Sir, I can understand why Professor Blinkhorn and colleagues express disappointment with the results of their study of oral health educators in general dental practice (BDJ2003, 195: 395) but I wonder if they are correct to be downhearted? In the NHS, every initiative has an opportunity cost, and this study shows that the intervention might not be a cost-effective choice for PCTs making difficult choices about funding for local dental services. This is a worthwhile finding.
The results moreover, (an improvement in parental knowledge, attitudes and skills, but no statistically significant impact on children's disease levels), are by no means surprising. Kay and Locker's systematic review1 concluded that oral health promotion was effective for increasing knowledge levels, but there was no evidence that changes in knowledge were causally related to changes in behaviour.
The way forward may therefore be to move 'upstream' as recommended recently by Sheiham and Watt2, by tackling the determinants of poor health, and taking community-wide measures to make it easier for parents to make healthy choices on behalf of their children2. Nor should dental health education in the surgery setting necessarily be abandoned completely, as a result of the findings of Blinkhorn et al's study.
The dedicated dental health educators employed in the trial to provide intensive counselling seem not to have been cost-effective. However, the provision of in-house surgery-based, simple, scientifically sound, preventive advice to parents of children at high risk of, or already suffering from, caries must still be an ethically correct component of a much broader health promotion approach. As the authors note that there are significant barriers to dentists providing this service at present, perhaps other less costly models could be tested to try to overcome them.
