Challenges impeding integration of oral health into primary health care.

The primary healthcare (PHC) services in the Islamic Republic of Iran have succeeded in addressing high levels of communicable diseases; however, they seem less able to deal with maternal and paediatric oral diseases. The aim of this study was to examine problems in integrating oral health services into PHC. This was a qualitative research study comprising focus group discussions and interviews. Five focus-group discussions were held with midwives, family healthcare practitioners, rural PHC workers, duty-service dentists, and public health dentists. Also, individual interviews were organized with experts of faculty members in related fields, informant managers and policy makers, and in-depth interviews were done with pregnant women in four PHC centres. Audiotapes were transcribed following each session, and then a qualitative thematic analysis was carried out on gathered data. Data analysis resulted in 4 main themes relating to the challenges: environmental, educational, organizational and school-based programme factors. This study provides a clearer understanding of the challenges of integrating oral health services into PHC.

Oral health and treatment needs among 18-year-old Iranians.

OBJECTIVE: To investigate the oral health status of 18-year-old Iranians in relation to their gender, place of residence and level of education. SUBJECTS AND METHODS: Thirty-three calibrated examiners in 2002 collected data as part of a national survey, according to World Health Organization criteria for sampling and clinical diagnoses, across 28 provinces. The study sample was 4,448; male: 2,021 and female: 2,427 made up of urban: 2,564 and rural: 1,884. Oral health status was assessed in terms of number of teeth, decayed teeth (DT), filled teeth (FT), decayed, missing or filled teeth (DMFT), community periodontal index and plaque index. RESULTS: The mean number of teeth was 27.4, with DMFT: 4.3, DT: 3.0 and FT: 0.7. The mean number of sound teeth was higher (p < 0.01) in men (24.1 vs. 23.3 in women), FT in urban residents (1.0 vs. 0.2 in rural residents) and DT in women (3.3 vs. 2.8 in men). Three of 4 subjects were in need of restorative treatments. All subjects had dental plaque; 387 (8%) healthy gingiva; 1,016 (23%) exhibited bleeding; 2,025 (48%) calculus and 1,020 (21%) deepened pockets. Men's periodontal status was worse than women's (p < 0.002). Low level of education was associated with having 27 or fewer teeth (OR = 1.7), calculus (OR = 1.5) or deep periodontal pockets (OR = 2.7). CONCLUSION: A majority of 18-year-old Iranians seem to enjoy a full dentition. High prevalence of dental plaque, calculus, periodontal pockets and untreated dental cariesespecially among underprivileged groups may put them at risk for tooth loss in adulthood.

Oral health among 35- to 44-year-old Iranians.

OBJECTIVE: To investigate the oral health status of 35- to 44-year-old Iranians in relation to gender, place of residence and education. SUBJECTS AND METHODS: In 2002, data (n = 8,301) were collected as part of a national survey using WHO criteria for sampling and clinical diagnoses across 28 provinces by 33 calibrated examiners who performed examinations under a dental light with a WHO probe. The study sample was 8,301; male: 3,625 and female: 4,676; urban: 4,854 and rural: 3,447. Oral health status was assessed by number of decayed (DT), filled (FT) and missing (MT) teeth and by DMFT and need for periodontal treatment [community periodontal index for treatment needs (CPITN)] indices. Gender, age, place of residence and level of education served as socio-demographic information. Estimates were adjusted for the 35- to 44-year-old provincial population. ANOVA, chi(2) test and logistic regression analysis with odds ratios (OR) and their 95% confidence intervals (CI) were the methods of statistical evaluation used. RESULTS: The mean number of teeth was 21.5 +/- 6.2, with DMFT: 11.0 +/- 6.4, DT: 2.6 +/- 2.7, and FT: 1.8 +/- 3.2. DT existed in 6,080 (73%) of the subjects and FT in 3,209 (41%). The mean number of FT was greater (p < 0.001) among urban residents, women and those with a higher level of education. Only 1% had a CPITN of 0; 6% exhibited bleeding, 40% had calculus, 43% shallow and 10% deep pockets. Illiterate subjects were more likely to have DT (OR = 1.6, 95% CI = 1.4-1.8) and calculus or periodontal pockets (OR = 6.3, 95% CI = 5.1-7.8). CONCLUSION: The findings indicate an impaired oral health status in Iranian adults, particularly those of low social status and educational level.