The World Oral Health Report 2003: continuous improvement of oral health in the 21st century--the approach of the WHO Global Oral Health Programme

Chronic diseases and injuries are the leading health problems in all but a few parts of the world. The rapidly changing disease patterns throughout the world are closely linked to changing lifestyles, which include diets rich in sugars, widespread use of tobacco, and increased consumption of alcohol. In addition to socio-environmental determinants, oral disease is highly related to these lifestyle factors, which are risks to most chronic diseases as well as protective factors such as appropriate exposure to fluoride and good oral hygiene. Oral diseases qualify as major public health problems owing to their high prevalence and incidence in all regions of the world, and as for all diseases, the greatest burden of oral diseases is on disadvantaged and socially marginalized populations. The severe impact in terms of pain and suffering, impairment of function and effect on quality of life must also be considered. Traditional treatment of oral diseases is extremely costly in several industrialized countries, and not feasible in most low-income and middle-income countries. The WHO Global Strategy for Prevention and Control of Noncommunicable Diseases, added to the common risk factor approach is a new strategy for managing prevention and control of oral diseases. The WHO Oral Health Programme has also strengthened its work for improved oral health globally through links with other technical programmes within the Department for Noncommunicable Disease Prevention and Health Promotion. The current oral health situation and development trends at global level are described and WHO strategies and approaches for better oral health in the 21st century are outlined.     

Global policy for improvement of oral health in the 21st century – implications to oral health research of World Health Assembly 2007, World Health Organization

Abstract – The World Health Organization (WHO) Global Oral Health Programme has worked hard over the past 5 years to increase the awareness of oral health worldwide as oral health is important component of general health and quality of life. Meanwhile, oral disease is still a major public health problem in high income countries and the burden of oral disease is growing in many low‐ and middle income countries. In the World Oral Health Report 2003, the WHO Global Oral Health Programme formulated the policies and necessary actions to the continuous improvement of oral health. The strategy is that oral disease prevention and the promotion of oral health needs to be integrated with chronic disease prevention and general health promotion as the risks to health are linked. The World Health Assembly (WHA) and the Executive Board (EB) are supreme governance bodies of WHO and for the first time in 25 years oral health was subject to discussion by those bodies in 2007. At the EB120 and WHA60, the Member States agreed on an action plan for oral health and integrated disease prevention, thereby confirming the approach of the Oral Health Programme. The policy forms the basis for future development or adjustment of oral health programmes at national level. Clinical and public health research has shown that a number of individual, professional and community preventive measures are effective in preventing most oral diseases. However, advances in oral health science have not yet benefited the poor and disadvantaged populations worldwide. The major challenges of the future will be to translate knowledge and experiences in oral disease prevention and health promotion into action programmes. The WHO Global Oral Health Programme invites the international oral health research community to engage further in research capacity building in developing countries, and in strengthening the work so that research is recognized as the foundation of oral heath policy at global level.     

Determinants for preventive oral health care need among community‐dwelling older people: a population‐based study

The aim was to study the determinants of preventive oral health care need among community‐dwelling old people. The study population consisted of 165 participants, a subpopulation in the Geriatric Multidisciplinary Strategy for Good Care of Elderly People (GeMS) study. Fifty‐five percent of the edentate participants with full dentures and 82% of the dentate had a need for preventive oral health care. In the total study population, the need for preventive care was associated with co‐morbidity (measured by means of the Modified Functional Co‐morbidity Index) odds ratios (OR) 1.2 (confidence intervals [CI] 1.0–1.5), being pre‐frail or frail, OR 2.5 (CI 1.2–5.1), presence of natural teeth, OR 4.8 (CI 2.2–10.4), and among dentate participants, the use of a removable partial denture, OR 12.8 (CI 1.4–114.4). Primary care clinicians should be aware of the high need for preventive care and the importance of nonoral conditions as determinants of preventive oral health care need.     

The common risk factor approach: a rational basis for promoting oral health

Conventional oral health education is not effective nor efficient. Many oral health programmes are developed and implemented in isolation from other health programmes. This often leads, at best to a duplication of effort, or worse, conflicting messages being delivered to the public. In addition, oral health programmes tend to concentrate on individual behaviour change and largely ignore the influence of socio-political factors as the key determinants of health. Based upon the general principles of health promotion this paper presents a rationale for an alternative approach for oral health policy. The common risk factor approach addresses risk factors common to many chronic conditions within the context of the wider socio-environmental milieu. Oral health is determined by diet, hygiene, smoking, alcohol use, stress and trauma. As these causes are common to a number of other chronic diseases, adopting a collaborative approach is more rational than one that is disease specific. The common risk factor approach can be implemented in a variety of ways. Food policy development and the Health Promoting Schools initiative are used as examples of effective ways of promoting oral health.     

21世纪继续提高人类口腔健康水平(世界卫生组织全球口腔卫生策略)

当今世界上除极少数地区外 ,慢性疾病和伤害已成为最主要的健康问题。这可以归因于那些威胁人类健康的可以预防的主要危险因素。今后几十年里 ,如果我们能够降低这些危险因素 ,就可以避免这一类疾病的巨大负担 ,从而不仅提高民众健康水平 ,还将降低卫生不公平性 ,促进社会的可持续发展。世界卫生组织 (WHO )非传染性疾病和精神健康部门 (NoncommunicableDiseasesandMentalHealthCluster)以领导全球提高生命全过程的健康水平为使命 ,协助各成员国减少因慢性非传染性疾病导致的伤残、疾病和死亡。工作重点是按照全球非传染性疾病 (NCDs)…     

Influences of social support on the oral health of older people in Britain

A national UK study involving a random sample of 876 non-institutionalized older people (aged 65 or older) were recruited, to identify the association between social support (living alone), self-reported oral health status and oral health behaviour (use of services). Home interviews were undertaken exploring oral health behaviour (time and reason for last dental visit) and oral health status measures (self-reported number of teeth possessed and denture status). In addition, socio-demographic characteristics were collected. Bivariate analysis identified that social support was associated with time since last dental visit (P < 0.01), reason for last dental visit (P < 0.01), self-reported number of teeth possessed (P < 0.01) and denture status (P < 0.01). In regression analysis, social support emerged as an important predictor of reason for last dental visit and denture status having accounted for other factors in the model (age, gender, social class and educational attainment). Social support is associated with oral health status and oral health behaviour of older people in Britain and is likely to influence both the decision making process of when to seek dental care and what type of treatment to opt for.     

Priorities for research for oral health in the 21st century--the approach of the WHO Global Oral Health Programme

The World Health Organization (WHO) "World Oral Health Report 2003" emphasized that despite great improvements in the oral health status of populations across the world, problems persist. The major challenges of the future will be to translate existing knowledge and sound experiences of disease prevention and health promotion into action programmes, this is particularly the case with developing countries that have not yet benefited from advances in oral health science to the fullest extent possible. The WHO Oral Health programme gives priority to research helping correct the so called 10/90 gap which relates to the fact that only 10% of funding for global health research is allocated to health problems that affect 90% of the world population. As knowledge is a major vehicle for improving the health of the poor in particular, the WHO Oral Health Programme focuses on stimulating oral health research in the developed and developing world to reduce risk factors and the burden of oral disease, and to improve oral health systems and the effectiveness of community oral health programmes. Building and strengthening research capacity in public health are highly recommended by WHO for effective control of disease and the socioeconomic development of any given country.     

Oral health and health care for older adults: A spatial approach for addressing disparities and planning services

The purpose of this paper was to examine the geographic distribution of New York City adults aged 65 and older by race/ethnicity and poverty status. Also analyzed was seniors' access to dental care as defined by the location of dental providers and their proximity to the subway system lines in Manhattan and the Bronx. ArcGIS software was used to create a geographic information system (GIS) incorporating relevant data from a variety of sources. Individual and overlay maps were then produced to examine the aims of this analysis. Data showed that Black race, Hispanic ethnicity, and poverty status tend to co‐occur spatially among seniors in Northern Manhattan and the South Bronx. Further, a spatial/transportation barrier may inhibit access to dental care for seniors who reside in these areas. By presenting multiple layers of local information juxtaposed, GIS can help provide directions for planning oral health service delivery for seniors.     

Oral disease in Africa: a challenge to change oral health priorities

Colonial and other unsustainable oral health strategies exported to Africa have failed to improve oral health in the region. An alternative way of interpreting and responding to the problems of oral health in Africa is presented. It begins with a systematic interpretation of the health information available, using the application of the basic epidemiological principle of defining a specific health problem by describing its prevalence, severity (morbidity, mortality) and age adjusted distribution in the population. African oral disease priorities determined in this way are shown to be fundamentally different from those perceived previously. It is recommended that this new approach be used in customising a viable set of oral health policies and intervention strategies for each individual African community.     

General health and oral health self-ratings, and impact of oral problems among older adults

The aim was to assess associations of general and oral health perceptions, and the impact of general and oral health functional problems on general health perceptions. Data were collected from adults, 60-71 yr of age in 2008, and included global self-ratings of general and oral health, Oral Health Impact Profile (OHIP-14) scores, and health problem scores [using the five items from the EuroQol instrument (EQ-5D)]. Responses were collected from 444 subjects (response rate = 68.8%). Self-rated general and oral health showed fair to good agreement (kappa = 0.47). Adjusted estimates of self-rated general health showed that worse ratings were associated with lower social status [prevalence ratio (PR) = 0.42] and with more health problems (PR = 0.64). Adjusted estimates of self-rated oral health also showed that worse ratings were associated with lower social status (PR = 0.48) and with more health problems (PR = 0.63), as well as with higher OHIP scores (PR = 0.21). The interaction of health problems and OHIP scores was significant for self-rated general health, with self-rated general health being worse when both health problems and OHIP score were higher. For older adults, general health and oral health were associated, although oral health impact was only associated with general health for those with more health problems, indicating that those in worse health suffer more impact from oral health problems.     

Older peoples' perceptions of oral health: 'it's just not that simple'

Abstract: Objectives: Little is known about older persons’ perceptions of oral health and oral health care. The purpose of this study was to explore the viewpoint of older adults’ regarding their oral health care practices. Methods: A qualitative interpretive methodology was employed comprising three analytic levels: coding of data into concepts, analysis of concepts into themes, followed by an in‐depth analysis of relationships within concepts and between themes. In‐depth individual interviews were conducted with 19 participants aged 65 to 87 years. Results: Older people’s decision to access oral health care involves complex and personally meaningful strategies. A dental visit surfaces hopes and fears based on past and present experiences. Mouth and teeth are not merely objects of dental care; they represent a person’s social and relational self. Age‐related changes challenge the relational self as represented in societal ideal images of youth and perfection (the perfect smile). This study highlights older peoples’ resilience and determination when faced with the dilemmas in accessing oral health care – it costs, personally as well as financially. Contrary to the assumption that older peoples’ oral health status is related to neglect, rather for many, it is the result of the intersection of their history with technological advances. Conclusions: These findings challenge oral health care practitioners to be sensitive to the contexts affecting their older client’s oral health care status. They do not ‘just go’ to the dentist; they bring with them their past dental experiences and their hopes for the future. It matters how one is treated at this vulnerable time.     

Oral health promotion interventions on oral reservoirs of staphylococcus aureus: a systematic review

The oral cavity serves as a reservoir of Staphylococcus aureus for infection of the lower respiratory tract and cross-infection to other patients. This systematic review was designed to examine the effectiveness of oral health promotion interventions on this pathogen. The PubMed, ISI Web of Science, and Cochrane Library databases were searched for clinical trials assessing the effect of oral health promotion interventions on oral and oropharyngeal carriage of S. aureus. Oral health promotion interventions on oral reservoirs of S. aureus in both systemically healthy and medically compromised groups consisted of oral hygiene interventions only. There was a lack of evidence pertaining to the effectiveness of mechanical oral hygiene interventions against this pathogen. Chlorhexidine delivered in oral hygiene products such as mouthrinses, gels, and sprays appeared to have some utility against S. aureus, although some studies found equivocal effects. There was a dearth of studies investigating the efficacy of other chemical agents. Although many chemical agents contained in oral hygiene products have proven in vitro activity against S. aureus, their clinical effectiveness and potential role as adjuncts or alternative therapies to conventional treatment remain to be confirmed by further high-quality randomized controlled trials.     

Prevention and management of periodontal diseases and dental caries in the older adults

As a result of aging populations, in the future, dental practitioners will be caring for more older adults than ever before. These older adults, especially in developed countries, will demand a greater number of dental services, driven by increased tooth retention and an expectation of excellent oral healthcare throughout the life course. Further, the global rise in the prevalence and incidence of chronic diseases will increase the risk and/or severity of oral diseases and add a layer of complexity to the management of oral diseases in older adults. More older adults will be at a higher risk of periodontal disease and root caries as a result of reduced tooth loss and edentulism. This article reviews information on periodontitis and root caries, oral diseases which reflect the cumulative risk of the individual, and which are best addressed through prevention. Oral healthcare providers must embrace the concept of lifelong emphasis on prevention, as well as participation as active members of a healthcare team which provides healthcare for older adults in various settings (eg, hospital/clinic-based care, community-based settings, and long-term care facilities). National guidelines that address oral health are being considered by some countries, and if these are implemented they will increase the accessibility to oral health for older adults. In parallel to this, revisions of existing older adult insurance schemes (eg, the inclusion of routine oral healthcare in the US Medicare program) would promote the maintenance of a functional dentition that is pain-free and conducive to general health. The opportunity exists to implement a holistic approach to oral health that will align oral health with general health and emphasize that true health can only be achieved with the inclusion of oral health.     

The oral health of older people: general dental practitioners' beliefs and treatment experience

The purpose of this study was to examine New Zealand general dentists' beliefs about older people's oral health and to identify the important barriers that prevent dentists from treating institutionalized older adults. A postal survey was distributed nationwide to a representative sample of 700 dentists (response rate 64.5%). Dentists' beliefs were mostly consistent with current epidemiological knowledge, although most (81.5%) mistakenly believed that the root surface caries increment was greater than that for coronal caries. One in four had visited a long‐term care (LTC) facility during the previous 2 years. Over threequarters cited the inconvenience of leaving their practices as a barrier, and the lack of a financial incentive was cited by almost half. The results suggested that the areas most in need of attention were the LTC staff's oral health knowledge and attitudes, as well as government policies. Although dentists' beliefs, practices, and attitudes occasion some optimism, the increase in the dentate older population means that policymakers will need to examine efficient, dentist‐acceptable ways of delivering care. The profession will need to develop and sustain an appropriate workforce.