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1、UnitEighteen
ORALHEALTHFORALLTHROUGH
ALTERNATIVEORALHEALTHCARESYSTEMS
Thepreventionandcontrolofdentalcariesinindustrializedcountrieshavebeenduemainlytouseoffluoridesinmanydifferentwaysandtothewidespreadadoptionofeffectiveoralhygienehabits.
Inspiteofthesesuccessesthediseaseisnotconqueredinallcomm
2、unities.Itmightstillbecalledaneglectedepidemicinunder-privilegedandlow-incomegroups.
Therearemanyhigh-riskpopulationsintheUSA:
97%ofthehomelessneedoralcare,blackchildrenhave65%moreuntreateddecaythantheaveragecitizen,lowincome91%andAmericanNatives265%.
Morethan50%ofthehouseboundelderlyhavenotseena
3、dentistfor10years.
Traditionalsystemsfororalcarearebasedonvariouscombinationsofpublicsalariedservicesandprivatepractice.Thepublicservicesareusuallyresponsibleforprevention,careofschoolchildrenanddisadvantagedgroups;andprivatepractitionersprovideawiderangeoftreatmenttothegeneralpublic.Allthesesystem
4、sareorientedinsuchawaythatthedentistprovidesmostofthecare.
IntheUSA:
84%of17yearoldshavehadtoothdecayandanaverageof11toothsurfacesisdamaged.
Peopleaged40to44haveanaverageof30toothsurfacesaffectedbydecay.
41%ofpeopleaged65oroverhavenoteethatall.
Indevelopingcountries,thelevelofdentalcarieswasrar
5、elyashighasinindustrializedcountriesand,insome,successfulpreventiveactivitieshavebeenimplemented.However,inmanythereisstillthethreatofincreasingcariesrelatedtochangingdietandlifestyles.
Commonoraldiseaseindevelopingcountries
Theburdenofdemandfortreatmentonlyofseverecariesorperiodontaldiseasecanbe"
6、estimated”.Inaboutonethirdofthesepopulations,about1350millionpeoplewillrequirepainrelieftreatment(extractions)3timesintheirlives.Abouttwo-thirdsor2400millionpeoplewillneed5ormoreextractions.
Howeverinmanycommunitiesthesesystemsdonotmeeteventhebasicneedsofthepublic.Mostpublicserviceshaveonlyverylowc
7、overage;communitiesinlow-incomeruralandurbanareascannotaffordprivateoralcare.Further,developingcountriescannotaffordtoestablish,staffandraneducationfacilitiesfordentists;orhopetoprovideadequateemploymentopportunitiesfordentiststrainedabroad.
Inallcountrieseconomicrestraints,changesindemandfororalhe
8、althcare,politicalpressurestoextendservicestounder-privilegedgroups,concernaboutquality,costsandeffectivenessofcaredemandthatalternativewaysoforganizingoralhealthandcareareexaminedandimplemented.
Costandlackofaccessforunder-privilegedandlow-incomegroupsconstrainalloralhealthcaresystems.
Whataction
9、scanbetakentocombatthisneglect,breakdownthebarriersofcostandimproveaccesstooralhealthandcare?Alternativeoralcaresystemsneedtobedevelopedmthatamaximumnumberofpeoplecanhaveaccesstoandcanaffordoralhealthandcare.
Severalrecentadvancesgivegreatscopeforthetransformationofthedeliveryandqualityoforalcare.
10、
Theseare:
Neweducationaltechnologiesthatmakelearning-bothknowledgeandskills-simplerandfasterforalltypesofpersonnel;
Simplifiedandlogicaldesignoforalclinicsthatimprovetheworkplaceandsubstantiallyreducecapitalcostsofequipmentandneedformaintenance;Bettermaterialsthatareeasierandsimplertouse.
Usingt
11、hesetechnologicaladvances3typesofcarecanbedefined:
Rathersimple,verycosteffective,Moderateleveltechnologythatisratherexpensive,and
Hightechnology,oftenextremelyexpensive..
Arational,healthpromotingandaffordablemixofcaremustbeplannedandimplementedinallcountries.
Firstlevelcareincludes:
Prophylax
12、is,removalofcalculus,applicationofsealant,restorationofsinglesurfacecariescavities
Asaconsequenceofimprovingoralhealthinmostindustrializedcountriestheneedformoderatelycomplexcareisdecreasing.Withfurtheremphasisonprevention,needanddemandforfirstlevelinterventionswillincreaseslightly;whiletheneed.for
13、hightechnologycarewillprobablyincreaseforseveraldecadesduetothedesiretopreservenaturalteethandtheincreasingnumbersofelderlypeople,whohavesomenaturalteeth.
Firstlevel,mainlynon-interventivecarewillcontinuetobethemajorneedinmostdevelopingcountries.Thetraditionaldentistorauxiliaryworkercannowprovideby
14、speciallytrainedhealthcenterpersonnel,ratherthanthistypeofcare.
Inthosedevelopingcountrieswherecariesisincreasing,arisingdemandformoderatetechnologycarewillcontinueoverthenextfewdecades.
Arathersmallneedforhightechnologycare-mainlyrelatedtorepairoftraumaandreconstructionafterseverepathology-winrem
15、ainandw川eventuallyincrease.
Moderatelycomplexcareincludesmultiplesurfacerestorations,removalprosthesesandextractions.
Complexoralcareincludesprecisionprosthetics,implantsorthodontics,complexsurgeryandoralmedicine.
Inallcountriespreventionandcontrolcarecanminimizetheneedforintervention.
Inanysoci
16、ety,hightechnologycanonlybeaffordedinlimitedamounts.Itmustbeofgoodqualityandappropriate.
AlternativesystemsinindustrializedcountriesIncreasingaccesstobasicoralcare
Firstlevel,mainlynon--invasiveinterventionshavebeenpreparedandarebeingtestedaspartoftheworkofcommunityhealthclinicsforminoritygroupsan
17、dlow-incomeinnercityandruralcommunities.Theelderlyandgroupswithspecialneedswouldalsobenefitfromout一reachactivitiesfromsuchclinicswhichwouldprovidehealtheducationandpromotioncoordinatedwithhealth-checkprogrammesbymultidisciplinarypersonnel.Aseffective,simpleandacceptablecarereducesthereferralneed_sfo
18、rthemoderateandhightechnologytypeofcare,oralcarecostscouldbereducedbythisapproachtoalevelthatcanbesustainedbymostcommunities.
Somelocationsareexperimentingwithdifferentrelationshipsbetweenoralcareprofessionals,e.g.hygienistsworkingindependentlyinoffices,inpatient*shomesandininstitutions.Greateracce
19、ssisthemainaimofsuchoutreachactivities.
Financingoralcare.
Someofthedifferentapproachesbeingusedtofinanceoralcarearequalitycontrolguidelines,fixedfeeagreements,capitationschemes,healthmaintenanceorganizations,andrewarding.
Increasedpreventivecare.
Usinginformationaboutthedurationofacceptablecare
20、procedures,qualitycontrolguidelinesarebeingpreparedthatindicatetheaveragenumberofyearseachtypeofcareshouldlast.Ifacareproceduredoesnotlastthespecifiedtime,theclinicianisthenobligedtogiveretreatmentfreeofcharge.Suchguidelinesareaimedatreducingunnecessarytreatment,whichcausesprogressivedestructionofto
21、othsubstanceandhighercostsoforalcare.
Insomecountries,formostprocedures,dentistscanonlychargefixedfeesthatareagreedbetweenthehealthauthoritiesandtheprofessionals.Theycanonlyexceedthosefeesforspecialtreatmentandafterareviewofthediagnosisandproposedprocedure.Incountriesusingthissystemcostsoforalcarea
22、renotrisingandinsometheyaredecreasing.
Capitationschemespaythedentistafixedsumforeachpersonenrolledasapatientintheirdentalclinic.Forthisfixedannualfeeadentistcontractstomaintaintheoralhealthoftheenrolledpatients.However,patientsmustundertaketoattendforcheckupsonaregularbasis,ortheylosetheirrightsan
23、dhavetopayforthetreatmenttheyneedtorestoretheiroralhealth.Itseemslikelythatthistypeofprogrammewillreducecosts.
Healthmaintenanceorganizations(HMO)contractwithagroupoforalcareprofessionalstoprovidecaretoagroupofcommunitiesorindividuals,atagreedfees.HMOsareusuallyorganizedandmanagedbycompaniesthatspe
24、cializeinhealthinsurance.Thishasprovedaneffectivewaytolimitthecostsofprovidingcomprehensiveoralcare.
Inonecountryaprojecttoencouragepreventivecaregivesdentalcaremanagersafinancialrewardifdiseaselevelsdonotincreaseinthepatientsintheircatchmentarea.
Alternativeapproachesindevelopingcountries
Wherea
25、sthevarioussystemsbeingtriedinindustrializedcountriescanbeofuniversalrelevance,thedevelopingcountrieshavespecialproblemsinactuallyprovidingcare.
Althoughmostcareneededisofthefirstlevel,minimallyinvasivetype-dentistsusuallyprovidealltypeofcare.Themostcommonmoderatelevelcaregivenisextractionandfreque
26、ntlydentistsresistthetraininganduseofothertypesofpersonnelforthisandevenlessinvasivetasks.
Therearealsosituationswhereteethwithratherminorcariesproblemsareextractedbecausethatistheonlytreatmentavailable,duetolackofsupplyoffillingmaterials.Inoralareasitisclearthat,becauseoflackoforalcarepersonnelofa
27、nytype,mostcariousorinfectedteetharenottreatedintime.Ratherthediseaseprogresses,causingintermittentpainthatisenduredbythesuffererandmanagedbyavoidinguseoftheaffectedareaofthemouth.Onlywhenextremepainorsevereinfectiondevelopsisanattemptmadetofindtreatment.Ageneralhealthworkeroratraditionalhealerinpri
28、vatepracticeoftenprovidesthis.Thistreatmentmaybeextremelycostlywhencountedintermsoflossofearnings,productionlost,travelcostsandfeesthatmaybeashighasthosechargedbydentists.Delayingtreatmentuntilthereissevereinfectioncausesahighrateofdebilitatingandevenlifethreateningconditionsinsuchcommunities.
Thea
29、pproachthatseemslikelytoprovideaneffectivealternativesolutioniscalledAtraumaticRestorativeTechnique(ART)combinedwithcommunityparticipationincareoralcareorganization.ARTbasthepotentialtorevolutionizethetypeofcarethatcanbegiveninthecommunity.Itisbasedonusingdentalhandinstrumentsandglassionomer,arather
30、recentlydevelopeddentalfillingmaterial.Thetechniquedoesnotneedelectricityorcleanpipedwaterasdotraditionaldentaldrillsandequipment.Asglassionomersticksverywelltotoothtissues,thecariousteethdonotneedtobecutandshapedwithadentaldrillasisneededwhenamalgamisused.nThismeansthatsmallcariescavitiescanbetreat
31、edusinghandinstrumentstoscrapeoutandremovethediseasedpartsofteeth,andthencavitiescanbefilledwithglassionomerwhichisalsocapableofhavingapreventiveeffect.
Forthisapproachtobesuccessful,itneedstobepartofacommunityorganizationthatprovidesbothpreventionanddiseasecontrolcare.Membersofthecommunityneedtofe
32、elresponsibleforthegoodfunctioningandsuccessoftheservice.Otherwise,peoplewillcontinuetodemandcareonlywhentheyhavepainandbythattimethecarieslesionswillbetoolargetobeadequatelytreatedwiththistechnique.Theaimistoavoidhavingtousemoretraditionaltypesofcare,whichareinvasiveandtoocostly.
Communityparticip
33、ation
Alternativeoralcaresystemsbasedoncollaborationwithandparticipationofmembersofthecommunityhavethepotentialtochangethewayoralhealthandcareservicesfunction.Thecommunitycanparticipatethrough,
■ Involvingpeopleinpreventionandpromoting"selfcare".Whenpeoplerealizethattoothacheisnotaninevitableparto
34、flife,theresponsibilityforactivereductionoftheneedformoderatelevelinterventivetreatmentactsasacatalystforchange;
■ Organizingregularcommunitycampaignstoexaminepeople*smouthstoidentifyearlylesionswhilestillsmallenoughtotreatwithART;Participatingindecisionmakingaboutneedsandprioritiesfororalcare;
■
35、Trainingmembersofthecommunityofprovidelowlevelcare;Useoflocallyconstructedequipment;
■ Devisingandmanagingthefinancingarrangementsfororalcare.
Associatedwiththisandotherapproachesaretrainingsystemswhichfocusonoptimalergonometricprinciples.Asetofmanualsforlearningtheseproceduresandasetofwelldesigne
36、d,lowcostequipmentforbothlearningandcareisavailablefromWHOandUNICEF.
ItisimportanttorealizethattheuseofapproachessuchasARTandthenewtypeofequipmentandtrainingtechnologyarenotbeingpromotedonlyfordevelopingcountries.TheARTmethodologyhaspotentialforqualitycareatanylevelofdevelopmentorsociety.Theergonom
37、etricapproachtodeliverservicesnomatterwhichsystemisusedwaspioneeredinJapanbasedonperformancelogic.Ithasnowbeenusedandadaptedovermanyyearsinseveraldentalschools,notablyinSanFranciscoandMaryland,USA,Otago,NewZealandandVancouver,Canada.
Therereallyisagreatpotentialtoextendhealthpromotingoralcaretolarg
38、ernumbersofunder-servedcommunitiesaroundtheworld.
VOCABULARY
1. oralhealthforallaneglectedepidemic
2. under-privilegedgroupsconstrain
3. highriskpopulationstheaveragecitizen
4. AmericanNativeshouseboundelderly
5. disadvantagedgroupsprivatepractitioners
6. lifesfyle(s)estimate(d)
7. economi
39、crestrainsaccess
8. deliverycosteffective
9. affordablemixofcarecomplexcare
10. moderatelycomplexcarenon-interventivecare
11. non-invasiveinterventionsout-reachactivities
12. basicoralcarecomplexoralcare
13. comprehensiveoralcaremulti-disciplinary
14. referralneeds28capitationschemes
29. hea
40、lthmaintenanceorganizationsqualitycontrolguidelines
30. chargefixedfeeshealthauthorities
31. dentistcontractshealthinsurance
32. financialrewardalternativeapproach(es)
33. alternativesystemsuniversalrelevance
34. intermittentpainlossofearnings
35. atraumaticrestorativetreatmentglassionomer
36
41、. scrapeoutselfcare
37. catalystcommunitycampaign
38. communityparticipationergonometric人人享有口腔衛(wèi)生保健一種受到忽視的流行病不享有特殊待遇的人群約束，強(qiáng)制高危人群一般（普通）公民美洲土著人（因?。┚蛹依先松顥l件差的人群私人開業(yè)醫(yī)生生活方式大致估計(jì)（粗略估計(jì)）經(jīng)濟(jì)約束（限制）進(jìn)入途徑，入口供給（應(yīng)），提供有成本效果的（成本低，效果大）承受得起的各種保健綜合保?。ㄖ父呖萍急＝。┲械人骄C合保健非干預(yù)性保健非侵入性干預(yù)
（診室）范圍以外的活動基本口腔保健綜合口腔保健綜合口腔保健多學(xué)科的就醫(yī)需要接人頭收費(fèi)方案（計(jì)劃）衛(wèi)生保健機(jī)構(gòu)質(zhì)量控制指南收取固定費(fèi)用衛(wèi)生當(dāng)局（領(lǐng)導(dǎo)機(jī)構(gòu)）牙醫(yī)合同書健康保險經(jīng)費(fèi)報酬選擇性途徑（取代性）選擇性制度普通相關(guān)間歇性疼痛收入減少
（ART）無損傷性修復(fù)治療玻璃離子樹脂刮涂
自我保健促進(jìn)因素社區(qū)活動社會參與人體功力學(xué)的
39. pioneer(ed)預(yù)試驗(yàn)，開辟倡導(dǎo)performancelogic合理操作，操作邏輯
40. under-servedcommunities得不至U(保健)服務(wù)的社區(qū)UNICEF=UnitedNationsChildren*sFund聯(lián)合國兒童基金會
專業(yè)英語 Unit 18教案.docx
