Communication (or rather lack of it) is blamed for much of the confusion in the world, despite the fact that the word itself is possibly the most misunderstood of all. After all, what do people mean when they use the word 'communication'? The problem is that words themselves are not always clearly understood by the people using them, resulting in confusion because different people mean different things when they use the same word or phrase.

Take the phrase 'independent dentistry' which came to prominence in the dental psyche around 1990. As I recall it was created to provide dentists with an alternative description for private dentistry that would not sound as expensive. When the 'New Contract' started there was an initial flurry of movement towards conversion to private practice, a movement that was greatly strengthened by the fee cut in 1992. The phrase "independent dentistry" was seized on to try and help dentists sell private dentistry because it supposedly did not have the same perception for patients as the term 'private dentistry' did.

Unfortunately not everyone used the term independent dentistry in the same way. Sometimes it was a synonym for private dentistry? At other times it appeared to refer to a new level of service somewhere between private and NHS, with some practices offering patients a 3-tier system of pricing with independent dentistry in the mid-price range. Matters were never really clarified, and the name gradually faded into well-deserved obscurity.

Not so with another name that is not only alive and well, but has multiple meanings depending on to whom you talk. I am referring to the phrase 'preventive dentistry', and unlike independent dentistry (which was simply a passing phase) I do believe the profession has a responsibility to decide what preventive dentistry really means.

For some preventive dentistry implies the application of topical fluoride and fissure sealants to children's teeth. For others the term implies a practice with an emphasis on periodontal care. Another view of preventive dentistry is to provide dietary and plaque control, sometimes in purpose-built premises where the term 'preventive dental unit' (or PDU) describes a physical area for groups of patients to learn how to 'prevent' dental disease. Still another view is a philosophy of dental care embracing a 'preventive approach' to all forms of dentistry, from the design of dentures to the restoration of minor cavities.

It would appear that a 'preventive practice' could apply to almost any practice depending on the understanding of the term.

Preventive dentistry can also apply to different disciplines of dental care. Thus we have interceptive orthodontics, non-surgical periodontics, conformative occlusal practice and the inappropriately named 'extension for prevention' in cavity design. Some people expand the meaning of 'prevention' still further by talking of restoring teeth using crowns to prevent further breakdown, or using bridges to prevent tooth movement and occlusal problems. In fact it would appear that a 'preventive practice' could apply to almost any practice depending on the understanding of the term.

The NHS Statement of Dental Remuneration for the GDS is at least clear, defining preventive care as intensive instruction in oral hygiene and dietary control and the application of fissure sealants and topical fluoride. It may not be everyone's idea of prevention, but at least it is clear. But is it enough? Is it right? Is it the definition that everyone in dentistry wants?

Looking at the wider picture prevention has a public dental aspect with health policies that include oral health promotion, fluoridation and various oral health strategies to encourage the population to eat appropriately and brush their teeth regularly. For many this aspect of prevention is far more important than the individual approach that the term implies because it affects far more people. But is this preventive dentistry or simply a dental public health approach?

Do we need to try and agree among ourselves what we would like preventive dentistry to mean, especially from the viewpoint of our patients. While the overall concept seems to be agreed, that we are all trying to prevent oral disease, is this really clear enough? The NHS definition suffers because it remains so limited. Surely our goal should be a philosophy of oral care that embraces the principles of prevention of further disease? But for some people that does not need a further name - for that is simply dentistry.