Managing dental caries with atraumatic restorative treatment in children: successful experience in three Latin American countries.

OBJECTIVE: To compare survival rates and cost differentials between the atraumatic restorative treatment (ART) technique and amalgams by type of dental personnel in Ecuador, Panama, and Uruguay. METHODS: Children 7 to 9 years of age in rural and urban schools with at least one lesion with initial cavitated enamel caries or a dentinal lesion on a first permanent molar were selected and randomized into the ART (intervention) or amalgam (control) group. Restoration failure was evaluated at 12 and 24 months. Cooperation and pain experienced during the procedures were measured. Cumulative and incident failure of restorations at 12 and 24 months was calculated for dentists who placed ART or amalgam restorations and auxiliaries who placed ART restorations at 12 months only. RESULTS: The total sample comprised 1 629 children. Study groups were similar by country, gender, and geographic location. Cumulative failure rate at 12 months varied by group: dentists' amalgam, 0.9% to 5.7%; dentists' ART, 2.0% to 10.5%; and auxiliaries' ART, 5.7% to 15.8%. At 24 months, higher cumulative failures were observed for the dentists' amalgam group compared with the dentists' ART group in Ecuador and Panama but not in Uruguay. Amalgam was least likely to have the best level of cooperation and an auxiliary using ART was associated with the least pain. The cost of using the ART approach for dental caries treatment, including retreatment, was roughly half that of using amalgam without retreatment. CONCLUSIONS: Having auxiliary personnel perform ART will lead to treatment survival that is expected to be lower than dentists using amalgam or ART. In spite of the greater risk of failure, the rate is not unacceptable and potential cost savings are substantial.

Managing dental caries with atraumatic restorative treatment in children: successful experience in three Latin American countries / Control de la caries dental mediante tratamiento restaurador atraumático en niños: experiencia exitosa en tres países de América Latina

OBJECTIVE: To compare survival rates and cost differentials between the atraumatic restorative treatment (ART) technique and amalgams by type of dental personnel in Ecuador, Panama, and Uruguay. METHODS: Children 7 to 9 years of age in rural and urban schools with at least one lesion with initial cavitated enamel caries or a dentinal lesion on a first permanent molar were selected and randomized into the ART (intervention) or amalgam (control) group. Restoration failure was evaluated at 12 and 24 months. Cooperation and pain experienced during the procedures were measured. Cumulative and incident failure of restorations at 12 and 24 months was calculated for dentists who placed ART or amalgam restorations and auxiliaries who placed ART restorations at 12 months only. RESULTS: The total sample comprised 1 629 children. Study groups were similar by country, gender, and geographic location. Cumulative failure rate at 12 months varied by group: dentists' amalgam, 0.9% to 5.7%; dentists' ART, 2.0% to 10.5%; and auxiliaries' ART, 5.7% to 15.8%. At 24 months, higher cumulative failures were observed for the dentists' amalgam group compared with the dentists' ART group in Ecuador and Panama but not in Uruguay. Amalgam was least likely to have the best level of cooperation and an auxiliary using ART was associated with the least pain. The cost of using the ART approach for dental caries treatment, including retreatment, was roughly half that of using amalgam without retreatment. CONCLUSIONS: Having auxiliary personnel perform ART will lead to treatment survival that is expected to be lower than dentists using amalgam or ART. In spite of the greater risk of failure, the rate is not unacceptable and potential cost savings are substantial.

OBJETIVO: Comparar las tasas de supervivencia de las restauraciones y las diferencias en cuanto a costo según el tipo de profesional odontológico, entre la técnica de tratamiento restaurador atraumático (TRA) y las amalgamas en Ecuador, Panamá y Uruguay. MÉTODOS: Se seleccionaron niños de 7 a 9 años de edad, de escuelas rurales y urbanas, que presentaban como mínimo una lesión inicial cavitada de caries del esmalte o una lesión de la dentina en un primer molar permanente, y se distribuyeron aleatoriamente en el grupo sometido a TRA (intervención) o en el grupo tratado con amalgamas (control). Se evaluó el fracaso de la restauración a los 12 y 24 meses. Se midió el grado de cooperación y el dolor observados durante los procedimientos. Se calculó el fracaso acumulado e incidental de las restauraciones a los 12 y 24 meses para los dentistas que aplicaron restauraciones de tipo TRA o amalgamas, y únicamente a los 12 meses para el personal auxiliar que llevó a cabo restauraciones de tipo TRA. RESULTADOS: La muestra total incluyó a 1 629 niños. Los grupos de estudio fueron similares en cuanto a país, sexo y ubicación geográfica. La tasa de fracaso acumulado a los 12 meses varió según el grupo: fue de 0,9 a 5,7% para la amalgama aplicada por dentistas; de 2,0 a 10,5% para el TRA aplicado por dentistas; y de 5,7 a 15,8% para el TRA aplicado por personal auxiliar. A los 24 meses, se observaron mayores fracasos acumulados en el grupo de amalgamas aplicadas por dentistas en comparación con el grupo de TRA aplicado por dentistas en Ecuador y Panamá pero no en Uruguay. Fue menos probable que la aplicación de amalgama obtuviera el mejor grado de cooperación, y la aplicación de TRA por personal auxiliar se asoció con la menor intensidad de dolor. El costo de usar el método de TRA en el tratamiento de la caries dental, incluido el retratamiento, fue aproximadamente de la mitad del costo del empleo de amalgama sin retratamiento. CONCLUSIONES: La restauración mediante TRA llevado a cabo por personal auxiliar logrará una supervivencia presumiblemente inferior a la obtenida por la aplicación de amalgama o TRA por dentistas. A pesar del mayor riesgo de fracaso, la tasa es admisible y la potencial reducción de costos es importante.

Integrating oral health into Haiti's National Health Plan: from disaster relief to sustainable development / Integración de la salud bucodental en el Plan Nacional de Salud de Haití: de la ayuda en casos de desastre al desarrollo sostenible

In 2010, Haiti suffered three devastating national emergencies: a 7.0 magnitude earthquake that killed over 200 000 and injured 300 000; a cholera outbreak that challenged recovery efforts and caused more deaths; and Hurricane Tomas, which brought additional destruction. In the aftermath, the Pan American Health Organization (PAHO) reoriented its technical cooperation to face the myriad of new challenges and needs. Efforts included support and technical assistance to the Ministry of Health and Population of Haiti and coordination of actions by the United Nations Health Cluster. This Special Report focuses specifically on the PAHO Regional Oral Health Program's call to action in Haiti and the institutional partnerships that were developed to leverage resources for oral health during this critical time and beyond. To date, achievements include working with Haiti's private sector, dental schools, public health associations, and other stakeholders, via the Oral Health of Haiti (OHOH) Coalition. The OHOH aims to meet the immediate needs of the dental community and to rebuild the oral health component of the health system; to provide dental materials and supplies to oral health sites in affected areas; and to ensure that the "Basic Package of Health Services" includes specific interventions for oral health care and services. The experience in Haiti serves as a reminder to the international community of how important linking immediate/short-term disaster-response to mid- and longterm strategies is to building a health system that provides timely access to health services, including oral health. Haiti's humanitarian crisis became an important time to rethink the country's health system and services in terms of the right to health and the concepts of citizenship, solidarity, and sustainable development.

En el 2010, Haití padeció tres emergencias nacionales devastadoras: un terremoto de 7,0 de magnitud que causó la muerte de 200 000 personas y traumatismos a 300 000, un brote de cólera que vulneró las actividades de recuperación y causó mßs muertes, y el huracßn Tomßs, que causó mßs destrucción. En el período inmediatamente posterior, la Organización Panamericana de la Salud (OPS) reorientó la cooperación técnica para afrontar los múltiples retos nuevos y necesidades que surgieron. Estas actividades incluyeron apoyo y asistencia técnica al Ministerio de Salud y de la Población de Haití, y la coordinación de las medidas llevadas a cabo por el Grupo de Acción Sanitaria de las Naciones Unidas. Este informe especial se centra específicamente en la convocatoria a la acción del Programa Regional de Salud Bucodental de la OPS en Haití y en las alianzas institucionales que se establecieron para aprovechar los recursos de salud bucodental durante esta crisis y a partir de ese momento. Hasta la fecha, los logros comprenden la colaboración con el sector privado de Haití, las facultades de odontología, las asociaciones de salud pública y otros interesados directos por intermedio de la Coalición para la Salud Bucodental de Haití. Esta coalición procura satisfacer las necesidades inmediatas de la comunidad odontológica y reconstruir el componente de la salud bucodental del sistema de salud; proporcionar materiales y suministros odontológicos a los centros de salud bucodental de las zonas afectadas; y lograr que la "canasta bßsica de servicios de salud" incluya intervenciones específicas para la atención y los servicios de salud bucodental. La experiencia de Haití muestra a la comunidad internacional la importancia de vincular la respuesta inmediata y a corto plazo ante catßstrofes con las estrategias a mediano y largo plazo para establecer un sistema de salud que brinde acceso oportuno a los servicios de salud, incluida la salud bucodental...

Integrating oral health into Haiti's National Health Plan: from disaster relief to sustainable development.

In 2010, Haiti suffered three devastating national emergencies: a 7.0 magnitude earthquake that killed over 200 000 and injured 300 000; a cholera outbreak that challenged recovery efforts and caused more deaths; and Hurricane Tomas, which brought additional destruction. In the aftermath, the Pan American Health Organization (PAHO) reoriented its technical cooperation to face the myriad of new challenges and needs. Efforts included support and technical assistance to the Ministry of Health and Population of Haiti and coordination of actions by the United Nations Health Cluster. This Special Report focuses specifically on the PAHO Regional Oral Health Program's call to action in Haiti and the institutional partnerships that were developed to leverage resources for oral health during this critical time and beyond. To date, achievements include working with Haiti's private sector, dental schools, public health associations, and other stakeholders, via the Oral Health of Haiti (OHOH) Coalition. The OHOH aims to meet the immediate needs of the dental community and to rebuild the oral health component of the health system; to provide dental materials and supplies to oral health sites in affected areas; and to ensure that the "Basic Package of Health Services" includes specific interventions for oral health care and services. The experience in Haiti serves as a reminder to the international community of how important linking immediate/short-term disaster-response to mid- and longterm strategies is to building a health system that provides timely access to health services, including oral health. Haiti's humanitarian crisis became an important time to rethink the country's health system and services in terms of the right to health and the concepts of citizenship, solidarity, and sustainable development.

Estudio piloto sobre políticas de salud bucal y VIH / Pilot study of oral health policy and HIV

OBJETIVO: Obtener y evaluar información sobre las políticas nacionales para la atención odontológica de los pacientes con VIH/Sida en los países de las Américas. MÉTODOS: Se llevó a cabo un estudio transversal y descriptivo mediante un cuestionario en línea diseñado para ser completado por los encargados nacionales de la salud bucal en la Región. RESULTADOS: De los 38 países invitados a participar, solamente 12 (31,6 por ciento) completaron el cuestionario. De esos 12 países, ocho (66,7 por ciento) informaron tener políticas nacionales y estrategias para proveer salud bucal al paciente con VIH/Sida. Las líneas de investigación más desarrolladas por los países durante los últimos cinco años fueron i) prácticas de control de infecciones, ii) prevalencia de lesiones bucales asociadas a VIH/Sida, iii) discriminación del paciente seropositivo en la consulta odontológica y iv) cobertura odontológica para personas infectadas. Entre las necesidades informadas por los encargados nacionales del sector, se encuentran el incrementar el conocimiento sobre las buenas prácticas de control de infecciones y los avances en materia VIH, la creación de espacios para intercambio de ideas y de foros de discusión en línea, y contar con información sobre fuentes de financiamiento para estudios y proyectos. CONCLUSIONES: A pesar del incremento en la incidencia y prevalencia del VIH/Sida en las Américas, en general no parece haber políticas, estrategias ni programas que aborden idóneamente el problema de la salud bucal y la infección por este virus. Es imperante establecer una comunicación efectiva entre investigadores y hacedores de políticas dentales sanitarias, a fin de confrontar una epidemia que requiere cada vez más de profesionales odontólogos altamente capacitados para ofrecer una mejor calidad de vida a la población afectada.

OBJECTIVE: To obtain and evaluate information on national oral health policies regarding patients with HIV/AIDS in the countries of the Americas. METHODS: A cross-sectional descriptive study was conducted using an online questionnaire designed to be completed by the national oral health officials in the Region. RESULTS: Of the 38 countries that were asked to participate, only 12 (31.6 percent) completed the questionnaire. Of these 12, eight (66.7 percent) reported having national policies and strategies in place to promote oral health for the HIV/AIDS patient. Areas of study most explored by the countries over the last 5 years have been: (a) infection control practices; (b) the prevalence of HIV/AIDS-related oral lesions; (c) discrimination toward the HIV-positive patient during dental consultation; and, (d) dental coverage for infected individuals. Among the needs reported by the national officials of this sector were: increasing knowledge of good infection-control practices and HIV advances, development of forums for exchanging ideas and holding online discussions, and having access to information on sources of funding for studies and projects. CONCLUSIONS: Despite increased HIV/AIDS incidence and prevalence in the Americas, in general, there do not seem to be any model policies, strategies, or programs that address the issue of oral health and HIV infection. Establishing effective communication between dental health researchers and policymakers is imperative to confronting this epidemic, which increasingly requires more from the highly-trained dental professionals who offer quality of life to the affected population.

[Pilot study of oral health policy and HIV]. / Estudio piloto sobre políticas de salud bucal y VIH.

OBJECTIVE: To obtain and evaluate information on national oral health policies regarding patients with HIV/AIDS in the countries of the Americas. METHODS: A cross-sectional descriptive study was conducted using an online questionnaire designed to be completed by the national oral health officials in the Region. RESULTS: Of the 38 countries that were asked to participate, only 12 (31.6%) completed the questionnaire. Of these 12, eight (66.7%) reported having national policies and strategies in place to promote oral health for the HIV/AIDS patient. Areas of study most explored by the countries over the last 5 years have been: (a) infection control practices; (b) the prevalence of HIV/AIDS-related oral lesions; (c) discrimination toward the HIV-positive patient during dental consultation; and, (d) dental coverage for infected individuals. Among the needs reported by the national officials of this sector were: increasing knowledge of good infection-control practices and HIV advances, development of forums for exchanging ideas and holding online discussions, and having access to information on sources of funding for studies and projects. CONCLUSIONS: Despite increased HIV/AIDS incidence and prevalence in the Americas, in general, there do not seem to be any model policies, strategies, or programs that address the issue of oral health and HIV infection. Establishing effective communication between dental health researchers and policymakers is imperative to confronting this epidemic, which increasingly requires more from the highly-trained dental professionals who offer quality of life to the affected population.

The global burden of oral diseases and risks to oral health.

This paper outlines the burden of oral diseases worldwide and describes the influence of major sociobehavioural risk factors in oral health. Despite great improvements in the oral health of populations in several countries, global problems still persist. The burden of oral disease is particularly high for the disadvantaged and poor population groups in both developing and developed countries. Oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related oral disease and orodental trauma are major public health problems worldwide and poor oral health has a profound effect on general health and quality of life. The diversity in oral disease patterns and development trends across countries and regions reflects distinct risk profiles and the establishment of preventive oral health care programmes. The important role of sociobehavioural and environmental factors in oral health and disease has been shown in a large number of socioepidemiological surveys. In addition to poor living conditions, the major risk factors relate to unhealthy lifestyles (i.e. poor diet, nutrition and oral hygiene and use of tobacco and alcohol), and limited availability and accessibility of oral health services. Several oral diseases are linked to noncommunicable chronic diseases primarily because of common risk factors. Moreover, general diseases often have oral manifestations (e.g. diabetes or HIV/AIDS). Worldwide strengthening of public health programmes through the implementation of effective measures for the prevention of oral disease and promotion of oral health is urgently needed. The challenges of improving oral health are particularly great in developing countries.

Promoting oral health: the use of salt fluoridation to prevent dental caries

[From Introduction]: This publication has come out of the experience of national salt fluoridation programs and of 12 workshops corresponding to Phase II (first evaluation) of such programs that were held in Mexico in 1994 and in Jamaica in 1996. The book gives a historical overview of successful salt fluoridation programs; details the components, effectiveness, and benefits of the programs; and offers recommendations to health administrators who are considering establishing such a program in their countries. We hope that it helps to confirm salt fluoridation as an effective method of preventing dental caries and encourages its application through the world. As programs continue to be developed in the Region, PAHO will share information and knowledge with the public health community as a way to improve the dental health of the Region’s population.