This document discusses the need for improved access to dental care services in rural areas of Nepal. It proposes training local health workers to provide basic dental services, such as tooth extractions, fillings, and oral health education. The health workers would establish dental clinics and work with schools to promote oral health through daily brushing programs, checkups, and curriculum. The goal is to make essential dental care more accessible and affordable for rural communities that currently lack such services.

1. Dr RITESH SHIWAKOTI

2. Introduction

Due to the geographical and economical condition of
the country, it takes time to access much needed
dental health care services in rural and small
communities in Nepal.

3. Background

 The Government of Nepal has already declared primary health
care policy approach and needs adequate health care stations
with skilled manpower in rural and communities.
 Oral health is frequently not perceived as a priority amongst
the deprived communities, hence oral health related problems
are increasing day by day in these communities.
 There are no oral health care facilities in the health posts in the
rural areas and most of the people from rural communities do
not receive essential dental care services. Hence there is an
acute need for appropriate dental health service and made
accessible and affordable in the community

4. Project Outline

 The trained Health Worker would be able to
 Diagnose common oral diseases.
 Perform simple tooth extractions.
 Minimize gums problems, performing scaling.
 Instruct the use of fluoride tooth paste.
 Spread oral health education in the communities as well
as in the schools.
 Carry out ART fillings.
 Provide first aid facilities of mandible and maxillary
fractures.

5. Method

 Seminars are organized through schools, by village
teams, to introduce the community to their new
dental clinic and to teach prevention. Teams
collaborate with the Oral Health Coordinator at each
school. After two years, schools run their own oral
health education.
 Education & Checkups
 Local Treatment

6. 

7. 
 Clinics
Services
-Filling
-Extraction
-Referral
-Scaling

8. Schools and Oral Health

 Run a daily brushing program at school
 Ensure each student gets at least one dental checkup
per year
 Include oral health education in the school health
curriculum
 Organize fun, creative activities to promote oral
health care: competitions, fairs, dramas, art
exhibits…anything goes!

10. Treatments and Procedures

 Treatments and procedures performed by oral
maxillofacial surgeons address a variety of conditions and
diseases of the mouth, teeth, jaw and face. These include:
 Diagnosis/treatment of potentially life-threatening
infections of the maxillofacial region
 Performing biopsies and other diagnostic tests
 Diagnosis/treatment of oral cancers
 Diagnosis/management of impacted teeth, wisdom teeth,
tooth extraction and dentoalveolar surgery, which
encompasses all procedures relating to the teeth,
supporting tissue and bony structures in the mouth

11. 
 Surgical treatment of facial pain problems related to the
temporomandibular joint (TMJ)
 Surgical correction of oral and facial deformities caused by
differences in skeletal growth between upper and lower jaws,
and congenital defects, including cleft lip and palate
 Reconstructive jaw surgery to correct hard and soft tissue
injuries in the upper and/or lower jaws resulting from trauma
or tumor surgery
 Treatment/repair of traumatic injuries to the face, jaws, mouth
and teeth
 Dental implant placement (single tooth, several teeth, entire
mouth)
 Cosmetic facial procedures

12. 
 Pathological oral maxillofacial conditions that may
benefit from corrective jaw surgery include:
 Chronic jaw or jaw joint (TMJ) pain unresponsive to
conservative therapy
 Open bite (space between the upper and lower teeth
when the mouth is closed)
 Unbalanced facial appearance
 Facial injury or birth defects
 Receding chin

13. 
 Protruding jaw
 Inability to make lips meet without straining
 Sleep apnea (breathing problems when sleeping;
such as snoring
 Depending on the procedure, corrective jaw surgery
may be performed under general anesthesia in a
hospital, ambulatory surgical center or in the oral
maxillofacial surgery office. Surgery may take from
one to several hours.

14. 
 Common cosmetic procedures that oral maxillofacial
surgeons are qualified to perform include:
 Cheekbone implants (malar augmentation) to achieve
higher, more prominent cheekbones and improved facial
balance
 Chin surgery (genioplasty) to increase/decrease the chin's
length and projection
 Ear surgery (otoplasty) to change the shape, size or
placement of ears

15. 
 Eyelid surgery (biepharoplasty) to remove fat and
excess skin from upper and lower eyelids
 Facelift (rhytidectomy) to provide a younger-looking
appearance by tightening facial skin and muscles,
and removing excess skin
 Facial and neck liposuction to sculpt the face by
removing excess fat; neck liposuction often is done in
conjunction with procedures such as corrective jaw
surgery

16. 
 Forehead/Browlift to improve brow positioning,
minimize frown lines and reduce forehead wrinkles
 Lip enhancement to reshape the upper and lower lip for a
more attractive/youthful look; lip augmentation employs
various materials to "plump" lips, creating fullness and
decreasing vertical lines
 Nasal reconstruction (rhinoplasty) to reduce/increase
nose size, alter shape of nose tip or bridge, narrow the
span of the nostrils, or change the angle between the nose
and upper lip

17. Cleft lip and palate

 Primary management
 Antenatal diagnosis:
 cleft lip could be diagnosed by US after week 18 of
gestation
 Cleft palate cannot be diagnosed on antenatal scan
 Feeding:
 Soft teats and modified teats
 Enlarging the hole in the teat.

18. 
Surgical techniques:
Cleft lip
 Principle : attach and reconnect the muscles around nasal
aperture and oral sphincter
 Performed btw 3- 6 months
 Skin incisions to restore displaced tissues including skin
and cartilage to their normal position
 Nasolabial muscles are anchored to the premaxilla
 Oblique muscles of orbicularis oris are sutured to the base
of the ant nasal spine
 Closure is completed by suturing the horizontal fibers of
orbicularis oris.

19. 
Cleft palate
 Principle : mobilization and reconstruction of the
abbarent soft palate muscles, together with closure of the
residual hard palate cleft by minimal dissection and
subsequent scarring
 Cleft palate closure can be achieved by one or two stage
palatoplasty.
 Delaire technique and sequence is one the regimens used
for timing of primary cleft lip and palate procedures:
 Cleft lip alone:
 Unilateral : one operation at 5-6 months
 Bilateral : one operation at 4-5 moths

20. Prosthetic Restoration of Hard
Palate Defects

 Surgical Obturators: A surgical obturator is a
temporary prosthesis used to restore the continuity
of the hard palate immediately after surgery
 Service includes:
Delivery in the operating room
Unpacking of the defect
Maintenance and relines of the obturator

21. 
 Interim Obturators: An interim obturator is a
prosthesis that is made after a surgical resection of a
portion or all of one or both maxilla; frequently, this
may include replacement of teeth in the defect area.
 Definitive Obturators: A definitive obturator is a
prosthesis that artificially replaces part or all of the
maxilla and associated teeth lost due to surgery or
trauma. It is fabricated after complete healing of the
defect has occurred.

22. 
 Mandibular Resection Prostheses:
A mandibular resection prosthesis is a maxillary and/or
mandibular prosthesis delivered after a mandibular
resection to provide the remaining deviated mandibular
segment improved occlusal contact with the maxillary
dentition. This can require the use of a flange, guide, or
occlusal platform incorporated in the prosthesis to guide the
mandibular segment into optimal occlusal contact.
.
Prosthetic Treatment of
Mandibular Defects

23. 
 Mandibular Reconstruction Prostheses:
A mandibular reconstruction prosthesis is a prosthesis
delivered after surgery to reconstruct continuity of the
mandible following a mandibular resection.
 Palatal Augmentation Prostheses:
A palatal augmentation prosthesis is a prosthesis that allows
reshaping of the hard palate to improve tongue-palate
contact during speech and swallowing. The prosthesis is
necessary in patients with impaired tongue mobility caused
by surgery, trauma, or neurological motor deficits

24. Prosthetic Restoration of Soft
Palate Deficiencies

 Speech Aid Prostheses:
A speech aid prosthesis is a removable maxillary
prosthesis to restore an acquired or congenital defect of
the soft palate. A portion of the prosthesis extends into
the pharynx to separate the oropharynx and nasopharynx
during phonation and deglutition, thereby completing the
palatopharyngeal sphincter.
 Palatal Lift Prostheses
A palatal lift prosthesis is a removable prosthesis that aids
in velopharyngeal closure by elevating an incompetent
soft palate that is dysfunctional due to clefting, surgery,
trauma, or paralysis.

25. Prosthetic Restoration of Facial
Defects

 Auricular Prostheses:
An auricular prosthesis replaces the auricular
portion of an ear that is partially or totally missing
due to surgery, trauma, or a congenital anomaly.
 Nasal Prostheses:
A nasal prosthesis is a prosthesis that replaces a nose
that is partially or totally missing due to surgery or
trauma.

26. 
 Orbital Prostheses:
An orbital prosthesis is a prosthesis that replaces the
contents of the orbital region, including the eyelids
and the eyeball, following surgery or trauma.
 Ocular Prostheses:
An ocular prosthesis is a prosthesis that replaces an
eyeball following surgery or trauma.

27. Prosthetic Restoration of
Congenital Defects

 Prostheses for Cleft Palate and Other Craniofacial
Anomalies:
 These prostheses are needed to obturate a cleft or
restore missing/defective dentition in patients with
cleft palate or other craniofacial anomalies. Feeding
aids for infants can also be fabricated

28. Fabrication of Cranial
Implants

 A cranial implant is a biocompatible, permanently
implanted replacement for a portion of the skull.

29. Fabrication of Radiation
Stents & Carriers

 Radiation Stents:
 A radiation stent is an intraoral prosthesis designed to
position/shield tissues during radiotherapy of the head
and neck regions. Types of radiation stents include:
 Tongue Depressing Stents:
 A tongue depressing stent is a custom made device which
positions the mandible and depresses the tongue during
radiotherapy of head and neck tumors. These stents are
more accurate and provide greater patient comfort than
the commonly used "cork and tongue blade."

30. 
 Balloon Bolus Supporting Stents:
 A balloon bolus supporting stent supports a saline-filled
balloon bolus in a maxillectomy defect during
radiotherapy following a maxillectomy due to head and
neck cancer. The bolus serves to improve dosimetry at the
defect site. The stent also positions the mandible and
depresses the tongue outside of the radiation field.
 Parotid Stents:
 A parotid stent contains an alloy that shields contralateral
tissues during unilateral radiotherapy of the parotid
gland or buccal mucosa.

31. 
 Perioral Cone Positioning Stents:
 A perioral cone positioning stent positions a perioral
cone during radiotherapy for head and neck tumors.
This type of stent is commonly used when boosting
the dose to the tumor site.
 Radiation Carriers:
 A radiation carrier is a device used to administer
radiation to confined areas by means of capsules,
beads, or needles of radiation emitting materials.

32. Fabrication of Miscellaneous
Maxillofacial Prostheses

 Surgical Stents
Surgical
Mouthguards
 Surgical Splints Nasal
Stents
 Fluoride Carriers Digital
(Finger) Prostheses
 Lip & Cheek Support
Prostheses Athletic
Facemasks
 Laryngectomy Aids
Facial Moulages
 Tracheostomy
Obturators Sleep
Apnea Appliances
 Orofacial Plugs Other
Miscellaneous
Prostheses