Prevention in practice
The realities of adopting a preventive approach were
examined by Threlfall and colleagues, who revealed
troubling shortcomings in relation to both the content
and delivery of advice to patients by General Dental
Practitioners (GDPs). Looking first at the messages that
were conveyed7, the authors concluded that it was worrying
to find so much variation in approach to the essential
activity of preventing caries in young children. They
secondly examined the factors that influenced the provision
of preventive care8. Generally, dentists were more inclined
to give advice and spend more time advising middle class
parents, whom they perceived as being more motivated
than parents from a lower social class. Dentists reported
that they became disillusioned when people did not listen
or obviously had not acted upon their advice. Almost all
believed that the key to preventing caries in young children
was education and the majority provided preventive advice
verbally, in the form of a mini lecture. There was a lack
of imagination in the delivery of preventive advice and a
lack of additional materials for parents to take home. Most
GDPs seemed to limit their role to being prescriptive, many
seeming to model themselves on a teacher in a classroom
with parents and patients as their pupils, some of whom
were good, and listened attentively, and others of whom
were bad and did not listen. There was little evidence of
reflection about the way the GDPs delivered preventive
advice.
The authors concluded that the arrival of the new dental
contract provided an opportunity for change by placing
prevention at the heart of dental care, but that this would
be squandered unless efforts were made to improve both
the content and the delivery of preventive advice. Training
could be provided, both as part of the undergraduate
curriculum and as part of continuing professional
development, to promote a better understanding of
counseling skills and educative techniques. In addition,
individual GDPs needed to reflect on their own delivery
of preventive care to identify ways in which it might be
improved.
Commenting on the authors’ papers, Hancocks noted
that a picture emerges of somewhat haphazard content
and delivery of ‘messages’ in many ways skewed by the
subjective views of the individuals doing the ‘educating’9.
Hancocks suggests that some consistent guidelines, as
well as effective teaching methods, should be developed.
However, the question remains as to whether the dentist or
other members of the dental team, with different skills, are
best placed to fulfill the patient education role10.