Littérature scientifique sur le sujet « Dental caries in children Prevention Vietnam »

While there is no doubt that the best way to tackle the problem of dental caries is through an effective programme of prevention, as outlined in previous chapters, it is unfortunate that many children still suffer from the disease and its consequences. Hence, there is a need to consider operative treatment to prevent the breakdown of the dentition. As discussed in earlier chapters, there are a number of different techniques and philosophies for treating dental caries. This chapter will concentrate mainly on the methods of complete caries removal (a ‘surgical’ approach). Research to support different philosophies, techniques, and materials frequently lacks evidence from randomized controlled trials, which are considered as the gold standard. Consequently, lower levels of evidence are used to support different techniques. More importantly, dentists need to be skilled in different techniques and philosophies to ensure that appropriate care is provided to each and every child. The removal of caries is not a new concept for the treatment of dental decay. Over the years the treatment of dental caries in children has been discussed and many attempts have been made to rationalize the management of the disease. Writing more than 150 years ago, Harris (1839) was one of the first to address the problem of restoring the primary dentition. Even in those days he was emphasizing the importance of prevention by good toothbrushing. Caries could be arrested by ‘plugging’, but from his description he obviously found treatment for the young patient difficult and not as successful as for adults. However, he did emphasize the importance of looking after children’s teeth: ‘If parents and guardians would pay more attention to the teeth of their children, the services of the dentist would much less frequently be required’, and ‘Many persons suppose that the teeth, in the early periods of childhood, require no attention, and thus are guilty of the most culpable neglect of the future well-being of those entrusted to their care’. Unfortunately, this statement still applies today. Caries removal can be a stressful experience for the child, the parent, and the dentist. Therefore it is important that there is a positive health gain from any treatment that is provided.

Oral diseases are largely preventable but are still highly prevalent. What is going wrong? Why have oral diseases not been eradicated? The answer to these questions is not straightforward. As highlighted in Chapter 2, a complex array of factors influence the health status of individuals and populations. Many of these factors are outside the control of health professionals and the health service. If oral diseases are to be prevented, it is necessary to have a strategy or a plan to tackle the determinants. This chapter discusses the principles of strategy design with reference to prevention. First, it considers the basic principles that need to be addressed when preparing any strategy. Second, it examines the various approaches that can be taken when considering prevention and discusses the advantages and disadvantages of each. It looks at issues concerning selection of population groups and individuals through screening, and considerations involved in designing a strategy to tackle a major oral health problem. The existence of a strategy implies that there is an organized plan to reach a goal. In this sense, designing preventive strategies is similar to other health care planning. The same essential elements must be present (Box 4.1). It is important to have a clear vision of what you are trying to achieve and how it is planned to get there, otherwise it is unlikely that the goal will ever be realized. The first stage is to identify the aim of the project. What is to be achieved? The second stage is to identify the objectives of the project. What are the various steps that will eventually mean that the aim is reached? To formulate the aims and objectives of a programme it is necessary to collect data to provide information. Asking a series of questions can facilitate this. These data will include the following. What is the problem that is to be addressed? Is it, for example, caries in pre-school children or early identification of oral cancer? What is the natural history of the disease? What are its aetiology, risk factors, and predisposing factors? What is its epidemiology? Is the incidence increasing, decreasing, or stable? How important is the disease within the population? It may be important in two ways: it may affect many people within the population or it may affect few people but be of major impact.

Injuries are a major cause of morbidity and mortality in both developed and developing countries around the world. It is estimated that, of the total burden of global disease, just over 12% is attributable to injuries (WHO 2008). Depending on the cause, injuries can be divided into unintentional and intentional. Two-thirds of the global burden of injury is classified as unintentional and these are mainly caused by road traffic injuries and falls. Intentional injuries are caused by violence. The term ‘accident’ is discouraged, as this suggests that chance or bad luck are the main causes of the harmful event (Davis and Pless 2001). Injuries are in fact predictable and preventable in most cases. The multiple and interacting causes of injury provide a good example of the broader determinants of health. Injuries are not solely caused by the behaviour of individuals. Instead, the underlying influences and causes of the behaviour, the broader context, need to be understood. Hanson et al. (2005) have proposed an ecological approach that describes three key dimensions: the individual, the physical environment, and the social environment. A better understanding of the true causes of this major global public health issue will help to inform more effective intervention strategies. In dentistry, increasing clinical and public health interest has focused on the issue of traumatic dental injury (TDI). This chapter will present an overview of the epidemiology of TDI. The impact of the condition will be highlighted and the key aetiological factors identified. A critical appraisal of treatment and preventive approaches will be presented and an alternative public health approach will be outlined. Data on the extent and severity of TDIs are rather limited in comparison to the amount of information available in relation to dental caries and periodontal diseases. Comparisons between populations is also hampered, as surveys often use different methods to measure and assess TDIs. A recent review of the global literature indicated that amongst pre-school children approximately one-third had suffered TDI in the primary dentition (Glendor 2008 ). It was estimated that a quarter of all school children and almost a third of adults had suffered trauma to the permanent dentition, although significant variations existed both between and within countries.

The child patient can be a challenging and daunting proposition for the junior dentist and dental student. Whilst children can be anxious, unco­operative, and unpredictable, they also present an extremely rewarding opportunity, which, if managed correctly, may go on to influence their healthcare experiences for the rest of their lives. Excellent behavioural management of the child patient (and their parents!) is fundamental to a successful clinical and patient- reported outcome. Aside from possible behavioural issues, paediatric patients may pre­sent with a series of unique clinical presentations that require additional skills and knowledge above and beyond those required for adult pa­tients. Differences in the micro- and macro- structures of primary and permanent teeth, coupled with variations in eruption dates, lead to an evolving mixed dentition that can lead to some difficult diagnostic and treatment planning scenarios. Furthermore, dental anxiety and the pre­ponderance for dento- alveolar trauma in children and young adults may exacerbate the patient management of an already complex situation. Prevention is central to paediatric dentistry. However, whilst signifi­cant progression has occurred in some areas, poor dietary habits and suboptimal oral hygiene regimes remain significant concerns for the pro­fession, with large numbers of dental extractions still performed under general anaesthesia each year. Key topics include: ● Tooth anatomy and eruption patterns ● Abnormalities of structure and form ● Prevention and management of dental caries, including pulp therapy ● Dental trauma ● Dental extractions and space management ● Behavioural management ● Safeguarding ● Pharmacological management.