By Andrea Shepperson - 7 Mar 2011
In December 2010 the Ministry of Health published results of the NZ Oral Health Survey, a review of our attitudes, beliefs, knowledge and dental practices. Last published in 1988, how much progress have we made in 20 years?
I'm getting to that age where I enjoy antiquity and it's history
on television, much to the frustration of my teenagers who would
rather command the remote to watch The Simpsons. Antiques
Roadshow is a fascinating world of design and invention. It's
also a commentary on British teeth - many of which appear to be as
ancient as the objects on show. The Brits have long been
chastised for their apparant dental laissez faire when it comes to
their smiles. We all recall the Simpsons episode where Lisa's
dentist shows her the Big Book Of British Smiles. In fact the
oral health of UK children has improved and compares well in a 2006
OECD report published in the Economist.
Read that article here.
But what about our nation?
In December 2010 the MoH published the NZ Oral Health Survey.
Key findings show:
Oral health of New Zealanders has improved
Total tooth loss has decreased dramatically.
Adults are retaining more of their natural teeth.
Four in five children had visited a dental professional in the
previous year.
Despite this improvement dental decay remains the most
prevalent chronic disease in New Zealand.
Only one in two children aged 2-17 years were decay-free.
The majority of adults used a dentist when they had a dental
problem, rather than visiting for routine check-ups.
People who visited only for a dental problem had significantly
worse oral health than regular users.
Dental problems have an indirect cost to
society
One in ten adults aged 18-64 years have taken 2.1 days off
work or school in the previous year due to problems with their
teeth or mouth.
Compared with Australian adults, New Zealand adults had poorer
oral health across a range of clinical oral health indicators, and
were also less likely to have visited a dental professional in the
previous year.
Read the full report here.
So how do we get that shift in behaviour towards more regular
care, knowing that the outcome is better for us, less costly in the
long run to both the individual and society? And what drives
the poor attendance record?
The two commonly cited reasons are pain and cost. This
modern dental era offers much to alleviate dental pain and
sensation - topical anaesthetic sprays, painless injections,
various kinds of sedation for relaxation and memory supression,
noise cancelling headphones - but pain is often a memory, a relic
of the 'dental nurse days' for many New Zealanders over the age of
40. The widespread placement of large amalgam fillings
through the 1960's and 70's has left our teeth vulnerable to
fracture and the cost of reconstruction becomes substantial, adding
to the burden.
A prevention model however, costs very little. The annual
committment with a dentist/hygienist is less than most women spend
at the hairdresser every year, and less than a moderate annual
alcohol consumption.
The dental profession has long referred to Patient Dental IQ -
an assessment of where the patient sees themselves in a Maslows
Heirarchy of Needs Model. Those with the highest dental IQ
are patients who value prevention, gaining peace of mind knowing
that they have accessed the best possible care for themselves, and
that they have minimised or eliminated the risk of dental disease
with their choices. A high dental IQ doesn't necessarily
correlate with affluence, it simply reflects a personal sense of
self worth and value. A patient with low dental IQ is focused
on the most basic of needs - physical survival, relief of pain and
discomfort. Once again there is not always a correlation
between an ability to pay and the desire to make the choice of
extraction versus tooth preservation. The patients in
the middle are those that want the best for themselves, but cannot
afford it at this point in time.
The profession has a responsibility to shift patient IQ through
education and understanding of the emotional and financial benefits
of prevention. When a patient presents with a low dental IQ
it is my job to cultivate an appreciation of quality
dentistry. When personal financial circumstances prohibit
this my role is to find acceptable alternatives and financial
pathways to reach that goal over time.
After 25 years of supporting patients through a shift in dental
IQ, it is a satisfying place to see my patients year after
year with annual dental costs for prevention only. In many
cases it has taken 20 years to get there....the result of saving
hard, investing well and being committed to avoiding dental
disease.