Healthy smiles forever
Doctors have come to the conclusion that the mouth is both the cause and reflection of an individual’s health and well-being – of course, you must throw in some consideration for genetic predisposition, behavioural inclinations and diet patterns as well.
What you put in your mouth and how orally hygienic you are, is bound to show up in public, when you smile, whether you like it or not.
“If the eyes are the window to one’s soul, perhaps one can say the mouth is the gateway to one’s health and well-being” said the Health Ministry director-general Tan Sri Dr Mohd Ismail Merican in his opening speech at the 13th FDI-MDA Scientific Convention & Trade Exhibition, in February.
How true that is!
In Malaysia, national concern for oral health of the younger generation has led to the creation of community-specific initiatives in the form of outreach programmes and incremental dental care programmes in schools, to help fight oral “decay”, literally, among our society’s most vulnerable.
With a view that habits are nurtured from young (and they are hard to change), the oral health services of the Health Ministry has made oral healthcare among schoolchildren its ultimate mission.
In 2005, almost 90% of primary schoolchildren and about 59% of secondary schoolchildren were rendered “orally fit”.
However, despite this high coverage, there is much to lament pertaining to the oral health of the youngest segment of our population.
A snapshot of the oral health status among five-year-olds in 2005
Data from a nationwide survey in 2005 on 16,192 five-year-olds in kindergartens showed more than 75% had dental caries.
Although the experience was almost similar by gender, there was a disparity by location. Children in rural areas are often worse off than those in urban dwellings.
If one were to examine 100 preschool children in Kuala Lumpur, an estimated 52 would have dental caries, but sadly, 96 would be affected, in the states like Terengganu and Kelantan.
Oral health among five-year-olds remains poor when compared to data of the first baseline survey of five-year-olds in 1995. The average Malaysian five-year-old has more than five out of 20 “baby” teeth affected by dental caries – a minimal improvement from figures found 10 years ago.
More than a quarter of these children have 10 or more of their 20 infant teeth affected by caries, making them prime candidates for further dental deterioration.
Improving the oral health of preschool children: a universal issue
Having unhealthy chomppers among five-year-olds is far from being a myopic issue in Malaysia.
Findings from other countries show disparity in dental health and treatment among the minority, the poor, as well as those who are socially disadvantaged in other ways, prompting the US Surgeon General in 2004 to coin oral diseases among children as a “‘silent epidemic’ because it is an enormous, though largely unrecognised, problem . . . an infectious, progressive, multi-factoral diet-dependent disease, with significant behavioural component, which impacts a significant percentage of the population . . .
“As oral diseases are almost entirely preventable, the scenario thus becomes an aspect of wellness that holds severe gravity during one’s infancy and childhood stages.”
In Malaysia, oral health programmes for preschool children are focused around themes of “awareness promotion” and “disease prevention” within the confines of the preschool institution. The primary purpose is to introduce the importance of proper personal oral hygiene habits at an early age, within a familiar and friendly environment.
This mode of early exposure, though perhaps, indefensibly places great stress on pre-school educators to conduct toothbrushing drills and make decisions on healthy food options in school, however, needs parental involvement for better synergy and effective results.
Having parents and dental personnel as good role models, combined with effective pedagogical skills of teachers, can never be over emphasised in the course of carrying out effective oral healthcare programmes by the Ministry – this is, in a way, everyone’s responsibility.
Considering new breakthroughs in atraumatic treatment modalities, the Ministry has, for years, worked towards expanding oral health services – with special emphasis on early diagnosis and treatment of dental caries – via an outreach concept to the gates of the preschool institution.
However, in spite of such targeted oral healthcare strategies, families often fail to bring their children to designated clinics for proper dental evaluation and subsequent treatment, especially when it comes to medically compromised children.
Recent findings show the destruction of gingivae (gums) in diabetic children, who are as young as six years old, marking the onset of periodontal illness at an age earlier than once thought possible.
Ironically, it is often medically compromised children who face dental neglect, due to other more “pressing” health concerns. The problem is one of conflicting concurrent needs with parents of such children often perceiving oral healthcare as of a “lesser” priority.
Early childhood caries (ECC)
Beware: there is a form of childhood caries that is even more severe than the common tooth decay that comes with the moniker – Early Childhood Caries (ECC). It is a type of childhood caries that is rampant and not self-limiting and requires professional intervention.
But given the trend of parental disregard, an unfortunate pattern of delay in seeking treatment exists, which leads to a worsening of the child’s condition and complicates the necessary treatment procedure. Coupled with diminishing dental expertise, the problems spirals into “ignorant bliss” within the population.
The most common immediate consequence of untreated dental caries is pain. In spite of recognition that dental pain is typical and with possibly serious outcomes, there has been limited research on dental pain among children.
A child may endure dental pain for days, even weeks, with significant impact on daily activities such as eating, sleeping and playing – without the knowledge of adults.
Hence, such pain adds to the constellation of other burdens faced by those who are disadvantaged or medically compromised.
Inevitably, the luxury of other options does not exist in cases of advanced caries. The child’s cycle of dental problems perpetuates with possibilities of future orthodontic problems if his or her posterior teeth are removed.
Therefore, children with ECC are likely to face the continuous vicious cycle of oral health problems in their lifetime. A recent report from one of the few longitudinal studies on oral health indicates that poor oral health in one’s early years, in addition to low socioeconomic status, is a predictor of poor oral health in adulthood. Therefore oral health inequalities in one’s early years are likely to persist through the later years.
The issue of dental caries and dental pain needs to be considered from a larger perspective of disparity. The consequence of such diseases falls more heavily on the poor and the disadvantaged, making such children lag behind more acutely in achieving parity in many aspects of life, compared to their privileged counterparts who live within the higher strata of our society.
What’s your call?
We have the knowledge, skills and resources to eradicate many diseases yet our most helpless young are still subject to dental woes and pain.
Therefore, the noble intentions of obliterating dental pain has to be translated into a system that provides consistent and comprehensive oral healthcare to those who need it the most – our children.
In the eyes of the oral health services of the Health Ministry, it’s not only about the provision of desired oral health services, but more importantly, the propagation of awareness and knowledge among parents and childcare providers.
Perhaps, it is timely to look into the real life conditions of the disadvantaged to truly understand their plight and their interaction with the oral healthcare system of our country.
With technological advances in dental materials and the advent of atraumatic treatment procedures, current and future oral health services carried out by the Ministry shall focus more on formalised mechanisms of oral healthcare of preschool children.
Motivating mothers on caries prevention
Dissemination of messages usually targets mothers as agents of change. However, much of such efforts have revolved around orthodox advice-giving sessions by oral healthcare personnel along with the distribution of pamphlets and posters as well as attention-grabbing media campaigns.
However, the effectiveness of such approaches have come under question, which has lead to ongoing work to discover other ways in keeping mothers focused on their child’s oral health.
Findings of a study demonstrates that high consumption of carbonated soft drinks among the young is a risk indicator for dental caries in their deciduous teeth and should be discouraged – which very much remains a task that requires parental discretion.
Given that a can of soft drink contains anything from 8 to 10 teaspoons of sugar, children who display high consumption patterns will face significantly higher dental caries experiences than those who drink milk, water or fruit juices.
So what do you say?
Moms...
- Try not to add sugary stuff to your child’s drink
- Clean your baby’s teeth as soon as they appear. Cleaning can be done with a soft toothbrush, face cloth or towel
- For children below six, use a very small amount (nothing more than the size of a pea) of fluoride toothpaste on the toothbrush. You can also smear the toothpaste on the toothbrush
- Hold your baby when you feed him and lay your baby down when he or she sleeps
- Give baby water, rather than milk or juice, when he wakes up
- Limit the time your baby spends sipping and snacking, because the longer he does this, the greater chance of tooth decay
- Try to use a cup when you are giving drinks
- Choose healthy snacks like fruits and vegetables in between meals
- Bring your child to a dentist for check up twice a year
