荷兰的牙科教育、医疗及健康保障体系

荷兰位于西欧,其牙科教育和医疗水平在欧洲居领先地位。荷兰目前有3所牙学院,每年共招生约300名本科学生,每年仅培养5～7名牙科矫正医师和3～5名牙科外科医师。目前全荷兰有7623名职业牙医,283名牙科矫正医师和203名牙科外科医师,约8500名牙科助手和2000名牙科洁治医师。在荷兰,牙科行医必须符合《个人卫生健康职业法令》,只有先行注册,才可被称为“牙医”。牙医这一职业由于导致很大的职业压力,近年来备受西方国家关注。本文总结了该方面的主要研究成果,并介绍了荷兰近年在医疗保障体制上的改革现况,可资我国医改借鉴。     

An assessment of the dental public health infrastructure in the United States

OBJECTIVES: The National Institute of Dental and Craniofacial Research commissioned an assessment of the dental public health infrastructure in the United States as a first step toward ensuring its adequacy. This study examined several elements of the U.S. dental public health infrastructure in government, education, workforce, and regulatory issues, focused primarily at the state level. METHODS: Data were drawn from a wide range of sources, including original surveys, analysis of existing databases, and compilation of publicly available information. RESULTS: In 2002, 72.5% of states had a full-time dental director and 65% of state dental programs had total budgets of 1 million dollars or less. Among U.S. dental schools, 68% had a dental public health academic unit. Twelve and a half percent of dental schools and 64.3% of dental hygiene programs had no faculty member with a public health degree. Among schools of public health, 15% offered a graduate degree in a dental public health concentration area, and 60% had no faculty member with a dental or dental hygiene degree. There were 141 active diplomates of the American Board of Dental Public Health as of February 2001; 15% worked for state, county, or local governments. In May 2003, there were 640 U.S. members of the American Association of Public Health Dentistry with few members in most states. In 2002, 544 American Dental Association members reported their specialty as Dental Public Health, which ranged from 0 in five states to 41 in California. Just two states had a public health dentist on their dental licensing boards. CONCLUSIONS: Findings suggest the U.S. dental public health workforce is small, most state programs have scant funding, the field has minimal presence in academia, and dental public health has little role in the regulation of dentistry and dental hygiene. Successful efforts to enhance the many aspects of the U.S. dental public health infrastructure will require substantial collaboration among many diverse partners.     

Dental education in Malaysia

There was only one dental school in Malaysia until 1997 but five new schools have been established since 1998. This review provides information about dental education in Malaysia including; the history of dental education, the current dental school system and curriculum, and dental licensure. There are four public and two private dental schools in Malaysia. High school graduates are required to take the nationwide matriculation entrance examination or the Higher School Certificate (HSC) to apply for a dental degree programme. A five-year dental programme leads to the BDS or the DDS degree. National or state examinations are not required to practise dentistry. Currently, there are approximately 2,500 dentists, with a ratio of 1 dentist for every 10,000 people.     

Should dentists become 'oral physicians'? No, dentistry must remain dentistry

Dentistry is not an allied health profession. It is not a paramedical profession. It is time that dentistry be recognized as the profession that offers patients some of the most complex surgery performed on the human body--namely, restorative dentistry and rehabilitation of the masticatory system. Dentistry is the only anatomically focused health care profession that is university-based and for which primary care responsibility is maintained by the profession. An inferiority complex about what it means to be a dentist has served only to confuse the public and bring us further from our goal of improving the health of all our patients. This inferiority complex is driven by the public and the medical profession, neither of which understands how dentistry fits into overall health care. It is essential that every academic health center have oral health education as an integrated part of health care education for dentists, physicians, nurses, allied dental personel, physical therapists, psychologists and all who receive university-based health care education. In this way, all the health professions and the public will see dentistry and oral health as essential to patients' overall health. The idea of emulating those who do not have the strength of basic-science education, practice complexity, surgical skills or community status by seizing a new title will not elevate the profession for the future. The public knows what a dentist is. It is our task to inform the public about the capabilities of dentists and the value of oral health and our profession. We can accomplish this best by assuring that our profession's name, "dentistry," is understood to represent one of the world's most accomplished surgical endeavors, one that is thoroughly integrated into the fabric of health care. Thus, good oral health will be thoroughly integrated into what it means to be healthy.     

Community dentistry in Nordic dental schools

Approximately a decade after the first plans for the teaching of community dentistry were made in the Nordic countries, a questionnaire survey of Nordic dental schools was conducted to find out to what extent community dentistry subjects had been introduced in undergraduate curricula. Replies were received from the 12 dental schools in Denmark, Finland, Norway and Sweden. These schools admitted 915 students in 1982-83. Seven had a department of community dentistry, and at least two others had plans to start one. About 100 h of teaching were given on community dentistry subjects during the 5-yr course of study, mostly on the traditional subjects of epidemiology, statistics, law and ethics. In some schools health education and other behavioral sciences subjects received a large amount of curriculum time. Decisionmaking theory and political science were not reported taught at any school. Three departments had attached clinics, with widely differing functions. The Nordic textbook in community dentistry was widely used, and separate examinations were held in community dentistry at most schools. Full-time postgraduate courses were offered at three schools. Although schools in all four countries expected the number of dental students to decrease in coming years, several schools expected community dentistry to expand with regard to curriculum time and staff, in keeping with trends in other countries.     

Geriatric dentistry in dental education

Geriatric patients have both special medical problems (problems with aging and general health problems) and specific dental problems. This requires special skills of dentists who are treating these patients. The medical problems require a dentist with a wide medical education and a friendly attitude towards his patients. The dental problems require a dentist who is more problem orientated on his way of treatment. Both aspects are present in the theoretical teaching in most of the dental schools. For treatment of institutionalized geriatric patients it is advocated to train specialists in geriatric dentistry taking into account the need for a multidisciplinary and specific approach.     

Geriatric dentistry education in European dental schools

As the numbers of elderly adults continue to grow within European populations, the need for dental students to be trained in the management of geriatric patients becomes increasingly important. Many dental schools have developed training programmes in geriatric dentistry in response to the changing oral health needs of older adults. The purpose of this on-line survey was to identify the current status of geriatric dentistry education in European dental schools. A questionnaire relating to the teaching of geriatric dentistry was posted on the Internet, and 194 dental schools in 34 European countries were invited to participate. Data from completed questionnaires were submitted to the investigators via email from 82 schools in 27 countries (42% response rate). Thirty-six percent of schools offered a specific geriatric dentistry course that included didactic teaching or seminar groups, 21% taught geriatric dentistry by means of organised presentations in the curriculum, and 36% taught the subject by occasional lectures. 7% of schools did not teach geriatric dentistry at all. A clinical component to the geriatric dentistry curriculum was reported by 61% of schools and 18% reported operating a specific geriatric dentistry clinic within the school. Of those providing clinical geriatric dentistry training, it was provided within the school in 45% of cases, with a further 29% of schools providing training both within the school and at a remote location. Seven percent of schools operated a mobile dental clinic for treating geriatric patients. Twenty-eight percent of schools had a geriatric programme director or a chairman of a geriatric section and 39% indicated that they plan to extend the teaching of geriatric dentistry in the future. Geriatric dental education has clearly established itself in the curricula of European dental schools although the format of teaching the subject varies widely. It is of concern that geriatric dentistry was not taught at all in 7% of schools. No data are available concerning whether or not geriatric dentistry is taught in the 58% non-responding schools.     

Special Needs Dentistry: perception,attitudes and educational experience of Malaysian dental students

A compromised oral health condition amongst patients with special health care needs (SHCN) has been associated with the reluctance and shortage of skills of dental professionals in managing such patients. Lack of training and experience at the undergraduate level are reported barriers to the provision of care for this patient cohort. Undergraduate education therefore, plays an important role in producing professionals with the knowledge, skills and positive attitude in treating patients with SHCN. This study aims to determine the level of knowledge, comfort and attitudes of Malaysian undergraduate dental students towards caring for patients with SHCN, as well as their perception on education in this field. A self‐administered questionnaire was administered in the classroom style to final year undergraduate dental students in Malaysian public dental schools. Most students were aware of Special Needs Dentistry (SND) as a specialty after being informed by academic staff. The majority of the students demonstrated poor knowledge in defining SND and felt uncomfortable providing care for such patients. They perceived their undergraduate training in SND as inadequate with most students agreeing that they should receive didactic and clinical training at undergraduate level. A high percentage of students also expressed interest in pursuing postgraduate education in this area of dentistry despite the lack of educational exposure during undergraduate years. The study supports a need for educational reform to formulate a curriculum that is more patient‐centred, with earlier clinical exposure in various clinical settings for students to treat patients with special health care needs, applying the concept of holistic care in a variable clinical condition.     

Oral health behaviour and its determinants amongst Iranian dental students.

OBJECTIVES: To study the oral health behaviour (OHB) of Iranian senior dental students in relation to their gender, background characteristics, knowledge of preventive care, and attitudes towards preventive dentistry. MATERIALS AND METHODS: Using a cluster random sampling approach, a questionnaire survey was conducted with 327 senior dental students in seven dental schools. The questionnaire covered age, gender, parents' employment in dentistry, previous academic education in dental hygiene, oral self-care, most recent dental check-up, knowledge of preventive dentistry and attitudes towards it. Attending a dental check-up by a dentist or a classmate within the last year was defined as preventive care use. Chi-square test and logistic regression models were used for statistical analyses. RESULTS: Women reported significantly higher frequencies of tooth brushing (P < 0.001), fluoridated toothpaste use (P = 0.001) and flossing (P < 0.001) compared with men. Respondents who had been previously educated as dental hygienists had lower frequencies of eating sugary snacks (P < 0.001) and paid more attention to preventive care (P = 0.03) than others. Those with more extensive knowledge of preventive care reported higher frequencies of using fluoridated toothpaste (P = 0.05). Reported frequencies of brushing were higher amongst those with more positive attitudes (P = 0.03). In logistic regression models, having at least one parent employed as a dentist was significantly associated with higher frequencies of eating sugary snacks (P = 0.047, OR = 0.3) and more frequent preventive care use (P = 0.048, OR = 2.9). CONCLUSION: Education and training in preventive measures should be effective enough to overcome background characteristics. There is room for improving the OHB of Iranian dental students.     

School Dental Health in Honduras

Project HOPE has been working with the Honduran government since 1983 to establish educational programs for health workers and improve the country's health care services. The Ministry of Health in Honduras, under the direction of the president, is planning a new emphasis on preventive dentistry. The feasibility of community water fluoridation is being examined, and dental health programs have been implemented in pilot schools around the country. The Ministry of Health plans to expand these pilot programs to include all elementary schools in Honduras. This article describes the dental health services in Honduras and the government's effort to establish a nationwide school dental health program with emphasis on preventive dentistry.     

State and development of dental care for employees in Finland

Abstract – The aim of this study was to analyze the present state of occupational dental care in Finland. In addition, the viewpoints of employees and employers concerning possibilities for developing occupational dental care were evaluated. Five percent of employers had arranged dental services for their employees. Twenty-four firms either had their own dentist or had made an agreement with a dentist about dental care for their employees. Most of these dentists delivered all kinds of dental treatment to employees, and the costs of treatment were usually paid from the worker's sickness benefit funds. Many such funds also subsidized the costs of dental treatment delivered in other dental offices. In 1978 about 49% of the workers covered by such funds received subsidies for their dental expenses. The most important means of developing adult dental care in Finland was considered to be widening the scope of public dental care. The second means was widening the scope of the national health insurance system. In third place, the employers supported development of private dentistry. Employees, however, preferred to include dental care in agreements made by collective bargaining.     

Barriers to leadership positions for Indian women in academic dentistry

Indian women, have come up a long way during the past 50 years. Gone are the days when the leadership positions in dentistry and health care professions were occupied solely by males and the women in-charge were looked down upon as anomalies. The staff rooms in dental and medical schools, the research laboratories in India today are employing women, who have quietly begun challenging the conventional male ideas that had shaped the policies earlier on. Women have advanced considerably in academic dentistry but like every coin, this story too, has two sides. In spite of the considerable gain in equity of status, women in research and academic careers related to health care professions still face innumerable barriers to their careers. This study was conducted with an aim to highlight the various barriers being faced by women in leadership positions in academic dentistry in India and this paper also suggests issues which require global concern for unbiased advancement of women. This was a questionnaire-based study in which the subjects were women in leadership positions in the various dental colleges in India. The questions are related to the various barriers like family commitments, attitude of the society, sexual harassment, gender bias and lack of cooperation from spouse which hinders the development of the careers of such women with tremendous potential. The results show that 67% of the subjects feel there are more barriers to their careers as women than men and health care professions definitely need more women leaders for improvement in women's health status globally. 63.5% of women in dentistry feel their family commitments are barriers to rising in their careers and 64.7% report that a marriage is happier if the husband's career graph is better than wife's. The survey results indicate that the same salary is paid to 93.5% women as their male colleagues. The results of the study show that there certainly has been a change in outlook of Indian women as they have broken the traditional norms and taken up careers in academic dentistry. There certainly is a positive side to this story but numerous challenges especially in the form of family commitments still remain for women in leadership positions in the dental colleges in India.     

An outline of competencies and the appropriate postgraduate educational pathways in implant dentistry

The use of dental implants has become a widely accepted and well-documented treatment option offering to both patients and dentists an alternative to traditional treatment modalities and at the same time opening a brand new area in dental postgraduate education. As such, it is necessary to define the competencies that the graduate student/dentist will need at the different levels of clinical practice in Implant Dentistry and the educational pathways that are required to convey those competencies in a structured manner. The present position paper provides an initial suggestion for the knowledge, skills and behaviour necessary for a graduate student to practice implant dentistry at the different levels of clinical complexity. An outline of the necessary competencies and structure of various levels of postgraduate university courses is provided together with different educational approaches to support them. The present paper should be evaluated as a platform for discussion for future development of postgraduate curricula in implant dentistry rather than a manual on how to design and operate such curricula.     

Geriatric oral health issues in Australia

Aim : To identify and discuss geriatric oral health issues in Australia. Methods : A discussion of the demographic trends, oral health trends, and barriers to dental care for older Australians is presented, together with a review of Australian public and private sector geriatric dental services, geriatric dental research, and geriatric dental education. Conclusions : Key geriatric oral health issues for Australia include: edentulism is decreasing and older Australians are retaining more natural teeth; coronal and root caries are significant problems, especially as older adults become more functionally dependent, cognitively impaired, and medically compromised; the oral health status of institutionalised older Australians is poor; the onset of severe oral diseases appears to occur in many older Australians prior to their institutionalisation, when they are homebound and dependent upon carers; carers of older adults do not have access to practical education about dental care; the majority of older Australians are eligible to use public‐funded dental services, but barriers limit their access to these services; few Australian public or private dental services are designed with a geriatric focus; geriatric dental education does not have a high profile in Australian dental schools; no specialty exists in Australia for geriatric dentistry, nor is there a national geriatric dentistry association.     

Caries management: technical solutions to biological problems or evidence‐based care?

Caries-related clinical decision-making remains a centrepiece of clinical dentistry. However, the oral disease patterns are rapidly changing towards the better among major sections of the populations, most notably in the high-income countries. The caries decline is well documented among children and younger adults, and is gradually seen to trickle into middle and old age as well. Although it is tempting for the dental profession to take the credit for this development, the evidence points in a different direction. The major contribution of dentistry seems primarily related to changes in the treatment philosophies towards a less interventionist approach. This review aims to spur a further change in the diagnostic and treatment criteria used in the management of dental caries for the benefit of the oral health status of our patients. We must come to terms with the fact that our traditional core skills, our manual dexterity and technical competence, have less to offer to oral health than we have been accustomed to think. The dental schools and the professional dental organizations must carry the responsibility for promoting the necessary changes in the caries related clinical decision-making strategies to allow practicing dentists to provide appropriate oral health care to our populations.     

English language education in Japanese dental schools

English is the common language of international scientific and cultural exchange. As the world becomes more globalized and with increasing dependence on the Internet, English becomes increasingly important as a second language. English is the official language for all international associations, societies, organizations etc and their meetings and publications. High quality international collaboration usually requires a high standard of English language proficiency. There is very little information regarding English language education in dentistry on a global basis, particularly in Japan. In 1999 we undertook a comprehensive survey of English education in all 29 Japanese dental schools in the form of a questionnaire. Few schools had native-speaking educators or those at native speaker level and most did not have a background in dentistry or the health sciences. There are no ideal textbooks for dental students studying English. Most disciplines within dentistry have a professional society or an association with meetings and publications. Currently there is no such group for English-language education in dentistry. Closer collaboration amongst those concerned may help improve the quality of education. The level of English-language ability of current dental students will affect the quality of future dental educators and researchers.     

Dental education in relation to the needs of the South African community.

The dental needs of a heterogeneous South African community are not being fully met because the majority of the already deficient dentist population is in private practice, mostly in urban areas, where they are rendering services to a small minority of the population who can afford comprehensive dental care. Contrary to public health services in general, public dental services are inadequate in extent and provide a limited range of treatment to some eighty-five per cent of the population. Millions of under-privileged people, particularly in rural areas, are not within range of any professional dental care whatsoever. Organized community preventive programmes and dental health education on a national basis are non-existent. Water fluoridation has not yet become a reality. Realizing the shortcomings in community dental services the Government recently adopted a national dental health policy which is aimed at limiting and preventing dental diseases and also at expanding the public dental service to bring it within reach of all sections of the community. In order to meet the dental needs of the community and also to give momentum to the national dental health policy, the following steps are being taken as far as dental education is concerned: (i) The Department of Health is planning to assist universities to establish departments of community dentistry with the object of promoting extended education in community dentistry at under-graduate and post-graduate level. (ii) Consideration is being given to a scheme whereby dental students will have to do one year compulsory intership. (iii) Additional dental schools are being established to enable more non-White dentists to qualify. (iv) With the extended education in community dentistry it is hoped to draw more dentists into community dental services. (v) Dental therapists are being educated to perform duties such as extractions, simple fillings, prevention and dental health education, under the supervision of dentists, in areas where the shortage of dentists is most crucial.     

Special care dentistry for people with intellectual disability in dental education: an Italian experience

Aim:  This study documented: (i) the curriculum in special care dentistry in the Italian dental schools, as perceived by Deans and by students, (ii) the rate of satisfaction of dental students with their curricular education in special care dentistry, (iii) the attitude of the dental students towards special care dentistry and towards the 'Special Smiles' programme.
Methods:  The quality and amount of didactic and clinical training delivered by each dental school for subjects with intellectual disability (ID), the interest of students towards this health field and the 'Special Smiles' programme were collected. Self-administered surveys were sent to the Dean and to all the final year students of all dental schools in 20 Italian Universities.
Results:  Only four Deans of the 20 dental schools answered the survey, stating to provide didactic and clinical education in special care dentistry. A 51% of student response rate was obtained. Dental students reported to spend about 4% of didactic and 5% of clinical training in the dental care for ID subjects. Most students (83%) rated the training they had received on the topic to be poor. Over 50% of students expressed interest in working in dental offices specifically dedicated to ID patients and 25% of students wished to become Special Smiles volunteers.
Conclusions:  Although the paucity of didactic and clinical training in dental care for ID patients, this survey demonstrated a high level of student's interest in learning more about treating these subjects. The current results could suggest to revise the curricular standards of dental schools, by promoting ID-oriented education programmes.     

Residency Training in Dental Public Health: Assessment of Status, Needs, and Issues

The opportunities for public health training have declined over the years while the need for public health skills is likely to increase. This paper reports the results of a project, sponsored by the Health Resources and Services Administration, which answers the question of "how best to invest in the dental public health education system so as to fulfill the profession's responsibilities to protect and improve the oral health of individuals and society.' An information base on dental public health education, practice, and specialization was developed from an extensive review of the literature and a survey of dentists concerning employment and practice requirements for public health dentists. An advisory group considered this information, met to discuss the issues involved in dental public health training, and provided advice to the project staff. Based on the information gathered as part of the project, recommendations were made to: (1) develop a grant program to support advanced education in dental public health; (2) increase the competencies of dentists who are working in public health positions and not eligible for board certification via off-site residencies; (3) develop model programs in areas of great need, such as general public health, management, policy, prevention, environmental health and research, that in conjunction with a basic public health core, could satisfy the eligibility requirements of the American Board of Dental Public Health; (4) develop student loan forgiveness programs for dentists and dental hygienists working in public health; and (5) develop additional credential recognition programs for dental public health workers.