Dr RITESH SHIWAKOTI

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.

Introduction

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

Background

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.

Project Outline

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

Method

Clinics

-Filling

-Extraction

-Referral

-Scaling

Services

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!

Schools and Oral Health

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

Treatments and Procedures

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

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

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.

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

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

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

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.

Cleft lip and palate

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.

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

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

Prosthetic Restoration of Hard Palate Defects

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.

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.

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Prosthetic Treatment of Mandibular Defects

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

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 nasopharynxduring phonation and deglutition, thereby completing the palatopharyngeal sphincter.

Palatal Lift ProsthesesA 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.

Prosthetic Restoration of Soft Palate Deficiencies

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.

Prosthetic Restoration of Facial Defects

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.

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

Prosthetic Restoration of Congenital Defects

A cranial implant is a biocompatible, permanently

implanted replacement for a portion of the skull.

Fabrication of Cranial Implants

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."

Fabrication of Radiation Stents & Carriers

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.

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.

Surgical Stents

Surgical Mouthguards

Surgical Splints Nasal Stents

Fluoride Carriers Digital (Finger) Prostheses

Lip & Cheek Support ProsthesesAthletic Facemasks

Laryngectomy AidsFacial Moulages

Tracheostomy Obturators Sleep Apnea Appliances

Orofacial Plugs Other Miscellaneous Prostheses

Fabrication of Miscellaneous Maxillofacial Prostheses