A method of planning a dental treatment program for an institutionalized population.

A dental treatment program, for a subnormal group in an institution near London, England, was designed by applying both epidemiologic data and empirically derived data from the Experimental Dental Care Project at The London Hospital Dental School. For the epidemiologic study, a two-examiner system was developed to help overcome the special problems of examining subnormal adults. The data collected in the study had to be flexible enough to allow the analysis of several alternative treatment strategies. Once these alternative treatment strategies were defined, the data from the Experimental Dental Care Project were applied to analyze the effects of using dental teams of varying composition to carry out the treatment. It was found that to meet the dental needs of the group, a team consisting of one dentist, three New Cross auxiliaries and one dental surgery assistant would be 30% less expensive than a traditional team of one dentist and one assistant. This larger team would also be able to complete the necessary initial treatment in less than half the time that the traditional team would require.

Dental caries, socio-economic development and national oral health policies.

A relationship between a population's level of socio-economic development and dental caries has often been assumed. Proxy measures such as sugar consumption have been used to reflect this. This study tests the hypothesis that there is a relationship between dental caries and the level of socio-economic development, using recent international data. It goes on to explore the implications of this relationship for the development of national oral health policies. Dental caries data was obtained from the WHO, Global Oral Epidemiology Data Bank for the period 1981-1996. Socio-economic data was obtained from the United Nations Development Programme (UNDP). Countries were ranked according to the Human Development Index (HDI) and their GNP. The study confirms the existence of a relationship between dental caries and development. Caries is a good proxy measure for socio-economic development. Countries in the throes of socio-economic transition have the highest DMFT scores.

Developing appropriate dental education systems: the impact of changes in oral health status and oral health care systems.

Current education programmes for oral health care workers have failed to adapt to the changing oral health status and the changing demands made upon oral health care systems. In order to adapt, education systems need to recognise the forces that are influencing the demands on the oral health care system and identify the most appropriate solutions. The most logical solution is to develop programmes which reflect the Primary Health Care Approach (PHCA), and in particular emphasise inter-sectorial collaboration. The challenge for dental education systems is to identify mechanisms through which these principles can be applied.

Setting global goals for oral health for the year 2010.

OBJECTIVE: To discuss the determinants for the possible setting of global goals for oral health for the year 2010. RESULTS AND CONCLUSIONS: If the application of oral health goals is to measure the outcome of oral health strategies and plans, they need to be substantially redesigned to reflect disparities in oral health and access to oral health care. It is no longer acceptable to focus only upon one or two arbitrarily selected disease entities and say these reflect the oral well-being of communities and the success (or failure) of oral health programmes. The use of validated socio-dental indicators to assess prevalence of socio-dental impacts seems essential, as does the avoidance of goals for conditions that are strongly influenced by culture, class, ethnicity and other widely variable local influences.

Health as a fundamental human right.

Access to health care is problematic for many people throughout the world, and the environments in which they live are often detrimental to their health. Recognising health as a human right provides a platform from which to argue for strong public health programmes.

Medicine in a muddle?

I believe that medicine is currently in a muddle and like a magician lost in a maze of caves and tunnels, is trying to get out of the muddle by creating ever stronger magic potions and spells. The magic opens new tunnels, but does not create an opening out into the fresh air. Or so it seemed to me when, as a new professor of dentistry. I had to think about my vision of the future of dentistry in South Africa.

Public water fluoridation in Ireland: twenty-five years on.

In July of this year, 1989, Ireland celebrates 25 years of fluoridation of the public water supplies. No other country has had such a long experience of a national mandatory public water supply fluoridation programme. There is good reason therefore to review experiences and attempt to draw some conclusions.

Oral diseases and socio-economic status (SES).

OBJECTIVE: To determine the association between social, economic and behavioural risk factors and national prevalences of: oral cancer, dental caries (12-year-olds) and destructive periodontal disease (35-44-year-olds). DATA SOURCES: Sources for the social and economic parameters were the UN Development Program; the behavioural risk factors' source was the World Health Organization, the UN Food and Agricultural Organization and the World Atlas of History. Oral diseases data came from UICC Globocan and the World Health Organization databases. DATA EXTRACTION: Data were extracted by hand from official publications. DATA SYNTHESIS: Data were synthesized and analyzed in sequence using SPSS, Pearson's correlation coefficient and multiple regression analyses. CONCLUSIONS: There is a discernable association between the three oral diseases and the variables selected, which varies in strength, being strongest for chronic destructive periodontitis and weakest for oral cancer. Dental caries lies in between. The degree to which variables account for differences in the three oral diseases between the countries studied is striking, being insignificant for oral cancer incidence, modest for oral cancer mortality, stronger for dental caries and strongest for destructive periodontal disease. Removing variables with strong co-linearity with the Human Development Index has little effect on the regression coefficients.

The Kilkenny Integrated Oral Health Project.

The Kilkenny Health Project, started in 1985, aims to reduce the level of risk factors in the community for coronary heart disease through health promotion. Dental disease and coronary heart disease share risk factors of tobacco use, alcohol consumption and poor dietary patterns. A baseline oral health survey demonstrated significant levels of dental disease in Kilkenny in the 429 adults and 523 children who were examined there in 1987. Seventy one per cent of adults required treatment for periodontal disease and 49% of children surveyed required treatment for dental decay. The Kilkenny Oral Health Project was developed as a community participation project aiming to reduce the level of common risk factors in the community for coronary heart disease and dental disease. It has run parallel with the main Kilkenny Health Project and is one of the first health promotion projects which has an integrated health message preventing dental disease and coronary heart disease.

Context as a critical influence on dental education.

The problems which beset dental education in many African countries are not unique to the African continent. While modified by the continent's history and present stage of development many of the difficulties are similar to those in developing and industrialised countries throughout the world. The need for oral health education programmes to produce, in the most cost-efficient manner, competent, high-quality graduates capable of coping in diverse situations is universal. This article reviews the limitations that the local context places on achieving these dual objectives and highlights the significance of the role of consumer demand for dental care in creating viable dental education programmes, particularly in poorer countries.

Dental caries status of 5-7 year old children in three districts in Tanzania, Uganda and Mozambique.

This paper presents the baseline data of a longitudinal study assessing the dental caries status of 5-7 year old children in Tanzania, Uganda and Mozambique. Approximately one hundred 5-7 year-old-children from randomly selected schools in each of three locations (formal urban, informal urban and rural) were examined using the 1997 WHO Oral Health Survey Criteria. Thirty nine percent of the entire sample were found to bc caries-free, however this differed from location to location and from country to country. The overall mean dmft was 2.4 (SD 2.8), with the decayed component being 2.0 and the missing component 0.4. Of the children examined, only three had filled teeth. The mean dmft was significantly higher (p-value < 0.05) in Tanzania and Uganda than in Mozambique. There were also significant differences in the mean dmft between the various locations in Uganda and Mozambique. The prevalence of dental caries was not consistent across the formal urban, informal urban and rural locations in the three countries studied. It is thus essential to desegregate oral health status data to the most local level possible.