FUTURE OFDENTISTRYIt might be reasonable to speculate that the avail-
ability of oral hygiene products, both mechanical
and chemotherapeutic, in industrialized countries
might improve periodontal health in industrialized
countries and possibly, by association, certain sys-
temic health conditions. Progress in lower-income
or in emerging-market economies would be slower.
In the latter, availability of affordable products for
prevention would be a real issue.
Oral Manifestations of Systemic Diseases
Infectious systemic diseases, such as HIV, which
have oral manifestations, could increase. Middle-
income and emerging-market countries that experi-
ence rapid dislocations of traditional institutions
and cultural practices might undergo changes in
diet, housing, sanitation, and income, and may
exhibit disease patterns associated with the resulting
reduced immunologic resistance. For example, the
anticipated increase in the number of HIV cases in
the United States and elsewhere in the world will
affect oral health and treatment requirements.
As populations age throughout the world, they will
experience multiple chronic debilitating diseases, as well
as more complex oral conditions, multiplying the chal-
lenges for the dental professional familiar with the pre-
vention, diagnosis, and treatment of caries and peri-
odontal diseases in individuals with no other health
concerns. The management of oral health and systemic
health will be more closely aligned and dentists world-
wide will need to work with physicians and other
health care practitioners to meet these challenges.
Oral Cancers
Oral cancers will continue to be a major and grow-
ing public health problem where using tobacco,
chewing betel nuts, and consuming alcohol or other
carcinogens are risk behaviors of sizable proportion.
Whether in the United States or in countries from
which the United States receives immigrants, the
delivery of prevention, early diagnosis and manage-
ment of oral and nasopharyngeal cancers will
remain an issue.
FUTURE CHANGES IN ORAL HEALTH CARE
DELIVERY
Countries, including the United States, with large
population segments that have unique health care
needs, such as the elderly, uninsured adults, young
children, and recent immigrants, may find solutions
to oral health problems by studying models and
policies in societies that have comparable trends.
The challenge is to understand the significance of
these demographic and disease trends and to devel-
op strategies to meet these needs. As the population
ages, the systems by which health care is delivered,
the sites for service delivery, and the mechanisms of
payment may require options already found in
countries with large populations of elderly. For
example, solving the problem of how to reimburse
the elderly in the United States for oral health care
or health care having oral complications might be
facilitated by examining solutions and options in
countries that have already come to terms with this
demographic phenomenon.
In 1996, the United States Bureau of the Census
(U.S. Bureau of the Census, Economics and
Statistics Administration) reported that 16.5% of
the United States population was age 60 and over.
Twenty-four countries had even higher proportions
in that age group. Italy, Greece, and Sweden topped
the list, followed by Belgium and Spain. In 1996,
the estimated number of persons in the world 60
years of age and older was 550 million; by 2025
there will be 1.2 billion persons 60 and older in the
world. Older populations in the least developed
countries are growing much more rapidly than those
in the more developed countries.
Similarly, countries, including the United States,
with large proportions of uninsured adults or young
children, may find solutions by studying models and
policies in societies that may have comparable
trends. The challenge is to understand how signifi-
cant these demographic and disease trends might be
and to develop a strategy to meet these needs.
It has been asserted by the International Summit
on the Private Health Sector that the private health
care sector outside the United States will double in
the next 5 years (Academy for International Health
Studies, 2000). In the interest of profit making, the
private sector may abandon or ignore the economi-
cally disenfranchised, the elderly, the poor, the
unemployed, and the less fortunate. Towards
responding to these issues, the international summit
will facilitate a number of globalized efforts foster-
ing public/private partnerships across national bor-
ders, providing a forum for information-sharing
about health reforms, globalization of health care
services and trade, health investor information, andGlobal Oral Health