Providing preventive dental care in the community using the team approach: a comparison of five training programs.

Five dental schools developed training programs for dental and dental auxiliary students in planning and delivering preventive dental services in a community setting. The schools (1) designed a curriculum that would train dental students to plan, organize, and manage the delivery of community preventive services using a team approach; (2) developed a related curriculum for dental auxiliary students; (3) implemented the program intramurally and extramurally in selected community settings; and (4) planned and conducted an evaluation of the program. Each school individualized the program to the interests of its students, the constraints of its curriculum, and the needs of community groups. A total of 228 dental and 576 dental auxiliary students were trained. A full range of community sites and target populations were provided with preventive dentistry services.

Role of nutrition in the oral health of the aging patient.

The food, diet and nutrition needs of the elderly patient should be considered a part of his total supportive management. It is incumbent upon the dentist to provide the patient with this nutritional information for optimal oral health, because what is good for preventing oral disease will be equally good for preventing general illness. Essentially, if the clinician keeps in mind that the calorie needs for an older patient are less but all other nutrient requirements are as high in old age as they were in youth, the geriatric patient will be well treated. Certainly there are distinctive environmental, physiological and psychological problems that must be considered, but these should not be imponderable. The best possible general advice is that daily diets should include meat, milk, vegetables and fruit, and bread. We suggest an emphasis on good quality protein foods and a generous selection of vegetables and fruits and somewhat less stress on fats, starches, and sugars to avoid an excess of calories. For the individual geriatric new denture wearer we might add that each diet prescription should be based on an analysis and evaluation of his individual food habits (the "why" of the diet) and actual food intake (the "what" of the diet). Furthermore, the physical nature of the diet should be consistent with the patient's experience and ability to swallow, chew, and bite with his dental prosthesis.

How to deliver a comprehensive preventive dentistry service that dental insurance carriers can underwrite.

The successful practice management of preventive dentistry requires that it be comprehensive and include both chairside and counseling procedures. The chairside clinical procedures are a prophylaxis, topical application of fluorides, application of pit and fissure sealants, and fabrication of mouth-guards and space maintainers. The counseling procedures include plaque control and nutritional guidance. The caries activity test can be used as a means of monitoring excessive sugar intake. It is the responsibility of the dentist to determine the preventive dentistry needs of his patient based on the latter's caries score, periodontal, gingival, and plaque indexes, and diet evaluation. Since patients are prone to certain dental problems during particular age periods, the preventive management procedures must consider the existing and anticipated dental problems on the basis of the patient's age. Each of the preventive services is objective in nature because it involves either chairside or counseling procedures. During the counseling service,worksheets and clinical case notes are kept as part of the patient's dental record. The progressive effectiveness of the home-care preventive dentistry counsling procedures can be measured by scores and indexes. The frequency of repeating the service depends on proven clinical merit and the individual needs of the patient. The delivery of preventive dentistry services can be monitored by dental insurance carriers through peer review of clinical services, data sheets, case notes, a preventive dentistry record, and by patient questionnaire. A method for managing, measuring, and monitoring an objective, comprehensive preventive dentistry service has been presented so that the insurance carrier can underwrite this type of coverage as part of its dental insurance plan.