Introduction
Etiology of traumatic dental injuries
Mechanism of traumatic dental injuries
Epidemiological triad
Host factors
Agent factors
Enviromental factors
Impact of TDI on Oral health related quality of life
Classification of traumatic dental injuries
Public health implications
Conclusion
References
Dental management of children with special health care needsaravindhanarumugam1
hope this will throw a light in understanding special children and dental management of the same particularly for pediatric dentistry PGs .children with genetic diseases and emotionally handicapped ( child abuse and neglect ) are not discussed here as they are separate topics.
dr. aravindhan
Introduction
Etiology of traumatic dental injuries
Mechanism of traumatic dental injuries
Epidemiological triad
Host factors
Agent factors
Enviromental factors
Impact of TDI on Oral health related quality of life
Classification of traumatic dental injuries
Public health implications
Conclusion
References
Dental management of children with special health care needsaravindhanarumugam1
hope this will throw a light in understanding special children and dental management of the same particularly for pediatric dentistry PGs .children with genetic diseases and emotionally handicapped ( child abuse and neglect ) are not discussed here as they are separate topics.
dr. aravindhan
Risk Factors
Levels of Prevention
Upstream and Downstream Approach
Oral Health and General Health
Common Risk Factors
Rationale for Promoting Oral Health
CRFA application in Indian scenario
Importance of caries risk assessment, factors influencing dental caries: as well as risk indicators and predictors have been included in this power point.
Diagnostic aids with description both traditional and recent methods have been covered with required evidence.
School- based oral health education programs; How effective are they?Ghada Elmasuri
How effective are school based oral health education programs?
An evidence based review
A number of systematic reviews have been conducted on the the effectiveness of school-based behavioral interventions all over the world.
The aim of this presentation is to collect and review these evidences on the effectiveness of these programs and to identify important factors which contribute to the effectiveness of these programs.
Oral Health Policy: Needs, Barriers & Strategies in IndiaHaritha RK
Oral health policies are essential to ensure oral health for all. This presentation deals with the needs, barriers, burden & various policies executed in India since 1986. For more such info check: www.rkharitha.wordpress.com
Risk Factors
Levels of Prevention
Upstream and Downstream Approach
Oral Health and General Health
Common Risk Factors
Rationale for Promoting Oral Health
CRFA application in Indian scenario
Importance of caries risk assessment, factors influencing dental caries: as well as risk indicators and predictors have been included in this power point.
Diagnostic aids with description both traditional and recent methods have been covered with required evidence.
School- based oral health education programs; How effective are they?Ghada Elmasuri
How effective are school based oral health education programs?
An evidence based review
A number of systematic reviews have been conducted on the the effectiveness of school-based behavioral interventions all over the world.
The aim of this presentation is to collect and review these evidences on the effectiveness of these programs and to identify important factors which contribute to the effectiveness of these programs.
Oral Health Policy: Needs, Barriers & Strategies in IndiaHaritha RK
Oral health policies are essential to ensure oral health for all. This presentation deals with the needs, barriers, burden & various policies executed in India since 1986. For more such info check: www.rkharitha.wordpress.com
DEFINITION
“Actions directed to preventing illness and promoting health to reduce the need for secondary or tertiary health care.
Mosby’s Medical dictionary, 8th edition, 2009
“The action of stopping something from happening or arising”.
Oxford English Dictionary. Lexico 2020
GOALS OF PREVENTION
To promote health
To preserve health
To restore health when it is impaired
To minimize suffering and distress
Successful prevention depends upon:
a knowledge of causation
dynamics of transmission
identification of risk factors and risk groups
availability of prophylactic or early detection and treatment measures,
LEVELS OF PREVENTION
1) Primordial Prevention
2) Primary Prevention
3) Secondary Prevention
4) Tertiary Prevention
PRIMORDIAL PREVENTION
It is the prevention of emergence or development of risk factors in countries or population groups in which they have not yet appeared.
Main intervention is through individual and mass education.
Eg: Efforts directed towards discouraging children from adopting harmful lifestyles.
PRIMARY PREVENTION
“Primary prevention can be defined as the action taken prior to the onset of disease, which removes the possibility that the disease will ever occur.”
Intervention is in the pre- pathogenesis phase of a disease or health problem.
The WHO has recommended the following approaches for the primary prevention of chronic diseases where the risk factors are established: –
A) Population (mass) strategy
B) High -risk strategy
SECONDARY PREVENTION
Definition
“ An Action which halts the progress of a disease at its incipient stage and prevents complications.”
Modes of intervention – Early Diagnosis and Specific treatment
The health programmes initiated by governments are usually at the level of secondary prevention.
Advantages:
Important in reducing the high mortality and morbidity of certain diseases like hypertension, cancer cervix and breast cancer.
Disadvantages:
More expensive and less effective than primary prevention.
Patient is already subjected to mental anguish, physical pain;
TERTIARY PREVENTION
It is defined as “all the measures available to reduce or limit impairments and disabilities, and to promote the patients adjustment to irremediable conditions”.
It is the intervention in the late pathogenesis phase.
Treatment, even in late stages of disease, may prevent sequelae and limit disability.
Modes of Intervention - Disability limitation and Rehabilitation.
MODES OF INTERVENTION
“Intervention” can be defined as any attempt to intervene or interrupt the usual sequence in the development of disease in man.
5 modes of intervention
1. Health promotion
2. Specific protection
3. Early Diagnosis and treatment
4. Disability limitation
5.Rehabilitation
CONCLUSION
To initiate preventive measures it is not necessary to know everything about natural history of the disease.
Main objective of preventive medicine - to intercept or oppose the “cause” and thereby the disease process
Oral health promotion is a comprehensive approach to enhancing the oral health of
families, communities and populations which both
complements and challenges the approach on which formal
health care systems are based.
Evidence for Public Health Decision MakingVineetha K
The presentation gives an overview of evidence based public health with emphasis on the seven steps of EBPH Framework. It also includes the data sources to search for evidence and relevant articles explaining the current trend in decision making. One of the sources of the presentation is from EBPH training series by Rocky Mountain foundation. The link is provided in the end slide. Do contact me if you need any help with the resources.
Presentación en la que Gina Perigo hace una brillante exposición de como los Enfermeros de Práctica Avanzada y más concretamente los Nurse Practitioners pueden jugar un papel fundamental a la hora de potenciar y generar un cambio en los comportamientos en la población de salud que contribuyen al mantenimiento del estado de salud de la población y de la comunidad
Day 1: Challenges and opportunities for better detection, diagnosis and clini...KTN
The focus of this session is to explore how the UK health system is currently responding to the increasing number of patients with multiple long-term conditions and the impacts of healthcare inequalities on patient outcomes. We will also explore opportunities for businesses to bring about much needed innovations in the prevention, early diagnosis and management of multi-morbidity.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. 2
Contents
• Introduction
• Public Health Approaches to prevention
• Strategy Approaches
• Prevention for individuals
• Prevention for population
• Public Health measures to reduce dental caries
• Public Health measures to reduce periodontal diseases
• Public health approaches for oral cancer prevention
• Public health agenda to prevent Traumatic Dental Injuries (TDIs)
• Criteria for developing oral health strategies (WHO)
• Case-studies: public health action to promote oral health
• References
• Conclusions
3. 3
Public Health Approach – primary role is in control and prevention of disease in populations or
groups of individuals, some activities (e.g., diagnosing cases associated with outbreaks and treating
persons with communicable diseases such as tuberculosis or syphilis) may overlap with those in clinical
medicine.
Introduction
4. 4
Criteria For Prioritizing Health Problems
Size of problem
Seriousness of problem
Availability of current interventions
Economic or social impact
Public health concern
Political will to address issue
Availability of resources
Disease of international interest
Equity
• Prevalence of the condition.
• Impact of the condition on the
individual level.
• Impact on wider society.
• Condition is preventable and
effective treatments are available
Source: https://www.cdc.gov/globalhealth/healthprotection/fetp/training_modules/4/prioritize-problems_fg_final_09262013.pdf
5. 5
• Oral diseases are preventable but remain widespread due
to external factors beyond the control of healthcare
providers.
• The increasing prevalence of oral diseases in many low-
and middle-income countries is linked to broader social,
economic, and commercial changes.
• The United Nations Declaration (UN 2011) on Prevention
and Control of Noncommunicable Disease urges
governments worldwide to take significant and sustained
action to address the growing burden of
noncommunicable diseases, including oral diseases.
• Integrated and cross-sectoral approaches to combatting
noncommunicable diseases are recommended, given the
shared risk factors for oral diseases and other major
Why oral diseases are public health problem?
11. 11
Evidence base for preventive
interventions for oral disease
An evidence loop for the prevention of oral diseases.
12. 12
Principles of strategy design
• To prevent oral diseases, a strategic plan must be developed that addresses the underlying
determinants
• This plan should consider basic principles, various prevention approaches, and the advantages and
disadvantages of each.
• It should also include population and individual screening, as well as strategies to address major oral
health problems.
• A comprehensive and strategic approach is necessary to effectively prevent oral diseases, taking into
account various factors and prevention methods.
13. 13
Identifying the
problem
• What is the problem
that is to be
addressed? Is it, for
example, such as
caries in pre-school
children or early
identification of oral
cancer.
Understanding the
problem
• Understanding the
natural history,
epidemiology, and
impact of the
disease on the
population is also
important
Understanding the
possible solutions
• To explore potential
solutions, including
effective
interventions,
means of delivery,
and necessary
resources.
Understanding the
evaluation phase
• Evaluating the
success of the
strategy should be
built into the
process, including
ongoing monitoring
and incorporating
lessons learned into
future design. The
planning cycle
should be a
continuous process,
with constant
reassessment of the
problem and the
effectiveness of the
strategy.
14. 14
Risk
• Before implementing preventive
measures, it's important to assess the risk
of the disease occurring.
• For instance, smallpox vaccination
programs were discontinued after the
disease was eradicated.
• However, for most conditions,
determining the level of risk is more
complex.
• Prevention strategies aim to reduce risk
by modifying disease determinants (Burt
2005), and the impact of these
determinants on disease occurrence rates
affects the approach taken to prevent the
15. 15
Strategy approaches (Rose 2008)
Strategy Approaches
Whole –Population
approach
Risk Approach
Directed or Targeted
approach
High Risk approach
16. 16
The whole-population approach
• A whole-population approach is justified when the consequences of not intervening to prevent a condition
in even one person are severe.
• However, sometimes there may not be enough resources to provide the intervention to the whole
population, which can lead to hard decisions.
• Examples of a whole-population approach include water fluoridation, seatbelt legislation, and smoke-free
environments.
• The whole-population approach is based on the idea that
everyone in a population has some degree of risk for a
particular disease, and reducing the overall disease burden
requires altering the determinants of disease for the entire
population.
• This approach is favored by Rose, who argues that risk
factors affect all members of society and that it is more
effective to work with the entire population rather than just
a high-risk subgroup.
18. 18
The risk approach
The targeted-population approach
• The targeted-population approach is a public health approach to addressing dental caries in specific groups
that are at higher risk of the disease.
• This approach involves implementing interventions that address the specific needs of the targeted group,
such as clinical, environmental, or skill-based interventions.
• It is particularly useful when resources are limited or when a group is disproportionately affected by a health
issue.
• This approach is also known as proportionate universalism and seeks to reduce health inequities.
• Examples of targeted-population approaches for dental caries include introducing fluoride varnish schemes
in schools or refurbishing housing to improve the environment.
19. 19
The high-risk approach
• The high-risk approach involves targeting specific individuals through
screening programs rather than the whole population.
• It is only beneficial if those at greatest risk of developing a condition
can be identified and there is an effective way of preventing it.
• The approach may miss some individuals who will still contract the
condition, and the specificity and sensitivity of the screening test must
be at an acceptable level.
• Examples include requiring dental students to demonstrate their
hepatitis status before entering the course, and providing intensive
dental prevention programs to individuals who have received
irradiation of their salivary glands.
21. 21
Principles of screening
Types of Screening
(Holland and Stewart- 1990)
screening for individuals with
risk factors that predispose to
disease but are not
themselves alerting
symptoms;
screening for individuals with
early signs of disease;
screening for individuals for
which preventive action could
be taken to restore health;
screening for established
disease that could be
alleviated by continuous care
and surveillance.
Ten principles of screening (Wilson and Jounger- 1968)
The condition should be an important health problem.
There should be an accepted treatment for patients with recognized disease.
Facilities for diagnosis and treatment should be available.
There should be a recognizable latent or early symptomatic stage.
There should be a suitable test or examination.
The test should be acceptable to the population.
The natural history of the disease, including its development from latent to declared
disease, should be adequately understood.
There should be an agreed policy on whom to treat as patients.
The cost of case-fi nding (including diagnosis and treatment of patients diagnosed)
should be economically balanced in relation to possible expenditure on medical care
as a whole.
Case finding should be a continuous process and not a ‘once and for all’ project.
22. 22
Prevention for individuals
• Preventive dentistry techniques like sealants and fluoride can prevent dental issues in individuals, but
barriers like accessibility and cost can create health disparities.
• These techniques do not address the root cause of dental problems, and their effectiveness should
be evaluated for accessibility, acceptability, and affordability.
• Monitoring and evaluation are crucial to ensuring their continued benefits. A common risk-factor
approach can help reduce health inequalities.
• Past disease experience is the most reliable predictor for caries prevention. Evaluate effectiveness,
accessibility, acceptability, and affordability before selecting a technique.
23. 23
Prevention for populations
• Population prevention focuses on addressing the determinants of health to create better health
conditions without relying on individual compliance.
• The common risk-factor approach targets multiple diseases and is more resource-efficient.
• Tobacco control is a successful example, using public health strategies like regulation and
education.
• Evaluation can be challenging but can measure participation or changes in sales. Population
prevention is more effective and creates long-lasting improvements in public health.
24. 24
Other classifications of prevention:
• It is important to note that the primary, secondary, and tertiary classification of prevention is now
considered outdated and has been replaced by newer methods that focus more on the determinants
of health and population-based approaches.
• However, this classification is limited in that it concentrates more on the disease process and the
individual rather than the risk factors and the population. It is also difficult to distinguish when one
type of prevention ends and the next begins.
The primary level of prevention aims to prevent the onset of a disease.
Secondary level aims to detect and treat the disease at an early stage.
Tertiary prevention focuses on restoring form and function and arresting the
progression of the disease.
25. 25
Public Health measures to Reduce Dental Caries
Community water fluoridation is an effective measure to prevent
dental caries, as per the World Health Organization.
School-based programs can improve children's oral health by
providing preventive services and educating them about oral
hygiene and healthy eating.
Sugar taxation has been implemented in some countries to reduce
sugar consumption and prevent dental caries.
Health education campaigns can raise awareness about the
importance of good oral hygiene, healthy eating habits, and regular
dental check-ups, and have been shown to reduce dental caries in
high-risk populations.
27. 27
Areas Cause Health promoting school
Dental caries/periodontal disease Sugary diet, lack of oral hygiene
•No sugar
•A ban on sugary foods and drinks
on the school premises
•Policy developmenThe role of
school in supporting local health
issues, for example, water
fluoridation
•Oral health education
•Oral health education should form
part of all subjects in the school
curriculum
•Daily supervised tooth brushing
drills
•Training for parents about good oral
health and encouragement for them
to take part in health promotion
activities at school
•Training for school staff
Public Health Measures on School Oral Screening
28. 28
Areas Cause Health promoting school
Trauma
Sports injury, violence/fights and
unsafe playgrounds
Healthy school environment
Safe and well‐designed school
buildings and playgrounds to
prevent injuries and avoid “sick
building syndrome”
A caring and respectful psychosocial
environment
A protocol for dealing with bullying
and violent behavior, as well as
interpersonal conflicts
Oral injury
Accident prevention
Clear protocol of vital actions to be
taken without delay
Monitoring incidence of oral trauma
A protocol on safe sport, for
example, use of mouth guards
29. 29
Areas Cause Health promoting school
General and oral health
Lack of knowledge, habits, social
environment
•Oral health service
•Working closely with central or
local oral health service providers
•Dealing with dental emergencies
•Role of teachers in oral health
surveillance, screening and basic
treatment, for example, ART
•Monitoring of oral health‐related
complaints and absenteeism.
•Training for school staff
•Physical exercise
•Commitment to provide safe
facilities for training in sport and
leisure activities
•Exercise and physical education are
a compulsory part of the school
curriculum
30. 30
Public Health measures to Reduce Periodontal Diseases
Integrate oral hygiene into body cleanliness education at
nurseries and schools.
Incorporate the importance and skills of oral hygiene into
training of health, education, and social care professionals.
Use fiscal policy to reduce costs of oral hygiene aids and
toothpaste: remove VAT at national level and/or sell products at
cost price within NHS premises.
Organizational policy: ensure oral hygiene is placed on health-
promoting schools’ agendas— structural change within schools
regarding provision and design of toilet facilities.
Comprehensive public health strategies to reduce smoking,
especially amongst low-income groups.
32. 32
Public health approaches to oral cancer prevention:
• Developing a public health strategy is essential in
significantly reducing oral cancer incidence.
• The strategy should focus on:
• understanding the determinants of oral
cancer,
• targeting high-risk groups and addressing
health inequalities,
• utilizing a common risk-factor approach,
• working in partnerships with different sectors
and agencies,
• engaging with the community, and
• using a range of complementary health
promotion approaches.
34. 34
Public health agenda to prevent traumatic Dental
Injuries (TDIs)
• To prevent traumatic dental injuries (TDIs) caused by
falls, collisions, traffic accidents, and violence, a public
health approach is essential.
• Applying the Ottawa Charter principles and improving
physical and social environments, such as implementing
safety policies in schools and addressing bullying and
violence, are important steps in TDI prevention.
• A collaborative multi-agency strategy that addresses
the links between violence and alcohol, involving police,
healthcare staff, local authorities, and the judiciary, can
also reduce TDI incidence.
35. 35
Criteria for developing oral health strategies (WHO)
• oral health strategies should enable individuals and
communities to assume more power over the personal,
socioeconomic and environmental factors that affect their oral
health.
Empowering
• oral health professionals should encourage the active
involvement of key stakeholders in the planning,
implementation and evaluation of oral health strategies.
Participatory
• oral health initiatives should foster physical, mental and social
health, and focus upon the common risks and conditions that
influence both general and oral health.
Holistic
• Oral health professionals should collaborate with the relevant
agencies and sectors to place oral health upon a wider agenda
for change.
Intersectoral
• Oral health policies should be guided by a concern for equity
and social justice and should ensure that inequalities in oral
health are addressed where possible.
Equity
36. 36
• Oral health interventions should be developed on the
basis of existing knowledge of effectiveness and good
practice.
Evidence base
• Oral health policies should bring about changes that
individuals and communities can maintain and sustain
once initial funding has ended.
Sustainable
• Oral health strategies should use a combination of
approaches, including policy development,
organizational change, community development,
legislation, advocacy, education and communication to
promote improvement in oral health.
Multi-strategy
• Sufficient resources and appropriate methods should
be directed towards the evaluation and monitoring of
oral health strategies. Both process and outcome
evaluation measures should be used.
Evaluation
37. 37
Case-studies: public health action to promote oral
health
Reorientation of services — smoking
in clinical dental settings
• Tobacco use adversely affects general and oral
health, and is a significant global public
health problem.
• Dentists and their teams are ideally placed to
provide advice on smoking cessation, to offer
support to smokers and to become actively
involved in broader tobacco control policies.
• For many years, in several countries, smoking
cessation initiatives have been developed for
use in dental practices.
• A range of barriers have however hindered
major progress in this important area of
prevention.
Healthy public policy — Oral Health
Victoria, Australia
• Vic Health in Australia has developed a wide
range of innovative and progressive public
health programmes.
• Their Oral Health Strategy has adopted many
elements of the Ottawa Charter and was
developed on the basis of a thorough review
of the evidence base .
• The strategy outlines detailed examples of a
range of oral health policies, together with
clear guidance on the roles and
responsibilities of different partners.
Source: Watt RG. Strategies and approaches in oral disease prevention and health promotion. Bulletin of the World Health Organization.
2005;83:711-8.
38. 38
Personal skills — participatory schools
programme in Scotland
• Scottish children have one of the highest
levels of caries experience in Europe.
• To address this problem a randomized
controlled trial was undertaken to assess
the efficacy of supervised toothbrushing in
schools.
• The innovative element of the programme
was the delivery of the intervention by local
mothers who volunteered to supervise
toothbrushing.
• A significant mean reduction in caries
increment was found in the test groups
when compared with the controls.
Community action — empowering local
people in Chiang Mai, Thailand
• The national Thai Health Promotion
Foundation has supported and encouraged
a variety of community initiatives to
empower the community and foster
participation in health programmes.
• In Chiang Mai, in the north of Thailand,
rural oral health outreach programmes
have been established in which the local
community is actively engaged in efforts to
promote better oral health .
• The dental faculty in Chiang Mai is also
developing the concept of a health
promoting dental school.
• One of the aims of this programme is for
dental students to engage with the wider
39. 39
Supportive environments — health promoting schools in Curitiba,
• The WHO Health Promoting Schools Initiative has encouraged the
development of holistic action to improve the physical and social
environment, curriculum and ethos in schools.
• A health promoting school can be characterized as a school that is
constantly strengthening its capacity as a healthy setting for living,
learning and working.
• In the city of Curitiba in southern Brazil, the local government has
developed a range of healthy public policies including a health promoting
schools network.
• A detailed evaluation of the impact of this approach on oral health
revealed positive effects on levels of dental caries and orofacial trauma
among the children attending schools with supportive policies.
40. 40
Source: Watt RG. Strategies and approaches in oral disease prevention and health promotion. Bulletin of the World Health Organization.
2005;83:711-8.
41. 41
Source: Watt RG. Strategies and approaches in oral disease prevention and health promotion. Bulletin of the World Health Organization.
2005;83:711-8.
42. 42
Policy
FDI World Dental Federation supports the view that:
• General populations, healthcare providers, policy and
decision makers, and other stakeholders should be
educated towards the understanding that oral health is
an integral part of general health.
• Members of health professions, governments,
intergovernmental, nongovernmental organizations,
and the media, among others, need to promote the
understanding that most oral diseases can be
prevented.
• Inter-professional collaboration between stakeholders
needs to adopt relevant and practical oral health
approaches that are integrated into the prevention of
other chronic noncommunicable diseases.
• Undergraduate training should emphasize prevention
rather focusing on curative models.
• National health policies and programmes should be
aimed towards preventing oral diseases and promoting
and maintaining oral health.
43. 43
Conclusion
• Effective prevention of oral diseases requires a comprehensive public health approach that focuses on the
underlying social, economic, and political determinants of oral health.
• Such an approach should target high-risk groups, work in partnerships across sectors and agencies, and
involve the local community.
• Clinical prevention and health education should be complemented by legislative and environmental
interventions. It is important to address inequalities in oral health to prevent further disparities.
• A common risk-factor approach is more likely to be effective in achieving significant oral health gains,
both in developed and developing countries.
• The implementation of public health strategies requires collaboration and appropriate training of oral
health personnel.
44. 44
References
1. Daly B, Batchelor P, Treasure E, Watt R. Essential dental public health. Oxford university press; 2013 May 23.
2. Rose, G. (2008). Rose’s strategy of preventive medicine . Oxford, Oxford University Press.
3. Birch S, Bridgman C, Brocklehurst P, Ellwood R, Gomez J, Helgeson M, Ismail A, Macey R, Mariotti A,
Twetman S, Preshaw PM. Prevention in practice–a summary. BMC Oral Health. 2015 Dec;15(1):1-9.
4. Burt, B. (2005). Concepts of risk in dental public health. Community Dentistry and Oral Epidemiology , 33 ,
240–7.
5. Hausen, H. (2008). Caries prediction. In Dental caries—the disease and its clinical management , 2nd edition
(eds O. Fejerskov and E. Kidd), pp. 527–42. Munksgaard, Blackwell.
6. Marmot, M. (2010). Fair society, healthy lives: strategic review of health inequalities in England post-2010 .
London, Marmot Review.
7. Watt RG. Strategies and approaches in oral disease prevention and health promotion. Bulletin of the World
Health Organization. 2005;83:711-8
8. WHO (World Health Organization) (2003). WHO Framework Convention on Tobacco Control . Geneva,
What is going wrong? Why have oral diseases not been eradicated?
A coordinated approach towards common risk factors can lead to a rational and collaborative strategy for promoting oral health and preventing chronic diseases.
Therefore using the Common Risk Factor Approach (CRFA) will become mainstream for all health sectors and dentists must be involved in applying that approach by incorporating programmes for promotion of oral health and prevention of oral diseases into programmes for the integrated prevention and treatment of chronic diseases such as heart diseases, cancers, hypertension and diabetes.
A common risk factor approach can be applied to address the shared risk factors for various chronic diseases, including oral health.
This approach considers social, environmental, and political factors that influence both oral and general health.
By focusing on common risk factors such as diet, hygiene, smoking, alcohol use, stress, and trauma, improvements can be achieved more efficiently and effectively for a range of chronic conditions.
Oral health promoters can work with people in general health promotion to place oral health matters on the wider health promotion agenda.
The bidirectional relationship between oral health and diet and nutrition should also be considered, and the consumption of sugars should be reduced to prevent dental caries.
Oral diseases and inequalities in oral health are influenced by social determinants such as social, economic, environmental, and political factors. Modern dentistry has been limited by a narrow approach focused on biological, behavioral, and clinical factors. The International Association for Dental Research advocates for a broader social determinants approach in dental research. Improving oral health and reducing inequalities requires action on social determinants, as shown in the complex interrelationships between structural and intermediary determinants on oral health outcomes.
a summary of the impact of oral conditions on
the individual and society. Finally, it is important to
consider the potential for prevention and treatment of
the disease.
The conceptual model illustrated identifies three discrete yet closely interrelated stages or levels of determinants: upstream, midstream,and downstream [7].
Upstream level factors: The framework identifies social, physical, economic and environmental factors as being the most fundamental determinants of oral health. These include a range of interrelated factors such as education, employment, occupation, working conditions, income, housing, and area of residence. The framework also indicates that these fundamental determinants are themselves influenced by even more upstream factors, namely, government policies, globalisation, and culture.
Midstream level factors: Social, physical, economic and environmental contexts throughout life influence health either indirectly via psychosocial processes and dental health behaviours, or more directly, for examplevia injuries. The dental care system also plays some part in determining oral health within a society. However, it plays only a modest and moderating role.
Downstream level factors: Ultimately, oral diseases are a consequence of adverse biological reactions to changes or disruptions in various physiological systems. The poorer health profile of some patients or population subgroups is due in part to longer-term adverse physiological and biological changes that are brought about by poorer psychosocial health and more harmful dental health behaviours.
The concept
The dominant preventive model adopted by dental
professionals across the world remains an individually
focused approach that utilizes a combination of clinical
preventive measures and behaviour change techniques.
As outlined in Discussion Points 2, evidence of
the effectiveness of this downstream approach in
reducing oral health inequalities is very limited. An
urgent need exists for the adoption of an upstream
approach that utilizes a broader range of public health
measures to tackle the underlying determinants of oral
diseases (Watt 2007 , 2012 ).
Preventive programs should be based on conceptual
and empirical evidence of the determinants of variation
in oral disease among patients or population groups in
order to identify more points of intervention in the prevention
of oral disease.
Integrated models are emerging that address the continuum
of opportunities for prevention, In such models people are distributed
across different target groups: the well population,
those at risk, those diagnosed with disease, and those
with controlled disease. Interventions are specific to these
stages and have different objectives, such as preventing
movement into the at-risk group, preventing progression
to established disease, or averting recurrence of disease
and loss of oral function. In such as approach to prevention,
the evidence-base on different interventions is a
key component of the support systems.
The evidence-based approach to prevention begins
with the identification and definition of an oral health
problem for which an objective for oral health gain can be
stated. Related evidence on the efficacy of interventions is
synthesized and assessed, after which an intervention
plan is decided upon and implemented. Finally, the oral
health outcomes among patients or populations are monitored
and the whole process reassessed over time. These
fundamental components might be expanded into a more
detailed evidence loop for the prevention of oral diseases,
as presented in figure 1. Each aspect of this evidence loop
for the prevention of oral diseases is necessary for sound
decisions on either an individual or population level. Following
the various stages ensures that resources are not
used to address less important problems or alter less significant
determinants, and that preventive interventions
are not maintained beyond their useful life should the
burden of disease alter. The loop also recognizes that
some interventions might work less satisfactorily in different
contexts.
The existence of a strategy implies that there is an organized plan to reach a goal. In this sense, designing preventive strategies is similar to other health care planning. The same essential elements must be present ( Box 4.1 ). It is important to have a clear vision of what you are trying to achieve and how it is planned to get there, otherwise it is unlikely that the goal will ever be realized. The fi rst stage is to identify the aim of the project. What is to be achieved? The second stage is to identify the objectives of the project. What are the various steps that will eventually mean that the aim is reached? To formulate the aims and objectives of a programme it is necessary to collect data to provide information. Asking a series of questions can facilitate this. These data will include the following.
Rose ( 2008 ) presented four possible relationships between exposure to a cause and the associated risk of disease ( Figure 4.2 ), each of which will need different approaches to prevention. Example (b) shows the relationship between cigarette smoking and lung cancer. In this situation any reduction in exposure is likely to be accompanied by a reduction in disease. Choosing an approach that reaches the whole population is appropriate. Example (c) shows a scenario where signifi cant risk is likely to occur mainly at greater levels of exposure, and an approach that reaches only those at high risk may be preferable. Example (a) is a case where there is no increase in risk until a particular level is reached, while example (d) shows increasing risk at both ends of the spectrum, illustrating a case where it may be desirable to move people towards a middle point. The concept of risk and how much risk is ac - ceptable is of major importance in deciding which approach to take. There is rarely no risk, so in altering determinants to health it is only possible to reduce the risk.
Rose ( 2008 ) divides strategy approaches into two distinct groups: those aimed at the whole population and those in which certain sections of the population are identifi ed, either as a group or as individuals. The fi rst approach is known as the whole-population approach, and the second as the risk approach. The risk approach has two subdivisions. Where population subgroups are identifi ed, it is known as the directed or targeted approach, and where individuals are identifi ed, it is known as the high-risk approach.
If a disease is normally distributed in the population, then everyone has some disease risk. Assuming that the decision is made to try to reduce the overall disease burden, the choice is between trying to reduce everybody’s exposure to the agents that are responsible for the disease and selecting a subgroup of the population at the right-hand end of the distribution, those at highest risk. Rose is strongly in favour of the whole-population approach in this case. He considers that risk factors affect all who live in society and it is therefore more effective to work with the whole population ( Figure 4.3 ). Rose posed the fundamental question: does a small increase in risk in a large number of individuals generate more cases than a large increase in risk in a few individuals? Another justifi cation of the whole-population ap - proach is when the results of not intervening to prevent a condition in even one person are very severe. The outcome in that person may be devastating or the costs to society of not treating that condition may be very great. One often-quoted problem ( Box 4.2 ) is that sometimes, although it is known that the whole population would benefi t, there just may not be enough money or personnel to provide the intervention. This is more usually a problem with clinically based interventions than with environmental change programmes. It then means that hard decisions have to be made. Batchelor and Sheiham ( 2006 ) have argued that more dental caries will be prevented by concentrating on a wholepopulation approach, as more caries will occur in those with low levels of disease.
Examples of a whole-population approach
Water fl uoridation is an excellent example. Dental caries is a disease that affects most people and the strategy is to alter the environment by adjusting the level of fl uoride in the water supply. The advantages are that everyone on the centralized water supply receives the intervention, so that compliance is not a problem. Other examples include seatbelt legislation, where all car passengers are required to wear seatbelts, and smoke-free environments.
The risk approach
The targeted-population approach
This works on the principle that some groups of the population are at greater risk compared with the whole population. A variety of interventions can be used: it may be a clinical intervention, more of an environmental approach, or the developing of community and individual skills. It is important to note that this approach means that not all people who are at risk of the disease will be included within the target group. It may be a useful approach particularly where resources are limited or where one group is clearly more disadvantaged than another. With the emphasis on reducing inequities in health, this approach is more in favour and is termed proportionate universalism (Marmot 2010 ). It differs from the high-risk approach in that not every person within the targeted group is at higher risk but as a whole the group is. With the high-risk approach every person targeted is at increased risk.
Examples of a targeted-population approach
Identifying a section of the population as being at greater risk of dental caries may lead to the decision to provide a targeted-population approach. An example of this might be a small geographical area that has been found to have much higher levels of dental decay. The schools are identifi ed and a decision is made to introduce a fl uoride varnish scheme. In Cardiff, a targeted-population approach was used to try to improve the health of people living in an area called Riverside. All the housing in this area was beingrefurbished, and it was hoped that by upgrading the environment of this targeted population, its overall health would also improve.
The high-risk approach is used when the treatment of only those at greatest risk is considered most appropriate. Rather than using the whole population or part of it, only specifi c individuals are identifi ed by a screening programme. As Figure 4.4 illustrates, it involves cutting off the tail of the curve. Before deciding that a high-risk approach is what is required, consider the advantages and disadvantages ( Box 4.3 ). It is only of benefi t if it can identify those in the population who are at most risk of developing a condition and if there is an effective way of preventing that condition (Burt 2005 ). It will inevitably miss some people who will contract the condition of interest. By defi nition, ‘high risk’ omits those who are at ‘low risk’, but ‘low risk’ does not mean ‘no risk’ (Batchelor and Sheiham 2006 ; Tickle and Milson 2008 ). This may or may not be acceptable to either decision-makers or the public. If a screening test is used then the specifi city and sensitivity must be of an acceptable level; these terms are defi ned in Principles of screening , but to summarize: high values of these ensure that people with a high risk will be identifi ed and those without will not. Examples of a high-risk approach Dental students are required to demonstrate their hepatitis status before entering the dental course. There are two reasons for this: fi rst, to ensure the public’s safety by not letting infected people undertake invasive procedures, and second, to enable an effective immunization to be administered as part of the strategy to stop the dental students contracting a potentially fatal illness. In the UK this high-risk approach is satisfactory, only immunizing those who are most at risk (by virtue of their occupation). In other countries where the disease is endemic a whole-population approach is more likely to be appropriate. Another condition where a high-risk approach is taken is in suggesting to all women who have lost a close relative to breast cancer before the age of 50 that they have regular mammograms. Mammograms have not been shown to be effective in the whole population in this age group, but it is of use in those with a higher risk of contracting the disease. They are limited to women over the age of 50 where effectiveness has been shown. Finally, in people who have received irradiation of their salivary glands it is highly appropriate to provide a very intensive programme of clinical prevention because of their known greatly increased risk of developing dental caries.
In dentistry there are several clinically effective preventive techniques available, for example fi ssure sealants and professionally applied fl uorides. Where do these techniques fi t into a preventive strategy? It is important to understand that individual prevention is really another form of treatment. As such it has many of the problems associated with traditional operative care. The preventive techniques may be aimed at a specifi c subgroup of the population, but if those people have problems accessing dental care or they experience other barriers to dentistry, then it is unlikely that they will be able to receive these preventive techniques. Individually based prevention requires compliance. Unless alternative methods of delivery are used it is highly probable that the desired level of uptake will not be achieved. The inverse care law can be as applicable to preventive care as to treatment. Offering preventive care without a strategy may even increase health inequalities because it can often be those who least need the prevention who take it up. All the limitations of the medical model approach also apply to prevention for an individual. A good example of this is caries prevention. Despite the hype and extensive commercial investment in caries diagnostic predictors, the best predictor of future caries remains past disease experience (Burt 2005 ; Hausen 2008 ). Over the years, attempts have been made to use fl uoride programmes in schools with varying amounts of success. Above all else, the use of individual methods of prevention does not use the common risk-factor approach and does little to alter the determinants of disease, which are, after all, the factors that caused the problems. It also is important that any individual method is subject to evaluation and monitoring. It may be that the problem fl uoride was introduced to solve no longer exists or is being prevented in an alternative way. A good example of this was a school fl uoride mouth-rinsing programme in the USA. Over time, the prevalence of dental caries in the population dropped, the cost–benefi t of using a mouth-rinse became much smaller, and the total benefi t to the population was greatly reduced. It was thus decided that the most sensible course of action would be to cease the programme. However, this proved much more diffi cult than had been anticipated (Disney et al . 1990 ). Before selecting a preventive technique it is important to examine it in the same way as one would a treatment option. A series of questions need to be asked. Is the technique effective? Is it accessible to the desired target population? Is it acceptable to those people? Is it affordable to whoever is responsible for paying? Preventive techniques should also be clinically effective.
Prevention for populations
Population prevention can adopt many different approaches and options. However, excluding those activities that are really individual methods, for example immunization, the preventive techniques that are most useful are those that focus on the determinants of health. By following the principles of the OttawaCharter (see Chapter 8 ), it is possible to bring about change in the environment to create better conditions for good health that does not require action by individuals to ensure compliance and success. In Chapters 1 and 8 the common risk-factor approach to disease is outlined. By working across several diseases using the common risk-factor approach, it is likely that this will have more success than other approaches that are limited to one disease. It also makes better use of the limited resources that are available and thus better economic sense. Tobacco control is an excellent example: the use of multiple public health strategies has led to a fall in the rates of smoking in many countries around the world. Clearly, the most relevant factor is the ensuing drop in the rates of lung cancer, but this reduction in smoking may also be implicated in the lower levels of periodontal disease that are now recorded. What are these multiple public health approaches? The World Health Organization has coordinated global action on tobacco through the Framework Convention on Tobacco Control (FCTC) (WHO 2003 ). This global public health strategy adopted a radical approach which aimed to tackle both the supply and demand for tobacco through a range of complementary actions including: regulation of ● smoking in work and public places ● contents, packaging, and labelling of tobacco products ● prohibition of sales to and by young people ● illicit trade in tobacco products reduction in consumer demand by ● price and tax measures ● comprehensive ban on tobacco advertising, promotion, and sponsorship ● education, training, raising public awareness, and assistance with quitting smoking. More than 170 countries have now adopted the FCTC, which has helped to create a social environment in many parts of the world where tobacco use is no longer seen as a socially acceptable or desirable behaviour. The legislative and policy framework has created smoke-free living and working conditions for many millions of people—a remarkable public health success story. It is important to realize that these results are not instant. It may take many years to bring about dramatic changes in the smoking rates of the population. However, there is evidence that rates of smoking and rates of smoking-related cancers are declining in many developed countries. The evaluation of population-based prevention is particularly diffi cult to undertake, especially measuring its success by examining changing patterns of disease. However, other types of evaluation are easier. The success of the process can be examined, investigating how many people participated in a screening programme or what has happened to cigarette sales following a health education campaign.
Community water fluoridation: Fluoride is a naturally occurring mineral that has been shown to prevent tooth decay. Adding fluoride to community water supplies is a cost-effective public health measure that benefits everyone who drinks the water, regardless of their age, income, or education level. According to the World Health Organization, community water fluoridation is one of the most effective ways to reduce dental caries [1].
School-based programs: School-based programs can educate children about proper oral hygiene and healthy eating habits, provide dental screenings, and offer preventive services such as fluoride treatments and dental sealants. These programs have been shown to improve children's oral health and reduce dental caries [2].
Sugar taxation: Sugar taxation has been proposed as a public health measure to reduce sugar consumption and prevent dental caries. Taxing sugar-sweetened beverages has been implemented in several countries, including Mexico, France, and the United Kingdom, and has been associated with reduced consumption of sugary drinks and improved oral health outcomes [3].
Health education: Health education campaigns can raise awareness about the importance of good oral hygiene, healthy eating habits, and regular dental check-ups. Health education programs have been shown to improve knowledge and attitudes about oral health and reduce dental caries in high-risk populations [4].
Personal and social education aimed at developing life skills—Pupils and students can be accessed during their formative years, from childhood to adolescence. Students develop lifelong oral health‐related behavior, as well as beliefs and attitudes are being developed.
Schools can provide a supportive environment for promoting oral health. Access to safe water, for example, may allow for general and oral hygiene programs. Also, provision of mouth guards—accessible and affordable sports protection, a safe physical environment and school policy on bullying and violence between students reduce the risk of dental trauma.
The burden of oral disease in children is significant. Most established oral diseases are irreversible, will last for a lifetime and have an impact on quality of life and general health.
School policies on control of risk behaviors, such as intake of sugary foods and drinks, tobacco use and alcohol consumption.
Schools can provide a platform for the provision of oral health care, that is, preventive and curative services [14–18].
Common risk factor approach‐based oral health promotion policies in schools can lead to improvement in oral health and reduce oral health inequality [10, 16].
Public health approach
Due to the recognized limitations of current treatment modalities and the diffi culty of introducing a comprehensive screening programme, the only means of signifi cantly reducing the incidence of oral cancer is through the development of a public health strategy that tackles the underlying causes of the condition. In line with the principles of health promotion outlined in Chapter 8 , a public health strategy to reduce oral cancer should be based upon the following principles: ● An understanding of the underlying social , economic , and political determinants of oral cancer; that is, the broad range of factors infl uencing tobacco and alcohol use and the barriers to increasing fruit and vegetable consumption. ● A directed population approach that targets action at high-risk groups and addresses health inequalities. (A high-risk approach alone is not applicable due to the limitations of current screening methods.) ● It should be based upon a common risk-factor approach in which dental health professionals collaborate with other health professionals to address common threats to oral and general health, for example, tobacco and alcohol. ● It recognizes the need to work in partnerships across sectors and agencies beyond health services. ● It should be based upon the need to work with community members , addressing their concerns and jointly tackling the underlying causes of the problem. ● It stresses the importance of utilizing a range of complementary health promotion approaches beyond a sole reliance on health education (see Box 14.3 ).