SOME ASPECTS OF ORAL HEALTH CARE IN LITHUANIA Baltic meeting Sep. 21–22, 2012 Palanga, Lithuania Erminija Guzaitiene Member of the Council of the Lithuanian Dental Chamber

Current situation* Total POPULATION in Lithuania 3.2 mln Children population Dentists Dentist specialists Oral health specialists Expenditure for oral health 3.2 mln 0.689 mln 2 974 629 3 193 0,21 billion Lt in a year (0,19% of Gross domestic product) ________ *Statistics Lithuania Lithuanian Dental Chamber database Websana. Lietuvos Respublikos odontologų rūmai 2008-2012. 2012, 52 p. CECDO figures, EU & EEA// https://www.cecdo.org/pages/database%20intro.html

Difficulties with eating food and pain 27% of Lithuanians experienced difficulties with eating food and pain. (EU average 15%)* ________ *Eurobarometer 330. (Oral health, 2010)

Satisfaction of the teeth and dentures’ appearance* 15% Lithuanians felt embarrassed of the appearance of their teeth and dentures. (EU average is 7%). This heads some interviewers to restriction of their participation in social activities. ________ *Eurobarometer 330. (Oral health, 2010)

Eating habits* ________ 22% of Lithuanians who responded to the survey question “how often do they eat biscuits, cakes, cream cakes“ answered “often”. (EU average is 18%) Citizens in Poland, Hungary, Lithuania, Slovakia, Greece appear to be the most regular eaters of confectionery. ________ *Eurobarometer 330. (Oral health, 2010)

Prefered type of dental facilities* 74% of Lithuanians prefer to go to dentist’s office or private dentists, others – to clinics run by the city, government or university. (EU average is 79%). ________ *Eurobarometer 330. (Oral health, 2010)

Prefered type of dental facilities* Percent of Lithuanians, who responded to the survey have visited dentists in the last 12 months is 46. From them only 26% visited state or municipal institution. It means only 11,96% of population visited clinics run by the city, government or university. ________ *Eurobarometer 330. (Oral health, 2010)

The frequency of visiting dentists* The frequency of visiting dentist of Lithuanians who claimed to have seen a dentist within 12 months is 2,1 (EU average – 2,2). The worse situation is if to explore the reason for the last visit among those who claimed to have visited a dentist within the last year. Only 21% of Lithuanians visited for check-up examination or treatment (EU average – 50%, Netherlands – 79%, UK – 72%, Denmark – 69%). Another figure is regarding emergency treatment –24% (EU average –17%, Netherlands, UK – 8%) and routine treatment – 54% (EU average – 33%, NL – 13%) ________ *Eurobarometer 330. (Oral health, 2010)

Main reason why respondents haven’t consulted a dentist in the last 2 years* Their dental problem was not considered to be serious enough. Having no teeth, or the fact that the respondent had false teeth, the cost of dental consultation and treatment were also frequently mentioned reasons. ________ *Eurobarometer 330. (Oral health, 2010)

Targets for oral health care should be: Improve oral health Improve access to services Develop appropriate oral health care Develop oral health database Prioritise investments Involve other stakeholders and health professionals.

Improve oral and general health The common risk factor approach emphasises the need to tackle the common risk factors and conditions that are shared by chronic non-communicable diseases. These common risk factors include: tobacco use poor diet stress alcohol consumption poor hygiene injuries sedentary lifestyle

Improve oral and general health Targeting these risk factors at a population and individual level would help reduce the incidence of: obesity heart disease stroke cancers diabetes mental illness oral diseases

Action of improving oral and general health (1/III) The most effective and efficient method of promoting oral health is to integrate oral health promotion with health promotion. Commission oral health promotion interventions that are evidence-based and evaluated. Improve the effectiveness of oral hygiene instruction provided by oral and other health professionals.

Action of improving oral and general health (II/III) Promote the development and adoption of nutrition and healthy eating guidelines which emphasize reducing the frequency of intake of sugary drinks and foods. Ensure schools, colleges and other settings are aware of and adopt guidelines on first aid for dental injuries.

Action of improving oral and general health (III/III) Dental teams should routinely enquire about patient’s tobacco use and to give smoking cessation advice. Regular engagement with General practitioners and dental teams (conferences with General practitioners, courses). Provide training for dental teams to develop their health promoting knowledge and skills.

Improve access to dental services 46% of Lithuanian population had seen a dentist over last 12 months. This means need to achieve a 57% (EU average) increase.* 90% of children should have an oral examination. ________ *Eurobarometer 330. (Oral health, 2010)

Action to improve access to dental services (I/II) Make information about dental services available in a form that is acceptable, accessible and familiar to the public. Encourage good oral health by making preventive advice easily accessible (TV, internet, messages in non-medical environments). Establish and maintain a single point of contact or dental ‘portal’ by internet. Review need for specialist services, (e. g. oral surgery, periodontology and endodontology ), and develop services ir regions.

Action to improve access to dental services (II/II) To tackle the problems: children and adults with disabilities at home older people in residential homes people with mental health problems Develop appropriate oral health care The 4th most frequently mentioned reason not visiting dentist or hygienist in the last 2 years was fear (reported 10% of respondents)* ________ *Eurobarometer 330. (Oral health, 2010)

What was the main reason you did not visit a dentist in the last 2 years? (EU)* ________ *Eurobarometer 330. (Oral health, 2010)

Action Establish and support development of specialist services e. g. sedation, patients with special needs. Develop anxiety management services to include conscious sedation Develop sedation services ???

Action should be taken of National Health insurance Fund: Prioritise investments to prevention – vouchers for pregnant, kids for free treatment (in the year 2011 the number of births was 34 385). Invest resources effectively according to needs of population. Support IT development for dental practices

Action of developing oral health database Undertake regular epidemiological surveys to establish oral health/ health needs of the population and evaluate it. Collect and monitor need of oral health profesionals. Review data collected through patient satisfaction surveys.

Action of involving other stakeholders and health profesionals (I/II) Consider training General Practitioners to undertake examination of the oral mucosa of tobacco users, heavy drinkers and older people. Encourage and train pharmacists to recognise oral health problems that need referral to dentist or specialist care. Promote mouth guard wear for sports where risk of tooth damage is high.

Action of involving other stakeholders and health profesionals (II/II) Consider funded scheme for provision of mouth guards. Ensure schools, colleges and other settings are aware of and adopt guidelines on first aid for dental injuries. Use media, TV, internet, social advertisment to promote oral health.

References CECDO figures, EU & EEA// https://www.cecdo.org/pages/database%20intro.html Eurobarometer 330. (Oral health February 2010). Lietuvos Respublikos odontologų rūmai 2008-2012. 2012, 52 p. Statistical information from Lithuanian Dental Chamber database Websana. Statistical information from Lithuanian Statistics Department http://www.stat.gov.lt