Chapter 30

Evidence-based prevention

PREVENTION IS BETTER THAN CURE

The importance of prevention, which UK oral health educators (OHEs) have been teaching for many years, is recognised by the UK Department of Health and NHS as crucial in improving the general and dental health of the nation [1, 2].

Prevention encompasses a wide range of strategies designed to prevent the development of dental disease and should be initiated in early childhood.

Examples of prevention include:

• Fluoridation of drinking water.
• Administration of topical fluoride in toothpaste and by other means if thought necessary (i.e. tablets and drops for infants, mouthwash, gels and varnish for older children and adults).
• Fissure sealing of first permanent molars.
• Choosing a diet low in extrinsic sugars.
• Effective oral hygiene techniques.
• Regular dental check-ups – that screen for diseases and conditions, such as oral cancer, caries and periodontal disease.

EVIDENCE-BASED PREVENTION

In the United Kingdom, much emphasis is placed on the importance of evidence-based prevention by the dental profession, the General Dental Council (GDC) and the government [2]. The term is used when research has shown that a particular strategy in reducing dental disease has been effective. For example, it can be scientifically proven that the addition of fluoride to drinking water and toothpaste reduces caries. This is evidence-based prevention.

If, however, there is no tangible proof that a particular oral health strategy works, such as a reduction in dietary sugars has reduced the caries rate, then although it is to be recommended, it cannot be said to be evidence-based. The OHE can stress the importance of less sugar in the diet, but has no concrete proof to provide patients with. This does not mean that such non-evidence-based advice is wrong and should not be given.

The OHE should be familiar with a key NHS publication, Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention [2]. The publication provides ‘clear and simple messages that are based firmly on the current available research evidence endorsed by a wide range of specialist organisations who were consulted during its development‘ [2].

There are three main types of prevention: primary, secondary and tertiary.

Primary prevention

Primary prevention should be directed at healthy patients and aims to prevent illness and improve the quality of health and life, as recent thinking suggests that all patients should be given the benefit of />