Volume 62, Issue 5 , Pages 525-526, May 2004
Oral health in the global community: the tasks ahead for oral and maxillofacial surgery
Article Outline
- Develop cooperative residency training and shared faculty
- Develop international standards of care
- Share science
- Develop cultural competencies
- Government, association, community, and individual partnerships
- References
- Copyright
Oral diseases are among the leading acute and chronic diseases afflicting humanity. Because of the global spread of regional bacteria and viruses, shared lifestyles, and shared habits, new patterns of oral diseases are emerging across the planet. The World Health Organization (WHO) has recently completed the World Oral Health Report 2003, which reviews the current global oral health disease burden and strategies for improving oral health in the 21st century.1 It is an important document that elucidates problems that present in every local community and in every OMS practice. Oral and maxillofacial surgeons practice in a global community, which offers new cultural and pathophysiologic experiences on a daily basis.
Oral diseases are being induced by the advancing global technology and economy. For example, modern food technology has introduced a more refined and processed diet for peoples as diverse as the Aleuts and Samoans. Airfreight delivery to remote native Alaskan villages now includes pallets loaded with sugary cereals and soft drinks. Snowmobiles and all-terrain vehicles diminish the caloric needs of the users and may encourage them to seek a higher carbohydrate diet. The result is a high rate of caries and greater obesity in societies exposed to modern diet and the benefits of modern technology.
In its report, the WHO cites risk behaviors such as inadequate oral hygiene, diet, tobacco, and alcohol as adding to the oral disease burden.1 Although smoking has decreased in North America, it is a growing scourge in economically emerging regions such as Southeast Asia. Oral cavity malignancy is now nearly twice as common in less developed countries than in fully industrialized countries.2 Smoking is seen in emerging economies as a status symbol, much as it was in the US in the post-World War II era. Cigarettes are marketed as indicative of affluence and virility in these emerging markets. Economically advancing nations are seizing many of the negative health behaviors that have long plagued industrialized regions. When combined with indigenous problems, new and alarming disease patterns can emerge. In India, the combination of betel nuts, tobacco, and alcohol has created an oral cancer incidence 18 times higher than the remainder of Asia.1
The industrialized nations have successfully marketed their diet, technology, and habits to emerging countries. Of course many benefits have been reaped by the importation of modern ideas and products. While modernity has benefited emerging nations, it also has unintended consequences. The problems of water-borne illness, industrial pollution, environmental degradation, population growth, unregulated emigration, and new infectious diseases may be modernity’s unintended effect on the third world.
Massive unregulated emigration to industrialized countries has created a global health environment in local communities of industrialized countries. Even small towns in the United States are facing global health issues. For example, these include reemergence of tropical diseases, water-borne diseases, and tuberculosis in industrialized communities.
The flourishing of multicultural societies, especially in North America and Europe, has created a collision of these factors in the health care environment that makes for unique and challenging cases in the daily practice of oral and maxillofacial surgeons in these regions. A patient leaves his home equatorial country and arrives by airplane in the United States with a high fever and facial swelling. After incision and drainage the wound breaks down, denuding skin, muscle, mucosa, teeth, and bone. The OMS resident on call comments that it is just like the cases he saw at a missionary hospital in Kenya. His attending surgeon is reminded of the digital photos the resident forwarded of noma patients during his visit to Kenya. He e-mails his colleague in Africa for advice on the care of these patients. His Kenyan colleague reminds him that while noma is a frequent problem in East Africa, he was not sure he could offer advice on the treatment of this patient in an American setting. His hospital in Kenya did not always have the modern resources it needed to provide comparable care.
Globalization has reached the practice of oral and maxillofacial surgery in every nation. This has created new tasks for the specialty that will serve our patients not just in distant lands but in our own communities as well. Here are some suggestions that will help us advance in the practice of oral and maxillofacial surgery in the global community.
Develop cooperative residency training and shared faculty
Resident exchanges offer multicultural experiences that help both the rotating resident and the hosts to develop further understanding of global surgical issues. Residency programs should develop direct partnerships with sister institutions in different cultures for the purpose of cooperative training. Surgeons can share their knowledge and skills electronically or through visits with their colleagues. Other resources such as medical information systems and telemedicine offer opportunities for shared expertise. Common standards of education may then reasonably evolve to support international standards of care in the future.
Develop international standards of care
Disease must be treated in a variety of environments and in a variety of cultures. However, trauma, tumors, and microorganisms are blind to cultures and borders. Common approaches to disease management will offer universally applicable guidelines and will help define the resources necessary to improve oral health in every setting.
Share science
Oral and maxillofacial surgery is developing a global clinical science that has gained universal recognition. The Journal of Oral and Maxillofacial Surgery is an important vehicle for the dissemination of global knowledge. The English language surgical journals are commonly read and available, but contributions in non-English regional journals are often missed by the global audience. English abstract availability in on-line vehicles such as PubMed, OMIM, OVID, and Science Direct is growing and offers a tremendous opportunity for sharing global clinical expertise and science. Electronic translation of text and voice offers the hope that further sharing of clinical science will be forthcoming.
Develop cultural competencies
To practice in the global community, surgeons benefit from understanding the cultural influences on health, response to illness, and proposed therapy for their patients. Much attention in health care education is now toward the development of cultural competency. Cultural competency is the knowledge, behaviors, and attitudes that help surgeons be effective in helping patients in a cross-cultural setting. It is a competency beyond language skills that demands an examination of one’s own culture and how it interfaces with the characteristics of another.
Government, association, community, and individual partnerships
Partnerships need to develop that will ensure the effective local treatment of global diseases. Organizations such as the WHO can work with national agencies such at the Centers for Disease Control on global oral health surveillance. Governments can design programs to improve oral health based on the successes of others. Professional oral and maxillofacial surgical associations can develop partnerships of mutual benefit across borders.
Individuals develop the truly essential partnerships that make a difference. Tackling the problems of oral health in the global community offers more than just tasks and challenges to those who seek to address its many complex issues. It is an exciting, enjoyable, and fulfilling endeavor that reaches into our common humanity and purpose for living. An example from a few years back might amplify this point. Before returning from a distant place on a mission to build and sustain a rural health program, Dick and Pauline Topazian, dental students, medical students, and OMS residents of the University of Connecticut posed with their local colleagues and patients for a parting photograph in front of “their” clinic. The faces of the teachers, students, and patients emanated a memorable joy.
References
PII: S0278-2391(04)00199-5
doi:10.1016/j.joms.2004.03.001
© 2004 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Volume 62, Issue 5 , Pages 525-526, May 2004
