Objectives: Traditionally, the concept of prevention refers to primary (P1), secondary (P2) and tertiary (P3) prevention. In 1995, Jamoulle et al introduced in medicine the concept of quaternary prevention (P4) which encompasses all actions taken to identify a patient or a population at risk of over-medicalisation, to protect them from invasive medical interventions and provide for them care procedures which are ethically acceptable. More recently, in 2014, Brodersen et al proposed an alternative and transversal definition of P4 : protecting individuals (persons/patients) from medical interventions that are likely to cause more harm than good. The present communication aims to discuss the notion of P4 in caries management and to analyze probable causes and the impacts on patient outcomes as well as on health systems based on the current litterature. Methods: Pubmed database was searched for the terms "quaternary" ; "prevention" ; "dentistry" ; "dental caries". Abstracts were screened by two independent assessors in order to relevant publications to the field on dentistry. Results: P4 is relevant at each stage of caries management. It refers to all preventive, non-invasive and ultra-conservative treatments that are not properly indicated according to individual caries risk level (e.g. preventive sealants for low caries risk patients). P4 also refers to unnecessary invasive/surgical interventions when non-invasive (fluoride and therapeutic sealants) and micro-invasive techniques (resin infiltrations) can be indicated. In accordance with the Brodersen et al approach. referring to iatrogenic damages, partial excavation in deep carious lesions fits well into P4 concept; indeed, a complete excavation is considered iatrogenic as it compromises the pulp vitality and the tooth survival.
Conclusions: The causes of over-treatment in dentistry can be explained by several factors such as financial incentives (supplier induced demand), lack of appropriate continuous professional development, or pressure for unnecessary treatments by the patient itself. The absence of P4 acknowledgement is likely to be associated with a negative impact on patient outcomes as well a financial burden for health systems.
IADR/AADR/CADR General Session
2019 IADR/AADR/CADR General Session (Vancouver, BC, Canada) Vancouver, BC, Canada
2019 3541 Behavioral, Epidemiologic and Health Services Research
Mazevet, Marco
( King's College London Dental Institute
, London
, Bouvet Island
)