Presentation on theme: "Sue Gregory Consultant in Dental Public Health"— Presentation transcript:
1Sue Gregory Consultant in Dental Public Health Prevention in practice – an initiative between BASCD and Department of HealthSue GregoryConsultant in Dental Public Health
2The taskDH want to focus on prevention - How can prevention be built into the new contract?What help can be given to PCTs to help them commission more effectively?Can we maximise the yield from the preventive tools we have and the knowledge on how they work?
3Following the publication of Choosing Better Oral Health - 3 supporting documents:‘Smokefree and Smiling’ - Guidance to PCTs on smoking cessation and how it fits in with dental practice – Richard Watts, May 2007Guidance on improving oral health among adults and children with disabilities – Colette Bridgman, to be launched soon‘Delivering Better Oral Health’ - Provision of evidence-based information to support the commissioning of preventive services – Sue Gregory, Sept 2007
8The Team Chair – Sue Gregory (BASCD president) Secretary – Semina MakhaniDerek Richards (BASCD)Gill Davies (BASCD)Keith Milsom (National Oral Health Unit)Rowena Pennycate (BDA)Baldeesh Chana (FGDP)Nigel Carter (BDHF)Richard Watt (OHPRG)Tom Dyer (GDP)Tony Jenner / Jerry Read (DH)Rosemary Khan, Jan Clarkson
9The PrinciplesStatements must be supported by evidence – the stronger the betterThe potential benefits of prevention have not been maximisedNot doing enoughPrevention not evidence basedChallenges the ‘high risk’ approach in favour of a practice ‘population’ approach
10The Principles Messages would be in line with wider health messages The common risk factor approachProviding information forThe whole dental teamDental care at primary, secondary and tertiary levelPrimary Care Organisations to assist with commissioning
12GradeStrength of evidenceIStrong evidence from at least one systematic review of multiple well-designed randomised control trials e.g Cochrane reviews.IIStrong evidence from at least one properly designed randomised control trial of appropriate size e.g. comparison of 2 toothpastes.IIIEvidence from well-designed trials without randomisation, single group pre-post, cohort, time series of matched case-control studies e.g. plaque reduction studies.IVEvidence from well-designed non-experimental studies from more than one centre or research group.VOpinions of respected authorities, based on clinical evidence, descriptive studies or reports of expert committees.
13Prevention of caries in children age 0 – 6 years Advice to be givenEBProfessional interventionChildren aged up to 3 yrsAll children aged 3-6 yrsBreast feeding is best for babiesFrom 6 months of age infants should be introduced to drinking from a cup, and from age one year feeding from a bottle should be discouragedSugar should not be added to weaning foodsParents should brush / supervise toothbrushingUse only a smear of toothpaste containing no less than 1000 ppm fluorideAs soon as teeth erupt in the mouth brush them twice dailyIIIIVIVBrush last thing at night and on one other occasion,Brushing should be supervised by an adultUse a pea size amount of toothpaste containing ppm fluorideSpit out after brushing and do not rinseThe frequency and amount of sugary food and drinks should be reduced and, when consumed, limited to mealtimes. Sugars should not be consumed more than four times per daySugar free medicines should be recommendedV, IApply fluoride varnish to teeth twice yearly (2.2% F-)Children giving concern; E.g those likely to develop caries,those with special needsAll advice as above plus:Use a smear or pea size amount of toothpaste containing ppm fluorideEnsure medication is sugar freeAdvise that dietary supplements containing sugar and glucose polymers are given at mealtimes when possible and not last thing at nightApply fluoride varnish to teeth 3-4 times yearly (2.2% F-)Prescribe fluoride supplement and advise re maximising benefitReduce recall intervalInvestigate diet and assist to adopt good dietary practiceEnsure medication is sugar free or given to minimise cariogenic effectII
14Prevention of caries in children aged from 7 years and young adults AdviceEBProfessional interventionAll children and young adultsBrush twice dailyIApply fluoride varnish to teeth twice yearly (2.2% F-)Brush last thing at night and on one other occasionVUse fluoridated toothpaste (1350 ppm F or above)Spit out after brushing and do not rinseIVThe frequency and amount of sugary food and drinks should be reduced and, when consumed, limited to mealtimes. Sugars should not be consumed more than four times per dayIIIThose giving concern – E.g. those likely to develop caries,those undergoing orthodontic treatment andthose with special needsAll the above, plus :Use a fluoride mouth rinse daily (0.05% NaF) at a different time to brushingFissure seal permanent molars with resin sealantApply fluoride varnish to teeth 3-4 times yearly (2.2% F-)For those 8+ years with active caries prescribe daily fluoride rinseFor those 10+ years with active caries prescribe 2800 ppm toothpasteFor those 16+ years with active disease consider prescription of 5000 ppm toothpasteInvestigation of diet and assistance to adopt good dietary practice
15Prevention of caries in adults AdviceEBProfessional interventionAll adult patientsBrush twice daily with fluoridated toothpasteIUse fluoridated toothpaste with at least ppm F-Brush last thing at night and on one other occasionVSpit out after brushing and do not rinseIVThe frequency and amount of sugary food and drinks should be reduced and, when consumed, limited to mealtimes. Sugars should not be consumed more than four times per dayIIIThose giving concern – E.g. those with current active caries, exposed roots, dry mouth, other predisposing factors, those with special needsAll the above, plus :Use a fluoride mouth rinse daily (0.05% NaF) at a different time to brushingApply fluoride varnish to teeth twice yearly (2.2% F-)For those with active caries prescribe daily fluoride rinseFor those with active disease prescription of or 5000 ppm toothpasteInvestigation of diet and assistance to adopt good dietary practiceII
16Prevention of periodontal disease – to be used in addition to caries prevention Risk levelAdviceEBProfessional interventionAll adolescents and adultsBrush teeth systematically twice daily with either aVDemonstrate methods of improving plaque control- manual brush with a small head and round end filaments, a compact angled arrangement of long and short filaments and a comfortable handleOR- a powered toothbrush with an oscillating/ rotating headIInvestigate possible improved control of predisposing systemic conditionsTake a history of tobacco use, give brief advice to users and signpost to local Stop Smoking ServiceInvestigate diet and assistance to adopt good dietary practiceDo not smokeIIIUse toothpastes containingtriclosan with copolymeror triclosan with zinc citrateto improve levels of plaque controlClean inter-dentally using inter-dental brushes or flossEat a well balanced diet
17Prevention of oral cancer Risk levelAdviceEBProfessional interventionAll adolescents and adultsDo not smokeDo not use smokeless tobacco E.g. Paan, chewing tobacco, gutkhaIIITake a history of tobacco use, give brief advice to users and signpost to local Stop Smoking ServiceVReduce alcohol consumption to moderate (recommended) levelsIVSignpost to local Alcohol Misuse Support ServicesMaintain good dietary practice in line with Balance for Good HealthIncrease fruit and vegetable intake to at least 5 portions per day
18ErosionCurrently the evidence is based upon laboratory studies or observational studies. No evidence could be found which measured the effectiveness of providing preventive advice in a clinical setting.Until such evidence emerges guidance will be provided in the Appendix 8 in the Supporting InformationWith acknowledgement of the original work carried out by:Mrs J T DuxburyMiss M A CatleughProf R M DaviesDr G M Davies