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East Beckons West—Integration of Oral Healthcare Models

(Hony) Brig Dr Anil Kohli

Developing the ability to work reverently and efficiently with diverse populations has become an integral part of healthcare education, practice, and research. Within developing countries, we find huge differences in the health status of urban and rural populations. Many strategies have been tested and applied to address the realities of rural communities. Cultural competence, currently the gold standard for care, is expected of individual caregivers, systems, and institutions. Global public health indicators show significant improvements over the past decade. However, the information is not shared by everyone: witness the growing gap between wealthy and developing countries.

There are enormous and widening disparities in access to quality care, particularly in rural areas. Training more oral healthcare providers and nurses is one interventional option, but it is expensive and these individuals rarely choose to practice in rural poor regions. Another option is to help communities organize their own health committees and support the training of rural health workers.

For many years, the approach to dental caries, periodontal disease, and acquired or hereditary oral conditions has been to treat destructive effects and then initiate a preventive program. Contemporary guidelines recommend more emphasis on early professional intervention consisting of an oral examination, risk assessment of infants and anticipatory guidance for parents including dental care during pregnancy. The goal of primary prevention is to stop the onset of disease or to interfere with its progression before treatment becomes necessary.

Future global medical outreach will require that non-governmental organizations look to build bridges among communities, institutions, and providers, and develop health systems through collaboration and cooperation. As developing nations shift their healthcare focus from the treatment of injuries and infectious diseases to the promotion of health, prevention of oral/dental disease, and management of chronic disease, outreach organizations must shift their focus from “suitcase” medical campaigns toward global relief that develops sustainable programs and projects.

In India, the health system is problematic due to the diversities the land presents. Infectious disease and nutrition-related ailments are major causes of morbidity and mortality, yet India’s health expenditures estimate only 0.8% of its Gross Domestic Product (GDP), compared to the European Union’s expenditure of 8% of its GDP. However, India’s health indicators can only partially be explained due to the different levels of access to healthcare based on place of residence, class/caste, and gender. The effect of political and social systems on the delivery of healthcare in India highlights some indicators of progress.

The majority of the Indian population resides in rural areas; more than 40% of this group is children. Therefore, the impact of preventive and pediatric dentistry is tremendous. School-based screening and motivation significantly improve the percentage of children who seek free dental treatment at a dental school, but also suggest that reinforcement is essential to further improve the response rate for the treatment of dental problems.

We must provide information to help healthcare professionals understand the rationale behind recommendations. Specific clinical recommendations concerning bottle use, brushing technique, and preventive oral health must also be discussed with emphasis on vertical transmission of cariogenic bacteria from the mother to the child.

Healthcare systems across the planet face shared socio-economic problems. We must provide some innovative approaches to cost-effective healthcare. Differences between Eastern and Western core philosophies and logic explain why some systems will inevitably yield unbearable costs. The exploration of complementary and alternative medicines by biomedical, clinical, and research communities provide opportunities for honest assessment of healthcare models. Local experience in public health and private settings finds that some modalities are viable in India, and the system must be able to address some of the most pressing issues. Research models must be discussed to assess health, social, and economic benefits of various modalities.

It may be concluded that the greatest need for dental health education is at an early age. This should include proper instruction of oral hygiene practices and school-based preventive programs, which would help to improve preventive dental behavior and attitude, which is beneficial for a lifetime. With early professional intervention, it may be possible to reduce or even eliminate dental caries.

Prospective plans at the Dental Council of India include a merger of the two very strong philosophies of the East and the West to create compliant oral healthcare delivery systems.