Institute of Medicine of the National Academies. The National Academies Press price £42.00; pp 268 ISBN

The National Academies Press

This text is a concise report that aims to inform the US government and influence policy change. It is of relevance to clinicians interested in public health measures and is an effective introduction to the American healthcare model for any reader.

Although the NHS may seem a world apart from the insurance driven system in the United States, the challenges we face are similar. This is a factual account of an effort to provide dental treatment to the most disadvantaged and battle the perceived divide between general health and oral health.

The book is broadly divided into five sections: introduction; oral health and overall health and wellbeing; the oral health care system; HHS and oral health; and a new oral health initiative.

The first chapter introduces the aims of this report and defines its place within the current body of literature. In the following sections it discusses oral health provision within a health service that regards dentistry as a discipline completely separate to medicine. The facts and figures are illustrated with charts and diagrams making the information easy to digest, shedding light on the extent of oral disease experienced by different communities.

The next chapter offers an overview of preventative measures and discusses the many challenges to bringing about change. Accounting for the finance, organisation, education and regulation of the dental workforce in America, it gives a clear outline of where dental services are being provided.

Finally the history of government strategies and the role of different organisations who contribute to oral health are described. A chart of proposed initiatives, (most of them failed to receive funding), demonstrates the difficulty in financing schemes and the vagaries of political support. The book concludes with a recommendation for a centralised plan to improve oral health, echoing the tenets of clinical governance.

It is well researched, written and referenced. I consider this a comprehensive introduction to the provision of dental services in the United States. For readers in the UK there is little content directly applicable to practice and while it contains a wealth of information it informs rather than engages the reader.