Health education.

The processes of health education and health promotion are linked and may overlap. Health education is the process by which messages aimed at enabling individuals to take greater control over and improve their health are defined. The first step in the process is to gain an understanding of the basic cause of the disease process under consideration. The second step is to identify the essential causative factors. Some of these will be beyond individual personal control, such as environmental factors and genetics. However, other factors may be under the control of the individual and amenable to change. The final step is that to define and communicate key messages derived from the previous stages so as to improve the health of both individuals and populations. Health promotion is the process by which these messages are taken and disseminated whether by word of mouth, in print or through one of the rapidly expanding forms of electronic media. The World Health Organisation defines health promotion as the process that extends health education beyond a focus on individual behaviour towards a wide range of social and environmental interventions.

Dietary factors and dental caries.

DATA SOURCES: Articles were sourced using Medline, the Cochrane Library, reference lists of identified articles and selected textbooks. STUDY SELECTION: Studies chosen for inclusion in the review were randomised or controlled clinical trials of at least 2 years' duration that used caries increment in the permanent or primary dentition as the end point. Publications in Danish, English, French, German, Italian, Norwegian, Spanish or Swedish were included. For multiply reported trials the one with the longest follow-up period was included. DATA EXTRACTION AND SYNTHESIS: Inclusion decisions and grading of the studies was carried out independently by two of the authors. The main outcome was caries increment and the measure of treatment effect was either relative risk reduction or prevented faction. A qualitative synthesis of the included studies was conducted. RESULTS: Eighteen studies met the inclusion criteria. They included the total or partial substitution of sucrose with sugar substitutes or the addition of protective foods to chewing gum. No study could be found that had evaluated the effect of information designed to reduce sugar intake/frequency as a single preventive measure. It is suggested that the evidence for the use of sorbitol or xylitol in chewing gum, or for the use of invert sugar, is inconclusive. No caries-preventive effect was found from adding calcium phosphate or dicalcium phosphate dihydrate to chewing gums. CONCLUSIONS: The review dearly demonstrates the need for well-designed randomised clinical studies, with adequate control groups and high compliance, looking at the effect of dietary measures on dental caries.