At the recently concluded FDI World Dental Congress 2023 in Sydney, Australia, Professor Nicola West, secretary general of the EFP, delivered a compelling presentation titled "Oral health – in a state of decay." In her address, Prof. West emphasised the urgent need for a paradigm shift in dental healthcare economics, advocating for a new economic model rooted in prevention rather than the existing treatment-centric approach.
"The current payment model is not working,” West stated emphatically. "We are paying for treatment and surgical intervention, but we should incentivise prevention instead. Prevention is cost-effective. We need to move towards a value-based care payment model, as well as introducing targeted interventions to reduce inequalities in oral health.”
West's call for change stems from a growing body of research that suggests investing in prevention care not only improves public health but also leads to significant cost savings in the long run. The European Federation of Periodontology's collaboration with the Economist Impact in 2021 produced a white paper titled "Time to take gum disease seriously," which aimed to capture the attention of policy makers.
The findings of the white paper were clear: prevention, diagnosis, and management of periodontitis are cost-effective. However, achieving this shift to prevention-focused care requires better integration of dental and general healthcare, a synergy of societal and individual public health campaigns, and improved affordability of dental care.
West announced a forthcoming analysis, undertaken in collaboration with the Economist Impact and Haleon, focused on dental caries. This analysis seeks to determine the lifetime costs of managing dental caries and assess the impact of prevention and management interventions on these costs across different socio-economic groups in select countries.
Dr Harleen Kumar, Clinical Senior Lecturer, School of Dentistry, The University of Sydney, Australia, who attended the presentation commented: “In the realm of dental care, a stark contrast exists between the prevailing surgical approach and the proven effectiveness of a disease management model centred on prevention and education.” Dr Kumar emphasises “the overwhelming evidence supporting the superiority of prevention and education in managing dental caries worldwide. However, the conventional surgical model, where tools like handpieces or extraction forceps are employed after an initial consultation, remains the most utilised approach, often overshadowing disease management.”
Various factors, such as time constraints, financial considerations, health policy, and societal pressures, contribute to the persistence of the surgical model in dental practices.
Kumar suggests that demonstrating the cost-effectiveness of education and prevention, in comparison to repair and ongoing maintenance, could sway healthcare policymakers. She cites a successful case in New South Wales, Australia, where the “Steps to smiles programme”, based on a Chronic Disease Management (CDM) protocol from the USA, has shown promise in reducing dental general anaesthesia procedures and remineralising carious lesions. Further economic analysis is deemed necessary to quantify the benefits of the CDM protocol, potentially influencing policy and healthcare outcomes.
Dr Kumar concludes: "A paradigm shift is required as a collaborative effort by clinicians, government, patients and their families to treat dental caries as a chronic condition."
Prof. West's vision for a dental healthcare system that prioritises prevention and embraces value-based care payment models holds immense promise. By addressing the root causes of oral health issues and reshaping how we approach dental care, we can improve the well-being of individuals but also alleviate the economic burden associated with treatment-centric models.
The call for change has been sounded at FDIWDC23, and it is now up to policymakers, healthcare professionals, and other stakeholders to heed this crucial message and usher in a new era of preventive oral healthcare.