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Evidence-Based Dental Care

Policy Date: 1/1/1997
Policy Number: 9706

The American Public Health Association,
Being aware of the overall changes in prevalence, incidence and rate of progression of dental caries in the US and other developed countries,1 and with enhanced understanding of its biology, behavioral associations, diagnosis and reversal by remineralization;2-4 and
Recognizing that in adults most restorative treatment for caries is retreatment;5,6 and
Being aware that periodontal disease does not inevitably lead to tooth loss, and is often amenable to simpler non-surgical treatments;7,8 and
Foreseeing that maintaining greatest integrity of the dentition through minimal treatment intervention enhances tooth retention and oral function over the lifespan;9 and
Aware of the need for health education of the public to support and utilize community water fluoridation, community oral health services and personal preventive measures including other fluoride products, dental sealants, diet in accordance with the US Department of Agriculture "food pyramid" guidelines including sugar moderation, personal oral hygiene measures for control of dental plaque10,11 as well as limitation of alcohol intake and cessation of tobacco-use to reduce the risks of oral, pharyngeal and other cancer and of periodontal disease;12-14 and
Realizing that misapplied fee-for-service systems may promote overtreatment and that poorly organized capitated systems may lead to underprevention;15-17 and
Realizing that insufficient scientific and professional attention18,19 has been given to justification for dental treatments and their health outcomes, despite a growing public awareness of this deficiency;20,21 and
Knowing that underprevention and overtreatment of oral disease involves retreatment and cost escalation throughout the lifetime, to maintain functions of chewing, speech, facial expressive communication and appearance;22 and
Realizing that the burden of oral diseases, and consequent pain and infection remains significantly higher in those without access to care;23 and
Concluding that the 40% of US adults and children who have inadequate access could improve their accessibility and oral health outcome under more effective public health programs, and that the quality of oral health care generally would benefit from systematic, evidence-based review; which is an evaluative process that objectively applies scientific evidence on oral health practices to treatment guidelines and standards;24-26 therefore;
1. Supports the principle and application of evidence-based dental services;
2. Encourages the collection, review, dissemination and policy applications of knowledge supporting or negating the efficiency and cost-effectiveness of specific forms of dental care;
3. Supports federal agencies such as Health Resources and Services Administration, National Institute for Dental Research, Agency for Health Care Policy and Research, the Centers for Disease Control and Prevention, the Health Care Financing Administration, the Veterans Administration, as well as state health agencies and the health insurance industry in adequately funding systematic reviews and research projects which provide further evidence of efficiency and cost-effectiveness of oral health care;
4. Encourages dental professionals, consumers, private and public health care financing agencies, and state licensing authorities to adopt an evidence-based approach to dental services, in order to rationally control costs, help assure quality and favorable outcomes, and extend more affordable dental care to a wider public; and
5. Supports dental care programs for underserved populations, and urges their inclusion in evidence-based care research and development.

References


  1. Glass RL (Ed.). The first international conference on the declining prevalence of dental caries. J Dent Res 1982;61: 1304-1383.

  2. Moss ME, Zero DT. An Overview of Caries Risk Assessment and its Potential Utility. J Dent Educ 1995;59:932-940.

  3. Brown JP (Ed.). Dilemmas in Caries Diagnosis. Symposium proceedings. J Dent Educ 1993;57:407-443.

  4. Lagerlof F, Oliveby A. New Strategies for Caries Treatment, in Stookey GK (Ed.) Early Detection of Dental Caries. Univ. Indiana Dental School, Indianapolis 1996. pp. 296-321.

  5. Anusavice KJ. Treatment regimens in preventive and restorative dentistry. J Am Dent Assoc 1995;126:727-740.

  6. Reinhardt JW, Douglass CW. The Need for Operative Dentistry Services: Projecting the Effects of Changing Disease Patterns. Oper Dent 1989;14:114-120.

  7. Burt BA. Public Health implications of recent research in periodontal disease. J Public Hlth Dent 1988;48:252-256.

  8. Capilauto ML, Douglass CW. Trends in the prevalence and severity of periodontal diseases in the US: a public health problem? J Public Hlth Dent 1988;48:245-251.

  9. Dawson AS, Makinson OF. Dental treatment and dental health Part 1. A review of studies in support of a philosophy of minimum intervention dentistry. Part 2. An alternative philosophy and some new treatment modalities in operative dentistry. Aust Dent J 1992;37:126-132, 205-210.

  10. Equity and Access for Mothers and Children. Strategies from the PHS Workshop on Oral Health of Mothers and Children. HRSA-MCHB, Dept Community Dentistry UTHSC San Antonio and NCEMCH Washington, DC, 1989.

  11. Steffensen JEM, Brown JP. PHS Workshop on Oral Health of Mothers and Children. Background Issue Papers. J Public Hlth Dent 50:Special Issue No. 6, 1990.

  12. National Strategic Planning Conference for the Prevention and Control of Oral and Pharyngeal Cancer: Proceedings. Chicago. American Dental Association, Centers for Disease Control and Prevention, National Institute of Dental Research NIH. Aug. 7-9, 1996.

  13. Christen AG, McDonald JL, Christen JA. The Impact of Tobacco Use and Cessation on Non-malignant and Precancerous Oral and Dental Diseases and Conditions. Indiana University School of Dentistry, Teaching Monograph. 1991.

  14. Smokeless tobacco or health, an International Perspective. Smoking and Tobacco Control Monograph No. 2 USPHS NIH Publication No. 93-3461, 1992.

  15. Kantor ML (Ed.). Symposium Proceedings, Clinical Decision Making in Dentistry. J Dent Educ 1992;56(12): 788-878.

  16. Dawes C. Editorial: Should Dentists Be Doing What They Do? J Dent Res 1991;70:1221.

  17. Lennon MA, Worthington HV, Coventry P, Mellor AC, Holloway PJ. The Capitation Study 2, Does Capitation Encourage Prevention? British Dental Journal 1990;168(5):213-215.

  18. Chalmers I. The Cochrane Collaboration: preparing, maintaining and disseminating systematic reviews of the effects of health care. Ann NY Acad Sci 1993;703:156-163.

  19. Mulrow CD. Rationale for systematic reviews. Br Med J 1994;304:597-599.

  20. Friedman JW. Complete guide to dental health; how to avoid being overcharged and overtreated. Yonkers, NY. Consumer Reports Books, 1991.

  21. Ecenbarger W. How honest are dentists? Readers Digest 1997; Feb, 50-56.

  22. Hollister MC, Weintraub JA. The Association of Oral Status with Systemic Health, Quality of Life, and Economic Productivity. J Dent Educ 1993;57(12): 901-912.

  23. US Public Health Service (USPHS), Oral Health Coordinating Committee. Toward Improving the Oral Health of Americans: An Overview of Oral Health Status, Resources, and Care Delivery. Public Health Reports 1993; 108(6):657-672.

  24. Brown JP. Research Required to Advance Early Detection Methods for Dental Caries, in Stookey GK (Ed.) Early Detection of Dental Caries. Univ. Indiana Dental School, Indianapolis; pp. 322-332, 1996.

  25. Isman RE. Integrating Primary Oral Health Care into Primary Care. J Dent Educ 1993;57:846-852.

  26. Woolf SH. Manual for Conducting Systematic Reviews. Agency for Health Care Policy and Research USPHS (Draft) August 1996.