Dental Education at the Crossroads Challenges and Change (1995) / Chapter Skim
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3 Oral Health Objectives and Dental Education
3 Oral Health Objectives and Dental Education
Pages 59-87
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From page 59... ...
This chapter briefly reviews key indicators of oral health status and recommendations of other groups; it then presents the committee's views on oral health status goals and their implications for dental education. DATA SOURCES The data on oral health status and services reviewed by this committee came from three primary sources.
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From page 60... ...
These included the RAND Health Insurance Experiment report on dental health status {Spolsky et al., 1983J, some state surveys, a recent National Institute on Aging {NIAJ study of elders in New England {Douglass et al., 1993J, and selected historical sources {see Chapter 2J. The background paper by White et al.
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From page 61... ...
IMPROVED HEALTH STATUS The last 50 years have seen significant improvements in oral health status {see, for example, NIDR, 1990; Burt and Eklund, 1992 Brown. 1994; and the background paper by White et al.J.
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From page 62... ...
For those aged 65 and over, the average number of missing teeth was 15 in the first survey and 10 in the second. Three state surveys by the North Carolina Division of Dental Health from 1960 to 1986-1987 show a considerable drop in the mean number of missing teeth in childrenfrom 0.60 to 0.04 {Caplan et al., 1992~.~ · From the 1971-1974 NHANES through the 1979-1980 and the 1986-1987 NIDR surveys, the average number of decayed, missing, or filled surfaces on permanent teeth declined for children at all ages, especially those aged 12 or older.
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From page 63... ...
CONTINUED PREVALENCE OF ORAL HEALTH PROBLEMS Despite the trends cited above and a general acceptance that most oral health problems are preventable, dental disease remains one of the most common if not the most common human health problems. By age 17, more than 8 out of 10 children have experienced dental caries in their permanent teeth iNIDR, 1989~.
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From page 64... ...
DISPARITIES IN ORAL HEALTH STATUS Although oral health status has improved generally across the U.S. population, important disparities in status persist.
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From page 65... ...
This difference in survival rates exceeds that for all other major cancers. Visible disparities In health status may translate Into other problems TABLE 3.1 Mean Number and Percentage Component of Decayed, Missing, and Filled Permanent Teeth tDMFTJ Among Children by Age Group and Race, United States 1963-1987 Age Group Mean Percentage D Percentage M Percentage F Race {years)
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From page 66... ...
if they affect individual performance at school or work or if they prompt negative assessments by teachers and employers. The impact of such assessments on obese individuals is beginning to be understood, but little if any systematic research has been undertaken to document the effects of visible dental defects {e.g., missing, discolored, or maloccluded teeth)
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From page 67... ...
In the same year, 41 percent of the population reported some form of private dental insurance, much of it quite limited. In contrast, over 70 percent of nonelderly Americans have private medical insurance, and virtually all elderly Americans have medical coverage under Medicare, which does not cover dental services.
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From page 68... ...
What developments might substantially affect oral health status? Four likely sources of change merit brief review: expanded use of existing technologies, new scientific and technological discoveries, more patient outcomes research and guidelines for dental practice, and improved access to oral health services.
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From page 69... ...
School-based programs are attractive, but legal restrictions on the use of allied personnel to apply sealants may reduce the scope of school-based sealant initiatives until simpler techniques are developed or licensure restrictions are eased. If health care reforms were enacted to cover childhood preventive services, financial obstacles to broader use of this technology would be much reduced.
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From page 70... ...
Because many of these innovations are most accessible to the more affluent and healthier-populations and because they often emphasize aesthetic benefits, their potential impact on population health status appears more limited than interventions that affect the high-risk groups that have limited access to dental care. Nonetheless, refinements in existing bonding, implant, and other interventions and better appreciation of their overall benefits for many patients will expand their application (NIDR, 1990; Leinfelder, 1993~.
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From page 71... ...
. The journal of the American Dental Association recently devoted an entire special issue to the emerging field of oral pharmaceuticals, a key component of the medical management of diverse oral health problems (Douglass and Fox, 1994~.
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From page 72... ...
This paper describes efforts to analyze dental practice variations, measure outcomes of dental interventions, and develop guidelines for dental practice. The 3The American Dental Association and some other dental organizations have followed the conventions of the American Medical Association {AMA)
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From page 73... ...
To the extent that better evidence of the effectiveness of dental interventions is accumulated and transformed into guidelines that, in turn, shape dental practice, the result should be further improvements in dental care and oral health status. Practice guidelines are not, however, self-implementing.
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From page 74... ...
Three dimensions of potential health care reform are particularly important: the definition and administration of a standard or basic benefit package; the tax treatment of private insurance coverage beyond a basic or standard benefit package; and the provisions for the elderly and the poor. At issue in decisions about the benefit package are: What would be covered {e.g., primarily preventive services or restorative care as well)
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From page 75... ...
RECOMMENDATIONS OF OTHER GROUPS ORAL HEALTH STATUS AND SERVICES The most common dental diseases-caries and periodontal disease- are largely preventable through a combination of community, professional, and personal practices. Thus, most proposals to improve oral health status of individuals and populations over the long run focus on preventive rather than curative strategies.
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From page 76... ...
Preventive Services Task Force noted the importance of good oral health status. Appendix 3B presents an excerpt from the guidelines developed by that group to advise physicians on oral health counseling.
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From page 77... ...
29, 31) , "these attributes imply a challenging analytic strategy for developers of practice guidelines that, in summary, involves the following steps: · formulation of the problem {for example, the clinical condition to be considered, the key issues to be addressed, and the relevant alternative courses of care to be examined, which may include 'watchful waiting'!
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From page 78... ...
reducing disparities in oral health status arid services experienced by disadvantaged economic, racial, or other groups; 2. improving our knowledge of what works and what does not work to prevent, diagnose, or treat oral health problems; 3.
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From page 79... ...
Dental educators have a central role to play in encouraging and promoting basic science and clinical and health services research to distinguish effective and ineffective oral health services; to clarify oral disease patterns or trends and the factors affecting them; and to identify cost-effective strategies likely to help those with the poorest health status and those with limited access to oral health services. Such strategies include both individual and community services and methods for organizing as well as delivBring care to those most in need.
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From page 80... ...
Department of Health and Human Services to regularly assess the oral health status of the population and identify changing disease patterns at the community and national levels; · develop and implement a systematic research agenda to evaluate the outcomes of alternative methods of preventing, diagnosing, and treating oral health problems; and · make use of scientific evidence, outcomes research, and formal consensus processes in devising practice guidelines. These steps will help prepare dental educators, practitioners, and policymakers to understand and respond to various possible futures.
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From page 81... ...
Dental educators have an important role to play in building the scientific, epidemiological, and organizational knowledge base for improved oral health and oral health services. Measuring and evaluating progress in oral health, however, requires more consistent and regular information on oral health status and more research on the outcomes of established and new oral health interventions.
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From page 82... ...
Special Population Targets Caries Prevalence Children aged 6-8 whose parents have less than high school education 13.1b American Indian/Alaska Native children aged 6-8 13.1c Black children aged 6-8 13.1d American Indian/Alaska Native adolescents aged 15 13.2 Dental Caries Among Children 13.2a Children aged 6-8 whose parents have less than high school education 13.2b American Indian/Alaska Native children aged 6-8 13.2c Black children aged 6-8 13.2d Hispanic children aged 6-8 Among Adolescents 13.2a Adolescents aged 15 whose parents have less than high school education 13.2b American Indian/Alaska Native adolescents aged 15 13.2c Black adolescents aged 15 13.2d Hispanic adolescents aged 15 1986-1987 Baseline 70% 92%a 52%b 61% 93%b 2000 Target Dental Percent Decrease 45% 45% 40% 70% Reduce untreated dental caries so that the proportion of children with untreated caries {in permanent or primary teeth) is no more than 20 percent among children aged 6 through 8 and no more than 15 percent among adolescents aged 15.
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From page 83... ...
{Baseline: 11 percent of children aged 8 and 8 percent of adolescents aged 14 in 1986-1987, Increase to at least 75 percent the proportion of people served by community water systems providing optimal levels of fluoride. {Baseline: 62 percent in 1989)
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From page 84... ...
13.13 Extend to all long-term institutional facilities the requirement that oral examinations and services be provided no later than 90 days after entry into these facilities. iBaseline: Nursing facilities receiving Medicaid or Medicare reimbursement will be required to provide for oral examinations within 90 days of patient entry beginning in 1990; baseline data unavailable for other institutions, 13.14 Increase to at least 70 percent the proportion of people aged 35 and older using the oral health care system during each year.
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From page 85... ...
Screening for oral cancer should be performed for high risk groups {see Chapter 15J, and all patients should be counseled regarding the use of tobacco products {Chapter 48J. Children should also be examined for evidence of baby bottle tooth decay, mismatching of upper and lower dental arches, crowding or malalignment of the teeth, premature loss of primary posterior teeth {baby molarsJ, and obvious mouth breathing.
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From page 86... ...
APPENDIX 3.D DESIRABLE ATTRIBUTES OF CLINICAL PRACTICE GUIDELINES (IOM) Attribute Explanation VALIDITY Strength of Evidence Practice guidelines are valid if, when followed, they lead to the health and cost outcomes projected for them.
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From page 87... ...
. Practice guidelines should be as inclusive of appropriately defined patient populations as evidence and expert judgment permit, and they should explicitly state the populationts)
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