1. i i ORAL HEALTH IN EUROPE – AN OVERVIEW Dr Paula Vassallo President – Council of European Chief Dental Officers Consultant Dental Public Health

2. i i THE COUNCIL OF EUROPEAN CHIEF DENTAL OFFICERS

3. i i The Council of European Chief Dental Officers (CECDO) mission is to: Promote dental public health throughout Europe

4. i i  High prevalence  High cost of treatment  Considerable impact on individuals  Affects quality of life - handicapping  Causes are know - diet and dirt  Easy and cheap to prevent  Diagnosis is easy  Easy to evaluate treatment PUBLIC HEALTH IMPORTANCE OF ORAL DISEASES Sheiham A, Watt RG. Oral health policy and prevention. In: Murray J, Nunn JH, Steele JG, editors. Prevention of oral diseases. 4 th ed. Oxford: Oxford University Press; 2003. p. 243-257.

5. i i IMPACT OF ORAL DISEASES

7. i i Growing Pressure on Health care budgets Changing demographics Increasing inequalities Increasing expensive medical technology Increased demand for aesthetic dentistry Lack of policy emphasis placed on prevention within oral health in Europe CHALLENGES

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9. i i EU ORAL HEALTH CARE WORKFORCE (2010) 27 member states 500,000,000 population 360,000 active dentists 400,000 dental nurses (Chair side Assistants) 150,000 dental technicians 30,000 dental hygienists

10. i i NUMBER OF SPECIALTIES RECOGNISED http://www.cecdo.org/pages/database%20intro.htmlhttp://www.cecdo.org/pages/database%20intro.html; 7.2.13

11. i i Prevalence of oral diseases in the EU Dental caries – some improvement in last 30 years but none in some socio-economically deprived. Periodontal diseases – may be getting worse but data are extremely poor. Oral Cancer – increasing prevalence

12. i i CHANGES IN DMFT IN 12 YEAR OLDS

13. i i 13 www.oralhealthplatform.eu THE FACTS Only 41% of Europeans still have all their natural teeth. 50% of EU population may suffer from periodontitis and 10% have severe disease. Prevalence increases up to 70-85% of population aged 60-65 years old. Caries still remain a problem for many people in Eastern Europe and for those from socio- economically deprived groups in all EU Member States. Access to oral healthcare services remains a major problem among vulnerable and low income groups. A major public health burden in Europe

14. i i 14 www.oralhealthplatform.eu THE FACTS The EU 27 spent an estimated 79 billion EUR on oral health in 2012 and will spend around 93 billion EUR by 2020. Much of the burden in high-income countries is due to caries and its complications. Expenditure on treatment of oral conditions often exceeds that of cancer, heart disease, stroke and dementia Delivering oral health services accounted for 5% of total health expenditure and 16% of private health expenditure in OECD countries in 2009. Lack of data and a challenge in estimating the expenditure on the provision of oral healthcare and in quantifying out-of- pocket and indirect costs Economic impact

15. i i Australian data suggests oral disease is the second most expensive disease to treat Evidence from Denmark and Sweden that preventing dental caries is cheaper than treating it

16. i i 1.Address oral health inequalities 2.Recognise the common risk factors for oral diseases and other chronic diseases, and work towards linking oral health policies across other EU policies 3.Plan and develop an appropriate workforce 4.Reorient Health services and focus on prevention 5.Improve data and knowledge base 6.Identify best practices 7.Make a commitment to improving oral health as part of EU policies by 2020 RECOMMENDATIONS FOR POLICY MAKERS

17. i i DETERMINANTS OF ORAL HEALTH Poverty Housing Sanitation Leisure facilities Shopping facilities Employment Work/educational Environment Income Policy - International - National - Local Commercial Advertising Economic, Political and Environmental conditions Oral Health Social norms Peers groups Social capital Cultural identity Religion Social & Community context Diet Hygiene Smoking Alcohol Injury Services Oral health Related behaviours Sex Age Genes Biology Individual Watt RG, Harnett R, Nowjack-Raymer R, Treasure E, Munday P, Daly B, Kay E, Morgan A, Fuller S. Oral health promotion evaluation toolkit. London: Stephen Hancocks Publishing; 2004.

18. i i SHIFT TO PREVENTION – WHAT TO DO?

19. i i GETTING OFF THE TREATMENT TREADMILL - SAYING GOOD-BYE TO THE BURR

20. i i Oral health strategies need to change. We need a shift from downstream victim blaming … … to upstream strategies for effective prevention. CHANGING THE STRATEGIES

21. i i REFOCUSING UPSTREAM NOT DOWNSTREAM McKinlay JB. A case for refocusing upstream – the political economy of illness. Processing of the American Heart Association. Conference on applying behavioural sciences to cardiovascular risk; 1974. p. 7-17.

22. i i Fiscal Measures National &/or local policy initiatives Legislation/Regulation Healthy Settings- HPS Community Development Training other professional groups Media Campaigns School dental health education Chair side dental health education Clinical Prevention ‘Upstream’ Healthy Public Policy ‘Downstream’ Health Education & Clinical Prevention Upstream - downstream interventions Watt, (2007)

23. i i Confidential. For your information only. 23 Denmark: preventative health care model Sweden: community- centred based programmes: oral health promotion targeted at immigrants families + advice for self-management of periodontal diseases Fluoridated milk programmes (targeted to the population) Hungary: Oral cancer screening in high- risk groups France: national prevention programme targeting teenagers Promoting sugar-free products Water fluoridation programmes (drinking water) UK: evidence- based toolkit for prevention +Child Smile in Scotland Fluoridated salt programmes Restricting marketing & improving the labelling of certain food products Public online best practice portals Good practice examples

24. i i Water Fluoridation Fluoridated Salt progrmmes Fluoridated Milk programmes Childsmile programme – Scotland Evidence based toolkit for prevention Community centre based programmes Oral Health Promoting Schools Oral Cancer screening programmes Promotion of sugar free products Improving labelling of food products GOOD PRACTICE EXAMPLES

25. MAKE A COMMITMENT TO IMPROVING ORAL HEALTH AS PART OF EU POLICIES BY 2020 Set nationals goals which are measurable and achievable

26. i i Dr Paula Vassallo President Council of European Chief Dental Officers e-mail: paulavassallo@gmail.com Telephone: +35699465805 THANK YOU FOR YOUR ATTENTION.