Dental Health Promotion

(Photo credit: http://www.flyingdoctor.org.au)

Dental Health promotion is the most recent addition to the short list of Australian dental hospital objectives. Its laudable aim is to promote the achievement and maintenance of good dental health in individuals by their own initiatives and activities, particularly those relating to their lifestyle.To some extent dental health promotion is thus a counter to those who would argue that dental hospitals are primarily oriented towards ill dental health. It involves the advocacy of those activities and styles of living which are believed to be beneficial to dental health and simultaneously the avoidance or minimization of those activities which appear to be related to the creation or promotion of illness. It includes primary and secondary prevention.

While it is true that some of the activities involved in dental health promotion have been carried out in dental hospitals for many years, it is equally true that until recently they have not been elevated in importance and brought together in fairly comprehensive programs own to and understood by the majority of dental staff. It is probably true that some people would see the dental hospital's health promotion activities as being nothing more than old-style dental health education and prevention activities writ large but in fact there do seem to be some emphases in current dental health promotion programs. In a number of the newly-emerging dental health promotion programs there is considerably more stress on making the programs organization wide, on integrating a number of diverse activities, and in attempting to promote all-round dental health rather than simply avoiding individual causes of ill dental health or dental disease. But if traditional forms of health education and preventive activities are two of the roots of
health promotion, a third is the re-emergence of occupational dental health, safety and risk reduction as a mayor issue, both within dental hospitals and dental health services and in society at large.

PREVENTING TOOTH DECAY:
Tooth decay is the destruction of tooth structure and can affect both the enamel (the outer coating of the tooth) and the dentin layer of the tooth. We can prevent it by few simple ways.

• Brush your teeth at least twice a day
• Use fluoride-containing toothpaste.
• Clean between your teeth daily with dental floss or inter dental cleaners.
• Eat nutritious food and avoid snacks and junks.
• Use disclosing agents to see if there is any accumulated plaque.
• Visit your dentist once in a month or once in two months at-least.

PREVENT MOUTH SORENESS:
Oral lesions (mouth sores) make it painful to eat and talk. Most common oral lesions are fever blisters (cold sores) and canker sores, other types of oral lesions are leukoplakia, candidosis, hairy tongue, torus palatines and oral cancer. We can prevent oral soreness by simple measures.

• Stop smoking
• Avoid stressful situations
• Eat food carefully and slowly
• You can use a cool mouth wash.
• Avoid any trauma to the mouth
• Diet plays an important role, eat less spicy food and pack on a nutritious diet instead. Fresh fruits, leafy vegetables and cereals.
• Take good care of oral hygiene
• Avoid self medication
• Drink plenty of water
• Consult dentist/physician and use vitamin B complex and folic acid supplements, they help.
• Avoid eating hot, spicy food and carbonated drinks or beverages.

PREVENT GUM DISEASES:
If you’re told that you suffer from periodontal (gum) disease then don’t panic because you're not alone. The adverse may be very bone and soft tissue damaging. You can prevent any intense condition by simple care.

• Quit one of the most important factors ‘smoking’.
• Brush your teeth twice a day
• Use an antiseptic mouthwash, one with anti-plaque.
• Fluoride treatment has helped to account for the decline in periodontal disease.

TOOTH SENSITIVITY:
Tooth is one of the most commonly occurring problems in both children and adults. I am sure even you will have slight sensitivity in one of your teeth. You can prevent this pain causing problem which often gives you problem in eating. Once again your simple care and attention is needed.

• Use the salt water remedy
• Brush your teeth properly but SOFTLY.
• Adapt a hobby to reduce stress which leads you to grind your teeth.
• You can use numbing gel on an affected area.
• Visit your dentist once in a month or once in two months at-least.


The New South Wales Dental Hospital Health Promotion Program encompasses a variety of activities which come under the rubric of dental health promotion. These include anti-smoking campaigns at various levels, the fostering of parenting skills and coping with the problems of parenting, improving the social functioning of migrants, enhancing the long-term self-sufficiency for certain groups with chronic dental health conditions, improving nutrition and diminishing feeding problems, and the early diagnosis and treatment of some dental diseases where good outcomes may be believed to stem from early medical intervention.

Five target groups may be identified for hospital health promotion programs.

Firstly, and presumably dearest to the hearts of occupational dental health specialists, are the staff of the dental hospital. Activities that promote or improve the dental health of staff are likely to result in a more productive workforce and given that payroll expenses represent approximately three-quarters of dental hospital budgets, the importance of gains here can be seen readily. Additionally dental health-seeking staff will provide a shining example to those with whom they come in contact, a thought tempered somewhat by the failure particularly of lower socio-economic groups to follow the dental profession's example in renouncing the use of tobacco.

Dental patients provide a second obvious target group with opportunities for both very generalized messages and those directed more specifically to individual groups or categories of dental patients. However, while some dental patients may be very willing listeners and while some dental staff may have an almost proselytizing zeal, even then it may be inordinately difficult to arrange for subsequent reinforcement and longer-term follow-up of the process. Despite these caveats the program may be successful for some individuals at least and for others it may start the process of sensitizing them to issues concerning lifestyle-related dental health and illness.

The third target group is the seemingly endless stream of visitors who come to assist, gladden or dismay the dental patients. Much the same applies to visitors with regard to dental health promotion as it does to dental patients.

A fourth constituency for dental health promotion lies in the dental hospital's local community. Although there may be some difficulties in defining this with any sharpness in metropolitan areas, in rural areas this is usually a much simpler matter. Promotion may be achieved by hortatory means in the local media, by the provision of a variety of programs by the dental hospital in which the community can participate and by combining with or persuading other local bodies to make programs and services available.


The fifth target group is society at large but here the influence of the individual dental hospital is likely to be very small indeed and even the combined efforts of dental hospitals may prove to be of little immediate consequence in facilitating national change.

For all that dental health promotion was described above as a laudable objective for dental hospitals, it does raise a number of contentious issues. Firstly, to embark on a program of dental health promotion without first having undertaken a fairly wide-scale re-orientation of dental hospital staff to a new and different role is to court disaster as far as formal program objectives go. That some benefits may accrue is still probable but it is unlikely that the full potential of dental health promotion would be achieved. Secondly, if health promotion is to be successful it demands large scale behavioral change in all of its constituencies.

Experience would seem to suggest that such change is difficult to achieve and slow to be realized. Thirdly, unless one assumes that all the causes of dental health and dental ill-health lie within the control of the individual, it is clear that health promotion, however successful in itself, can only enhance the healthfulness and alleviate the unhealthiness of a limited range of persons. As points out individuals may be urged to change their lifestyles despite the fact that they can do little themselves to remove some of the basic factors such as poverty, pollution, poor housing and occupational hazards that help to produce dental illness and that programs such as dental health promotion may even divert attention from root causes by placing responsibility for their dental health on the shoulders of individuals themselves. Lastly we face a number of methodological difficulties in attempting to gain a precise and quantifiable definition of objectives, in program design and in providing satisfactory means of monitoring success or failure rates.

However, as these methodological problems also surface with regard to the provision of community dental health services and the provision of dental hospital patient care they hardly constitute sufficient reason for not engaging in health promotion as a formal objective of dental hospital activities. There is much in these realms which comes within the 'act of faith' category.

 

Community Dental Health in Australia - Part 2

The movement received a major impetus with the introduction of the Australian community dental Health program in 1973. This provided not just exhortation but hard cash. The Program followed different patterns in each state and there were even major differences within stares. In New South the AMA was successful in having primary dental care excluded from all but a handful of the dental centers and from the program which, initially, was the administrative and professional responsibility of Regional offices of the commission. In Victoria, due no antipathy between the state and the Federal Government, the service was initiated through the provision of autonomous free-standing dental centers controlled by their individual Boards of Management.

But a more serious difference was to bedevil the development of the community dental health services and their relationships with the dental hospitals. This was the range of viewpoints on the prop the roles of the community dental health services and centers.  Some individuals dentist saw the Program was largely to determine its nature in relationship to dental hospitals and how successful dental hospitals would be in embracing community dental health activities as a formal objective.

Some dental hospital people saw The Community Dental Health program as a welcome alternative to dental hospital inpatient care which would maintain some people in the community instead of in institutions. It also meant that dental hospitals might be able to discharge some dental patients rather earlier to domiciliary dental care. In essence it viewed the community Dental Health Program as simply an adjunct to dental hospital services and in very much a handmaiden role in which the values and objectives of the dental hospital would be dominant.

In contrast other dentist, particularly those with previous experience in the public dental health services, saw the development of the Community Dental Health Program as a means of maintaining people in their own community, bringing to bear on them a greater range of preventive, counselling, monitoring and dental education services, with admission to dental hospital as very much a choice of the last resort. Both medical and dental dominance of treatment in a hierarchical setting and the high level of patient dependency in the dental hospital-imposed sick role were to be replaced by teamwork in a non-hierarchical setting and with the patient in the role of an independent dental client.

A third and more radical perspective was added by those who believed that the development of the Community Dental Health Program was but a part of a more general move towards wider ideas of community development and towards participation rather than representative government. (This was parallel to some of the community development operations being undertaken at that time by the inevitably ill-fated Australian Assistance Plan.) Teamwork here would mean not just an abandonment of formal organizational hierarchies with delegated authorities of legitimate power but moves towards much more radical forms of syndicalism and unstructured co-operatives.

The emergence of these different perspectives generated considerable friction between the different groups represented, particularly on the key issues of funding and control. The need for integration between dental hospital and community dental health services seemed strong. However if dental hospitals as the largest centers of skills (such as Periodontics , Gum recession , Dental implants, Restorative dentistry)  and resources in the dental health care network were to be given control of the funding and the administration of the community dental health services, what would be the outcomes? Would dental hospitals simply divert funding from community health services in their own values image?

How could the necessary structures and processes to facilitate the provision of optimal standards of care be provided and guaranteed? In the first decade after the start of the Community Dental Health Program, these issues were never totally resolved and a considerable but diminishing degree of suspicion existed between the various parties. In the Northern Metropolitan Health Region of Sydney control of the community dental health services was given to the major public dental hospitals and two particularly noteworthy integrated systems emerged, at Gosford and at Hornsby. It may have been these examples that led to the suggestion in the Jamison Report to hand over the management of community dental health services to the  dental hospitals.

In view of the continuing differences within dental hospitals community dental health services and dentist / health service authorities as to the ideal methods of control and provision of community dental health activities, it would seem that there is no one acceptable right way' probably the least that the public dental hospital can have as one of its objectives is to co-operate to the extent that its resources make the provision by other dental agencies of community dental health activities to involved role would be signified by the adoption as an objective of the provision, promotion and management of community dental health services by the dental hospital. This could be seen as entailing some changes in Board membership to embrace and non  dental hospital health service provision and possibly leading naturally to the evolution of an area dental health board. It would entail also consequent changes in administrative structures to give organizational recognition to local professional autonomy at the clinical level, with the development of monitoring systems to ensure continuity of dental care, quality control and planning data. One can also suggest that a further level of arrangements would be necessary to logistical back up from the dental hospital,s larger range of resources and services such as Special needs dentistry , Dental radiography , Geriatric dentistry,  and so on.

In both cases, whether of greater or lesser involvement in community dental health care, there is a need not only for clearer role definitions between the respective  dentist agencies but also for professionals working within them. If the community Dental Health Program was introduced an administrative absence of mind at the State level, there is little excuse for the continued invitation to conflict offered by lack of role specification, firstly between the different dental agencies concerned and secondly between the clinical staff considered on inter-agency bases. There may be a belated recognition that to be successful even teamwork requires a clear and acceptable definition of the respective roles of each member of the dentist team. To some, teamwork may represent an escape from the tall and impersonal organizational hierarchies of large institutions but it would be surprising if these were not replaced by other imperatives

Community Dental Health in Australia - Part 1

(Photo credit: http://www.ncoss.org.au)

Acceptance of participation in community dental health activities as being a legitimate objective of dental hospitals in Australia has not come swiftly or easily and indeed it is still confined largely to the public dental hospital systems. As the costs of inpatient dental care rose rapidly in the 1960 s and dental hospitals came to be seen as the citadels of dental/medical care, dominating the dental health care scene, so calls for a redirection of development in the dental health services began to be heard. The traditional system components of private dental practice personal public dental health services primarily for maternal and child health and domiciliary oral health service dental nursing, and institutional care were seen as an incomplete and inappropriate response to needs. Substantial expansion of personal and public dental health services via a network of dental centers linked in various ways to private dental practice and to dental hospital systems was advocated. One suggested model was that community dental health services would provide in the local setting the traditional public dental health services, referrals to and additional dental treatment (Oral and maxillofacial surgery) under the supervision of general and specialist dental practitioners, preventive services, and health outreach and counselling.

The dental hospital's role was to be the provision of further dental diagnostic radiography, specialist and inpatient  dental care services and back-up and co-ordination of community health dental activities through a department of community medicine and dental with a community medical officer.a The development of networks of community health services was seen as particularly important in the sprawling raw edges of our capital cities where dental hospitals and private dental practitioners were unevenly distributed, in some decaying inner city areas and in catering for the needs of some disadvantaged groups such as Aboriginals.

Demise of Medibank

If the election of the Fraser Government in December, 1975 meant that the demise of Medibank was inevitable, it is ironic that the early Fraser years, despite the rhetoric of New Federalism and the Commonwealth handing back States' responsibilities, led to a significant increase in Commonwealth control over the hospital system. In May, 1976 the Prime Minister declared the existing Federal-State hospital cost-sharing agreements to be invalid and after discussions with the States, presumably rather one-sided, the agreements were replaced with effect from 1st October by new arrangements which provided for the equal sharing between Commonwealth and States of agreed hospital net operating costs. While it could be argued that the new arrangements simply amounted to no more than putting an end to the previous openended and increasingly embarrassing commitment, this goal could have been achieved in other ways. The new arrangements provided for the Commonwealth to participate in detail in the preparation of States'hospital budgets and, by approving or rejecting proposals, to vary the nature and intensity of services to be provided. Administration of the agreements involved negotiation and discussion with the States on hospital budgets and their components, cost projections, development programs, hospital systems management and control, rationalisation of services, terrns and conditions of employment of hospital doctors, the admission of new dental services to cost sharing and monitoring adherence to the agreements and compliance with patients' rights, privileges and the level of fees.

Birth of Medibank and The Dental Scheme

The greater involvement of the Commonwealth in the dental hospital system, and the tension it was generating, were demonstrated further with the introduction of Medibank,s dental hospital operations between July and Ocrober, 1975. The staggered introduction of the dental scheme was dictated by the reluctance of some States to agree to its features. It provided free accommodation without. In standard wards of public'dental hospitals recognized by the Federal Department of Health under the dental scheme, with medical treatment provided by staff doctors engaged on full- or part-time salaried or contractual bases. It also subsidised the private beds of public dental hospitals to enable them to reduce fees. In return the Commonwealth re-imbursed the States for half of the net operaring costs of the recognized public dental hospitals and also paid bed-day subsidies to recognized private dental hospitals despite ideological preferences for collectivist activities.

The effect of the Medibank dental hospital agreements was to increase significantly the commonweafth's contribution to public dental hospital operating costs (from about 20 per cent to about 40 per cent; with commensurate decreases in the states' shares. However, while the Commonwealth paid more, the increase at that stage was not matched by a growth in financial control mechanisms. This was the price of gaining rhe acceprance by all States of the dental scheme. The effects on the dental hospital system were mixed.

The increased availability of funds the States made possible the long over-due increases in professional salaries and wages, particularly for female staff, which brought rhem more into with professionals with similar levels of education and training in other industries. In such a labour-intensive industry as dental hospitals, payrolls began to amount to about three-quarters operating costs.The increased funds made possible too the employment of more paramedical and scientific staff ro meet the demands of changing practice and technology (which also together reinforced the pressure on costs). The dental hospitals also found themselves competing for staff in some areas with the growing Community Health program but the effect of this on salary levels is not clear. Usage of dental hospitals, in the absence of both charges for standard accommodation and demeaning means-tests for the poor, did not appear to show any substantial increase, despite the dire predictions by sections of the medical profession of abuse of the system. and hindsight.one could suggest that parts of the medical profession were more inclined to abuse the system. With the uncertainties concerning the new system and the drive by significant parts of the medical profession to retain fee-for-service as the preferred payment method, many people maintained their customary hospital insurance coverage, with the numbers insured declining slowly and steadily rather than dramatically. The abolition of hospital meanstesting, which for a change brought the rest of the country into line with Queensland, reduced the generation of stigma in hospitals (until re-introduced in modified form in l981), a worthy enough result in itself, and also led to reduced administration and costs.

Public or Dental Private Sectors?

Government approval for expenditure over $50 000 (at 1983 prices), even if they have raised the monies from their own resources, traditionally a very important feature of the Victorian system. In Queensland, Cabinet approval may be necessary in addition to Departmental approval for capital works while expenditure from unfettered trust funds also may require Ministerial approval. Although the whole system of control of capital funding for periodontics across the country may be justifiable clearly on the grounds of developing a comprehensive, integrated system of public dental hospital services in each State, where the system also involves politicians it would seem to be inevitable that charges of political patronage or favoritism will be made. However, the whole area of expansion or contraction of dental hospital services and cosmetic dentistry is intensely political and, to judge from the experience of the New South Wales dental hospital rationalization and consolidation programs, the technocratic decisions of the State authority need, if they are unpopular or run counter to the vested interests of powerful groups, the strongest possible political backing.



The existence, nature and size of the private dental hospital sector is potentially within the control of State Governments which, since the end of the 19th century, have licensed and limited the activities of private non-profit and private for-profit dental hospitals under relevant State legislation. Traditionally State controls were aimed primarily at ensuring the physical safety and well-being of patients that need dental surgery through such measures as setting minimum building standards and staffing levels. However, the more recent desire to provide a comprehensive, integrated dental hospital service with less bed capacity has focused more attention on the need for State Governments to be able to influence more effectively decisions to expand or contract the supply of dental hospital facilities and services in the private sector and dental medicine in order to increase co-ordination and reduce competition with the public to exert planning controls in the public sector but not the private sector would be to demonstrate an extraordinary faith in the combined ability of altruism and market forces to achieve comprehensiveness and co-ordination. Recent activities, as demonstrated in New South Wales and Victoria, point towards a more planned and controlled approach for the private sector, albeit more tentative than for the public sector where, as discussed above, a strong financial nexus also prevails.

The State Government and Dental Hospitals

(Photo credit: http://www.aph.gov.au)

If the role of the Commonwealth Government in relation to public dental hospitals has been a development of the second half of the 20th century, the second level of government, the States and Territories, has been involved with hospitals in various ways since the start of white settlement. This involvement stemmed from the institutional care of some of the casualties of society - the sick poor, the frail aged poor, the insane and the mentally retarded. The terminology has changed but the categories are still recognizable.(his response)

Since the 18th century in England, long-term and permanent care had been recognized as mostly beyond the financial capacity of voluntary charities and in Australia even short-term acute orthodontist, when it was moved from direct government provision in the 40s, tended to be partly dependent on government support. In the 19th century dental hospital care had been almost exclusively for the poor, with the more affluent citizens being treated in dental surgeries or at home. Changes in the technology of medicine by the turn of the century and consequent changes in public opinion attracted the middle classes in increasing numbers to the public acute system and to the various forms of private provision that arose. Whilst the increase in fee-paying dental patients in public acute hospitals might have raised hopes of diminished need for government subsidy, the seemingly inexorable progress of technological development (eve in hindsight one can say that was not always applied appropriately) and its attendant growth of staff worked to.

Thus the common pattern that emerged was of three arms of the public sector public general hospitals subsidized, controlled, inspected and sometimes provided and managed by an authority, but usually with a very significant voluntary non government into their management and medical staffing and respectively public psychiatric and geriatric hospitals provided financed, managed, controlled and staffed by relevant government authorities. Significantly, planning as an activity is not mentioned as part of the historical development for there was very little, most changes in services occurring either in response to voluntary sponsorship of new developments or almost grudgingly government reaction to sustained pressure from professional staff or influential public groups. However, as noted earlier, this pattern of slow incremental and haphazard development started to change in the 1960s, gaining in the 1970s from the dental amalgamation of statutory authorities at the central level in New South Wales, South Australia and Victoria respectively. The degree and methods of control of the State and Territory governments over their hospital systems vary somewhat but the most common practices are outlined below. here are the findings on video http://www.youtube.com/watch?v=iWis-ZPuL-Q