2002-14-3-Editorial - Saudi Dental Journal

ISSN (Print) 1013-9052
EISSN 1658-3558

The Saudi Dental Journal,
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia

Tel.	966-1-467-7328
Fax.	933-1-467-7308 / 966-1-467-7534
Email	saudidj@ksu.edu.sa

Editorial

A Philosophy of Global Oral Health

Over the past several years the dental profession has evolved from being an isolated component of the health care industry into a major contributor to improved health in every corner of the world. Several factors are responsible for this transition. Distance and language no longer are barriers to international involvement, as new technologies such as the Internet have quickened the pace and lowered the cost of communication. The mass media, especially television, have brought events from around the world directly into our homes, and expanded international travel has greatly increased our knowledge of the world.

Historically, international health has not been a high priority among dental professionals. Most dentists, irrespective of their country of origin, have been content to look at problems strictly from the perspective of their individual locality. Fortunately, this attitude is changing. Recognition of the value of a worldwide view of oral health, and development of strategies to guide the profession's international activities and programs have entered our thinking. A philosophy of global, rather than provincial oral health is emerging.

This artical presents some of the opportunities and challenges that lie ahead as the dental profession adopts a more global approach.

Globalization of Dental Education

Nowhere does globalization have more potential than in education. Dental educators have long realized the importance and value of international collaboration, and programs to exchange faculty and students among dental schools throughout the world have accelerated. Exchange programs provide participants the opportunity to learn from each other, and even more importantly, to gain mutual insights into the cultures of the participating countries. Yet the benefits of these programs have not reached their full potential, as most exchange programs are limited to the institutions involved and do not enjoy the broad-based national organizational support necessary to expand the benefits more widely.

Graduate (specialty) education is another area of both potential and concern. For years dentists from international countries have opted to receive specialty education in a country other than their own. A problem arising from this situation is that a graduate student or visiting professor may develop a strong tie to the host country and may desire to remain there following the completion of the program. This situation, commonly referred to as the "brain drain," can be devastating to the person's home institution as these individuals are vital for its future progress. On the other side of the coin, international dentists are a rich source of talent for faculty positions at the host schools. The dilemma is how to satisfy both concerns. Finally, we must not lose sight of the fact that certain countries have very little formal dental education and very limited resources to overcome this deficiency. More richly endowed countries, especially those with more advanced dental educational systems have a responsibility to assist these less fortunate countries to develop their own educational resources.

Globalization of Dental Research

Opportunities to expand knowledge through scientific research depend in large measure on the availability of well-qualified scientific talent to address needed research questions, the availability of adequate research cases, and sufficient funds to conduct the research. Certain countries have outstanding oral science workforces but little exposure to some of the rarer diseases. Conversely, many serious diseases exist only is certain parts of the world and these countries traditionally have a shortage of well-trained researchers. Higher prevalence of head and neck cancers in Southeast Asia and rare infectious diseases, such as noma, in Africa are examples. Even questions about the optimal level of fluoride for humans takes on international significance due to unique geography and dietary practices. Fortunately, all three factors lend themselves to international collaboration. Cooperation among nations will bring together scientists trained in epidemiology, dental informatics, health services research and other vital areas who are capable of addressing these research questions. If the financial burden is shared by multiple institutions and countries, the research has a much greater chance of being realized.

Globalization of Dental Practice and Dental Products

Global standardization of the dental products that are available in worldwide markets could have a very positive effect for practicing dentists throughout the world. At present, dentists do not have the assurance that the products they buy meet even minimal standards. This situation has assumed even greater importance as more and more dentists are relying on the Internet to purchase products from around the world.

Ethical dental manufacturers support rigid and consistent international standards. Such standards guide the development and distribution of their products, and ensure their acceptability in the marketplace. In addition, universal standards could result in lower product costs, greater choice in products of better and consistent quality, confidence in the assessment of products, and enhanced safety and health for our patients.

Global Oral Health in the Future

Although dental caries has declined significantly in certain locations, this disease remains a constant challenge throughout the world. Some experts predict that the prevalence of dental caries actually may rise as urbanization increases, especially in developing countries. Not only might the population in these countries adopt more cariogenic diets, but they might also be affected by bacterial infection and the unknown effects associated with the stress of rapid social and economic change.

Likewise, reports from several countries indicate a decrease in the prevalence of periodontal diseases. However, the emerging association between periodontal diseases and systemic conditions, such as cardiac disease and low infant birth weight will require continued monitoring of these conditions and their health effects. Lifestyle, especially the widespread use of tobacco, will ensure that periodontal disease will continue to be a major health factor.Infectious systemic diseases, such as HIV, which have oral manifestations, may increase. Countries that experience rapid dislocations of traditional institutions and cultural practices might undergo change in diet, housing, sanitation, and income, and may exhibit the disease patterns associated with the resulting reduced immunologic resistance. Finally, as populations age throughout the world, they will experience multiple chronic debilitating diseases, as well as more complex oral conditions, multiplying the challenges for the dental professional.

The management of oral and systemic health will be more closely aligned, and dentistry worldwide will need to work with physicians and other health care practitioners to meet these challenges.

Is there a Global Solution?

At present, there is no ready answer for any these conditions, but relying on the wisdom that "the first step to finding a solution is to recognize the problem," we can make a start.No individual country or government has the expertise, financial resources, nor the mandate, to support all needed international collaborative efforts, but we all can become advocates for such a philosophy. Working together, we can provide critical leadership through our mutual strengths in science, technology, and clinical expertise.

Electronic communication offers enormous promise, and the dental profession is well positioned to take advantage of this revolution in technology. Distance is no longer an impediment to students, faculty, or clinicians in any location. Dental schools can fill voids in their curricula through electronic communication, and this technology also will facilitate more and better continuing education, drawing upon the expertise of dentists from around the globe. Electronic data management also should facilitate the establishment and maintenance of a global data banks on health conditions that have oral significance. With such data banks in place, researchers from anywhere in the world will be able to secure not only data, but also willing collaborators who will help to prevent the spread of diseases and promote the best clinical practices.

It may be many years before these questions are answered, but dental profession must become the leader in addressing both oral and general health issues to its members and to other professions.

Michael J. Till, DDS, Phd

Reference:
The Future of Dentistry: The American Dental Association, 2001