FDI Vision 2020: shaping the future of oral health - FDI World ...
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International Dental Journal 2012; 62: 278–291
ORIGINAL ARTICLE
doi: 10.1111/idj.12009
FDI Vision 2020: shaping the future of oral health
Michael Glick1, Orlando Monteiro da Silva2, Gerhard K. Seeberger3, Tao Xu4, Gilberto
Pucca5, David M. Williams6, Steve Kess7, Jean-Luc Eisele2 and Tania Severin2*
1
School of Dental Medicine, University at Buffalo, Buffalo, NY, USA; 2FDI World Dental Federation, Geneva, Switzerland; 3University of
Cagliari Dental School, Cagliari, Italy; 4Peking University School of Stomatology, Beijing, China; 5Oral Health Department, Brazilian Ministry
of Health, Brasilia, Brazil; 6Bart’s and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK;
7
Henry Schein, Inc., Melville, NY, USA.
working document, to drive forward the future priori-
PREFACE
ties of FDI in accordance with the mission of ‘Leading
The initial idea for this document came to light in the the World to Optimal Health’; and further, that FDI
aftermath of the FDI General Assembly in Mexico in believes that only the dentist is the competent and
the autumn of 2011, when it was observed that, at responsible leader of the dental team. In this regard,
the present time, the dental profession is lacking an FDI underlines the principle: ‘Delegation – yes, substi-
overarching long-term vision of the main challenges tution – no”.
oral health is facing and direction as to how the pro- The present document is therefore the result of a
fession can grow in order to make a significant contri- wide consultation process and reflects priorities which
bution to the improvement of global oral health we hope are valid in various countries, regions and
during the next decade. As a first step, the concept of settings.
this document was informally discussed within the For the sake of clarity, let us briefly delineate what
FDI leadership. Shortly after, a task team was nomi- this document is, and what it is not. It is, as its name
nated under the name FDI Vision 2020. Great care says, a Vision, which paves the way for a new model
was taken to ensure balanced representation from of oral health care led by dentists in collaboration
Academia, Research, Education, General Dentistry, with a wide range of other stakeholders. It roughly
Government and Industry in order to foster an overall sketches the possible look of oral healthcare by the
view of all the issues discussed. year 2020 if we tackle the challenges and seize the
Under the chairmanship of Prof Michael Glick, the opportunities that arise in a timely and adequate man-
FDI Vision 2020 Task Team was given the mandate ner. As a Vision, this document is meant to be aspira-
to identify the main challenges and opportunities oral tional and inspirational; it is NOT meant to be
health and its workforce are facing today, with a spe- operational. It provides avenues which will need to be
cific focus on issues with a legislative, regulatory or further explored and discussed, but, intentionally, it
advocacy dimension. In an inclusive and iterative pro- does not provide any specific strategies, tactical
cess, all FDI member associations were invited to approaches, implementation tools or ready-to-use for-
nominate an official representative to provide input mulae, as those will depend largely on local needs and
and comments on the task team’s groundwork. Fur- circumstances in the spirit of the United Nations
ther comments and feedback were collected from FDI Development Programme’s report: ‘Think globally act
leadership, through its committees, and from a panel locally’. This document is the beginning of a continu-
of industry leaders. The task team met twice, resulting ous process aimed at generating discussion and collab-
in two rounds of consultation. The draft Vision was oration between FDI and all its partners.
then circulated to all FDI committees and member
associations for feedback and finally presented to FDI
EXECUTIVE SUMMARY
General Assembly.
The FDI General Assembly during its meeting in Oral health is an essential component of good health,
Hong Kong on August 31st, 2012, adopted the follow- and good oral health is a fundamental human right.
ing resolution: ‘It is resolved that FDI General Assem- The role of the dental profession is to help the popu-
bly support the objectives of Vision 2020 as a lation and decision makers to achieve health through
278 © 2012 FDI World Dental FederationShaping the future of oral health
good oral health. FDI and its member associations tions, perhaps because poor oral health primarily
need to be in the forefront to identify challenges and affects morbidity rather than mortality. In recent
opportunities and advocate for the benefit of our years, however, there has been a growing realization
patients, our profession and our governments. that oral health constitutes an integral part of overall
Among those demanding appropriate and timely health, and a very positive move has been observed
consideration and action, we can enumerate persisting towards the inclusion of oral health into general
oral health inequalities; lack of access to oral health- health strategies. This movement was initiated with
care; unaffordability of dental treatment in many the US Surgeon General’s report in 2000. It was taken
places; a growing and ageing population; workforce up by WHO in 2002, when the policy of its Global
migration; dental tourism; the emergence of new edu- Oral Health Programme emphasized that oral health
cational models; the evolving distribution of tasks is integral and essential to general health and a deter-
between members of the oral healthcare workforce; minant factor in quality of life. More recently a
ongoing legislative actions targeting hazardous materi- WHO resolution called for oral health to be inte-
als; and the increasing use of information and com- grated into chronic disease prevention programmes.
munication technologies in all segments of our lives
and professions. These, we believe, are two sides of
The dawn of new area
the same coin and can be looked at as either over-
whelming and threatening challenges or unique oppor- Building on this momentum, we believe that the time
tunities to reshape our profession to better equip our is now right for developing a new model for oral
workforce for the future, while the fully trained den- health care, which considers oral health as an integral
tists, as leaders of the dental team, retain full respon- part of general health and addresses the needs and
sibility for diagnosis, treatment planning and demands of the public and the right of each individual
treatment. to good oral health. We believe that, by shifting the
focus of our model from (i) a traditionally curative,
mostly pathogenic model to a more salutogenic
A heavy disease burden
approach, which concentrates on prevention and pro-
Historically, the approach to oral health has focused motion of good oral health and (ii) from a rather
overwhelmingly on treatment rather than on disease exclusive to a more inclusive approach, which takes
prevention and oral health promotion. This approach into consideration all the stakeholders who can partic-
has, however, limitations. Globally, the burden of oral ipate in improving the oral health of the public, we
diseases remains high and the traditional curative will be able to position our profession at the forefront
model of oral health care is proving too costly, in of a global movement towards optimised health
terms of both human and financial resources, to through good oral health. Furthermore, we will be
remain viable in the light of the increasing demand. much better equipped to address the burgeoning
Worldwide, oral disease is the fourth most expensive demand of governments and non-governmental orga-
disease to treat; dental caries affects most adults and nizations (NGOs) for constructive solutions to reduce
60–90% of schoolchildren, leading to millions of lost social inequalities in oral health and to assist the pub-
school days each year, and it remains one of the most lic in achieving health through good oral health. In
common chronic diseases; periodontitis is a major short, we will be able to play a leading role in bring-
cause of tooth loss in adults globally, and oral cancer ing oral health to the forefront. To bring our Vision
is the eighth most common cancer and most costly to life, we have defined five areas of priority as cor-
cancer to treat. With oral infection has been associ- nerstones of a new, responsive and fair model:
ated with issues ranging from pre-term birth and low 1 Meet the increasing need and demand for oral
birth weight to heart diseases, it is now established healthcare.
that poor oral health may be an important contribut- 2 Expand the role of existing oral healthcare profes-
ing factor of several preventable diseases. In addition, sionals.
stark inequalities of access to oral healthcare subsist. 3 Shape a responsive educational model.
One of the main reasons for this is that too little 4 Mitigate the impacts of socio-economic dynamics.
attention has so far been paid to the social determi- 5 Foster fundamental and translational research and
nants of oral health. technology.
Political agendas Meet the increasing need and demand for oral
healthcare
For decades, oral health has failed to be considered as
an issue worthy of being moved to the top of the Oral health is a basic human right and its contribu-
agendas of governments and international organiza- tion is fundamental to a good quality of life. There
© 2012 FDI World Dental Federation 279Glick et al.
are, however, persistent stark inequalities of access to interprofessional education and interprofessional prac-
proper oral healthcare. These might be due to differ- tice. A further opportunity for us to embrace is in the
ent reasons: an unequal geographical distribution of field of advocacy for global standards of competence
qualified professionals worldwide, but also within to educate and train an oral health workforce up to the
countries; the unaffordability of treatments for some task of optimizing its community’s oral health.
segments of the population; lack of utilization of
existing oral healthcare offerings; or a mismatch
Mitigate the impacts of socio-economic dynamics
between the offer in oral health care and the real
needs of the population. Fluctuations in socio-economic circumstances have a
Improving oral health literacy of the public, optimis- significant impact on oral healthcare resources and
ing overall workforce planning, providing adequate policies. In times of economic hardship, resources
resources for education and training, devising effective tend to be drawn from oral healthcare and redirected
workforce retention strategies in underserved areas, and towards areas and diseases where lack of treatment
scrutinising the effectiveness and appropriateness of dif- leads to faster and more visible consequences, nota-
ferent workforce models are challenges and opportuni- bly mortality. Furthermore, patients tend to delay
ties which need to be addressed to meet a current unmet consultation and treatment during economic down-
needs and growing demands in coming years. turns. Conversely, economic upturns tend to foster
an increase in demand that must be met. To ensure
the sustainability of oral healthcare delivery and of
Expand the role of existing oral healthcare
our profession through economic ups and downs, the
professionals
responsibilities we need to take on in the coming
As highlighted in the recent United Nations Political years include advocating for oral health in all poli-
Declaration, there is now broad recognition that oral cies.
health shares the same social determinants and risk fac- Furthermore, evidence-based oral healthcare mod-
tors with other Non-Communicable Diseases (NCDs). els, which bring fairness in remuneration for care
This means that oral health cannot be dealt with in iso- that delivers beneficial and measurable health out-
lation from other health issues. Furthermore, the emer- comes, must be developed. Finally, the capacity to
gence of a new type of oral health workers provides an contribute to ensuring that the public is able to
opportunity to reshape and expand the role of existing access and utilize oral healthcare services at all
oral healthcare professionals. times, must be addressed.
The profession has a unique opportunity to actively
participate in efforts to improve patients’ overall
Foster fundamental and translational research and
health by taking on new tasks such as screening for
technology
and monitoring of non-communicable diseases
(NCDs) (e.g. glycemic control), playing a leading role At present, the field of oral health is experiencing sub-
in patient education and disease prevention, and guid- stantial difficulties in disseminating and implementing
ing and supervising teams of oral healthcare workers. research findings and technological innovations in a
A stronger integration of dentists into the overall timely fashion into daily practice. There is therefore
health system will reinforce the recognition of their an opportunity to develop a consensus and science-
clinical competence and provide for an expanded based approach to oral healthcare. A proactive and
leadership role towards health workforce team mem- innovative use of available dental technology and
bers working under a dentist’s direction and advice. materials could be encouraged. Links could be facili-
tated between ongoing changes in types of oral health-
care deliverables and ongoing research efforts. E-
Shape a responsive educational model
Health technologies (E-Health means the ‘application
Current traditional models of dental education have of internet and other related technologies in the
not yet been able to address adequately disparities in healthcare industry to improve the access, efficiency,
oral health. Moreover there is a growing disconnect effectiveness and quality of clinical and business pro-
between dental and medical education, despite oral cesses utilized by healthcare organizations, practitio-
health now being widely recognized as an important ners, patients and consumers to improve the health
part of general health. To better equip members of the status of patients’) can be used to foster communica-
oral healthcare workforce for the challenges ahead ave- tion between members of the health team and speed-
nues worthy of investigation include revising educa- up processes. By seizing these various opportunities,
tional curricula to take account of a stronger focus on oral healthcare professionals will be able to foster fun-
public health and epidemiology, as well as placing damental and translational research and technology in
more emphasis on critical thinking, team management, the next decade.
280 © 2012 FDI World Dental FederationShaping the future of oral health
The way forward: oral health in all policies on quality of life and well-being, as well as signifi-
cant economic impacts. Root causes of oral disease
The relevance of oral health is not about to fade
are varied but relate predominantly to persistent
despite a significant proportion of oral diseases being
inequities in access to oral healthcare. Although
preventable. Each of the five areas of priority identi-
there are more than a million practicing dentists
fied in this document contributes towards shaping a
worldwide, their unequal geographic distribution
new model of oral healthcare which seeks to be
results in an over-supply in some wealthy urban
inclusive, participative, adaptive and effective. Its
areas, which starkly contrasts with a critical short-
focus on oral health promotion and oral disease pre-
age in many of the world’s poorer and remote
vention reflects trends observed in other areas of
areas. Globally, roughly only 60% of the population
healthcare and priorities set by international agen-
worldwide enjoys access to proper oral healthcare,
cies. It is now up to dentists to reach constructive
with coverage ranging from 21.2% in Burkina Faso
solutions to respond to these trends and needs. This
to 94.3% in Slovakia. Between countries, the den-
is a unique opportunity for members of the profes-
sity of qualified dentists varies from one dentist per
sion to become true leaders and role models. In line
560 people in Croatia to one dentist per 1,278,446
with the principles of the Adelaide Statement on
people in Ethiopia; and distribution within countries
Health, we strongly advocate for the inclusion of
also strongly varies. Reflecting a strong social gradi-
Oral Health in All Policies; and for the engagement
ent, wealthier adults in almost any given country
of oral healthcare professionals with leaders and pol-
enjoy a higher coverage compared with those less
icy-makers at all levels of government and NGOs, i.
wealthy.
e. local, regional, national and global. The emphasis
Increased globalization, which facilitates the
is on the fact that government objectives are best
migration of dentists to more affluent areas or
achieved when all sectors include health and well-
countries, is also a source of concern as it can lead
being as key components of policy development. We
to domestic shortages. For instance, in the UK 22%
believe that this advocacy will help to increase oral
of dentists are foreign-born, while the Philippines is
health literacy and awareness among the public,
current world leader in dental workforce export
thereby supporting a community-driven demand to
with two-thirds of its dental graduates migrating to
governments for better access to oral healthcare ser-
the USA.
vices. In conclusion, we have a significant role as
Already in 2006, The World Health Report 2006:
health advocates: it involves educating and influenc-
working together for health, recognized that insuffi-
ing decision makers, including senior government
cient numbers of appropriately trained health workers
officials, national and international agencies, commu-
represented a significant threat to achieving the
nity leaders and the public. Should our profession
health-related Millennium Development Goals
shirk its responsibility of taking the lead other par-
(MDGs) and the issue therefore would need urgent
ties lacking the necessary professional knowledge and
attention.
expertise in dentistry are likely to step in to take it
Furthermore, with more than one billion of the
on our behalf in the years ahead.
world’s population living on one dollar a day or less,
the affordability of oral care for the world’s poor
poses a serious problem even within a geographic area
MEET THE INCREASING NEED AND DEMAND FOR
where dentists are available.
ORAL HEALTHCARE
Lastly, there is a serious need for awareness-build-
ing of the necessity of preventive oral health care and
Where we are now
‘self health’ among underserved and at-risk popula-
All over the world, population growth and ageing tions, requiring health literacy on a culturally compe-
have led to an increasing need for oral healthcare. tent basis.
Furthermore, a gradual increase in awareness as
well as mass media exposure to ‘perfect smiles’ have
The way forward
led to an increased demand for high quality oral
health. At present, neither the need nor demand is The current shortage and unequal geographic distribu-
fully met on a global level, despite the fact that tion of qualified oral healthcare professionals, which
oral health is a basic right and its contribution is tends to affect poorer countries and regions more than
fundamental to a good quality of life and overall wealthier ones, remote areas more than urban ones,
health. combined with challenges in terms of globalization,
Oral diseases, despite many of them being pre- migration and ageing, calls for firm and targeted
ventable, represent the most common diseases actions and gives rise to a series of opportunities our
worldwide. Poor oral health has a profound impact profession must now seize.
© 2012 FDI World Dental Federation 281Glick et al.
First, we believe there is a significant opportunity retaining full responsibility for diagnosis, treatment
for our profession to take on a leadership role in planning and treatment.
tackling the social determinants of oral health and
in generating constructive solutions with regard to
Our Vision is that by 2020, inequities with regard to access
the problem of the current unmet need and demand
to oral healthcare will be substantially reduced and the
for oral healthcare. Taking on a leadership role
global need and demand for oral healthcare more largely
means, for us as a profession, to work together to
will be met thanks to increased oral health literacy, the
raise awareness at all levels; to identify suitable
development of rational workforce planning, education,
solutions to achieve equity in oral health; and to
training and retention strategies, and an improved
advocate their implementation at local, regional,
collaboration between members of the health workforce
national and international levels. Persistent inequities
on issues pertaining to oral health promotion, disease
in access to oral healthcare and the unmet need and
prevention and treatment.
demand for oral healthcare services have different
root causes that will need to be addressed. One of
our first efforts should be to promote advocacy
Summary
aimed at improving the oral health literacy of the
public. This represents a first and crucial step
Status
in helping communities realize their right to oral
health by increasing their ability to adopt healthy • Lack of oral health care professionals results in
oral health behaviours and demand care when increased demand for appropriately trained profes-
needed. sionals.
Second, we believe there is a role for us in advocat- • Uneven geographic distribution of oral health care
ing for increased resources to be allocated for educa- professionals worldwide but also within individual
tion and training of dentists and of the oral health countries.
team. This goes hand-in-hand with a call to authori- • Need for enhanced oral health literacy.
ties and administrations to optimize health profes- • Lack of access to oral health care among vulnerable
sional workforce planning and provide a sustainable and poor populations.
economic environment to educate, train and retain
sufficient numbers of oral healthcare workers to work
Opportunities
in the places and settings where a need has been iden-
tified. • Play a leading role and generate constructive solu-
Finally, acknowledging the fact that the prevalence tions for tackling the social determinants of oral
of trained dentists, the composition of the oral health and the problem of the unmet need and
healthcare team, and the educational pathways to demand for oral healthcare.
becoming an oral healthcare worker vary widely • Advocate for:
depending on local circumstances, we believe that – improved oral health literacy.
there is a crucial role for our profession in leading – increased resources for education and training
and participating in efforts with multiple stakehold- of dentists and the oral health care team.
ers and to examine the effectiveness and appropriate- – an optimized health professional workforce
ness of oral health workforce models in different planning.
geographical settings. This represents a unique – a sustainable economic environment to educate,
opportunity for our profession to define the roles train and retain dentists in areas of need.
and responsibilities of the oral healthcare workforce, • Participate in and lead efforts with multiple stake-
while considering specific local needs, resources and holders to
desired outcomes. This is also an opportunity to – examine the effectiveness and appropriateness
spearhead the development and implementation of of oral health workforce models in different
oral health education for all different members of geographical areas;
the health care workforce team with appropriate – define the roles and responsibilities of the health
structured formal education within approved educa- care workforce based on
tional institutions. We can shape a new model of – appropriate and approved formal structured
oral healthcare delivery which relies on a team-based education and training which is
collaborative approach where fully trained dentists – aimed at delivering a health care workforce to
take responsibility for supervising a team, provide achieve a desired outcome, whilst
sufficient training to the healthcare workforce and – taking into consideration local needs and
delegate specific tasks as deemed appropriate while resources.
282 © 2012 FDI World Dental FederationShaping the future of oral health
– spearhead the development and implementation that: ‘Renal, oral and eye diseases pose a major health
of oral health education of the health care work- burden for many countries and that these diseases share
force. common risk factors and can benefit from common
responses to non- communicable diseases’. As docu-
mented in its NCD Advocacy Guide, FDI has been at
EXPAND THE ROLE OF EXISTING ORAL
the forefront of this initiative.
HEALTHCARE PROFESSIONALS
Where we are now The way forward
The traditional role of dentists is facing new chal- The increasing recognition that oral health plays a
lenges from increasing and evolving needs of patients, pivotal role in general health and quality of life repre-
advances in technology, economic constraints in vari- sents, for our profession, a set of unique opportunities
ous parts of the world, as well as ongoing debates to play a central and leading role in patient education
about the distribution of tasks and responsibilities and disease prevention; to strengthen our integration
between different workers involved in the provision of into the overall health system; to reinforce the recog-
oral healthcare. In addition, associations between oral nition of our clinical competence; and to shoulder an
health and communicable diseases, maternal and child expanded leadership role towards health workers
health and NCD call for a shift in the focus of our under our direction and advice.
profession. At present, more than 60% of deaths First, as stated in FDI’s Guide to Advocacy, because
worldwide are due to NCDs, which kill 36 million of the shared risk factors with other NCDs, we
people each year. Low- and middle-income countries believe we can play a central role by sharing our
are disproportionately affected and, in 2010, 80% of experience in prevention and by actively contributing
NCD deaths occurred in those countries, highlighting to early NCD diagnosis, screening and monitoring.
once again the importance of tackling the social deter- Through regular access to ‘healthy’ or at least ‘asymp-
minants driving the NCD epidemic. tomatic’ patients during check-ups, dentists are in a
According to the World Economic Forum, the global unique position to raise awareness of risk behaviour
economic impact of the five major NCDs – cardiovas- and thereby increase prevention, but also to screen,
cular disease (CVD), chronic respiratory disease, can- monitor and evaluate patients for conditions such as
cer, diabetes and mental ill-health – could amount to a CVD or diabetes and refer them to their physicians
total of 47 trillion US dollars over the next 20 years. for further action. As an active partner of worldwide
This represents approximately 4% of annual global health- check-programmes, oral health professionals
GDP. In recent years, there has been a growing realiza- can contribute to the cost-effectiveness and feasibility
tion that oral health is an integral part of overall health. of primary and secondary prevention.
In addition, there are associations between oral disease Second, as scientifically valid oral fluid-based
and major NCDs, the two share common risk factors diagnostic tools become available, there is an oppor-
and there are indications that oral disease in itself rep- tunity for us to take on a leadership role in health
resents a risk factor for NCDs. Altogether, connections screening and surveillance based on these new
between systemic disease and oral manifestations have techniques. Implementing such cost-effective and
been identified in over 100 diseases, such as diabetes, non- invasive tests into our daily practice, and refer-
cardiovascular diseases, respiratory infections, cancer ring patients to a physician for appropriate care,
or nutritional problems. This growing realization led treatment and follow-up whenever necessary, will
the WHO to re-orient its Global Oral Health Pro- allow our profession to reinforce the recognition of
gramme in 2002 in order to foster its integration with its clinical competence and integration in the general
chronic disease prevention and general health promo- healthcare system. This calls for a proactive, positive
tion. Five years later, in 2007, the World Health and affirmative collaboration with colleagues from the
Assembly’s resolution on ‘Oral health: action plan for medical arena, which will reflect the reality of our
promotion and integrated disease prevention’ urged medical role and relevance, and will enhance our cred-
Member States to adopt measures ‘to ensure that oral ibility as professionals.
health is incorporated as appropriate into policies for Third, as the composition of the oral health work-
the integrated prevention and treatment of chronic force team evolves and encompasses workers with dif-
non-communicable and communicable diseases, and ferent backgrounds, knowledge, skills and
into maternal and child health policies’. In September competencies (dental assistants, dental hygienists, den-
2011, this reorientation culminated in a High-level tal therapists, dental technicians, but also primary
Meeting of the General Assembly of the United Nations care workers, community nurses, or even educators
on the Prevention and Control of Non-communicable and teachers), there is a need for our profession to
Diseases, whose final statement expressly recognizes shoulder an expanded leadership role towards health
© 2012 FDI World Dental Federation 283Glick et al.
practitioners working in oral health under our direc- these common determinants by using the common
tion and advice. As stated previously, we strongly risk factor approach.
value a team-based collaborative approach where fully • Become highly specialized experts in prevention,
trained and skilled dentists remain the primary con- diagnostics, health consulting, biotechnology and
tact persons for all questions about oral health and functional rehabilitation with high technology.
take the exclusive responsibility for supervising and
leading a team of health workers. Such collaboration
SHAPE A RESPONSIVE EDUCATIONAL MODEL
and delegation of tasks can be particularly powerful
in the field of oral health promotion and prevention
Were we are now
strategies, where joining forces with primary care pro-
viders and teachers, as well as other members of the Dentistry emerged as a profession with its own system
community, can contribute to reduce lack of access to of education at the end of the 19th century. Since
care in areas of need and foster rapid dissemination of then, it has been increasingly separate from medical
targeted prevention and promotion messages. Such teaching in various parts of the World. In countries
collaboration may focus on achieving the objectives of such as North and South America, Northern and
the MDGs. We strongly insist, however, that responsi- Western Europe, Japan, India and Australia, dental
bility for diagnosis, treatment planning and rehabilita- education is recognized as an autonomous discipline
tion and treatment plans must always remain in the according to the so-called ‘odontology model’ or ‘den-
hands of the dentists in order to ensure optimum tal medicine model’. In contrast, the stomatology
safety and care for patients. model, which considers dentistry as a specialty of
medicine, prevails in some other countries. Both mod-
els cover, with a different focus, theoretical and prac-
Our Vision is that, by 2020, oral health will be fully
tical training, including anatomy, physiology,
recognized and accepted as a crucial part of overall health
biochemistry, pathology, behavioural sciences and
and well-being. The credibility and relevance of our
dental materials science, as well as clinical skills.
profession will be enhanced thanks to our significant
However, dental education and training is often dis-
contribution to addressing major health issues, such as
proportionately focused on restorative care, neglecting
NCDs; our leadership role in prevention and promotion
oral health promotion, disease prevention and public
strategies; and our capacity to guide and supervise teams
health. Moreover, new knowledge and technologies
of health practitioners working together to improve oral
become available at an ever increasing pace, in areas
health, and thereby overall health, in our communities. In
ranging from connective tissue biophysics/mechanics,
a similar way that the oral cavity is the visible gateway to
tissue engineering, biotechnology and molecular engi-
the human body, our vision is that our profession will be
neering, to informatics and biomaterials, with the
an universally acknowledged, recognized and valued
potential to transform dental care. So far, however,
gateway to better health through improved oral health.
the integration of information related to new knowl-
edge and technologies into dental education has been
rather slow.
Summary From a statistical point of view, the current dispar-
ity in the number of dental schools and dental gradu-
Status
ates is enormous. The countries with the most dental
• Increased recognition that oral diseases share com- schools in 2006 were India (206), Brazil (191) and
mon risk factors with other NCDs. China (93), whilst many African countries such as
• Increased recognition that oral diseases cannot be Sudan, Tanzania or the Democratic Republic of
dealt with in isolation from other diseases. Congo, have just one, or no dental school. As a result,
• The role of dentists is changing due to the emer- while Brazil trained approximately 10,000 newly-
gence of different oral health workforce models. graduating dentists in 2008, all 46 WHO/AFRO
member states combined managed only to train 168
Opportunities new dentists in 2002. Many countries and regions
worldwide suffer from a critical shortage in the
• Become leaders of oral healthcare teams; Lead number of qualified oral health professionals (see
efforts in prevention and patient education. Section 1).
• Become an integral part of overall health and per- Globally, the burden of oral diseases remains high
form new tasks, such as screening and monitoring and the viability of the predominantly curative
of common risk factors for NCDs by for example approach to oral health care taught in universities is
oral fluid-based diagnostics. In addition, influence being challenged. Current traditional models of dental
284 © 2012 FDI World Dental FederationShaping the future of oral health
education have not yet been able to adequately Secondly, considering the need to address the social
address disparities in oral health. In addition, despite determinants of oral health, we believe there is a
the fact that oral health is now widely recognized as strong argument for reinforcing the public health
an important part of overall health, there is often a focus of dental education, with a view to widening
growing disconnection between dental education and the perspective of our students and graduates and
medical education. preparing them to become leaders in health promo-
tion and disease prevention efforts and strategies. We
also believe that supporting trans-professional educa-
The way forward
tion, in an effort to break professional silos, is of
There is a growing realization that leading the world paramount importance in order to bring an appropri-
to optimal oral health means addressing its underlying ate answer to WHO and UN calls for integrated dis-
social determinants. There is also an increased recog- ease prevention, in connection with NCDs in
nition of the fact that oral health is a crucial part of particular. Fostering greater collaboration between
overall health, and associations between oral disease dentists and physicians at an early stage will without
and major NCDs are increasingly acknowledged. a doubt help counter the growing disconnection
These factors, in conjunction with recent advances in between the two professional bodies and encourage
medical education theory and with the emergence of future closer collaboration for the ultimate benefit of
new educational models, call for a concerted action to the public.
revitalize and adapt our own educational models in Finally, we believe that providing standards of com-
order to ensure their responsiveness and adequacy petence to educate and train an oral health workforce
with regard to evolving trends and needs in oral capable of optimizing the oral health in their commu-
health and systemic health. nity is a further opportunity for us, as this implies for
In recent years, medical education has received a our profession to take responsibility not only for our
lot of attention, which led to the publication of vari- own education and training, but also for that of all
ous reports in countries like Canada, the UK and the health workers who participate in oral healthcare.
US. Beyond the acquisition of specific knowledge and
facts, these reports all focused on common generic
Our Vision is that by 2020, our newly minted graduates will
competencies such as patient-centred care, interdisci-
benefit from responsive, dynamic and modular curricula,
plinary teams, evidence-based practice, continuing
which contents reflect state-of-the art knowledge and
professional development, use of information tech-
technologies that can be used to provide optimal oral
nology, integration of public health and research
healthcare and, in addition, provide learners with extensive
skills, as well as the acquisition of competencies in
critical thinking and analytical skills training as a
policy, law, management and leadership. Acknowl-
foundation for a career based on life-long learning and
edging the exponential speed at which our society
continuing professional development. We further envision
evolves, and therefore the growing importance to
that a stronger focus on public health and inter-professional
learn how to learn, and how to find and interpret
education will greatly ease collaboration with medical
information rather than remember facts, the Educa-
professionals and hence strengthen the recognition of our
tion of Health Professionals for the 21st Century
profession as mentioned in Section 2. Similarly, taking on
report advocates a shift from informative learning to
the responsibility for the oral health education of health
transformative learning, with the purpose of teaching
workers will promote our profession into a position of
students ‘to learn how to learn’, to develop leader-
natural leadership, which will aptly highlight our relevance.
ship attributes and finally to produce ‘enlightened
change agents’.
First, even if their prime focus lies in medical educa-
tion, the outcomes of these reports also apply to a Summary
great extent to dental education. We believe investi-
gating these recommendations and adapting them in a Status
creative, innovative and inspired way into our own
curricular reforms will allow us to train and educate • Existing educational models have not adequately
addressed disparities in oral health.
graduates who will be much better equipped to deal
with the challenges they will face throughout their • Increasing gap between general medical education
and dental education. Lack of emphasis on public
career. Drawing inspiration from transformative
awareness with regard to the importance of preven-
learning techniques, focusing our attention on foster-
tion.
ing critical thinking among learners and providing
them with sufficient tools to become effective team • Need active involvement to show that our profes-
sion is critical for public health.
leaders are among the priorities we must consider.
© 2012 FDI World Dental Federation 285Glick et al.
Opportunities statistics where the average price of a routine
check-up amounts to 41 dollars, while the average
• Develop an educational system which focuses more
cost of emergency treatment with hospitalization
on public health issues and on the recognition of
sky-rockets to over 5,000 dollars. Furthermore,
oral health disparities.
given the increasingly recognized link between oral
• Include more emphasis on critical thinking, inter-
health and general health, decreased resources for
professional communication at an early stage and
oral health, including caries, periodontal disease,
throughout the professional career.
and oral cancer, may result in an increase in other
• Advocate education and training to the oral health
health concerns, such as heart disease and diabetes.
workforce, which can help optimize the oral health
Conversely, economic uptrends tend to foster an
of the community.
increase in demand for oral healthcare that must be
• Promote application the application of new technol-
met, implying the availability of an appropriately
ogy during the process of professional educational
trained workforce.
for both treatment and prevention.
• Educate the whole profession to be more active in
terms of their social responsibility to promote den- The way forward
tal public health rather than their mere passive
To guarantee the long-term sustainability of our
involvement.
profession throughout the ups and downs of the
• Advocate sufficient continuing professional develop-
economy and the public’s ability to access and
ment.
utilize oral healthcare services, we need to focus
• Encourage all dental educational institutions to
our attention on further integrating oral healthcare
include a ‘green dentistry’ dimension in the curricu-
into overall healthcare. We need to shift from
lum.
an insular perspective to one of integration and
collaboration.
To achieve this, we need to be at the forefront of
MITIGATE THE IMPACTS OF SOCIO-ECONOMIC
advocacy efforts to include Oral Health in All Policies
DYNAMICS
at all levels of governmental and non-governmental
agencies: local, regional, national and global. By
Were we are now
emphasizing that governmental objectives are best
According to WHO, oral disease is the fourth most achieved when all sectors include health and well-
expensive disease to treat worldwide. For example, being as key components of policy development, we
total expenditure for dental care in the United will be able to strengthen the position of oral health.
States was estimated at more than 100 billion dol- Furthermore, we believe that advocating Oral Health
lars in 2009, and the market for dental supplies in in All Policies will help increase oral health literacy
China alone is due to reach 3.1 billion dollars in and awareness among the public, thereby supporting
2012, with an 11% annual growth rate. In addition a community-driven demand of governments for bet-
to these direct costs, there are also indirect costs to ter access to oral healthcare services. Grassroots
consider, including lost productivity for individuals demand can be a powerful way of promoting our
suffering from oral disease. Oral diseases cause an stand and play a key role in shaping government
untold number of school and work hours to be lost agendas.
around the world. In terms of benefits, dentistry Second, it is our responsibility to develop evidence-
and the related oral healthcare industry generate, at based models of oral healthcare, which bring fairness
least in developed countries, significant contributions in remuneration for care that delivers beneficial and
to a country’s employment and economy as a measurable health outcomes. This, we believe, implies
whole. considering oral health promotion, a risk factor
Nevertheless, fluctuations in socio-economic cir- approach to disease prevention, and treatment as
cumstances have a strong impact on oral healthcare three equally important cornerstones of oral health-
resources and policies. In times of economic hard- care.
ship, resources tend to be drawn from oral health- Third, we believe there is a need to foster partner-
care and redirected to areas and diseases where lack ships between the private and public sector to address
of treatment leads to faster and more visible conse- the right to universal access to oral healthcare, irre-
quences, notably mortality. Patients who experience spective of individual financial situations. Taking this
deterioration in their financial situation during eco- into account, there is also a role for us to play in
nomic downturns tend to delay consultation and advocating the inclusion of oral care in corporate
treatment. This can, however, have disastrous finan- health insurance schemes and health promotion
cial consequences, as illustrated by Californian activities.
286 © 2012 FDI World Dental FederationShaping the future of oral health
The emphasis of oral disease management is over-
Our Vision is that, by 2020, collaboration and whelmingly directed at treatment in a clinical setting,
partnerships between the private and public sector will and this is reflected in the research that is undertaken.
have led to the inclusion of Oral Health in All Policies and By contrast, much less effort is directed at research
that new evidence-based models of oral healthcare will be into the effective prevention of oral disease at the
available to ensure fair and appropriate remuneration for population level; understanding the social determi-
care that delivers measurable health outcomes, thereby nants of oral health; and integrating oral healthcare
shifting the focus from a preliminarily procedure-based into wider programmes targeting a reduction in the
remuneration model to models which foster a holistic global burden of NCDs.
approach to oral healthcare and consider promotion, We currently live in an era characterized by a
prevention, and treatment as equally important. wealth of advances and discoveries in research and
technology. In dentistry, these are predominantly
directed toward connective tissue biophysics/mechan-
Summary ics; tissue engineering; biotechnology, including gene
therapy, and drug delivery, transport dynamics; and
Status molecular engineering (macromolecular structure, pro-
• Fluctuations in socio-economic circumstances have tein structure, and molecular therapies). Dental tech-
a significant impact on oral healthcare resources nologies are also evolving, especially with regard to
and policies. biomaterials and dental materials. The results of this
research effort mean that the outlook for patients
with advanced oral and dental disease has been revo-
Opportunities lutionized. However, it is recognized that practitioners
• Ensure integration of oral health into overall health use the knowledge, products and technologies they
policies. were exposed to during their education and training
• Develop an evidence-based model of oral health and tend to be less aware of innovations that become
care which brings fairness in remuneration for care available once they are established practitioners. As a
that delivers beneficial and measurable health out- consequence, there is a major gap in the timely imple-
comes. mentation of research findings and technological inno-
• Contribute to ensuring the ability to access and uti- vations into daily practice.
lize oral health care. The dental profession has been rightly proud of its
achievements in improving the world’s oral health, but
this has been accompanied by a relative isolation from
FOSTER FUNDAMENTAL AND TRANSLATIONAL
thinking in mainstream medicine and healthcare, and a
RESEARCH AND TECHNOLOGY
lack of awareness of wider environmental and political
issues that have implications for oral healthcare and
Were we are now
how it is practised. For example, environmental issues
Poor oral health remains a major issue in all countries are currently high on the agenda of national and inter-
– contributing significantly to the overall burden of national agencies, and international environmental pro-
disease and costs of healthcare - and major inequali- tection institutions are increasingly targeting dental
ties in oral health exist both within and between products and materials as hazardous. Although amal-
countries. This is despite the fact that most oral dis- gam waste discharge from dentistry is estimated to be
ease is readily preventable through simple and effec- responsible forGlick et al.
Further, information technology is increasingly and safety, we need to adopt a proactive approach. We
impacting the way we work, interact, communicate, need to develop a research agenda that will position us
inform ourselves and learn. There is therefore a great to effectively advocate measures to improve oral health
need to foster, as well as regulate and monitor, the and maintain patient safety in a timely and constructive
use of information and communication technology manner. This presents a unique opportunity for our
(ICT) in oral healthcare to ensure that the benefits it profession to take a leadership role in advocacy
can bring to society are realized. towards public authorities and our industry partners
for environmentally safe manufacturing standards in
dental industry and oral health care practice. It also
The way forward
presents an opportunity to integrate environmental
We believe that it is time for a concerted call to action considerations into our agenda and to be at the fore-
to ensure that oral health research priorities receive front of the development of policies and strategies that
sufficient attention and resources, and that research support effective and sustainable ‘green dentistry’ ini-
outcomes are widely and swiftly disseminated and tiatives, which emphasize the lifecycle approach.
implemented. The current significant delay in imple- Third, while it is crucial that we strongly encourage
menting research findings and technological innova- quality and innovative research, we also believe that
tions into prevention and practice is hampering the we need to encourage and foster a timely implementa-
achievement of improved oral health at a global level tion of research findings into daily practice. It is there-
and the reduction of oral health inequalities. We need fore our belief that stronger connections and
to be in a position to influence and work effectively iterations between research and daily practice need to
with agencies concerned with safety and compliance be developed. While there is traditionally a time lag
issues pertaining directly to oral health. We also need of several years between original research and its
to ensure that the drive to position oral health in the incorporation into common practice (estimated at an
wider context of general health is based on sound sci- average of 17 years in medicine), it is our conviction
entific evidence. that concerted educational and communication efforts
First, with regard to research, it is time to work can contribute to a significant reduction, for the bene-
with partner organizations to develop a science-based fit of patients. In order to facilitate two-way commu-
approach to oral healthcare, using agreed definitions nication between research and clinical practice, we
and methods for data collection and analysis. By strongly encourage all dental medicine faculties to
working cooperatively, there is also an opportunity to perform research- scientific, educational and social –
define a consensus research agenda and broad in order to cultivate a good understanding among all
research priorities. In this regard, we share the view oral health professionals of research mechanisms, and
of the International Association for Dental Research to enhance their life-long learning behaviour, skills
(IADR) that it is vital to emphasize the importance of and attitudes as well as widen their perspective.
multi-, inter- and trans-disciplinary research and Finally, access to ICT is spreading quickly on a
translational research, seeking input from a range of global scale. Because of the rapid spread of technol-
social scientists and health professionals. We need to ogy, E-Health is rapidly becoming a reality. Through
better understand the full range of oral health deter- E-Health, the potential to disseminate and collect
minants that include not only genetic, biological and targeted and accurate information quickly is very
environmental factors, but also the behavioural and high and there is a huge opportunity for oral health-
social determinants of health and well-being. This will care professionals to be at the forefront of an inno-
help us develop disease prevention strategies that are vative, rational and ethical use of new technologies.
based on upstream prevention rather than down- However, the use of E-Health technologies to dis-
stream treatment, and promote the integration of oral seminate and collect health-related information will
health into general health. This has particular rele- increasingly need to be carefully monitored in order to
vance with regard to NCDs, where our profession is prevent abuse, ensure the quality of the information pro-
in a strong position to work on a broad common vided and respect the confidentiality of patient data. We
research agenda and to advocate the allocation of believe that, properly controlled, E-Health will allow us to
additional resources and funding for oral health strengthen professional and inter-professional collabora-
research projects and priorities. It is crucial that the tion through tools such as electronic health records and
strategies to emerge from this research are capable of professional forums; improve access to oral healthcare ser-
local interpretation in a way that respects cultural sen- vices through telemedicine and telediagnosis; assist in dis-
sitivities and socio-economic constraints. seminating prevention and promotion messages through
Second, in view of the increasing importance of electronic media; and foster universal access to professional
external policies that examine dental technologies and education through online learning tools accessible from
materials and pass judgement on their sustainability anywhere to anyone with an internet access. These are all
288 © 2012 FDI World Dental FederationShaping the future of oral health
approaches that could have a major beneficial impact on • Information and Communication Technology is
oral health, but it is evident that considerable research is changing the way we work, learn, and communi-
needed if this is to be achieved in a properly regulated way. cate.
• International environmental protection institutions
Our Vision is that, by 2020, major improvements in oral are targeting dental products as hazardous materi-
health will have been achieved and inequalities will have als and may affect the future of the profession.
been reduced through research-led strategies for more
effective disease prevention, with the integration of oral Opportunities
health into healthcare in general. The credibility of our
profession will be reinforced thanks to a solid, balanced • Engage in a concerted call to action to ensure that
and forward-thinking research agenda, which will oral health research priorities receive sufficient
encompass broad common priorities. We believe that attention and resources, and that research outcomes
sustained educational and communication efforts will have are widely and swiftly disseminated and imple-
greatly improved the effective, rapid translation of mented.
research findings into daily practice. State-of-the art use • Work with partner organizations to develop a sci-
of E-Health technologies - and of mobile E-Health ence-based approach to oral healthcare, using
technology in particular - will have fostered a more agreed definitions and methods for data collection
collaborative approach to oral healthcare as well as an and analysis. By working cooperatively there is also
improved access to expert knowledge to all, in urban and an opportunity to define a consensus research
remote areas, in developed and developing countries alike. agenda and broad research priorities.
• Promote the integration of oral health into general
health. We will, through better understanding the
full range of oral health determinants - including
Summary genetic, biological and environmental factors, as
well as the behavioural and social determinants of
Status health and well-being - able to develop disease pre-
• Poor oral health remains a major issue in all coun- vention strategies based on upstream prevention
rather than downstream treatment.
tries and major inequalities in oral health exist both
within and between countries, despite the fact that • Develop effective oral healthcare strategies at a glo-
most oral disease is readily preventable through bal level capable of local interpretation, in a way
simple and effective means. that respects cultural sensitivities and socio-eco-
• There is insufficient effort directed at research into nomic constraints.
the effective prevention of oral disease at the popu- • Advocate an innovative and proactive use and
lation level; understanding the social determinants application of available dental technology and
of oral health; and integrating oral healthcare into materials.
wider programmes directed at reducing the global • Encourage all dental medicine faculties to perform
burden of NCDs. research, including scientific, educational and social
• The dental profession is relatively isolated from research.
thinking in mainstream medicine and healthcare, • Ensure a strong link between ongoing changes in
with a lack of awareness of wider environmental the type of oral healthcare deliverables and research
and political issues that have implications for oral efforts.
healthcare and how it is practised; • Develop policies and strategies to support effective
• In spite of advances in understanding the basic cel- and sustainable ‘green dentistry’ initiatives which
emphasize the lifecycle approach.
lular and molecular mechanisms of oral disease and
developing novel, effective treatments, there are • Advocate:
major gaps in implementing this research into day- – continuous development of international dental
to-day patient care and the time lag in implement- standards to enable appropriate levels of quality
ing research findings is too long. and safety in oral health care;
• There is a need to develop a science-based approach – environmentally safe manufacturing standards
to oral healthcare using agreed definitions and meth- in dental industry and oral health care practice;
ods for data collection and analysis, to ensure that – clean water and energy preservation practices
current research efforts are not fragmented. among oral health professionals;
• Technology evolves very quickly and its use in oral – a state-of-the-art use of Information and Com-
health needs to be monitored and regulated to munication Technology in all aspects of oral
ensure it benefits patients; healthcare and delivery.
© 2012 FDI World Dental Federation 289You can also read
