1. Proposed 10-Year Regional Plan On Oral Health Lessons learned 1993-2006 Forty national oral health surveys indicate a marked decline between 35% to 85% in the prevalence of dental caries, attributed mostly to cost-effective salt and water fluoridation programs Burden of oral disease is severe and remains high in certain geographic areas and high risk populations Strong scientific evidence suggests the associations between oral infections, chronic diseases and adverse pregnancy outcomes Best Practice Models on prevention and delivery of oral care Lessons learned 1993-2006 Forty national oral health surveys indicate a marked decline between 35% to 85% in the prevalence of dental caries, attributed mostly to cost-effective salt and water fluoridation programs Burden of oral disease is severe and remains high in certain geographic areas and high risk populations Strong scientific evidence suggests the associations between oral infections, chronic diseases and adverse pregnancy outcomes Best Practice Models on prevention and delivery of oral care Pan American Health Organization

2. EMERGENT DMFT > 5 Belize GROWTH DMFT 3-5 Argentina CONSOLIDATION DMFT < 3 Bahamas BoliviaCanadaBermuda BrazilColombiaCuba ChileEcuadorGuyana Costa RicaC. IslandDominica Dominican Republic El Salvador Guatemala Haiti Honduras Jamaica Nicaragua Paraguay Mexico Panama Peru Trinidad Venezuela USA Uruguay Typology Table in Oral Health 19902004 EMERGENT DMFT > 5 Guatemala St. Lucia GROWTH DMFT 3-5 Argentina Bolivia Chile Dominican Republic Honduras Panama Paraguay CONSOLIDATION DMFT < 3 Anguilla Jamaica Aruba Nicaragua Bahamas Peru Barbados Suriname Belize Trinidad Bermuda Turks and Brazil Caicos Canada Uruguay Cayman USA Colombia Venezuela Costa Rica Mexico Cuba Curacao Dominica Ecuador El Salvador Grenada Guyana Haiti

3. PAHO/IADB Clinical Trials in Ecuador, Panama and Uruguay PRAT PROBABILITY OF SUCCESS AND FAILURE SuccessFailure Dentist doing amalgam0.9430.057 Dentist doing ART0.9600.040 Auxiliary doing ART0.9420.058 SuccessFailure Dentist doing amalgam0.9430.057 Dentist doing ART0.9600.040 Auxiliary doing ART0.9420.058

4. Pan American Health Organization

5. Scientific evidence suggest that pregnant women with periodontal disease are seven times more likely to deliver PTLBW baby. This risk is much higher than tobacco and alcohol. Clinical trials suggest that treating oral infection in pregnant women before 26 weeks of gestation reduces the incidence of PTLBW by 28% to 82%. Oral Infections and Pregnancy Outcomes

6. Framework for the strategy Primary priority countries: Bolivia, Haiti, Honduras, Guyana, Nicaragua Secondary priority countries: Ecuador, Guatemala, and Paraguay Priority groups: MCH, Children, Women in reproductive age groups, HIV/AIDS, Indigenous groups, Elderly Primary priority countries: Bolivia, Haiti, Honduras, Guyana, Nicaragua Secondary priority countries: Ecuador, Guatemala, and Paraguay Priority groups: MCH, Children, Women in reproductive age groups, HIV/AIDS, Indigenous groups, Elderly Best Practice Model Partnerships Downstream Investment Measurement of Progress Pan American Health Organization

7. GOAL # 1: A Minimum Level of Oral Health Care For All By Addressing Gaps in Care For the Most Vulnerable Groups Reduction of Oral Infections Increasing Access to Oral Health Care

8. GOAL #2 The Integration of Oral Health Into PHC Services  Develop mechanism to integrate oral health within current PHC services  Incorporate oral health component into prenatal programs  Scale up best practice models  Develop mechanism to integrate oral health within current PHC services  Incorporate oral health component into prenatal programs  Scale up best practice models

9. GOAL # 3 Scaling-Up of Proven Cost Effective Interventions Salt fluoridation  Support Bolivia, Ecuador, Haiti, Honduras, Nicaragua, Paraguay and Saint Lucia to reach full implementation of fluoridation programs  Consolidate fluoridation programs with appropriate surveillance GOAL # 3 Scaling-Up of Proven Cost Effective Interventions Salt fluoridation  Support Bolivia, Ecuador, Haiti, Honduras, Nicaragua, Paraguay and Saint Lucia to reach full implementation of fluoridation programs  Consolidate fluoridation programs with appropriate surveillance Sealants $21.17 FL Supplements $2.53 Water Fluoridation $0.54 Salt Fluoridation $0.06

10. Scale Up Oral Health Coverage Using Cost-Effective and Simple Technologies, PRAT $ 1.50 to treat/seal a tooth Peru 200,000 children treated with PRAT Uruguay priority PRAT program 100,000 disadvantage children Mexico over 10 million restorations under PRAT

11. In Summary Best practice model provides a framework to implement at large scale oral health programs We have the evidence and the knowledge that it works Evidence demonstrates feasibility with extreme cost- benefit Implementation requires leadership, commitment to guide downstream investment to improve equity and efficiency and quality of life in the Americas Action by the Executive Committee for government support for dental public health programs and technical Cooperation Plan and Proposed Budget Best practice model provides a framework to implement at large scale oral health programs We have the evidence and the knowledge that it works Evidence demonstrates feasibility with extreme cost- benefit Implementation requires leadership, commitment to guide downstream investment to improve equity and efficiency and quality of life in the Americas Action by the Executive Committee for government support for dental public health programs and technical Cooperation Plan and Proposed Budget Pan American Health Organization

12. Trends of DMFT-12 for the Region of the Americas PROJECTIONS 2007-2010 EVIDENCE 1987-2003