WFPHA Newsletter - Special Edition on Oral Health
WFPHA Newsletter 12 - 2013
Published: December 2013
In this newsletter:
1.WFPHA - Oral Health Working Group - the first steps
2.Bring back the mouth into the body
3.Oral Health activities in the world
1.WFPHA – Oral Health Working Group – the first steps
creation of the WFPHA oral health group was a significant step, both for the
WFPHA as a whole as well as the global oral health community. It has created, first, an opportunity for
the dental public health organizations, which have not embraced their national
public health community, to embrace their activities with each other and also
engage with the global community in public health. Second, the oral health group has also
encouraged pan national organizations, e.g. the European Dental Public Health
Association, to join the oral health group as well as WFPHA itself. Third, and most importantly, the group can
advocate the importance of oral health to general health to the wider public
health community and recruit dental health professionals to engage in more
general public health initiat
The aim of
the article is to provide a commentary on the initial activities of the oral
health group during its first year.
The Oral Health Working Group (OHWG) was able to agree a constitution within a few weeks and
subsequently established an executive group, which hold teleconferences every 2
months and a reference group which meets every six months. As a new group we decided to hold our first
election and AGM at the 2015 WFPHA meeting in Kolkata, India. At present the chairman is Professor Raman
Bedi and the two vice chairs are Drs Myron Allukain and Ken Eaton.
agreed to focus, during the first two years, on three activities; first to
raise the profile of the group, primarily through participation at public
health conferences, both within the WFPHA and the wider public health
communities. Second, to undertake a
survey, via a questionnaire, of global dental public health capacity. Third, to agree a Declaration on Child Oral
Health and to pass this as a resolution at a WFPHA general assembly.
have attempted to give key note addresses at public health meetings and also to
have sessions which focus upon oral health.
In April 2013 at the 1st Arab World Congress on Public Health, Dubai,
United Arab Emirates, the oral health group was able to organize presentations
and panel discussion. The focus of the
session was the high levels of childhood dental caries and local strategies
aimed at oral health improvement. The
Chief Dental Officers of Oman, Saudi Arabia and Qatar made presentations and
the session was chaired by myself and Dr Bettina Borisch. One practical outcome of the session was
the creation of a Gulf Oral Health network which is chaired by Dr Maryam
Farhan, former head of the community programme at the National Guard, Saudi
Arabia. Another oral health session was
also held, under the chairmanship of Dr Myron Allukian, at the 2013 American
Public Health Association conference.
2013 the questionnaire on dental health capacity was sent to lead dental public
health individuals in all the WHO regions.
Considerable debate, among both the executive and reference groups, as
to the information needed, took place throughout the summer. Finally, the questionnaire was finalised and
piloted and the survey, which will be the first of its kind, will help map out
the global dental health capacity and its geographical distribution. It is anticipated that the report will be
finalised in the summer of 2014.
declaration on Access to Oral Health for Children, aims to offer all children
an equal opportunity to thrive and reach their full potential for a promising
future, was proposed by the Oral Health Working Group and endorsed by the WFPHA
policy committee. On May 19th 2013 the
WFPHA General Assembly passed a resolution on “Oral Health for Children” and it
has been well received by the health care community.
Declaration on Child Oral Health
has a right to good oral health. Oral health problems in children can impact on
many aspects of their general health and development, causing substantial pain
and disruption to their lives and often altering their behaviour. Oral health
is an integral part of overall well-being and essential for eating, growth,
speech, social development, learning capacity and quality of life.
oral health every child should have access to:
health education including oral hygiene instructions and dietary advice, and
access to affordable toothbrushes and toothpaste containing fluoride as soon as
the first primary tooth erupts
Preventive interventions, appropriate to the infrastructure and priorities of
the country, which may include dental sealants, community fluoridation, and
regular fluoride varnish applications
of early stage decay to stop it from progressing to cavities, and treatment of
dental cavities, acute pain and other oral diseases
Environments that eliminate advertising of unhealthy foods to children.
good oral health all children will have an equal opportunity to thrive and
reach their full potential for a promising future.
year of the oral health group has been a busy on and as Chair I am grateful to
the support of all the members of the executive and reference group. In addition the help of the WFPHA central
office has been invaluable. However, it
is the on-going efficiency and work of Dr Marta Lomazzi, our Oral Health WG
Executive Coordinator which has made much of our progress possible.
Chair WFPHA Oral Health Working Group
2.Bring back the mouth into the body
The link between oral health and overall
body health is well documented and backed by robust scientific evidence. Traditionally,
Dental schools are separated from Medical schools in most places of the world. Another secession can be observed between oral
health and public health; both communities live in separate circles. Despite
this, better linking up of both the dental/medical and the public health worlds
would bring substantial improvements for global population health.
The WFPHA as the only worldwide professional society representing and serving the
broad field of public health is committed to
facilitating and supporting the exchange of information, knowledge and the transfer
of skills and resources for a healthy and productive world. Prof
Borisch, Director of the WFPHA Headquarter, feeling that there is a need for a rapprochement of the expertise
secluded in the respective groups of public and oral health, launched the idea of an Oral Health Working Group. She had the
opportunity to find three experts willing to start this adventure: Raman Bedi,
King’s College London; Ken Eaton, UK and Myron Allukian, US. The plan for a
working group of global oral public health in the WFPHA was drafted so that in April 2012 the WFPHA general assembly and council of the
WFPHA approved the establishment of the WFPHA Oral Health working group.
We hope that at the long
run all people working with oral health from all horizons will come together
and help to establish oral health as a pillar of global public health!
B. Borisch, founding member of the WFPHA Oral Health Working Group
3.Oral Health activities in the world
AFR - African Region
Oral Health: A community approach in Rural Western Kenya
Diseases associated with oral health lead
to death for many children in sub-Saharan Africa. Debilitating flesh eating oral
infections continue to exist due to poor sanitation, poor oral hygiene,
malnutrition and immunosuppression among the poorest children in Africa. A
large contributor to the adverse effect of oral diseases is lack of access to
appropriate health services or preventative care. This poor health access rates
have been linked to the low numbers of health workers and lack of available,
affordable, and acceptable health services.
The only available dental unit for patients at the local primary
care facility (KCH)
An Oral Health Promotion strategy that
engages the community has been developed for a rural community in Western
Kenya. The inhabitants of this
community are served by an occasional dentist using a make-shift dental chair
at a faith based community hospital - Kiminini Cottege Hospital (KCH). The ratio
of dentist to the population is estimated at 1;300,000 anecdotal evidence
suggests that majority of the community resort to Traditional and Herbal
remedies for their oral ailments; putting them at high risk of infections and
complications of late presentations of oral disease.
The intervention plan ‘Smiling Healthy’
involves a training programme for members of the local community who will
spread the message of healthy behaviours to reduce the burden of disease in the
area. The plan also includes the scale- up of existing dental services at KCH. As
support continues to be sought to implement this project, a local NGO – Link
Africa Development Initiative, partnering with the Local Hospital (KCH) and
volunteers from charities from abroad (Smiles in Kenya) have contributed to the
development of this plan. This is a challenging undertaking, but is certainly a
step in the right direction to improving quality of life and provision of sustainable
healthy behaviour advice in this community.
Images of the local market at Kiminini in Rural Western Kenya
Courtesy of Link Africa Development Initiative
K. Wanyonyi, AFR regional coordinator of the WFPHA Oral Health Working Group
diseases are not necessarily life threatening, but they represent a serious
public health problem because of their high prevalence, their seriousness, and
the public demand for services due to their impact on the individual and on
society. According to the WHO, at least 80% of the global population
suffers from oral disease, 80% of who live in developing countries such as Africa.
Objective: The objective of the study was to evaluate the oral
health of the rural population and to analyze their attitude to oral health.
Methods: We carried out a descriptive, cross-sectional and
analytical survey on 2,254 people living in rural areas. Senegal has 14 similar
regions in terms of the size of the rural population. In each region, 160
people were surveyed, for a total of 2,254 people.
Results: The frequency of oral diseases is high, and fluoride
toothpaste, which is inaccessible and unavailable, is often replaced by the
chew stick. Dental services are located more than 50 kilometers from the homes
of at least 52% of the population. Distance plays a negative role in access to
care because people living less than 50 kilometers away are twice as likely to
attend dental care facilities; this also applies to age with the age group
18-35 years 39% less likely to attend a dental clinic compared with other age
is expensive for more than 75% of the population who prefer to self-medicate or
visit the traditional heale.
Conclusion: An oral health policy focused on rural areas is necessary with the
integration of indicators such as the availability and accessibility of
fluoride toothpaste, the creation of a minimum service package, and youth
To read the full article, click here.
Tanzania, Uganda & Kenya
Kenya, Tanzania and Uganda Piloting to Phase
Down Dental Amalgam Use and Best Manage its Waste
- 6th November, 2013, Muhimbili University of Health and Allied
Sciences in Dar es Salaam, Tanzania hosted a results workshop of the East
Africa Dental Amalgam Phase-Down Project that is being successfully implemented
in Kenya, Uganda and Tanzania.
Amalgam remains the most widely used means of repairing
large cavities in molar teeth worldwide. Despite being in use for more than 150
years, scientists have expressed concerns about its contribution to mercury
environmental pollution. Pollution occurs through mismanagement
of amalgam wastes leading to
possibilities of environmental release of mercury, which when methylated
produces methylmercury, the most
toxic form of mercury. Methylmercury can reach
contaminated water through the food chain such as fish and seafood. Amalgam contains up to 50 per cent
mercury, a chemical that has been linked to various health effects on the immune system, altering genetic and enzyme
systems, damaging the nervous system, including coordination and the senses of
touch, taste, and sight as well as damage to the digestive tract. Methylmercury is particularly damaging to developing
embryos, which are five to ten times more sensitive than adults.
The Minamata Convention whose aim is to protect
the human health and the environment from anthropogenic emissions and releases
of mercury and mercury compounds recommends
that each country that signs and ratify the convention should take measures to
phase down the use of dental amalgam taking into account the country’s domestic
circumstances and shall include two or more of the following measures:
(i)Setting national objectives aiming at dental caries
prevention and health promotion, thereby minimizing the need for dental
national objectives aiming at minimizing its use;
(iii)Promoting the use of cost-effective and clinically effective
mercury-free alternatives for dental restoration;
research and development of quality mercury-free materials for dental
representative professional organizations and dental schools to educate and
train dental professionals and students on the use of mercury-free dental
restoration alternatives and on promoting best management practices;
insurance policies, and programmes that favour dental amalgam use over
mercury-free dental restoration;
(vii)Encouraging insurance policies and programmes that favour the use
of quality alternatives to dental amalgam for dental restoration;
(viii)Restricting the use of dental amalgam to its encapsulated form;
the use of best environmental practices in dental facilities to reduce releases
of mercury and mercury compounds to water and land.
co-ordination of UNEP Chemicals branch Division of Technology, Industry,and
Economics (DTIE) and the World Health
Organization’s Oral Health Programme, the ministries of Environment and Health
in Kenya, Tanzania and Uganda are collaborating with the FDI World Dental
Federation, International Dental Manufacturers (IDM) and their respective National
Dental Associations to explore essential conditions for a phase-down in the use
of dental amalgam.
project has been investigating the status of supply and trade of dental amalgam
and dental filling materials alternative to amalgam. It has also assessed the
current waste management practices, created awareness of preventive dental care
and encouraged a switch to appropriate alternatives to dental amalgam for small
cavities among dental facilities’ supporting staff, students, practitioners, and
patients. In addition, the project promoted environmentally sound management of
dental amalgam waste in selected dental facilities in Kenya, Tanzania and
Uganda through donation of 9 amalgam separators.
with the success of the pilot project, the three East African Countries face
inadequate funding to roll out to all dental facilities across the region. Stakeholders
interested in this subject are encouraged to support the sustainability of this
pilot project in Africa through the respective national Governments, national
dental associations, UNEP Chemicals DTIE and WHO Oral Health Programme.
E. A. Mugonzibwa-Mwanga
AMR - Region of the Americas
Canada – the debate over the benefits
of the water fluoridation continues
fluoridation has consistently been acknowledged as a key contributor to the
improvements of health in Canadians and been acknowledged for these achievements
by the Centres for Disease Control (CDC) in the United States and by the Canadian Public Health Association (CPHA). In 2008, the recommended fluoride levels by
Health Canada were lowered from 0.8–1.0 mg/L to 0.7 mg/L to minimize the risk
of dental fluorosis. However, in recent years, the debate over the benefits of water
fluoridation in Canada continued to be in the news. Several Canadian
municipalities have voted to stop fluoridating water, including Calgary,
Windsor and Waterloo. Fluoride's opponents primarily cite health and
environmental concerns as risks of adding fluoride to the water supply. They
also believe that fluoridating the public water supply is a fundamental
violation of civil liberties. The decision whether to fluoridate lies with
local governments, with guidelines set by provincial, territorial, and federal
governments. In 2012, just under 40% of Canadians drank optimally fluoridated
water, a reduction from 45% as measured in 2007. This slight reduction is indicative
of the push back by public health and is not comparable to what was intended to
be archived by the anti-fluoridation groups. Each time, city councils got pressured
by relatively small and vocal anti-fluoridation groups and each time, dental
professionals, researchers and advocacy groups would descend on the public
hearings to bring the evidence that water fluoridation is a safe and efficient
public health intervention. Such large cities as Toronto started to implement
water fluoridation since 1963 and continue to fluoridate its water today. This
is true of most of the large population centres where discussions have taken place
and where communities opted to remain with water fluoridation. The Canadian public
health community, including the Canadian Association
of Public Health Dentistry, are encouraged that large cities continue to
implement water fluoridation and dental professionals and public health leaders
across the country continue to promote the effectiveness of community water
fluoridation. The debate continues. It has much to teach us about how people
evaluate potential health risks and how we can help them respond and understand
the public health interventions.
Oral Health in the United States
Over 204 million
Americans live in fluoridated communities, about 74% of US population on public
water supplies. The Healthy People 2020 (National Prevention Objectives) goal is
that by the year 2020, 79.6 % of the US population will live in a fluoridated
Fluoridation has made an enormous impact in preventing
tooth decay in the US.
National Health Program
In the year 2010
the Affordable Care Act (Obama Care) became law in the US with different phases
being implemented each year. For the first time, most Americans will have some
form of health insurance. Currently about 33 million low income US children are
eligible for dental care under Medicaid a federal-state health insurance program
for the low income. The Affordable Care Act will add another 7 million low
income children to the Dental Medicaid program.
Access to dental
care is difficult for millions of Americans, so changes are occurring in state
dental laws :
- Dental hygienists are allowed
to provide more dental services. In the year 2000 only 8 states allowed dental
hygienists to work under general supervision. By 2013 this had increased to 36
- A number of states are considering
the dental therapist model similar to the New Zealand’s to improve access. The first dental therapists in the US were in
Alaska in 2005 serving Alaska Natives and American Indians. In 2009 Minnesota passed
a law to allow dental therapists and
about 10 other states are considering dental therapists.
- At least 45 states have changed
their state practice acts to allow young patients in physician’s office to get
dental preventive treatment such as fluoride varnish by a medical assistant or
- Many dental students are
graduating with debts as high as $250,000 – $400,000. This is creating a great
burden for newly graduated dentists and making care costly.
- Dental care is not included in Medicare
(health care for those over age 65 years), therefore many seniors, and
especially those who are homebound and in nursing home, have difficulty getting
Many changes are
occurring in the United States to respond to the access to care crisis. The
challenges are many, as we try to improve oral health for all.
For more information, click here.
M. Allukian, vice-Chair WFPHA Oral Health Working Group
Oral health of oldest citizens
For more than a decade the oral health
community in the United States – non-profit organizations, educational
institutions, professional associations, as well as government entities has
concentrated its efforts on improving access to dental care for infants,
children and adolescents. Many states
have expanded their public insurance to cover both preventive and restorative
care for those citizens 21 years of age and younger. In addition, the country’s
new universal health coverage mandates pediatric dental care. Only in the last few years has the dental
community begun to assess the oral health needs of seniors– those 65 years of
age and older.
While some individual states have implemented
oral health assessments of their adult residents 65 years of age and older; as
a country, 92% have experienced dental caries in their permanent teeth, and 23%
have untreated tooth decay – more than the untreated caries among U.S. children.No longer are adults losing all or most of
their teeth as they age. The use of life-long preventive strategies including
community water fluoridation, fluoride toothpaste and professional preventive
dental care has caused 73% to have some natural teeth.
The senior population currently represents
13% of the country’s citizens and is expected to grow to more than 20% by
2050. With more than 80% of seniors having
at least one chronic disease and the evidence supporting a relationship between
oral health and general health, more attention needs to be paid to increasing
access to affordable dental care for all seniors, those living at home and in
long-term care. This may be addressed through
the acceptance of dental hygienists and dental therapists in settings that
serve seniors, in addition to the universal training of physicians and nurses
to perform oral and dental screenings.
Currently, just 36 states allow dental hygienists to practice in
settings outside of private practice and without the supervision of a dentist, very
few states allow dental therapists, and the majority of medical and nursing schools
don’t provide a meaningful number of hours in oral health education.
While the U.S. continues to concentrate its
efforts on improving the oral health of its youngest citizens, in parallel it
needs to continue the work that has been started by developing and supporting
policies that will address the oral health of its oldest citizens.
L. A. Bethel
EMR - Eastern Mediterranean Region
Future of Dental Public Health
in the GCC
Dental Public Health (DPH) is that part of dentistry providing
leadership and expertise in population –based dentistry , oral health surveillance
, policy development, community-based
disease prevention and health promotion, and the maintenance of the dental
safety net (1).
However there are obstacles facing the Dental Public Health Systems in the Gulf Countries
(GC). The Public Health Systems in the GC fails to fully define the scope of Dental Public Health professionals and how they fit into the
matrix of today's dental profession.
Public Health Systems in Gulf Cooperation Council (GCC) countries
are not well established. Therefore, there is a need for an effective integrated and organized mechanism to shape
this system based on acceptable
guidelines and laws focusing on population health needs (2).
To improve this situtation, different activities should be carried out:
First, there is great need for effective
legislative measures to support public dental health policies or measure.
There are effective interventions in improving dental public health
like water fluoridation which need law
or legislation to be implemented; there is strong scientific evidence that
legislature measures can help improving health (3).
Second, it is the appropriate time and place to investment in
management and leadership development for DPH professionals. Therefore dental schools in the Gulf Region should
include leadership courses in the curriculum for dental
students and as part of lifelong learning for practicing dentists, as
well as for academics, to exhibit
appropriate leadership skills in clinical education (4-5).
The last point is the oral health surveillance. An essential component of the oral health
information systems is the analysis of trends in oral disease and the
evaluation of oral health programs at the GCC region. Standard methodology for the collection of
epidemiological data on oral health should be developed and by GCC oral health executive group and used
for the surveillance of oral disease. The regional
and national oral health databank should be developed to highlight
the changing patterns of oral disease which primarily reflect changing
risk profiles and the implementation of oral health strategies and programs oriented towards oral disease
prevention and oral health promotion.
Article references available here.
M. Alfahran, Chair of the Oral Health Subgroup of the EMR region
Iran (Islamic Republic of)
Dental Public Health in Iran
with 75,000,000 populations is a vast country with diverse oral health needs. The
public as well as the private sectors are active in order to meet the
based preventive programs are now active to help the control of dental
problems. These programs cover oral health and hygiene education, preventive
and curative activities exclusively to be conducted by public sector for
prevention and treatment of oral diseases.
Some of the current national level activities
in oral health system of the country are:
1-Oral health care program
for under 3 years old children.
2-Oral health care program
for kindergartens children (3-6years).
3-Oral health promotion for
elementary school children (6-12years).
Oral healthcare activitis for children
4-Oral health care program
for pregnant mothers.
5-Smoking cessation in
dental office program.
6-Vital Pulp Therapy program
using CEM-cement, a locally developed material.
applied research in different areas such as policy, manpower, surveillance system,
8-National oral health survey was conducted over
2012-2013 using the latest version of WHO suggested pathfinder survey
methodology, instructions and questionnaire.
9-In policy domain an
extensive research has been carried out in order to develop evidence-based
oral health policies for use at the national level in Iran.
The WHO Collaborating Center for
Training and Research in Dental Public Health as well as the Preventive
Dentistry Research Center at Shahid Beheshti University of Medical Sciences in
Iran are helping with all aspects of the Oral health related activities. Over the past few years Iran has been very
active in the field of Oral Health nationally and internationally. Two
inter-country meetings of WHO-EMRO was held in Isfahan (2011) and Shiraz (2012).
The final draft of Regional Oral Health Policy that was developed in the
previous two meetings were finalized and sent to Geneva for final approval.
is interested to exchange successful experiences in different areas of Dental Public
Health and collaborate with other countries to further the Oral Health of the
Oral healthcare activitis for children
Lebanon & Middle East
On Line Public Health Networking in the Middle East: Lessons Learned
(from APHA meeting presentation)
EMRAIN, Eastern Mediterranean Regional Academic Institutional Network (EMRAIN), is a join initiative of the American University of Beirut (AUB) and the World Health Organization (WHO). The purpose of EMRAIN is to create a network of academic public health institutions across the Eastern Mediterranean Region for the sharing of best practices and research, and to improve health systems and influence policy. A comprehensive mapping of 266 institutions has been completed, and a survey will be distributed to these academic institutions to gather information about their academic programs, research initiatives, and administrative capacity. There will be opportunities for inclusion of oral public health institutions within this platform with the concurrent distribution of a dental public health survey by the World Federation Public Health Association’s Oral Health Working Group. The public health landscape has drastically changed in the Middle East over the past two years due to the Syrian Civil War, with six million Syrian refugees displaced both externally and internally. This has placed a lot of financial burden on government and international institutions such as UNRWA. Private individuals and organizations are addressing these needs with their own initiatives, whether it be Syrian refugee dental humanitarian aid mission trips, such as Zeitouna (Karam Foundation), or health social entrepreneurial start-ups, such as Donner Sang Compter. Due to long-standing Palestinian refugees in Lebanon, Syria, and Jordan, the Palestinian Dental Association is addressing the shortage of oral health needs in the camps by offering dentists bi-monthly scientific/research learning days, CE courses, vaccination programs, and OHI/fluoridation for children. On December 13th, the PDA will also be holding their 2nd International Scientific Conference.
EUR - European region
State of Oral Health in Europe
In September 2012, the Platform for
Better Oral Health in Europe (PBOHE) published a report The State of Oral Health in Europe. The report assessed a number of key issues
for Member States of the European Union (EU) including:
- The prevalence of oral
- An assessment of the
economic impact of oral diseases.
- Identification of best
practice initiatives in oral health promotion.
A set of key recommendations for
decision-makers to improve oral health was developed. Key findings were that:
- Although the prevalence
of dental caries has declined significantly in Western European children, other
than those from socio-economically deprived groups, there has been little if
any improvement in many Eastern European countries.
epidemiological methods to assess periodontal diseases are so poor and there
have been few national studies to assess them, it is impossible to report with
any certainty on trends for this group of diseases.
- The number of people
dying annually from oral cancer has
steadily increased over the last 15 years
- In 2012, oral health
services accounted for 5% of total health spending, which was estimated at 79€
- Oral health services
were delivered by a team of over 1 million people, including 400,00 dentists
and 450,000 dental nurses.
- There was good evidence
from EU Member States such as Denmark and Sweden that the benefits of
preventing dental caries exceeded the costs of treatment.
Three of the 15 key policy
recommendations were to:
- Recognise the common
risk factors for oral and other chronic diseases and wotk towards linking oral
health policies with EU healthcare policies.
- Better integrate oral
health into relevant national and EU health programmes.
- Develop a coherent
European strategy for the promotion of oral health and the prevention of oral
For more information, click here.
K. Eaton, vice-Chair WFPHA Oral Health Working Group
for improving children’s oral health in Andalusia: dental sealant knowledge,
opinion, values and practice of Spanish dentists
Dental caries is among the most common of preventable childhood
infections , and methods are
currently available to cost effectively reduce caries . The most
effective method to reduce occlusal caries are pit and fissure
sealants, and over the last four years more than 11 guidelines and
reviews have recommended pit and fissure sealant use for at-risk
populations [3-13]. However, studies from U.S. [14-16], Greece ,
Sweden , and Scotland [19,20] all indicate that sealants are
In Spain, recent surveys indicate a 56% caries prevalence among 15–16
year olds, while only 17% have sealants [21,22]. Other Spanish studies demonstrate that occlusal sealants can reduce
both occlusal and smooth surface decay by 87% and 68%, respectively, over a two
year period . Over a nine year
period sealants can reduce occlusal decay by 65% .
Thus there are effective methods for caries prevention, but they are
underutilized. The theoretical frame for behavior change is an assessment of
knowledge and attitudes affecting practice. However, neither theories of
behavior change nor knowledge nor attitudes predict clinical practice . Instead, both indicate that values are better
predictors [20,26]. Therefore, we
examined knowledge combined with opinions and values, as a first step toward
initiating comprehensive caries prevention program in Spain. More particularly
we assessed dentists Andalusia regarding to the use of pit and fissure
The results suggest that, similar to other countries, Andalusian
dentists know that sealants are effective, have neutral to positive attitudes
toward sealants; though, based on epidemiological studies, underuse sealants.
Therefore, methods other than classical behavior change (eg: financial or legal
mechanisms) will be required to change practice patterns aimed at improving
children's oral health.This is a prelude to the generation of a regional plan
for improving children’s oral health in Andalusia.
School dental examinations. Number of children with/without fissure sealants present.
Continuing education for dentists
Article references available here.
L. San Martin
in the United Kingdom granted direct access to dental hygienists and therapists
the United Kingdom, the General Dental Council has this year granted patients
direct access to dental hygienists and therapists; this change has been met by
a widespread mixed reaction. While hygienists and therapists have greeted such
a change with positivity, citing clinical freedom as a main advantage, many
dentists have expressed disappointment with the decision.
general consensus is that such a ruling goes against best practice and negates
the principle of teamwork in dentistry. A main concern is that while hygienists
and therapists are valuable members of the dental team, their training is not
as comprehensive as that of a dentist. Thus, there are worries that this may
lead to oral health conditions remaining undiagnosed in patients who opt to visit
the hygienist but not the dentist.
essence, patients can now access hygienists and therapists directly without
first seeing a dentist. However, the new
guidelines have made it clear that dental professionals must not work beyond
the scope of both their training and capability. One key idea behind this new
development was to give the general public greater choice, however, this
further complicates the division between dentistry as a healthcare profession
and a consumer driven business. Nonetheless, it is hoped that such a move will
actually promote skill mix within dental teams and ultimately pave the path for
the future of dentistry. Whether this move will foster the foundations for
better oral health within the general public remains to be seen.
Wordley, EUR regional coordinator of the WFPHA Oral Health Group
SEAR - South-East
India: the oral health care manpower provider
is the biggest country in the South East Asian Region with a population of over
1.2 billion. The start of the new millennium saw a mushrooming growth of dental
education in the country. Dental Council of India governs the dental education
and offers Bachelor and Masters of Dental Surgery degree along with courses for
Dental Mechanist and Hygienist. BDS is a 4 year teaching program followed by 1
year of compulsory internship. MDS is a 3 year program which offers post
graduation in 9 specialities.
nearly 300 dental schools are approved by the government to offer BDS courses
and about 25,000 dentists are created. About 2,500 post graduate students from
different specialities complete their post graduation. Although India still
lacks dental manpower as per World Health Organization guidelines, many Indian
Dentists are willing to work on foreign soils. India may play a major role in
supplying dental manpower to the rest of the world in times to come.
issues regarding the use of this potential dental manpower in other parts of
the world are quality dental education and training which is being constantly
monitored by the council. There is still scope to improve training and make it
at par it international standards with latest tools and techniques. Further
other countries need to recognize dentists who have studied in India. Student
exchange programs are very limited at present time.
Public Health is one of the recognised specialities in India and post
graduation is obtained after 3 years of MDS. Presently more than 100 dentists
seek further education in this speciality. The scope of this subject is wide
and limited work has been carried out in this field. There are no function
National Oral Health policies. Oral health care is provided in India mostly
through private fee for service method. There are no dental insurance schemes
by private or government sector.
is an immense need for collaboration between Indian dentists and those of other
parts. This will provide Indians technical expertise and help us train our
students better who in turn may provide services in other parts of the world.
The Oral Health Working Group of World Federation of Public Health Associations
is good attempt to let us closer.
P. Gupta, SEAR regional coordinator of the WFPHA Oral Health Group
Community Empowerment and Effective Prevention Programs in Indonesia
(from APHA meeting presentation)
In Indonesia there is a huge caries problem with 6 years old children already having 2 permanent teeth decayed in some provinces. With limited and exhausted dental manpower, and facts that each province has different caries severity and progression rate, it is needed an innovation in dealing with the situation. Innovative School Oral Health Approach, in short iUKGS (the word “I” means Innovative, but also represent ownership of every stakeholder in school oral health program) has been launched in 2006 and adopted by MOH as National policy in 2011. iUKGS believe in two things, (1) One for all treatment is no longer suitable, so risk-based approach is very important. (2) To have sustainable program, leadership and empowerment of stakeholders should be built and strengthened.
iUKGS focused on prevention approach before the caries disease ends up in decays. There are three pillars of preventions. (1) Caries risk assessment using Dr I. Adyatmaka ’s Donut software, (2) Remineralization therapy, to stop the progression of demineralized white spot lesions and to recover the pH plaque and saliva pH. (3) Surface protection to mature the erupting molars and to protect black fissured teeth from ongoing demineralization process. The difference between iUKGS and other programs is that the engines in iUKGS are local resources, such as the school communities (parents and teachers), local health district, local ministry of education.
So how iUKGS can move all the local resources? Because iUKGS starts with Dr I. Adyatmaka ’s Donut risk assessment which designed to give feedback of current condition, magnitude of the problem, motivate parents to take more responsibilities, gives advices and menu, bring empathy and build self efficacy. This software was built after a huge research involving 2,500 kindergarten pupils with their parents. This tool has becoming a strategic entry point to empowerment.
So what is empowerment? Empowerment is when we strive to give knowledge and skills to people so that they are motivated to take steps to improve their own lives.
Empowerment that has happened, was measured through 3 indicators, (1) technology transfer, (2) improvement in behavior and oral health condition, (3) community ownership. Presentation demonstrated the successful achievement on key performance indicators.
WPR - Western Pacific Region
Dentistry in Australia
In spite of having an
extensive dental industry, Australians continue to suffer from the serious and
costly impacts of oral diseases on their everyday lives. Caries rates remain
unacceptably high across all strata of society, but, as with periodontal
diseases, their effects are much more pronounced on population groups at risk. So
Australia’s small public oral health workforce has much to do to address not
only population oral health improvement but also the nation’s disparities in oral
health care access and outcomes.
Although small in number our public oral health professional
members have been highly active. We are committed to reducing oral health
inequities across population subgroups and to improving overall oral health by
regularly measuring, evaluating and reporting on:
- oral health care access and equity
- population wide and targeted oral
health promotion strategies
- oral health outcomes (epidemiology) of
the whole population, of specific at risk populations and all age groups.
We also play key
roles in population oral health research, oral health promotion, and policy
advocacy in all political and stakeholder forums, including primary health
Australia is a
wealthy country with a national health care system (Medicare) that provides
universal access to care, ostensibly free of direct cost to patients.
However, because the majority of health care professionals are self
employed and able to set their own fee structures, many people find it
difficult to afford the gap between private fees and Medicare reimbursements.
Free public hospital and bulk billing medical services are available but access
can be difficult and waiting times lengthy. So the Medicare system is far from
equitable, especially as allied health and dental care have been largely
excluded from it. Indeed, much has been made of the omission of dental care
from Medicare and the implication that oral health is unrelated to general
health and wellbeing.
National Oral Health Plan 2004-2013 “healthy mouths, healthy lives” contained
four underpinning themes:
- oral health is an integral part of
- a population health approach
- access to appropriate and affordable
- education of the workforce and
The Plan identified
eight interrelated Action Areas:
- Promoting Oral Health
across the Population
- Children &
- Older People
- Low Income &
- People with Special
- Aboriginal &
Torres Strait Peoples
- Rural & Remote
expert panels are working on producing short, medium and long timeframe actions
for each Action Area in preparation for the release of the second National Oral
Health Plan 2014-2023. It will be based on the framework of the first Plan
which now has a proven track record of usefulness.
In 2013 a National
Oral Health Promotion Plan was also prepared through wide consultation. It has
gone to the Federal government but to date its recommendations and
implementation plans have not been made public which is of considerable
Across the 20th
century, oral health in Australia improved dramatically through a combination
of many factors including:
- advances in scientific knowledge
- increased population and individual
oral health literacy encouraging oral hygiene and tooth retention
- improvements in clinical techniques
making dentistry more acceptable
- growth in Australia’s wealth and middle
class making dental care, including aesthetic and specialist care, more
desirable and affordable
- a growing oral health workforce to
population ratio making dental care more accessible and available; and
- widespread fluoridation (still a fight
with anti-fluoridationists) and routine use of fluoride toothpaste and other
fluoride supplements and treatments.
the past four or five generations, the expectations of both the public and the
dental profession have shifted from extractions and dentures to prevention, dedicated
tooth retention and aesthetic dentistry for those patients who have been able
to afford such care. Historically, single-dentist private practices have
dominated Australia’s oral health care provision. Practices have
generally been established in more affluent urban settings, and targeted at
attracting regular patients and families who can afford the cost of
But as our National
Plan indicates, there remain many for whom dentistry continues to be expensive,
difficult to access and focused mainly on relief of pain. State and Territory
governments provide public dental services targeted at children and financially
disadvantaged adults but they are quite inadequate to meet the expressed demand
for services let alone actual normative needs, based upon regular personalised
and risk-based preventive care.
Today Australia is at
an incredibly interesting and challenging cross road in oral health
care. Over the past 10 years, the number of dental schools has
doubled through the introduction of new dental courses in regional
universities; and the number of new dental graduates, including oral health
therapists and hygienists, has trebled. Added to this has
been a rapid rise in overseas qualified dentists passing the Australian Dental
Council’s assessment process.
Suddenly we have gone from having a long term dental workforce
undersupply problem, compounded by a major maldistribution disadvantaging rural
areas and public dental services to an apparent oversupply situation given the
current funding models and constraints to universal demand for normative care.
How will governments respond? Will they embrace the opportunity to create
policies that address current disparities and inequities and expand the
accessibility of personalised preventive dental care and flexibility of the
workforce or will they simply seek to tighten the screws?
I hope readers have gained a picture of the Australian situation and some
of the challenges public oral health professionals are addressing in seeking to
improve the nation’s oral health.
B. Simmons & J. Rogers
Oral Health Activities for Children in China
From 2008, the Chinese Central Government has
set up a comprehensive oral health promotion project for children in the middle
and western regions of China with a special governmental fund. The project
covers 23 provinces and includes providing oral health education programs
through training the trainers, providing oral health care training courses in
community level, providing pits and fissure sealants for the first permanent
molars in high caries risk children. During the 5 years, the governmental input
of this project has been increased from 8.8 million Chinese Yuan ($1.5 million)
in 2008 to 46.49 million Chinese Yuan ($7.8 million) in 2012, and the coverage
of school children increased from 150 000 in 2008 to 540 000 in 2012, and the
number of teeth sealed increased from 530 000 in 2008 to 2310 000 in 2012. The
ability to providing oral health care in community level of health care workers
improved through oral health care training, more than 20 000 health workers
have received the oral health care training in this project. Based on this
project, the provincial governments in the developed areas, such as provinces
in the eastern region, started to provide provincial fund for oral health care
for school children. Now a day, the comprehensive oral health promotion project
is conducted in almost all provinces in China with the financial support from
the central and provincial governments and the content of the project includes not
only the content mentioned above, but also providing topical application of fluoride,
such as fluoride varnish, for high-risk preschool children to prevent tooth
decay in primary teeth, and providing simple fillings for permanent and primary
Oral health education in kindergarten
Providing sealants for school children in outreach clinic
Launching the Alliance for a Cavity Free Future (ACFF) - Malaysia Chapter
The Malaysian Association of Dental
Public Health Specialists (MADPHS) takes pride in working alongside the Alliance
for a Cavity-Free Future (ACFF) and Colgate-Palmolive Malaysia in providing the
platform for the launching of Malaysia as the second Asian ACFF Chapter after
China. The invited guest of honour Dr Khairiyah Abdul Mutalib, Principal Director
of Oral Health Malaysia, officiated the launch of ACFF-Malaysia Chapter. Prof
Nigel Pitts, Chairman of ACFF in announcing the appointment of Prof Rahimah
Abdul Kadir, founder and Immediate Past President of MADPHS, as Chairman of the
Malaysian Chapter believed Malaysia can contribute significantly to the
aspirations and objectives of ACFF in meeting the goal of a cavity free
population in the future. He is hopeful that Prof Rahimah with her vast network
in the region will also inspire other regional countries to work towards the
same goal. In her acceptance speech, Prof Rahimah pledged to work towards
achieving the three goals formulated for Malaysia by working alongside all
relevant stakeholders. The official launching of ACFF Malaysia Chapter culminated
with the signing of the Alliance for A Cavity-Free Future Malaysia
Chapter Declaration between the ACFF Chairman and Chairman of ACFF-Malaysia
Chapter as well as supporting signatories; the Director of Oral Health
representing the Oral Health Division MOH, Chairman of the Deans’ Council and President
of MADPHS. In attendance was Mr John Hazlin, Managing Director of Colgate-Palmolive
Malaysia. The occasion followed a 3-day, 23-25 October 2013, of activities, in
Kuala Lumpur on the theme “Delivering a New Standard of Care in Cavity
Protection” which included Early Caries Management Expert Workshop organized by
MADPHS; ICDAS/ICCMS™ Train the Trainers
Course organized by the Dental Deans’ Council and, Early Caries Management Symposium organized by MADPHS with Oral Health Division,
The launch of the ACFF
from Smoke, a Healthier Mouth a Healthier You” Campaign in Malaysia
Smoking is still prevalent
in Malaysia affecting mostly male adults but seeing an increase among the teens
and women. Malaysia is a signatory to the WHO Framework Convention on Tobacco Control
(FCTC) with the Ministry of Health leading Smoking Control efforts. Dentists involvement
in tobacco control intervention efforts however was slow in coming. Few dental
schools included smoking control in their curriculum and Tobacco Control was
only recently included in the Oral Health Division MOH 2011-2020 National Oral
Health Plan. In support of this move, the Malaysian Association of Dental
Public Health Specialist (MADPHS) organized the first ever 5-day smoking cessation
campaign in Malaysia, working alongside the academia (private and public
institutions), government health agencies (Oral Health Division MOH, Malaysian
Armed Forces Dental Unit) and
non-governmental organization (MyWATCH). The big scale program officiated by the
Deputy Minister of Health Malaysia was carried out from 9 – 13 October 2013 in
a popular shopping mall in Lembah Klang, covering the Kuala Lumpur-Petaling
Jaya residential areas,and was supported by our partner in dentistry, Johnson and
Johnson-Listerine Malaysia. The campaign also officially launched the first
Malaysian Tobacco Control Newsletter Bulletin for Health Professionals – a
quarterly newsletter initiated by a multidiscipline expert panel from
University Malaya Centre of Addiction Sciences and supported by Johnson &
Johnson Malaysia. Activities included Oral Health screening by dentist
volunteers, smoking level assessment, tobacco control counseling, public forums
and talks by multidiscipline experts working in tobacco control, smoking
posters and hands-on exhibition, schoolchildren school drawing competition
among others. The effort was well received by the public from all walks of
life. In addition, almost 700 adults consented to undertake oral screening, smoking
assessment tests and counseling.
Deputy Minister launching Campaign
Year dental students showcase
Oral Health in the Pacific
Access to timely and appropriate dental care is
challenging in Pacific island countries due to limited transportation between
remote islands and shortage of formally trained dental workforce. Theses
countries are also facing a transition in diet patterns, from locally produced
products to imported foods and beverages that include high-sugar. Considering
these special situations and pressing needs for oral health education and
timely and accessible care, oral health experts from both public and private
entities in the Pacific region have launched various oral health activities.
Global Child Dental Fund started its Pacific Dental Network this year to design
and implement Legacy projects in the Pacific region, starting from Fiji, Solomon
Islands, and Vanuatu Islands. The aim of this network is to convene partners in
dental public health to design, implement and expand impactful oral health
projects to ultimately improve children’s oral health in this region.
The School of Oral Health of the Fiji National University,
the dental school which provides dentistry and oral health professionals to
over 14 Pacific island countries, recently hosted the Annual College of Oral
Health Academics Meeting with support from Colgate Australia. Participants from
8 different institutions from the Pacific region discussed various dental
workforce models and academic assessment methodologies for dental hygiene,
dental therapy and oral health therapy programs in Australia, New Zealand and
Fiji. The dental school also plans to launch a pilot project to provide
interdisciplinary care to address the need for feeding assistance, counseling,
speech therapy, caries management, orthodontic and oral surgery treatment among
children with cleft lip and palate in Fiji. These children receive initial
cleft closure care however there is no follow-up management provided to assist
the child and family cope with the many challenges associated with clefts.
islands implemented its first National Oral Health Survey in May 2013 and data
collection is currently underway. Honiara
City, the capital of Solomon Islands, focuses on vigorous and effective
community dental preventive programs, including a city-wide launch
of a toothbrushing day that more
than two thousand children and adults participated and demonstrated
toothbrushing in public in 2013. The Honiara city oral health services also
plans to provide oral health education for pregnant women and new mothers at antenatal
clinics from 2014. This is a new initiative, however it needs to be
strengthened and supported urgently be partners in public health due to the
absence of such programs in Solomon Islands.
involved in the survey- Honiara City, Solomon Islands
Oral health survey in Guadalcanal province, Solomon
Vanuatu archipelago has a unique
oral health workforce model, which formed a group called VOHA (Vanuatu Oral
Health Awareness). Through VOHA, Vanuatu migrant farm workers in New Zealand,
called Ni-Vanuatu, bring their newly gained knowledge of the importance of
maintaining good oral hygiene back to their communities in Vanuatu. In
partnership with Colgate and various charities, these Ni-Vanuatu oral health
educators reached over 3,500 people by providing oral health awareness sessions
at schools and churches this summer.
Oral health education for children – Vanuatu Islands
H. Lee, WPR regional coordinator of the WFPHA Oral Health Group
If you are interested in the OHWG and its activities please visit our webpage or contact us!
We wish you all Happy Holiday and a New Year
filled of Prosperity and Health!