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Lessons in Promoting Preventive Dentistry
Lessons in promoting preventive dentistry
M ary E. Bernhardt
Promoting “preventive dentistry” has its problems. This was the experience o f the Council on Dental Health when it devoted its Second Conference on Practice Administration to “ emphasis on preven tion in practice.” The lack of agreement on pre vention was apparent in conference discussions and was further identified and detailed in post conference evaluations. On the basis o f this ex perience, the Council suggests some factors that will complicate the promotion o f prevention.
Taking-off points The conference was held to solicit the views of representatives of the various agencies within or ganized dentistry on how the Association could emphasize prevention. As a basis for an open forum, papers were presented on what the Coun cil considered to be elements o f prevention in practice: the use o f fluorides, nutritional counsel ing, plaque control, and dental health education by the dentist and dental hygienist. Some other key elements in moving the profession toward prevention were included: implications for prac tice, the role o f the dental schools and pro and con position papers on including plaque control programs in dental prepayment. Three brief keynote papers set the foundation for expressing dissident opinions on prevention. 808 ■ JADA, Vol. 84, A pril 1972
A private practitioner, Leonard Brewster o f Tucson, called on the Association to exercise greater leadership in prevention. H e expressed the frustration o f many general practitioners at being considered “commercial tooth fixers” and called for a more positive relationship with pa tients in helping them to solve their dental prob lems and prevent their future disease. A spokesman for the Association, past Council chairman W. Kenneth Thurmond, Fort Worth, emphasized that there was “no single way, no single answer to prevention in practice” but noted that many prevention advocates promote “a single means o f prevention not only to the exclusion of others but with sharp criticism o f others.” H e also pointed out the dangers o f basing preventive practice on “salesmanship.” H e said, “to do this will discourage many dentists from emphasizing prevention and will doom other dentists to fail ure in preventive practice if they cannot muster the necessary power o f personality.” The failure to implement scientific knowledge to prevent dental disease makes prevention a public health problem, said John C. Greene, di rector, Public Health Service Division of Dental Health. “Fluoridation is the best and obvious example o f our failure to capitalize on the preven tive possibilities open to us. Even this late in the history o f that remarkable measure, only about half o f the people who could be drinking fluori dated water are actually doing so.”
Varying views The conference was attended by about 150 invited representatives o f constituent and component so
cieties, dental schools, specialty groups, and other dental organizations. At the forum session of the conference, many were outspoken in their demands that prevention move further and faster. Comments o f other participants, however, sug gested some reasons why prevention has not moved faster. The “personality cults” and “dissension” in preventive dentistry were criticized by one con stituent society representative. He questioned whether the dental leadership, including deans and heads of periodontal departments, really had a consensus on prevention. Another dentist maintained that “the ADA cannot tell me how I should practice or how I should not practice. What they can do is to try to disseminate information.” He added that giv ing priority to prevention in practice may be the view o f the conference participants but it was too much to assume that it was the “general view of the whole dental profession.” H e noted further the difficulties for a dentist without “critical judg ment” to know if information on preventive prac tice is “reliable.” A periodontist emphasized the importance of plaque control and flossing in prevention and called on the Association to promote flossing more actively in its materials. But a dental edu cator questioned the belief that plaque control is “ an absolute panacea” and said that more re search was needed on the subject. The dental health message to the public should stress that individuals can control their own den tal health and that their dentists can teach them how, recommended another conferee. This would prompt those dentists who are not informed on prevention to learn about it in order to fill the patients’ requests. Dentists can “turn on to prevention” by enroll ing themselves, their families, and staff in preven tive control programs. A pedodontics representa tive said this would inspire dentists to start their own control programs. A dental educator declared that “if there are those who believe that preventive dentistry is nothing but plaque control. . . we’re in trouble because preventive dentistry cannot be practiced within the four walls o f a dental office.” Preven tive dentistry is also “fighting to get sweets out of our local schools” and fluoridating the water supply. Many o f the participants responded to the Council’s request for suggestions on moving the profession toward prevention.
A dental school spokesman said the Associa tion’s greatest contribution would be in requiring preventive subjects in the curriculum for accredi tation. The American Student Dental Association representative recommended that prevention be taught throughout the curriculum, taking over some of the prominence presently given to re storative dentistry. Others suggested that dental students be taught to control their own plaque as a first step in instructing them how to teach pa tients to brush and floss. State boards of dental examiners could also play a key role in promoting prevention by asking questions on preventive practice, pointed out an other dental educator. Several constituent representatives suggested that they could promote prevention by forming prevention committees, holding workshops on prevention at the constituent and component levels, featuring plaque control booths at meet ings, working with schools to get plaque control included in the elementary and secondary cur riculum, and emphasizing prevention in continu ing education. The participants discussed a definition o f pre ventive dentistry suggested by the Council on Dental Health but there was no consensus on whether a definition was needed or what it should include. In response to those who had no interest in a definition, one educator commented on the difficulty of promoting prevention “based on 100,000 practitioners’ ideas o f what prevention is.”
Lessons learned The second explosion of opinions came forth in the evaluation sheets returned by participants. Their ratings of the conference ranged from “out standing” to “disastrous.” It was obvious that the conference affected participants in different ways depending on their attitude toward prevention and the Association’s role in it. Many were frus trated because the Association was not doing more, but could not suggest specifically what the Association should be doing. Many preferred the evangelical approach o f the American So ciety of Preventive Dentistry’s first prevention convention. These comments were seen by the Council as indicators o f the variety, and even confusion, of opinion that prevails within the profession on prevention. As a result, the Council identified
Bernhardt: LESSONS IN PROMOTING PREVENTIVE DENTISTRY ■ 809
the following as complicating factors in promo tion of preventive dentistry: — lack o f consensus on what “preventive den tistry” means, with definitions confusing the issue further — differing levels o f acceptance for prevention ranging from evangelical fervor and uncritical en thusiasm to questioning unbelief or rejection of prevention as “hucksterism” — the need to document the long-term results o f plaque control to influence dental care pro grams, administrators and some dentists — the lack of understanding o f the different roles involved in diffusing information through out organized dentistry, coordinating the efforts o f the Association, its constituents and compo nents, dental schools, research agencies, state boards o f dental examiners, and dental care pro grams — conflict between practice administration or management aspects o f prevention which are vying with and often overtaking scientific research as the basis for promoting prevention — enthusiasm which often covers the lack of supporting facts and thus spreads misinformation and misunderstanding
810 ■ JADA, Vol. 84, April 1972
Many participants of the conference were frus trated because they felt that the experience did not result in what they considered to be positive steps toward promoting the preventive procedures they advocate. For the Council and for others, the experience was educational and informative in uncovering some o f the factors to contend with in educating the profession on prevention. One lesson learned was that the enthusiasm on the part of some of preventive dentistry’s most ardent advocates may make it difficult for the Association and other agencies to move ahead responsibly on prevention because any less than dramatic or spectacular actions are vulnerable to their criticism. To spread a philosophy o f preven tion throughout organized dentistry will require more than enthusiasm; it will require the orga nized efforts o f every dental agency working through every available mechanism. The Coun cil’s conference was one mechanism.
Miss Bernhardt is Secretary of the Council on Dental Health and the Coordinating Committee on Preventive Den tistry.
M ary E. Bernhardt
Promoting “preventive dentistry” has its problems. This was the experience o f the Council on Dental Health when it devoted its Second Conference on Practice Administration to “ emphasis on preven tion in practice.” The lack of agreement on pre vention was apparent in conference discussions and was further identified and detailed in post conference evaluations. On the basis o f this ex perience, the Council suggests some factors that will complicate the promotion o f prevention.
Taking-off points The conference was held to solicit the views of representatives of the various agencies within or ganized dentistry on how the Association could emphasize prevention. As a basis for an open forum, papers were presented on what the Coun cil considered to be elements o f prevention in practice: the use o f fluorides, nutritional counsel ing, plaque control, and dental health education by the dentist and dental hygienist. Some other key elements in moving the profession toward prevention were included: implications for prac tice, the role o f the dental schools and pro and con position papers on including plaque control programs in dental prepayment. Three brief keynote papers set the foundation for expressing dissident opinions on prevention. 808 ■ JADA, Vol. 84, A pril 1972
A private practitioner, Leonard Brewster o f Tucson, called on the Association to exercise greater leadership in prevention. H e expressed the frustration o f many general practitioners at being considered “commercial tooth fixers” and called for a more positive relationship with pa tients in helping them to solve their dental prob lems and prevent their future disease. A spokesman for the Association, past Council chairman W. Kenneth Thurmond, Fort Worth, emphasized that there was “no single way, no single answer to prevention in practice” but noted that many prevention advocates promote “a single means o f prevention not only to the exclusion of others but with sharp criticism o f others.” H e also pointed out the dangers o f basing preventive practice on “salesmanship.” H e said, “to do this will discourage many dentists from emphasizing prevention and will doom other dentists to fail ure in preventive practice if they cannot muster the necessary power o f personality.” The failure to implement scientific knowledge to prevent dental disease makes prevention a public health problem, said John C. Greene, di rector, Public Health Service Division of Dental Health. “Fluoridation is the best and obvious example o f our failure to capitalize on the preven tive possibilities open to us. Even this late in the history o f that remarkable measure, only about half o f the people who could be drinking fluori dated water are actually doing so.”
Varying views The conference was attended by about 150 invited representatives o f constituent and component so
cieties, dental schools, specialty groups, and other dental organizations. At the forum session of the conference, many were outspoken in their demands that prevention move further and faster. Comments o f other participants, however, sug gested some reasons why prevention has not moved faster. The “personality cults” and “dissension” in preventive dentistry were criticized by one con stituent society representative. He questioned whether the dental leadership, including deans and heads of periodontal departments, really had a consensus on prevention. Another dentist maintained that “the ADA cannot tell me how I should practice or how I should not practice. What they can do is to try to disseminate information.” He added that giv ing priority to prevention in practice may be the view o f the conference participants but it was too much to assume that it was the “general view of the whole dental profession.” H e noted further the difficulties for a dentist without “critical judg ment” to know if information on preventive prac tice is “reliable.” A periodontist emphasized the importance of plaque control and flossing in prevention and called on the Association to promote flossing more actively in its materials. But a dental edu cator questioned the belief that plaque control is “ an absolute panacea” and said that more re search was needed on the subject. The dental health message to the public should stress that individuals can control their own den tal health and that their dentists can teach them how, recommended another conferee. This would prompt those dentists who are not informed on prevention to learn about it in order to fill the patients’ requests. Dentists can “turn on to prevention” by enroll ing themselves, their families, and staff in preven tive control programs. A pedodontics representa tive said this would inspire dentists to start their own control programs. A dental educator declared that “if there are those who believe that preventive dentistry is nothing but plaque control. . . we’re in trouble because preventive dentistry cannot be practiced within the four walls o f a dental office.” Preven tive dentistry is also “fighting to get sweets out of our local schools” and fluoridating the water supply. Many o f the participants responded to the Council’s request for suggestions on moving the profession toward prevention.
A dental school spokesman said the Associa tion’s greatest contribution would be in requiring preventive subjects in the curriculum for accredi tation. The American Student Dental Association representative recommended that prevention be taught throughout the curriculum, taking over some of the prominence presently given to re storative dentistry. Others suggested that dental students be taught to control their own plaque as a first step in instructing them how to teach pa tients to brush and floss. State boards of dental examiners could also play a key role in promoting prevention by asking questions on preventive practice, pointed out an other dental educator. Several constituent representatives suggested that they could promote prevention by forming prevention committees, holding workshops on prevention at the constituent and component levels, featuring plaque control booths at meet ings, working with schools to get plaque control included in the elementary and secondary cur riculum, and emphasizing prevention in continu ing education. The participants discussed a definition o f pre ventive dentistry suggested by the Council on Dental Health but there was no consensus on whether a definition was needed or what it should include. In response to those who had no interest in a definition, one educator commented on the difficulty of promoting prevention “based on 100,000 practitioners’ ideas o f what prevention is.”
Lessons learned The second explosion of opinions came forth in the evaluation sheets returned by participants. Their ratings of the conference ranged from “out standing” to “disastrous.” It was obvious that the conference affected participants in different ways depending on their attitude toward prevention and the Association’s role in it. Many were frus trated because the Association was not doing more, but could not suggest specifically what the Association should be doing. Many preferred the evangelical approach o f the American So ciety of Preventive Dentistry’s first prevention convention. These comments were seen by the Council as indicators o f the variety, and even confusion, of opinion that prevails within the profession on prevention. As a result, the Council identified
Bernhardt: LESSONS IN PROMOTING PREVENTIVE DENTISTRY ■ 809
the following as complicating factors in promo tion of preventive dentistry: — lack o f consensus on what “preventive den tistry” means, with definitions confusing the issue further — differing levels o f acceptance for prevention ranging from evangelical fervor and uncritical en thusiasm to questioning unbelief or rejection of prevention as “hucksterism” — the need to document the long-term results o f plaque control to influence dental care pro grams, administrators and some dentists — the lack of understanding o f the different roles involved in diffusing information through out organized dentistry, coordinating the efforts o f the Association, its constituents and compo nents, dental schools, research agencies, state boards o f dental examiners, and dental care pro grams — conflict between practice administration or management aspects o f prevention which are vying with and often overtaking scientific research as the basis for promoting prevention — enthusiasm which often covers the lack of supporting facts and thus spreads misinformation and misunderstanding
810 ■ JADA, Vol. 84, April 1972
Many participants of the conference were frus trated because they felt that the experience did not result in what they considered to be positive steps toward promoting the preventive procedures they advocate. For the Council and for others, the experience was educational and informative in uncovering some o f the factors to contend with in educating the profession on prevention. One lesson learned was that the enthusiasm on the part of some of preventive dentistry’s most ardent advocates may make it difficult for the Association and other agencies to move ahead responsibly on prevention because any less than dramatic or spectacular actions are vulnerable to their criticism. To spread a philosophy o f preven tion throughout organized dentistry will require more than enthusiasm; it will require the orga nized efforts o f every dental agency working through every available mechanism. The Coun cil’s conference was one mechanism.
Miss Bernhardt is Secretary of the Council on Dental Health and the Coordinating Committee on Preventive Den tistry.