This series of four papers reports and interprets the findings of the Adult Dental Health Survey (ADHS), 2009, published in early 2011. This is the fifth in a series of surveys repeated every decade since 1968. The evolution of the surveys and the way the supporting methodology has changed to meet the changing needs and circumstances over the last 40 years is described. In 1968, 37% of adults in England and Wales were edentate. By 2009, only 6% of the combined population of England, Wales and Northern Ireland were edentate. Among the dentate in 1968, there were a mean of 21.9 teeth. By 2009, not only had the dentate increased by 30 percentage points as a fraction of the population, but the number of teeth in this group had also increased by nearly four teeth on average to 25.7. There were significant variations in oral health according to geography and social variables and smaller differences according to sex. The retention of 21 or more teeth is widely used as a way of defining a minimum functional dentition. The proportion of adults with 21+ teeth increased from 73% in 1978 to 86% in 2009. Further huge improvements are projected as younger generations age, assuming future tooth loss continues at current low rates. We might expect that over 90% of those aged 35-44 in 2009 have a realistic prospect of retaining a functional natural dentition of 21 or more teeth by age 80.
This paper confines itself to the description of the profile of a general dentist while outlining where the boundary between specialist and generalist may lie. The profile must reflect the need to recognize that oral health is part of general health. The epidemiological trends and disease variation of a country should inform the profile of the dentist. A particular tension between the provision of oral healthcare in publicly funded and private services may result in dentists practicing dentistry in different ways. However, the curriculum should equip the practitioner for either scenario. A dentist should work to standards appropriate to the needs of the individual and the population within the country’s legal and ethical framework. He/she should have communication skills appropriate to ascertain the patient’s beliefs and values. A dentist should work within the principles of equity and diversity and have the knowledge and clinical competence for independent general practice, including knowledge of health promotion and prevention. He/she should participate in life‐long learning, which should result in a reflective practitioner whose clinical skills reflect the current evidence base, scientific breakthroughs and needs of their patients. Within the 4–5 years of a dental degree it is not possible for a student to achieve proficiency in all areas of dentistry. He/she needs to have the ability to know their own limitations and to access appropriate specialist advice for their patients while taking responsibility for the oral healthcare they provide. The dentist has the role of leader of the oral health team and, in this capacity; he/she is responsible for diagnosis, treatment planning and the quality control of the oral treatment. The dental student on graduation must therefore understand the principles and techniques which enable the dentist to act in this role. He/she should have the abilities to communicate, delegate and collaborate both within the dental team and with other health professionals, to the benefit of the patient. The profile of a dentist should encompass the points raised but will also be based upon competency lists which are published by a variety of countries and organizations. It is important that these lists are dynamic so that they are able to change in light of new evidence and technologies.
This study investigated the disposal of clinical waste within dental surgeries in Bangkok, Thailand and followed the waste trail to the rubbish tips. A questionnaire was sent to all dental practices in the Bangkok Metropolitan Area. The response rate was 57.7 per cent. At the same time, rubbish collectors and scavengers were interviewed to see if they encountered clinical dental waste. Few dentists complied with all recommendations for the disposal of waste. Most waste was disposed of into the domestic rubbish stream. Rubbish collectors and scavengers knew what dental rubbish looked like and some had had needle-stick injuries. Although recommendations can be made to the dental profession to alter their behaviour, real improvement is unlikely without changes to legislation and social policy.
Preschool children are difficult to access for community trials. Dental examinations and sealant placement were acceptable to the majority of families who were seen.
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