Dr RITESH SHIWAKOTI
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.
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
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.
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

 
 Clinics 
Services 
-Filling 
-Extraction 
-Referral 
-Scaling
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!
Oral health program and etc
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
 
 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
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.
 
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
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
 
 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. 
. 
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
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.
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.
 
 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.
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
Fabrication of Cranial 
Implants 
 
 A cranial implant is a biocompatible, permanently 
implanted replacement for a portion of the skull.
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."
 
 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.
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

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Oral health program and etc

  • 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