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Women and Family Health and Oral Health: A Working Group Report

Our purpose is to report on the completion of an "environmental scan" concerning the relationship between family health and oral health and the interface with government, society, and family responsibilities. For purposes of this report, oral health includes caries, periodontal, mucosal infections, oral and pharyngeal cancers, development disorders, malocclusion, and trauma. Oral health is considered for all demographic categories, from infants to elders and with consideration for women’s oral health in the discussion. Family health is defined as other health conditions including but not limited to physical, mental, social, and emotional health.

The outcomes of this working group discussion on women and family health and oral health during the 2^nd International Women’s Leadership Conference provide a foundation for a future symposium that will discuss potential directions and roles of government, society, family, and the dental profession in addressing oral and family health.

	Issues Discussed by the Working Group

Top Issues discussed by the... Topics of the environmental... Outcomes of discussion

 
The following questions were considered by this group.

Role of Government.
Are there models where the government is appropriately addressing oral and family health to the satisfaction of oral health care providers? If so where? Should government take a more active role? How? Are there models where that occurs successfully? What are the pitfalls? Identify strategies where key individuals in government positions can be made aware of the importance of oral health and its connection to general health. Discuss specific oral health conditions that could be addressed through government or public health-based consortiums or groups.

Role of Society.
How do cultural, family, religious, and other social groups currently impact on oral health and family health? Are there advantages and disadvantages to using the formal or informal networks within a particular locale or country? Are there methods to "educate" society about its obligations to attaining and maintaining oral health for all its citizens? How?

Role of Family.
Who has the current responsibility for oral and general health in the family unit? Is that satisfactory? Can there be a change? If so, how can that be accomplished in the future? Can there be linkages developed to assist families in improving their knowledge and skills? How does culture, religion, etc. play a role?

Role of Profession.
What is the current role of oral health and health professionals? Are they providers, initiators, prevention advocates, or educators? Are there any innovative programs utilizing auxiliary oral health professionals that could impact on oral health and general health? Is there potential to develop linkages with other health professionals, interdisciplinary services, education, or planning?

Role of Education.
Is professional education addressing oral and family health? Are the linkages between oral health and systemic health included in professional education and/or continuing education? Can dental schools and medical schools develop collaborative models with practitioners, both oral and general health, to address the needs in a community?

Role of the Corporate Sector.
What are the responsibilities of the corporate sector for oral health and general health? How might the corporate sector contribute to the resolution of the issues raised?

	Topics of the Environmental Scan

Top Issues discussed by the... Topics of the environmental... Outcomes of discussion

 
The group discussion was founded on six underlying topic areas intersecting health and oral health and three specific questions framing the diseases of oral health. Participation by representatives from several countries (Sweden, Finland, Bulgaria, United States) and states/territories (Washington, Oregon, Nevada, Michigan, and Puerto Rico) resulted in a spectrum of answers to the framing questions (see Table 1).

The underlying topic areas and specific oral health questions were:

1. Where does the responsibility for family health lie?
   
2. Where does the responsibility for family oral health lie?
   
3. Who is responsible for paying for family health?
   
4. Who is responsible for paying for family oral health?
   
5. What are the origins of information on family health?
   
6. What are the origins of information on family oral health?
   • What are the diseases of oral health?
     
   • What are the diagnostics of oral health?
     
   • What are the treatments of oral health?
     
   
   

	Outcomes of Discussion

Top Issues discussed by the... Topics of the environmental... Outcomes of discussion

 
The participants engaged in a discussion that included descriptions of specific programs, strengths and weaknesses of current programs addressing oral and general health, and comments about future directions that local, regional, or government agencies could pursue (see Table 2). The international composition of the discussion group highlighted varying priorities and approaches to oral health care delivery. For example, in Finland and Sweden, the needs of children and elders guide the government-sponsored delivery system. The focus of the future will include emphasis on primary prevention with access not dependent on socioeconomic status.

All members of the discussion group agreed that family influence in seeking and cooperating in oral health care is important. In some instances, participants in a program may be first-generation dental patients. Thus, a family-centered as well as patient-centered approach is critical to success.

Linkage between oral health care professionals and other health care professionals, especially physicians, was suggested. This linkage is especially important as the relationship of oral health and general health continues to become evident. Community and individual education about oral health status, prevention, and health promotion must be evidence-based.

Some participants suggested that future strategies should include mechanisms to reward changes in behaviors that impact on health, such as smoking cessation. The valuable role of supportive corporations that are interested in supporting oral health prevention and education was suggested. Corporate support can include both financial and advisory personnel. All participants agreed that corporate support is valued and encouraged on all levels from program planning to implementation and evaluation.

Overall, the discussion provided insights into current successes and initiatives in the United States and throughout the world. All participants agreed that additional opportunities for discussion were critical. It was agreed to develop a listserv that included all participants as a resource for discussion and information.

Recommendations for symposia discussions and policy change included the following:

• Improvement of family health and oral health depends on a new understanding of oral health on overall quality of life.
  

• Improvement of family health and oral health requires policy change at the governmental level to promote integration of health and oral health programs and educational outreach.
  
• Improvement of family health and oral health requires policy change in health professions to integrate prevention, diagnosis, and treatment of patients with no separation between the mouth and the rest of the body.
  
• Improvement of family health and oral health requires universal access to preventions such as fluoride varnish, sealants, early screening, and studies to provide evidence-based support for these and future interventions.
  
• Improvement of family health and oral health demands that all practitioners are educated to pay attention to the full lifespan: children, adults, elderly, frail elderly.
  
• Improvement of family health and oral health will result from an increased linkage of oral health to systemic health.
  
• Improvement of family health and oral health requires substantive new interventions to change the current reality that an individual’s level of education determines his or her health status.
  
• Improvement of family health and oral health requires new ways of providing health professional compensation to maximally benefit integrated patient care.
  
• Improvement of family health and oral health requires more collaboration to share models and to collect common best practices.
  

	Footnotes

 
Dr. Silverton is Associate Dean of Research, University of Nevada, Las Vegas School of Dentistry and Professor of Biological Sciences, UNLV College of Sciences; Prof. Zarkowski is Associate Dean for Academic Administration and Professor, University of Detroit Mercy School of Dentistry. Direct correspondence to Dr. Silverton at University of Nevada, Las Vegas, School of Dentistry, 1001 Shadow Lane, MS 7410, Las Vegas, NM 89106-4124; 702-895-2885 phone; 702-985-2025 fax; sfsilverton{at}ccmail.nevada.edu.

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