Questions :

19. Promoting Oral Health : Individual and Collective Responsibilities

Contributed by:

Professor Dr. Ishak Bin. Abdul Razak

Department of Community Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur

Every year the Malaysian Government spends a considerable amount of money in meeting the oral health needs of the Malaysian public. About 18 million Ringgit was spent in 1975. By 1996, this amount had increased by 33 folds. This does not take into consideration the out-of-pocket expenses incurred in obtaining actual treatment in the private sector as well as other related expenses incurred in seeking care. Does more money spent on oral health means better oral health status?

Data on oral health status of 5 year-old pre-school children in 1995 indicate that 87% of these children had experienced tooth decay with an average of 6 deciduous (milk) teeth being affected. Among 12 year-old children, 70% were found to have experienced dental decay in 1988 which was a slight improvement from 78% in 1970. The mean number of decayed teeth among these children had also declined from 3.7 to 2.4 within this period. Current data suggests that on average less than 2 teeth are decayed. Among adults, the proportion of the population who suffered from the ravages of tooth decay has remained somewhat stagnant at about 95% in 1974 and 1990. The latter survey also found that the rate of edentulousness (total tooth loss) starts to rise from the age of 35 onwards. Nine out of ten adults showed some evidence of gum diseases. In 1993/94, about 1.5% of adults aged 25 years and above in Malaysia were found to have oral cancers or precancers with the prevalence increasing with increasing age.

So inspite of the large amount of money spent on oral care, it would appear that the oral health status of the Malaysian public has not shown significant improvement. While the dental services has been effective in meeting the treatment needs after the onset of disease, it has little influence in promoting a healthy lifestyle. It should be noted that the major oral diseases namely dental decay. gum diseases and oral cancers are actually diseases of lifestyle. For as long as unhealthy habits remain unchanged, oral diseases will occur or recur to the extent that it will drain the existing resources to treat them. What then can the public do as an individual and collectively as members of society in order to maintain and promote oral health in order to reduce the disease burden. Health preserved by way of life is far superior to health restored by treatment of disease.

There are three ways to achieve this:

  • adopt healthy life practices.
  • use wisely available oral health services.
  • make decisions both collectively and individually to improve the community's oral health and environment.

Adopt healthy life practices

Control sugar intake both in amount as well as frequency. Sugar not only contributes to tooth decay but also to the occurrence of diabetes, heart disease and obesity. Restrict consuming food or drinks containing sugar only to mealtimes. Beware of hidden sugars in food because it is often used as a flavouring as well as a preservative agent. Make it a habit to read food labels.

Use fluoridated toothpaste. The most effective measure to overcome tooth decay on an individual basis other than sugar restriction is to use fluoridated toothpaste. Use only a pea sized amount of toothpaste. For young children, brushing should be supervised to prevent swallowing of excessive toothpaste.

Regular and thorough tooth cleaning is the only way to maintain the health of the gums. Brush effectively twice a day especially before bedtime and use dental floss to remove food debris and bacteria in between teeth.

Avoid smoking and alcohol consumption and refrain from betel quid chewing. Smoking not only causes oral cancer, gum diseases, mouth odour and nicotine stain but more importantly it also causes lung cancers and heart diseases. A dose-response relationship between tobacco smoking and oral cancer has been demonstrated. Tobacco chewing is also hazardous to oral health because very often the tobacco is kept in a particular site in the mouth for long period of time with deleterious local effects leading to the development of oral cancers. Alcohol consumption is also an important independent risk factor. There is evidence that the combined effects of smoking and alcohol consumption is greater than the sum of the risks from exposure to either on its own.

Pay greater attention to your children's teeth even though these may by deciduous (milk) teeth. Inculcate healthy habits early in life so that it will remain the norm.

Use wisely available oral health services

isit the dentist at least once a year to enable the dentist to undertake preventive measure before the onset of disease or to detect oral diseases at an earlier stage to ensure better prognosis in treatment. Preventing disease is a better option than treatment. However when treatment is required, choose the treatment options that will have the least oral health impact on function and aesthetics. A natural tooth that requires filling is better than having it extracted and having it replaced by a denture. So try and save the tooth whenever circumstances permit.

Collective actions

What can you do collectively as members of society in order to prevent oral diseases and enhance oral health. In other words what can you do to make the healthier choice the easier choice or to make the unhealthy choice more difficult.

Insist on fluoridation. Water fluoridation has been found to be the most cost effective means of reducing dental decay. It has been proven conclusively in bringing about a 50% reduction in dental decay, although effect is slightly reduced with the declining trend in dental decay. It is estimated that this benefit only cost 20 sen per capita per year.

Health cannot be achieved by the health sector alone. You have a role either as an individual or collectively as members of society in adopting healthy life practices and in ensuring that the healthy choice remains the easier choice.


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