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

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WHATS HEALTH?

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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)
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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.

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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.

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Why Is Oral Health Important?

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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.
2.
3.
4.

Increased understanding of the

nature of dental caries and
periodontal disease .
Increased appreciation of the
shortcomings of traditional
restorative dentistry.
Advances in dental materials
and restorative techniques.
Changing
aspirations
of
patients.
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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 .

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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.

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 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.

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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.

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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.

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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
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1. Oral Health Trends

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

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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

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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).

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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.

Trends in Oral Health

Malocclusion
Premature loss of primary molars predisposes
children to malocclusion (improper alignment of the
jaws and teeth).[10]

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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]

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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.

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Trends in Oral Health

Craniofacial disorders cleft lip and palato

(hereditary causes or accidents )

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Trends in Oral Health

Oral and facial pain

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Trends in Oral Health

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)

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 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 .
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Health food education

Community programs ( schools, hospitals,)

The availability of advice on nutrition
(no sweets between meals, etc)

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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.

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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.

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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.

Primary prevention:
Prevent, Arrest, Reverse

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Community water fluoridation

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

[
[

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Pit and fissures sealants

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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.

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

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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.

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Tertiary prevention
Prosthodontics

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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

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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 selfcare 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.
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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):21723. 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.

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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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Thanks

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