Transcript new.paho.org

Proposed 10-Year Regional Plan On Oral Health
• Lessons learned 1993-2006
• Forty national oral health surveys indicate a marked decline
between 35% to 85% in the prevalence of dental caries, attributed
mostly to cost-effective salt and water fluoridation programs
• Burden of oral disease is severe and remains high in certain
geographic areas and high risk populations
• Strong scientific evidence suggests the associations between oral
infections, chronic diseases and adverse pregnancy outcomes
• Best Practice Models on prevention and delivery of oral care
Pan American
Health
Organization
Typology Table in Oral Health
1990
2004
EMERGENT
DMFT > 5
GROWTH
DMFT 3-5
CONSOLIDATION
DMFT < 3
EMERGENT
DMFT > 5
GROWTH
DMFT 3-5
CONSOLIDATION
DMFT < 3
Belize
Argentina
Bahamas
Bolivia
Canada
Bermuda
Guatemala
St. Lucia
Brazil
Colombia
Cuba
Chile
Ecuador
Guyana
Costa Rica
C. Island
Dominica
Dominican
Republic
El Salvador
Guatemala
Haiti
Honduras
Jamaica
Nicaragua
Paraguay
Mexico
Panama
Peru
Trinidad
Venezuela
USA
Argentina
Bolivia
Chile
Dominican
Republic
Honduras
Panama
Paraguay
Anguilla Jamaica
Aruba
Nicaragua
Bahamas Peru
Barbados Suriname
Belize
Trinidad
Bermuda Turks and
Brazil
Caicos
Canada
Uruguay
Cayman USA
Colombia Venezuela
Costa Rica Mexico
Cuba
Curacao
Dominica
Ecuador
El Salvador
Grenada
Guyana
Haiti
Uruguay
PAHO/IADB Clinical Trials in Ecuador, Panama and Uruguay
PRAT PROBABILITY OF SUCCESS AND FAILURE
• Dentist doing amalgam
• Dentist doing ART
• Auxiliary doing ART
Success
0.943
0.960
0.942
Failure
0.057
0.040
0.058
Cost by Provider Modality
(US $)
$20.00
$18.00
$16.00
$14.00
$12.00
$10.00
$8.00
$6.00
$4.00
$2.00
$-
Ecuador
Panama
Uruguay
Amalgam
$7.77
$12.95
$17.65
PRAT by DDS
$3.64
$9.00
$5.19
PRAT by Auxiliary
$1.48
$3.48
$3.37
Pan American
Health
Organization
Oral Infections and Pregnancy Outcomes
Scientific evidence suggest
that pregnant women with
periodontal disease are seven
times more likely to deliver
PTLBW baby. This risk is
much higher than tobacco
and alcohol.
Clinical trials suggest that
treating oral infection in
pregnant women before 26
weeks of gestation reduces
the incidence of PTLBW by
28% to 82%.
Framework for the strategy
•
•
•
•
Best Practice Model
Partnerships
Downstream Investment
Measurement of Progress
Pan American
Health
Organization
Primary priority countries:
Bolivia, Haiti, Honduras, Guyana, Nicaragua
Secondary priority countries:
Ecuador, Guatemala, and Paraguay
Priority groups:
MCH, Children, Women in reproductive age
groups, HIV/AIDS, Indigenous groups, Elderly
GOAL # 1:
A Minimum Level of Oral Health Care For All
By Addressing Gaps in Care For the Most
Vulnerable Groups
Reduction of Oral Infections
Increasing Access to Oral Health Care
GOAL #2
The Integration of Oral Health Into PHC Services



Develop mechanism to integrate oral health within current
PHC services
Incorporate oral health component into prenatal programs
Scale up best practice models
GOAL # 3
Scaling-Up of Proven Cost Effective Interventions
Salt fluoridation
 Support Bolivia, Ecuador, Haiti, Honduras, Nicaragua, Paraguay and
Saint Lucia to reach full implementation of fluoridation programs
 Consolidate fluoridation programs with appropriate surveillance
Sealants
FL Supplements
Water Fluoridation
Salt Fluoridation
$21.17
$2.53
$0.54
$0.06
Scale Up Oral Health Coverage Using Cost-Effective and
Simple Technologies, PRAT
$ 1.50 to treat/seal a tooth
Peru 200,000 children treated
with PRAT
Uruguay priority PRAT program
100,000 disadvantage children
Mexico over 10 million restorations under PRAT
In Summary
• Best practice model provides a framework to implement at
large scale oral health programs
• We have the evidence and the knowledge that it works
• Evidence demonstrates feasibility with extreme costbenefit
• Implementation requires leadership, commitment to guide
downstream investment to improve equity and efficiency
and quality of life in the Americas
• Action by the Executive Committee for government
support for dental public health programs and technical
Cooperation Plan and Proposed Budget
Pan American
Health
Organization
Trends of DMFT-12 for the Region of
the Americas
EVIDENCE 1987-2003
6.0
DMFT at age 12
5.0
4.0
third quartile
median
first quartile
3.0
PROJECTIONS 2007-2010
2.0
3
1.0
2.5
0.0
1987
1989
1991
1993
1995
1997
1999
2001
2003
2
1.5
1
0.5
0
2007
2008
2009
2010