8: Integrating Oral Health Education into Primary Dental Care

Chapter 8

Integrating Oral Health Education into Primary Dental Care


The aim of this chapter is to provide the scientific basis of dental health education and to illustrate its application in everyday clinical practice by means of a number of oral health education programmes specifically tailored to the needs of general practice.


After reading this chapter the reader should know the scientific basis of dental health education and be able to relate the principles and models outlined in the previous chapter to preventive interventions in clinical practice. The interventions include the prevention of dental caries and periodontal disease, the promotion of the use of fluorides, dental attendance, smoking cessation and screening for oral cancer.

Dental Health Education in Everyday Clinical Practice

The dental health education provided by the dental team must be scientifically sound and based on the best available evidence. There are several publications that have attempted to provide policy and evidence-based dental health education for those working in primary dental care. These publications include the Scientific Basis of Dental Health Education and a series of eight articles in the British Dental Journal, focusing on prevention in practice. These publications have been combined to form A Guide to Prevention in Dentistry (including the Scientific Basis of Oral Health Education) (Kay 2004). The following sections will describe the policy defined in the Scientific Basis of Oral Health Education and recommendations for everyday clinical practice.

The Scientific Basis of Oral Health Education

The Scientific Basis of Dental Health Education was originally conceived in 1976 and later editions were each divided into two parts. These publications provided standardised dental health education advice based on scientifically sound and evidence-based research to be given to patients. The aim of the latest edition (Levine and Stillman-Lowe 2004) is to ‘provide a sound basis for giving information and advice on the main aspects of oral health. The [four] key messages are a consensus of expert opinion and . . . form the basis of all oral health advice given to the public’

The four key messages are:

  • diet: reduce the consumption and especially the frequency of drinks, confectionery and foods containing added sugars

  • toothbrushing: clean teeth thoroughly twice a day with a fluoride toothpaste

  • fluoridation: fluoridation of the water supply is a safe and highly effective public health measure to prevent dental decay

  • dental attendance: have an oral examination every year.

The Scientific Basis of Oral Health Education includes chapters on dental caries, fluoride, diet and oral health, periodontal health, plaque control, erosion, oral cancer, other oral diseases – for example, oral ulceration – advice for ‘under-fives’, advice for older people and denture wearers, frequency of dental attendance and health education. At the end of each chapter important statements are made indicating ‘the level of supporting scientific evidence’ for each of the key areas discussed. These are described as:

  • evidence base A: statements supported by the highest level of evidence

  • evidence base B: statements support by the majority of research studies

  • evidence base C: statements that cannot be supported by research evidence but where there is a ‘consensus of scientific basis and professional opinion’.

For the main areas the scientific details concerning the supporting evidence with regard to the prevention of oral disease are provided:


  1. Water fluoridation – the benefits of water fluoridation are provided

  2. Fluoride dietary supplements – information with regard to who should be provided with supplements, the dosages (Table 8-1) and advice for safe storage are given. Tablets or drops should be given at a different time to brushing with fluoride toothpaste

  3. Fluoride toothpaste – information is provided on the three concentrations of fluoride in toothpaste and the target patient groups (Table 8-2). The need for parents to use ‘an amount of toothpaste no greater than a small pea on the brush’ with children under the age of seven is emphasised, together with the need for parents to supervise brushing and to encourage the children to spit the toothpaste out rather than rinsing with water.

  4. Fluorsis – information is provided with regard to the relationship between excessive ingestion of fluoride during enamel formation and fluorsis.

Table 8-1 Daily dosage of fluoride dietary supplements
Daily dosage schedule for area with less than 0.3ppm fluoride in the water supply:
6 months to 3 years: 0.25mg F (0.5mg NaF)
3 years up to 6 years: 0.5mg F (1.1mg NaF)
Over 6 years of age: 1.0mg F (2.2mg NaF)


Table 8-2 Concentrations of fluoride toothpastes
Category of toothpaste Concentration
(ppm F)
Target group
Low concentration pastes <600ppm F Low caries risk children under the age of seven, particularly if living in a water fluoridated area
Higher concentration pastes 1000–1450ppm F High caries risk children under the age of seven (parents must use only a small pea-size amount of toothpaste)
  1450ppm F Children over the age of seven or older
Highest concentration pastes 2800ppm F High caries risk adults and older people

Dietary control:

  1. Sugars and dental caries – scientific evidence is provided to demonstrate the relationship between dental caries and the frequent ingestion of cariogenic sugars. Cariogenic sugars are defined as ‘non-milk extrinsic sugars’. These include sucrose, glucose, fructose, maltose, dextrose, invert sugar, hydrolysed starch and so on. They are contained in foods containing added sugars at the time of manufacture, table sugar, fruit juices, pulps, purée, honey and so on.

  2. Non-cariogenic sweeteners are listed and include – for example, mannitol, sorbitol, xylitol and so on. Xylitol, in particular, is important in the reduction of dental caries as small dietary additions lead to impressive reductions in caries incidence.

  3. Frequency of sugar intake is highlighted, together with the use of sugar-free medicines.

Plaque control:

  1. Plaque control and dental disease – the relationship between plaque, dental caries and periodontal disease is unravelled. The document endorses the removal of plaque in the prevention of periodontal disease but cautions against plaque removal in the prevention of dental caries: ‘The results have been inconclusive and have failed to demonstrate a clear association between regular and efficient toothbrushing and a low caries experience’.

  2. The value of toothbrushing in the prevention of dental caries is as a vehicle for fluoride toothpaste.

  3. Plaque removal – detailed information is given on the type of toothbrush, interdental cleaning and techniques to be used in plaque removal for children and adults.

  4. Mouthwashes or chemical plaque suppressants are described and discussed, with evidence being provided with regard to their efficacy and use.


  1. Dietary factors are highlighted as being primary in the causation of dental erosion. If gastric regurgitation is suspected, referral to a medical practitioner is essential.

  2. Erosion may be prevented by reducing the intake of erosive drinks and foods. Children, adolescents and young adults should be targeted and encouraged to drink beverages through a straw.

  3. Resistance to erosion can be increased by the use of topical fluorides – for example, fluoride toothpaste and/or mouthwashes – or by professional application of fluoride varnishes and gels.

  4. Brushing to be avoided for one hour after the ‘acidic episode’.

Advice for denture wearers:

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Jan 4, 2015 | Posted by in General Dentistry | Comments Off on 8: Integrating Oral Health Education into Primary Dental Care
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