5.14.5. Control tools and policies

Primary prevention

For the control of smoking see Chapter 8; for the control of excessive alcohol consumption see Chapter 8 ; and for diabetes mellitus see Chapter 5.4.

It is possible to develop public knowledge and practices on health promotion and prevention by implementing community health programmes. Even if the most common oral diseases are preventable, a large proportion of the community still lacks sound information or does not benefit from appropriate oral health promoting actions. Informing mothers on the benefits of appropriate promoting of oral health behaviours can significantly improve their confidence in managing the oral health of their children. Schools provide an ideal setting for promoting oral health. The school years are an influential stage in people’s life for the development of a lifelong oral health related behaviour as well as beliefs and attitudes. Schools are also the only places where economically and socially disadvantaged children, who are at risk, can access oral health services. Although meticulous oral hygiene and appropriate dietary practices contribute to caries prevention and control, the most effective approaches include fluoride use.

Secondary prevention

Special attention should be given to the systematic integration of oral health indicators in any health surveillance system so that trends and changes in life-style and quality of life behaviour in relation to oral health can be monitored effectively. If there is a general move of health strategies towards health promotion and prevention, consideration should nevertheless be given to the fact that the situation varies considerably from country to country. There will be situations for example, where the information priority will be given to the organisation or the reorganisation of the health system for a better quality of care. Clearly health priorities are considerably variable in time and from country to country.

Numerous projects have been proposed by different teams from European countries within the framework of the Community Action Programme in the area of health surveillance. The European Commission Health Monitoring Programme has as its main objectives to monitor the trends in the European community, evaluate community programmes and actions, as well as provide Member States with appropriate health information to make international comparisons and support their national health policies. The development of national and international health surveillance systems has resulted in a deluge of indicators overwhelming health services personnel in charge of epidemiological surveillance and evaluation of care programmes. The oral health sector is no exception.

Within a context of a profusion of health indicators, operating a selection is not an easy task. The need for the necessary integration of the oral health sector within the national and European health information systems is an added challenge, considering that this should be done at all levels of the reference system. A challenge that this European public health project will contribute to meet with practical and decisive recommendations. In recent years, the European Commission has supported the development of a set of European Global Oral Health Indicators (www. egohid.eu). The objectives of this international project are to help to identify basic oral health indicators for a European surveillance system and to make recommendations for improving health system information performance through the establishment of the major indicators of reference. A core group of oral health indicators is being designed for integration into national health systems. The indicators will focus in particular on health status, morbidity and oral function, behavioural determinants, oral health delivery models and outcomes, and oral health related quality of life.

Oral health systems play an important role in establishing optimum oral health by integrating oral health promotion and oral disease prevention into oral health services. Interdisciplinary and inter-sectoral approaches to the promotion of oral health have the potential for reorienting oral health services towards primary oral health care and services that may better diminish oral disease burdens (Petersen et al, 2005). Increasingly European Member States or regions within Members States have formulated health priority areas or targets for health policies. There is a noticeable trend to broaden the spectrum of health objectives moving from simple morbidity measurements, or prevalence of specific diseases to objectives expressed in terms of quality of life improvements, reduction of health inequalities with reference to social policies enabling goals. For example, health promotion and prevention tend to focus on specific population groups according to specific life-styles – i.e. children or elderly people; goals are formulated for quality of care and access to care, or in terms of social life involvement of entire groups of population such as the ageing population. For the oral health sector, this evolution implies a broader concept of the role of oral health professions and their contribution to general health.

Public policymakers have long recognized the need for programs to facilitate access to dental services for children and adults especially from low-income households. Despite the potential for improved oral health status, the level of untreated dental caries tends to vary in Europe on the basis of sociodemographic factors. A concern among public health policy makers is that some special groups are disadvantaged in terms of untreated disease and less desirable patterns of dental care. Information from the surveys on patterns of untreated dental care in Europe will assist in identifying disadvantaged groups, and will contribute to oral health policy development. Countries of the European Union have undertaken a number of strategies to address access problems, such as providing incentives to dentists to serve people enrolled in primary oral care services, expanding the scope of practice for dental hygienists and other providers, and supporting education and prevention activities. Primary care services need to be accessible to all, including those with mobility, sensory or mental impairments. Surveillance to evaluate best practices for expanding oral health service care services for vulnerable and underserved populations is necessary to provide those populations with access to necessary preventive and restorative primary oral health care.

The burden of oral disease is particularly high among older people affecting their quality life (Petersen and Yamamoto, 2005). An EU oral health strategy must take full account of the changing demography of the European population. The challenges which may result from a constantly ageing population require the development of sustainable measures, e.g. through innovative projects and cross-sectoral work both at EU and at national level. The strategy is to promote oral health among older people, aiming at improving oral health, general health and well-being into old age through a life-long perspective in health promotion, integrated disease prevention, and emphasis on age-friendly primary health care.