Mouth Cavity Sanitation

MOUTH CAVITY SANITATION, systematic treatment of existing and timely prevention of newly arising pathological processes in the oral cavity, as well as regular medical supervision over it throughout the entire period of formation of permanent teeth, i.e., from 6 to 15 years of age, which largely coincides with the so-called school age. Only in the USSR are working-class children widely covered by the state network of school-prophylactic outpatient clinics, where systematic free sanitation of their oral cavity is conducted according to a unified plan and methodology. The latter is based on the system of Professor Kantorovich with corresponding modifications introduced by P. Daugė and resulting from the peculiarities of organizational forms of Soviet medicine on the one hand, and from the specific conditions of public education in the USSR on the other. At present, in the USSR there is not a single major urban or industrial center where sanitation of the oral cavity (S.p.r.) is not conducted among working-class children. In February 1931, the People's Commissariat of Health issued, in connection with the decree on compulsory schooling, a circular 'on compulsory S.p.r. of school-age children.' This circular primarily has in mind industrial centers, as well as the socialist sector of the village, where sanitation is conducted with the broad participation of dental public health workers, in the framework of patronage work, etc. Principles and methodology of S.p.r. The main feature of the sanitation system conducted in the USSR is the principle of sequential planning. The lack of strict planning and the unsuitability of the individualistic form of dental care established for decades led to the fact that all previous attempts at mass sanitation of children were unsuccessful. Even in Strasbourg, the cradle of school dentistry, in 1905-06, out of 7,491 children covered by the preventive dental outpatient clinic, 4,885 children turned to it because of pain, i.e., not for the purpose of preventing tooth decay, but for their individual treatment or extraction of deeply decayed teeth. The number of extractions of deciduous and permanent teeth in most German cities predominated over the number of preventive fillings. The overall coverage of children was negligible. In 1912, only 5% of Berlin schoolchildren were treated, Leipzig-8%, Cologne-12%, Strasbourg-35%, Bonn-20%. Meanwhile, Kantorovich as early as 1920 managed to achieve complete coverage of school-age children in Bonn and its vicinity and to raise the percentage of sanitized, i.e., completely healthy, children to 95-98%, with extractions reduced to a minimum and almost entirely limited to deciduous teeth. Practice also showed that the number of doctors required for systematic planned preventive health care of the oral cavity of the younger generation is many times less than when using methods of unplanned individual treatment of neglected children's mouths. 'Since permanent teeth begin to erupt at the age of six and since they are still healthy at this time, the first school year (compulsory education in Germany is established from the age of six) is the most suitable moment to begin treatment of just beginning caries. At this time, treatment of such a tooth requires from 5 to 10 minutes of time, whereas in 3 years it will require 60 minutes' (Kantorovich). In one of his later works, Kantorovich reduced the time required for sanitation filling to 3-5 minutes. Thus, we see that the task of systematic S.p.r. is to not miss the moment of just beginning tooth decay, i.e., it requires the strictest organization. The main points of sanitation come down to the following: health authorities in charge of sanitation must establish the closest ties with education authorities. Each dental outpatient clinic must know exactly the number of primary schools and kindergartens in its area, as well as the contingent of children of different age groups, starting from 6 years of age. Having determined the number of children, one can calculate in advance the required number of doctors for conducting sanitation work. After this, the prepared personnel begins the initial examination of children. This is best done in school, in order to establish close contact between the outpatient clinic and school workers, whose task is to ensure the punctual arrival of children at the appointed time in the outpatient clinic and to supervise the correct attendance of schoolchildren called for repeated treatment. The first examination of children in school has a dual meaning: 1) purely organizational, educational, and the school administration should in every way facilitate the task of the examining doctor: to compile alphabetical lists of the groups to be examined, to fill in the headers of sanitation cards, etc.; 2) educational: the doctor gets acquainted with the children, with the school and educators, holds brief conversations with them, explaining the material and therapeutic advantages of early intervention, its undoubtedly lesser pain, speed, etc. Children are called to the outpatient clinic in groups of 15-20 people in accordance with its capacity, accompanied by the class teacher, who presents in advance special sanitation sheets in alphabetical order and with filled headers. It is desirable to take the entire group at one time (necessarily starting with the youngest group) and to sanitize it in one session, regardless of the number of carious teeth. This requirement is basically quite feasible, since in the first year we are dealing only with the youngest six-year-old group, in which the first six-year-old molars have just erupted, the coefficient of decay of which in the seventh year ranges from 0.2 (according to Shapiro) to 1.34 (according to Kantorovich). The matter is complicated when we are dealing not with a kindergarten, but with a primary school, the compulsory age of children in which in the RSFSR is set at 8 years. Here the caries coefficient accordingly increases to 0.9-2.59 teeth. Under these conditions, the youngest, i.e., 8-year-old, group requires 1 or 2 extra sessions. Fissure or approximal caries should be filled with the utmost care to guarantee the tooth against secondary caries—in permanent teeth with amalgam, in front teeth predominantly with silicate cement. The time required for preventive filling of superficial caries, on the basis of carefully verified timing, has been established for Soviet dental outpatient clinics at 10 minutes (Daugė), which constitutes one labor unit. In sanitation of school age, attention should be paid to the timely neutralization of deciduous teeth, since they pose a danger to adjacent permanent teeth: deeply decayed ones are removed or ground down, strong deciduous teeth with superficial caries and with a distant time of replacement (e.g., canines) are filled. Systematic S.p.r., as stated, should be started with the youngest group, fundamentally from the age of six. In the first sanitation year, the doctor deals with the first permanent molars. Since these teeth are next to the second deciduous molars, the latter, in case of caries, must be immediately neutralized in order to protect the first permanent molars from approximal caries. In the second school year, in addition to monitoring the integrity of the first molar, mainly its mesial surface, the doctor's task should be focused on the permanent central incisors, the normal time of eruption of which occurs at the age of 8. In case of decayed neighbors, i.e., lateral deciduous incisors, the latter are immediately removed. In the third year, attention should be focused, in addition to monitoring the integrity of existing first molars and central incisors, on the lateral incisors erupting at the age of 9, which may be threatened by a carious deciduous canine, the time of eruption of which occurs in 2-3 years. A firmly seated deciduous canine must be treated and filled according to the general rules for permanent teeth. In the 4th year, attention should be paid, in addition to careful monitoring of previous groups of teeth, to the erupting first premolar, which may be threatened on the mesial side by a carious deciduous canine, and on the distal side by a carious second deciduous molar. In case of such a danger, these neighbors must be removed in a timely manner. In subsequent years, until the end of the replacement of deciduous teeth, all sanitation work is carried out on the same principles. As for the wisdom tooth, it is excluded from the school sanitation plan due to its late eruption.—In addition to preventing caries, the task of S.p.r. also includes careful monitoring of the condition of soft tissues of the mouth, as well as hypoplastic lesions of teeth and in general instilling in children's consciousness all the rules of dental and oral hygiene. In addition, systematic (2 times a year) control over sanitized groups is required. Since the sanitation methodology outlined above has in mind coverage of schoolchildren from the age of 6, and in our country compulsory education is established from the age of 8, corrections must be made to the above sanitation plan.

This is achieved in various ways: the best method is the organized coverage of all six-year-old children in children's homes, kindergartens, and other preschool institutions. In most cases, this is achieved in our country through patronage and other social work. Where such preschool sanitation cannot be implemented, planned sanitation must be carried out in a strictly organized manner, starting sequentially with the youngest school age group. But since at the age of 8-9 years there is already a significant percentage of deeply affected teeth with pulpitis, gangrene, paradentitis, etc., such delayed sanitation requires much more time, which once again proves the enormous advantage of early sanitation coinciding with the eruption of the first group of permanent teeth. Methodology for recording and accounting for sanitation work. For sequential mouth cavity sanitation of the younger generation on a national scale, centralized accounting is necessary. The latter requires an accurate, unified registration system. Based on the experience of sanitation work in various regions and districts of the RSFSR over several years, as well as the children's department of GISO, conducted on the basis of Kanatorovich's registration card, P. Daughe recently introduced a number of corrections and developed a maximally simplified registration system. According to the latter, 4 forms of cards are established: 1) individual sanitation card; 2) physician's calendar statement; 3) school statement and 4) annual report. The annual report is compiled from summarized school statements of all educational institutions covered by the sanitation plan in such a way that by comparing the total number of organized preschool and school-age children (from 6 to 15 years) in a given region (republic, territory) and the number of children covered by sanitation, a clear picture of the degree of actual improvement of the oral cavity of the younger generation is obtained. With systematic mouth cavity sanitation, all basic work comes down to a series of the simplest mechanical manipulations—small fillings, tooth cleaning, removal of milk teeth with resorbed roots, elementary sanitary-hygienic education—which can be entirely entrusted to qualified middle-level medical personnel, while the general guidance and all complex therapeutic, surgical, orthodontic work remains the responsibility of physicians. Mouth cavity sanitation of preschool age and adult population. As is clear from all the above, mouth cavity sanitation of school age is not prevention in the exact sense of the word—but merely a health-improving procedure at an age when the chewing apparatus has already reached a certain development (often defective) and often a significant degree of caries. Mouth cavity sanitation is the interruption and further prevention of pathological processes in the oral cavity. But at the current stage of our social construction, it represents the most accessible, economical, and effective form of mass health improvement for the younger generation. True prevention should begin from the fetal and lactation period of the child, and sanitation of the milk apparatus—from the moment of eruption of the first milk tooth until the change of teeth, i.e., until school age. This work is partially carried out by the organs for the protection of motherhood and infancy, but it is not carried out systematically. The task of the health authorities is to make it systematic. The principles of mouth cavity sanitation of preschool age do not differ from the principles of mouth cavity sanitation of school age. As for the sanitation of the adult population, at present it is carried out only in large medical combines or unified dispensaries and is limited in most cases to workers in leading industries and especially workers in occupations harmful to the oral cavity and teeth. Valuable work in this direction has been done in Rostov-on-Don by S.P. Mayorov, who carried out sanitation of several thousand workers from printing, food, leather, and other industries. However, this work is not sanitation in the exact sense, but purely clinical health-improving work, after the complete implementation of which it will be possible to speak of further systematic sanitation observation. Systematic mouth cavity sanitation gives enormous benefit to all working people, if after its sequential implementation in school age, sanitation observation and all corresponding measures are continued among those who have completed primary school both in higher educational institutions and among factory youth and rural youth of the social sector. But this can be achieved only in the system of large medical combines in which dental prophyloria will function with the widest differentiation of sanitation work by age and labor groups.