Oral Health in Western Pacific Region, Current States, Challenges and Way Forward

International Journal of Clinical Preventive Dentistry Volume 7, Number, June Oral Health in Western Pacific Region, Current States, Challenges and Way Forward KyuHwan Lee, SeungChul Shin, MiRa Lee, YeonSoo Chang Dental Clinic, Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, Department of Preventive Dentistry, School of Dentistry, Department of Oral Health, Dankook University, Cheonan, Korea Objective: The purpose of the study is to show the such level of the states for oral health as mainly in DMFT index rate in years old, dft index rate in years old and the oral cancer rate, according to gender distribution, in each country, related with such influencing factors as the dental environments, socioeconomical situation and the systemic environments conditions, according to classify the GNP level of each nation, in order to suggest the proper public oral health programs to contribute to promote the oral health level, for each country. Methods: Data analysis study was done with the information from the data bank of WHO internet or intranet, mainly, for categories as the oral health status, systemic conditions related with the oral health, socioeconomical factors, the dental systems, and the Public Oral Health activities, in 8 countries of WP RO region. Results: DMFT was low in high income countries and increased in middle upper or lower middle income, otherwise low level again in low income countries. Each country has performed the eligible programs for oral health promotion, with the consideration of the socioeconomical factors for each country, in order to promote the oral health level and to prevent the oral diseases. Conclusion: Oral health can be promoted effectively by establishing the proper policies and programs by a responsible organization in each country as well as to be suggested with the appropriate guide lines from WHO. So WPRO should recommend or suggest to each country for effective public oral health program, by establishing the eligible and professional oral health department in governmental organization. Keywords: oral health, public oral health, oral environmental factors Introduction Corresponding author SeungChul Shin Email: scshin@dankook.ac.kr Received March, 7,, Revised June,,, Accepted June,, The main oral disease as dental caries and periodontal disease have such characteristics as pandemic, chronic and accumulated disease but possible for prevention, compared with the systemic diseases, in general. It is obvious that the more trials with the proper programs for public oral health they have, the less in prevalence of the oral diseases. Such factors as the economic level, dental workforces, population per dentist ratio, sugar consumption, smoking or drinking habits, dental care system or dental insurance and the public oral health programs, might be influenced, to the caries or periodontal disease level at each country. Moreover, it has been proved that the oral health is closely related with the systemic health condition, for examples smoking and drinking habits might influence the cause of the oral cancer as well as to the enhance the basic dental problems. So, it is needed to understand not only in oral health conditions, but also the tentative situation of the systemic condition together, in order to establish the proper public oral health plans. Even though the dental caries prevalence was very high in economical advanced countries in years ago, it becomes reduced in recent years, by performing the adequate public oral health 8

International Journal of Clinical Preventive Dentistry programs and by changing the dental environments. Such factors as the dental environments, socioeconomical situation and the systemic conditions might influence with the complex, to cause the results for caries index of each country. The purpose of the study is to show the such level of the states for oral health as mainly in DMFT index rate in years old, dft index rate in years old and the oral cancer rate, according to gender distribution, in each country, related with such influencing factors as the dental environments, socioeconomical situation and the systemic environments conditions, according to classify the GNP level of each nation, in order to suggest the proper public oral health programs to contribute to promote the oral health level, for each country. Material and Methods. Subject 8 countries, belong to Western Pacific Regional Office of the World Health Organization were subjected for investigation and analysis, by collecting the data for oral health and the socioeconomical factors related with the oral health, except a few country without the available data. It was classified according to the economical level by GNP per capital by World Bank as,, Korea and New Zealand as High Income OECD country, Brunei Darussalam and as High Income NONOECD country, and as Upper Middle Income country,,, Papua New Guinea,,, Islands, and as Lower Middle Income country,, Lao People s Democratic Republic and as Low Income country (9).. Method Data analysis study was done with the information from the data bank of WHO internet or intranet, mainly, for categories as the oral health status, systemic conditions related with the oral health, socioeconomical factors, the dental systems, and the Public Oral Health activities. Such items of the oral health status as DMFT index/rate in years old, dft index/rate in years old, the oral cancer rate at each gender and the edentulous rate in elderly people for each country, were investigated with the most data from WHO, provided by Malmö dental school, Sweden, as one of the collaborating center of WHO. Newly announced data were used in some countries, instead of WHO data base, in case of the national wide dental survey has been done and published them in recent years, by collecting the recent data from the questionnaire for individual country. General health conditions related to the oral health were also examined with the preliminary data from WHO, in such as the life expectancy/health life expectancy, smoking rate, drinking rate, and sugar consumption. Such factors of the socioeconomical level as the population, GNP per capital and the expenditure rate for health per GDP, were also checked and the dental factors were classified and investigated for such items as the numbers of dentists, population per dentist ratio, numbers of the dental schools, numbers of the auxiliary dental workforces as dental hygienist, dental therapist, dental technician, dental assistant nurse, or related personnel, and the dental insurance system. Public oral health program was checked with the score as no program for point, little or poor activity as a pilot program for point, moderate activity as parts of population has benefits for points and very well activity as national wide program as more than half of population has benefits for points, applied on such items as the water fluoridation, school oral exam, dental education program, toothbrushing or fluoride mouth rinsing program, fluoride application, sealant, ART, school dental clinic program, dental program for the senile or disabled persons, establishing and acting the public oral health center, the national wide dental survey in recent years and the establishment of the department for oral health office in the government organization, by collecting the information from WHO data base and the questionnaires from each country. All data were collected with the variation in time of collection from different sources and arranged and analyzed according to the classification by the economical level of World Bank suggested standardization, classified with the economical levels by the GDP income as High in OECD, High in non OECD countries,,, countries, in order to compare them in each country. Results Oral health related data on several countries in WPRO, were shown in Table, Table, Table, Table 4 and Table. Discussion Dental Caries and periodontal disease are the main oral diseases to be controlled in every country although there are many kinds of oral diseases can be experienced. Dental caries as one of the representative oral diseases is caused by the combination factors such as the host factors, microorganism factor and environmental factor. It is well known that the oral health of each country is influenced the socioeconomical and cultural level as the environmental factors. World Bank already classified each country with the economical level by GNP per capital as high income with OECD, high 8 Vol. 7, No., June

KyuHwan Lee, et al:oral Health in Western Pacific Region, Current States, Challenges and Way Forward Table. Social factors (population, GDP/capital, life expectancy ) in WPRO countries Classified Countries Populat. (Million) GNP/Capita. H.Exp/GDP Life expect H.Life Expect D.Insurance score High income (OECD) NonOECD 8 48 4. 4.4.8.,8.7. 8..9.48.. 4..8 8.,,48,9,7 4, 4,4, 4,,8,,4,9,8,47,48,,74, 8.7 7.9. 9.4.4 4 4. 4.... 4.9 4.7.4 4. 7... 8. 8. 78. 8 8. 9 7. 7. 7. 8. 7 8. 74. 7 7. 7 8 7. 7 9. 4. 9 9. 8. 47. H.Life Expect: healthy life expectancy, H.Exp/GDP: health expenditure per GDP. income nonoecd, upper middle, lower middle and low income. Western Pacific Regional Office (WPRO) has divided their countries according to the classification as,, Korea South and New Zealand for high income with OECD, Brunei and are included in high income without OECD, and for upper middle,,, PNG, Philippine,,,, for lower middle and, and for low income countries. According the classification, such social factors mostly as population, GNP per Capita, Health expenditure per GDP, Life expectancy, Health life expectancy and establishment of dental insurance system were showed in Table. Population factor has many variations between each country and it can be one of the bases for country power to develop, but in some case, it would be easy and rapid to change for promotion in less population country like in. GNP per capital is not always the same in order, with the economical level classified and suggested by WPRO, Health expenditure per GDP was revealed as, more than 8% in high income countries except South Korea otherwise about from % to % in middle or low income countries except and, which spent with the as high rate of health expenditure, even though they were in low incomes. It was considered that those countries were responsible the health of the people by Government mostly, otherwise the other countries were by private. Life expectancy was revealed as about 8 years in high income countries, otherwise from to 7 in middle or low income countries, and the healthy life expectancy was revealed as about years less, than life expectancy at most countries. It was estimated as comparatively well organized in dental insurance system in high income countries with national wide system either by government or by private, otherwise not so much activities or no system in lower middle or low income countries. Table shows the oral health status in WPRO countries. DMFT index for years old, as one of the representative index for oral health state in each country. It showed about from. to. of DMFT index of years old, in most countries of WPRO area, except in South Korea as. in. It was considered that it was decreased in DMFT index in high income countries, by active programs of the public oral health and the oral health education, especially was known as well develop and active in oral health program by establishing the Bureau of oral health with 4 departments, related with the oral health in central government organization. Otherwise, in low middle or low income countries, it is estimated as low level of DMFT index too. It was considered as due to the low level of the sugar consumption. DMF rate in years old were revealed as from about 4% to 7%, and distributed without any patterns, by socioeconomical level. On comparing the DMF rate in and in Indonesia, IJCPD 8

International Journal of Clinical Preventive Dentistry Table. Oral health status (DMFT, dmft, rate, index, edentulous rate ) in WPRO countries Classified Countries DMFT () DMF rate dmft () dmf rate E.dent (%) O. Canc. M O. Canc. F yr High income (OECD) NonOECD.7.7....4.9.7.9..7....8.87 4. 8.. 4.. 4.8 7 7 97. 77. 48..9.7.8. 4.84.. 4.4 8.4. 7.4 4.4. 4.4 7.7 48. 49.9 88. 7 7. 97 9. 9 7. 8.7 7. 9 4...8..8.4. 4.9....7. 4..7...8 4.7.8....7.7. 4.7.7.7.7..9 98 97 9 94 94 98 94 7 E.dent: edentulousrate, O. Canc. M: oral cancer rate in male, O. Canc. F: oral cancer rate in female. DMFT was low in high income countries and increased in middle upper or lower middle income,otherwise low level again in low income countries. which are the same level of DMFT index as about., it was guessed that few children had much caries in as lots of caries free children, otherwise about 8% of children had a little caries, as distributed for all. So, the different policy would be applied with the consideration of both of DMFT index and rate. In primary teeth consideration as dmf index for years old was revealed as very high in upper middle and in low income countries. It showed that comparatively low level both in, and, moreover dmf rate was the similar pattern as low, both in countries, compared with other countries. It was due to the school dental clinic with emphasizing the preventive care for preschool children, managed at the school dental clinic, both in countries and also in New Zealand. Edentulous rate for over age was estimated as high in and very low level in and. It was considered that not so many years had passed since the active public oral health program has began in, so it should be decreased in edentulous rate in near future. Oral cancer per, population for male was revealed as high level in and. For female, and was revealed in high level. It might be due to relate with the level of cigarette consumption rate per person in. DMFT index for years old is one of the representative data for oral health level in each country. It revealed as desirable that DMFT index for years old was below. in most countries of WPRO. It was very low in,, and, as.. but there was the different trend of these countries as decreasing tendency in and, otherwise increasing tendency in and, even though it revealed about. at present situation. It is certain in traditional that caries prevalence trend would be in the increasing tendency according to increase the economical development at the first stage, but it would be changed to the decreasing tendency after achieving the high level of socioeconomic environment as a developed country, by performing the eligible and active public oral health programs. In consideration of the trends, some countries with low middle or low income, should try to establish the proper policy for public oral health program at present, even though it revealed a little bit low level in caries prevalence at present. Malmö University, as one of WHO Collaborating centers has suggested to appraise the DMFT index with the newly developed index as the Significant Caries Index (SIC) together, because DMFT index was revealed as low level or similar level in lots of countries and need for the different standardization for analysis, by calculating with one third of the population with the highest caries score. In deciduous dentition, dmft index and rate were revealed as relatively high in most countries, leave to be controlled in the 84 Vol. 7, No., June

KyuHwan Lee, et al:oral Health in Western Pacific Region, Current States, Challenges and Way Forward Table. Dental workforces in WPRO countries Classified Countries Dentist Pop/Dent Dental school Training yr DH DT D.Assis Therap Denturist High income (OECD) NonOECD 9. 9,874,788,, 7,, 4 9,8 4 7,8.7,8,9,99,8,8 8,8 8,9, 8, 8,4 7, 9,97,,98 9,, 9 47 4. 4 7 77 7,97, 7 4 8,,7 8, 7,4,,,7 (,), 7,7, 8,4 8 4,7,4* 8 84 7 Assist.88 Pop/Dent: population per dentist ratio, DH: numbers of dental hygienist, DT: numbers of dental technician, D. Assis: dental assistant, Therap: dental therapist. *Dental Therapist in was estimated as not original dental personnel but a kind of bare foot dentist. Population per dentist ratio was revealed as increasing tendencyaccording to decrease the income of each country. future and edentulous rate over age might be increased by extension of life expectancy in most countries. The numbers of dentists were showed as variable in each countries by the scale of the population and land in the each country, so population per dentist ratio is more important and eligible. About, to, of population per dentist ratio were revealed in high income countries, otherwise, to, in lower middle or low income countries as the deficiency of the numbers of the dentists. Numbers of dental schools were revealed as from to 47, in each country by the scale of the country. But in small island countries in South Pacific Region has no dental school at all. There had been established the dental schools recently, in some of middle or low income countries or not established yet. The particular thing is in as, even though there were dental schools in, not so many dentists had been produced and high level of the population per dentist ratio. It was due to the less pass rate of the national board examination for dentist. In, dentist license system was established in 998 as recent years but lots of unlicensed dentists so we call as bare foot dentists, or they think of then as a dental therapist, have been working together. 4 to 7 years had been chosen for training course at each country and, Korea and had kinds of system for training year, But has decided them as one system as 7 years course in recent years, even though systems. As 4 years post graduate school and years dental school system were still remain in South Korea to be left for unification. and South Korea have a big numbers of dental hygienist system for 4 years and they are included in the top level, in numbers of dental hygienist in the world. Even though, these two countries have a large number of dental hygienist, their role are different from USA or European countries, as mainly focusing on the dental assisting instead of preventive care or oral health education. So it would be needed to change their roles to original things by establishing the dental assistant system. New Zealand is the first nation to develop the dental therapist as a school dental nurse system in the world from the year 9, and is also well organized country for school dental clinic system and dental therapist system. The number of laboratory dental technician was revealed as variety at each country and some countries as, and small island in South Pacific region have no dental technician system. Such countries as, New Zealand, and have still left the denturist system with a small number and has an assistant dentist system with 88 personnel. Table 4 shows the systemic or general conditions for health in each country. There was a limitation to investigate only few item related with the oral health in this study. Smoking rate was shown as very high in South Korea,, IJCPD 8

International Journal of Clinical Preventive Dentistry Table 4. Systemic conditions (tabacco, drinking, HIV, sugar cons. )in WPRO countries Classified Countries % Smoke Cigar Cons % Drink. Abst Sugar con HIV/AIDS High income (OECD) NonOECD. 9. 4...4 7. 9.8 4.4.,,8,7 4 4,4,7 447 44 887 9.8 9 49 9 7 9 48 9 47 7 8 48. 8 9...........8.. Cigar Cons: average cigar consumption per person per year. and in Pacific island countries, otherwise very low in. Cigarette consumption per person for an year was estimated as the top in and proceeding in South Korea, and. It means that the smoking rate is decreasing tendency in but more heavy smoking was still done for smoker and that phenomenon was the similar in and in. So, it was recommended that the quit smoking activities should be done continuously and more active in those countries as well as in South Korea and. Drinking Abstain rate was revealed as high in South Asian Countries, otherwise not so much active in such country as,, Korea, and. It was considered that not so much drinking in hot climate areas and restrain the drinking in nation wide was done because of the religion problem in. Sugar consumption per person is very important and related with causing the basic oral diseases. Relatively high consumption of sugar was revealed in such countries as in, South Korea, New Zealand,, and. Generally, it was shown that sugar consumption per person was relatively low in economically low middle or low income countries except in, in which high level in the past but in low level of the well education for health to restrain the sugar consumption or recommending the sugar substance, like a Xylitol. HIV/AIDS rate was examined as high in and PNG, otherwise, relatively safe in South Korea, New Zealand,, and. Oral health is much related with the systemic conditions and such symptoms of HIV/AIDS. It can be checked or screened by OralQuick Advance Kit which was produced in USA, with simple procedure by swabbing the oral mucosa slightly with the Kitbar, at dental clinic. So it was recommended to use the Kit at dental clinics for early detection of HIV/AIDS to elongate the patient s life as well as getting more adequate infection control at dental clinics. Anyway, it should be considered the oral health related with systemic state together. Table shows the public oral health program in each country. Each country has performed the eligible programs for oral health promotion, with the consideration of the socioeconomical factors for each country, in order to promote the oral health level and to prevent the oral diseases. The appraisal score was given for each item of public oral health project as from point to points, with standardization as for no program doing, point for few case done, points for large extended with active performed and points for national wide active program. The data and information were gained from WHO data base mainly or from the questionnaire survey for recent activities in some countries. Such item as water fluoridation, oral health education, oral examination, school oral health program, the activities of the public dental health center, and establishment or management of the department of oral health in government organization, were examined with the scoring system, at each country s state. Water fluoridation is known as the best way for public oral 8 Vol. 7, No., June

KyuHwan Lee, et al:oral Health in Western Pacific Region, Current States, Challenges and Way Forward Table. Thescore of the public oral health program (water fluoridation, school oral health, O.H education) Classified Countries Water, fluoride F. milk/sal School Oral.Exam Oral H. Educ. T B I F. M. Rinse F. Apply Sealant School D.Clin ART High income (OECD) NonOECD F. milk/sal: milk/salt fluoridation, Oral H. Educ.: oral health education program, T B I: tooth brushing instruction program, F. M. Rinse: fluoride mouth rinsing program, F. Apply: fluoride topical application program, School D. Clin: school dental clinic program, ART: ataumatic restorative technique program. Table. The score of the public oral health program (water fluoridation, school oral health, O.H education) Classified Countries OH Camp Eldery P. P. H. Cent Mobile C Basic Tx Gov.Office N.OHSurv Total High income (OECD) NonOECD 8 4 9 7 9 9 OH Camp: oral health campaign program, Eldery P.: eldery oral health program, P. H. Cent: public dental health center, Mobile C: mobile dental clinic program, Basic Tx: basic dental treatment program, Gov.Office: dental department at government, N.OHSurv: national oral health survey, Total: total score of public oral health programs. IJCPD 87

International Journal of Clinical Preventive Dentistry health to prevent dental caries. and New Zealand was the well developed countries for water fluoridation in national wide as more than % of cities, Brunei and are metropolitan cities to be easy to process for water fluoridation. Some cities have got the water fluoridation in Korea and as % of the cities. Otherwise one or two cities were known as to be involved the water fluoridation as a pilot program in,, PNG, and. One of the big problems for water fluoridation in Asian Pacific countries have been revealed as the decreasing tendency in numbers of cities for joining the program, because of the neglect of the program or antifluoridation movement from the society for naturalism in certain countries. So it is needed to inform them with the correct and the proper information about the water fluoridation program from WHO, to promote the program to be extended. Such countries as,, a part of, PNG and has been examined to use the fluoride milk or fluoride salt system, instead of water fluoridation. Most of the WPRO countries have performed the periodic oral exam, and oral health education systems for children, whether it was done in active or not, without consideration of establishing the oral health goals, plans or appraisal system. So, it was needed that the eligible goals for oral health and proper directions of the oral health education at each age group, with the adequate of the appraisal system, should be established in each country. Tooth brushing instruction was the most prevalent performed items for oral health education in WPRO countries. Fluoride mouth rinsing program has been done in, South Korea,,,, and at some schools, for one of the caries prevention programs. Fluoride topical application program was done in some countries including well developed the school dental clinic program. In, New Zealand and, fluoride topical application program was relatively active than in, Korea, and, which were the countries with a little performed the program for fluoride application. Sealant program was in active in such countries as, New Zealand and as a national wide school dental clinics program have been performing. Korea and had the national wide sealant programs for school children both at some school dental clinics or public dental health centers, for last years, and had well system for dental management with sealant program for young children under age, at the dental public health centers, including fluoride application. % of primary, middle and high schools have equipped the school dental clinics in, New Zealand and, except small scaled schools, manage by dental therapist, otherwise only under % of primary schools had school dental clinics in Korea and lots of schools in have school dental clinics, manage by public health dental hygienists under indirect supervision of public health dentists. Such countries as, and have a pilot programs of school dental clinics at few primary schools. School dental clinic program is known as the most active for prevention and possible to supply the comprehensive dental caries with continuous management for school children, as one of the strongly recommended program for public oral health. So, it should be extended to all countries in Asian Pacific Region, to set the program as possible as they can, for promoting the oral health for school children. ART, atraumatic restorative technique has been done in some of south east countries as one of the public oral health programs where the dental unit chair and high/low speed engine had not equipped at the remote areas, as a combined care for prevention and early treatment of dental caries. But there would be no needed to supply ART in which the residents could easily contact to dental clinics or public dental health centers. Most of countries have proper activities for oral health campaigns, through deciding the oral health day in each country. Special public oral health programs for elderly persons and for disabled persons were revealed as comparatively well done in high income countries. The public dental health center was established and managed by public dental health personnel in high income countries, for basic dental treatments for poor or senile residents in such countries as, Korea, New Zealand and, and had equipped the mobile dental buses. Most of countries have been established the governmental organization at central government, but Korea had closed it in the past and reopened with a half as combined with other department together, in recent years. Otherwise some countries as lower middle or low income countries have no organization for it yet. Many of countries in WPRO have been performed the national dental survey periodically but such countries as,, PNG,,,,, and Viet Nam had not done in regular or periodically. Total score of the public oral health level was revealed as the proportion to the economical level of the country, except as high score for public oral health activities in spite of including in the middle of the economical leveled country. From the data, it was certain that caries prevalence were decreasing tendencies in high economical leveled countries, by several and appropriate public oral health programs, otherwise increasing tendencies in low economical countries with the less of the programs. WPRO has a responsibility to enhance them 88 Vol. 7, No., June

KyuHwan Lee, et al:oral Health in Western Pacific Region, Current States, Challenges and Way Forward to suggest and to recommend the proper programs to each country to promote the oral health in Asia Pacific Region. There were such limitations in this study as collecting the data from a limited sources and information by answerer s opinions. Conclusion From the above data, it was suggested the followings to each country in WPRO, for promoting the oral health.. and New Zealand are well done countries for oral health except comparatively more in sugar consumptions than those of the other countries. So it is needed to try reducing it gradually. It was revealed relatively high of edentulous rate and oral cancer rate for senile group or natives in those countries to be recommended to try for decreasing them.. has no program for water fluoridation and school dental clinic at all, even though DMFT or dmft was decreasing tendency by performing with the several kinds of preventive and public health dentistry. So it was suggested to attempt for performing it as well as for establishing the school dental clinic program, in circumstances were permitted. Cigarette consumption and HIV/AIDS rate were revealed as relatively high in. So it was needed to make a proper policy to reduce them, in order to promote not only for the oral health but also for general health. It was recommended to reduce the number of dentist gradually and change the role of dental hygienist for original missions as the prevention and the education.. Korea had better to establish the government organization for oral health separately in the Ministry of Health and Welfare, in order to perform more active public oral health programs which have been inactive or weaken such program as water fluoridation and school dental clinic program in recent years, even though DMFT index was still high to be reduced more. Number of dental hygienists was enough produced but their roles were similar with the dental assistants, like a. So it is needed to change their roles, focusing on prevention and education as the original roles, and it should be needed to establish the dental assistant system in South Korea. 4. is a metropolitan city country and well organized the public oral health program, and comparatively easy to be controlled. But sugar consumption was revealed as high to be reduced.. and have been needed the various dental personnel more, even though relatively well organized in public oral health programs, compared with neighbor countries. Especially, should be needed for establishing the oral health program for elderly peoples, because of high rate of edentulous in senile.. is the biggest country and needed more dental personnel as not only the dentists but also for other dental workforces. Water fluoridation was recommended to Chinese cities, rather than other programs because it is too big country to apply any other programs easily in, Cigarette smoking rate was revealed as high and to be needed for reducing the rate. 7. need more dentist as well as to develop the such kind of dental personnel as dental hygienist, dental technician or dental assistant. Dental therapist system with mobile car might be recommended because the population is scattered with rare residences, and not easy to contact to dental clinics, by establishing the mobile school dental clinic or public oral health center, managed by dental therapist, like a Canadian style. Milk or salt fluoridation is suggested for more extent, instead of the water fluoridation, in consideration of n characteristics as not well developed in piped water system at rural areas. 8. PNG has not so much data except the extremely lack of dental personnel and very few of public oral health programs. Even though has lots of dental schools, relatively few numbers of dentists are produced, because of the low pass rate of the National board exam, and the dental educational problems. So it would be needed to be leveled up for all dental schools in. Water fluoridation is highly suggested in because a little bit big population and relatively well developed the piped water supply at cities, compared with the neighbors countries. Cigarette consumption was a little bit high in and try to be reduced it. 9. In,, and are the similar conditions as lake of dental personnel, not so much activities for public oral health programs, and a little data reported. So, national wide periodic dental survey would be needed to establish the proper oral health program for each country. Most of the dental personnel, even though that is not so much in numbers, was educated in as a well developed neighbor country, and school dental clinic system is introduced like an n style, focusing on children s oral health first, with prevention and early treatment at school or public health center, managed by well trained dental therapist as school dental nurse.., and VietNam are the similar conditions as the deficiency of dental personnel as well as not so much ac IJCPD 89

International Journal of Clinical Preventive Dentistry tivities for public oral health program. Even though the caries prevalence are a little bit low level at present, it might be worried to be increased by economical development, as like as most of developing countries already had experienced. So, it needed for prevention oriented public oral health program as fluoride mouth rinsing with toothbrushing, fluoride topical application or sealant programs would be suggested at schools or public health centers, not to increase the dental caries for school children. Moreover, HIV/AIDS rate was relatively high in and VietNam, and it is suggested to make a health policy to control it as well as to detect it more earlier by use of Oral Quick Advance test as smearing at the oral mucosa with simple method in dental clinic, as one of the public health programs.. SIC (Significant Caries Index) and CPI or CPITN for periodontal index should be included on the national dental survey in all countries of WPRO, in order to analyze the data and to establish the more eligible oral health policy at each country.. Oral health can be promoted effectively by establishing the proper policies and programs by a responsible organization in each country as well as to be suggested with the appropriate guide lines from WHO. So WPRO should recommend or suggest to each country for effective public oral health program, by establishing the eligible and professional oral health department in governmental organization. References. FDI. Global goals for oral health in the year. Int Dent J 98;:747.. Clarkson J, Watt RG, Shin SC, et al. Proceedings: 9th World Congress on Preventive Dentistry (WCPD): "Community Participation and Global Alliances for Lifelong Oral Health for All," Phuket, Thailand, September 7, 9. Adv Dent Res ;():.. Hodell M, Petersen PE, Clarkson J, Johnson N. Global goals for oral health. Int Dent J ;:88. 4. Ministry of Health of. Comprehensive guide to the Survey of Dental disease... Ministry of Health of. National Epidemiological Survey on Oral Health. 8.. Ministry of Health of Thailand. th National Oral Health Survey. 8. 7. Ministry of Health & Social Welfare of VietNam. nd National Oral Health Survey, in 999. 8. Ministry of Health & Welfare of Korea. National Dental Survey.. 9. Shigeru O. PeopleCentered Health CareA policy framework. WHO, West Pacific Region; 7: WPR/RC8/SR/8.. Shin SC. Oral helth in the world. 99. Kunja Publishing, Korea. Christine NN. Dental Public Health. nd ed. USA: Pearson Education LTD;.. WHO. Country Health Information Profiles (CHIPS). 9. http://www.wpro.who.int/countries/countries.html. WHO. Formulating Oral Health Strategy for South East Asia, Report of a Regional Consultation. Thailand. 9. SEA NCD.8 4. WHO. Global Sugar Consumption,. http://www.whocollab. od.mah.se/ expl/globalsugar.html. WHO. National Health Accounts (NHA). http://www.who.int/nha/country/en/index.html. WHO. Oral Health. http://www.who.int/mediacentre/factsheets/fs8/en/index.html 7. WHO. Periodontal Profile.. http//www.dent.niigatau.ac. jp/prevent/perio/perio.html 8. WHO. Significant Caries Index (SIC). WHO. Oral health country/area profile program, http://www.whocollab.od.mah.se/ expl /sic.html 9. WHO. Who oral health country/area profile program. WHO head quarter Geneva, Oral health program (NPH), WHO Collaborating Center, Malmö University, Sweden.. CAPP home page: http://www.whocollab.od.mah.se/ 9 Vol. 7, No., June