1.concepts and principles of preventive dentistry.pdf

Concepts and principles of preventive dentistry

Libyan International Medical University

2nd Year First Semester

D Caroline Piske de A. Mohamed

Objectives: You should be able to explain and discuss:

1. Oral health trends

2. Levels of prevention

3. Oral disease prevention through:

Changing attitudes towards health

Patients responsibility

Practitioners responsibility

2 D Caroline Mohamed

WHATS HEALTH?


World Health Organization's (WHO's) definition of "health:

"Health is a state of complete physical, mental

and social well-being and not merely the absence of disease or infirmity.

Is: "a resource for everyday life, not the objective

of living. Health is a positive concept emphasizing social and personal resources, as

well as physical capacities (Ottawa Charter for Health Promotion , WHO, 1986)


Physical Health

Another term for physical health is physical wellbeing.

Physical wellbeing is defined as something a person can achieve by developing all health-related components of his/her lifestyle.

Other contributors to physical wellbeing

may include proper nutrition, bodyweight

management, abstaining from drug abuse,

avoiding alcohol abuse, responsible

sexual behavior (sexual health),

hygiene, and getting the right amount

of sleep.


Mental health

Mental health refers to people's cognitive and emotional well-being. A person who enjoys good mental health does not have a mental disorder.

According to WHO, mental health is: "a state of well-being in which the individual realizes his or her own

abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community". No matter how many definitions people try to come up with regarding mental health, its assessment is still a subjective one.


D Caroline Mohamed 7

Why Is Oral Health Important?


Oral Health is part of the global Health!

In recent decades have seen a change to a more preventive oriented approach. Factors influencing this traditional include: 1. Increased understanding of the

nature of dental caries and periodontal disease .

2. Increased appreciation of the shortcomings of traditional restorative dentistry.

3. Advances in dental materials and restorative techniques.

4. Changing aspirations of patients.


Oral health is essential to overall health!

Good oral health improves a persons ability to speak, smile, smell, taste, touch, chew, swallow, and make facial expressions to show feelings and emotions.1, 2

However, oral diseases, from cavities to oral cancer, cause pain and disability .


Oral Health, General Health, and Well-Being

Oral health and general health are intertwined, affecting and

affected by one another. General health can affect oral health. Conversely, oral diseases and conditions can affect general health. Medical conditions often have oral implications and consequences. Signs of illness or abuse can be present in the mouth. Vitamin deficiencies; bacterial, viral, and fungal infections; congenital conditions; systemic conditions; and child abuse can have orofacial manifestations.


Medical interventions and medications can directly or indirectly affect oral health. Altered saliva quality and quantity can be a side effect of anti-anxiety medications, anticonvulsants, antidepressants, antihistamines, decongestants, diuretics, narcotics, non-steroid anti-inflammatory medications, and sedatives. Tetracyclines and oral preparations such as iron supplements can cause staining of the teeth.


Severe oral disease can play a part in the following:

Difficulty chewing. Children with severe oral disease may have difficulty chewing. These children may not eat enough or may have modified diets that do not contain the nutrients required for healthy growth and development.

Reduced self-esteem. Children with severe oral disease may be reluctant to smile owing to embarrassment about the appearance of their teeth.

Difficulty sleeping. Infants and children with severe oral disease may have difficulty sleeping.

Missed opportunities for learning. Infants and children with severe oral disease may have frequent absences from school, child development programs, or other child care programs.


Oral Health Trends Access to Care


Vulnerable populations of children (especially children from families with low incomes, those who are homeless, those in families without dental insurance, and those with special health care needs) have more oral health problems and less access to care than the general population.

These children suffer from frequent often urgent oral health problems and generally receive inadequate care.

Factors contributing to inadequate access include geographic maldistribution of oral health professionals, inadequate relatively few pediatric dentists who may be more likely to treat Medicaid-eligible children, individuals knowledge and attitudes concerning oral health, and other difficulties reaching culturally diverse populations.

Barriers that can limit a persons use of preventive interventions and treatments include:1,2,3

Limited access to and availability of dental services

Lack of awareness of the need for care

Cost

Fear of dental procedures

There are also social determinants that affect oral health. In general, people with lower levels of education and income, and people from specific racial/ethnic groups, have higher rates of disease.2, 3, 4, 5, People with disabilities and other health conditions, like diabetes, are more likely to have poor oral health.1


1. Oral Health Trends

Tooth Decay

Dental caries is the most common chronic childhood disease five times more common than asthma [3].


Trends in Oral Health

Untreated Tooth Decay

Among children ages 6-8, 72 percent of American Indian/Alaskan Native children, 50 percent of Hispanic children, 34 percent of black children, and 31 percent of all children experience untreated tooth decay.[9]

Among libyan children dental caries prevalence in 12 year-old children was high(57.8%), the mean DMFT (1.68) was low compared with other developing countries, but higher than the WHO goal for year 2020. The high level of untreated caries is a cause for concern, representing a high unmet treatment need.

Huew R, Waterhouse PJ, Moynihan PJ, Maguire A, 2011; WHO, 2003


Oral health trends The first teeth to loose.

In many 50-65 year olds, most of the molars (the most efficient teeth for chewing) have been lost.

Trends in Oral Health Periodontal (gum) diseases


In Libya there is a high prevalence of periodontal disease and that is the main cause of tooth loss in adulthood. Among the 3544 years old, there is none with healthy periodontium and bleeding. 13% had calculus, 53% had shallow pockets, and 34% deep pockets (WHO Global Oral Data Bank (GODB), 1993).

More than half of the adult population in Sebha are detected with the signs of destructive periodontitis. If this trend continues, in the coming years the severity of periodontal disease is bound to increase enormously ( Peeran, 2012).

Oral health trends Dental caries and periodontal diseases are the main

indications for dental extraction.

In many industrialized and several developing countries, 30-50% of the population older than 65 years is edentulous.


Malocclusion Premature loss of primary molars predisposes

children to malocclusion (improper alignment of the jaws and teeth).[10]


Trends in Oral Health Injury and Violence -Traffic accident, sports

Craniofacial, head, face, and neck injuries occur in more than half of the cases of child abuse.[15]


Trends in Oral Health Children with Special Health Care Needs Results of the 1994-1995 National Health Interview Survey on access to

care and use of services indicates that the most prevalent unmet health need among children with special health care needs is oral health care.[16]

Coordinated and collaborative efforts on the parts of all health professionals are needed to ensure that all infants and young children regardless of their race/ethnicity and their socioeconomic status and of whether they have special health care needs enjoy optimal oral health.



Craniofacial disorders cleft lip and palato (hereditary causes or accidents )



Oral and facial pain



Oral and pharyngeal (mouth and throat) cancers1, 2, 3, 4, 5


Oral cancer presents in this region of the world ( middle east) with the average age incidence of 55 years old. The prevalence is still smaller than in developed and industrialized however, it is expected that this region experience the greatest increase of all WHO regions in two decades (between 100% and 180%). These expectations refer to many factors, including expected growth and aging population and increasing exposure to risk factors such as smoking, changing habits to unhealthy diets, physical inactivity, environmental pollution alongside the late diagnosis of the disease. ( WHO, 2009)

Several factors have shaped oral health trends globally, affecting the rates of caries and periodontal disease.

Caries prevalence has decreased significantly among children and young adults in most industrialized countries.

There has been a downward movement in the prevalence of caries in virtually all the industrialized countries in particular the Scandinavian countries, Australia, and New Zealand improved from very high to low caries prevalence.

Changing levels of dental caries experience (DMFT) among 12 year olds in

developed and developing countries

.

In developing countries, the general trend is for caries prevalence to increase except where preventive programs have been set up.

Why?

1. The promotion of oral hygiene,

2. The widespread use

of fluoride toothpastes,

Water Fluoridation

Community water fluoridation is the most effective way to deliver the benefits of fluoride to a community. Studies show that it prevents tooth decay by 18 to 40 percent.

Lack of fluoridated water may disproportionately affect children from families with low incomes and children in certain minority groups, who are less likely to receive other preventive interventions, increasing morbidity and costs of care.[14]

In Benghazi, as an example, the levels of fluoride vary naturally from 0.4 to 0.9 (Sahli, 2011). In places with the same geographical and climate situation the optimal levels of fluoride could be around 0.7. Lower levels is a lost of therapeutic benefit and higher levels can lead to dental fluoroses. Other cities around Benghazi and mainly cities localized in the southeast part of the country presents higher levels of dental fluoroses.

Thats an issue to be studied and object of a national essay .


Health food education

Community programs ( schools, hospitals,)

The availability of advice on nutrition

(no sweets between meals, etc)


We dont want to be sick or with dental caries! Bring a healthy lunch to school.

As a result of the progress made in the last 25 years, developing countries now have the knowledge and means of prevention to enable them to avoid the costly problems that industrialized countries have had to face and indeed are still facing.

Areas for public health improvement:

Increase awareness of the importance of oral health to overall health and well-being. Increase acceptance and adoption of effective preventive interventions. Reduce disparities in access to effective preventive and dental treatment services.

Potential strategies to address these issues include: Implementing and evaluating activities that have an impact on health behavior. Promoting interventions to reduce tooth decay, such as dental sealants and

fluoride use. Evaluating and improving methods of monitoring oral diseases and conditions. Increasing the capacity of State dental health programs to provide preventive oral

health services. Increasing the number of community health centers with an oral health component.


2. Levels of prevention

Preventive services are the methods employed by the clinician and/or patient to promote and maintain oral health.

Preventive services fall into three groups: primary, secondary and tertiary.

Level 1: Primary prevention :

Pre pathogenic stage employs measures that forestall the onset of the disease, to reverse the progress of the initial stage, or to arrest the disease process before (secondary preventive ) treatment becomes necessary.


Primary primary prevention: Preventive dentistry measures Education from the beginning to prevent postnatal transmission of cariogenic microbes and poor dietary habits from mother to

child.

Prevent, Arrest, Reverse

Primary prevention:



[

[

[

Community water fluoridation and school-based dental sealant programs are 2 leading evidence-based interventions to prevent tooth decay.

Pit and fissures sealants


Level 2: Secondary prevention Pathogenic stage employs routine treatments methods, to terminate a disease process and to restore tissues as near normal as possible. Promoting early intervention in those already affected to halt progression at incipient stage of disease. Relief of pain.


Secondary prevention Deep scaling / Restoration / Periodontal surgery Endodontics / Exodontics


Level 3: Tertiary prevention Employs measures necessary to replace lost tissues and to rehabilitate patients to the point that functions is as near normal as possible, after the failure of the secondary preventions.


Tertiary prevention

Prosthodontics


3. Oral disease prevention through: Changing attitudes towards health: Patients responsibility

It is the duty of dental professionals to educate and motivate the public, health personnel, and politicians to regard intact teeth and healthy gingiva. It is all a matter of changing attitudes and priorities Good self-care, such as brushing with fluoride

toothpaste, daily flossing, and professional treatment, is key to good oral health.1, 2, 3, 4

Health behaviors that can lead to poor oral health include:

Tobacco use Excessive alcohol use Poor dietary choices1, 4, 5


Patient responsibility

Motivation is defined as readiness to act or the driving force behind our actions.

Greater responsibility has been described as the motivating factor of longest duration.

Optimized responsibility may sometimes result in lifelong motivation.

Adults should believe, "No dentist or dental hygienist should accept more responsibility for my oral status than I do myself, because it is my mouth.

With the current level of knowledge about the etiology, prevention, and control of dental caries and periodontal diseases, it has been shown that patients who are well motivated and well educated in self-diagnosis and self-care can prevent and control these diseases by themselves.

Oral disease prevention through: Changing attitudes towards health: The Health Professionals Role in Promoting Oral Health

Health professionals can help ensure that infants and young children receive the care they need by referring infants to a dentist for an oral examination within 6 months of the eruption of the first primary tooth, and no later than age 12 months[1], and by establishing the childs dental home.

Establishment of the dental home provides an opportunity to foster the development of preventive oral health habits that can help keep children free from oral disease.

Dental Health professionals can promote the oral health of the community by sharing information about oral development, oral disease, oral hygiene, fluoride, nutrition, and injury and violence prevention and working in partnership with civil organizations. D Caroline Mohamed 52

Practitioner responsibility

Clinicians are required to practice dentistry according to modern science and established, well-tried methods, ie, the state of the art.

The dental profession is obliged to concentrate on

prevention, control, and arrest of dental caries and periodontal diseases.

For dental caries, "prevention instead of extension" or at least "prevention before extension," should be given priority.

Aggressive treatment of dental caries with extractions and "drilling, filling, and billing," and of periodontal diseases with extractions, aggressive scaling, and extensive flap surgery, must be regarded as outdated and more or less unjustified.

CONCLUSION Oral health and general health are strongly correlated with

the level of education. All over the world, the level of education is improving.

Eventually, increasingly well-educated patients will learn the implications of high-quality dentistry and will request more preventive dentistry, instead of "drilling, filling, and billing." Dentists who are not willing to comply with their patients' requests will find that their practices decline.

References 1US Department of Health and Human Services, Public Health Service, Office of the Surgeon General. Oral health in America: A report of the Surgeon General. Rockville, MD: National Institutes of Health, National Institute of Dental and Craniofacial Research; 2000, p. 33-59.

2US Department of Health and Human Services, Public Health Service, Office of the Surgeon General. Oral health in America: A report of the Surgeon General. Rockville, MD: National Institutes of Health, National Institute of Dental and Craniofacial Research; 2000, p. 155-88.

3US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention. A national call to action to promote oral health, Rockville (MD): National Institutes of Health, National Institute of Dental and Craniofacial Research; May 2003, p. 1 -53. (NIH Publication; no. 03-5303).

4Dye BA, Tan S, Smith V, et al. Trends in oral health status: United States, 19881994 and 19992004, Vital Health Stat. 2007 Apr;11(248):1-92. 5US Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Oral health: Preventing cavities, gum disease,

tooth loss, and oral cancers: At a glance 2010 [Internet]. Atlanta: CDC; c2010 [cited 2010 March 8]. Available from:http://www.cdc.gov/chronicdisease/resources/publications/AAG/doh.htm#aag

6US Government Accountability Office (GAO). Medicaid: Extent of dental disease in children has not decreased and millions are estimated to have untreated tooth decay. 2008 Sep. 46 p. (GAO-08-1211).

Huew R, Waterhouse PJ, Moynihan PJ, Maguire A. Prevalence and severity of dental caries in Libyan schoolchildren. Int Dent J. 2011 Aug;61(4):217-23. doi: 10.1111/j.1875-595X.2011.00060.x.

SAHLI N. Fluoride Concentration in The Man-made River Project Water (Phase 1&2) Lbia, 2010. Syed Wali Peeran,1 A. J. A. Ranjith Singh,2 G. Alagamuthu,3 Syed Ali Peeran,4 and P. G. Naveen Kumar5 Periodontal Status and Risk Factors among Adults of Sebha City (Libya) International Journal of Dentistry

Volume 2012 (2012), Article ID 787502, 5 pages doi:10.1155/2012/787502 The WHO Global Oral Health Data Bank for periodontal disease, 2012, http://www.dent.niigata-u.ac.jp/prevent/perio/perio.xls. 9- WHO. Regional Office for the Eastern Mediterranean. Towards a strategy for cancer control in the Eastern Mediterranean y for Research on Cancer

(IARC) In: Region / World Health Organization.Regional Office for the Eastern Mediterranean.p 72. WHOEM/NCD/060/E/7.09/400.. 2009.

-WHO. The World Oral Health Report 2003. In: http://www.who.int/oral_health/media/en/orh_report03_en.pdf. Acesso em 04/1/2010.


Recommended sites

A Health Professional Guide for Pediatric Oral Health Managment 2010 National Maternal and Child Oral Health Resource Center | Georgetown University In : http://www.mchoralhealth.org/PediatricOH/mod2_5.htm


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