A Way Forward for A Greener Future – Sustainability in Oral Health Care

Oral health professionals promote universal oral health for diseases that are primarily preventable and/or treated in their early stages. The delivery of oral health care, whether through therapeutic interventions, pre-ventive care, or long-term maintenance, causes pollutants and has a significant carbon footprint. Oral health practitioners share a moral obligation to society to offer optimal oral health services, ensure patient safety, and decrease their environmental impact. To ensure the long-term viability of oral healthcare services, all or-ganisations should recognise the critical need to work together to develop knowledge, identify remedial pos-sibilities, and exchange best practices that are environmentally friendly.

Literature review and prospect on oral cognition and disease diagnosis and treatment between Han and Tang dynasties / 华西口腔医学杂志

Chinese medicine entered a significant period from foundation to maturity between Han and Tang dynasties when the Chinese traditional stomatology was a key stage. Sorting and analysis of existing literature and research outcomes have showed that current research on stomatology between Han and Tang dynasties focuses on oral physiology, pathology, diagnosis and treatment, and health care. It also involves stomatology history and explanation of termino-logies related to mouth and teeth recorded in medical books, use of simple methods, and thinking with citation and analysis of literature simply listed and reasoning preliminarily deducted. From the macro perspective, current research has not unveiled the whole picture of stomatology between the two dynasties and left a series of key issues unresolved. Thus, new methods should be developed and employed to carry out medical research on stomatology between Han and Tang dynasties given that is has a prosperous future.

Effectiveness of “Oral Health Care for Children with Autism Spectrum Disorder Module” in Improving Tooth-Brushing Practice among Children with Autism Spectrum Disorder in Hospital Universiti Sains Malaysia

@#Introduction: Autism spectrum disorder (ASD) is associated with behavioural problems which may affect children’s oral health statuses. Caregivers have crucial roles in caring for these children’s oral health. Thus, this study is aimed to evaluate the effectiveness of the Oral Health Care for Children with ASD (OHASD) Module in improving caregivers’ tooth-brushing difficulties in children ASD. Methods: Quasi-experimental study on caregivers of children with ASD aged 7 to 12 years who were registered at the Psychiatry Clinic Hospital Universiti Sains Malaysia (USM), Kelantan. The sociodemographic data obtained, and behavioural problems were assessed. Tooth-brushing difficulties were evaluated at pre- and six months post-intervention using OHASD Module. Data were analysed using IBM SPSS 26.0. Results: A total of 32 Malay children with ASD including their caregivers participated in this study. Caregivers were mostly mothers (78.1%) and children were mostly boys (84.4%), with mean age (SD) of 39.1 (4.19) and 8.8 (1.52) years respectively. Parent-reported questionnaire using the Modified Checklist for Autism in Toddlers (M-CHAT) showed 65.6% of children were highly sensitive to noises, 53.1% sometimes stared at nothing or wandered without purpose and 59.4% were unable to imitate caregivers’ faces. Significant differences between pre- and post-intervention for items; children who liked to close their mouths, turn their heads in different directions, did not understand the purpose of tooth-brushing (P<0.05). Conclusion: OHASD Module is useful in assisting caregivers in practising daily tooth-brushing of children with ASD.

Oral Health Beliefs, Perceptions and Utilisation of Oral Health Care Services among the Indigenous People (Orang Asli) in Pahang, Malaysia: A Qualitative Study

@#Introduction: Orang Asli refers to the indigenous people of Peninsular Malaysia, representing 0.6% of the Malaysian population. Vast inequality was observed regarding oral health beliefs, behaviour, and utilisation of oral health services between the Orang Asli and non-Orang Asli. The aim of the study was to explore the oral health beliefs, perceptions, and oral health service utilization behaviour among Orang Asli in the district of Bera, Pahang, Malaysia. Methods: Orang Asli’s oral health beliefs and perceptions of oral healthcare service were ascertained through four FGDs. Nineteen participants from Bera’s semi-urban and rural Orang Asli communities were convened. Emerging themes from the qualitative data were analyzed using thematic analysis. Results: Orang Asli believed that oral health is essential for an individual’s function and aesthetics. They are also aware that inadequate oral hygiene care will result in tooth decay and gum disease. Most of the Orang Asli that chewed betel nuts believed that limestone paste could cause oral cancer. The main barriers to Orang Asli accessing oral healthcare services were time constraints and distance to the nearby clinic. Conclusion: The Orang Asli believed oral health care is essential in ensuring a healthy oral condition. Despite their generational belief towards traditional healers and medication, Orang Asli in Bera had a perceived positive acceptance towards oral healthcare services.

Sistema de salud en Japón y su énfasis en la protección de la salud oral: una comparación con Chile / Oral health system in Japan: a comparation with Chile

Japón está compuesto por 126 millones de habitantes y corresponde a la tercera potencia económica mundial. El sistema de salud se basa en un único seguro obligatorio universal, con cobertura médica y odontológica. En las últimas décadas, el envejecimiento poblacional ha sido un punto importante a considerar en la planificación de políticas públicas sanitarias. La eficiencia de este sistema ha sido punto de comparación con distintos países, no así con Chile. Por ello, el objetivo de esta revisión narrativa es comparar el sistema de salud oral chileno y japonés. Se realizó una revisión narrativa utilizando los repositorios de revistas científicas Science Direct, y PubMed, así como publicaciones disponibles en páginas gubernamentales de Japón y Chile.El seguro japonés prioriza la promoción de salud y prevención de enfermedades, enfatizando en la población más vulnerable. Al contrario, en Chile el sistema de salud tiene énfasis en la curación y rehabilitación. Japón ha adoptado un seguro debido a la transición demográfica y epidemiológica, para garantizar la sustentabilidad del sistema en el tiempo, modelo que podría ser aplicado en Chile; considerando el envejecimiento poblacional y la carga de enfermedades crónicas no transmisibles. Ambos países tienen ventajas y limitaciones en los atributos de sus sistemas de salud. Chile tiene una Red integrada de servicios de salud y ha implementado políticas como GES. Japón tiene un sistema universal, más eficiente y equitativo. Las fortalezas del sistema japonés podrían implementarse en Chile, a través de nuevas políticas públicas que fortalezcan la salud del país, incluyendo la odontología.

Japan has a population of 126 million, and it is the third national economy in the world. The health system is on a single universal mandatory insurance, with medical and dental coverage. In the last decades, Japan has faced the ageing of its population, and this has been a relevant matter in the planning of public health policies. The efficiency of the health system has been a point of comparison in different countries, but not in Chile. Thus, the objective of this narrative review is to compare the Chilean oral-health system with the Japanese.A non-systematic review was made using Science Direct, PubMed repositories of journals and official Japanese and Chilean government pages. The Japanese healthcare insurance prioritizes health promotion and disease prevention, emphasizing the most vulnerable population. Conversely, Chile has a health system that focalizes on healing and rehabilitation. Japan has adopted insurance because of the demographic transition to guarantee the system's sustainability. Considering the increased ageing population and the non-communicable disease load, this insurance model could be applied in Chile.Both Chile and Japan have advantages and limitations regarding the attributes of their health systems. Japan has a universal, more efficient, and equitable system. Chile should study the strengths of the Japanese system for its implementation of new public policies that strengthen the country's health, including dentistry.

Application of nanoparticles in preventing enamel demineralization during orthodontics / 口腔疾病防治

@#Enamel demineralization is one of the most common adverse reactions to orthodontic treatment. The existence of orthodontic appliances affects oral hygiene maintenance, which easily leads to plaque accumulation and oral flora dysbiosis, and cariogenic bacteria produce acid to cause enamel demineralization. It not only affects aesthetics but may develop into caries and endanger oral health. Therefore, enamel demineralization has become an urgent problem. Nanoparticles generally refer to solid particles with diameters of 1 to 100 nm and have unique physicochemical properties that provide a new strategy for preventing enamel demineralization during orthodontics. Reviewing the relevant literature, nanoparticles used for the prevention of enamel demineralization in orthodontics may be classified into antibacterial, remineralization and carrier-type nanoparticles according to their functions. Most research was performed on the application of nanoparticles to modify orthodontic adhesives for enhancement of antibacterial or remineralization properties, but some studies also focused on the modification of orthodontic appliances with nanoparticles for surface coating or overall doping to provide antimicrobial properties. The advantage of these two approaches is that they are not dependent on patient compliance. Nanoparticle-modified fluoride varnishes and nanocarriers loaded with antimicrobial or remineralization agents may be used to promote oral health care in orthodontic patients, which have a sustained preventive effect but depend on the cooperation of the patient. It was indicated that the small size effect of nanoparticles provides better performance, but there may be certain safety issues, and there is still some influence on the physicochemical properties of the modified materials themselves. These issues must be further explored. Although there are some limitations in the current studies, nanoparticles are expected to play an important role in the prevention of enamel demineralization during orthodontics in the future.

Fatores associados à redução de atendimentos odontológicos na Atenção Primária à Saúde no Brasil, com o surgimento da COVID-19: estudo transversal, 2020 / Factores asociados a la reducción de la atención odontológica en Atención Primaria de Salud en Brasil con la aparición de COVID-19: estudio transversal, 2020 / Factors associated with the reduction of dental care in Primary Health Care in Brazil after the emergence of COVID-19: a cross-sectional study, 2020

Objetivo: Analisar fatores associados à redução de atendimentos odontológicos na Atenção Primária à Saúde, durante pandemia de COVID-19 no Brasil. Métodos: Estudo transversal, com cirurgiões-dentistas das unidades básicas de saúde (UBS). O desfecho foi a redução dos atendimentos odontológicos, e as variáveis de exposição, dados sociodemográficos, disponibilidade de equipamentos de proteção individual (EPIs) e medidas adotadas pela UBS na pandemia. Realizou-se regressão de Poisson para determinar razão de prevalências e intervalo de confiança de 95% (IC95%). Resultados: A redução de atendimentos acima de 50% após o início da pandemia foi relatada por 62,6% dos 958 participantes. Adoção de protocolos de biossegurança (RP = 1,04; IC95% 1,01;1,07), disponibilidade de EPIs preconizados por novos protocolos (RP = 0,94; IC95% 0,89;0,99) e adoção da teletriagem (RP = 0,90; IC95% 0,85;0,96) estiveram associados à redução. Conclusão: A disponibilização dos novos EPIs e a implementação da teletriagem nas UBS parecem ter minimizado a redução dos atendimentos odontológicos após o início da pandemia.

Objetivo: Analizar factores asociados a la reducción de consultas odontológicas en Atención Primaria de Salud en Brasil durante el COVID-19. Métodos: Estudio transversal con cirujanos dentistas de las Unidades Básicas de Salud (UBS). El hecho investigado fue la reducción de consultas odontológicas y las variables de exposición incluyeron factores sociodemográficos, aspectos de los equipos de protección personal (EPPs) y las medidas adoptadas por la UBS tras la aparición del COVID. La regresión de Poisson se utilizó para determinar la razón de prevalencia y el intervalo de confianza del 95% (IC95%). Resultados: El 62,6% de los 958 participantes informó una reducción en la asistencia superior al 50% después del inicio de la pandemia. La adopción de protocolos (RP = 1,04; IC95% 1,01;1,07), disponibilidad de EPPs recomendados por los nuevos protocolos (RP = 0,94; IC95% 0,89;0,99) y la adopción de teletriaje (RP = 0,90; IC95% 0,85;0,96) fueron factores que se asociaron con esta reducción. Conclusión: La disponibilidad del nuevo EPP y la implementación de la teleprotección en las UBS parecen haber minimizado la reducción en la atención bucal después del inicio de la pandemia.

Objective: To analyze factors associated with the reduction of dental care in Primary Health Care, during the COVID-19 pandemic in Brazil. Methods: This was a cross-sectional study conducted with dentists in primary healthcare centers (PHCCs). The reduction of dental care was the outcome, and the exposure variables were sociodemographic data, availability of personal protective equipment (PPE) and measures adopted by PHCCs during the pandemic. Poisson regression was performed to determine the prevalence ratio and 95% confidence interval (95%CI). Results: Of the total of 958 participants, 62.6% reported a reduction of over 50% in dental visits after the beginning of the pandemic. Adoption of biosafety protocols (PR = 1.04; 95%CI 1.01;1.07), availability of PPE recommended by new protocols (PR = 0.94; 95%CI 0.89;0.99) and adoption of tele-screening (PR = 0.90; 95%CI 0.85;0.96) were associated with the reduction. Conclusion: The availability of new types of PPE and implementation of tele-screening in PHCCs seem to have minimized the reduction of dental care after the beginning of the pandemic.

Investigation and analysis of oral health status of the elderly in nursing homes in Taiyuan / 华西口腔医学杂志

OBJECTIVES@#This study aims to investigate awareness of oral health care and health status among elderly people in nursing homes in Taiyuan. Strategies for preventing and treating oral diseases and improving the quality of life of the elderly in nursing homes were formulated on the basis of analyzed data.@*METHODS@#A total of 359 participants from 48 nursing homes in six districts were selected randomly. Awareness, attitude, and behavior with regard to oral health care among the elderly were investigated through a survey using questionnaires and oral health examinations. Data were statistically analyzed with SPSS 20.0.@*RESULTS@#Among the elderly in the nursing homes in Taiyuan, awareness and behavior with regard to oral health care were deficient and inappropriate, and thus professional guidance was needed. In addition to method and time of brushing teeth and bad oral habits, the oral health status of the elderly was statistically affected by age and education. Compared with the data of the Fourth National Oral Epidemiological Investigation, the number of elderly people aged 55-64 or 65-74 years who brush their teeth every day and accept oral diagnosis and treatment was lower. However, the ratios of edentulous and missing teeth without treatment were higher than the national average level for the same age groups.@*CONCLUSIONS@#The awareness and attitude of the elderly in nursing homes with regard to oral health care are unsatisfactory, and their oral health status is poor. Education on oral health care, development of good oral care habits, and regular oral health examination are essential to the maintenance of oral health in elderly people.

Periodontal disease distribution, risk factors, and importance of primary healthcare in the clinical parameters improvement / Distribución de la enfermedad periodontal, factores de riesgo e importancia de la atención primaria en salud en la mejora de los parámetros clínicos

The objective of this study is to show the distribution of periodontal disease, risk factors, and importance of primary healthcare, for the improvement of clinical parameters. Two phases study transversal and nonrandomized trial (before - after), with educational intervention and conservative treatment, were carried out at Dental School of the Universidad Autónoma de Guerrero México, in 161 subjects who met the inclusion criteria. Oral healthcare education was carried out as well as conservative periodontal treatment, with six months follow up. Clinical measurements were performed with a Williams probe, O'Leary plaque index, calculus index and dental mobility Miller method. Periodontal disease was found on 82 % of all participants. Multinomial logistic regression analysis showed an odds ratio of 14.3 (95 % CI: 2.5, 82.1), 13.4 (95 % CI: 1.7, 103.5), 29.2 (95 % CI: 3.2, 260.9) and 68 (95 % CI: 6.6, 711.0) plaque in gingivitis, mild, moderate and severe chronic periodontitis, respectively. The longitudinal panel data analysis showed a significant effect (p <0.001) in the mean decrease of the clinical parameters after intervention, probing depth 0.4 mm (95 % CI: -0.5, -0.3), pockets depth 1.1 mm (95 % CI: -1.3, -0.9), amount of pockets 4.5 (95 % CI: -5.2, -3.7), bleeding 5.2 (95 % CI: -5.9, -4.5) and dental mobility 0.6 degrees (95 % CI: -0.7, -0.5). Primary healthcare is still the best option to improve the periodontal health in population who do not have access to specialty services. Dentists can achieve significant clinical improvement at very low cost, if they are aware of primary health care.

El objetivo del estudio fue mostrar la distribución de la enfermedad periodontal, los factores de riesgo y la importancia de la atención primaria de salud, para la mejora de los parámetros clínicos. Material y método: Estudio de dos fases transversal y no aleatorizado (antes - después), con intervención educativa y tratamiento conservador, realizado en la Facultad de Odontología de la Universidad Autónoma de Guerrero México, en 161 sujetos que cumplieron con los criterios de inclusión. Se llevó a cabo una educación sanitaria oral, así como un tratamiento periodontal conservador, con un seguimiento de seis meses. Las mediciones clínicas se realizaron con una sonda Williams, el índice de placa O'Leary, el índice de cálculo y el método Miller de movilidad dental. Resultados: se encontró enfermedad periodontal en el 82 % de todos los participantes. El análisis de regresión logística multinomial mostró un odds ratio de 14.3 (IC 95 %: 2.5, 82.1), 13.4 (IC 95 %: 1.7, 103.5), 29.2 (IC 95 %: 3.2, 260.9) y 68 (IC 95 %: 6.6, 711.0) placa en gingivitis, periodontitis crónica leve, moderada y grave, respectivamente. El análisis de datos del panel longitudinal mostró un efecto significativo (p <0.001) en la disminución media de los parámetros clínicos después de la intervención, profundidad de sondeo 0.4 mm (IC 95 %: -0.5, -0.3), profundidad de bolsillos 1.1 mm (IC 95 %: -1.3, -0.9), cantidad de bolsillos 4.5 (IC 95 %: -5.2, -3.7), hemorragia 5.2 (IC 95 %: -5.9, -4.5) y movilidad dental 0.6 grados (IC 95 %: -0.7, - 0.5). Conclusiones: la atención primaria de salud sigue siendo la mejor opción para mejorar la salud periodontal en la población que no tiene acceso a servicios especializados. Relevancia clínica: los dentistas pueden lograr una mejora clínica significativa a un costo muy bajo, si conocen la atención primaria de salud.

An exploratory study on development policy and the status of oral health care in the North Korea during the Kim Jong-Un era / 대한구강보건학회지

OBJECTIVES: Studies on oral health care in North Korea are being pursued in South Korea. However, the covertness of North Korea offers substantial resistance to the access of information from the country, including in the field of oral health care. In this study, we explored North Korea's oral health care policy and its status in the Kim Jong-Un Era.METHODS: We used existing information from Internet searches and also interviewed three health care professionals who had recently contact with North Korea.RESULTS: At present, there are four development policies of oral health care in North Korea: expansion of dental institutions and resource support, strengthening the prevention and treatment of dental diseases, improvement of dental prosthetics, and increasing the responsibility and role of the dental workforce. In addition, there has been an increasing interest in children's oral health with the development of a few programs.CONCLUSIONS: In order to improve overall oral health care, cooperation is required from North Korea in accessing relevant information in the field of children's oral health, dental prosthetics, and dental materials. For this to occur, there should be a preliminary trust building process between North Korea and South Korea as well as access to information from reliable sources.

Produção especializada no SUS em capitais brasileiras com centros de especialidades odontológicas: uma análise descritiva / Specialized production in the unified health system in Brazilian capitals with dental specialty centers: a descriptive analysis

Centros de especialidades odontológicos (CEOs) são estabelecimentos de saúde de âmbito especializado que devem realizar uma quantidade mínima de procedimentos. Objetivos: descrever a produção odontológica especializada e reportar o cumprimento das metas nas capitais brasileiras com CEOs. Materiais e método: foi conduzido um estudo do tipo longitudinal retrospectivo, sendo realizada uma busca por CEOs cadastrados no Cadastro Nacional de Estabelecimentos de Saúde (CNES). A produção odontológica foi pesquisada no Sistema de Informações Ambulatoriais do Sistema Único de Saúde (SIASUS), de maio de 2015 a abril de 2016. Resultados: foram encontrados e considerados elegíveis para o presente estudo 59 CEOs, localizados em 19 capitais brasileiras e no Distrito Federal, sendo 48% CEOs tipo II. Cerca de 730 mil procedimentos especializados foram realizados durante os 12 meses avaliados. Uma taxa de 86% das metas foi cumprida, sendo que cirurgia foi à área com maior cumprimento (92%), seguida de periodontia (89%) e endodontia (76%). Uma das capitais apresentou apenas 33% das metas cumpridas. Três capitais não atingiram nenhuma das metas estabelecidas em procedimentos de endodontia. Conclusão: foi observada uma grande variação no cumprimento das metas entre as capitais com CEOs. Enquanto algumas capitais apresentaram elevado cumprimento das metas, outras exibiram dados preocupantes, principalmente nos procedimentos de endodontia. (AU)

Dental Specialty Centers (Centros de Especialidades Odontológicas ­ CEOs) are specialized health facilities that should perform a minimum number of procedures. Objectives: this study aimed to describe the specialized dental production and report the achievement of goals in Brazilian capitals with CEOs. Materials and method: a retrospective longitudinal study was performed with a search for the CEOs listed in the National Registry of Health Establishments. The dental production was searched in the Outpatient Information System of the Brazilian Unified Health System for the period from May 2015 to April 2016. Results: fifty-nine CEOs were found and considered eligible for the present study. They were located in 19 Brazilian capitals and in the Federal District, whereas 48% were CEOs Type II. Approximately 730 thousand specialized procedures were performed during the 12 months evaluated. A rate of 86% of goals was met and surgery presented the highest achievement (92%), followed by periodontics (89%) and endodontics (76%). One of the capitals achieved only 33% of the goals. Three capitals did not achieve any of the goals set for endodontic procedures. Conclusion: there was a great variation in the achievement of goals among capitals with CEOs. While some capitals showed high achievement of goals, others presented concerning data, especially for endodontic procedures. (AU)

A sampling survey of remaining teeth and edentulous jaw arch in people aged 35-74 in Guangdong Province (2015-2016) / 口腔疾病防治

Obiective@#To investigate the current status of remaining teeth and edentulous jaw arch of people aged 35⁃44, 55⁃64 and 65⁃ 74 in Guangdong province.@*Methods@#An equal⁃ sized stratified multi⁃stage randomly sampling design was applied to select a total of 288 Guangdong residents in urban and rural areas, and the subjects were between the age of 35⁃44, 55⁃64 and 65⁃74, with a gender ratio of half to half. The status of remaining teeth and edentulous jaw arch were assessed according to the Guideline for the 4th National Oral Health Survey. @*Results@#88.89% subjects in the 35⁃44 year group had more than 28 teeth and 100% subjects had more than 20 teeth, with an average of 29.88 teeth remaining and no edentulous jaw. The average remaining teeth was 26.06 in the group of 55 ⁃ 64 year, with 87.50% subjects having more than 20 teeth, 59.03% subjects having 28 or more teeth, 4.16% subjects having single edentulous jaw arch, and 1.04% subjects having both edentulous jaw arch. 73.96% and 35.07% subjects in the group of 65⁃74 year had 20 above or 28 above remaining teeth, respectively, and the average teeth was 22.94. There were 8.34% subjects having single edentulous jaw arch and 1.39% subjects having both edentulous jaws. In the 35⁃44 and 65⁃74 year group, the prevalence of missing teeth in the female was significantly higher than the male (P < 0.05), while no significant difference was found between urban and rural areas (P > 0.05). More remaining teeth were noticed in current survey (2015) when compared to the data in 2005 (P < 0.05). @*Conclusion@#The 35⁃44 year people have few lost teeth, and over half of the elderly people have several lost teeth. Elderly people with edentulous arch are very few.

A sampling survey of gingival bleeding and dental calculus in Guangdong Province (2015-2016) / 口腔疾病防治

Objective @# To investigate the current status of gingival bleeding and dental calculus in the 12- to 74-year old population in Guangdong Province with the aim of providing information to support oral health care.@*Methods @# A stratified, multistage, random sampling design was used to obtain 7 provincially representative sample groups consisting of 8, 544 Guangdong residents aged 12, 13, 14, 15, 35-44, 55-64 and 65-74 years old with a 50/50 gender ratio. The status of gingival bleeding and dental calculus in the whole mouth was assessed according to the Guidelines of the Fourth National Oral Health Survey using a CPI probe. The resulting data were analyzed using the SAS9.2 package. @*Results @#The prevalence of gingival bleeding in residents aged 12, 13, 14, 15, 35-44, 55-64 and 65-74 years old was 43.75%, 42.76%, 49.06%, 39.38%, 81.94%, 90.97%, and 84.03%, respectively, while the average number of teeth with gingival bleeding per person was 1.95, 2.07, 2.59, 2.39, 9.62, 10.36, and 9.98, respectively. In the 12-, 13-, 14-, and 15-year-old groups, peak prevalence was observed at age 14 (P < 0.05). In the 35-74-year-old group, the prevalence and mean number of teeth with gingival bleeding per person increased with age, and both parameters reached a peak in the 55-64-year-old group. The prevalence of dental calculus in the 12-, 13-, 14-, 15-, 35-44-, 55-64- and 65-74-year-old group was 40.57%, 41.09%, 45.05%, 54.84%, 98.96%, 97.22%, and 92.01%, respectively, and on average, each person had 1.61, 1.71, 2.14, 3.52, 20.30, 20.55, and 17.26 teeth, respectively, with dental calculus. The prevalence and mean number of teeth with dental calculus increased with age. In the 35- to 74- year-old group, the prevalence of dental calculus was higher in urban areas than in rural areas and the mean number of teeth with dental calculus was higher in males than in females. Otherwise, there were no significant differences in the prevalence or the mean number of teeth with dental calculus or gingival bleeding between urban and rural areas or between males and females. @*Conclusion @#There is a high prevalence of both gingival bleeding and dental calculus in all 7 age groups in Guangdong, indicating that poor oral hygiene and gingival inflammation are common in Guangdong Province.

Dental fluorosis of permanent teeth among 12-year-old people of Guangdong Province: a sample investigation (2015—2016) / 口腔疾病防治

Objective@#To investigate the dental fluorosis status of permanent teeth of a 12-year-old population of Guangdong Province to provide informational support for oral health care in Guangdong.@*Methods @#An equal-sized cross-sectional random-sample assessment was carried out among 1 920 urban and rural residents of Guangdong Province, half male and half female, aged 12 years. We examined the dental fluorosis status of complete permanent teeth crown based on a health survey and the criteria of clinical dental fluorosis from the fourth national oral health survey. The data were analyzed by SAS9.2 to investigate the prevalence and community fluorosis index as well as gender and urban and rural differences, and compared with the prevalence of fluorosis in Guangdong Province in 2005 and 1995.@*Results @# In the 12-year-old population, the prevalence of dental fluorosis was 5.05%, and the community fluorosis index was 0.108. There was no significant difference between genders（P > 0.05）, but there was a significant difference between subjects from urban and rural areas（P < 0.05）. There were significant differences among prevalence of dental fluorosis and community fluorosis index in 1995, 2005 and 2015—2016（P < 0.05）.@*Conclusion@# The prevalence of dental fluorosis and the community fluorosis index of 12-year-old people of Guangdong Province are relatively low, but there is an upward trend.

A sampling survey of remaining teeth and edentulous jaw arch in people aged 35-74 in Guangdong Province (2015-2016) / 口腔疾病防治

@#Obiective To investigate the current status of remaining teeth and edentulous jaw arch of people aged 35-44, 55-64 and 65- 74 in Guangdong province. Methods An equal- sized stratified multi-stage randomly sampling design was applied to select a total of 288 Guangdong residents in urban and rural areas, and the subjects were between the age of 35-44, 55-64 and 65-74, with a gender ratio of half to half. The status of remaining teeth and edentulous jaw arch were assessed according to the Guideline for the 4th National Oral Health Survey. Results 88.89% subjects in the 35-44 year group had more than 28 teeth and 100% subjects had more than 20 teeth, with an average of 29.88 teeth remaining and no edentulous jaw. The average remaining teeth was 26.06 in the group of 55-64 year, with 87.50% subjects having more than 20 teeth, 59.03% subjects having 28 or more teeth, 4.16% subjects having single edentulous jaw arch, and 1.04% subjects having both edentulous jaw arch. 73.96% and 35.07% subjects in the group of 65-74 year had 20 above or 28 above remaining teeth, respectively, and the average teeth was 22.94. There were 8.34% subjects having single edentulous jaw arch and 1.39% subjects having both edentulous jaws. In the 35-44 and 65-74 year group, the prevalence of missing teeth in the female was significantly higher than the male (P < 0.05), while no significant difference was found between urban and rural areas (P > 0.05). More remaining teeth were noticed in current survey (2015) when compared to the data in 2005 (P < 0.05). Conclusion The 35-44 year people have few lost teeth, and over half of the elderly people have several lost teeth. Elderly people with edentulous arch are very few.

A sampling survey of periodontal health status in 15-74-year-old population in Guangdong province (2015-2016) / 口腔疾病防治

Objective @# To investigate current status of periodontal health in the population at the age of 15-74 in Guangdong province and provide information for oral health care in Guangdong. @*Methods@# A stratified multistage randomly sampling design was applied to obtain 4 provincially representative sample groups consisted of 2784 Guangdong residents, aged at 15, 35-44, 55-64 and 65-74 respectively, with a gender ratio of half to half. The status of probing depth (PD) and loss of attachment (LOA) of the whole mouth were assessed according to the Guideline for the fourth National Oral Health Survey by using a CPI probe, and the data obtained were analyzed with SAS9.2 package.@*Results @#The prevalence of shallow periodontal pocket in the 15, 35-44, 55-64 and 65-74 years old group were 0.52%, 38.54%, 49.65%, 47.22% with 0.02, 2.05, 3.74, 2.80 affected teeth on average. The corresponding percentages of deep periodontal pocket in the 4 groups were 0.05%, 3.47%, 15.97%, 9.03% with 0, 0.07, 0.31, 0.16 affected teeth on average. Prevalence and the mean affected teeth of 4-5 mm LOA were 0.10%, 26.74%, 33.68%, 35.07% and 0, 1.54, 4.33, 4.05. The prevalence and the mean affected teeth of 6-8 mm LOA were 0, 6.94%, 32.29%, 27.08% and 0, 0.24, 1.23, 0.97. The prevalence of LOA≥4 mm were 0.10%, 35.07%, 79.17%, 74.65% and the prevalence of LOA≥6 mm were 0, 8.33%, 45.49%, 39.58%. In the 35-74 years old group, the prevalence and the mean teeth with PD and LOA increased with age and reached a peak in 55-64 years old group (P < 0.05). There were no significant differences in the prevalence and the mean teeth of PD and LOA between urban and rural areas. The mean teeth of PD in 35-44 and 55-64 years old groups were significant higher in the male than the female. The prevalence and the mean teeth with LOA were both significant higher in the male than the female.@*Conclusion @#The periodontal diseases indications are common in 35-74 years old people and most necessary at the age of 55-64 in Guangdong. The periodontal health may have extensive influence on oral health status in the middle-aged and the elder population in Guangdong.

Effect of Professional Oral Healthcare Program on the Oral Status of Elderly Residents in Long-Term Care Facilities / 치위생과학회지

This study was conducted to investigate the effects of professional oral healthcare program in eldery residents long-term care facilities. Ninety-four elderly residents from 5 different facilities in Asan participated in this study. The subjects were divided into 3 groups, with 32 in experimental group I, 30 in experimental group II, and 32 in the control group. Subjects in experimental group I were treated by a dental hygienist with professional oral healthcare and received daily oral care from caregivers who had completed elderly oral healthcare course. Subjects in experimental group II received daily oral care from caregivers who had completed elderly oral healthcare course. Control group received daily oral care from caregivers. These 3 groups were tested for dental plaque, halitosis, tongue coating, and salivary flow at baseline, and after 4 and 12 weeks of treatment. There were significant differences in the dental plaque index between the groups, mediate times, and mediate methods, in halitosis between the mediate methods, and in tongue coating between the mediate times, as well as the mediate methods. Finally, salivary flow was significantly different with regard to mediate methods between experimental group II and the control group. Therefore, to improve the oral health condition of elderly residents, involvement of a part-time dentist and scheduled professional oral healthcare are necessary. Furthermore, elderly oral healthcare education for nursing staff, including managers, should be provided.

Rede de atenção à saúde bucal pública: experiência em um município de médio porte / Public oral health care network: experience in a medium-sized city

Introdução: as Redes de Atenção à Saúde (RAS) são organizações que permitem, através de um objetivo único, oferecer contínua e qualitativa atenção de saúde à popula- ção. Objetivo: analisar as condições e extensões da RAS com enfoque no município de Maringá/Paraná, direcionado à saúde bucal pública. Para isso, foi construído um mapa com todos os pontos de atenção em saúde bucal do município em suas diferentes complexidades, trazendo, assim, para o concreto a imagem da Rede de Atenção à Saúde Bucal Pública do município. Metodologia: fundamentou-se em revisão bibliográfica do referencial teórico sobre a RAS, Saúde Pública e Saúde Bucal e entrevista com a gestora municipal de saúde bucal. A coleta de dados caracterizou os pontos de atenção e suas complexidades, perfil epidemiológico da população, fluoretação das águas de abastecimento, para que, dessa forma, fosse construí- do o mapa da rede. Resultados: o município possui uma rede estruturada da atenção em saúde bucal, havendo todos os níveis de complexidade em diferentes regiões do município, possibilitando um maior acesso da população. Conclusão: por meio da estruturação do mapa da rede, constatou-se que há uma grande potência de serviços em saúde bucal, com os três níveis de complexidade e, ainda, parcerias com o consórcio intermunicipal e instituição de ensino superior, podendo beneficiar a população, oferecendo um tratamento integrado aos usuários do sistema e servir de suporte aos profissionais da rede.

Introduction: The Oral Health Care System (OHCS) is a network which, with a single goal, offers continuous and quality care to the public. Objective: This study aimed to analyze the conditions and extent of the OHCS in the city of Maringá, Paraná, with a specific focus on the oral health of the public. A map was carefully created, illustrating all the points in Maringá where the public can receive oral health care, whether it is preventative care or more specific care that needs to be met. This map presents a concrete image of the city's Public Oral Health Care Network. Methodology: The methodology was based on a literature review of the theoretical framework concerning the Health Care System, Public Health, and Oral Health, as well as an interview with the manager of the municipal oral health program. The data collection characterized points of attention and their complexities, the epidemiological profile of the population, and fluoridation of water supplies. Results: Using this data, the citywide network map was created, and from this map, we are able to conclude that the city has a structured network for oral health care needs, which encompasses all the levels of complexity and the various locations in the different municipal regions, allowing greater access for the population. Conclusion: By constructing the network map, we found there is a powerful array of services in oral health, with three levels of complexity, and even partnerships with the inter-municipal association as well as the local institutions for higher education. These relationships can benefit not only the population, by offering users of this network integrated treatment, but also can serve as a support network for the healthcare professionals.

Change in plaque control ability by the professional oral health care program / 대한구강보건학회지

OBJECTIVES: This study aimed to examine the impact of a regular professional oral health care program and the accompanying oral health education. METHODS: We included 552 patients who visited the C dental hospital more than 5 times as part of a regular professional oral health care program from January 2009 to March 2014. This program comprised of an O'Leary plaque control record, tooth brushing instructions, professional tooth brushing, professional tooth cleaning, periodontal or operative treatment (optional), and education on auxiliary devices. The O'Leary plaque control record was evaluated at the fifth consecutive visit, from the first visit to the recent visit. RESULTS: The study data revealed that patient plaque control rate significantly increased with a lapse in care provided from the baseline. However, no intergroup differences were observed with respect to age and sex. The plaque controlling ability of a patient who was educated on the Watanabe's brushing method, which was a combination of the Watanabe's brushing method and rolling method, was significantly increased. Use of an interdental brush, attending the 5-time tooth brushing instruction program, and tooth polishing aided to enhance the plaque-control rate. Further, the plaque control rate of a patient with a pontic, fully covered tooth and implant was significantly higher than those without the same. The Watanabe's brushing method, number of fully covered teeth, and number of implants were significant variables that impacted the final plaque control rate, as ascertained using multiple linear regression analysis. Increased plaque control rate was maintained till the recent evaluation from the fifth visit. CONCLUSIONS: The ability of patients to reduce plaque formation was improved after the educational program, which comprised of tooth brushing instructions as part of a regular professional oral health care program.

Pay-for-performance and efficiency in primary oral health care practices in Chile / Pago por desempeño y eficacia de las prácticas de atención sanitaria primaria oral en Chile

Background Payment mechanisms for health care providers have been used as a strategy to improve management, health indicators, cost containment, equity and efficiency. Among the mechanisms implemented in the past decade is pay-for-performance (P4P). In Chile, it was incorporated since 2003 in primary care in addition to the salary by seniority and training. Objectives To assess the impact of P4P on the efficiency of primary oral health care providers in Chile. Methods We performed a retrospective cohort study to compare the performance of oral healthcare practices belonging to primary health providers measured by the rate of dental discharge in 6 year-old children between years in which P4P was used and years in which P4P was not used, in the 52 municipalities of the Metropolitan Region of Chile. We also explored whether rurality, and the human development index (HDI) had an association with the efficiency of health care teams. We calculated the rate of discharge per 1000 patients, and its adjusted and unadjusted association with the predictors of interest, using a Random-effects Poisson regression. Results We found statistically significant differences in the rate of dental discharges when comparing P4P versus no P4P (822.59/1000 and 662.59/1000, respectively, p < 0.0001) and high versus low HDI (692.23/1000 and 832.85/1000, respectively, p = 0.01). Rurality was not statistically associated with P4P (727.24/1000 in rural and 770.19/1000 in urban municipalities, p = 0.553). Unadjusted and adjusted rate ratios were very similar. Conclusions P4P financial incentives can improve the performance of primary care dental practices, and seem to be useful interventions to improve the performance of oral health care providers.

Antecedentes Se han venido utilizando mecanismos de pago a los profesionales de la atención sanitaria para mejorar la gestión, los indicadores sanitarios, la contención de costes, la equidad y la eficacia. Entre los mecanismos introducidos en el último decenio se encuentra el pago por desempeño- pay for performance (P4P). En Chile, se lleva incorporando a la atención primaria desde 2003, además del salario por antigüedad y la formación. Objetivos Evaluar el impacto del P4P sobre la eficacia de los profesionales de la atención sanitaria oral primaria en Chile. Métodos Realizamos el estudio comparativo de un grupo, para comparar el desempeño de las prácticas de los cuidados sanitarios orales de los profesionales de la salud primaria, medido mediante el índice de las altas dentales en niños de seis años, entre los años en que se utilizó el P4P y los años en que no, en cincuenta y dos municipios de la región metropolitana de Chile. También exploramos si la ruralidad y el índice de desarrollo humano (IDH) estaban asociados a la eficacia de los equipos de atención sanitaria. Calculamos el índice de altas por 1000 pacientes, y su asociación ajustada y no ajustada a los predictores del interés, utilizando el modelo de regresión de los efectos aleatorios de Poisson. Resultados Encontramos diferencias estadísticamente significativas en el índice de altas dentales al comparar P4P frente a no P4P (822,59/1000 y 662,59/1000, respectivamente, p < 0,0001), y el elevado frente al bajo IDH (692,23/1000 y 832,85/1000, respectivamente, p = 0,01). La ruralidad no estuvo estadísticamente asociada al P4P (727,24/1000 en municipios rurales y 770,19/1000 en municipios urbanos, p = 0,553). Los ratios no ajustados y ajustados fueron muy similares. Conclusiones Las incentivas financieras P4P pueden mejorar el desempeño de las prácticas de atención primaria dental, y parecen resultar unas intervenciones útiles para mejorar el desempeño de los profesionales de la atención sanitaria oral.