Dental public health in California: a view of the future.

This article has described two recent successful initiatives that have utilized the unique knowledge and skills of dental public health specialists--the enactment of California's new fluoridation law and the first oral health needs assessment of California children--as examples of the types of activities in which practitioners of this specialty of dentistry are engaged on a day-to-day basis. It has also underscored how dental public health can be considered not only a specialty of dentistry, but also a specialty of the broader field of public health, as a result of its mission to assure, promote and protect the oral health of communities. We believe that assuring the oral health of Californians and the nation is far too large an undertaking for any one group or organization. The individual orientation of dental clinicians and the community orientation of dental public health practitioners will both be needed, as will be the collaboration of many other individuals and organizations, if we are to look forward to the 21st century as one in which barriers to oral health are overcome, oral diseases become distant memories, and Americans can look forward to a lifetime of oral health.

Integrating primary oral health care into primary care.

Despite increasing national attention and emphasis on primary health care, there has been little impetus to define or specify the content of primary oral health care. This paper defines primary oral health care and the scope of services it includes, using an adaptation of a Health Resources and Services Administration definition of primary health care and its attributes as its model. The proposed scope of services encompassed by primary oral health care is a set of basic dental services used by the Indian Health Service. Policy recommendations are presented to improve the integration of primary oral health services with primary health care and primary health care delivery.

The use of dental sealants in the Washington State Medical Assistance Program: a second-year report.

The second year utilization and cost data were reviewed for the Medical Assistance sealant program in Washington State. This report covers the period from November 1, 1986 to October 31, 1987. A total of 6,814 children received sealants, or 17.2 percent of all individuals (ages six to fourteen) who made at least one visit to a dentist. Sealants were placed on 21,685 teeth, with an average of 3.18 teeth sealed per child. This represents 2,095 or 10.7 percent more teeth sealed than in the first year of the program. There were 726 dentists who participated in the sealant program during the study period, for an increase of 22 percent over the previous year of the project. The total cost of providing sealants to this group of children was $193,303. This represents an increase of 12 percent for the second project year. In 1987 there were eighteen states that included sealants as a dental benefit for EPSDT children. A 1988 survey of dental programs in Medicaid reveals, however, that twenty-two states now provide sealants as a covered service. The second-year report shows steady progress in the Washington State Medical Assistance sealant program.

Public views on fluoridation and other preventive dental practices.

The political nature of fluoridation is due in part to public misconceptions about its purpose, and about its efficacy and practicality in preventing tooth decay as compared with other preventive practices. This paper describes a public opinion survey conducted in Portland, Oregon in May 1980, immediately following a referendum that repealed an earlier vote to fluoridate Portland's water supply. A household interview survey was conducted of 313 Portland residents aged 18 and over. The primary objectives of the survey were to: 1) determine attitudes on fluoridation; 2) gauge the effectiveness of several pro- and antifluoridation arguments; 3) determine key target populations for fluoridation education efforts; and 4) determine the relative impact of different sources of information about fluoridation. Among the significant findings of the survey were: 1) preventive practices involving fluorides were rated less important to dental health than other preventive practices; 2) 71% of respondents knew the purpose of fluoridation; 3) newspapers were the predominant source of information about fluoridation; and 4) the "loss of freedom of choice" was by far the most powerful argument against fluoridation.

Fluoridation: strategies for success.

Of 19 referenda on community water fluoridation held in the first six months of 1980, 17 were defeated. Among the postulated reasons are a growing distrust of government and the health establishment. The public remains largely ignorant of the purpose and benefits of fluoridation. The emotionalism surrounding the issue has made it difficult to generate public support outside of the health professions. Opponents have also learned to fight fluoridation with increasingly sophisticated techniques. Some of the strategies used in recent successful campaigns in Oakland, California, and Portland, Oregon are described; recommendations that can be applied to communities considering fluoridation include careful wording of ballot measures so they are unequivocally clear and simple; timing ballot measures with elections likely to draw the largest voter turnout; broadening the base of political and financial support; using a figurehead if possible; and making maximum use of the media.

Appraising the performance of dentists.

This paper has attempted to provide an overview on the subject of performance appraisal of dentists, particularly those in supervisory positions in publicly funded clinical programs. Some of the problems inherent to the definition and measurement of the quality, quantity, and effective management of dental care have been discussed. The qualitative aspects of dental care have been the most thoroughly investigated of the subareas, but primarily with regard to evaluating the care rather than the performance of the person providing it. Less has been written on the quantitative or managerial aspects of appraising a dentist's performance. While further research is certainly indicated about the appropriateness of the measures proposed and their usefulness in identifying and helping to correct performance deficiencies, the intent is to begin using such a system on a pilot basis rather than waiting for the "perfect" program to come along. As long as the scarcity of public resources for dental care persists, public programs ought to use those appropriate means available to demonstrate their accountability in order to ensure optimal use of public dollars.