Love your teeth day

World Health • 47th Year, No. l, Jonuory-Februory 1994 love Your Teeth Day Bian Jin You Each year, China celebrates 20 September as Love Your Teeth Day, with massive campaigns to raise awareness about self-care in oral health. This event, tested in four model areas for community programmes on oral health care, has already brought about remarkable progress. Look how easy it is to brush your teeth! Health is not complete without oral health, and Health for All by the Year 2000 can only be achieved through the medium of the primary health care approach. There is, in fact, a close relationship between oral health and the essential elements of primary health care, since health education - as the first component and initiative - will bring both together. The Chinese government recently integrated Health for All firmly within the state plan for social and economic development in the near future. A complete system of primary health care has been established. In a population of about 1200 million, of whom nearly 900 million live in the rural areas, this system covers 790 million people or 66% of the total. With the assistance of the WHO Collaborating Centre for Research and Training in Preventive Dentistry in Beijing, a first rural community care model for oral health was developed in 1984 in Yuncheng. Since 1988, when the Ministry of Public Health established the Chinese National Committee for Oral Health (CNCORH), a further three models have been started. 13 About the same time, a massive national campaign called "Love Your Teeth Day" has been celebrated on 20 September each year. This campaign started in the municipalities and capitals of provinces and cities, and has gradually spread to the rural areas year by year since 1989. The common aims of these two important activities are to provide essential oral health care within primary health care to all members of the rural community involved, and to promote popular awareness of self- care in oral health and of community involvement in oral health education programmes. Using these two approaches, oral health care is being provided to the people in their own communities in both rural and urban areas, and using different methods that are adapted to fit their lifestyles. Rural infrastructure In the traditional Chinese rural infrastructure, a county is relatively independent, and has a fairly complete social structure in which the health care delivery system consists of three levels- village, township and county. At the village level, there are two or three village doctors as well as health workers and midwives, who work together in each village health station; 88% of the villages are now covered. In the model areas, at least one member of the team is trained as a primary oral health worker to provide examinations, oral hygiene instruction, preventive advice and prophylaxis to the villagers. 14 At the township level, an oral health unit operates within a community health centre, with at least one doctor trained for up to one year by an oral health team from the nearest oral health centre and dental school. These doctors' responsibilities are to provide appropriate treatment of common oral diseases, such as filling teeth, pulp intervention, extracting teeth and making removable dentures, as well as advising, monitoring and evaluating the quality of primary oral health care. At the county level, there is a department of stomatology affiliated with the county general hospital or county health centre, with between three and fifteen oral health personnel, including dentists, nurses and technicians. They are responsible for providing comprehensive oral health care to the public, together with technical guidance, manpower training, and community programmes related to oral health in the county. Four county-based community models- Yuncheng in Shanxi Province (1984), Linkou in Helongjian Province (1986), Wuyi in Zejiang Province (1988), and Zelimomen in Inner Mongolia (1988) - were set up by the health authorities. The infrastructure is similar, though there are some differences in the way manpower is trained, in facilities and equipment, and in funding. The Love Your Teeth Day campaign went into its fifth successful year in 1993. After each Day two types of questionnaire are sent to members of the public and to the organizers respectively, which are then returned for data processing. These data are used to evaluate progress. Better oral health The results show a remarkable improvement in oral health status, especially among rural children living in the model areas. The percentage of people with caries fell from 49.8% (1986) to 38.7% (1990), the average number of decayed, missing and filled teeth dropped from 0.97 to 0.67, and the fillings rate increased from 0.1% to 11.7% at 12 years of age. The percentage of people who regularly brush their teeth increased to 67.4% in 1990 compared with 13.5% in 1984 in Yuncheng, and reached levels of more than 80% in other target areas. Data from Yuncheng also indicated that the percentage of people with healthy gums increased from 1% to 37%, gingivitis dropped from 99% to 63%, and calculus decreased from 85% to 43% at 15 years of age. The numbers of oral health personnel in these model areas increased rapidly. The ratio of oral health personnel to the population changed from 1 per 120 000 (1980) to 1 per 8000 (1990) in Yuncheng; from 1 per 32 000 (1986) to 1 per 6100 (1990) in Wuyi; from 1 per 8400 ( 1985) to 1 per 6700 ( 1989) in Linkou; and from 1 per 130 000 (1980) to 1 per 17 000 (1990) in Zelimomen. World Health • 47th Year, No.1, January-February 1994 The fmdings from a four-year study of Love Your Teeth Day indicated that the activities which started in 1989 in three municipalities, 26 capitals of provinces and some large cities had by 1992 spread to most cities in the urban sector and to about 300 counties in the rural sector. Some 14 000 oral health personnel and health workers participated as providers of information in 1989, but this total increased to 40 000 in 1992. As a result, oral health knowledge- assessed at 37% in 1989- rose to 76.2% in 1992. These community models are still developing, and the big challenge is to increase the proportion of the population covered by oral care services. It is too early to judge the eventual success, but certainly much progress has been made. Whether such improvement can be maintained and extended will also be assessed. It is foreseeable that the Love Your Teeth Day campaign, as an initiative, will play an important role in pushing forward achievement of the essential goal of primary oral health care for all Chinese people by the year 2000. • Dr Bion)in You is Professor and Chairman of the Deportment of Preventive Dentistry at Beiiing Medical University, and Deputy Director of the WHO Collaborating Centre for Research and Training in Preventive Dentistry, Beiiing I 0008 I, Chino.