Preventive dentistry and oral health promotion
Evidence-based prevention
Core measures: community water fluoridation, twice-daily brushing with 1000 ppm fluoride toothpaste for children and adults (5000 ppm for high-risk patients aged 16+ where appropriate), professional fluoride varnish (22,600 ppm) two to four times a year for high-risk patients, resin fissure sealants on at-risk permanent molars, and silver diamine fluoride for arresting active primary-tooth caries where its staining is acceptable and it is approved for use. Diet advice targets free-sugar frequency, not just quantity. Motivational interviewing outperforms telling people what to do.
Promotion, not just education
Oral health promotion works upstream: school and kōhanga toothbrushing programmes, Lift the Lip, smokefree and vapefree environments, and whānau-centred approaches consistent with Te Tiriti o Waitangi - partnership, participation and protection. Equity matters: target effort at communities with the greatest need, and make the healthy choice the easy choice.
Worked example
A high-risk 6-year-old with active white-spot lesions and a sibling with caries. Rather than a lecture on sugar, you ask the whānau what a typical day looks like, agree one change (water in the drink bottle at school), apply varnish, plan sealants as molars erupt, arrange a three-month recall, and offer the school toothbrushing programme.
Traps
Giving generic diet sheets; assuming fluoride varnish causes fluorosis (the dose is negligible); sealing a partially erupted, contaminated molar without moisture control; promising sealants prevent all caries.