Dental diseases and disorders

1. Dental Diseases
Presenter:
Beker Dove NKAYIVU

2. Course outline
• Introduction
• Main Disease burden in African region
• Oral health is a public health concern in Uganda
• Parts of a tooth
• Halitosis
• Dental plaque
• Dental Caries
• Pulpitis
• Dental Abscess
• Periodontal diseases

3. Outline cont’d
• Fluorosis
• Dental hypersensitivity
• Oral cancers
• Oral Manifestations of HIV
• Noma
• Public Health Importance of Dental diseases
• General symptoms
• Conclusion

4. Introduction
• The World Health Organization (WHO) defines oral health as ‘a state of being
free from mouth and facial pain, oral and throat cancer, oral infection and
sores, periodontal disease, tooth decay, tooth loss, and other diseases and dis-
orders that limit an individual’s capacity in biting, chewing, smiling, speaking,
and psychosocial wellbeing.
• The Global Burden of Disease Study 2019 estimated that oral diseases affect
close to 3.5 billion people worldwide, with caries of permanent teeth being
the most common condition. Globally, it is estimated that 2 billion people
suffer from caries of permanent teeth and 520 million children suffer from
caries of primary teeth.

5. Introduction cont’d
• In most low- and middle-income countries, the prevalence of oral
diseases continues to increase with growing urbanization and changes
in living conditions.
• Existing interventions to prevent and control oral diseases are
meager, rather than as a fundamental human right for everyone.
• Consequently, a large proportion of the global burden of oral disease
remains unattended, and oral diseases receive only a low allocation of
resources for surveillance, prevention, care and research.

7. Global Estimates of Burden of Oral Conditions in 2017
All Ages (No. of Cases) Global
Estimates of Burden of Oral
Conditions in 2017
Prevalence (Millions) Incidence (Millions) YLDs (Millions)
All oral conditions 3,467 (3,272 to 3,676) 3,600 (3,233 to 3,992) 18.3 (10.9 to 28.3)
Untreated caries in deciduous
teeth
532 (443 to 622) 1,058 (756 to 1,401) 0.1 (0.06 to 0.3)
Untreated caries in permanent
teeth
2,302 (2,105 to 2,526) 2,452 (2,234 to 2,665) 1.6 (0.7 to 3.1)
Severe periodontitis 796 (671 to 930) 71 (62 to 81) 5.2 (2.0 to 10.7)
Total tooth loss 267 (235 to 300) 18 (16 to 21) 7.3 (4.9 to 10.4)
Other oral conditions 139 (133 to 146) 4.0 (2.5 to 5.9)
Number of prevalent and incident cases andYLDs rate, in 2017 for untreated caries, severe periodontitis, total tooth loss, other oral conditions,
and all oral conditions combined, globally.Values in brackets correspond to the 95% uncertainty interval.
YLDs, years lived with disability.

8. The Oral Health Atlas 2 Edition

9. Main disease burdens in African Region
There are six conditions that make up the bulk of the oral disease
burden.
These are:
• Dental caries, or tooth decay or cavities;
• Gum disease;
• Oral cancers;
• Oral manifestations of HIV infection;

10. Main disease burdens in African Region
cont’d
• Oro-dental/facial trauma.
• Cleft lip and palate.
• Specifically in the African Region, the spectrum of oral diseases also
includes Noma, which is a necrotizing disease that affects children
between the ages of 2 and 6 years. Almost all of these conditions are
largely preventable, or can be treated in their early stages.

11. Oral health is a public health concern in Uganda
• Uganda has reported 75% prevalence of tooth decay among adults
whereas among the children the prevalence is almost 90% and the
high rate is due to increased rampant carriers as seen among children
using and often abusing medication in syrups formulation (MoH,
2014).
• Economic improvement together with urbanization introduces the
increasing prevalence of these conditions mediated primarily by
changes in the sugar content of the diet and tobacco exposure.

12. Parts of a Tooth

13. Parts of tooth.
• The teeth are hard-calcified structures set firmly in bone sockets
in the maxilla and mandible by means of a root or roots. The
part visible in the oral cavity is the crown.
• The crown is covered with hard shiny enamel. The tissue
covering the root is the cementum.

14. Parts of tooth cont’d
• The ivory-like structure that forms the bulk of the tooth is the
dentine. Enamel lacks the capacity for self-repair since it contains no
cells. It resists wear only through its extreme degree of hardness.
• Dentine is capable of repair, but it is less hard and resistant than
enamel. Investing between the roots of teeth and socket wall formed
by alveolar bone.
• The gingival, periodontal ligament, alveolar bone and cementum
which support the teeth are collectively termed as periodontium.

15. Halitosis/Bad Breath
Chronic unpleasant odour from the oral
cavity that cannot be removed by
brushing, mouthwash or mint.
Causes
• Poor oral hygiene
• Gum disease due to infections in the
mouth
• Tobacco smoking and chewing
• Systemic conditions or illnesses, such
as liver disease, Kidney disease, lung
disease etc.)
• Improper cleaning of dentures or
retainers
• Decayed teeth
• Diet
• Xerostomia(dry mouth)

16. Treatment
Your treatment of halitosis will ultimately depend on the root cause.
• Poor oral hygiene: Brush after you eat, floss twice a day, brush your tongue and
go to checkups at the dentist at least twice a year.
• Improper cleaning of dentures/retainers: Purchase cleaning tablets that
effectively clean your retainers or dentures to rid the majority of bacteria
present.
• Tobacco products: Find a way to quit all tobacco products.
• Dry mouth: Talk to your doctor or dentist about how to address your dry mouth.

17. Dental Plaque
Dental plaque is thin, tenacious, firmly adherent and
well organized biofilm adhering to the tooth surface,
restorations and dentures.
• Microorganisms ferment sucrose, to produce acids
that cause demineralization of inorganic substances
• Various proteolytic enzymes cause disintegration of
the organic substances of the teeth.
.

18. Dental Plaque Cont’d
• The dental plaque holds the acids produced in close contact with the
tooth surfaces and prevents them from contact with the cleansing
action of saliva.
• The dental plaque may be cariogenic, causing dental caries or
calculogenic, causing periodontal diseases

19. Dental Caries
Dental caries/tooth decay occur when
microbial biofilm (plaque) formed on
the tooth surface.
Converts the free sugars contained in
food and drinks into acids.
The acids dissolve tooth enamel and
dentine over time.

20. Causes of Dental Caries

21. Strategies of preventing Dental caries

22. Dental caries distribution with Age

23. Epidemiological Measurements of the Load
of Dental Caries:
• Caries prevalence of permanent teeth in a community is generally assessed by an
index known as “Decayed Missing and Filled teeth (DMFT)”.
• It is calculated by counting the number of DMFT of each individual and then
calculating the mean for the group examined.
• A very common age group used for international comparisons of DMFT is the 12-
year age group.

24. Measurement of DMFT cont’d
• The WHO also recommends this age group, and the WHO goal was to
achieve “3 or less DMFT” among 12 year old children” by the year
2000.
• According to estimates, 70% of the countries, representing 85% of the
world population had achieved this goal by 2001; however, several
developing countries have reported a trend towards higher level of
dental caries

25. Pulpitis
Inflammation of the pulp of a tooth
Causes
• Commonly presents as a complication of dental caries.
• Thermal, chemical, or traumatic insult to the pulp.
Clinical features
• Pulsatile pain that lasts for several hours and worsens at night.
• Thermal sensitivity.
• Tooth is very tender to percussion.

26. Dental Abscess
Infection with pus formation at the root of a tooth as a sequel to pulpitis caused
by dental caries or trauma
Causes
• Mixed bacterial flora but mainly Staphylococcus spp
Clinical features
• Severe pain that disturbs sleep
• Facial swelling may be localized in the gum or extend to adjacent tissues
• Abscesses of the mandibular incisors or molars may discharge extra orally
• Affected tooth is mobile and tender to percussion
• Fever and headache may be present if infection has spread

27. Fluorosis (Mottling)
Brown discolouration of teeth
Cause
• Occurs due to long term excess of fluoride.
• Endemic in areas of high fluoride water
content occurring naturally in the water
Clinical features
• Varies from white opacities to severe pitting
and discolouration due to incorporation of
the excess fluoride in the enamel structure

28. Prevention and control strategies of Dental
Fluorosis

29. Dentin Hypersensitivity
This condition is due to wearing off of the enamel, making it thinner leading to
exposure of the dentin
Causes
• Gum recession due to age or improper tooth brushing
• Acidic beverages that cause enamel erosion and dentin exposure
• Tooth grinding
• Chipped or fractured tooth may also expose the dentine
• Eating disorders, e.g. bulimia nervosa and anorexia nervosa (exposure to vomitus)
Clinical features
• Sensitivity to hot, cold, sweet or very acidic foods and drinks, and breathing in
cold air

30. Mouth Sores
• There are various types of sores that can appear on the gums, tongue,
inner cheeks, lips, or at the bottom of the mouth.
• They can range from mild sores that appear due to irritation, such as
biting one’s cheek, to more serious sores that are indicative of illness
such as cancer of the mouth.
The most common sores of the mouth include
• canker
• cold sores.

31. Mouth sores cont’d
• Canker sores are non-contagious and may be caused by hormone changes, stress,
a weakening of the immune system, certain health conditions, or a lack of
vitamins such as iron or B12.
• Herpes simplex virus causes cold sores that hormone changes, or fever and
illness. This type of sore starts off as blister clusters before crusting over.

32. Prevention
• Prevention of mouth sores depends on the type of sore. sores from
bites to the inner cheek can prevent them by chewing more slowly
and carefully.
• Canker and cold sores may be prevented by reducing stress, which is
a trigger for both.
• Antiviral medications may also be given to help prevent cold sores
from appearing.
• Over-the-counter pain relievers or
• Gargle with cool or salt water.

33. Periodontal diseases
Gingivitis.(chronic inflammation of the
gums),
The development of gingivitis is mostly
known to be caused by nonspecific bacterial
plaque flora, which changes over time from
predominantly gram positive to more gram
negative which is very widespread and for
the majority of patients completely
reversible.
In about 15 percent of the population the
disease can progress further to severe
periodontitis that leads rapidly to tooth loss.

34. Gingivitis
In gingivitis the gums become spongy, red, swollen,
bleed when brushed or touched, stand away from teeth,
often causing little pain and discomfort.
The disease can spread to involve deeper supporting
tissues viz. periodontal ligament, cementum and alveolar
bone. Due to apical migration of junctional epithelium
there is formation of a gap between teeth and gums
known as the periodontal pocket.
Such pockets harbor dental plaque and calculus which, if
untreated, ultimately leads to alveolar bone resorption,
mobility of teeth and exfoliation.

35. Periodontitis
• Periodontitis disease manifests as swollen, painful or bleeding gums
and bad breath.
• Like dental caries/tooth decay, it is caused by poor oral hygiene, but
can also be caused by smoking.
• In severe cases, the teeth can be detached from the gum and
supporting bone and become loose.
• It was estimated that approximately 12–14% of 35–44-year-olds and
22% of 60–69-year-old adults in the WHO African Region suffered
from severe periodontal (gum) disease that can cause tooth loss in
2017.

36. Progression of gingivitis to periodontitis

38. Prevention and treatment of Periodontal
diseases

39. Oral Cancers
• Oral cancer includes cancers of the lip and all subsites of the oral
cavity, and oropharynx.
• They often appear initially as a persistent ulceration, and can cause
pain, swelling of the soft tissue in the mouth and throat, bleeding, or
difficulty in eating or speaking.
• The age-adjusted incidence of oral cancer (cancers of the lip and oral
cavity) in the world was estimated at 4 cases per 100 000 people in
2018. However, there is wide variation across the globe: from no
recorded cases to around 20 cases per 100 000 people.

40. Oral cancers cont’d
• Oral cancer is more common in men, in older people, and varies
strongly according to socioeconomic condition. It is reported that
oral cancer is increasing in eastern and southern Africa.
• If detected early, oral cancers can be treated more easily

42. Oral cancers
• Oral cancer appears as a growth or sore in the mouth
that does not go away
• Oral cancer includes cancers of the lips, tongue,
cheeks, floor of the mouth, hard and soft
palate, sinuses, and pharynx (throat. It can be life-
threatening if not diagnosed and treated early)

43. Oral Cancers cont’d
. The biggest risk factors are:
• Smoking or chewing tobacco
• Alcohol use
• Human papillomavirus (HPV)
Signs of Oral Cancer
• Sores
• Lumps
• Rough areas in the mouth
• Change in your bite
• Difficulty chewing or moving your
tongue or jaw

44. Prevention and treatment of Oral cancer

45. Oral-Dental/Facial Trauma
• Injury to the oral or dental tissues as a result of trauma.
• Oral injuries account for 5 percent of all injuries, and craniofacial
trauma is responsible for about half of the estimated total 8.5 million
trauma deaths worldwide.
• They include fractures of the jaws and other facial bones, as well as
fractures, dislocations and loss of teeth.

46. Risk factors include
• traffic and motorcycle accidents,
• falls,
• interpersonal violence,
• contact sports and
• tongue and lip piercings.

47. Management of Oro-dental trauma
• Tetanus administration if needed
• Radiographs of affected teeth to check for root fractures
• Oral surgery for reduction and immobilisation of mobile teeth and
alveolar fragments
• Administration of prophylactic antibiotics
• Orthodontics, Root canal treatment or protection of the pulp

48. Edentulousness (tooth loss)
• Tooth loss results from dental caries, periodontal diseases
and trauma. Tooth loss increases with advancing age.
• Loss of the teeth results in decreased masticatory efficiency, causing
a shift in dietary practices.
• This may result in nutritional deficiencies.
• Tooth loss may also cause problems in speech and affect aesthetics,
causing an overall loss of self-esteem and confidence.
• Very little data are available on tooth loss.

49. Oral Manifestations of HIV
• Lesions in the mouth are common among people with HIV.
• Oral manifestations occur in 30–80% of people with HIV, with considerable
variations depending on factors such as accessibility 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 early in the course of the disease

50. Oral Manifestations of HIV cont’d
• More than half of HIV-positive people develop oral symptoms early in
the course of the disease, including
• fungal,
• bacterial and viral infections,
• severe periodontitis,
• hairy leukoplakia, warts, dry mouth, Kaposi sarcoma, and lymphoma.

51. Oral Manifestations of HIV
• Oral HIV lesions cause pain, discomfort, dry mouth, eating restrictions and are a
constant source of opportunistic infection which have significant negative impacts
on quality of life.
• Early detection of HIV-related oral lesions can be used to diagnose HIV infection,
monitor the disease’s progression, predict immune status and result in timely
therapeutic intervention. The treatment and management of oral HIV lesions can
considerably improve oral health, quality of life and well-being.

52. Noma
• Noma is a necrotizing disease that affects children between the ages
of 2 and 6 years.
• Mostly prevalent in sub-Saharan Africa. Noma starts as a soft tissue
lesion (a sore) of the gums, inside the mouth.
• The initial gum lesion then develops into an ulcerative, necrotizing
gingivitis that progresses rapidly, destroying the soft tissues and
further progressing to involve the hard tissues and skin of the face.

53. Risk factors
• Malnutrition,
• Coexisting infectious disease,
• living in extreme poverty and with
• weakened immune systems
• However, the great majority of affected communities in Africa are situated
in peri urban and rural areas where traditional beliefs and stigma are
prevalent, and early detection, diagnosis and access to care are difficult.
• Survivors suffer from severe facial disfigurement, have difficulty speaking
and eating, face social stigma, and require complex surgery and
rehabilitation.

54. Strategies to prevent Noma
• Ensure referral of patients with advanced Noma
to specialist care.
• Provide rapid and appropriate primary care for
patients with early stages of Noma.
• Strengthen early detection of Noma cases based
on integrated community health strategies.
• Support comprehensive measures that contribute
to reducing poverty, malnutrition and other
environmental and behavioural risk factors of
Noma for children.

55. Dental-Facial Anomalies
Cleft Lip/Palate
• Clefts of the lip and palate are
heterogeneous disorders that affect the
lips and oral cavity
• occur either alone (70%) or as part of a
syndrome, affecting more than 1 in 1000
newborns worldwide.

56. Risk factors
• genetic predisposition is an important factor for congenital
anomalies,
• poor maternal nutrition,
• tobacco consumption,
• alcohol and obesity during pregnancy
• high mortality rate in the neonatal period in poor communities.

57. Malocclusion
Malocclusion is any deviation from the
normal relation of the teeth in the
same arch to each other, and to the
teeth in the opposite arch
Causes
Aetiology is usually multifactorial
Discrepancies in the craniofacial
skeleton, dentition, or both.

58. Causes of Dental-Facial anomalies and
Malocclusion

59. Control strategies of dental facial anomalies

60. Public Health Importance of Dental Diseases
• Untreated tooth decay is now known to be the most
prevalent of the 291 conditions studied between 1990 and
2010 within the frame of the international Global Burden of
Disease Study.
• This is the most authoritative estimation of global disease
burden and serves as a basis for health policy planning and
resource allocation.

61. Disease Burden cont’d
• Severe periodontitis, which is estimated to affect between 5
and 20 percent of populations around the world, was found
to be the sixth most common condition.
• Oral cancer is among the 10 most common cancers in the
world, and even more prevalent in South Asia, with numbers
expected to rise due to increasing tobacco and alcohol
consumption

62. PHB Cont’d
• Approximately 50 percent of the 35 million people living with HIV
suffer from oral fungal, bacterial or viral infections.
• In 1998, WHO estimated that there were 140 000 new cases of Noma
annually. A 2007 WHO survey revealed that 39 countries in the WHO
African Region had reported cases of Noma, although Burkina Faso,
Ethiopia, Mali, Niger, Nigeria and Senegal are the countries with the
highest burden of the disease. Without treatment, Noma is fatal in
90% of cases.

63. PBI continued
• And oral and facial trauma, associated with unsafe environments,
sports and violence, exacts a high toll, particularly on children.
• Moreover, one in every 500 to 700 children is born with a cleft lip
and/or palate.
• The many links between general and oral health, particularly in terms
of shared risk factors and other determinants, this therefore provides
the basis for closer integration of oral and general health for the
benefit of overall human health and wellbeing

66. General symptoms of Dental diseases
Symptoms can vary depending on the cause. However, common symptoms of
dental problems include:
• toothache
• sensitivity to cold or hot food or drinks
• loose teeth
• sudden pain when eating cold or sweet foods
• tooth changing color or shape
• worn teeth, including holes, cracks, or chips on the tooth
• bleeding or swollen gums
• gum pain
• swollen cheeks
• clicking jaw

67. Oral Health and Development

68. Conclusion
• Oral diseases can impact every aspect of life, including personal
relationships and self-confidence.
• It can lead to significant pain, anxiety, disfigurement, acute and
chronic infections, eating as well as sleep disruption and can result
in social isolation, loss of work and school days, and an impaired
quality of life.
• The good news is that oral health can be maintained by being
aware of the risk factors and taking actions to address these.
• Most oral health conditions are largely preventable and can be
treated in their early stages.

69. References
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References cont’d