Care of the teeth
Dental care or broadly speaking oral hygiene is an important aspect of the personal health of an individual. Good oral hygiene implies sound teeth and healthy gums with healthy surrounding tissues. The physical act of giving food promotes saliva and gastric secretions and helps in digestion. The act of chewing and tasting is called mastication. It gives pleasure and therefore, emotional satisfaction of eating food. Teeth are essential not only for mastication of food, but also for good appearance and clear speech. There is evidence that improvement of oral hygiene does improve the general health. The nursing staff have a special contribution to make it in the care of oral hygiene of their patients in hospitals, nursing homes and other residential institutions. All too often this care is neglected.
The most common dental ailments, throughout the world, are dental caries and periodontal disease that is gum disease or also called as pyorrhoea. the term halitosis is used for bad breath. Halitosis is due to poor oral hygiene, periodontal disease, sinus infections, tonsiilitis and infections of nose and throat. These conditions are quite common in India and often begin in early childhood. Dental diseases in children often continue into adult life.
Dental caries: Dental caries is the most destructive of all dental diseases, leading to cavity formation and tooth decay. Dental decay is due to the action of acids on tooth enamel, and these acids are produced by certain mouth bacteria acting up on food particles lodging in the mouth. If the acids come in prolonged contact with enamel, a cavity develops on the enamel surface. Once damaged, the enamel cannot repair itself. It is now accepted that dental caries is due to bad oral hygiene. A lot of research has shown that sugar consumption can increase caries, particularly when the sweet substance is in a sticky form.
Periodontal disease: This is better known to the lay people as "Pyorrhoea" or pockets of pus around the teeth. It develops slowly. As it is a painless condition, it remains unnoticed by the patient for a long time. It is responsible for more tooth loss than any other single factor. It affects the supporting structures surrounding the teeth to the extent that a tooth may eventually fall out or have to be removed. Pockets of pus around the teeth also act as septic foci, and undermine the general health of the body. Hygiene of the mouth is therefore, essential for the control and prevention of dental diseases. The care of teeth comprise the following measures.
Tooth brushing: Teeth should be cleaned at least twice a day. Many people in the countryside use tender twigs of neem or babool as a toothbrush. Some use ashes, some charcoal, and some tooth powders. The toothbrush is the best means for the removal of food debris and dental plague. Dental plague is the name given to the soft, proteinous material and that accumulates around the neck of the teeth. Combined with day and dentifrices (toothpastes or powder), toothbrushing is ideal for cleaning the teeth. The bristles of the toothbrush should not be too sharp or too hard. In general, a vertical or circular brushing technique is recommended. Teeth should be cleaned and the mouth rinsed soon after food is eaten because the food particles in the mouth begin to ferment and from an acid in 15 to 20 minutes. The tongue should also be scraped or brushed and the mouth gargled with lukewarm water to keep that throat clean. Some toothpaste contain fluoride which can be helpful in preventing dental caries. Electric toothbrushes have been devised for the handicapped where manual skin is limited.
Use of fluorides: Whenever drinking water contains less than 0.5 mg of fluorides per litre, excessive dental caries has been observed. The optimum level of fluoride in drinking water is between 0.5 to 0.8 mg per litre. Fluorides decrease enamel solubility in acids. It is now a common practice in many developed countries to add fluorides to drink water in fluoride deficient areas. Fluorides in drinking water act both systematically and locally. An alternative to fluoridation of drinking water is to apply tropical fluorides on the tooth surfaces. Fluoride containing dentifrices are also available in the market. They can reduce dental caries by 15 to 20 percent. The use of fluoride is a valuable means of caries prevention.
Regular dental check -up: Dental check up twice a year is recommended for early diagnosis and treatment of dental ailments. In some countries, regular dental services are provided to all school children through school dental nurses and dental hygienists.
Diet: The relationship between diet and dental disease is well known. In civilized communities, dental disease are on the increase. Excessive intake of refined carbohydrates such as sugar, sweets, jalebis, pastries, cakes, chocolates and biscuits promote dental caries. Soft and sticky foods that adhere to the teeth produce more decay than other foods that are quickly cleared. Therefore, the frequency of there intake should be reduced. On the other hand, intake of fruits and vegetables (example apples, carrots, celery) reduces the frequency of dental caries. These foods are called "nature's toothbrushes" and their daily intake should be promoted. In fact, one should eat a variety of foods.
Habits: Certain habits promote dental caries. The habit of holding a sweet in the mouth causes a marketed increase in tooth decay. Similarly, a baby holding a feeding bottle with milk or sweetened juices in its mouth when going to sleep or frequently sucking it throughout the day is likely to develop dental caries -later this is called by the dentists as "baby bottle syncdrome". The habit of eating snacks frequently in between meals is also a bad habit. The habit of chewing betal leaves and tobacco is an important cause of bad oral hygiene in india. Cancer of lips and oral cavity are potential hazards of smoking and betel chewing. Research has borne out that the parental example has the strongest influence upon a child's dental health practice. The foundation of good oral health is laid in early childhood.
Care of dentures: Dentures false teeth are man made substitutes like spectacles or false limbs. All dentures are potentially traumatic. Dentures should be removed after meals and thoroughly cleaner because food particles which accumulate are broken down by the enzymes in the saliva. These breakdown products acts as irritants and cause inflammation of soft tissues. All dentures must be removed at night because they can act as incubators of bacteria. Further, they can cause excessive pressure on the soft tissues and bone. The soft tissues of the mouth also require rest. After removing the dentures, the mouth should be rinsed thoroughly with warm salt water. The dentures should be cleaned with a toothbrush. Do not place the dentures in boiling water or run boiling water over them as this will cause them to warp and discolour. Dentures may be cleaned in any washing-up detergent or baking soda.
Care of the eyes
Prevention and control of infection: The eyes is a delicate and sensitive organ. Any discharge, redness or pain in the eye should be taken note of seriously. The conditions resulting from infection are mainly conjunctivitis and trachoma. Conjunctivitis is an acute inflammation of the outer layer of the eye and is caused by bacterial or virus agents, allergy or following an eye injury. In recent years, epidemics of conjunctivitis have also been reported. Trachoma is a form of conjunctivitis, caused by a virus. It is spread through the use of infected clothes, handkerchief, towels, surma sticks and flies. Trachoma is common in school children. The preventive measures comprise (1) early diagnosis and treatment until cure is achieved. (2) Health education emphasizing the importance of using clean towels, fly control and preventing flies from sitting on the faces of infants and children and attention to good personal hygiene.
Injuries: The eye is exposed to injuries while at work or play. Accidents just do not happen. They are the result of negligence. In industries and occupations where eye injuries are common, the workers must use protective glasses. A large number of eye injuries in children are caused by fire crackers and fireworks during Diwali festival. Similarly, playing with bow and arrow is also a hazardous game. Small particles of charcoal, sand, splinters etc which fall into the eye also cause considerable discomfort. Such foreign bodies should be washed out immediately with plenty of water. It is harmful practice to rub the eyes when there is a foreign body. If the foreign body does not comes out easily a doctor must be consulted immediately.
Eye strain: Reading must be done in good light in order to avoid eye strain, the light coming from left and behind. Hold the book about a foot and a half away from the eyes and at an angle of 45 to 70 degrees from horizontal. Avoid reading in moving trains and buses or in lying down position. It is better to avoid reading books of magazines with a very fine print. While doing close work, give rest to the eyes frequently by closing them or by looking away to a distant object from time to time. The eyes must be protected from direct expose to sunlight, glare and excessive brightness. It is desirable to wear sunglasses to avoid excessive brightness but very dark glasses are not adviced.
Good diet: Some eye disease are due to malnutrition. Deficiency of vitamin 'A' leads to Xerosis- dryness of the conjunctiva, Keratomalacia- softening of cornea and night blindness. These are widespread in india, all preventable by ensuring a well balanced diet. Protective foods such as green leafy vegetables, fruits, milk and butter should be included in the daily diet. As blindness due to vitamin 'A' deficiency is so common in certain parts of the country, the government of India in 1970 launched a program of "mass prophylaxis" by administering large doses of vitamin 'A' to pre school children in endemic states. The program is continuing at present.
Squint: If there is a crossed eye or squint, a qualified eye specialist should be consulted. The defect can be rectified by the use of glasses or eye exercises for both. In some cases, an operation may be necessary. The defect of squint eyes should be treated early in life. Full vision cannot be stored if treatment is delayed till adult life.
Regular check- up: Signs of eye diseases such as watery discharge, collection of pus, soreness of eyes or lids, swelling of eyelids, blurred vision, spots before eyes, headache, eye fatique, seeing coloured halos around lights, should not be neglected. A regular check up, by a specialist once a year untill the age of 10 and thereafter, every 3 years will lead to early detention and treatment of many eye diseases. Mention must be made of errors of refraction. As a person ages, he becomes more and more long-sighted (presbyopia). Short sightedness is called myopia. Nearly everybody over the age of 45 needs glasses for close work.
Hygiene of the eyes: The skin around the eyes should be kept clean by washing with soap and clean water. Washing at bed time is a very good practice as it removes the dust and dirt collected during the day. Use of common towels for wiping the face and eyes should be discouraged. Eyes should not be touched with unclean fingers or any other cloth. Eyes should not be exposed to dust, very bright light or direct sunlight. Exercise is good for the eyes. It is most effective in the early morning. This may be done by blinking the eyes 10 times quickly, then shutting the eyes for a moment and then blinking again 10 times. This exercise tones up the muscles of the lid. There are other exercises also like circling the eye balls, in clockwise and anticlockwise directions.
Care of eyes in newborn: In a new born, the natural body defences in the eye are lacking. Therefore, the eye is susceptible to infection. The infection may occur during birth from the mother, or after birth, during baby bath or subsequently by soiled linen. Care should be taken to prevent contamination of conjunctiva at the time of birth and immediately thereafter. Sterile wet swab should be used to clean the lid margins of the newborn before the eyes are open. At the time of bath, water should not be allowed to run into the eyes. Freshly prepared silver nitrate solution or freshly prepared penicillin drops should be instilled into the eyes. Any discharge from the eye of an infant is pathological and calls for immediate attention.
Harmful practices: The practice of applying kajal for black soot mixed in oil for beautification may be harmful. Often this practice has been blamed for transmitting trachoma and other eye infections. Some people lose their eyes because of irritants prescribed by quacks or by the interference in the eye by quacks. In summary, the care of eyes is more than mere medical attention. The basic social cause of ignorance, poverty, low standard of personal hygiene and inadequate medical services are to be remedied.