Why Prevention Isn’t Working

In contemporary dental practice, patient education is constant. Dental hygienists review brushing technique, demonstrate interdental aids, explain inflammation, discuss the oral–systemic connection, and reinforce recare intervals daily. Prevention is embedded in nearly every appointment. Yet preventable disease remains prevalent.

According to data from the United States Centers for Disease Control and Prevention, untreated dental caries continues to affect millions of children and adults in the US.¹ Periodontitis remains one of the most common chronic inflammatory conditions, affecting nearly half of adults aged 30 years and older.² The bidirectional relationship between periodontal diseases and diabetes is well established, with evidence suggesting that periodontal therapy may contribute to improved glycemic control.³ Despite decades of preventive emphasis and clinical advancement, population level outcomes have not shifted proportionately.

The profession is not lacking information. The question is whether we are consistently translating information into patient understanding.

Education Is Not the Same as Comprehension

Healthy People 2030 defines health literacy as the degree to which individuals can obtain, process, and understand basic health information needed to make appropriate health decisions.⁴ That final phrase make appropriate health decisions, this is where prevention either succeeds or stalls. Chairside instruction is routine. Confirming comprehension is less routine.

In clinical and community-based settings, as well as through interdisciplinary collaboration, one pattern becomes clear: patients frequently receive information but do not always internalize its significance. They may understand how to floss, but not why bleeding gums signal inflammation. They may attend recare visits without recognizing the systemic implications of untreated periodontal diseases. When education remains transactional, behavior change is inconsistent.

Patterns Behind Preventable Disease

Caries progression, recurrent gingival inflammation, and preventable emergency department visits reflect behavioral and social patterns, not randomness. Dental-related emergency department visits continue to cost the healthcare system billions annually, often addressing conditions that were preventable with earlier intervention.⁵

Early childhood caries remains one of the strongest predictors of future dental disease.⁶ These data suggest that access alone does not resolve disease burden. Understanding influences outcomes.

In community outreach environments, conversations frequently reveal misconceptions: the belief that bleeding gums are normal, that primary teeth are insignificant, or that oral health exists separately from overall health. These gaps are not necessarily due to resistance. They reflect limited oral health literacy. Prevention requires more than demonstration. It requires translation.

Oral Health Literacy and Medical-Dental Integration

Medical-dental integration (MDI) continues to gain traction as healthcare systems recognize the oral-systemic connection. Emerging research continues to explore associations between periodontal inflammation and cardiovascular disease, adverse pregnancy outcomes, and metabolic disorders.^3,7

However, integration efforts that rely solely on referrals and documentation risk overlooking a critical variable: patient comprehension. If a patient with diabetes does not understand how periodontal inflammation may influence glycemic control, integration remains procedural rather than transformative. If a pregnant patient does not grasp the inflammatory implications of untreated periodontal diseases, preventive recommendations lack urgency.

Dental hygienists are uniquely positioned in this landscape. We often spend extended one-on-one time with patients, creating opportunities to contextualize information rather than merely deliver it. Understanding shifts prevention from compliance to ownership.

Measuring What Matters

Dental practice routinely measures plaque indices, probing depths, bleeding scores, and radiographic findings. These indicators are essential. Yet comprehension remains largely unmeasured.

In interdisciplinary and community settings, one observation consistently emerges: when patients can articulate oral–systemic connections in their own words, adherence improves. When they recognize that gingival bleeding reflects inflammatory burden rather than a minor inconvenience, self-care behaviors shift. When they understand that preventive visits protect more than teeth, recare compliance strengthens. Education delivers information. Understanding influences decisions.

As healthcare increasingly emphasizes measurable outcomes and value-based models, oral health literacy should be considered a clinical variable rather than an abstract concept. Dental hygienists are not lacking expertise or commitment. The opportunity lies in intentionally assessing whether information has translated into comprehension.

Prevention does not begin when instructions are delivered. It begins when understanding informs choice.

References

1. United States Centers for Disease Control and Prevention. 2024 Oral Health Surveillance Report.
2. Eke PI, Thornton-Evans GO, Wei L, et al. Periodontitis prevalence in adults in the United States: NHANES 2009–2018. J Dent Res. 2020;99:1174–1181.
3. Sanz M, Ceriello A, Buysschaert M, et al. Scientific evidence on the links between periodontal diseases and diabetes: consensus report. J Clin Periodontol. 2018;45:138–149.
4. United States Department of Health and Human Services. Healthy People 2030: Health Literacy.
5. American Dental Association Health Policy Institute. Emergency Department Referrals.
6. Tinanoff N, Baez RJ, Diaz Guillory C, et al. Early childhood caries epidemiology, pathology, and prevention. Pediatr Dent. 2019;41:373–382.
7. Tonetti MS, Van Dyke TE. Periodontitis and atherosclerotic cardiovascular disease: consensus report. J Periodontol. 2020;91:S24–S29.