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      Prevention in practice – a summary.

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          Abstract

          Background

          This paper is a summary document of the Prevention in Practice Conference and Special Supplement of BMC Oral Health. It represents the consensus view of the presenters and captures the questions, comments and suggestions of the assembled audience.

          Methods

          Using the prepared manuscripts for the conference, collected materials from scribes during the conference and additional resources collated in advance of the meeting, authors agreed on the summary document.

          Results

          The Prevention in Practice conference aimed to collate information about which diseases could be prevented in practice, how diseases could be identified early enough to facilitate prevention, what evidence based therapies and treatments were available and how, given the collective evidence, could these be introduced in general dental practice within different reimbursement models.

          Conclusions

          While examples of best practice were provided from both social care and insurance models it was clear that further work was required on both provider and payer side to ensure that evidence based prevention was both implemented properly but also reimbursed sufficiently. It is clear that savings can be made but these must not be overstated and that the use of effective skill mix would be key to realizing efficiencies. The evidence base for prevention of caries and periodontal disease has been available for many years, as have the tools and techniques to detect, diagnose and stage the diseases appropriately. Dentistry finds itself in a enviable position with respect to its ability to prevent, arrest and reverse much of the burden of disease, however, it is clear that the infrastructure within primary care must be changed, and practitioners and their teams appropriately supported to deliver this paradigm shift from a surgical to a medical model.

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          Most cited references29

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          Minimal intervention dentistry for managing dental caries - a review: report of a FDI task group.

          This publication describes the history of minimal intervention dentistry (MID) for managing dental caries and presents evidence for various carious lesion detection devices, for preventive measures, for restorative and non-restorative therapies as well as for repairing rather than replacing defective restorations. It is a follow-up to the FDI World Dental Federation publication on MID, of 2000. The dental profession currently is faced with an enormous task of how to manage the high burden of consequences of the caries process amongst the world population. If it is to manage carious lesion development and its progression, it should move away from the 'surgical' care approach and fully embrace the MID approach. The chance for MID to be successful is thought to be increased tremendously if dental caries is not considered an infectious but instead a behavioural disease with a bacterial component. Controlling the two main carious lesion development related behaviours, i.e. intake and frequency of fermentable sugars, to not more than five times daily and removing/disturbing dental plaque from all tooth surfaces using an effective fluoridated toothpaste twice daily, are the ingredients for reducing the burden of dental caries in many communities in the world. FDI's policy of reducing the need for restorative therapy by placing an even greater emphasis on caries prevention than is currently done, is therefore, worth pursuing.
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            How has research into cytokine interactions and their role in driving immune responses impacted our understanding of periodontitis?

            To review current knowledge on cytokine interactions and the cytokine-mediated links between innate and adaptive immunity that are relevant to the pathophysiology of periodontitis. A structured review of the literature was undertaken to identify relevant research publications using a Medline search from 1950 to September 2010. The focus of the search was on the functional role of cytokines, i.e. their actions and responses relevant to the pathogenesis of periodontal disease rather than more descriptive studies of their expression in tissues and body fluids. It was not possible to conduct a traditional systematic review with a focussed question due to the heterogeneity of published research. There is enormous heterogeneity in the periodontal literature in terms of experimental approaches. We have the deepest understanding of the role of the pro-inflammatory cytokines [e.g. interleukin (IL)-1β, tumour necrosis factor-α, IL-6] with accumulating data on T-cell regulatory cytokines (e.g. IL-12, IL-18), chemokines and cytokines which mediate bone cell development and function (e.g. receptor activator of NF-κB ligand, osteoprotegerin). It is clear that there are multiple, overlapping and complex functional links between cytokines with regulatory control exerted at a number of levels and involving numerous cell types (both immune cells and resident cells in the periodontium). Cytokines appear to interact functionally in networks in the periodontium and integrate aspects of innate and adaptive immunity. However, our understanding is far from complete, particularly how molecular and cellular pathways relate to disease pathogenesis. We should adopt consistent experimental approaches to gain better insight into the totality of cytokine networks and how they drive immune responses in the periodontium. © 2011 John Wiley & Sons A/S.
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              A systematic review of risk factors during first year of life for early childhood caries.

              Early childhood caries (ECC) describes dental caries affecting children aged 0-71 months. Current research suggests ECC has important aetiological bases during the first year of life. Gaps in knowledge about disease progression prevent the effective and early identification of 'at risk' children. To conduct a systematic review of research studies focusing on (a) acquisition and colonization of oral bacteria and ECC and (b) risk and/or protective factors in infants aged 0-12 months. Ovid Medline and Embase databases (1996-2011) were searched for RCT, longitudinal, cross-sectional and qualitative studies. Two investigators undertook a quality assessment for risk of bias. Inclusion criteria were met for (a) by four papers and for (b) by 13 papers; five papers were rated medium or high quality. Bacterial acquisition/colonization and modifying factor interrelationships were identified, but their role in the caries process was not clarified. Key risk indicators were infant feeding practices (nine papers), maternal circumstances and oral health (6) and infant-related oral health behaviours (4). This review confirmed that factors occurring during the first year of life affect ECC experience. Despite heterogeneity, findings indicated maternal factors influence bacterial acquisition, whereas colonization was mediated by oral health behaviours and practices and feeding habits. © 2012 John Wiley & Sons Ltd, BSPD and IAPD.
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                Author and article information

                Contributors
                Conference
                BMC Oral Health
                BMC Oral Health
                BMC Oral Health
                BioMed Central
                1472-6831
                2015
                15 September 2015
                : 15
                : Suppl 1
                : S12
                Affiliations
                [1 ]Centre for Health Economics and Policy Analysis, McMaster University, Canada
                [2 ]Manchester Centre for Health Economics, University of Manchester, UK
                [3 ]Public Health England, 4th Floor, 3 Piccadilly Place, London Road Manchester, M1 3BN, England, UK
                [4 ]NWORTH, Y Wern, The Normal Site, Bangor University, Holyhead Road, Gwynedd, UK
                [5 ]The Colgate Palmolive Company, Piscataway, NJ, United States
                [6 ]Dental Health Unit, School of Dentistry, University of Manchester, Manchester, England, UK
                [7 ]Dental Health Unit, School of Dentistry, University of Manchester, Manchester, England, UK
                [8 ]Apple Tree Dental, 8960 Springbrook Drive, Suite 150 Minneapolis, MN 55433, USA
                [9 ]Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, USA
                [10 ]School of Dentistry, University of Manchester, Manchester, England, UK
                [11 ]Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, Ohio, 43210, USA
                [12 ]Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
                [13 ]School of Dental Sciences and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2, 4BW, UK
                [14 ]Dental Health Unit, School of Dentistry, University of Manchester, Manchester, England, UK
                [15 ]School of Dentistry, University of Leeds, Leeds, LS2 9LU, UK
                Article
                1472-6831-15-S1-S12
                10.1186/1472-6831-15-S1-S12
                4580841
                26391906
                2155ffd8-5aee-4e06-aff5-9150ee418f12
                Copyright © 2015 Birch et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Prevention in practice - making it happen
                Cape Town, South Africa
                2962014
                History
                Categories
                Proceedings

                Dentistry
                Dentistry

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