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Editorial:

Regional Oral Health Strategy for the 1990s

by Dr. Saskia Estupinián-Day, Regional Oral Health Advisor, Pan American Health Organization


Although complete and accurate data may not be available for an exhaustive assessment, the current status of oral health in the LAC Region is characterized by an elevated incidence of dental caries and periodontal disease. Other conditions of emerging importance are oral manifestations of HIV and AIDS, as well as oral and pharyngeal cancer. These maladies are, however, unevenly distributed in the population. Dental caries, although highly prevalent in the whole Region, are most severe among low-income, poorly educated subgroups. Likewise, most oral cancers are closely associated with tobacco and alcohol use, and HIV infection is related to particular sexual behaviors or IV drug use.

In order to alter this epidemiological profile and its determinants, countries have count on an organized network for delivery of curative oral health services, with participation of the public sector, mainly through the Ministry of Health, and the private sector. These services, however, may be inadequate to address the changing needs of the communities. In many LAC countries, public dental services are poorly organized, under financed, and understaffed. Quality care may only be accessible in urban areas at high costs. Private providers, on the other hand, may be easier to reach, but their approach is mostly curative. Higher income groups generally enjoy greater accessibility to private dental services.

Since dental conditions are usually not life-threatening, they are not included in mortality statistics, and thus in national health policies. Other health conditions may overshadow the significant burden of oral health disease, making planning or policy making for oral health programs a

difficult task in the Region.

Assisting countries in the Region to change both the oral epidemiological profile and the adverse characteristics of the dental care delivery systems pose the greatest challenge to the PAHO Regional Oral Health Program for the 1990s and beyond. In order to adequately address this challenge, the Program contemplates elements of PAHO's Strategic Orientations to formulate the following Regional Oral Health Objectives and Strategies.

PAHO will assist countries to strengthen their ability to respond to the oral health challenge, as the Region nears the 21st. century. PAHO strategic objectives in support of dental health programs in the Region are:

1. To promote improvement of oral health conditions in the countries of the Americas, with emphasis on those with higher burden of disease.

2. To assist countries to develop accessible, effective, and sustainable oral health services.

The strategies to pursue the above objectives include:

1. Promotion of national oral health preventive programs aimed at reducing the incidence of caries and periodontal disease.

2. Strengthen sustainable integration of oral health services into Local Health Systems (SILOS).

3. Inspire training of human resources appropriate to the needs and new directions of oral health programs in the Region.

4. Support policy development in education, and communication programs aimed at improving decision making and community awareness about caries, periodontal disease, HIV and related oral conditions, oral cancer, and preventive practices; and,

5. Development of a regional oral health information system.

PAHO's Oral Health Strategy for the 1990s proposes to move countries from a stage characterized by lesser and oral health status indicators and weak or lacking public oral health policies to a stage were improved oral health indicators and public, preventive policies, are predominant. The strategy is based on an oral health development typology which classifies countries in the Latin America and Caribbean Region using the most current reported level of the DMF-12 index (decayed-missing-filled teeth at 12 years of age) and the availability of national policies to promote fluoridated water or salt as preventive interventions. This typology situates LAC countries in three categories of oral health development: Emergent, Growth, and Consolidation. The strategy's intent is to support countries in the Emergent category develop programs and activities leading to improve overall oral health status. By doing so, countries will first move to the Growth category, and eventually to the Consolidation category. It is expected that by the end of the decade, all countries in the LAC Region will have reached the goal stated by WHO of a DMF-12 of 3 by the year 2000 (WHO).

In this context, PAHO will delineate general strategic guidelines for countries to consider during the 1990s and beyond, using the Organization's Strategic Orientations and program Priorities as a reference. The objective of the Regional Oral Health Strategy is to ensure that PAHO's resources are used in the most efficient way, to improve the oral health of the people of the Americas.

Mailing address:

Panamerican Health Organization

525 Twenty Third Street,

N. W. Washington DC - 20037-5895 - U. S. A.

Phone: (001) (202) 861-2648

Fax: (001) (202) 861-8494


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