Changes in division of labour and tasks within public dentistry: relationship to employees work demands, health and work ability.

OBJECTIVE: By 2023, fewer dentists are expected in Sweden, at the same time as the demand for dental care is expected to increase. Older people, in particular, are expected to require more dental health than previous generations. To meet this demand, the public sector dentistry in Sweden is moving towards changes in division of labour among dental professionals, including dentists, dental hygienists and dental nurses. However, the impact of this reallocation on the physical and psychosocial wellbeing of employees is unknown. The aim of this study was to compare workplaces with an equal or larger proportion of dental hygienists than dentists (HDH) with workplaces with a larger proportion of dentists than dental hygienists (HD) on the physical and psychosocial work load, musculoskeletal and psychosomatic disorders and sickness presence. MATERIAL: A total of 298 persons employed in the Public Dental Service in a Swedish County Council participated in this study. CONCLUSION: The medium large clinics HDH reported 85% of employee's with considerably more high psychosocial demands compared to employees in medium HD (53%) and large HD (57%). Employees in medium large clinics HDH also reported sleep problems due to work (25%) compared with employees in medium large clinics HD (6%), large clinics HD (11%) and small clinics HDH (3%). Clinic size does not seem to influence the outcome of the HD and HD clinics to any great extent. Of all employees, about 94-100% reported high precision demands and 78-91% poor work postures.

Não comparecimentos às primeiras consultas odontológicas na atenção secundária em um município mineiro de grande porte / No-shows to the first scheduled dental appointments for secondary care in a large Minas Gerais city

O não comparecimento de usuários a consultas agendadas, especificamente aquele relativo à atenção secundária odontológica em Belo Horizonte, não é problema recente, representando impactos à saúde, prejuízos à resolutividade e integralidade do cuidado, além de custos desnecessários ao sistema. O presente estudo, por meio do método quantitativo, visou à identificação e análise de possíveis fatores associados aos não comparecimentos, em 2011, às primeiras consultas odontológicas agendadas de usuários residentes em Belo Horizonte, pertencentes a ambos os sexos, com idade igual ou superior a 18 anos referenciados, a partir da atenção primária, para as especialidades odontológicas cirurgia, endodontia, periodontia e disfunção têmporo-mandibular, no Centro de Especialidades Odontológicas (CEO) Centro-Sul. Foi utilizada pesquisa em base de dados secundários do Sistema de Regulação da Secretaria Municipal de Saúde da Prefeitura de Belo Horizonte(SMSA/PBH). A variável dependente foi o "não comparecimento" à primeira consulta agendada e as variáveis independentes analisadas foram: idade, tempo na fila de espera, sexo, distrito sanitário de origem e especialidade para a qual o usuário foi referenciado. Foram utilizados os testes de Mann-Whitney e qui-quadrado de Pearson para análise bivariada e regressão de Poisson com variância robusta para análise multivariada. Os testes foram conduzidos com um nível de significância de 5% e intervalo de confiança de 95%. Entre as 6.428 primeiras consultas odontológicas agendadas para 2011, nas quatro especialidades selecionadas para análise, 32,9% não foram realizadas em função da ausência do usuário...

The platform for better oral health in Europe--report of a new initiative.

Public health practitioners are required to apply their competencies at a range of levels from governmental to small community groups. A recurring theme at BASCD conferences has been the need to influence policy at the highest level if improvements to oral health and better treatment of oral ill-health are to occur. This paper presents a clear example of such dental public health action at a European level. This report outlines the reasons why it is necessary to try to improve oral health within Europe, in general, and the European Union in particular. It goes on to describe how the newly formed Platform for Better Oral Health in Europe is trying to work at a macro level, and bring interested associations, groups and individuals together. Collectively they can then alert European institutions and national governments to oral health problems and promote policies to improve the current situation. It describes the current problems, their resource implications, the objectives of the Platform, its actions so far and its plans for the immediate future. It suggests that, if the problems are to be addressed, it will be necessary for all interested parties to work together at a European level to raise oral health issues higher on the E.U. agenda.

A curriculum for the new dental practitioner: preparing dentists for a prospective oral health care environment.

The emerging concept of prospective health care would shift the focus of health care from disease management to disease prevention and health management. Dentistry has a unique opportunity to embrace this model of prospective and collaborative care and focus on the management of oral health. Academic dentistry must better prepare future dentists to succeed in this new health care environment by providing them with the scientific and technical knowledge required to understand and assess risk and practice disease prevention. Dental schools must consider creating career pathways for enabling future graduates to assume important leadership roles that will advance a prospective oral health care system.

Organisation and management of public dentistry in Sweden. Past, present and future.

UNLABELLED: Professional organisations present challenges in management compared to producing companies, as control of the work lies within the professional groups themselves. Management in the Public Dental Health Service (PDHS) has an added difficulty in the two-tiered political governance in Swedish public dentistry. The aim of this thesis was to contribute to better understanding of the organisation and management of Human Service Organisations, especially the PDHS in Sweden, thereby contributing to long-term sustainability with due regard to the professionals. The aim was also to point to some future difficulties facing the PDHS and possible solutions to these. Four papers are included in the thesis. The first paper set out to define the professions in dentistry in Sweden from theories on professions. Dentists and, to a lesser degree; dental hygienists were the identified professional groups. The second paper scrutinised the external environment for dentistry in Sweden in the form of political decisions, i.e., laws and regulations. The findings were that there can be a gap between the formal objectives and the factual behaviour from the political level, and that certain politically attractive ideas might reoccur at a later time despite good scientific arguments against them. Also indicated in this paper were ways to influence the political processes, by active participation in the early stages of decision-making The third paper dealt with the heads (CDOs) of the PDHS in the counties and is based on a questionnaire to them on management. It was found that ideas on management and organisation usually were embedded in the way the respective county council was organised. A strong belief in advantages of scale was noted, both for administration and also for dental care itself. The fourth paper compared overall job satisfaction among publicly employed dentists in Denmark and Sweden. A focus on size of clinic, on professional development and on influence at the work place was found to be important. The Danish dentists were generally more satisfied with their overall job situations than the Swedish ones. One explanation might be found in the environment for the respective service, with a much stronger element of competition in Sweden. Another aspect could be that the expectations of the Danish dentists might be more realistic when they entered the public service. In an appendix the history of the Swedish Public Dental Health Service is outlined. CONCLUSIONS: Dentists in Sweden are an established profession and dental hygienists are an emerging profession; they and society would benefit from a clearer delineation and definition of their unique competences. Political decision-making is not necessarily rational, and garbage can models or similar can give a better understanding of political processes. CDOs have a widespread belief in advantages of scale in administration as well as in care, which may pose future problems for the provision of dental care in sparsely populated areas. Overall job satisfaction, as part of Good Work, is founded in an atmosphere at the clinic that is focussed on professional values. It is noteworthy that PDHS dentists not born in Sweden had a lower job satisfaction than those born in Sweden. Perhaps a closer cooperation between the dental colleges and the PDHS might give the newly qualified dentists a more realistic view of the professional challenges in public dentistry, as well as giving the colleges access to the vast material on patients in the PDHS. The future division of tasks between the general dentists, dental hygienists and specialist care dentists has a great impact on the future need for personnel, and needs to be carefully analysed. The future diminishing numbers of dentists and the difficulty for the PDHS to retain dentists may be met by adapting the organisations to a much greater flexibility by allowing different teams to organise their own work. The possibilities to give the patients good service quality will depend on continued democratisation and less managerial control. Producer cooperatives, franchising, or similar, could be revisited and tried. However, such forms will require carefully designed contracts where the objectives and the outcomes are possible to define and to evaluate. The balance between good work for dentists, an efficient organisation and perceived good service to the public will be objects for further studies.

A potencial influência do capital social na saúde bucal: um estudo de perdas dentárias em adultos / The potential influence of social capital on oral health: a study of tooth loss among adults

O capital social tem sido investigado no campo da Saúde Pública como um dos fatores determinantes do processo saúde-doença. No entanto, poucos são os estudos que abordaram a questão do capital social e a saúde bucal até a presente data. Objetivos: (i) verificar, por meio de uma revisão sistemática de literatura, a possível associação entre capital social/conceitos correlatos e desfechos em saúde bucal; (ii) testar a possível associação entre o capital social e as perdas dentárias em adultos de 35-44 anos de idade residentes em municípios do entorno de Belo Horizonte (zona urbana), Minas Gerais, Brasil. Métodos: este estudo transversal exploratório analisou dados referentes a 1013 adultos residentes em oito municipios do entorno de Belo Horizonte. O capital social foi medido por meio de oito indicadores...

Acesso a serviços odontológicos e auto-percepção da saúde bucal em adolescentes, adultos e idosos / Access to dental services and self-perception of oral health in adolescents, adults, and the elderly

Conhecer e identificar as condições e a auto-percepção da saúde bucal dos indivíduos contribui favoravelmente para o planejamento e implementação de ações e programas. O objetivo deste trabalho foi descrever a experiência de cárie, condições de acesso a serviços odontológicos no Estado de São Paulo,e verificação da auto-percepção da saúde bucal de adolescentes, adultos e idosos, associada às condições clínicas encontradas. Um total de 1824 adolescentes (15 a 19 anos), 1612 adultos (35 a 44 anos) e 781 idosos (65 a 74 anos) participaram deste estudo. Os exames odontológicos foram realizados em domicílios, seguindo critérios da Organização Mundial de Saúde. As informações sobre acesso a serviços e autopercepção foram obtidas por meio de entrevistas. Os dados foram descritos e analisados com uso do teste Qui-quadrado, com 95% de confiança. O índice CPOD correspondeu a 28,6 para os idosos, 20,9 para os adultos e 6,5 para os adolescentes. Quanto ao acesso aos serviços odontológicos e tempo da última visita ao dentista, a maior frequência foi há menos de 1 ano para adolescentes (60,1%) e adultos (47,9%), e há mais de 3 anos (58,5%) para idosos. Os adolescentes com menos experiência de cárie, ou seja, com CPOD abaixo da média, representaram 54,8%; a proporção de adultos com 20 ou mais dentes presentes foi de 64,3% e a prevalência de idosos edêntulos foi de 59,9%. A auto-percepção foi semelhante entre os grupos; com exceção dos idosos. A auto-percepção apresentou dados positivos para os adolescentes e adultos que apresentaram condições clínicas mais favoráveis. Diante destes resultados, torna-se necessária a implantação de ações de programas efetivos para educação e prevenção, com enfoque na manutenção dos dentes para adultos e idosos. Para adolescentes, há necessidade de controle e manutenção da saúde bucal para que futuramente estes apresentem melhores condições de saúde bucal que as encontradas dentre os adultos e idosos.

Saúde bucal e qualidade de vida do idoso usuário do Sistema Único de Saúde de um município de médio porte em Minas Gerais- Brasil / Oral health and quality of life of elderly user single health system the medium sized municipality of Minas Gerais

Este estudo transversal teve por objetivo verificar a associação da condição de saúde bucal com qualidade de vida de idosos usuários do Sistema Único de Saúde (SUS), de um município de médio porte de Minas Gerais. Participaram do estudo 163 indivíduos com 60 anos de idade ou mais, de ambos os sexosfuncionalmente independentes, não institucionalizados, usuários do Sistema Único de Saúde (SUS), na zona urbana do município pesquisado. Os dados sócio-demográficos foram obtidos a partir de um questionário com o intuito de se caracterizar a amostra e a utilização dos serviços de saúde. As variáveis incluídas foram: idade, sexo, situação conjugal, renda mensal individual e familiar, escolaridade, vivência familiar, número de consultas médicas realizadas na UBS (nos últimos 06 meses), número de doenças referidas (nos últimos 6 meses), número de medicamentos utilizados diariamente (nos últimos 6 meses)e modelo de trabalho presente na UBS frequentada. Quanto a qualidade de vida os dados foram coletados por meio da palicação do questionário WHOQOL-OLD e entrevista gravada com 8 idosos...

Changes in the oral health of US children and adolescents and dental public health infrastructure since the release of the Healthy People 2010 Objectives.

We examined progress in US children's oral health and dental public health infrastructure since the Healthy People 2010 Oral Health Objectives were issued. We summarize trends in the prevalence of dental caries and dental sealants on the basis of national and state-specific data. Trends in state oral health program activities, funding, and staffing were derived from annual surveys. The prevalence of dental caries in primary teeth of children aged 2-4 years increased from 18% in 1988-1994 to 24% in 1999-2004. Racial disparities persisted in that age group, with caries significantly more prevalent among non-Hispanic black and Mexican American children than among non-Hispanic white children. Caries prevalence in primary teeth of non-Hispanic white children aged 6-8 years remained unchanged, but increased among non-Hispanic black and Mexican American children. State-specific prevalence of caries among third-graders ranged from 40.6% to 72.2%. Caries in permanent teeth declined among children and adolescents, while the prevalence of dental sealants increased significantly. State oral health programs' funding and staffing remained modest, although the proportion of states with sealant programs increased 75% in 2000 to 85% in 2007 and the proportion with fluoride varnish programs increased from 13% to 53%. Progress toward improving the oral health of America during the past decade has been mixed. Greater attention to the oral health of young children is clearly needed, and child health professionals can be valuable partners in the effort. With continued high prevalence of a largely preventable disease, ongoing problems with access to basic oral health services, and increased national attention to health care reform, there is a clear need and opportunity for governments to make serious and sustained investments in dental public health.

Dental public health: the "big picture" specialty.

The specialty of dental public health is focused on improving oral health in the aggregate. Its principal tools include assessment, policy development, and assurance of effective outcomes. Although there are fewer than 200 active diplomates of the American Board of Dental Public Health, the effect of this specialty is large because of its impact on the interpretation of oral health issues and its influence on allocation of funding resources. Diplomates in dental public health work primarily in the federal government and academic settings, performing administrative, research, and teaching functions. In the current debate over the level, effectiveness, and distribution of health resources, dental public health can be expected to play an increasing role in helping to set the agenda.

[The dental aspects of public health in Hungary. Review article]. / Magyarország népegészségügyi helyzetének fogorvosi vonatkozásai. Osszefoglaló közlemény.

Despite great improvements in the oral health status of the population, public health and dental public health continue to be a major problem in society. A number of epidemiologic studies revealed the importance of the social, behavioral and environmental factors contributing to inequalities in the maintenance and restoration of oral health. Dental public health is the science and art of preventing oral diseases, promoting oral health and improving the quality of life through the organized efforts of the public. The aim of the authors was to provide an overview about the development and the functions of the Hungarian public health and dental public health system, its associations with international dental public health organizations and about the present dental public health status of the Hungarian population. According to WHO pathfinder studies, the Hungarian population has a usual cariologic and periodontal status in Europe, but a number of WHO statistical analyses reveal the sad situation regarding the high frequency of oral malignancies in our country. The social support system is given, the tasks are in front of us, and Hungary intends to follow the oral health strategies of the WHO for 2020 in order to improve the dental public health status of the nation, but it is necessary to declare that not only behavioral but also political decisions are necessary for that goal.