Looking at the Concept of Prevention in Dentistry

An interesting article written by Jay W. Friedman, DDS, MPH, appears in J Evid Base Dent Pract, vol. 12, pp. 53 – 54, 2012. In the article a discussion of three different types of prevention is made.

  1. primary prevention
  2. secondary prevention
  3. tertiary prevention

Primary prevention is described as the well known prevention in which one attempts to not have any dental caries, not have any periodontal disease, and not have any loss of teeth. This form of prevention is when one regularly brushes their teeth, flosses, has a dental cleaning, and radiographs performed. The author discusses how typically dentists recommend 6 month intervals between examinations and cleanings. He then says

“Patients who form minimal calculus and have no periodontal disease likewise do not need semiannual prophylaxis, or additional service…Lacking evidence of need, this is not prevention but rather FUN (functionally unnecessary) treatment.”

The author defines secondary prevention as the treatment of what cannot be prevented and needs to be treated. Secondary prevention can sometimes of course help teeth be maintained for a lifetime. The author states the problem with secondary prevention is when the treatment goes beyond the definition and results in the replacement of functional fillings and prophylactic removal of wisdom teeth. The author defines tertiary prevention as simply restoration such as replacing a visibly missing tooth.

The author discuses how evidence based practice should be followed but how clinical proficiency takes precedence in dental school. Furthermore bills have to be paid and a salary needs to be left over and prevention and evidence based practice often results in low fees being generated. The author recommends moving away from a fee for service model and to a salaried model where those in the dental team are paid differently depending on their skills, training, and experience. Further he recommends that research is conducted to see whether or not a fee for service model or a salaried model results in better clinical outcomes.

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