ORAL HYGIENE AIDS

Oral hygiene aids

About
Oral hygiene aids are the tools used in the mouth to remove food residue and plaque, a bacterial film that causes tooth decay (dental caries ), periodontal disease, and halitosis (bad breath). Bacterial plaque must be removed daily. The toothbrush and dental floss are the primary oral hygiene aids for this process. 

Here are some of the most common oral hygiene aids for homecare:

• Dental Flosses. Dental floss is the most common interdental and subgingival (below the gum) cleaner and comes in a variety of types and flavors.
• Interdental Cleaners. 
• Mouth Rinses. 
• Oral Irrigators. 
• Rubber Tip Stimulators.
• Tongue Cleaners. .
• Toothbrushes.

Dental caries (tooth decay):

Dental caries results when plaque forms on the surface of a tooth and converts the free sugars (all sugars added to foods by the manufacturer, cook, or consumer, plus sugars naturally present in honey, syrups, and fruit juices) contained in foods and drinks into acids that destroy the tooth over time. Continued high intake of free sugars, inadequate exposure to fluoride, and a lack of removal of plaque by tooth brushing can lead to caries, pain, and sometimes tooth loss and infection.

Periodontal (gum) disease:

Periodontal disease affects the tissues that both surround and support the tooth. The disease is characterized by bleeding or swollen gums (gingivitis), pain, and sometimes bad breath. In its more severe form, the gum can come away from the tooth and supporting bone, causing teeth to become loose and sometimes fall out. Severe periodontal diseases are estimated to affect nearly 10% of the global population. The main causes of periodontal disease are poor oral hygiene and tobacco use.

Oral cancer:

Oral cancer includes cancers of the lip, other parts of the mouth and the oropharynx. The global incidence of cancers of the lip and oral cavity) is estimated at 4 cases per 100 000 people. However, there is wide variation across the globe: from no recorded cases to around 20 cases per 100 000 people.3 Oral cancer is more common in men and in older people and varies strongly by the socio-economic condition.

 In some Asian-Pacific countries, the incidence of oral cancer ranks among the three top cancers.3 Tobacco, alcohol, and areca nut (betel quid) use are among the leading causes of oral cancer.4 In North America and Europe, human papillomavirus infections are responsible for a growing percentage of oral cancers among young people.5

Oral manifestations of HIV infection:

Oral manifestations occur in 30-80% of people with HIV,6 with considerable variations depending on the affordability of standard antiretroviral therapy (ART).

Oral manifestations include fungal, bacterial, or viral infections of which oral candidiasis is the most common and often the first symptom. Oral HIV lesions cause pain, discomfort, dry mouth, and difficulties swallowing.

Early detection of HIV-related oral lesions can be used to diagnose HIV infection and monitor the disease’s progression. Early detection is also important for timely treatment.

Oro-dental trauma:

Oro-dental trauma results from injury to the teeth, mouth, and oral cavity. Around 20% of people suffer from trauma to teeth at some point in their life.7 Oro-dental trauma can be caused by oral factors such as lack of alignment of teeth and environmental factors (such as unsafe playgrounds, risk-taking behavior, and violence). Treatment is costly and lengthy and sometimes can even lead to tooth loss, resulting in complications for facial and psychological development and quality of life.

Noma:

Noma is a severe gangrenous disease of the mouth and the face. It mostly affects children between the ages of 2 and 6 years suffering from malnutrition, affected by infectious disease, living in extreme poverty with poor oral hygiene, and/or with weakened immune systems.

Noma is mostly found in sub-Saharan Africa, although cases have also been reported in Latin America and Asia. Noma starts as a soft tissue lesion (a sore) of the gums, inside the mouth. The initial gum lesion then develops into acute necrotizing gingivitis that progresses rapidly, destroying the soft tissues and further progressing to involve the hard tissues and skin of the face.

In 1998, WHO estimated that there were 140 000 new cases of noma annually. Without treatment, noma is fatal in 90% of cases. Survivors suffer from a severe facial disfigurement, have difficulty speaking and eating, face social stigma, and require complex surgery and rehabilitation. Where noma is detected at an early stage, its progression can be rapidly halted, through basic hygiene, antibiotics, and improved nutrition.

Cleft lip and palate:

Clefts of the lip or palate affect more than 1 in 1000 newborns worldwide. Genetic predisposition is a major cause. However, poor maternal nutrition, tobacco consumption, alcohol, and obesity during pregnancy also play a role.8 In low-income settings, there is a high mortality rate in the neonatal period. If lip and palate clefts are properly treated by surgery, complete rehabilitation is possible.

Non communicable diseases and common risk factors:

Most oral diseases and conditions share modifiable risk factors (such as tobacco use, alcohol consumption, and an unhealthy diet high in free sugars) common to the four leading non communicable diseases (cardiovascular disease, cancer, chronic respiratory disease, and diabetes).

In addition, it is reported that diabetes is linked in a reciprocal way with the development and progression of periodontal disease. Moreover, there is a causal link between the high consumption of sugar and diabetes, obesity, and dental caries.

Oral health inequalities:

Oral diseases disproportionately affect the poor and socially-disadvantaged members of society. There is a very strong and consistent association between socioeconomic status (income, occupation and educational level) and the prevalence and severity of oral diseases.⁹ This association exists from early childhood to older age, and across populations in high-, middle- and low-income countries.

Prevention:

The burden of oral diseases and other noncommunicable diseases can be reduced through public health interventions by addressing common risk factors.

These include:

• Promoting a well-balanced diet low in free sugars and high in fruit and vegetables, and favouring water as the main drink;
• Stopping use of all forms of tobacco, including chewing of areca nuts;
• Reducing alcohol consumption; and
• Encouraging use of protective equipment when doing sports and travelling on bicycles and motorcycles (to reduce the risk of facial injuries).

Adequate exposure to fluoride is an essential factor in the prevention of dental caries.

An optimal level of fluoride can be obtained from different sources such as fluoridated drinking water, salt, milk and toothpaste. Twice-daily tooth brushing with fluoride-containing toothpaste (1000 to 1500 ppm) should be encouraged.

Access to oral health services:

Unequal distribution of oral health professionals and a lack of appropriate health facilities in most countries means that access to primary oral health services is often low. Overall, according to a survey of adults expressing a need for oral health services, access ranges from 35% in low-income countries to 60% in lower-middle-income countries, 75% in upper-middle income countries and 82% in high-income countries.¹⁰ Moreover, even in high income settings, dental treatment is costly, averaging 5% of total health expenditure and 20% of out-of-pocket health expenditure.¹¹ Efforts in support of UHC  can  help  frame policy dialogue to address weak  primary oral   health   services,   and   address   substantial  out-of-pocket expenses associated with oral health care in many countries.

WHO response:

Eight years after the United Nations High-Level Meeting on Noncommunicable Diseases recognized that oral diseases pose a major health burden for many countries, 2019 saw the inclusion of oral health in the Political Declaration on Universal Health Coverage. During the same period, Members States, with the support of the WHO, developed and endorsed strong regional strategies and calls for action in favour of oral health in the African, East Mediterranean, South-East Asia and Western 

Pacific regions.

In such a context, WHO is committed to ensuring promotion of oral health and quality, essential treatment for oral health conditions for all people in all countries without individual financial hardship.

Reducing oral health conditions calls for a reform of oral health systems to shift the focus from invasive dental treatment to prevention and more minor treatment.

WHO has identified key strategies for improving oral health, with a focus on low-income and marginalized populations where access to oral health care is most limited. These include strengthening both cost-effective population-wide prevention and patient-centred primary health care.

This work is being implemented through a three-year roadmap (2019-2021) that comprises a mix of normative work and practical support to countries. A top priority is the development of a global oral health report, which will provide information about the status of oral health globally. The report will serve as the evidence base for the development of a global oral health action plan.

WHO also supports countries in this area by:

• Supporting interventions to accelerate the phase-down of dental amalgam in the context of the Minamata Convention on Mercury;
• Building capacity and providing technical assistance to countries to support a life-course approach and population-based strategies to reduce sugar consumption, control tobacco use, and promote fluoride-containing toothpaste and other vehicles of fluoride;
• Providing assistance to strengthen oral health systems such that they are an integral part of primary health care and do not cause financial hardship; and
• Reinforcing oral health information systems and integrated surveillance with other noncommunicable diseases to demonstrate the scale and impact of the problem and to monitor progress achieved in countries.

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