Preventive Dentistry

Contents
• Introduction
• History of Preventive Dentistry
• Objectives
• Levels of Prevention
• Dental Caries
• Periodontal Diseases
• Malocclusion
• Oral Cancer
• Role of public health dentist
• Future challenges
• Conclusion
Introduction
• Prevention is derived from the word “PRAEVENTO”
it means a forestalling = to act before hand
• PREVENTION= To keep from happening
• MAKE IMPOSSIBLE BY PRIOR ACTION
Definition
• Prevention is defined as “ actions taken prior to the
onset of disease, which removes the possibility that
a disease will ever occur.”
History of Preventive Dentistry
• 19th century: Majority - satisfied by home care
remedies
• 20th century: etiologic factors of most oro dental
disease were identified emergence of prevention
• In the first three decades
– Great emphasis was placed on oral hygiene
History of Preventive Dentistry
• In the fourth and fifth decade
– Anticarious effect of fluorides was
established
– Water fluoridation and topical fluoridation
started
• In the sixth and seventh decade
– Fluoride toothpastes, mouthwashes, rinses,
gels & varnishes became popular
– Pit and fissure sealants were also used
widely
Objectives of Prevention
• To avert initiation of disease process
• To intercept their progress
• To control their spread
• To limit their complications and after effects
• To provide rehabilitation
Scope of preventive dentistry
• Factors predisposing to disease
e.g. – Dental plaque & other deposits
• Factors encouraging the advancement of disease
e.g. – host resistance & TFO
• Complication of disease & deformity
e.g. – Loosening, Drifting of teeth
Scope of preventive dentistry
• Factors interfering with rehabilitation
e.g.- Defective restorative dentistry
• Factors causing recurrence of disease
e.g. - poor oral hygiene , lack of patient
motivation
Successful prevention
Levels of Prevention
1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention
Modes of Intervention (Preventive
services)
1. Health promotion
2. Specific protection
3. Early diagnosis & treatment
4. Disability limitation
5. Rehabilitation
Primordial Prevention
• Prevention of emergence or development of risk
factors in countries or population groups in which
they have not yet appeared
e.g. – efforts directed towards discouraging
children from adopting harmful life styles
• Here the main intervention is by individual and
mass education
Primary prevention
• Defined as “Action taken prior to onset of disease
which removes the possibility that a disease will
ever occur”
• Phase of intervention: PRE-PATHOGENESIS PHASE
• Specific causal factors (risk factors) are already
present
Modes of intervention for primary
prevention
W.H.O. approaches for primary prevention
of chronic diseases
Population (Mass) Strategy
• Directed at the whole population irrespective of
individual risk levels.
• Aims at socio-economic, behavioral and lifestyle
changes.
Eg.- A small reduction in the average blood
pressure of a population would produce a large
reduction in cardiovascular disease.
- Health education to improve oral hygiene
practices.
High –risk strategy
• Aims to bring preventive care to individuals at
special risk.
• Requires detection of individuals at high risk by the
optimum use of clinical methods.
• Eg: Topical fluoride application for those with high
risk.
Secondary prevention
• Defined as “Action which halts the progress of
disease in its incipient stage and prevent
complications.”
• PATHOGENESIS PHASE
• Health programmes - Initiated by government are
at this level.
Modes of intervention for secondary
prevention
Tertiary prevention
• Defined as “All measures available to reduce or
limit impairments and disabilities, minimize
suffering caused by existing departures from good
health to promote patients adjustment to
irremediable conditions”.
• LATE PATHOGENESIS PHASE
Modes of intervention for tertiary
prevention
Health promotion
• Defined as a “process of enabling people to
increase control over and to improve health.”
• It involves “organizational , political , social and
economic interventions designed to facilitate
environment and behavioral adaptations that will
improve or protect health.”
Health education
• One of most cost-effective intervention.
• Adequate information about diseases an
encouraging people to take necessary precautions
in time.
• Target group for educational efforts include General
public, patients, high risk groups, community
leaders , decision makers , health providers.
Environmental modifications
• The history of medicine – many infectious diseases
have been successfully controlled in western
countries through this intervention.
• Non- clinical and do not involve the physician.
• Examples:
* Provision of safe drinking water
* Improvement of housing
* Control of insects and rodents
* Community water fluoridation
Nutritional interventions
Examples:
* Food distribution & nutrition improvement
of vulnerable groups
* Child feeding programmes
* Dietary counseling
Lifestyle and behavioural changes
• Examples: Motivating people to avoid smoking,
panchewing and drinking alcohol
Specific protection
• To avoid disease altogether is the ideal but this is
possible only in limited number of cases
Early diagnosis and prompt treatment

• In order to prevent overt disease or disablement ,

the criteria of diagnosis if possible be based on
early biochemical , morphological and functional
changes that precede the occurrence of manifest
signs and symptoms.
• The earlier a disease is diagnosed , the better it is
from the point of view of prognosis and preventing
the occurrence of further cases or any long term
disability.
eg: Oral cancer screening, hypertension, AIDS
Concept of disability
Rehabilitation
• Medical rehabilitation
Restoration of function – Prosthesis
Speech therapy
• Vocational rehabilitation
Restoration of capacity to earn livelihood
• Social rehabilitation
Restoration of family and social relationships
• Psychological rehabilitation
Restoration of personal dignity and confidence
 Prevention of malocclusion
Primary prevention Secondary Tertiary prevention
prevention
Health Specific Early diag Disability Rehabilit
promotion protection & prompt limitation ation
treatment
Indivl Periodic visits -Use of Use of dental Use of dental Use of
to dentist protective professional professional dental
device services services professional
-Habit control services

Comm -DHE -Mouth guard Provision of Provision of Provision of

Programme programmes dental dental dental
-Promotion of -Safety services services services
Protective measures for
coverings play
& protective
guards
Dent Patient Caries control; Minor Major Maxi-facial
prof education Periodontitis orthodontics orthodontics & Prostho
control; surgery Plastic
Space maintainers surgery
prenatal care parent
counseling
 Prevention of oral cancer
Primary prevention Secondary Tertiary prevention
prevention
Health Specific Early diag Disability Rehabilit
promotion protection & prompt limitation ation
treatment
Indivl Periodic visits -Avoidance of -Self - Use of dental Use of
to dentist known irritants examination & professional dental
referral; services professional
services

Comm -DHE -Mouth guard - Periodic Provision of Provision of

Programme programmes screening & dental dental
-Promotion of -Safety referral; services services
research efforts measures for
play

Dent Patient -Removal of known Complete Chemo- Maxi-facial

prof Education irritants in the oral examination ; therapy & Prostho
& motivation cavity -Biopsy; Radiation Plastic
-Oral cytology; Surgery surgery
-Complete
excision
Role of public health dentist in
prevention
• Identify and define the problem and risk groups
• Advocate and involve appropriate preventive
measures
• Evaluate the applied programme
Future challenges
• Socio-economic disparities in providing health care
• Reoccurrence of some communicable diseases,
which are successfully controlled past
• Prevention of chronic non-communicable diseases
• Population control
Conclusion
• In the developing country – more efforts on the
part of individual and government is needed to
bring the developments in preventive dentistry
within the reach of common man
• “Our objective should be the perpetual
preservation of what remaining rather than
meticulous restoration of what is missing”
THANK YOU!