Smoking cessation - the role of the dental team implications for the Caribbean [abstract]

There is increasing awareness that cigarette smoking not only threatens systemic health but also compromises oral health. For example, smoking can result in staining of teeth, halitosis (bad breath), altered salivary flow, predisposition to chronic and acute periodontal disease and oral candidosis, delayed wound healing, failure of dental implants, oral mucosal lesions, oral precancer and cancer. Although data from the United Kingdom show a reduction in the prevalence of smoking since the 1960s, there is an upward trend of smoking among young adults, particularly teenage girls. There are no comparable data for the Caribbean but it is plausible to assume a similar trend may exist, suggesting the need for primary prevention strategies. The dental team often treats patients in a primary care setting and, apart from an important role in early detection of smoking-related oral conditions, may also be well placed to aid in preventive strategies through the implementation of chair-side smoking cessation programmes. These programmes are based on the 4-As strategy: Ask, Advise, Assist, Arrange, and have been recently developed specifically for the dental team. There should also be close collaboration between the dental team and other primary health care professionals to improve health promotion strategies aimed at reducing the prevalence of smoking. Dental health professionals in the Caribbean must be made aware of smoking cessation programmes for their patients and research into their effectiveness, in a Caribbean population, is required. (AU)

The driving forces behind oral education/promotion activities among Jamaican dental auxiliaries [abstract]

OBJECTIVE: To determine the factors which influence decisions relating to oral health education/promotion activities by dental auxiliaries. METHOD: Fifty per cent of the dental auxiliaries in the Ministry of Health's Schools Dental Health Programme islandwide were systematically selected for completion of a questionnaire on oral health education/promotion. Regional Dental Coordinators also acted as key formants in assessing dental health education/promotion activities. RESULTS: A significant number of auxiliaries (94.7 percent, p<0.03) thought dental health education was an integral part of public health practice. Numerical targets set by the Ministry of Health were more a driving force than were the special needs of children in carrying out oral health education/promotion activities. The use of the lecture method supported by visual aids when conducting sessions was directly related to the availability of resources for carrying out such sessions. The staff was more likely to use the lecture method in pre- and primary schools (p= 0.003). Oral health promotional intervention procedures such as prophylaxis were carried out by a significant number (96.8 percent) of nurses. Atruamatic restorative treatment (ART) 67 percent, sealant 55.6 percent and preventive resin restoration (PRR) 48.4 percent were also done. Lack of material and equipment was the most common reason reported by these persons who were not carrying out ART, sealant, PRR procedures (45 percent, 96.6 percent, 71 percent respectively). CONCLUSIONS: Numerical targets and availability of educational material were the major driving forces for oral health education/promotion in this group. Emphasis on the utilization of other oral health promotion interventions, however, is vital to the maintenance of a reduced decayed, missing and filled teeth (DMFT) index in Jamaica. (AU)

Oral health status of 12 year old children in St. Lucia and its association with oral health knowledge, attitudes and practices

OBJECTIVE: This study was carried out in St. Lucia, one of the islands of the eastern Caribbean. The island's population of 150,000 persons is relatively young, with 45 percent under the age of twenty years. The study sought to determine the oral health status of 12-year-old children and its association with oral health knowledge, attitudes and practices. METHODS: A cross-sectional survey was undertaken. Four schools (two rural and two urban) were randomly selected from 14 schools in the north of the island. Simple random sampling was used to select 97 students aged 12 years (15 percent of the school population). Trained dental personnel performed a dental examination and recorded the students' decayed, missing or filled teeth (DMFT) status. The principal investigator (SA) administered a structured questionnaire as well as performed the oral examinations. World Health Organization (WHO) guidelines for DMFT surveys were adhered to. The data were collected in July 2000 and analysed using SPSS, version 9. RESULTS: The DMFT level of the students was 2.0, which by WHO standards is low. This compares quite favourably with a 1997 study when the DMFT level identified in an island-wide study was 6.0. It should be noted, however, that 65.3 percent of children had 1 to 7 decayed teeth, 8.2 percent had 1 to 4 missing teeth, with only 9.2 percent have 1 to 2 filled teeth, indicating the need for access to routine dental examination and treatment. Knowledge and practice levels were generally good, which may explain the low DMFT level. CONCLUSION: Dental health education is currently integrated into the school curriculum and is provided by teachers. This would seem to be an effective avenue for dental health education. However, it needs to be supported by increased access to rutine examination and treatment by dental health personnel. Proper planning or oral health education programmes that include oral health education and behaviour modification, along with public health measures such as salt fluoridation, would contribute to further reducing the incidence of oral diseases. (Au)

Oral Health related behaviours of a Caribbean group living in South London

According to the 1991 census there are approximately 3 million people from minority ethnic groups residing in England and Wales, which constitutes 6 percent of the total population. The Black Caribbean group are the second largest ethnic group living in England and Wales today, however there is little dental research aimed towards this group when compared to other ethnic groups. It is essential to gain an understanding in the way ethnic groups live and behave as all are inherently different and therefore can not be seen as homogenous, especially when planning services and implementing policy. This piece of research aimed to look at a number of oral health related practices of Caribbean groups living in the South London area in order to gain an understanding and insight into this particular group. Community groups were used as a starting point to gain access. The method of data collection used was quantitative. Group leaders were willing to participate once the aims of the research had been explained. The majority of the sample, 64.7 percent cleaned their teeth twice a day. There was an even split between those who regularly attended the dentist, 23 percent and those who only attended when in pain, 25 percent. When asked "where they last went for treatment in the UK." 60 percent said they went to an N.H.S dentist, 16 percent reported "never" attending the dentist. The majority of respondents had not experienced any problems with their teeth in the last month, however bleeding gums was reported most frequently in this particular ethnic group. When asked if the respondents were "satisfied" or "not satisfied" with their teeth, 60 percent felt satisfied. Concern relating to dissatisfaction was attached to colour, fillings and size of teeth. The research points to areas of concern amongst this ethnic group. Despite claiming to clean their teeth on a regular basis their dental attendance was very poor, only attending when in pain. Therefore oral hygiene appeared to be high but did not match their attendance patterns. Irregular attendance could be due to factors such as access and lack of information. It is apparent that research of this nature is essential in order to gain a clearer understanding of attitudes and behaviour of different ethnic groups. (AU)

AIDS/Hepatitis, and tuberculosis: implications for the dentist and dental profession

Dentists worlwide treat and manage patients with a variety of oral and systemic complaints. Bacterial fungal and viral infections are commonly seen in dentist practice. Although primarily sexually transmissible, serious diseases such as hepatitis B, herpes, HIV/AIDS and tuberculosis are the major infections for which the dentist must reduce or eliminate the risk of transmission. The best approach to minimize cross-infection to, or from, a patient or other health care worker (HCW) is to use "Universal Precautions" that is, to treat every patient as if they were a carriers of some infection. However, unlike infection control strategies of developed countries, in developing countries these precautions may need to be modified to match the socioeconomic constraints of the region. Governments and HCWs should work together to make vaccinations against hepatitis B a national priority, and improve the education of patients and colleages concerning the risks from all STDs including HIV/AIDS, hepatitis B and tuberculosis. (AU)

Dental nurses in Trinidad and Tobago

The dental nurse training program in Trinidad and Tobago has made a substantial improvement in the dental operator to population ratio in the islands over the last 10 years. Nevertheless, the 66 dental nurses employed by the Government Dental Service are too few and are unevenly distributed both geographically and in relation to the child population. Further training of dental nurses, to expand the workforce, must be considered, taking into account the priorities for spending in the health care sector. The dental nurses play an important role in improving oral health education to children and pregnant women. An ungoing program of continuing education would help to ensure that their knowledge and skills are kept up to date. Some of the dental nurses encounter problems in their work which, if solved, could improve their efficiency and job satisfaction. These problems include maintenance and supply of equipment and materials. There is also scope for the dental nurse, dentist, and dental assistant to improve their teamwork. There is no doubt that the dental nurses training program has had a big impact on oral health services in Trinidad and Tobago, and expansion of this program is to be recommended. (AU)

An assessment of the level of dental knowledge and practices among sixth graders of two urban primary schools in Jamaica and Aruba

A study was conducted to assess the level of dental knowledge, the source of dental information and practices among sixth graders in Aruba and compare it to their counterparts in Jamaica, in the months of March and April 1988. The study was aimed at obtaining baseline data on dental knowledge and practices of school children in Aruba, which will assist in the planning of a dental health education programme for all the primary schools in Aruba. Dental health education is provided on a regular basis by the dental nurses in Jamaica. In Aruba, dental health education is provided by the teachers in primary school but this information is sporadic and not standardized. There is no significant difference between the level of dental knowledge of the two samples. Although both samples had adequate knowledge of dental care, this certainly could be improved. The brushing technique most often used is the same for both samples. A higher percentage of the Jamaican students had visited a dentist or dental nurse during 1987 than the Aruban students but for both samples the figures were low (AU)