2012 in review: “challenging but fruitful”FDI President Dr Orlando Monteiro da Silva looks back at 2012 and delivers his verdict: "a challenging but fruitful year for FDI".
2012 in review: “challenging but fruitful”2012-12-13
FDI President Dr Orlando Monteiro da Silva looks back at 2012 and delivers his verdict: "a challenging but fruitful year for FDI".
2012 turned out to be a challenging and fruitful year for FDI. It was challenging because these are difficult times: FDI, like many businesses and non-governmental organizations, had to carry out its own stress test to measure its capacity to adapt to the economic downturn and review the scope and outreach of its operations accordingly.
The year was fruitful because FDI not only succeeded in expanding its capacity for advocacy in the field of public health and oral health, but also, and simultaneously, drew up and adopted a blueprint for the dental profession in the coming decade.
That blueprint, ‘Vision 2020, shaping the future of oral health' was the year's most high-profile achievement. The original draft, prepared from scratch in late 2011, went through a series of discussions and amendments within the specially set up Task Force chaired by Michael Glick.
Just 8 months after its first appearance, Vision 2020 was translated, printed and ready to present to the General Assembly meeting in Hong Kong, where it was greeted with a high level of consensus and adopted with only minor editorial changes (Int Dent J 2012 62:278–291).
Vision 2020's immediate success was not because the document does not make waves: on the contrary, the ideas it contains are provocative and challenging to the profession. Furthermore, it has generated a lot of curiosity among dentists, which is why I have talked about Vision 2020 in every presentation that I have made in the last few months.
These include addresses to young dentists in Romania, a government-organized public health congress in Brazil, to meetings in Indonesia, Bangladesh, Russia and, closer to home, in Spain and Portugal. The most frequent question has been: "what solutions will you provide to the issues raised?" That is the next stage of the project: to draw inspiration from Vision 2020 to develop a plan of action, starting early in 2013, in collaboration with our corporate partners.
These difficult times also make it imperative for the dental profession to keep abreast of the latest trends, thinking and issues in the field of public health and fully engage with other medical professions and the health authorities. In short, become more visible.
It is also a matter of self interest: in a time of shrinking health budgets, dental practitioners need to explain to public health authorities, interested only in the bottom line, what distinguishes dentists from other practitioners in oral health in terms of expertise and quality. We have to ensure that all FDI activities at national level through NDAs and international level through work with WHO keep oral health at the top of the health agenda.
During the course of 2012, FDI took the lead by developing advocacy guides for its members to use in two key areas: noncommunicable diseases (NCDs) and dental materials. The first was developed as a means of building the capacity of national dental associations to engage in an area of healthcare that has been a prime subject of national and international debate in the past few years, provide input and demonstrate how the dental profession can play a key role in NCD control and prevention.
The second advocacy guide was in an area of immediate interest to the profession: the right to continue to make clinical decisions on materials used in dental restoration in the face of international pressure, through a treaty currently in its final stages of drafting, to ultimately ban the use of dental amalgam.
FDI developed the guide for dentists to support their contacts with treaty negotiators, government authorities and the media and, in the light of recent developments, has taken the step of writing personally to the Chair of the treaty negotiating committee to express its concern.
Some national dental associations have wide experience with government, some less. For the latter, if FDI continues to provide guidance on the approach to adopt in advocacy and government relations and provides the necessary endorsement of national and local oral health activities, we believe it could have a massive impact on the credibility of NDAs and vastly increase their sphere of influence at national level.
FDI's recent African Summit in Cape Town, South Africa, is a case in point, where the national dental associations present committed to developing their relations with government and, in some cases, immediately made contacts in the following days or weeks. It is through cooperation with national governments that FDI can help reduce disparities in access to care and achieve its goal of ‘oral health for all'.
Image and credibility
The last twelve months have also seen FDI focusing on image and credibility through project activities in the field and external communications. FDI is becoming more concrete: its activities can have a profound effect on people's lives. We have a story to tell and it is up to us to find the means to tell it.
"One of the things that has struck me since I took over as FDI President is the warmth and feelings of fraternity within the international community of dentists. I have detected a groundswell of support, not just rational but emotional, unique to our federation at every event that I have attended.
"We need to build on this and develop our social capital to show that to be part of FDI is to be part of a world community of which we are proud, a community demonstrating its commitment to its vision through its oral health activities and advocacy."
The landmark event of 2012 was the FDI Annual World Dental Congress in Hong Kong, which achieved recognition at the highest level through the presence at the welcome ceremony of the Chinese Minister of Health. At the same event, we received a personal message broadcast by Dr Margaret Chan, Director General of the World Health Organization, who highlighted the pioneering role of the dental profession in prevention..
The Scientific Programme was also hugely successful both in the calibre of its invited speakers and the record number of abstracts presented. This was the 100th AWDC and the last one organized according to the old model. We look forward to an even more successful Annual World Dental Congress in Istanbul in 2013, organised according to a new model, which we believe, with is focus on more equitably shared risk, is better adapted to the needs of FDI and congress participants.
We should never lost sight of the fact that the FDI Congress is key to our federation's mission and its democratic credentials. It is a forum for debate on oral health and related issued, a once-a-year opportunity for NDAs to voice their opinions and resolve differences at the world parliament and a unique and important source of continuing education
FDI has also emerged stronger from periods of doubt and anxiety in the last few years and is now set to face the future with greater confidence. The LLL partnership has made great progress and I can personally bear witness to the credibility it brings to FDI. Internally, we have moved forward both on the financial front, with a balanced and predictable budget, and through a greater sense of joint trust and commitment.
The signs are also visible of a new departure in FDI management and I would also like to highlight the performance of the FDI office under the leadership of Executive Director Jean-Luc Eiselé.
2013: best ever FDI congress
The challenges continue in the coming year. We are determined to make FDI 2013 Istanbul the best ever Annual World Dental Congress, with significant national, regional and international impact. We also have great hopes for the re-launch of World Oral Health Day, now set for 20 March 2013, and on 20 March every year thereafter.
I am glad to be able to count on the support of so many NDAs, colleagues and friends, and I wish you all a great 2013. See you all in Istanbul!
Dental amalgam: FDI expresses concern over draft treaty contentsFDI has taken the exceptional step of writing personally to Fernando Lugris, Chair of INC5, to express concern about the latest draft (October 2012) of the future international treaty on mercury. FDI fears that, if the draft is adopted in its current form, it could pose serious risks for oral heath care.
Dental amalgam: FDI expresses concern over draft treaty contents2012-12-13
FDI has taken the exceptional step of writing personally to Fernando Lugris, Chair of INC5, to express concern about the latest draft (October 2012) of the future international treaty on mercury. FDI fears that, if the draft is adopted in its current form, it could pose serious risks for oral heath care. .
INC5 refers to the fifth meeting of the Intergovernmental Negotiating Committee, set up to discuss the text and form of the mercury treaty. The issue has taken on some urgency for FDI because the INC 5 meeting will be taking place in Geneva from 13 to 18 January 2013 and its current agenda, at governmental level, leaves little room for comments and questions from the floor by NGOs and other stakeholders.
A threat to public health
The letter, penned by Dr Stuart Johnston, Chair of the FDI Dental Amalgam Task Team, points out that the draft treaty text ignores best available science and represents a radical step backward. "If adopted, it would gravely threaten public health and further stress healthcare provision. The document totally ignores the importance of prevention in reducing the number of caries and fillings required and needed research into existing and new restorative materials."
Furthermore, FDI takes the document to task for not giving due consideration to the ‘phase-down' approach recommended by the World Health Organization in its report Future Use of Materials for Dental Restoration, which recognizes that ‘a phase out' of dental amalgam at any set future date is not feasible.
A flawed review process
FDI highlights what it sees as a flawed review process, which would revisit issues such as dental amalgam on a regular basis. In Dr Johnston's words,"this would only divert attention and resources away from the important work of reducing demand for amalgam through prevention and research on other materials".
Among a series of specific comments, FDI points out that the proposed document is an "environmental treaty and must not dictate personal or professional health care decisions. Clinical issues must control in these decisions."
In its conclusion, FDI reiterates its belief that the ‘phase-down' approach recommended by WHO is the most effective based upon prevention, research, environmentally sound lifecycle management and education.
Bangladesh: FDI President addresses dental studentsFDI President Dr Orlando Monteiro da Silva was in Bangladesh mid-November to strengthen ties with local member, the Bangladesh Dental Society (BDS). This first visit by an FDI president would, he said, have a huge impact and play a key role in enhancing the credibility of the local national dental association (NDA).
Bangladesh: FDI President addresses dental students2012-12-13
FDI President Dr Orlando Monteiro da Silva was in Bangladesh mid-November to strengthen ties with local member, the Bangladesh Dental Society (BDS). This first visit by an FDI president would, he said, have a huge impact and play a key role in enhancing the credibility of the local national dental association (NDA).
The trip was also an opportunity for Dr da Silva to address some 400 of the country's future dentists gathered on 23 November to learn more about FDI, its Vision 2020—the FDI roadmap for dental medicine in the coming decade—and the landmark initiative Live.Learn.Laugh. (LLL), fruit of a unique partnership between FDI and Unilever.
The presentation by the FDI president—the third during 2012after Istanbul in February and Cape Town in early November—reflects the crucial role played by LLL within FDI activities, strategy and overall vision of ‘Leading the World to Optimal Oral Health'. The event was organized by Unilever Bangladesh.
LLL in Bangladesh is implemented through the BDS, which represents the interests of the country's 4,500* dentists. As a low-income developing country** Bangladesh has a relatively low density of dental practitioners per head of population at 1 dentist per 35,259* population, but still significantly higher than the world average (1: 62,595).
LLL in Bangladesh
The project, called the ‘Bangladesh Dental Society Health Awareness Programme', led by local FDI National Liaison Officer Dr Emdadul Haque, seeks to educate and train school teachers to facilitate oral health care in schools. It also provides oral health education among primary school children and motivates them to brush twice daily with a fluoride toothpaste.
BDS has also published an Oral Health Education training manual for school teachers and an Oral Health Storybook for children to illustrate the importance of good oral health habits. In addition, BDS dentists from have provided oral health checkups and dental treatment for the schoolchildren.
"It was wonderful opportunity to be in contact with Bangladesh's up and coming dentists and learn from them," said Dr da Silva, interviewed after the event. "Being there and talking to colleagues means learning more about local and national issues, which also translates into more knowledge for FDI.
For example, I already knew that Bangladesh had a high incidence of oral cancer: just over twice the world average for men and more than five times the world average for women***. It seems that the local custom of chewing tobacco could be among the causes."
FDI presence and support have a huge impact and play a key role in enhancing the credibility of the local national dental association among major stakeholders. FDI has the capacity integrate and unify: it is far more powerful than we sometimes think it is!"
FDI/ERO debates European integrationA meeting of the joint FDI/European Regional Organization (ERO) Working Group ‘Integration' took place in Moscow on 15 November, at the invitation of the Russian Dental Association and the trade fair Mosexpodental (Moscow, 14 to 17 November).
FDI/ERO debates European integration2012-12-13
A meeting of the joint FDI/European Regional Organization (ERO) Working Group ‘Integration' took place in Moscow on 15 November, at the invitation of the Russian Dental Association and the trade fair Mosexpodental (Moscow, 14 to 17 November).
Participants focused in particular on the Europe-wide standardization of several aspects of the profession as well as local approaches to pan-European issues such as recognition of diplomas—with a view to increasing the professional mobility of dentists—oral health policy and academic training.
A further aim of the meeting to was to help NDAs establish structure and policies, build capacity and come to agreement on the exchange of epidemiological data, the presentation of national programmes and continuing education
"It was a great meeting that fully achieved its aim of sharing experience among dentists in west, central and Eastern Europe. Many thanks to the organizers," said FDI President Orlando Monteiro da Silva, present at the event.
A focus on patient safetyIn the run-up to FDI 2013 Istanbul, FDI is planning a series of interviews with some key personalities in field of oral health in Turkey. We begin with FDI Councillor Nermin Yamalik, who talks about why and how she is involved in the patient safety policy, strategy and projects.
A focus on patient safety2012-11-29
In the run-up to FDI 2013 Istanbul, FDI is planning a series of interviews with some key personalities in field of oral health in Turkey. We begin with FDI Councillor Nermin Yamalik, who talks about why and how she is involved in the patient safety policy, strategy and projects.
Patient safety is one of the key focus areas of FDI and FDI Councillor Prof Nermin Yamalik, who has written and lectured extensively on the subject. She participates in a number of FDI committees and task teams that have either direct or indirect impact on the issue, notably the FDI World Oral Health Workforce Task Team.
She notes that a number of FDI activities address patient safety either directly or indirectly. "However, a specific statement on patient safety or even a charter of patient rights is missing and I feel that we need to work in this direction," says Prof Yamalik.
Outside FDI, Prof Yamalik works on patient-safety related issues with a number of international and European partners. She maintains permanent liaison with the World Health Organization and was FDI expert on the WHO Expert Working Group that developed the ‘Mulitprofessional Patient Safety Curriculum Guide for Health Professions'.
"I feel that it is one of the best resources in its field and I am very proud to be a part of it," says Prof Yamalik.
Prof Yamalik, what are the essential differences between patient safety within the field of dental medicine and within the field of medicine in general?
Although dentistry always has a genuine concern for patient safety, the first thing I can say is patient safety is quite ‘immature' in dentistry when compared to medicine. There are several reasons for this. Firstly, in medical practice, they started earlier due to the serious consequences of ‘errors'. Dental errors may be perceived as ‘less' serious.
Secondly, health care is mostly provided on an institutional basis (e.g. in hospitals), while dentists are usually solo-practicing professionals and are a little ‘isolated'. Reporting of incidents may be quite low. It is different to implement patient safety measures in institutions compared to dental practices.
Thirdly, medical care is generally provided by teams of professionals and this team approach is quite different from team work in dentistry. The way patients perceive dentistry and medicine may also differ and this may act as another determinant.
What are the main areas of concern?
We carried out a patient safety/risk management survey among the FDI member national dental associations: it clearly showed us that in most countries there is not much information available and some countries lack particular laws and regulations about patient safety.
Naturally, it is important to have the necessary laws and regulations; however, the attitude of dental practitioners (e.g. reluctance) also seems to be very important. It is essential that dental professionals do not see implementation of quality care, standards and patient safety measures into daily dental practice as a bureaucratic process.
Improving the working conditions of dental professionals and the dental team and supporting them in complying with the patient safety measures is also an important factor. The impact of culture and the disclosure of errors and ‘apology' is another topic of discussion. The pressure that a health professional may feel when a ‘culture of blame' is operating is also an issue of concern.
Is there any important issue within the field of patient safety that you feel is not being addressed or is being inadequately addressed at this time?
The multifactoral nature of patient safety and the many determinants are likely to be either underestimated or to a certain extent ignored. The particular difficulties of health professionals in complying 100% with patient safety measures (e.g. shortage of health professionals, limited infrastructure, etc.) also needs to be addressed further.
What patient safety standards does Turkey currently implement and how is patient safety currently regulated?
Last April a new regulation was introduced, which was developed by the Ministry of Health. Although there have always been lectures dealing with some patient safety issues under the heading of ‘ethics', patient safety is recently being treated as a relatively new (separate) discipline in most of the medical and dental faculties.
In most faculties we notice topics of patient safety in the medical and dental curriculum. We also see more continuing education courses.
In practice, what disparities exist between implementation of patient safety rules in urban and rural practice?
As expected, there are clear discrepancies. However, it is not only a matter of geographical location. Even in urban settings we may see that patient safety is either underestimated or lacks the desired priority in general. So it is my personal feeling that the problem in implementation of patient safety measures to daily practice is deeper than we may assume.
What is the biggest risk a patient faces and how is this managed under current procedures?
Although most dental procedures are carried out without significant negative outcomes, it is obvious that every intervention has some risks. Complying with the patient safety measures, trying to reduce errors, provision of quality care and maintaining updated professional standards, etc. are all essential.
We have to realize that the general measures to reduce errors and increase patient safety are not so different from what common sense tells us. As an example, when we are tired, errors may increase. So we need to keep this in mind when programming our daily work schedule.
Having a good dentist-patient relationship, respecting patient rights, having informed consent, continuing education, having concern for the quality of dental equipment and materials/products, etc. also deserve a particular interest. All these once again highlight the fact that when patient safety is concerned, it's the multifactoral nature that needs to be considered.
Note: The opinions expressed in this interview are Prof. Yamalik's own: they do not necessarily reflect the views of FDI.
Annual Session of the American Dental Association (ADA)
San Francisco, 18 to 21 October 2012
Congress and Exhibition of the Association Dentaire Française (ADF)
Paris, 27 November to 1 December 2012 (Exhibition from 28 November)