This document discusses strategies for preventing periodontal disease as a public health problem in the UK. It argues that current approaches focus too much on downstream treatment rather than upstream prevention. It advocates for whole population prevention strategies like reducing risk factors through public health measures, health education and policy changes. These include integrating oral hygiene education into schools, using media campaigns, and making oral hygiene products more affordable. A combination of population-level interventions and some targeted high-risk approaches is recommended over just clinical treatment to more effectively address periodontal disease on a public health scale.

1. Prevention Strategy of Periodontal
Disease as a Public Health
Problem in UK
“An ounce of prevention is worth a pound of
cure”
IBRAHIM BHAMJI
POST GRADUATE STUDENT MSC DENTAL PUBLIC HEALTH (2015 -2016)

2. Why do we fail in tackling
periodontal disease?
Focus on downstream approaches.
Inappropriate delivery of interventions.
Focus on treatment rather than prevention.
Lack of integration and isolation of the mouth from the rest of the
body.
Lack of community-based approaches.

3. Preventative strategies
Aim for prevention
If the overall aim of the dental public health strategy is focus on
individualistic approach then it wont be feasible strategy.
Whole population strategy and using upstream approach.

4. WattRG.2007.Fromvictimblamingtoupstreamaction:tacklingthesocialdeterminantsoforalhealthinequalities.CommunityDent
OralEpidemiol;35:1–11

5. High risk vs whole-population
strategies
Two approaches for tackling periodontal disease: high risk or population
approaches.
“High-risk” approach: In which individuals at high risk of disease are
identified and targeted for preventive treatment. This is the most
natural and traditional way of dental professional use as a preventive
strategy. It relies on screening of individuals and providing an
intervention for those at high risk.

6. There is no strong evidence or study which can
recommend any clinical research to be implemented in a
clinical setting or population setting.
With this limitation highlighted, it needs to focus on
population strategy.

7. “Population” approach: In which population-wide changes in risk factors are made.
This addresses the determinants and lowers the mean level of risk factors by
shifting the whole population distribution to a favorable position.
For example, addressing the underlying cause plaque level and smoking
which reduces the risk and therefore produces a greater benefit.(rose
2008).
Rose G. (2008). Rose strategy for preventive medicine. Oxford, oxford university press.

8. Modified risk approach, the targeted population strategy can also be
used to direct action at particular high risk group within the population
but not individual.
To control periodontal condition a combined approach is needed.

9. Prevention in clinical practice
Health promotion for prevention of periodontal diseases progression.
To be effective it should be based on scientific and evident based.
Basic periodontal examination should be used routinely for assessing and
examine the periodontal health.
Oral health care professional should impart knowledge, skills and
demonstration of brushing for effective oral hygiene self practice.

10. Key health education messages to promote
periodontal health (Department of Health 2012)
Children under 7 years should be supervised with their brushing.
Using manual or powered tooth brushed.
Gentle pressure hold brush with pen grip
Use of of interdental cleaning aides.
Tooth brush size use a small head with a medium texture.
Replace tooth brush when bristles become excessively slayed.
Chlorhexidine is most effective chemical plaque suppressant.
Do not smoke.
Löe, H. (2000), Oral hygiene in the prevention of caries and periodontal disease. International Dental Journal, 50: 129–139. doi: 10.1111/j.1875-
595X.2000.tb00553.x
Department of Health (2012). Delivering better oral health an evidence based tool kit for prevention, 3rd edition, London, Department of Health.

11. Smoking cessation advice
It is a major etiological factor for periodontal disease and other chronic
condition.
If a patient is smoker should be given advice in regards to effect of
smoking on oral and general health.
Patient who wish should be refer to local NHS stop smoking service are
available and provide a evidence based support and treatment.

12. Public health approaches
Clinical preventive measure is not alone sufficient, public health
measures are essential elements in preventive strategy (Watt and
Peterson, 2012)
Watt,R.G and petersen, P.E. (2012). Periodontal health through public health --- the case for oral health
promotion. Periodontology 2000, 60, 147-155

13. Public health measures to reduce
periodontal disease
A community wide approach incorporating the principle of integration with
general health education, diversity of educational approaches, and community
participation.
Community leader education.
Mass media intervention.
Integrate oral hygiene into body cleanliness education in nurseries and
school.
Incorporate the importance and skills of oral hygiene into training of health,
education and social care professional.
Use fiscal policy to reduce cost of oral hygiene aids and toothpaste; remove VAT
at national level sell the products at cost price in NHS premises.
Dorri, M ., Sheiham , A., and watt , R.G (2009). Relationship between general hygiene behaviours and oral hygiene in Iranian adolscents.
Europe journal of oral sciences, 117, 407-12
Kay, L. and Locker, D (1996). Is dental health education effective? A systematic review of current evidence. Community dentistry and
epidemiology, 24, 231-5.
Watt,R.G. and Marinho, V. (2005). Does oral health promotion improved oral hygiene and gingival health? Periodontology 2000, 60,
147-55

14. Environmental change : Organizational policy; ensure oral hygiene is
placed on health promoting schools’ agendas structural change within
school provision and design of toilet facilities.
Comprehensive public health strategies to reduce smoking, epically
among low income groups.
Sheiham, A. and Netuveli, G. S. (2002), Periodontal diseases in Europe. Periodontology 2000, 29: 104–
121. doi: 10.1034/j.1600-0757.2002.290106.x

15. Conclusion
As a clinical approach alone is not sufficient to achieve a feasible
periodontal care modalities. So it is best to adopt upper stream
approach and public health approach in getting a success to
prevent a periodontal disease as a public health problem.
Improve a periodontal health of population
Smoking cessation in population.

16. Thank you for listening
“An ounce of prevention is worth a pound of cure”
Any questions?