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TRENDS I N PUBLIC HEALTH DENTISTRY I N LAT
V i c t o r Lopez Carnara, C.D., M.P.H.
N AMERICA
Denta l problems a r e beg inn ing t o be cons idered a m a t t e r o f importance among t h e genera l aspec ts i n p u b l i c h e a l t h i n most o f ou r c o u n t r i e s i n L a t i n America. More t h a n 200 m i l l i o n peop le , s p e a k i n g Spanish, Por - tuguese o r F rench i n t w e n t y d i f f e r e n t c o u n t r i e s , a r e f a c i n g s i m i l a r h e a l t h problems and a r e t r y i n g t o s o l v e them i n s i m i ? a r ways b u t hav ing c o n s i d e r a b l y d i f f e r e n t economica l means t o do so. Resources a r e be ing used i n t r y i n g t o a t t a c k t h e b i g g e r m o r t a l i t y problems, such as malar ia , g a s t r o i n t e s t i n a l d i s e a s e s o r r e s p i r a t o r y d iseases . T h i s approach i s t h e reason why, u n t i l now, some o f o u r c o u n t r i e s were n o t a b l e t o con- s i d e r d e n t i s t r y among t h e i r h e a l t h programs, o r t hey j u s t c o n s i d e r e d i t i n a ve ry s l i g h t manner.
L a t e l y t h e r e has been a s t r o n g tendency o f t h e governments o f t h e L a t i n American c o u n t r i e s t o o rgan ize d i v i s i o n s o r s e c t i o n s of d e n t i s t r y w i t h i n t h e i n s t i t u t i o n s d e d i c a t e d t o p u b l i c h e a l t h , a l t h o u g h n o t y e t a l l o f them have done it. Probab ly t h e recommendation o f t h e p r o j e c t " A 1 1 i a n c e f o r P r o g r e s s " ' t o t h e governments, f o r t h e p r e p a r a t i o n o f n a t i o n a l h e a l t h p l a n s f o r t h i s decade, w i l l h e l p them r e g a r d i n g t h e d e c i s i o n o f hav ing a s e c t i o n ded ica ted e n t i r e l y t o t h e s p e c i a l problems o f p u b l i c h e a l t h d e n t i s t r y . They w i l l h e l p them a l s o i n p l a n n i n g f o r u t i l i z a t i o n o f t h e d e n t a l resources f o r t h e n e x t t e n years, c o n s i d e r i n g them as an i n t e g r a t e d and inseparab le p a r t o f t h e n a t i o n a l h e a l t h p lans m e n t i ~ n e d . ~
The s i t u a t i o n i n t h i s f i e l d i s a c t u a l l y d i f f i c u l t , because d e n t a l needs are , by f a r , much b i g g e r than t h e d e n t a l resources i n a l l L a t i n America. However, t h e f u t u r e o f pub1 i c h e a l t h d e n t i s t r y i n most of o u r twenty c o u n t r i e s has t o be seen i n an o p t i m i s t i c way.
We w i l l t r y t o comment b r i e f l y on what we t h i n k c o u l d be, i n t h e immediate f u t u r e , t h e genera l development o f pub1 i c h e a l t h d e n t i s t r y i n L a t i n America.
DENTAL MANPOWER
There a r e ve ry few L a t i n American c o u n t r i e s t h a t a t t h e p r e s e n t mo- ment do n o t have a t l e a s t one d e n t i s t w i t h a Pub1 i c Hea l th degree. Most o f them a r e o c c u p y i n g a d v i s o r y p o s i t i o n s , b u t t h e tendency i s toward a d m i n i s t r a t i v e p o s i t i o n s a t t h e n a t i o n a l l e v e l i n every coun t ry .
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The d e n t i s t - p o p u l a t i o n r a t i o v a r i e s w i d e l y , f r o m one d e n t i s t f o r every 1,500 persons i n U r ~ g u a y ~ ' ~ t o 1:36,000 i n H a i t i . 1 4 D e n t i s t s tend t o c o n c e n t r a t e more i n b i g towns. Many c o u n t r i e s have f r o m 40 t o 50 per c e n t o f t h e i r d e n t i s t s i n t h e i r c a p i t a l c i t i e s , where t h e r e i s a p - p r o x i m a t e l y 10 per c e n t o f t h e t o t a l p o p u l a t i o n ; i n c o n t r a s t t h e r e a r e some areas hav ing more than 100,000 p o p u l a t i o n and no p r o f e s s i o n a l pe r - sonne l t o t a k e c a r e o f t h e i r d e n t a l needs . I ' T h i s s i t u a t i o n m i g h t be due t o t h e poor economic c o n d i t i o n s o f t h e peop le l i v i n g i n t h e a reas and t h e accompanying u n d e r - u t i l i z a t i o n o f d e n t a l s e r v i c e s t h a t f o r c e s t h e d e n t i s t s t o seek o t h e r p laces where they can l i v e and be p a i d f o r t h e i r s e r v i c e s i n a b e t t e r way. There a r e s t i l l some c o u n t r i e s where more than 40 p e r c e n t o f t h e p o p u l a t i o n l i v e i n a reas where t h e r e a r e no d e n t i s t s . l l Even i n b i g c i t i e s h a v i n g a r a t i o o f one d e n t i s t f o r every 1,200 persons, t h e t r e a t m e n t rece ived takes c a r e o f app rox ima te l y o n l y one t h i r d o f t h e i r needs.5 T h i s s i t u a t i o n means t h a t even t h e b e s t r a t i o o f d e n t i s t s pe r p o p u l a t i o n i s n o t adequate. I t i s observed t h a t s e r v i c e s a r e p r e f e r a b l e f o r a d u l t s , o b v i o u s l y because t h e y a r e more " d e n t a l l y - c o n s c i o u s " t h a n c h i l d r e n .
I n genera l t h e s i t u a t i o n seems t o remain " s t a t u s quo." P r o d u c t i v i t y o f schoo ls o f d e n t i s t r y i s growing a t t h e same r a t e as t h e general POPU-
l a t i o n , t h u s m a i n t a i n i n g t h e same r a t i o o f d e n t i s t s p e r p o p u l a t i o n i n t h e g r e a t m a j o r i t y o f c o u n t r i e s i n t h e reg ion .
The use o f t h e den ta l p r o s t h e t i s t i s ve ry genera l i zed , and t h e number i s f a i r l y adequate f o r t h e a c t u a l demand f o r work done f o r d e n t i s t s . The r e s t o f t h e a u x i l i a r y personne l a re p r a c t i c a l l y begging t o f u n c t i o n i n a few c o u n t r i e s . 1 0 - 1 3 - 1 8 - 2 1 - 2 3 - 2 5 The t r e n d i s t o u t i l i z e them more and more every t ime, bu t , a t p r e s e n t t hey a r e employed o n l y i n govern- mental se rv i ces . Such personne l c o n s i s t s ma in l y o f a u x i l i a r i e s of den- t a l hygiene (sometimes c a l l e d d e n t a l h y g i e n i s t s ) and d e n t a l a s s i s t a n t s . The re i s no o t h e r k i n d o f a u x i l i a r y p e r s o n n e l i n d e n t i s t r y i n L a t i n America.
A t t h e i n t e r n a t i o n a l l e v e l , t h e r e i s o n l y one p u b l i c h e a l t h d e n t i s t work ing w i t h t h e World H e a l t h Organ iza t i on i n t h e Region o f t h e Americas as a whole.8 He a c t s as a c o n s u l t a n t t o t h e governments t h a t ask f o r adv i ce on d e n t i s t r y w i t h i n t h e i r m i n i s t r i e s o f h e a l t h . There have been some o c c a s i o n s i n wh ich s h o r t - t e r m c o n s u l t a n t s have been employed t o g i v e adv i ce i n t h e f i e l d s o f den ta l p u b l i c hea l th , and/or i n the o rgan i - z a t i o n o f t h e c u r r i c u l u m o f d e n t a l s c h o o l s o f some c o u n t r i e s . 2 2 I t seems t h a t i n a s h o r t t ime t h e r e w i l l be den ta l c o n s u l t a n t s work ing w i t h t h e Wor ld H e a l t h O r g a n i z a t i o n -- Pan American S a n i t a r y Bureau a t t h e zone l e v e l s ( c o v e r i n g f rom one t o s i x L a t i n American c o u n t r i e s ) o r i n s p e c i f i c c o u n t r i e s a t n a t i o n a l l e v e l s . 8 T h i s s i t u a t i o n undoubtedly w i l l improve p u b l i c h e a l t h d e n t i s t r y i n L a t i n America because ( I ) i t w i l l b r i n g as an immediate consequence the t rend t o make un i fo rm the u t i l i z a - t i o n o f den ta l resources i n a l l t he c o u n t r i e s (up t o where i t i s p o s s i b l e
4
o r adv i sab le ) and (2) hav ing i n t e r n a t i o n a l adv isers , t o c o o r d i n a t e and make p l a n s f o r t h e b e t t e r use o f w i 1 be a v a i l a b l e from t h e p r o j e c t s o f programs o f b o r p h i l a n t h r o p i c a id .
EDUCAT1 ON
i t w i l l be p o s s i b l e t h e resources t h a t l a t e r a l , u n i l a t e r a l
L a t i n Amer i can p u b l i c h e a l t h d e n t i s t s a r e t r a i n e d m a i n l y a t t h e School o f Pub1 i c H e a l t h o f Sao Pau lo , B r a z i l . The re a r e some o t h e r schoo ls o f p u b l i c h e a l t h , such as those i n A rgen t ina , Colombia, Mexico, P u e r t o R i c o and C h i l e , t h a t a r e a l s o o f f e r i n g p u b l i c h e a l t h t r a i n i n g t o d e n t i s t s . 5
I n r e g a r d t o t h e s u b j e c t o f t h e t r a i n i n g o f d e n t i s t s , t h e r e a r e around 75 d e n t a l s c h o o l s i n L a t i n America: j u s t one c o u n t r y does n o t have a d e n t a l schoo l . T h e i r p r i n c i p a l problems seem t o be t h e s e l e c - t i o n o f s tuden ts , o r g a n i z a t i o n o f t h e c u r r i c u l u m , t r a i n i n g o f t eachers and methods f o r t e a c h i n g . P r o d u c t i v i t y o f some s c h o o l s i s v e r y low ( 4 t o 5 ) pe r yea r , a b o u t 80 p e r c e n t o f t h e i r s t u d e n t s b e g i n n i n g t h e d e n t a l course b u t n o t f i n i s h i n g it.5 The p r o p o r t i o n o f female s tuden ts i s h i g h i n a l m o s t a l l s c h o o l s , r e a c h i n g i n some o f them 40 p e r c e n t o r more. For s e v e r a l reasons , t h e p r o p o r t i o n o f f ema le d e n t i s t s n o t work ing i n d e n t i s t r y i s a l s o h igh .
The o b j e c t i v e s o f schoo ls o f d e n t i s t r y a r e n o t u n i f o r m i n t h e coun- t r i e s o f t h e r e g i o n s , so t h e c u r r i c u l u m canno t be u n i f o r m e i t h e r . I n t r y i n g t o d e v e l o p recommendat ions t o s-olve t h i s p a r t i c u l a r p rob lem, t h e Wor ld H e a l t h O r g a n i z a t i o n , i n c o o p e r a t i o n w i t h t h e Government o f Colombia, t h e W. K. K e l l o g g Foundat ion and t h e L a t i n American Associa- t i o n o f Schools o f D e n t i s t r y , i s o r g a n i z i n g t h r e e " L a t i n American Sem- i n a r s on t e a c h i n g o f D e n t i s t r y . " 1 7 The f i r s t o f them t o o k p l a c e i n Bogota j u s t a few days ago, f r o m O c t o b e r 14 t o 19. R e p r e s e n t a t i v e s o f a l l t h e d e n t a l schoo ls i n L a t i n America a r e go ing t o a t t e n d a t l e a s t one o f t h e s e m e e t i n g s , and a l l t h e s c h o o l s a r e g o i n g t o r e c e i v e t h e r e s o l u t i o n s t a k e n i n each o f t h e semina rs .17 E v e r y L a t i n Amer ican d e n t a l schoo l shou ld be m o t i v a t e d t o be a member o f t h e L a t i n American A s s o c i a t i o n o f Schoo ls o f D e n t i s t r y and t o f o l l o w t h e recommendations g i v e n i n o r d e r t o c l a r i f y t h e g o a l s o f d e n t i s t r y i n t h e i r c o u n t r i e s .
I n r e l a t i o n t o t h e t r a i n i n g o f t eachers , t h e W. K. K e l l o g g Founda- t i o n 2 6 i s p l a y i n g a ve ry i m p o r t a n t r o l e i n g i v i n g f e l l o w s h i p s t o p ro - f e s s o r s o f d i f f e r e n t s u b j e c t s , r e i n f o r c i n g , i n t h i s way, t h e q u a l i t y o f d e n t a l e d u c a t i o n . Many L a t i n American s c h o o l s have p r o f e s s o r s on an exchange b a s i s and obse rva t i on programs f o r teachers o f o t h e r schools. The L a t i n American A s s o c i a t i o n o f Schoo ls o f D e n t i s t r y , i n c o o p e r a t i o n w i t h Wor ld H e a l t h O r g a n i z a t i o n and W. K. K e l l o g g Founda t ion , has o r -
17 gan ized a cou rse on d e n t a l e d u c a t i o n f o r L a t i n American p r o f e s s o r s : i t w i l l t a k e p l a c e a l s o i n Bogota , Co lombia , i m m e d i a t e l y a f t e r t h e
5
c e l e b r a t i o n o f t h e Seminar on T e a c h i n g o f D e n t i s t r y . I t i s i n t e n d e d 17 t o i n v i t e a t l e a s t one r e p r e s e n t a t i v e o f every L a t i n American coun t ry .
I t shou ld be h i g h l y recommended t h a t a course o f t h i s t y p e be organ ized, i f n o t a t e v e r y d e n t a l s c h o o l , a t l e a s t i n e v e r y c o u n t r y i n o r d e r t o make i t a v a i l a b l e f o r most o f t h e teachers . I t i s a v e r y s h o r t cou rse (one week 's d u r a t i o n ) , so t h i s t i m e f a c t o r c o u l d f a c i l i t a t e i t s o r - g a n i z a t i o n i n many o f t h e c o u n t r i e s o f t h e reg ion .
A s i n g l e , v e r y i m p o r t a n t a c t i v i t y t h a t w i l l be i n f l u e n t i a l i n t h e deve lopment o f p u b l i c h e a l t h minded d e n t i s t s i n o u r c o u n t r i e s i s t h e c r e a t i o n o f d e p a r t m e n t s o f s o c i a l d e n t i s t r y i n s c h o o l s . 2 The School o f D e n t i s t r y o f t h e U n i v e r s i t y o f An t ioqu ia , aga in i n c o o p e r a t i o n w i t h t h e Wor ld H e a l t h O r g a n i z a t i o n and t h e W. K . K e l l o g g F o u n d a t i o n , has c r e a t e d a Depar tment o f P r e v e n t i v e and S o c i a l D e n t i s t r y i n M e d e l l i n , C o l ~ m b i a . ~ It i s hoped t h a t t h i s department w i l l a c t as a demonst ra t ion and t r a i n i n g c e n t e r f o r t h e c r e a t i o n o f s i m i l a r d e p a r t m e n t s i n o t h e r L a t i n American Schools.
Ano the r v e r y i m p o r t a n t a s p e c t f o r t h e improvement o f p u b l i c h e a l t h d e n t i s t r y i n t h e r e g i o n i s t h e o r g a n i z a t i o n o f r u r a l , o r s o c i a l s e r v i c e p e r i o d f o r s t u d e n t s f i n i s h i n g t h e l a s t y e a r o f d e n t a l schoo l .12 Some governments demand, as a r e q u i s i t e f o r a t t a i n m e n t o f t h e d e n t a l degree, t h e f u l f i l l m e n t o f a c e r t a i n p e r i o d o f t i m e w o r k i n g i n r u r a l a reas o r i n a reas where t h e d e n t i s t - p o p u l a t i o n r a t i o i s l o w e r t h a n i n t h e r e s t o f t h e c o u n t r y .
12 The advantages expec ted f rom t h e r u r a l yea r a re :
A more complete p r a c t i c a l educat ion o f t he s tuden t B e t t e r knowledge o f d e n t a l needs i n t h e coun t ry Fac i 1 i t a t i o n of d e n t a l s e r v i c e s f o r some s e c t o r s o f t he
p o p u l a t i o n t h a t do n o t have enough economic resources t o go t o p r i v a t e d e n t i s t s
A t ta inmen t o f a b e t t e r d i s t r i b u t i o n o f d e n t i s t s i n the coun t ry .
I n some c o u n t r i e s t h e c o m p u l s o r y r u r a l y e a r f o r d e n t a l s t u d e n t s means d u p l i c a t i o n o f t h e number o f d e n t i s t s work ing i n t h e p u b l i c h e a l t h se rv i ces .
A few c o u n t r i e s a r e engaged i n t h e i n - s e r v i c e t r a i n i n g o f d e n t i s t s w o r k i n g i n l o c a l p rograms. D i f f e r e n t s e m i n a r s o r s h o r t c o u r s e s a r e o r g a n i z e d i n o r d e r t o g i v e them some up - to -da te knowledge, e s p e c i a l l y i n rega rd t o p r e v e n t i v e measures and a d m i n i s t r a t i o n o f d e n t a l programs a t l o c a l l e v e l s . They a r e i n t e n d e d t o be f o l l o w e d by o t h e r semina rs as a c o n t i n u i n g e d u c a t i o n a l program.
T r a i n i n g o f a u x i l i a r y p e r s o n n e l i s s t i l l b e g i n n i n g i n some o f o u r c o u n t r i e s . io -12-18-21-23-25 Courses f o r d e n t a l a s s i s t a n t s have been
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T r a i n i n g o f a u x i l i a r y p e r s o n n e l i s s t i l l b e g i n n i n g i n some o f o u r c o u n t r i e s . 10-12-18-21-23-35 Courses f o r d e n t a l a s s i s t a n t s have been g i v e n i n s e v e r a l p l a c e s and s e v e r a l t i m e s , b u t , maybe s i n c e d e n t a l s t u d e n t s a r e n o t t a u g h t t o use them e f f e c t i v e l y , t h e y u s u a l l y d o n o t h e l p t h e d e n t i s t i n t h e a p p r o p r i a t e way.
A new t y p e o f a u x i l i a r y pe rsonne l , t h e a u x i l i a r y o f d e n t a l hyg iene, i s now i n use i n some o f t h e L a t i n Amer i can c o u n t r i e s . 1 5 They a r e t r a i n e d i n c o u r s e s o f f r o m one t o t h r e e months’ d u r a t i o n and a r e ex - pec ted t o work m a i n l y i n programs o f t o p i c a l a p p l i c a t i o n o f f l u o r i d e s . They a r e a l s o i n charge o f some o t h e r a c t i v i t i e s , such as h e a l t h educa- t i o n o f t h e p u b l i c -- p r e f e r a b l y c h i l d r e n and mo the rs -- management o f r e c o r d s and, i n some i n s t a n c e s , a c t a l s o as d e n t a l a s s i s t a n t s . By now t h i s t y p e o f p e r s o n n e l i s w o r k i n g o n l y i n p u b i i c h e a l t h p rograms suppor ted by governments, b u t t h e t i m e w i l l come when d e n t a l h y g i e n i s t s w i l l be w o r k i n g i n t h e p r i v a t e o f f i c e o f t h e d e n t i s t , a l s o h e l p i n g him i n o t h e r a c t i v i t i e s as i n o t h e r coun t r i es .24
I t i s expec ted t h a t i n t h i s decade t h e i n t e r n a t i o n a l agenc ies w i l l h e l p t h e L a t i n Amer ican c o u n t r i e s i n t h e s u p p o r t and o r g a n i z a t i o n o f t r a i n i n g courses, b o t h f o r p r o f e s s i o n a l and a u x i l i a r y personne l work ing i n h e a l t h s e r v i c e s .
PREVENTIVE MEASURES
I n t h e p r e s e n t c i r c u m s t a n c e s , w i t h t h e knowledge t h a t d e n t a l needs a r e never g o i n g t o be s o l v e d o r d i m i n i s h e d i n a s i g n i f i c a n t p r o p o r t i o n t h r o u g h t h e use o f p r e s e n t manpower r e s o u r c e s , t h e mass p r e v e n t i v e measures a r e t h e b e s t approaches t o t h e problem.
I t i s r e c o g n i z e d t h a t i n a l l L a t i n Amer i can c o u n t r i e s t h e f i r s t d e n t a l p u b l i c h e a l t h p rob lem i s d e n t a l c a r i e s . I t s p r e v a l e n c e v a r i e s not o n l y f r o m c o u n t r y t o c o u n t r y b u t f r o m p l a c e t o p l a c e , b e i n g f rom 2.4 t o 4.3 DMF a t 7 y e a r s o f age and f r o m 5 . 8 t o 12. I DMF a t 12 y e a r s o f age i n p l a c e s t h a t do n o t have t h e p r o t e c t i o n o f f l u o r i d e s . l 0 - I 3 - l 4 18-21-23-25 The i n c i d e n c e o f d e n t a l c a r i e s a l s o v a r i e s f r o m 0.5 t o 1.6 DMF p e r c h i l d and p e r y e a r .
The p r o b l e m t h a t seems t o f o l l o w d e n t a l c a r i e s i n i m p o r t a n c e i s t h a t o f p e r i o d o n t a l d i s e a s e s . There a r e no d a t a i n r e g a r d t o t h e s e p rob lems , because, u n t i l now, t h e r e i s no one i n d e x used u n i f o r m l y i n t h e s t u d y o f t h i s g roup o f d i s e a s e s i n L a t i n America. Anyway, i t i s r e c o g n i z e d i n mos t o f o u r c o u n t r i e s as t h e second p r o b l e m i n i m - p o r t a n c e i n d e n t a l pub1 i c h e a l t h .
I n t h e p r e v e n t i o n o f t h e c a r i e s problem, t h e most e f f e c t i v e measure i s w a t e r f l u o r i d a t i o n . U n f o r t u n a t e l y t h e r e a r e v e r y few c o u n t r i e s u s i n g i t i n a c o n s i s t e n t way. The m o s t advanced c o u n t r i e s i n t h i s a s p e c t a r e w i t h 39 f l u o r i d a t i o n p r o j e c t s , and C h i l e , w i t h 23 i n o p e r a t i o n now and a n o t h e r 29 p lanned f o r n e x t year . ” More than s i x o f t h e t w e n t y c o u n t r i e s a r e n o t u s i n g f l u o r i d a t i o n , and many o f
7
them have j u s t one demonst ra t ion p r o j e c t .
B a r r i e r s t o f l u o r i d a t i o n a r e m a i n l y economic. A l t h o u g h t h e r e has been no o r g a n i z e d o p p o s i t i o n t o f l ~ o r i d a t i o n , ~ g r e a t p r o g r e s s has n o t been made, because wa te r q u a l i t y and q u a n t i t y a r e s t i l l b a s i c problems i n o u r r e g i o n . B e s i d e s , t h e c o s t o f i m p o r t i n g s a l t s and e q u i p m e n t makes i n i t i a t i o n and o p e r a t i o n more d i f f i c u l t .
Even k n o w i n g t h a t w a t e r f l u o r i d a t i o n i s o r w i l l be a v a i l a b l e t o o n l y a sma l l segment o f o u r p o p u l a t i o n i n L a t i n America, t h e b e n e f i t s o f t h e measure o u g h t t o be g i v e n t o t h o s e who a r e i n a p o s i t i o n t o have it. Most o f t h e e f f o r t s o f p u b l i c h e a l t h d e n t i s t s i n L a t i n America a r e b e i n g employed i n t h i s p a r t i c u l a r a rea . Programs o f t o p i c a l f l u - o r i d e s a r e n o t v e r y p o p u l a r a t t h e p r e s e n t moment, because t h e r e i s a l a c k o f a u x i l i a r y pe rsonne l t o c a r r y them o u t . As soon as t h e aux- i l i a r y personnel i s t r a i n e d , these programs w i l l become t h e bas i c preven- t i v e measure f o r d e n t a l c a r i e s i f , by t h a t t i m e , t h e r e i s n o t a new form o f a d m i n i s t r a t i o n , o r a new k i n d o f p r e v e n t i v e procedure.
R e s t r i c t i o n on t h e i n t a k e o f c a r b o h y d r a t e s i s promoted by h e a l t h e d u c a t o r s and a u x i l i a r i e s o f d e n t a l h y g i e n e . What i s g e n e r a l l y ex - pec ted f rom t h e p romot ion o f t h i s s u b j e c t , i s t h a t t h e p u b l i c , i n gen- e r a l , w i l l know t h e d i r e c t r e l a t i o n between sugar and d e n t a l c a r i e s . Recommendations a r e made i n t h e sense o f r e s t r i c t i n g t h e consumpt ion o f s u g a r i n f r e q u e n c y and amount. I n some c o u n t r i e s , m a t e r i a l s i n t h e fo rm o f f l i p - c h a r t s and f i l m s t r i p s a r e used i n e lemen ta ry s c h o o l s and m o t h e r ' s c l u b s .
I n rega rd t o p e r i o d o n t a l d i seases , t h e o n l y p r e v e n t i v e measure used 16 i n a l m o s t a l l o f o u r c o u n t r i e s i s t h e p r o m o t i o n o f t o o t h b r u s h i n g ,
e s p e c i a l l y i n programs o f d e n t a l h e a l t h e d u c a t i o n i n schoo ls .
Cons ide r ing t h a t t h e two a forement ioned problems t a k e a l l t h e e f f o r t s made i n t h e a p p l i c a t i o n and p r o m o t i o n o f p r e v e n t i v e measures, t h e r e i s no chance t o a p p l y any o t h e r i n t r y i n g t o s o l v e any one o f t h e r e s t o f t h e problems o f d e n t i s t r y i n p u b l i c h e a l t h i n L a t i n America.
PROGRAMS OF TREATMENT
We have seen t h a t d e n t a l manpower, p r o f e s s i o n a l o r a u x i l i a r y , i s ex t reme ly inadequate t o t a k e c a r e o f t h e d e n t a l needs o f o u r p o p u l a t i o n i n L a t i n America. On t h e o t h e r hand, p r e v e n t i v e measures a r e n o t h e l p i n g ve ry much i n reduc ing t h e d e n t a l h e a l t h problems. It has been necessary, t h e r e f o r e , t o o r g a n i z e t h e programs o f t r e a t m e n t i n a way t o o b t a i n more reasonab le b e n e f i t s f o r t h o s e s e c t o r s o f t h e community where t h e e f f o r t s a r e more needed and a r e a l s o more p r o d u c t i v e . I n g e n e r a l , t h e t h o u g h t o f t h e L a t i n Amer ican pub1 i c h e a l t h d e n t i s t i s t o l i m i t t h e s e r v i c e s rendered t o t h e p o p u l a t i o n i n o r d e r t o g i v e a t t e n t i o n t o more i m p o r t a n t demands o f b i g g e r g roups .20 The more accep ted p o l i c y
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r e g a r d i n g d e n t a l t r e a t m e n t p rog rams i n mos t o f o u r c o u n t r i e s i s t o have c e r t a i n p r i o r i t i e s i n t h e t y p e o f s e r v i c e s g i v e n and t h e k i n d o f p o p u l a t i o n g roups t r e a t e d . These p r i o r i t i e s , v a r y i n g l i t t l e f rom c o u n t r y t o coun t ry , a re :
Emergencies i n any k i n d o f p o p u l a t i o n group E x t r a c t i o n s f o r school boys and pregnant women F i l l i n g s i n permanent t e e t h o f school c h i l d r e n .
I n v i e w o f t h e v e r y 1 i m i t e d r e s o u r c e s , i t has been n e c e s s a r y t o r e s t r i c t t h e s e r v i c e s t o t h o s e m e n t i o n e d above. Some p rog rams a r e a b l e t o g i v e a t t e n t i o n o n l y t o t h e f i r s t o f t h e p r i o r i t i e s , some can be extended more and more; b u t ve ry few a r e a b l e t o g i v e f u l l a t t e n t i o n t o a l l t h e l i s t e d p r i o r i t i e s .
The f o l l o w i n g d i s t r i b u t i o n o f t i m e i n t h e programs o f d e n t a l t r e a t - ment has been suggested:’
70% f o r o p e r a t i v e work i n school c h i l d r e n 15% f o r e x t r a c t i o n s i n pregnant women 10% f o r emergency s e r v i c e s i n any k i n d o f p a t i e n t 5% f o r h e a l t h educat ion programs and p ro fess iona l r e l a t i o n s .
A t t h e p r e s e n t moment t h e i dea o f f o l l o w i n g t h e p r i o r i t i e s ment ioned i s n o t y e t f u l l y a c c e p t e d by d e n t a l c l i n i c i a n s b u t i s g a i n i n g such acceptance. Complete u n d e r s t a n d i n g seems t o be j u s t a m a t t e r o f t ime.
The o t h e r b i g problem f a c i n g t h e a d m i n i s t r a t o r o f programs o f d e n t a l t r e a t m e n t i n L a t i n Amer ica i s t h a t o f p r o d u c t i v i t y . A v i c i o u s c i r c l e appears when s a l a r i e s a r e low and equipment and s u p p l i e s a r e d e f i c i e n t . The h e a l t h a d m i n i s t r a t o r r e f u s e s t o improve them when p r o d u c t i v i t y i s l o w and, v i c e v e r s a , d e n t i s t s r e f u s e t o i n c r e a s e p r o d u c t i v i t y o r s i m p l y c a n n o t d o so when t h e y a r e u n d e r p a i d o r do n o t have adequa te means t o work e f f i c i e n t l y . T h i s p rob lem has t o be s o l v e d i n d i v i d u a l l y f o r each case.
I n r e g a r d t o p rog rams o f t r e a t m e n t , t h e more g e n e r a l i d e a seems t o be t h e o r g a n i z a t i o n o f p i l o t h e a l t h c e n t e r s t o s t u d y t h e a p p l i c a - t i o n s o f l o c a l programs and t o s e r v e as d e m o n s t r a t i o n c e n t e r s f o r t h e o r g a n i z a t i o n o f programs i n o t h e r h e a l t h u n i t s .
D i f f e r e n t t y p e s o f o r g a n i z a t i o n have been recommended f o r gove rn - 19 mental p u b l i c h e a l t h programs, such as group f i n a n c i n g o f d e n t a l care ,
prepayment and postpayment, b u t t hey have r e s u l t e d i n be ing i ncompa t ib le w i t h c i v i l s e r v i c e r e g u l a t i o n s . However, t h e s e k i n d s o f p l a n s a r e v e r y e f f e c t i v e i n s e r v i c e s f o r s o c i a l o r i n d u s t r i a l i n s t i t u t i o n s and t h e i r use i s g r a d u a l l y g row ing i n L a t i n America.
HEALTH EDUCATION
Much o f t h e e f f o r t s o f t h e d e n t a l p r o f e s s i o n i n t h e m a j o r i t y o f
9
o u r L a t i n Amer i can c o u n t r i e s have been used i n t h e f i e l d o f h e a l t h e d u c a t i o n o f t h e p u b l i c . D e n t i s t s a r e concerned abou t t h e impor tance o f h e a l t h e d u c a t i o n b e i n g a b a s i c a c t i v i t y i n t h e p r a c t i c e o f p u b l i c h e a l t h , such as p r e v e n t i o n and t r e a t m e n t .
The r e s u l t s o f h e a l t h e d u c a t i o n programs have n o t been s a t i s f a c t o r y i n many ins tances , maybe because t h e o b j e c t i v e s have n o t been r e a l i s t i c o r p r a c t i c a l . The genera l i dea i s t o educate t h e pub1 i c t o seek d e n t a l s e r v i c e s , w i t h o u t knowing i f t h e group r e c e i v i n g t h e impact o f d e n t a l e d u c a t i o n i s a b l e t o pay f o r t h e s e r v i c e s o f f e r e d o r i s w i l l i n g t o change i t s a t t i t u d e s o r p r e f e r e n c e s so r a p i d l y and go t o t h e d e n t i s t i n s t e a d o f b u y i n g c i g a r e t t e s .
What t h e p u b l i c h e a l t h d e n t i s t s want i n o u r r e g i o n i s t h a t h e a l t h e d u c a t i o n be a p p l i e d i n a way t o o b t a i n p r a c t i c a l r e s u l t s and t h a t t h e a c t i v i t y be c a r r i e d o u t by t h e a u x i l i a r y p e r s o n n e l -- e i t h e r t h e h e a l t h e d u c a t o r o r t h e a u x i l i a r y on d e n t a l h y g i e n e -- and n o t by t h e d e n t i s t . 1 5 I n t h i s way, t h e d e n t a l c l i n i c i a n c o u l d d e d i c a t e h i s t i m e t o t h a t a c t i v i t y wh ich he i s t h e o n l y one capab le o f pe r fo rm ing . The j o b o f t h e d e n t i s t i n t h i s f i e l d c o u l d be t o g i v e i n f o r m a t i o n t o t h e pe rsonne l who a r e g o i n g t o p u t h e a l t h e d u c a t i o n i n t o p r a c t i c e d i r e c t l y w i t h t h e pub1 i c .
RESEARCH
I n t h e f i e l d o f p u b l i c h e a l t h d e n t i s t r y , research i s p l a y i n g a ve ry i m p o r t a n t r o l e i n o u r c o u n t r i e s . Den ta l needs a r e b e t t e r known eve ry t i m e t h e e p i d e m i o l o g i c a l i n v e s t i g a t i o n s o f d e n t a l d i s e a s e s a r e more extended. New p r e v e n t i v e measures a r e be ing s t u d i e d i n t h e l a b o r a t o r i e s o f d e n t a l s c h o o l s . The most f a s c i n a t i n g , b u t a l s o most d i f f i c u l t t o ge t , i s t h e v a c c i n e f o r d e n t a l c a r i e s . New ways o f a d m i n i s t r a t i o n o f f l u o r i d e s t o schoo l c h i l d r e n a r e s t u d i e d . F l u o r i d e t a b l e t s a r e g i v e n t o t h e s t u d e n t s and r e s u l t s a r e b e i n g measured.23 Maybe t h e measure w i l l n o t be as e f f i c i e n t as f l u o r i d a t i o n , b u t i f i t p r e v e n t s d e n t a l c a r i e s i n an a c c e p t a b l e p r o p o r t i o n , i t c o u l d be an a l t e r n a t i v e when f l u o r i d a t i o n c a n n o t be a t t a i n e d .
The use o f f l u o r i d a t i o n would be more extended i n t h e L a t i n American c o u n t r i e s i f f l u o r s p a r ( c a l c i u m f l u o r i d e ) c o u l d be p roved e f f i c i e n t f rom t h e a d m i n i s t r a t i v e p o i n t o f v iew . W i t h f l u o r s p a r much e a s i e r t o g e t i n o u r c o u n t r i e s t h a n i s any o t h e r f l u o r i d e compound, i t would be much cheaper t o o p e r a t e . The e s t i m a t e d c o s t wou ld be a round one t h i r d o f t h a t o f sod ium s i l i c o f l u o r i d e .
Another a l t e r n a t i v e method t o wa te r f l u o r i d a t i o n i n o u r r e g i o n c o u l d be t h e use o f f l u o r i d a t e d t a b l e s a l t , T h i s v e h i c l e i s a l r e a d y i n use f o r t h e a d m i n i s t r a t i o n o f i o d i n e i n t h e f i g h t a g a i n s t g o i t r e . S a l t f l u o r i d a t i o n i s n o t y e t b e i n g s t u d i e d i n any o f o u r c o u n t r i e s , b u t i t c e r t a i n l y i s i n t h e m i n d s o f many o f o u r p u b l i c h e a l t h d e n t i s t s .
10
N o t o n l y l a b o r a t o r y o r e p i d e m i o l o g i c a l r e s e a r c h i s c a r r i e d o u t i n t h e r e g i o n . A d m i n i s t r a t i v e r e s e a r c h has a l r e a d y begun, o r i s a b o u t t o begin, i n many o f t h e c o u n t r i e s . The p i l o t h e a l t h c e n t e r s ment ioned b e f o r e a r e s e r v i n g t h i s purpose. New c l i n i c a l methods o r a d m i n i s t r a t i v e p rocedures a r e b e i n g p roved t h e r e , and, when e f f e c t i v e , t h e y a r e r e c - ommended f o r use i n t h e o p e r a t i o n o f t h e programs o f t h e d e n t a l se rv i ces .
A l though research i s a b a s i c a c t i v i t y i n any f i e l d o f p u b l i c h e a l t h , f o r t h e moment we have t o depend on t h e i n v e s t i g a t i o n done i n o t h e r c o u n t r i e s t h a t have s u f f i c i e n t means t o do it. Our l i m i t e d b u d g e t f o r d e n t a l pub1 i c h e a l t h does n o t a l l o w o u r c o u n t r i e s t o go f a r i n i n t h e f i e l d o f r e s e a r c h .
SUMMARY AND CONCLUSIONS
G e n e r a l l y speak ing , t h e t r e n d s i n p u b l i c h e a l t h d e n t i s t r y i n L a t i n Amer i ca a r e , i n t h e f i r s t p l a c e , t o w a r d d i m i n i s h i n g d e n t a l needs by t h e e x t e n s i v e use o f e v e r y p o s s i b l e p r e v e n t i v e measure. The p r o b l e m i n t h i s a s p e c t i s t o make e a s i e r t h e a p p l i c a t i o n o f t h e s e measures. I n t h e second p l a c e , t h e r e i s t h e i d e a o f mak ing b e t t e r use o f and, a t t h e same t i m e , i n c r e a s i n g t h e d e n t a l resources . The second o b j e c - t i v e i s be ing approached by t r y i n g t o augment the p r o d u c t i v i t y o f schoo ls ?f d e n t i s t r y , c r e a t i n g and u s i n g e x t e n s i v e l y d i f f e r e n t types o f aux i 1 i a r y ge rsonne l , i m p r o v i n g d e n t a l h e a l t h programs t h r o u g h t h e e s t a b l i shment o f p r i o r i t i e s i n t h e s e r v i c e s g i v e n and t h e p o p u l a t i o n s e l e c t e d , groups mak ing r u r a l s e r v i c e by d e n t a l s t u d e n t s compulsory and t r y i n g t o d i s - t r i b u t e i n a b e t t e r way t h e d e n t a l manpower a v a i l a b l e i n t h e d i f f e r e n t c o u n t r i e s .
I n o r d e r t o imp lemen t a l l t h e s e i d e a s and be c l o s e r t o t h e f i n a l o b j e c t i v e o f d e n t a l p u b l i c h e a l t h , t h e L a t i n Amer ican d e n t i s t works on t h e f i r s t s t e p wh ich i s t o have a s p e c i a l d i v i s i o n o r s e c t i o n w i t h i n t h e m i n i s t r i e s o f h e a l t h .
I t i s hoped t h a t t h e d i v i s i o n s o f p u b l i c h e a l t h d e n t i s t r y w i l l b e a b l e t o i n t e g r a t e t h e i r a c t i v i t i e s o f p r o m o t i o n , p r o t e c t i o n and r e - c o v e r i n g o f h e a l t h w i t h t h e n a t i o n a l h e a l t h p l a n s o f o u r L a t i n American c o u n t r i e s .
We w i l l n o t be a l o n e i n t h e achievement o f o u r o b j e c t i v e s . A s s i s t - ance f rom d i f f e r e n t agenc ies and i n d i f f e r e n t forms w i l l be a v a i l a b l e .
The Pan American H e a l t h O r g a n i z a t i o n , r e g i o n a l b ranch o f t h e World H e a l t h O r g a n i z a t i o n , w i l l c o o p e r a t e w i t h governments t o u t i l i z e t h e i r p r e s e n t r e s o u r c e s i n t h e b e s t p o s s i b l e way. i t s s p e c i f i c a r e a s o f work w i l l be:8
Ass is tance i n t h e development o f t r a i n i n g i n d e n t a l p u b l i c
Ass is tance i n t h e development o f t r a i n i n g i n d e n t i s t r y h e a l t h
Ass is tance i n the development o f t r a i n i n g o f a u x i l i a r y per- sonnel and f o r t he opera t i on o f demonst ra t ion p r o j e c t s us ing them
Ass is tance t o n a t i o n a l departments o f h e a l t h i n s t reng th - en ing t h e i r den ta l programs.
The O r g a n i z a t i o n o f Amer ican S t a t e s has a v e r y a c t i v e program o f f e l l o w s h i p s i n wh ich , o f cou rse , t h e f i e l d o f d e n t i s t r y i s i nc luded . The " A c t o f Bogota" and t h e program " A l l i ance f o r Progress" have among t h e i r o b j e c t i v e s t h e i n t e g r a t i o n o f a l l h e a l t h a c t i v i t i e s f o r t h e i m - provement o f s o c i a l and economic deve lopment o f L a t i n Amer ican coun- t r i e s . ' W. K. K e l l o g g F o u n d a t i o n has been a s s i s t i n g , and i t i s ex- pec ted t h a t i t w i l l c o n t i n u e do ing so i n t h e s t r e n g t h e n i n g o f t each ing i n d e n t a l schools.26 The p o i n t I V program o f t h e U n i t e d Sta tesGovern- ment, t h r o u g h t h e A i d t o I n t e r n a t i o n a l Development, a l s o has an ac- t i v e program o f f e l l o w s h i p s and g i v e s a s s i s t a n c e i n some s p e c i a l p ro - j e c t s . The N a t i o n a l I n s t i t u t e s o f H e a l t h w i t h t h e i r i n t e r n a t i o n a l p rograms w i l l , no doubt , i n f l u e n c e i n t h e improvement o f d e n t a l r e - search .
I n t h e f i e l d o f o r g a n i z a t i o n o f t h e p r o f e s s i o n , t h e d e n t a l assoc ia - t i o n s a t t h e n a t i o n a l l e v e l s a r e w o r k i n g v e r y ha rd t o have b e t t e r i n - t e r n a t i o n a l p r o f e s s i o n a l r e l a t i o n s . A ve ry good example has been t h e s p e c i a l emphas is t h a t t h e Amer i can D e n t a l A s s o c i a t i o n has g i v e n a t t h i s annual sess ion t o t h e improvement o f r e l a t i o n s w i t h L a t i n American co l l eagues .6 The F e d e r a t i o n D e n t a i r e I n t e r n a t i o n a l e i s p l a y i n g a ve ry i m p o r t a n t r o l e i n t h e o r g a n i z a t i o n o f t h e d e n t a l p r o f e s s i o n th roughout t h e world. I t i s hoped t h a t i n t h e p resen t decade i t w i l l be adequately represented i n L a t i n America.
I am s u r e t h a t we, t h e L a t i n American d e n t i s t s , a r e g o i n g t o make e v e r y p o s s i b l e e f f o r t t o h e l p i n t h e c o r r e c t u t i l i z a t i o n o f o u r own resources and t h e i n t e r n a t i o n a l ass i s tance . T h i s s h a l l be done i n t h e most e f f e c t i v e manner, because i t i s t h e o n l y way t o o b t a i n f o r o u r p e o p l e t h e b e s t p o s s i b l e s t a t e o f h e a l t h , a v e r y i m p o r t a n t f a c t o r i n t h e achievement o f t he u l t i m a t e goal o f humanity: happiness.
I t h i n k t h a t we c o u l d say, w i t h o u t f e a r o f b e i n g wrong, t h a t t h i s w i l l be t h e g r e a t decade o f p u b l i c h e a l t h d e n t i s t r y i n L a t i n America.
REFERENCES
1. A l i a n z a p a r a el P r o g r e r o . R e u n i o n E x t r a o r d i n a r i a d e l C o n s e j o E c o n o - m i c o y S o c i a l l n t e r a m e r i c a n o a 1 n i v e l m i n i s t e r i a l . O E A C o c u m e n t o s O f i c i a l e s . D O C . 1 ~ 5 , a g o s t o , 1 9 6 1 .
J . D e n t . E d u c . , 2 U : 1 9 7 - 2 0 0 , S e p t e m b e r , 1 9 6 0 . 2 . B l a c k e r b y , P h i l i p E . Why n o t a d e p a r t m e n t o f s o c i a l d e n t i s t r y ?
3 . C a s t a g n o l a L. D e n t i s t r y i n S o u t h A m e r i c a . I A r g e n t i n a . - S c h w e i z . U s c h r . Z a h n h k . 6 8 : 4 9 9 - 5 0 3 . d u n e , 1 9 5 8 .
12
4 .
5 .
6 .
7 .
8 .
9 .
10.
11.
1 2 .
1.3 - 14.
1 5 - 1 6 .
17.
18.
1 9 .
2 0 .
2 1 .
2 2 .
C a s t a g n o l a L. D e n t i s t r y i n S o u t h A m e r i c a . I I U r u g u a y . S c h w e i z . M s c h r . Z a h n h k . 6 8 : 4 9 9 - 5 0 3 . J u n e , 1 9 5 8 .
C h a v e s , M a r i o . M . D e n t a l h e a l t h p r o b l e m s a n d p r o g r a m s i n L a t i n A - m e r i c a : a n i n t e r n a t i o n a l p e r s p e c t i v e . P u b . H e a l t h D e n t . , 2 1 : 1 9 - 2 5 , N o . 1 6 2, S p r i n g - S u m m e r , 1 9 6 1 .
C h a v e s , M a r i o . M . I m p o r t a n c e o f g o o d i n t e r n a t i o n a l u n d e r s t a n d i n g . A m . D e n t . A s s . J . , 6 4 : 1 1 9 / 5 6 3 - 5 , A p r i l , 1 9 6 2 .
C h a v e s , M a r i o . M . S u g e s t i o n s s o b r e l a s a c t i v i d a d e s d e l s e r v i c i o d e n - t a l d e u n a u n i d a d s a n i t a r i a . B i l . O f . S a n . P a n . , X L : 3 7 5 - 7 , No . 5 , m a y o 1 9 5 6 .
C h a v e s , M a r i o . M . T h e d e n t a l p r o g r a m o f t h e P a n A m e r i c a n H e a l t h O r g a n i z a t i o n i n t h e d e c a d e o f t h e 6 0 ' s . WHO/PAHO, 1 9 6 1 .
F a c u l t a d d e O d o n t o l o g i a , U n i v e r s i d a d d e A n t i o q u i a . A c u e r d o e n t r e e l G o b i e r n o d e l a R e p u b l i c a d e C o l o m b i a , L a O r g a n i z a c i o n P a m a m e r i - c a n a d e l a S a l u d y l a F u n d a c i o n W . K . K e l l o g g p a r a l a o r g a n i z a c i o n d e u n d e p a r t a m e n t o d e O d o n t o l o g i a p r e v e n t i v a y s o c i a l e n l a F a c u l t a d d e O d o n t o l o g i a d e l a U n i v e r s i d a d d e A n t i o q u i a . M e d e l l i n , C o l o m b i a , 1 9 6 1 .
G a r c i a , M a g a l i . C o m u n i c a c i o n p e r s o n a l . S a n t i a g o , C h i l e . 1 9 6 2 .
Guzman 0 . y M e n e n d e z O t t o . D e n t i s t - p o p u l a t i o n r a t i o i n G u a t e m a l a i n 1 9 5 7 . B o l . c o l . e s t o m a t . G u a t e m a l a , 6 : 2 4 - 8 , N o v - O e c . 1 9 5 7 . J a n - A p t . 1 9 5 8 .
L o p e z C a m a r a , V i c t o r . O r g a n i z a c i o n d e l s e r v i c i o . * I d e 1 0 s p a - s a n t e s d e o d o n t o l o g i a . S e c . d e S a l u b . y A s i s t . , m i m e s g . 7 p. M e x i c o , J u l i o , 1 9 6 2 .
M a z o A g u i l a r , C o n r a d o . C o m u n i c a c i o n p e r s o n a l . M e d e l I i n , C o l o m b i a . 1 9 6 2 .
O f i c i n a S a n i t a r i a P a n a m e r i c a n a . D e n t a l p u b l i c h e a l t h i n L a t i n A m e r - i c a . (Summary r e p o r t ) . Doc . O f i c i a l e s , HHP-1765-56 /AMRO-72 , W a s h i n g - t o n , O . C . , O i c i e m b r e , 1 9 5 6 .
O r g a n i z a c i o n M u n d i a l d e l a S a l u d . C o m i t e d e e x p e r t o s e n p e r s o n a l a u x i l i a r d e O d o n t o l o g i a . O r g . Mund. S a l u d . S e r . I n f . Tecn . , 1 9 5 9 , 1 6 3 .
O r g a n i z a c i o n M u n d i a l d e l a S a l u d . L a s p a r o d o n t o p a t i a s . O r g . m u n d . S a l u d S e r . I n f . T e c n . , 1 9 6 1 , 2 0 7 .
O r g a n i z a c i o n P a n a m e r i c a n a d e l a S a l u d - P r i m e r s e m i n a r 1 0 L a t i n o A m e r i c a n 0 s o b r e l a e n s e n a n z a d e l a o d o n t o l o g i a . O M S l O S P N o t i c i e r o s N o s . 2 y 3, a b r i l - j u l i o , 1 9 6 2 .
P a l m a V i l l a s e n o r , R o l a n d o , C o m u n i c a c i o n p e r s o n a ! . G u a t e m a l a , G u a t e - m a l a . 1 9 6 2 .
P e l t o n , W a l t e r , J . G r o u p f i n a n c i n g o f d e n t a l c a r e - w h a t i t m e a n s . J . D i s t . C o l u m b i a D e n t . S o c . 3 5 : 2 - 7 , J u n e 1 9 6 0 .
P r i m e r C o n g r e s o d e l a F e d e r a c i n O d o n t o l o g ! r a d e C e n t r o A m e r i c a y Panama. S e r v i c i o s d e n t a l e s p a r a e s c o l a r e s . k ~ c o m e n d a c i o n e s g e n e - r a l e s . B o l . O f . S a n . P a n . X L I v : 8 5 - 6 , No. 1, e n r r o 1 9 5 8 .
S a n c h e z P . , A l b a R h i n a . C o m u n i c a c i o n p e r s o n a l . S a n S a l v a d o r , E l S a l v a d o r . 1 9 6 2
S e b e l i u s , C a r l L . T h e d e n t a l h e a l t h p r o g r a m o f t h e W o r l d H e a l t h O r g a n i z a t i o n . B u l . A m . Ass . Pub. H e a t t h D e n t . , 1 7 : 9 - 1 1 N o v . 1 9 5 7 .
23. V i e g a s , A l f r e d 0 R . C o m u n i c a c i o n p e r s o n a l S a o P a u l o , B r a z i l 1 9 6 2 .
13
24. W a t e r m a n , G e o r g e E. T h e e f f e c t i v e u t i l i z a t i o n o f a u x i l i a r y d e n t a l p e r s o n n e l . M u ! . Med. , 122:405-7 J u n e 1956.
25. W i l l i a m s A . , D o n a l d o . C o m u n i c a c i o n p e r s o n a l . Panama, Panama.
2 6 . W . K. K e l l o g g F o u n d a t i o n . D e n t a l c a r e - i n c r e a s i n g l y I m p o r t a n t i n h e a l t h s e r v i c e s . W. K. K e l l o g g Found . Rep. f o r 1957, 53-66
D r . C a m a r a i s D e n t a l C o n s u l t a n t , M i n i s t r y o f H e a l t h a n d A s s i s t a n c e , M e x i c o C i t y , M e x i c o .
TRAINING OF WBLIC HEALTH DENTISTS
IN LATIN AMERICA
A l f redo Reis Viegas, D.D.S., M.P.H.
There are two types o f courses f o r t h e t r a i n i n g o f d e n t i s t s i n pub- l i c h e a l t h i n L a t i n America. The f i r s t i s a genera l course i n p u b l i c h e a l t h educa t ion and does n o t i n c l u d e a s e c t i o n s p e c i f i c a l l y designed f o r d e n t i s t r y o r , i f d e n t i s t r y i s i nc luded , i t i s i n a v e r y genera l manner. The second course, w h i l e s u p p l y i n g a genera l background i n p u b l i c h e a l t h , o f f e r s , a t t h e same t ime, a s p e c i f i c d e n t a l t r a i n i n g .
I n t h e cou rses o f t h e f i r s t type, p u b l i c h e a l t h d e n t i s t s a c q u i r e o n l y a genera l e d u c a t i o n i n p u b l i c h e a l t h , w h i l e i n t h e second, they r e c e i v e bas i c p u b l i c h e a l t h t r a i n i n g and a s p e c i f i c educa t ion i n den- t a l h e a l t h t r a i n i n g . As a consequence, t h e f i r s t group i s t r a i n e d u n i l a t e r a l l y and t h e second b i l a t e r a l l y . I n t h e l a t t e r group, i n ad- d i t i o n t o t h e s p e c i f i c p u b l i c h e a l t h t r a i n i n g , t h e d e n t i s t has an op- p o r t u n i t y t o a c q u i r e c a p a c i t y f o r i n t e r p r e t i n g t h e d e n t a l problems: w i t h e x a c t i t u d e f rom t h e genera l p u b l i c h e a l t h t r a i n i n g , he r e c e i v e d t h e necessary b a s i s f o r i n t e g r a t i n g t h e d e n t a l program i n t o t h e t o t a l program o f pub1 i c hea l th .
We a r e go ing t o d i s c u s s t h e second type, s p e c i f i c a l l y t h e program o f t h e Faculdade de H i g i e n e e Saude P u b l i c a da U n i v e r s i d a d e o f Sao Paulo, B r a z i l . T h i s course was e s t a b l i s h e d on t h e b a s i s of analyses, obse rva t i ons and suggest ions presented t o us i n a r e p o r t by t h e Denta l Consul tant o f t h e Pan American Heal th Organizat ion, Mar io W. Chaves,' q 2
a f t e r a s tudy o f t h e p u b l i c d e n t a l h e a l t h problem i n L a t i n America.