How Much Do Dentists Contribute to Health Promotion? A Critical Appraisal Through the Lens of The Ottawa Charter

The Ottawa Charter for Health Promotion provides a comprehensive framework for evaluating health promotion activities across five strategic action areas. This perspective critically examines the extent to which dental professionals contribute to health promotion as defined by the Charter. While dentistry has made notable contributions to developing personal skills and re-orienting health services toward prevention, substantial gaps remain in building healthy public policy, creating supportive environments, and strengthening community action. The available evidence suggests that dental professionals perceive health promotion as an important aspect of their role, yet they often do not clearly distinguish between health promotion and disease prevention. Innovative models of care that focus on upstream determinants of health offer promising pathways forward, though structural constraints-including reimbursement models, educational priorities, and practice organization-limit the profession's capacity to fully realize its health promotion potential. This perspective argues that meaningful progress requires fundamental changes in dental education, payment systems, professional culture, and health policy engagement.

The Ottawa Charter for Health Promotion, adopted at the First International Conference on Health Promotion in 1986, remains the foundational framework for understanding what health promotion truly entails. It defines health promotion as "the process of enabling people to increase control over, and to improve, their health"-a definition that deliberately moves beyond the mere absence of disease toward a holistic conception of wellbeing. The Charter identifies five strategic action areas: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and re-orienting health services [1]. These domains collectively demand that health promotion be understood as an intersectoral, socially engaged enterprise rather than a collection of clinical interventions delivered in isolation.

Dentistry, as a clinical discipline, has historically positioned itself at the interface between curative treatment and preventive care. Yet the question of how substantially dentists contribute to health promotion as defined by the Ottawa Charter invites critical scrutiny. Are dentists just pretending to care about prevention (by handing out floss and giving lectures), while their actual daily work, financial incentives, and professional training are still 100 percentage centered on waiting for diseases to develop and then mechanically repairing the damage? Or have they genuinely embraced the Charter's vision of enabling people and communities to take control over their health?

This perspective argues that while dentistry has made meaningful contributions to several Ottawa Charter domains-particularly developing personal skills and re-orienting health services toward prevention-substantial gaps remain in healthy public policy engagement, community action, and the creation of supportive environments. These gaps reflect not a failure of individual practitioners but rather structural constraints that limit dentistry's capacity to function as a truly health-promoting profession.

Developing Personal Skills: Dentistry's Traditional Strength

Of the five Ottawa Charter action areas, developing personal skills is the domain where dentistry's contribution is most visible and well-established. Dental professionals routinely engage in patient education, providing instruction on oral hygiene practices, dietary choices, and the consequences of tobacco and alcohol use. This activity aligns with the Charter's emphasis on enabling people to learn throughout life and prepare themselves for all of its stages.

Yet the scope of personal skills development in dentistry has expanded considerably beyond traditional oral hygiene instruction. Contemporary dental practice increasingly incorporates lifestyle medicine principles-supporting nutrition, physical activity, sleep, stress management, and the avoidance of harmful substances. Dentists are well-positioned to deliver brief behavioral interventions, including smoking cessation counseling, given that the mouth is often the first site where the adverse effects of tobacco become visible [2]. Evidence indicates that tobacco cessation programs integrated into routine dental practice can significantly increase quit rates [3]. Similarly, dental settings offer promising opportunities for screening and brief advice regarding hypertension, diabetes, and other non-communicable diseases.

However, even in this relatively well-developed domain, questions persist. Is patient education in dental practice truly health promotion in the Ottawa Charter sense, or does it remain a form of clinical paternalism-telling patients what to do rather than enabling them to increase control over their own health? The distinction matters. Health promotion, as the Charter conceives it, is fundamentally empowering. It requires that health professionals work with people, not on them. Dental education that merely delivers instructions without fostering genuine patient agency may fall short of this ideal [4].

Re-Orienting Health Services: Progress and Its Limits

The Ottawa Charter calls for health services to move increasingly in a health promotion direction, beyond their traditional responsibility for providing clinical and curative services [1]. Dentistry has arguably made significant paces in this regard. The profession has long embraced a culture of prevention-routine cleanings, screenings, and early intervention are standard practice. This preventive orientation distinguishes dentistry from many other clinical disciplines and represents a meaningful contribution to the re-orientation of health services.

Moreover, dental professionals are increasingly recognized as part of the interdisciplinary healthcare team. The growing awareness of oral-systemic connections-the links between periodontal disease and cardiovascular disease, diabetes, cognitive decline, and adverse pregnancy outcomes-has positioned dentists as potential sentinels for systemic health conditions [5]. Screening for chronic disease risk factors in dental settings shows promise as a cost-effective approach to improving population health.

Yet the re-orientation remains incomplete. Despite the recognized importance of integrating oral health into primary care, dentistry continues to operate largely in parallel to, rather than in partnership with, the broader healthcare system [6]. The World Health Organization has noted that oral health professionals have historically played a subordinate role in medical hierarchies [7]. Re-orienting health services is not merely about what dentists do within their own clinical settings; it requires systemic change that positions oral health as integral to overall health, not as an afterthought [8].

Building Healthy Public Policy: The Advocacy Deficit

The Ottawa Charter's first action area-building healthy public policy-requires that health be placed on the agenda of policy makers in all sectors and at all levels [1]. This demands advocacy, coalition-building, and the pursuit of legislative and regulatory changes that create the conditions for health.

Here, dentistry's contribution is considerably more modest. While professional organizations engage in advocacy around fluoridation, dental coverage, and workforce issues, the profession as a whole has been less visible in broader health policy debates that shape the social determinants of oral health. Policies regarding sugar taxation, food labeling, alcohol regulation, and tobacco control-all of which profoundly influence oral health-have often been advanced with limited dental professional involvement [9].

This is not to say that dentists are indifferent to policy. Many individual practitioners and organizations advocate for improved access to care, particularly for vulnerable populations. Yet policy advocacy remains, for most dental professionals, an activity undertaken by a small minority rather than a core component of professional identity. The Ottawa Charter envisions health professionals as advocates for health-not merely as clinicians who happen to comment on policy when time permits. In this respect, dentistry has considerable ground to cover [10].

Creating Supportive Environments: An Underdeveloped Frontier

The creation of supportive environments-settings in which people live, work, and play that enable healthful choices-represents another Ottawa Charter domain where dentistry's contribution has been limited [1]. The Charter recognizes that health is shaped by the environments in which people live: housing, income, education, and social conditions [4].

Dental programs have traditionally focused on individual-level interventions rather than environmental change. While tobacco control provides a powerful example of how environmental strategies-smoke-free bylaws, tobacco taxes, mass media campaigns-can transform population health, analogous approaches in oral health have been slower to emerge [5]. Sugar consumption, a primary driver of dental caries, is influenced by food environments, marketing practices, and pricing policies. Yet dental professionals have been less engaged in shaping these environments than one might expect given the centrality of diet to oral disease [2].

Schools represent a setting where dentists could contribute more actively to creating supportive environments. Policies regarding healthy eating, brushing programs, and access to fluoridated water in educational settings are all within the purview of dental advocacy. Community-based oral health promotion programs that extend beyond clinical settings and into schools, workplaces, and public spaces remain the exception rather than the rule [6].

Strengthening Community Action: The Missing Dimension

Perhaps the most significant gap in dentistry's health promotion portfolio is in the domain of community action. The Ottawa Charter emphasizes that health promotion works through concrete and effective community action-setting priorities, making decisions, planning strategies, and implementing them to achieve better health [1]. At the heart of this process is the empowerment of communities.

Dentistry has historically been characterized by a one-on-one clinical model that, while valuable, does not easily translate into community engagement and empowerment. Community-based oral health programs exist, of course, but they often take the form of outreach services delivered to communities rather than initiatives developed with and by communities. The distinction is fundamental: health promotion in the Ottawa Charter tradition is participatory and democratic, not merely a matter of extending clinical services into underserved areas [6].

Some encouraging developments warrant mention. Dental professionals are increasingly participating in school-based education programs, community health fairs, and collaborative initiatives with nursing and public health colleagues [8]. Participatory approaches offer rewards through reflexivity and by fostering intellectual humility, which means being open to new ideas and challenging perspectives [6]. Yet these efforts remain fragmented and often under-resourced. Community action cannot be an afterthought; it must be integral to how dentistry conceives its social role [4].

The Common Risk Factor Approach: A Missed Opportunity?

One framework that could help dentistry realize its health promotion potential more fully is the common risk factor approach. This approach recognizes that many oral diseases share risk factors with other non-communicable diseases-tobacco use, unhealthy diet, harmful alcohol consumption, and inadequate hygiene [5]. By addressing these common risks, dental professionals can contribute to the prevention of both oral and systemic diseases simultaneously [9].

The common risk factor approach aligns elegantly with the Ottawa Charter's intersectoral vision. It demands that dental professionals see themselves as partners in broader public health efforts, not as specialists working in isolation. It also requires engagement with policy and environmental strategies that address risk factors at their source [2]. Yet the approach has been adopted unevenly across dental education and practice. Many dental curricula continue to emphasize disease treatment over population health, and many practitioners lack the training and institutional support to implement comprehensive risk factor interventions [3].

Structural Constraints and the Limits of Individual Agency

It would be unfair to place the full burden of dentistry's health promotion deficits on individual practitioners. Several structural constraints limit what dentists can realistically contribute to health promotion as defined by the Ottawa Charter.

First, the dominant payment and reimbursement models in dentistry reward treatment, not prevention or health promotion. Fee-for-service systems incentivize procedures; capitation and salary models may do little better in promoting the kind of comprehensive, community-oriented practice that health promotion requires [10]. Until financing mechanisms align with health promotion goals, individual practitioners will struggle to invest time and resources in activities that are not directly remunerated [7].

Second, dental education has historically emphasized biomedical and technical competence over population health, advocacy, and community engagement. While many dental schools now include public health content, it often remains peripheral to the core curriculum. Producing dentists who are equipped to function as health promoters requires fundamental changes in how the profession is educated [8]. Community-engaged education is a promising pedagogical model that situates learning within real-world contexts, fosters empathy, cultural competence, and advocacy skills, and strengthens professional identity formation [6].

Third, the organization of dental services-predominantly private, small-scale practices-does not easily support the kind of intersectoral collaboration and community engagement that the Ottawa Charter envisions [1]. Dentists working in isolation have limited capacity to influence healthy public policy, create supportive environments, or strengthen community action. These are collective endeavors that require professional organizations, public health agencies, and government to play enabling roles [5].

Toward a Deeper Expression of Health Promotion in Dentistry

If dentistry is to contribute more fully to health promotion in the Ottawa Charter tradition, several directions warrant attention.

The profession must embrace advocacy as a core competency, not an optional extra. This means preparing dental students to engage with policy processes, equipping practitioners with advocacy skills, and creating organizational structures that support sustained policy engagement [7]. The recent adoption of the WHO Global Oral Health Action Plan 2023-2030 provides a policy window that dental professionals should seize [10].

Dentistry must also deepen its engagement with community action. This requires moving beyond outreach to genuine partnership-working with communities to identify priorities, develop strategies, and evaluate outcomes [6]. Community-based participatory research approaches, in which communities are co-investigators rather than passive subjects, offer a model for this kind of engagement [8].

The integration of oral health into primary care and universal health coverage represents another critical pathway. When oral health is seen as integral to general health, dental professionals gain opportunities to contribute to health promotion across the life course and in partnership with other health professions [9]. The "no health without oral health" principle must become operational reality, not merely a slogan [5].

Finally, the profession must embrace the common risk factor approach more systematically. This means expanding the scope of dental practice to include screening and brief intervention for tobacco use, unhealthy diet, and harmful alcohol consumption [2]. It also means engaging with policy and environmental strategies that address these risk factors at their source [3].

The question "how much do dentists contribute to health promotion?" admits no simple answer. Measured against the Ottawa Charter's five action areas, dentistry's contributions are substantial in some domains-particularly developing personal skills and re-orienting health services toward prevention-but limited in others, specially building healthy public policy, creating supportive environments, and strengthening community action.

This pattern is not merely a matter of individual practitioner choices. It reflects structural constraints embedded in how dentistry is financed, educated, and organized. Addressing these constraints requires changes at multiple levels: in dental education, in payment systems, in professional culture, and in the broader health policy environment.

The Ottawa Charter reminds us that health promotion is not a technical fix but a social and political endeavor. It requires health professionals to see themselves as advocates, enablers, and mediators-not merely as clinicians. For dentistry to realize its full potential as a health-promoting profession, it must embrace this broader vision. The alternative is to remain a technically proficient but socially limited discipline, treating disease in individual patients while the social and environmental conditions that produce disease go unchallenged. The choice, in the end, is between a dentistry that treats and a dentistry that transforms. The Ottawa Charter points unmistakably toward the latter.

Conflicts of Interest

The author has no conflicts of interest to declare.