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HEALTH PROMOTIONOral Health Promotionin South AfricaOral diseases adversely affect overall qualitytion - we conducted studies to determinecurriculum: the LifeSkills Training (LST). Inof life, self-esteem and social confidence.predictors of gingivitis among adolescentsaddition to teaching stress-coping skills,Although oral diseases are largely prevent-and to explore the association between atti-the LST curriculum provided informationable, they still pose a significant burden totude to oral health and smoking. Given theon short-term health consequences ofmany people in marginalised communities,existing evidence linking household povertysmoking, focusing on effects such as badwhere pain control and dental treatment arewith stress among adolescents and in linebreath and its influence on social interac-still not readily accessible. Of the nine prov-with the salutogenic theory of Antonovsky,tion, especially as it relates to the adoles-inces of South Africa, Limpopo Province haswe were particularly interested in exploringcents’ romantic aspirations.the lowest human development index, andhow rural adolescents’ ability to cope with•A randomised controlled trial showed thatthe recent national children oral health sur-stress, as measured on a sense of coherenceafter two years, when compared to thevey suggests that the adolescents in thisscale, influence their oral health.usual health education taught in 11 con-province have the highest burden of poorperiodontal (gingivitis) health. Gingivitiscommonly presents as frequent gum bleedingupon tooth brushing. In addition to thefact that periodontal diseases, if not controlled,could lead to tooth loss, there is alsogrowing evidence that periodontal diseasesare a risk factor for pre-term low birth weightand cardiovascular diseases in adulthood.Behavioural Risk FactorsBacterial plaque accumulation on teeth thatcould result from irregular tooth brushing isthe main aetiologic agent implicated inperiodontal diseases. However, other importantrisk factors include smoking and stress,both of which are also common risks forcardiovascular diseases. The recognition ofthese common risk factors - together withthe realisation that there are limitedresources to run oral health promotion programmesseparately from other programmesdirected at promoting general health -informed the WHO’s resolve in 2007 to formallyadopt the integrated approach to oraldisease prevention. This public healthThis photo was used during the oralhealth promotion project: “Boy beingrejected by a girl as a result of badbreath developed from smoking”Project’s Findings• Adolescents who did not live with theirmother were more likely not to be brushingregularly.• This study further demonstrated thatadolescents with a predisposition to copeadequately with stress and those notsmoking were more likely to brush regularlyand experienced a good gingivalhealth, irrespective of the level of oraltrol schools, the LST curriculum taught inten schools was very effective in promotingadolescents’ regular tooth-brushingbehaviour and good gingival (gum) health.• However, the intervention did not significantlyreduce smoking prevalence, butincreased non-smokers’ cigarette-offerrefusal self-efficacy, which may reducesusceptibility to future smoking.• Nevertheless, the LST curriculum alsosignificantly reduced alcohol use amongadolescents in schools that received theprogramme as compared to the controlschools.• Future programmes designed to promotehealthy behaviours among adolescentsshould consider ways to enlist the supportof the family members, particularlytheir mothers where possible.• Furthermore, considering that we foundthat on average only 60% of the curriculumwas taught, we would need to investigatehow the teachers and studentsthemselves found the curriculum in orderto improve the outcomes of the curriculumwith regards to smoking prevention.D E C E M B E R 2 0 0 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7approach seeks to address modifiable riskhygiene.factors common to both oral health and• Smoking onset on the other hand, wasBart van den Borne and Olalekangeneral health, but only limited evidence isleast likely when youth strongly believeAyo-Yusuf | Researcher, Associateavailable on its effectiveness. While the rolethat smoking causes bad breath and thatProfessor - PhD Student - Faculty ofof oral hygiene and smoking is well docu-bad breath has negative social conse-Health, Medicine and Life Sciences,mented, there is only limited information onquences, such as peer rejection.Maastricht University, the Netherlandsthe role of stress in oral health.• These results supported the implementa-Email: b.vdborne@gvo.unimaas.nltion and evaluation of an interventionIn the initial phase of our project - leadingintegrating oral health promotion with aup to an intervention for oral health promo-social skills-based smoking prevention21