REPORr OF THE REGIONAL COMMI:TrEE I'
ANNEX 4 (WP/RC12/14)
TECHNICAL DISCUSSIONS
Ie 1
FIRST SESSION
Subject The subject was "The significance and importance of dental disease with
special reference to the problems of the western Pacific Region". 2 Organization of the discussion and introduction The Technical Discussions were opened by the Chairman, Colonel J. Ferris FULLER, who called for nominations for rapporteurs. Dr Yen (China) as Rapporteur in English. (Australia). Dr YON (Korea) nominated
This was seconded by Dr DOWNES
Medecin-Colonel CAILLARD (France) nominated Dr Truong (Viet Nam) This was seconded by Dr KENNEDY (New
as Rapporteur for the French language. Zealand) •
.
,~.
Decision:
Dr Yen and Dr Truong were unanimously elected Rapporteurs.
Panel presentation The Chairman then introduced the members of the Panel, Associate Professor G.N. Davies, Mr P.B. Cadell and Mr N.H. Taylor who between them discussed the subjects suggested by the Guide Lines. 3.1 The aetiology of dental caries and periodontal disease Dental caries is caused by acids formed by the action of oral microorganisms on fermentable carbohydrates. I ,_ ~
The main local aetiological factor
in inflammatory periodontal disease is the formation and retention of bacterial plaque and materia alba on the teeth in contact with the gum.
44
REGIONAL COMMr'ITEE: TWELFTH SESSION
A number of predisposing factors which increase the irritating qualities of the plaque were mentioned and the importance of the formation of calculus was emphasized. Systemic factors also affect periodontal disease by reducing
local tissue resistance.
3.2 The prevalence and severity of dental disease in the Western Pacific Region The prevalence of caries is highest in countries with the highest and most frequent consumption of refined sugar and flour. In some countries the prevalence of caries is high in deciduous teeth but low in permanent teeth and this difference is commonly associated with evidence of defects in the structure of enamel and a relatively low standard of maternal and infant nutrition. In high prevalence countries carious lesions
increase in size very rapidly, whereas in low prevalence areas the progress of caries is slow and chronic. Neglected caries inevitably leads to oral sepsis
and the dissemination of infection to other parts of the body. In many countries periodontal diseases constitute a greater public health problem than dental caries. cancer are prevalent. Malocclusion, osteomyelitis of the jaws and oral ~
,
3.3 Regional and ethnic variations In most individual countries regional and ethnic variations in the prevalence of both dental caries and periodontal disease are so marked that they are worthy of detailed and careful study. From a public health point
of view, there is an urgent need to reassess the prevalence of dental diseases throughout the Region, using uniform criteria for diagnosis and standardized methods of examination and recording.
REPOR!? OF THE REGIONAL COMMITTEE.
3.4 The importance of dental disease in the general health concept Dental tissues reflect environmental conditions which affect both dental and systemic disease. In New Zealand epidemiological studies have shown an
association between the prevalence of gOitre and dental caries and soil conditions. Because environmental factors affect general, as well as dental,
health there is an urgent need for a multi-disciplinary approach to epidemiological research.
3.5 Dental and systemic implications of nutrition in the ·('lestern Pacific &gipn
Within the western Pacific Region many people produce all their food locally; such areas provide ideal situations for the study of the effect of environmental factors on nutrition, as well as general and dental health. Since many of these countries cannot support research of this type, there is an obvious need for the for.mation of a co-operative regional research team.
3.6 soil, plant and animal studies in relation to dental and general health ,
,
From a regional and public health point of view, there is a need for field investigation of the ecological types which relate the prevalence of general and dental disease to geographic and environmental factors. Such
~
y
research can form an integral part of a medical service.
Indeed, the research
team depends upon the observation and experience of the medical and dental service staff. Examples w·ere given of research of this type which led to the
discovery that deficiencies in the soil were related to the health of animals and man. These studies emphasized the importance of co-operative teamwork in There are exceptional opportunities for carrying In this
epidemiological research.
out such ecol.ogical research in the Western Pacific Region.
connection the UNESCO/FAO project to integrate and publish a World SOil Ma.P was noted and it appeared to be worthy of the support and encouragement of WO.
46
REGIONAL COMMITTEE: TWELFTH SESSION
3.7 The need or otherwise for surveys either before planning a public dental health programme or for evaluating the effectiveness of existing services It was emphasized that no realistic dental health programme could be planned unless the type, extent and relative severity of the dental problem were known. The objects of a dental health programme are to reduce the
magnitude of the existing dental problem and to reduce the consequences of dental disease. The extent to which these objects are being fulfilled can
only be assessed if a base-line survey is follovred by periodic re-evaluation surveys. '1.
3.8 Principles in planning surveys of national dental problems Dental surveys will be most productive and rew"arding if they are conducted by a dentist as part of an ecological survey of general health and nutrition problems, using the methods and criteria to be recommended by an expert committee which will meet in Geneva in November. An experienced dental
consultant in the WHO Regional Office would greatly facilitate the co-ordination of various national surveys.
4
Group discussion The topics presented by the Panel were discussed in plenary session.
4.1 The existence of marked regional and ethnic variation in the prevalence of dental caries and periodontal disease was confirmed.
4.2 In several countries there are isolated groups or localities Where the prevalence of caries differs markedly from the expected pattern.
4.3 Betel nut chewing appeared to be associated with a low prevalence of caries and a high prevalence of pericdontal disease.
REPORr OF TEE REGIONAL COMMITTEE
47
4.4 Some traditional customs, such as vigorous mouth rinsing after meals, was associated with a low prevalence of caries.
4.5 In the Philippines extensive dental surveys have been sponsored by the WHO/UNICEF assistance progrannne.
4.6 In several countries periodontal disease is a greater public health dental health problem than dental caries. In some areas even young children
are severely affected by advanced periodontal disease.
4.7 Qdontoclasia' .of deciduous teeth is common in several isolated communities·. Its association with poor maternal and infant nutrition was confirmed.
4.8 Examples were cited of contributions made by dental research workers to the solution of general health problems.
4.9 There was general agreement that the size of the existing public dental health problems would not be reduced by the provision of a treatment service. 4.10 There was general support for the need to undertake epidemiological studies of the ecological type in the vTestern Pacific Region, and for the appointment of a dental health consultant to the Regional Office. Several
representatives expressed the hope that this meeting would adopt concrete recommendations in support of these proposals.
II.
SPECIAL SESSION
1
Subject The operation of a fluoridation plant.
48
REGIONAL COMMrTl'EE: TvJELFTH SESSION
2
organization The Committee visited the Hutt Park Pumping station at Lower Hutt where
representatives were welcomed by His Worship the Mayor, Mr P. Dowse.
FolloWing
a brief introduction and the announcement of the latest results obtained after six and a-half years of fluoridation at the city of Hastings by the Chairman of the Technical Discussions, the Hutt City Engineer, Mr Reynolds Bach, described the engineering aspects of fluoridation. The Engineer in charge of
fluoridation, Mr Odlin, and Mr Tregarthen described the installation of the equipment, the pumping station and the control and supervision of the fluoride dosage. The party broke up into groups for conducted tours of the station
to inspect the fluoridation machine and its associated eqUipment and to see a demonstration of the method of analysing water for fluoride. After a lunch
provided in the Council Chambers by the Hutt City Council the Chairman of the Regional COmmittee, Dr H.B. Turbott, thanked the Mayor and Engineers. Both the Mayor and the Right Honourable W. Nash spoke on the sociological and political implications of fluoridation.
III.
SECOND AND THIRD SESSIONS
1
Subject The organization and administration of a dental health service and the
use of trained personnel including dental auxiliaries. 2 panel presentation The Panel of three: Dr G.H. Leslie, Dr G.N. Davies and Dr C.N.D. Taylor
discussed the following topics: 2.1 The School ])ental Service in New Zealand ,·rith particular reference to
REPORT OF THE REG! ONAL COMMITTEE
its evolution, policy, staff, training of dental nurses, buildings, equipment, finance, organization and administration, treatment policy and health education. The improvement in the dental health of children which has occurred was demonstrated. 2.2 , ~.
Current methods in the control and prevention of dental caries and
periodontal disease and the place of prevention and research in a public health programme. 2.3 The role of health education in a dental health programme, with particular reference to the place of dental health education in a general health education programme.
3
Discussions and conclusions During the course of the discussion the following points were made:
3.1 An organized treatment service reduces the consequences of dental disease but does not reduce the magnitude of 3.2 th~
public dental health problem.
In the first instance, if at all possible in any developing country, the
dental programme should be based on a number of fully-trained graduate dentists. 3.3 It was realized that in some countries dental auxiliaries are required. The type of dental auxiliary required varies from country to country and the type of dental health programme must be adapted to the local conditions of each country.
3.4 When for economic and other reasons dental auxiliaries only are trained, proviSion should be made for these people to receive further training to become fully-qualified dentists.
50
REGIONAL COMMITTEE: TWELFTH SESSION
3.5 There is a need to strengthen eXisting national dental services and to ensure that in each programme there is a proper balance between the provision made for research, prevention, health education and treatment.
3.6 There is a need to strengthen existing training programmes for dentists, assistant dental practitioners and dental auxiliaries.
3.7 There is a need for Member countries to make a more thorough, survey of the size and severity of national dental problems, to assess their seriousness relative to other health problems and to determine the causes for differences manifested between and within different ethnic or geographic groups of people.
3.8 There is an urgent need for the interchange of information and experience between Member countries and that this could be greatly facilitated by the apPOintment of a dental consultant to the Regional Office. should be a dental epidemiologist. This consultant
4
Evaluation Of the completed questionnaires received, all 33 assessed the choice of
the topic "Dental Health" as timely; 21 rated the Technical Discussions as excellent, and 11 as reasonably good; 20 said they had gained new ideas in concept, and 13 as gaining some.
,
...
5
Topic for the next Technical Discussions The Technical Discussions group unanimously recommended that the topic
for the Technical Discussions during the thirteenth session of the Regional Connnittee should be: "The role of health services in the improvement of community water supplies".
REPORr OF THE REGIONAL COMMITTEE
51
ANNEX
5
LIm OF DOCUMENrS
WP/RC12/1 Rev.l WP/RC12/1-a WP/RC12/2 WP/RC12/3
Agenda Annotated agenda Report of the Regional Director Review of the proposed programme and budget for 1962 in the light of present budgetary adjustments and consideration of amendments proposed by Member countries proposed programme and budget estimates for the financial year 1 January - 31 December 1963 priorities in programme Malaria eradication Malaria eradication postage stamps Resolutions of regional interest adopted by the twenty-seventh and twenty-eighth sessions of the Executive Board and the Fourteenth World Health Assembly The isolation of the trachoma virus, production of trachoma vaccine and preliminary results of the clinical trials Place of the thirteenth session of the Regional COmmittee Expanded Programme of Technical Assistance (country programming procedures) List of representatives Report of the Sub-Committee on Programme and Budget Report of the Technical Discussions Report of the twelfth session of the Regional Committee for the Vlestern Pacific
wp/RC12/4 and Corr.l WP/RC12/5 \vp/RC12/6 wp/RC12/7 WP/RC12/8
IVP/RC12/9 ~ ~l#
WP/RC12/l0
• ,.~
,
WP/RC12/ll WP/RC12/12 WP/RC12/13 WP/RC12/l4 WPjRC12/15 Rev.l ~
.:.-..
52
REGIONAL COMMITrEE: TWELFTH SESSION
•
f
WP/RC12/Min/l Rev.l WP/RC12/Min/2 Rev.l WP/RC12/Min/3 Rev.l WP/RC12/Min/4 Rev.l WP/RC12/Min/5 Rev.l WP/RC12/P&B/l WP/RC12/P&B/2
Minutes of the First Meeting - 31 August 1961 Minutes of the Second Meeting - 1 September 1961 Minutes of the Third Meeting - 1 September 1961 Minutes of the Fourth Meeting - 5 september 1961 Minutes of the Fifth Meeting - 5 september 1961 Sub-Cormnittee on programme and Budget agenda Analysis of proposed programme and budget estimates - regular funds (field activities) ...,' . '.
WP/RC12/p&B/Min/l Rev.l WP/RC12/p&B/Min/2 Rev.l
Minutes of the First Meeting of the Sub-Committee on programme and Budget - 31 August 1961 Minutes of the Second Meeting of the Sub-Committee on programme and Budget - 4 September 1961 Highlights of problems in dental health The prevalence of dental disease in the ~lestern Pacific and its public health importance The significance of dental research in a dental health programme .-
WP/RC12/TDl WP/RC12/TD2 WP /RC12/TD3 WP/RC12/TD4 WP/RC12/TD5 WP/RC12/TD6 WP/RC12/TD1 WP/RC12/TD8 WP/RC12/TD9 WP/RC12/TD10
Guiding principles in the organization and administration of a dental health service Dental health planning at a national level Fluoridation Technical Discussions programme Procedures and techniques for the Technical Discussions Guide-lines for the Technical Discussions Selection of Technical Discussion topics for the thirteenth (1962) session of the Regional Committee Individual evaluation questionnaire for the Technical Discussions
.
WP/RC12/TDll