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November 2011
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Health interventions are often costly as they involve manpower and other resources not readily available in the Caribbean. These costs can be reduced by including oral health in the common risk factor approach. Health promotion should therefore involve a multi-sectoral approach when educating patients about reducing environmental and behavioural risk factors common to oral and general health. This approach focuses on improving the overall health for the general population, which includes high risk groups, thus reducing social inequities and the burden of oral disease. An example of this would be the strategy used to deal with smoking, which is the most preventable cause of disease and death worldwide. Its involvement in both oral and systemic diseases has also been well documented, where the oral presentations range from tooth staining to more serious precancerous oral lesions and oral cancer. The health research provided, along with advocates for health, resulted in Trinidad and Tobago formulating and enforcing legislation that banned smoking in public places in February 2010. Subsequently, primary care medical and non-medical personnel were also trained in smoking cessation techniques which served to follow two of the principles of the Ottawa Charter of 1986, namely by building health through public policy and creating a supportive environment in the public health sector. One of the best examples of the effective use of health research is the employment of immunization worldwide to reduce the incidence of infectious diseases. In the Caribbean, however, there has been a noticeable shift from infectious disease toward chronic and lifestyle related illness, such as obesity and cardiovascular disease. Preliminary Caribbean data confirms the internationally reported association between the two chronic diseases, periodontal disease and diabetes. The Caribbean Health Research Council (CHRC) has produced evidence-based guidelines on managing diabetes in the Caribbean. In their multidisciplinary team approach, part of the initial physical examination of diabetic patients includes inspection of the mouth for periodontal disease. Water fluoridation has shown promising results in reducing oral health inequalities across the social classes. However, in the Caribbean where municipal water supplies are less reliable, salt fluoridation has shown promise as an effective alternative. Caries levels in children in Jamaica fell dramatically over a six-year period following the introduction of fluoridated salt. A recently launched initiative between Colgate and PAHO has included the implementation of community based fluoride varnish programmes for young children in the Caribbean, the effectiveness of this intervention having been established through high quality studies. Oral cancer and oral problems related to HIV and AIDS Most oral diseases progress slowly with an initial asymptomatic stage with patients presenting for treatment when symptoms occur. For diseases such as oral cancer, ranked the eighth most common cancer worldwide early detection can affect treatment outcomes and survival rates. Screening of high risk groups such as smokers and the elderly should be part of local oral health promotion strategies in the Caribbean and if other healthcare providers are trained to examine the oral cavity, then serious oral diseases could be identified for early referral and diagnosis. Notwithstanding this shift towards increased chronic diseases, there is still a high prevalence of HIV/AIDS in the Caribbean. The prevalence rates of HIV/AIDS in the region are second only to sub-Saharan Africa. Dentists can aid in early detection of oral lesions associated with HIV/AIDS, sometimes the first markers of the disease and can also be involved in the multidisciplinary approach needed for care of these patients, which includes appropriate referral for counselling and treatment. Public Health Strategies Oral health is a human right that is essential to general health and quality of life efforts must therefore be made to protect this right by increasing access to quality research informed oral healthcare. However, management of disease can only be truly effective when we move away from treatment to prevention and health promotion. More research is needed on interventions that address general and oral health inequalities thereby improving the quality of life of people in the Caribbean. Building research capacity and strengthening oral health research networks has been identified as an important strategy for developing countries by the WHO and oral health promotion and disease prevention have been identified as strategic health priorities in the Caribbean region. Some countries in the Caribbean are in the early stages of designing public health strategies to address inequalities in oral health. Similar to the situation in other developing regions of the world, such strategies should include evidenced-based initiatives as outlined by the WHO, including:
Oral health promotion policies and strategies addressing the determinants of oral disease in the Caribbean require a focused research agenda involving stakeholders from academic institutions, the private sector, governmental and non-government organizations across the region. Inequalities can only be addressed when health research provides evidence-based strategies appropriate to local population needs, based on the principles of oral health promotion. These strategies must also include greater access to effective primary dental care especially for vulnerable and disadvantaged groups in the population. This is an excerpt from a paper, Oral Health Inequalities in the Caribbean, prepared by Dr. Rahul Naidu (Senior Lecturer Community Dentistry), Dr. Ramaa Balkaran (Instructor), and Dr. Avind Harracksingh (Part-time Lecturer) from the School of Dentistry, UWI, EWMSC. Full paper can be read here. |
Oral health research has shown that oral diseases and disorders can affect general health and that oral complications of many systemic diseases also compromise the quality of life. There is strong evidence for a direct relationship between diabetes and periodontal disease and it is also suggestive of a relation between periodontal disease and diabetes control. There is also some evidence that poor oral hygiene and low grade periodontal inflammation is associated with greater of risk of cardiovascular disease.