Public Health Approaches To Prevention of Oral Diseases

PUBLIC HEALTH APPROACH TO
PREVENTION ORAL HEALTH

DISEASE 1
Group 7
Supervisor : Dr NorKhafizah Saddki
public health approach to prevention oral

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health disease
Topic to be covered..
2
 Definition of oral health

 Definition of dental public health
 Determinants of health
 The changing pattern of oral diseases
 Health promotion action means (Ottawa
Charter)
 Strategies in oral health promotion
 Whole-population vs. risk approach
 Common risk factor approach
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Definition
3
Dental Public Health can be defined as the

science and practice of preventing oral
diseases, promoting oral health and improving
quality of life through the organized efforts of
society.
(Essential of Dental Public Health, pg 1)

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4
Oral health definition

 1. WHO – completely healthy dentition (with
32 sound straight teeth and no periodontal or

other soft tissue lesions) which result in ‘a
state of physical, mental and social well
being’.
 2. Dolan 1993 – A comfortable and functional
dentition that allows individuals to continue

their social role.
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DETERMINANTS OF HEALTH
5

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health disease
What are health determinants?
Why do we need to know about it?
6
 Factors influencing health

 Failure to address the underlying causes of
disease in society will mean that
sustainable improvements in the health of
population and a reduction in health
inequalities will never be achieved

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The Broader Picture
7
 According to Prof Thomas Mckeown (1979), a

pioneer in public health research, concluded that the
most important reasons for the decline in mortality
rates were social changes in society such as
improvements in living conditions and sanitations,
access to clean water, better nutrition and reduced
family size.
 Medical treatments contributed only 17% to the gain
in life expectancy that occurred in twentieth century

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Social Determinants of Health
8
 Public health research over the last 20 years has

highlighted the impact on health of such factors
as poverty, poor housing, unemployment, and
social isolation ( Marmot and Wilkinson 1999)
 Adverse conditions and influences can have a
particularly significant effect at critical points in
the life course (Bartley at al 1997)

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Figure1: Determinants of health. By Daphlgren and
whitehead, general factors that affect health
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Limitations of the Lifestyle Approach
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 Lifestyle approach: Focus upon changing the

behaviour of their patients as the main means of
promoting health and preventing disease
 Solely focusing on changing the lifestyle of
individuals is ineffective and costly (Syme 1996)
 Such an approach diverts attention away from the
causes of the causes (Sheiham 2000)

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 Behaviours are enmeshed within the social,
economic and environmental conditions of living
(Graham 1999)
 Individuals’ behaviours are therefore largely
determined by conditions in which they live in
(Sheihem 2000)
 Focusing solely on changing lifestyle can be
considered as ‘victim blaming’ approach which is
not only ineffective but may also widen health
inequalities (Schou and Wight 1994)
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HEALTH INEQUALITIES
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 Teenager is far more likely to be physically

fit than a man aged 75. the differences are
due to effect of ageing or biology and are
therefore unavoidable.
The differences that are both avoidable and

considered unacceptable in modern society

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 In the UK research into health inequalities,
 Health inequality is widespread: the most
disadvantaged have suffered most from poor
health
The Black report (Townsend and Davidson

1982) demonstrated that for almost all
reported conditions the mortality and
morbidity rates were higher in people from
lower socio-economic groups
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The Black Report outlined four possible explanations for
health inequalities ( Townsend and Davidson 1982)
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 Artefact. The inequalities are not real, but rather a

function of how social class and health are measured
 Selection process. This explanation process that people in
poor health drift down the social scale. Based upon this
analysis, health therefore determines social class position
 Lifestyle effects. The social distribution of risk behaviour
such as smoking and drug misuse is higher amongst the
lower social class
 Materialistic and structuralistic factors. This argument
places emphasis upon the effects of poverty and
disadvantageon health
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DETERMINANTS OF ORAL HEALTH
COMMON RISK FACTOR APPROACH WHO 2000
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 The basis of this approach is the importance of focusing

attention on changing factors that determine disease
 Diet, smoking, alchohol, hygiene, stress, and exercise are
linked with wide range of important diseases such as
cancers, heart disease and diabetes
 Altering these factors will reduce the risks of these
systemic conditions as well as oral diseases such as
caries, periodontal disease, and oral cancer (Sheiham
and Watt 2000)

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DETERMINANTS OF ORAL HEALTH
COMMON RISK FACTOR APPROACH WHO 2000
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PARTNERSHIP WORKING
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 Focusing action on the risk factors and

promoting health factors that provide a
supportive environment for good health and
well being
 Health professionals need to work in
partnership with a range of different
organizations and agencies to effectively
rpomote health

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Changing Patterns of Oral
Diseases
18

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health disease
Introduction
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 Globally, there have been dramatic changes in the pattern of

oral condition.
 Periodontal disease is found to be the prevailing problem for

the younger adult.
 Hence, National Oral Health Survey was conducted

 To monitor the progress of oral diseases
 To evaluate the overall effectiveness of its oral healthcare delivery
system
 To estimate the present oral health status and future needs of
12/9/21 population public health approach to prevention oral
Age Group Selection
 Malaysian adult oral health surveys covered

those aged 15 years and above.
 Others :
 Singapore – 20 years and above
 Hong Kong – 35-44years & 65-74 years only
 WHO – as used by Hong Kong
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• Oral status involved :
– Dental caries status (tooth decay)

– Periodontal status (gum disease)
– Oral and pharyngeal cancers
– Dentition status
– Prosthetic status
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(A) Dental Caries
22
 Dental caries is still a major global oral health

problem in most industrialized countries
 The prevalence is increase in developing

country but stable/decline in developed
country
 Caries prevalence remained high exceeding

85% for all age groups in Malaysia
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EPIDEMIOLOGY
23
 Dental caries were uncommon in Western

industrialized countries such as England
before 1850.
 Thereafter the caries rate increased rapidly
due to the rise in sugar consumption.
 There have been dramatic changes in the
pattern and distribution of dental caries in
children and adult in all over the world
(especially in UK) over the last 25 years.
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 In pre-school children
 The biggest changes in decay experience
were seen in 5 y/o between 1973 and 1983,

when the percentage who were caries free
had almost doubled and the dmft index had
halved (Murray and Pitts, 1997)
 In Malaysia, dmft index of pre-school
children decrease from 6.3 (in 1970-1971) to
5.6 (in 2005)(NOHPS 2006)
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dmft 6 years Year
6.3* 1970-71
5.5* 1988
5.8 (5 years) 1995
4.1 1997
5.6 2005
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 Among 11-and 12-year-olds the annual
reduction rates were 3.8% in The Hague and in
Shropshire, England; 4.8% in Denmark; 5.1% In
the USA; 5.0% in Bristol and 8.7% in Finland.
(Downer, 1984)
 Study done by NOHPS shown that:
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DMFT 12 years Year
3.7* 1970-71
2.4* 1988
1.6 1997
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 Adult dental health
 Steady and substantial improvement in adult dental
health were seen in the 1988 national survey
compared to the previous national survey (Downer,
1998).
 The proportion of the adult with some natural teeth
rose from 17% in 1978 to 79% in 1988 and 87% in
1998, and it expected to reach 90% in 2008 (Downer,
1991).
 Younger adult had the most dramatic improvement;
sharp increase in the proportion with no restored
teeth( otherwise sound) from 9% in 1978 to 13% in
1988 and 30% in 1998.(Nunn et al,. 2001)
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 In Malaysia (NOHPS 2005):
DMFT 12 Year DMFT 15- Year
years 19 years
3.7* 1970-71 6.2* 1974/75
2.4* 1988
4.6 1990
1.6 1997
2.9 2000
DMFT 16 Year
years DMFT 20- Year
24 years
4.8 1970
4.35 1988 8.8* 1974/75
2.8 1997 6.9 1990
4.4 2000
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DMFT 20-24 Year DMFT 35-44 Year
years years
8.8* 1974/75 14.5* 1974/75
6.9 1990 12.9 1990
4.4 2000 12.1 2000

years years
11.5* 1974/75 17.8* 1974/75
9.1 1990 15.6 1990
6.0 2000 15.4 2000

years years
12.1* 1974/75 20.7* 1974/75
10.9 1990 20.3 1990
8.4 2000 20.1 2000
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 Elderly:
 Edentulousness become decreased in UK
 1968 - 37%
 1998 - 13% - (Kelly et al,. 2000)
 Many older people have retained natural teeth
in their mouth
 The improvement in adult with ‘20 functional
teeth’ was very marked between 1978 (83%)

and 1988 (81%)
(Murray and Pitts, 1997)
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DMFT 65+ YEAR
25.2 1975/75
22.8 1990
23.5 2000
(NOHPS 2006)
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Root caries:
 As people retained their teeth for longer into
old age, root caries may become a problem.

 Recent survey done by oral health and diet and
nutrition of adult age ≥65 found that 80% of

the root of retained teeth had root decay and
some root restoration (Steel et al,. 1998)
 Infrequent tooth brushing and heavy plaque
deposits in association with a partial denture

were strongly associated with primary root
caries in older people (Steel et al,. 1998)
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The National Oral Health Survey of Adults 2000
in Malaysia has shown that caries prevalence
among elderly aged 65-74 and 75 years and
above was 95.2% and 94.1% respectively,
DMFX(T) index for age-group of 65-74 years
was 23.20 (Oral Health Division, 2004).
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 An oral health survey done in Japan, from October 1988 to
February 1989 among elderly population living in public and
private institutions found that, in dentate persons, the mean
number of remaining teeth present and the number of decayed
(D) and filled teeth (F) as follows:
Age Decay Filled
65-74 y/o 13.4 8.6
75-84 y/o 9.5 6.8
> 85 y/o 8.4 6.5
35 (Miyazaki et al.,1992)
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CAUSES OF CHANGES IN ORAL HEALTH
TREND
36
 Major cause of caries is the consumption of

fermentable carbohydrate (sugar)
 Greater availability of sugar is a/w increase dental

caries experience in children (Screebny, 1983)
 A recent survey of oral health and diet and nutrition in

young people found that there were links between the
frequency of consumption of sugary foods and dental
decay (Gregory et al,. 2000)
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 Of 20 countries where two surveys had been
conducted on 12-yearolds, 15 have recorded
marked increases in caries.
 Examples of increases in DMF are; from 2.8 to

6.3 in Chile, 2.7 to 5.3 in four years in Mexico,
0.2 to 2.7 in Jordan, 1.2 to 3.6 in Lebanon, 0.6 to
4.4 in Thailand and 4.7 to 9.8 in the Philippines.
(Janczuk Z, 1983, WHO 2000)
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 Fluoride exposure
 Reduces the enamel's solubility in acid and
influences remineralization of lesions

 In addition, fluoride may interfere with the
metabolism, transmission and implantation of

cariogenic organisms.
 Availability of dental services
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(B) Periodontal Disease
39
 CPITN data from the WHO Global Oral Data Bank

show:
 15-19 years old in developing countries have high
levels of bleeding on probing and calculus
 In age group 35-44, the prevalence and severity of

periodontal disease vary widely
 Elderly; no data available due to great variation

between country due to loss of teeth
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% persons coded
Country/year Age
Group Healthy Bleeding on Calculus Shallow Deep
probing pockets pockets
(4-5mm) (6mm>)
Thailand, 89 18 3 3 87 7 0
Singapore, 94 15-18 26 14 59 1 0
Sri Lanka Na
Indonesia, 90 15 0 3 54 41 2
Laos, 91 15-19 9 8 83 0 0
Malaysia, 90 15-19 17 10 69 4 0
Comparison of CPITN data between

selected country for age group 15-19
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% persons coded
Country/year Age
Group Healthy Bleeding on Calculus Shallow Deep
probing pockets pockets
(4-5mm) (6mm>)
Thailand, 89 35-44 1 0 53 35 11
Sri Lanka, 84 35-44 5 4 55 27 10
Indonesia, 88 35-44 1 0 56 36 6
Laos, 94 35-44 0 0 94 4 2
H Kong, 90-91 35-44 0 0 26 57 17
Japan, 91-92 35-44 3 3 38 48 8
Australia, 95-96 35-44 6 10 47 24 13
NZ, 89 35-44 11 3 38 44 4
UK, 88 35-44 4 1 20 62 13
Malaysia, 90 35-44 5 3 61 23 9
Comparison of CPITN data between selected

country for age group 35-44
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 Community Periodontal Index of Treatment Needs (CPITN)
 1990: 7.2% free from periodontal disease
 2000: 9.8% free from periodontal disease
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 Studies have shown that the prevalence of periodontal
diseases increases with age
 However, severe periodontal disease only affects a much
smaller proportion compared to gingivitis and shallow
periodontal pockets
 only 0.4% of those from the 65–74 years age-group were
found to have healthy gingivae (NOHSA 2000)
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 The traditional ‘progressive’ disease model has been
replaced by the ‘burst’ theory – periodontal disease
have short ‘bursts’ of activity followed by long periods
of remission and healing
 Findings of the study indicate some improvement in
periodontal profile
 Dental plaque causes periodontal disease, but other
factors such as stress, smoking, poor restoration
contour leads to plaque accumulation
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(C) Oral Cancer
45
 Oral cavity cancer is amongst the most prevalent

cancers worldwide
 Oropharygeal cancer is the 11th most common cancer
 Each year, increase number of new cases
 Incidence rate are higher in men than women
 Tobacco use, including smokeless tobacco and excessive
alcohol consumption are estimated to account for about
90% of oral cancer
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Country Sex Location
Mouth Tongue
China(Hong M 1.9 2.1
Kong)
F 0.8 1.2
India M 10.8 6.5
F 8.9 3.7
Thailand M 2.5 2.0
F 3.0 1.2
Australia M 2.8 2.8
F 1.3 1.0
USA M 3.0 1.0
F 1.7 0.7
Oral cancer in selected country,WHO

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 1967 to 1991 : 150 – 200 cases
 1998, oral cancers accounted for 7.1% of cancer
deaths
 60% occur in the Indian ethnic group
 Indians in estate communities have a 6- to 7-fold
propensity for betel quid chewing habit and a 4-
fold predilection for alcohol consumption
 Also a higher occurrence of oral precancerous
lesions noted among the Indigenous (Other
Bumiputera) groups in the states of Sabah and
Sarawak
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 Oral cancer is not a notifiable disease in Malaysia
 A pilot study in Kelantan from 1994 – 1998 quoted an
incidence rate of oral cancer adjusted to world population
of 1.13 ± 0.15 per 100,000 among Kelantanese Malays
 Over the 20-year period data (1974-1994), it would seem
as though there was an increase in prevalence of lesions –
from 5.5% that was inferred in 1974 to that of 9.6% for oral
lesions in 1993/1994
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Health Promotion Action
49
(Ottawa Charter)

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health disease
50
 The Ottawa Charter for Health Promotion is a

1986 document produced by the World Health
Organization
 It was launched at the first international
conference for health promotion that was
held in Ottawa, Canada

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Action areas of the Ottawa Charter
51
Five action areas for health promotion were

identified, these are:
 Developing personal skills
 Strengthening community action
 Re-orientating health care services toward
prevention of illness and promotion of health
 Build healthy public policy
 Create supportive environments
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1. Developing personal skills
52
 Development of personal & social skills: can

be achieved through health education
 Health education: defined as opportunities

created for learning specifically aimed at
producing a health related goal (WHO 1984)

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Health education
53
 Aims to equip individuals and/or communities

with the necessary knowledge, attitudes, and
skills to maintain and improve health
 One of the strategies in health promotion=>
specifically concerned with promoting some
form of educational change
 Ex: to increase patient’s knowledge about the
role of sugar and plaque in aetiology of dental
disease
 Promotion of self care is now seen as being of
fundamental importance.
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2. Strengthening community action
54
 Can be achieved through a community

development approach
 Involves the mobilization of community
resources (human & material)
 “a process in which the community defines its
own health needs, decides how these can be
best tackled, and then takes appropriate
action

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 Problems adopting this approach:
 Time consuming nature of the work
 Difficulty of evaluation
 Potential conflicts that may arise within
communities
 Requires skills in consultation, empowerment,

and communication
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3. Reorienting health services
56
 Work together towards a health care system

which positively contributes to the pursuit of
health
 A reorientation towards health promotion
requires changes in many aspects of health
services.

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4. Build healthy public policy
57
 Placing health onto the policy agendas of

influential decision makers
 Either national or local level
 Ex: the legislation required to fluoridate public
water supplies

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5. Creating supportive environments
58
 Recognizes the impact of the environment on

health and seeks to identify opportunities to
make changes conducive to better health.
 Ex: water fluoridation, to change at national
level, action can also take place at local level
 Developing policies within local
organizations (school, workplaces, and

hospitals)
 Termed as organizational change
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Strategies in Oral Health
Promotion
59

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health disease
Whole-population VS Risk Approach
Common Risk Factor Approach
60
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Strategy Approaches
Risk Whole-population
Approach Approach
61
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The Whole-Population Approach
62
 If a disease is normally distributed in the

population then everyone has some disease.
 Assuming that the decision is made to try to

reduce the overall disease burden, the choice is
between:-
A. To reduce everybody’s exposure to the agents that
are responsible for the disease, OR
B. To select a subgroup of the population at the right-
hand end of the distribution, those at highest risk.
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 Rose (1992) is strongly in favor of the
whole-population approach in this case.
 He considers that the risk factors affect all

who live in society and it is therefore more
effective to work the whole population.
The Whole-population Approach

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Does a small increase in risk in a
large number of individuals
generates more cases than a large
increase in risk in a few
individuals??

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 Another justification 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.

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Strengths of the whole-population approach
Radical
This approach seeks to remove the underlying
●
impediments by addressing the social and political

factors confronts the root causes.
A small shift in the population distribution of the

●
Powerful risk factors may have a large effect on the

number of people affected.
Appropria Changing the normal behaviour of the population

●
to accepted behaviour for good health.

te
(Adapted from Rose 1992.)
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Limitations of the whole-population approach
Acceptabili It may not be acceptable to the population and they
●
may not be willing to make personal changes or
ty support environmental changes.
Feasibility Other pressures within society may make

●
the changes very hard to bring about.
Costs and ●
The costs have to be paid immediately but the benefits are more
long term.
safety
●
Reducing access to risk factors may adversely affect some people.
(Adapted from Rose 1992.)

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 Water fluoridation is an excellent example.
 Dental caries is one which affects most people

and the strategy is to alter the environment by
adjusting the level of fluoride in the water supply.
 Everyone on the centralized water supply

receives the intervention so that compliance is
not a problem.

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The Risk Approach
70
A) The Targeted-Population Approach

 Some groups of the population are at greater
risk compared with the whole population.
 A variety of interventions:
 Clinical intervention,
 More of an environmental approach, OR
 The developing of community and individual
skills.
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 Not all people who are at risk of the disease will
be included within the target group.
 Useful when resources are limited or where one

group is clearly more disadvantaged than another.
 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.
The Risk Approach – Targeted-population

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 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.
 Example: the schools are identified and a

decision is made to introduce a fluoride
toothpaste brushing scheme.

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B) 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 specific individuals are identified by
a screening programme.
 It is only of benefit 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 it.
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 It will inevitably miss some people who will
contract the condition of interest.
 This may or may not be acceptable to either

decision makers or the public.
 If a screening test is used, the specificity and

sensitivity must be of an acceptable level.
 High values of these ensure that people with a

high risk will be identified and those without
will not. The Risk Approach – High-risk
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By definition “high risk”
omits those who are at
“low risk”, but “low
risk” does not mean
“NO risk”!!!!

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Strengths of the high-risk approach
 Intervention is appropriate to the individual.
 It avoids interference with those who are not
at special risk.
 It is readily accommodated within the ethos
and organization of medical care.
 It offers a cost-effective use of resources.
 Selectivity improves the benefit-to-risk ratio.
(Modified from Rose 1992.)

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Weakness of the high-risk approach
 Prevention become medicalized.
 Success is only palliative and temporary.
 The strategy is behaviourally inadequate.
 It is limited by a poor ability to predict the
future of individuals.
 There are problems of feasibility and cost.
 The contribution to overall control of a disease
may be disappointingly small.
(Modified from Rose 1992.)
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Example 1:
 Dental students are required to demonstrate
their hepatitis status before entering the

dental course.
 There are 2 reasons:-
1. To ensure public’s safety by not letting infected

people undertake invasive procedures.
2. To enable an effective immunization to be
administered as part of the strategy to stop the
dental students contracting a potentially fatal
illness.
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Example 2:
 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.

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Strategies in oral health
promotion
81
Common risk factor

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health disease
Strategy action based on common risk
approach
82
 Many health problems share common risk

factor ; eating an unhealthy diet which is high
in fat and sugars and low in fibre can lead to
development of obesity, coronary heart
disease, and diabetes as well as dental caries.
 Therefore it offer the potential for effectively
dealing with a combination of health problems
together.

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The common risk factor approach (adapted from Petersen, 2003)
84

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 Oral health promoter need to work closely
with the people in general health promotion
 They have a key role of placing oral health

matters on the wider health promotion
agenda
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Periodontal disease
86
 Aetiology
 Dental plaque,others include : smoking, certain
systemic disease, stressful life events

 Cigarette smoking and diabetes mellitus (with
poorly controlled diabetes) are two major risk

factors associated with periodontal disease and
appear markedly to affect the initiation and
progression of the disease (Genco 1996;
Papapanou 1999).
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 Public health Strategy
 Promote oral cleanliness and reduce
smoking
 Treatment of periodontal diseases consists
of plaque removal, scaling, and sometimes

surgery, plus motivation and instruction in
oral hygiene
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Oral cancer
88
 Aetiology
 It is not well documented
 Most important risk factor are tobacco and
alcohol
 In Malaysia, betel quid chewing has been
suggested as the most important risk factor

 Public health strategy
 Early detection of cancer and health promotion
activities aimed at reducing the consumption of

12/9/21 alcohol and tobacco product public health approach to prevention oral
 Policy instruments include regulating tobacco
advertising and promotion; enacting smoking bans in
work-places, restaurants, and public buildings and on
public transportation; and increasing excise taxes on
tobacco products (Fiore, Hatsukami, and Baker 2002;
WHO 2002).
 The WHO Framework Convention on Tobacco
Control (WHO 2003) summarizes tobacco control
policies and programs related to regulation, taxation,
and education.
 Da Costa e Silva (2003) shows prioritized treatment
approaches for tobacco cessation, based on
countries' levels of resources
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 Excessive alcohol use accounts for 20 to 30
percent of liver and esophageal cancer (WHO
2001). Interventions to reduce excessive
consumption of alcohol have many principles
in common with tobacco control, including the
effectiveness of regulatory and taxation
measures along with health promotion and
addiction treatment programs
90
12/9/21
Dental caries
91
 Aetiology
 Consumption of fermentable carbohydrates,
this is dose – response, between quantity of

sugar and the development of dental caries.
 Public health strategy
 Reduction in sugar consumption
 ‘Kempen Kurangkan Gula’

12/9/21
 Hence, based on the common risk factors approach,
our oral health promotion activities should move
towards facilitating the adoption of healthier
lifestyles. I am pleased that the ongoing “reduction of
sugar consumption campaign” has the strong support
of the dental profession, as sugar is a common risk
factor for obesity, cardiovascular disease, diabetes,
dental caries and other health problems-SPEECH BY
YB DATO’ SRI LIOW TIONG LAI,MINISTER OF
HEALTH MALAYSIA
92
12/9/21
Disease or condition Causes Actions needed and methods
Dental caries High or frequent sugar consumption, -Targeted actions against causative
plaque present, highly cariogenic factors on community and individual
microorganisms, nonuse of fluorides, levels
reduced saliva flow, systemic diseases, -Health education toward self-care
and other individual risk factors capacity, fluoride programs, sugar
restriction, actions based on risk
assessment of individuals and groups
Periodontal diseases Plaque present, pathogenic bacteria, -Improved oral hygiene, professional
influence of systemic diseases, tobacco cleaning, antibiotics, identification
use and treatment of systemic diseases
-Elimination of pockets if present
and removal of local dental irritants,
such as rough fillings
-Tobacco cessation
Oral precancer and Tobacco and alcohol use; -Tobacco cessation;

cancer
93
Oral and Craniofacial Diseases and Disorders, Disease Control Priorities in Developing Countries. 2nd edition public health approach to prevention oral
12/9/21
References
 http://en.wikipedia.org/wiki/Ottawa_Charter_for_Healt
h_Promotion
 Chapter 38, Oral and Craniofacial Diseases and
Disorders, Disease Control Priorities in Developing
Countries. 2nd edition.Jamison DT, Breman JG,
Measham AR, et al., editors.Washington (DC): World
Bank; 2006
 Essential dental public health,blanaid Daly et al.,1st
edition ,oxford university press
 Oral health care in Malaysia,oral health divison,
Ministry of health, April 2005
94
12/9/21

Public Health Approaches To Prevention of Oral Diseases

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PUBLIC HEALTH APPROACH TO

PREVENTION ORAL HEALTH

public health approach to prevention oral

 Definition of oral health

Dental Public Health can be defined as the

(Essential of Dental Public Health, pg 1)

public health approach to prevention oral

Oral health definition

32 sound straight teeth and no periodontal or

dentition that allows individuals to continue

public health approach to prevention oral

 Factors influencing health

public health approach to prevention oral

 According to Prof Thomas Mckeown (1979), a

public health approach to prevention oral

 Public health research over the last 20 years has

public health approach to prevention oral

 Lifestyle approach: Focus upon changing the

public health approach to prevention oral

 Teenager is far more likely to be physically

The differences that are both avoidable and

public health approach to prevention oral

The Black report (Townsend and Davidson

 Artefact. The inequalities are not real, but rather a

 The basis of this approach is the importance of focusing

public health approach to prevention oral

 Focusing action on the risk factors and

public health approach to prevention oral

public health approach to prevention oral

 Globally, there have been dramatic changes in the pattern of

 Periodontal disease is found to be the prevailing problem for

 Hence, National Oral Health Survey was conducted

 Malaysian adult oral health surveys covered

– Dental caries status (tooth decay)

 Dental caries is still a major global oral health

 The prevalence is increase in developing

 Caries prevalence remained high exceeding

 Dental caries were uncommon in Western

were seen in 5 y/o between 1973 and 1983,

5.8 (5 years) 1995

 Study done by NOHPS shown that:

DMFT 25-29 Year DMFT 45-54 Year

DMFT 30-34 Year DMFT 55-64 Year

teeth’ was very marked between 1978 (83%)

old age, root caries may become a problem.

nutrition of adult age ≥65 found that 80% of

deposits in association with a partial denture

Age Decay Filled

65-74 y/o 13.4 8.6

75-84 y/o 9.5 6.8

> 85 y/o 8.4 6.5

 Major cause of caries is the consumption of

 Greater availability of sugar is a/w increase dental

 A recent survey of oral health and diet and nutrition in

 Examples of increases in DMF are; from 2.8 to

influences remineralization of lesions

metabolism, transmission and implantation of

 Availability of dental services

 CPITN data from the WHO Global Oral Data Bank

 In age group 35-44, the prevalence and severity of

 Elderly; no data available due to great variation

Comparison of CPITN data between