Enrico Gherlone Political and professional activity

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Prof Gherlone's professional dentistry political activity in addition to his academic activity as a member of the College of Dentistry received an abrupt acceleration when he joined the Berlusconi government. In 2008, Prof. Fazio, first as undersecretary then as deputy minister and later as minister, immediately called on him as his dentistry contact person to represent this speciality in the national health planning commission at the Ministry of Health.

Subsequently, he became the sole representative of dentistry under the delegation of Minister Fazio as a full member of the Higher Health Council until August 2013.

Since 2012, he has been a member of the 'Technical Group on Dentistry' (established by DD of 24 May 2012) of the Department of Public Health and Innovation, Ministry of Health.

In recent years, as referent of the Minister of Health, Prof. Gherlone has been an actor in the agreement between the ministry itself, Andi (National Association of Italian Dentists) and OCI (Italian Catholic Dentists) concerning Social Dentistry, i.e. the promotion of affordable access to extra LEA (Essential Levels of Care) services for the less affluent sections of the population. In the Higher Council of Health, he was rapporteur and promoter of the approval of the 'clinical recommendations in dentistry', i.e. operational protocols recommended to professionals to achieve good treatment results and drawn up by all the scientific societies in synergy with the professional associations the College of Dentistry under the coordination of the CAO (Dentists' Association Commission). Also, within the framework of the board, he was rapporteur for the approval of new specialities of dentistry interest.

Actions taken

In view of the national epidemiological picture and the current knowledge of the public and private supply situation, in agreement with the current political-administrative leadership, Prof. Gherlone felt it his duty to promote a whole series of initiatives that find in prevention the key to tackling the clinical problems involving the oral cavity of our fellow citizens in a more decisive and timely manner.

In particular, the first act was to have the document entitled 'National guidelines for the prevention of oral pathologies in the age of development' approved, created with the aim of defining, in collaboration with various medical figures (gynecologists, neonatologists, pediatricians, nutritionists, dentists, dental hygienists public health experts), unitary guidelines for the prevention of caries, the prevention of gingivitis, the prevention of orthopedic problems of the jaws, the prevention of mucous membrane pathologies, with particular reference to subjects with special needs and for the promotion of oral health education in childhood. The document, once approved by the Minister, Prof. Fazio, was published and widely distributed in all dental journals and at conferences and seminars.

In the wake of this initiative, again under the coordination of Prof. Gherlone and thanks to the contribution of talented colleagues, the 'National guidelines for the prevention of oral diseases in adulthood' and the 'Guidelines for the promotion of oral health and the prevention of oral diseases in individuals of developmental age who are to undergo chemo- and/or radiotherapy' and the 'Clinical recommendations for the prevention of osteonecrosis of the jaw/ mandible by bisphosphonates' were drafted, approved and published.

The 'Clinical Recommendations in the Dental Sector' were also produced. This document, which saw the involvement of everyone in the dental sector, is intended to provide guidelines not only of a clinical nature but also on the appropriate use of equipment and materials commonly used in dentistry.

Still about prevention, the current National Prevention Plan (PNP) 2010-2012 provides for a 'Line of Support' for the 'Dental Pathologies' area, which has practically translated into the presentation of oral prevention projects by eight Italian regions. The aim of this support is to make available all the most valid knowledge on the most effective experiences to enable the improvement of prevention strategies and the early recognition of the most common pathologies of the oral cavity. Until now, no attention had ever been given to dentistry within the framework of a Regional Prevention Plan.

Therefore, to guarantee greater access to dental care, a special Agreement has been signed between the Ministry of Health and the liberal professions engaged in the practice of dentistry, with the aim of permitting the provision of packages of services at agreed fees to categories of citizens throughout the country. The Agreement provides citizens who, in the various Regions, are exempt from paying co-payments for specialist medical services, or who fall within the benefits provided for based on the ISEE index established by their municipality of residence, with a series of services at much lower fees than those usually charged. In addition, the beneficiary categories, limited to oral hygiene services, include, regardless of income, pregnant women.

The Agreement, voluntarily adhered to by dentists, and operational since April 2009, has so far been joined by more than 6,000 dental practices nationwide.

For the first time, therefore, a specific section devoted to odontostomatology has been set up within the 'Report on the Health Status of the Country 2007-2008', to give, even to non-specialists, especially 'politicians', a precise and accurate picture of the dental situation in our country, just as a special section devoted to dental health has been activated on the home page of the Ministry's website (http://www.ministerosalute.it/sorrisoSalute/sorrisoSalute.jsp).

Moreover, in view of the reported shortage of human resources in the NHS in the dental field, which is also linked to the bureaucratic procedures required to gain access to the professional qualification of dentist (mandatory possession of a specialization diploma), Prof. Gherlone was the promoter of a proposal to the Minister of Health, contained in the bill 'Clinical trials and other health provisions', approved by the Council of Ministers, to repeal the law 'Clinical trials and other health provisions', which was approved by the Council of Ministers. Gherlone was the promoter at the Ministry of Health of a proposal, contained in the bill 'Clinical trials and other health-related provisions' approved by the Council of Ministers, for the repeal of the current rules indicating the specialization diploma in dentistry as a prerequisite for access to the professional managerial profile of dentist and for the appointment as head of a complex structure in the National Health Service (SSN). This, in view of the already specialized content of the Degree Course in Dentistry, should translate, not into a short cut, but into a greater possibility of access to the managerial profile of dentist within the NHS.

Certainly 'something' has been done, but much more remains to be done, especially in a sector that is almost exclusively the preserve of the liberal professions and is sometimes neglected by those involved in public health. Certainly, one of the next objectives concerns the clear and precise definition of the professional figure of the dental practice assistant (ASO). In fact, as called for by many, it is necessary to standardize this professional figure throughout Italy in terms of both the training course and the definition of a specific job description. Work is under way to this end, in an excellent spirit of cooperation between all those involved in this delicate path.

Among the various actions exercised by Prof. Gherlone during the period, specified above, at the Ministry of Health (Department of Public Health and Innovation), it is worth mentioning:

• An Agreement was signed with the scientific community of gynecologists, neonatologists, pediatricians, nutritionists, dentists, dental hygienists, and public health experts for the drafting of national guidelines on the promotion of oral health and the prevention of diseases such as dental caries and periodontal disease, in individuals of developmental age.
  • Objective: to define, in collaboration with the various medical figures, unified guidelines for the prevention of caries, the prevention of gingivitis, the prevention of orthopedic problems of the jaws, the prevention of mucous membrane pathologies, with reference to subjects with special needs and for the promotion of oral health education in childhood.
  • The document, entitled 'National guidelines for the prevention of oral diseases in childhood' was finalized, published, and widely distributed in all dental journals.
  • (Bodies involved: Department of Prevention and Communication, WHO Centre for Oral Epidemiology and Community Dentistry).

• Concluded a project for:
  • a census of public dental facilities in the country, with a dedicated specialist 'workforce'.
    • Objective: to know in detail the structural and human resources that can be relied upon for the provision of dental services under the NHS and to plan public health interventions. The document has been published on the Ministry's website in the 'Dental and Mouth Health' section http://www.salute.gov.it/sorrisoSalute/paginaInternaMenuSorrisoSalute.jsp?id=1484&menu=offerta
    • (Bodies involved: Former Department of Prevention and Communication, WHO Centre for Oral Epidemiology and Community Dentistry in Milan).
  • experimentation of a prevention model (sealing of the first permanent molars) supplemented by training courses through the involvement of the public service (ASL Roma A, ASL Sassari, ASL Lecce, ASL Napoli Scampia), to assess the public's ability to cope with the needs of preventive practices in the field of odontostomatology.
    • Objective: to assess, after a cost/benefit analysis, the possibility of applying the tested healthcare model throughout the country, for the benefit of individuals in the age of development.
    • The trial, for the implementation of which 900,000.00 euro was allocated, involved 40 socio-sanitary districts. Sealants were applied to 8,377 individuals aged 7 years and to a total of 15,000 definitive elements. This is a completely new initiative for Italy, since, for the first time, a dental prevention intervention has been proposed and implemented on such a large scale.
    • (Bodies involved: Department of Prevention and Communication, General Directorate for Health Prevention, WHO Centre for Oral Epidemiology and Community Dentistry, ASL Roma A, ASL Lecce, ASL Sassari, ASL Napoli Scampia).