1

Prevention
■ Introduction
■ Prevention is derived from the word “pravento”,it
means a forestalling=to act before hand.
Prevention= to keep from happening.
Make impossible by prior action

2
Definition

Health: The World health organisation(WHO) defines

health as a “state of complete physical, mental and
social well-being, not merely the absence of disease
or infirmity”.
Prevention: Prevention is defined as “actions taken
prior to the onset of disease which removes the
possibility that a disease will ever occur”.
(Or)
Prevention can be defined as the “action of keeping
from happening or of rendering impossible and
anticipated event of act”

3
• The definition assumes that the thing being prevented is
anticipated, but it does not mean that the extent, severity or
extent of the thing is always known.
• History of prevention:
• In 1753,James Lind has done the first ever epidemiological
study.
In 1796, Jenner's discovered the vaccination of smallpox.
Sanitary conditions of the labouring population of Great Britain was
done by Edwin Chadwick in 1842.

4
• In 19th century, majority satisfied by home care remedies.
• In 20th century, etiologic factors of most orodental diseases
war identified.
Emergence of prevention.
Criteria for disease prevention:
1.The disease and conditions are in significant.
2.There is prevention that works.
3.Prevention is better than cure, repair or doing nothing.

5
4.Sufficient resources are available to implement the preventive
measures.
• 5.The economics can be calculated.
• 6.The process is ethical.
• Objectives of prevention:
• To evert initiation of disease process.
To intercept their progress.
To intercept or oppose the cause and thereby its disease process.
To provide rehabilitation.

6
Concepts of prevention:
✓ The goals of medicine are to promote health, to preserve health,
to restore health, when it is impaired, and to minimise suffering
and distress.
✓ These goals are embedded in the word prevention.
✓ Successful prevention depends upon the knowledge of
causation, dynamics of transmission, identification of risk factors
and risk groups, availability of prophylactic or early detection
and treatment measures to appropriate persons or groups.

7
8
 Levels of Prevention:
● Successful prevention
Knowledge of causation, dynamics of transmission,identification of risk
factors availability of prophylactic or early detection treatment measures
organisation for applying these measures continuous evaluation of
procedures applied
The four levels of prevention are:
1.Primordial prevention. 3. Secondary prevention
2.Primary prevention. 4. Tertiary prevention
9
10
1.Primordial prevention:
◆ Primordial prevention is new concept of receiving
special attention in the prevention of chronic
diseases.
◆ This is primary prevention in its purest sense,
i.e.prevention of the emergence of or development
of risk factors in countries population groups in
which they have not appeared.
11
◆ For example, many adult health problems(e.g.
Obesity, hypertension) how their own early origins in
childhood, because this is the time where lifestyles are
formed (e.g. Smoking,eating,exercise).
◆ Here the main intervention is by individual and mass
education.

12
2. Primary Prevention:
◆ Defined as, “actions taken for to the onset of disease
which removes the possibility that a disease will ever
occur”.
◆ Phase of intervention: pre-pathogenesis phase.
◆ It signifies the intervention in the pre-pathogenesis phase of
a disease or health problem (e.g. low birth weight)or other
departure from health.

13
◆ Primary prevention is far more than averting the
occurrence of a disease and prolonging life. It includes the
concept of “positive health”, a concept that increases
achievement and maintenance of an “acceptable level of
health that will enable every individual to lead a
socially and economically productive life”.
◆ It concerns and individuals attitude towards life and health
and the initiative he takes about positive and responsible
measures for himself, his family and his community.

14
◆ the concept of prevention is now being applied to prevention of
coronary heart disease, hypertension and cancer based on
elimination or modification of “risk factors” of the disease.
◆ Modes of intervention for primary prevent
1.Health promotion
2.Specific protection
◆ The WHO approaches for primary prevention of chronic
diseases are:
◆ 1.Population (mass) strategy 2. High-risk strategy

15
16
Population (mass) strategy:
• Another preventive approach is “Population
strategy”, which is directed at the whole
population irrespective of individual risk levels.
• For example, studies have shown that even small
cholesterol reduction in the average blood
pressure or serum cholesterol of a population
would produce a large reduction in the incidence of
cardiovascular disease.
17
• The population approach is directed towards
socio-economic, behavioural and lifestyle
changes.
High-risk strategy:
• The high risk strategy aims to being preventive
care to individuals at special risk. This requires
detection of individuals to high risk buy the
optimum use of clinical methods.
18
• Primary prevention is a desirable goal. It is worthwhile to
recall the fact that the industrialized countries succeed in
eliminating a number of communicable diseases like cholera,
typhoid and dysentery and controlling several others like
plaque, leprosy and tuberculosis not by medical interventions
but mainly by rising the standard of living(primary
prevention)
• The application of primary prevention to the prevention of
chronic disease is a recent development.

19
• To have an impact on the population, all the about three
approaches (primordial prevention, population strategy and
high risk strategy)should be implemented as they are usually
complementary.
• In summary, primary prevention is a “Holistic approach”, it refers
on measures design to promote health or to protect against specific
diseases agents and hazard in the environment.
• Fundamental public health measures and activities like
sanitation,infection control,immunization,production of food,milk.......

20
and water supplies, environmental protection and protection
against occupational hazards and accidents all are back to primary
prevention.
• Basic personal hygiene and public health measures have an
major impact on halting communicable diseases, epidemics,
immunization, infection control (e.g. Hand washing), refrigeration
of foods, garbage collection, solid and liquid waste management,
water supply protection and treatment, and general sanitation
have reduced threats to population.

21
• Primary prevention has been identified as with “Health
education “and the concept of individual and community
responsibility for health.

22
23
Secondary prevention:

• Secondary prevention can be defined as, “actions

which halts progress of a disease at its
incipient stage and prevents complications”.
• The specific interventions are early diagnosis
and adequate treatment (screening test, case
finding programs).

24
• Secondary prevention attempts to arrest the disease
process; restore health by speaking out unrecognised
disease and treating it before a reversible pathological
changes have taken place; reverse communicability of
infectious disease.
• Secondary prevention is largely the domain of clinical
medicine. The health programs programme initiated by
government are usually at the level of secondary
prevention.

25
• The drawback of secondary prevention is that the patient
has already been subject to mental, anguish, physical pain
and the community to loss of productivity.
• Modes of intervention for secondary prevention:
1.Early diagnosis
• 2.Prompt treatment
Pathogenesis face

26
Tertiary prevention:
• Defined as, “all measures available to reduce all limit
impairments and disabilities, minimise suffering
caused by existent departures from good health to
promote patients adjustment to ire medial
conditions”.
• Late pathogenesis phase

27
28
• For example, treatment if undertaken late in the natural history
of disease may prevent sequelae and limit disability. When
defect and disability are more or less stabilized, rehabilitation
will play a preventable role.
• Tertiary prevention extends the concept of prevention in to
fields of rehabilitation.
• Modes of intervention for tertiary prevention:
Disability Limitation
Rehabilitation

29
30
Modes of intervention:
“Intervention” can we define as any attempt to intervene
or interrupt the usual sequence in the development of disease
in man. This may be by the provision of treatment, education.
5 modes of intervention have been described which form a
continuum corresponding to the natural history of any
disease.

31
■ It involves, “organisational, political, social and economic
interventions design to facilitate environment and behavioural
adaptations that will improve or protect health”.
■ The well-known intervention areas are:
A)health education
B)Environmental modifications
C)Nutritional intervention
D)Lifestyle and behavioural changes

32
• They are:
• Health promotion
• Specific protection
• Early diagnosis and treatment
• Disability limitation
• Rehabilitation
Health promotion:
Defined as a,“ process of enabling people to increase control
over and to improve health”.

33
34
A)Health Education:
• One of the most effective intervention.
• A large number of diseases could be prevented with little or no medical
intervention if people were adequately informed about them.
• Adequately information about diseases and increasing people to take
necessary precautions on time.
• The targets for educational efforts include the general public health,
patients, priority groups, health providers, community leaders, decision
makers.

35
B)Environmental modifications:
• A comprehensive approach two health promotion requires
environmental approach health promotion, such as providing
of safe water, installation of sanitary latrines, control of insects
and rodents, improvement of housing etc.
• The history of medicine-many infectious diseases have been
successfully controlled in western countries through this
intervention.

36
C) Nutritional interventions:
• Examples:
• Food distribution and nutrition improvement of vulnerable groups
• Child feeding programs
Dietary counselling.
• D) Lifestyle and Behavioural changes:
The conventional public health measures or intervention have not
been successful in making inroads and lifestyle reforms.

37
2) Specific Protection:
“The provision of health education for normal
mental, and physical functioning of the human being
individually and in the group. It includes the
promotion of health, the prevention of sickness and
curative and restorative medicine in all its aspects”.

38
• Health education is a basic element of all health activity. It is
of paramount importance in changing the views, behaviour
and habits of people.
• Examples: motivating people to avoid smoking, pan chewing,
drinking alcohol.

39
Intervention:
✓ Immunization
✓ Use of specific nutrients
✓ Chemoprophylaxis
✓ Protection against occupational hazards
✓ Protection against accidents
✓ Protection from carcinogens
✓ Avoidance of Allergens
✓ Control of specific hazards in general
population and environment (e.g. air
pollution, noise control)
✓ Control of consumer product quality and
safety of food, drugs, cosmetics etc.
40
3) Early Diagnosis and Treatment:
■ A WHO expert committee defined early diagnosis of health impairment
as, “detection of disturbances of homeostatic and compensatory
mechanism while biochemical, morphological and functional
changes are still reversible”.
■ Early detection and treatment are the main interventions on disease
control.
■ The earlier the diseases diagnosed and treated the better it is from the
point of view of prognosis and preventing the occurrence of further
cases (secondary cases) or any long term disability.
41
■ “it is like stamping out of the spark rather than calling fire
brigade to put out the fire”.
■ Strictly speaking, early diagnosis and treatment cannot be called
prevention because the disease has already commenced in the
host. However, since this intercepts the disease process, it has
been included in the scheme of prevention.
■ Early diagnosis and treatment on not as effective and economical
as primary prevention, maybe critically

42
important in reducing the high morbidity and mortality in certain
diseases such as essential hypertension, cancer, tuberculosis, leprosy,
STD.
• It includes:
• Arrests or stops the disease process.
• Restore the health.
• Treat the disease before irreversible pathological changes occurs.
• Reverse the communicability of infectious disease.
Screening surveys (urine examination for diabetes).

43
 Early diagnosis -> better prognosis
• Mass treatment approach:
• Juvenile mass treatment
• Selective mass treatmen
• Total mass treatment
Example: mass treatment used in control of certain diseases viz.
Pinta,yawns,bejel,trachoma &filiria. The rationale for program is
the existence of at least 4-5 cases of latent infection for each
clinical case of active disease in the community.

44
4) Disability Limitation:
• When a patient response late in the pathogenesis phase, the
mode of intervention is disability limitation.
• The objective of this intervention is to prevent or halt the
transition of the disease process from impairment to handicap.
• Concepts of disability:
• The sequence of events leading to disability and handicap have
been stated as follows:
Disease-impairment-disability-handicap

45
• The WHO has defined these terms as follows:
• Impairment:
• “any loss of abnormality of psychological,
physiological or anatomical structure of
function”
• Examples: loss of foot, defective vision,mental
retardation.
And impairment may be visible or invisible /temporary
or permanent/ progressive or regressive.
46
• Further, one male lead to development of another
secondary impairments.
• Examples: leprosy-
• Where damage to nerves(primary impairment)
Plantar ulcers(secondary impairments).
Disability:
Because of impairment, the affected person may be
unable to carry out certain activities considered normal
for his age, sex etc.

47
• The inability to carry out certain activities is termed disability.
• Defined as, “any restriction or lack of ability to perform an
activity in the manner or within the range considered
normal for a human being”.
• Handicap:
As a result of disability, the person experiences certain
disadvantages in life and he is not able to discharge the obligations
required for him and play the role expected of him in the society.

48
• Defined as, “disadvantage for a given individual ”resulting from an
impairment or a disability, that limits or prevent the fulfilment of a role
that is normal (depending on age, sex, social and cultural factors) for
that individual.
• Taking accident for an example,
Accident - Disease (disorder)
Loss of foot - Impairment(extrinsic or intrinsic)
Cannot walk- Disability (objectified)
Unemployed - handicap (socialized)

49
50
Disability prevention:
• reducing the occurrence of impairment viz. Immunization against polio
(primary prevention)
• Disability limitation by appropriate treatment (secondary prevention).
• Preventing the transition of disability to handicap(tertiary prevention).
• Example:
Disease - dental caries
Impairment - loss of tooth
Disability – can’t talk
Handicap – can’t socialize
51
52
5) Rehabilitation:
• It is defined as,“ the combined and coordinated use of medical,
social, educational and vocational measures for training and
retraining the individual to the highest possible level of
functional ability”.
• It includes all measures aimed to reducing the impact of disabling
and handicapping conditions and at enabling the disabled and
handicapped to achieve social integration.
• Social integration is the participation actively of disabled and
handicapped people in the mainstream of community life. 53
Types of Rehabilitation:
• Medical rehabilitation- Restoring the function.
• Vocational rehabilitation- Restoration of the
capacity to earn a livelihood.
• Social rehabilitation- Restoration of the family
and social relationships.
• Psychological rehabilitation- Restoration of
the personal dignity and confidence.

54
 Examples of Rehabilitation:
✓ Establishing school for the blinds.
✓ Exercising in neurological disorders.
✓ Provision of aids for the crippled.
✓ Reconstructive surgery in leprosy.
✓ Muscle re education and graded exercises.
✓ Change of profession for a most suitable one.
✓ Modification of life in general in the case of cardiac patients,
tuberculosis.
✓ Prosthetic restorations for the lost tooth.
55
56
57
58
Barriers(challenges) to preventive strategies :
• Diversity of population - A homogeneous message cannot be
appropriate for heterogeneous population.
• Inherent beliefs / mores - include fee of health for medical profession,
confusion from previous message,enorneous message etc.
• Adversting - propaganda produces pressure selling on children and
blackmail on parents.
Pressure groups - many groups base their opposition to health-
promoting moves on basis of loss of autonomy and choice.

59
• Access - access to people to improve health is usually
forest to those who are in most need of intervention.
• Resources - although governments stress the importance
of prevention, the major drain on health is the acute
healthcare sector.

60
Levels of prevention of dental caries :
■ "Primary prevention of dental caries in children (before
disease occurs)":
■ An explicit caries risk assessment should be made for each child
presenting for dental caries.
The following factors should be considered when assessing caries risk:
Clinical evidence of previous disease.
Dietary habits, especially frequency of sugary food and drink
consumption.

61
Several habits are associated with caries incidence:
• Amount of for fermentable carbohydrates consumed.
• Sugar concentration of food.
• Physical form of carbohydrate.
• Oral retentiveness.
• Frequency of eating meals and snacks.
• Length of interval between eating.
• Sequence of food consumption
• Other factors like use of fluoride, plaque control, saliva, medical
history.
62
Secondary and tertiary prevention of dental caries :
• Limiting the impact of caries at an early stage
• Rehabilitation of decayed teeth with further preventive caries
• Diagnosis of dental caries:
• Bitewing radiographs are recommended as an essential adjunct to
patients first circular examination.
The frequency of further radiographic examination should be
determined by an assessment of the patients caries risk

63
Management of carious lesions :
■ Occlusal caries:
■ If only a part of the fissure system is involved in small to
moderate dentin lesions with limited extension the treatment
of choice is composite sealant restoration.
■ If caries extend clinically into dentin,then carious dentin
should be removed and the tooth restored.
Dental amalgam is effective filling material.

64
Approximate caries:
■ Preventive care e.g. topical flouride varnish, rather than
operative care is recommended.
■ If approximal lesion requiring restoration,a conventional
class 2 should be placed in preference to tunnel preparation
Re-restoration:
■ The diagnosis of secondary caries is extremely difficult and
clear evidence of involvement of active disease should be
ascertained before replacing the restoration.

65
Prevention of dental
caries

66
67
68
Levels of prevention of periodontal
disease :
● prevention of build up of plaque.
● removal of other etiological risk factors.
The essential three approaches to prevent build up of
plaque are:
1.mechanical plaque removal by individual
2.mechanical plaque removal by dental professional
3.chemotheraupetic method of plaque control.
69
1.Mechanical plaque removal by individual:
✓ It involves daily removal of plaque, biofilm from the teeth and adjacent
oral tissues.
✓ Home care - includes mechanical and chemical methods
Mechanical plaque control:
1.Toothbrush
✓ Manual
✓ Electrical
✓ Ionic toothbrush
✓ Sonic and ultrasonic
70
2. Interdental oral hygiene aids
✓ Dental floss
✓ Dental floss holder
✓ Toothpicks and toothpick holder
✓ Interproximal brushes and single tuft brushes
✓ Knitting yarn
✓ Gauge strip
✓ Wedge stimulations and pipe cleaner
3. Adjunctive aids
✓ Irrigation devices, tongue cleaner.
71
✓ Dentrifices and mouth rinses
✓ Rubber strip stimulator
✓ Denture brush
2. Mechanical plaque removal by dental professional:
Professional care has been shown to
successfully control plaque deposits and gingivitis and seem
to control the progress of periodontitis.

Professional care -
✓ To provide information about dental health
72
✓ Motivate the patient to bring about a change in his behaviour
✓ Includes dental hygiene, diet influencing plaque formation, smoking
cessation.
✓ Scaling and root planing - scaling is sufficient to remove plaque
and calculus from enamel completely.
✓ Polishing - it inhibit formation of pellicle and calculus but there is no
documented evidence of periodontal health benefits. It is not a
routine procedure as it has drawbacks of removing fluoride from
enamel.

73
Prevention of periodontal
disease:

74
75
Prevention of oral cancer:
- Oral cancer is one of the 10 most common malignancies in the
world.
- site - lips and other intraoral sites but para oral sides such as
salivary glands, the oropharynx, nasopharynx are not included.
- the WHO defined a precancerous lesions as ,"generalized
associated with a significant increase risk of cancer".
- leukoplakia and erythroplakia constitute the important precancerous
lesion.

76
 Risk areas -
• Floor of the mouth
• Lateral border of the tongue
• Lower buccal sulcus
• Alveolus and angle of mouth.
• Risk factors -
• Tobacco, alcohol,diet and nutrition
• Ultraviolet light,Fungal and viral infection
• Habits and chronic irritation
Immunodeficiency or suppression,Occupational risk.
77
Prevention of oral
cancer:

78
79
Prevention of orofacial
defects, malocclusion and
accidents:

80
81
Role of public health dentist in prevention:
1.Identify and define the problem and risk groups.
2. Advocate and involve appropriate preventive
measures
3. Evaluate the applied program

82
83
Future challenges:
1. Socio economic disparities in providing healthcare
2. Recurrence of some communicable diseases which are
successfully controlled in past
3. Prevention of chronic non communicable diseases
4. Population control
5. Importance of public education, research and program
administration to control diseases on a community level

84
Conclusion:
• In the developing countries like India- more efforts on the
parts of individual and government is need it to bring the
developments in preventive dentistry within the reach of
common man.
• Oral health education programs must be developed in
attempt to control of oral disease, and school based
programs should be combined with family and community
preventive programs.
85
• High number of untreated caries in children
require immediate action.
• "our objective should be the perpetual
preservation of what remaining rather than
meticulous restoration of what is missing".

“prevention is better than cure”

86
References:
■ Park.k. Textbook of preventive and social medicine.
■ Soben Peter. Essential of public health dentistry.
■ Joseph John.Textbook of preventive and community
dentistry.
■ S S Hiremath. Textbook of preventive and community
dentistry.
■ Ch.Marya. Textbook of public health dentistry.

87