Global oral health

by JoAnn R. Gurenlian, RDH, PhD

Every now and then I use this column as a means to step out of what we do on a daily basis and consider opportunities that extend beyond the operatory. While oral health remains a challenge in the United States, it also persists as a global issue. Oral health burdens that affect people in our country are equally paramount in countries abroad. Gross economic disparities, limited access to care, and legislative policies and programs that continue to fail the public yet remain in existence contribute to the lack of improvement in oral health worldwide.

Recently, I attended the International Association for Dental Research (IADR) meeting held in Seattle, Wash. At that meeting, the IADR, in partnership with the Global Oral Health Inequalities Research Agenda (IADR-GOHIRA), presented its call to action. Within this initiative, the organization has established a research agenda designed to reduce the inequalities in oral health. The time frame is one generation. This call to action is designed to focus international leaders in oral health research on their role in achieving this goal.

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Before you breathe a sigh of relief and think that this does not apply to you, allow yourself a moment to consider the aims and challenges identified by the IADR-GOHIRA. The aims of this agenda include the following:

• For better understanding of the full range of oral health determinants that include biological and environmental factors as well as behavioral and social determinants of health and well-being
• To promote research on social and physical environments, across the social gradient, with emphasis on marginalized and vulnerable communities
• To focus on research strategies that can better serve to reduce existing health inequalities, including oral health inequalities within and between countries
• To develop and maintain usable resources for compiling evidence-based systematic reviews and guidelines on methods and strategies to address the inequalities in oral health1

The three challenges identified for this initiative are noted below:

1. Gaps in knowledge and, specifically, insufficient focus on social policy
2. The separation of oral health from general health
3. Inadequate evidence-based data (including research-driven programs, capacity-building strategies, standardized systems for measuring and monitoring, etc.)1

The IADR-GOHIRA proposes to network with key partners and policymakers to accomplish their aims. They specifically note the desire to partner with the World Health Organization (WHO) and the FDI World Dental Federation. Both groups can certainly assist with this agenda. However, I want you to consider where dental hygiene fits into this picture.

If you have a few minutes, obtain a copy of this call to action and ask yourself what is missing. For example, outreach to dental hygiene groups is not mentioned. Perhaps the IADR-GOHIRA is not aware that there is an International Federation of Dental Hygienists (IFDH) or an American Dental Hygienists' Association (ADHA). They may not know that the ADHA has its own research agenda. It is conceivable that they are unaware that dental hygienists conduct research and could contribute to this initiative.

The IADR-GOHIRA has task group chairs addressing dental caries, periodontal disease, oral cancer, oral infections, developmental abnormalities, and implementation and delivery. Have you any experience in those areas? If so, consider writing to the board and asking to contribute. After all, if anyone knows something about oral health, disease prevention, and the need to improve oral health, it is you. You see these issues on a daily basis. You can join a research team that would contribute to understanding the gaps in knowledge and how to close them.

As you read this column, maybe you are thinking that you are happy where you are in your operatory in a private practice setting. That is fine. At some point, however, do start asking yourself and your profession how long we can be willing to watch the effects of oral inequality continue, for how long will it be acceptable to see families suffer the effects of poor oral health, and for how long will we sanction policies and procedures that are clearly ineffective? In doing nothing, we contribute to the problem.

We have an opportunity to serve as oral health advocates, educators, and researchers. What we do locally can affect global health considerations. Let us support this call to action by creating models for improving oral health, testing them, and sharing the results. It is time we became part of the solution. RDH

Reference

1. Sgan-Cohen HD, Evans RW, Whelton H, Villena RS, MacDougall M, Williams DM. IADR Global Oral Health Inequalities Research Agenda (IADR-GOHIRA®): A Call to Action. J Dent Res 2013;92(3):209-211.

JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing-education programs to health-care providers. She is a professor and interim dental hygiene graduate program director at Idaho State University, and president-elect of the International Federation of Dental Hygienists.