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1、UnitEighteenNote:Pleasepayattentiontotheunderlinedwordsorphrasesinadditiontothebluewords.ORALHEALTHFORALLTHROUGHALTERNATIVEORALHEALTHCARESYSTEMSThepreventionandcontrolofdentalcariesinindustrializedcountrieshavebeenduemainlytouseoffluoridesinmanydifferentwaysand(othewidespreadadoptionofeffectiveoralh
2、ygienehabits.Inspileofthesesuccessesthediseaseisnotconqueredinallcoinmunities.Itmightstillbecalledaneglectedepidemicinunder-privilegedandlow-incomegroups.Therearemanyhigh-riskpopulationsintheUSA:97%ofthehomelessneedoralcare,blackchildrenhave65%moreuntreateddecaythantheaveragecitizen,lowincome91%andA
3、mericanNatives265%.Morethan50%ofthehouseboundelderlyhavenotseenadentistfor10years.Traditionalsystemsfororalcarearcbasedonvariouscombinationsofpublicsalariedservicesandprivatepractice.Thepublicservicesareusuallyresponsibleforprevention,careofschoolchildrenanddisadvantagedgroups;andprivatepractitioner
4、sprovideawiderangeoftreatment(othegeneralpublic.Allthesesystemsareoriemedinsuchawaythatthedentistprovidesmostofthecare.IntheUSA:84%of17yearoldshavehadtoothdecayandanaverageof11toothsurfacesisdamaged.Peopleaged40to44haveanaverageof30toothsurfacesaffectedbydecay.41%ofpeopleaged65oroverhaveno(ee(halall
5、.Indevelopingcountries,thelevelofdentalcarieswasrarelyashighasinindustrializedcountriesand,insome,successfulpreventiveactivitieshavebeenimplemented.However,inmanythereisstillthethreatofincreasingcariesrelatedtochangingdietandlifestyles.CommonoraldiseaseindevelopingcountriesTheburdenofdemandfortreatm
6、entonlyofseverecariesorperiodontaldiseasecanbeestimated.Inaboutonethirdofthesepopulations,about1350millionpeoplewillrequirepainrelieftreatment(extractions)3timesintheirlives.Abouttwo-thirdsor2400millionpeoplewillneed5ormoreextractions.Howeverinmanycommunitiesthesesystemsdonotmeeteventhebasicneedsoft
7、hepublic.Mostpublicserviceshaveonlyverylowcoverage;communitiesinlow-incomeruralandurbanareascannotaffordprivateoralcare.Further,developingcountriescannotaffordtoestablish,staffandruneducationfacilitiesfordentists;orhopetoprovideadequateemploymentopportunitiesfordentiststrainedabroad.Inallcountriesec
8、onomicrestraints,changesindemandfororalhealthcare,politicalpressurestoextendservicestounderprivilegedgroug,concernaboutquality,costsandeffectivenessofcaredemandthatalternativewaysoforganizingoralhealthandcareareexaminedandimplemented.Costandlackofaccessforunder-privilegedandlow-incomegroupsconstrain
9、alloralhealthcaresystems.Whatactionscanbetaken(ocombatthisneglect,breakdownthebarriersofcostandimproveaccesstooralhealthandcare?Alternativeoralcaresystemsneedtobedevelopedmthatamaximumnumberofpeoplecanhaveaccesstoandcanaffordoralhealthandcare.Severalrecentadvancesgivegreatscopeforthetransformationof
10、thedeliveryandqualityoforalcare.Theseare:Neweducationaltechnologiesthatmakelearning-bothknowledgeandskills-simplerandfasterforalltypesofpersonnel;Simplifiedandlogicaldesignoforalclinicsthatimprovetheworkplaceandsubstantiallyreducecaiialcostsofequipmentandneedformaintenance;Bettermaterialsthatareeasi
11、erandsimplertouse.Usingthesetechnologicaladvances3typesofcarecanbedefined:Rathersimple,verycosleffeclive.Moderateleveltechnologythatisratherexpensive,andHightechnology,oftenextremelyexpensive.Arational,healthpromotingandaffordablemixofcaremustbeplannedandimplementedinallcountries.Firstlevelcareinclu
12、des:Pronhylaxis,removalofcalculus,applicationofsealant,restorationofsinglesurfacecariescavitiesAsaconsequenceofimprovingoralhealthinmostindustrializedcountriestheneedformoderatelyconmlexcareisdecreasing.Withfurtheremphasisonprevention,needanddemandforfirstlevelinterventionswillincreaseslightly;while
13、theneedforhightechnologycarewillprobablyincreaseforseveraldecadesduetothedesiretopreservenaturalteethandtheincreasingnumbersofelderlypeople,whohavesomenaturalteeth.Firstlevel,mainlynon-intervemivecarewillcontinuetobe(hemajorneedinmostdevelopingcountries.Thistypeofcarecannowbeprovidebyspeciallytraine
14、dhealthcenterpersonnel,ratherthanbythetraditionaldentistorauxiliaryworker.Inthosedevelopingcountrieswherecariesisincreasing,arisingdemandformoderatetechnologycarewillcontinueoverthenextfewdecades.Arathersmallneedforhightechnologycare-mainlyrelatedtorepairoftraumaandreconstructionafterseverepathology
15、-willremainandwilleventuallyincrease.Moderatelyconmlexcareincludesmultiplesurfacerestorations,removalprosthesesandextractions.Complexoralcareincludesprecisionprosthetics,implantsorthodontics,complexsurgeryandoralmedicine.Inallcountriespreventionandcontrolcarecanminimizetheneedforintervention.Inanyso
16、ciety,hightechnologycanonlybeaffordedinlimitedamounts.Itmustbeofgoodqualityandappropriate.AlternativesystemsinindustrializedcountriesIncreasingaccesstobasicoralcareFirstlevel,mainlynon-invasiveinterventionshavebeenpreparedandarebeingtestedaspartoftheworkofcommunityhealthclinicsforminoritygroupsandlow-incomeinnercityandruralcommunities.Theelderlyandgroupswithspecialneedswouldalsobenefitfromout-reachactivitie
