Oral and dental conditions presenting to medical practitioners in Trinidad and Tobago.

OBJECTIVES: To describe the type and frequency of oral and dental conditions presenting to medical practitioners in Trinidad and Tobago, type of management, and interest in continuing education in oral diseases. METHOD: Cross sectional survey of registered medical practitioners in Trinidad. 20-item self-reported questionnaire. RESULTS: 103 medical practitioners participated in the study (response rate 69 per cent). Mean age 33 years. Mean years since qualifying was 8 years and 72 per cent worked mainly in hospital service or private practice (19 per cent); 67 per cent had seen patients with a dental problems, with 69% of those at least as frequently as once a month. Most frequently seen problems were dental abscess (72.5 per cent) and toothache (59.4 per cent). In the case of dental abscess and oral mucosal infection 31.9 per cent and 63.8 per cent respectively, diagnosed and treated before referring. 84 per cent expressed interest in receiving continuing education in oral diseases. CONCLUSIONS: In the context of access to oral care in Trinidad and Tobago, medical practitioners appear to be important providers and may benefit from further training in the diagnosis and management of oral diseases.

The oral health and treatment needs of school children in Trinidad and Tobago: findings of a national survey

OBJECTIVE: To describe the oral health and treatment need of schoolchildren in Trinidad and Tobago. Design and method: Cross-sectional survey using stratified cluster sampling. Participants were children in primary (aged 6-8 years) and secondary school (aged 12 and 15 years). Main outcome measures were DMFT/dmft, treatment need, and fluorosis. RESULTS: Examinations were completed on 1064 children. The dmft of the 6-8-year-olds was 2·54 (95 per cent CI = 2·32, 2·76). For 12-year-olds, the DMFT was 0·61 (95 per cent CI = 0·51, 0·71), whereas for 15-year-olds, the DMFT was 1·06 (95per cent CI = 0·87, 1·25). Most of the caries experience in 6-8-year-olds was from decayed teeth. Sixty-seven per cent of the sample (95 per cent CI = 64 per cent, 69 per cent) had some type of treatment need. Most frequently occurring need was for fillings at 42 per cent (95 per cent CI = 40 per cent, 44 per cent) with 28 per cent (95 per cent CI = 26 per cent, 31 per cent) of the total sample needing two or more surface fillings, followed by fissure sealants at 33 per cent (95 per cent CI = 30 per cent, 36 per cent) and caries-arresting care at 12 per cent (95 per cent CI = 10 per cent, 14 per cent). Extraction of one or more teeth was needed in 13 per cent (95 per cent CI = 11 per cent, 15 per cent) of children. Rates of fluorosis were negligible. CONCLUSION: The caries experience of 12- and 15-year-old children were low but was high for schoolchildren aged 6-8 years, in terms of prevalence and severity. Effective oral health promotion strategies need to be implemented to improve the oral health of primary schoolchildren in Trinidad and Tobago.

The oral health and treatment needs of schoolchildren in Trinidad and Tobago: findings of a national survey.

OBJECTIVE: To describe the oral health and treatment need of schoolchildren in Trinidad and Tobago. DESIGN AND METHOD: Cross-sectional survey using stratified cluster sampling. Participants were children in primary (aged 6-8 years) and secondary school (aged 12 and 15 years). Main outcome measures were DMFT/dmft, treatment need, and fluorosis. RESULTS: Examinations were completed on 1064 children. The dmft of the 6-8-year-olds was 2.54 (95 per cent CI = 2.32, 2.76). For 12-year-olds, the DMFT was 0.61 (95 per cent CI = 0.51, 0.71), whereas for 15-year-olds, the DMFT was 1.06 (95 per cent CI = 0.87, 1.25). Most of the caries experience in 6-8-year-olds was from decayed teeth. Sixty-seven per cent of the sample (95 per cent CI = 64 per cent, 69 per cent) had some type of treatment need. Most frequently occurring need was for fillings at 42 per cent (95 per cent CI = 40 per cent, 44 per cent) with 28 per cent (95 per cent CI = 26 per cent, 31 per cent) of the total sample needing two or more surface fillings, followed by fissure sealants at 33 per cent (95 per cent CI = 30 per cent, 36 per cent) and caries-arresting care at 12 per cent (95 per cent CI = 10 per cent, 14 per cent). Extraction of one or more teeth was needed in 13 per cent (95 per cent CI = 11 per cent, 15 per cent) of children. Rates of fluorosis were negligible. CONCLUSION: The caries experience of 12- and 15-year-old children were low but was high for schoolchildren aged 6-8 years, in terms of prevalence and severity. Effective oral health promotion strategies need to be implemented to improve the oral health of primary schoolchildren in Trinidad and Tobago.

Diagnostic approaches to common oral symptoms

In routine dental practice patients seek oral care for various reasons. Some of these reasons are pain, swelling and ulcers. This chapter will deal with various aspects involved in evaluating the above listed symptoms AU)

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)

Oral health status and dental treatment needs of a group of children with HIV/AIDS in Trinidad [abstract]

The study was conducted to determine the oral health status of children with HIV/AIDS and to develop a model for appropriate, effective and cost-effective prevention-oriented intervention based on the findings. Outcome measures included caries experience, caries prevalence, periodontal health, oral lesions, oral hygiene, human resource requirements and cost of care. The teeth of 30 children aged 7 months to 15 years were examined using the National Institute for Dental and Craniofacial Research criteria for Early Childhood Caries and the Modified WHO criteria for caries status. Periodontal health was assessed using the Periodontal Screening Record (12 to 15-year-olds) and oral hygiene was evaluated, based on the presence or absence of plague and/or calculus. About 34.48 percent of children required treatment, including one child with gross oral neglect. The mean DMFT and dmft were 1.10 and 2.37, respectively, indicating higher severity in the primary teeth. While 55.17 percent of all the children were caries free, a higher proportion of children aged 2-5 years were caries free (68.42 percent) compared with children aged six to 15 years (40.0 percent). Although 83.77 percent of all the teeth were sound, all the decayed teeth were untreated, indicating a virtually non-existent utilization of dental services. There were no restored teeth but 21.86 percent of all teeth were either decayed or missing due to caries. Of the decayed teeth, 29.7 percent were permanent while the primary teeth accounted for 68.3 percent. Restoration was required in 66.7 percent of the decayed teeth while 33.3 percent needed to be removed and 70 percent of all children requiring treatment accounted for all the extractions (33.34 percent of all teeth). The caries and oral hygiene status as well as periodontal health of the children were better than that reported for 6, 9, 12 and 15 year-old children in the general population (DMFT 4.9 and 14 percent caries-free at age 12 years). Although both caries prevalence and severity are low, base on the WHO criteria, a small proportion of children (34.48 percent) accounted for a high burden of disease. The findings indicate that it is possible to maintain good oral hygiene, periodontal health and low caries status in children with HIV/AIDS provided their oral health is routinely monitored. (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 and denture quality: a pilot study in Trinidad

OBJECTIVE: To assess the quality of dentures worn by a sample of the population in Trinidad and respondents' attitude towards their oral health and dentures. DESIGN AND METHODS: Respondents to advertisements in all the local newspapers for persons wearing full dentures were interviewed and examined clinically. Dentures were examined for processing defects. Mandibular functional movements were measured and dentures were evaluated for reproduction of these movements. RESULTS: In the 54 subjects studied none of the dentures were made to function with mandibular jaw movements. For the maxilla and mandibular dentures, 96.8 percent of the axial inclination of the teeth were set incorrectly. All of the denture extensions were found to be short and none had any retention or stability. None of the participants had post delivery visits. The majority (77.5 percent) of all the dentures had never been repaired and 61.3 percent had fractured teeth. A majority (51.6 percent) of participants were found to be in need of palliative treatment and 48.4 percent needed urgent treatment. The primary concerns of the participants were that they were slack (35.5 percent). The majority of dentures sampled (80.6 percent) were made by a dental technician who also did the clinical procedures. CONCLUSIONS: The dentures made in Trinidad fall below acceptable standards and majority were made without any relation to functional jaw movements. However, patients' compliance with their prostheses was high (75 percent). There is an urgent need to a concerted effort by health officials to standardize oral health care.(AU)

Knowledge, attitude and practices towards preventive dental health in the young adult, ages 18-35 years as compared to the elderly ages 65 years and over attending for dental care

Dental diseases in the Caribbean are the most common diseases, but yet its prevention and treatment are the most neglected. Prevention rather than repair, but when problems do arise repairs are the answers. It is estimated that prevention takes much less time and money than treatment and it is better. Dental disease cannot be ignored in any health care delivery system. It is a priority of primary health care in the quest of health for all by the year 2000. In countries where preventive dental care is practiced, there are fewer oral health needs than population served basically by restoration and maintenace type of dental care. A cross-sectional survey was carried out between the period of February and March 1999. A sample of 62 consumers was selected by stratified systematic sampling method, from three health care facilties, two public and one private, in the Kingston and St. Andrew Health Department Zone. The main findings were that a low number of elderly attended the dental health clinic and all obtained curative dental health services. The respondent's choice of dental clinics was influenced by cost, accessibility and quality of the services. There is a need for greater public awareness about preventive dental health. Health education in this area of health is recognised as important but is currently focused primarily on the school population. The main conclusion was that while the majority of the respondents displayed a fairly high level of knowledge, attitude and practices toward preventive dental health, the elderly more than the young adults, there were a high level of Decayed, Missing and Filled permanent Teeth (DMFT) present in both sample groups (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)

Oral health of 6, 12, and 15 year old children: population sample of Grenada

Reports on a study to determine the state of dental health in Grenadian children. The age groups 6, 12, and 15 were selected to indicate conditions of the primary dentition, conditions of the mixed dentition, and conditions of the pemanent dentition, respectively. A total of 1329 children were examined in Grenada, Carriacou and Petit Martinique. The results indicate that caries prevalence among 6, 12, and 15 year olds had increased since the survey conducted in 1984. Also DMFT (decayed, missing, filled teeth) had increased for all ages and was above the level considered healthy by WHO. Recommendations for the improvement of oral health among the population are given

Epidemiological survey of oral diseases in Trinidad and Tobago: 1989 / Oral health of 6, 9, 12, and 15 year old children of Trinidad and Tobago; 1989

The purpose of this study was to conduct an oral health survey of the school age children in Trinidad and Tobago using a population sample of children in the age groups of 6, 9, 12, and 15 years old. This study also served to provide continuing education to three (3) dental surgeons, ten (10) nurses, ten (10) dental surgery assistants in the following areas:(1) Oral Health Survey Design, Planning and Administration. (2) Use of dental indices to evaluate oral health. The overall objective of the survey was to ascertain the present level of oral diseases in the 6-15 year old population, therefore a systematic approach of collection and analysis of data, using specially designed forms, this data will (1) Provide baseline data (indices) of the oral health of specific age groups in Trinidad and Tobago. (2) Serve as a base for initiation of preventive and prophylactic dental health programs. (3) Serve as a baseline for the evaluation of any preventive measure introduced by the Ministry of Health. (4) Serve as a base for planning oral health in the year 2000. (5) Serve as a base for further research.(AU)