DentaltownUK February 2018 - 47

students

oral health are key roles of dental students and
dental professionals. Few other professions
have the luxury of spending large amounts
of time in clinic with patients, gaining their
trust and confidence.
And as dental professionals, we have a
major role in reinforcing the message of living
well and taking care of your health (oral and
general). This has been recognised by large
numbers of international bodies responsible
for regulation of dental professionals through
the creation and championing of various
competency standards focusing on both
treatment and prevention.
Health promotion efforts in oral health
are on the rise. This is due to the success
of several health promotion initiatives that
have already decreased caries rates and to
the understanding that money can be saved
by targeting the causes of dental disease and
making it easier for people to make the right
and healthy choices. Treatment is therefore
no longer needed as an initial line of therapy.
If you think about it further, surely
treatment should never have been our first line
of therapy in early-stage lesions. Introducing
a restorative/tooth interface will simply lead
to an area of plaque buildup, making it harder
to maintain and look after the tooth.
Some of my tutors in the past have talked
about the 'restorative spiral'-a patient comes
to have a simple filling, which soon after needs
to be redone, leading to the loss of more tooth
structure. Soon after, the patient needs a
crown, then an endodontic intervention, then
an extraction, then prosthetic replacement. ...
It may seem exaggerated, but I've seen it
happen over my years at dental school.
Behaviour change is so important; it will
inf luence whether the patient faces this
restorative spiral problem. In patients with
poor oral hygiene, this restorative spiral
effect is likely.
However, health promotion has been
challenging to plan, implement and execute,
because the philosophy of dentistry is primarily
targeted and focused on a downstream patientcentered approach. Significant other barriers

to implementation of preventive care measures
include the structure of dental services and
government funding that reinforces clinical
treatments.
This results in public funds being directed
toward those in need, rather than general
public engagement and education. And
unless there is a financial gain and reward
for dentists who engage in changing oral
health behaviour, this may never come to
life, because having busy practice settings
and patient workflow creates barriers.
The following are some aspects I believe
all dental professionals/students should keep
in mind regarding oral health education and
promotion:

Fluoride
Fluoride is found in minimal levels in
rocks, soil and air. It forms an essential
component of bones and teeth, as well as
having a role in several other tissue types.
Calcium fluoride occurs naturally in water
supplies; sodium fluoride is used to artificially
raise f luoride levels in drinking water.
(London's water network is not fluoridated;
it's far too extensive to allow for this.)
Fluoride reduces the risk and progress of
dental caries by forming more acid-resistant
fluoroapatite, which withstands a lower pH,
rather than the normal critical pH of 5.5.
Fluoride also blocks the enzymatic systems
in bacteria, inhibiting their capacity to turn
sugar into acid.
Fluoride is known to convert early carious
lesions into arrested lesions, which appear
harder, shinier and smoother than their
active comparisons.

Tobacco use and smoking
Tobacco use is still a major public health
concern in the UK. Although the rate of
smoking has declined since the 1970s, it
still remains an area of concern.
Many people want to quit smoking; the
negative health effects are well known and
well documented. Government and media
initiatives have improved education levels.

The major reasons behind why people
smoke include addiction, social habits, weight
loss and stress relief.
Smoking tobacco products can have
several effects on oral health, including
halitosis, dry mouth (xerostomia), hairy black
tongue, and increased risk of periodontitis
and oral cancer.

Communication
The major component involved in health
behaviour change is sending messages to
patients in a way they can understand easily.
This involves breaking down huge amounts of
complex information into simple chunks that
can be explained without the use of jargon.
Some patients may have left the clinic
feeling more nervous, anxious and annoyed
than when they arrived, and it's your job to
ensure that this is not the case.
It cannot be blamed upon the patients
if they've not understood something that
you've said. I have learnt that there are three
golden rules to communicating with patients:
1. If you tell them, they'll forget soon
after.
2. If you show them, they'll remember.
3. If you involve them, they will learn.
Communication is all about involving
patients in the conversation about their health.

Prevention
I look at prevention from three angles:
1. Primary prevention is initiative, which
aims to prevent disease generation in healthy
individuals.
2. Secondary prevention aims to reverse
lesions or disease in those with disease that
has the potential to be reversed.
3. Tertiary prevention aims to stabilise
disease that has led to destruction of tissue. ■

References
1.
Bagramian RA, Garcia-Godoy F, Volpe AR. The global increase
in dental caries: a pending public health crisis. Am J Dent
2009;22(1):3-8.
2.
Marthaler TM. Changes in dental caries 1953-2003. Caries Res
2004;38(3):173-81.
3.
The Ottawa charter for health promotion: first international
conference on health promotion. Geneva: World Health
Organization, 1986

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