EuropeanOralHealth

ReportCard
PreliminaryFindings1
st
edition

18March2014
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PreliminaryFindingsfromDataforREPORTCARD
GatheredbyaQuestionnaireBasedonPlatformforBetterOralHealthinEurope's2020Targets
In2013,thePlatformforBetterOralHealthinEurope(thePlatform)developedandlaunchedits2020
Targets (Annex A) in order to highlight three key areas, where oral health policy improvement is
needed urgently. These are data collection systems, preventive policies and education and
awareness.
It appeared to the Platform that currently there are very few data available on the status of oral
diseasepreventionintheMemberStatesoftheEuropeanUnion.Inordertoassessthesituationin
more detail, during the last quarter of 2013, the Platform for Better Oral Health in Europe sent a
questionnaire(AnnexB)onsomeoftheindicatorstoleadingdentistsfromthe28MemberStatesof
the European Union (EU). In particular, it went to selected members of the Association of Dental
Education in Europe (ADEE) and of the European Association of Dental Public Health (EADPH) plus
ChiefDentalOfficers.
Todaterespondentsfrom25EUMemberStateshavecompletedthequestionnaire,includingthenew
Member State Croatia. So far there have been no responses from, Luxembourg, Sweden, and
Slovenia.Becausetheirsystemsfortheprovisionoforalhealthvary,thefour home countrieswithin
theUnitedKingdomEngland,Scotland,WalesandNorthernIrelandhaveallrespondedseparatelyto
the survey. In addition to the 25 Member States, Belarus, Israel, Norway and Turkey also completed
thequestionnaire.However,theirresponsesarenotreportedinthissummary.
Theresponsestothequestionnairehavebeenanalysedandconsolidatedtoformthefirst editionof
theEuropeanOralHealthReportCard.Subjecttoconfirmationofthedatathathasbeenreported,it
highlights the Platform's preliminary findings on the status quo of those oral health indicators that
gaugesomeoftheitsmostimportant2020Targets.
It should be noted that the questionnaire did not include questions on indicators for six of the 14
targets.Thiswasbecausethreeofthetargets(1,3,and7)willrequireworkatEuropeanlevelandit
wasconcludedthatbecauseofthelengthofthequestionnaireTargets4,6,11wouldnotbeincluded
in this initial Report Card. They will be addressed in the next questionnaire. It is the intention of the
Platform to repeat this exercise at regular intervals to generate uptodate progress reports (Report
Cards) on the Targets. The data presented in this summary for indicators 8 and 9 are not from the
questionnaire but from recent studies carried out by the Council of European Chief Dental Officers
(CECDO).
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I. GovernanceofPreventionPracticesofOralDisease
measuring2020Targets2,5
Indicator1:Anoralhealthmonitoringsystemwhichcollectsdataregularlyexists(data
collectionsystemsTarget2)Questions1and2
Five countries (France, Ireland, Romania, Croatia, and Czech Republic) out of 25 Member States
reported that they had no national oral health monitoring system in place at all. Only four Member
States(Germany,Italy,Latvia,andSpain)plusScotlandandWalesreportedthattheyhadregionaloral
healthmonitoringsystemsinplace.OnlytwoMemberStatesreportedthattheyhadlocalmonitoring
systems in place. Nevertheless, 19 Member States reported that they had a national monitoring
system in place. However, not all respondents could cite a reference for, or name, the organisation
that operated the monitoring system. Furthermore, not all of the national monitoring systems
(invariably epidemiological surveys) appeared to be truly representative of the population, in some
Member States it appeared that smaller pathfinder studies, which only covered selected cities and
partsoftheMemberStatesconcerned,providedthedata.
Respondentsfrom15MemberStatesreportedthatnationaldatacollectionwascompletedregularly.
Fourreportedregularregionaldatacollectionandtworegularlocalreporting.Therespondentsfrom
all other Member States reported that regularity of data collection was not guaranteed, and that
surveyswereadhoc,atnational,regionalorlocallevels.
Indicator2:percentageofindividualsagedover65yearoldswithfunctionaldentitions(21
ormorenaturalteeth)(datacollectionsystemsTarget2)Question3
Respondents from the majority of Member States were unable to report data for this indicator.
Nevertheless, ten were able to report some data, mostly on 65 to 74 yearolds. The reported
percentagesvariedanddidnotalwaysarisefromthesamedefinition.Forexample,forAustriaitwas
reported that 9% of this age group still possessed (all) their natural teeth, this was a selfreported
figure.Ontheotherhand,intheUnitedKingdom,thelatestnationalsurveyindicatedthat61%of65
74yearoldsstillhadfunctionaldentitions.
Conversely, other Member States only reported data on edentulism (toothlessness) in over 65 year
olds. For example 50% of over 75yearsolds were reported as toothless in Estonia and total
edentulismwasreportedas22.6%for6574yearoldsinGermany.
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Indicator3:NationalHealthPromotionStrategy/ActionPlanexists(Preventivepolicies
Target5)Question4
Atleast20outofthe25MemberStatesreportedthattheyhadageneralNationalHealthPromotion
StrategyoranActionPlaninplace.Someofthemonlyidentifiedregionalplans.Romania,Croatiaand
EnglandreportedthattheydidnothaveageneralNationalHealthPromotionPlan,butasfaras
EnglandwasconcernedNationalHealthPromotionstrategieswerereportedtoexistforspecific
diseasesandconditions.
Indicator4:NationalHealthPromotionStrategy/ActionPlanincludesoralhealthora
dedicatedOralDiseasePreventionPlanexists(PreventivepoliciesTarget5)Question5
16 Member States reported that their national Health Promotion Strategy included Oral Health.
However,onlythree(Belgium,Cyprus,Germany)plusWalesreportedthattheyhadadedicatedOral
HealthPromotionPlan.
Indicator5:Anationalhealth/researchprogrammeexists.Health(Researchprogrammes
providefundingforresearchincertainareassuchastheUKPublicHealthResearch
Programme).(PreventivepoliciesTarget5)Question6
15MemberStatesreportedthatanationalhealth/researchprogrammesexisted.Someofthe
respondentscouldnotspecifyiftheresearchwasgenuinelysupportedbyanationalresearch
programme.
Indicator6:OralHealthisincludedintheNationalHealth/ResearchProgrammesincludes
oralhealth.(PreventivepoliciesTarget5)Question7
OnlyeightMemberStatesreportedthatOralHealthwasincludedintheirNationalHealth/Research
Programmes.OnlyBulgaria,FinlandandScotlandreportedthattheyhadadedicatedOralHealth
ResearchProgrammeinplace.
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II. RoleofOralHealthprofessionsinPreventionofOralDisease
measuring2020Targets810,13
Indicator7:AnationalOralHealthWorkforcePlanexists(thisplanatbestquantifiesthe
ratiooftheoralhealthcareworkforcetopopulationanditsplanneddistributionacrossthe
territory).(PreventivepoliciesTarget8)Question8
OnlytenMemberStatesreportedthattheyhadanationalOralHealthWorkforcePlaninplaceand
onlyfourcountrieswerereportedashavingregionalnationalworkforceplansinplace.
Indicator8:OralHealthcareworkforceplanningaimsatmakingtheworkforces
compositionandcompetencesmeetfuturepopulationneedsalsointermsofstandards
andspecialattentiontounderservedareas/deprivedgroups.(Notpartofthequestionnaire.
DataarefromtheCouncilofEuropeanChiefDentalOfficers(CECDO)WorkforcePlanning
Survey2013)(PreventivepoliciesTarget8)
TheCECDOWorkforceplanningSurvey2013reportedthat6outof25MemberStatesdidnot
controlthenumberofeducation/trainingplacesindentalschoolsfordentists.*
Indicator9:Theprofessionofdentalhygienistisformallyrecognised.Notpartof
questionnaire,informationfromCECDO(2013)(PreventivepoliciesTarget10)
Theprofessionofdentalhygienistsisformallyrecognisedin13ofthe24MemberStatesbytraining
and dental hygienists are licensed. In some other Member States, dental nurses are sometimes
trained for extended duties, which include giving oral hygiene and preventive advice and simple
tooth cleaning. In seven Member States: Austria, Belgium, Cyprus, Estonia, France, Greece and
Luxembourg,dentalhygienistsarenottrainednorlicensed.**
Indicator10:Nationalhealthauthoritieshaveissuedscientificguidelinesfororaldisease
preventiontargetingprimarycareprofessionalsandthepublic.(PreventivepoliciesTarget
10)Question9
Eleven Member States reported that they had no scientific guidelines for oral disease prevention in
place,14reportedthattheyhad.
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Indicator11:Thenumber/percentageofdentalschoolsthathaveintegratedthe
CompetenceDomainPrevention&HealthPromotionencompassingthecompetences
aimedatpromotingandimprovingtheoralhealthofindividualsintheircurricula(cf.
ProfileandCompetencesfortheGraduatingEuropeanDentist(AssociationforDental
EducationinEurope(2009)(ADEE)(EducationandAwarenessTarget13)Question10
Respondents from only 14 Member States, plus Northern Ireland and Wales were able to give an
answer to this question, 12 of whom stated that 100% of their dental schools integrated the ADEE
CompetenceDomainPrevention&HealthPromotionintotheirundergraduatecurricula.
Indicator12:Oralhealthclinicianshaveoralcancerdiagnosisresponsibilities(Preventive
policiesTarget9)Question11
Withsomeminorvariations,allMemberStatesreportedthatdentistsintheircountriesaretaughtto
diagnose oral cancer during their undergraduate training, postgraduate/specialist training and
professionaldevelopment/continuingeducation.TherespondentfromBelgiumansweredthatitonly
takes place in undergraduate courses and during continuing education. In the Czech Republic,
Hungary and Romania it was reported as taking place during under and postgraduate training. Two
MemberStates,DenmarkandPortugalteachoralcancerdiagnosisduringundergraduatecoursesand
Cyprusonly providesthis trainingthrough continuingeducation,becausethereisnodentalschool (
hencenoundergraduateorpostgraduateeducation)inCyprus.
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III. EducationandAwarenessofPreventivePracticesorOralDisease
measuring2020targets11,12,14
Indicator13:Oralhealthpreventioninformationisdeliveredtochildrenaged612yearsin
schools(EducationandawarenessTarget12)Question12
Eleven Member States and England reported that there was no national school based oral health
promotionprogramme;othersreportedthatitwasonlydeliveredoccasionally,someonlyatthelevel
ofKindergarten(e.g.inBelgium).
Indicator14:Reportingonprevalenceofdentalcariesin12yearoldsexist.Forinstance,itis
currentlyestimatedthataround68%of12yearoldsinDenmarkarecariesfree.(Preventive
policiesTarget12)InformationfromCECDO.
OnlytencountriesofallEUMemberStatesreportedtohave50%ormoreofcariesfree12year
olds.**
Indicator15:Oneormorenationalassociationsarededicatedtopromotingoraldisease
preventionpracticestothepublic(EducationandAwarenessTarget14)Questions13and
14
AmajorityofMemberStatesreportedthattheyhadnationaloralhealthpromotioncampaigns
targetedatcitizensinplace.Theserangedfromonecampaignduringthelasttwoyearstofour
biannually.SevenMemberStatesreportedthattheyhadregionalcampaignsinplace,butmost(12)
focusedonlocalcampaigns.Themajorityofthesecampaignswereorganizedbyadentalprofessional
organization(18),followedbyhealthauthorities(13)andcommercialenterprises(11).Otherwisethey
areorganizedbynationalassociations,suchasthenationaldentalassociations(9)andotherswiththe
helpofuniversities,asinBelgiumorNGOs,suchastheChildrensOralHealthFoundationinHungary.

Someoftherespondentstothequestionnairealsomadecomments,amongwhichwere:
Thereexistsalimitedinterestofdentiststowardhealthpromotionissues.(Bulgaria)
PreventionmeasuresshouldbeharmonizedthroughouttheEU.(Greece)
AcalluponthePlatformtoadvancethelevelofPreventiveandCommunityDentistryinEurope,aiming
attangibleandbeneficialresultsforallEuropeancitizens.(Greece)

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AnnexAPlatformforBetterOralHealthinEurope2020Targets
AnnexBQuestionnaireusedinPlatformforBetterOralHealthSurveyin2013
*In2003,theCECDOcarriedoutanoralhealthworkforcesurvey.Thesurveywasrepeatedin2013
usingthesamequestions.In2013thesurveyhastodatecollected25answersfromMemberStates.
**InformationretrievedfromTheCouncilofChiefDentalOfficers(CEDCO)websitewww.cecdo.org
at21February2014.
Conclusions
Thesepreliminaryresultsfromresponsestothequestionnaireneedtobeconfirmedbythe
respondents.However,overalltheyreinforcetheresultspublishedinTheStateofOralHealthin
Europe(2012).Theaccuracyofsomeoftheanswerstothequestionnairemightbecriticisedasitisin
parttheopinionofleadingdentistsindifferentEUMemberStates.However,theresultingReport
CardshouldbethebasisofincreasedeffortsintheMemberStatesandinparticularatEUlevel.The
reportedpreliminaryfindingsonthestatusquooftheoralhealthindicatorsdefinedbythePlatform
showgreatvariabilityinqualityofdataandthemethodologyapplied.Giventhegreatvarietyin
qualityofGovernanceofPreventivePracticesorOralDisease,theRoleOralHealthProfessionsplay
andtheEducationandAwarenesswhichisfocusedonthenecessityofOralDiseasePrevention
Practices,theeffectivenessofthecurrentoralhealthcaresystemsinmanyEUMemberStatesfor
oralhealthpromotionisquestionable.