“Toothache is worse than a serious illness”! If you don’t pay attention to diet and oral hygiene for a long time, you are prone to periodontal disease and tooth decay, which will affect their health and quality of life in middle-aged and elderly people. Initially, the 8020 plan was ordered for dental health, hoping that the elderly can keep at least 20 teeth naturally by the age of 80. According to the Department of Health’s 2011 Oral Health Survey, 40% of non-institutionalized elderly people aged 65 to 74 have less than 19 teeth; three adults are facing serious damage to all teeth or teeth. Although the dental health of the elderly has improved in recent years, if we want to achieve the goal of “8020”, we don’t have to do a good job of prevention early, and determine the globalization of primary dental services for different age groups.
In recent years, the Hong Kong government has proposed the service direction of early prevention, early detection and early treatment in oral health and dentistry, among which “wide and shallow” and “narrow and deep care” are the key strategies. “Wide and shallow” mainly focuses on oral health education for different age groups, encouraging the general public to have regular dental examinations and cleanings, and to detect and treat dental diseases early. “Narrow and deep” provides nutritious and appropriate dental care for people who currently have difficulty in obtaining dental care services and high-risk groups, including dental examinations, teeth cleaning and basic dental treatment (basic dental treatment includes fillings and tooth extraction).
Based on data from the Census and Statistics Department, the HKCSS found that about 40% of general respondents did not have the habit of checking their teeth. The lower the monthly income of the household, the more likely they are to have the habit of teeth cleaning and checking their teeth. The prevalence of teeth cleaning among grassroots residents with an income of less than 10,000 is only 13%, which is 14% lower than that of urban residents with an income of about 50,000 (27%) (Figure 1); if we focus on the middle-aged population aged 34 to 54, low-income people (income less than 20,000) are less involved in preventive oral care, and their prevalence of teeth cleaning is about 11 to 12%, but the prevalence of teeth cleaning among middle-aged people with an income of more than 50,000 is 31% (see Figure 2). Grassroots residents often seek medical treatment only when they need to have their teeth extracted, and the number of people who go to the clinic for tooth extraction is four times higher than that of people with higher incomes (see Figure 3). Finally, we also found that the elderly have the highest rate of tooth loss and belong to the high-risk group.
Many countries have used medical subsidies to encourage low-income people to self-check their teeth to improve the accessibility of dental services. Take Singapore as an example. They provide different subsidies to fully cover basic dental care in different communities and encourage residents to manage their oral cavity. First, for the lowest-income grassroots people, Singapore has established a social assistance assistance program (Community Health Assistance Program CHAS) to provide subsidies to eligible persons. Holders of health assistance cards can check their teeth or wash their teeth at designated clinics with high subsidies. All elderly people with income and assets can enjoy full medical subsidies, allowing them to prevent dental diseases early and maintain oral health.
For ordinary citizens, the government’s polyclinics (polyclinics) and the Central Health Insurance Scheme provide them with basic dental treatment, including dental examinations, washing and filling services, at a low price, about half of the charges of private clinics. If ordinary citizens need to undergo complex dental treatment and surgery, such as wisdom tooth extraction, dental implants, etc., they can apply for part of the surgical technology fees from the Central Provident Fund health account.
In Hong Kong, the current CSSA recipients include the CSSA poor (CSSA recipients receive different dental treatment items, including preventive primary dental care, such as oral examinations, X-ray examinations and teeth cleaning), while non-CSSA low-income people can only use public emergency dental services (public dental services only provide emergency services for the general public, including tooth extraction and pain relief), but the number of places is quite limited, and the scope of services only includes pain relief and tooth extraction. Grassroots people need dental examinations and teeth cleaning, but they are discouraged by private doctors’ higher fees, which seriously affects their oral health.
In view of this, the government will launch the “Youth Dental Care Co-governance Pilot Program” to subsidize part of the cost of dental examination services for teenagers aged 13 to 17 to encourage them to develop the habit of dental care. The government is also studying non-governmental organizations to provide more comprehensive dental services for a group, but has not yet announced the specific plan. Our government recommends referring to the above pilot program to provide preventive oral health and care services (such as teeth cleaning) for low-income people, promote the establishment of a good habit of regular dental examinations, and prevent dental diseases.
In addition, insufficient teeth are also a bottleneck for increasing dental services. The government can refer to Singapore’s experience to review and relax the duties of dental hygienists and dental therapists, and study allowing dental therapists to provide preventive dental care and basic dentistry (fillings, tooth extractions) in non-government dental clinics to reduce the waiting time for public services for those who need treatment; at the same time, improve the capabilities and qualifications of dental hygienists and therapists, and study whether non-therapeutic dental services such as education, consultation, dental examinations, and the use of intraoral or extraoral X-rays can be provided in non-government dental clinics without dentists.
Finally, working citizens generally have a low awareness of preventive oral care and work long hours, so they only deal with it when they have toothache. We suggest that health lectures can be conducted, and fitness innovative technology products can be used to assist health lectures, and oral health education and correction work can be carried out to strengthen the promotion of preventive oral care.
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