Latvian National Prevention programm
(elaborated in 1995)
Asoc.prof. Egita Senakola
Asoc.prof. Anda Brinkmane
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
25
20
15
5.8
DMFT
10
1.2
5
0
6-7
yrs
12 - 13
yrs
35 - 44
yrs
65 - 74
yrs
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
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.
2.
3.
4.
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.
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 HygienistsMedical Academy of Latvia
Since 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
2005
1993
43,9%
21,0%
72,6%
1,2%
5,0%
14,5%
22,7%
5,3%
Specialization
Nr of dentists-stomatologists
5,8%
5,1%
1993
%
3,0%
2005
%
1436
72,6%
1522
52.1%
105
5,3%
104
3,0%
0
0,0%
177
3,9%
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%
415
21,0%
501
17.7%
Nr of dental-therapists (educated till1976)
Nr of dental hygienists (educated since1995)
Nr of dental nurses (educated since1991)
Nr of dental technicians (educated since1961)
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.
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:
Age
1993
1999
6 – 7 yrs
275
578
12 – 13 yrs
324
565
15 – 16 yrs
295
(1998)
523
894
1666
•143 kindergartens  16.000 children (5 – 7 yrs)
Total
•142 schools  40.000 children (7 – 12 yrs)
•In total  46.000 children.
An organized daily
kindergarten – based tooth
brushing intervention with
oral health education in all
age groups was introduced.
Caries prevalence in Riga
(1993-1998)
DMFT
decline - 52%
DMFT
decline - 28%
7,3
8
7
5,7
5,1
6
DMFT
decline - 23%
4,45
5
3,7
DMFT 4
3
1,26
2
0,29 0,61
1
98
6
-1
15
15
-1
6
y.
o.
19
y.
o.
19
95
8
19
9
o.
,
y.
13
12
y.
o.
,
19
9
,1
99
y.
o.
3
-1
8
3
19
98
o.
,
y.
o.
,
y.
6
7
12
6
-7
y.
o.
,
19
19
98
93
0
R.Care, I.Urtāne, E.Senakola 1999.
CPITN – index of 12 – 13 year old Latvian (Riga city) children (1993 - 1999)
60,0%
80,0%
60,0%
40,0%
40,0%
20,0%
0,0%
20,0%
1993
0,0%
1999
Healthy
15,0%
Healthy
62,0%
Bleeding
58,1%
Bleeding
19,5%
Calculus
26,9%
Calculus
18,5%
R. Care, 2000
In four rural districts the study
population comprised 4478
kindergarten children:
Age
1997
2000
3 yrs.
1364
699
6 yrs.
1253
1262
2517
1961
 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.
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
8
3
dmft=6,06
2,5
6
dmft=1,51
dmft=3,73
2
4
1,5
1
0,5
0
DMFT
=0,38
2
0
2000
1997
1997
DMFT
=0,24
2000
f-t, F-T
1,61
0,04
1,59
0,1
f-t, F-T
0,26
0
0,21
0
m-t, M-T
0,44
0
0,42
0
m-t, M-T
0,06
0
0,06
0
d-t, D-T
4,01
0,34
1,72
0,14
d-t, D-T
2,24
0
1,24
0
3 yrs
6 yrs
E.Senakola, A.Brinkmane, D.Rakicka 2001.
Index of DMFt for permanent teeth
of 12-year-olds
3,9
4,0
3,6
3,5
3,4
3,5
3,0
2,5
2,0
1,5
1,0
0,5
0,0
2000
2001
2002
2005
nl
a
a
19
19
3
98
19
9
7
4,1
96
m
ar
k
19
Sw
96
ed
en
19
No
96
rw
ay
19
Ic
96
el
an
d
19
96
W
HO
20
00
nd
Ri
g
tv
ia
19
9
DMFT 3
La
19
95
5
De
n
a
6
Fi
ni
to
ni
a
th
ua
Es
Li
DMFT levels at age 12 in Baltic and Scandinavian states
5,8
5,0
3,7
4
3,0
2.1
2
1,2
1,2
1,2 1,4
3,0
1
0
Explanation for the finding of
caries decline in Latvia
(1995 – 2005)
1.
2.
3.
4.
5.
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.
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
Phase II (2005 – 20010)
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
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 secondlevel professional programmes.
DENTAL PERSONNEL EDUCATION TYPES IN LATVIA
Types
Dental hygienists
(DH)
Since
Length education
Intake per
year
Training
1995
(2 y DN) +
18-24
1 y curriculum
Medical Academy of
Dental Hygienist`s
school
1y DA,
2 y DN+
Riga Stradins
university since
2002
2007
24-27
2 y curriculum
Dental nurses
(DN)
1991
Dental assistants
(DA)
1997
Dental laboratory
technicians
(DT)
1961
2 y curriculum
1y curriculum
2.5 y curriculum
30
30
25
For dental hygienists “step-by-step” education model
Riga 1st
Medical School
(for auxiliaries)
Riga 1st Medical
college since 2005
Dental hygienists in Latvia
(2008 - 2010)
Year to which Dental hygienists
data apply
Totally
educated
Latvia
2008
June, 2009
June, 2010
Dental
hygienists:
dentist ratio
1:12,607
1:14,973
1:8,3
1:9,7
1:11,157
1:9,873
Indicates service
accessibility
1:7,3
authorised
to practise
177
151
200 (23 graduates)
226 (26 graduates)
Dental hygienist:
population ratio
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
Distribution of the Dental Staff in Latvia
1993
2009
0%
0%
0%
5%
1%
21%
73%
Specialization
Nr of dentists-(stomatologists)
Nr of dental-therapists (educated till1976)
1993
1436
105
%
72,6%
5,3%
2009
1465
82
%
40,5%
2,3%
Nr of dental hygienists (educated since1995)
Nr of dental nurses (educated since1991)
Nr of gen. Med. Nurses (certif. in dentistry since
1997)
0
23
0,0%
1,2%
151
346
4,2%
9,6%
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%
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)
The mean cariess experience (DMFT) in
the population of
Latvia
(ICS-II, 2007)
24.84
24.9
25
25
20
20
15
15
DMFT
DMFT
10
10
5.8
3.30
0.71
5
1.2
5
0
19.02
19.2
0
6-7
yrs
12 - 13
yrs
35 - 44
yrs
65 - 74
yrs
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
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
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
6
DMTF index of permanent teeth for
12 year old children
5,8
5
3,9
4
3,5
3
3,2
2,4
2
1
0
1993
2000
2002
2007
2008
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
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
May 2009 CED Resolution
Competences required for the practice of dentistry in the European Union
Fields of competences
I. Professionalism. Ethics and Communication
(evidence-based therapy,
Continuing Professional Development,
self assessment, referral)
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
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 things
We want to see them happen
We don’t want just to talk about them.
Egita Senakola
Email: esenakol@latnet.lv
Thanks for attention!
Magritte