Global Oral Health Goals 2020

8/6/2019 Global Oral Health Goals 2020

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International Dental Journal (2003) 53, 285288

2003 FDI/World Dental Press

0020-6539/03/05285-04

Global goals for oral health 2020

Martin HobdellHouston, USA, Leader of FDI Joint Working Group

Poul Erik PetersenWorld Health Organisation, Geneva, Switzerland

John ClarksonInternational Association for Dental Research, Alexandria, USA

Newell JohnsonFDI Science Commission, Ferney-Voltaire, France

How to use this document

It is anticipated that dentists andother health planners in manydifferent circumstances will use thisdocument for guidance when devel-oping their plans for oral health.

We recognise that no documentcan provide an exact blue print foreach and every set of circumstances

where oral health plans are to be

developed. What is presented hereis a range of possible areas thatneed to be taken into considera-tion when plans are being devel-oped. It also provides a usefulchecklist against which existingplans might be examined to deter-mine if there are any possible gaps.

Fundamental to the success ofany plan is a clear understanding of

what resources are already avail-able or might become available

once the plan has been adoptedofficially. Initially it may not benecessary to have a detailed inven-tory of all resources available, asimple analysis like the completionof the questionnaire in Annexure B

will give a quick guide as to thelevel of resources available to you.

This, combined with a prioritisedlist of the oral health problems ofthe community or population youare planning for, will help you iden-

tify those types of interventions thatare likely to be most appropriateand sustainable under the prevail-ing circumstances.

Background

The FDI and the WHO establishedthe first Global Oral Health Goalsjointly in 1981 to be achieved bythe year 2000. A review of thesegoals, carried out just prior to theend of this period, established thatthey had been useful and, for manypopulations, had been achieved orexceeded. However, for a signifi-

cant proportion of the worldspopulation, they remained only aremote aspiration. Nonetheless, theOral Health Goals had stimulatedawareness of the importance oforal health amongst national andlocal governments and acted as acatalyst for securing resources fororal health in general. Therefore,even though not all countries hadachieved the goals, they provided akey focus for the effort.

Recently, the FDI, WHO andIADR have embarked on theactivity of preparing goals for thenew millennium, for the year 2020,and these are presented here. They

were developed by a WorkingGroup including representatives ofthe FDI, WHO and IADR fromdifferent regions of the world (see

Annexure A for the Groupsmembership).

The drafts of this document

were circulated to all NationalDental Association members(NDAs) of the FDI and placed onthe global Dental Public Health list

server for comment. All WHOCollaborating Centres in OralHealth (WHOCC) and the IADR

were also consulted. Responsesreceived from NDAs, IADR,

WHOCC as well as from individualshave subsequently been incorpo-rated in this document.

Aims

This document, which containsproposals for new Global OralHealth Goals, Objectives and

Targets of increasing detail andcomplexity, aims to provide aframework for health policymakers at different levels regional,national and local. The goals andtargets are not intended to beprescriptive. By being focusedbroadly on the global level, it ishoped that it will encourage local

action in the spirit of the UnitedNations Development Programmesreport: Think globally act locally.

Thus, the document will providean instrument for local and nationalhealth care planners to specify real-istic goals and standards for oralhealth to be achieved by the year2020.

The process of formulating aregional, national or local oral healthstrategy necessitates many stages.

This document provides the firststep in that process by guidinghealth planners to evaluate thecurrent situation of oral health and


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set oral health goals, objectives andtargets. The present Goals differsignificantly from those of 1981 ina number of ways. First, they aremore general. Their purpose is tofacilitate regional, national and

local oral health policy developmentand activities, leading to moredetailed and locally relevant goals.

The previous Goals, in their detail,are similar in scope to the presenttargets. Second, no absolute valuesare given, as these have to beestablished on the basis of localcircumstances such as the adequacyof the information base, localpriorities and oral health systems,as well as disease prevalence andseverity and socio-environmentalconditions.

Each situation will be differentnot only in so far as the epidemiol-ogy of oral diseases, but also withregard to the political, socio-econo-mic, cultural and legislative context.It will require detailed knowledgeof the prevailing circumstances andthe significant determinants of oralhealth. This knowledge is crucial tothe development of policies, whichaddress not only the immediateknown risk factors but also helpcreate a social, legislative and econo-mic environment that is conduciveto good oral health.

The following goals, objectivesand targets are proposed based oncurrent classifications of diseasesand established criteria for theirdiagnosis. After careful considera-tion of alternative ways of presenting

them, it was decided to set themout in the familiar way in relationto different groups of diseases.

Goals, Objectives and Targets

Goals

1. To minimise the impact ofdiseases of oral and craniofacialorigin on health and psycho-social development, givingemphasis to promoting oral

health and reducing oral diseaseamongst populations with thegreatest burden of such condi-tions and diseases.

2. To minimise the impact of oraland craniofacial manifestationsof systemic diseases on individu-als and society, and to use thesemanifestations for early diagno-sis, prevention and effective

management of systemic diseases.

Objectives

1. To reduce mortality from oraland craniofacial diseases

2. To reduce morbidity from oraland craniofacial diseases andthereby increase the quality oflife

3. To promote sustainable, prior-ity-driven policies and pro-

grammes in oral health systemsthat have been derived fromsystematic reviews of best prac-tices (i.e. the policies are evidence-based)

4. To develop accessible cost-effective oral health systems forthe prevention and control oforal and craniofacial diseases

5. To integrate oral health promo-tion and care with other sectorsthat influence health, using the

common risk factor approach6. To develop oral health pro-grammes that will empowerpeople to control determinantsof health

7. To strengthen systems andmethods for oral health surveil-lance, both processes and out-comes

8. To promote social responsibil-ity and ethical practices of caregivers

9. To reduce disparities in oralhealth between different socio-economic groups within a coun-try and inequalities in oral healthacross countries

10.To increase the number ofhealth care providers who aretrained in accurate epidemio-logical surveillance of oraldiseases and disorders.

Targets

By the year 2020 the following willhave been achieved over baseline:1. Pain:

A reduction of X% in epi-

sodes of pain of oral andcraniofacial origin

A reduction of X% in thenumber of days absent fromschool, employment and

work resulting from pain of

oral and craniofacial origin A reduction of X% in the

number of people affectedby functional limitations (thiscovers a number of measur-able factors such as pain andimpairments, missing teeth,traumatised incisors andcongenital dental and facialanomalies

A reduction of X% in theprevalence of moderate andsevere social impacts on dailyactivities resulting from pain,impairments and aesthetics(this includes missing teeth,dental anomalies, enameldefects such as fluorosis,traumatised incisors, severegingival recession and oralmalodour.

2. Functional disorders A reduction of X% in the

numbers of individualsexperiencing difficulties inchewing, swallowing andspeaking/communicating.

This covers a large numberof measurable factors relatedto tooth lossand congenitaland acquired facial/dentaldeformities.

3. Infectious diseases To increase by X% the

numbers of health care

providers competent torecognise and minimise therisks of transmission ofinfectious diseases in the oralhealth care environment.

4. Oro-pharyngeal cancer To reduce by X% the preva-

lence of oro-pharyngealcancer

To improve by X% the sur-vival (5-year survival rate) oftreated cases

To increase early detectionby X%

To increase rapid referral byX%


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To reduce exposure to riskfactors by X% with specialreference to tobacco, alco-hol and improved nutrition

To increase by X% thenumber of affected individu-

als receiving multidisciplinaryspecialist care.

5. Oral manifestations of HIVinfection To reduce by X% the preva-

lence of opportunistic oro-facial infections

To increase by X% thenumber of health providers

who are competent to diag-nose and manage the oral

manifestations of HIV infec-tion To increase by X% the num-

bers of policy makers whoare aware of the oral impli-cations of HIV infection.

6. Noma To increase by X% data on

Noma from populations atrisk



To reduce exposure to riskfactors by X% with specialreference to immunisationcoverage or measles,improved nutrition and sani-tation

To increase by X% thenumber of affected individu-als receiving multidisciplinaryspecialist care.

7. Trauma To increase early detection

by X% To increase rapid referral by

X% To increase the number of

health care providers whoare competent to diagnoseand provide emergency careby/to X/Y%

To increase by X% the

number of affected individu-als receiving multidisciplinaryspecialist care where necessary.

8. Craniofacial anomalies To reduce exposure to risk

factors by X% with specialreference to tobacco, alco-hol, teratogenic agents andimproved nutrition

To increase access to geneticscreening and counselling byX%



To increase by X% thenumber of affected individu-als receiving multidisciplinaryspecialist care

To increase early detectionof seriously handicappingmalocclusions and theirreferral by X%.

9. Dental caries To increase the proportion

of caries free 6-year-olds byX%

To reduce the DMFT par-ticularly the D componentat age 12 years by X%, withspecial attention to high-risk

groups within populations,utilising both distributionsand means

To reduce the number ofteeth extracted due to dentalcaries at ages 18, 3544 and6574 years by X%.

10.Developmental anomalies ofteeth To reduce the prevalence of

disfiguring dental fluorosis byX% as measured by cultur-

ally sensitive measures andwith special reference to thefluoride content of food,

water and inappropriatesupplementation

To reduce the prevalence ofacquired developmentalanomalies of teeth by X%,

with special reference toinfectious diseases and inap-propriate medications

To increase early detection

by X% for both hereditaryand acquired anomalies

To increase referral by X%

for both hereditary andacquired anomalies.

11.Periodontal diseases To reduce the number of

teeth lost due to periodontal

diseases by X% at ages 18,3544 and 6574 years withspecial reference to smok-ing, poor oral hygiene, stressand inter-current systemicdiseases

To reduce the prevalenceofnecrotising forms of peri-odontal diseases by X% byreducing exposure to riskfactors such as poor nutri-tion, stress and immuno-

suppression To reduce the prevalence of

active periodontal infection(with or without loss ofattachment) in all ages by X%

To increase the proportionof people in all ages withhealthy periodontium (gumsand supporting bone struc-ture) by X%

12.Oral mucosal diseases

To increase the number ofhealth care providers whoare competent to diagnoseand provide emergency careby X%


To increase rapid referral byX%.

13.Salivary gland disorders To increase the numbers of

health care providers who

are competent to diagnoseand provide emergency careby X%


To increase rapid referral byX%.

14.Tooth loss To reduce the number of

edentulous persons by X%at ages 3544 and 6574

years To increase the number of

natural teeth present by X%


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at ages 18, 3544 and 6574years

To increase the number ofindividuals with functionaldentitions (21 or more natu-ral teeth) by X% at ages 35

44 and 6574 years.

15.Health care services To establish evidence-based

Annexure B

Resource Assessment Questionnaire

Before planning any specific intervention try to answer the following questions:

Questions Yes No Dont Know

Finance1. Is there a central public health budget for oral health? G G G2. Are there sufficient capital funds for the equipment and instrumentation? G G G3. Are there sufficient recurrent funds for salaries and materials? G G G4. Are sufficient funds allocated for prevention and oral health promotion? G G GPersonnel5. Are there sufficient appropriately trained personnel? G G G6. Are there sufficient personnel to manage, monitor and evaluate the intervention? G G GEquipment and Instrumentation7. Is the equipment available, appropriate? G G GInfrastructure8. Has a needs assessment been carried out in sufficient detail to select the

intervention? G G G9. Are there clear lines of communication to the community? G G G10.Are there clear lines of communication for the acquisition of resources? G G G11.Are there functional lines of communication for reporting? G G G12.If it is necessary to make use of transportation (e.g. for people and goods),

is it available and functioning? G G GIf there are less than six questions answered yes = low availability of resources.If there are between five and ten questions answered yes = moderate availability of resources.If there are more than nine questions answered yes = high availability of resources.

plans to create humanresources that can providecare that are appropriate tothe cultural, social, economicand morbidity profiles of allgroups within the popula-

tion To increase the proportion

of the population withaccess to adequate oral health

care by/to X/Y%.

16.Health care information systems: To increase the proportion

of the population coveredby satisfactory information

systems by/to X/Y%.

Annexure A

Membership of the Working Group

Professor N. W. Johnson, FDIProfessor M. H. Hobdell, FDIDr G. Pakamov, WHO, Geneva

Dr. S. Estupinan-Day, WHO/PAHO/AMROProfessor. P. E. Petersen, WHO/EURODr. S. Thorpe, WHO/AFRO

Professor J. Clarkson, IADRDr. J. van den Heuvel, NetherlandsDr. A. Horowitz, United States of America

Dr. E. Kay, United KingdomDr. N. Myburgh, South AfricaDr. J. Nasruddin bin Jaafar, Malaysia

Documents

Global Oral Health Goals 2020