School of Dentistry, Aarhus University Faculty of Health Sciences, Aarhus, Denmark.
J Dent. 2011 Dec;39 Suppl 2:S9-19. doi: 10.1016/j.jdent.2011.10.015. Epub 2011 Nov 4.
Dental professionals are expected to engage in oral disease prevention, but their tools limit the approach to chair side activities based on the common notion that the major dental diseases, dental caries, gingivitis and periodontitis, are behavioural diseases shaped by individual lifestyles. However, lifestyles also have causes and individual behaviours reflect cultural norms, expectations and opportunities that are socio-economically determined and structurally maintained. Importantly, the effects of the societal and socio-economic determinants reach way above their influences as individual attributes, and effective approaches to the prevention and control of oral diseases are aligned with this causal chain. Unfortunately, the ethos and philosophy of dentistry is focused to a downstream, patient-centred, curative and rehabilitative approach to oral diseases. Whilst such services are needed to care for those who have already suffered the consequences of oral diseases, they do not influence population oral health. A more balanced distribution of efforts and resources along the whole range of intervention points from the downstream curative to the upstream structural healthy policy approaches is required if appropriate, evidence-based, effective, cost-effective, sustainable, equitable, universal, comprehensive and ethical delivery of health care, including oral health care, is the goal. The implementation of healthy policies and sound approaches to population oral health will require substantial commitment and political will on the part of the public and their elected officials.
口腔专业人员被期望参与口腔疾病预防，但他们的工具仅限于椅旁活动，这是基于一个常见的观念，即主要的口腔疾病，龋齿、牙龈炎和牙周炎，是由个体生活方式塑造的行为性疾病。然而，生活方式也有其原因，个体行为反映了文化规范、期望和机会，这些都是由社会经济决定和结构性维持的。重要的是，社会和社会经济决定因素的影响远远超出了它们作为个体属性的影响，预防和控制口腔疾病的有效方法与这一因果链相一致。不幸的是，牙科的精神和理念侧重于下游的、以患者为中心的、治疗性和康复性的口腔疾病方法。虽然这些服务是为了照顾那些已经遭受口腔疾病后果的人而提供的，但它们并不影响人群的口腔健康。如果要实现适当的、基于证据的、有效的、具有成本效益的、可持续的、公平的、普遍的、全面的和合乎道德的医疗保健，包括口腔保健，包括口腔保健，就需要沿着从下游治疗到上游结构性健康政策方法的整个干预点，更均衡地分配努力和资源。公共卫生政策和人口口腔健康的健全方法的实施将需要公众及其民选官员的大量承诺和政治意愿。
