A common cause: oral health

FDI President Orlando Monteiro da Silva had a heavily charged schedule during his early May visit to Iran, where he addressed the 52nd Congress of the Iranian Dental Association and addressed the International College of Dentists.

The Congress opened in Tehran on 8 May. Dr da Silva also did the rounds of the Congress Exhibition in the Milad Tower Convention Center, about 6500 m2 where well-known international brands were displayed alongside local brands and distributors.

"At the exhibition, I had the opportunity to be in contact with a very cosmopolitan and open minded group of colleagues, including young dentists who are very keen to "absorb" the trends of the profession, especially in terms of post-graduate activities and practice models in Iran," noted Dr da Silva.

Common goals

In his addresses, FDI President Dr Orlando Monteiro de Silva highlighted FDI's long-standing partnership with both the IDA and ICD, "with which we share common values and goals". He noted in particular, the focus on the exchange of information and the issue of oral health and development.

Highlighting FDI's role in ‘thought leadership' for the dental profession and oral health, he outlined the aims and content of FDI's landmark Vision 2020, notably its values of oral health and ‘oral health in all policies'. This notion derives from the Adelaide Statement on Health in all Policies, a WHO report published in 2010.

"By taking these two values and adapting them to the needs of its Vision 2020, FDI is re-affirming its policy and conviction that general health is inseparable from oral health," stressed Dr da Silva.

Health policy

He also informed his audiences about FDI's intensified cooperation with other international NGOs notably in the field of public policy and health policy,
"This is something that I, for one, am very pleased to see: it has been my long-held belief that dentistry has an interest and a duty to re-position itself better within the medical system," commented Dr da Silva.

He pointed to the unique contribution of the dental profession in the field of noncommunicable diseases (NCDs), dentists being the sole health professionals whose job focuses on the inside of the mouth, who have access to well ‘patients' during their annual check-up—uniquely placed to identify risk behaviours or even suspect oral lesions—and who have a long-standing tradition of promoting prevention.

Dr da Silva further highlighted FDI's close cooperation with the World Health Organization (WHO) and the World Health Professions Alliance WHPA on the subject of NCDs, and the role of the WHPA NCD Toolkit in strategies for NCD control and prevention.

Important visit

Commenting his visit, Dr da Silva said: "I had the privilege of engaging with an organized profession, delivering care according to the world's best standards of dental medicine, and seeing a growing market in terms of demand for dental services."

"FDI's presence was extremely important for the dentists attending the Congress, as well as for the Iranian Dental Association, the Deans and Professors from Dental Schools, etc. Engaging the profession through international participation and a focus on shared values and experience is an investment in the future.

"It illustrates the ‘quiet' force of FDI, uniting people in a common cause, oral health," emphasized Dr da Silva

He also detected among the professionals he spoke to Iran a great wish to attend the FDI Annual World Dental Congress in Hong Kong; but more especially the 2013 AWDC in Istanbul, more practical since Iran is one of Turkey's Eastern neighbours.

Some statistics on Iran

• Population estimated at nearly 78 million
• Some 25,000 dentists
• 80% in private practice
• 3,800 in the public sector
• 11 specialties
• More than 40 Dental Schools

No cause and effect established between oral disease and ASVD

A recent report affirms that current scientific evidence does not establish a direct cause and effect between gum disease and heart disease or stroke. Additionally, the evidence does not establish that gum disease increases the rate of heart disease or stroke.

The report, which examined 537 peer-reviewed studies on the subject, was published this month in Circulation, the journal of the American Heart Association.

"Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD [i.e. atherosclerotic vascular disease] or modify its outcomes," notes the AHA.

Value of good oral hygiene

Commenting the report, the American Dental Association (ADA) Council on Scientific Affairs says agrees with the conclusions. It notes that, although there is a body of research showing that gum disease is associated with several health conditions such as heart disease, stroke, and diabetes; just because two conditions are associated with each other does not mean that one causes the other. Both heart disease and gum disease share common risk factors, such as smoking and diabetes, which play a role in the development of both diseases.

ADA says American Heart Association (AHA) report acknowledges the value of good oral hygiene to maintain good overall health but noted that current scientific data do not indicate whether regular brushing and flossing or treatment of gum disease can decrease the incidence of atherosclerosis, which is the narrowing of the arteries that can lead to cause heart attacks and strokes.

Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association? A Scientific Statement From the American Heart Association

Scottish study

Earlier this year, FDI reported the results of a study published in the April 2010 edition of the British Medical Journal (BMJ) entitled ‘Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey'.

The study concluded that "Poor oral hygiene is associated with higher levels of risk of cardiovascular disease and low grade inflammation, though the causal nature of the association is yet to be determined."

ADA Annual Sessions in San Francisco in October

The American Dental Association (ADA) will be holding its next Annual Session in San Francisco from 18 to 21 October 2012. The theme of the event is ‘The Future of Dentistry Meets Here'.

International delegates can register for US$ 75 if they are Affiliate ADA members). The standard fee for non-members is US$ 275. Signing up to Affiliate Membership costs only US$ 75.

ADA Annual Session Information and registration 

New developments

Elsewhere, ADA reports that the US National Institute of Dental and Craniofacial Research has announced new classification criteria on the common autoimmune condition Sjogren's syndrome

Sjogren's syndrome is a disease that causes dryness in the mouth and eyes and can lead to dryness in other places that need moisture, such as your nose, throat and skin; complications include tooth decay

ADA also reports that the US Council on Dental Education and Licensure voted 4 May to support the American Society of Dentist Anesthesiologists' request for specialty recognition.

Oral health in Uganda

The challenges facing the oral health sector in Uganda include poor infection control measures, inadequate personnel and faulty or old dental equipment, said Principal Dental Surgeon Dr Nabbanja Juliet Katumba in a wide-ranging analysis presented in Kampala in December 2011.

She said the way forward would be to attract more investment, notably through public- private partnerships as well as lobby the government for increased funding to the sector. She called for a joint effort among the country's dentists for more teamwork, a greater focus on promoting oral health care and more research.

View full presentation ‘Situation analysis of oral health in Uganda'
View picture book of Uganda's World Oral Health Day 2011

FDI participates in key WHO NCD event

FDI was one of several key NGOs invited by WHO to participate in the recent ‘2nd Informal Dialogue on a global monitoring framework and recommendations for a set of voluntary global targets for the prevention and control of noncommunicable diseases'.

The Dialogue, held in Geneva on 30 April 2012, is one of several consultations WHO is holding with different stakeholders to get their views and comments on the second version of the NCD Discussion Paper prepared by the WHO technical working group.

The WHO event also provided an opportunity for the FDI delegation to meet with Dr. Oleg Chestnov, the newly appointed Assistant Director-General for Noncommunicable Diseases and Mental Health, which integrates the Oral Health Unit headed by Dr. Poul-Erik Petersen.

Disappointment

A number of the NGOs, among them FDI, expressed their disappointment with the Discussion Paper. From FDI's perspective, it includes no indicators and targets directly linked to oral health. Furthermore, its focused objectives as well as its restriction to the four main NCDs leave little room for other significant areas of disease, notably oral disease.

As things stand, the major outcome it proposes at global level is a 25% reduction in mortality, between the ages of 30 and 70, from cancer, diabetes and cardiovascular and chronic respiratory diseases.

This outcome is supported by four voluntary global targets on blood pressure/hypertension, tobacco smoking, dietary salt intake and physical inactivity. These targets are in turn complemented by 15 global indicators.

Important indicators omitted

FDI was among a number of NGOs to argue for the inclusion of an indicator on added sugars. This was omitted from the Discussion Paper on the grounds that these were difficult to define and measure on a global level.

Other proposals are absent due to lack of data at national level, preventing the definition of a baseline and outcome measures. Similarly, the WHO technical working group included no indicators involving children or linked to childhood caries, health inequalities and access to care.

FDI argued strongly for an indicator specific to oral health, a suggestion noted by the rapporteur and mentioned in the meeting report.

Take action now

WHO Member states will debate and decide the contents of the Second Discussion Paper during the World Health Assembly, 21 to 27. This leaves a brief window of opportunity for NDAs to lobby their Minister of Health for the inclusion of oral health indicators and targets.

However, even if these are not included at the global level, there is no reason to let up the pressure: there will be other occasions to propose similar or more specific objectives for inclusion at the regional and national levels.

The political initiative on NCDs offers FDI and the oral health community a unique opportunity and momentum to advocate for better oral health and increased resources. It will also reinforce the link between oral health and global health and the role of dentists in the prevention and diagnosis of NCDs.

Second WHO Discussion Paper - NCD Global Monitoring Framework and Targets [link http://
World Health Professions Alliance NCD Toolkit:
Health Improvement Card
Targeta para mejorar la salud
Fiche d'amélioration de la santé