Expert Summary

The multidisciplinary ADVOCATE consortium has a shared vision of achieving a step change in health systems design and performance.

EU spending on oral health care is close to €79 billion pa.1 Globally, 3.9 billion people suffer from the common oral conditions2 of dental caries, advanced gum disease and tooth loss, all of which are preventable conditions. Dental Caries is the 1st and Severe Periodontal Disease the 6th most prevalent conditions worldwide affecting 35% and 11% of the global population, respectively1 . This poses major challenges to public health and society. Socioeconomic and lifestyle conditions contribute to the epidemic nature of oral conditions. Their impact on individual quality of life and well-being and their collective burden for society is very large3. The current restoration and conservation paradigm in oral care originated in an era when the caries level in the population was of epidemic proportions. While still the most common chronic disease, the severity of caries is greatly reduced and the disease is no longer epidemic, but now endemic and preventable. In contrast, health system elements such as provider payment still do not mirror the prevention paradigm, with fee-for-service remaining the predominant reimbursement mechanism. Such health system characteristics may accommodate under-utilization of oral care in high risk groups and over-utilization in low risk groups. We are committed to active and meaningful Patient (consumer) Public Involvement (PPI) and development of our EU ADVOCATE has benefited from our research questions being shaped with PPI members input.

The multidisciplinary ADVOCATE consortium has a shared vision of achieving a step change in health systems design and performance.

By this project they will establish an innovative framework to bring health system planning into the 21st century. Policy and planning of services and care systems, previously informed by general epidemiological data, will be transformed by the application of novel advanced data science, to develop both system and practice level dashboards for performance management for use at the practitioner and system level. These will serve as a governance instrument for benchmarking health care service, health care planning policy and improving its health outcomes.


The application of novel advanced data science to performance management promotes efficiency improvements as well as better health outcomes, and facilitates the early translation of advances in care to a consumer friendly needs and evidence based disease prevention paradigm. The capacity of this approach for population impact is vast since the ADVOCATE consortium joins forces and works across systems and countries. The project will access longitudinal data on a mixture of public and private insurance schemes from different settings and countries (Germany, NL, Ireland, UK, Denmark and Hungary). With our approach we will establish the framework to improve the efficiency and equity of oral health care service across Europe. To ensure relevance of our models across all member states we have obtained the full backing and cooperation of Council of European Chief Dental Officers, whose members advise European governments on oral health, has committed their support to the ADVOCATE project, and we will work with them and the International Association for Dental Research at the European Platform for Better Oral Health.

The ADVOCATE project uses the context of Oral Health Care Services as a template for health care services in general. It will shift the focus from dental surgery and treatment paradigm towards a consumer friendly evidenced dental medicine and disease prevention paradigm.

The project is broken down into 6 work packages, with leaders, spread across Europe, each chosen for their expertise in data collection, analysis, manipulation and dissemination. The project is coordinated by the Dean of the School of Dentistry at the University of Leeds.

1 Patel, R. The State of Oral Health in Europe – Report Commissioned by the European Platform For Better Oral Health 2012.

2 Marcenes W, Kassebaum NJ, Bernabe E, Flaxman A, Naghavi M, Lopez A, Murray CJ (2013). Global burden of oral conditions in 1990-2010: a systematic analysis. J Dent Res; 92:592-597

3 Petersen PE. The World Oral Health Report 2003 Continuous improvement of oral health in the 21st century – The approach of the WHO Global Oral Health Programme. Community Dentistry and Oral Epidemiology 31 (Suppl 1): 3-24