A realistic way forward

08 April, 2024 / indepth
 The Realistic Dentistry Group  

The Realistic Dentistry Group sets out its purpose, vision and ambitions for a realistic way forward for the profession

Do you work with your patients to make shared decisions, or simply advise them what you recommend? Are those new dentures you made actually being worn by the patient? You provide a restoration with good margins and the perfect fissure pattern, but do you know what your patient’s experience was?
Did that referral provide value to your patient? Are you factoring in the value of care provided for wider society? Will that prescription actually be used and what is the environmental impact of your prescriptions? 

These are all questions that Realistic Dentistry helps you find positive answers for.

What is Realistic Dentistry? 

Realistic Dentistry is based on the six key pillars of Realistic Medicine to help deliver Value Based Health and Care.

These pillars are: 

  1. A personalised approach to care.
  2. Shared decision-making.
  3. To reduce harm and waste.
  4. Managing risk better.
  5. Reduce unwarranted variation.
  6. To become improvers and innovators.

By embedding these principles, we can ensure the best outcomes for patients and the best use of
our resources.


Scotland’s oral health has witnessed significant improvements over the years1,2, thanks to the concerted efforts of everyone involved in the delivery of dentistry and our oral health improvement programmes.

However, we must acknowledge the persisting challenges and find creative solutions that reduce oral health inequalities, relieve pressure on dental care services and promote equitable access to care.

The COVID-19 pandemic and the current cost of living crisis present additional pressures
to dental services and to resources and have affected those central to our purpose – people.

The Realistic Dentistry model can revolutionise oral healthcare delivery, enhance patient outcomes, and create a more sustainable dental profession. To achieve this, in Scotland we have established the Realistic Dentistry Group, bringing together thought leaders and experts in the emerging field
of Realistic Dentistry.

This group seeks to transpose the principles of Realistic Medicine3 to dentistry nationally, to help meet the profession’s unique challenges and realise its ambitions.

Feedback from recent focus group work with patients and the public on some of these principles, such as shared decision-making, has been positive.

This work has been conducted as part of a fellowship project from The Healthcare Improvement Studies (THIS) Institute, led by Dr Heather Cassie at the University of Dundee4.

The Scottish Government’s dental reform, Determination I, introduced in November 2023 alongside the shift in terminology used in the regulations from ‘securing’ to ‘maintaining oral health of the patient’, is also a positive and realistic step forwards. 

In April 2024, NHS24 is planning to deliver a third phase of the ‘It’s OK to Ask’ national campaign5. As before, the campaign will look to raise awareness of the ‘BRAN’ questions amongst the public and encourage them to ask questions whenever they are in conversation with a health and care professional around their care. 

The BRAN questions are a simple way to support a conversation between patients and healthcare professionals about their conditions and the care options available.

What are the benefits?

What are the risks

Are there any alternatives?  

What if we do nothing?

A quote from a participant involved in the focus group stated: 

“…the BRAN tool looks great for shared decision-making … it’s much more likely to boost patient activation.” (PPI Focus Group Participant)

Our aims as the Realistic Dentistry group are:

To advocate for, and pioneer the adoption of a person-centred, value-based approach to dentistry.

To align Realistic Dentistry with Realistic Medicine, helping the whole dental care workforce practice Realistic Dentistry principles by ensuring alignment of visions.

To encourage the delivery of personal value by promoting approaches that involve patients in decisions that respect what matters to them, delivered through shared decision-making.

To promote sustainability to optimise the use of resources, reduce unwarranted variation, and minimise waste, thereby delivering technical value.

To empower patients to be supported in engaging with dental care professionals on decisions that impact them.

To promote approaches that reduce inequalities by ensuring the fair distribution of resources.

To foster profession-wide consideration of the wider societal impacts of dentistry and encourage action to maximise the positive effects and minimise the negative.

To equip all dental care professionals with the appropriate skills and training necessary to nurture realistic dentistry across all sectors.

To promote and support a whole systems approach that facilitates the delivery of person-centred, value-based health and care and delivers outcomes that matter to patients.

How are we going to do it?

  1. Work with all relevant stakeholders to increase awareness and understanding of Realistic Dentistry. 
  2. Provide a repository for Realistic Dentistry materials.
  3. Undertake scoping exercises to understand current activity related to realistic dentistry.
  4. Create links between the Realistic Dentistry Group and other pioneering groups in healthcare professions to foster and grow a cross-sectoral community of Realistic Dentistry practice. 
  5. Determine the routes of progression for Realistic Dentistry.
  6. Embed the principles of Realistic Dentistry within dental education at undergraduate and postgraduate education level for the whole dental team.
  7. Incorporate Realistic Dentistry into national guidelines on patient care. 
  8. Support and promote the delivery of preventative and proactive approaches to improve oral health and reduce oral health inequalities. 
  9. Promote the allocation of resources towards systems that enable higher value care to reduce waste and ensure sustainability.
  10. Support and promote effective prescribing practices.
  11. Promote awareness of Value-Based Health and Care and Realistic Dentistry through public engagement to help support shared decision-making and improve health literacy and advocacy.
  12. Explore opportunities to access funding to support the progression and implementation of Realistic Dentistry

Preliminary research suggests that patients are supportive of a realistic approach and feel positive and encouraged to hear about the steps being taking in dentistry to support this: “Stimulating and reassuring to see dentistry doing this. It’s just brilliant. It’s very, very responsible. The message you’re giving out to people like me is that you are compassionate about your patients.” (PPI Focus Group Participant)

Want to find out more? 

Please join us at our lecture at the Scottish Dental Show on Friday 31 May 2024 to find out more (sdshow.co.uk/education). If you want to get in touch, please contact Emma O’Keefe or Lorenzo Iafrate at: fife.realisticdentistry@nhs.scot


  1. www.ndip.scottishdental.org/ndip-reports
  2. www.scottishdental.org/tag/scottish-adult-oral-health-survey
  3. www.realisticmedicine.scot
  4. www.thisinstitute.cam.ac.uk/about/people/dr-heather-cassie/
  5. www.nhsinform.scot/campaigns/its-ok-to-ask

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