Dental Hygiene and Malarial Patients

Malaria is a widespread disease throughout Central and South America, sub-Saharan Africa, the Indian subcontinent, Southeast Asia, the Middle East, and Oceania. It is transmitted by the
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Plasmodium parasite present in infected female Anopheles mosquitoes, and affects red blood cells of persons who are bitten by them. There are two stages in malaria infectiona phase of multiplication
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in human liver cells, followed by a maturation phase in human blood cells. Depending on the severity
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of infection, several clinical features may arise, including cyclic periods of fever, chills, sweating, headache, dizziness, or vomiting. Oral effects of malaria are also present, due both to systemic manifestations of the disease and side effects of medications. For example, persistent fever frequently observed in malarial patients may induce xerostomia (dry mouth) and dehydration, resulting in tongue sticking to the palate, burning and soreness of the oral mucosa and tongue which, left untreated, can accelerate the development of oral biofilm-causing gum disease, tooth loss, and caries. Further,
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anemia in malarial patients may induce pallor of the tongue and buccal mucosa, angular cheilitis (inflammatory lesions at the corners of the mouth), or erythema (redness of the skin). Other oral manifestations may arise concurrently with nutritional deficiencies; acute malaria may cause malnutrition and anorexia, which predispose patients to malodor and coated tongue.
Preventing Oral Symptoms of Malaria
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In a recent publication, Newcomb and colleagues report that dental hygienists have a key role to play in making malarial patients aware of good prevention behaviors to avoid oral manifestations of the disease (Figure). Indeed, oral symptoms such as xerostomia can be reduced with agents stimulating
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the production of saliva; in this regard, toothpastes, sprays, gels, lozenges, mouthrinses, saliva substitutes, or stimulants may be recommended. In addition, products known to be effective in the
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prevention of tooth decay or remineralization of tooth enamel can be suggested to avoid caries, such as xylitol-containing gums or lozenges, products containing amorphous calcium phosphate (ACP), casein phosphopeptide-ACP, and calcium sodium phosphosilicate. Dental hygienists may also encourage patients to eat foods rich in iron and take folic acid and vitamin B12 to resolve oral symptoms generated by anemia.
Public Health Concerns and Measures

Despite the efforts over the last few years to improve care for malarial patients and avoid its transmission, malaria remains a highly important public health concern. Half of the worlds population
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is at risk of contracting malaria, the fifth leading cause of death from infectious diseases worldwide. Moreover, the emergence and spread of drug resistance to medication used to treat
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malaria, along with high population growth, strongly contribute to the expansion of the disease. Malaria is now noticed in previously uninfected geographical regions. The greatest part of morbidity
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and mortality due to malaria is borne by vulnerable populations, including pregnant women, young children, and patients suffering from other infectious diseases. It is important for healthcare providers
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to be aware of all the aspects of malaria in order to reduce its transmission, prevent drug resistance, and aid research to improve its care. colgate oral care report