A paradigm shift in models of oral health care: An example and a call to action

The consequences of oral disease are wide-ranging and can have a major impact on an individual's and that person's family's quality of life. A range of factors interact to determine a person's oral and general health. Such factors can be biological, social, economic, political, cultural, or environmental, in addition to knowledge, attitudes and behaviors. Traditional models of oral health care, however, have generally ignored these factors and instead have focused on the treatment and management of existing pathology (tertiary prevention/downstream approach). This has had no effect on the rate of hospitalization or the inequitable distribution of dental diseases. To reduce the prevalence and severity of oral diseases at the individual and population levels, holistic evidence-informed prevention-based health-promoting models of care that focus on upstream determinants of health are required. The Oral Health Program at North Richmond Community Health in the state of Victoria, Australia, has developed an innovative model of oral health care based on the following principles: health promotion, disease prevention, risk-based access to care, client-and familycentered care, team-based provision of care, multidisciplinary care, and innovation. Evaluation of this approach is currently being conducted to study the sustainability of such a model under the current public dental service funding model.