5.14.1 Introduction

Oral disease such as dental caries, periodontal disease, tooth loss, oral mucosal lesions, oropharyngeal cancers and dental trauma are major public health problem. Dental caries, otherwise known as tooth decay, is one of the most prevalent chronic diseases of people worldwide; individuals are susceptible to this disease throughout their lifetime (Selwitz and Ismail, 2007). To avoid pain and discomfort, decayed primary teeth need to be restored, particularly molars in children aged 6 to 8 years. Retention of primary molars until they fall out normally – age 10 to 12 – allows adequate dental arch space for the eruption of succeeding permanent premolars, avoids the tipping forward of first permanent molars, and might possibly create serious orthodontic problems.

Carious permanent teeth should be repaired promptly in order to keep fillings small and maintain as much natural tooth as possible. Often, fillings have to be replaced several times during life; each time, additional tooth structure has to be removed, thus weakening the tooth. Current research also indicates that children from low income households have higher caries rates and more unmet dental treatment needs than their higher income counterparts. 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.

Periodontal diseases are usually seen as a multifactorial chronic inflammatory disease initially caused by bacterial infection with the destruction of the supporting tissue of the teeth. One consequence of periodontal diseases can be the loss of attachment. This manifestation of periodontal diseases is a major cause of tooth loss after the age of 40-45. Epidemiology has further enabled the distribution of periodontitis in various populations that still have to be assessed and whose risk factors are still to be identified. It has recently been suggested that untreated periodontal disease constitutes a risk for general well-being and health, especially with respect to cardiovascular and respiratory disorder, pre-term birth, and diabetes (Bourgeois and Baehni, 2003).

Recently in Europe, the roles of oral health professionals are changing in a variety of ways. They include imbalances between supply and demand, the creation of new roles in response to changing patterns of disease and emerging technologies, changing professional expectations and changing public expectations. The need for workforce planning in the oral health sector may be considered as an acknowledgement of one aspect of market failure in the health sector, giving rise to the challenge of ensuring sufficient staff with appropriate skills to meet the needs of a labour intensive service with high social utility. The overall aim of workforce planning is the provision of an adequate number of personnel with appropriate competencies to meet the service needs of the population and ensure that personnel is available and distributed equitably and coherently between geographical regions, establishments, and levels of care. Thus, the importance of reframing regulatory systems to ensure that the health workforce of the future is prepared to meet the changes that must take place in health care delivery cannot be underestimated.

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.