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Interview: Concerted action can lead us towards a cavity-free future

Prof. Nigel Pitts is the Global Chairman of the Alliance for a Cavity-Free Future (ACFF), an organisation that promotes integrated clinical and public health action in order to stop caries initiation and progression. (Photograph: Nigel Pitts)
Brendan Day, DTI

Brendan Day, DTI

Mon. 6. August 2018


It is a curious truth of modern dentistry that, despite growing awareness of the importance of oral health, the prevalence of dental caries remains at an alarmingly high rate. Dental Tribune spoke with Prof. Nigel Pitts, Global Chairman of the Alliance for a Cavity-Free Future (ACFF) and Director of the Innovation and Translation Centre at King’s College London Dental Institute in the UK, about how caries can be prevented and the ACFF’s current projects.

Why is the prevention of caries so important? Does it go beyond oral health?
Dental caries is the most common oral disease, and the Global Burden of Disease Study has shown us that untreated dental cavities ranks number one for adults and number ten for children in terms of the impact of the disease on the public and patients. Because caries shares risk factors with other non-communicable diseases, improving oral health can also help in reducing obesity and other systemic medical conditions.

What are some of the main issues that we face in the prevention and control of caries, and in what ways can governing bodies and NGOs like the ACFF combat this?
The ACFF has a key role in joining up both public health and clinical dental advocacy across many stakeholder groups in explaining that there are many parts to the caries puzzle that all have to be considered if we are to be effective in the prevention and control of caries. The ACFF has led a group of global experts in building a detailed caries puzzle based on global evidence. Concerted action around these puzzle pieces can lead us towards a cavity-free future.

Are there any populations that caries affects disproportionately? If so, what can be done to help those who are disadvantaged?
Dental caries affects individuals and populations across the life course. It is a disease that in many societies disproportionately affects the very young, who can suffer early childhood caries, and the very old, where compromised salivary flow, exposed root surfaces and limited manual dexterity can all play a part in increasing caries attack. Caries is unevenly distributed both across and within countries, producing significant health inequalities linked to both socio-economic status and access to services. Traditionally so-called developing countries have had low caries and developed countries have had higher levels. However, rapid changes in both the global economy and in the availability of sugar have made such distinctions less clear.

What projects does the ACFF currently have running?
The ACFF has a range of different, locally appropriate, projects running in each of its chapters. All chapters are working towards the charity’s four global goals, but also supplement this work with their own priorities. In addition, a particular focus over the past two years for the ACFF has been working with the Policy Institute and Dental Institute at King’s College London through Policy Lab meetings.

These meetings have explored such themes as “How do we accelerate a policy shift towards increased resource allocation for caries prevention and control?” and, in July 2018, “Towards paying for health in dentistry—How do we create and implement acceptable prevention-based dental payment systems to achieve and maintain health outcomes?”. This latest lab built on the success of the first and has an international group of multiple stakeholders, including health economists, mapping the way forward together with a new blueprint for a payment model. This model specifies (1) what we should pay for, (2) who the system must work for and (3) how we deliver the change needed. We intend to continue this exciting and novel work to build the collaborative network driving this change and to share the results widely. The ACFF concept is to work globally—that is, co-creating global solutions and facilitating their adaptation for local conditions.

Over the past several years, the ACFF has continued to expand the numbers of countries in which it has established a chapter. Is this a trend that you would like to continue in the future?
We were delighted to welcome the newly formed Japan chapter to the ACFF family in February this year, which brought the number of chapters to 27, working in more than 40 countries. There are plans to expand a little further to reflect interest from new areas, but our focus is now on consolidation of existing activities and driving towards achieving our goals to secure a cavity-free future for all.