A 1980 study in the Netherlands found that dentists, dental hygienists and dental assistants simply didn’t know enough about prevention. The team gave 142 dentists, 21 dental hygienists and 35 dental assistants a questionnaire consisting of forty questions on preventive dentistry – all common questions that patients ask all the time. The average percentage of questions answered correctly was 57 per cent for dentists, 58 per cent for hygienists and 37 per cent for assistants. These figures are disappointingly poor. Older dentists know more than younger ones but it was found that very few of the dentists answered T don’t know’, which was an available choice for each question. A subject over which people are very confused and on which the dental professionals have been slow to offer evidence is how often individuals should have dental checkups. Most people are told by their dentists to have twice yearly check-ups but there is no reason for this. Young children certainly benefit from this frequency of check-ups but after the age of 16 there is no evidence that it has much preventive value. Yearly check-ups are probably adequate over the age of 16, especially in someone who is running their dental health along the lines suggested in this article, but there will always be those who will need to go more frequently.

Careful studies have shown that the difference in consumer satisfaction between dental patients with good dental health and those with poor dental health is negligible. This reflects a situation in which the criteria by which patients judge their dentists are very different from the criteria dentists use (or ought to use) to guide their work. Pain was the sole and compelling reason for seeking dental treatment in 33.3 per cent of university graduates and 46 per cent of those with a lower educational level, according to a study in 1974. In general, dentists have not ‘sold’ themselves adequately as preventive practitioners, although there are obviously individual exceptions to this. A study of dentists’ attitudes to prevention, carried out in 1976, does not make happy reading although it has to be said that things have improved somewhat in the last decade. Given that dental hygienists can and should do much to further prevention and health care it is not surprising that only in the south of England did this study find a willingness on the part of dentists to expand the role of their hygienists.

Most of the 358 dentists favoured some kind of National Health Service fee for preventive services. Throughout the study dentists showed themselves to be far more committed to the dental health of their immediate family than to that of their patients.

Why should there be so little real prevention going on in routine dental practice and why is it that dentists still see themselves mainly as people who treat disease rather than preventing it? The answer starts in dental training schools. A recent UK report on dental education said that ‘Students are mainly taught a mechanistic and qualitative approach to dentistry and it is not surprising that many adopt a materialistic attitude to practice. We perceive a tendency in many dental schools to value more highly the teaching of the prescribed body of knowledge and technical skills than the inculcation of professional attitudes based on a broad-based education.’ The report advocated that dental disease be studied in the context of general health and lifestyles of different groups. Little attention is paid to teaching dentists to be counselors and the report found resistance to the idea that dental students be taught simple applied psychology. Is it surprising, then, that dentists are loath to act as educators, and agents of social and behavioural change?

But the greatest problem is the way dentists are paid. Various countries pay very different proportions of their health budgets to dentistry, with Germany at the top of the league spending 14.3 per cent of the total health budget on dental treatments. The figure for the UK is 3.8 per cent, and for the US 7 per cent. Preventive practices flourish in the free-enterprise systems but the National Health Service is a treatment service and dentists are not remunerated for prevention. Dental disease is a prime example of an area of health in which practitioners could be paid to help keep patients dentally fit (like in ancient China, where patients paid the doctor to keep them well and stopped paying when they were ill). At the moment most countries are spending vast sums ‘picking up the pieces’ of dental disease, the majority of which could and should have been prevented.

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