Pandemic Considerations on Essential Oral Health Care

The coronavirus disease 2019 (COVID-19) pandemic revealed a lack of consensus on the concept of essential oral health care. We propose a definition of essential oral health care that includes urgent and basic oral health care to initiate a broader debate and stakeholder alignment. We argue that oral health care must be part of essential health care provided by any health system. Essential oral health care covers the most prevalent oral health problems through an agreed-on set of safe, quality, and cost-effective interventions at the individual and community level to promote and protect oral health, as well as prevent and treat common oral diseases, including appropriate rehabilitative services, thereby maintaining health, productivity, and quality of life. By default, essential oral health care does not include the full spectrum of possible interventions that contemporary dentistry can provide. On the basis of this definition, we conceptualize a layered model of essential oral health care that integrates urgent and basic oral health care, as well as advanced/specialist oral health care. Finally, we present 3 key reflections on the essentiality of oral health care. First, oral health care must be an integral component of a health care system's essential services, and by implication, oral health care personnel are part of the essential health care workforce. Second, not all dental care is essential oral health care, and not all essential care is also urgent, particularly under the specific risk conditions of the pandemic. Third, there is a need for criteria, evidence, and consensus-building processes to define which dental interventions are to be included in which category of essential oral health care. All stakeholders, including the research, academic, and clinical communities, as well as professional organizations and civil society, need to tackle this aspect in a concerted effort. Such consensus will be crucial for dentistry in view of the Sustainable Development Goal's push for universal health coverage, which must cover essential oral health care.

Prevalence and severity of dental caries in Costa Rican schoolchildren: results of the 1999 National Survey

In 1987, Costa Rica implemented a comprehensive national salt fluoridation programme using sodium fluoride (225-275mg F/kg salt).

AIM

To describe dental caries prevalence and severity in Costa Rican children in 1999.

METHODS

Eight calibrated examiners (inter-examiner Kappa = 0.70 or higher) recorded information on dental caries, treatment needs, enamel fluorosis, and dentofacial anomalies for schoolchildren aged 6-8,12, and 15-years (N=3758). The survey utilised a multistrata probability sample with fixed allocation to represent seven regions of the country.

RESULTS

The overall mean dmft for age 6-8 years was 3.32. The DMFT for age 12 was 2.46 and for age 15 was 4.37. Regional differences were observed; for example, the DMFT at age 12 years ranged from 1.93 to 3.86. Compared with pre-fluoridation data collected in 1984, schoolchildren aged 12 years, experienced a 28 per cent decrease in caries prevalence (100 per cent to 72 per cent) and a 73 per cent decrease in severity (DMFT from 9.13 to 2.46, representing an 8.3 per cent compound annual per cent reduction).

CONCLUSIONS

Between 1984 and 1999, Costa Rican schoolchildren experienced substantial reductions in caries prevalence and severity. Many factors may be involved in this decline, but the most important appears to be exposure to fluoridated salt.

Methodological and biological factors explaining the reduction in dental caries in Jamaican school children between 1984 and 1995

OBJECTIVE

To assess the methods used and results found in two surveys, one conducted in 1984 and the other in 1995, that indicated a large reduction in the prevalence and severity of dental caries among children in Jamaica, with special attention focused on methodological differences between the two surveys and the biological factors that may explain the large reduction in caries.

METHODS

In 1984 a modified "pathfinder" methodology was used to measure the prevalence and severity of dental caries in 6-, 12-, and 15-year-old children in Jamaica. A similar survey was conducted in 1995. A comparison of the two surveys showed an 84% reduction in the severity of dental caries at age 12. Both surveys used the same diagnostic criteria and clinical procedures, but the 1984 survey included a higher proportion of rural residents than did the 1995 one.

RESULTS

The data show an epidemiological transition between 1984, when dental caries was highly prevalent and severe, and 1995, when the disease was less prevalent and was concentrated in a smaller proportion of the population.

CONCLUSIONS

Most of the reduction in dental caries between 1984 and 1995 is attributable to the introduction, in 1987, of salt fluoridation. While the 1995 survey included fewer rural areas than the 1984 survey did, that does not invalidate the observed reduction in dental caries. The use of fluoride toothpaste and dietary fluoride supplements as well as access to dental health promotion and preventive and curative services do not seem to be major contributors to the reductions observed.