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Objective: To determine the diagnostic accuracy of three screening questions (3Q/TMD) in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized clinic., Material and Methods: Consecutive patients, >18 years, referred with a possible TMD complaint to the Orofacial Pain and Dysfunction clinic, Academic Centre for Dentistry Amsterdam, the Netherlands, were included in the study. All patients (n = 449; mean age 44 years; 72% females), answered the 3Q/TMD and the DC/TMD questionnaire before a DC/TMD examination. The 3Q/TMD constitutes of two questions on weekly pain from the jaw, face and temple region (Q1), and on function (Q2), and one function-related question on weekly catching and/or locking of the jaw (Q3). Q1 and Q2 were evaluated in relation to a DC/TMD pain diagnosis and Q3 in relation to a subgroup of DC/TMD intra-articular diagnosis, referred to as the reference standard., Results: In total, 44% of patients received a pain-related DC/TMD diagnosis and 33% an intra-articular reference DC/TMD diagnosis. Sensitivity for the two pain screening questions was high (0.83-0.94), whereas specificity was low (0.41-0.55). For the function-related question, sensitivity was low (0.48), whereas specificity was high (0.96)., Conclusions: In a specialized pain clinic, the two pain questions (Q1, Q2) are positive in most patients with pain-related TMD. Therefore, in case of a positive response, further diagnostic procedures for TMD pain are warranted. For the functional screening question (Q3), a positive response is indicative for an intra-articular DC/TMD diagnosis, while in case of a negative outcome, an intra-articular TMD might still be present.

Dental public health is a unique specialty of dentistry that focuses on prevention of oral diseases among populations rather than individual patients. It encompasses several complementary disciplines and greatly varies in its functions and activities. Several federal, state, local, and nonpublic entities operationalize the mission of dental public health to improve population oral health through a diverse and vibrant workforce., (Copyright © 2018 Elsevier Inc. All rights reserved.)

We examine a strategy for improving oral health in the United States by focusing on low-income children in school-based settings. Vulnerable children often experience cultural, social, economic, structural, and geographic barriers when trying to access dental services in traditional dental office settings. These disparities have been discussed for more than a decade in multiple US Department of Health and Human Services publications. One solution is to revise dental practice acts to allow registered dental hygienists increased scope of services, expanded public health delivery opportunities, and decreased dentist supervision. We provide examples of how federally qualified health centers have implemented successful school-based dental models within the parameters of two state policies that allow registered dental hygienists varying levels of dentist supervision. Changes to dental practice acts at the state level allowing registered dental hygienists to practice with limited supervision in community settings, such as schools, may provide vulnerable populations greater access to screening and preventive services. We derive our recommendations from expert opinion.

Objective: By 2023, fewer dentists are expected in Sweden, at the same time as the demand for dental care is expected to increase. Older people, in particular, are expected to require more dental health than previous generations. To meet this demand, the public sector dentistry in Sweden is moving towards changes in division of labour among dental professionals, including dentists, dental hygienists and dental nurses. However, the impact of this reallocation on the physical and psychosocial wellbeing of employees is unknown. The aim of this study was to compare workplaces with an equal or larger proportion of dental hygienists than dentists (HDH) with workplaces with a larger proportion of dentists than dental hygienists (HD) on the physical and psychosocial work load, musculoskeletal and psychosomatic disorders and sickness presence., Material: A total of 298 persons employed in the Public Dental Service in a Swedish County Council participated in this study., Conclusion: The medium large clinics HDH reported 85% of employee's with considerably more high psychosocial demands compared to employees in medium HD (53%) and large HD (57%). Employees in medium large clinics HDH also reported sleep problems due to work (25%) compared with employees in medium large clinics HD (6%), large clinics HD (11%) and small clinics HDH (3%). Clinic size does not seem to influence the outcome of the HD and HD clinics to any great extent. Of all employees, about 94-100% reported high precision demands and 78-91% poor work postures.

Objective: To analyze oral health work changes in primary health care after Brazil's National Oral Health Policy Guidelines were released., Methods: A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care., Results: Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people's participation and social control; and intersectorial actions., Conclusions: Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

The aim of this study was to obtain an understanding of the factors that affected the way new technology and methods were used in dentistry after a training program. A qualitative research method was used to collect data. Nine dentists working in the Public Dental Service (PDS) in Uppsala County in Sweden agreed to be interviewed in the study. They worked in five different clinics, all with laser equipment, and had received training in the use of lasers. The interviews were tape recorded and transcribed, and were analysed using manifest and latent qualitative content analysis. The categories in this study were identified as "Prerequisites and obstacles to imple- mentation", "Attitudes to laser technology and treatments" and "Laser technology in the future'". The dentists described working with lasers as complicated and problematic. They had concerns about the method relating to the working environment, evidence of efficacy of treatment, costs, and benefits for patients and dentists. The main finding was that the decision to adopt the technology seemed to be based on individual perceptions of the value of lasers compared to other ways of achieving the same goal. They provided uniform proposals regarding how an organization should implement new methods, including an emphasis on the importance of preparation and having opportunities to be able to test and evaluate the technology. Another important factor was support from surrounding staff, colleagues and management. Despite all the barriers, the respondents were positive about working with lasers in the future, mainly due to their belief that patients would demand laser treatment. In conclusion both individual and organizational factors affected the extent to which the respondents used the laser. The main finding was the individual perception of the value of lasers compared to other methods which could achieve the same goal.

The rhetoric concerning mid-level providers and their impact on general dental practice is building in intensity. This is a complex issue and there is no clear picture of either the benefits or dangers to the public of such a delivery model, whether such plans are economically sustainable, or the role of general dentists in the configuration of future practices. The opinions of a representative sample of thinkers from various perspectives are sampled.

Public health practitioners are required to apply their competencies at a range of levels from governmental to small community groups. A recurring theme at BASCD conferences has been the need to influence policy at the highest level if improvements to oral health and better treatment of oral ill-health are to occur. This paper presents a clear example of such dental public health action at a European level. This report outlines the reasons why it is necessary to try to improve oral health within Europe, in general, and the European Union in particular. It goes on to describe how the newly formed Platform for Better Oral Health in Europe is trying to work at a macro level, and bring interested associations, groups and individuals together. Collectively they can then alert European institutions and national governments to oral health problems and promote policies to improve the current situation. It describes the current problems, their resource implications, the objectives of the Platform, its actions so far and its plans for the immediate future. It suggests that, if the problems are to be addressed, it will be necessary for all interested parties to work together at a European level to raise oral health issues higher on the E.U. agenda.

Aim: This study aimed to examine how leadership positions in the Public Dental Service (PDS) were distributed between women and men and how the female and male lead dentists perceived themselves as managers or leaders and whether their superiors, the leading doctors and municipal decision makers or their subordinates, the public dentists, found differences between female and male lead dentists as leaders., Methods: Gender aspects on the leadership qualities of the lead dentists in the Public Dental Service were evaluated by four professional groups using a questionnaire. The groups surveyed were: lead dentists (in charge of the municipal PDS clinics), leading doctors (lead dentists'line managers), the directors of municipal health boards, and the PDS dentists (subordinates to the lead dentists). Factor analysis, chi-square and non-parametric tests were used to analyse the data gathered., Results: Women made up 50% (96/192) of the lead dentists, 80% (211/263) of the public dentists, 31% (47/152) of the leading doctors, and 27% (33/124) of directors of the municipal health boards (P<0.001). Nearly all female (92%; 86/93) and 78% (70/90) of the male lead dentists considered themselves to be good people-oriented leaders (P<0.01) and three-quarters of the men (74%; 67/90) and 59% (54/92) of the women good goal-oriented managers (P<0.05). In the eyes of their nearest superiors, the female and male lead dentists were rated equally; they were given scores as goal-oriented managers, people-oriented leaders (both medians= 3.2 on a scale from 1 to 4), and their ability (median=3.5) to take care of their tasks. Their decision authority, power in municipal decision-making (median=2.8), was considered weaker. Most, 67% (70/105), of the PDS dentists evaluated their female superiors and 50% (75/150) their male superiors good as goal-oriented managers (P<0.001), and 51% (54/105) considered their female superiors and 35% (53/150) their male superiors good as people-oriented leaders (P<0.05)., Conclusions: Female dentists had not become lead dentists in proportion to their numbers in the PDS. Those who had a leading position felt that they were good leaders, their superiors considered them as good as their male colleagues, and their subordinates felt they were better.

The emerging concept of prospective health care would shift the focus of health care from disease management to disease prevention and health management. Dentistry has a unique opportunity to embrace this model of prospective and collaborative care and focus on the management of oral health. Academic dentistry must better prepare future dentists to succeed in this new health care environment by providing them with the scientific and technical knowledge required to understand and assess risk and practice disease prevention. Dental schools must consider creating career pathways for enabling future graduates to assume important leadership roles that will advance a prospective oral health care system.

California has virtually no statewide dental public health infrastructure leaving the state without leadership, a surveillance program, an oral health plan, oral health promotion and disease prevention programs, and federal funding. Based on a literature review and interviews with 15 oral health officials nationally, the paper recommends hiring a state dental director with public health experience, developing a state oral health plan, and seeking federal and private funding to support an office of oral health.

Complete denture services at comprehensive care public health clinics are not common in part because of clinician concerns regarding outcomes. Educational debt forgiveness has attracted recent dental graduates to public health dentistry; however, not all recent graduates receive denture education experiences necessary to attain proficiency. While fundamental patient assessment and denture construction are taught, psychological assessment and communication with denture patients requires experience. A thorough understanding of occlusion, phonetics, esthetics and laboratory steps is also necessary. Expecting recent dental graduates to become proficient providing complete dentures at minimal reimbursement levels, with no mentorship or on-site laboratory support, is unrealistic. Public health dental clinics operate at full capacity performing emergency, preventive and restorative procedures. Complete dentures come with a laboratory fee approximately one-half the total reimbursement, meaning a remake drops clinic revenue to zero while doubling expenses. It is understandable that full schedules, marginal reimbursement, unpredictability and the risk of an occasional failure block clinician interest in providing denture services. This one-year report of services describes a three-appointment complete denture technique offering improved patient and laboratory communication, reduced chair time and controlled cost, resulting in high-quality complete dentures.

Unlabelled: Professional organisations present challenges in management compared to producing companies, as control of the work lies within the professional groups themselves. Management in the Public Dental Health Service (PDHS) has an added difficulty in the two-tiered political governance in Swedish public dentistry. The aim of this thesis was to contribute to better understanding of the organisation and management of Human Service Organisations, especially the PDHS in Sweden, thereby contributing to long-term sustainability with due regard to the professionals. The aim was also to point to some future difficulties facing the PDHS and possible solutions to these. Four papers are included in the thesis. The first paper set out to define the professions in dentistry in Sweden from theories on professions. Dentists and, to a lesser degree; dental hygienists were the identified professional groups. The second paper scrutinised the external environment for dentistry in Sweden in the form of political decisions, i.e., laws and regulations. The findings were that there can be a gap between the formal objectives and the factual behaviour from the political level, and that certain politically attractive ideas might reoccur at a later time despite good scientific arguments against them. Also indicated in this paper were ways to influence the political processes, by active participation in the early stages of decision-making The third paper dealt with the heads (CDOs) of the PDHS in the counties and is based on a questionnaire to them on management. It was found that ideas on management and organisation usually were embedded in the way the respective county council was organised. A strong belief in advantages of scale was noted, both for administration and also for dental care itself. The fourth paper compared overall job satisfaction among publicly employed dentists in Denmark and Sweden. A focus on size of clinic, on professional development and on influence at the work place was found to be important. The Danish dentists were generally more satisfied with their overall job situations than the Swedish ones. One explanation might be found in the environment for the respective service, with a much stronger element of competition in Sweden. Another aspect could be that the expectations of the Danish dentists might be more realistic when they entered the public service. In an appendix the history of the Swedish Public Dental Health Service is outlined., Conclusions: Dentists in Sweden are an established profession and dental hygienists are an emerging profession; they and society would benefit from a clearer delineation and definition of their unique competences. Political decision-making is not necessarily rational, and garbage can models or similar can give a better understanding of political processes. CDOs have a widespread belief in advantages of scale in administration as well as in care, which may pose future problems for the provision of dental care in sparsely populated areas. Overall job satisfaction, as part of Good Work, is founded in an atmosphere at the clinic that is focussed on professional values. It is noteworthy that PDHS dentists not born in Sweden had a lower job satisfaction than those born in Sweden. Perhaps a closer cooperation between the dental colleges and the PDHS might give the newly qualified dentists a more realistic view of the professional challenges in public dentistry, as well as giving the colleges access to the vast material on patients in the PDHS. The future division of tasks between the general dentists, dental hygienists and specialist care dentists has a great impact on the future need for personnel, and needs to be carefully analysed. The future diminishing numbers of dentists and the difficulty for the PDHS to retain dentists may be met by adapting the organisations to a much greater flexibility by allowing different teams to organise their own work. The possibilities to give the patients good service quality will depend on continued democratisation and less managerial control. Producer cooperatives, franchising, or similar, could be revisited and tried. However, such forms will require carefully designed contracts where the objectives and the outcomes are possible to define and to evaluate. The balance between good work for dentists, an efficient organisation and perceived good service to the public will be objects for further studies.

Objectives: The sense of urgency concerning the inadequacies of the current U.S. oral health care system in better preventing oral diseases, eliminating oral health disparities, and ensuring access to basic oral health services has increased in recent years. This paper sought to articulate the attributes that an ideal oral health care system would possess, which would be consistent with the principles of the leading authorities on the public's health., Methods: The authors reviewed policy statements and position papers of the World Health Organization, The Institute of Medicine, The American Public Health Association, Healthy People 2010 Objectives for the Nation, and the American Association of Public Health Dentistry., Results: Consistent with leading public health authorities, an ideal oral health care system would be have the following attributes: integration with the rest of the health care system; emphasis on health promotion and disease prevention; monitoring of population oral health status and needs; evidence-based; effective; cost-effective; sustainable; equitable; universal; comprehensive; ethical; includes continuous quality assessment and assurance; culturally competent; and empowers communities and individuals to create conditions conducive to health., Conclusions: Although there are some attributes of an ideal oral health care system on which the United States has made initial strides, it falls far short in many areas. The development of an oral health care delivery system that meets the characteristics described above is possible but would require tremendous commitment and political will on the part of the American public and its elected officials to bring it to fruition.

The elimination of oral health disparities in the US will require enhancing access to oral health care services. The workshop convened in 2009 by the Institute of Medicine on the "US Oral Health Workforce in the Coming Decade" highlighted both the current workforce's failure to meet the nation's needs as well as the promising opportunities presented by various workforce strategies to significantly enhance access and improve oral health outcomes. In this article, we have briefly reviewed and expanded on the contributions in this special issue of the Journal of Public Health Dentistry, with the goal of identifying common themes and providing a framework for evaluation. There are several key areas where change is critically needed in order to ensure successful implementation of any new workforce models. These areas include a) the public and private financing of dental care, b) the dental educational system, and c) state and federal policies.

Objective: The dental safety net includes the facilities, providers, and payment programs that support dental care for underserved populations including those individuals disadvantaged by a variety of social, economic, and health conditions. Its components-health centers, dental schools, clinics, Medicaid-oriented dental practices, free-care programs, hospital emergency rooms, and others-vary in availability, comprehensiveness, continuity, and quality. The objective of this overview is to identify options and opportunities for policy changes to enhance oral health professional workforce in the safety net., Methods: Characteristics of the dental safety net and its components are reviewed and compared., Results: Professionals who now staff the dental safety net are a small subset of US dental providers and few current trainees anticipate practicing in these programs. Therefore, the safety net will continue to confront workforce challenges., Conclusions: Multifactorial policy alternatives to increase the availability of dental professionals who care of the underserved include proposed changes in dental education, licensure, scope of practice for allied dental personnel, and federal and state financing of public insurance. Also needed are local efforts to establish social norms and activities among private dentists that engage more private practitioners in care of the underserved.

Background: Caries on children and adolescents in Denmark has declined significantly over the last 30 years. Our first analysis in 1999, however, disclosed huge inter-municipality disparities in mean DMFS values as well as in prevalence of caries on Danish children; that fluoride in the water supply and the length of the education of the mothers could explain up to 45% of the above-mentioned disparity and that very few municipalities were positive outliers, i.e. were providing significant better caries results than expected from the background variables. Three of the aims of this second analysis were to repeat the analyses done on the 1999 sample, but now on a 2004 sample and then compare it with the results from 1999. A fourth aim was by means of an interview of CDOs to determine their interpretation of relevant conditions in the public dental health service in relation dental health outcome., Methods: A total of 204 (99%) and 191 (93%) municipalities were involved in 1999 and 2004, respectively. Unit of analysis were the municipalities. Mean DMFS of 15-year-olds was used as outcome variable. Eight background variables were accounted for during the analysis: For the fourth aim, a sample of CDOs representing municipalities with positive (n = 10), with no change (n = 10), or with negative change (n = 10) in mean DMFS, relative to all municipalities, between 1999 and 2004 was selected., Results: The inter-municipality variation in mean DMFS 1999 was 0.88 to 8.73 and in 2004 was 0.56 to 6.19. The analyses found that fluoride level of the drinking water and mothers' length of education were significant variables explaining about 44% of the variations in mean DMFS in both years. Only one municipality was characterized as a positive outlier in 1999 as well as in 2004. The dose-response relations between increasing fluoride concentrations in the water supply and DMF-S values diminished in both years at a level above 0.35 ppm. The structured interview disclosed that municipalities with significant improvement in mean DMFS from 1999 to 2004 had established goals and were committed to the prevention of dental caries at the individual level. Instability in manpower; number of children in the service and economy was associated to municipalities with negative changes in caries experience.

Work as a dentist is stressful and demanding. In the Public Dental Health Service (PDHS) the heads of clinics' have a great influence on the work environment. In turn the heads have to adapt to the overarching policies on management in each County, which create the environment for the clinics. The aims of this paper were to describe the management structure of the PDHS as described by their Chief Dental Officers (CDOs), and to test hypotheses that the management systems had "a logical administrative structure". A postal questionnaire was mailed to all 21 CDOs,who all responded. Context analysis and bivariate correlations were used. The PDHS employed on average 60% of all dentists in a county. The numbers of clinics for general dentistry in Sweden was 698, and for specialist care 144. The heads of clinics were dentists in 92%. Four hypotheses were tested. 1. separate political board did not lead to closer governance of the PDHS. 2. There was more emphasis on measurable than on qualitative objectives and followup. 3. There was only partial correlation between a larger county and a more formalized management. 4. There was no correlation between size of county and beliefs on advantages of scale. There was a widespread belief in advantages with larger clinics both from administrative, and rather surprisingly, from clinical aspects. Two of the four hypotheses could not be corroborated which indicates that the management structures were more formed by county specific principles. The four hypotheses on administrative behaviour were only partially corroborated. The implications for delivery of care to sparsely populated areas need to be monitored in view of the beliefs in larger clinics. The limits for decisions by management and for professional discretion must be monitored closely considering their effects on work environment and on the quality of care the professionals are able to deliver.

We examined progress in US children's oral health and dental public health infrastructure since the Healthy People 2010 Oral Health Objectives were issued. We summarize trends in the prevalence of dental caries and dental sealants on the basis of national and state-specific data. Trends in state oral health program activities, funding, and staffing were derived from annual surveys. The prevalence of dental caries in primary teeth of children aged 2-4 years increased from 18% in 1988-1994 to 24% in 1999-2004. Racial disparities persisted in that age group, with caries significantly more prevalent among non-Hispanic black and Mexican American children than among non-Hispanic white children. Caries prevalence in primary teeth of non-Hispanic white children aged 6-8 years remained unchanged, but increased among non-Hispanic black and Mexican American children. State-specific prevalence of caries among third-graders ranged from 40.6% to 72.2%. Caries in permanent teeth declined among children and adolescents, while the prevalence of dental sealants increased significantly. State oral health programs' funding and staffing remained modest, although the proportion of states with sealant programs increased 75% in 2000 to 85% in 2007 and the proportion with fluoride varnish programs increased from 13% to 53%. Progress toward improving the oral health of America during the past decade has been mixed. Greater attention to the oral health of young children is clearly needed, and child health professionals can be valuable partners in the effort. With continued high prevalence of a largely preventable disease, ongoing problems with access to basic oral health services, and increased national attention to health care reform, there is a clear need and opportunity for governments to make serious and sustained investments in dental public health.

Objective: To develop prediction models of the relative need for care to differentiate between urgent and not urgent individuals presenting for emergency dental care., Design and Methods: Data were collected from 839 adults presenting to public dental clinics across South Australia (SA) and New South Wales (NSW) for emergency dental care. Prediction of the urgency of emergency dental care was based on the assessment of two binary logistic regression models - Model 1: urgency of care=<48 hours vs. 2+ days, Model 2: urgency of care=2-7 days vs. 8+ days. Subsequently predictive equations for urgency of emergency dental care were developed using binary logistic regression analysis. The models incorporated subjective oral health indicators (i.e., experience of pain or other oral symptoms) and measures of psychosocial impact of oral disorders (i.e., difficulty sleeping and being worried about the appearance/health of one's teeth or mouth)., Results: The cut-off point for the prediction of urgency was defined as a probability value > or =0.40 and > or =0.50 for Model 1 and Model 2 respectively. These cut-off values were chosen as they produced test results that were consistent with the proportions of patients falling into various urgency categories derived from dentist's assessment of urgency. Model 1's sensitivity was 58%, specificity 77% and positive predictive value (PPV) 59%. Model 2's sensitivity was 75%, specificity 65% and PPV 71%., Conclusions: These models of relative need may be useful tools for the screening of urgent dental care and for allocating priority among patients presenting for emergency dental care.

Severe disparities in oral health and inequities in access to oral health care exist globally. In New Zealand, the cost of oral health services is high. Physician services and medicines are heavily subsidised by the government -- however, in contrast, private financing, either as out-of-pocket payments or as private insurance, dominates dental care. Consequently, the use of services is often prompted by symptoms, and services are mostly oriented towards relief of pain. The high cost of dental care with insufficient emphasis on primary prevention of oral diseases, poses a considerable challenge for providing equitable access to health care as laid down by the Alma-Ata Declaration on Primary Health Care (PHC). While improving oral health is one of the health objectives of the New Zealand Health Strategy, providing accessible and affordable oral health services does not feature prominently in the current Primary Health Care Strategy. This paper discusses current knowledge regarding oral health in relation to general health and health care strategies and frameworks, in order to highlight that oral health care is an important component of primary health care. The authors also propose that oral health care should be integrated into primary health care in New Zealand. This could be achieved by placing oral health within the broader framework of PHC as encapsulated by the Alma-Ata Declaration and the New Zealand Primary Health Care Strategy.

Disparities remain among the United States population with regard to who receives dental treatment. This article assesses current programs designed to provide dental insurance coverage. This assessment examines person-level use and expenditures as a function of preferences, price, and the use of third-party coverage.

Oral health is associated with overall health, and lack of access to dental care has consequences that go far beyond aesthetics. Most oral diseases are preventable and are relatively easy and inexpensive to address at early stages. However, multiple barriers make dental care unreachable for a sizable portion of the United States population, who consequently has higher incidence and prevalence of disease. Achieving meaningful improvements in oral health status among these groups will require a revamping of the dental infrastructure, augmenting the productivity and skills of the dental workforce, and increasing the population's oral health literacy.

The oral health action plan, recommended for adoption to the Sixtieth World Health Assembly of the World Health Organization in January 2007, included many of the necessary components. Had fissure sealants been added to the list of prevention methods and the roles of dental educational institutions and hygiene community better clarified, the action plan would have made a more viable and realistic package for the ministries and their directors of national programmes receiving the support of the World Health Organization and partners. Sealants remain under-utilized, few dental hygienists are integrated in the primary oral health team and fewer dental graduates have had service-learning experiences--all contradictory to the evidence in the literature. Translating research findings into public health action programmes is one of the recommendations made in the action plan and one way we can begin this is by implementing sealant programmes in 'Health Promoting Schools' that are WHO's brain child and borne of the wisdom of using schools as 'platforms' for the promotion and delivery of health care to the community.

Objectives: This study examined the health-related effects of two worksite interventions, physical exercise and reduced workhours, on women employed in dentistry., Methods: Six workplaces were randomized to one of the following three conditions: (i) 2.5 hours of weekly, mandatory physical exercise of middle-to-high intensity to be performed during workhours (N=62), (ii) a reduction of full-time weekly workhours from 40 to 37.5 hours (N=50), and (iii) reference. In all, 177 women participated. Biomarkers and self-ratings in questionnaires were obtained before the intervention (T (1)), and six (T (2)) and 12 months (T (3)) after the intervention., Results: The results showed increased levels of physical activity and exercise in all of the groups, the level of physical exercise being significantly greater in the physical exercise group. Repeated-measures analyses of variance using data from T (1)and T (3)for biological measures and all three time points for self-ratings produced significant interaction effects for glucose, waist-to-hip ratio, and work ability and clear trends for general symptoms and upper-extremity disorders. Posthoc analyses showed that the results of the health-related measures differed between the interventions, decreased glucose and upper-extremity disorders in the exercise group, and increased high-density lipoprotein and waist-to-hip ratio among those working reduced hours., Conclusions: These results show that the two interventions had small and varied effects on biomarkers and self-reports of different aspects of health among women. It is suggested that interventions involving a modest reduction in workhours seem to be more effective if these hours are used for physical exercise.

Dental public health is a unique and challenging American Dental Association-recognized specialty because the patient is the entire community or population, such as a school, neighborhood, city, state, or the nation, with a focus on vulnerable populations. Limited resources are maximized through prevention, policies, programs, and organized community efforts to respond to great unmet needs. Although dental public health professionals are few in number, millions of people every day have better oral health because of these professionals, who work on the local, state, and national level.

The dental services of the public health service (OGD) should not confine themselves to dental screening in kindergartens and schools but also turn their attention to the advancement of oral health in the special risk groups of the senior citizens. Although government resources are limited, new capacities could be gained by restructuring. Is it really prudent, in a lifetime perspective, for the OGD to solely focus on the oral health of youths while oral neglect in long-term care carries on unabated? A stronger support by the OGD of gerodontology should be instituted on its boards, publicised in health reports, and implemented in supervisory bodies for quality management of the long-term care facilities. An endorsement of the structures of long-term care insurance and training facilities would be desirable. The OGD could assist the fitter seniors through specific education to participate in dental prevention programmes and motivate physicians to inspect the oral cavity. Furthermore, recommendations regarding the structuring of geriatric dental care by the OGD would be helpful. The OGD is a vital partner to gerodontology. Therefore, further projects should be conducted in cooperation with dental organisations.

Objectives: The National Institute of Dental and Craniofacial Research commissioned an assessment of the dental public health infrastructure in the United States as a first step toward ensuring its adequacy. This study examined several elements of the U.S. dental public health infrastructure in government, education, workforce, and regulatory issues, focused primarily at the state level., Methods: Data were drawn from a wide range of sources, including original surveys, analysis of existing databases, and compilation of publicly available information., Results: In 2002, 72.5% of states had a full-time dental director and 65% of state dental programs had total budgets of 1 million dollars or less. Among U.S. dental schools, 68% had a dental public health academic unit. Twelve and a half percent of dental schools and 64.3% of dental hygiene programs had no faculty member with a public health degree. Among schools of public health, 15% offered a graduate degree in a dental public health concentration area, and 60% had no faculty member with a dental or dental hygiene degree. There were 141 active diplomates of the American Board of Dental Public Health as of February 2001; 15% worked for state, county, or local governments. In May 2003, there were 640 U.S. members of the American Association of Public Health Dentistry with few members in most states. In 2002, 544 American Dental Association members reported their specialty as Dental Public Health, which ranged from 0 in five states to 41 in California. Just two states had a public health dentist on their dental licensing boards., Conclusions: Findings suggest the U.S. dental public health workforce is small, most state programs have scant funding, the field has minimal presence in academia, and dental public health has little role in the regulation of dentistry and dental hygiene. Successful efforts to enhance the many aspects of the U.S. dental public health infrastructure will require substantial collaboration among many diverse partners.

Objectives: To evaluate the long term impact on fairness of children's dental care programmes., Methods: Data were taken from the Health Module of the Spanish Disability Interview Survey in 1999 (n=8,049). The probability of visit to a dentist and the number of visits are estimated with binary logistic models and count data models in order to compare the regions with consolidated dental care programmes, PADI regions, with the rest of Spanish regions. The effects of family income, residential status and living in small village settings on dental care access for both regions are investigated and compared., Results: The scope of the dental care programme (PADI) makes a very significant difference. Regions with consolidated PADI are by far more equitable than the rest. Once the other explanatory factors have been controlled, the percentage of users is by far larger in PADI regions, odds ratio 3.47 (95% CI 2.38 to 5.07). In PADI regions family income doesn't have any significance in the probability of visits to the dentist, odds ratio 1.9 (95% confidence interval 0.92 to 1.81). In non PADI regions poorer families have less probability of visiting a dentist, odds ratio 1.68 (95% CI 1.50 to 1.88). In addition, in each region, inequalities discriminating against those children that live in small villages cannot be found in PADI regions., Conclusions: PADI regions have more equity in access to dental care. The PADI programme managed to drop any income base discrimination in access and succeeded in equalizing access in small villages and in urban areas. The use of dental services is very unequal among the population. Public dental care programmes for children equalize utilization and strongly contribute to improving children's oral health.

Female unpromoted general practice dentists (GPDs) in the Public Dental Health Service (PDHS) constitute about one fourth of all working dentists in Sweden. Unpromoted means that the position is without managerial functions. According to many reports, they have a problematic psychosocial work situation., This Thesis Aimed to: Describe the perceived health for these GPDs, in comparison with others with a similar work situation. Analyse their sense of support in comparison with others. Describe how they perceived "good work", i.e. both the healthy and socially responsible work, and whether there was a difference between their ideal and their reality. Analyse patterns in two aspects - the moral and the career aspects - of "good work" for dentists. In zooo, questionnaires were sent to all female unpromoted GPDs in the PDHS in a region of Sweden. The response rate was 94%., Results: The dentists felt unwell, worse than other compared groups. There was little support from the management. There was little inter-colleague contact. There was no cross-sectional assciation between collegial neworks and support, but the qualitative investigation showed that collegial networks were perceived as positive. There was a great difference between ideal and reality concerning good work. The dentists felt a lack of influence, and this was the greatest difference of all. Three components of good work - "moral values and skill discretion", "career development" and "work environment" were found. The dentists emphasized the moral basis of their work, confirming the character of dentistry as primarily human service work., In Conclusion: There were serious work environmental problems among these dentists. The dentists felt unwell and felt a great lack of influence on important decisions. There was little inter-colleague contact, but collegial networks were perceived as positive. There was little support from the management, indicating a clear weakness in the relations between employers and female unpromoted GPDs in the PDHS. Three components of good work were found, where the moral component was the most important but it also showed the greatest difference between ideal and reality. Thus, the dentists emphasized the moral basis of their work, confirming the character of dentistry as primarily human service work and not industrial work. The dentists with the highest level of commitment perceived the largest differences. The PDHS organization has therefore failed to convince or engage those whom it ought to engage, i.e. those with the greatest commitment. The way to improve the female unpromoted GPDs' work situation would be through increased influence and support, bridging the gap between ideal and reality.

Californians face significant dental public health problems. To address these problems, state government, professional organizations, and philanthropic entities in some areas have joined forces. Major issues such as fluoridation, access to care, and the role of the Dental Board of California are examined in terms of the varying roles these critical segments play in affecting the oral health of Californians. This issue of the Journal is dedicated to an examination of public health dentistry in California. While often thought of as innovative and at the "cutting-edge," the state presents a mixed picture of publicly funded oral health programs. Public health concerns sometimes take a lower priority or are overlooked by state government in an era of cutbacks. California lags behind other states in many public goods crucial to the overall quality of life of its residents. This dichotomy is evident in dental public health as it is in education, general health, and air quality. This paper assesses selected dental public health programs, identifying those where innovations have occurred and other program areas where the state has inadequately addressed the dental public health needs of its population.

California is home to more than 70 dental clinics operated or funded by the U.S. government. They operate on annual appropriations from Congress to serve a specific population and regulations that specify the type of dental services provided are usually promulgated at the national level. Dental clinics have the challenge of creating a program that delivers high-quality care within these financial and programmatic constraints. In California, U.S. government appropriations are the main source of funding dental clinics of immigration services, the Veterans Administration, the Bureau of Prisons, the Coast Guard, and American Indian clinics. The evolution and current practices of these five dental public health programs are described.

At present the European Union is developing its competence on health and new important issues will be taken on board in European health policy. Increasing mobility of people and integration of the applicant countries puts pressure on the current health care provision systems. A mandate for an open co-ordination process in public health is expected to be given by the European Council. The process will start by exchange of information and best practice models. The next step will be the presentation of common targets between member countries, followed by national action programmes and indicators. It is likely that a lot of emphasis will be put on access to health services, comparisons of costs of health care and benchmarking the costs of items of care. In the long run this will mean convergence of the health care systems. If oral health is to be considered an integral part of general health dental professionals need to be aware of and be able to influence the actions to be taken.

In 2003, Kansas received a grade of "D+" from Oral Health America in an annual rating of the state's oral health status (Oral Health America, 2003). This low grade confirmed what advocates had been saying for some time: Kansas---at several levels--is not taking seriously the oral health needs of many of its citizens. The purpose of this article is to discuss the Kansas dental health system and the role of the nurse in oral health.