UnitEighteenNote:Pleasepayattentiontotheunderlinedwordsorphrasesinadditiontothebluewords.ORALHEALTHFORALLTHROUGHALTERNATIVEORALHEALTHCARESYSTEMSThepreventionandcontrolofdentalcariesinindustrializedcountrieshavebeenduemainlytouseoffluoridesinmanydifferentwaysand(othewidespreadadoptionofeffectiveoralhygienehabits.Inspileofthesesuccessesthediseaseisnotconqueredinallcoinmunities.Itmightstillbecalledaneglectedepidemicinunder-privilegedandlow-incomegroups.Therearemanyhigh-riskpopulationsintheUSA:97%ofthehomelessneedoralcare,blackchildrenhave65%moreuntreateddecaythantheaveragecitizen,lowincome91%andAmericanNatives265%.Morethan50%ofthehouseboundelderlyhavenotseenadentistfor10years.Traditionalsystemsfororalcarearcbasedonvariouscombinationsofpublicsalariedservicesandprivatepractice.Thepublicservicesareusuallyresponsibleforprevention,careofschoolchildrenanddisadvantagedgroups;andprivatepractitionersprovideawiderangeoftreatment(othegeneralpublic.Allthesesystemsareoriemedinsuchawaythatthedentistprovidesmostofthecare.IntheUSA:84%of17yearoldshavehadtoothdecayandanaverageof11toothsurfacesisdamaged.Peopleaged40to44haveanaverageof30toothsurfacesaffectedbydecay.41%ofpeopleaged65oroverhaveno(ee(halall.Indevelopingcountries,thelevelofdentalcarieswasrarelyashighasinindustrializedcountriesand,insome,successfulpreventiveactivitieshavebeenimplemented.However,inmanythereisstillthethreatofincreasingcariesrelatedtochangingdietandlifestyles.CommonoraldiseaseindevelopingcountriesTheburdenofdemandfortreatmentonlyofseverecariesorperiodontaldiseasecanbeestimated.Inaboutonethirdofthesepopulations,about1350millionpeoplewillrequirepainrelieftreatment(extractions)3timesintheirlives.Abouttwo-thirdsor2400millionpeoplewillneed5ormoreextractions.Howeverinmanycommunitiesthesesystemsdonotmeeteventhebasicneedsofthepublic.Mostpublicserviceshaveonlyverylowcoverage;communitiesinlow-incomeruralandurbanareascannotaffordprivateoralcare.Further,developingcountriescannotaffordtoestablish,staffandruneducationfacilitiesfordentists;orhopetoprovideadequateemploymentopportunitiesfordentiststrainedabroad.Inallcountrieseconomicrestraints,changesindemandfororalhealthcare,politicalpressurestoextendservicestounderprivilegedgroug,concernaboutquality,costsandeffectivenessofcaredemandthatalternativewaysoforganizingoralhealthandcareareexaminedandimplemented.Costandlackofaccessforunder-privilegedandlow-incomegroupsconstrainalloralhealthcaresystems.Whatactionscanbetaken(ocombatthisneglect,breakdownthebarriersofcostandimproveaccesstooralhealthandcare?Alternativeoralcaresystemsneedtobedevelopedmthatamaximumnumberofpeoplecanhaveaccesstoandcanaffordoralhealthandcare.Severalrecentadvancesgivegreatscopeforthetransformationofthedeliveryandqualityoforalcare.Theseare:Neweducationaltechnologiesthatmakelearning-bothknowledgeandskills-simplerandfasterforalltypesofpersonnel;Simplifiedandlogicaldesignoforalclinicsthatimprovetheworkplaceandsubstantiallyreducecaiialcostsofequipmentandneedformaintenance;Bettermaterialsthatareeasierandsimplertouse.Usingthesetechnologicaladvances3typesofcarecanbedefined:Rathersimple,verycosleffeclive.Moderateleveltechnologythatisratherexpensive,andHightechnology,oftenextremelyexpensive.Arational,healthpromotingandaffordablemixofcaremustbeplannedandimplementedinallcountries.Firstlevelcareincludes:Pronhylaxis,removalofcalculus,applicationofsealant,restorationofsinglesurfacecariescavitiesAsaconsequenceofimprovingoralhealthinmostindustrializedcountriestheneedformoderatelyconmlexcareisdecreasing.Withfurtheremphasisonprevention,needanddemandforfirstlevelinterventionswillincreaseslightly;whiletheneedforhightechnologycarewillprobablyincreaseforseveraldecadesduetothedesiretopreservenaturalteethandtheincreasingnumbersofelderlypeople,whohavesomenaturalteeth.Firstlevel,mainlynon-intervemivecarewillcontinuetobe(hemajorneedinmostdevelopingcountries.Thistypeofcarecannowbeprovidebyspeciallytrainedhealthcenterpersonnel,ratherthanbythetraditionaldentistorauxiliaryworker.Inthosedevelopingcountrieswherecariesisincreasing,arisingdemandformoderatetechnologycarewillcontinueoverthenextfewdecades.Arathersmallneedforhightechnologycare-mainlyrelatedtorepairoftraumaandreconstructionafterseverepathology-willremainandwilleventuallyincrease.Moderatelyconmlexcareincludesmultiplesurfacerestorations,removalprosthesesandextractions.Complexoralcareincludesprecisionprosthetics,implantsorthodontics,complexsurgeryandoralmedicine.Inallcountriespreventionandcontrolcarecanminimizetheneedforintervention.Inanysociety,hightechnologycanonlybeaffordedinlimitedamounts.Itmustbeofgoodqualityandappropriate.AlternativesystemsinindustrializedcountriesIncreasingaccesstobasicoralcareFirstlevel,mainlynon-invasiveinterventionshavebeenpreparedandarebeingtestedaspartoftheworkofcommunityhealthclinicsforminoritygroupsandlow-incomeinnercityandruralcommunities.Theelderlyandgroupswithspecialneedswouldalsobenefitfromout-reachactivitie