Common Risk Factor Approach as a Tool to Promote Oral Health care

Recently, health, well-being and functional ability have improved among residents in highly developed countries such as Finland and Japan. However, it is uncertain, if the positive development will continue in the future. For example, dietary habits have become less healthy and physical activity has declined (Kaikkonen R. et al. 2012). Health inequalities remain high between different regional and educational background groups in these countries (Koponen P. et al. 2018; Yamamoto T. & Tsuneishi M. 2015).

Promoting health with the means of multi professional work is an important way to promote better life for inhabitants of municipalities. Universities of applied sciences educating dental hygienists need to prepare future professionals to work together on the challenges of healthcare, in the changing societies and in different cultural contexts.

In this blog post, we will discuss the common risk factor approach and its means to improve the oral health of people in Finland and Japan.

Insights to health and oral health in Finland and Japan

Both Finland and Japan are highly developed countries. Technological development in both countries has been rapid during the past 50 years, also in health care sector. In Japan and Finland, health care sectors are wide and diverse, but still, there are inequalities and health divides between different population groups (e.g., low-income pensioners).

In Finland, there is polarization, which means that there is a small group of children, who suffer from many different problems in their social environment and in health issues, like oral and dental diseases. Only half of children brush their teeth twice a day, as it is recommended. There is also poverty in addition to bad dietary habits (too much sugar and not enough vegetables/ berries and fruits). (Kaikkonen R. et al. 2012).

Children’s overweight and obesity status are a serious public health problem. Around 10% of three- to five-year-old boys and 15% of girls at the same age group, and more than every fifth child at school was overweight or obese. There seems to be not enough responsible adults to guide children growing. Even one excluded youth causes severe consequences for individuals, families and communities. (Kaikkonen R. et al. 2012.)

In Japan, which has the world’s highest life expectancy, the main causes of death are cancer, heart disease, pneumonia, and cerebrovascular diseases. These account for approximately 70% of all deaths. In the past 50 years, there has been a great shift in the disease structure and causes of death. Theoretically, if these diseases could be successfully prevented, there could be an extension in average life expectancy. In case of cancer, this could be around 3 to 4 years. In case of heart disease, an extension in average life expectancy could be around 1.5 years , and in the case of pneumonia and cerebrovascular diseases around 1 year. Since many Japanese live longer than the average life expectancy, the healthcare system must take this fact into consideration (Fukai K. 2015).

The results of the study regarding the association of dental and oral health with main causes of death and non-communicable diseases revealed that there exists evidence that shows associations with

• diabetes mellitus
• pneumonia
• cancer
• cardiovascular diseases
• metabolic syndrome.

In order to efficiently carry out dental health education in the field of clinical and public health, there is a need to consider the cost-effectiveness of various types of dental health education. (Yamamoto T & Tsuneishi M 2015) In particular, learning the theoretical framework related to strategies and approaches in disease prevention, such as the common risk factor approach, is very important. This is because theoretical study is important not only to deepen the understanding of the content, but also to connect it to clinical practice.

Metropolia University of Applied Sciences and Tokushima University have implemented international student exchange program for oral hygiene students from year 2010.  An international survey in the oral hygiene student exchange program was carried out between the partners regarding oral health care in elderly care facilities. This study indicated that the oral health care in health care facilities for the elderly is not enough in both countries, and the major problems of oral health care in health care facilities for the elderly are almost the same in both countries. (Iga H. et al. 2018)

The benefits of common risk factor approach

The common risk factor approach aims to address common risk factors such as nutrition, hygiene, smoking and alcohol, in order to promote more efficient preventive programs. Many studies (Sheiham & Watt 2000; Watt & Sheiham 2012; Do 2014) point out the importance of the common risk factor approach concerning oral health and general health such as

• pneumonia and oral health
• obesity and periodontal disease.

However, most courses in oral hygiene do not take into consideration these common inter-relationships. Moreover, Finnish and Japanese nursing and oral hygiene students do not have enough opportunities to learn these relationships together. Periodontal disease, which represents one of major oral diseases worldwide, has both aspects of an infectious disease and lifestyle-related disease. Therefore, in the clinical setting, it is believed that improved lifestyle habits will lead to a reduced risk of periodontal disease. Dental health guidance performed in conjunction with treatment, which has been shown to greatly affect prognoses, occupies an important place in dental care. Social exclusion is one of the risk factors among the patients of oral health care sector.

The common risk factor  approach is highly influential in integrating oral health into general health improvement strategies. Oral health professionals can effectively reduce the morbidity and mortality from chronic diseases and decrease the incidence of oral diseases, by working within and between their professional organizations in order to find enduring solutions.

There is a need for cooperation and collaboration in health promotion of the client.  For example, health care professionals should understand that smoking cessation counseling in the dental setting is effective. Common risk factor approach is suitable in the health care sector development in community level. Policy makers should develop the legal infrastructure to facilitate the provision of smoking cessation counseling in the dental setting based on this evidence.

International course on common risk factor approach

Degree programs in Oral health care at Metropolia UAS and Tokushima University have developed an inter-professional e-learning course to address the risk factors between oral and general health in different age groups. Development of the course increased the knowledge of students and teachers in both countries in the aspects of general and oral health and their relation. Familiarizing with the common risk factor approach gave new insights into teaching contents in both institutions.  For example, students of Tokushima University learned that the Finnish ”sugar tax”, which is not found in Japan, has a role in suppressing sugar overdose and preventing the onset of obesity and diabetes. In addition, they learned more about the contents of the law revision regarding smoking cessation measures in Japan. Metropolia students learned more about dysphagia and its relation to pneumonia.

The course was developed in the project “The common risk factor approach: Developing an international e-learning course for oral hygiene students in Finland and Japan”. Publications produced in the project disseminated the topic to the wider audience.   

Common risk factor approach in curriculum

The common risk factor approach is suitable to be included in the curriculum of oral hygiene students. It is also suitable for other health care professionals’ education. This model will provide broader perspectives and new insights to students during studies including international exchanges and collaboration.

The common risk factor approach shows that multiprofessional collaboration is important in promotion of general and oral health. This promotes the better health and longer life of people in Finland and Japan.

—

The project “The common risk factor approach: Developing an international e-learning course for oral hygiene students in Finland and Japan” has received funding from Finnish National Agency for Education / Asia programme.

Literature

• Do LG, Scott JA, Thomson WM, Stamm JW, Rugg-Gunn AJ, Levy SM, Wong C, Devenish G, Ha DH, Spencer AJ (2014). Common risk factor approach to address socioeconomic inequality in the oral health of preschool children-a prospective cohort study. BMC Public Health 6;14:429. doi: 10.1186/1471-2458-14-429.
• Fukai K (2015): Oral health and aging: Fukai K et al. (Eds.). The current evidence of dental care and oral health for achieving healthy longevity in an aging society 2015. (PDF, opens jda.or.jp)
• Iga H, Hinode D, Rodis O, Shirayama Y, Toivanen-Labiad T, Nuutinen E, Haarala P, Ahokas A, Kawano F: International survey regarding oral health care in facilities for elderly in the dental hygiene student exchange program, Journal of Oral Health and Biosciences 31 (1) 73-77, 2018.
• Kaikkonen, R et al. (Eds.). (2012). Health and well-being inequalities among children and their families. National institute for health and welfare (THL) Report 16/2012. 188 Helsinki. (PDF, opens thl.fi)
• Koponen P, Borodulin K, Lundqvist A, Sääksjärvi K, Koskinen S, (Eds) (2018).Terveys, toimintakyky ja hyvinvointi Suomessa – FinTerveys 2017-tutkimus (aukeaa urn.fi). Raportti 4/2018. Terveyden ja hyvinvoinnin laitos, Helsinki.
• Sheiham A, Watt RG. (2000). The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol Dec;28(6):399-406.
• Watt RG, Sheiham A. (2012). Integrating the common risk factor approach into a social determinants framework. Community Dent Oral Epidemiol. 40(4):289-96.
• Yamamoto T, Tsuneishi M (2015): Effects of dental care: Fukai K et al. (Eds.). The current evidence of dental care and oral health for achieving healthy longevity in an aging society 2015. (PDF, opens jda.or.jp)

Authors

Aija Ahokas, Manager of Education Export / Senior Lecturer (MEd, RN, Specialist Qualification in Product Design). Ms Ahokas has many years of working experience abroad in the Middle East, in Saudi Arabia and United Arab Emirates. Her core competencies are in different international activities, networks and partnerships. In addition, her competencies include teaching and tutoring multicultural students. Transnational education is close to her heart.

Saila Pakarinen is lecturer (M.A Education, Oral Hygienist) in Degree program in Oral Hygiene in Metropolia UAS. She is interested in promoting the learning of students and multi professional collaboration to improve the oral health of clients.

Hiroki Iga (D.D.S., PhD) is a Professor at the Department of Oral Health Education in Tokushima University Graduate of Biomedical Sciences and an Oral Surgeon. Professor Iga has been the contact person for international collaboration between TU and Metropolia since 2011. Dr Iga is responsible for the curriculum development and development of educational methods in the degree program in dental hygiene.

Daisuke Hinode (D.D.S., PhD) is a Professor at the Department of Hygiene and Oral Health Science Tokushima University Graduate School of Biomedical Sciences. His special area is preventive dentistry for elderly care and epidemiology of elderly. In this project, the expertise area of Dr. Hinode is to organize and review the contents of lecture regarding the common risk factor approach in order to develop an inter-professional e-learning course.

Omar Marianito Maningo Rodis (D.M.D., PhD) is an Associate Professor at the Department of International Oral Health Science Education in Tokushima University Graduate of Biomedical Sciences. His specialty is behavioral pediatric dentistry and dental education. Currently, his scientific grants are focused on curriculum development to globalize dentistry in Japan. Dr. Rodis is to support for organization and reviewing the contents of lecture regarding the common risk factor approach.

Makoto Fukui (D.D.S., PhD) is an Associate Professor at the Department of Hygiene and Oral Health Science Tokushima University Graduate School of Biomedical Sciences. His special area is preventive dentistry for elderly care and epidemiology of elderly. In this project, the role of Dr. Fukui is to promote and to develop an inter-professional e-learning course regarding the common risk factor approach.