Prevention Strategy of Periodontal Disease as a Public Health Problem in

UK“An ounce of prevention is worth a

pound of cure”

IBRAHIM BHAMJ IPOST GRADUATE STUDENT MSC DENTAL PUBL IC HEALTH (2015-2016)

Why do we fail in tackling periodontal disease?

Focus on downstream approaches.

Inappropriate delivery of interventions.

Focus on treatment rather than prevention.

Lack of integration and isolation of the mouth from the rest of the body.

Lack of community-based approaches.

Preventative strategies Aim for prevention

If the overall aim of the dental public health strategy is focus on individualistic approach then it wont be feasible strategy.

Whole population strategy and using upstream approach.

Watt RG. 2007. From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Community Dent Oral Epidemiol ; 35: 1–11

High risk vs whole-population strategies

Two approaches for tackling periodontal disease: high risk or population approaches.

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

There is no strong evidence or study which can recommend any clinical research to be implemented in a clinical setting or population setting.

With this limitation highlighted, it needs to focus on population strategy.

“Population” approach: In which population-wide changes in risk factors are made. This addresses the determinants and lowers the mean level of risk factors by shifting the whole population distribution to a favorable position.

For example, addressing the underlying cause plaque level and smoking which reduces the risk and therefore produces a greater benefit.(rose 2008).

Rose G. (2008). Rose strategy for preventive medicine. Oxford, oxford university press.

Modified risk approach, the targeted population strategy can also be used to direct action at particular high risk group within the population but not individual.

To control periodontal condition a combined approach is needed.

Prevention in clinical practice

Health promotion for prevention of periodontal diseases progression.

To be effective it should be based on scientific and evident based.

Basic periodontal examination should be used routinely for assessing and examine the periodontal health.

Oral health care professional should impart knowledge, skills and demonstration of brushing for effective oral hygiene self practice.

Key health education messages to promote periodontal health (Department of Health 2012)

Children under 7 years should be supervised with their brushing.

Using manual or powered tooth brushed.

Gentle pressure hold brush with pen grip

Use of of interdental cleaning aides.

Tooth brush size use a small head with a medium texture.

Replace tooth brush when bristles become excessively slayed.

Chlorhexidine is most effective chemical plaque suppressant.

Do not smoke. Löe, H. (2000), Oral hygiene in the prevention of caries and periodontal disease. International Dental Journal, 50: 129–139. doi: 10.1111/j.1875-

595X.2000.tb00553.xDepartment of Health (2012). Delivering better oral health an evidence based tool kit for prevention, 3rd edition, London, Department of Health.

Smoking cessation advice

It is a major etiological factor for periodontal disease and other chronic condition.

If a patient is smoker should be given advice in regards to effect of smoking on oral and general health.

Patient who wish should be refer to local NHS stop smoking service are available and provide a evidence based support and treatment.

Public health approaches

Clinical preventive measure is not alone sufficient, public health measures are essential elements in preventive strategy (Watt and Peterson, 2012)

Watt,R.G and petersen, P.E. (2012). Periodontal health through public health --- the case for oral health promotion. Periodontology 2000, 60, 147-155

Public health measures to reduce periodontal diseaseA community wide approach incorporating the principle of integration with general health education, diversity of educational approaches, and community participation.

Community leader education.

Mass media intervention.

Integrate oral hygiene into body cleanliness education in nurseries and school.

Incorporate the importance and skills of oral hygiene into training of health, education and social care professional.

Use fiscal policy to reduce cost of oral hygiene aids and toothpaste; remove VAT at national level sell the products at cost price in NHS premises.Dorri, M ., Sheiham , A., and watt , R.G (2009). Relationship between general hygiene behaviours and oral hygiene in Iranian adolscents. Europe journal of oral sciences, 117, 407-12Kay, L. and Locker, D (1996). Is dental health education effective? A systematic review of current evidence. Community dentistry and epidemiology, 24, 231-5.Watt,R.G. and Marinho, V. (2005). Does oral health promotion improved oral hygiene and gingival health? Periodontology 2000, 60, 147-55

Environmental change : Organizational policy; ensure oral hygiene is placed on health promoting schools’ agendas structural change within school provision and design of toilet facilities.

Comprehensive public health strategies to reduce smoking, epically among low income groups.

Sheiham, A. and Netuveli, G. S. (2002), Periodontal diseases in Europe. Periodontology 2000, 29: 104–121. doi: 10.1034/j.1600-0757.2002.290106.x

Conclusion As a clinical approach alone is not sufficient to achieve a feasible periodontal care modalities. So it is best to adopt upper stream approach and public health approach in getting a success to

prevent a periodontal disease as a public health problem.

Improve a periodontal health of population

Smoking cessation in population.

Thank you for listening

“An ounce of prevention is worth a pound of cure”

Any questions?