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.

A new approach to the training and education of oral health personnel.

An innovative curriculum has been designed for the Fiji School of Medicine to enable dental personnel to proceed through a sequence of educational modules on a career path leading from a dental assistant through other auxiliary grades to a dentist with a BDS degree. The courses for each grade are formulated to be relevant to the pattern of oral diseases in Fiji and the Pacific Islands; be designed in accordance with specified job-descriptions; have a strong community orientation, with emphasis on prevention and the promotion of oral health; permit exit and re-entry at each level; incorporate, where appropriate, the principle of problem-based learning; and incorporate procedures to ensure early establishment of clinical skills. Details of the first year and an outline of the structure of the course for the subsequent years are presented.

Attitudes to oral health, preventive practices and dental services in a Thai population.

1500 subjects aged 15-18 and 35-44 years, providers of oral health care and village headmen from 6 north Thailand districts with different dental services were interviewed about their knowledge of and attitudes to oral health, preventive practices and oral health services. Current oral symptoms mentioned by the 1500 subjects included pain (20.7 per cent), holes in teeth (10.5 per cent), ulcer, lump or swelling (5.9 per cent), loose teeth (5.2 per cent), calculus (2.9 per cent) and bleeding gums (1.3 per cent). Those complaining of holes in teeth had a significantly higher mean number of DMFT (2.05) than those who had no current problem (0.60). There was a general lack of appreciation of periodontal disease as a clinical problem. 57.5 per cent of those with a current problem did nothing about it because of lack of time or because they did not know where to go. 98 per cent said they used a toothbrush and 75.1 per cent used it two or more times a day. 58 per cent said that oral disease was preventable. Virtually all methods mentioned referred to dental caries which was a minor problem in this age group. A significant number had received advice on oral health from primary health care workers. In two districts primary oral health care workers trained at the Intercountry Centre for Oral Health for two weeks to do superficial tooth scaling provided care for 110 subjects, 85-88 per cent of whom were satisfied with the care received. Village headmen were sceptical about preventing oral disease and wanted more frequent visits from mobile dental units. The dentist and dental nurses were unable to cope with the range of work required and wanted additional training. Sub-district health workers and primary oral health workers were frustrated by the limitations of their work and wanted additional training to do fillings and extractions.

Periodontal status and treatment needs in the Chiangmai/Lamphun provinces of Thailand.

As part of an oral health survey concerned with the evaluation of a collaborative primary oral health care program, the CPITN system was used to determine the periodontal status and treatment needs of 2009 Thai people aged 12-44 yr. Calculus dominated the CPITN scores. The percentage of persons with healthy periodontal tissues was small, ranging from 0.7% at age 35-44 to 4.1% at age 12. Ranges for other highest scores were bleeding-0.4% at age 35-44 yr to 6.1% at age 12 yr; calculus-62% at age 35-44 yr to 92.6% at age 17-18 yr. Pocketing did not occur to any significant extent until age 35-44 where 23.9% had 3-5 mm pockets and 12.8% had pockets 6 mm or deeper. 15-18-yr-olds who had received prior care from a Village Scaler had a significantly higher number and proportion of healthy sextants than those who had not received such care. No such effect was demonstrated in 35-44-yr-olds. The need for caution in the interpretation of this result is stressed. Attention is drawn to the desirability of differentiating between supra- and sub-gingival calculus in the CPITN scoring system and to the excessive treatment requirements that arise from classifying everyone with calculus as requiring prophylaxis and scaling. A great deal of improvement will need to be affected if the Thai national and global goals for periodontal health are to be achieved in the districts covered by this survey.

The Danish oral health care service for children: a comparison with alternative systems.

Aarhus in Denmark, Adelaide in Australia, Saskatchewan in Canada, Bristol in England and Limerick in Ireland were chosen as representing five different systems for improving the dental health of children. Fluoridation apart, the system of dental care delivery seems to have little influence on the level of dental disease, but appears to have remarkable cost implications. The most expensive system employs salaried dentists to carry out all the operative procedures. Employing dental therapists to do the simple operative procedures reduces costs materially, but utilizing private dentists in an insurance scheme that encourages efficient practice may be less expensive still. The results of this study highlight the need for more detailed comparison of delivery systems, in order to advise public dental health authorities on the most effective and efficient systems for children.