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.     

Written Testimony from the American Board of Dental Public Health

The American Board of Dental Public Health strives to improve the health of our nation by establishing and promoting standards for dental public health practice and recognizing dentists for their special knowledge and ability in dental public health and preventive dentistry. As one of the eight specialties recognized by the American Dental Association, this specialty focuses upon the oral health of communities and population groups with an emphasis on oral health promotion, disease prevention, and access using organized community efforts. The board offers the following 12 recommendations:

• 1 Dental education must actively support diversity in education and practice to meet the public's needs in a culturally sensitive and cost-effective manner. Also, dental education must define its educational base in light of current as well as emerging and evolving needs of society.
• 2 Dental education must incorporate the interdisciplinary and multidisciplinary aspects of health services delivery.
• 3 3. Disease prevention and health promotion must be given a much higher priority in dental education.
• 4 Basic knowledge and experience in dental public health must be an integral component of predoctoral education.
• 5 The number of specialists in dental public health needs to be increased, and graduate training in both traditional and expanded areas of dental public health needs to be enhanced and increased.
• 6 Dental education must develop methods for incorporating new scientific knowledge and technologies into the curriculum and practice.
• 7 A systematic, objective approach needs to be developed to improve and enhance the role of oral health professionals to respond to a constantly evolving social and political environment and science base.
• 8 The role of dental education institutions in continuing education must be restructured and improved to address practitioner competency and relevancy to the needs of society.
• 9 Dental practice guidelines need to be established and monitored.
• 10 Accreditation, licensure, and certification need to be restructured to meet the health needs of the public.
• 11 Education and behavioral research to improve the dental education process needs to be reestablished, improved, and expanded.
• 12 Pilot programs need to be developed, implemented, and supported to stimulate the necessary changes in dental education to be more responsive to the needs of society.

The American Board of Dental Public Health (ABDPH) appreciates this opportunity to provide written testimony to the Institute of Medicine's (IOM) Committee on the Future of Dental Education. The recommendations of this committee will provide the nation with critical guidance toward meeting the oral health needs well into the next century.     

The practice and infrastructure of dental public health in the United States

Dental public health is a unique and challenging American Dental Association-recognized specialty because the patient is the entire community or population, such as a school, neighborhood, city, state, or the nation, with a focus on vulnerable populations. Limited resources are maximized through prevention, policies, programs, and organized community efforts to respond to great unmet needs. Although dental public health professionals are few in number, millions of people every day have better oral health because of these professionals, who work on the local, state, and national level.     

Clinical practice of the future. The future of dentistry.

The last 20 years have brought enormous change to the dental profession. The American Dental Association Future of Dentistry Report examines some of these advancements and discusses what changes to anticipate in the future. Among the most significant changes are those that will occur in the scope of clinical dental practice. This is largely due to anticipated shifts in patient demographics, provider availability, advancements in science and technology, and a changing role for the dentist in the health care community. Future dentists will maintain their role as experts on diseases of the oral cavity. However, their responsibilities will change and increase as they observe the interaction between oral and systemic health. Dental education, therefore, must reflect the changing role of the dentist.     

Dental public health research in action: population and community-based research

Dental public health investigators conduct research from a population and societal perspective. Population-based epidemiologic studies are at the heart of dental public health research, as well as many other types of clinical and translational studies that aim to benefit dental practice, influence oral health policies, and improve the oral health and health of the public. This article gives examples of dental public health research in action, including many ongoing or recently completed studies conducted in California.     

Dental hygiene's interdisciplinary relationship with dental public health: a position paper

Dental hygienists' collaboration with social institutions, health-care workers and organisations, educational institutions, and dentistry can prevent oral diseases. Dental hygienists working in these organisations can reach an unprecedented number of people, thereby increasing preventive oral care to many undeserved. Working within a dental public health career increases choices and opportunities for the dental hygienist and benefits the public.     

An argument for dental hygiene to develop as a discipline

Abstract:  The practice of dental hygiene was developed to provide oral health education and preventive oral health care, originally for children. It has grown to provide oral health services valued by a broad spectrum of society, but has not attained the desired respect and status accorded to other professional groups. Objective:  Professional disciplines link actions of practitioners with the science that is the foundation of practice. The purpose of this paper is to examine whether dental hygiene practice could benefit from pursuit of development as a discipline. Methods:  Literature on professionalization and disciplines, related to dental hygiene in general and the North American context specifically, was retrieved from databases and grey sources, such as organizational reports. Dental hygiene's current characteristics relative to a discipline were examined. Results:  Dental hygiene has developed some characteristics of a discipline, such as identifying a metaparadigm that includes concepts of the client, the environment, health/oral health and dental hygiene actions, with a perspective that includes a focus on disease prevention and oral health promotion. However, research production by dental hygienists has been limited, and often not situated within theoretical or conceptual frameworks. Conclusion:  Dental hygiene draws its knowledge for practice from a variety of sources. Dental hygiene could strengthen its value to society by prioritizing development of highly skilled researchers to study interventions leading to improved oral outcomes, and transferring that knowledge to practitioners, strengthening links between practice and science. Intentional pursuit of knowledge for practice would lead to dental hygiene's eventual emergence as a professional discipline.     

The Dental Hygiene Program in Portugal

Abstract: The Dental Hygiene Program is a fairly recent addition in the field of the health professions in Portugal. In the past 19 years, the programme has developed community activities alongside with clinical work. This programme provides an education that is responsive, scientific and professional, in a learning environment that is dynamic, student-centred and that encourages collaboration between students and faculty. The community activities play a major role in the curricula of the programme and allow the students to develop skills in working with a wide range of population groups and to attend to their specific needs. Dental hygienists are integrated in health teams and work under the supervision of a physician or a dentist. Among other responsibilities, the following functions are part of the scope of the profession: to participate in health education programmes and sensitise the population to the prevention of dental diseases, to participate in the planning, implementation, and evaluation of the public health programmes and to perform clinical treatment for prevention and control of gingivitis, periodontitis, and dental caries. An overview of the activities developed in the year 2002 and future perspectives are presented in this article.     

Reforming dental workforce education and practice in the USA

The USA dental education programmes are facing challenges similar to those confronting countries around the globe, particularly amongst the industrialised nations. The purpose of this study was to evaluate the educational programmes of 15 USA dental schools to determine their impact on improving workforce diversity and oral health care access. The study investigates the predictors of public service plans of dental school seniors in Pipeline and non‐Pipeline Program dental schools. We analysed baseline and post‐intervention data collected in the American Dental Education Association (ADEA) Annual Survey of Dental School Seniors and a set of contextual variables. Public service plans (dependent variable) was predicted by four types of independent variables: intervention, contextual, community‐based dental education (CBDE), and student characteristics. Findings from the study show that access to a state or federally sponsored loan repayment program was the most significant predictor of public service plans and that increasing educational debt was the most significant barrier. In the short‐term we may be able to sustain the USA loan repayment programs to motivate senior dental students to provide public service to address the oral health care access crisis. However, in the long‐term, a new workforce development initiative will be required to transform dental education and practice, modelled after the well‐respected licensure programmes for Physician Assistants and/or Advanced Practice Registered Nurses, to expand oral health care access, particularly amongst vulnerable population subgroups, such as low‐income children and families.     

Quality assurance and dental hygiene

Abstract:  Dental hygiene in Canada has experienced significant growth. It has shifted from an emerging occupation to a regulated health profession in several jurisdictions. Many achievements may be attributed to this growth, including self-regulation and a national code of ethics. However, the majority of Canadian dental hygienists are relying on traditional, outdated and ineffective quality assurance mechanisms, such as mandatory continuing education requirements. In the interests of public protection, dental hygiene needs to ensure that the quality assurance activities required from its members are effective, valid and reliable. Quality assurance in health care continues to undergo modifications that better reflect the public's need for competent, ethical, safe and appropriate health care. Dental hygienists and dental hygiene regulatory bodies are challenged to find valid, reliable and effective methods of quality assurance. This paper discusses some of the developments in quality assurance in health care as well as some of the key and significant achievements of dental hygiene in Canada. The use of quality assurance mechanisms currently used in dental hygiene in Canada is also discussed. The paper concludes with a discussion on the potential barriers and issues that the profession may face when attempting to incorporate suitable quality assurance activities into daily dental hygiene practice.     

Tooth decay in our poorest children: what can we do?

Dental programs for the poor have failed to deliver improved oral health for children to the same degree as their more well-off counterparts. Community health workers continue to identify dental problems as the greatest unmet need in their communities. Yet, many do not see this as a problem. Practitioners need to act in concert through their dental societies to establish and efficiently manage community-based outreach programs. Child dental health can also be improved by increasing access through public and non-profit community clinics and integrating child dental services with medical care.     

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.     

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.     

Dental plaque biofilm in oral health and disease

Dental plaque is an archetypical biofilm composed of a complex microbial community. It is the aetiological agent for major dental diseases such as dental caries and periodontal disease. The clinical picture of these dental diseases is a net result of the cross-talk between the pathogenic dental plaque biofilm and the host tissue response. In the healthy state, both plaque biofilm and adjacent tissues maintain a delicate balance, establishing a harmonious relationship between the two. However, changes occur during the disease process that transform this 'healthy' dental plaque into a 'pathogenic' biofilm. Recent advances in molecular microbiology have improved the understanding of dental plaque biofilm and produced numerous clinical benefits. Therefore, it is imperative that clinicians keep abreast with these new developments in the field of dentistry. Better understanding of the molecular mechanisms behind dental diseases will facilitate the development of novel therapeutic strategies to establish a 'healthy dental plaque biofilm' by modulating both host and microbial factors. In this review, the present authors aim to summarise the current knowledge on dental plaque as a microbial biofilm and its properties in oral health and disease.     

A Symposium on Building a Coalition To Improve the Public''s Oral Health: Reaction Paper

The dental research community has a social and civic responsibility to participate actively in promoting the public's oral health, but participation should be carefully orchestrated with other groups. The ADHA "Hearing on Needs" has stimulated a coalescing of groups and individuals to contribute to the welfare of society's oral health. Dental organizations—especially dental public health organizations—need to work more cooper- atively together to work, in turn, with other organizations. "In union, there is strength."     

中国口腔医疗保险发展之分析

本文通过查阅大量文献,分析口腔疾病的特点、影响口腔服务利用的因素以及国内外口腔保险的现状,着重讨论了口腔医疗保险对改善口腔医疗服务利用率和促进人群口腔健康的积极作用,利用PEST分析法分析了在中国建立和完善口腔医疗保险的必要性和可行性,提出急需解决的核心问题和发展策略.只有发展口腔保险事业,提高人们对口腔健康的关注度以...     

Are Dental Hygienists Prepared to Work in the Changing Public Health Environment?

Health care reform, the changing public health environment, and a lack of clarity about what defines a ‘public health professional’ create challenges as well as opportunities for dental hygienists who wish to pursue positions or careers in public health.BackgroundAlthough many studies have been conducted about dental hygienists in clinical practice, there are few describing dental hygienists working in public health positions, particularly in non-clinical roles, or how well their education and other resources prepared them for these roles. Competency statements and the 10 Essential Public Health Services to Promote Oral Health in the U.S. provide a public health framework to assess what skills will be required for future opportunities that may emerge for dental hygienists.MethodsPublished literature, recent unpublished survey data, selected professional health care reform documents, competency statements, accreditation standards, and the 10 Essential Public Health Services to Promote Oral Health in the U.S. were analyzed. Competencies in public health/dental public health provide an overview of skills needed by dental hygienists who will be seeking public health positions. Health reform statements describe the need for more leadership and workforce models in public health, while the 10 Essential Services can serve as a framework for career preparation/transition.ConclusionsThe literature does not provide a comprehensive historical review or current profile of dental hygienists who work in various public health positions or their various roles, especially non-clinical roles. More research is needed regarding current positions, degree and experience requirements, and role responsibilities. Additionally, the credentials and public health background of the faculty teaching community/public health courses in dental hygiene programs requires exploration. Follow-up studies of dental hygiene program graduates could help determine how well courses prepare students for public health activities or careers and what resources aid in transitioning from clinical to public health positions. Dental hygienists need more information about education, continuing education and employment opportunities related to pursuing a career in public health.     

The role of the dental team in promoting dental health and general health through oral health.

The two major dental diseases are related to diet and dirt. These are common risk factors for a number of chronic diseases. A logical approach to the prevention of chronic diseases is to focus on risk factors rather than on specific diseases, a common risk factor approach using health promotion. Health promotion is the process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health. The concepts incorporated in health promotion include a promotion of health through public policy, creating supportive environments, developing personal skills, strengthening community action and reorienting health services. The dental team should incorporate the following principles: integration with general health education, encouraging participation of the community, the public and staff in the planning process; making healthy choices the easier choices. By adopting a Common Risk Factor Strategy incorporated into Primary Health Care, dental teams can promote dental health and general health. The latter objective will be achieved by reducing pain and suffering related to dental diseases. A much broader remit for dental teams is outlined, one which will do justice to the abilities and training of all members of the team.     

Holes a plenty: oral health status a major issue for newly arrived refugees in Australia

BACKGROUND: Dental health needs of newly arrived refugees are much greater than for the wider Australian community. This paper identifies the disparities and highlights major dental health issues for Australia's growing and constantly changing refugee population. METHODS: Using available data and the decayed, missing and filled teeth (DMFT) index as a measure of oral health, the reported oral health status of refugee groups in Australia was compared with that of the general population, Indigenous Australians, recipients of public dental services, special needs groups in Australia and other refugee groups outside Australia. RESULTS: The reported oral health status of Australian refugees compared poorly with the comparison groups. Of particular concern was the number of reported untreated decayed teeth (D). This ranged from a mean of 2.0 to 5.2 compared with 0.6 to 1.4 for the general Australian population. Refugee groups also reported fewer filled teeth (1.0 to 5.8) compared with the general population (4.1 to 9.3). Similar results were found when reported D, M and F teeth for refugees were compared to Indigenous Australians, public dental service recipients, immigrants and special needs groups in Australia. CONCLUSIONS: Dental health of refugees, particularly untreated decay, compared poorly to that of Indigenous Australians, and special needs populations in Australia who all have known worse dental health than the general population. There is an urgent need for the inclusion of this at risk population among targeted dental services. In addition, sources of health related data must clearly identify refugees to enable appropriate comparisons with other population groups. Recommendations for refugees are made regarding on-arrival dental assessment and treatment, and community based oral health programmes.     

Prevalence of systemic diseases in Brisbane general and periodontal practice patients

BACKGROUND: Periodontitis has been associated with a number of systemic diseases such as atherosclerosis, coronary heart diseases, and respiratory diseases. This study aimed to determine whether there is a significant difference in the prevalence of systemic diseases (a) in patients referred for periodontal care compared to the general practice population, (b) in patients attending a public hospital and private practices, (c) in patients attending public and private periodontal practices, and (d) among patients with periodontitis of varying severity. METHODS: Charts of 1000 adult patients were selected from four clinics (University of Queensland (UQ) School of Dentistry Admissions Clinic, UQ School of Dentistry Periodontics Clinic, Private Periodontal Practice, and Private General Dental Practice). The prevalence of medical conditions was evaluated using validated self-reported health questionnaires. The periodontal condition was assessed from the most recent relevant radiographs in the files. RESULTS: Periodontal patients had a higher prevalence of systemic diseases compared to the general practice population. Public patients had a greater prevalence of systemic diseases compared to patients in private practice for both general practice and periodontal patients. In patients with advanced periodontitis, bronchitis, hepatitis and rheumatoid arthritis were most prevalent. Patients with periodontitis also took more medications and were more likely to suffer from multiple conditions compared to the general dental population. CONCLUSIONS: Patients attending public dental facilities have an increased prevalence of systemic disease compared to those attending private practices. Furthermore periodontal patients have a greater prevalence of diseases compared to general practice patients. Patients with moderate or advanced periodontitis show an increase in the prevalence of some systemic diseases previously reported to be risk factors for periodontal disease.