Strategies to promote better access to over the counter products for oral health in Europe: a Delphi survey.

OBJECTIVES: 'Over The Counter' (OTC) is a pharmaceutical product or medicine whose distribution or the administration does not require medical authorisation, and which can be used by consumers on their own initiative. This can be to prevent, relieve or treat symptoms or moderate pathologies and whose use, under the forms, packaging and authorised formulation are safe for the consumer. A Delphi consultation in the perspective of coming to a consensus was initiated to identify the current and future orientations on the best strategies of administration of OTC products for oral health in Europe. METHODS: A Delphi Survey was conducted with 54 experts from 23 countries in Europe. Each indicator statement was considered to be in consensus if the expert's opinion rating was of 4 or 5 for more than 75% in a scale of seven categories. The first questionnaire concerned self medication and the situation of OTC prescriptions in 2006. The second included 19 statements focused on the possible role of OTC products in dental practice. Both qualitative and quantitative analyses were created. RESULTS: There was a strong consensus that the population's common practices towards OTCs should be modified. Practitioners should possess communication qualities allowing them to share their power and to advise patients of their decision-making concerning oral care. CONCLUSIONS: The Delphi Survey was successful in underlining that dentists have to be involved in oral health OTC prescription which, currently, seems unsatisfactory. OTC products and especially fluoride toothpaste improve oral health but have to be available, accessible and used advisedly.

Report of the EGOHID I Project. Selecting a coherent set of indicators for monitoring and evaluating oral health in Europe: criteria, methods and results from the EGOHID I project.

OBJECTIVES: The EGOHID I (European Global Oral Health Indicators Development) project started in 2002 under the European Health Monitoring Programme. The aim was to develop a set of indicators for monitoring and describing oral health morbidity and different facets of oral health care systems in Europe. The challenge was to define valid indicators that would cover common concerns and would have the same meaning throughout the different European health care systems. METHODS: EGOHID included i) a review of existing recommendations on oral health indicators, ii) a European study of the availability of national/or regional statistics to construct recommended indicators; iii) a consensus process using aggregation of preferences methods to select a list of essential indicators; iv) the production of a catalogue for information users, including descriptions for all indicators. RESULTS: A set of 40 indicators in oral public health were identified which, even though restricted to a minimal essential list, still addressed four key dimensions. The 40 indicators were described in four categories. Part A. indicators for monitoring the oral health of children and adolescents; Part B. indicators for monitoring the oral health of general population; Part C. indicators for monitoring oral health systems and Part D. indicators for monitoring oral health quality of life. This work has enabled a feasibility study (EGOHID II, which is now in progress), which is an essential part of an overall project, since it will allow Member States to evaluate their capability to use these indicators. CONCLUSIONS: The EGOHID 1 project was successful in identifying a set of 40 indicators which drew on and consolidated previous work. Consensus was achieved from a wide group of stakeholders on precise indicators in areas where uncertainty about appropriate indicators was high; some areas were also targeted for future development.

Factors influencing the long-term results of endodontic treatment: a review of the literature.

The purpose of this review of the literature is to examine the factors and their influence on the outcome of endodontic treatments, and also to attempt to have an authors' consensus concerning the impact of these factors on long-term results. The documentary research was conducted using the meta-analysis principles of critical reading of the literature. Two groups of factors can be identified regarding the outcome of endodontic treatments: those which influence the success of the procedure and those which do not significantly affect the success rate. Agreement is obtained in all studies on two major factors, the preoperative periapical status and the apical limit of the obturation, which appear to strongly influence the success of endodontic therapy. This review highlights the methodological problems of retrospective studies and points out the need for consensus regarding the evaluation criteria of root canal therapy.

Oral health status and treatment needs of 35-44-year old adults in Lebanon.

OBJECTIVES: The purpose of this study was to assess the oral health status and treatment needs of a Lebanese adult population. DESIGN: An epidemiological survey of 401 Lebanese adults aged 35-44 years was carried out in 1996. It followed the WHO methodology in assessing the oral health status and treatment needs of adult populations. A structured questionnaire and a standardised oral health exam were used for the investigation. RESULTS: Showed that the Decayed, Missing and Filled Teeth (DMFT) index was 16.3 and that 1.5 per cent of the sample had a DMFT score of zero, whereas, 55 per cent had a score of less than 4. Of the 401 subjects, 24 per cent had at least one bridge and 16 per cent had a removable prosthesis. Compared to other neighbouring countries, Lebanon ranked the highest in the DMFT index and its separate components. Close to 60 per cent of the sample was in need of operative treatment, 31 per cent needed tooth extraction and 60 per cent were in need of a crown or a bridge. Significant variations were observed in the oral health status as well as treatment needs of the sample when examining gender, socio-economic status, and place of residence differences. CONCLUSION: This study can be used as a stepping stone in the direction of building the base of knowledge on oral health in Lebanon. The planning and implementation of any strategy for oral health status improvement is crucial, alongside the country's infrastructure development.

The World Health Organization initiative on noma.

Oro-facial noma is a worldwide scourge in a context where the World Health Report 1998 gives a global incidence of 140,000 cases, a prevalence in 1997 of 770,000 persons surviving with heavy sequelae. The background and the five steps of the WHO oral health programme to control noma including: (i) ensuring training and awareness on early diagnosis and treatment for each public health structure, (ii) raising awareness and informing populations, (iii) promoting epidemiological research, (iv) promoting aetiological research, (v) setting up an African regional centre for the treatment of after-effects, are developed in this paper.

Epidemiology of the incidence of oro-facial noma: a study of cases in Dakar, Senegal, 1981-1993.

Oro-facial noma is an oral gangrene occurring in early childhood in extremely poor areas. As many as 70-90% of those with noma die, and to date, there is no satisfactory treatment to fight this disease. Within the context of the World Health Organization international program against noma, a 13-year retrospective study based on clinical records was carried out in Dakar, Senegal in an attempt to understand the epidemiology of noma. Between 1981 and 1993, 199 cases of noma were identified, among them; 36.7% were acute cases and 63.3% showed sequelae. Chronic sequelae of noma were seen in patients 2-41 years of age, but the acute phase of noma was found only in young children (77.7% in those 1-4 years of age, maximum age = 9 years, mean age +/- SD age = 3.4 +/- 1.9 years). A total of 73.1% of the cases with acute disease were reported in the Dakar, Diourbel and Kaolack regions during the dry season (57.0% of the cases). The lesions of progressive noma were localized mainly on the upper lip (42.4%) and the cheek (31.1%). A total of 96.9% of the patients with acute diseases were had poor general health with serious associated diseases; only 20.0% had a good vital prognosis. The development of epidemiologic surveillance programs for noma should be a public health priority in Senegal.

Periodontal conditions in 65-74 year old adults in France, 1995.

In 1995, a study was undertaken in France to assess the periodontal health status of 603 noninstitutionalized elderly subjects aged 65-74 years. Thirty areas were identified in the Rhône-Alpes region, with a sampling method based on stratified quotas according to sex, place of residence and socio-economic group (S-EG). The CPITN index was used. The total prevalence of healthy dentate adults (n = 483) was 16.5 per cent, whilst 16.3 per cent of the adults were edentulous. The prevalence of CPITN code 1 + 2 (low) was 50.7. The higher S-EG having fewer codes 1 and 2 (45.8 per cent) than the lower S-EG (49.7 per cent) and the medium S-EG (55.7 per cent). The total prevalence of periodontal disease (code 3 + 4) was 31.5. The prevalence of periodontal disease was lower in adults of medium socio-economic status and was also lower in adults living in urban residences. Overall, 66.9 per cent of the entire population needed oral hygiene instruction, 56.6 per cent scaling and 2.3 per cent complex periodontal treatment.