Public policy on oral health and old age: a global view.

This paper reviews major trends in the global demography and oral health status of populations, the challenges faced in ensuring successful aging because of these trends, and basic principles to guide public policy responses. Virtually all populations in which the dental caries prevalence reached high levels in the first half of the 20th century have experienced large reductions. A feared increase of the disease in the developing world has been far less than expected. Some countries that did suffer large increases dating from the 1960s already have managed to return to their former low levels because of timely use of preventive measures. Improving oral hygiene and a consequent reduction in the occurrence and severity of periodontal diseases further bolster the mainly positive trend in global oral health. Only in the former socialist economies is oral health status worsening. These positive changes have brought the expectation that an intact and well-functioning dentition should last for life, no matter how extended the lifespan becomes. But these changes take us into "uncharted waters" and the most appropriate strategies for preserving health in old age are unknown because they have never been tried. However, public policies to support community awareness and acceptance of broad-based preventive behaviors to preserve oral health in old age are essential. Policies also must provide guidance on how to proceed when disabling disease occurs, provide for regular research and updating of information, and ensure access to cost-effective and high-quality services for all.

Banco Mundial de Datos sobre Salud Bucodental de la OMS, 1986-1996: panorámica de las encuestas de salud bucodental a los 12 años de edad / WHO Global Data Bank, 1986-1996: an overview of oral health surveys at 12 years of age

En el presente artículo se describe la situación mundial de la salud bucodental de los niños de 12 años de edad - el índice de dientes cariados, perdidos y obturados (CPO) y el porcentaje de la población afectada - a partir de los estudios representativos más recientes sobre 80 países incluidos en el Banco Mundial de Datos sobre Salud Bucodental (BMDSB) de la OMS entre 1986 y 1996. El volumen de información varió mucho: 68 por ciento de las economías de mercado de los países desarrollados tenían por lo menos un conjunto nacional de datos, en comparación con 38 por ciento de las economías de los países en desarrollo y 36 por ciento de las economías en transición. Las proporciones en cada región de la OMS fueron las siguientes: Mediterráneo Oriental, 55 por ciento; Europa, 50 por ciento; Pacífico Occidental, 48 por ciento; Africa, 39 por ciento; Asia Sudoriental, 30 por ciento; y las Américas, 26 por ciento. En el mundo en general, el índice ponderado de dientes CPO en todos los datos del BMDSB es 3,0 por ciento, que es la meta de la OMS/Federación Dental Internacional para el año 2000. Con respecto a los datos reseñados en el presente artículo, se discuten el logro y el incumplimiento de esa meta, al igual que la variación del índice medio de dientes CPO y la proporción de niños afectados en varias agrupaciones de países. Hay dificultades para obtener datos recientes sobre muchos países, pero en el artículo se recalca la necesidad de mantener y ampliar el BMDSB para facilitar la recopilación de datos de salud bucodental válidos, fidedignos y comparables

WHO Global Oral Data Bank, 1986-96: an overview of oral health surveys at 12 years of age.

The global oral health situation of 12-year-old children--decayed, missing, filled teeth (DMFT) index and the percentage of population affected--is described in this article using the latest representative studies for 80 countries included in the WHO Global Oral Data Bank (GODB) between 1986 and 1996. The quantity of information varied considerably: 68% of developed market economies had at least one national data set, compared with 38% of developing countries and 36% of economies in transition. By WHO region, the proportions were as follows: Eastern Mediterranean, 55%; European, 50%; Western Pacific, 48%; African, 39%; South-East Asia, 30%; and the Americas, 26%. Globally, the weighted DMFT index for all data in the GODB is < 3.0%, the WHO/Fédération Dentaire Internationale goal for the year 2000. For the data reviewed in this article, achievement and nonachievement of this goal are discussed, as is the variation in DMFT means and proportions of children affected for various country groupings. There are difficulties in obtaining recent data for many countries, but the article emphasizes the need to maintain and develop the GODB to facilitate the compilation of valid, reliable and comparable data on oral health.

The community care model of the Intercountry Centre for Oral Health at Chiangmai, Thailand.

The Intercountry Centre for Oral Health opened in Chiangmai, Thailand, in November, 1981. In 1984, as part of its mandate to promote new approaches to the delivery of oral health care, it initiated a demonstration project known as the Community Care Model for Oral Health. Logistic, financial and organisational difficulties prevented the full implementation of the original plan. Nevertheless, consideration of the strengths and weaknesses of the Model has provided valuable suggestions for adoption by national and international health agencies interested in adopting a primary health care approach to the delivery of oral health services. Important features which could be appropriate for disadvantaged communities include: integration into the existing health service infrastructure; emphasis on health promotion and prevention; minimal clinical interventions; an in-built monitoring and evaluation system based on epidemiological principles, full community participation in planning and implementation; the establishment of specific targets and goals; the instruction of all health personnel, teachers and senior students in the basic principles of the recognition, prevention and control of oral diseases and conditions; the application of relevant principles of Performance Logic to training; and the provision of a clear career path for all health personnel.

Adding fluoride to sugar--a new avenue to reduce dental caries, or a "dead end"?

A study group was formed in 1989 by the Oral Health Program of WHO, Geneva, to consider the possibility of reducing dental caries by adding fluoride to sugar. Although a few promising clinical reports were available for review, the group found that information was too scarce for field trials to be recommended at this stage. Among the many items to be considered was what concentration of fluoride in sugar could reasonably be regarded as cariostatic. Thus, the committee decided to initiate studies to obtain further background information. Unlike fluoridated salt, the concept of fluoridated sugar does not involve trying to give the individual a certain daily amount of fluoride, since daily consumption varies considerably. Instead, the idea is to elaborate on recent fluoride research showing that low concentrations of fluoride may also be beneficial, particularly for remineralization, if present at the sites where caries occurs. This paper is an introduction to a set of papers describing the background for the project, attempting to define optimal concentrations for a clinical trial, and concluding that, although dental caries prevalence continues to decrease in industrialized countries, the potential for large increases remains in the huge populations in developing countries. All avenues must be searched for a system which optimizes preventive efficiency. However, the possible introduction of fluoridated sugar on the market is not related only to oral health. Safety aspects are of high priority, and several ethical, political, and economic factors must also be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Gathering data on oral mucosal diseases: a new approach.

A new approach to gathering epidemiological data on oral mucosal diseases has been tested with encouraging results in Sri Lanka. Its main advantage is that it does not depend on the examiner's ability to make a diagnosis, so it can be carried out by non-professionals such as dental students.

CPITN--a WHO initiative.

When the WHO Global Oral Data Bank was initiated in 1969 the Periodontal Index and the Simplified Oral Hygiene Index were the two preferred methods for data accumulation. It became clear that these two indices were not wholly satisfactory and in 1977 a WHO Scientific Group meeting was convened in Moscow which produced a prototype index, the TRS 621. In 1980 a Joint Working Group was established with the FDI from which emerged the formal adoption of CPITN. As a result the CPITN has enabled the sufficient accumulation of epidemiological data to permit much progress in our knowledge of periodontal disease, as well as being developed for clinical use in screening. Those involved with the development of the CPITN may be justly proud of the subsequent achievements resulting from this initiative.

Standard descriptive tables in WHO Oral Health epidemiological studies.

For many years the Oral Health Programme of the World Health Organization has promoted the development of oral health epidemiological surveys. The objective of this article is to make oral health researchers aware of the variables and statistical tables recommended by WHO for the standardization, presentation and comparability of international surveys. The influence of the growing impact of computer technology in providing better knowledge of oral health systems is also discussed in this article.

Inter-country application of standard epidemiology tools in oral health.

If there is a single project which could demonstrate the intensive use of the WHO standard oral epidemiology methods which have been discussed and demonstrated in papers published elsewhere, it is the series of collaborative studies of oral health care systems referred to in brief as ICS-I and II. These consist of multi-country studies from which to assess the relative merits of different delivery systems based on interlinked clinical and sociological data for the consumer and sociological data for the provider. In both the ICS-I and II, each participating country team followed the same protocol and every effort was made to retain, for ICS-II, not only the same research strategy, but also as much of the methodology as possible. ICS-I covered the years 1973 to 1983: ICS-II began in 1988 and is due to end in 1995. A detailed description of the sampling, survey and analysis approaches is given in the first part of this article and highlights of the inter-country clinical data in the second part. Although ICS-I was hampered in its objective to compare relative strengths of delivery systems, or elements thereof, by the lack of comparative longitudinal data, its results had tremendous impact both for participating countries and others which could learn from the study findings. That impact was evident in the most practical form of wholesale changes in various systems and approaches and in application of study findings in constructing new systems. ICS-II data are intriguing both in the new examples they present and in comparisons over time, as well as in the improved methods developed as a result of lessons learned in ICS-I. The full report will be available in 1995.

The application of the theoretical model WHO/FDI planning system to an industrialised country: France.

The results of the application of the WHO/FDI planning system to a specific situation in an industrialised country provide valid arguments in favour of its use. It is shown to be an aid to planners when estimating oral health personnel requirements and emphasises the necessity of obtaining basic information on the oral health status and demand for treatment in industrialised countries. The strength of the system lies in the fact that it enables the user to forecast requirements, by age cohort and by type of care, while at the same time including socio-economic variables which have a major influence in industrialised countries with moderate caries levels. This flexibility of use enables the system to be adapted, if necessary, or even improved, according to the constraints which may result from a specific situation analysis.

Evaluation of the World Health Organisation pathfinder methodology for oral health surveys in industrialised countries.

The aim of this study was to carry out a survey using the pathfinder methodology developed by the World Health Organisation for international surveys and to compare the results (DMFT, DT, MT, FT) with those obtained from a national survey in France. The statistically significant difference observed between the results of the DMFT and DT indices obtained by using the two methods does not affect the classification of France at the 'moderate' level on the World Health Organisation scale for caries prevalence at the age of 12 years. The observed DMFT difference is an argument in favour of using the World Health Organisation pathfinder methodology, as it provides a satisfactory degree of precision on the oral health status of a population for planning purposes.

Profiles of periodontal conditions in older age cohorts, measured by CPITN.

Results of more than 80 CPITN surveys from almost 30 countries for the age groups of 45 years and above are assembled. In this first overview, data for the older age cohorts are presented, showing the percentages of persons according to the highest score per person and the mean numbers of sextants affected per person. Results for three age groups are presented: 45-54, 55-64 and 65-74 years, with two additional surveys in older persons. There were marked variations in periodontal conditions between surveys. The assumed differences between industrialized and non-industrialized countries with regard to periodontal diseases did not show in the data examined. Also, the expected increase in periodontal destruction with increasing age was not reflected in values for pocketing or deep pocketing in the successive age groups. Some variations between surveys was also noted for the rate of tooth loss, expressed in the mean number of excluded CPITN sextants. However, on average, at age 50, almost one sextant was excluded, increasing to 1.5 sextants at 60 and almost 2.5 sextants at age 70. It is therefore suggested that the progress of periodontal destruction with age is not shown in an increase in periodontal CPITN scores, but in increased tooth loss, specified by an increasing number of excluded CPITN sextants. For the age group 65-74 years, this results in, on average, almost half of all sextants being excluded. Of the remaining sextants, approximately half had shallow and/or deep pockets.

WHO pathfinder caries survey in Beijing extended with data for prevalence of mutans streptococci.

A pathfinder caries survey was carried out in Beijing, People's Republic of China, using WHO standard methodologies, in order to estimate the trend by comparing the results with the 1981 caries survey, performed in the same area. Simultaneously, the levels of mutans streptococci in the group were estimated in order to define the proportion of children with high and low mutans levels. Twelve-year-old children were randomly selected from schools in five districts within the city limits. Examinations for caries were performed according to 'WHO Oral Health Surveys' by two calibrated examiners. A total of 178 children were examined for caries and 156 of them were randomly selected for saliva sampling of mutans streptococci, using the 'Strip mutans' method. The number of colonies adhering to the strips were compared with a chart, supplied by the manufacturer, and given a score between 0 and 3, indicating low to very high saliva mutans counts, respectively. The results showed a mean DMFT of 1.87 (1.61-0.06-0.20, for decayed, missing and filled teeth respectively); 66.3 per cent of the children were affected. Fourteen per cent had mutans class 0, 28 per cent class 1, 35 per cent class 2 and 23 per cent class 3. The mean DFT, for each mutans class was 0.82, 1.48, 2.09 and 2.69, respectively. The differences were statistically significant (P = 0.0015). In the lowest mutans class, 50 per cent had caries and the mean number of teeth requiring conservative care was 0.68. For the high mutans group, the corresponding values were 72 per cent and 2.11 teeth.(ABSTRACT TRUNCATED AT 250 WORDS)

Profiles of periodontal conditions in adolescents measured by CPITN.

Results of more than 100 CPITN surveys from over 60 countries for the age group 15-19 years, stored in the WHO Global Oral Data Bank as of 1 August 1990, are assembled. They are presented in the form of graphs showing the mean number of sextants affected per person and arranged by country according to WHO regions. It is hoped that these overviews provide a frame of reference for the evaluation of periodontal conditions in populations and population subgroups. The most frequently observed condition in adolescents was score 2 (calculus with or without bleeding). Calculus seems to be much more prevalent in non-industrialized than in industrialized countries. Although some shallow pocketing of 4 or 5 mm was present in two-thirds of all populations observed, it affected mostly only a minority of the sample and then only in one or two sextants. However, a few surveys showed a relatively high prevalence of pocketing. As the surveys were carried out in adolescents, such high figures indicate serious problems ahead.