Tuesday, 23 December 2014

Health demotion interventions

Oral health promotion 

I am in the process of writing a piece about how to engage general dental practitioners in oral health promotion drawing on theories and empirical research around how to change professionals' practice. The Ottawa declaration defined health promotion as "the process of enabling people to increase control over, and to improve, their health". The scope of those responsible for health promotion is much broader than just the healthcare system and includes governments, social and educational sectors as well as non-governmental organisations.

However, as a clinician with an interest in promoting evidence-based practice that involves shared decision making I look at the "enabling" and "control" bits with fondness. In my previous blog I discussed the use of decision aids and option grids to try and help convey the risks of good and bad outcomes to patients in ways they are more likely to understand. One of the key findings from the Cochrane review on decision aids found that patients were less likely to opt for invasive procedures when they used one.

Oral health demotion  

As I was thinking about all the health promoting things we would like to be able to do (and be effective at - smoking cessation, sugar reduction, oral hygiene improvement) and how we identify the barriers to doing these things, I had in the back of my mind the problem of things we do that not only don't promote health but actually increase the risk of harm. I thought an apt term for this would be health demotion. The sorts of things I am thinking about are: 
  • antibiotic prescribing when there is known to be no benefit (e.g. irreversible pulpitis) that leads to short term side effects and long term resistance that potentially demotes our long term health
  • crowns or veneers for cosmetic reasons only on vital teeth that increase the risk of demoting a healthy tooth to a carious, or worse, non-vital tooth
As with health promotion there will not be health demotion in all cases but the risk of this increases. Of course, particularly with the cosmetic treatments, patients have a right to choose a treatment they think may be beneficial but I wonder, if they were given the risks of harm as part of a decision aid, if they might choose the less health demoting route and, by consequence, promote their chance of retaining healthy teeth for a lifetime. If we don't enable patients by communicating evidence in impartial ways they won't be able to take control over their oral health and will be at greater risk of health demotion.

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