Jurnal a - FDI Social Determinants

8/11/2019 Jurnal a - FDI Social Determinants

1/14

O R I G I N A L A R T I C L E

FDI Vision 2020: shaping the future of oral healthMichael Glick1, Orlando Monteiro da Silva2, Gerhard K. Seeberger3, Tao Xu4, Gilberto

Pucca5, David M. Williams6, Steve Kess7, Jean-Luc Eisele2 and Tania Severin2*1School of Dental Medicine, University at Buffalo, Buffalo, NY, USA; 2FDI World Dental Federation, Geneva, Switzerland; 3University ofCagliari Dental School, Cagliari, Italy; 4Peking University School of Stomatology, Beijing, China; 5Oral Health Department, Brazilian Ministryof Health, Brasilia, Brazil; 6Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK;7Henry Schein, Inc., Melville, NY, USA.

PREFACE

The initial idea for this document came to light in theaftermath of the FDI General Assembly in Mexico inthe autumn of 2011, when it was observed that, atthe present time, the dental profession is lacking anoverarching long-term vision of the main challengesoral health is facing and direction as to how the pro-fession can grow in order to make a significant contri-bution to the improvement of global oral healthduring the next decade. As a first step, the concept ofthis document was informally discussed within theFDI leadership. Shortly after, a task team was nomi-nated under the name FDI Vision 2020. Great carewas taken to ensure balanced representation fromAcademia, Research, Education, General Dentistry,Government and Industry in order to foster an overallview of all the issues discussed.

Under the chairmanship of Prof Michael Glick, theFDI Vision 2020 Task Team was given the mandateto identify the main challenges and opportunities oralhealth and its workforce are facing today, with a spe-cific focus on issues with a legislative, regulatory oradvocacy dimension. In an inclusive and iterative pro-cess, all FDI member associations were invited tonominate an official representative to provide input

and comments on the task teams groundwork. Fur-ther comments and feedback were collected from FDIleadership, through its committees, and from a panelof industry leaders. The task team met twice, resultingin two rounds of consultation. The draft Vision wasthen circulated to all FDI committees and memberassociations for feedback and finally presented to FDIGeneral Assembly.

The FDI General Assembly during its meeting inHong Kong on August 31st, 2012, adopted the follow-ing resolution: It is resolved that FDI General Assem-bly support the objectives of Vision 2020 as a

working document, to drive forward the future priori-

ties of FDI in accordance with the mission of Leadingthe World to Optimal Health; and further, that FDIbelieves that only the dentist is the competent andresponsible leader of the dental team. In this regard,FDI underlines the principle: Delegation yes, substi-tution no.

The present document is therefore the result of awide consultation process and reflects priorities whichwe hope are valid in various countries, regions andsettings.

For the sake of clarity, let us briefly delineate whatthis document is, and what it is not. It is, as its name

says, a Vision, which paves the way for a new modelof oral health care led by dentists in collaborationwith a wide range of other stakeholders. It roughlysketches the possible look of oral healthcare by theyear 2020 if we tackle the challenges and seize theopportunities that arise in a timely and adequate man-ner. As a Vision, this document is meant to be aspira-tional and inspirational; it is NOT meant to beoperational. It provides avenues which will need to befurther explored and discussed, but, intentionally, itdoes not provide any specific strategies, tacticalapproaches, implementation tools or ready-to-use for-mulae, as those will depend largely on local needs and

circumstances in the spirit of the United NationsDevelopment Programmes report: Think globally actlocally. This document is the beginning of a continu-ous process aimed at generating discussion and collab-oration between FDI and all its partners.

EXECUTIVE SUMMARY

Oral health is an essential component of good health,and good oral health is a fundamental human right.The role of the dental profession is to help the popu-lation and decision makers to achieve health through

278 2012 FDI World Dental Federation

International Dental Journal2012; 62: 278291

doi: 10.1111/idj.12009


2/14

good oral health. FDI and its member associationsneed to be in the forefront to identify challenges andopportunities and advocate for the benefit of ourpatients, our profession and our governments.

Among those demanding appropriate and timelyconsideration and action, we can enumerate persistingoral health inequalities; lack of access to oral health-care; unaffordability of dental treatment in manyplaces; a growing and ageing population; workforcemigration; dental tourism; the emergence of new edu-cational models; the evolving distribution of tasksbetween members of the oral healthcare workforce;ongoing legislative actions targeting hazardous materi-als; and the increasing use of information and com-munication technologies in all segments of our livesand professions. These, we believe, are two sides ofthe same coin and can be looked at as either over-whelming and threatening challenges or unique oppor-tunities to reshape our profession to better equip our

workforce for the future, while the fully trained den-tists, as leaders of the dental team, retain full respon-sibility for diagnosis, treatment planning andtreatment.

A heavy disease burden

Historically, the approach to oral health has focusedoverwhelmingly on treatment rather than on diseaseprevention and oral health promotion. This approachhas, however, limitations. Globally, the burden of oraldiseases remains high and the traditional curative

model of oral health care is proving too costly, interms of both human and financial resources, toremain viable in the light of the increasing demand.Worldwide, oral disease is the fourth most expensivedisease to treat; dental caries affects most adults and6090% of schoolchildren, leading to millions of lostschool days each year, and it remains one of the mostcommon chronic diseases; periodontitis is a majorcause of tooth loss in adults globally, and oral canceris the eighth most common cancer and most costlycancer to treat. With oral infection has been associ-ated with issues ranging from pre-term birth and lowbirth weight to heart diseases, it is now established

that poor oral health may be an important contribut-ing factor of several preventable diseases. In addition,stark inequalities of access to oral healthcare subsist.One of the main reasons for this is that too littleattention has so far been paid to the social determi-nants of oral health.

Political agendas

For decades, oral health has failed to be considered asan issue worthy of being moved to the top of theagendas of governments and international organiza-

tions, perhaps because poor oral health primarilyaffects morbidity rather than mortality. In recentyears, however, there has been a growing realizationthat oral health constitutes an integral part of overallhealth, and a very positive move has been observedtowards the inclusion of oral health into generalhealth strategies. This movement was initiated withthe US Surgeon Generals report in 2000. It was takenup by WHO in 2002, when the policy of its GlobalOral Health Programme emphasized that oral healthis integral and essential to general health and a deter-minant factor in quality of life. More recently aWHO resolution called for oral health to be inte-grated into chronic disease prevention programmes.

The dawn of new area

Building on this momentum, we believe that the timeis now right for developing a new model for oral

health care, which considers oral health as an integralpart of general health and addresses the needs anddemands of the public and the right of each individualto good oral health. We believe that, by shifting thefocus of our model from (i) a traditionally curative,mostly pathogenic model to a more salutogenicapproach, which concentrates on prevention and pro-motion of good oral health and (ii) from a ratherexclusive to a more inclusive approach, which takesinto consideration all the stakeholders who can partic-ipate in improving the oral health of the public, wewill be able to position our profession at the forefront

of a global movement towards optimised healththrough good oral health. Furthermore, we will bemuch better equipped to address the burgeoningdemand of governments and non-governmental orga-nizations (NGOs) for constructive solutions to reducesocial inequalities in oral health and to assist the pub-lic in achieving health through good oral health. Inshort, we will be able to play a leading role in bring-ing oral health to the forefront. To bring our Visionto life, we have defined five areas of priority as cor-nerstones of a new, responsive and fair model:

1 Meet the increasing need and demand for oralhealthcare.

2 Expand the role of existing oral healthcare profes-sionals.

3 Shape a responsive educational model.4 Mitigate the impacts of socio-economic dynamics.5 Foster fundamental and translational research and

technology.

Meet the increasing need and demand for oralhealthcare

Oral health is a basic human right and its contribu-tion is fundamental to a good quality of life. There

2012 FDI World Dental Federation 279

Shaping the future of oral health


3/14

are, however, persistent stark inequalities of access toproper oral healthcare. These might be due to differ-ent reasons: an unequal geographical distribution ofqualified professionals worldwide, but also withincountries; the unaffordability of treatments for somesegments of the population; lack of utilization ofexisting oral healthcare offerings; or a mismatchbetween the offer in oral health care and the realneeds of the population.

Improving oral health literacy of the public, optimis-ing overall workforce planning, providing adequateresources for education and training, devising effectiveworkforce retention strategies in underserved areas, andscrutinising the effectiveness and appropriateness of dif-ferent workforce models are challenges and opportuni-ties which need to be addressed to meet a current unmetneeds and growing demands in coming years.

Expand the role of existing oral healthcareprofessionals

As highlighted in the recent United Nations PoliticalDeclaration, there is now broad recognition that oralhealth shares the same social determinants and risk fac-tors with other Non-Communicable Diseases (NCDs).This means that oral health cannot be dealt with in iso-lation from other health issues. Furthermore, the emer-gence of a new type of oral health workers provides anopportunity to reshape and expand the role of existingoral healthcare professionals.

The profession has a unique opportunity to actively

participate in efforts to improve patients overallhealth by taking on new tasks such as screening forand monitoring of non-communicable diseases(NCDs) (e.g. glycemic control), playing a leading rolein patient education and disease prevention, and guid-ing and supervising teams of oral healthcare workers.A stronger integration of dentists into the overallhealth system will reinforce the recognition of theirclinical competence and provide for an expandedleadership role towards health workforce team mem-bers working under a dentists direction and advice.

Shape a responsive educational modelCurrent traditional models of dental education havenot yet been able to address adequately disparities inoral health. Moreover there is a growing disconnectbetween dental and medical education, despite oralhealth now being widely recognized as an importantpart of general health. To better equip members of theoral healthcare workforce for the challenges ahead ave-nues worthy of investigation include revising educa-tional curricula to take account of a stronger focus onpublic health and epidemiology, as well as placingmore emphasis on critical thinking, team management,

interprofessional education and interprofessional prac-tice. A further opportunity for us to embrace is in thefield of advocacy for global standards of competenceto educate and train an oral health workforce up to thetask of optimizing its communitys oral health.

Mitigate the impacts of socio-economic dynamics

Fluctuations in socio-economic circumstances have asignificant impact on oral healthcare resources andpolicies. In times of economic hardship, resourcestend to be drawn from oral healthcare and redirectedtowards areas and diseases where lack of treatmentleads to faster and more visible consequences, nota-bly mortality. Furthermore, patients tend to delayconsultation and treatment during economic down-turns. Conversely, economic upturns tend to fosteran increase in demand that must be met. To ensurethe sustainability of oral healthcare delivery and of

our profession through economic ups and downs, theresponsibilities we need to take on in the comingyears include advocating for oral health in all poli-cies.

Furthermore, evidence-based oral healthcare mod-els, which bring fairness in remuneration for carethat delivers beneficial and measurable health out-comes, must be developed. Finally, the capacity tocontribute to ensuring that the public is able toaccess and utilize oral healthcare services at alltimes, must be addressed.

Foster fundamental and translational research andtechnology

At present, the field of oral health is experiencing sub-stantial difficulties in disseminating and implementingresearch findings and technological innovations in atimely fashion into daily practice. There is thereforean opportunity to develop a consensus and science-based approach to oral healthcare. A proactive andinnovative use of available dental technology andmaterials could be encouraged. Links could be facili-tated between ongoing changes in types of oral health-care deliverables and ongoing research efforts. E-

Health technologies (E-Health means the applicationof internet and other related technologies in thehealthcare industry to improve the access, efficiency,effectiveness and quality of clinical and business pro-cesses utilized by healthcare organizations, practitio-ners, patients and consumers to improve the healthstatus of patients) can be used to foster communica-tion between members of the health team and speed-up processes. By seizing these various opportunities,oral healthcare professionals will be able to foster fun-damental and translational research and technology inthe next decade.


Glick et al.


4/14

The way forward: oral health in all policies

The relevance of oral health is not about to fadedespite a significant proportion of oral diseases beingpreventable. Each of the five areas of priority identi-fied in this document contributes towards shaping anew model of oral healthcare which seeks to be

inclusive, participative, adaptive and effective. Itsfocus on oral health promotion and oral disease pre-vention reflects trends observed in other areas ofhealthcare and priorities set by international agen-cies. It is now up to dentists to reach constructivesolutions to respond to these trends and needs. Thisis a unique opportunity for members of the profes-sion to become true leaders and role models. In linewith the principles of the Adelaide Statement onHealth, we strongly advocate for the inclusion ofOral Health in All Policies; and for the engagementof oral healthcare professionals with leaders and pol-

icy-makers at all levels of government and NGOs, i.e. local, regional, national and global. The emphasisis on the fact that government objectives are bestachieved when all sectors include health and well-being as key components of policy development. Webelieve that this advocacy will help to increase oralhealth literacy and awareness among the public,thereby supporting a community-driven demand togovernments for better access to oral healthcare ser-vices. In conclusion, we have a significant role ashealth advocates: it involves educating and influenc-ing decision makers, including senior governmentofficials, national and international agencies, commu-

nity leaders and the public. Should our professionshirk its responsibility of taking the lead other par-ties lacking the necessary professional knowledge andexpertise in dentistry are likely to step in to take iton our behalf in the years ahead.

MEET THE INCREASING NEED AND DEMAND FORORAL HEALTHCARE

Where we are now

All over the world, population growth and ageing

have led to an increasing need for oral healthcare.Furthermore, a gradual increase in awareness aswell as mass media exposure to perfect smiles haveled to an increased demand for high quality oralhealth. At present, neither the need nor demand isfully met on a global level, despite the fact thatoral health is a basic right and its contribution isfundamental to a good quality of life and overallhealth.

Oral diseases, despite many of them being pre-ventable, represent the most common diseasesworldwide. Poor oral health has a profound impact

on quality of life and well-being, as well as signifi-cant economic impacts. Root causes of oral diseaseare varied but relate predominantly to persistentinequities in access to oral healthcare. Althoughthere are more than a million practicing dentistsworldwide, their unequal geographic distributionresults in an over-supply in some wealthy urbanareas, which starkly contrasts with a critical short-age in many of the worlds poorer and remoteareas. Globally, roughly only 60% of the populationworldwide enjoys access to proper oral healthcare,with coverage ranging from 21.2% in Burkina Fasoto 94.3% in Slovakia. Between countries, the den-sity of qualified dentists varies from one dentist per560 people in Croatia to one dentist per 1,278,446people in Ethiopia; and distribution within countriesalso strongly varies. Reflecting a strong social gradi-ent, wealthier adults in almost any given countryenjoy a higher coverage compared with those less

wealthy.Increased globalization, which facilitates the

migration of dentists to more affluent areas orcountries, is also a source of concern as it can leadto domestic shortages. For instance, in the UK 22%of dentists are foreign-born, while the Philippines iscurrent world leader in dental workforce exportwith two-thirds of its dental graduates migrating tothe USA.

Already in 2006, The World Health Report 2006:working together for health, recognized that insuffi-cient numbers of appropriately trained health workers

represented a significant threat to achieving thehealth-related Millennium Development Goals(MDGs) and the issue therefore would need urgentattention.

Furthermore, with more than one billion of theworlds population living on one dollar a day or less,the affordability of oral care for the worlds poorposes a serious problem even within a geographic areawhere dentists are available.

Lastly, there is a serious need for awareness-build-ing of the necessity of preventive oral health care andself health among underserved and at-risk popula-tions, requiring health literacy on a culturally compe-

tent basis.

The way forward

The current shortage and unequal geographic distribu-tion of qualified oral healthcare professionals, whichtends to affect poorer countries and regions more thanwealthier ones, remote areas more than urban ones,combined with challenges in terms of globalization,migration and ageing, calls for firm and targetedactions and gives rise to a series of opportunities ourprofession must now seize.




5/14

First, we believe there is a significant opportunityfor our profession to take on a leadership role intackling the social determinants of oral health andin generating constructive solutions with regard tothe problem of the current unmet need and demandfor oral healthcare. Taking on a leadership rolemeans, for us as a profession, to work together toraise awareness at all levels; to identify suitablesolutions to achieve equity in oral health; and toadvocate their implementation at local, regional,national and international levels. Persistent inequitiesin access to oral healthcare and the unmet need anddemand for oral healthcare services have differentroot causes that will need to be addressed. One ofour first efforts should be to promote advocacyaimed at improving the oral health literacy of thepublic. This represents a first and crucial stepin helping communities realize their right to oralhealth by increasing their ability to adopt healthy

oral health behaviours and demand care whenneeded.

Second, we believe there is a role for us in advocat-ing for increased resources to be allocated for educa-tion and training of dentists and of the oral healthteam. This goes hand-in-hand with a call to authori-ties and administrations to optimize health profes-sional workforce planning and provide a sustainableeconomic environment to educate, train and retainsufficient numbers of oral healthcare workers to workin the places and settings where a need has been iden-tified.

Finally, acknowledging the fact that the prevalenceof trained dentists, the composition of the oralhealthcare team, and the educational pathways tobecoming an oral healthcare worker vary widelydepending on local circumstances, we believe thatthere is a crucial role for our profession in leadingand participating in efforts with multiple stakehold-ers and to examine the effectiveness and appropriate-ness of oral health workforce models in differentgeographical settings. This represents a uniqueopportunity for our profession to define the rolesand responsibilities of the oral healthcare workforce,while considering specific local needs, resources and

desired outcomes. This is also an opportunity tospearhead the development and implementation oforal health education for all different members ofthe health care workforce team with appropriatestructured formal education within approved educa-tional institutions. We can shape a new model oforal healthcare delivery which relies on a team-basedcollaborative approach where fully trained dentiststake responsibility for supervising a team, providesufficient training to the healthcare workforce anddelegate specific tasks as deemed appropriate while

retaining full responsibility for diagnosis, treatmentplanning and treatment.

Our Vision is that by 2020, inequities with regard to access

to oral healthcare will be substantially reduced and the

global need and demand for oral healthcare more largely

will be met thanks to increased oral health literacy, thedevelopment of rational workforce planning, education,

training and retention strategies, and an improved

collaboration between members of the health workforce

on issues pertaining to oral health promotion, disease

prevention and treatment.

Summary

Status

Lack of oral health care professionals results in

increased demand for appropriately trained profes-sionals.

Uneven geographic distribution of oral health careprofessionals worldwide but also within individualcountries.

Need for enhanced oral health literacy.

Lack of access to oral health care among vulnerableand poor populations.

Opportunities

Play a leading role and generate constructive solu-

tions for tackling the social determinants of oralhealth and the problem of the unmet need anddemand for oral healthcare.

Advocate for:

improved oral health literacy. increased resources for education and training

of dentists and the oral health care team.

an optimized health professional workforceplanning.

a sustainable economic environment to educate,train and retain dentists in areas of need.

Participate in and lead efforts with multiple stake-holders to

examine the effectiveness and appropriatenessof oral health workforce models in differentgeographical areas;

define the roles and responsibilities of the healthcare workforce based on

appropriate and approved formal structurededucation and training which is

aimed at delivering a health care workforce toachieve a desired outcome, whilst

taking into consideration local needs andresources.


Glick et al.


6/14

spearhead the development and implementationof oral health education of the health care work-force.

EXPAND THE ROLE OF EXISTING ORALHEALTHCARE PROFESSIONALS

Where we are now

The traditional role of dentists is facing new chal-lenges from increasing and evolving needs of patients,advances in technology, economic constraints in vari-ous parts of the world, as well as ongoing debatesabout the distribution of tasks and responsibilitiesbetween different workers involved in the provision oforal healthcare. In addition, associations between oralhealth and communicable diseases, maternal and childhealth and NCD call for a shift in the focus of ourprofession. At present, more than 60% of deaths

worldwide are due to NCDs, which kill 36 millionpeople each year. Low- and middle-income countriesare disproportionately affected and, in 2010, 80% ofNCD deaths occurred in those countries, highlightingonce again the importance of tackling the social deter-minants driving the NCD epidemic.

According to the World Economic Forum, the globaleconomic impact of the five major NCDs cardiovas-cular disease (CVD), chronic respiratory disease, can-cer, diabetes and mental ill-health could amount to atotal of 47 trillion US dollars over the next 20 years.This represents approximately 4% of annual global

GDP. In recent years, there has been a growing realiza-tion that oral health is an integral part of overall health.In addition, there are associations between oral diseaseand major NCDs, the two share common risk factorsand there are indications that oral disease in itself rep-resents a risk factor for NCDs. Altogether, connectionsbetween systemic disease and oral manifestations havebeen identified in over 100 diseases, such as diabetes,cardiovascular diseases, respiratory infections, canceror nutritional problems. This growing realization ledthe WHO to re-orient its Global Oral Health Pro-gramme in 2002 in order to foster its integration withchronic disease prevention and general health promo-

tion. Five years later, in 2007, the World HealthAssemblys resolution on Oral health: action plan forpromotion and integrated disease prevention urgedMember States to adopt measures to ensure that oralhealth is incorporated as appropriate into policies forthe integrated prevention and treatment of chronicnon-communicable and communicable diseases, andinto maternal and child health policies. In September2011, this reorientation culminated in a High-levelMeeting of the General Assembly of the United Nationson the Prevention and Control of Non-communicableDiseases, whose final statement expressly recognizes

that: Renal, oral and eye diseases pose a major healthburden for many countries and that these diseases sharecommon risk factors and can benefit from commonresponses to non- communicable diseases. As docu-mented in its NCD Advocacy Guide, FDI has been atthe forefront of this initiative.

The way forward

The increasing recognition that oral health plays apivotal role in general health and quality of life repre-sents, for our profession, a set of unique opportunitiesto play a central and leading role in patient educationand disease prevention; to strengthen our integrationinto the overall health system; to reinforce the recog-nition of our clinical competence; and to shoulder anexpanded leadership role towards health workersunder our direction and advice.

First, as stated in FDIs Guide to Advocacy, because

of the shared risk factors with other NCDs, webelieve we can play a central role by sharing ourexperience in prevention and by actively contributingto early NCD diagnosis, screening and monitoring.Through regular access to healthy or at least asymp-tomatic patients during check-ups, dentists are in aunique position to raise awareness of risk behaviourand thereby increase prevention, but also to screen,monitor and evaluate patients for conditions such asCVD or diabetes and refer them to their physiciansfor further action. As an active partner of worldwidehealth- check-programmes, oral health professionals

can contribute to the cost-effectiveness and feasibilityof primary and secondary prevention.Second, as scientifically valid oral fluid-based

diagnostic tools become available, there is an oppor-tunity for us to take on a leadership role in healthscreening and surveillance based on these newtechniques. Implementing such cost-effective andnon- invasive tests into our daily practice, and refer-ring patients to a physician for appropriate care,treatment and follow-up whenever necessary, willallow our profession to reinforce the recognition ofits clinical competence and integration in the generalhealthcare system. This calls for a proactive, positive

and affirmative collaboration with colleagues from themedical arena, which will reflect the reality of ourmedical role and relevance, and will enhance our cred-ibility as professionals.

Third, as the composition of the oral health work-force team evolves and encompasses workers with dif-ferent backgrounds, knowledge, skills andcompetencies (dental assistants, dental hygienists, den-tal therapists, dental technicians, but also primarycare workers, community nurses, or even educatorsand teachers), there is a need for our profession toshoulder an expanded leadership role towards health




7/14

practitioners working in oral health under our direc-tion and advice. As stated previously, we stronglyvalue a team-based collaborative approach where fullytrained and skilled dentists remain the primary con-tact persons for all questions about oral health andtake the exclusive responsibility for supervising andleading a team of health workers. Such collaborationand delegation of tasks can be particularly powerfulin the field of oral health promotion and preventionstrategies, where joining forces with primary care pro-viders and teachers, as well as other members of thecommunity, can contribute to reduce lack of access tocare in areas of need and foster rapid dissemination oftargeted prevention and promotion messages. Suchcollaboration may focus on achieving the objectives ofthe MDGs. We strongly insist, however, that responsi-bility for diagnosis, treatment planning and rehabilita-tion and treatment plans must always remain in thehands of the dentists in order to ensure optimum

safety and care for patients.

Our Vision is that, by 2020, oral health will be fully

recognized and accepted as a crucial part of overall health

and well-being. The credibility and relevance of our

profession will be enhanced thanks to our significant

contribution to addressing major health issues, such as

NCDs; our leadership role in prevention and promotion

strategies; and our capacity to guide and supervise teams

of health practitioners working together to improve oral

health, and thereby overall health, in our communities. In

a similar way that the oral cavity is the visible gateway to

the human body, our vision is that our profession will bean universally acknowledged, recognized and valued

gateway to better health through improved oral health.

Summary

Status

Increased recognition that oral diseases share com-mon risk factors with other NCDs.

Increased recognition that oral diseases cannot bedealt with in isolation from other diseases.

The role of dentists is changing due to the emer-gence of different oral health workforce models.

Opportunities

Become leaders of oral healthcare teams; Leadefforts in prevention and patient education.

Become an integral part of overall health and per-form new tasks, such as screening and monitoringof common risk factors for NCDs by for exampleoral fluid-based diagnostics. In addition, influence

these common determinants by using the commonrisk factor approach.

Become highly specialized experts in prevention,diagnostics, health consulting, biotechnology andfunctional rehabilitation with high technology.

SHAPE A RESPONSIVE EDUCATIONAL MODEL

Were we are now

Dentistry emerged as a profession with its own systemof education at the end of the 19th century. Sincethen, it has been increasingly separate from medicalteaching in various parts of the World. In countriessuch as North and South America, Northern andWestern Europe, Japan, India and Australia, dentaleducation is recognized as an autonomous disciplineaccording to the so-called odontology model or den-tal medicine model. In contrast, the stomatology

model, which considers dentistry as a specialty ofmedicine, prevails in some other countries. Both mod-els cover, with a different focus, theoretical and prac-tical training, including anatomy, physiology,biochemistry, pathology, behavioural sciences anddental materials science, as well as clinical skills.However, dental education and training is often dis-proportionately focused on restorative care, neglectingoral health promotion, disease prevention and publichealth. Moreover, new knowledge and technologiesbecome available at an ever increasing pace, in areasranging from connective tissue biophysics/mechanics,

tissue engineering, biotechnology and molecular engi-neering, to informatics and biomaterials, with thepotential to transform dental care. So far, however,the integration of information related to new knowl-edge and technologies into dental education has beenrather slow.

From a statistical point of view, the current dispar-ity in the number of dental schools and dental gradu-ates is enormous. The countries with the most dentalschools in 2006 were India (206), Brazil (191) andChina (93), whilst many African countries such asSudan, Tanzania or the Democratic Republic ofCongo, have just one, or no dental school. As a result,

while Brazil trained approximately 10,000 newly-graduating dentists in 2008, all 46 WHO/AFROmember states combined managed only to train 168new dentists in 2002. Many countries and regionsworldwide suffer from a critical shortage in thenumber of qualified oral health professionals (seeSection 1).

Globally, the burden of oral diseases remains highand the viability of the predominantly curativeapproach to oral health care taught in universities isbeing challenged. Current traditional models of dental


Glick et al.


8/14


9/14

Opportunities

Develop an educational system which focuses moreon public health issues and on the recognition oforal health disparities.

Include more emphasis on critical thinking, inter-professional communication at an early stage and

throughout the professional career. Advocate education and training to the oral health

workforce, which can help optimize the oral healthof the community.

Promote application the application of new technol-ogy during the process of professional educationalfor both treatment and prevention.

Educate the whole profession to be more active interms of their social responsibility to promote den-tal public health rather than their mere passiveinvolvement.

Advocate sufficient continuing professional develop-

ment. Encourage all dental educational institutions to

include a green dentistry dimension in the curricu-lum.

MITIGATE THE IMPACTS OF SOCIO-ECONOMICDYNAMICS

Were we are now

According to WHO, oral disease is the fourth mostexpensive disease to treat worldwide. For example,

total expenditure for dental care in the UnitedStates was estimated at more than 100 billion dol-lars in 2009, and the market for dental supplies inChina alone is due to reach 3.1 billion dollars in2012, with an 11% annual growth rate. In additionto these direct costs, there are also indirect costs toconsider, including lost productivity for individualssuffering from oral disease. Oral diseases cause anuntold number of school and work hours to be lostaround the world. In terms of benefits, dentistryand the related oral healthcare industry generate, atleast in developed countries, significant contributionsto a countrys employment and economy as a

whole.Nevertheless, fluctuations in socio-economic cir-

cumstances have a strong impact on oral healthcareresources and policies. In times of economic hard-ship, resources tend to be drawn from oral health-care and redirected to areas and diseases where lackof treatment leads to faster and more visible conse-quences, notably mortality. Patients who experiencedeterioration in their financial situation during eco-nomic downturns tend to delay consultation andtreatment. This can, however, have disastrous finan-cial consequences, as illustrated by Californian

statistics where the average price of a routinecheck-up amounts to 41 dollars, while the averagecost of emergency treatment with hospitalizationsky-rockets to over 5,000 dollars. Furthermore,given the increasingly recognized link between oralhealth and general health, decreased resources fororal health, including caries, periodontal disease,and oral cancer, may result in an increase in otherhealth concerns, such as heart disease and diabetes.Conversely, economic uptrends tend to foster anincrease in demand for oral healthcare that must bemet, implying the availability of an appropriatelytrained workforce.

The way forward

To guarantee the long-term sustainability of ourprofession throughout the ups and downs of theeconomy and the publics ability to access and

utilize oral healthcare services, we need to focusour attention on further integrating oral healthcareinto overall healthcare. We need to shift froman insular perspective to one of integration andcollaboration.

To achieve this, we need to be at the forefront ofadvocacy efforts to include Oral Health in All Policiesat all levels of governmental and non-governmentalagencies: local, regional, national and global. Byemphasizing that governmental objectives are bestachieved when all sectors include health and well-being as key components of policy development, we

will be able to strengthen the position of oral health.Furthermore, we believe that advocating Oral Healthin All Policies will help increase oral health literacyand awareness among the public, thereby supportinga community-driven demand of governments for bet-ter access to oral healthcare services. Grassrootsdemand can be a powerful way of promoting ourstand and play a key role in shaping governmentagendas.

Second, it is our responsibility to develop evidence-based models of oral healthcare, which bring fairnessin remuneration for care that delivers beneficial andmeasurable health outcomes. This, we believe, implies

considering oral health promotion, a risk factorapproach to disease prevention, and treatment asthree equally important cornerstones of oral health-care.

Third, we believe there is a need to foster partner-ships between the private and public sector to addressthe right to universal access to oral healthcare, irre-spective of individual financial situations. Taking thisinto account, there is also a role for us to play inadvocating the inclusion of oral care in corporatehealth insurance schemes and health promotionactivities.


Glick et al.


10/14

Our Vision is that, by 2020, collaboration and

partnerships between the private and public sector will

have led to the inclusion of Oral Health in All Policies and

that new evidence-based models of oral healthcare will be

available to ensure fair and appropriate remuneration for

care that delivers measurable health outcomes, thereby

shifting the focus from a preliminarily procedure-based

remuneration model to models which foster a holistic

approach to oral healthcare and consider promotion,

prevention, and treatment as equally important.

Summary

Status

Fluctuations in socio-economic circumstances havea significant impact on oral healthcare resourcesand policies.

Opportunities

Ensure integration of oral health into overall healthpolicies.

Develop an evidence-based model of oral healthcare which brings fairness in remuneration for carethat delivers beneficial and measurable health out-comes.

Contribute to ensuring the ability to access and uti-lize oral health care.

FOSTER FUNDAMENTAL AND TRANSLATIONALRESEARCH AND TECHNOLOGY

Were we are now

Poor oral health remains a major issue in all countries contributing significantly to the overall burden ofdisease and costs of healthcare - and major inequali-ties in oral health exist both within and betweencountries. This is despite the fact that most oral dis-ease is readily preventable through simple and effec-tive means. Enormous advances have been made inunderstanding the basic cellular and molecular mecha-

nisms of oral disease and in developing novel, effec-tive treatments, yet there are major gaps in theimplementation of this research into day-to-daypatient care. Together, these facts constitute twomajor research challenges for the oral health commu-nity. How can we shift the emphasis of oral diseasemanagement towards effective prevention and awayfrom treatment in a clinical setting, which is unafford-able and impractical in many global regions? Andwhat should we do to ensure the better implementa-tion of research findings at all levels for the benefit ofthe global community?

The emphasis of oral disease management is over-whelmingly directed at treatment in a clinical setting,and this is reflected in the research that is undertaken.By contrast, much less effort is directed at researchinto the effective prevention of oral disease at thepopulation level; understanding the social determi-nants of oral health; and integrating oral healthcareinto wider programmes targeting a reduction in theglobal burden of NCDs.

We currently live in an era characterized by awealth of advances and discoveries in research andtechnology. In dentistry, these are predominantlydirected toward connective tissue biophysics/mechan-ics; tissue engineering; biotechnology, including genetherapy, and drug delivery, transport dynamics; andmolecular engineering (macromolecular structure, pro-tein structure, and molecular therapies). Dental tech-nologies are also evolving, especially with regard tobiomaterials and dental materials. The results of this

research effort mean that the outlook for patientswith advanced oral and dental disease has been revo-lutionized. However, it is recognized that practitionersuse the knowledge, products and technologies theywere exposed to during their education and trainingand tend to be less aware of innovations that becomeavailable once they are established practitioners. As aconsequence, there is a major gap in the timely imple-mentation of research findings and technological inno-vations into daily practice.

The dental profession has been rightly proud of itsachievements in improving the worlds oral health, but

this has been accompanied by a relative isolation fromthinking in mainstream medicine and healthcare, and alack of awareness of wider environmental and politicalissues that have implications for oral healthcare andhow it is practised. For example, environmental issuesare currently high on the agenda of national and inter-national agencies, and international environmental pro-tection institutions are increasingly targeting dentalproducts and materials as hazardous. Although amal-gam waste discharge from dentistry is estimated to beresponsible for


11/14

Further, information technology is increasinglyimpacting the way we work, interact, communicate,inform ourselves and learn. There is therefore a greatneed to foster, as well as regulate and monitor, theuse of information and communication technology(ICT) in oral healthcare to ensure that the benefits itcan bring to society are realized.

The way forward

We believe that it is time for a concerted call to actionto ensure that oral health research priorities receivesufficient attention and resources, and that researchoutcomes are widely and swiftly disseminated andimplemented. The current significant delay in imple-menting research findings and technological innova-tions into prevention and practice is hampering theachievement of improved oral health at a global leveland the reduction of oral health inequalities. We need

to be in a position to influence and work effectivelywith agencies concerned with safety and complianceissues pertaining directly to oral health. We also needto ensure that the drive to position oral health in thewider context of general health is based on sound sci-entific evidence.

First, with regard to research, it is time to workwith partner organizations to develop a science-basedapproach to oral healthcare, using agreed definitionsand methods for data collection and analysis. Byworking cooperatively, there is also an opportunity todefine a consensus research agenda and broad

research priorities. In this regard, we share the viewof the International Association for Dental Research(IADR) that it is vital to emphasize the importance ofmulti-, inter- and trans-disciplinary research andtranslational research, seeking input from a range ofsocial scientists and health professionals. We need tobetter understand the full range of oral health deter-minants that include not only genetic, biological andenvironmental factors, but also the behavioural andsocial determinants of health and well-being. This willhelp us develop disease prevention strategies that arebased on upstream prevention rather than down-stream treatment, and promote the integration of oral

health into general health. This has particular rele-vance with regard to NCDs, where our profession isin a strong position to work on a broad commonresearch agenda and to advocate the allocation ofadditional resources and funding for oral healthresearch projects and priorities. It is crucial that thestrategies to emerge from this research are capable oflocal interpretation in a way that respects cultural sen-sitivities and socio-economic constraints.

Second, in view of the increasing importance ofexternal policies that examine dental technologies andmaterials and pass judgement on their sustainability

and safety, we need to adopt a proactive approach. Weneed to develop a research agenda that will position usto effectively advocate measures to improve oral healthand maintain patient safety in a timely and constructivemanner. This presents a unique opportunity for ourprofession to take a leadership role in advocacytowards public authorities and our industry partnersfor environmentally safe manufacturing standards indental industry and oral health care practice. It alsopresents an opportunity to integrate environmentalconsiderations into our agenda and to be at the fore-front of the development of policies and strategies thatsupport effective and sustainable green dentistry ini-tiatives, which emphasize the lifecycle approach.

Third, while it is crucial that we strongly encouragequality and innovative research, we also believe thatwe need to encourage and foster a timely implementa-tion of research findings into daily practice. It is there-fore our belief that stronger connections and

iterations between research and daily practice need tobe developed. While there is traditionally a time lagof several years between original research and itsincorporation into common practice (estimated at anaverage of 17 years in medicine), it is our convictionthat concerted educational and communication effortscan contribute to a significant reduction, for the bene-fit of patients. In order to facilitate two-way commu-nication between research and clinical practice, westrongly encourage all dental medicine faculties toperform research- scientific, educational and social in order to cultivate a good understanding among all

oral health professionals of research mechanisms, andto enhance their life-long learning behaviour, skillsand attitudes as well as widen their perspective.

Finally, access to ICT is spreading quickly on aglobal scale. Because of the rapid spread of technol-ogy, E-Health is rapidly becoming a reality. ThroughE-Health, the potential to disseminate and collecttargeted and accurate information quickly is veryhigh and there is a huge opportunity for oral health-care professionals to be at the forefront of an inno-vative, rational and ethical use of new technologies.However, the use of E-Health technologies to dis-seminate and collect health-related information will

increasingly need to be carefully monitored in order toprevent abuse, ensure the quality of the information pro-vided and respect the confidentiality of patient data. Webelieve that, properly controlled, E-Health will allow us tostrengthen professional and inter-professional collabora-tion through tools such as electronic health records andprofessional forums; improve access to oral healthcare ser-vices through telemedicine and telediagnosis; assist in dis-seminating prevention and promotion messages throughelectronic media; and foster universal access to professionaleducation through online learning tools accessible fromanywhere to anyone with an internet access. These are all


Glick et al.


12/14

approaches that could have a major beneficial impact onoral health, but it is evident that considerable research isneeded if this is to be achieved in a properly regulated way.

Our Vision is that, by 2020, major improvements in oral

health will have been achieved and inequalities will have

been reduced through research-led strategies for moreeffective disease prevention, with the integration of oral

health into healthcare in general. The credibility of our

profession will be reinforced thanks to a solid, balanced

and forward-thinking research agenda, which will

encompass broad common priorities. We believe that

sustained educational and communication efforts will have

greatly improved the effective, rapid translation of

research findings into daily practice. State-of-the art use

of E-Health technologies - and of mobile E-Health

technology in particular - will have fostered a more

collaborative approach to oral healthcare as well as an

improved access to expert knowledge to all, in urban andremote areas, in developed and developing countries alike.

Summary

Status

Poor oral health remains a major issue in all coun-tries and major inequalities in oral health exist bothwithin and between countries, despite the fact thatmost oral disease is readily preventable throughsimple and effective means.

There is insufficient effort directed at research intothe effective prevention of oral disease at the popu-lation level; understanding the social determinantsof oral health; and integrating oral healthcare intowider programmes directed at reducing the globalburden of NCDs.

The dental profession is relatively isolated fromthinking in mainstream medicine and healthcare,with a lack of awareness of wider environmentaland political issues that have implications for oralhealthcare and how it is practised;

In spite of advances in understanding the basic cel-

lular and molecular mechanisms of oral disease anddeveloping novel, effective treatments, there aremajor gaps in implementing this research into day-to-day patient care and the time lag in implement-ing research findings is too long.

There is a need to develop a science-based approachto oral healthcare using agreed definitions and meth-ods for data collection and analysis, to ensure thatcurrent research efforts are not fragmented.

Technology evolves very quickly and its use in oralhealth needs to be monitored and regulated toensure it benefits patients;

Information and Communication Technology ischanging the way we work, learn, and communi-cate.

International environmental protection institutionsare targeting dental products as hazardous materi-als and may affect the future of the profession.

Opportunities

Engage in a concerted call to action to ensure thatoral health research priorities receive sufficientattention and resources, and that research outcomesare widely and swiftly disseminated and imple-mented.

Work with partner organizations to develop a sci-ence-based approach to oral healthcare, usingagreed definitions and methods for data collectionand analysis. By working cooperatively there is alsoan opportunity to define a consensus research

agenda and broad research priorities.

Promote the integration of oral health into generalhealth. We will, through better understanding thefull range of oral health determinants - includinggenetic, biological and environmental factors, aswell as the behavioural and social determinants ofhealth and well-being - able to develop disease pre-vention strategies based on upstream preventionrather than downstream treatment.

Develop effective oral healthcare strategies at a glo-bal level capable of local interpretation, in a waythat respects cultural sensitivities and socio-eco-

nomic constraints. Advocate an innovative and proactive use and

application of available dental technology andmaterials.

Encourage all dental medicine faculties to performresearch, including scientific, educational and socialresearch.

Ensure a strong link between ongoing changes inthe type of oral healthcare deliverables and researchefforts.

Develop policies and strategies to support effectiveand sustainable green dentistry initiatives whichemphasize the lifecycle approach.

Advocate:

continuous development of international dentalstandards to enable appropriate levels of qualityand safety in oral health care;

environmentally safe manufacturing standardsin dental industry and oral health care practice;

clean water and energy preservation practicesamong oral health professionals;

a state-of-the-art use of Information and Com-munication Technology in all aspects of oralhealthcare and delivery.




13/14

Acknowledgements

FDI Council would particularly like to thank allnational dental associations, national liaison officers,industry leaders and individual members who contrib-uted to this report through constructive feedback andsuggestions.

Disclaimer

The Vision 2020 report was developed by a largegroup of individuals, selected for participationbecause of their knowledge, expertise and commit-ment to the welfare of the dental profession and thepublic it serves. Throughout the different developmentphases of this report, the creative effort was con-ducted with great independence. The ideas expressedherein are not necessarily those of, nor endorsed by,FDI World Dental Federation.

Conict of interest

S. Kess is an employee of H. Schein Inc.

BIBLIOGRAPHY

1. Balas EA. From appropriate care to evidence-based medicine.Pediatr Ann 1998 27: 581584.

2. Beaglehole R, Bonita R, Horton R et al. for The Lancet NCDAction Group and the NCD Alliance. Priority actions for thenon-communicable disease crisis. The Lancet2011 377: 14381447.

3. Beaglehole R, Benzian H, Crail J et al. The Oral Health Atlas:Mapping a Neglected Global Health Issue. Brighton, UK: FDIWorld Dental Federation, Myriam Editions; 2009.

4. Bloom DE, Cafiero ET, Jane-Llopis E et al. The Global Eco-nomic Burden of Non-communicable Diseases. Geneva: WorldEconomic Forum; 2011. Available from: www.weforum.org/EconomicsOfNCD. Accessed 20 June 2012.

5. Challacombe S, Chidzonga M, Glick M et al., on behalf ofInternational Associations for Dental Research. Global oralhealth inequalities: oral infections challenges and approaches.Adv Dent Res2011 23: 227236.

6. Cisco (2011), Cisco Visual Networking Index: Global MobileData Traffic Forecast Update, 20102015.

7. Cisco (2012), Cisco Visual Networking Index: Global MobileData Traffic Forecast Update, 20112016.

8. Donaldson ME, Gadbury-Amyot CC, Khajotia SS et al. Dental

education in a flat world: advocating for increased global col-laboration and standardization. J Dent Educ 2008 72: 408421.

9. FDI (2010) General Assembly Resolution on Amalgam [inter-net]. Available from: http://www.fdiworldental.org/c/document_library/get_file?uuid=4e418f83-20ff-41eb-9d46-3c64b891bf30&groupId=10157. Accessed 2 April 2012.

10. FDI (2011) Oral Health and the United Nations Political Dec-laration on NCDs A Guide to Advocacy. FDI World DentalFederation, available from: www.fdiworldental.org/library.

11. Frenk J, Chen L, Bhutta ZA et al. Health professionals for anew century: transforming education to strengthen health sys-tems in an interdependent world. The Lancet 2010 376: 19231958.

12. Garcia I, Tabak LA, on behalf of International American Asso-ciations for Dental Research. Global oral health inequalities:the view from a research funder. Adv Dent Res 2011 23: 207210.

13. Haumschild MS, Haumschild RJ. The importance of oralhealth in long-term care. J Am Med Dir Assoc 2009 10: 667671.

14. Hosseinpoor AR, Itani L, Petersen PE. Socio-economic inequal-

ity in oral healthcare coverage: results from the World HealthSurvey. J Dent Res 2012 91: 275281.

15. Iacopina A. The influence of New Science on dental educa-tion: current concepts, trends, and models for the future. J DentEduc 2007 271: 450462.

16. International Telecommunication Union (2011) ICT Facts &Figures 2011 [internet]. Available from: http://www.itu.int/ITU-D/ict/facts/2011/material/ICTFactsFigures2011.pdf. Accessed 3March 2012.

17. Jin LJ, Armitage GC, Klinge B et al., on behalf of InternationalAmerican Associations for Dental Research. Global oral healthinequalities: task group periodontal disease. Adv Dent Res2011 23: 221226.

18. Johnson NW, Warnakalasuriya S, Gupta PC et al., on behalf ofInternational American Associations for Dental Research. Glo-

bal oral health inequalities in incidence and outcomes for oralcancer: causes and solutions. Adv Dent Res 2000 23: 237246.

19. Jokstad A, Fan PL. Amalgam waste management. Int Dent J2007 56: 147153.

20. Jontell M, Glick M. Oral health care professionals identifica-tion of cardiovascular disease risk among patients in privatedental offices in Sweden. JADA2009 140: 13851391.

21. Lalla E, Kunzel C, Buekett S et al. Identification of unrecog-nized diabetes and pre-diabetes in a dental setting. J Dent Res2011 90: 855860.

22. Marmot M, Bell R, on behalf of International American Associ-ations for Dental Research. Social determinants and dentalhealth. Adv Dent Res 2011 23: 201206.

23. Mossey PA, Shaw WC, Munger RGet al., on behalf of Interna-tional American Associations for Dental Research. Global oralhealth inequalities: challenges in the prevention and manage-ment of orofacial clefts and potential solutions. Adv Dent Res2011 23: 247258.

24. Northridge ME, Glick M, Metcalf Set al. Public health supportfor the health home model. Am J Public Health 2011 101:1818018200.

25. Petersen PE, Bourgeois D, Ogawa H et al. The global burdenof oral diseases and risks to oral health. Bull World HealthOrgan 2005 83: 661669.

26. Peterson PE. World Health Organization global policy forimprovement of oral health World Health Assembly 2007.Int Dent J2008 58: 115121.

27. Pitts N, Amaechi B, Nierderman R et al., on behalf of Interna-tional American Associations for Dental Research. Global oralhealth inequalities: dental caries task group research agenda.Adv Dent Res2011 23: 211220.

28. Pizzo G, Guiglia R, Lo Russo L et al. Dentistry and internalmedicine: from the focal infection theory to the periodontalmedicine concept. Eur J Intern Med2010 21: 496502.

29. Sheiham A, Alexander D, Cohen L et al., on behalf of Inter-national American Associations for Dental Research. Globaloral health inequalities: task group implementationand delivery of oral health strategies. Adv Dent Res 2011 23:259267.

30. The Institute of Medicine.Crossing the Quality Chasm: A NewHealth System for the 21st Century. Washington, DC: NationalAcademy Press; 2001.


Glick et al.


14/14

31. United Nations General Assembly. September 2011 Sixty-sixthsession Agenda item 117. United Nations Millenium Develop-ment Goals.

32. United Nations. Political declaration of the High-level Meetingof the General Assembly on the Prevention and Control ofNon-communicable Diseases, 16 September 2011 A/66/L.1.

33. Williams DM, on behalf of International American Associationsfor Dental Research. Global oral health inequalities: the

research agenda.Adv Dent Res 2011 23: 198200.34. Petersen PE, Bourgeois D, Ogawa H et al. The global burden

of oral diseases and risks to oral health. Bull World HealthOrgan 2005 83: 661669.

35. World Health Organisation. The World Health Report 2006:Working Together for Health. Geneva: World Health Organisa-tion; 2006.

36. World Health Organisation. Adelaide Statement on Health inAll Policies, Report from the International Meeting on Healthin All Policies. Adelaide, SA: World Health Organisation;2010.

37. World Vision. Living on a Dollar a Day, January 2, 2010.

Correspondence to:

Tania Severin,FDI World Dental Federation,Avenue Louis Casai 84,

Case Postale 3,CH-1216 Geneva, Switzerland.

Email: [email protected]



Documents

Jurnal a - FDI Social Determinants