In the mid 19th century there was an outbreak of cholera in London. A young physician by the name of John Snow decided on a new and different approach to the challenge. On a map of Soho, he marked the homes in which a death had occurred. A pattern emerged – the dots centered most densely around a public water pump on Broad street.
John Snow removed the handle of the pump and ended the outbreak.
What did John Snow do?
He carried out an investigation. He thought in terms of prevention. He found an effective intervention.
What didn’t John Snow do?
He didn’t wait for the evidence. This was just before Louis Pasteur had conducted his experiments on the relationship between germs and disease. Before Koch postulated Koch’s postulates. Before Joseph Lister came up with sanitation.
He didn’t educate the community about how to dispose of baby diapers. He didn’t educate about germs and the transmission of disease.
He did recommend that “water be filtered and boiled before it is used” – but nobody listened.
He didn’t get cooperation. In fact, government officials replaced the handle on the Broad Street pump as soon as the epidemic subsided. To accept his theory would have meant accepting the fecal-oral method transmission of disease – unpleasant.
In due course, of course, John Snow’s actions were attested and became regarded as the foundation of the science of epidemiology.
If we look at the never-ending flow of the infectious disease called dental caries (tooth decay), clearly buckets are not going to be the solution. Especially as caries is on the rise and untreated caries is the most prevalent of all medical conditions – 35% of adults globally! The buckets, representing dentistry (which is largely clinical, restorative and about disease management) cannot keep up with the flow – there are not enough dental professionals and the dental clinics are not in the right places. As advanced, immaculate, well-intentioned and helpful as they are – they are still only buckets. Golden buckets overflowing with caries.
Responsible dentistry seeks the taps, to turn on and off the determinants of oral health and disease.
Unlike our clinic plumbing, caries pipes run in places beyond our control – in homes, schools, shops, workplaces and government. The taps are often old and stuck, and like the habits that cause oral disease, are hard to turn. They are rusty and attempts to turn them are often met with resistance. It’s not easy to control the mix of sugar, fluoride, bacteria. That’s why our toolbox includes the spanners and grease that are innovation, collaboration, integration, evaluation, publication. But first, we must lead with preventive interventions that are designed based upon investigation within the community. This is John Snow’s legacy and our inspiration.
When I was a kid my mother used to say that I should be a plumber.