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).
  • An Agreement was signed with the National Association of Italian Dentists (ANDI) and the Association of Italian Catholic Dentists (OCI) for the provision, to specific categories of citizens, throughout Italy, of packages of services at agreed fees.
    • 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 ISE index established by their municipality of residence, with a series of services at fees on average 40% lower than those usually charged. In addition, the beneficiary categories, limited to oral hygiene services, include, regardless of income, pregnant women. The Agreement, with voluntary adherence, initially only of ANDI and OCI members, and operational since April 2009, saw the adherence of more than 6,000 dental practices nationwide. Subsequently, freelancers not registered with the above-mentioned Associations were also granted the freedom to join the Agreement.
    • (Bodies involved: Ministry of Health, National Association of Italian Dentists, Italian Catholic Dentists Association, other sector Associations).
  • Implementation of the 'Dental Pathology Support Line' as part of the National Prevention Plan 2010-2012, which provides for the monitoring and management of 8 regional projects for the promotion of oral health (Line P). For the first time, the Ministry of Health has deemed it its duty, in the field of dentistry, to provide answers capable of valorizing positive elements, avoiding the repetition of inveterate practices that are now completely useless, as well as to identify new methods of intervention that are characterized by the simplification of bureaucratic procedures, effective prioritization and collaboration with sectors outside the health system (public administrations, associations, etc.).
  • A specific section dedicated to odontostomatology has been produced as part of the "Report on the Health Status of the Country 2007-2008 and 2009-2010".
    • The report is a tool for analyzing the epidemiological situation, health determinants, and the responses in terms of prevention, care, rehabilitation, and quality of the NHS. About the dental sector, all the elements relating to diseases of the teeth and mouth, dental prevention and care activities have been brought to the country's attention, all with a view to fostering good healthcare planning.
  • The 'National Guidelines for the Promotion of Oral Health and the Prevention of Oral Diseases in Adulthood' have been published.
    • Objective: to offer unambiguous, shared indications based on the best available scientific evidence for the prevention, in adults, of pathologies such as hard tissue diseases (e.g. caries), periodontal disease, edentulism, pre-cancerous lesions, and oral carcinoma. It therefore represents a tool to support the work of practitioners.
    • (Bodies involved: Ministry of Health, University of Rome 'Tor vergata', University of Bari; University Vita-Salute San Raffaele-Milan, University 'Sapienza' of Rome). The document was published on the Ministry's website and in specialist journals in the sector.
  • “National guidelines for the promotion of oral health and the prevention of oral diseases in children undergoing chemo- and/or radiotherapy” published.
    • Objective: to offer unambiguous, shared indications based on the best available scientific evidence for the management of problems involving the oral cavity in patients of developmental age who are candidates for antineoplastic treatment, undergoing treatment or who have completed it.
    • (Bodies involved: Ministry of Health, Association of Italian Dental Hygienists, Children's Hospital "Regina Margherita-Sant'Anna" of Turin, University Vita-Salute San Raffaele-Milan, University "Sapienza" of Rome, University of Sassari, University of Brescia, University of Bologna, University "Federico II" of Naples, University Hospital "A. Mayer' of Florence, Oncology Institute Veneto-IRCCS, Italian Federation of Parents of Oncohaematological Children, Bambino Gesù Hospital, WHO Centre for Oral Epidemiology and Community Dentistry). The document has been published on the Ministry's website and in specialist journals in the field.
  • Published the monograph (series "Quaderni del Ministero della salute") entitled "Community dentistry: criteria of clinical, technological and structural appropriateness for the prevention and treatment of the main diseases of the oral cavity" (http://www.quadernidellasalute.it/quaderni-html/7-gennaio-febbraio-2011.php). Objective: to provide a series of information to public and private operators necessary for the definition of intervention standards for taking care of odontostomatological pathologies.
  • Published the 'National guidelines for the prevention and clinical management of dental trauma in individuals of developmental age'. Objective: to adopt, on a national level, unified guidelines for improving the "management" of traumatized children, from the moment of trauma to taking charge of the pediatric dentist.
  • Published the document: "Drug-addicted population: indications for the promotion of oral health and prevention and protection interventions". Objective: to provide indications for promoting oral health and preventing oral pathologies in drug-addicted subjects.
  • Three oral health projects funded by the CCM
    • "Experimentation of a clinical pathway concerning the prevention/diagnosis and treatment of oral pathologies in drug addicted, HIV and HCV positive patients, guests of recovery communities".
      • Main partner: Centro San Raffaele del Monte Tabor Foundation, IRCSS
      • Duration: 12 months
      • Funding: euro 50,000.00
    • "Experimentation of a territorial pathway for the prevention/diagnosis of malignant tumors of the oral cavity.
      • Main partner: Centro San Raffaele del Monte Tabor Foundation, IRCSS
      • Duration: 12 months
      • Funding: euro 200,000.00
    • "Design and experimentation of a sustainable system to increase and improve the quality of dental care for patients with difficulties in accessing treatment and the differently abled.
      • Main partner: University of Trieste
      • Duration: 24 months (ongoing)
      • Funding: euro 700,000.00
  • Various events were organized at the Ministry's headquarters (Auditorium, Via Lungotevere Ripa, 1) to promote community prevention programmers in the dental field. Of note was the one held concerning a professional refresher course on oral carcinoma, organized by the National Commission of Dentists (CAO).
  • Elaboration of Clinical Recommendations in the field of dentistry. It was intended to provide guidelines not only of a clinical nature but also on the appropriate use of equipment and materials commonly used in dentistry.
    • The above is also necessary in view of the growing trend towards a generalized and uncontrolled reduction in professional fees, which could lead to the provision of lower quality dental services, resulting in situations that are not easily manageable, to the detriment of the health of the citizen-patient.
    • Moreover, this initiative is also particularly important in view of the implementation of the Supplementary Funds as of 2010.
    • The elaboration of the above-mentioned Clinical Recommendations, under the supervision of the Ministry, took place through the collaboration of the following actors
      • Professional Association (C.A.O.): for the aspects of deontological competence.
      • College of Dentistry.
      • The most representative professional associations (ANDI, AIO, ADI): for the verification of practical applicability to the professional world.
      • The most significant scientific societies for each subject, both academic and freelance.
      • Experts in Forensic Dentistry, who have endorsed the work produced, for the prevention of aspects relating to medico-legal litigation.
    • Finally, approval at the Superior Health Council of the same topics:
      • CONSERVATIVE DENTISTRY
      • ENDODONTICS
      • PERIODONTOLOGY
      • PROSTHETICS/GNATHOLOGY
      • SURGERY/IMPLANTOLOGY
      • PEDODONTICS
      • ORTHODONTICS
      • ORAL PATHOLOGY
      • SPECIAL ODONTOSTOMATOLOGY PATHOLOGY
    • In addition, Prof. Gherlone was the scientific coordinator of an ordinary targeted research project in 2007, entitled 'Evaluation of implant-prosthodontics rehabilitations in disability, special needs and low socio-economic condition patients'. This project envisaged a clinical protocol of implant-prosthodontic rehabilitations on patients with disabilities, special needs, and low socio-economic status, clinically performed in the operating room and dental units of the San Luigi - Ville Turro center.
  • Revision of the 'National Guidelines for Oral Health Promotion and Prevention of Oral Diseases in Adults' published.
    • Objective: to offer unambiguous, shared indications based on the best available scientific evidence for the prevention, in adults, of pathologies such as hard tissue diseases (e.g. caries), periodontal disease, edentulism, precancerous lesions, oral carcinoma. It therefore represents a tool to support the work of practitioners. The guidelines have been revised according to the latest scientific evidence in the dental literature.
  • SEPTEMBER 2017: The Ministry of Health's 'Review of Clinical Recommendations in Odontostomatology' was published, for which Prof Gherlone was the scientific coordinator of the various working groups.
  • Prof. Gherlone is currently Scientific Coordinator of the following Ministry of Health Working Groups
    • Revision of the "National guidelines for the prevention and clinical management of dental trauma in individuals in the age of development" with the appendix dedicated to the "treatment of traumatic outcomes on the TMJ"
    • Coordinator of the first ministerial guidelines on "The use of amalgam in dentistry".

Since 10 April 2020, he has been Coordinator of the Ministry of Health technical table on "operational indications for dental activity during phase 2 of the Covid-19 pandemic".

Since 30 September 2020, he has been a member of the National Observatory of Specialist Health Training of the Ministry of University and Research.

He is currently Coordinator of the Technical Table of the Ministry of Health aimed at training, research, and planning of dental activity, appointed by Decree of the Chief of Cabinet of the Minister of Health on 5 November 2020.

On 15 February 2022, by Decree no. 2923 of the Ministry of Health, he is appointed as a full member of the Superior Health Council.

In December 2022, he was awarded the Bonifacio VII International Prize "...for a culture of peace", a prize previously awarded to personalities such as the Presidents Emeritus of the Republic Oscar Luigi Scalfaro and Carlo Azeglio Ciampi, Nobel Prize winner Rita Levi Montalcini, Senator Giulio Andreotti and many others.

On 5 January 2023 he was appointed Counsellor to the Minister of Health for the dental area.

In January 2023 he was elected National President of the Italian Society of Odontostomatology and Maxillofacial Surgery.

On 23 February 2023 he was appointed to the National University Council (CUN) as representative of non-state universities.

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