Dentistry and population approaches for preventing dental diseases

Dental professionals are expected to engage in oral disease prevention, but their tools limit the approach to chair side activities based on the common notion that the major dental diseases, dental caries, gingivitis and periodontitis, are behavioural diseases shaped by individual lifestyles. However, lifestyles also have causes and individual behaviours reflect cultural norms, expectations and opportunities that are socio-economically determined and structurally maintained. Importantly, the effects of the societal and socio-economic determinants reach way above their influences as individual attributes, and effective approaches to the prevention and control of oral diseases are aligned with this causal chain. Unfortunately, the ethos and philosophy of dentistry is focused to a downstream, patient-centred, curative and rehabilitative approach to oral diseases. Whilst such services are needed to care for those who have already suffered the consequences of oral diseases, they do not influence population oral health. A more balanced distribution of efforts and resources along the whole range of intervention points from the downstream curative to the upstream structural healthy policy approaches is required if appropriate, evidence-based, effective, cost-effective, sustainable, equitable, universal, comprehensive and ethical delivery of health care, including oral health care, is the goal. The implementation of healthy policies and sound approaches to population oral health will require substantial commitment and political will on the part of the public and their elected officials.