232 M. N. Naylor The APF gel and flouride paste used singly or together, produced significant reductions in decay but, as in Croydon, there was no significant difference between treatment groups. From these studies it would certainly seem that little or no advantage is to be gained from a multiple topical fluoride approach. Since fluorides, whether systemically or topically applied exert their maximum effect on the smooth non-biting surfaces of the teeth, it would obviously be desirable if some procedure could be devised to protect the biting surfaces. Fissure sealing is one possibility. This notion is not especially new as long ago as the 1920s T.P. Hyatt was advocating the sealing of fissures with amalgam prior to the onset of decay. Hyatt estimated that the chances of a fissure becoming decayed were 2,500 : 1. Whether these odds are valid today it is difficult to say, but it is certainly true that few fissure surfaces escape. It is therefore a reasonable approach to pre-empt the decay and seal the fissure immediately the tooth erupts through the gum. Sealing by means of amalgam which requires a very shallow cavity to be cut, has been superceded by a group of resinous materials which are polymerised in situ either by chemical means or ultra-violet light. Unfortunately, for such sealing to be successful an extremely meticulous technique is needed and a very co-operative subject. It is because of these very precise clinical requirements that the assessments of sealants, both in terms of retention and decay prevention have been so variable. Of course, far worse than losing the sealant, is the situation where the sealant remains in situ but leaks, thus allowing bacteria and sugars to accumulate beneath and start the caries process which can remain undetected for a very long time. Whilst present sealants can be successfully applied to selected patients, we shall have to await the development of material which demand a much less precise technique before sealing can be regarded as a community measure. For many years the notion of elaborating a vaccine against dental diseases has waxed and waned. It is not surprising that, with the relatively recent advances in knowledge of the microbiology of decay and periodontal disease we should see a resurgence of interest in the possibility of developing a human vaccine. Whatever anyone may have read in the tabloid Sunday newspapers, no effective human vaccine is in existence today. There is considerable work in progress in the U.S. and here in the U.K. at the Royal College of Surgeons and at Guy's Hospital Dental School. Primate studies have been most interest- ing, and encouraging. Nevertheless, there are many problems to overcome, not least the problem that these diseases are multi bacterial they are not due to a single organism like the recognised immunisable diseases. Furthermore, if and when a vaccine is developed, it will be necessary to convince the public that the risks associated with vaccination are justified, especially since there are other effective ways of prevention. From what has been said so far, it is clear that good dental health is within the reach of all. The problem is motivation and the creation of the right attitudes. Certainly, in my professional lifetime, which covers the years since the end of World War II, there has been tremendous progress. Undoubtedly, the availability of dental care as part of the NHS has played a great part in this. Other factors of equal importance are the advances in treatment techniques - local anaesthetics, the high speed air-turbine handpiece, low seated, four handed dentistry- are but a few. Advertising of dental products, notably toothpastes on commercial television, have done a superb job in bringing dental health right into the homes of the public. Together these factors have taken much of the fear and pain out of the visit to the dentist.

Dental health 233 Having said all this it is salutary to remind ourselves that, despite all the measures that can be taken to prevent disease, the advances in practice techniques and changing attitudes towards dental health, only about 40•o of the public seek regular dental care, that in 1977 an estimated 31•o of the public over age 16 years wear full dentures, that less than 10•o of the public drink water containing the optimum level of fluoride ions, that a high but unknown proportion of the population do not own a toothbrush, let alone use it, and that in the U.K. we buy approximately half the number of tubes of toothpaste per family, per annum, compared with the U.S. Despite the fact that nearly two thirds of the population fail to seek regular care, the dental profession is stretched almost to breaking point. If only a small proportion of the erstwhile 60•o decided to seek regular care the profession would reach the point when it couldn't cope. It is obvious that the whole approach to the provision of dental care has to change it has to change from an approach which is essentially reparative to one which is preventive. The profession alone cannot bring about that change. It requires everyone's participation- the profession, government, industry and the public. Indeed it is a com- munity responsibility.