The community care model of the Intercountry Centre for Oral Health at Chiangmai, Thailand.

The Intercountry Centre for Oral Health opened in Chiangmai, Thailand, in November, 1981. In 1984, as part of its mandate to promote new approaches to the delivery of oral health care, it initiated a demonstration project known as the Community Care Model for Oral Health. Logistic, financial and organisational difficulties prevented the full implementation of the original plan. Nevertheless, consideration of the strengths and weaknesses of the Model has provided valuable suggestions for adoption by national and international health agencies interested in adopting a primary health care approach to the delivery of oral health services. Important features which could be appropriate for disadvantaged communities include: integration into the existing health service infrastructure; emphasis on health promotion and prevention; minimal clinical interventions; an in-built monitoring and evaluation system based on epidemiological principles, full community participation in planning and implementation; the establishment of specific targets and goals; the instruction of all health personnel, teachers and senior students in the basic principles of the recognition, prevention and control of oral diseases and conditions; the application of relevant principles of Performance Logic to training; and the provision of a clear career path for all health personnel.

Evaluation of the utilization of complex periodontal care in an industrialized country with a national health insurance.

This paper presents an analysis of the utilization of periodontal care, subject to prior agreement, over a period of 3 months. It concerns insured persons covered by the Caisse Primaire d'Assurance Maladie de Lyon, which represents 5 per cent of the French population. It details 516 cases. The mean (+/- SD) age of the persons requiring care was 43 +/- 12.6 years; their dental health was good, and 58 per cent were women. The nature and geographical locality of the periodontal treatments are given and 1323 procedures are listed, with a high proportion of gingivectomies and flap operations.

The merit of the practice-profile-time study.

The practice-profile-time study is a method developed by Joint FDI/WHO Working Group 9 on the study of 'Economic factors related to the delivery of oral services and oral health' to record the time spent by general dental practitioners on different practice activities. The method was developed to support the policies of National Dental Associations, but can also be used by general dental practitioners themselves. This method was tested in nine countries. The method has proved to be reliable and valid, and produces a vast amount of useful information for Dental Associations and for individual practitioners.

[Sociodemographic and economic evaluation of periodontal care providers under a preliminary plan]. / Evaluation socio-démographique et économique des producteurs de soins parodontaux soumis à entente préalable.

A prospective epidemiologic survey performed over a three months period was done in association with the Health Insurance Fund of Lyon, France. The major objectives of this study were to evaluate the credentials of practitioners prescribing periodontal therapy under the health plan. 72.9% of the dentists received their dental diploma within the last 5 years and were predominantly male. None of the practitioners were specialists. Apparently, periodontal therapy represented only 10% of the treatment prescribed by the dentists surveyed.

Periodontal conditions in adolescents, 15-19 years of age: an overview of CPITN data in the WHO Global Oral Data Bank.

Results of 61 CPITN surveys in 39 countries for the age group 15-19 yr, stored in the WHO Global Oral Data Bank as of 1 July 1987, are assembled in an overview showing percentages of persons according to the highest score for each person and the mean numbers of sextants affected per person. The most frequently observed condition was score 2 (calculus with or without bleeding), although some shallow pocketing of 4 or 5 mm was present in most populations surveyed. It should thus be emphasized that the major thrust of activities in periodontal care should be in health promotion and education, leading to improved oral hygiene.

The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals.

The FDI-WHO Joint Working Group 1 on periodontal diseases supports the use of the CPITN as an epidemiological screening procedure for periodontal treatment needs in populations and also, in a modified form for screening and monitoring of individuals by dental practitioners. The advantages of the CPITN procedure have become more evident following 7 years of development and field experience. This report reviews the CPITN procedure and describes in detail the use of the method for both purposes. Methods, clinical criteria and evaluation of the CPITN data are discussed. The CPITN is primarily a screening procedure which requires clinical assessment for the presence or absence of periodontal pockets, calculus and gingival bleeding. Use of a special CPITN periodontal probe (or its equivalent) is recommended. For epidemiological purposes in adult populations, 10 specified index teeth are examined; for persons under 20 years of age only six index teeth are specified. In dental practice all teeth are examined and the highest score for each sextant noted. Only 6 scores are recorded. Measures of gingival recession, tooth mobility, intensity of inflammation, precise identification of pocket depths or differentiation between supra- and subgingival calculus are not included in the CPITN. Individuals are assigned to one of four treatment need categories determined from their CPITN scores. Detailed explanations are given for the evaluation of epidemiological data. Four tabulations provide an insight into the overall pattern of prevalence, severity and categories of treatment need. For health services planning, the data provide a basis for estimating overall population needs in terms of treatment categories and the clinical personnel required for periodontal care. In the clinical care situation the procedure offers a simple screening method for determining the level of intervention required and also a tool for the longitudinal monitoring of disease changes. Used with commonsense and an understanding of periodontal disease, the CPITN procedure provides the epidemiologist and the practitioner with a practical means of assessing periodontal treatment needs.

Periodontal conditions in adults, 35-44 years of age: an overview of CPITN data in the Who Global Oral Data Bank.

Results of 28 CPITN surveys in 24 countries for the age group 35-44 years, stored in the WHO Global Oral Data Bank as of 1 July 1986 are assembled in an overview presenting: percentages of persons according to the highest score for each person, the estimated national percentages of edentulousness and the mean numbers of sextants affected per person. It is concluded that for a large majority in most of the populations observed, the progress of periodontal disease has been slow and seems to be compatible with retention of a natural dentition until at least the age of 50.

[Prevention of dental caries in Thailand: 3 fluoridated products submitted for comparative tests]. / Prévention de la carie dentaire en Thaïlande: trois produits fluorés soumis à des tests comparatifs.

The aim of a three-year field trial was to compare the relative effectiveness of a 0.2% fluoride rinse used fortnightly, fluoride chewing-gum sweetened with sucrose and fluoride chewing-gum sweetened with a mixture of xylitol and sorbitol (4 sticks of gum chewed per day for 5 days a week during the school year). Indications from the data are that the chewing-gum/sucrose regime was at best considerably less effective than the other two regimes. The study shows that the effectiveness of the chewing-gum/xylitol-sorbitol and the fluoride rinse regimes was comparable.

[WHO activities in the epidemiology of dental caries (author's transl)]. / Revue des activités de l'O.M.S. en épidémiologie des caries dentaires.

The WHO program on the epidemiology of dental caries is presented: the activities undertaken in this program include the elaboration of appropriate methodology, the collection and classification of data to be used for planning services, and assistance to countries in planning and executing surveys of dental and oral health. Information available in the WHO Data Bank on the worldwide pattern of oral and dental diseases in developing and technically developed countries are studied, as well as the trends in the prevalence of caries. The WHO program of oral and dental disease prevention, started because of the increase in prevalence of caries in developing countries, is described briefly.

Basic method for recording occlusal traits.

This article describes a basic method for the recording of malocclusion that has been developed jointly by the World Health Organization and the International Dental Federation. The method was developed and field-tested in the period 1969-78 and should provide investigators and health authorities with a common basis for assessing the prevalence of malocclusion in various parts of the world. It should also serve as a basic reference tool in the development of methods for assessing the need and demand for orthodontic treatment.