To protect the public: professionalism vs competence in dentistry.

This paper uses evidence from reports in the British Dental Journal from 1958 to 1979 of disciplinary charges against dentists in the United Kingdom to question the General Dental Council's (GDC) claim that it is protecting the public in relation to the competence of dental practitioners. In that 20-year period only one charge out of 86 heard by the GDC Disciplinary Committee had to do with a possible lack of professional competence, whereas 47% of the charges were for fraud and other criminal offences, 18% were for drug-related offences, 18% were for sex offences and 16% were for breaches of professional ethics or discipline. The paper argues that the GDC has been much more concerned with developing a professional image and style for dentists than it has been with assuring an adequate level of dental care for patients by dentists once they graduate. Although the data used to support the argument are fom Britain and from dentistry, the argument may be extended to all professional occupations and countries where there is a State-enforced medical monopoly in relation to clients.

Dental status of pregnant women attending a Brisbane maternity hospital.

A sample of 314 consecutive women attending for their first antenatal visit at a public hospital were examined according to the WHO survey procedure. The women's age ranged from 16 to 42 yr with a mean of 23.5 yr. Only 3% were edentulous in both jaws, but 13% had some form of denture. A quarter had pocketing in at least one sextant and only 16% were free of gingivitis. The average number of DMF teeth was 15.8, comprising 2.7 decayed, 4.5 missing and 8.6 filled teeth; 70% had teeth needing restoration and 10% had at least one tooth needing extraction. There were significant relationships between DMF score and age (positive) and between number of teeth needing restoration and age, educational level, and the woman's own perception of her dental health (all inverse). Some form of dental attention was needed by 86% of the women; 12% had conditions needing immediate attention. By comparison with a 1971 study of pregnant women in Brisbane, there has been a marked decline in DMFT score (from 19.1 to 15.8).

Toward the formulation of sociodental indicators.

The bases for the construction of sociodental indicators is discussed in the paper, considering several available indexes of oral health status (dental caries, periodontal disease, malocclusion, oral hygiene, and other oral conditions) as well as measures of quality of services. Very little research exists relating any of the above measures to social indicators such as personal life-style or cultural and ecological factors. Such expansion would enable dental indicators to be useful for purposes of policy decisions. Combining any dental indicators or set of indicators with a potential global social health index is discussed in terms of potential problems obscuring dentistry's cost to society. Dentistry, in addition, is offered as a system in microcosm-one which can be useful for purposes of polishing methodology for the social health indicator movement.

Getting dental services to the rural 85 percent.

For the past 30 years the organization of government dental services in Papua New Guinea has been modelled on the School Dental Service in New Zealand. Although the two most important mouth diseases occur in adults, children have been given priority. The dental work has been done by a workforce of less than 200 dental officers and dental therapists. Dental services are invisible to the mass of Papua New Guineans. Such organization of dental services has been disastrous for the oral health of the rural population. The need is urgent to integrate dental services within the mainstream health services, doing as much as possible at the aid posts, and referring on to health centres only what cannot be done at the local level. Both the present cadre of 2250 orderlies in aid posts plus the planned new 4750 community health workers by the year 2000 need to be trained in basic dental skills. The 2400 aid posts need to be equipped with a kit of basic dental materials and instruments, costing about K250 each. Training in basic dental care can be done in six weeks, and should take place within the province, under conditions as close as possible to real life. The benefits of providing a basic dental service at aid posts are obvious--the population coverage will be much higher, the range of diseases that are preventable or controllable will increase, and many of the deaths that now occur from cancer of the mouth will be prevented or delayed.

Designing a government dental service for Papua New Guinea.

Dentistry deals with all the diseases and injuries of the mouth, teeth, jaws and surrounding face (for all age groups). Over the past 30 years government dental services in Papua New Guinea have been modelled on a New Zealand dental service directed primarily at children and adolescents for treating tooth decay. In designing a government dental service for the future, the two basic goals must be to retain the natural dentition for life for all Papua New Guineans and to eliminate oral cancer. The basic principles for such a dental service are to build on the specific realities of Papua New Guinea, encourage widespread community participation, base the dental services on the whole family rather than the child, make dentistry an integral part of the health services, and make dental care available at every level of health service. The seven major factors in the design are the foundational role of the dental doctor, with clear roles for other dental workers, a sound career structure, provision of continuing education, an effective supervisory structure and statistical reporting system, and a long-term financial commitment from the government for dental services. Over the next few years the priorities in implementing the design are to concentrate in selected model areas, emphasize the prevention of mouth cancer and tooth loss, and minimize the restoration of decayed teeth.

A radiographic study of chronic periodontitis in 15 year old Queensland children.

A retrospective study was carried out to determine the frequency of early periodontal bone loss in 15 year olds as seen in bite-wing radiographs. A total of 468 radiographs of 15 year olds was examined, 246 from 1970-74 and 222 from 1978-80. The alveolar bone crest on the mesial and distal of the first permanent molar teeth was examined for radiographic evidence of early chronic periodontitis. The condition of the adjacent proximal tooth surfaces was also recorded. No significant difference was found between the two groups; 39% of the 1978-80 and 43% of the 1970-74 group showed radiographic evidence of early chronic periodontitis (P less than 0.05). Males and females showed a similar frequency of periodontal disease levels. The mesial interproximal space of the first molars had significantly higher frequencies of radiographic evidence of chronic periodontitis than the distal interproximal spaces in the two groups examined. Fewer proximal restorations with overhangs were noted in the 1978-80 group, however more proximal subgingival calculus was found in this group than the 1970-74 group.