Oral Health Programmes And Dental Amalgam Use In Jamaica

ORAL HEALTH PROGRAMMES ANDDENTAL AMALGAM USE IN JAMAICAIrving McKenzie MD

CORE PRINCIPLES AND SERVICES Access Equity Quality ExaminationBasic PeriodontalScreeningDental ProphylaxisFluoride varnish/topicalFluoridePeriodontal ScalingDental Restorations –Nano-composites, TempsetcExodontiaDental Emergencies

EPIDEMIOLOGICAL PROFILE DMFT 5-6 y.o 1.0DMFT 12-13 y.o 1.08Caries Prevalence 40%SCI 2.2CPI 35-44 Oral Cancer survivalrates 2 yearsCase fatality rates 90% Fungal, bacterial or viralinfections in HIVAlmost half (40–50%) ofpeople who are HIVpositive have oral fungal,bacterial or viralinfections. These oftenoccur early in the courseof HIV infection.

ORAL EPIDEMIOLOGICAL PROFILE Oro-dental trauma16-40% of children inthe age range 6 to12years old are affectedby dental trauma due tounsafe playgrounds,unsafe schools, roadaccidents, or violence 40 -60% of MVA resultsin head & neck injuries.Significant increases inOro-dental trauma arenoted in contact sportslike Foot ball, Basketball, Karate andTaekwondo (50-60%)

RISK FACTORS FOR ORAL DISEASESAn unhealthy diet, tobacco use and harmfulalcohol use. These are also risk factors for the fourleading chronic diseases – cardiovasculardiseases, cancer, chronic respiratory diseases anddiabetes Poor oral hygiene is also a risk factor for oraldisease. Social determinants in oral health are also verystrong cause for . The oral disease burden is significantly higheramong poor and disadvantaged population groups

COMMON RISK FACTOR APPROACH

FRAMEWORK Services:1) Operative dentistry2) Oral Surgery3) Paedodontics4) Endodontics5) Orthodontics6) Prosthodontics7) PeriodonticsComprehensive carefacilities (Referral Centers) 3-4 Dental Operatories/UnitRadiology –Intraoral &PanoramicDental Surgical InstrumentsAutoclave & Statim SterilizerUltrasonic CleanersUltrasonic /Piezo ScalersCentral suction UnitDiode LaserLight Cure UnitHandpieces -Fast & SlowInstrument washersSupplies and SundriesSmall laboratory Infrastructure

STANDARD FACILITIESBasic Services: Examination Basic Periodontal Screening Dental Prophylaxis –w/oFluoride varnish/topicalFluoride Periodontal /Gross Scaling Dental Restorations –Nanocomposites, Temps etc Exodontia Dental EmergenciesInfrastructure 1-2 Dental Operatories/Unit Radiology –intraoral Central suction Compressor Light Cure Unit Dental Instruments/surgicaletc Supplies & Sundries Autoclave-Dedicated Unit Ultrasonic Cleaner Handpieces-Fast & Slow Ultrasonic & Piezo Scalers Intraoral camera

DENTAL INFRASTRUCTURE

ORAL HEALTH PROGRAMMESPreventive inclusive of the “Caries freecommunity initiative”. Curative Diagnostic Rehabilitative Oral Health Education and Health Promotion Referral Integrated Disease Prevention module

ORAL HEALTH PROGRAMMESOral Public Health - Preventive a) Prophylaxis b) Sealant c) Fluoride Varnish d) other forms of topical Fluoride - Oral Cancer Screening Programme -Oral Disease Surveillance Programme

CURATIVE PROGRAMMEExamination & Charting Basic Periodontal Charting Restorations a) Amalgams b) Composites c) Sedative Dressing Anaethetic & Pain Management Exodontias

CURATIVE PROGRAMMEPeriodontal Scaling Periodontal Surgery Incision and Drainage Prosthodontics a) Dentures b) Crown and Bridge Endodontics Orthodontics

CLINICAL USE OF DENTAL AMALGAM 1.1 It is prudent to avoid the placement or removal ofdental amalgam restorations during pregnancy,especially during the first trimester when the mother isbreastfeeding, and its use in those patients with kidneydisease.1.2 Amalgam is a material suitable for largerrestorations of posterior permanent teeth in children,young adults and adults.1.3 Directly-placed tooth coloured restorative materialsin permanent posterior teeth should be restricted to onesurface restorations and small and medium sized twoandthree-surface restorations when adequate isolation canbe achieved.

CLINICAL USE OF DENTAL AMALGAM1.4 No conclusive, scientific validated evidencecurrently exists to justify the removal of dentalamalgam restorations to relieve certainsystemic symptoms, or treat particular medicalconditions (other than proven allergy). 1.5 Only pre-capsulated amalgam is to be used.

CURRENT SALES & DISTRIBUTIONMajor suppliers – Optimum Trading Ltd - Cornwall Medical & Dental Major Consumer – Ministry of Health - 50% reduction in use of DA Usage:Mainly in Rural Communities

WASTE MANAGEMENT OF DENTAL AMALGAM2.1 ‘Recommendations in handling DentalAmalgam should be followed to reduceoccupational and patient exposure to mercury indental practices from amalgam waste. 2.2 All public dental clinics in shall be equippedwith specialist systems to trap waste amalgam tocontrol the distribution into the generalenvironment. 2.3 All reasonable measures should be taken tominimize the discharge of mercury into theenvironment

WASTE DISPOSAL OF AMALGAM2.4 Amalgam and amalgam-filled extracted teethmust not be incinerated and should be recycledwherever possible 2.5 Waste amalgam should be stored in an airtight plastic container labeled “Amalgam forRecycling”1 2.6 It is recommended that mercury waste bereturned to metal or precious metal recyclers forreclamation. If necessary the EnvironmentProtection Authority should be contacted forspecific requirements for disposal of mercury.

DENTAL INFRASTRUCTURE

RISK FACTORS FOR ORAL DISEASES An unhealthy diet, tobacco use and harmful alcohol use. These are also risk factors for the four leading chronic diseases -cardiovascular diseases, cancer, chronic respiratory diseases and diabetes Poor oral hygiene is also a risk factor for oral disease. Social determinants in oral health are also very