An evidence-based approach to the prevention of oral diseases

The evidence-based approach has become the mantra of health care and service delivery. But just what it means, whether it is feasible, how to build it and the outcome of its use are not well understood. The aims of this paper are to provide an overview of an evidence-based approach to the prevention of oral disease, to examine the assessment of clinical trial evidence, to examine emerging approaches to assessing population-wide interventions and oral health promotion, and to illustrate some principles and issues through examples from preventive dentistry. The evidence-based approach to prevention is presented using an evidence loop, which emphasizes that the evidence-base should begin with an understanding to the burden of oral disease and its determinants, rather than a consideration of the efficacy or effectiveness of interventions in clinical dental research. A systematic review of evidence from clinical dental research is compiled and assessed, after which the intervention is decided upon and implemented. The evidence loop is completed by the monitoring of outcomes and reassessment of the intervention process. Attention is also given to steps in assessing non-randomized population-wide interventions and evidence on oral health promotion based on expert opinion. The requirement for evidence creates a substantial challenge which can only be met by increased research activity, improved quality of information and the appropriate application of the outcomes of research to policy making for the prevention of oral disease.