurture are inextricably linked, and mind and body are both expressions of our human biology, so, too, we must recognize that oral health and general health are inseparable”. As America’s deplorable dental care continues, we must continue to research, correct, and educate for the very essence of human connection and life.

Teeth can be considered a history book for developmental high points and environmental changes. The whole history of the human being is behind the smile and inside the oral cavity. With intertwined dental history per person, it quickly can infiltrate the rest of the human body connection. Bad teeth are also to be considered a window into overall health and well-being. How so? According to a publication by the World Health Organization, “Severe caries detracts from children’s quality of life: they experience pain, discomfort, disfigurement, acute and chronic infections, and eating and sleep disruption as well as a higher risk of hospitalization, high treatment costs and loss of school days with the consequently diminished ability to learn. Caries affects nutrition, growth, and weight gain. Children of three years of age with nursing caries weighed about 1 kg less than control children because toothache and infection alter eating and sleeping habits, dietary intake, and metabolic processes. Disturbed sleep affects glucosteroid production. In addition, there is suppression of hemoglobin from depressed erythrocyte production” (Sheiham, 2011). With this study, we can see that our youth are a prime target for the development of healthy dentition. Unfortunately, educating our youth about the effects of poor dental hygiene is not a prime subject in our schools.

In our adult population in America, you will see a parallel universe of chronic diseases in both the body and the mouth. Chronic diseases such as obesity, diabetes, and caries are increasing in numbers, especially in our areas where inequalities are seen most. A medical complication that is clinically linked is a condition known as Ludwig’s angina. Ludwig’s angina is an acute bacterial infection of the mouth and throat with progression deep within the neck. This is usually caused by a tooth abscess or infection. In a journal article from the AJN, Donna Cohill stated: “50 years ago patients with Ludwig’s angina had a high morbidity and high mortality rate. But the incidence of the disease has decreased significantly because of antibiotic therapy, improved oral hygiene, and preventative dentistry” (Cohill, 2002). The most common medical factors of Ludwig’s angina are poor oral hygiene. With this study, we see that oral hygiene can prevent deadly, painful diseases. Unfortunately, we still live in a nation where a lot of people do not have access to antibiotic therapy, proper dental hygiene education, and preventative dentistry.

Inequality

Just as access to affordable healthcare is divided among classes and races, so is dental care. There are numerous barriers and roadblocks for these populations in obtaining affordable, quality health care, and dental care. Lack of dental coverage and the rising cost of care continue to add to the inconsistencies in obtaining proper oral health. People who lack medical insurance surely will be lacking dental insurance.

Societal income is considered to be a primary factor in establishing differences between social groups. Income has a lot to do with obtaining proper dental hygiene. Because poor dental hygiene plays a large part in psychological stability, those with poor oral health are likely to be affected by self-esteem issues, relationships, and emotional permanence. In a study by the ADA, “respondents from counties with higher levels of income inequality reported experiencing social and functional problems related to their mouth and teeth more often than did those from counties with less income inequality” (Moeller, Jamie et al., 2017).

Changing Oral Health in America

Educating our youth on the importance of dental hygiene at a young age in schools across America would be the first proactive approach to change the future of dental hygiene. While this is not the only factor in poor oral hygiene, it is a great road to embark upon for better societal oral health. A way to make this possible is by administering a simple solution like fluoride varnish in our schools. Fluoride varnish can be administered by a school nurse. Fluoride varnish is a highly concentrated form of fluoride that is applied to the tooth’s surface by a dentist, auxiliary, or other health professionals. It is not permanent but is applied to the enamel or dentin to prevent caries (decay), remineralize the tooth surface, and treat hypersensitivity (Robinson, 2017).

A journal article from Public Health Nursing states: “Fifty‐five percent of children have dental caries by age 8. The majority of these children are nonwhite and poor. Caries could be decreased by 40% if fluoride varnish application started with tooth eruption” (Gnaedinger, 2018). With this information, we can gather that if school nurses were allowed to apply fluoride varnish, 40% of caries can be prevented in children if they are unable to access proper dental care at home.

Conclusion

Because losing teeth and having poor dental health is considered to be an impairment or disability by definition, we must cross the historical bridge where the oral cavity is no longer dissociative to the rest of the body. Oral disorders contribute to emotional and psychosocial barriers. We need to improve dental conditions in our youth and areas of inequality, and if not, we continue to bridge the gap between people through smiles.