Connections between preventive dentistry and public health

The dental profession needs to build a stronger connection between oral health and general health—not only for individual patients, but also at the community level, according to the special June issue of The Journal of Evidence-Based Dental Practice (JEBDP), the foremost publication of information about evidence-based dental practice, published by Elsevier.

The special issue follows the usual format of JEBDP, comprising expert reviews and analyses of the scientific evidence on specific dental procedures. "Yet the coverage goes beyond a review of specific clinical interventions to broader ones that address prevention on a community basis," according to an introductory guest editorial by Robert J. Collins, DMD, MPH, of University of Pennsylvania.

Dr. Collins highlights the role of evidence-based innovations such as home dental care, community water fluoridation, and dental sealants in shifting public perceptions of dental care from replacement or repair of missing or damaged teeth to protection against oral diseases. In his editorial, he calls on dentists to recognize the value of collaboration in addressing the problems of the public and the dental profession: "As professionals, clinicians have a responsibility to care for their patients as individuals and a community."

The goal of the special issue is to forge a closer link between the research-proven clinical care provided to individuals and the larger public health goals of improving health in the community. "The oral health status of individuals, families, and communities can be greatly improved when patient-centered, evidence-based care intersects with focused, larger community prevention efforts," states the CDC's William Bailey, DDS, MPH, Assistant Surgeon General and Chief Dental Officer, U.S. Public Health Service, highlighting the link between clinical care and public health.

The issue includes review and article analyses and evaluations on a wide range of topics related to prevention in dental care. The focus is on techniques that not only prevent dental diseases, but also reflect a growing appreciation of the connections between dental health and general health. Topics illustrating these areas of crossover include:
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"Rubber cup" dental prophylaxis—there's little evidence of a health benefit for this familiar "preventive" technique, but it continues to be widely used. -1.
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Prophylactic surgical extraction of wisdom teeth—a growing body of evidence questions the need for this common procedure, although controversy continues. -1.
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Chlorhexidine mouthwash to reduce the risk of ventilator-associated pneumonia—an example of how better oral health can help prevent a serious medical condition, with important implications for dental care in nursing home residents. -1.



A highlight of the issue is an invited commentary by American Dental Association (ADA) President William R. Calnon, DDS. In contrast to its historical emphasis on surgical treatment of dental diseases after they have occurred—"drilling and filling"— Dr. Calnon believes the ADA and the dental profession at large need to develop a new framework for prevention of oral disease. He writes, "Perhaps it is time to think about prevention as the management of oral health risks, including the identification, assessment, and prioritization of these risks, and to take actions designed to mitigate the risks of oral disease or dysfunction."

The special issue also includes opinion pieces on key issues related to prevention and dental public health. Invited editorials highlight the need for private dental practitioners to take on increased responsibility for carrying out essential public health functions; and the impact of financial incentives on the provision of evidence-based preventive services in clinical dentistry.

"Our focus is on collaboration between dental professionals involved in community health and clinical health," Dr. Collins commented. "The issue is extremely important, particularly in looking at what we can do about the 25 to 30 percent of the population who don't have regular access to dental care."

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The JEBDP special issue on prevention is supported by educational grants from Colgate and the American Association of Public Health Dentistry. Every dental school and all dental public health residents in the United States will receive copies of the special Issue of JEBDP.