In health care and in dentistry especially - prevention is about lifestyle. Although it’s not always a popular message, it is our choices that determine much about our health.

Dentists talk to their patients to find out about their health, lifestyle and any problems they have. We examine them and then we make recommendations and/or do treatment. The recommendations we make are often lifestyle related, and the changes can often be quite small. It would surprise many people to know that having sweet food or drinks just 5 times a day (for example tea or coffee with sugar) can cause tooth decay, whereas having it fewer than 4 times per day will usually cause no problem.

Prevention is however not as easy to do as it sounds. On paper it is quite straightforward. Make some changes and over time things improve. But in reality we are asking people to take responsibility for their own health and change their lifestyle, which is often a difficult message. I joke to my patients whilst dispensing brushing advice that it is the literal definition of ‘changing the habit of a lifetime’. Accepting these messages requires taking personal responsibility for one’s own health, not something everyone we meet is willing to do. In fact I often feel as though for some, a dental check-up is their way of at least sharing the responsibility for their own dental health with the dentist and for some passing it on entirely.

The mouth is essentially a system, evolved to enable us to chew, speak, swallow (and smile). It is a biological system rather than a machine, but it is a system nonetheless which requires maintenance, cleaning and repair. Whilst some people see the logic of maintaining this system, others do not, maybe they think it will or should maintain itself, after all many other parts of the body do not need any help, why should the mouth be different? But it is very different in that teeth once formed do not heal/repair themselves (apart from a small amount internally), and they wear down constantly throughout life. Most of the rest of our bodies is being renewed and replenished on a continuous basis. In the mouth there is a thriving ecosystem, comprised of possibly over 1000 species of micro-organisms.

One group of people who are much less likely to follow preventative advice are those who have a severe anxiety about, or phobia of, dentistry. I occasionally meet anxious patients who are extremely keen to prevent problems, to avoid treatment, but they are rare, and sometimes missing the target despite trying hard. The majority of severely anxious people rarely attend and when they do, they often have pain or swelling due to dental problems, this is often so bad that attendance has become unavoidable. This will require complicated or difficult treatment which can also be expensive. Once the problem is solved it’s easy to breathe a sigh of relief and not return until there is another serious problem. As such this behaviour reinforces the belief that what dentists do is always big, complicated, expensive (and often in their experience) – painful. As such they elect to avoid this experience by convincing themselves that everything is okay. This rarely works out as pain or infection generally returns. It returns as lifestyle changes are not put in place, and problems are avoided not addressed.

There is another group of people who are even more puzzling to the dental profession some of this group have mild anxiety, others none, but when offered preventative advice say “if its not broken, don’t fix it” or words to that effect. Why is this? For some its financial – money is tight and they are trying to be frugal. It is doubtful whether this approach saves money in the long term. The problems which could have been avoided or at worst treated in a minimal-way return later and often are more serious. They also cost more to sort out later, both in terms of money, time and inconvenience.

Some patients have an almost fatalistic mind set that prevention is not going to work. They believe that things are predetermined. Maybe they feel that their parents had bad teeth, so they will have bad teeth too. They do not think that using more fluoride, eating sugar less often and brushing better will decrease the amount of tooth decay they will suffer from. Prevention seems like a waste of time, this is a difficult narrative and a mind set to counter. I frequently ask patients to change their brushing habits and suggest that they try the changes for two weeks before deciding if it is worthwhile. Inevitably they notice the improvements, and are much more likely to keep it up. The first time you try to floss you’ll be put off by the difficulty, the bleeding and the soreness of the gums, all of which disappear in time.

When dentists see healthy people who hardly ever have any trouble with their teeth, we do not think- ‘this must be a lucky person’! Almost always that healthy person is healthy because they made choices which are more compatible with health, and they have fewer problems. Fate, I am afraid, has nothing to do with it. If it did how would we explain that many people undergo a big turnaround in their health? Going from poor dental health to excellent in the space of a few years just by making small changes.

On the more psychological side prevention, unlike toothache, cannot be easily seen, felt or measured. It is hard to notice that something did not happen! Many patients whose gum disease is being kept at bay by their good brushing, our scaling and polishing and other treatments may not realise that although the problem cannot be cured, it would be much worse if these beneficial things were not taking place regularly. As such, it is important when we prevent something that we make sure, we draw attention to it, otherwise it often goes unnoticed. A good example of this is the much lower rate of heart disease, partly due to treating high blood pressure, lowering LDL (bad) cholesterol, reduction in smoking, better diet and managing diabetes better. The rate of heart disease is falling, but it is hard for someone who resents all the tablets to appreciate that the alternative might be a lot worse. For someone who has had a heart attack (due to a lack of prevention) then the medication afterwards is greatly appreciated.

Measuring prevention is particularly problematic for the NHS. As a former member of a Primary Care Commissioning Group for a PCT, I have seen how difficult it is to receive funds for a prevention programme. Applications must be able to demonstrate outcomes. Since it’s extremely difficult to measure cavities that did not form, or teeth that did not break, the approach adopted is often one of measuring treatments such as fillings, which are only being done because they weren’t prevented. The NHS often talks about the importance of prevention but often struggles to actually deliver it.

Despite being very difficult to do, I strongly believe that prevention is better than cure and my dental team are as committed to prevention, reaching out to the community we serve. Changing patients’ behaviour might be hard, but it is by far the easier, cheaper and more convenient way to ensure good health in the long term. Prevention is an important part of effective public health care. In dentistry, some of the treatment only happens when prevention fails. So when people say, in a throw away fashion “prevention is better than cure” that’s because it is! It’s up to you to decide what you are going to do about it. Prevention is an active process, it means doing things to prevent problems, instead of doing nothing and hoping for the best. The other throw away phrase “if it isn’t broken, don’t fix it” should read “just because it isn’t broken doesn’t mean we shouldn’t look after it”.