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Asoc.prof. Egita Senakola Asoc.prof. Anda Brinkmane

Asoc.prof. Egita Senakola Asoc.prof. Anda Brinkmane. Latvian National Prevention programm (elaborated in 1995). Baltic Dental Meeting 18.-19.August, 2011 Sigulda. The mean cariess experience (DMFT) in the population of Latvia (ICS-II, 1993). 24.9. 19.2. 5.8. 1.2.

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Asoc.prof. Egita Senakola Asoc.prof. Anda Brinkmane

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  1. Asoc.prof. Egita SenakolaAsoc.prof. Anda Brinkmane Latvian National Prevention programm (elaborated in 1995) Baltic Dental Meeting18.-19.August, 2011Sigulda

  2. The mean cariess experience (DMFT) in the population of Latvia (ICS-II, 1993) 24.9 19.2 5.8 1.2

  3. Explanations for these findings in Latvia till 1993 were: low content of fluorides in drinking water, difficulties to obtain different fluoride supplements, lack of information - motivation for the necessity of improving oral health, total imbalance in the compositions of dental team, not enough dental auxiliaries.

  4. In 1995 National Preventive Programme in Dentistry was created at the Oral Health Centre and Fund (Institute of Stomatology) in close cooperation with the State Dental Centre and WHO Collaborating Centre in continuing Dental Education in Latvia. The programme was divided into 5 blocks and the responsibilities were taken from both sides: education – research and health – care systems. Phase I 1995 – 2005 Phase II 2005 - 2010

  5. Information-motivation block - broad system for children and parent’s education in oral health promotion • Educational - Education block - education of dental, general medical and pedagogical staff in oral health prevention and promotion. Training of highly educated auxiliary staff - dental hygienist and nurses. • Scientifically - epidemiological block - on the basis of the data bank accounts, to analyze the effectivity of preventive measures. Carrying out separate clinical and epidemiological studies. • Responsibility for all three blocks was undertaken by Oral Health Centre (OHC) Institute of Stomatology.

  6. Next two blocks - by State Centre of Dentistry. • Prevention block – inco-operation with Sickness Funds and local governments, to provide curative and preventive work in dentistry, based on basic and individual programs. • Data bank block - assessment of effectivity of preventive and curative work should be based on regular accounting of dental data in definite age groups. Data collecting is performed by regional OHC. • Establishing of Local Oral Health Centers (OHC) in all 26 districts of Latvia

  7. Common Risk/Health Factor Approach

  8. Strategies recommended to prevent and control oral diseases are part of a common risk factor approach to control those risks common to a number of chronic diseases. These are: • A food and health policy to reduce sugars consumption. • A community approach to improve body hygiene and oral hygiene. • Smoking cessation policy. • Policy on reducing accidents. In addition to those four strategies the specific oral strategies are: 1. Policies on water fluoridation and fluoride toothpaste use. 2. Ensuring the availability of appropriate dental care.

  9. Prevention in Latvian dentistry was based on the principles of Health Promotion and Education, developing whole population strategies, involving dental and general health teams, School councils and Sickness funds, media and industry. With the introduction of the National preventive programme in Latvia since 1995– till 2000, only preventive block was financed by the state, but despite the hardships the programme was gradually developing according to the strategic plans, distribution of responsibilities, thanks to preventive dental and general health promotion teams, with the financial help of the municipalities, School councils, Sickness funds and industry.

  10. During the period (1995 - 2005) there were published: 74 informative articles, 3 books, two programmes, 28 booklets, 4 posters prepared, 49 TV and radio broadcasts, regular annual campaigns since 1994,organized 36 post graduate training courses, 45 conferences and seminars, 3 congresses. All there activities were financed by the representatives from industry: “Wrigley”, “Procter & Gamble”, “Grindex”,“Jordan”, “Colgate” Aquafresh”, “Zendium”, “3M”.

  11. During the period (1995 – 2005) five kindergarten and school based oral health education programs were introduced, covering 190 000 children. Two special programs for parents, teachers and school nurses were worked out.

  12. School of Dental Hygienists-Medical Academy of LatviaSince 2002Riga Stradins University School project was worked out in the spring of 1995 at the Centre of Oral Health of the Institute of Stomatology, Medical Academy of Latvia In September 1995, thanks to the support of Medical Academy of Latvia and the Institute of Stomatology the school got their work started, admitting students for a one-year training course (previous education diploma of a dental nurse or general nurse was demanded). During the period 1995 – 2003177 diplomas were awarded. Session 2004/2005 was marked by the activities to change the legal status of the School and its conversion into a academic school (two year curriculum). The programme was started in year 2007.

  13. Distribution of the Dental Staff in Latvia Specialization 1993 % 2005 % Nr of dentists-stomatologists 1436 72,6% 1522 52.1% Nr of dental-therapists (educated till1976) 105 5,3% 104 3,0% Nr of dental hygienists (educated since1995) 0 0,0% 177 3,9% Nr of dental nurses (educated since1991) 23 1,2% 201 5,7% Nr of gen. Med. Nurses (certif. in dentistry since 1997) 0 0,0% 786 14.9% Nr of dental assistants (educated since1997) 0 0,0% 173 2.7% Nr of dental technicians (educated since1961) 415 21,0% 501 17.7%

  14. In June 1997 – Latvian Dental Hygienists Association was founded and in July 1998 – association was accepted as a member of International Dental Hygienists Association (first member from the Eastern European countries).

  15. Dental hygienists in Latviaweretrained for clinical and community work.They are able tolead the local Oral Health Centres.

  16. Dental team in local oral health centers in Latvia

  17. With the introduction of National Preventive programme in Dentistry – creating a broad system in oral health education and promotion supported by industry, with increasing number of highly educated dental auxiliary personnel working in the community - we can find caries decline in Latvia.

  18. In Riga city the study population comprised 2560 school children: Starting from 1994 fluoride containing tablet program was introduced – financed by the city council. • Program covered: • 143 kindergartens  16.000 children (5 – 7 yrs) • 142 schools  40.000 children (7 – 12 yrs) • In total  46.000 children. An organized daily kindergarten – based toothbrushing intervention with oral health education in all age groups was introduced.

  19. Caries prevalence in Riga (1993-1998) DMFT decline - 23% DMFT decline - 52% DMFT decline - 28% R.Care, I.Urtāne, E.Senakola 1999.

  20. CPITN – index of 12 – 13 year old Latvian (Riga city) children (1993 - 1999) R. Care, 2000

  21. In four rural districts the study population comprised 4478kindergarten children: • Supervised tooth brushing twice a day with a low concentration fluoride toothpaste. • Oral health promotion and education programs for children and their parents, for kindergarten teachers and nurses. • highly educated dental auxiliary personnel – dental hygienists and dental nurses involved in oral health promotion, education and clinical - preventive work.

  22. The mean caries experience (dmft, DMFT) of 3 and 6 year-old Latvian (rural) children by year of study (1997-2000) dmft decline - 41% dmft decline - 38% DMFT decline - 37% dmft=2,56 dmft=6,06 dmft=1,51 dmft=3,73 DMFT=0,38 DMFT=0,24 6 yrs 3 yrs E.Senakola, A.Brinkmane, D.Rakicka 2001.

  23. Index of DMFt for permanent teeth of 12-year-olds 3,9 3,6 3,5 3,4 4,0 3,5 3,0 2,5 2,0 1,5 1,0 0,5 0,0 2000 2001 2002 2005

  24. DMFT levels at age 12 in Baltic and Scandinavian states 2.1

  25. Explanation for the finding of caries decline in Latvia (1995 – 2005) • Introduction of National Preventive program in Dentistry - together with industry was created a broad system in oral health education and promotion. • Wide selection and regular use of fluoride containing supplements (for reasonable prices). • Increasing number of highly educated dental auxiliary personnel – dental hygienists, dental nurses involved in health and oral health promotion, education also clinical – preventive work. • Curative and preventive work in co-operation with Sickness Funds and State Dental Centre. • Organized 26 local Oral Health Centres.

  26. The World Oral Health Report 2003 • Oral health and fluorides • Diet, nutrition and oral health • Tobacco and oral health • Oral health through Health Promoting Schools • Oral health of youth • Oral health improvement amongst the elderly • Oral health, general health and quality of life • Oral health systems • HIV / AIDS and oral health • Oral health information systems, evidence for oral health policy and formulation of goals • Research for oral health

  27. Phase II (2005 – 20010)

  28. Oral health strategy in Latvia 1. Dental caries (children and adults) Aims and objectives Comparison with past indicators Strategy and recommendations (fluorides, diet, sealants, preventive screening, treatment) 2. Other issues – chronical periodontal disease, orthodontic care, dental trauma, dental health promotion and hygienists training 3. Cost and provision of dental services 4. Manpower issues

  29. Dental hygienists academic school logo Since 2007

  30. First-level professional HE (university college) programmes comprise 80–120 (120–180 ECTS) credits and lead to the 4th level professional qualification. These programmes are targeted mainly to the labour market. Yet, the graduates of the first-level programmes can continue their studies in second-level professional programmes.

  31. DENTAL PERSONNEL EDUCATION TYPES IN LATVIA For dental hygienists“step-by-step”education model

  32. Dental hygienists in Latvia (2008 - 2010) • The total number for a country  The number legally authorised to practice (registration sertification/ or licensure)

  33. Dental personnel in the Nordic countries and Latvia (per population) E.Widström, et al. Developments in Oral Health Policy in the Nordic Countries Since 1990 Oral Health & Preventive Dentistry, Vol 3, No4, 2005

  34. 18 dental hygienists and 3 dentists were attending the congress in Glasgow

  35. Decision making responsibility and work supervision for DH clinicians Collaborative Dental hygienist and dentists together decide services required: dentist may be off site Dental office/Public sector (In Public sector – independent – dental hygienists decides in collaboration with patients <18 years of age)

  36. The government in responsible of the dental care of the children up to 18 years of age. 24 % of dental hygienists working in public health. 2009

  37. The dental hygienists and also dentists profession remains predominately female in Latvia – women are comprising 98% as dental hygienists and 89% as dentists. 2009

  38. Distribution of the Dental Staff in Latvia 1993 2009

  39. Objectives of training community dental hygienists – they shall demonstrate their knowledge and ability to: • Identify target groups within the community particularly at risk; • Support dentists in the planning, organization and execution of preventive measures in community; • Carry out and participate with other health personnel in oral and dental health education and preventive measures for target groups; • Carry out, in co-operation with the dentist, oral and dental health education; • Support dentist carrying out epidemiological investigations; In Latvian Dental organization system – dental hygienists can head the local Oral Health Centres in close integration with dentists and dental nurses.

  40. The mean cariess experience (DMFT) in the population of Latvia (ICS-II, 2007) The mean cariess experience (DMFT) in the population of Latvia (ICS-II, 1993) 24.84 24.9 19.02 19.2 5.8 3.30 0.71 1.2 Care R., et al, 2007

  41. Tooth brushing twice a day with a fluoride toothpaste - children 11 – 12 years old 57% - adult male 15 – 64 years old 27% - adult female 15 – 64 years old 45% Health Promotion centre agency (2008) LATVIA

  42. Data from Sickness funds 2008

  43. EU Manual of Dental Practice: version 4.1 (2009)

  44. Nordplus – Baltic Network Dental hygienists meeting Riga 27-28 May, 2010

  45. Inter Nordic Collaboration A web based distance course Oral Health – a community perspective 7,5 - 8 ECTS Credits 2003, 2004, 2006 , 2008, 2009 2003, 2005, 2006 , 2008, 2009 Falun Oslo Åbo (Turkuu) Sweden Norway Finland 2010 - 2 students from Riga (Latvia) 2011 – 31 students from Riga (Latvia) have applied and 22 finished the course G Müller Amsterdam 2009

  46. May 2009 CED ResolutionCompetences required for the practice of dentistry in the European Union Fields of competences I. Professionalism. Ethics and Communication II. Practice Organization and Management, Knowledge Management III. Assessment of the Patient, Diagnosis, Treatment Planning IV. Establishment and Maintenance of Oral Health, Therapy V. Prevention, Health Promotion, Public Health

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