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Dentistry at a tipping point.

Dentistry at a tipping point; an interview with Professor David Williams (DW)

 

 
Professor David Williams
Professor of Global Oral Heath,
Bart's and The London School of Medicine and Dentistry, UK 

 

Julian Fisher - JF: How is the dental profession responding to the emerging 2015 development agenda, specifically the call by the UN for a social determinants approach to health?

DW: Whilst the importance of the common risk factors has long been recognised in the causation of oral disease, dentists are increasingly coming to recognise that the major oral diseases, in common with noncommunicable diseases (NCDs) in general, follow the social gradient. The lower the position that any individual occupies along the gradient, the worse their oral health will be.   However, despite the increasing recognition of the importance of social determinants, this has still to translate into effective and widely implemented strategies for prevention.  We would argue strongly for the integration of strategies for the prevention of oral disease into a social determinants of health approach to NCDs in general.

JF: How do you see dentists being involved in advocacy in terms of SDH / addressing oral health inequalities?

DW:The International Association for Dental Research Global Oral Health Inequalities Research Agenda (IADR-GOHIRA) sets out ten key action priorities to address oral health inequalities.  Key among these is the importance of raising the issue of oral health inequalities in wider public debate with policy makers, governmental and non-governmental agencies, and other health professionals Effective advocacy is a fundamental requirement if the reduction in global oral health inequality called for by the GOHIRA initiative is to be achieved.  Furthermore, we argue the need to advocate for the inclusion of oral health in all policies, in line with the Adelaide Statement of Health in All Policies

JF: What are the knowledge gaps? How is the dental profession/IADR addressing them?

DW:The IADR-GOHIRA initiative recognises the need to identify gaps in knowledge.  However, the principal challenge represented by the persistently high global oral disease burden is in large part attributable to the failure to implement what is already known about the prevention of oral disease.  This would argue for a greater focus on translational research.  However, there has also been a failure to understand the causes of the causes of oral diseases, and to rely either on activities that dental practitioners can deliver to patients, or on advice to people to adopt healthy behaviours and to avoid unhealthy ones.  In other words, the failure to reduce inequalities in behaviours, and to avoid unhealthy behaviours, and to reduce population exposures to risks for diseases, in large measure reflects the failure to build strategies that address the social determinants of oral diseases.  

JF: How is the dental profession engaging in the WHO global noncommunicbale disease action plan ? 

DW: Dental practitioners, represented by the World Dental Federation-FDI, and the oral and dental research community, represented by the International Association for Dental Research, have a close working relationship with WHO.  It is through this relationship that both constituencies engage with the WHO Global NCD Action Plan.

The IADR-GOHIRA has identified three priorities for action that are aligned with the WHO Global NCD Action Plan.  These are to:

  • Emphasize the importance of integrating research on oral health inequalities, with wider approaches to reducing health inequality as a whole
  • Emphasize the importance of multi-disciplinary and translational research seeking input from a range of social scientists and health professionals
  • Develop disease prevention strategies based on broad social and environmental determinants of health, adopting upstream rather than downstream strategies

JF: How is dental profession aligning and harmonising upstream and downstream aspects of oral disease prevention and health promotion towards a public health approach and patient centred care?

DW:The traditional role of the dental profession has been the treatment of disease, usually in a dental practice setting and often undertaken in isolation from the rest of healthcare.  If oral healthcare is to be properly integrated with the rest of healthcare, it is essential that all members of the oral health team understand the importance of the social determinants of oral health and integrate their activities with other groups.  Working in partnership with other professional groups and agencies is an essential first step in tackling oral and general health inequalities and promoting health.  Leaders in dental education and continuing professional development should adopt an interprofessional approach to teaching on the social determinants of health, to ensure that all members of the dental team have the competences and skills to work alongside other health professions in addressing inequalities in health.

Water fluoridation has been highly effective in reducing dental decay; indeed it is one of the most effective of all public health interventions.  However, fluoridation is not capable of preventing dental caries in its entirety.  Hence, the role of dietary sugars in the causation of dental caries is receiving increasing attention, at the same time as their role on obesity is being recognised.  It is clear that many oral diseases share other determinants in common with NCDs.  Thus the implementation of effective strategies involving dentists together with other healthcare professionals has the potential to improve both oral and general health at the same time and to bring about significant reduction in health inequality.

JF: How could the IADR GOHIRA initiative provide leadership in dental research alongside FDI World Dental Federation and the WHO Global Oral Health Programme?

DW: The mission that guides the IADR-GOHIRA initiative is:

  1. To advance research and increase knowledge directed at reducing the inequalities in oral health within and between countries;
  2. To support and enable the global research community, by developing and promoting the agenda for research on reducing inequalities; 
  3. To facilitate the communication and application of existing and new research findings to reduce global oral health inequalities.

The IADR is the largest oral and dental research organisation, with comprehensive global membership.  Its key strategic partners are WHO Global Oral Health Prgoramme and the World Dental Federation-FDI. The initiative to address the oral health inequalities research agenda is well-aligned with the WHO Global Plan of Action on Social Determinants of Health and is in line with the World Dental Federation-FDI policy statement on non-communicable diseases.  Thus both the World Dental Federation-FDI and IADR are well positioned to provide leadership in both research and effective treatment in support of the WHO Oral Health Programme

JF: Looking towards Sir Michael Marmot´s report ´Working for health equity, the role of the health professional´; as the dentist´s role expands to encompass multi-sectoral advocacy, how might this impact curriculum development and interprofessional education?

DW: Dentists have a clear role address the issues raised in the Marmot Report on the role of health professionals in working for health equity.  The UK oral health community contributed to the report and made the following recommendations:

1.All members of the oral health team should acquire a thorough understanding of the importance that social determinants play in oral as well as general health.  They should have a thorough understanding of how the conditions in which people are born, live, work and age can affect their health, and how they can act to tackle these.

2.Dentists and the oral health team should engage in partnership with communities to help them better understand and tackle the social, economic and environmental factors that determine oral health and increase inequalities.

3.Dentists and the oral health team should engage with colleagues such as primary health care professionals in the development of cross-sectoral partnerships, so that oral health promotion strategies become incorporated into all strategies for health. 

4.Dentists should become advocates for health, particularly oral health, with their patients and the wider community.  This should include an emphasis on acting as enablers, helping to make healthy choices the easier choices and empowering people to take control of their own lives and health.

The UK Dental Schools Council will commit:

  • To advocate for all dentists to be made aware of their responsibilities for the promotion of oral health across all socio-economic groups. 
  • To encourage all Schools to embed a greater understanding of SDH into the undergraduate dental curriculum

Further the World Dental Federation-FDI has argued in its Vision 2020 statement for the dental profession worldwide to play a leading role and generate constructive solutions for tackling the social determinants of health, (both oral and general) and the problem of the unmet need and demand for oral healthcare.  This is a key insight that underpins the principal of oral health as an essential component of good health, and good oral health as a fundamental human right. Vision 2020 asserts that the role of the dental profession is to help the population and decision makers to achieve health through good oral health.

In conclusion, dentistry is at a tipping point.  There is increasing momentum for a shift in education, prevention and patient care towards more effective prevention though the adoption of a social determinants of health approach that integrates oral healthcare into strategies to promote health in general. 

 

 

 

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