By Dr. Bertrand R. Stuart, DDS

MODERN dentistry provides many challenges for the dental practitioner. Some of these involve the acquisition of technical skills, such as the ability to use new materials and provide new treatment options.

While such skills form the foundation of dental care, technical expertise is always provided in a social context. Not only is there the relationship between the dentist and patient, but also the interface between the dentist and the community.
There are both opportunities and barriers to the achievement of oral health. First, there are changing trends in levels of oral disease. Overall, there has been a substantial improvement in the oral health of young people in the industrialised countries of the world. However, one important challenge involves the maintenance of these improvements into adulthood.
General improvement can, however, mask variations due to geographic region and social class background. Not everyone has benefited to the same extent and some people from particular cultural backgrounds can be at particular risk. For example, do our indigenous brothers and sisters who reside in the Rupununi Savannahs have equal or acceptable opportunities of oral care as we on the coastland?
The challenge of worsening levels of oral disease in parts of relatively non-developed areas of our country has to be faced. Can the dental profession help to improve the oral health of all members of all communities or even societies?
As the demographic profile of industrialised countries changes to reflect the growing number of older people, new demands for different types of expertise in dentistry are being created. Will the need for the care of the common oral diseases by dentists diminish in some parts of the world? And could dentists be replaced by dental auxiliaries in many instances?
The extent to which improvements in oral health are due to clinical practice is debatable. Some argue that oral health is improving because of changes in society, rather than being due to improved professional care. Perhaps a reduction in the number of trained dentists will have relatively little impact on oral health. There are also debates as to whether the provision of information to patients about the prevention of dental disease can be effective in helping them to change their behaviour. Those involved in health promotion recognise that providing clinical services is only one part of a more broad based exercise which will include working with schools, community groups, industry and supermarkets.
Health promotion will involve arguing policies that involve preventative measures for achieving oral health, such as water fluoridation. These obviously take place beyond the surgery. Does the dentist have a part in these activities and if so, what should it be? So, there are many interpersonal challenges. To treat disease successfully requires the development of special communication skills, such as an ability to provide reassurance, personal care and comfort. One does not have to be a dentist or dental practitioner to impart dental health knowledge. For many years I have been advocating that all allied health workers in the public service should be trained to, and be required to educate their patients in the generalities of health care, especially in countries like Guyana. Successful dental care offers an opportunity to improve the quality of life of individuals using current methods and high-quality restorative materials. In all of these instances, patient satisfaction with treatment is a crucial aspect of care.
The public is being encouraged to have a voice in the planning of local services and to make its views known as consumers of health care. The need to overcome barriers to the receipt of dental care and to reduce anxiety and discomfort to an acceptable level remains.
Making a realistic response to these different challenges means that the members of a dental team need to develop a wide range of knowledge, skills and ways of thinking. But equally important is that policy makers and those responsible for the dental health of a nation must be thoroughly convinced of how vital it is within the realm of chronic diseases.