Chapter 1: Your Own Teeth and Gums

Next time you look in a mirror, look at your teeth and the skin (gums) around them. Look in your children’s mouths, too. Look at both gums and teeth, because the health of one often depends on the health of the other. To be strong, teeth need healthy gums. Healthy gums need clean teeth.

What can good teeth give you?

· GOOD HEALTH
· GOOD LOOKS
· GOOD SPEECH
· GOOD EATING
· GOOD BREATH

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And when you think of your teeth, think of your gums. Gums are important for holding each tooth in place.

You need strong teeth to eat different kinds of foods. Different foods are important for health. Nuts, maize, fruits, and meat are some of the best foods - but they are difficult to bite and chew if your teeth are loose and hurting!

You can usually tell if your teeth and gums are healthy or not. Look at the pictures on Chapter 6 and compare them with your own mouth. If you find a problem in your mouth, look for its name in Chapter 6 and look for its treatment in Chapter 7.

Most important: when you are not sure of a problem or how to treat it, talk to an experienced dental worker.

If you notice a problem early, often you can stop it from getting worse. It is even better to prevent the problem from starting. You can do this if you know how to keep your teeth and gums healthy.

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Learn to take care of your own teeth and gums before you try to teach others. A good example is one of your best teaching tools. People will see that you are healthy, and they will want to know why. When you tell people ways to care for their teeth, they will believe you if they know that you do these things yourself. First take care of your own teeth and gums. Then teach your family what you have learned. They, too, will be good examples for others to see.

EAT ONLY GOOD HEALTHY FOODS

The best food is food that you grow or raise yourself. Mix different kinds of food together and eat several times a day. This helps your body as well as your teeth and gums to stay strong and healthy. Traditional food is usually good food.

Sweet food, especially the kind you buy from the store, can mix with germs and make cavities - holes in the teeth. Soft food sticks to the teeth easily and it, too, can make a coating of germs and food on the teeth that starts an infection in the gums - gum disease.

Soft and sweet food and drinks with a lot of sugar are bad for both teeth and gums.

Breast feed to help a child’s teeth grow and stay strong. An older child can drink from a cup.		Do not give a baby anything to drink from a bottle. Sweet tea, sugar water or fruit juice can easily make holes in the child’s teeth.
Figure	REMEMBER: BREAST IS BEST!		Figure
YES GOOD FOR TEETH			NO BAD FOR TEETH

Even milk has sugar that can wash over the baby’s teeth and cause cavities when it comes from a bottle.

CLEAN YOUR TEETH EVERY DAY

If you do not clean properly, the food that is left on your teeth can hurt the teeth as well as the gums near them.

HIDING PLACES

Bits of food stay longer in grooves and ‘hiding places’. This is where both tooth and gum problems start.

To prevent problems you must take special care to keep these protected places clean.

It is better to clean your teeth carefully once every day than to clean poorly many times a day.

Here are 3 places where problems start.

Use a soft brush to clean your teeth. Buy one from the store (be sure it says soft on the package), or make a brush yourself. To make a brush:

1. Use a small branch, young bamboo, strong grass or the skin from sugar cane or betel nut.

2. Cut a piece that is still green and soft.

3. Chew one end to make it stringy like a brush.

4. Sharpen the other end so it can clean between the teeth (see Cleaning between the teeth is very important).

You can twist the fiber from inside a coconut husk into a kind of brush. First rub it and shake away the loose bits. Then use the end to clean your teeth.

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Whatever kind of brush you use, be sure to clean your back teeth as well as your front teeth. Scrub the tops and sides where the grooves are. Then push the hairs between the teeth and scrub.

Toothpaste is not necessary. Charcoal or even just water is enough. When your teeth are clean, rinse away the loose pieces of food.

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CAVITIES, TOOTHACHES AND ABSCESSES

‘Cavities’ are holes in teeth. Cavities are made by the infection called tooth decay. If you have a black spot on your tooth, it might be a cavity. If that tooth hurts some of the time, such as when you eat, drink, or breathe cold air, it probably has a cavity in it.

You will get cavities in your teeth if you eat sweet food and then do not clean your teeth. If you see a cavity starting in your mouth or feel a tooth hurting you, get help right away. A dental worker knows how to fill the cavity so you can keep that tooth. Do this before the pain gets worse.

If you do not fill a cavity, it grows bigger. It also grows deeper.

When decay touches the nerve inside, the tooth aches, even when you try to sleep.

When infection reaches the inside of a tooth, it is called a tooth abscess.

A tooth with an abscess needs treatment at once, before the infection can go into the bone. In most cases the tooth must be taken out. If it is not possible to do this right away, you can stop the problem from getting any worse if you follow these steps:

1. Wash the inside of your mouth with warm water. This removes any bits of food caught inside the cavity.

2. Take aspirin for pain.

3. Reduce the swelling:

· hold warm water inside your mouth near the bad tooth.

· Wet a cloth with hot water and hold it against your face. Do not use water hot enough to burn yourself!

A tooth abscess can cause swelling like this.

SORE BLEEDING GUMS

Healthy gums fit tightly around the teeth. Gums are infected if they are loose, sore, and red, and if they bleed when the teeth are cleaned. Infection in the gums is called gum disease.

Gum disease, like tooth decay, happens when acid touches the teeth and gums. This acid is made when sweet and soft foods mix with germs (see How do germs make holes in the teeth).

HEALTHY TEETH AND GUMS

CAVITIES AND GUM DISEASE

Infection from gum disease can spread into the root fibers and bone. But you can stop gum disease and prevent it from coming back. There are two things to do: clean your teeth better and strengthen your gums.

1. Even if your gums are sore and they bleed, you must still clean the teeth beside them. If more food collects on the teeth, the gum infection will get even worse. Get a soft brush and use it gently. This way you will not hurt the gums when you clean.

2. To make your gums stronger and more able to fight the infection:

· Eat more fresh fruits and green leafy vegetables, and fewer soft sticky foods from the store.

· Rinse your mouth with warm salt water. Do this every day, even after your gums feel better.

(1) Mix some salt with a cup of warm water. (2) Take a mouthful and rinse. (3) Spit it out. Repeat until all of the salt water is finished.

MORE SERIOUS GUM DISEASE

Painful gums that bleed at the slightest touch need special treatment. If you have this problem, ask for help, A dental worker can explain what is happening and what needs to be done. A dental worker can also scrape the teeth and remove the tartar that is poking the gums, making them sore.

At home, you can do some things to help.

1. Clean your teeth near the gums with a soft brush. Gently push the brush between the tooth and the gum. It may bleed at first, but as the gums toughen, the bleeding will stop.

2. Make your food soft, so it is easier to chew. Pounded yam and soup are good examples.

3. Eat plenty of fresh fruits and vegetables. If it is difficult for you to bite into fruit, squeeze it and drink the juice.

4. Start rinsing your mouth with a mixture of hydrogen peroxide and water. You can get hydrogen peroxide from your clinic or your pharmacy (chemist).

The strength of hydrogen peroxide is important. Ask for a 3% solution, and mix it evenly with water - that is, 1/2 cup of hydrogen peroxide with 1/2 cup of water.

WARNING:

Read the label to be sure the solution is 3%. A mixture with more than 3% hydrogen peroxide can burn the mouth.

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Take some into your mouth and hold it there for about 2 minutes. Then spit it out and repeat. Do this every hour you are awake.

Use hydrogen peroxide for only 3 days. Then change and start rinsing with salt water.

If you take care, you can keep your teeth for a lifetime.

Chapter 2: Teaching Family and Friends In Your Community

Old people can remember when there were fewer problems with teeth and gums. Children’s teeth were stronger and adults kept their teeth longer.

Times are changing. Today there are more tooth and gum problems than ever before. In many countries, tooth decay and gum disease are two of the fastest growing health problems.

This unhealthy situation is getting worse, for two reasons: changes in the kind of food people now are eating, and not enough cleaning after they eat.

BEFORE, the food people ate was their own, grown and prepared by themselves.	NOW, more people are buying softer and sweeter food from the store. This kind of food sticks to the teeth more easily so it has more time to attack the teeth and gums.
Figure	Figure
Even sugar cane was not as bad as the sticky candy children eat today. The sugar was bad for the teeth, but the fiber in the cane helped rub them clean.	Everyone must be more careful to clean away soft, sweet food. But many people do not know how. Some, especially children, do not even try.

Many people do not understand that tooth and gum problems are caused by certain kinds of food, and poor cleaning of the teeth. In fact, some have a completely different belief.

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Do not attack a belief because it is traditional. Many traditions are more healthy than ‘modern’ things. Often, instead of telling people that their belief is wrong, you can remind them of a different tradition that is healthy.

Help your family and friends to recognize their healthy traditions. Then help them find new ways to use these same traditions for better health.

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BE A GOOD EXAMPLE

Other people like to watch what you do before they try something different. First show members of your family and then they will be an example to others in your community. For example:

1. Instead of buying all your foods from the store, buy fresh fruits and vegetables from the market. It is even better to grow food in your own garden.

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Learn to use several different kinds of foods in each meal. Mixing foods is a healthy idea. Invite friends to share your meals and see the number of different foods you have at each meal.

2. Do not buy fizzy drinks like Coca-Cola or Fanta. They have a lot of added sugar which quickly makes children’s teeth rotten.

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Also, do not sweeten your child’s milk or tea.

When she is young she can learn to enjoy drinks that are not sweet.

Clean, cool water, tea with little sugar, milk, or water from a young coconut are best to drink. Fresh fruits are delicious when you are thirsty.

Most important: do not give your child a feeding bottle, especially one with a sweet drink inside. (See Eat only good healthy foods)

3. Keep your children’s teeth clean. Your friends will notice clean teeth or teeth that are dirty or have cavities. Remember, clean teeth are healthy teeth.

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An older child can clean his own teeth if you show him how.

A younger child cannot. He needs help. Each day someone older should clean his teeth for him.

When you teach, remember that as others learn, they too become teachers. Each person can teach another.

Encourage people to pass along what you have taught. Mothers can teach family and friends. Students can talk at home with brothers, sisters, and older family members.

FROM THE HEALTH CLINIC ...	...TO THE HOME
Figure	Figure
... TO THE SCHOOL ...	... TO THE HOME
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If all learners become teachers, a simple message can begin in the health clinic or school and reach many more people at home.

FINDING THE BEST WAY TO TEACH

Deciding what to teach is important, but just as important is how to teach.

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Learning cannot take place when you use words that people do not understand. They will learn something only when they see how it is related to their lives.

Remember this when you teach about eating good food and keeping teeth clean. Design your own health messages, but be ready to change them if people are not understanding or accepting what you say.

Here are five suggestions for teaching well.

1. Learn First From the People

Get involved in your community’s activities. Learn about people’s problems, and then offer to help solve them. People will listen to you when they know that you care about them and want to help.

Sit and talk with people. Learn about their customs, traditions and beliefs. Respect them.

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Learn about their health habits. Improving health may require changing some habits and strengthening others.

Learn also about tooth decay and gum disease in your community.

Make people smile - then look into their mouths.

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Find out how many children and adults are having problems with their teeth and gums. Do a survey such as the one on Reference pages - Surveys.

2. Build New Ideas Onto Old Ones

People find their own ways to stay healthy. Many traditions are good, helpful, and worth keeping. But some are not.

When you teach, start with what people already understand and are doing themselves. Then add new ideas.

This method of teaching is called ‘association of ideas’. It helps people to understand new ideas because they can compare them with what they already are doing.

In this way people can more easily accept, remember, and do what you suggest.

A HEALTHY TRADITION	-	builds	®	NEW IDEAS AND WAYS
Figure				Figure
Just as sweeping the compound makes it a clean and healthy place to live.	-	in the same way	®	Brushing the teeth and gums keeps them clean and healthy.
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A small child cannot find his own lice. Mother knows she must help him.	-	in the same way	®	A small child cannot see the food on his teeth. He needs help with that also.
Figure				Figure
Different vegetables when planted together - like maize and yams - help each other to grow.	-	in the same way	®	Eating different kinds of food helps people to grow. Eating them several times a day makes your teeth and gums, as well as your whole body, grow stronger.

3. Keep Your Messages Short and Simple

Instead of partially teaching too many things, it is better to discuss a few things well. After learning what health problems the people feel are greatest, decide what information will help them solve these problems. Then think of how to share the information. Try to:

· Use simple words (see Finding the best way to teach). If you must use a big word, take the time to explain it.

· Teach people when they are ready to learn. A sick person, for example, usually wants to know how to prevent his sickness from returning. He will remember what you tell him.

· Repeat the most important message many times. Whenever you teach about staying healthy, remember to emphasize eating good food and keeping teeth clean. Repetition helps people remember.

· Let people see what you mean. See Chapter 3 - Part 2: Making learning exciting, visual, and fun for ways to use pictures, puppets, and plays.

4. Teach Wherever People Get Together

Knowing where to teach is sometimes as important as how you teach. Instead of asking people to come to a class you have organized, go to them. Look for ways to fit into their way of living. You both will gain from the experience. They will ask more questions, and you will learn how to work with people to solve problems.

	Talk with people where they gather near their homes.
Talk to women at health clinics, in the market, and at their church meetings.	Figure	Talk to men as they sit together and discuss important issues. Also go to their business and farming meetings.
	Teach men and women at reading groups.

5. Teach Something People Can Do Right Away

It is good to tell a mother to keep her child’s teeth clean, but it is better to show her how to do it. She will remember how if she actually watches you clean her child’s teeth.

An even better way for a mother to learn is to let her clean her child’s teeth while you watch. A person discovers something for herself when she does it herself.

Pick out a child and clean his teeth yourself. Let his mother watch.

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Use a soft brush (or for a baby, a clean cloth). Gently but quickly brush or wipe his teeth. Do the best you can even if he cries.

If mothers make this into a habit, the child will expect to have his teeth cleaned and will soon cooperate - just the way he does to have lice removed from his hair.

Now let each mother clean her own child’s teeth. Teach her to clean on top and on both sides of every tooth.

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Ask her to do the same at home each day. At the next clinic, look at the children’s teeth and see how well the mothers are doing. Give further help when needed. Always praise and encourage those who are doing well.

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Chapter 3: Teaching Children At School

Children want to learn. They want to know more about things that are real to them. Family, friends, and teachers are all important sources of new knowledge for the children.

It is important to keep alive their desire to learn, so that children can continue to ask questions, discover, and learn more for themselves.

When children are interested in something, they will work hard to learn all they can about it.

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If you relate your teaching to children’s interests and needs, they will learn more easily. New information added to what they already know helps children to understand your lesson better. As a result, they will want to learn more because the information is both interesting and worthwhile.

Teaching about teeth and gums is important. You must do it well if you want children to pay attention, learn, and finally act to take care of their own teeth and gums.

As school children continue to learn, they can share their new ideas and information at home with brothers, sisters, mothers, fathers, and grandparents. In this way, the circle of teaching and learning comes back into the family and is complete.

This chapter has two parts. Part 1 gives seven guidelines for assuring that learning takes place. Part 2 suggests ways to have fun while learning - with stories, games, and pictures. In Chapter 4 there are nine questions on teeth and gums with specific activities for learning how to answer them.

PART 1: TEACHING SO THAT LEARNING CAN TAKE PLACE

More children than ever before are having problems with their teeth and their gums.

A tooth that hurts or gums that are sore can affect a student’s ability to pay attention in school and learn.

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Treating the problem makes the child feel better, and that is important. It is equally important to prevent the same problem from returning later.

Working together, teachers and school children can do much to prevent both tooth decay and gum disease.

Keeping the mouth healthy involves learning about eating good food and keeping teeth clean. Just giving information is not enough, though. To truly learn, children need a chance to find out things for themselves.

Forcing a person simply to accept what you say does not work very well.

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A student learns not to question. What you teach may have no relation to his own experiences and needs.

As a result, he may end up not doing what you teach - not eating good foods, and not cleaning his teeth.

Learning happens when a student with a question or an idea is able to discover more about it himself.

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It also happens when he has a chance to do whatever is necessary to take better care of himself and his family.

He can learn by doing. Give him a chance to eat good food and clean his teeth at school.

Learning about teeth and gums can be fun. When the teaching is real and practical, students love to learn. Here are some ideas:

Teaching so that learning can take place 1. Teach and learn together with your school children. 2. Start with what the students already know. 3. Let students see and then do. 4. Let children help each other. 5. Teach about teeth and gums together with other subjects. 6. Be a good example. 7. Make the community part of your classroom.

1. Teach and Learn Together with School Children.

Share ideas instead of always giving information. Children learn more when they are involved.

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A lecture transfers your own notes to the children’s notebooks without ever passing through their minds.

A discussion draws out information and opinions.

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It helps you to learn more about the school children, what they already know and believe to be true.

But it also allows you to introduce important information that is related to the discussion.

2. Start with What the Students Already Know.

To have meaning, learning should be a part of daily living. Talk with your students. Find out what they know about teeth and gums, and what questions they might have.

Add information by building upon what a person already knows.

Do not use big words. Scientific names and textbook explanations are confusing, and you usually do not need them. Talk about teeth and gums using words that a school child can understand and use later at home.

This way makes students feel stupid.

This way lets the students feel good, because it makes sense and they know something about it.

When you can understand new information, you gain confidence and you look forward to learning more.

3. Let Students See and Do.

Students learn best when they can take part and find out for themselves about something new.

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A lecture about brushing teeth is usually not interesting at all.

Learning is more interesting when students can see how to make a brush and how to clean teeth properly.

If students can actually make their own brushes and clean their own teeth, it is not only interesting but fun.

A student who takes part will not forget. What he learns by doing becomes part of himself.

4. Let Children Help Each Other.^*

^* For more ideas on how school children can help each other, write to CHILD-to-child Program, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, England.

In most families, older children have important work to do - taking care of their younger brothers and sisters. These older children can do much to teach the younger ones about care of teeth and gums. For example:

(1) When they feed their younger brothers and sisters they can encourage them to eat good food, like fruit instead of candy.

(2) They can do a play or puppet show about care of teeth and gums.

(3) They can check the teeth and gums of the younger children and ‘score’ them on how healthy they are.

(4) Best of all, they can actually clean the teeth of the younger ones, and show them how to clean their own teeth when they are able.

Here a group of school children in Ajoya, Mexico is putting a high-fluoride paste on the teeth of the younger children.

5. Teach About Teeth and Gums Together with Other Subjects.

Teeth and gums are part of a bigger health picture. Teach about them in class at the same time.

Eating good food can be part of a discussion on nutrition, teeth, farming methods, and the politics of who owns the lands.

Cleaning the teeth can be part of a discussion on hygiene, clean water, and traditions and customs.

A good way for school children to learn about using numbers is to do a survey in the community.

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The results will tell the children something about health problems in their community. For an example of a survey of health problems, see Helping Health Workers Learn.

6. Be a Good Example.

Children watch people around them. They pay attention to what you do, as well as to what you say.

Be a good example. Take care to do yourself what you are teaching to your students.

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Your family can be a good example for others.

· Clean your teeth carefully every day. Also, help your children keep their teeth clean.

· Make a garden near your house and plant a variety of vegetables and fruits in it.

· Buy only good, healthy food from the store. Do not buy sweet foods and drinks for yourself or your children.

7. Make the Community Part of Your Classroom.

A child’s home and his community are really more important to him than his school. Learning will be more interesting for a student if the day-to-day needs of his home and his community are part of school discussion.

Let students find out more about problems at home and in their community.

For example:

· How many small children have cavities or red, bleeding gums?

· How many stores have mostly sweet snack foods on their shelves?

· Why do the people not grow and eat more local food?

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Back in the classroom, students can record what they find. Ask the children to think of ways to solve the problems they found. If they can think of a program to help solve a health problem, let them go back into their community and try it.

PART 2: MAKING LEARNING EXCITING, VISUAL, AND FUN

Here are some ideas to help students see what you are teaching, and to have fun while they learn. Students can also show these things to others. Teaching others is an excellent way to learn.

Tell a story about food or teeth. For example, tell a story about why a wild cat’s teeth are different in shape from a goat’s teeth. Stories are an excellent way to learn, both for the storyteller and for those listening. Leave time at the end to discuss the story and to introduce new information. See the example of storytelling on Reference pages - Story telling.

Make up a play or drama about good food or clean teeth. Show it later to the community.

The play should be about looking for an answer to a real problem. If the children invent the play, they will have to think, plan, and solve problems. A play also helps children learn how to talk with and teach others.

These school children in Nicaragua are doing a play about cavities. On the left, germs and sweet food are combining and trying to make a hole in the ‘tooth’. But a giant toothbrush (right) beats them away!

Do a demonstration using local resources.

Try, for example, the ‘tooth in the Coca-Cola’.

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Puzzles can help school children discover answers for themselves. You can make your own. The best puzzles are with words that the students know and can use easily.

EXAMPLE (for younger children just learning to read)

Try to find these words:

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As you find each word, put a beside it.

An older child can try to find important words that are more difficult.

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Spell some of the words diagonally (slanted). It will make the puzzle harder.

You can use pictures on posters, flip charts, and on flannel-boards.

Pictures that school children draw themselves are best. They learn simply by drawing them. Also, school children will draw local people and local experiences, and the people will understand their pictures better than the ones sent from a central office far away.

Photographs of local people and events are also good. If there is a photography club in a local secondary school, have them take some pictures for you. They may even print the photographs larger so that you can use them as posters.

Ask the children to make pictures big enough so that a person can stand far away and see them easily.

Let each child carry her poster home to show her family and friends.

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Hang up other posters in the store, church, or other places where people will see them.

Pictures can be made to stick to cloth and then used to tell a story. Cover a board with a piece of flannel cloth or a soft blanket, to make a flannel-board.^*

^* For more ideas on flannel-boards, see Helping Health Workers Learn.

Mix some flour and water to make glue. Then glue a strip of sandpaper to the back of each picture. The sandpaper sticks to the cloth and lets you place the picture where you want on the cloth.

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Let the child use her pictures and cloth outside of the school, to show her story to family and friends.

Flip charts are excellent for telling a story with pictures. Often, people can guess what the story is about just from the pictures. When showing the pictures on a flip chart, ask as many questions as you can, to get the people to tell you the story.

This is part of a flip chart presentation on mothers’ and children’s health. Notice the rings at the top that hold the flip chart together. They are made from old electrical cords.

Here a health worker from Mozambique is holding a flip chart with pictures about care of teeth and gums. There are no words with the pictures.

But he can read a short message written on the back of the page before. There are also examples of questions to ask. This way, anyone who can read can tell the ‘flip chart story’ to others.

There is also a small copy of the big picture on the back of the page before.

Find a way to attach the sheets of heavy paper. Here are two ways:

with 2 thin pieces of wood

with metal or wire rings

FLIP CHARTS - AN EXAMPLE

Dental workers in Mozambique created this flip chart presentation for teaching in schools.

1) Here is a healthy, happy schoolboy. In the circle you see the inside of his mouth. His teeth are white and clean. Look at his gums. What color are they? Are they tight or loose? Between the teeth, are the gums pointed or flat?

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2) This is an unhappy, sick boy. What color are his teeth? Not only are they yellow, there are black spots. These are cavities.

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What color are his gums? Are they pointed? Loose, red, swollen gums are signs of gum disease.

Both cavities and gum disease can be treated.

3) What happens if tooth and gum problems are not treated?

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a) The black hole grows bigger on the tooth and a sore forms on the gums near the root. The tooth hurts whenever you touch it.

b) The red, loose gums pull away from the tooth. Infection gets to the bone and eats it. The tooth loses the bone and the gum around it.

The first problem is a tooth abscess. The second is advanced gum disease. If either of these things happens, the tooth must be taken out.

4) Why does the boy have cavities and gum disease? There are 2 reasons.

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a) He eats too many sweet foods.
What foods do you see here?
What other foods hurt the teeth?

b) He does not clean his teeth regularly.
The germs in his mouth eat sugar from his food and make acid. Acid causes both cavities and gum disease.

5) What foods can the boy eat to keep his teeth and gums healthy? What do you see in this picture?

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Natural foods, with no sugar added, are the best. The foods you grow yourself and local foods from the market are better than sweet foods from the store.

6) How can we clean our teeth? Carefully is the important word to remember. Clean your teeth at least once a day, carefully brushing every part of every tooth - outside, inside, and top. Be very careful to push your brush between your teeth. That is where the germs and food collect to make acid.

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If you do not have a toothbrush, you can make one from a stick. Toothpaste is not necessary. Clean water is enough.

Chapter 12 in Helping Health Workers Learn is full of ideas on how to make and use pictures effectively. Once you have a good original, you do not need to be an artist to make a good copy. Here is an easy method that can involve every student.

Place thin see-through paper over the original drawing. Carefully trace a copy.

Now place the copy on a new sheet of heavy paper. Pressing firmly with a pencil, retrace all of the lines on the thin copy paper.

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Remove the tracing paper. Pressure from the pencil has made lines on the poster paper. Redraw them with a pencil so they stand out clearly.

Your copy is now ready for coloring. And you can use your copy paper again to make another copy.

Use puppet shows to act out the messages of eating good food and keeping teeth clean.

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Students can make their own puppets to look like people or animals.

Using puppets, it is often easier to say things that people themselves cannot. For example, they can talk openly about the bad food sold at the village store.

Children can make puppets easily from paper bags. They are good for showing teeth because you can make a wide-open mouth.

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A puppet made from a sock looks alive.

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1. Fit the sock over your hand.

2. Make the mouth by pushing in the cloth between your thumb and fingers.

3. Add eyes, nose and hair to the sock or to a box that fits over it.

Loosely fill a cloth bag with old cotton or paper. Put the end of a stick inside, and tie the bag to it with tape or string. Make a sad or happy face to fit the story. Dress the puppet with an old piece of cloth.

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PUPPET SHOWS - AN EXAMPLE^*

^* For another example of a puppet show, and more suggestions for making puppets, see Helping Health Workers Learn.

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Above, school children in Ajoya, Mexico are holding puppets they made themselves. On the left, you see them in front of the stage and at right, the children show how they hold the puppets behind the stage.

Figure	1) They called their puppet show “Rotten Teeth - And A Friend’s Advice.”
Figure	2) Pedro, a schoolboy, is sad. His friends looked into his mouth and saw two teeth with big holes in them. He tells his brother he wants to walk home alone.
Figure	3) On the way, Pedro meets Maria, a friend who is a dental worker. “I’m not sad because the others are laughing,” says Pedro. “I know the real problem. The holes in my teeth will get bigger. My teeth will rot and fall out, and maybe my permanent teeth coming in will rot, too.”
	Maria thinks she knows what to do. “We will talk to your father,” she says.
Figure	4) One day later.
	(Note how the scene behind the puppets changes. It is a flipchart with pictures to show the different places the puppets ‘go’.)
Figure	5) “I am a poor farmer,” Pedro’s father tells Maria. “I only go to the city two times a year to sell my crops. I cannot take the boy to the city and pay for fillings in his teeth.”
	Maria answers, “But we can save his teeth with a temporary cement filling.”*
		* To learn how to make a temporary filling, see Chapter 10.
Figure	6) “Then, when you have time and money, you can go to the city. I know a dental worker who will put in a permanent filling. I trust him. I will send a note with you, and it will not cost much.”
	“Good!” says the father.
	“Come on, Pedro,” says Maria, “I’ll put some cement in those holes!”
Figure	7) Four months later, Pedro visits the dental worker in the city. “Maria’s good fillings saved your teeth,” he says. “These permanent fillings will last for years.” “Terrific!” says Pedro.
Figure	8) After the show, the puppets played a game. Throwing a ball into the audience, they asked questions like “How do you keep cavities from happening?” Each child who caught the ball answered the question and threw it back. Then the children in the audience began asking questions for the puppets to answer. “Why did you get rotten teeth?” one child asked Pedro. The puppet looked down and said, “Too much candy!”

Chapter 4: School Activities for Learning About Teeth and Gums

We can help school children in two ways. First, they need treatment now for problems they already have. Second, they need to learn how to prevent problems from hurting them (and their families) later.

Treatment and prevention go together. It is a mistake to emphasize only prevention and to forget about treatment. In fact, early treatment is the first step to prevention because it usually meets a person’s most strongly felt, immediate need.

As a community dental worker, you can visit a school and find out what the felt needs are. Begin with the teacher. Examine for cavities, bleeding gums, or other problems. Then look at the students.

Chapter 6 tells you how to examine a person. It also helps you decide what treatment to give, and who should give it.

Then teach how to prevent dental problems. Give the teacher ideas to help students learn why they have problems, and how to keep the problems from returning. The best way to learn is by doing - through activities, not lectures. This chapter has many suggestions for activities.

The best health practice is to prevent cavities and gum disease from even starting. With these activities, children can do something to guard their health.

Figure

Teacher, each day at school:

Suggest ways for your students to eat good healthy kinds of food.

AND

Give your students time to clean their teeth.

A Note To Teachers:

Do not wait for a dental worker. This book, and especially this chapter, is written to help you learn and do things yourself. But do ask your dental worker to work with you. He probably has suggestions that would fit your situation. After examining the children, he can help you follow their progress. You can then find out how much they are learning and how healthy they are becoming.

To begin, talk with your students to find out what they think and what they already know. What are their traditional beliefs? Some may be helpful, and others may need changing. At first it is best simply to discuss.

Ask the kind of questions that get students talking. Later they will take part in discussions more easily.

Add new information as you go along, changing some ideas but usually building upon what the students already know.

This chapter asks nine questions:

1. Why do we need teeth and gums?
2. Why do some teeth look different?
3. What holds the teeth?
4. How often do teeth grow in?
5. What makes teeth hurt?
6. How do germs make holes in the teeth?
7. What makes the gums feel sore?
8. What does it mean if a tooth is loose?
9. How can we prevent cavities and sore gums?

Figure

For each question, there is an activity to help students discover answers for themselves. The questions are not in any particular order, nor are they written for any particular grade level. Make your own lesson plan, using the main idea to help you. Shorten the lesson and make it easier for younger children. Add more information for older students and let them do more activities.

Why Do We Need Teeth and Gums?

THE IDEA:

Your teeth and the gums around them help you in many ways.

Figure

Teeth are important for:

Good Health. Infection from a bad tooth can spread to other parts of your body.

Good Looks. Healthy teeth that look good help you feel good.

Good Speech. Your tongue and lips touching the teeth help you make many sounds.

Good Eating. Your teeth break food into small pieces so that you can swallow and digest it better.

Good Breath. If you leave food around your teeth, your breath will smell bad.

Figure

Your gums are important too.

They fit tightly around the teeth, and help to keep them strong. Without strong gums, your teeth are of no use. Most old people lose teeth because of bad gums, not bad teeth.

THE ACTIVITY:

1. Draw or cut pictures of people from magazines. Make posters to show that healthy teeth make a person happy, while bad teeth make a person sad. Use the posters for discussion.

Figure

Hang up a picture of a person the students know and like. Put black on one of her front teeth. Talk about it.

OR

Leave the picture for a few days. Then put black on some of her teeth before the students come to school. See who notices first.

When someone sees the difference, talk about how the person looks, how teeth can be lost, how to prevent that, and what she can do now.

Make a picture of a person who has lost all of his teeth. He looks old.

Figure

Talk about how hard it is for him to eat properly or speak clearly.

2. Have the students say words that use teeth to make sounds.

Figure

“v” and “f” - friend, fever - the lower lip touches the top teeth.

“th” - the, teeth - the tongue touches the top teeth.

“s” - sun - air goes between the teeth.

Now, try saying the same words again, but do not let the tongue or lips touch the teeth.

3. Have students draw pictures of good foods we use our teeth to eat. Then draw foods that we can eat if we lose our teeth.

Need Teeth	No Teeth Needed
Figure	Figure
And Many More!	But NOT Much More!

Talk about this together. Try to eat a mango or some maize without using your teeth, or using only your front teeth.

Why Do Some Teeth Look Different?

THE IDEA:

We need two different kinds of teeth to help us eat our food.

Figure

The outside of a tooth is the hardest and strongest part of your body. When a tooth is healthy, it can chew hard food, even bone. The shape of a tooth allows us to swallow food when the small pieces can slide down its smooth sides.

Figure

Small bits of food often get caught inside deep lines, or grooves, in a tooth.

Look for them on the top and the sides of back teeth.

Food that is not cleaned away from the grooves can make a cavity (hole) in them.

A tooth with a cavity is weak and often hurts.

THE ACTIVITY:

1. Ask the students to bring different kinds of food to class. Bring some yourself.

Figure

Eat the food using first the front and then the back teeth.

Bite a guava using only the back teeth.

Chew completely a mango or piece of maize, using only the front teeth.

2. Collect teeth from different animals. Let the students discover from the shape of an animal’s teeth the kind of food it usually eats. For instance, a wild cat needs sharp pointed teeth to tear meat, but a goat needs flat teeth to chew grass.

Figure

Make a poster to show the animal, its teeth, and the kind of food it likes to eat.

3. Have each student take a partner. Let each look at the shape of the front and back teeth in the other’s mouth.

Talk about the many different kinds of food we need to stay healthy. Discuss which teeth we use to chew meat, fish, mango, and other good foods in your area. (For most foods, the answer is both front and back teeth!)

What Holds the Teeth?

THE IDEA:

When you look inside someone’s mouth, you see only the top part of each tooth. The bottom part, its root, is inside the bone under the gum.

The roots of the tooth hold it in the bone just like the roots of a tree hold it firmly in the ground.

Figure

The roots of the tooth do not actually touch the bone. Root fibers connect the root and bone, holding the tooth in place.

Figure

The gums do not hold the teeth, but healthy gums will keep harmful germs from getting to the bone and root fibers. When the gums are not healthy, they form deep ‘pockets’ which collect germs. Soon, these germs will reach the root fibers and bone. The bone pulls away from the tooth in order to get away from the germs. With no bone to hold it, the tooth is lost. This is the most common reason why teeth fall out.

THE ACTIVITY:

1. Have the students look for an old jaw bone from a dog or other animal. Notice that bone goes around every root of every tooth and holds it tightly. Break away some of the bone and look at the roots of the teeth.

Figure

Front teeth need only one root because they are used for biting.

Figure

Back teeth have 2, 3, or even 4 roots. That makes them strong enough to chew tough meat and even break hard bone.

2. Show your students how infected gums can cause teeth to fall out.

A. When gum disease is beginning, a small red ‘pocket’ forms where the tooth meets the gum. Germs and food collect in the gum and make acid. This makes the gums sore.

B. As a result, the gum pulls away and the pocket becomes deeper.

C. The bone moves away from the infection and no longer holds the tooth.

Try to think of other ways to teach how gum disease pushes the bone away from the tooth. In Jamaica, dental workers ask, “What do you do if someone attacks you with a machete (long knife)?” “I run away!” most people answer. “Exactly,” say the dental workers, “and when you have a lot of germs attacking the root of your tooth, the bone ‘runs away’ and leaves the tooth with nothing to hold it.”

Tell a story to show how, when the gum moves away from the top of the tooth, the root and bone are open to attack. For example:

Figure

Enrique was sleeping on a cold night when suddenly he had diarrhea. Still dreaming, he went outside, and afterward, he forgot to close his pants tightly. Suddenly, he saw an ugly monster coming after him! He ran away without thinking of his pants. Finally he could not run because his pants were around his knees, and the monster caught him.

Explain to the children that when the gums are red near a tooth, they are like Enrique’s pants - not tight enough around the tooth. When germs come near the tooth, they will go inside and the gums will ‘fall down’ and show part of the root of the tooth. When this happens, the germs attack not only the top of the tooth, but also the bone and root.

How Often Do Teeth Grow In?

THE IDEA:

A child gets two sets of teeth. The first set, baby teeth, starts to grow when the child is a baby. The second and last set grows in at school age. They are the permanent teeth. Permanent teeth should last a lifetime.

A child grows his first baby tooth at about 7 months of age. It is usually a front one.

Figure

A baby who is poorly nourished, however, may not grow his first tooth until later. Do not wait for the first tooth before giving him the extra soft food he needs to grow and stay healthy.

The remaining baby teeth grow in over the next 24 months. By the time the child is 30 months old, there will be a total of 20 baby teeth in his mouth, 10 on top and 10 on the bottom.

Most permanent teeth form under the baby teeth. When the child is between 6 and 12 years old, the permanent teeth push against the roots of the baby teeth, making them fall out. Not all of the baby teeth fall out at once. One tooth at a time becomes loose, falls out, and then is replaced with a permanent tooth. The new tooth may not grow in immediately. Sometimes 2 or 3 months pass before the new tooth grows into the space.

In the 6 years between ages 6 and 12, the 20 permanent teeth replace the 20 baby teeth. In addition, 8 other teeth grow in behind the baby teeth.

At 6 years the four 1st permanent molars start to grow in at the back of the mouth. This means an 8-year-old child should have 24 teeth, or spaces for them.

At 12 years, the four 2nd permanent molars grow in behind the 1st molars. This means a 14-year-old child should have 28 teeth, or spaces for them.

Figure

Between 16 and 22 years, the four 3rd permanent molars grow in. This means that an adult should have a total of 32 permanent teeth: 16 on top and 16 on the bottom.^*

^* (Note: the third molars often do not grow in correctly. This is a very common cause of tooth pain.)

THE ACTIVITY:

Have the students examine each other.^* Help them learn which are baby teeth and which are permanent teeth. Look for the important 1st permanent molars at the back.

^* Here the children are only counting the teeth. They can also learn to check for cavities and gum disease.

Show the students how to count the teeth and the spaces that are ready for new teeth to grow in.

Figure

Then have them count their friends’ teeth, to find out how many teeth should be growing in different age groups. Later, they can do this with their brothers and sisters at home.

· Wash your hands.

· Count the teeth.

· Count the spaces where new teeth have not yet grown in.

TOTAL = teeth + spaces

· Find out the person’s age.

Have the students first write their totals on the blackboard. Then make a chart for the children to remember and discuss the results.

Figure

Discuss the number of teeth children have at different ages. Young children 6 to 12 years old, for example, have 24 teeth; older students, 28 teeth; and adults, 32 teeth.

At home, students can count brothers’ and sisters’ teeth to learn how many teeth small children have. Count only the teeth and not the spaces.

Figure

Ask the students what other things they saw inside someone else’s mouth. This is a good time for students to discover important things about good health practices. Encourage them to learn as much as they can from what they see, and then show them how to use a book like this to answer their own questions. For example, if students see cavities and red bleeding gums, you can start a discussion on tooth decay and gum disease. Use some of the activities on How can we prevent cavities and sore gums.

For another example, if the students see a baby who has only a few teeth, they may have some interesting questions. Show them this book and invite them to read Why baby teeth are important to find answers to questions like these:

· Can Chenia, who is six months old and has no teeth, eat soft foods? Should she have more than just breast milk?

· When Chenia’s teeth grow in, will they give her diarrhea and fever?

· Will a 2-year-old girl get more baby teeth?

· Why do we care for baby teeth, when we only need them for a few years?

What Makes Teeth Hurt?

THE IDEA:

A tooth will hurt if it is broken, loose, or if it has a cavity. Cavities are the usual cause of toothaches.

Healthy teeth are alive.

Two thin strings enter each tooth. One, the nerve, comes from the brain and carries the message of pain. The other is the blood vessel. It comes from the heart and carries blood to the tooth.

Figure

If you could peel away the gum and look inside the bone, you would see that a nerve and a blood vessel go into each one of a tooth’s roots,

They give the tooth life and feeling.

The hard cover of the tooth protects the nerve and blood vessel inside it. But when tooth decay eats through that cover, the nerve and blood vessel are unprotected. A cavity lets food, water and air get closer to the nerve, and that can make the tooth hurt.

The sugar in food makes tooth decay possible. Sweet food that is also sticky is the worst of all because it glues itself to the teeth. Germs inside your mouth use the sugar to grow and to work harder at making cavities.

Figure

See the next section for more discussion of how germs and sugar combine to cause cavities.

A cavity may look small on the outside, but it is much bigger inside. Decay spreads more easily in the soft part under the hard cover of the tooth.

A tooth with a cavity may hurt, but it usually does not hurt all the time. This is because the bottom of the cavity is close, but not yet on the nerve inside the tooth.

Figure

Fill a small cavity and save a tooth.

A small cavity that is not treated grows bigger and gets deeper. When the cavity finally touches the nerve, it causes a tooth abscess. Infection from the tooth decay going inside the tooth causes the tooth to ache all the time, even when you try to sleep.

Infection can pass from the tooth to the bone. As it spreads under the skin, there will be swelling of your face.

Figure

A tooth with an abscess must either be taken out or have its nerve treated.

An abscessed tooth is dying. When it dies the tooth changes color from white to dark yellow, grey, or even black. Pus from the end of its root can pass to the gum, making a sore called a gum bubble.

A tooth is like a light bulb.

When the bulb is alive from power inside, it is bright and useful.

Figure

The little wires inside the bulb are like the nerves inside the tooth. When the bulb burns out, it is dark and not useful any more.

Figure

THE ACTIVITY:

1. Have each student look inside a partner’s mouth. Look for black spots that may be cavities, for dark teeth that are dead, and for sores on the gums, especially near a bad tooth.

2. Discover how sweet food sticks to teeth.

Cut several different kinds of food with a knife Vegetables and meat do not stick to the knife.

Figure

Sweet foods, like chocolate and jam buns, do stick to the knife.

They stick to your teeth the same way.

Pour some cola or juice in a dish, and leave it outside overnight.

Figure

As water is lost, the juice left in the dish becomes sticky. It attracts flies.

Figure

The air you breathe dries the cola and causes a sticky, very sweet coating to form on your teeth. It attracts germs.

Try to find some old teeth. Ask the students to keep their own baby teeth when they fall out. (Note: in some countries this is not acceptable.) Your dental worker can save you some teeth that were taken out at the clinic.

Scrape the outer cover of the root with a knife. Feel how hard and smooth it is.

Then find out what happens when the students leave a tooth in cola, milk, or plain water.

Figure

After 3 days scrape each tooth again with a knife. Students will discover that sweet cola drinks make teeth softer and darker in color.

Figure

3. Look inside a tooth for the space where the nerve and blood vessel used to be. See how close they were to the tooth’s hard outer cover. Look for a small hole at the end of the root. That is the place where the nerve and blood vessel enter the tooth.

Ask your dental worker to find an old tooth with a cavity and grind it for you.

OR

1. Take a hammer.

2. Gently break open a tooth.

Figure

3. Look inside.

Figure

See how much bigger the cavity is on the inside. It spreads under the hard cover.

Cut through a rotten yam. See how the rotten part spreads under its skin in the same way.

4. Do a project in class.

· Count the number of students with cavities.

· Count the number of teeth having cavities. Show the students how to look for them on the tops, sides and between the teeth.

· Find out the person’s age.

Have the students write on the blackboard what they counted. Then make a chart or graph.

Figure

· Decide if tooth decay is a serious problem in your school. Ask your dental worker to look at your results and to come and treat the students, and help you prevent the problem from returning.

· Do the same with brothers and sisters at home. Find out if tooth decay is a problem with these young children. Tell your dental worker what you find.

How Do Germs Make Holes in the Teeth?

THE IDEA:

Acid makes holes in the teeth. The acid is made when sweet foods mix with germs in your mouth.

It is not possible to prevent cavities or gum problems by trying to kill all of the germs in your mouth. There are too many - and some germs are good for you. The important thing is to keep the germs from getting together and making a film or coating on your teeth.

This film on the teeth is called plaque, but you do not need to use this word. Every morning we can all feel a ‘furry film’ on our teeth. This film must not be allowed to stay on the teeth! It will mix with sugar and make acid. Worse, if it stays in a group (or ‘colony’) for more than 24 hours, it will mix with saliva, harden, and make tartar.

The main reason for cleaning teeth is to break up these colonies so they cannot make acid. Also, if you forget to clean your teeth, tartar will form, and you will need a dental worker to scrape it off. This is why it is important to clean your teeth at least every 24 hours, so the tartar can never form on your teeth.

THE ACTIVITY:

Here is a game called “Scatter!” that students can play outside. You need:

· Five ‘bases’ (a tree, rock, or the corner of a house can be a base) in a half circle, 12 meters apart. Each base must have a ‘monitor’ who stays at the base. Note: children who cannot run can be good monitors.

· One person with a broom. This person is the ‘decolonizer’.

Children in Jocuixtita, Mexico, beginning a game of “Scatter!.” The ‘decolonizer’ is the girl in the center with the broom.

The Game:

20 students called ‘colonizers’ stand facing the decolonizer. When the decolonizer says “go!” they try to ‘form colonies’ around the bases before the decolonizer can touch them with the broom.

The ‘decolonizer’ (with broom) has lost the game. The children behind him have formed a ‘colony’.

The colonizers win if they make a colony. There are two kinds of colony: (1) 15 people touching one monitor at a base, or (2) a chain of 12 people holding hands, touching two monitors.

Play two games: one with children trying to form the first kind of colony, one with the second kind. These photos are from the second game.

The decolonizer tries to stop the others by touching them with the broom. When the decolonizer touches a colonizer with the broom, the colonizer must leave the area for one minute. (Give that child a task to do - run around the school-house or lie down and sit up 30 times.)

Here the decolonizer stops a boy from completing a chain.

The decolonizer wins if no colonies form in 5 minutes.

After The Game:

Talk to the students about germs in their mouths and how small they are. Can anyone see germs? No, but they can feel them and taste them. Ask the group what their mouths feel like in the morning when they wake up. You may get these answers:

· my teeth feel mossy!
· my breath is bad.
· I feel a coating on my teeth, but it goes away when I brush them.

To teach about things too small to see, look at the suggestion on Helping Health Workers Learn.

Tell the students that this coating on the teeth is a ‘colony’ of germs. They are always trying to group together on the teeth or in spaces between the teeth - just as the ‘colonizers’ did in the game!

What Makes the Gums Feel Sore?

THE IDEA:

Healthy gums fit tightly around the teeth and help to hold them strongly. Healthy gums also cover and protect the bone under them.

Figure

Healthy gums are pink in color, or even blue or dark yellow in some people. But healthy gums are never red.

Healthy gums are pointed between the teeth. This lets food slide away and be swallowed.

Healthy gums fold under, making a little pocket around the tooth.

As we saw with the last activity, when you have ‘colonies’ of germs on your teeth, they can make acid that makes holes on your teeth. The same coating of germs can make a different acid that makes the gums sore. This also happens when food mixes with the coating on your teeth. Soft food is the worst kind, because when it mixes with spit it sticks more and stays longer on your teeth. Juice from tea, betel nut, and meat color this food, making the tooth look dark.

Figure

Healthy gums become sore because of acid. Also, if the coating on the teeth becomes hard, it is called tartar. Tartar can be very sharp and hurt the gums. Also, the ‘colonies’ of germs can make a coating on top of tartar more easily than on a clean tooth. When the colonies are new, they make more acid to cause tooth and gum problems. After 24 hours, they harden and make a new layer of tartar. The tartar gets bigger and bigger.

Here is a larger picture of the teeth in the box above:

Sore gums are infected. Infected gums are red and bleed easily.

Infected gums are round and swollen between the teeth. They are also loose instead of tight against the teeth.

Infected gums have a deep gum pocket which catches even more food.

Infection in the gums is called gum disease. It is important to treat gum disease early, before it can spread to the root fibers and the bone.

If you have sore, bleeding gums, you can do much to treat the infection yourself.

1. Clean your teeth with a soft brush gently and more often.

2. Eat more fresh fruits and vegetables.

3. Rinse your mouth with warm salt water.

4. Clean between your teeth with dental floss or string. At first your gums may bleed when you do this. But when the gums are stronger the bleeding will stop.

THE ACTIVITY:

1. Have the students look in each other’s mouths. Can they see the coating on the teeth? Usually they cannot. They may see food or ‘white stuff, but this is not the coating that makes acid. However, if someone has been chewing betel nut or eating berries, you will see stains on her teeth and the stains will be darkest where she has these colonies of germs on her teeth.

Figure

Put something on the teeth to stain the colonies of germs. Try using food dye, betel nut or berry juices. Remember: first wash your hands! Older students can rub berries on the teeth of the younger ones. Have them rinse with a little water and spit it out. After this, the colored areas on the teeth will show where the colonies of germs are forming. Where are they? Usually you will see the dark colors:

· between the teeth
· in the pits or holes in the teeth
· on the tops (biting surfaces) of the teeth.

The older students can now show the younger ones the best way to clean teeth. Let the younger ones see in the mirror if they are getting the colored juice from their teeth. They will learn that it is most difficult to get rid of the color between their teeth. Give them some string, dental floss, or even the soft stem from a young palm leaf, and show them how to use it between their teeth. Remind them to be gentle, or they will hurt their gums. You should clean between your teeth every day.

What Does It Mean if a Tooth is Loose?

THE IDEA:

Baby teeth become loose when children are between 6 and 12 years old. This is normal. If a loose baby tooth does not have a cavity, and if the gums around it are healthy, there is probably a permanent tooth growing under it.

But a tooth might be loose because it is broken or because it is sick from an abscess or gum disease. Either can destroy the bone around the tooth’s roots.

Figure

When bone is lost, the tooth becomes loose. A loose tooth hurts and usually must be taken out.

There is no medicine to make bone grow back around the roots of loose teeth. All you can do is stop the infection from getting worse.

THE ACTIVITY:

1. Let the students look into each other’s mouth for loose baby teeth. Look carefully to see why a tooth is loose.

Figure

Touch the gum and bone beside the loose tooth. You can feel a bump - it is the new permanent tooth growing.

Save the baby tooth after it has fallen out. Look to see how the permanent tooth has eaten away its root by pushing against it.

2. Look for teeth that have cavities or gum disease around them. The students can do this with each other, and then later at home, (Remember they must wash their hands!)

Figure

A tooth that has some of its root showing is probably loose.

Using your fingers or the handles of two spoons, rock the tooth back and forth gently. See how much it moves, and ask how much it hurts.

Tell the person what he can do to prevent other teeth from becoming loose. (See the next section.)

How Can We Prevent Cavities and Sore Gums?

Eating good food and carefully cleaning the teeth prevents both tooth decay and gum disease.

Food from your own garden and local food from the market is best. These foods are good for your body, your teeth, and your gums.

Vegetables, especially those with dark green leaves.	Peas and beans, like green beans, soybeans, winged beans, and mung beans.	Oil, from palm nut kernels, ground nuts, and coconut.
Fruits, like banana, guava, oranges, and papaya.	Fish, meat and eggs.	Clean water, coconut water, and milk are best to drink.

Soft foods and sweet foods from the store are not good for you. Soft foods stick to your teeth easily. They can work longer to cause cavities and infected gums. Sweet foods have mostly sugar in them, and it is ‘factory sugar’, not the ‘natural sugar’ that is in the foods in the pictures above.

This kind of sugar is quick to mix with germs and make acid. Remember: natural sugar makes acid slowly; factory sugar makes acid quickly.

Figure

Children who eat a lot of sugar lose their appetite for other foods - the foods that help them grow strong, stay healthy, and learn well in school.

Store foods are also expensive. You can usually get better food, and more of it for the same money, from your garden or in the market.

Cleaning your teeth carefully every day is another important way to take care of both teeth and gums. However, cleaning teeth is like building a house. To do a good job, you need to work slowly and carefully. Once a day is enough, if you clean your teeth well every day.

Figure

Buy a brush from the store, or make one yourself. But be sure the cleaning end of the brush is soft so that it won’t hurt the gums.

Figure

Use your brush to clean all the teeth, especially the back ones with the grooves. Back teeth are harder to reach and so it is easy not to clean them well enough. Cavities start from sweet food and germs left together inside the grooves.

1. Scrub the inside, outside, and top of each tooth.

2. Push the hairs of your brush between two teeth. Sweep the food away.

3. Wash your mouth with water, to remove any loose bits of food.

Small children are not able to clean their teeth carefully enough by themselves. They need help. Look at the pictures on the cover to see how you can do this. Older children can care for younger brothers and sisters at home.

THE ACTIVITY:

One of the best ways to teach is by example.

Students will believe what their teacher says if they know he eats good food and cleans his teeth.

Figure

The reverse is also true. Learning is harder when students know that their teacher does not do those things himself.

Students can be a good example for their community, too. They can:

· draw pictures of foods that are both good and bad for teeth. Use them to make posters and flannel-board stories.

· make puppets and plays to discuss ways people can become healthier.

There are some other ways to make learning meaningful and fun.

1. Make a garden at school. Divide the ground so that each class has its own space to plant a garden.

Use some of the garden’s food to prepare a meal for the students, perhaps once a week. Students can bring food from home if there is not enough ready in the garden.

2. Organize a school lunch program. Each day the students can bring some good food from home. Cooked yams, or maize, nuts, fruit and fresh vegetables are all good. Often the students will exchange food and talk about the many different foods that can be grown locally.

3. Find the best way to clean teeth. Divide the class into groups. They will learn more easily in a small group of 4 to 8 students.

Give all the students something to eat that is sweet, sticky and dark in color, such as sweet chocolate biscuits. Ask the students to look in each other’s mouth, to see how easily the biscuit sticks to the teeth. One or two of the students in a group can then try to clean away the pieces of biscuit, using a different method.

Figure

When they are finished, the students can look at the teeth to decide if they are clean or not. Put your findings on a chart and talk about what you have learned.

Figure

4. Make cleaning part of a daily health activity.

Older students can look after younger students. They can first check their hair for lice, then sores for infection, and teeth for old food or germs. One partner can point out to the other where washing and brushing can be done better.

Figure

CLEANLINESS CAN BEGIN AT SCHOOL

At school, students can wash their hands before lunch and brush their teeth afterward. Encourage them to keep a piece of soap and a toothbrush or brushstick. One day a week, the whole class can rinse with fluoride water to prevent cavities.

Figure

Have the students score each other’s progress. Do not make it hard to judge, or they will not do it. In the example below, the tooth is either clean or not clean.

SCORING TEETH

Pick 4 teeth, a back tooth and a front tooth - two on top and two on the bottom.

Use the same 4 teeth for each person. Look for food on each tooth near the gums.

A clean tooth = 2 points
A dirty tooth = 0 point
Total possible points each day is 4 teeth x 2 = 8 points.

Figure

In this example the score is:

Tooth 1 = 2 points
Tooth 2 = 0 point
Tooth 3 = 0 point
Tooth 4 = 2 points
Total = 4 points

Have each student put his daily score on a chart. At the end of the month he can see how much he has improved.

Figure

Chapter 5: Taking Care of Teeth and Gums

We can prevent most tooth and gum problems. This chapter gives more information about how teeth grow in and how to keep teeth and gums healthy. Share this information and you will prevent problems from starting.

But remember that people are most interested in the problems they have now. Before listening to what you know about prevention, people will want treatment for the problems that are already causing them pain and discomfort.

Early treatment is a form of prevention. It can prevent a tooth or gum problem from becoming more serious.

When you treat a person’s problem, it shows that you care about him. It also shows that you know what treatment he needs. As his confidence in you grows, he will want to learn from you about preventing tooth or gum problems.

KNOW YOUR LIMITS.

In order to help a person it is important to know what the problem is and what is the best treatment. But just as important is knowing what you are not able to do, and when to seek help.

In this chapter, you will learn more about teeth, gums, and problems affecting them, but you must never be too proud to get help from more experienced dental workers.

TAKING CARE OF BABY TEETH

A child’s baby teeth are being made before birth while the baby is still inside the mother’s womb. During the last months of pregnancy and the first few months after the child is born, the baby teeth take their final form. Pregnant mothers and young children need good food and good health in order to have strong baby teeth.

Strong teeth are white and their front surface is smooth.

Weak teeth have yellow marks that are pitted and rough.

Baby teeth get marks on them when: 1) the pregnant mother is sick or does not eat good food; 2) the young baby is sick or does not eat good food; or, sometimes, 3) the baby’s birth was early or the delivery was difficult.

Figure

The marks are rougher than the rest of the tooth. Food sticks easily to them and turns the tooth yellow.

The marks are also soft. They need to be cleaned well every day to prevent them from becoming cavities. A tooth with a cavity hurts. When children’s teeth hurt, they do not want to eat as much.

Cavities in baby teeth can make a child’s malnutrition worse. Remember this whenever you see a weak, poorly nourished child. When you examine a child at the health clinic, lift his lip and look at his teeth. Do this as part of your routine examination.

You can fill cavities with cement (Chapter 10). Cement prevents food and air from going inside the cavity and hurting the child.

Figure

A sore on the gums may be a gum bubble. If so, it means the tooth has an abscess. That cavity should not be filled with cement. Instead, the tooth needs to be taken out (Chapter 11) before the infection can get worse.

For baby teeth to grow strong, mother and baby must stay healthy.^* Help her to understand how important this is. A pregnant mother should:

1. Eat enough good kinds of foods, both for herself and her baby growing inside (see Where There Is No Doctor, Chapter 11, and Helping Health Workers Learn)

2. Attend health clinic each month, so the health workers can examine her regularly and she can receive important medicines (see Where There Is No Doctor).

3. Not use the medicine tetracycline, because it can cause the teeth to turn dark. You, the health worker, must remember - do not give tetracycline to a pregnant woman or to a young child. If she needs an antibiotic, use a different one.

^* See the story about pregnancy and dental care.

For baby teeth to stay strong, and to prevent marks from turning into cavities, mother should:

1. Continue to breast feed and never feed her child juice or sweet tea from a bottle. Start adding soft foods, mashed banana or papaya when the child is 4 months old.

2. Wipe her baby’s teeth with a clean cloth after the baby eats. This cleans the baby’s teeth, and helps the baby get used to teeth cleaning. Later he will be happy with a brush.

Figure

Around 1 year of age, there will be several baby teeth. At that time, mother should start using water - not toothpaste - on a soft brush or brushstick. (With toothpaste, you cannot see the child’s teeth clearly because of the bubbles it makes.) She should scrub the sides and tops of each baby tooth as well as she can.

The child can also try to clean his own teeth. That should be encouraged. However, since he is too young to clean properly, mother (or father, or older brother, sister) must clean his teeth once a day for him. Continue helping in this way until the child is old enough to go to school.

Figure

You can make a large brush smaller, to fit more easily into a young child’s mouth.

Pull out some of the back hairs, or cut them with scissors.

Why Baby Teeth Are Important

Baby teeth are just as important to children as permanent teeth are to adults. They help a child to eat, talk, and look good.

However, many people feel that it is not worth the effort to look after baby teeth. Nor is it worth fixing them. After all, parents think, the permanent teeth will take their place.

This kind of thinking is understandable. The problem is that we are forgetting one other useful purpose of baby teeth. Baby teeth keep space in the mouth for the permanent teeth to grow in. If there is not enough space, the new teeth will grow in crooked, and cavities grow faster around crooked teeth.

Under each baby tooth a new permanent tooth is growing.

At the same time, extra permanent molars are forming at the back of the mouth, inside the bone.

Front baby teeth become loose and fall out (usually 6-7 years, but sometimes as young as 5 years) ahead of back baby teeth (10-12 years). This is because the front permanent teeth are formed and ready to grow in first.

Permanent molars (PM) come in behind the baby molars (BM).

The permanent molar (1 PM) is often the first of the permanent teeth to grow into the mouth. That happens at 6 years of age.

The first permanent molar grows into the mouth by sliding against the back of the second baby molar (2BM).

Figure

Slowly but steadily the upper and lower permanent molars grow until they meet and fit tightly together.

Figure

Between the ages of 6 and 11, a child needs healthy baby molars to guide the first permanent molars into position and then to hold them there. When the first permanent molars grow into the right place, this is a good sign. It means the other permanent teeth will also grow in properly, because they will have enough space.

Note: Some people are born without enough space. But most people are not born with this problem - they lose the spaces when they remove baby teeth instead of fixing them.

HEALTHY BABY TEETH	-	help to make	®	STRAIGHT PERMANENT TEETH
Figure				Figure
10 years				adult
SICK BABY TEETH	-	help to make	®	CROOKED PERMANENT TEETH
Figure				Figure
10 years				adult

Tell mothers why baby teeth are important. Good food and regular cleaning keeps them healthy. They should know that new teeth coming in do not cause diarrhea and fever, but that a child may have diarrhea or fever at the same time.

If there is a cavity, fix it so the tooth can be kept in the mouth to do its important work (see Chapter 10).

TAKING CARE OF MOLAR TEETH

We often notice front teeth growing in, but not the back ones. Back teeth - molars - are not so obvious. Swelling on the face can be either a new molar growing in or an abscess. So, to help you to decide, look at the tooth for a cavity and at the gums beside it for a gum bubble.

When you see a swollen face, look for the two signs of an abscess.

But if the person is young (16-22 years), it often is not an abscess. The third permanent molar tooth may be growing in at the back of her mouth. As the tooth grows, it cuts through the skin. Just as a dirty cut on a person’s hand can get infected, the cut gum around her new tooth also can get infected, causing a swollen face.

Look behind her back teeth.

See the red swollen skin on top of the new tooth.

If there is enough space for the tooth, it will grow in by itself It only needs time. Before acting, decide how serious the problem is.

If there is no swelling and she can open her mouth, explain to her what is happening and what she can do herself to reduce infection and toughen the gums. The best medicine is to rinse warm salt water over the sore area. A good home remedy is to rinse until the tooth grows all the way into the mouth.

If it does appear serious (severe pain, swelling, not able to open the mouth).

TAKING CARE OF ALL YOUR TEETH

This book often repeats an important message: eat good food and clean your teeth. It is repeated because this is the most important thing you can learn from this book. Later chapters will discuss what to do when problems occur, but if you follow these two suggestions, you will almost never have problems with your teeth and gums. This is true because good food keeps your whole body healthy, including your teeth. Also, with no ‘colonies’ of germs or harmful factory sugar on your teeth, your mouth cannot make the acids that cause both tooth and gum problems. So, remember:

1. Eat Good Food

An easy-to-remember rule is the same foods that are good for the body are good for the teeth. A healthy body is the best protection against infection.

The MAIN FOOD is at the center of every meal.

Good nutrition (eating well) means two things:

One, eat a mixture of different kinds of foods every time you eat. Look at the pictures on How can we prevent cavities and sore gums. There are several groups of foods. Every time you eat, try to eat one or two foods from each of the groups. This way, you will get three important kinds of food: GROW FOOD (body-building food) to give you the protein you need; GLOW FOOD (protective food) to give you vitamins and minerals; and GO FOOD (concentrated energy food) to give you calories to be active all day.

Two, be sure you eat enough food to give your body the energy it needs. This is even more important than the first suggestion. We get half or more of our energy from our MAIN FOOD. In most parts of the world, people eat one low-cost energy food with almost every meal. Depending on the area, this MAIN FOOD may be rice, maize, millet, wheat, cassava, potato, breadfruit, or banana. The MAIN FOOD is the central or ‘super’ food in the local diet.

A spoonful of cooking oil added to a child’s food means he only has to eat about ¾ as much of the local main food in order to meet his energy needs. The added oil helps make sure he gets enough calories by the time his belly is full.

Be sure always to eat GROW FOODS and GLOW FOODS to get the vitamins and protein you need.

Figure

Your energy foods give you the most important part of your diet - calories. Half or more of our calories come from the MAIN FOOD, and most of the other calories come from GO FOODS.

WARNING ABOUT ‘GO FOODS’: Although GO FOOD gives us the energy we need, some GO FOODS are worse than others. Honey, molasses and especially white sugar can be very bad for the teeth, even though they have the calories we need. Fruits, nuts, and oils all give us energy (calories) without attacking the teeth.

2. Clean Your Teeth

Cleaning teeth requires time and care. If you hurry, you will leave food and germs behind, and they continue to make cavities and sore gums.

You may find that different dental workers recommend different ways of brushing teeth. Some ways are definitely better, but often they are harder to learn.

Teach a method of cleaning that a person can learn and will do at home. Let him start by scrubbing his teeth (and his children’s teeth) back and forth, or round and round. Encourage him to improve his method only when you think he is ready.

Toothpaste is not necessary. Some people use charcoal or salt instead. But it is the brush hairs that do the cleaning, so water on the brush is enough.

Scrub the outside, inside, and top of each tooth carefully.

Figure

When you finish, feel the tooth with your tongue to make sure it is smooth and clean.

Finally, push the hairs of the brush between the teeth and sweep away any bits of food caught there. Do this for both upper and lower teeth.

Figure

Sweep away in the direction the tooth grows: sweep upper teeth down and lower teeth up.

Explain how important it is to use a brush with soft hairs. A brush that is stiff and hard will hurt the gums, not help them.

Figure

You can make a hard brush softer by putting the hairs into hot water for a few minutes.

Figure

Do not put the plastic handle into the hot water, or it will melt.

If your store has only hard brushes, tell the storekeeper that hard toothbrushes do not help the people in the community. Ask him to order and sell only soft toothbrushes.

Note: Another important way to reduce cavities is by adding fluoride to teeth. Fluoride is a substance which, like calcium, makes teeth harder and stronger. Fluoride in drinking water, toothpaste, vitamins, and mouth rinses, helps to prevent cavities. These methods are sometimes expensive. Perhaps the most effective and inexpensive method is the weekly rinse at school. Fluoride can also be found naturally in food and water. For example, tea leaves and most foods from the sea contain a large amount of fluoride. So, your source of fluoride can be either: Figure

CLEANING BETWEEN THE TEETH IS VERY IMPORTANT

Here are three ways to clean between the teeth:

1. Push the hairs of a toothbrush between the teeth, and sweep the bits of food away.

2. Remove the stem from a palm leaf. Use the thinner end and move it gently in and out between the teeth.

Figure

Rub the stem against one tooth and then the other. This way, you clean the sides of both teeth.

Figure

3. Use some thin but strong thread or string. String can be the best method of all - but you must be careful with it.

Get some thin cotton rope used for fishing nets. Unwind and use one strand of it.

OR

Buy and use Dental Floss. This is a special kind of string for cleaning between the teeth.

Be careful! The string can hurt your gums if you do not use it correctly. The next page shows how to use the string, but the best way to learn how to ‘floss’ your teeth is to have someone show you. Ask a dental worker who has experience.

Wrap the ends of the string around the middle finger of each hand.

Figure

Use the thumb and finger to guide the string. Go back and forth to slide the string between two teeth. Be careful not to let it snap down and hurt the gums.

Figure

With your fingers pull the string against the side of one tooth. Now move the string up and down. Do not pull the string back and forth or it will cut the gum.

Figure

Lift the string over the pointed gum and clean the other tooth.

Figure

When you have cleaned both teeth, release the string from one finger and pull it out from between the teeth. Then wrap it around your two middle fingers once again, and clean between the next two teeth.

Remember: clean teeth and good food will prevent almost all dental problems.