China's oral care system in transition: lessons to be learned from Germany.
OBJECTIVE
The objective of this discussion paper is to investigate whether the experience gained through the German paradigm shift in dental care can be of benefit in China's deliberations on the introduction of universal dental care for its people. METHODOLOGY A comparison of representative oral health outcome data from China and Germany, two countries at different stages in their development, is presented here in order to analyse whether the findings meet expected outcome and confirm the presumption that more developed countries perform better.


RESULTS
The epidemiological comparison reveals surprising findings concerning the severity of dental diseases and, in particular, missing teeth per person in adults and rates of total edentulousness in seniors. In all of these areas German adults and seniors show significantly inferior outcomes compared with the Chinese population. The main reason for these striking discrepancies, as it turned out, is the decisive role played by the treatment philosophies and strategies of German dentists.


CONCLUSIONS
If dentists take a less interventionist approach, checking as well as treating dental diseases with preventive and strictly tooth-preserving methods, dental treatment results in oral health. Under these conditions it can be assumed that modern dentistry is generally good for the teeth. These findings are important for developing countries that are seeking to integrate dental care into their health care system. On the basis of long-term experience from highly industrialized Western countries and especially from Germany we will attempt to put forward proposals for creating an effective and efficient dental care system in China.
Department of Dental Care in the Federal Ministry of Health, Bonn, Germany. ruediger@saekel.de
Ruediger
R
Saekel
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003149:Community Dentistry; D003695:Delivery of Health Care / Q000458:organization & administration*; D003731:Dental Caries / Q000453:epidemiology; D003752:Dental Health Services / Q000458:organization & administration*; D003815:Dentists / Q000600:supply & distribution; D005858:Germany / Q000453:epidemiology; D018166:Health Care Reform; D006291:Health Policy; D006292:Health Priorities; D019456:Health Transition; D006801:Humans; D007348:Insurance, Health; D008875:Middle Aged; D009066:Mouth, Edentulous / Q000453:epidemiology; D009909:Oral Health; D017063:Outcome Assessment, Health Care; D010510:Periodontal Diseases / Q000453:epidemiology; D010685:Philosophy, Dental; D011313:Preventive Dentistry; D012051:Reimbursement Mechanisms; D016388:Tooth Loss / Q000453:epidemiology; D019472:Universal Health Insurance / Q000458:organization & administration; D055815:Young Adult