Composition of kitchen wastes in Chinese cities (unit: %).
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\r\n\tEditors hope to build a line of transformative research based on the adaptation of energy and design solutions from natural models to technical models, using methodologies and solutions which will open new areas of work about how to solve efficiency requirements based on natural solutions honed by evolution. This process is based on creativity and forces researchers to think out of their boxes and open new scientific challenges. What drives the research is the urge to find alternative, more efficient solutions to tackle problems. Due to the wide range of possibilities offered by biodiversity’s tested solutions, the methodology prioritize (although not exclude) solution-based approaches.
The World Health Organization (WHO) estimates that there are more than one billion people in the world living with some form of impairment or disability, of whom nearly 200 million have considerable difficulties in functioning [1]. There is a growing proportion of people with disabilities worldwide, and these are vulnerable groups in both developed and developing countries.
Currently, the National Organization on Disability (NOD), a private and nonprofit organization, estimates that 54 million children and adults in the United States have one or more disabilities, with 35 million Americans being severely disabled [2, 3, 4]. The proportion of children with disabilities is estimated to be 12.5 million or around 18% [3, 4, 5]. According to the estimated data by National Health and National Health and Nutrition Examination Survey (NHANES), 46% of adults in the United States have periodontitis, and 8.9% have severe periodontitis [6].
The geopolitical and social plurality of states and regions in Brazil have shown the emerging need for effective public policies to meet the specific needs of this diversity. According to the Brazilian Institute of Geography and Statistics, 45.6 million Brazilian citizens (equivalent to 23.9% of the population) have some type of neuropsychomotor impairment as physical, sensory—visual and auditory—and intellectual disabilities. Among these, 17.7 million people (6.7% of the population) have severe disability. The majority of this target public is found in urban areas and is aged between 15 and 64 years; further, the northeastern areas have a higher number of cities with at least one person with disability [7]. Hence, oral health care needs should be emphasized mainly for this target public due to high susceptibility to infection risks and great vulnerability to develop illnesses. Mental disorders associated or not with disabilities must also be considered in these individuals. In this condition, the familiar influence shall be taken into account for these groups once their human development directly depends on the good relationship among them.
Regarding children with developmental disorders, especially the autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (AD/HD), or specific learning disorder (LD), the field of “special care dentistry” is rapidly gaining recognition as a necessary service once they require oral health care needs at all times [8]. According to American Psychiatric Association (APA) [9], these disorders have relatively been growing due to the increase in birth rates and life expectancy of these individuals. Another relevant factor would be the ability or difficulty to perform their self-care, in particular, in the mouth, resulting in a negative impact of precarious oral conditions. The main oral signs and symptoms found in this target public include poor oral hygiene, dental caries, and severity of periodontal diseases (PD). High incidence of dental hypoplasia, traumatic lesion (factitious, iatrogenic, and accidental), drug-induced gingival overgrowth, dental malocclusion, and tooth missing are also evidenced [8, 10]. It is important to highlight that the large dental loss of intact teeth is caused by the destruction of the collagen fibers of the periodontal ligament (PDL) and severe resorption of alveolar bone tissue from the persistent supra and subgingival and periopathogenic microbiota, recognized as periodontal disease [11]. Therefore, this disease is one of the most common oral chronic infections in people with special health care needs (SHCN), becoming an important dental public health problem.
Based on combined data from the literature and our scientific experiences, we discussed the microbiological, histopathological, and clinical features of PD in each “special care needs” group. Furthermore, we reported some advances in “Omic” technologies which are molecular biology methods used to assess the genomics (genes), proteomics (proteins), transcriptomics (mRNA), and metabolomics (metabolites) aspects of PD. These methods promote a better understanding of the mechanisms involved in the etiopathogenesis and in the identification of new biomarkers of PD that help in the diagnosis of PD and in tissue responses after treatments of gingivitis and periodontitis. In addition, alternative therapies to PD in patients with SHCN were recommended in order to aggregate new scientific knowledge, some of them being investigated at the Center of Biosciences Applied to Persons with Special Care Needs (CEBAPE) of the Institute of Science and Technology of the São Paulo State University (UNESP).
The field of “special care dentistry” is rapidly gaining recognition as a service that should be provided to persons with physical, mental, or intellectual disabilities by general physicians, pediatric physicians, geriatric physicians, dental practitioners, and dental hygienists. Considering the limited opening of the oral cavity and the great difficulty of clinical procedure handling, the special needs patients may be treated under applying of psychological, physical, or pharmacological techniques in order to control their behavior and the voluntary or involuntary body movements. These patients may be affected by several comorbid physical illnesses including diabetes mellitus, cardiovascular diseases, respiratory illnesses as aspiration pneumonia, sleep disturbance as obstructive sleep apnea, malignant neoplasms, and so on.
Extrinsic and intrinsic factors may corroborate to the installation and perpetuation of PD, as well as increase the susceptibility to supra and subgingival periopathogens in these individuals, even after oral hygiene promotion and/or intensive conventional mechanical treatment, combined or not with a supportive therapy. Concerning the main extrinsic factors, previous studies have considered oral mucositis-inducing chemotherapy drugs, saliva flow-reducing medications, respiratory disturbances as mouth breathing leading to oral hyperventilation and, as a consequence, dry mouth, motor deficit, cognitive impairment, learning difficulty and disability, crowded teeth, and inappropriate diet. The intrinsic factors include immune response deficiency, a high amount of periopathogens, sleep disorders such as obstructive sleep apnea, dysfunction of the oropharyngeal muscles resulting in severe dysphagia, and the risk of occurrence for aspiration pneumonia. Previous studies confirm the presence of respiratory pathogens in the oral cavity which may be aspirated into the lung alveoli due to severe dysphagia, developing aspiration pneumonia [12, 13]. This comorbidity may negatively influence the oral health homeostasis, aggravating the preexistent inflammatory processes, in particular, the PD.
Current researches confirm that the therapy applying neuromuscular electrical stimulation on the masticatory muscles was effective in adults with cerebral palsy. This biostimulating effect also reflected in the electrical activity of the oropharyngeal muscles, favoring their functional performance; then, a positive effect on the apnea and hypopnea index was found. These episode cascades reduced the number of pathological respiratory events, promoting improvements in the quality of life for these patients [12, 13, 14].
Regarding the oral health status of these populations, the main oral manifestations are dental caries, dental hypoplasia, dental agenesis, orofacial traumas, drug-induced gingival overgrowth, and, in particular, PD [8]. Recent studies have shown that the presence of periodontopathic microbiota at the oral biofilm and/or spread throughout the saliva may explain the higher susceptibility to PD in this target public [15, 16].
According to the Joint Advisory Committee for Special Care Dentistry (JACSD), “special care dentistry” provides oral services for people with an impairment or disability including physical, sensory, intellectual, mental, medical, social, or a combination of one or more of these [17]. Several conditions, disorders, and/or disabilities lead these patients to the need of specialized oral assistance. In Brazil, the Federal Council of Dentistry has recognized the specialty of Dentistry for Patients with Special Health Care Needs as a dental service which has been assisting people with simple or complex disabilities, of acute or chronic nature, and temporary or permanent conditions or disorders. This target public is inserted into the following categories: neuromotor disability (1), sensory disability (2), mental disorder (3), infecto-contagious diseases (4), chronic systemic diseases (5), and systemic conditions (6).
The neuromotor disorders (1) include people with physical and intellectual disabilities which are from an unknown, environmental, and a genetic origin. These disorders consist of cerebral palsy, cerebrovascular disturbances (e.g., ischemic and hemorrhagic cerebral strokes), spinal cord injury, myelomeningocele, infectious disease (e.g., poliomyelitis or infantile paralysis), autoimmune diseases (e.g., myasthenia gravis and multiple sclerosis), muscular dystrophy resulting in muscle weakness and cellular degeneration, metabolic bone diseases (e.g., rachitis or osteomalacia caused by genetic, nutritional and/or hormonal abnormalities affecting bone growth and remodeling), and bone genetic disorder (e.g., dysostosis, osteopetrosis and imperfect osteogenesis). The congenital and acquired abnormalities, resulting in craniomaxillofacial deformities, complex malformations, and syndromes are also included in the neuromotor disorders. It is important to emphasize that the intellectual disabilities may be associated with these conditions.
The sensory disorders (2) include the hearing and visual disabilities, generating immediate harmful effects as depression, isolation, dementia, and decrease of quality of life [18]. The severity of these impairments may result in the disruption of interpersonal relations and decrease of self-sufficiency in daily living activities, both of which are critical to the well-being of a person [19]. Hearing disability, with its resultant difficulties in communication function, pervades multiple domains of function in the individuals, decreasing activity, increasing depressive symptoms, and confounding assessment of cognitive ability. Although it is not curable, this impairment is often remediable with appropriate audiologic evaluation and the prescription of amplification devices. Visual disability also affects multiple domains of function, limiting the individuals’ ability and increasing the risk of falls, fractures, and morbidity. In order to attenuate the consequences of visual disability, the cause must be identified to obtain an effective treatment [20].
Conforming to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association (APA) under coordination of the Division of Mental Health of the World Health Organization (WHO) and the National Institute of Mental Health (NIMH), a mental disorder (3) is a syndrome characterized by clinically significant disturbances in an individual’s cognition, emotion regulation, or behavior which reflects a dysfunction in psychological, biological, or developmental processes underlying mental functioning [9]. Thus, mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss (e.g., the death of a loved one) is not considered a mental disorder [9]. For a better elucidation, the new North American classification of mental disorders is briefly mentioned in Figure 1.
Different condition groups of mental disorders described in the fifth edition of the diagnostic and statistical manual of mental disorders published by the American Psychiatric Association [9].
Among the different groups of psychopathologies, it is worth mentioning the neurodevelopmental disorders which include intellectual disabilities (mild, moderate, and severe levels), autism spectrum disorder (ASD), attention deficit and hyperactivity disorder (ADHD), communication disorders (speech and language impairments), specific learning disorder, motor disorders (e.g., stereotyped movement disorder and tic disorders), and so on [9]. Children with neurodevelopmental disorders may experience difficulties with language and speech, motor skills, behavior, memory, learning, or other neurological functions [14]. While the symptoms and behaviors of neurodevelopmental disabilities often change or evolve as a child grows older, some disabilities are permanent. Diagnosis and treatment of these disorders may be difficult, frequently involving a combination of professional therapy, pharmaceuticals, and home- and school-based programs.
Considering the most common mental disorders including dementia, depression, generalized anxiety disorder, panic disorder, obsessive–compulsive disorder, posttraumatic stress, and phobias, the psychiatric patients have presented high susceptibility to PD. These illnesses have been caused by a set of processes such as the presence of oral microbial biofilm due to poor oral hygiene, psychotropic medication-induced dry mouth, and gingival hyperplasia [15, 21]. Mental health clinicians should also be aware of the oral consequences of prescribed medications, especially the antipsychotic drugs [15]. About this, the depression may dysregulate regulatory mechanisms within the brain involved in immune regulation, alter the immune system responses, and thereby influence the development and progression of infections and inflammatory diseases, including periodontitis [22]. As a support therapy, antidepressant drugs, such as fluoxetine, tianeptine (selective serotonin reuptake inhibitor), and venlafaxine (serotonin-norepinephrine reuptake inhibitor) are used; however, the side effects could affect the periodontal tissue health [23]. Current studies using animal models showed that the fluoxetine reduced the alveolar bone loss due to suppression of inflammatory response and protection against periodontal bone resorption and collagen fibers destruction of the periodontal ligament (PDL), while the tianeptine influenced the immune system, enhancing the plasma concentrations of pro-inflammatory and T regulatory cytokines and interleukins in response to the gram-negative bacterial lipopolysaccharide (LPS) antigen. As a consequence of these processes, there is an inhibition of the periodontal disease progression [24, 25]. On the other hand, the venlafaxine influenced the increase of alveolar bone loss, most likely due to its anti-inflammatory and immunoregulatory effects on the periodontitis once it is considered an inflammatory disorder and an immunologically compromised disease [22].
Therefore, an increased focus on the physical health of psychiatric patients should encompass oral health including closer collaboration between the dental practitioners and clinicians. Possible interventions must include the following approaches: to apply the best practices in health care focusing the transdisciplinary, to remove first the infectious foci as oral microbial biofilm and dental calculus through dental scaling and root planning for an appropriate teeth cleaning and reduction or inactivation of periodontal pockets, to guide the regular use of dental floss or interdental brushes and tooth brushing, to insert monitoring processes on oral self-care such as to create a strategic planning on interdental cleaning behaviors according to the difficulty levels of learning and the motor and cognitive dysfunction of each individual, and to perform periodic oral appraisals for necessary methodological adjustments in order to ensure the maintenance and the preservation of good oral health. Before introducing these procedures, the dental practitioner must comprehend the profile of each patient with SHCN, so as to know the physical and intellectual limitations, to identify the presence of comorbid diseases which may affect the overall health, and to assess the psychiatric behavior related to oral self-care. Surely, this systemic overview may favor the homeostasis of the stomatognathic system and improve the general health conditions, once these approaches can prevent the development of extensive and severe PD avoiding dental mobilities and/or loss.
The infecto-contagious diseases (4) is a subset category of highly dangerous transmissible diseases which include mainly infected patients with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS), patients with active tuberculosis disease, patients with viral hepatitis, and other such patients.
The chronic systemic diseases (5) are illnesses that spread throughout the body, affecting multiple organs and body systems, which may evolve into comorbidities, complicating the diagnosis and, consequently, influencing the prognosis. Considering this concept, the diseases imply juvenile rheumatoid arthritis, diabetes mellitus, congenital and acquired heart diseases, hematological diseases or disorders, chronic renal failure, autoimmune diseases (lichen planus, pemphigoid, pemphigus vulgar, erythema multiforme, lupus erythematosus, epidermolysis bullosa, etc.), vesiculobullous diseases, and so on.
The systemic conditions (6) are recognized as secondary factors that may modulate the disease initiation or progression rather than acting as primary etiological factors. These circumstances may affect the onset, progression, and treatment of such disease. Several patient types are included in these conditions, such as patients submitted to radiotherapy and chemotherapy in the head and neck regions, patients who received an organ transplant, patients with medication-induced immunosuppression, and similar others that may affect the general health conditions of the individual.
To better comprehend the relation among the environmental, genetic, and social effects and a person, a diagram was elaborated showing the occurrence of diseases, conditions, and/or disorders which may manifest during the life course of an individual. It is important to emphasize that these etiopathological factors may contribute to the development of one or more disabilities, leading to an acquired or congenital disability. On the other hand, an individual may be born with one or more disabilitiy and, concomitantly, develop diseases or disorders due to the high susceptibility to the environment and the different levels of disability complexity, characterizing the person with SHCN. It is noteworthy that the social impact resulting from precarious conditions of survival on the people with SHCN could explain the causes of health disparities or high occurrence of oral diseases (Figure 2). Socially disadvantaged groups have demonstrated poorer overall and oral health than the general population, becoming an aggravating factor, especially, in groups with SHCN. Therefore, a better attention to the public services in oral health for this population should be one of the main goals in government plans.
Diagram showing the life course of a susceptible individual to several extrinsic and intrinsic factors which may lead him/her to a disorder, disease, and/or a disability.
Some case reports of patients with SHCN were briefly described in relation to their clinical, radiographic, histopathological, and laboratorial characteristics together with the oral manifestations, clinical procedures, and transdisciplinary approaches; then, we correlate them with the findings found in the literature. Furthermore, we mainly discuss the clinical management related to the PD. The additional commentaries are aimed to reinforce the importance of the early diagnosis and an appropriate dental treatment for each complexity of disability. Types of PD that were correlated with some categories of people with SHCN are depicted in the following section.
A 14-year-old adolescent girl with Robinow syndrome had low stature, mild exophthalmos, hyperthyroidism, frequent thrombocytopenia, splenomegaly, and genital abnormality such as hypoplastic clitoris and small lips (a). Esophageal reflux was reported in the initial years of life. Using the Nicodemo et al. [26] and Grenlieh-Pyle [27] methods, dental and bone ages were 11.4 and 12, respectively. The intraoral examination showed mouth respiration, angular cheilitis, dental malocclusion, and ulcerated gingival surface (b and c) and accentuated alveolar bone loss (d), especially, at the region of mandibular incisors. Histologically, gingival tissues showed intense infiltration of mononuclear inflammatory cells diffusely spread throughout the connective tissue. Junctional epithelium hyperplasia with intense exocytosis (e) and extensive areas with no epithelium cover associated with infiltration of polymorphonuclear inflammatory cells into the lamina propria were also evidenced. In addition, presence of bacterial colonies (black arrows) and necrotic alveolar bone tissue fragments (blue arrows) was found (f and g). The diagnosis was chronic periodontitis with ulceration areas (Image 1).
Chronic periodontitis associated with genetic disorder (hematoxylin–eosin; original magnifications 100 and 50×).
A 19-year-old young man with Down syndrome associated with ectodermal anomalies. The extraoral features displayed dry skin and alopecia of eyelashes, eyebrows, and hair (a) while, the intraoral features showed dry mouth due to the severe reduction of saliva flow and mouth breathing, frequent angular cheilitis resulting from immune system deficiency, bilateral absence of the inner and upper third molars, presence of left upper and right lower deciduous canines, upper lateral incisors with microdontia, unerupted left upper permanent canine, generalized chronic gingivitis (a–d), and absence of caries. The recommended dental treatment was periodontal prophylaxis through the use of disclosing agents such as the scaling and root planning (e–g). It is important to point out that oral hygiene orientation and diet control must be continuously performed because of the neuromotor dysfunction of these patients, resulting in great understanding difficulties and difficulties in handling of cleaning devices and leading to a poor oral hygiene. Concerning dental education, we consider that the learning for repetition and use of ludic techniques or resources are effective strategies which must be implemented by dental practitioners. We also suggest the saliva analysis to assess their physicochemical properties, to determine the susceptibility to stress measuring the concentrations levels of salivary amylase or cortisol, and to identify the occurrence risk for aspiration pneumonia using as a biomarker the Pseudomonas aeruginosa. It is important to highlight that patients with Down syndrome present immune system disorders; therefore, oral infections must be avoided for general health balance and maintenance (Image 2).
Chronic gingivitis associated with genetic disorders plus ectodermal anomalies.
A 11-year-old female child with West syndrome had multiple epileptic spasms and, as a consequence, a severe neuropsychomotor impairment. The electroencephalography showed a hypsarrhythmia pattern confirming the diagnosis. The recommended treatment to this condition has been the use of phenobarbital and/or valproic acid since birth. The intraoral features were drug-induced generalized gingival proliferative lesion with partial covering of the posterior teeth and gingival bleeding. Some permanent teeth were still impacted due to the presence of gingival fibrosis (a–c). The recommended dental therapy was the prophylactic periodontal treatment and gingivectomy (Image 3).
Severe medications-induced gingival overgrowth.
To illustrate this case, histopathological features were depicted in order to show the medication effects on the oral mucosa, in particular, on the gingival tissues (epithelium and connective tissue) (Figure 3).
Medication-related gingival hyperplasia. Photomicrography showing gingival hyperplasia characterized by the epithelium hyperplasia and proliferation of dense connective tissue. Epithelial crest projections were thin and long (blue arrows), interconnecting them (black arrows) (a). A lamina propria exhibited infiltration of mononuclear inflammatory cells, especially lymphocytes, plasma cells, and macrophages. Furthermore, scattered eosinophilic globules of gamma globulin, known as Russell bodies (b; square), were also seen (hematoxylin–eosin; bars = 200 and 50 μm).
A 7-year-old male child with spastic quadriplegic cerebral palsy, caused by hypoxic–ischemic brain damage, exhibited poor cognitive function and has been feeding on semi-solid food since 3 years of age. Ranitidine hydrochloride was used to treat gastroesophageal reflux, and botulinum toxin was never used to decrease the severity of the sleep bruxism. As a consequence, severe upper and lower teeth wear reaching the region of the dental pulp were evidenced (a).
This child was in primary dentition phase and exhibited discreet chronic gingivitis, mouth-breathing pattern, severe dysphagia, and involuntary tongue movements. First, oral hygiene orientation and diet control under supervision were done due to his severe neuromotor dysfunction. Posteriorly, we used a masticatory device denominated “hyperbola” to attenuate the sleep bruxism and, consequently, to improve the quality of his life. After the proposed therapy, we obtained satisfactory results, including reduction of the sleep bruxism and improvements of sucking-swallowing movements at meals. (Source: Giannasi, et al. [14]) (Image 4).
Discreet chronic gingivitis associated with severe bruxism. (Source: Giannasi, et al. [14]).
A 9-year-old male child with visual disability resulting from the intracranial hypertension and/or alterations in the vascularization of the optical nerves which were caused by the cystic craniopharyngioma. Diabetes insipidus was developed as a complication of this disease, whereas, the motor functions, learning ability, memory, and mental health were preserved. The intraoral features showed generalized chronic gingivitis and deep caries, in particular, in the molar regions, resulting from poor oral hygiene. Considering that the periodontal disease is one of the main oral complications of diabetes, the oral health balance must be a major goal of the dentists once hyperglycemic control in a diabetic child becomes is a great challenge for parents and doctor (Image 5).
Chronic gingivitis associated with visual disability and metabolic disease.
A 59-year-old man with diagnosis of active positive-HIV had squamous cell carcinoma in the vestibular fornix region. In the clinical history, the patient was a smoker since the age 13 and had arterial hypertension, saphenous bridge, and type 2 diabetes mellitus. The diagnosis of positive-HIV was confirmed when the patient was 36 years old. To treat the malignant neoplasm, chemotherapy and radiotherapy were indicated by the oncologists; however, no emergency dental treatment was done before the recommended therapies in order to first eliminate the dentoalveolar infection foci. We imply that the severe periodontitis combined with periapical lesion caused by the presence of residual root, quickly evolves into an abscess with spontaneous extraoral suppurative drainage. The neoplasm overgrowth and the indicated therapies with no support dental treatment surely influenced this infectious process (a and b). Severe candidiasis was spread on the hard palate and, in particular, superior alveolar ridge (c). The exfoliative cytology confirmed the diagnosis, showing a great amount of Candida albicans hyphae (d) and indicating a highly immunocompromised patient. As a consequence of the oral condition, this patient was with a severe malnutrition and cachexia resulting in hypoglycemic shock and, then, progressing to his death in 15 days. Most likely, there was no favorable response to the medical therapeutic protocols due to the severity of the immunosuppression and the presence of generalized acute oropharyngeal infections (Image 6).
Necrotizing periodontal disease in combination with AIDS and metabolic disorder (Papanicolaou stain, original magnification 400×).
A 61-year-old man had uncontrolled and insulin-dependent type 2-diabetes mellitus, arterial hypertension, ankylosing spondylitis, and hepatitis C. Regarding the diabetes control, the patient was treated with sinvastatina (10 mg), galvus (100 mg) and lantus (44 mL). The glycated hemoglobin (HbA1c) value was 9.1% (Reference values: normal: ≤5,6%, prediabetes: 5,7–6,4%, and diabetes mellitus: ≥6,5%, in accordance with the American Diabetes Association) [28]. In the intraoral features, generalized chronic periodontitis characterized by the clinical attachment loss and the periodontal abscess with suppurative drainage placed, in particular, at the right canine region were evidenced (a, b, c, and d). Oral hygiene was unsatisfactory, most likely because of the pain and the gingival bleeding stimulated by the use of cleaning devices. The periodontal treatment was done associated with prophylactic drugs as antibiotics. No local vasoconstrictive anesthetic agent was administered during the clinical procedures. (Courtesy: Professor Doctor Ana Cristina Solis) (Image 7).
Generalized chronic periodontitis associated with heart and metabolic diseases. (Courtesy: Doctor Professor Ana Cristina Solis).
Concerning the etiology of PD in patients with uncontrolled diabetes, the progressive attachment loss was detected due to the function and reduction of polymorphonuclear leukocyte chemotaxis leading to an increase in infection susceptibility, collagen synthesis and maturation reduction, increased collagenase activity, and the formation of advanced glycation end products (AGEs) that bind to the receptor for advanced glycation end products (RAGEs) in macrophages and monocytes. The effects of AGE accumulation increase tissue oxidant stress, alter the endothelial cell functions, elevate the activity of matrix metalloproteinases leading to the production of free radicals, and promote vascular dysfunction and cellular death. These factors may directly affect the migration and activity of inflammatory cells, impairing the mechanisms of defense against microorganisms and delaying the periodontal tissue repair processes, resulting in great losses of support structures [11].
To clarify these clinical findings, periodontal tissue alterations resulting from oral complications of diabetes were depicted, including intense alveolar bone resorption at the furcation region, proliferation of junctional epithelium (hyperplasia) toward the furcation, diffuse infiltration of mononuclear inflammatory cells which consisted of macrophages, lymphocytes, and especially plasma cells. Numerous blood vessels were congested and the diapedesis mechanism (leukocyte extravasation into connective tissue) were well evidenced, justifying the great amount of inflammatory cells at the lamina propria (Figure 4).
Photomicrography showing chronic periodontitis related to Case 7 (Masson’s trichrome; bars = 1000, 200, 100, and 50 μm).
A 33-year-old woman with chronic mucocutaneous inflammatory disorder of immunological background showing aggressive and extensive oral lesions with erythematous, erosive and extensive areas, especially in the marginal and attached gingivae (a and b). Histopathological features showing a band of infiltration of lymphocytic inflammatory cells under the surface epithelium extending throughout the gingiva (c), besides hydropic degeneration and sharpness loss of the basal layer (d) (hematoxylin and eosin, 50× and 100×). The diagnosis was lichen planus. (Source: Gomes et al. [29]) (Image 8).
Gingivitis associated with autoimmune disease (desquamative gingivitis) (Source: Gomes et al. [29]).
A 23-year-old young woman with Fanconi’s anemia had severe pancytopenia and a prolonged, long-term immunosuppression which resulted in the development of an abscess on the infra-orbicular region. This process progressed to phlegmon causing tissue necrosis of the nostrils, nasal septum, nasal fossa, and posterior orbit region of the right side (a). The etiologic agent of the phlegmon was Streptococcus parasanguinis. The myelogram shows moderately hypocellular bone marrow with cellular dysplasia involving the granulocytic, erythrocytic, and megakaryocytic (arrow) series (b). The intrabuccal examination showed abundant and spontaneous gingival bleeding, edema on the interdental papillae, hematomas on the superior and inferior lips, and inadequate oral hygiene (c and d). No caries, alveolar bone loss, and periodontal pockets were evidenced. No bone marrow transplant was performed due to incompatibility of donors; thus, the only available option was an alternative treatment through the erythrocytes and platelets-concentrated transfusion to prevent spontaneous hemorrhages and severe anemia. Oral exfoliative cytology was performed, showing superficial epithelial cells with nuclear and cytoplasmic alterations, erythrocytes, bacterial colonies (cocci), and numerous hyphae and spores of Candida albicans (e). Based on this, drug administrations, as antifungal medication and antibiotics, were also indicated to treat the oral acute inflammatory processes caused by bacterial and fungal infections. It is important to emphasize that the dental interventions were done together to the recommended medical therapy until the disease remission period. Initially, the periodontal prophylaxis was carried out by dentist and, posteriorly, the orientation and control of oral hygiene and diet accomplished by nurses and caregivers after adequate training in oral health. The health multiprofessional team, who may participate in this treatment process, corroborated in favor of supportive health care, leading to a quick recovery time of the patient (Source: Gomes et al. [30]) (Image 9).
Gingivitis associated with hematological disorders (Leishmann stain, 600×; Papanicolaou stain, 400×) (Source: Gomes et al. [30]).
A 14-year-old adolescent boy with Acute Lymphoblastic Leukemia (ALL) underwent the chemotherapy and radiotherapy on the region of the central nervous system for relapse prophylaxis of the primary disease (a). The myelogram before the medical therapies displayed hypercellular bone marrow composed exclusively by lymphoblastic cells with numerous atypical mitoses (square) (b and c). Extra and intraoral features of the patient, before the recommended dental treatment, were acute necrotizing ulcerative gingivitis, severe oral mucositis with areas necrosis associated to pseudomembranes, and facial asymmetry with signs of phlogistic processes (d and e). The exfoliative cytology of the hard palate and attached and free gingivae shows a great number of inflammatory polymorphonuclear and mononuclear cells, besides a great amount of Candida albicans hyphae confirming the diagnosis of candidiasis (f and g). The dental treatment protocol, inserted together to the medical therapies until the primary disease remission period, corroborated in favor of the patient’s general recovery time and of the elimination of the oral acute inflammatory process (h). The myelogram after the remission phase of the disease showed normal bone marrow (i and j). In extra- and intraoral features, the patient showed discreet facial asymmetry, discreet chronic gingivitis, and palate mucosae with normal features (l and m). Considering these clinical and histological findings, we dare reinforce that the insertion of a dental practitioner into the hospital transdisciplinary team is crucial to the medical therapy success and to the good quality of health services, in particular, for systemically highly compromised patients. (Source: Gomes et al. [31]) (Image 10).
Necrotizing ulcerative gingivitis associated with hematological disorder plus chemical and physical agents (Leishmann stain, 600×; Papanicolaou stain, 400×) (Source: Gomes et al. [31]).
With advances in genomic (genes), transcriptomic (mRNA), proteomic (proteins), and metabolomic (metabolites) capabilities, an increased interest has emerged in the biologic system to define the complex regulatory networks that result in health or disease [32]. This implies a greater understanding of the data related to the etiopathogenesis of PD. These diseases are a multifactorial, highly complex disease involving some factors as host, environment, and microbiota. However, it is the host inflammatory response which may lead to the soft and hard tissue destruction. In severe diseases, this can lead to tooth loss [33].The host response to the infections draws upon the innate, inflammatory, and adaptive immune systems which provide an appropriate response to the aggressive microorganisms. In some individuals and with some bacteria, this phenomenon will be an innate-only response, others will need to invoke the inflammatory response, and yet others will require the adaptive immune response (cellular, humoral, or both) in order to reduce the microbial activities [33, 34].
Although much of what Page and Schroeder proposed in 1976 has stood the test of time, advances in the fields of basic and periodontal immunology need a reassessment of their work, as well as their integration with emerging new concepts [35]. Major advances have been made regarding the cellular and molecular mechanisms underlying the induction, regulation, and effector functions of immune and inflammatory responses. Likewise, Kornman [36] described a new look of the PD pathogenesis when he reported the specific bacteria and immunoinflammatory mechanisms related to innate differences among individuals and changes in environmental factors. This fact may accelerate or attenuate these biochemical changes [37].
With emerging genomic, proteomic, and metabolomic data and tools of biology systems for interpreting data, it is now possible to start describing the basic elements of a new model of pathogenesis [36]. Stunning new findings have begun to clarify several complexities of the host-pathogen interaction of PD, pointing to key roles for microbial dysboisis and immune imbalance in the pathogenesis of disease [34].
Regarding the genomic knowledge, inflammation, cellular infiltration, and expression of a complex array of cytokines, chemokines, and lipid mediators are key characteristics of PD. In PD, the presence of elevated inflammatory cytokines, including tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, interferon (IFN)-γ, and IL-12, is considered a central force when coupled with cell activation and RANKL (receptor activator of nuclear factor kappa-Β ligand) activation in driving pathogen elicited bone loss [38, 39]. In addition to pro-inflammatory cytokines, an array of chemokines including IL-8 and monocyte chemotactic protein (MCP)-1 and others are frequently elevated in PD [40]. Some examples of this type of interaction are described in the literature, for example, studies that reported a positive association between polymorphism of the IL-1 and PD [41, 42]. In addition, the presence of antiinflammatory and regulatory cytokines, such as transforming growth factor-beta (TGF-β), IL-10 and IL-4, has been reported [43, 44].
T lymphocyte cells (T cells) are well known as key regulating cells which orchestrate the host immune response. Considering the cells arise from the CD4+ population and are based on cytokine profiling, early studies showed that these cells were segregated into Th1 and Th2 populations. Modern cytokine profiling and transcription factor analysis have led to a much more detailed classification of Th cells and the emergence of the Th17, Treg, TFH, Th9, and Th22 subsets [45, 46]. More advances have been recognized in what concerns the Toll-like receptors (TLRs) and TLR signaling; TIR-domain-containing adapter-inducing interferon-β (TRIF), interferon regulatory factors and type 1 interferon, and other pattern recognition receptors and PD, including scavenger receptors (SRs) and nucleotide-binding-oligomerization-domain (NOD)-like receptors (NLRs) [34].
With a similar importance, the transcriptomics aspects are defined as gene expression profile and when altered may influence the microbiota composition of periodontal pocket, as observed by Papapanou et al. [47]. In the same way, recent studies started to use proteomic techniques, promoting high resolution in the evaluation of proteins and molecular pathways involved in gingival inflammation [48, 49].
The gingival fluid composition of inflamed sites of patients with generalized aggressive periodontitis was evaluated by Bostanci et al. [50], demonstrating the proportion of enzymes associated with neutrophils, metalloproteinase of matrix-8, catepsin G, mieloperoxidase in addition to bacterial, viral, and yeast proteins that were increased in aggressive periodontitis when compared to healthy sites of individuals without periodontitis. Cystatin B and defensins, defense proteins, were detected only in healthy individuals.
Proteins involved in immune response and antimicrobial function, such as α-amylases, calgranulin A, cystatin, C-lysozyme, and cathepsin G were regulated positively in the induction phase of gingivitis. In the resolution phase, several histones and neutrophilic proteins, including cathepsin G, myeloperoxidase, and defensin-1 had their production decreased [49].
Concerning metabolomic aspects, among the earliest host-response molecules found in response to infection are lipid mediators [51]. Resolution of inflammation involves the production of lipid mediators named immunoresolvents and includes the resolvins, protectins, lipoxins, and maresins [51, 52]. Functionally, resolvins limit inflammation in part through prevention of neutrophil penetration, limiting inflammation at the local level, and promote tissue regeneration. The reduction of inflammation, through the use of resolvin-based approaches, may represent a novel strategy to potentially augment PD treatment approaches [53].
New models in the next few years will be merely frameworks for integrating key knowledge as it becomes available from the “Omic” technologies for diagnosis, providing by identifying one or more biomarkers the detection of active disease, predict future progression, and evaluate the response to periodontal therapy, thereby improving clinical management through early diagnosis and intervention, especially in case of patients with SHCN.
As an alternative treatment to obtain the regeneration of the periodontium, the photobiomodulation (PBM) and some bioactive materials may be indicated, once they strongly stimulate the periodontal tissue response, attenuate the inflammatory processes, and/or promote the microstructural reconstruction of the periodontium. However, in the indication of these therapies, PBM must be carefully studied, since it depends exclusively on the general and oral health status of each patient.
Concerning the patients with SHCN associated to immune system deficiency, the PBM, also known as low-level laser therapy (LLLT), has been largely used to promote therapeutic and biostimulating effects, such as analgesia, antiinflammatory action, angiogenesis, and mitogenesis [11]. Gomes et al. [11] assessed the impact of the GaAlAs diode laser on the periodontal tissues and investigated its effects on the alveolar bone remodeling process during orthodontic tooth movement in normoglycemic and diabetic rats. The authors demonstrated that the PMB strongly stimulated the alveolar bone remodeling and favored the continuous reorganization of the soft periodontal tissues, leading to the maintenance and the integrity of periodontal microstructures under orthodontic force, especially in uncontrolled diabetic rats (Figure 5).
Low-level laser therapy applied on the periodontal tissues under orthodontic force (a) in a period of 21 days. Photomicrographs showing furcation region of the right mandibular first molar in diabetic rats: (b) diabetic rats with no laser irradiation displaying alveolar bone loss due to intense osteoclastic activity (square); and (c) diabetic rats with laser irradiation exhibiting suitable alveolar bone formation because of the intense osteoblastic activities (square) and the integrity of the periodontal ligament fibers (Source: Gomes et al. [11]).
Several bioactive materials have been used in the regenerative medicine, especially in patients with complex metabolic and cellular disorders. Among them, we highlighted homogenous demineralized dentin matrix (HDDM), amniotic membrane (AM) used as a biological dressing, and different types of platelet concentrates such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). These biomaterials were applied in the craniomaxillofacial complex resulting in tissue regeneration and microstructural reconstruction due to their effective inductive and conductive properties. The HDDM, PRP, and AM in implantation sites may initiate an inductive cascade as chemotaxis of progenitor cells, mitogenesis, angiogenesis, and differentiation into a wide variety of cells. The cell recruitment, division rate, and differentiation of cell lines are under the direct control of several growth factors and stem cells which are found in these biomaterials [54, 55, 56].
In particular, the AM is a huge source for multipotent mesenchymal stem cells (MSCs) with the ability to differentiate into a wide variety of cells, such as chondroblasts, osteoblasts, adipocytes and fibroblasts, myocytes, endothelial cells, neuronal cells, and hepatocytes, leading to formation of cartilage, bone, connective tissue, muscle, blood vessel, nerve, and liver tissue, respectively [56, 57, 58]. This membrane acts as a barrier, preventing the entry of pathogens and toxins, preserving the tissue structures, and, consequently, reducing the levels of local pro-inflammatory cytokines [58, 59]. Thus, it could be largely used to selectively guide the tissue regeneration in the periodontium following destructive PD.
Regarding the second-generation platelet concentrate, the PRF clot forms a strong and dense natural fibrin mesh full of growth factors that can stimulate proliferation of PDL cells and osteoblasts; besides, it favors various cytokine entrapment and preserves the growth factors from proteolysis [60]. This concentrate is characterized by a high content of platelets and leukocytes that release an array of growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-beta 1 (TGF-β1), insulin-like growth factor (IGF), vascular endothelial growth factor (VEGF), and the antiinflammatory cytokines [61].
Although the use of autologous platelet concentrates is not new to periodontics, current researches are strongly encouraging the combination of platelet concentrates, such as PRP, PRF, and concentrated growth factors, with bone graft materials, membranes for guided tissue regeneration and MSCs to stimulate the periodontal regeneration. Most likely, this pool has synergistic effects, favoring the environment and the development of desirable periodontal tissues which were seriously compromised by the periodontal disease.
Considering the high susceptibility to PD in people with SHCN, it is important that the dental practitioners know the different levels of disability complexity and how the undesirable environment may impair the human and physical development, leading to temporary or permanent disorders and/or diseases. Among the most common oral diseases, periodontal disease is an inflammatory condition which has been identified as a potential risk factor for systemic diseases. Therefore, it must be continuously controlled by the dentists to maintain the general health status of this individual.
In addition, other treatments for oral rehabilitation may be indicated when the periodontium is healthy, such as orthodontics, dental implants and/or the use of dental prostheses, contributing to the balance of the stomatognathic system, the preservation of the general health, a better quality of life, and, consequently, social inclusion.
In search of alternative therapies for this target public, the photobiomodulation for periodontal tissue biostimulation and the reconstructive surgeries using bioactive materials may be recommended in order to favor the periodontal regeneration, to protect the periodontium under daily actions of physicochemical agents and psychic conditions, and to restore lost periodontal microstructures.
Despite the entire scientific and technological development for people with SHCN, we may presume that the major challenges for health multiprofessionals are to promote the best transdisciplinary practices in oral healthcare on dental services and hospitals due to the high complexity of disabilities, conditions, disorders and diseases of these individuals; to perform people management focusing on the good interpersonal relationship among the health multiprofessionals, patient, family and caregivers; and to combat the several environmental and social factors that may strongly affect the decision-making power of the patient to carry out a satisfactory self-care.
This book chapter was supported by the São Paulo State Secretariat for the Rights of the Person with Disability (SEDPcD) and State of São Paulo Research Foundation (FAPESP; grant number: 2017/06835-8), in Brazil. The authors would like to thank the Associate Professor Sergio Lúcio Pereira de Castro Lopes, the Associate Professor Maria Aparecida Neves Jardini, the Doctor Professor Ana Cristina Solis, and the dentist Mario Augusto Gomes by the technical support and radiographic and clinical assistances.
Authors have no conflict of interests.
ADHD | attention-deficit and hyperactivity disorder |
AGEs | advanced glycation end products |
AIDS | acquired immune deficiency syndrome |
AM | amniotic membrane |
ALL | Acute Lymphoblastic Leukemia |
APA | American Psychiatric Association |
ASD | autism spectrum disorder |
DSM | Diagnostic and Statistical Manual of Mental Disorders |
GaAlAs | gallium-aluminum-arsenide |
HbA1c | glycated hemoglobin |
HDDM | homogenous demineralized dentin matrix |
HIV | human immunodeficiency virus |
IFN | interferon |
IFN-γ | interferon-gamma |
IGF | insulin-like growth factor |
IL | interleukin |
IL-1 | interleukin-1 |
IL-10 | interleukin-10 |
IL-12 | interleukin-12 |
IL-4 | interleukin-4 |
IL-6 | interleukin-6 |
IL-8 | interleukin-8 |
JACSD | Joint Advisory Committee for Special Care Dentistry |
LLLT | low-level laser therapy |
LPS | bacterial lipopolysaccharide |
MCP-1 | monocyte chemotactic protein-1 |
mRNA | messenger ribonucleic acid |
MSCs | mesenchymal stem cells |
NHANES | National Health and Nutrition Examination Survey |
NIMH | National Institute of Mental Health |
NLRs | nucleotide-binding-oligomerization-domain (NOD)-like receptors |
PBM | photobiomodulation |
PD | periodontal diseases |
PDGF | platelet-derived growth factor |
PDL | periodontal ligament |
PRF | platelet-rich fibrin |
PRP | platelet-rich plasma |
RAGEs | receptor for advanced glycation end products |
RANKL | receptor activator of nuclear factor kappa-Β ligand |
SHCN | special health care needs |
SRs | scavenger receptors |
T cells | T lymphocyte |
TFH | T-follicular helper cell |
TGF | transforming growth factor |
Th cells | T helper cells |
Th1 | T helper cell 1 |
Th17 | T helper cell 17 |
Th2 | T helper cell 2 |
Th22 | T helper cell 22 |
Th9 | T helper cell 9 |
TLRs | Toll-like receptors |
TNF | tumor necrosis factor |
TNF-α | tumor necrosis factor-alpha |
Treg | regulatory T cell |
TRIF | TIR-domain-containing adapter-inducing interferon-β |
VEGF | vascular endothelial growth factor |
WHO | World Health Organization |
Increasing growth in human population has necessitated increased agricultural production. Agricultural production in the last five decades has been said to increase more than three times. Other factors responsible for increased agricultural production include technological advancement toward green revolution and expansion of soil for agricultural production [1, 2]. It has been estimated that agricultural sector provides about 24 million tons of food globally [1] with accompanying health risks and threat on ecosystems [3]. We cannot do without agriculture because food is a necessity across the globe, but the impact of agriculture on the environment is also evident. For example, it has been documented that about 21% of greenhouse gas emission comes from agriculture. The negative influence of agriculture on the environment, aquatic lives and human health have necessitated improvement in agricultural production, involving effective and efficient ways of handling agricultural solid wastes [4].
\nThe global leaders have been mandated to prioritize production of more food and energy for increasing human population which is estimated to exceed 10 billion by 2050 as well as to tackle the impacts already caused. However, this mandate is expected to be achieved with lower emissions of pollutants, zero solid waste and less fossil fuel [5, 6]. The future prediction for increased agricultural production involves food production for human population, industrial needs, and animal feed [7]. However, every step of agricultural production, processing and consumption generates quantities of agricultural solid wastes, depending on the type of agricultural produce or product, processing techniques and purpose of use.
\nThe agricultural sector is one of the main sectors generating the largest quantities of agricultural solid wastes, which may be allowed to accumulate indiscriminately and constitute nuisance to global health and threat to food security or used as raw materials for bio-economy [8, 9]. The benefits of recycling of agricultural solid wastes include reduction of greenhouse gas emissions and use as fossil fuel as well as contributing significantly to the development of new green markets, creation of jobs, production of bio-energy and bio-conversion of agricultural solid wastes to animal feed [10, 11].
\nThe emphasis on the management of agricultural solid wastes cannot be overemphasis. Agricultural solid wastes are generated from many sources. One of such sources are pesticides, including herbicides and insecticides. It has been estimated that the global food production would fall by an estimate of about 42% if the use of pesticide is completely stopped [12]. The influence of agricultural solid wastes on human health, animal health, and the environment is significant and all hands must be on deck to tackle the menace posed by mismanagement of agricultural solid wastes. Agricultural solid wastes are mismanaged largely owing to ignorance. Many of the farmers and household managers who generate these wastes do not know how to effectively manage them. Many of them do not know the health implications of what they toy with, while some who know are ‘handicapped’. Year after year, large tons of agricultural solid wastes are being produced, with an annual increase of about 7.5% [13, 14]. In many parts in developing countries, agricultural solid wastes are indiscriminately dumped or burnt in public places, thereby resulting in the generation of air pollution, soil contamination, a harmful gas, smoke and dust and the residue may be channeled into a water source thereby polluting the water and aquatic environment [15, 16, 17].
\nAgricultural solid wastes are produced mainly from farming activities. However, it is not limited to the production but other activities associated with farming and food chain. Every stage and phase of the agricultural-food chain can generate significant agricultural solid wastes. The broad classification of agricultural solid wastes includes the following:
Animal production solid wastes;
Food and meat processing solid wastes;
Crop production solid wastes;
On-farm medical solid wastes;
Horticultural production solid wastes;
Industrial agricultural solid wastes;
Chemical wastes.
Animal production solid wastes—animal production solid wastes are solid wastes generated from the production of livestock for whatever purposes. Examples of such wastes include bedding/litter, animal carcasses, damaged feeders, and water-trough, etc.
Food and meat processing solid wastes—this class of agricultural solid wastes are produced from the processing of crop or animal products for human consumption, such as abattoir or slaughterhouses. Examples of food and meat processing agricultural solid wastes include hoofs, bones, feathers, banana peels, etc.
Crop production solid wastes—crop solid wastes are associated with agricultural solid wastes typically produced from agricultural activities involving crop production. Examples of such agricultural solid wastes are crop residues, husks, etc.
On-farm medical solid wastes—on-farm medical solid wastes refer to solid wastes that are generated from the use of drugs, insecticides or vaccines used on or animals. Examples of such wastes include vaccine wrappers or containers, disposable needles, syringes, etc.
Horticultural production solid wastes—this group of agricultural solid wastes refer to solid wastes generated from cultivation and maintenance of horticultural plants and landscape for beautification. Examples of such wastes are prunings and grass cuttings.
Industrial agricultural solid wastes—agricultural produce and livestock are not only cultivated and produced for dietary consumption. They are used for other uses and it is not unlikely that such activities result in agricultural solid wastes. Wood processing and cuttings readily come to mind as a source of agricultural solid wastes. Paper production using agricultural products as raw materials also generate some quantities of agricultural solid wastes.
Chemical wastes—chemical wastes in this context have to do with agricultural solid wastes generated from the use of pesticides, insecticides and herbicides on the farm or store, such as pesticide containers or bottles. Agricultural activities still depend on the use of pesticides, insecticides, and herbicides, being handled by many uneducated and untrained farmers in developing countries, resulting in abuse by these uneducated farmers [18, 19]. Some uneducated farmers mishandle pesticide containers, thereby resulting in unpredictable environmental hazards. It has been reported that about 2% of pesticides remain in the containers after use, which some ignorant and uneducated users may throw in the ponds or on the open field resulting in food poisoning, environmental and water pollution, causing death of many lives [20, 21].
Agricultural solid wastes are usually generated through agricultural activities involving preparation, production, storage, processing and consumption of agricultural produce, livestock and their products. Agricultural solid wastes are produced via:
Farming activities
Poor road network
Poor electricity or lack of rural electrification
Inadequate drying technique and storage facilities
Food spoilage
Kitchen-generated agricultural solid wastes
Farming activities—the main source of agricultural solid waste generation is agriculture. Beginning from land clearing till harvest, every phase of farming activities results in the generation of agricultural waste. From preparing the pen for the arrival of the animals to the farm, preparation of pasture/paddock till the animals are slaughtered and sold, solid wastes are generated.
Poor road network for transporting harvested produce from the farm to the market or storage is another avenue of generating large quantities of agricultural solid wastes. This happens largely as a result of the bad road network in some developing countries, which may result in a road accident or delay of agricultural produce from farms to markets. When road accident occurs, perishable agricultural produce result easily in wastage, and when delayed, the same result may occur. The spoilt produce is either thrown away on the road or separated to be discarded once the farmer gets to the market. Figure 1 shows agricultural produce being transported in a city in Nigeria.
Poor electricity or lack of rural electrification—the epileptic power supply and lack of rural electrification in some parts of developing countries with significant agricultural activities are contributing in no small measure to the generation of agricultural solid wastes. Stable electricity could have facilitated the cold storage of the harvested produce and thereby reduce spoilage and consequently agricultural solid wastes.
Inadequate drying technique and storage facilities—spoilage of much agricultural produce could be prevented with adequate drying techniques. If farmers have access to adequate drying technique or moisture monitor, it would have gone a long way in militating against food spoilage and agricultural solid waste, thereby enhancing food security and reducing the impact of agricultural solid waste on human health and the environment. Many of the farmers depend largely on the unpredictable solar system to dry their produce before they are stored, as well as rely on the conventional method of moisture monitoring which is neither effective nor accurate. Inadequate monitoring of moisture content in grain before storage has been reported to result in aflatoxin infestation. Aflatoxin is produced by Aspergillus flavus. Aflatoxin infestation is both a cause and a product of food spoilage [22] and its contamination of food and livestock feed can lead to significant annual crop losses globally [23].
It has been estimated that about 10% of global crop harvest is destroyed by filamentous fungi through contamination of food and feed with mycotoxins. Aflatoxins have been reported to produce liver carcinogens, impair human health in developing countries, and result in the huge economic losses, in the U.S. corn alone amounting to about $280 million annually. The economic losses could be as high as 1 billion dollars if other crop-infestation such as cotton, peanuts and tree nuts are included. Aflatoxins B1 and B2 which cause preharvest and postharvest crop infestation are produced by Aspergillus flavus [22].
Food spoilage is another important source or cause of agricultural solid wastes. It has been estimated that about 40% of food is wasted in the US alone annually. This waste has been estimated to cost about 162 billion dollars Natural Resources Defense Council [24]. Pest and insect infestation may also increase wastage owing to spoilage.
Kitchen-generated agricultural solid wastes: in most cases, the end result of agricultural activities is family consumption. Usually, the consumption of agricultural produce at the family level is not without the production of agricultural solid wastes. Some of these wastes are generated out of necessity. For example, orange peels and banana peels are discarded as agricultural solid wastes in many homes. However, agricultural solid wastes may also be generated unintentionally, arising from food spoilage. Kitchen-generated agricultural solid wastes become significant when restaurants are included as kitchens (commercial kitchens). Of all the kitchen wastes considered in cities in China, agricultural solid wastes (food wastes) constitute between 88 and 94% [25]. Figure 2, Tables 1 and 2 respectively show home-generated agricultural solid wastes, the composition of kitchen wastes and nutritional characteristics of kitchen wastes in selected cities in China.
Transportation of agricultural produce in Nigeria. Source: Vanguard Newspaper [79].
Home-generated agricultural solid wastes.
Cities | \nFood waste | \nPaper | \nMetal | \nBone | \nWood | \nFiber | \nPlastic | \n
---|---|---|---|---|---|---|---|
Guiyang | \n92.09 | \n0.80 | \n0.10 | \n5.20 | \n1.01 | \n0.10 | \n0.70 | \n
Shenyang | \n92.16 | \n0.42 | \n0.08 | \n5.22 | \n1.31 | \n0.12 | \n0.69 | \n
Chongqing | \n94.13 | \n0.31 | \n0.00 | \n5.24 | \n0.02 | \n0.13 | \n0.19 | \n
Wuhan | \n88.40 | \n2.80 | \n0.20 | \n5.20 | \n1.00 | \n0.30 | \n2.10 | \n
Cities | \nMoisture\na\n\n | \nVolatile solid\nb\n\n | \nCrude protein\nb\n\n | \nEther extract\nb\n\n | \nOil\na\n\n | \nSalinity\na\n\n | \n
---|---|---|---|---|---|---|
Beijing | \n74.34 | \n80.21 | \n25.86 | \n24.77 | \n3.12 | \n0.36 | \n
Tianjin | \n70.99 | \n85.64 | \n24.30 | \n25.96 | \n2.63 | \n0.70 | \n
Chongqing | \n85.07 | \n92.66 | \n14.45 | \n17.02 | \n1.96 | \n0.24 | \n
Suzhou | \n84.43 | \n82.98 | \n21.80 | \n29.30 | \n3.28 | \n0.70 | \n
Hangzhou | \n74.94 | \n91.50 | \n16.46 | \n24.31 | \n2.09 | \n1.32 | \n
Nutritional characteristics of kitchen wastes in Chinese cities (unit: %).
Wet basis.
Dry basis.
Source: Li et al. [25].
The influence of agricultural production on human, health, change in climate, animal healthy and the environment cannot be over-emphasized. For example, it has been suggested the greenhouse gas emissions need to be reduced drastically to avert the impeding threat on the planet, earth and its inhabitants to avert temperature rise by at least an average rise of 35.6°F [26]. Animal production has been indicted to produce about 37 and 65% of global methane and nitrous oxide emissions respectively [27], which are more potent than carbon dioxide. Indiscriminate burning of agricultural solid wastes produces climate-relevant emissions. Improper handling of agricultural solid wastes influence change in climate and change in climate in turn hampers food production. The effects of indiscriminate disposal of agricultural solid wastes cannot be overemphasized. Some of the effects are outlined below:
Flood
Health and environmental implication
Food security
Flood: One major cause of flood has been the blockage of waterways. Waterways are blocked primarily when human beings build on waterways or when the canals or waterways are blocked by solid wastes. In an agricultural environment, the indiscriminate dumping of agricultural solid wastes can result in blockage of waterways which when that happens will result in floods which may result in losses of lives and properties.
Health and environmental implication—arising from indiscriminate burning of generated wastes. Indiscriminate dumping and burning of agricultural solid waste have resulted in pollution, a threat to human lives as well as other environmental problems, calling for global attention, although these wastes can be recycled to improve soil fertility, being rich in nutrient required for sustainable agricultural production [13, 28, 29]. Figure 3 shows the agricultural solid wastes being dumped in open space.
Food security and agricultural solid wastes: Continuous human population growth has been linked with increased agricultural activities which consequently results in increased generation of agricultural solid wastes. There are currently about 7.5 billion people around the globe and a significant portion of this population still do not have enough food to eat. Figure 4 is a chart comparing the human population according to continents while Table 3 shows the current human population parameters according to continents. The effects of food insecurity are enormous, ranging from poor health, slow progress in education and employment development [30]. One of the important 17 Global Sustainable Goals is to end hunger, achieve food security and improve nutrition and promote sustainable agriculture by 2030. Unfortunately, 10 years ahead of the deadline for this goal, there are still about 821 hungry people across the globe [30]. It has been argued that the main problem of food insecurity is not that we are not producing enough food, but agricultural solid wastes, mainly food wastage is responsible. Africa and Asia have been noted as the fast-growing population in the world, incidentally, these are the regions with most food insecure people and inefficient waste management [31, 32]. It has been estimated that one-third of the food we produce annually is lost or wasted, costing about one trillion US dollars annually. Wastage occurs mostly in developing countries during the production and supply chain while it occurs mainly in developed countries on the plate [30]. Agricultural solid wastes can be recycled as nonconventional feed ingredients to enhance food security by enhancing animal protein production [33]. Figures 5 and 6 respectively show food wastage chart in America and estimate of unconsumed food by an average American family.
Dumping of agricultural solid wastes at the public. Sources: Akande and Olorunnisola [78] and Olayiwola et al. [34].
Current population of the seven continents. Source: Worldometers [32].
Rank | \nContinent | \nPopulation | \nArea, km2\n | \nDensity, P/km2\n | \nWorld population share, % | \n
---|---|---|---|---|---|
1 | \nAsia | \n4,641,054,775 | \n31,033,131 | \n150 | \n59.5 | \n
2 | \nAfrica | \n1,340,598,147 | \n29,648,900 | \n45 | \n17.2 | \n
3 | \nEurope | \n747,636,026 | \n22,134,900 | \n34 | \n9.6 | \n
4 | \nNorth America | \n592,072,212 | \n21,330,000 | \n28 | \n7.6 | \n
5 | \nSouth America | \n430,759,766 | \n17,461,112 | \n25 | \n5.5 | \n
6 | \nAustralia/Oceania | \n42,677,813 | \n8,486,460 | \n5 | \n0.6 | \n
7 | \nAntarctica | \n0 | \n13,720,000 | \n0 | \n0.0 | \n
Unconsumed food by an average American family. Source: Rescuing Leftover Cuisine [24].
Food wastage chart in America. Source: Rescuing Leftover Cuisine [24].
There are options on how agricultural solid wastes could be handled. This chapter is necessary because of the need to focus people’s attention on efficient ways of managing these wastes. Traditionally, shafts from palm oil processing could be used as fuel in fuel wood for cooking and heating. In the recent time, some of these wastes are put into better uses. Some of these agricultural solid wastes could be used as additives in cement mixes, water glass manufacturing, paper making, ethanol production, animal feed, electricity and biogas generation, heavy metal removal, mulching, organic fertilizers, and compost. An effective means of managing agricultural solid wastes is to recycle them to produce useful products. This can be achieved through:
Compositing/organic manure
Substrates for edible fungi cultivation
Nonconventional feed ingredient
Traditional soap making
Alternative energy sources and bio-fuel production
Production of silica
Compositing: Li et al. [25] recommended that kitchen wastes, largely agricultural solid waste from food wastage could be used as an animal feed via sterilization, fertilizer via composting and bioenergy via anaerobic digestion. These wastes are important candidates for compositing owing to their high organic matter content and nutrients, although their high salt, moisture content and oil may impair composting.
Substrates for mushroom cultivation: mushroom has been grown on different agricultural solid wastes as substrates [34, 35]. Steps involved in mushroom cultivation and its benefits are highlighted by Olayiwola et al. [34].
Nonconventional feed ingredient. Several attempts have been made to feed agricultural solid wastes to livestock as a means of recycling as well as a cheap source of feed for raising animal-source protein. A nonconventional feed ingredient, mycomeat has also been produced from agricultural solid wastes. The wastes served as substrate and a mixture of the substrates and the cultivated fungi (mushroom) was feed to broiler chicks, as a nonconventional feed ingredient, mycomeat [33, 35, 36, 37, 38] fed some agricultural solid wastes to albino rats and recommended processing of the wastes in order to obtain a better result. Adebiyi et al. [39] recommended the combination of 40% cassava peel +40% concentrate +20% watermelon wastes for feeding grower pigs. Poultry feathers could be used for several products instead of being indiscriminately discarded or burnt. Traditional, feathers are used for decoration, pillows and could be converted as nonconventional feed ingredients to feed livestock.
Feathers are a group of agricultural solid wastes that are generated in large quantities annually as a by-product of poultry processing [40]. It may account for about 6% of the total live weight of a mature chicken. They are rich in a keratinous protein, which is a fibrous and insoluble protein [41]. Adejumo et al. [42] reported protein content of between 84 and 87% for feather meal, hence, effective use of feather meal as livestock feed ingredient may payoff than its use as other produce. Feathers can be used in erosion control, for diaper filling, as biodegradable composites, in the greenhouse industry, animal feeds, upholstery, artwork, paper alternatives, light-weight structural materials, water filtration fibers, fabric, aircraft, and automotive industries and thermal insulation [43, 44]. The major limitation to the use of feathers as a livestock feed ingredient is the insoluble keratinous protein, but recent studies are suggesting ways of overcoming the limitation [36, 42, 45]. It has been documented that about 80% of kitchen wastes, largely food wastage are fed to pigs in China, although direct feeding of kitchen waste has not been without restriction in China, arising from the concern of foot and mouth disease [46] Processing of agricultural solid wastes could enhance their value for feeding pigs [47, 48]. The effect of dried sweet orange (Citrus sinensis) peel has been tested on humoral immune response of broiler chickens [49] as well as maize replacement and its effect evaluated on growth performance and carcass qualities of broiler chickens [50], instead of allowing them to accumulate and constitute a nuisance as agricultural solid wastes.
Traditional soap making: traditional technology exists in Africa decades ago for turning some of the agricultural solid wastes into useful products. Cocoa pods which could turn agricultural solid wastes are usually either allowed to naturally decompose and enrich the soil or are used to make black soap, which may be used for washing dishes or bathing.
Alternative energy source and bio-fuel production: agricultural solid wastes can be converted to green energy through anaerobic digestion [9]. High protein and fat contents of these wastes may impair anaerobic digestion stability, as well as unavailability of efficient technology required for disposal of biogas residues [51]. However, pre-treatment techniques such as mechanical (sonication), chemical addition (acid or alkali), oxidative (ozone), biological (enzyme addition), thermal ad osmotic (freezing and sodium chloride treatment) may improve the physical and chemical properties of the wastes, thereby enhancing their solubilization of organic particles, sterilization effect as well as the promotion of their subsequent recycling (biogas production) [52, 53]. Despite many challenges confronting its production, bio-fuel and bio-energy attract many hopes as a sustainable renewable energy source, which tend to promote rural and regional development, reduction of CO2 emission, creation of job opportunity as well as replacing the energy from nonrenewable fossil fuel with green energy [54, 55, 56]. Agricultural solid wastes (rich in cellulose, hemicellulose, starch, lipids and proteins) which are produced in large tons and burnt in open-field or allowed to accumulate in some developing countries may be channeled toward bio-fuel generation [57, 58]. Key players and political leaders, particularly in developing countries should team up with researchers to scale up the conversion of biomass to alternative energy sources or bio-fuel generation. This is expected not only to reduce the health menace arising from open-field agricultural solid wastes burning or dumping but to improve energy production and reduce economic losses of waste disposal as well.
Production of silica: Production of silica: Silicon, the 2nd most abundant nonmetallic element in the earth crust with an atomic weight of 28 [59, 60] forms silica and silicates. It is rarely found in its elemental state owing to its affinity for oxygen [61]. It has been reported as a beneficial trace element, widely distributed in foods. Its health benefits include improvement of the structural integrity of nail, hair, skin, immunity, bone mineralization, bone calcification and reduces the occurrence of atherosclerosis [62, 63, 64]. In the presence of hydrochloric acid and other gastric fluids in the GIT, silicon compounds are degraded into bioavailable forms of silicic acid (ortho, meta, di, and tri-silicates) [65] and are diffused into different organs of the body [66, 67]. Silicon quantity decreases with age and tends to be more in plants than animal-sources, although dietary sources are low in silicon and may need to be supplemented in diets through other means [63, 68, 69, 70]. It does not bond with plasma proteins, hence, about 75% of plasma silicon is excreted within a few hours after ingestion [66, 71]. Agricultural solid wastes are potential sources of silica. Silica has been produced from agricultural solid wastes such as corn cob, rice husk, bagasse and rice straw using chemical, thermal, and microbial methods [72, 73, 74, 75, 76, 77].
Food wastage is an important source of agricultural solid wastes. Hence, the prevention of food wastage at all levels before they are created will salvage some of these wastes and prevent unnecessary ill-health and environmental disadvantages as well as huge economic losses. This can be achieved through proper education and awareness of those involved with agricultural activities at all levels as well as being a little more generous by feeding hungry people with fresh food instead of keeping them till they are spoilt. There are hungry people everywhere in the world. Feeding animals saves food scraps and bioconversion of agricultural by-products, which may turn to agricultural solid wastes if their values are not enhanced and will go a long way in preventing such wastes as well. Composting and conversion of agricultural solid wastes to a renewable energy source is another effective way of managing agricultural solid wastes. It is high time attention is focused on turning these huge potential agricultural solid wastes to wealth, particularly in developing countries. To make our world safer for us to live, all hands must be on deck. Research activities should be geared toward commercial scaling of some productive findings made toward the efficient recycling of agricultural wastes.
\nProper awareness should be made to everyone involved in agricultural activities whether at a middleman or woman, farmer, or consumer on the effects of indiscriminate disposal of agricultural solid wastes and benefits of efficient management of agricultural solid wastes. Political leaders, particularly in developing countries should be open-minded and formulate policies that ensure the efficient recycling of agricultural solid wastes and appropriate funds should be earmarked to achieving this. Attention should be focused on minimizing wastage by creating a more efficient sustainable agricultural supply chain through the development of sustainable durable markets and improving rural infrastructures such as electrification, roads, and storage [30].
\nIt should also be noted that huge revenue could be generated from the conversion of agricultural solid wastes into useful products, as it has the potential of employing people if well-harnessed. Hence, its importance goes beyond the health implication but includes income generation for individual and governments which receive tax from companies and individual working in such establishments involved in the conversion of wastes to useful products. Also, it could contribute significantly to minimizing civil unrest plaguing some villages in developing countries. Some idle youths used to foment trouble could be scarce to find if they are gainfully employed, and that gainful employment could be companies or individuals who are efficiently engaging in turning agricultural solid wastes to wealth. Recycling of agricultural solid wastes into useful products could generate other sets of agricultural solid wastes, which may serve as raw materials for another useful products, thereby necessitating the continuous recycling of agricultural solid wastes until every potential waste is converted into wealth.
\nWe have no conflicts of interest.
IntechOpen's Authorship Policy is based on ICMJE criteria for authorship. An Author, one must:
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