Evidence Based Approaches to Prevention Flashcards
Why is there national guidance on prevention?
Messages to public need to be consistent
Not all preventive activities are effective
Considerable investment in prevention
Need to do best for pts
How are national guidances developed?
BASCD, DH, Public Health England
Based on systematic reviews
2 levels - all adults, high risk groups
What are the levels of evidence?
Level 1 = strong evidence from 1+ SR Level 2 = strong evidence from 1+ RCTs Level 3 = other intervention studies Level 4 = non-experimental studies from 2+ groups/centres Level 5 = expert opinion
Diseases/conditions covered?
Caries Erosion Periodontal diseases Oral cancer Trauma
Caries prevention advised for all adults?
Level 1 evidence:
Brush x2 fluoridated toothpaste
Toothpaste with 1350ppmF
Brush last thing at night and one other occasion
Level 3 Evidence:
Brush last thing at night and one other occasion
Spit do not rinse
Restrict sugar intake to meal times and <4x daily
What adults give concern?
Active caries
Predisposing factors (dry mouth)
Special needs
= 33% of pts
Advice to adults giving concern?
Level 1 evidence:
Brush x2 fluoridated toothpaste AND daily NaF MW 0.05% at different time to brushing
Toothpaste with 1350ppmF
Brush last thing at night and one other occasion
2.2% F varnish x2 yrly
Evidence II - active caries: prescribe 2800 or 5000ppm toothpaste
Level 3 Evidence:
Brush last thing at night and one other occasion
Spit do not rinse
Restrict sugar intake to meal times and <4x daily
Investigate diet and assist adoption of good practice
Prevention of periodontal disease for all adults?
Prevention of gingivitis
- Daily, effective plaque removal by patient more important than professional scaling and polishing
Managing risk factors
- Smoking
- Diabetes
- Medications
Supportive periodontal therapy/maintenace
Evidence I = manual or powered toothbrush
III - don’t smoke
V - Brush gum line and each tooth twice daily, use small head with medium texture, interdental brushes or floss, maintain good diet
Professional intervention
I = Use behaviour change methods with OH instruction
III = Demonstrate methods of plaque control
V = Investigate better control of systemic conditions, ask advice act on tobacco use
How to prevent peri-implant disease?
Same risk of inflammation and disease in tissues around implants as natural teeth
Same principles for prevention and health as around teeth
Focus on effective plaque control
Regular checking on soft tissue health visually and by probing
How to prevent oral cancer?
Advice:
III - avoid tobacco (smoke or chewed), increase intake of fruit and veg
III-IV - Reduce alcohol to moderate levels <14 units per week
Professional interventions
V - ask advise act, signpost alcohol misuse support
Smoking cessation - how to ask, advice and act?
Ask - if pt smoker, ex-smoker or non-smoker
Advise on best way of quitting - with a combo of medication and specialist support
Act on patient’s response - build confidence, give info, refer, prescribe
Reasons pts give for use of e-cigarettes?
Recreational purposes
As preferable to smoking tobacco cigarettes
Alternative to tobacco cigarettes where smoking is prohibited
Reduce exposure to others of smoke
Cheaper than tobacco
Hard reduction tool
Smoke cessation tool to help reduce and stop tobacco
Advice to give to pts regarding e-cigarettes?
Long term safety of e-cigarettes not established
Likely to be less harmful than tobacco cigarettes
Effectiveness of e-cigarettes as either a smoking cessation tool or a harm reduction tool not yet established
No e-cigarettes are licensed as a medicine
Pt’s are recommended to use licensed NRT products to quit or reduce tobacco consumption
Best to stop smoking all together
If pt cannot use NRT products - e-cigarettes are likely to be better than you than smoking but safety cannot be assured
Advice on e-cigarettes are likely to change
Why doesn’t DHE work?
Evidence implicating plaque, sugar and tooth surface in caries/perio is strong
Hard to change behaviour due to social, cultural and personal environment
What is health promotion?
Process of enabling people to increase control over and to improve their health
