Improvement of oral health in Africa in the 21st century - the role of the WHO Global Oral Health Programme

Chronic diseases and injuries are overtaking communicable diseases as the leading health problems in all but a few parts of the world. This rapidly changing global disease pattern is closely linked to changing lifestyles which include diet rich in sugars, widespread use of tobacco and increased consumption of alcohol. These lifestyle factors also significantly impact oral health, and oral diseases qualify as major public health problems owing to their high prevalence and incidence in all regions of the world. Like all diseases, they affect primarily the disadvantaged and socially marginalized populations, causing severe pain and suffering, impairing functionability and impacting quality of life. Traditional treatment of oral diseases is extremely costly even in industrialized countries and is unaffordable in most low and middle-income countries. The WHO Global Strategy for prevention and control of noncommunicable diseases and the ”common risk factor approach” offer new ways of managing the prevention and control of oral diseases. This report outlines major characteristics of the current oral health situation in Africa and development trends as well as WHO strategies and approaches for better oral health in the 21st century. Key Words: Africa; oral health; risk factor; development African Journal of Oral Health Vol.1(1) 2004: 2-1

A fogszuvasodás előfordulása gyermekeknél : Pathfinder vizsgálatok Magyarországon 30 éven át : összefoglaló referátum

Ismeretes, hogy az utóbbi évtizedekben lényegesen javult az európai gyermekek orális egészsége, mind a tej-, minda maradó fogak vonatkozásában csökkent a caries előfordulása. Ugyanakkor néhány kelet- és közép-európai országbanmég mindig óriási teher a szájüregi betegségek nagy száma.Jelen közlemény célja a hazai 5–6 és 12 éves gyermekek caries előfordulásának ismertetése, a fogszuvasodás trendjénekhosszú távon, 30 éven át történő nyomon követése a hazai pathfinder vizsgálatok tükrében. Az egymást követőreprezentatív keresztmetszeti vizsgálatokat 1985 és 1917 között (1991, 1996, 2001, 2018, 2013) a WHO pathfindermethodology szerint végeztük. Az epidemiológiai adatgyűjtés vizuális klinikai vizsgálatokkal történt.Ezen időszak alatt az 5–6 éves ép fogú gyerekek aránya 30%-ról 2017-ben 43,8%-ra nőtt, a vidéki helyszíneken mindigalacsonyabb értékekkel. 2017-ben a városi érték 49,9%, a vidéki pedig 34,6% (p < 0,001), a dmft országos átlagértéke3,5. A tej frontfogak caries előfordulása az évek során kissé csökkent, legutóbb 21,6% volt. A 12 évesek caries frekvenciájaés intenzitása folyamatosan csökkenő trendet mutat, az 1985-ben mért 92,5%-ról 55,3%-ra, illetve 5,0 DMFT-ről2,3-ra javult (p < 0,001). Jelentős eredmény, hogy az ép fogazattal rendelkező gyerekek aránya 7,5%-ról 44,7%-ra nőtt.Azonban az utóbbi évtizedben a javulás intenzitása lassult, s egyidejűleg a D komponens értékének növekedése figyelhetőmeg. A Significant Caries Index (SIC index) értéke 5–6 éveseknél 8,43, 12 éveseknél 5,23. Az eredmények azt tükrözik,hogy országosan változatlanul nagy területi különbségek vannak a városi és a hátrányosabb helyzetben lévő vidékigyerekek orális egészségi állapotában. A care index 30%-os ellátottsági szintet jelez, tehát nagy a kezelési szükséglet.A legutóbbi adatok alapján megállapítható, hogy Magyarország az 5–6 évesek vonatkozásában a WHO/FDI 2000-rekitűzött globális céljait sem érte még el. A 12 éveseknél a globális célkitűzések megvalósultak ugyan, de az európaiaknem. Irreálisnak tűnik, hogy hazánk megfeleljen a 2020-as WHO/FDI/IADR elvárásoknak. Sürgető népegészségügyifeladat országos komplex prevenciós programok szervezése, konkrét fogászati célkitűzések, módszerek és feladatokmegjelölésével. Élvezzen prioritást a széles körű minőségi szájápolás, a fluoridok effektív alkalmazása és az iskolafogászatrevitalizálása

Povara afecţiunii orale şi riscul sănătăţii orale la nivel global şi regional

Summary The objectives of the paper are to outline the burden of oral diseases at global and regional levels and to emphasize the influence of major sociobehavioural risk factors in oral health. Despite great improvements in the oral health of populations in several countries, global problems still persist. The burden of oral disease is particularly high on the disadvantaged and poor population groups in both developing and developed countries. Oral diseases such as dental caries, periodontal disease, tooth loss, oral cavity cancer, HIV/AIDS related oral disease and oro-dental trauma are major public health problems worldwide and poor oral health has a profound effect on general health and quality of life of people at all ages. The diversity of oral diseases and patterns and development trends across countries and regions reflect distinct risk profiles and establishment of preventive oral health care programmes. The important role of socio-behavioural and environmental factors in oral health and disease are shown in a large number of socio-epidemiological surveys. In addition to poor living conditions, the major risk factors to oral health relate to unhealthy lifestyles (i.e. diet, nutrition, tobacco, alcohol, oral hygiene), and low availability and accessibility of oral health services. Several oral diseases are linked to non-communicable chronic diseases primarily because of common risk factors. Moreover, general diseases often have oral manifestations (e.g. diabetes or HIV/AIDS). Worldwide strengthening of public health intervention through implementation of integrated disease prevention measures, Primary (oral) Health Care, and health promotion is urgently needed. The challenges to oral health improvement are particularly high in developing countries.Obiectivele lucrării ţin să sublinieze importanţa poverii afecţiunilor orale la nivel global şi regional, cât şi să indice influenţa majoră a factorilor de risc socio-comportamental ai sănătăţii orale. În ciuda îmbunătăţirii majore a sănătăţii orale a populaţiei din mai multe ţări, problemele globale încă persistă. Povara afecţiunilor orale este deosebit de mare pentru persoanele defavorizate şi sărăce, care aparţin grupurilor de populaţie din ţările în curs de dezvoltare şi dezvoltate. Afecţiunile orale, cum ar fi: cariile dentare, bolile parodontale, pierderea dinţilor, cancerul cavităţii orale, HIV/SIDA şi traumatisme oro-dentare sunt probleme majore de sănătate publică în întreaga lume. Sănătatea orală deficitară are un efect predominant asupra stării generale de sănătate şi asupra calităţii vieţii oamenilor de toate vârstele. Diversitatea bolilor orale, a modelelor şi tendinţelor de dezvoltare în diferite ţări şi regiuni, reflectă diverse profiluri de risc, cât şi stabilirea programelor de prevenţie a sănătăţii orale. Rolul important al factorilor socio-comportamentali şi de mediu în domeniul sănătăţii orale este demonstrat prin numărul mare de anchete socio-epidemiologice. Pe lânga condiţiile de trai precare, factorii majori de risc pentru sănătatea orală se referă la un stil de viaţa nesănătos (dietă, nutriţie, tutun, alcool, igiena orală precară), precum şi disponibilitatea redusă, şi accesibilitatea serviciilor de sănătate orală. Mai multe tipuri de afecţiuni orale se atribuie bolilor netransmisibile cronice, în primul rând, datorită factorilor de risc comuni. Mai mult decât atât, boli generale au adesea manifestări orale (de exemplu: diabet zaharat sau HIV/SIDA). Este necesară consolidarea de urgenţă, la nivel mondial, a intervenţiei sănătăţii publice prin aplicarea măsurilor de prevenire a afecţiunilor orale şi îngrijirea primară a sănătăţii orale, dar şi promovarea sănătăţii. Provocările pentru îmbunătăţirea stării de sănătate orală sunt vizibile în ţările în curs de dezvoltare