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

Asoc.prof. Egita SenakolaAsoc.prof. Anda Brinkmane

Latvian National Prevention programm

(elaborated in 1995)

Baltic Dental Meeting18.-19.August, 2011

Sigulda

The mean cariess experience (DMFT) in the population of Latvia (ICS-II, 1993)

0

5

10

15

20

25

DMFT

F-T 0,3 2,0 7,7 3,2

M-T 0 0,2 7,8 20

D-T 0,9 3,5 3,7 1,7

6 - 7 yrs

12 - 13 yrs

35 - 44 yrs

65 - 74 yrs

1.2

5.8

19.2

24.9

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.

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

• 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.

Next two blocks - by State Centre of Dentistry.

• Prevention block – in co-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

Common Risk/Health Factor Approach

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:

1. A food and health policy to reduce sugars consumption.2. A community approach to improve body hygiene and oral

hygiene.3. Smoking cessation policy.4. 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.

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.

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”.

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.

School of Dental Hygienists-Medical Academy of LatviaSince 2002 Riga 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 – 2003 177 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.

Distribution of the Dental Staff in Latvia

1993

21,0%72,6%

1,2%

5,3%

17.7%50121,0%415Nr of dental technicians (educated since1961)

2.7%1730,0%0Nr of dental assistants (educated since1997)

14.9%7860,0%0Nr of gen. Med. Nurses (certif. in dentistry since 1997)

5,7%2011,2%23Nr of dental nurses (educated since1991)

3,9%1770,0%0Nr of dental hygienists (educated since1995)

3,0%1045,3%105Nr of dental-therapists (educated till1976)

52.1%152272,6%1436Nr of dentists-stomatologists

%2005%1993Specialization

43,9%

3,0%5,1%5,8%

22,7%

5,0% 14,5%

2005

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).

Dental hygienists in Latvia were trained for clinical and community work. They are able to lead the local Oral Health Centres.

Dental team in local oral health centers in Latvia

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.

Program covered:Program covered:

•143 kindergartens 143 kindergartens 16.000 children (5 – 7 16.000 children (5 – 7 yrs)yrs)

•142 schools 142 schools 40.000 children (7 – 12 yrs) 40.000 children (7 – 12 yrs)

•In total In total 46.000 children. 46.000 children.

In Riga city the study population comprised 2560 school children:

In Riga city the study population comprised 2560 school children:

Age 1993 1999

6 – 7 yrs 275 578

12 – 13 yrs 324 565

15 – 16 yrs 295 (1998)

523

Total 894 1666

An organized daily An organized daily kindergarten – based kindergarten – based toothtooth brushing brushing intervention with oral intervention with oral health education in all health education in all age groups was age groups was introduced.introduced.

Starting from 1994 fluoride Starting from 1994 fluoride containing tablet program containing tablet program was introduced – financed was introduced – financed by the city council.by the city council.

Caries prevalence in Riga (1993-1998)

1,26

0,29 0,61

5,1

3,74,45

7,3

5,7

0

1

2

3

4

5

6

7

8

DMFT

R.Care, I.Urtāne, E.Senakola 1999.

DMFT DMFT decline - 52%decline - 52%

DMFT DMFT decline - 28%decline - 28%

DMFT DMFT decline - 23%decline - 23%

CPITN – index of 12 – 13 year old Latvian (Riga city) children (1993 - 1999)

0,0%

20,0%

40,0%

60,0%

Healthy 15,0%

Bleeding 58,1%

Calculus 26,9%

19930,0%

20,0%

40,0%

60,0%

80,0%

Healthy 62,0%

Bleeding 19,5%

Calculus 18,5%

1999

R. Care, 2000

In four rural districts the study population comprised 4478 kindergarten 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.

Age 1997 2000

3 yrs. 1364 699

6 yrs. 1253 1262

2517 1961

The mean caries experience (dmft, DMFT) of 3 and 6 year-old Latvian (rural) children by year of study (1997-2000)

0

0,5

1

1,5

2

2,5

3

f-t, F-T 0,26 0 0,21 0

m-t, M-T 0,06 0 0,06 0

d-t, D-T 2,24 0 1,24 0

1997 2000

0

2

4

6

8

f-t, F-T 1,61 0,04 1,59 0,1

m-t, M-T 0,44 0 0,42 0

d-t, D-T 4,01 0,34 1,72 0,14

1997 2000

3 yrs 6 yrs

dmft decline - 41%dmft decline - 41% dmft decline - 38%dmft decline - 38%DMFT decline - 37%DMFT decline - 37%

dmft=2,56

dmft=1,51

dmft=6,06

DMFT=0,38

dmft=3,73

DMFT=0,24

E.Senakola, A.Brinkmane, D.Rakicka 2001.

3,93,6 3,5 3,4

0,0

0,5

1,0

1,5

2,0

2,5

3,0

3,5

4,0

2000 2001 2002 2005

Index of DMFt for permanent teeth of 12-year-olds

DMFT levels at age 12 in Baltic and Scandinavian states

5,0

4,1

5,8

3,7

1,21,2 1,2 1,4 3,0

3,0

0

1

2

3

4

5

6

DMFT

Lithuan

ia 1

995

Estoni

a 19

97Lat

via

1993

Riga

1998

Finla

nd 199

6Den

mar

k 19

96Swed

en 1

996

Norway

199

6Ic

elan

d 19

96W

HO 200

0

2.1

Explanation for the finding of caries decline in Latvia

(1995 – 2005)

1. Introduction of National Preventive program in Dentistry - together with industry was created a broad system in oral health education and promotion.

2. Wide selection and regular use of fluoride containing supplements (for reasonable prices).

3. Increasing number of highly educated dental auxiliary personnel – dental hygienists, dental nurses involved in health and oral health promotion, education also clinical – preventive work.

4. Curative and preventive work in co-operation with Sickness Funds and State Dental Centre.

5. Organized 26 local Oral Health Centres.

• 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

The World Oral Health Report 2003

Phase II (2005 – 20010)

Oral health strategy in Latvia

1. Dental caries (children and adults)

Aims and objectivesComparison 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 services4. Manpower issues

Dental hygienists academic school logo

Since 2007

  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.

DENTAL PERSONNEL EDUCATION TYPES IN LATVIA

Types Since Length education

Intake per year

Training

Dental hygienists(DH)

1995

2007

(2 y DN) + 1 y curriculum

1y DA,2 y DN+

2 y curriculum

18-24

24-27

Medical Academy of Dental

Hygienist`s school

Riga Stradins university since 2002

Dental nurses(DN)

1991 2 y curriculum 30Riga 1st

Medical School(for auxiliaries)

Riga 1st Medical

college since 2005

Dental assistants(DA)

1997 1y curriculum 30

Dental laboratory technicians(DT)

1961 2.5 y curriculum 25

For dental hygienists “step-by-step” education model

Dental hygienists in Latvia (2008 - 2010)

Year to which data

apply

Dental hygienists

Totally educated

authorised to practise

Dental hygienist: population

ratio

Dental hygienists:

dentist ratio

Latvia 2008

June, 2009June, 2010

177 151

200 (23 graduates)226 (26 graduates)

1:12,6071:14,973

1:11,1571:9,873

Indicates service accessibility

1:8,31:9,7

1:7,3

1:6,5

Indicates technical efficiency

The total number for a country The number legally authorised to practice (registration sertification/ or licensure)

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

18 dental hygienists and 3 dentists

were attending the congress in Glasgow

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)

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

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

2009

73%5%

0%1%

0%

0%

21%

  Specialization 1993 % 2009 %  Nr of dentists-(stomatologists) 1436 72,6% 1465 40,5%  Nr of dental-therapists (educated till1976) 105 5,3% 82 2,3%

Nr of dental hygienists (educated since1995) 0 0,0% 151 4,2%

  Nr of dental nurses (educated since1991) 23 1,2% 346 9,6%

Nr of gen. Med. Nurses (certif. in dentistry since 1997) 0 0,0% 786 21,7%

Nr of dental assistants (educated since1997) 0 0,0% 223 6,2%

Nr of dental technicians (educated since1961) 415 21,0% 561 15,5%

20091993

Distribution of the Dental Staff in Latvia

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.

The mean cariess experience (DMFT) in the population of Latvia (ICS-II, 1993)

0

5

10

15

20

25

DMFT

F-T 0,3 2,0 7,7 3,2

M-T 0 0,2 7,8 20

D-T 0,9 3,5 3,7 1,7

6 - 7 yrs

12 - 13 yrs

35 - 44 yrs

65 - 74 yrs

1.2

5.8

19.2

24.9

The mean cariess experience (DMFT) in the population of Latvia (ICS-II, 2007)

0

5

10

15

20

25

DMFT

F-T 0,39 1,33 4,12 2,46

M-T 0,02 0,15 7,26 19,85

D-T 0,3 1,82 7,64 2,53

6 - 7 yrs

12 - 13 yrs

35 - 44 yrs

65 - 74 yrs

0.71

3.30

19.02

24.84

Care R., et al, 2007

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

0

1

2

3

4

5

6

1993 2000 2002 2007 2008

5,8

3,93,5

3,2

2,4

DMTF index of permanent teeth for 12 year old children

Data from Sickness funds 2008

EU Manual of Dental Practice: version 4.1 (2009)

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

G Müller Amsterdam 2009

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

May 2009 CED ResolutionCompetences required for the practice of dentistry in the European Union

I. Professionalism. Ethics and Communication

II. Practice Organization and Management, Knowledge ManagementIII. Assessment of the Patient, Diagnosis, Treatment PlanningIV. Establishment and Maintenance of Oral Health, Therapy

V. Prevention, Health Promotion, Public Health

(evidence-based therapy, Continuing Professional Development,

self assessment, referral)

Fields of competencesFields of competences

We experience that dental hygienists in Latvia:

• Must be highly qualified in order to meet public expectations.

• Will be necessary in a big number in future health and oral health services.

• Are appreciated by most dentists, when they still look on auxiliaries by a limited fraction.

• Will be used to the full degree of their capability.• Should be trained in teams together with dental students.• Need international contact and inspiration to optimize the

professional development.

Adopted from Nørman S. (2002) Denmark

Baltic preventive conferences in Latvia

1995

1998

2007

2011

European Global Oral Health Indicators

Development Phase I and II

(2003 – 2008)

ICDAS pilot project20 dentists

participate (2008)

Non Carious Cervical

Lesion and Dentine

Hypersensitivity 11 dentists

and DH participate

(2011)

We want to change thingsWe want to see them happenWe don’t want just to talk about them.

Egita SenakolaEmail: [email protected]

Thanks for attention!

Magritte