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PubMed2005

Oral health information systems--towards measuring progress in oral health promotion and disease prevention.

This article describes the essential components of oral health information systems for the analysis of trends in oral disease and the evaluation of oral health programmes at the country, regional and global levels. Standard methodology for the collection of epidemiological data on oral health has been designed by WHO and used by countries worldwide for the surveillance of oral disease and health. Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health programmes oriented towards disease prevention and health promotion. The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers and the general public. WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems. Modern oral health information systems are being developed within the framework of the WHO STEPwise approach to surveillance of noncommunicable, chronic disease, and data stored in the WHO Global InfoBase may allow advanced health systems research. Sound knowledge about progress made in prevention of oral and chronic disease and in health promotion may assist countries to implement effective public health programmes to the benefit of the poor and disadvantaged population groups worldwide.

Adolescent↗
PubMed2005

Latino oral health: A research agenda toward eliminating oral health disparities.

BACKGROUND: The Hispanic population has become the largest minority group in the United States, resulting in an increase in oral health care demands. Developing a research agenda and promoting collaboration on Latino oral health issues are crucial. METHODS: The Hispanic Dental Association and the University of Puerto Rico, School of Dentistry, San Juan, convened a workshop of health care providers and other experts to examine the current state of Hispanic oral health research and identify gaps in existing data and research methods. Participants were asked to break out into small groups to discuss research priorities. RESULTS: The participants discussed the following research areas: population-based studies, social and behavioral sciences, health promotion and communications, gene-environment interactions, and research training and workforce development. Participants emphasized the importance of understanding variations among subgroups within the Hispanic population in the development of future studies. CONCLUSIONS: Participants recommended collaborative research studies to advance existing oral disease prevention and oral health promotion efforts, with a stronger focus on the development of a multidisciplinary pipeline of researchers participating in Latino oral health research to address the growing needs of this population. Practice Implications. Building an infrastructure for research training and workforce development would supply researchers with the necessary tools to develop new studies that could affect the overall oral health of the Latino population. The translation and dissemination of these research findings will benefit clinicians by leading to a better understanding of new trends and specific population needs, as well as appropriate targeted interventions.

Behavioral Sciences↗
PubMedDate not supplied

National Alliance for Oral Health Consensus Conference on Medically Necessary Oral Health Care: Legal issues.

This paper examines medical malpractice law as it applies to medically necessary oral health care. The basic legal concepts and reported cases involving medically necessary oral health care are reviewed. It is concluded that dental professionals and consumer advocates must advance their educational and legislative advocacy efforts so that health professional colleagues and the public will become aware of the importance of these services and insurers will routinely include coverage of medically necessary oral health care in their medical and dental policies. While failure to provide medically necessary oral health care can be violative of patient rights and legally actionable, medical malpractice litigation should always be the behavior modifier of last resort.

Delivery of Health Care↗
PubMed2002

Emerging theories into the social determinants of health: implications for oral health promotion.

In recent years public health research has increasingly focused upon exploring the social determinants of health. This interest has partly arisen through an acknowledgement of the limitations of educational preventive approaches in improving population health and reducing health inequalities. Many health education interventions have been influenced by health behaviour research based upon psychological theories and models. These theories focus at an individual level and seek to explore cognitive and affective processes determining behaviour and lifestyle. Current psychological theories have only a limited value in the development of public health action on altering the underlying social determinants of health. New theoretical approaches have however, emerged which explore the relationship between the social environment and health. This paper aims to review and highlight the potential value to oral health promotion of three important public health theoretical approaches: life course analysis, salutogenic model and social capital. It is important that an informed debate takes place over the theoretical basis of oral health promotion. As the field of oral health promotion develops it is essential that it is guided by contemporary and appropriate theoretical frameworks to ensure that more effective action is implemented in the future.

Adaptation, Psychological↗
PubMed2000

The common risk factor approach: a rational basis for promoting oral health.

Conventional oral health education is not effective nor efficient. Many oral health programmes are developed and implemented in isolation from other health programmes. This often leads, at best to a duplication of effort, or worse, conflicting messages being delivered to the public. In addition, oral health programmes tend to concentrate on individual behaviour change and largely ignore the influence of socio-political factors as the key determinants of health. Based upon the general principles of health promotion this paper presents a rationale for an alternative approach for oral health policy. The common risk factor approach addresses risk factors common to many chronic conditions within the context of the wider socio-environmental milieu. Oral health is determined by diet, hygiene, smoking, alcohol use, stress and trauma. As these causes are common to a number of other chronic diseases, adopting a collaborative approach is more rational than one that is disease specific. The common risk factor approach can be implemented in a variety of ways. Food policy development and the Health Promoting Schools initiative are used as examples of effective ways of promoting oral health.

Adolescent↗
PubMed2004

A national study of the importance of oral health to life quality to inform scales of oral health related quality of life.

OBJECTIVES: To assess the content validity of traditional oral health status scales as measures of oral health related quality of life (OHQOL), based on a general public's perception of the most important ways in which oral health affects quality of life (QoL). METHODS: A nationwide United Kingdom study involving a random probability sample of 1778 adults. Data were collected by face-to-face interviews in participants homes. RESULTS: Most 75% (1332) perceived oral health as being important to QoL. Among them, 53% (699/1332) identified oral health's importance to QoL as being in a positive manner. Existing scales predominantly fail to include this dimension. The general public ranked oral health's importance to QoL through a range of physical, social and psychological domains. Most frequently though affecting eating or comfort; domains considered by all instruments. Other domains/ways are presented. It is apparent that even when some of the multidomain scales are employed, they frequently omit items that the public perceives as being most important to QoL. CONCLUSION: The study raises concerns about the appropriateness of utilising many of the existing oral health status scales as measures of OHQOL because the concepts do not appear to be interchangeable.

Adolescent↗
PubMed2004

Evaluation of community-based oral health promotion and oral disease prevention--WHO recommendations for improved evidence in public health practice.

Systematic evaluation is an integral part of the organisation and delivery of community oral health care programmes, ensuring the effectiveness of these community-based interventions. As for general health promotion programmes the common problems from effectiveness reviews of oral health interventions relate to the quality and validity of programme evaluations. Problems identified mostly refer to the quality of outcome measures, short-term timescales to assess change, inadequate evaluation methodologies and inappropriate evaluation of programme implementation and processes. It remains a challenge to oral health professionals to integrate community oral health programmes into a wider health agenda. Public health research focusing on the development of evaluation methodologies has identified a variety of issues including the importance of using pluralistic evaluation approaches (quantitative and/or qualitative), limitations of the randomised controlled trial (RCT) design for evaluation of public health interventions, the need to match evaluation methods with the nature of intervention, development of outcome measures appropriate for the nature of intervention, importance of developing workforce capacity in evaluation techniques, and the need for development of partnerships between health practitioners and academics in conducting evaluations. In June 2003, the WHO Oral Health Programme at Headquarters organised a two-day workshop to take forward the development and documentation of the evaluation of oral health promotion and oral disease prevention programmes. The aims of the workshop were to: (1) identify common problems and challenges in evaluating community-based oral health interventions; (2) explore developments in the evaluation approaches in public health; (3) share experiences in evaluating oral health intervention programmes implemented at national or community levels in developing and developed countries and (4) develop guidelines for quality evaluation of national and community oral health programmes. Twenty-two invitees from 15 countries attended in addition to WHO staff. The first day was devoted to presentations of oral health promotion and oral disease prevention programmes from around the world. During the second day, WHO staff at Headquarters in Geneva discussed aspects of evaluation of public health programmes. Two working groups were formed to discuss agreed topics, and the reports from their deliberations, together with the general discussion, resulted in the presentation of emerging key issues and recommendations. In summary, it was agreed that evaluation of oral health promotion and disease prevention programmes should integrate, whenever possible, with general health programmes. While the design and advantages of RCTs in clinical evaluations are well documented, the relevance of this design in evaluation of community oral disease preventive programmes and oral health promotion programmes are much less clearly defined. Subsequently, the conduct of such programmes may be inappropriately evaluated in systematic reviews. There is a need for more research into appropriate immediate, interim and ultimate outcome measures, as well as process evaluation, an assessment that is poorly understood and practised less often than outcome evaluation. Guidance on potential design, conduct, and especially the evaluation, of community oral disease prevention programmes and oral health promotion programmes should be developed and updated regularly. WHO Collaborating Centres could have a role in promoting good practice, training and collaboration between teams throughout the world. Centres undertaking systematic reviews should consider the guidelines given in the proposed WHO document when defining their evaluation criteria.

Community Health Services↗
PubMed2004

Oral health status and oral treatment needs of dependent elderly people in Christchurch.

AIM: To describe the general health, oral health status, and treatment needs of dependent older people living in Christchurch rest homes. METHODS: 210 Grade 3 residents from seven randomly selected care facilities were examined for: dental/denture status, caries, periodontal disease, and oral cleanliness. RESULTS: Age ranged from 65 to 103 with an average age of 84.6 years. The female-to-male ratio was 3:1. Thirty-two percent of residents were dentate (average 14 teeth). This figure was up from 16-19% one decade ago (p<0.01; chi-squared test). Sixty-five percent of dentate residents had caries. Each dentate person had an average of 2.38 teeth with carious lesions in the root or crown. 51.5% of residents required restorative treatment and 38.2% required an extraction. Twenty residents had at least one 'carious stump'. Eighty-two percent of residents required scaling of the teeth. Two thirds had no natural teeth, and one third of those with dentures required treatment. Eighty-nine residents (42%) were unable to communicate about past dental behaviours. CONCLUSIONS: These data indicate that (compared to one decade ago) more dependent elderly people are retaining their natural teeth--but they are keeping no more teeth, and the health of the teeth has not improved. Most elderly people do not regularly receive dental assessments or care.

Aged↗
PubMed2004

Health behavior models and oral health: a review.

Dental hygienists help their clients develop health promoting behaviors, by providing essential information about general health, and oral health in particular. Individual health practices such as oral self-care are based on personal choices. The guiding principles found in health behavior models provide useful methods to the oral health care providers in promoting effective individual client behaviors. Theories provide explanations about observable facts in a systematic manner. Research regarding health behavior has explored the effectiveness and applicability of various health models in oral health behavior modification. The Health Belief Model, Transtheoretical Model and Stages of Change, Theory of Reasoned Action, Self-Efficacy, Locus of Control, and Sense of Coherence are examples of models that focus on individuals assuming responsibility for their own health. Understanding the strengths of each and their applicability to health behaviors is critical for oral health care providers who work with patients to adopt methods and modify behaviors that contribute to good oral health. This paper describes health behavior models that have been applied to oral health education, presents a critical analysis of the effectiveness of each model in oral health education, and provides examples of application to oral health education.

Behavior Therapy↗
PubMed2003

Partnerships for better oral health.

Improving oral health in populations who do not easily access the private dental office or the available community care site is a challenge to dental hygienists and others concerned with the health and well-being of all. Partnerships for improved oral health have been part of the community health efforts for many years and in many countries. With the knowledge, skills, and resources that are held by specific groups and organisations combined into a larger entity of a partnership or coalition, greater impact on oral health issue may be possible. Agencies and individuals interested in making improvements in oral health status in any particular target group may begin a process of working with others who have an interest in improving the health and well being of that target group. In a world that is increasingly synergistic and mutually dependent, improvements in oral health can be advanced by considering the elements of successful coalition building and forming partnerships with multiple organisations and individuals.

Community Health Services↗
PubMed2005

Confronting oral health disparities among American Indian/Alaska Native children: the pediatric oral health therapist.

American Indian and Alaska Native (AIAN) children are disproportionately affected by oral disease compared with the general population of American children. Additionally, AIAN children have limited access to professional oral health care. The Indian Health Service (IHS) and AIAN tribal leaders face a significant problem in ensuring care for the oral health of these children. We discuss the development and deployment of a new allied oral health professional, a pediatric oral health therapist. This kind of practitioner can effectively extend the ability of dentists to provide for children not receiving care and help to confront the significant oral health disparities existing in AIAN children. Resolving oral health disparities and ensuring access to oral health care for American Indians and Alaska Natives is a moral issue-one of social justice.

Alaska↗