nURD JOINT WHO/SPC S1!J4INAR:
Dl!NrAL HEALTH SERVICES
Sponsored by the WORLD HEAIll'H ORGANIZATION REGIONAL OFFICE FOR THE WESl'E1lN PACIFIC
and the SOUTH PACIFIC CCMotISSIOO
NOOJIIEA. NEW CALEDONIA
26 January - 2 February 1971 .
FINAL HEPOR!'
Nar FOR SALE
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PRINTED AND DISTRIBUTED
by the
REGIONAL .OFFICE FOR THE WESTEHN PACIFIC
of the World Health Organiz.~ion Manila. Philippines February 1972
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NOl'E
The views expressed in this report are those of the advisers and partiCipants at the seminar and do not necessarily reflect the policy of the World Health Organization or the South Pacific Commission.
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1. 2.
IN'I'ROOOCI'ICIl ••••••••••••••••••••••••••••••••••••••••••••••
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OBJECTIVES OF THE SEMINAR ••••••••.•.••••.•.••••.••••.••••• SUMMARY OF DISCUSSIONS •••••••••••••••••••••••••••••.••••••
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TopiC 1 - Oral Diseases and Abnormalities in the South Pacific ••••.••••.••••.•••••••••••••••••••• Topic 2 - Prevention of Dental Diseases and the Treatment of their COnsequences •••.••••••.•••••••••.••••.• TopiC , - Eduoation. Training and Utilization of Dental Persorme1 ...........•....•....•....•.......•.•.. TopiC 4 - Organization and Planning of Dental PUblic Health Sel'V'ices wi thin General Health Sel'V'ices ••••••••• Symposium 1 - Child Dental Health Sel'V'ices Symposium 2
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International Aid and FUture Dental Health Activities in the South Pacific •••••••••••••
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CONCLUSIONS OF '!HE ACKNCMIEOOEMENTS
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Annex 1 Annex 2 Annex , Annex 4 Anrlex·5
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Programme DetaIls •••••••••••••.•.••••.• e-a • • Participants, Reaource Persons and Staff.... List Of Working Papers and Documents ••••••• Summary of Country Reports ••••••••••••••••• .Evaluation .••.•.••••.••••.•.••...••...•..••
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1.
INTROOOCTION
At the twelfth session of the WHO Regimal ConIIlittee for the Western Pacific, held in Wellingtm in 1961, the subject for the technical discussion was dental health. Following this meeting a progranllle in dental health was established, the central idea of Which was that data on dental disease would be colleoted as a basis for future dental health pl8l'Uling. Courses in dental epidemiology were held in Singapore and SUva (FiJi) in 1964 and 1965, respeotively. By 1970 data were available for most of the SOUth Pacific countries. Sinoe the South Paoific Commissim had taken the initiative Of. appointing a dental publio health officer, WHO sought a oOlllbined seminar, Which was held at CoIIais.ian Headquarters, NGUMa, New caledonia, from 26 JanuarJ to 2 PebruarJ 1971, to cansider these data. The World Health Organization provided most of the finanoe and the South Pacific CoIIaissim the administrative services. Participants from Australia and New Zealand were invited to attend the s.1nar beoause of their experience in dental public health service. and in dental educatim. The.. participants contributed in a lII&Jor way to this report, including the conclUSions, but unless otherwise stated, the.. cmclulSions apply more specifically to the other Pacific island countries and territories. . In 1968 the South Pacific ec.ai8sion and the Department of PUblic Health of Papua New Quinea held a Joint Seminar on Dental Health Services Development and Co-operation in the PacifiC. At that seminar details of dental health programes were discussed, and are aVailable for reference in the report.* The NOUIIIea Seminar was opened officially by M8deoin Gfmeral J. Rondet, Director of Health and PUblic Hygiene, New caledmia •
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Afioga Afoafouvale Mi8imoa, Secretary-Oeneral of the South Pacifio ConIIIission, spoke on behalf of the South Pacific CCIIIIi88ion, and Dr K.K. WClOg on behalf of the World Health Organization. 'lbe official opening conoluded with the presentation of the opening theme by Brigadier J. FerriS-Fuller and Dr J. Bamaud.
of Seminar on Dental Health Services Development and eo-operatim in the Pacifio, Port Moresby, '-14 June 1968; SOUth Pacific ConIIIission, Noumea, 1968 •
*Report
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• 'DIe I11811bere of the Order of Dentists of New caledonia were inv! ted
work.
to be pre..nt as unottioial ob"l'V'ers and several attended the .... inar ..ssions which were of particular interest to them. Dr Amold and Dr ~ra who had oarried out dental sul'V'eya in the area (partly financed by the South Paoific eo.tission) gave aooounts of' the results ot their
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<BJEcrIVBS OF THE Sl!MINAR
(1)
To review the available epidemiological data on dental
41se...s in the South Pacific, especially tho.. collected' in the WHO inter-country dental health project (WPRO/01l5/0160): (2) To draw out the implication. ot the . . data for dental publ1c health sel'V'ices and basic health services, especially tor the control ot caries and periodontal di .....s:
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(J)
To .....s the de.irable and teasible pattems ot dental statting, and the training requirements tor dental .tatf': and To draw ccnclue10ns CI'1 the role of basic health ..rvices and sohool health sel'V'10es in relation to dental health, espeoially dental health education.
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(4)
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SUMMARr OF DISCUSSIONS
The infol'll&tion assembled in oountry reports is 8UID&l'1zed in Annex
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ToPio 1 - Oral Di.....s and Abnoma1i ties in the South Pacific A. 1. Dental !pi'deaiolop in the South Pacif'io '!he data two (au_ and Nortolk Island) of the at the seminar. '!he ..thods used criteria u ..d for CCllllOft i tema were were obtained. '!he methods used
Data were available f"* all but countries and territories represented in the sul'V'eys dittered but sinoe the similar, generally oCllparable results were: (a)
WHO doCWllent WPR/JJ4,164 Tra1nil\l Course CI'1 Dental Epidemiologioal Methods, Sinppore (Amerioan Sa/Ioa, F1J i, Tanga and Westem SUIo&). •
- (b) (c) (d) WPRO 0160 Assignment Rltport K.K. Weng (Gilbert and Ellice Islands). WHO Technical Rltport Seri•• Ho. 242 (French Pol1llesia. Cook
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Islands and New Caledonia). WHO Ba81c Oral Health Survey Method (New Hebride.).
()ther methods were used in Papua New GUinea, and the Trust Territory of the Paoific Islands. 2.
Dental caries
The prevalence of dental oaries in the South Pacifio area is between low and very low. The exceptions are in French Po11llesia and the Cook Islands where the dental caries pNValenoe is high.
There are difterences in dental cari•• pNValences in rural-urbancoastal areas within s~ oountrie. and territor:les. :In Fiji, Coole 1II1ands, and in 80M rural are... ot the Hishlanda ot Papua New GUinea, and in all urban Situations in countries where more marked changes are occurring in dietary pattern, dental oaries oanatitute
a public health probl_. In the panaanent dentition in children in rural coastal areas of Papua New GUinea a IJIIF _an ot 1.0-2.0 18 tound. S1ailar age groups in the Highlands and some other well defined areas shaw a IJIIF of 5.0-6.0.
Por the penaanent dentition, children aged 1'-14 had IMP values of approxilll&tely 10.0 in French Po11llesia and the Cook Islands. The value for the SIllll8 age group in Fiji was 2.5, and in other countries and territories it was about 1.0.
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For adults aged 45-54 years Western SuIoa had the lowest IMP (,.8). the IMP in 'l'onga was 9.0 and in Fiji it was 11.0 for this age group •
Gingivitis among children appeared to be less prevalent in Tonga and in Western Samoa than in American saoa and Fiji. The percentages affected were ~-6O,C in Fiji and 75-10Qrj in Amer:lcan s..o&. Gingivitis was !lOre prevalent in adults, 75-100J' of all persons in the area being affected, with little difterence between the island stat... The hipat recording ot poaket tOl'll&tion in adults occurred in AlMtrican Samoa. A range ot ,,~ of persons had poakets deeper than , .n.
- • ancl ~-'l_ deeper than 6 _. Scores deorea..d .in the order, Fiji, TcInp. end Westem SeIDoa. Q\ the buis of these data periodcmtal diseases
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constitute. apublic health probl. throushout the entire area despite the variations in prevalence reported. _. Handicapping dento-tao1al enomal1es
'lhroushout the whole area there 1a a low prevalenoe ot baDd10apping dento-tao1al encaal1e.,. 21_ in Fiji: ~ in Tonga; in Westem Buoa: and ~ in Meriom SMIoa required treatMnt. '!'he h1Shest pNYalenoe . s ob.. rYecl -ems Indians living in Fiji.
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Prosthetio end other neecla
Beoause ot the relative17 hip averap nuaber of teeth per peracn present in adul ta. the prosthetio neecla in the area OM be said to be 00llJ)&rative17 ..all. '1h1s is partioularl;r .80 in Westem s.o&. '!'he data were, however, 11.ll1ted to person. qed 5- or le.s. B. 1. The EtiolOJl ot Dental Caries end Periodontal Disease
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Dental oaries
'!he etiology of dental oarie. 1s baaed on the acid-deoalo1t1oatian theor;r, that is that baoteria in the dental plaque _tabolize tenaentable oarbohrdrates to produoe laotio aoid which 1. responsible tor the dellineral1u.t1on of tooth enamel. TWo aJor 00l1&1daratiOl1& in dental oaries are the qual 1107 ot the tooth struoture end the nature ot the dental plaque.
(a)
Tooth struoture 'lbt qual!t7 ot tooth atru01lare 1s detel'llinecl b7 preend post-erupt1ve nutrit1anal tactors as well as the genetio oonst1tution ot the indiv1dual. It is unl1ke17 that IUl7 group ot people in thi. area baa a racial or natural ~1t7 to dental oaries. The role ot fiuorine as a nutritianal ele.ut 1. ver;r 1Ilportent. Fluorine ...,. be inoorporated into the tooth struoture durine tooth to:nu.tion or attar tooth erupticn end M.7 be der1ved rn. toods, trca water, or trca various topical applioat1ans. There 1. crow1nc ev1denoe that other ele.ent. end croups ot el~ts could influenoe car1e. au.oept1b1l1 t7.
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(b)
Plague Dental plaque is essentially an orpnio matrix oenta1ning bacteria. 'n1e prino1pal oomponents of the matrix are proteins and oarbobJdrates. The oOlllpOsit1en and rateot fonaation ot plaque are intimatelY related to the tom. oODlpOsitien. and frequenoy of ingestien of foods. The distinguiab1ng feature of plaque assooiated with dental. oaries is the presenoe ot sucrose within it and the metabo1iSlil of that sucrose to produce both lactic aoid. dextrans and levans. There 1a o~siderable evidence that the introduction ot SUOl'Qse into the diet ot people Oo:n8UDIing unretined toods favoure an increased prevalence ot dental oarie8. 'Itle faotors involved include the ...ount of sugar conll1.Ded • the frequency and fom in whioh it is cenSUlllltd. and the other dietary iteu whioh are mixed with it. Other refined oarbohydrate foods appear to be of seoondary importanoe in these relationships.
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An attempt should be III&de to reveal causatIve faotors in dental cuies
in the various, 80IIIetiDles unique. and oMnging oral and environmental oenditions which are being observed in the region. The characteristics of SlllOOth surfaoe and oemental leden8 which distinguish theDI trom other dental caries lesions also require further investigation. 2.
Periodental disease
The aetiology ot periodontal disea.. is related to irr1 tation and inflanmation of the gingIval and periodontal tissues resultinS primarily 1'roIII acoumulation of plaque and sub- and supra-gingival caloulus. The etfeota of the .. local faotors are moditied by nutriticnal and .other systemI0 faoto~. GingIvItis and periodontItIs are associated wIth poor oral hygiene habits and observatIons in this region provide no exoeption. A result of poor oral hygiene together with a diet containing 80ft and starchy toods 1s the t011llatI00 ot plaque en the tooth surtace. Baoterial metabol1_ within the plaque oan produce toxins which Irr1ute soft t18sues. or the plaque IIBY oaloify and the oalculus so fomed may itself be a source of irri tationof the gingival and periodontal tissues and . taoilitate bacterial aot1en by providing relatiTely undisturbed sub-ging1val areas.
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• It is not necessary to have refin.d carbol'l7drate in the di.t to produc. the type of plaque which i. asSC)ciated with periodontal di...... Populations in both rural and urban are .. eating refin.d and unrefin.d foods may .xP8rience a high preval.noe and intensity of periodoDtal disease. While natural foods eaten after simpl. preparation are otten thought to have self cleansing properties and to inhibit plaque toraation, little .vidence of this action has been produoed. ene of the factors which may interf.re with selt cleansina _chani• • is JDalocclusion but, due to the absence, generally, ot serious ulocclusions in the people of this area, this factor is not a vital one in the populaticns under consideration. TopiC 2 - Prev.ntian of Dental Diseases and the Treatment of their Ccnseguenoes Dental h.alth prog1'lllll1l8s must have a strong preventive c~ent to prevent an increase in the preval.nc. of dental dis.ases in the South Pacific. Prevention must be the major and constant concem of the dental health s.rvices, which must be able to share their problems with governments and with populations. Indeed it is a well established fact that preventicm is cheaper than cure. Preventive servic.s should include activit1.s in each of the following areas: <a> (b) health .ducation, which !DUst take into account local 'radi tions and customs; nutrition. For example .xcessive use of products with a high sugar content should be discouraged; us. of foods rich in fluorides should be encouraged; oral hygiene. People must be taught how to use a toothbrush properly; fluoridation, or other methods of fluoride applicatian which can be applied either individually or to lerse groups; .arly conseX'V'at1v. treatment of carious l.sions.
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(c) <d)
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(e>
Fluoridation of drinking water, as advocated by WHO, is at pres.nt a. preventive method which greatly reduc.s the prevalence and incidence of dental caries. Its main advantage 1s that it does not require the active participation of the ind1vidual. In New Zealand, Australia, PapuaN.w Quinea and Fiji, fluoridation has been implemented following deCisions taken
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- 7 by the soYemments oonoemed on the advioe of the health sel"lioe •• However, populations have not, in all instance., acoepted these _alNres readily, either beoause they had not bHn properl,. informed or because of trad,i tional habits. Similar problems have arisen in uny oountries and have been overoa. by: <a> (b) (c> perauading the la,man throush health eduoation; overoCllling the apathy of govemJDents; and persuading local authori t1es that fluoridation 1s justified and that they should themselves initiate the required aotion in this field.
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It is desirable that investiptions be I8ade to d1scover what sources of flUOride exist in South Pacifio countries and terMtories, what intake oocurs from food and water and what the opt1mal fluoride level in publio water INpplies should be for these specifio oond! tions.
It was noted that there was little OpPOsition to fluoridation in Suva and Port Moresb,.. It is desirable that research be undertaken to asoertain the opt1mal fluoride level required for looal conditions in the South Paoific countries and territories. 'DIe research dclnein countries with high dental oaries prevalence has shown the greatest reduction in smooth surface leSions. In the PadUo islands, pit and fissure caries predClllinate in most Sl'O\1ps and especially in children. Thus the role of flUOridation in suoh areas 11es in preventing a rise in caries prevalence, espeoially smooth surface lesions, rather thml a reduotion in the already low oaries prevalenoe. There are other methods of INppl,.1ns fluoride but these are in general IIOre expensive and lIore d1tt1oult to dispense and oontrol. The,. include fluoride tablets, * llouthwashes. topioal application of solutions and gels, electrolytio treatMnt, dentifrioes and p~laotio pastes. The ve17 faot that all these methods are available shows that, as ,.t, thinking i8 not unanimous as to, which are the moat erteotive. Moat procr-s of topioal application of fluoride have required a considerable dental start and in SOll8 cases several patient visits eaoh ,.ar. :Reoent developments in the self application of flUOride preparations _y have an important bearing on future preventive dental progra.es in the region. Toothbrushing needs to be taught. FiJi desoribed its prosra-e in whioh low cost toothbrushes are sold to children for two oents Fijian eaoh, and kept at sohool so that the teeth can be brushed each day under supel"lisicn. Similar prc.gI..... S are oonducted in other oountries. '
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*The sohool ••
Cook Islands reported a 1N0GessM fluoride tablet progXMiii8 in
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• The use of occlusal sealants was described and they were thought to have a big potential in the prevention of pit and fissure carie• .nlch predominate in the Pacific. It would be worth.nlle to investlgate fluoridated. resin sealants, considering the length of time between successive treatments, numbers of staff required, costs, etc. '!be effeat of the resin on maturation of enamel is unknown. The use of prophylactic paste containing fluoride was discussed. The principal advantage is that fluoride can be applied without.an
increase in the operator's time devoted to eaoh patient, since all progl'lUlllles now include a prophylaxis, but many with a non-fluoride paste. The use of this paste has been shown to reduce the incidenoe of dental oaries b7 20-30 per cent. However, the cost tends to be high, est:lmated b7 Papua New Guinea to be $AlOO per 1000 children. The place of dental health education in public health eduoation Dental health cannot be segregated from general health or health eduoation 1'1'0lIl education in general. Yet there is a lack of co-ordination in a nuatber of cOWltries and territories in both of these respects. Several South Pacific countries have adopted a dental health education progr&lllllle. Such an Wldertaking cannot succeed unless there are enough health educators, unless both the Health and the Education Departments participate actively, and there is the active part1c1pat1on of doctors, nurses and teachers as well as practising dentists and dental auxiliaries. Many dentists feel they know little about health education methods. It 18 recommended that amongst dentists SOllIe should be trained as specialists in health education, and that in the curriculum for dentists, provis1on should be made for a sound basis in health education. There are many groups to wh1ch education can be applied: the pat1ent in the chair, schoolchildren, expectant mothers, women's groups, etc. There is a need to identify and educate the most influential groups in the cOllllllUJli ty • Amongst the territories represented, some already have health educators and health centres. aIt it would seem that few deal with dental health. It would be des1rable that these health educatora should prov1de advlce and asslstance to dental personnel in what they should teach and how it should be taught, and health staff should include SOllIe dental health eduoat1cm and advioe among their activities, as a support to the spec1alized dental personnel. Statistically 1t would be interesting to ocmpare. in each country, the health eduoation budget w1th the health budget. It was interesting to hear a description of the Singapore dental health educat10n progrume sponsored by the Goyemment of Singapore, the World Health Organ1zat1on and UNICEF. A Dental Health Eduoaticm Un1t waa set up 1
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- 9consist1ng ot one dentist, one health eduoator and six dental -.udl1aries. 1.'h1s teu is responlSible tor dental health eduoation ot cOl8Dlity perscnnel, school teachers, other health womers and WCIIIen'S society leeders. i'l1ey in tum are in charge ot the health eduoation ot all those groups ~ch they can teach, mostly ohilclftll. 'l'h1s they do aooor41ng to a prosru-t they have been ta.ucht to tollow: supe"is1on ot toothbruahing. advice an the 1f81' to use a toothbrush, oral health habits, nutritien, etc. ot oourse, such an undertak1ng would have to be supplemented by olose-by tacilities tor dental oare and this prssupposes that the Government tul.ly understands what is required. Although the Singapore experiment probably cannot be tully reproduced. in the South Paoitio countries and territories. it can be used as a basb tor their dental health prosr-s. For best results the plNming ot wah a progre by the health se"ice. awst be supplemented by olose oollaboration with other sel"V'ioes which lIIIke up the envil'ClllMftt ot the 1ndiY1dual and ot grcups. Populations BlUst be IIOtivated to ohIInp their aotivltles: ohanps in knowledp alene are 1nsutticient. A health educatien PR8N e mst provlcIe tor evaluation it'CIII tme to t.e. to Mke the ~ tor tllture actien and prevent serious mistakes be1ng -.de. The WHO rsport on Dental Health Eduoationl should be studied in develop1ng dental health eelloatien prog~8. TopiC , - Eduoation, Tra1nins and Utilization ot Dctal Perscnnel A. Dental Manpower and Dental Health Planning Present state ot IUl'lpower II
1.
All territories reported the eJaPloJMIlt ot protessicnal dental personnel: ali but two reported the use ot ncn-operat1ng auxiliaries; and eight reported the use ot operat1ng auxiliaries. '!'he oountries and territories in the South Paoifio can be divided into three groups by the way. they utilize dental manpower.
(a>
All operative 8e"ioes are pertomaecl by university graduates. The maJority ot the perscmnel is eithf/r expatriate or of European origin reoruited locally; the prinoipal disadvantages are statt shortages and cost. Most operative sel"V'icee are pertomaecl by graduates of the P1Ji School of Medioine. SollIe territories _ploy a fn university gNduates and a lblited I1WIIber of operating auxiliaries as well. i'l1e territories generally have well developed se",ioes but the supply of dentists 111&7 be atteoted by the incorporatian of the P1Ji School of Medioine .into the university of the SOUth Pacifio.
(b)
lwld 81th Org. Tech. Rep. Ser., 1970, 449.
- 10 (c) Most operative services are provided by operat1nS auxiliaries. The dentists supervise the auxiliaries and provide services be;ycnd the c~tence of operat1nC auxiliaries.
AlthCllllSh scme countries and territories were satisfied 'that at present they have no serious manpower 8hortaps, IIOst of theaI did have shortaps. 'n1ey are tak:1nS reMdial steps but are facing various probl.s.
an probl.... discussed ... re: Ca) a difficulty in reoruitment of suitable peracnnel at necessary educaticn levels to Wlderso the desired training course; a lack of financial reward, absence of a promotional advanc.-nt system, and unsatisfactor,r WOKing oonditicns; a lack of public awareness of the neoesa&r,r and 1IIIportant place of dentistry in cOlllllUnity health and weUare and the associated need for eduoated personnel; an apparent failure of SOlll8 goYernments to appreciate the dental needs of their country and the amount of finance needed to organize the necessary dental prograames in balance 1f1 th other health prognu.es; and a lack of legislation in sOlIe cases either for dental health as a whole or p&rticularl7 goveming .the use of operat:1ng auxiliaries and l1lll1tations on their duties and aotivities.
(b) (c)
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(d)
(e)
2.
P\lture manpower needs
Bach country and territory ahould cansider the types of dental pel'8Ol'lllel best suited to 'its conditions in developing a dental health progl'UDe. '!'he duties of the pel'llonnel should not be bound by traditional restraints. Priorities ahould be recosnized and IIIInpower trained to meet tbeII. Some factol'll which will affect the types of personnel are: (a) (b) (c) (d) geographic and dellOgraphic factors of the territor,r or country, dental disease pattem, standard of education in the terri tory or country, .oanCllio factors,
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( e) (f)
tor 8III8l.1 terr1 tories the av&1labil1 ty ot tra1n1ng tacili ties in other territories or countries, whether 8tatt should be Ja&l.e or t-.le, legal re8trictions i f these cannot be altered.
(g)
nIe profe8sional SCM oountries and territories stat.d. that the present oourae at FiJi prodlloecl the dentist best fitt.d. totbeir needs, whereas others preferred graduates of couraes at university level. Methods for determining the number of professionals required in a oountry . .re discussed. It was not.d. that throucl'KNt the Weetem Pacific Resion ot WHO the existing overall ratio ot Mdloa1 to dental. prote..lonals is ':1. ~ appropriate ratio for a partioular oountry or territory should be oalculated according to faotors such .. the prevalenoe of dental dlee&88, the deIIIUlCl for other health ..rvloe., aooio-eoClllOllio tactors, eta • The auxiliaries
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The u.e of auxiliarie8. their position in the dental te_ and their relationship with the profe8sional leader of the te_ are important planning oon8ideration8. The professional is the key person in any dental progruae and without him no programDe oan be expected to lSUooeed. The ratio of dentists to auxiliaries will d8pend upon the types ot auxiliaries used md other factors whioh vary fl'Olll territory to terr1tory. Supervision of auxUiaries 1lU8t be considered at the planning stage. The degree ot supervision po8sible will afteot the type of auxiliar,vemplQJed. and the training given.
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All dental personnel shcu1d be able to perfoma the duties within his 8phere of oompetenoe. to the _ high level • The purpose ot the auxiliary i8 to lDldertake the frequently occurr1ng operations thereby releasing the dentist !rom the perfomaanoe of routine operations 80 that be may oonoentrate on the IIOre cOlllplex and less OClllllCn diagnostic prooedures and treatment8. Auxiliaries should be trained in the least possible tiM oc:.aenaurate with developing the needed skills, Inoluding adequate repetitIon of operative prooedures. Therefore in defining theIr duties It is desirable that:
<a> (b)
the number of duties be kept to a min1aauD; and
the duties only inolude operations whioh have to be performed. frequent17.
- 12 B. Dental Education and Train1n& This topic was divided into the following are.. of train1ng: (1) (2) the professional; and the aux11iar1es.
A distinction was drawn between education and training; education to provide protessional leadership and direction, tra1n1na to provide techn1cal skills or to meet a specifio tunoticn. 1. The protessicnal
The existing hcitio courses provided in Fiji and Papua New Quinea were described and cCllllPared. SolIe oountries and territories exPressed ooncem at the rapid rais1ng ot entry standards which oould result in their being unable to send students to one of these dental oourses. The Jl\IIIIber of students graduating traa high school with the cambridge School Certifioate, or New Zealand School Certifioate or their equivalents, was low in sc.e places. RYen fewer students were reaching the level of New Zealand or Austral1an matriculation.
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Within the next five years it is likely that the Fiji School ot Medioine and the Port Moresby Dental Coll.pwill be inoorporated within the University ot the South Pacitic and the University ot Papua llew Quinea (respectively). The course at the Port Moresby Dental College has been recently re-organized so that it will eventually lead to the granting ot a degree. The type of dental course that w111 be given wi thin the University of the South Pac1fic has not been determined. 2. The auxiliaries
Ckloe the duties of auxiliaries have been defined, the curriculum can be planned~ The degree of field supervision is an 1IIIportant factor in the eduoaticnal methods used and the degree ot train1ng required. Where possible it is de81rable that auxiliaries be trained in the same inatitutions as professionals, so that they leam to wom with one another. This is dcne both at the PiJi School ot Medioine and the Port Moresby Dental College. However, un;r oountries and territories thought the idea illpractical because sending students overse.. when the7 could be trained 10cal17 was too expensive.
I,
- 13 It . . . oGll.1deNd that DCIl-operatq ..,.111&1'1•• aDd pem.pa tibe dIIltal b;q1en1et ooul.d. be tzoa1Ded loo.n,.. bJ' the dIIltUt. ~ bJ' 1D-_"ioe tnjnin.~ Seftral parUolpcte .tated • DIed tor • o CD oul'1"1ou1_ :In basl0 _"eeta 1'01" D.CID-operatSDs .wd.11al'1e'. It 18 PNteNble that operat:lns -zUtiaJo!e. be tatne41D a detal training 1nat1tutiClll. The oourse. tor aux1l1&l"1e. and tbe oountZ'le. ad tel"Z'ltoZ'le. oODduotSDs tbeII at PNHDt w1tb1n the aNa ot the SaIlth Paoltlc cc-1••1cn .aN l1eted below:
Dental lfurse
Papua 'l'Nat ~
New
~:In••
~l'1"1 to17
ot the Paolt1o Ielende
• • Dental ...letate are ..-1'al.1J' 1a1Ded. wltIdD ..... tarr1to17 _ required..
Pol" oountZ'le, and tel'1"1toZ'le. wbioh oMlDOt tra1n their .wd.Uar1e" the tollow1n& plD I, . . . . .teds (1) (2) det:lne dutie, ot operat1ng auxU1al7. acmd ,tu4cta to tbe echool whioh 1Dolude. the lal'pat a.b81" ot the pn..1I:lbed dutse••
Ole Ope~
•
(') sift add!UCID&l tahtng GIl NtuD ot the awt111al7 :In tb;ose aubJeot' not :lnoludR in the OCNl'H. Toe10 4- Orpnlzatlcn and nnw ot Deptal MUo Health Se"loee with:ln CJeneral Health Se"loe. It 18 NOOSDlHd tbat althoush each oountl'J' or tel'1"1to17w1tbJn the South Paolt1o aNa baa oerta:ln apeoltl0 pzroblm.. tbe,. abaft ......" --.1" ot 0 = m paoobl-. wl1;b I"ePI'd to tbe ....., ..t1_ ad pl ....,,.. ot . .tal plbUo health _I'rioe••
A o. an tactol" t.o aU 1. tbat c1ea:tal bMltll _I'rioea .at be ocnucJeNd w1th1n tbe tN.I.,aot basl0 ....ra11Walth
_"108,.
•
- 14 'lh1s tNMworic o~ basio pneral. Malth ..rdo.s is ot vital 1Ilportanoe. It it 18 ftak then all health disoiplines. inolud1n1 dental. will have di~~iou1t7 in providing even bUio .."io.s. 'lhua the tirst priorit7 ot a Malth administration is to provide a BOUnd basio health struoture in the develor-mt ot which there IIhould be partioipation b7 the dental administrator.
• •
This prin01pleot involvement ot the dental executive 1n pn.ral health administrative procedure llUet be oarried throushout all aubeequent planning and deY8lor-mt ot the geneml health se"1oo at all levels. Pol' .u.pl.. the chiet dental ad111niBtrator IIhould tom part ot the central. pbnning oc.aittee ot tho health departllent md th1a pr1n01ple appl1ed thl'ouIhGut the whole hiel'U'Clh7 ot the field _J'Y1oe in all an..
or distriot health planning
oommi~tees.
'l'bere is a need to pl'OVide· PY8~ta wi th ~OftI&tiGll reprd1ns 4entistl"J' pneral.17 and specifioal17 reprdins dental health .. "ioes for the co.mmit7 at large. in 0~t7 dellend for dental oare aa opposed to medical cue. '!'he.. dirt.rences can be related to a nwaber ot tactors suah U oo.t. aesthetics. etc. 'lbe POWI' ot the oost faotor in atfeottns ....."" md provis1G1l ot _"ioe. is oc.aon to all oc.am1t1e.. but in develop1ns populat1an. a tactor suoh U reprd for peracnal. appearanoe ....,. olwlp rapidl7 and .Drt a strang .t~eot GIl ct.ande. In desisning and iapl.-nting dental prosra-s the soarae reeouroe. of IIIDpoMtr and tiMDoe ...at be utlli..d U ettioient17 U possible. '1t11s iapl1e. that sovem.enta muat provide ettio1ent woricing oonditians.and for the1r part health woric.rs should be aware o~ the oo.t ot dental health .."1oe. and encouraged to uae resource. oooncmioal17.
•
.ld."
])eta! health ae"ioos and planners should be ....re that dirterenees
•
Dental health prograllllll8S IDUSt have an emphasis on prevention and ot oral heaith with the involvement ot the patients both as indiY1duals and as members of the oClllllUnit7. the prcmotion
Man7 prosra-es at present involve. oaptive Il'OUps, particularly sohoolohildren, who receive inol'8lMntal ae"ioea. Aa resources pel'llit. other oaptive poupe oan be inoluded in the prosn-. '!'be OCUILdlit7 at larp requires rel1e~ h'CIII pain and oral oonditions infaioal to their general health and well-being, and i t praotioable. ino~tal oare on deJIand. Se"ioea for sahoola will in . . . oountrie. and territories be provided b7 priYate praotitloners, and in others b7 both private praotitionors and sovenment 88"ioes. aovemMnt-provided .."ioe. tor adulta nead not neo....ri17 be tree o~ oharp.
..
- 15 In the provision of dental health .ervioes, particularly in rural. areas, It ahould be realized that the ocRNlllty relates to .theseneral health services provided and seeks attent1()n at rural health oentres or bospitals.
Dental servloes should be ProvIded in these .ltuatlcna, eIther b7 ot dental womrs at the larger oentres or hospItals or by attendanoe at resular intervals by personnel mainly conoemed with the provls1on ot sohaol health servIce •• the full tiM attendance
There should be close lial.on and co-operatlon bet.een dental health· workers and other health workers In health centre. and hospItals. Dental pera0lUl.81, partloularly the protes8ionale, should be eduoated to be able to worit with other health workers. A reaou1'Oe which IllUSt not be torsotten in the plannin& ot public dental health p~. 1. -the private dental practltlener. BYwlT attempt II1st be aade to sa1n the interest and the co-operation ot the . private practitIoners in coaaunlty dental health probl_s. In all oQUlltrles. partlcularly tho_ relying m.mly upon private practlticnera tor the .prov1s1en ot _rvloes. evel'7 endeavour should be made by SOV8mMntal apnoles to involve th. in o~ty health planning and health educatIon aot1vltle•• Sz!Po.ita 1 - Child Dental Health Services 1. Identitloation of neede
• •
The elata.bowd. that all countries required prognane. tor children to cClllbat dental oai'1es and periodontal <11sease. A better awarenea. _ensat the publio of what dentlstl'7 i. try1ns to do in ohild health servloes is necessary. The cleaand. tor the_ . . rvlces would _inorease and
•
a better chance of attaininS obJeotive. would tollow. Examples ot agencIes which oan assist in promotins dental health are 1fCIIIIHl'S cOIIIIIittee. who have ohild care in the foretl'ont ottheir III1nda. Local _rvlcea clubs have played a v:aluable role in acae terri tori••• It an attellpt to 1JBp18llent too .bit1oua sohetaes ia undertaken disappointaenta will tollow; but if procrau, CCIIIe8 within the facilities en hand, aoh1ev.en'tS will be reoosnized and It Is likely that public support and syapa"th7 will be obtained. Beoause ot generally limIted taollitles, ideal treatment otten-oannot be Siven for any Siven patient, so that cOIIprcm1ses have to be· ..topted. SOlIe countries and territories reported a d-.n4 tor speoialized _rvlcea in pedodontics and orthodcntloa.
- 16 It was recognized that the six-year-old i.s a pel'lSClll 1fho is at a critical stage in his developlll8nt. This emphasises the need for dental examinations at an earlier stap to 8naure that interceptive care will avoid unnecessarilY' extensive treatment. Speoial effort should be .-de to extend dental services to preschooloh1ldren. A suitable ocoaaionfbr this is durinS school vacation when dental pereormel are generally free tl'Olll school dental service duties. 2. Bx1sttng organizations to meet these needs
'!'he existing progJ'8lllll8S were described. Most countries and territories had progl'lUlllles for schoolchildren; but in the oase of ohildren not attending sohool - be they pre-schoolchi14ren or children of school age - they were generally not 1ncluded 1n these prosra-s except when servioes to relieve pa1n were required. Caries control was the priM concem of the progr&lllll8s. '!'here was an 1ncreuing tendenoy to use auxiliaries to provide the servioes. ,. Additional resources required to meet these needs 1n the tuture
It was agreed that dental servioeS tor ohildren are !lOst efficiently provided by treating children at sohool. Where schools are large 8DO\18h, permanent school olinios are desirable. Smaller schoolB oan be _"ioad by mobile cl1nios whsre roads are present. Where large central cl1nic!l have been established, the movement of children tram sohools to cl1nics should be provided either by publio health or education· authorities. The provision of services 1n remote areu is 1n scme cues being neglected. These areas can be reached by sea or air. There is a need for the development of portable dental equipment to serve such areu.
'!'he assistance of departlMnts of eduoation and school teachers can pla:y an 1IIportant role in the efficiency of dental Prog1Wllll8S. 'their oo-operation should always be sought by dental personnel. Fluoridation of water supplies and the other methods of prevention of dental caries using fiuorides were tully aupported. Action and 1nitiative were urged 1n developing progranmes of preventicn using selectively the eUective methods available. ll1ch Pl'08IZWii6S should . achieve ever-1ncreasing coverage of the child population until the ul t1mate goal of cCIIIPlete coverage isreacbed. SympoaiUIB 2 - Intematicnal AId and ""ture Dental Health Activities 1n the South Pacitic ""ture dental health activIties 1n the South Padfic . .re d1sClUsMd with special reterence to area prosra-s,. co-operative effort and the place ot 1ntematlonal and govemmantal aid and ua1atance. i
•
•
- 17 Attention was drawn to the particular geographio and demographio nature of the South Paoific CClaBission area wh1ch raised probl_s alwlQ'S to be kept in mind .nen planning servioes. The South Pacific oa..i8Sion area is situated in the world's water IO&SS. embraces 12 million equare miles and oontains 4 million people looated among ten thousand islands. 'ntis oreates great problems in oOlllll.lnicat1on not only with one another and with the outside world but also within territories themselves. It also raises problems of transportation and portability as .a discussed at length in the Seminar. The South Pac1fic is an area ocmprisingthree main etlmic groups of Pan1fic Islanders - Polynesian, Melanesian and Micronellian - who are beooming more and more independent. The whole area is in a process of rapid sooia1 and eoonomio change and it requires all the aid and assistance the outside world is willing to proyide. The sources of aid were discussed under the tollowing headings:
1.
Metropolitan Dcm.I:mments Direct aid is given by Metropolitan gove1'J'llll8Jlts to their territories
and tomer territories.
2.
South Pacitic Commission
The Commission was established in 1947 as an inter-gove:mmental agency for aid and assistance in the three areas: eoonomic, sooial and health.
For dental health the CaaIIIission has provided: Ca' Cb) (c' assistance to research proJeots: publioation of doOUlll8lltS: and finanoes and services for seminars.
It has recently appointed a dental public health officer who will be available to the territories who request his services. Where a request for assistance in dental health cannot be met by the dental public health officer. the Commission might consider the,appointment of a short-term consultant. Requests for the services ot the dental public health officer can usually be met in the year they are miLde. Requests which involve special financial provision, seminars, consultants, etc. must be made twelve months in advance. and with a forthcoming change in progrBllllling an indication of requirements should be made three years in advance. The CoaInission has a public health engineer. and shortly will appoint a ,health educator. The services of these two officers may be requested for assistance in dental programmes.
,
- 18 ,. World Health Organization
'lbe World Health Orpnizat1on ... established in 1~8. It has its Headquartere in (Jenna, and for the We.tam Pac1t'ic Rlgion a RltCiClll&l Office in ManUa. 'lbe WHO Representative's Qtfice in Suva covel'll all 1aclflc Island ~~tories except Quam which IsQovered from Taipei. Assistance for dental health has been provided to territories in the South Pacifio as follows: (a> (b> (c) (d) (e ) consultant services; assistance in the cenduct of dental health surveys; fellowships tor education and training of national dental health staff: advisory servioes and lecturere at dental schools; seminars and .etings; and
(r) data processing facilities. WHO acts at the request of governments only, and the budget i. normally set two years in advance. '!he Conaission and WHO have agreed that since the CoaIIIissien baa a
dental public health officer, it should play a leading role in dental publio health advisory servioes in the South Pacific, in close liaison wi th WHO. WHO does not have a full time dental offioer at the ManUa Regional Offioe, but has dental offioers at the Geneva Headquarters whose &ssistance is available. Data-processing facilities are also available at Headquarters. 4. Other United Nations Devalo ent Pro encies - UNICEF United Nations
•
'lbe.e agencies have in the past assisted with programmes which have dental aspects - UNICEF and UNDP in the development of water supplies, FAO in nutrition. UNICEF has aSSisted in· chUd dental health progrBllllleS but recent17 has indicated that greater emphasis will be given t.D pro&~. in eduoation. In the assistanoe given by. these agenoies preferenoe is given to prograames which lead to the development of oCIIIIPlete health .services. . WHO acts as adviser en health to the other United Natien. Specialized agencies.
5.
Private and Oovemment Programmes
There are numerous private and government programmes which provide assistance and dental perscnnel should become familiar with those available to their terri tory.
- 19 -
6.
Educational Institutions
'!be developed oountries concerned wittl the area provide p1aoes in their universities, technical institutes, h,ospitals and awdl1al7 tra1n1nS in.titutions for dental personnel trom the Pao1tic Xslands, at both undergraduate and post-graduate level.
'lbt question ... rai.ed oonoemins the desirability of the two dental sOhools wi thin the South Paoific establ1ah1ns a persaanent relationship with a dental soh,ool in Australia or Nn Zealand. Benefits whioh oould acorue would be in the fi.lds of staff and student .xohange, and in the provision of teachins materials.
7.
Dental Assooiations
•
At present there ... little oOllllunioation betwen dentists in the Paoitio, '!be P44eration Dentalre Internationale and dental associations of Australia and Nn Zealand. Ql. problem was that many territori.s did not have ad.ntal association. Br1sadier FUller undertook for the partiCipants as private individuals to brins to the notioe of the appropriate people the de.irability ot establi8h1nS a South Pacific Seotion of the Asian Pao1tic Dental Federation. The gen.ral conclusion ... that oansid.rable aid was available and that dental personnel should be .....re of the fonas of aid available to their terrltol7 and -.It. requests through the appropriate channels for the assistance they require.
4.
C(IlCWSIClJS OF THE SIMlNAR
Dllaediate1y fo11owins the seminar the contents of thi. ·section were distributed by the Conaission as the reoOllllllendationsof the ....inar. In this 'chapter the cono1u.ions are identical in wbstance to those reoOlllll8Jldations but the order has been ohanged. 4.1 Dental wrveys
4.1.1 That whenever tuture wrveys are contemplated in the territories of the South Pacific Conais.ion these be pertomed in aocordance with the prinCiples of WHO Ballic Oral Ileal th sUrvey Methods Manual (WHO;l:ii/69 .84) , the rewlts to be tabulated. in a .tandard fOnl. FUrthemore, that the SOuth Pacific Commission's and/or the World Health Organization's advice be souSht at an .arly stage. The question. of the inclUSion of age groups' after 54 should be considered so that an as.essment of prosthetio needs call be made.
4.1.2 That future survey. be pro~ for cOlllputer proce •• ins and tabulation. The Seminal' noted that assistance in plannins and analysis is available f'roaI the World Health Organization, Gen.va, and that French Polyn.sia posse •••• well developed cc.puter services.
• - 20 -
• 4.1., Sinoe in IIOst surveys there 1s an abaenoe of data on the looatlol1 of dental oaries by tooth surfaoes although .v1dence suggests a preciClll1nance of ocolusal oaries throushout the area. and sinoe this 1s a factor w1th an 1JIIportant bearing on the types. numbers and training of dental peracnnel and on the preventi.,. techn1ques to be teu&ht and used. a study mould be launched to obtain this inforaat1on. and tIltuN re-evaluation SUl"V8711 should also include th1s 1ntoraat1on.
4.2 Prevent1ve dent1stl'l and dental health educatlon 4.2.1 Health serv10es ought to oonsider pNventicm as the1r IIOst 1IIportant conoem. Anyone w1th respons1b1l1t1es in dental health ehould be educated to thh end. in Order to achieve tull integration of prevent1ve and curative MaaureS when planning and 1aple_nt1ng dental health pro.n.-s.
4.2.2 Health eduoaticn 1s an essent1al part of any dental health prosre-e and the orpnlzatlon and planning of dental bealth senloes IIIlst be OCIIIIIUJllty-based and or1entated in oral health plUlOtlcn. PUll use of existing oc.am1ty groups shQ1ld be ude in de.,.lop1ng the heAl.th eduoational p~.
Target populat1ons for dental health educaticm are as tollows: presohool school adults: expeotant mothers nureing _others other groups. Bltpeotant IIOthers and nursing mothers should be prior1ty groupis.
4.2.' The appoint.ent of a qualified health eduoator by the ~th Pac1f10 eoa.1ss1on to oo-ordinate. advise and guide health educators in the terr1tories of the area would enable effect1ve and evaluated.' ProgrullleS
to bedeviaed
4.2.4 The area health educator should be respons1ble for re ..arob in the oontent and . .thods to be used, and should investigate tha oultural, soolal and env1l"C1nMntal factors influencing these eduoat1cmal _thods and _terials.
4.2.5 WheN a publio health servloe e_ploys a health eduoator. dental health eduoation should be part of his duties. 4.2.6 All dental peraconel should be involved in the health eduoation prog~
which IIhoIlld be under the dlreoticn and gu1danoe ot a health
eduoator.
- al 4.2.1 Bach territory should enpp a health eduoator, who should intearate dental health eduoation in the pneral health eduoation prop- I • 4.2.8 Fluoridation procedures
ca-mity prognu.es for the Pl'CllllOtion ot t1uoridation aust be baaed on a health eduoation prognu.e direoted to the politioal, oivil, administrative and ~ty leaders. It is an aocepted soientitio tact that fiuorides are etteotive in the prevention ot dental caries. The Se1111nar theretore oonsiders that: (a> sovenuaents and local authorities should institute drinking water fiuoridation prop ... whenever it is poaaible: where fiuoridation ot publio dr1nk1ng water is not posslble, fiuorides' should be dlspensed by other _ans (e.g. tablets, school t1uoridators, etc. >j the use ot toplcal applicatlonsabauld be oona1deNd; the South Pacltlc ec-isslonahould prepare and dlstribute l1terature on the use ot fiuorldes: The South Paoitlc ec-lssion should enoou~ research on other vehicles and optimum t1uoride levels. ~search.
(b)
(c) (d) (e) (t)
The Se1111nar augpsts that the South Pacltic OoaIIIlsslon might sponsor research in two speoitl0 areas:
i>
the use ot nuoridated resins tor filling tislJl11'lls: and
•
11 > the use ot tluoridated prop1Q'lactic paste • 4.2.9 Olanp's in dlet
•
The dental health authorities should be oonsul ted when ....,01' policles atteCt1ng Motional or reglcaal dlets are under consideration because any chanp in baslc diet ~ have tuwhnhtal etfects on the oocurrence ot oral diseases. '1'Il1s baa 8pec1tl0 relevece to the oonllUlllP'tion ot retined oarboh7drates, either overall or in respect ot oertain population sectors ,tor ex.ple, those sernc! by school or presohool oanteens. All posslble _&SUres should be . .ployed to reduce . the Jlamtul dietary ettects ot inc~ased oonauaption ot supra.
.. - 22 -
4.2.10 Oral hll1ene prop mas In oonslderatlon of the high prevalenoe rate ot periodontal dl..... in thl. area, inten.lve oral h7liene prosr • abaul.d be 1natltute4. 'rhese lilhould inolude toothbruah1ng, prophylaxis, soaling and dental health education •. 4.' Bllucatlen and tra1nin§
4.,.1 Degree oourses 'rhe Se111nar noted the intention ot the dental .chools at Port Moreab7 and SUVa to develop within the next five J8ara curricula that will lead to a university degree oourse. It cODslders theretore that territorie. and countries lilhould eX8llline the eduoatlonal level trc. which they draw their dental student recruits to ensure they will be able to ...t the higher level ot entry that a degree course will entail. Territories end oountries whiOh oenslder they will be unable to . .t the requlreaents should indioate their dlUlou1tlesm4 eduoational detloiencles to the South Pao11'io eo-isslon and indicate alIIo the level to 1Ih10h they want their 1aIrDediate protessional dental .orit toroe eduoated. 'rhese territories and/or countries are advised bonnr to prepare tor the long-term movement towards the degree oourse.
4.,.2 Auxiliaries '!'he Seminar noted a diss1milar1 ty
ot views on the tra1ning end
dutie. ot operating auxiliaries and diUerences in their utilization. It believea that in my particular prograDllle their duties IIhould be clearly detined.
The Seminar noted that several territories are in need ot their own local expert gui4enoe in the tleld of dental publio health. It supports the ~elo;..nt of a oorps of dental ofticers educated at the post-graduate level on this subJeot by means of WHO tellowllh1ps.
4.,.4 Evaluation In riew ot the probl... revealed during the discuu1ona. clental eduoat1en end training tor the South Pacific should be en1\1&ttid and . .seaaed, possibly b;y or through the South Pacitic ec..1ssion. 'l'h1s might inclUde the deslrabll1t;y and te. .ib1l1t;y ot pool1na eduoational tacillties tor the Ehgllli1h-speaking seotor into one school and the establishment ot a school tor non-operating auxiliaries tor the Prenohspeaking territories.
4.3.5 Co-ordination In view of the need to ensure adequate infonaation and co-ordination between principals of dental training schools and heads of dental ae"ices, there should be cloae co-ordination between the dental schools and the dental health services in countries or territories through an adequate lmowledge of the level of qualifications required for ent1'7 into the schools, the qualifications obtained on leaving, and, in particular, a knOll'leci&e of the resources which !lUst be planned for students when thaT leave the training sQhool. Thls co-ordination could be obtained through a bl-annual or lIIIIlual infonaation bulletin, edited b7 the schools and circulated either directly or through tb8 South Paciflc ec.alssion to the heads of dental se"1ces.
4.4 Organlzation of dental public health 88"ices 4.4.1 The organizat1on of dental public health 88"lces should be structured around the dentist who provldes directlon, purpo88 and opt1mal supe"islon for the baslc treatment te. . , including operating dental auxiliaries and other supportinsstatt. 4.4.2 Accent should be placed on p~sx es for captlve srcups of all &ses and t7P8S, in partioular inoremental school se"ices, orientated to prevention and the promotion of oral. health awareness. Where ocaprehenaive se"1ces for sohoolchildren oannot be provlded, first prioritT should be given to the pennanent dentitlon. The senior dental officer in a territorT and oount1'7 should be included in the oentral po11cT, plannins and administrative oOlllDlttee of a health department or minist1'7.
4.4.3
4.4.4 Inmral areas, statio facilities should be provided within the health centre or dispensarT complex with as much liaison as possible with medioal staff. 4.4.5 • The p~vate sector of the profession should be encouraged to become involved in oOllllllWlity health problems •
4.4.6 Strenuous efforts should be made to create oonditions oonduaive to retention of looal s:taff and recruitment, where neoessa1'7, of expatriate staff.
4.4.7 Operating and non-operating aux1liarT funotion should be supported by legislation which not only provides a framework within which theT oan funct10n at the present level ot development but would be suftlc1ent17 fiexible to allow for possible ohanps in the role and aotual duties of auxilla1'7 personnel.
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4.4.8 When adJUstment8 are
IIade
to salarr 80ale8, oODClitioll8 ot .."ice
and pl'OlllOtional incentives in Departments otPublio Health in the aauth
Pao1tic 00III188ion area, negotiated advanoe. tor medical peracnnel lIhould be extended autc:.atioally to dental personnel on a huh ot parity, grade tor srade, with medical pereannel.
4.4.9 Attention i. drun to the extenaiye devel~t in Prench Po1Jne.1a U8ing lIOC1em data proces8ing and scientifio _thods ot orpnizat1on in the tield ot dental health which can be uHd etteotive17 to bring about an 1aproveMnt in dental heal ttl pluming and in Mdico-cJental. N ..arch. '!he S-inar NOOlllll8ruis that these JDethocla be used and that the7 be 1IIple.nted in 001laborationw1th the World Health Orpnization, with the South Pacitic CoaIIIis81on, and also With territories or countries . which already have experienoe in thi. tield 4 4.4.10 School dental health serv10es <a> As a general principle, sohool dental serV'1ce. should be provided in the schoolgrounda. An altemati" i. to proTide transport to aoentral olinic. Since the effeotiveness ot the dental peracrmel in school health i8 dependent upon the equi~t with which they are supplied, the South Pacifio CGIInission might undertake to produce a specitioation ot the minilml equipment required b7 dental peraconel. When the South ho1tic eo.1sa1on appoints a health
(b)
(0)
eduoator this offioer and the dental public lIealth offioer a1sht be asked to advi.. terri torte. on the cle"lopaent ot curricula in dental healthed.uoatiaD suitable for islanders, and organize training ccurses for dental personnel. • (d) Sinoe toothbrullhing is an essential procedure to at1;ain oral health tor the whole 00llllllUDi ty, supervised toothbrullhing prog!'8lllle8 should be carried out particularly in sohools, as a _aSUN tor educating ohlldren as well as parents and .chool teacbera in the develos-nt of a good health habit.
The lIMbers ot the Seminar willh to express their thank. to the SeONtarJ-Oeneral of the South Pacifio OcIIa1saicin, Atiop AtoatClUY&le Mi.1aoa, tor the _100118 enoouN&eMDt he has giYeD totba; to M4cleoinCWDMl J. Rondet, Director of Health- and l\1bl1olC1g1eM in ..... cal.edGDla, tor his _lcoae to Nn Caledonia and tor opening the s..'lIar.
•
-
25~-
The Seminar I18111bere are indebted to .the ..mere ot the SOUth Paottio ec-1ss1on statt who worked 80 hard lIdIlinisterms the S-inar:
the COnference otticer, Mne S. Bxbro;p.t
the Travel Offioer, ....
c.
aautier
the Interpretatlon/trenalatlon teem: Messre O. OWlcUer, c. stenereen and R. ec.ptcn-SIIith, and Mlle o. Bazinet
-u.
stenosrapher, ....
H. Ventr1110n
Mr I. Bo7d and Miss Z. Hopn of the Pinanoe Section; and. to all who helped. before, durinS and after the Seminar.
P1nal17, the _bere of the Sainar wish to thank the two orsanizaticns, the World Health Organization and the SOUth Pacific CCIIIB1ssicn, for provid1ns the finance, statf and facilities for the SeIIinar •
•
•
- 27 AlOfBX 1
Open1ng Session See
WPR/III/Infomal 1
0pen1nI D1scussiem atai:naan: Chief Rapporteur: 1. Dr K.K. Wcmg Dr J. Johnston
Briefblg on Seminar adlD1n1strat1Ye procedure - Dr M.J. Hollis Principal points Dr J. Bamaud
2. ,.
ot open1ns theme - Br1pdier J.F. :PUller and
Dental statistics - Dr K.K. Wens
Oo\mt17 Rltports Qla1:naan and
Rapporteur:
Dr M.J. Hollis
Participants were told in auletin No. 1 that they would be asked to sin a "17 briet oral countl7 report. Ve17 briet meens tlYe minutes. Participants are asked to Wl'f.te out their report and hand it to the Cha1:naan at the end ot the session. It there are more than one participant f'rc. a terri tory cnly eme country report is required.· •
TOpic 1 - Oral diseases and abnormalities in the South Pacific Olairman:
Brigadier J.F. PUller Professor N. Martin
Rapporteur: Work1ng Papers:
WPR/DI/1l/1 - Dental epidemiology in the South Pacific Dr K.K. Wons Reactor: Dr D. Na1'87an
WPR/DH/11j2 - The aetlolOl7 of dental carles and periodontal disease Dr M.J. Hollis •
Reactor:
Dr T. Malakl
- 28 Annex 1 oant'd. Topic 2 - The prevention of dental disease. and the treatMnt of their oonsequence. Chainnan:
Dr H.C. Pield. Dr A. Trotet
Rapporteur: Voridng Paper.:
WPR/lli/ll/3 - Prevention of dental disease. and the treatment of their consequenoe. . Dr J. Bamaud Reactor: Dr P. Moreau
WPR/IIi/l1/4 - The place of dental health education in public health education (South Pacitic aNa) Dr Q. IA>ison Reactor: Dr S. Kilis:lJllaai
TopiC , - Education, tra1nin§ and utilization
ot dental peraoonel
Rapporteur: Vorkin§ Papers:
Dr R. Cslllrasa
WPR/m/ll/5 - Dental IIIIIDpower and dental health planning Brigadier J.P. PUller
"
WPR/IIi/l1/6 - Denial education and training Dr A.H. Thomson Reactor: Dr A. Vele
TopiC 4 - Organisation and plsnng of dental publio health se"ioe. within pneral health se1'Y1oe. Chairun:
Dr J. Helkana Dr D. Anderson
Rapporteur:
•
- 29 -
Annex 1 oont'd. WoricinS Paper:
WPR/DH/1ll7- Organisation of dental public health service. Dr D. Ba11nes Reaotor: . Dr H.C. Pielcls ap,osiua 1 - auld dental health .. moes
Jlilpporteur: Panel:
Dr K.K. Wens and Dr J. Bamaud
Srapoa1UID 2 - PUture dental bealth actidtie. in the South Pacifio
Br18adier J .". IIUller ftapporteur: Dr J.. Johnsten( 011.1' JIapporteur)
Panel:
Dr K.K. Wong and Dr M.J. Hollis
N.B. ftapporteurs Blast. COIIIplete their reports each dq (enD though a topio M¥ Dot be oompleted) on t:lme 1'or the 011e1' Rapporteur to oheck the coPY' and. Si'" it to the Conference Offioer by 8:00 A.a. the 1'ollGWins day •
•
It is possible that on 5:00 p ....
IJCIII8
day. the ....1on.1Iq oontinue until
•
Tlme
Tuesday 28 JanUIY
Weelne""y 2'7 JaDUZY
ThlBlclay 28Januay
Fdclay 211 JaDuay
Saturclay 30 Januazy
Maaclay 1 February
T1IeIcIay 2 February
8:00 a.m.
ro 11:0&5 a. m. 10:00 a.m.
11:00 a.m. 0peDlJJI Sealon
Topic 1 Woddq Paper 2
Toplc 2 DlJcUlllOll
Topic 3 Woddlll Paper 5
CoanltaDu' meetllll
:::....cIe..t101l of .port Topic" WorJdDS Paper '7 BeI_mmenclltloDl ~cleJatlOll of .port ~eI recommenclatlooa .
11:30 a.m. 1:31 ,.m. 3:08.p.m. 3:15 p.m. ":30 D.m.
•
()peuJ.JI8 DlJcIllllOD .
Topic 1 DlJcaalOD
Sympollum 1
Toplc3 DlJcIllllOD
Topic " Dllcllllloa
Topic 2 COIIDtry Reports
Sympoalum 1
•
Wodd.DI Paper 3
•
Toplc 1 Wodd.Ds Paper 1 ---
Topic 2 WOIkiDI Paper " '-------
Sympoalum 1
Topic 3 CODIultaDU Sympollmn II WorIdDg Pa per 8 aDei all partlcljlants r.e DlJcUlllOD Toplc3 Sympotl,1IIIl II QuestlODI DlJcIlllloa --
~""cleJatlOil of .part Del recommenclatlooa.
~loIlDg AelcIIeJa ~
---
--
..
_-
-----
---
------
-
--
-- - -
i ,;. . •
i ..
•
- }l -
• LIST OF PARTICIPANTS Amerioan Samoa
ANNEX 2
Dr Harold C. Fields Supervisory Dental Officer LBJ Hospital of Tropical Medicine PAGO PAGO
Australia
Professor Noel D. Martin Department of Preventive Dentistry Uni versi ty of Sydney SYmEY
N. S. W.
2010
Cook Islands
.G. Fraser Principal Dental Officer RARar<:NGA Dr J Dr M.B.
Masi Dental Officer Central War Memorial Hospital P.O. Box 115
SUVA Dr
D. Narayan Clinical TUtor Dental Clinic Central War Memorial Hospital P.O. Box 115
SUVA
Frenoh Polynesia
M.D. Morin CcnIIIandant du Corps des Officiers d'Administratlon du Service de Sant4 des Annees Special1ste de rOrgan1sat1on et de l'Infonnat1que S.P. 91390 PAPEETE - TAHITI Dr T. Malaki Dental Officer Central Colony Hospital BIKENI:BEJJ - TARAWA
Gilbert & Ellice Islands Colony
•
- 32 Annex 2 cant 'd.
Quam
Dr William C. Slemone c/o Dental Sectian Department of Public Health and Social Services P.O. Box 2816 AGANA. 96910
New Caledania
Dr P. Moreau
Chef du Centre mili taire de Stomatologie Service de Sant~ des Troupes du Qroupe du Paoifique B.P. 20 NOOMEA Dr A. Trotet
•
Chirurgien-Dentiste B.P. 1132 NOOMEA New Hebrides (Condominium) Dr A. Chassary
Chef du Servioe de Sante des Nouwelles-H~rides
.
PORr VILA New Zealand Dr R.K. Logan Assistant Director Division of Dental Health P.O. Box 5013 WELLINGTON Dr R. McKegg Dental Surgeon KINGSTOO' Dr D. Andersan Chief of Dental Servioes Department of PUblio Health Konedobu Dr Andrew Vele Department of Publio Health RABAUL
•
Norfolk Island
Papua New QuiDea
•
•
-" Annex 2 oant'd.
Temp
Dr Siane Kilis1masi Chief Dental Offioer Dental Department NUKU'ALOFA
Trust Terri tOry of the Pacific
Islands
Dr Jack Helkena Chief Dental Health Services Dapartment of Health Services SAIPAN - MARIANA ISLANDS
96950
Dr Itor A. Harris Dental Officer Dapartnlent of Health Services KOLafIA - P<JlAPE Eastem Caroline Islands 96941
Westem Samoa
Dr Rex C8mrass Chief Dental Health Services Box loctr APIA
Dr A.R. Laumalil1 Siu Dental Officer Box 192 General Hospital APIA
• -~Armex 2 cont'd.
C<IlSULTANTS
Dr K.K. Weng University of california LOS ANGELES - CALIFORNIA U.S.A. (WHO Director of the Seminar) Dr M.J. Hollis Dental Publio Health Officer South Paoifio Commission P.B. No. 9 NOOMEA - NEW CALEDONIA (SPC Co-Direotor of the Seminar) Dr J. Bamaud Chef du SerYioe d 'Hygib dentaire P.B. 947 PAPEETE - TAHITI Dr David E. Barmes Epidemiologist Dental Health Un1t lIorld Health Organisat1on 1211 GBNEVA 27 - SWITZBRLAND Br1gad1er J. Ferris Fuller Direotor of Dental Serv1ces ArtJl7 Headquarters Private Bag Wellington C.l New Zealand
•
• ADVISERS
Dr J.W. Johnston Port Moresby Dental College P.O. Box 1881 BORatO - PAPUA HEW 0UIlIEA Dr A.H. Thomson
Senior Dental Officer . Dental .D1v1s1on Medioal Department P.O. Box 115
SUVA - FIJI
.. •
,
• Annex 2 oant'd. WHO Staff' who attended the Seminar:
Dr J. Hirshman WHO Representative P.O. Box 113
SUVA - FIJI
SPe Staf'f' who attended the Seminar: Dr Guy Loiaon Progrllllllle Direotor (Health)
SPC Staf'f' who HrY'ioed. the sem1nar: Mr M. Chandler
lnterpreter/Tranalator Mr R. Callptan-Smith
lnterpreter/Tranalator Mr C. Steneraen InterpreterjTranalator Mlle S. Exbroyat Conf'ereno. Of'fioer NIle H. Ventr11lon
Stenographer
..
-YTAIOIBX 3 LI8'l OP VOJIaIIO PAI'BRS AID DOCDIDftS
A.
Vor!d.D§ J!!P!N
VPR,/tII,l.Ll
Bpldemlo1ogy ~ Oral Dl...... and AbDolWtl.ltie. in tile SlNth Pultl0
Dr K.K. Wane Dr M.J. Ho111.
1fPR/!H/l2
m......
Aetlo10G' lind Pw.ent1On ot Oral aDd AtIaozwallt1e. :In the SlNth Pulno
'!'he 'is •• tl_ ot Dental ))l. . . . lind 1;M. '.rI'Sa_ _t ot Ita Cauequaoe, 1IPJt,/t1IIl~ ~
Dr J. S&iuud Dr O. Waon Br1pIdler J. PUller Dr A.H. ThauCIIl DrD.B. SaDIe.
Dental. He.tth atuoatlC11l Dental JIiDpoIMr . . Datal RHlth
WPR/iIf/15 WPIVDI,I.L6
Plun1n8 Dental Bduoatlon .ad Tra:ln:lns Orpnizatlon ot Datal Publl0 Health Serno••
,.rr1.
VPR/bI/17
B.
Doe1ment. aft1lab1e to eaoh partlo1p!Dt Ser. 10\6)
Upc!!!
arr1ftl.
Expert oa..lttee en Water PluorldatlC11l (Wld Hlth
Ors. tech. Rep.
Expert CcIB1ttee en Auz111&1'J' Pel'8Cll1De1 (WHO 'rRS Mo. 163)
•
PeriodGltal Di..... (WIfO 'l'RS Mo. ~satlC11l ~
!2I)
(WHO 'l'JIS Jfo. . . )
Dental Blluoat1all (VII) '1'R8 No.
-
Rltport1n8 ot Dental Di...... and Ocndltlon. .
!!!.)
OrpD1satlG1l ot Dental "'bl1. Health !ern... (WHO TRS 110. 298) Datal He.tth atueatlC11l (VIIO 'l'RS 110. ~9)
-
•
- ,a Annex, oOl1t'd. Fluorides and Dental a.alth, Oeneft (World a.alth Orpnisationa Monograph Series No. 59) Pluoridation and Dental a.alth - 'l'Wn't7-Seoond World a.a1th Assembly (A22/pe/T) Inter-Regional S-inar 011 the '1'N1nins and Ut11ization ot Dental Personnel in DeYelopins Countl'ie., New Delhi, 1961 International Cla••it1oatiOl1 ot Di ..a.e. Applioation to Dentist17 and stalatolog (WHO/J:HI69.8,) Report ot the Sellinar on Dental SerYloe. DevelopBtnt Del Co-operat,.1on in the faoit1c (Port'.-,More.b7, 1968)
• •
•
c.
Doouaents aftllable in cOI1terenoe libl'!l7 Report on a Dental &.tm7 in Westem Dr R.L. Siu and Dr X.X. Wena
s-oa (WPRO 0115) b7
Baport 011 a Sum7 ot Dental Di_a... and Ccnd1tlan. in PiJl (WPRO 0115) b7 Dr X.K. Wong Rlport 011 a Dental &.trYe7 in Tcmga (WPRO 0115) b7 Dr If. Mol 'l'apealaft and Dr K.K. 'Wema: Asa1snMnt Rlport (SOuth Paoitio Area) b7 Dr K.K. Wena AssllrJ11181lt Report (Frenoh Po11nesla) by Protesaor L.J. BaUM (French onl7) '1'N1nins Course on Dental Epidemiologioal Methods tor Countries ot the Veatem Pacitl0 Heglon (WPRO 0115) S:lnppol'8 - Malqsla
•
•
'.
•
•
•
'
. No. of children at .chool 2~91
.
.
stJIII4ARY OF COOH'l'R! REPORl'S
GEOGRAPHICAL AND POPQLATI(J{ ,DATA --"---
"-'No'. -, islands 6
--'rOtai ' land &J!'e&
PopUlation ' . Kames , Population of largest towns last oensus
Pluoridatlon, of water I
AMlRICAN SAMOA AUSTRALIA OO(J(
~ 12
76 2.V7 ~
II
27769 11,611 19 251 ~16
PAGO PAQO
85,1 2.59 •
SYIImr JWm(JfOA
2 591 720
Yes Yes
ISLANDS
9895 54 l57 'rf 000 ~591
5666 1~ 1~
FIJI PftBNCH POLYRESIA
80 70 29 1 8 ~1
7ctn ~lol ~O
727 5~
EJNA PAPBIrB
560
97 000
KIA
GBIC GUAM
BBTIO AOANA
006
212 1910,t
90 000 100 000 78000 2.8 II
9000 ~5
'rf 000 29900 18 ~1
NIW CAI.IIXmA HJII HBBRlDBB HJII ZBALAND
NOOMIA PORr VILA AUactAND
000
l20001 10, ~16
7917 600 000 ~1
,2 1
650 000 320 KIA 2~
Yes Ye.
~
NORPOIic PAIVA NEW GUDIBA TOfOA
N/A ~
1.3 182251 269 700 -
2., 77
1275 II
'ORr MORBSB! NUKU' AJlJPA
M8
~29
15685
560
T'l'PI WBS'l'l!3{
96 ,SAMOA ~ -,
91~
WI> APIA
5957 25~
312780
l200
1.31 ",7
,s045
-
1
Sq
kilometres
2 Main Islands only
i ..
Conducted B1 whom
Method
.... All
.m'AL """'Si
Rlwlta who1. oountl'l Ye. IfO
d1' . . . IJ4F . . .
appl10able tc 5-6
1,-14
Prevalence periodontal disealle Ace 13-14 Age 45-5~ 98.~ 98.~
IA_.. CAN
SAMOA
Y •• Ye. Ye. Y •• Y •• Ye. No
HOI!I~
~US'f'ftALIA
sta
0115 2~ 2~
1
Yea 6-19 Y.a I- Y ••
\1.0
1.1
-
poox ISLANDS jrLn: jnDal PBIC POLYNESIA
= s.u.e Wcnc
Hanaqn
Gl15 242
No Y •• Y •• No
0160'
4-19 Y ••
12.5-6.0 9-1' 1a.5 9 4.2 2.5 B 8.2 ~/A ~.4
9OJ'.
58.'nC 27 •• '7.~
-
86.4"
:,
57.l!lC 1 I
tJuAM • •
*-ra Holli.
2~
5-16 5-19 Y ..
•• Y •• Y
-
1.0
9.0 NIA 10
CAI.BDC*IA HIBRlDBS
~ ZDLARD ~0JnI0II;
Ye. Y •• Ye. lfo
0115 other
-
R:Uihot TapealaTa Dept.
other
-
-
IN/A
iPAPUA iIIW OUDIIA
~OA trrPI SAMOA
Y •• Ye. Yea Y ••
Y •• Y.s 5-18 Ye.
Yea
-
~
_fA il.2
2.20
N/A 40.~
-
\
0115 .
Y .. !We
-
-
1.0
ot
0tM1'
I~th
1.5
'.7 0.9
41.,. -
97." 98.~ _.
-
-
-
i i
1
I
g
:I , 1
I lI I 1 ~.-
i
0115
Ye.
---
1 WPII) 0115 2 WHO TBalHICAL SBRIBS 242
,
WPIIO 0160
. •
... Q.
g
()
f • •
•
.
,
.
•
.
r
'.
•
". DENTAL PERSONNEL2 Professional Operating
• , , I
'. TREA TMENT IN GOVERNMENT SERVICE
• SCI'OOL DENTAL SE1WICE
'
.
..
I
_----1---__
1
Non
Incremental Preschool children No Yes Yes No No No Yes No No Yes Yes No
Service for
Auxiliaries Operating
SCh~OI No Yes Yes Yes
I
I Dental Treatment I' Tootlbrush programme
i " ~
_---,-_ Fluoride therapy
l
I He~ i Educatlonl
I
---4AMERICAN SAMOA
Auxlliaries
chl~dren
available to adults Frequency 1 1 ~ demand No Yes Yes No No Yes No No No No No Yes Yes Yes Yes
_...1 No Yes Yes Yes Yes Yes Yes
I I ,
7/0
7/0
No No
I
Yes Yes Yes No Yes No Yes
' I
I ,
I I
I
AUSTRALIA COOK ISLANDS
1710/3100
48/0 8/0
983/5270 6/0 .
I
9/0 31/i!
9m
Yes Yes Yes No Yes
IFIll FRENCH POLYNESIA GEIC
i
I I
21/0 7/0 0/0 0/9 0/0
5/3 8/6 1/0 0/2 N/A
1y 1Y 6m
8/15
Yes Yes Yes No
3/0
I I
GUAM NEW CALEDONIA
4/9
1y
NEW HEBRIDES NEW ZEALAND NORFOLK PAPUA NEW GUINEA TONGA TTPl WESTERN S~MOA
I
7/25 0/4
I/O 1340/0
0/0
No Yes Yes Yes , Yes Yes Yes
.~
.... ....
120/900
0/1320 0/0 fil/S 5/0
6m Sm Iy
No No Yes Yes No Yes
Yes Yes' Yes Yes Yes ~__
Yes Yes Yes Yes Yes Yes
1 I/O 27/5 9/0
J/O &'0/2
OlO 15;0
27/1 5/0
41/0 12/0
I
S/O
The answer Is yes if the majo:ity of adults can reeeiv.! dental services other than relief of pain on demand. Some territories answering no do provide ser.. i"~,1 for selected groups of adults. 2 Number before stroke refers to number in government service, number after stroke the n1lmber in private practice,
Li Yes
NO
1Y
I
IY 18 m
No __ ~_
" ;;0
>
It
'" .... ,., o
IP
I:::
- "J, AIINBX 5 BY'AIDA'lI<If These quest1cana1rea, the first two be1D& .teDd_rd WHO ....ticana1rea for semnara, and the third dea1pecl ..,.o1tioal17 tor tbis _mar, were giftll to each partioipant. The questionnaire. . .re to be flll.e4 m and retv.med una1ped. 'l'Wn't7-tour seta of questioana1rea . .re retumec1, but not all questiona ..re anawred b7 eve1'7 partioipant. Moat ot the queatlona asked for an eTaluatlon en a three or four point aoale. The que.tiena and the Dmlber of anawre reoeived tor each point on the .oale are atated below.
•
Q.!!atioana1re Ho. 1 'lre.n1 Al'NftPMJlt were: Exoellent
15
Satiafacto1'7
6
RlUOlIab17 Satiataoto1'7
2
Unaatlafaoto1'7
1
PlQ'aioal Arl"8IIPMnt ot S1te and SeIIlnar _re: Exoe1lent 12 Aooe Adequate 8 Pair17 good
, 8
Unaati.facto1'7
1
:dation and Sel"lioea were:
Exoellent
5
Adequate
6
Heaaonab17 good
Unaatlsfaoto1'7
, 0
•
'!'be AIlount of Pree 'lime Available tor Personal. Mattere and Heat was:
Adequate
10· .JUst .enausb
11
Hot enoush
4
More than enoush
'l'he Total Length
ot the Seallnar was: latiafacto1'7 12 Too short
10 Ve1'7 aatiataoto1'7
1
Too long
1
'l.'he SoMdule ot the Seminar was:
9 Ve1'7 aatlataoto1'7
Sati.taoto1'7
1,
Too orowded
1
Too 1oo.e
1
'l'he Woridna Houre _re:
•
Ve1'7 5 aatiataoto1'7
Sl.tlatacto1'7
18
Too abort
0
Too 1cms
1
'l'be IntomatiClll aalle'Una md C1rcrulan . .re I
VeIT
lJJ
HelpfUl
8 ... re:
or ... n-lp
1
Of
DO
mlp
0
helptul L1bl'U'7 IIDIl Adequate ~tereDoell'aollities
14
.JUst riSht
8
L1IIited
1
Opportuni ties to Becoae Aoquainted with the Ot.bu Partlo1P11Dta IIDCl tM staft were I Allple
l2
SatiataotoIT
6
IIot enoqb
6
'!'be r.lldeNh1p at tM Sw
'nu" WU: 1 lI'a1l"lJ' pod
...
Poor
0
0
BIte.11ent ~atiGllD&1re
lJJ Iro. 2
8&t1ataotoIT
,
• 0 f
~r
Were 70Ll interested in tM Ve1"7 _eh 24 Did 70U pin my
Sew1nert
QJUte a bit lWIf
0
'1'0 . . . eztarnt 0
1'817 little
0
ide. . or ooncepts?
Man7
17
SCM
1
V.1"7 t_ Otm.
O
lfcne at all
0
Did you have enough opportuni tJ' to express JOur Aaple
ide. . at the S-1n&r'!
15
.JUst enough
7
Hot ...ouSh
o
1fCII1e at all
o
..
Did 70U have enGIlP opport.un1tJ' to excbUp knowledp IIDCl experienoe with other part101puta IIDCl statt outside sa 1nar bGura?
MIll.
7
1
IICIIle at all
o
Bach of 10U 0 - . with speolfio obJeotives and. upeotat1oDa. 70U teel that tn... have been attained.
To 1Ib&t ezUnt do
2 '!'be ROpe ot tbe diacuss10n WU:
A little
1
,
Too 1arp
"2
o
•
- 1J5 '!
'. The Seminar has been for you
Annex 5 cont·d.
Highly valuable
17
Valuable
6
Of sane value
1
Of little value
0
Ouestionnaire No.3
Amount learned Ve17 lII10h Wondng Paper WPR/DH/ll/l tlloh
Little
•
Dental Epld.alology in the SOUth Paciflc Work1ngPaper WPR/DH/ll/2 '!'be AetiolOID' of Dental carles and Periodontal
7
Disease Working Paper WPR/DH/ll/3 Prevention of Dental Disease and Treatment of their Consequences Working Paper WPR/DH/ll/4 The Place of Dental Health Education in Public
7
10
7
8
8
8
Health Eduoation Working Paper WPR/DH/ll/5 ~
7
7,
10
Dental Manpower and Dental Health Planning Working Paper WPR/DH/ll/6 Dental Education and Training Working Paper WPR/DH/ll/7 Organization of Dental Publio Health Services' S1IIIPOsium 1 Child Dental Servioes SflllposiUII 2
10
6
7
6
9
9
10
5
9
5
9
10
~
Puture Dental Health Activitie. in the &Nth PacUic
9
10
5
!
- IJ6 Annex 5 ooot' d.
Each questionnaire also had questions which asked for COIIIIII8I1tS. Many cClllllents were JUde and the following is a aua.ary of the points Mntianed by more tMn one participant.
QJestionn81re No.1 Question No.1}. What improvements would you suggest for future aaeet1ngs of this nature? Three improveJDents were suggested: (1) (2) (}) All partioipants be accCllllllOdated together. Woming papers be distributed to participants earlier. Recoamendations be edited before being brought to the plena1'7 seaaion. OOmments. !
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Question No. 14.
Most of the participants stated that the seminar was a suocess. Q1estionnaire No.2 ~est1oo No.9. of the seminar?
What do you consider were good features in the content
The features mentioned most often in the replies weN:
(1) (2)
Prevention COmmunioation with other dentists. What features did you oonsider not so good?
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Question No. 10.
Sixteen partioipants did not an.... r the question. Pre8Ulllab!y they did not oonsider that there were any notably poor parts of the seminar. Question No. 11. How w111 this seminar be retleoted in your plan tor development and improvement of dental health servioes in your oountry? TWo partioipants answered little. Fifteen states that at least one aspect of their dental health planning would be affeoted by the Seminar. Seven did not answer the question.
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- 47 Annex 5 oont Id. Oc
ants aeYen III8de noo~t.
Q.!!at1orma1re No. ,
oa-enta Thirteen Proa the .awn to the que.tiona and the 0: oODolu8icma are drawn: (1) The participants oonddered the
I(.,ts __ , the tollow1DS a suoces••
se.1na.r
(2)
The good teatures were:
(a) (b)
The . .eting
ot people and the exobange ot ideas.
The wolidq papers and diSOI18SiClll8 were helptul.
< 0) (,)
'!'be
organisation was sat1ataoto17.
Points that Deeded :lllpro,-.nt. <a> . AoCiC odation.
(b)
Wo:lit1ns papers di8tributed earlier. The method of considering the recOlllDendations •
(0)
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