SOUTH AFRICAN NATIONAL ORAL HEALTH STRATEGY

PREAMBLE

Most oral diseases are not life-threatening but affect almost every individual during his
and her life time, resulting in pain and discomfort, expenditure on treatment, loss of
school days, productivity and work hours, and some degree of social stigma. Oral
conditions are important public health concerns because of their high prevalence, their
severity, or public demand for services because of their impact on individuals and
society.

Oral disease levels appear to be increasing in major sectors of the South African
population, especially the underserved, disadvantaged and urbanising communities.

Basic health and social services are a human right and oral health is a significant
component thereof. Individual oral health treatment options are not available to most
people, with few oral health promotive and preventive activities. State dependent
people should have access to basic oral health treatment services. Oral diseases are
largely preventable and therefore oral health promotion and primary prevention are a top
priority.

Although national goals are be of some value it is recognised that communities and the
circumstances in which they live are extremely diverse. This strategy also provides
guidelines to oral health care workers at district level to make the best decisions on what
oral health strategies to implement. It allows for the most effective oral health
interventions to the specific needs, infrastructure and resources available to each
community.

AIM

The aim is to improve the oral health of the South African population by promoting oral
health and to prevent, appropriately treat, monitor and evaluate oral diseases.

NATIONAL, PROVINCIAL AND DISTRICT FUNCTIONS

These functions are in the National Health Bill, 2002.

Specific oral health functions of importance at each level are as follows:

National

ƒ National oral health strategy process (formulation, implementation and

review)
ƒ National water fluoridation programme and alternative fluoride measures
(formulation, implementation, monitoring and evaluation in collaboration
with the National Fluoridation Committee)
ƒ National norms and standard for oral health service delivery. Refer to the
following documents:

o A Comprehensive Primary Health Care Service Package for South

Africa
o The Primary Health Care Package for South Africa – A set of norms
and standards.
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o National Norms, Standards and Practice Guidelines for Primary Oral

Health Care

ƒ Essential national oral health research (support executing such research)

ƒ National oral health data set:

For monitoring and evaluation, specific data has to be collected from

the District Health Authorities via the Provinces to the national
Department of Health (Appendix 5)

ƒ National and international oral health matters liaison

Liaise with health related national associations, statutory councils,

training institutions, media and public as well as internationally with
the World Health Organization, International World Federation, US
Centers for Disease Prevention and Control etc.

ƒ Integration of oral health into other health programmes

e.g. HIV/AIDS, Maternal and Women’s Health, Child and Adolescent

Health, Nutrition, Chronic Diseases, Disabilities and Geriatrics.

Provincial

ƒ Provincial oral health operational strategy (formulation, implementation

and review)

ƒ Prevention of oral diseases and promotion of oral health as priority:

o Involved with the implementation of water fluoridation and

alternative fluoride programmes

o Identify and develop collaborative approaches to initiatives that

address oral disease common risk factors such as tobacco,
sugar, alcohol, unsafe sex, chronic medication, violence and
vehicle accidents.

o Raising the awareness of oral disease risk factors and

appropriate means of oral self care.

o Integrate oral health strategy elements and strategies into

programmes and policies of all sectors that have an impact on
community health like maternal and women’s health, child and
adolescent health, nutrition, chronic diseases, disabilities and
geriatrics.
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ƒ Co-ordination of the oral health care system in the province

ƒ Planning, supporting and evaluating district oral health services

ƒ Collection of data from districts for own and national use

ƒ Implement national norms and standards for oral health service delivery

District

The communities and the circumstances in which they live are diverse. Prepare a
customised set of intervention strategies and targets selected according to the
specific needs, determinants and other circumstances for each community.
Match oral diseases with the best intervention strategies and available resources.

ƒ As a minimum ensure:

™ the provision of appropriate disease prevention and health

promotion measures,

™ the provision of basic treatment services,

- an examination
- bitewing radiographs
- scaling and polishing
- simple (1-3 surface) fillings
- emergency relief of pain and sepsis, including dental
extractions

™ the implementation of cost–effective and evidence–based

strategies

ƒ The following steps must be taken to ensure that an appropriate oral

health plan is devised for each health setting:

1. Assess the oral health condition of the community (Appendix 1)

2. Prioritise the problems identified according to their prevalence,
severity and social impact (Appendix 2)
3. Identify the resources available (Appendix 3)
4. Select the most appropriate interventions (Appendix 4)
5. Implement, monitor and evaluate the selected strategies.

ƒ Collect appropriate data for Provinces and the national Department of

Health.

ƒ An adequate referral system should be established for advanced and

specialised oral health services
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NATIONAL GOALS FOR 2010

‰ Increase PHC-facilities, through the provinces, delivering oral health care

services by ensuring that these services are being (made) available in the
following order of priority:

ƒ District Hospitals
ƒ Community Health Centres, and
ƒ Clinics or Mobile Dental Units or Portable Dental Units

‰ Increase the percentage of children at age 6 who are caries free to 50%
(in line with WHO 2010 goals).

‰ Reduce the mean number of Decayed, Missing and Filled Teeth (DMFT)
at age 12, to 1.0 (in line with WHO 2010 goals).

‰ That 60% of the population on piped water systems receive optimally

fluoridated water.

‰ That 100% of clinics offer the primary oral health care package.

RESOURCES

Human Resources

Oral health human resources will form part of an integrated health human
resource plan.

Financial Resources

The national Directorate: Oral Health has its own budget.

Oral health at provincial level should have cost centres for budgeting purposes.
They have to, according to the MTEF, budget for oral health service delivery.
Financial management must comply with the PFMA.

For the upgrading and refurbishing of oral health facilities and equipment,
provinces have to budget through the MTEF, according to the needs determined
by the provincial oral health programme managers in each of the provinces.

The provinces will be responsible for the capital expenditure and appropriate
equipping of dental facilities in health facilities.

Oral health patients will be charged for services rendered according to the
Uniform Patient Fee Schedule.
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Physical Facilities

In the building of clinics and upgrading programme, oral health programme

managers must be consulted at the planning stage. All accommodation plans
and needs for public oral health services will be dealt with in accordance with the
health facilities planning directives.

Transport

Appropriate transport should be made available where necessary for oral health
service delivery.

LINKS BETW EEN NATIONAL AND PROVINCIAL HEALTH AUTHORITIES

In order to facilitate better communication between the national and provincial health
authorities it is important for:

‰ The national Directorate: Oral Health to meet with the Oral Health
Programme Managers of the provinces at national office at least three
times annually.

‰ The national Directorate: Oral Health to visit the provinces to assist and
guide provincial oral health services.

STRATEGY REVIEW AND DEVELOPMENT

The national Department of Health is required to convene a strategy review panel

annually, to assess the implementation and outcomes of this strategy, and make
recommendations accordingly. It is also responsible for collating the information
provided by provincial health authorities and the regular dissemination of summary data
and reports on the review process.
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Appendices
Appendix One: Assessing The Oral Health Of A Community
Data for oral health programme
management must be gathered Sample questions to assess the local impact of oral diseases
at the level w here programme 1. Age
implementation and decision-
2. Gender Male Female
making takes place. They
provide a basis for planning, 3. Do you have anything wrong with your mouth at this moment or
monitoring and evaluation. have you experienced any problems with your mouth in the past
month? Yes No
Appendices One and Tw o 4. If yes, which of the following conditions best describes what you
contain some examples of think was wrong?
Toothache Difficulty with chewing Pain
questions and formats to assist An ulcer/sore Appearance of teeth Bad breath
you in selecting questions and Bleeding gums Difficulty opening/closing your mouth
relevant information for a local Cold sore Difficulty in speaking Other……
oral health appraisal process.
5. Have you been treated for anything wrong with your mouth in the
Adapt or restructure similar data
past month? Yes No
sheets to suit your local 6. Have you experienced any pain from your teeth or mouth within the
circumstances. past month? Yes No
7. If yes, for how long have you experienced this pain?
When all such local data are Days Weeks Months
8. How bad was the pain?
aggregated then they also Mild Moderate Severe
provide justification for the 9. The impact of the pain: The pain stopped me from
allocation of financial and other 1. eating. drinking or chewing
resources to the oral health 2. sleeping
3. going to school or work
sector. To be useful for this
4. doing my normal daily activities
purpose such data must reflect 10. What did you do to stop or control the pain?
community priorities in oral 1. Nothing
health. For this purpose, the 12- 2. Took pain pills or medicine
year-old DMFT, is rarely 3. Visited the doctor/dentist or clinic
11. What did the health worker/clinic do?
adequate alone. Of far greater 1. Nothing
relevance, is the number of 2. Gave me medication
people suffering from toothache 3. Extracted a tooth
at any one time, or the number of 4. Other…………….
days of school or employment 12. Estimated DMFT
D M F Total
lost because of oral ill-health.
These types of data show
constituents’ concerns, are Etc…
measurable and are
understandable by those w hose
support for specif ic policies is essential.

Few if any accurate data exist for regions in South Africa on the impact of oral diseases on
peoples’ daily lives (pain, appearance, comfort, eating restrictions, bad breath etc). It is
recommended that as part of the general data gathering process simple community based
surveys to determine the frequency of oral health problems should be carried out. These data
should be gathered using a rapid appraisal approach such as the questionnaire show n in the
box above.
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Appendix Two: Priority Oral Conditions And Determinants
Most oral health programme managers have a rough idea of the oral health conditions prevalent
in their local communities. National and province-w ide surveys are complex, expensive and take
a very long time for the results to return to local level, so a simpler and quicker form of
assessment is required to verify the manager’s rough estimate.

Step One
Interview a number of reliable community informants such as clinic staff, general practitioners
and others, on their perception of how common (the prevalence) and how serious (social impact)
the community view s the conditions listed below . The accepted morbidity and mortality of each
condition is given.

Indicate your assessment of Social Impact and Prevalence as High, Medium, Low or None in the
blocks provided.

The prevalence and severity of oral conditions

Oral condition Social Impact Prevalence Morbidity Mortality

Bad breath Low None
Benign oral tumours Medium Low
Bleeding gums Medium None
Congenital abnormalities Medium Medium
Early childhood caries High Low
Fluorosis Low None
Harmful practises Medium Medium
Loose teeth Low Low
Mouth sores Medium Medium
Noma High High
Oral cancer High High
Oral HIV High High
Oro-facial trauma Medium Medium
Pain High Low
Tooth decay Medium Low
Tooth loss Medium Low
Other..
Note: This is only an example. You might add other conditions or delete some of these in your own list.

Step Two
Rank the listed conditions depending on how many times they score a High or Medium rating in
their row of the table. Those conditions you move to the top of list on this basis w ill represent the
priority oral health conditions in your particular community.

Step Three
This same group of community informants can assist you to identify the most prominent
determinants or risk factors for oral disease present in their community.

Factors know n to affect the risk of oral disease How widespread is this?
Tobacco use
Sugar consumption > 10kg/year
Use of fluoride toothpaste
Access to fluoridated water
Other e.g. areca or betel nut chewing, disability etc.
Indicate the responses as High, Medium, Low or None.
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Appendix Three: Oral Health Resource Assessment

An absence or limitation on resources does not need to mean non-delivery of services
but simply means alternative strategies that are less resource or technology-intensive
must be provided. For this reason a series of decision table illustrating an approach to
matching resources and interventions, is presented in Appendix Four.

However before proceeding to that stage of the process, it is first necessary to

determine the level of resources available to implement the interventions you are
considering. The following questions are designed to assist you in making this
assessment.

Yes No Don’t
Know
Finance
1. Is there an oral health budget?
2. Are there sufficient capital funds for equipment &
instrumentation?
3. Are there sufficient recurrent funds for salaries and materials?
Personnel
4. Are there sufficient, appropriately trained personnel?
5. Are there sufficient personnel to manage, monitor and evaluate
the intervention?
Equipment and Instrumentation
6. Is the equipment available appropriate?
Infrastructure
7. Has a needs assessment been carried out in sufficient detail to
select the intervention?
8. Are there clear lines of communication to the community?
9. Are there clear lines of communication for the acquisition of
resources?
10. Are there clear lines of communication for reporting?

11. If yes, are they functional?

12. When some form of transport is necessary, (for people or

goods), can you rely on the transport system to provide it?

Interpreting the responses you get

Num ber of questions answered YES Availability of resources

If there are less than six LOW
If there are betw een six and nine questions MODERATE
If there are more than nine questions HIGH
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Appendix Four: Decision Tables To Match Oral Diseases With Best

Interventions And Available Resources.
After determining local oral disease priorities, each separate condition must be assessed in
terms of the intervention options available and the resources or infrastructure necessary to
deliver them. Based on this a selection of the best locally viable strategy (S) can be made and
implemented. The outcome of each strategy may be measured using selected indicators such as
the suggested targets included below each oral disease table.

The Oral Health Targets suggested for each of the listed oral disease or health conditions, are
intended to provide a framew ork for health strategy makers at different levels – national,
provincial, and local. They are not intended to be prescriptive. It is hoped these Targets w ill be
mixed and matched according to prevailing local circumstances.

The tables are not provided for every conceivable condition and others w ill need to be
constructed as they become necessary. Future tables might include malocclusion, and
orthodontic treatment, occupational hazards such as erosion or abrasion, and others.

Always ask: Is the intervention based on best practice, i.e. is it

evidence-based? (Refer to Appendix 6 for some examples).
Pain RESOURCES INTERVENTION STRATEGIES

Low Medium High S1= Provide pain relief with analgesics and/or
antibiotics (See Essential Drugs List: EDL);
Adults S1 S2 S3 extraction

S2 = emergency endodontics of anteriors where

Children <6 years S1 S2 S3
indicated

S3 = emergency endodontics of posteriors where

indicated; pulpotomy
Suggested indicator Your target
A reduction in episodes of pain of oral and craniofacial origin of %
A reduction in the numbers of days absent from school, employment and work
resulting from pain of oral and craniofacial origin of %
A reduction in the numbers of days of difficulty in eating, and speaking/
communicating resulting from pain or discomfort of oral and craniofacial origin of %
A reduction in the numbers of days of difficulty in participating in social and cultural
activities resulting from pain or discomfort of oral and craniofacial origin of %

Oral HIV RESOURCES INTERVENTION STRATEGIES

Low Medium High S1 = Advocacy and support for the health system’s
response to the HIV pandemic; Universal Infection
Existence of HIV S1 S2 S2 Control; Prevent oral lesions amongst HIV + people
with chlorhexidine; Development of a local protocol
for all oral health workers.
S2 =S1 + specific treatment of oral mucosal lesions
(See current treatment protocols and EDL).
Suggested indicator Your target
To reduce the incidence of opportunistic oro-facial infections by %
To increase the numbers of health providers who are competent to diagnose and
manage the oral manifestations of HIV infection by %
To increase the numbers of strategy makers who are aware of the oral implications
of HIV infection by %
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RESOURCES INTERVENTION STRATEGIES (S)
Dental Caries Low Medium High S1 = Oral hygiene education, provide analgesics (See
EDL), tooth extraction for patients with pulpitis
Severe S2 S3 S3 S2 = S1 + Assessment of level of fluoride in water
supplies and level of fluoride toothpaste use. Advocate
for implementation of water fluoridation or distribute
Moderate S2 S2 S3 subsidised fluoride toothpaste.
S3 = S2 + Fissure sealants, Atraumatic Restorative
Technique, Preventive Resin Restorations, Simple
Mild S1 S1 S3 endodontic therapy for patients with pulpitis of anterior
teeth and extraction of posterior teeth with pulpitis, Use
of rotary instruments to place restorations i f viable.
Suggested indicator Your target
To increase the proportion of cari es-free 6-year-olds by %
To reduce the proportion of children with severe dental caries at age 12 years, with special
attention to high-risk groups within populations, by %
To reduce tooth loss due to dental caries at ages 18 years by %
To reduce tooth loss due to dental caries at ages 35-44 years by %
To reduce tooth loss due to dental caries at ages 65-74 years by %

Fluorosis RESOURCES INTERVENTION STRATEGIES

Low Medium High S1 = Identify alternative water source; Advocacy and

social mobilisation for de-fluoridation using appropriate
High prevalence of S1 S1 S3 technology.
fluorosis S2 = No intervention
Moderate or low S2 S2 S2 S3 = Clinical intervention for selected severe cas es.
prevalence
Suggested indicator Your target
To reduce the prevalence of disfiguring fluorosis with special reference to the fluoride
content of food, water and inappropriate supplementation by %

Chronic RESOURCES INTERVENTION STRATEGIES

periodontal Low Medium High S1 = self-care and education; Occupational health and
disease safety measures.
High priority S2 S2 S3
Attachment Loss or S2 = S1 + identify those at risk; Advocacy to reduce risk
pockets >5mm factors like poor nutrition, smoking, immuno-
suppression; Extraction of teeth with pain and mobility;
Low/moderate S1 S1 S1
Treatment of critical teeth to retain at least 5 posterior
Attachment Loss or occluding pairs; Scaling when necessary.
pockets <5mm
S3 = S1 + S2 More complex evidence-based treatment to
treatment to delay/slow progress, where appropriat e.
Suggested indicator Your target
To reduce tooth loss due to periodontal diseases at ages 18 years with special reference to
smoking, poor oral hygiene, stress and inter-current systemic diseases by %
To reduce tooth loss due to periodontal diseases at ages 35-44 years by %
To reduce tooth loss due to periodontal diseases at ages 65-74 years by %
To reduce the incidence of necrotizing forms of periodontal diseases by reducing exposure
to risk factors such as poor nutrition, stress and immuno-suppression by %
To reduce the incidence of active periodontal infection in all ages by %
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Noma RESOURCES INTERVENTION STRATEGIES

Low Medium High S1 = immunisation, nutrition, education, feeding schemes

(short-term), oral cleaning, chlorhexidine, mouthwash
Existence of noma S1 S1 S2 during acute infectious diseases, develop a local protocol
for the acute phase of noma.
S2 = S1 + reconstructive surgery.
Suggested indicator Your target
To increase reliable data on noma from populations at risk by %
To increase early detection and rapid referral by ….. and …….. respectively % and %
To reduce exposure to risk factors with special reference to immunization coverage for
measles, improved nutrition and sanitation by %
To increase the number of affect ed individuals receiving multidisciplinary specialist care by %

Oral Cancer RESOURCES INTERVENTION STRATEGIES

Low Medium High S1 = Train Primary Health Care (PHC) Workers in the de-
tection of oral pre-cancer and cancer; Early diagnosis by
Existence of Oral S1 S1 S1 PHC workers for oral pre-cancer and cancer; Advocate for a
Cancer functional referral system if none exists; Train general
pathologists in oral cytology and classification of oral
cancers; Measures to limit occupational risk factors;
Advocate for registration of all oral cancers in a national
register; Adopt and use standardised treatment protocols.
Suggested indicator Your target
To reduce the incidence of oro-pharyngeal cancer by %
To improve the survival of treated cas es by %
To increase early detection and rapid referral by ……… and ……… respectively % and %
To reduce exposure to risk factors with special reference to tobacco, alcohol and improved
nutrition by %
To increase the number of affect ed individuals receiving multidisciplinary specialist care by %

Benign RESOURCES INTERVENTION STRATEGIES

Tumours Low Medium High S1 = Training PHC workers in the detection of oral pre-
cancer and cancer; Early diagnosis by PHC workers for oral
Existence of S1 S1 S1 pre-cancer and cancer; Adopt and use standardised
Benign Tumours treatment protocols based on the availability of resources
Suggested indicator Your target
To increase the numbers of health care providers who are competent to diagnose and
provide emergency care by %
To increase early detection and rapid referral by ……. and …….. respectively % and %

Cleft Lip &/or RESOURCES INTERVENTION STRATEGIES

Palate Low Medium High S1 = Counselling, Ante-natal care; Surgical treatment of
condition; Train PHC workers in early recognition and
Occurrence of S1 S2 S2 referral for speech therapy etc.
Cleft Lip & Palate S2 = S1 + orthodontic and prosthetic treatment based on the
availability of resources
Suggested indicator Your target
To increase the number of affect ed individuals receiving multidisciplinary specialist care by %
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Oro-facial RESOURCES INTERVENTION STRATEGIES

Trauma
Low Medium High S1 = Advocacy and support for programmes that: a)
enhance social development; b) decrease alcohol and drug
Existence of Oro- S1 S1 S1 abuse; c) improve infra-structural development and d)
facial Trauma create legislation for occupational health and safety and
road safety; Adopt and use standardised treat ment protocols
based on the availability of resources.
Suggested indicator Your target
To increase early detection and rapid referral by ……… and ……… respectively % and %
To increase the numbers of health care providers who are competent to diagnose and
provide emergency care by………. to ………. % to %
To increase the number of affect ed individuals receiving multidisciplinary specialist care
where necessary by %

Tooth loss RESOURCES INTERVENTION STRATEGIES

Low Medium High S1 = Health Promotion and education; Advocacy and

support for programmes that enhance social development
Partial edentulism S1 S2 S2
S2 = S1 + Denture construction, based on the availability of
Complete S2 S2 S2 resources and according to current protocols.
edentulism
Suggested indicator Your target
To increase the number of natural teeth pres ent at ages 18 years by %
To increase the number of natural teeth pres ent at ages 35-44 years by %
To increase the number of natural teeth pres ent at ages 65-74 years by %

Harmful RESOURCES INTERVENTION STRATEGIES

practises Low Medium High S1 = Health Promotion and education; Advocacy and
support for programmes that enhance social development;
High S1 S2 S2 Education and training of health workers; Treatment of
severe complications
Low S1 S2 S2 S2 = S1 + Education and training of existing health
workers to recognise and advocate for the eradication of
harm ful practises; Education and training of existing oral
health personnel to use only evidence-based
interventions.
Suggested indicator Your target
A reduction in the numbers of individuals experiencing difficulties in chewing, swallowing
and speaking/communicating arising from a vari ety of harm ful practises of %
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Appendix Five: National Monitoring And Evaluation

The following information needs to be submitted annually by the provincial health authorities to
the national Department of Health.

1. National oral health programmes in place

1.1 Is there a provincial oral health operational strategy? Yes No

If no, why not?

When is it expected to have such a strategy finalised?

Attach a list of all health Districts, indicating (i) whether an oral health plan has been
prepared or the stage of the planning process that has been reached, and (ii) the extent to
which each plan has been implemented.

1.3 National water fluoridation programme.

Number of water providers in province

Number of water providers fluoridating water supplies
Number of water providers exempted from fluoridation

Attach a list of all water supply agencies/municipalities in the Province, indicating (i) the
stage of the fluoridation planning process that has been reached, (ii) the extent to which
fluoridation has been implemented, and (iii) the number of people receiving fluoridated
water.

2. Population strategies carried out

2.1 Are there oral health education and promotion programmes? Yes No

If no, why not?

Attach a list of all programmes of this kind that have been implemented, indicating (i) the
nature of the programme, (ii) where they have been implemented, and (iii) the
beneficiaries of the programme..

2.2 Are oral health strategies integrated with other health programme e.g. HIV/AIDS, health
promotion, maternal and women’s health, child and adolescent health, and nutrition.

Yes No

If no, why not?

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3. Oral health strategies prepared and interventions implemented

List of oral health Estimated Priority Number of LHA’S with intervention

conditions prevalence ranking strategies in place for these conditions

Total number of Local Health Authorities (LHA’s) in province

Attach copies of this table for each of the health districts in your Province.

4. Community oral health assessment data

Has community oral health assessment data per LHA been collected? Yes No

If no, why not?

Attach the data set for each health district in your Province for which this has been
collected.

5. Resource assessment

Attach a completed copy of the form in Appendix Three for the province.
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Appendix 6: Some Evidence-Based Practices for Dentistry

The table below contains some examples from published systematic reviews that have assessed
the evidence for the listed oral health interventions. The national Department of Health is tasked
with disseminating current research information, such as that illustrated below, to all Provinces.
M ore oral health conditions will subsequently be added to this list along with the interventions
proven to be affective ways to address them.

Oral Health Strategy Evidence

Oral Health There is clear evidence that oral health education/promotion can be
Promotion effective in bringing about changes in people’s knowledge. This process
must be ongoing for maximum effect.
Water Fluoridation Very effective at preventing caries
Mass Media Programmes for There is no evidence that mass media programmes significantly alter any
Oral Health oral health related outcome
S chool based health education There is no convincing evidence that these programmes had any effect on
programmes aimed at plaque levels in the participants mouths, even when daily brushing was
done. School based programmes run by dental professionals, teachers,
improving oral hygiene older pupils, etc have not been demonstrated to affect oral hygiene.
Toothbrushing Good evidence to recommend brushing twice daily with fluoride
toothpaste for caries prevention and gingivitis
Dental Flossing Good evidence to recommend flossing as an adjunct to toothbrushing for
control of gingivitis in adults
Not effective in preventing gingivitis in children
S caling Good evidence to recommend against subgingival scaling in sites with no
signs of disease.
Good evidence to recommend scaling for initial therapy in patients with
active periodontitis when combined with maintenance therapy.
Root planing No evidence regarding additional benefits of root planing in periodontal
therapy. There is a lack of scientifi c evidence regarding the effects of root
planing beyond the effects that can be achieved with sub-gingival scaling
alone.
Polishing Good evidence to recommend against polishing prior to topical fluoride
application
Good evidence to recommend against polishing for control of gingivitis
Recall No evidence that 6 monthly recall is optimal frequency
Prophylactic removal of There is little justification for the removal of pathology free impacted third
impacted third molars molars
Fissure Sealants Effective in preventing dental caries.
Effectiveness decreas es with time-so periodic reapplication is advisable
Self-curing sealants more effective than light cured sealants.
Water fluoridation appears to increas e effectiveness.
Some References (including websites for evidence based dentistry)
1. Brothwell DJ, Jutai DKG, Hawkins RJ. An Update Of Mechanical Oral Hygiene Practices: Evidence-Bas ed
Recommendations for Disease Prevention. J Can Dent Assoc 1998; 64(4): 295-304.
2. McDonagh MS, et al. Systematic review of wat er fluoridation. BMJ 2000; 321: 855-859. Also available on
http://www.bmj.com
3. Locker D, Kay E. A systematic review of the effectiveness of health promotion aimed at improving oral health.
Comm Dent Health 1998; 15: 132-144.
4. Song F, Landes DP, Glenny AM, Sheldon TA. Prophylactic removal of impacted third molars: an assessment of
published reviews. BDJ 1997; 182: 339-346.
5. Netting the Evidence: http://www.shef.ac.uk/~scharr/ir/netting/
6. Centre for Evidence-Based Medicine http://cebm.jr2.ox.ac.uk/docs/adminpage.html
7. Cochrane Collaboration http://www.cochrane.org/cochrane/general.htm