Water fluoridation has been confirmed by three recent reviews as one of the most cost-effective and safe primary preventive measure against dental caries. Despite this evidence no artificially fluoridated water scheme exists in South Africa. The economic impact of water fluoridation in times of a reduction in dental caries should be weighed against its benefits. A minimum package of oral care has been proposed for implementation in the public oral health services. Irrespective of the implementation of water fluoridation and/or a minimum package or oral care, it will impact on the required oral health human resources. The aim of this study was to investigate the economic viability of the implementation of water fluoridation and the delivery of the minimum package of oral care and the impact this will have on human resources planning for oral health in South Africa. Computerised simulation models were developed for this study. Per capita cost, cost-effectiveness and cost-benefit of the implementation of water fluoridation was calculated for seventeen major metropolitan cities, towns and water boards in South Africa. Treatment need data was converted to a per capita cost to express the delivery of the minimum package of oral care as a monetary value. The World Health Organization/Fédération Dentaire Internationale and a “Service Targets Method” model were used to calculate the oral health human resources required to deliver the minimum package of oral care. The average per capita cost of water fluoridation for the total population is R2.08. At an anticipated 30% caries reduction achieved with water fluoridation, average cost-effectiveness is R33.16 and cost-benefit was calculated as 0.18. Cost-benefit equals or exceeds 0.8 for only three municipalities or water boards at an anticipated 10% caries reduction as a result of the implementation of water fluoridation. The average per capita cost to provide the minimum package of oral care is R245.95 without the impact of water fluoridation and R186.03 at an anticipated 30% caries reduction due to water fluoridation. Oral hygienists represent more than 50%, dental therapists between 30 to 40% and dentists less than 10% of the total oral health human resources required to deliver the minimum package of oral care. At an anticipated caries reduction of 30% due to the introduction of water fluoridation, the number of dentists required decrease by 29%, dental therapists between 27.5 and 29.8% and oral hygienists between 2.1 and 10.5%. This converts to a saving in salaries of R14,8 million per year.</p It is recommended that water fluoridation remains a viable option for South Africa, even if only a 10% caries reduction as a result of its introduction is achieved. All provinces should actively pursue the introduction of the minimum package of oral care with appropriate modes of delivery by creating a number of posts as well as incentives to attract especially oral hygienists and dental therapists to the public service. The impact of the introduction of water fluoridation on human resources should always be considered in planning the number of oral health professionals to be trained. / Thesis (PhD)--University of Pretoria, 2009. / Community Dentistry / unrestricted

A Atenção Primária em Saúde (APS), que é base para o Sistema Único de Saúde (SUS), tem dois componentes fundamentais que são a integralidade e a educação em saúde. Compreender as moléstias crônicas em seu contexto social e familiar é dever dos profissionais que atuam nas equipes de Saúde da Família (eSF). Neste cenário, a incorporação dos profissionais da área de Saúde Bucal (SB) à Estratégia Saúde da Família (ESF) trouxe novas necessidades de conhecimento e prática para os trabalhadores da equipe de Saúde da Família executarem suas tarefas especialmente no atendimento domiciliar. Portanto, há necessidade de criação de materiais educacionais em Teleodontologia que sejam adequados às necessidades de informação e que respeitem o conhecimento prévio dos trabalhadores sobre Saúde Bucal (SB). Assim, é importante saber o que os profissionais da Estratégia Saúde da Família (ESF) conhecem e como aplicam os conceitos da promoção em Saúde Bucal (SB). Esta pesquisa procura saber o quanto cada categoria de profissionais de uma equipe de Saúde da Família (eSF) do Município de Platina, SP, conhecem e praticam Saúde Bucal (SB) e aplicam em suas atividades diárias. Para isso, foi elaborado um questionário aberto de livre adesão e os respondentes emitiam, com total e irrestrita liberdade, as suas observações, avaliações e sugestões relativas às suas experiências pessoais no seu trabalho na eSF a que pertencem. A coleta de dados contemplou uma única equipe, o que permitiu trabalhar com dados confiáveis. A partir das respostas tabuladas, analisadas qualitativamente e com percentuais de frequência, verifica-se que há necessidade dos trabalhadores se instrumentalizarem para as tarefas de ensinar e supervisionar o conjunto dos membros das famílias atendidas, quanto aos procedimentos de prevenção, de manutenção e promoção da saúde bucal, tornando a integralidade e conhecimento com educação em saúde bucal uma consequência efetiva na saúde geral de cada cidadão e da comunidade / The Primary Health Care (APS), the basis of the Unified Health System (SUS), has two main components: completeness and health education. Understanding the chronic diseases in their social and family environment is the duty of the professionals who work in the Family Health Teams (eSF). In this context the incorporation of professionals from the oral health area (SB) into the Family Health Strategy (ESF), brought new needs of knowledge and practice to the agents of the Family Health Teams (eSF) to perform their tasks especially in home care. Therefore, it is necessary to create educational materials on Teledentistry that are appropriate to the information needs, respecting the prior knowledge of the Oral Health agents (SB). Thus, it is important to know what the professionals of the Family Health Strategy (FHS) know and how they apply the concepts of promotion in Oral Health (SB). This research has the objective of knowing how much each category of professionals from the Family Health Team (eSF) in the municipality of Platina, SP, knows and practices Oral Health (SB) and apply it in their daily activities. In this regard, we designed an open free adhesion questionnaire where the responders had full and unrestricted freedom to issue their comments, evaluations and suggestions about their personal experiences in their work with the eSF they belong. Data collection included a single team. This allowed the work with reliable data. From the quantitatively tabulated responses, including the percentage of frequency, it appears that there is a need of the agents to prepare themselves to the task of teaching and supervising all the members of the families as to the procedures of prevention, maintenance and oral health promotion. All this makes the completeness and knowledge about oral health education an effective result in the overall health of every citizen and the community

A Atenção Primária em Saúde (APS), que é base para o Sistema Único de Saúde (SUS), tem dois componentes fundamentais que são a integralidade e a educação em saúde. Compreender as moléstias crônicas em seu contexto social e familiar é dever dos profissionais que atuam nas equipes de Saúde da Família (eSF). Neste cenário, a incorporação dos profissionais da área de Saúde Bucal (SB) à Estratégia Saúde da Família (ESF) trouxe novas necessidades de conhecimento e prática para os trabalhadores da equipe de Saúde da Família executarem suas tarefas especialmente no atendimento domiciliar. Portanto, há necessidade de criação de materiais educacionais em Teleodontologia que sejam adequados às necessidades de informação e que respeitem o conhecimento prévio dos trabalhadores sobre Saúde Bucal (SB). Assim, é importante saber o que os profissionais da Estratégia Saúde da Família (ESF) conhecem e como aplicam os conceitos da promoção em Saúde Bucal (SB). Esta pesquisa procura saber o quanto cada categoria de profissionais de uma equipe de Saúde da Família (eSF) do Município de Platina, SP, conhecem e praticam Saúde Bucal (SB) e aplicam em suas atividades diárias. Para isso, foi elaborado um questionário aberto de livre adesão e os respondentes emitiam, com total e irrestrita liberdade, as suas observações, avaliações e sugestões relativas às suas experiências pessoais no seu trabalho na eSF a que pertencem. A coleta de dados contemplou uma única equipe, o que permitiu trabalhar com dados confiáveis. A partir das respostas tabuladas, analisadas qualitativamente e com percentuais de frequência, verifica-se que há necessidade dos trabalhadores se instrumentalizarem para as tarefas de ensinar e supervisionar o conjunto dos membros das famílias atendidas, quanto aos procedimentos de prevenção, de manutenção e promoção da saúde bucal, tornando a integralidade e conhecimento com educação em saúde bucal uma consequência efetiva na saúde geral de cada cidadão e da comunidade / The Primary Health Care (APS), the basis of the Unified Health System (SUS), has two main components: completeness and health education. Understanding the chronic diseases in their social and family environment is the duty of the professionals who work in the Family Health Teams (eSF). In this context the incorporation of professionals from the oral health area (SB) into the Family Health Strategy (ESF), brought new needs of knowledge and practice to the agents of the Family Health Teams (eSF) to perform their tasks especially in home care. Therefore, it is necessary to create educational materials on Teledentistry that are appropriate to the information needs, respecting the prior knowledge of the Oral Health agents (SB). Thus, it is important to know what the professionals of the Family Health Strategy (FHS) know and how they apply the concepts of promotion in Oral Health (SB). This research has the objective of knowing how much each category of professionals from the Family Health Team (eSF) in the municipality of Platina, SP, knows and practices Oral Health (SB) and apply it in their daily activities. In this regard, we designed an open free adhesion questionnaire where the responders had full and unrestricted freedom to issue their comments, evaluations and suggestions about their personal experiences in their work with the eSF they belong. Data collection included a single team. This allowed the work with reliable data. From the quantitatively tabulated responses, including the percentage of frequency, it appears that there is a need of the agents to prepare themselves to the task of teaching and supervising all the members of the families as to the procedures of prevention, maintenance and oral health promotion. All this makes the completeness and knowledge about oral health education an effective result in the overall health of every citizen and the community