Essential Dental Public Health

264 Pages·2013·1.283 MB·English

by  Daly, Blanaid;Batchelor, Paul;Treasure, Elizabeth;Watt, Richard

Essential Dental
Public Health
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Essential Dental
Public Health
Second Edition
Blánaid Daly
Senior Clinical Lecturer/Academic Lead in Special Care Dentistry,
Specialist in Special Care Dentistry and Specialist in Dental Public Health,
King’s College London Dental Institute, London
Paul Batchelor
Hon. Senior Lecturer in Dental Public Health, UCL, and
National Research Facilitator and Course Director,
Dental Health Services Leadership and Management programme,
FGDP(UK), Royal College of Surgeons, London
Elizabeth T. Treasure
Professor of Dental Public Health and Deputy Vice Chancellor,
Cardiff University
Richard G. Watt
Professor and Honorary Consultant in Dental Public Health,
University College London

1
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Foreword
The time is now right for developing a new approach to because there are associations between risk factors for
promote oral health. One that considers oral health as oral disease and major NCDs. This realization led the
an integral part of general health and addresses the WHO to re-orient its Global Oral Health Programme to
needs and demands of populations and includes an foster its integration with chronic disease prevention
integrated public health approach to tackle the social and general health promotion. The World Health
determinats of chronic diseases. Greater recognition Assembly’s resolution on oral health: action plan for
should be placed on effectively promoting oral health promotion and integrated disease prevention urged
as there is a growing body of evidence of the benefi ts Member States to adopt measures ‘to ensure that oral
and effectiveness of investing in health promotion health is incorporated as appropriate into policies for
programs through an integrated approach. Integrated the integrated prevention and treatment of chronic
health promotion programmes deliver benefi ts for the non-communicable disease and communicable dis-
community through promoting positive wellbeing, ease, and into maternal and child health policies’
strengthening community capacity as well as minimizing (Peterson 2 008) . Recently, the declaration of the High-
the burden of serious diseases, such as diabetes and level United Nations Meeting on Prevention and
cardiovascular disease. A health promotion approach C ontrol of Noncommunicable Disease commits gov-
moves health from an individual lifestyle/choice model ernments of the world to signifi cant and sustained
to a broad community issue. Health is created where action to address the rising burden of noncommunica-
people live, love, work and play. Therefore a public health ble diseases (NCDs) such as diabetes, cancer, cardio-
promotion strategy starts from settings of everyday life vascular and respiratory diseases and oral diseases
within which health is promoted, rather than with disease (UN 2011 ). The Declaration calls for integrated and
categories, and with strengthening the health potential cross-sectoral approaches to tackle noncommunicable
of the respective settings. Because, to change behaviours diseases—an approach highly appropriate for most
one needs to change the environment that predisposed oral diseases. It is appropriate because the risk factors
people to health compromising behaviours. That is for oral diseases are common to other major chronic
why health promotion involving concern for social and diseases. Therefore using the Common Risk Factor
physical environments supportive of health is pivotal to Approach (CRFA) will become mainstream for all health
improving health. A re-orientation from prescription sectors and dentists must be involved in applying that
to health promotion, should redress the balance of approach by incorporating programmes for promotion
infl uences and make healthier choices easier, facilitate of oral health and prevention of oral diseases into pro-
decision-making skills rather than be prescriptive. He- grammes for the integrated prevention and treatment
alth promotion includes combatting the infl uences of of chronic diseases such as heart diseases, cancers,
those interests which produce and profi t from ill health. hypertension and diabetes.
That involves controls on industry sponsored educational The way forward for oral health policy is that policy
materials in schools, advertising, and campaigns to makers and deans of dental schools need to allocate a
reduce barriers and enable and empower people. higher priority and resources to oral health promotion
T here is a growing realization that oral health is an inte- directed at the social determinants of risk factors
gral part of overall health, and shares many common risk common to a number of diseases, the Common Risk
factors with leading non-communicable disease (NCDs) Factor Approach; to behavioural and political factors.
vi
Foreword
The WHO Commission on Social Determinants of of oral and general diseases because many of the risks
Health (CSDH 2008 ) defi nes social determinants of for disease and poor health functioning are shared by
health (SDH) as ‘the structural determinants and con- large numbers of people. One-to-one chairside inter-
ditions of daily life responsible for a major part of ventions do little to improve the overall oral health of
health inequities between and within countries’. The populations because new people continue to be aff-
determinants of health and health inequalities—the licted even as ’sick’ people are treated or cured. It
‘causes of the causes’, are socially patterned and this therefore is more cost-effective to prevent many chronic
patterning may pass from generation to generation. diseases using a common-risk factor approach at the
However, insuffi cient attention is given to the causes of community and environmental levels than to address
behaviours, the underlying social and environmental them at the individual level. An important focus for
conditions that infl uence behaviours. Environmental prevention should therefore relate to policies to control
conditions deserves much more attention. diet and to behaviour change. The environment deter-
Another important reason for changing from the cur- mines behaviour. The most effective way to change
rent approach to one using public health principles behaviour is to change the environment within which
outlined in this book, is that high levels of dental dis- people live. Making healthy choices the easier choices
eases persist despite the availability of a scientifi c epi- and unhealthy choices more diffi cult. Such a policy is
demiological basis for preventing them. There is a large enabling and supportive.
gap between what is known and carried out in practice. T he future roles of dentists therefore is to advise
Dentistry has not been capable of controlling, nor effec- patients and communities about risks to dental he -
tively or effi ciently preventing diseases. In an era of alth, investigating and controlling the risks, infl uenc-
evidence-based public health medicine and dentistry, ing the health related behaviours of patients and
such approaches are no longer acceptable. The limita- populations by changing their environments, diag-
tions of what conventional dentistry has achieved are nosing oral and dental diseases and assessing
serious. Therefore, on humanitarian grounds alone, a patients’ needs based on a combination of normative
major shift to effective dental public health approaches and perceived needs, providing high quality evidence–
are essential. based dental care—doing the right thing and doing it
Unfortunately relatively little emphasis is currently right, and administration of a dental team. Most den-
placed on effective dental public health and conse- tist involvement in dental public health policy devel-
quently high levels of dental disease and dental pain opment will be as health advocates. Every health
and functional disability are common. The main empha- professional has the potential to act as a powerful
sis remains on replacing artifi cially tissue lost by dis- advocate for individuals, communities, the health
ease despite the fact that no disease has ever been workforce, the general population and their elected
treated away. The current approach is equivalent to representatives. Since many of the factors that affect
dentists and their teams trying to clean the mess on health lie outside the health sector, dentists may need
the fl oor with better and more effi cient brooms, whilst to use their positions both as experts in health and as
leaving the tap full on. So the mess persists and may respected professionals to investigate or encourage
get worse and affect the underlying structures. Then changes in policies in other sectors. To increase effec-
more costly treatments are needed to remedy the tiveness, advocates build partnerships with the com-
accumulated destruction. A more rational solution is munity, other professional groups, and other sectors.
to try to turn the tap off, tackling the determinants of They place their skills at the disposal of the commu-
health, and cleaning up the smaller mess that remains. nity. Being available, not on top.
That requires dentists to deal with the determinants of U nderstanding and adopting the principles of dental
the diseases and treating what remains effectively. public health described in this book should be consid-
G reater emphasis must be given to the development ered as essential as knowing the principles of clinical
of interventions that focus on the ‘causes of the causes’ procedures. In order for the oral health workforce to
vii
Foreword
successfully reduce dental diseases and tackle ine- References
qualities in oral health the right education is essential.
CSDH. (2008). Commission on Social Determinants of
Teaching dental public health should form the central
Health. Closing the gap in a generation: health equity
hub of dental education around which its biological,
through action on the social determinants of health. World
clinical, and technological spokes should revolve. In-
Health Organization: Geneva, 2008. h ttp://www.who.int/
corporating the principles outlined in this book will social_determinants/thecommission/fi nalreport/en/
enable dentists to fulfi ll their professional and civic index.html
roles as altruistic health workers and encourage trust Petersen PE. (2008): World Health Organization global
and personal satisfaction because they have done policy for improvement of oral health – World Health
their best. Assembly 2007, I nternational Dental Journal 58 , 115–121.
UN (2011). United Nations General Assembly. Political
declaration of the High-level Meeting of the General
Professor Aubrey Sheiham
Assembly on the Prevention and Control of Non-
Emeritus Professor of Dental Public Health,
communicable Diseases. Resolution. A/66/L1. 2011.
Department of Epidemiology and Public Health, http://www.un.org/ga/search/view_doc.
University College London. asp?symbol=A/66/L.1
Preface to the second edition
W hen we wrote this book 11 years ago, Dental Public inequalities. The International Association of Research
Health (DPH) was a comparatively new specialty, still (IADR) has recently called for this agenda to be moved
defi ning its role in oral health policy and the delivery of forward and for researchers to focus now on research-
oral health services. That role is now well established ing the implementation of strategies to reduce oral
and DPH is a core topic in undergraduate dental cu- health inequalities.
rricula (GDC 2011, Association of Dental Education in The role of DPH is therefore well established, and
Europe 2010) and is shaping oral health policy and the whilst it focuses on the broader picture at a population
delivery of oral health services. level the practice of dental public health is everybody’s
I n England, DPH has informed the development of business, particularly the dental team in primary care
the oral health strategies Choosing Better Oral Health that makes fi rst contact with patients and the public. It
(2005) and Valuing People’s Oral Health (2007) and is essential that the dental team is equipped with the
the evidence based toolkit for prevention of dental appropriate knowledge, skills, and values required to
d isease in primary care Delivering Better Oral Health perform its role in society.
(2012) . In terms of oral health service delivery, the In the light of all the developments over the last 11
Steele Independent Review of NHS Dentistry evidenced years it is time to update this book. We have retained
a sea change in dental policy by placing public health the format of the fi rst edition and kept it as a basic
at the heart of dental services. introductory text. As with the fi rst edition we have pro-
In Scotland there is the innovative national C h - vided additional references for those of you who want
ildsmile dental prevention programme which starts in to explore the topic in more depth.
early childhood and aims to improve children’s oral W e are very pleased that the fi rst edition of the
health and tackle oral health inequalities. In Wales leg- book has reached such a wide audience. We have
islation has recently been enacted to support devel- enjoyed meeting students both in the UK and abroad
opment and introduction of clinical care pathways for who have used this book and we have incorporated
people with special needs as well as the introduction of their insights and feedback in producing this updated
Designed to Smile also aimed at improving pre-school version.
children’s oral health.
At an international level, there is a growing consen- Blánaid Daly
sus on the need to tackle the social determinants of Paul Batchelor
health and much high quality oral health research is Elizabeth T. Treasure
directed at describing and understanding oral health Richard G. Watt
Contents

Part 1 P rinciples of dental public health
1 Introduction to the principles of public health 3
2 Determinants of health 14
3 Defi nitions of health 23
4 Public health approaches to prevention 37
Part 2 O ral epidemiology
5 Overview of epidemiology 51
6 Trends in oral health 6 8
7 Evidence-based practice 79
Part 3 P revention and oral health promotion
8 Principles of oral health promotion 99
9 Overview of behaviour change 114
10 Prevention and oral health education in dental practice settings 126
11 Sugars and caries prevention 134
12 Fluoride and fi ssure sealants 144
13 Prevention of periodontal diseases 151
14 Oral cancer prevention 159
15 Public health approaches to the prevention of traumatic dental injuries 169
16 Prevention for people with disabilities and vulnerable groups 174
Part 4 H ealth services
17 Overview of health care systems 189
18 The structure of the NHS in the UK 197
19 The structure of dental services in the UK 207
20 The European Union and dentistry 215
21 Planning dental services 218
22 Health economics 231
23 Problems with health care delivery 238
Index 247