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In exhortation of advocacy: we can do better
Vol. 115 No. 5 May 2013
EDITORIAL
In exhortation of advocacy: we can do better Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology “provides comprehensive and complementary information regarding the diagnosis and treatment of oral and maxillofacial conditions from the perspective of four different dental specialties”. Over the past several years great progress has been made both in the diagnosis and management of patients who suffer from conditions characterized as “belonging to” these specialties. Much of the progress has come as a result of advances in research and scholarly activity finding their places in clinical practice so that clinicians can better serve their respective patients. Nevertheless, the World Health Organisation (WHO), in its current fact sheet #318, states: 1. Worldwide, 60%-90% of school children and nearly 100% of adults have dental cavities. 2. Dental cavities can be prevented by maintaining a constant low level of fluoride in the oral cavity. 3. Severe periodontal (gum) disease, which may result in tooth loss, is found in 15%-20% of middle-aged (35-44 years) adults. 4. Globally, about 30% of people aged 65-74 years have no natural teeth. 5. Oral disease in children and adults is higher among poor and disadvantaged population groups. 6. Risk factors for oral diseases include an unhealthy diet, tobacco use, harmful alcohol use, poor oral hygiene, and social determinants. Leaving aside dental caries and periodontal disease, the WHO includes oral cancer, oral infectious diseases, trauma from injuries, cleft lip-palate and hereditary lesions among the most common oral diseases, all of which “fall into” the disciplines of the TripleO. These conditions, you may say, are highlighted by the WHO because they are more problematic in developing nations than in rich countries. Perhaps so, but consider for a moment a recent BBC article entitled “Surgeons warn many cleft palate cases missed at birth” by Adam Brimelow (December 12, 2012), in which figures for England, Wales, and Northern Ireland showed more than a quarter of cases were not picked up within the required 24 hours after birth. The figures come from the Crane Database, which is a national register of information on those born with a cleft lip or palate in England, Wales and Northern Ireland. The Crane annual report says last year 28% of babies with a cleft palate alone did not get a diagnosis within 24 hours. And 5% of cases had not been picked up after a month. This rate of “failure to diagnose” is too high; moreover, it is preventable when an experienced clinician does
nothing more than a careful and thorough oral examination. Similar circumstances exist in which oral cancers, occult (and even frank) facial trauma, oral infections and hereditary lesions are “under-diagnosed”. The WHO points out that “Most oral diseases and conditions require professional dental care, however, due to limited availability or inaccessibility, the use of oral health services is markedly low among older people, people living in rural areas, and people with low income and education. Traditional curative dental care is a significant economic burden for many high-income countries, where 5%-10% of public health expenditure relates to oral health. In low- and middle-income countries, public oral health programmes are rare.”
WHAT TO DO? Dental specialists can be very effective advocates for improvements in the delivery of both oral health care and general health care, even in rich countries. Some examples follow. Oral and maxillofacial surgeons can be proactive by joining cleft lip and palate teams so that accepted treatment alternatives become known to patients and families alike. They can be part of the emergency services delivery, particularly as this relates to facial trauma. They can also join hospital tumor boards, as can oral and maxillofacial pathologists, to participate in regular meetings when head and neck and oral cancer patients are being “treatment planned”. Specialists in oral medicine can join hospital pain teams or pharmacy and therapeutics committees. Oral and maxillofacial radiologists can participate in hospital radiology rounds and contribute expertise in both technique and interpretation. Often determination and persistence on the part of the dental specialist will be required to gain acceptance in these wider forums. In my view it is well worth the effort. Even at the most peripheral level of participation the dental specialist can be a strong advocate for improving the care and well-being of the patient, all the while becoming a more important and active member of the health care team. To do this we must periodically leave the comfort of our office surroundings and take a much needed leadership role. David S. Precious, CM, DDS, MSc, FRCDC, FRCS, Dhc Section Editor, Oral and Maxillofacial Surgery
http://dx.doi.org/10.1016/j.oooo.2012.12.016
565
EDITORIAL
In exhortation of advocacy: we can do better Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology “provides comprehensive and complementary information regarding the diagnosis and treatment of oral and maxillofacial conditions from the perspective of four different dental specialties”. Over the past several years great progress has been made both in the diagnosis and management of patients who suffer from conditions characterized as “belonging to” these specialties. Much of the progress has come as a result of advances in research and scholarly activity finding their places in clinical practice so that clinicians can better serve their respective patients. Nevertheless, the World Health Organisation (WHO), in its current fact sheet #318, states: 1. Worldwide, 60%-90% of school children and nearly 100% of adults have dental cavities. 2. Dental cavities can be prevented by maintaining a constant low level of fluoride in the oral cavity. 3. Severe periodontal (gum) disease, which may result in tooth loss, is found in 15%-20% of middle-aged (35-44 years) adults. 4. Globally, about 30% of people aged 65-74 years have no natural teeth. 5. Oral disease in children and adults is higher among poor and disadvantaged population groups. 6. Risk factors for oral diseases include an unhealthy diet, tobacco use, harmful alcohol use, poor oral hygiene, and social determinants. Leaving aside dental caries and periodontal disease, the WHO includes oral cancer, oral infectious diseases, trauma from injuries, cleft lip-palate and hereditary lesions among the most common oral diseases, all of which “fall into” the disciplines of the TripleO. These conditions, you may say, are highlighted by the WHO because they are more problematic in developing nations than in rich countries. Perhaps so, but consider for a moment a recent BBC article entitled “Surgeons warn many cleft palate cases missed at birth” by Adam Brimelow (December 12, 2012), in which figures for England, Wales, and Northern Ireland showed more than a quarter of cases were not picked up within the required 24 hours after birth. The figures come from the Crane Database, which is a national register of information on those born with a cleft lip or palate in England, Wales and Northern Ireland. The Crane annual report says last year 28% of babies with a cleft palate alone did not get a diagnosis within 24 hours. And 5% of cases had not been picked up after a month. This rate of “failure to diagnose” is too high; moreover, it is preventable when an experienced clinician does
nothing more than a careful and thorough oral examination. Similar circumstances exist in which oral cancers, occult (and even frank) facial trauma, oral infections and hereditary lesions are “under-diagnosed”. The WHO points out that “Most oral diseases and conditions require professional dental care, however, due to limited availability or inaccessibility, the use of oral health services is markedly low among older people, people living in rural areas, and people with low income and education. Traditional curative dental care is a significant economic burden for many high-income countries, where 5%-10% of public health expenditure relates to oral health. In low- and middle-income countries, public oral health programmes are rare.”
WHAT TO DO? Dental specialists can be very effective advocates for improvements in the delivery of both oral health care and general health care, even in rich countries. Some examples follow. Oral and maxillofacial surgeons can be proactive by joining cleft lip and palate teams so that accepted treatment alternatives become known to patients and families alike. They can be part of the emergency services delivery, particularly as this relates to facial trauma. They can also join hospital tumor boards, as can oral and maxillofacial pathologists, to participate in regular meetings when head and neck and oral cancer patients are being “treatment planned”. Specialists in oral medicine can join hospital pain teams or pharmacy and therapeutics committees. Oral and maxillofacial radiologists can participate in hospital radiology rounds and contribute expertise in both technique and interpretation. Often determination and persistence on the part of the dental specialist will be required to gain acceptance in these wider forums. In my view it is well worth the effort. Even at the most peripheral level of participation the dental specialist can be a strong advocate for improving the care and well-being of the patient, all the while becoming a more important and active member of the health care team. To do this we must periodically leave the comfort of our office surroundings and take a much needed leadership role. David S. Precious, CM, DDS, MSc, FRCDC, FRCS, Dhc Section Editor, Oral and Maxillofacial Surgery
http://dx.doi.org/10.1016/j.oooo.2012.12.016
565