Provision of Oral Health Care in Turkey PROF. DR. BETÜL KARGÜL DEPTARMENT of PEDIATRIC DENTISTRY DENTAL SCHOOL MARMARA UNIVERSITY - TURKEY
TURKEY Since the formation of the Turkish Republic in 1923, it has attend to develop a secular democracy.
Since 1999, Turkey has been a candidate for membership in the European Union (EU); This is a major objective of the Government, with important influence on the direction of economic, political and social policy.
Population Structure The population of Turkey is 72.561.312 on December 31, 2009. 50,3% males (36.462.470 ) 49,7% females ( 36.098.842 )
Population Structure Proportion of the population between 15 and 64 years of age is 67% Half of population is below age 28,8 in Turkey
Population Structure The proportion of population living in the province and district centers is the highest Proportion of the total population living in
Oral health care, like all other health services, is mainly provided by Ministry of Health, SGK (Social Insurance Organization), Universities, Ministry of Defence, Private practitioners and Paramedical professionals.
The number of private hospitals is low whereas not all of them are providing oral health care.
For a long time there were 3 main sources of health care financing in Turkey: The state, Social Security Institutions and Direct Payment by the patient.
The new national health insurance system was introduced in 2008 and covers oral health care. It aims at decreasing the cost of health services and encouraging preventive health practices.
The private health insurance sector's having become the country's most fast-developing insurance branch
Turkey has not yet developed a system in which routinely regular dental visits are the accepted norm. In addition, oral health culture has not been developed either..
The population needs to be educated about the advantages of regularly visiting a dentist.
Oral health care programmes for use in mother-and-child health center, day-care center primary school.
Turkey has more than 22. 000 (92 %) active dentists Distribution of Dentists by Sex Female % Male % Year Source 40 60 2004 T D A
Of the total active dentist population; 65 % worked in private practices 25 % in government hospitals 9 % in University hospitals 1 % in other institutions Dentists by E mployment Government Service Private Practice University M ilitary Year Source 6048 12529 1574 673 2004 T D A
The Number of Dental Hospitals 38 dental hospitals in 2007 55 dental hospitals in 2008.
Oral Health Professionals C ategory Total Number Year Source Dentists 18 577 2004 T D A Dental Laboratory Technicians Chairside Assistants 11 750 2004 2 000 2004 T D A T D A
The Undergraduate Education in Turkey The undergraduate program covers 5 years of professional education in some dental school; One year of language education for students who are not sufficient in English
The Undergraduate Education in Turkey During the first 2 years of the professional education, students are required to take pre-clinic courses that will help to improve their technical skills besides basic medical sciences and basic dentistry courses.
The Undergraduate Education in Turkey Students start to study in the clinics beginning from the 3rd year of the undergraduate education, and this provides them to have more clinical experience which is crucial in dentistry, than before.
The Undergraduate Education in Turkey 4th and 5th years of the education are the periods that the clinical application experience is instructed intensely as well as dental and medical courses.
The Postgraduate Education in Turkey The doctoral program, which is minimum 4 years, is available in 8 disciplines. The required amount of credits can be completed by taking required or elective theoretical and practical/theoretical courses in the first two years.
The Postgraduate Education in Turkey Comprehensive exam can be taken once the required amount of credits is completed, and the academic dissertation can be completed and defended in consequent 2-4 years. in the pertinent program.
Dental Schools in Turkey There are 23 state dental schools and 5 private dental schools in Turkey
NUMBER OF DENTAL FACULTIES IN YEARS YEARS GOVERMENT FACULTY PRIVATE FACULTY 1908-1959 1-1960-1969 6-1970-1979 8-1980-1989 9-1990-1999 13 2 2000-2009 23 5
Dentists Depending on the increasing number of dental faculties, the number of dentists graduating each year in Turkey, has grown rapidly.
Turkish Dental Association (TDA) was founded on June 7th, 1985 as a regulatory body for dentistry in Turkey capital city of Turkey, Ankara.
One of the most important objectives of TDA improve the public oral- dental health
Related Projects TDA - Ministry of Education - Procter&Gamble - Oral - Dental Health Education- 1997 (5 years) TDA- Turkish Radio &. Television- Signal- Oral- Dental Health Programme (January 2000-52 weeks)
Turkish Dental Association (TDA), has made a protocol with Procter&Gamble, and Social Services and Child Protection Institution between January 1st 2005 and January 1st 2006. The objective is to identify the status of the oral health of the children residing in Children Nursing Homes of the Social Services and Child Protection Institution to improve their oral health and provide preventive dental care and education.
arranged by Turkish Dental Association and Colgate is being carried on in our country for 5 years. Tooth Protection Days cover 3 weeks time, during this period the public is informed regarding the development of oral health awareness regarding oral diseases that are preventable in nature and also fissure sealant is applied to the children aged between 6 and 12.
In the previous 5 years period study, 13421 dentists have participated, and Fissure sealant was applied free of charge to 214.375 children aged between 6-12 and 630.000 people have benefited from free oral examination. Since 2003 the workforce of the participation of the Dental Faculties to the campaign is also provided.
Objective of the Project to improve knowledge, attitudes and behavior of primary school students regarding the personal hygiene, oral health, tooth brushing and floride use This Project is scaled up province- based and is implemented between the students from 1st class to 5th class of the primary schools started in the 2007-2008 education period and will continue next four years
FDI-TDA-SIGNAL PROJECT Unilever and FDI co- project which was established in 2005 and contains 45 projects in 38 countries.
TDA / Signal / FDI research project will last a period of three years and more than 7000 people will take part in the project representing the profile of Turkey both from rural and urban areas. FDI-TDA-SIGNAL PROJECT improve the oral health education and encouragement in the already developed and still developing countries.
Epidemiological Data in Turkey
Epidemiological Data in Turkey Epidemiological data on oral health are scare in Turkey
Epidemiological Data in Turkey No representative data on status of the before 1988, when the first national study was conducted
Epidemiological Data for Children in TURKEY
National Survey of Oral Health Status of Children and Adults in Turkey Gökalp S. et al. Community Dental Health (2010) 27, 12 17 More than two- thirds of 5 (n=1539) 12 (n=1615) and 15 (n=1505)year- olds had at least one decayed. The situation was worse for adults and the elderly
National Survey of Oral Health Status of Children and Adults in Turkey Gökalp S. et al. Community Dental Health (2010) 27, 12 17 The mean dmf-t in 5- year- old females was lower than in males. No definite difference between the sexes was observed in the DMF-T of 12- year- olds The mean DMF-T was higher in females aged 15, 35-44 (n=1589) and 65-74 (n=804) years,
National Survey of Oral Health Status of Children and Adults in Turkey Gökalp S. et al. Community Dental Health (2010) 27, 12 17 Mean caries experience in the present study was DMF-T =2.3 ± 2.5 for 15- year- olds
Dental Caries Prevalence, Dietary habits, Tooth- brushing, and Mother's Education in 500 Urban Turkish Children. Eronat N, Koparal E. J Marmara Univ Dent Fac. 1997 Sep;2(4):599-604. 500 children with 2 and 13 ages and their families joined the study. The prevalence of caries increased by frequent and high sugar consumption. Lower age and lower caries experience followed a more balanced diet.
Dental Caries Prevalence, Dietary habits, Tooth- brushing, and Mother's Education in 500 Urban Turkish Children. Eronat N, Koparal E. J Marmara Univ Dent Fac. 1997 Sep;2(4):599-604. There was an inverse relationship between caries prevalence and the mothers' educational level. The percentage of children who never or irregularly brushed their teeth was highest in the caries active group.
Risk factors for dental caries in Turkish preschool children Namal N, Vehit HE, Can G. J Indian Soc Pedod Prev Dent. 2005 Sep;23(3):115-8. 5 nursery schools in Istanbul were included and results of 598 students' were collected. In the study, while although the percentage of children had 60% caries 36% of the students have insufficient oral hygiene. The age and father's occupation turned out to be the risk indicators that affect dft level.
Significant Caries Index Values and Related Factors in 5-6- year- old Children in Istanbul, Turkey Namal N, Yüceokur AA, Can G. East Mediterr Health J. 2009 Jan- Feb;15(1): 178-184 * A total of 542 5-6 year old children from five nursery schools in Istanbul were examined. dmft index 3.74 (SD 3.49) SiC index 7.75 (SD 2.56) About 76.8% of the children had experienced dental caries.
Significant Caries Index Values and Related Factors in 5-6- year- old Children in Istanbul, Turkey Namal N, Yüceokur AA, Can G. East Mediterr Health J. 2009 Jan- Feb;15(1): 178-184 SiC index and dmft showed that risk factors for poor dental status were low mother's education (OR 2.04)
Individual and maternal determinants of self- reported dental health among Turkish school children aged 10-12 years Cinar AB, Kosku N, Sandalli N, Murtomaa H. Community Dent Health. 2008 Jun;25(2):84-8. 591 children aged 10 to 12 and 533 mother were participated in this study Private school children's mothers were more likely to have had higher education (95% at least high school) than public school children's mothers (11%); they reported better dental health
Individual and maternal determinants of self- reported dental health among Turkish school children aged 10-12 years Cinar AB, Kosku N, Sandalli N, Murtomaa H. Community Dent Health. 2008 Jun;25(2):84-8. Frequency of regular dental visits (5%) and toothbrushing (65%) among children attending public schools were lower than frequency of regular dental visits (43%) and toothbrushing (79%)among children attending private school
Managing dental caries in children in Turkey a discussion paper BMC Oral Health. 2009 Nov 25;9:32. Topaloglu- AkA, Eden E, Frencken JE. This paper describes the oral healthcare system and disease situation amongst children in T u r k e y.
Managing dental caries in children in Turkey a discussion paper BMC Oral Health. 2009 Nov 25;9:32. Topaloglu- AkA, Eden E, Frencken JE. As a first step to controlling dental caries, a national health programme including promotional, preventive and minimal intervention approaches for managing dental caries is proposed. Daily tooth brushing with fluoridated toothpaste at home, in mother- and child- care centres, kindergartens, and schools is highlighted.
Epidemiological Data for Adolescents in TURKEY
Self- efficacy perspective on oral health among Turkish pre- adolescents Basak CA, Nilufer K, Murtomaa H Oral Health Prev Dent. 2005;3(4):209-15. A cross- sectional study of Turkish school pre- adolescents aged 10 to 12 (n = 611) by oral health examinations (OHE) and self- administered health behaviour questionnaire (PHBQ).
Self- efficacy perspective on oral health among Turkish pre- adolescents Basak CA, Nilufer K, Murtomaa H Oral Health Prev Dent. 2005;3(4):209-15. Pre- adolescents, mostly with regular toothbrushing habits (69% at least once a day) High levels of irregular dental visits (79%) The mean DMFS = 3.77 +/- 3.37.
Effects of oral health behaviors and socioeconomic factors on a group of Turkish adolescents Kanli A, Kanbur NO, Dural S, Derman O Quintessence Int. 2008 Jan 1;39(1):e26-32 The sample consisted of 582 randomly selected adolescents, 309 boys and 273 girls, who presented over a 3- month period with various complaints to the Hacettepe University Medical Faculty Adolescent Clinic.
Effects of oral health behaviors and socioeconomic factors on a group of Turkish adolescents Kanli A, Kanbur NO, Dural S, Derman O Quintessence Int. 2008 Jan 1;39(1):e26-32 A strong correlation exists between the oral health behaviors, socioeconomic and sociodemographic factors, and the oral health status of Turkish adolescents.
Epidemiological Data for Adults in TURKEY
Dental health status and risk factors for dental caries in adults in Istanbul, Turkey Namal N, Can G, Vehid S, Koksal S, Kaypmaz A. East Mediterr Health J. 2008 Jan- Feb;14(1):110-8. A random sample of 2183 individuals in Bayrampasa district aged between 18 and 74 years were invited for a free dental examination and interview. The mean DMFT: 11.44 and the SiC: 14.00 Older female and rural origin of birth were the significant risk indicators for a high SiC index.
Dietary habits and oral health related behaviors in relation to DMFT indexes of a group of young adult patients attending a dental school. Akarslan ZZ, Sadik B, Sadik E, Erten H. Med Oral Patol Oral Cir Bucal. 2008 Dec 1;13(12):E800-7. A total of 416 young adults (247 females and 169 males) with an age range of 18-25 Approximately 70% of the patients had regular main meals and a very high snacking rate (76.9%) was present. Although not at a high rate, most of the patients brushed their teeth regularly twice a day (44.2%) and Approximately half used other hygiene aids in addition to brushing (43.8%). The median of the DMFT : 5
Epidemiological Data for Students in TURKEY
An assessment of oral self- care in the student population of a Turkish university, Yavuz US. Public Health. 2006 Oct;120(10):953-7. Epub 2006 Jul 7. A sample of 610 non- dental university students attending the University of Ondokuz Mayis in Samsun were randomly selected 68% of the students brushed their teeth two times per day. Few subjects (3%) used dental floss daily. 30% of the students visited dentist for preventive treatment at least once a year.
Oral Health Attitudes and Behavior among a Group of Turkish Dental Students Peker I, Alkurt MT. Eur J Dent. 2009 Jan;3(1):24-31. The purpose of this study was to evaluate self- reported oral health attitude and behavior among a group of Turkish dental students and to compare differences in oral health attitudes between years of study
Oral Health Attitudes and Behavior among a Group of Turkish Dental Students Peker I, Alkurt MT. Eur J Dent. 2009 Jan;3(1):24-31. This study included 267 (153 female, 114 male) dental students.
Oral Health Attitudes and Behavior among a Group of Turkish Dental Students Peker I, Alkurt MT. Eur J Dent. 2009 Jan;3(1):24-31. Totally 141 preclinical (1, 2 and 3(rd) years of study) 126 clinical students (4 and 5(th) years of study)
Oral Health Attitudes and Behavior among a Group of Turkish Dental Students Peker I, Alkurt MT. Eur J Dent. 2009 Jan;3(1):24-31. This study confirmed that oral and dental health behavior and attitudes and also their knowledge about oral and dental health care of dental students improved with increasing level of education
Epidemiological Data for dental health programs in TURKEY
Effectiveness of 2- year application of school- based chlorhexidine varnish, sodium fluoride gel, and dental health education programs in high- risk adolescents. Ersin NK, Eden E, Eronat N, Totu FI, Ates M. Quintessence Int. 2008 Feb;39(2):e45-51. To compare the caries preventive effects of 2- year application of school- based chlorhexidine varnish, sodium fluoride gel, and dental health education programs among a high- risk group of 11- to 13- year- olds with low caries activity. A total of 149 subjects who had previous caries experience in the primary dentition
Effectiveness of 2- year application of school- based chlorhexidine varnish, sodium fluoride gel, and dental health education programs in high- risk adolescents. Ersin NK, Eden E, Eronat N, Totu FI, Ates M. Quintessence Int. 2008 Feb;39(2):e45-51. Subjects were allocated to one of 3 groups for treatment with chlorhexidine varnish (n= 50), sodium fluoride gel (n = 50), or dental health education program (n = 49), which were repeated throughout the 2- year study
Effectiveness of 2- year application of school- based chlorhexidine varnish, sodium fluoride gel, and dental health education programs in high- risk adolescents. Ersin NK, Eden E, Eronat N, Totu FI, Ates M. Quintessence Int. 2008 Feb;39(2):e45-51. After 2 years; There was no significant difference among the groups in the caries increment, in the Chlorhexidine varnish, Sodium fluoride gel, and Education groups, There were also no significant differences in the pre- and posttreatment plaque scores between the groups.
Atraumatic Restorative Treatment (ART) Programme in some rural areas of Turkey (I) Dulgergil CT. et al. Journal of Marmara University Dental Faculty, 2000; 2: 123-129. The aim of the project is to provide much needed oral health care mainly restoration of carious cavities using the ART approach for the children in the rural areas of the Southeast of Turkey. Dentists and often dental students visit the rural areas including Bagivar, a small town and Anatolia.
Atraumatic Restorative Treatment (ART) Programme in some rural areas of Turkey (I) Dulgergil CT. et al. Journal of Marmara University Dental Faculty, 2000; 2: 123-129. An average of 45 to 50 children is treated per visit. Art combined with fissure sealants or with fluoride varnishes have been performed in order to promote prevention of new caries appearing. This project meets the oral health care needs of the rural population and also provides learning experience for the dental students practising ART.
Epidemiological Data for Dental Trauma in TURKEY
Traumatic injuries to permanent teeth in Turkish children, Ankara. Dent Traumatol. 2009 Jun;25(3):309-13. Altun C, Ozen B, Esenlik E, Guven G, Gürbüz T, Acikel C, Basak F, Akbulut E. From a total of 4956 children aged 6-12 years 472 children (9.5%) were found to have suffered dental injuries during a period of 2 years. Injury rates were highest among children age 6 and ages 8-10. The most frequently injured permanent teeth were the maxillary central incisors (88.2%), and the maxillary right central permanent incisor made up 47.2% of all injured teeth. The most common cause of dental trauma was falling while walking or running (40.3%).
Dental Traumatology Volume 19 Issue 2, 72-75, 2003 Epidemiologic studies have focused on the investigation of the prevalence or incidence of dental injury. The patients were evaluated at Pediatric Dentistry, 2-year period. For these 300 patients (446 teeth), specific diagnoses were evaluated.
Dental Trauma in Turkish Children B Kargul Tanboga. Dental Traumatology Volume 19 Issue 2, 72-75, 2003 Dental injuries that presented most frequently in permanent dentition were crown fractures of enamel only and crown fractures of enamel and dentin. The most frequently presented dental injury in primary dentition were avulsions and crown fractures of enamel.
Epidemiological Data for Elderly in TURKEY
Oral Health Status of the Elderly in a Residential Home in Turkey, Gerodontology 2007; 24; 228-211 193 elderly were interviewed and were clinically examined according to WHO criteria. The mean age: 75.2 8.3 in males, 79.1 7.9 in females; 32.6% of subjects were dentate
The mean DMFT: 29.3 5.8 The mean root caries: 2.2 3.1 20.7% caries 18.1% root caries Oral Health Status of the Elderly in a Residential Home in Turkey, Gerodontology 2007; 24; 228-211
Summary To improve the oral health in Turkey through describing the current oral health situation and through using evidence- based alternatives to the prevalent failing methods of providing oral care.
Summary The dental profession government TDA University officials and other stakeholders need to meet, discuss and determine how best the oral health in Turkey can be improved.
Summary Efforts should be made at all levels to increase awareness of dental diseases and improve oral hygiene practices, by using the existing public health system.
bkargul@marmara.edu.tr THANK YOU
Pedodont ST 2011 7 th European Academy of Paediatric Dentistry Interim Seminar and 18 th Congress of the Turkish Society of Pediatric Dentistry 31 March - 2 April, 2011 Istanbul, Turkey Theme: Endodontics in primary teeth and immature permanent teeth Prof. Norbert Kraemer (Giessen, Germany) Prof. Monty Duggal (Leeds, UK) Prof. Demetrios Tziafas (Thessaloniki, Greece) www.turkpedo.org info@turkpedo.org