Putting the population back into oral health; decoupling oral health improvement from clinical dental practice

Some 20 years ago, there was much speculation about improving oral health and the subsequent emergence of a vastly different type of clinical dental practice and visa versa. Few of the predictions have come to pass in Australia. Caries in children has somewhat rebounded, new treatment philosophies have not gained widespread adoption, and work effort in clinical dental practice remains dominated by diagnostic services, restorations and removable prosthodontics. What was behind the wayward predictions was a failure to separate the potency of ‘care’ from ability to ‘cure’ and an overestimation of the improvement in child oral health attributable to clinical dental services. If progress is to be made in improving oral health, an understanding of the mid- and upstream determinants of oral health needs to guide new population oral health activities. The contribution of clinical dental services to oral health should also be enhanced, but this should not divert attention from necessary population oral health activities to improve oral health.A. John Spence