DEPT OF PREVENTIVE AND COMMUNITY DENTISTRY

Dept of Preventive and Community Dentistry PIDC

GOOD AFTERNOON

Dept of Preventive and Community Dentistry PIDC

Introduction to Public Health:

Definition
History of public health Changing concepts of health

Concepts of causation
Changing concepts of public health Primary health care Concept of prevention

Dept of Preventive and Community Dentistry PIDC

LEARNING OUTCOMES:
At the end of the lecture, the student should be able to
Describe the different concepts and phases of public

health Discuss the history of public health and concepts of causation Outline the principles of primary health care Identify and explain the concepts of prevention

Dept of Preventive and Community Dentistry PIDC

HEALTH
State of complete physical , mental and social well being and not merely the absence of disease or infirmity
PUBLIC HEALTH: Study and practice of managing threats to the health of community. Goal: To improve lives through the prevention or treatment of disease.
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Winslows Defintion (1920)

The science and art of : preventing disease prolonging life and promoting physical and mental efficiency through organized community effort for the sanitation of the environment control of communicable infections, the education of individual Education of the individual in personal hygiene the organization of medical and nursing services for the early diagnosis and preventive treatment of disease and the development of the social machinery to insure everyone a standard of living adequate for the maintenance of health Organizing these benefits to enable the birthright of health and longevity to every individual
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HISTORY OF PUBLIC HEALTH

1796 Edward Jenner came with the theory of

immunization Inoculated an 8 old boy with cowpox (small pox virus) and subsequently observed that he was resistant and immune to small pox .He inserted pus taken from cowpox pustule into an incision on the boys arm.

Dept of Preventive and Community Dentistry PIDC

MIASMA THEORY OF DISEASE

Mid 1800s Explains the spread of cholera in London and Paris Death was believed to be caused by miasma (pollution) was considered to be a poisonous vapor or mist filled with particles from decomposed waste and matter (miasmata). Disease was said to be prevented by basic hygiene practices.

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KOCHSS POSTULATES
1880s
Demonstrated that anthrax was caused by the

bacterium bacillus ANTHRACIS. Useful in determining and assessing the cause of the disease by microorganisms.

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GERM THEORY OF DISEASE

John Snow- Science of Epidemiology Proposes that microorganisms are the cause of many diseases Source of the 1854 Cholera epidemic in the soho neighborhood of London was traced Statistical analysis showed that drinking water was the vessel of transmission of the disease Cases occurred in homes which was supplied by the broad street pump at the centre of outbreak
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CONCEPTS OF HEALTH
BIOMEDICAL CONCEPT
ECOLOGICAL PSYCHOSOCIAL

HOLISTIC

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BIOMEDICAL
Health is viewed as absence of disease
Free from disease is considered healthy Based on germ theory of disease

Does not account in environmental, social and cultural

factors of health

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ECOLOGICAL
Health is the dynamic equilibrium between man and

his environment Disease is a result of the disruption in the equilibrium Focuses on imperfect man and imperfect environment Adaption of environment leads to longer life expectancies and a better quality of life

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PYSCHOSOCIAL CONCEPT
Health is not jus a biomedical phenomenon but is also

influenced by social, psychological, cultural, economic and political factors. Health is both a biological and social phenomenon

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HOLISTIC
Synthesis of all other concepts and implies that all

sectors of society play a role in the determination of health Recognizes the strength and significance of social, economic, political and environmental influences on health Emphasizes on the promotion and protection of health

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CONCEPTS OF CAUSATION
EPIDEMIOLOGICAL TRIAD
MULTIFACTORIAL CAUSATION NATURAL HISTORY OF DISEASE

WEB OF CAUSTAION
RISK FACTORS AND RISK GROUPS SPECTRUM OF DISEASE ICEBERG OF DISEASE

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EPIDEMIOLOGICAL TRIAD
Environment

AGENT
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HOST
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AGENT
Living or biological agents

(Eg:Bacteria, virus, Fungi) Non Living or inanimate a) Nutrient agents (Protein, fat) b) Chemical agents (Arsenic,Lead) 1) Internal (Urea,Ketone Bodies) 2) External (Temperature, pressure)

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HOST
Demographic characteristics :

Age, Gender, Ethnicity Biological characteristics: Genetic, background, physiologic and biochemical characteristics, immune status, nutritional status Socioeconomic characteristics: Social class, religion, education, marital status Life Style: Living habits, food habits etc
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ENVIRONMENT
Source or reservoir for the agents of disease
Helps in the transmission of agents to the host,

bringing about the contact and interaction Can be favorable and unfavorable to man and environment Two types Internal External

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 Internal

Pertains to each and every component part, every tissue, organ and organ system and their harmonious functioning within the system. External All that which is external to the individual human host Macro-environment is another term used to denote external environment Micro-environment is term used to denote ones personal environment comprised by the individual's way of living and life style
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 Physical environment:

Space around man containing gases, liquids and solids.

Biological environment:

The universe of all living things that surround man, comprising of animals and plants.
Social environment:

Comprises of all human beings around man and their activities and interactions, inclusive of social and economic factors.
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MULTIFACTORIAL CAUSATION
Concept was put forth by Pettenkofer of Munich (1819-

1901). Modern diseases of civilization like coronary heart disease and cancers could not be explained on the basis of the single cause idea. Concept offers multiple approaches for the prevention of disease.

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Natural History of Disease

This model signifies the way in which a disease evolves

over time from period of its earliest stage to its termination as recovery or death Consists of 2 phases Period of pre-pathogenesis-The process in the environment. The disease agent has not yet entered man, its the factors which favor its interaction with the human host are present in the environment Period of pathogenesis- The process in man, begins with the entry of the disease agent into the human host.
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WEB OF CAUSATION
Coined by MacMahon and Pugh
Applicable in certain diseases, where the causative

agent may be unknown or uncertain and the disease is the result of interaction of multiple factors Removable of some of them or even one of them may be sufficient to control disease

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WEB OF CAUSATION
Socioeconomic status Malaligned teeth Age Poor oral hygiene Diet Cariogenic micro organisms Reduced saliva Time Lack of knowledge
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Caries

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RISK FACTORS AND RISK GROUPS

An attribute or exposure that is significantly associated

with the development of disease A determinant that can be modified by intervention, thereby reducing the possibility of occurrence of disease or other specified outcomes. Risk groups are those who are exposed to risk factors.

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Dept of Preventive and Community Dentistry PIDC

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SPECTRUM OF DISEASE
It is a graphic representation of the variations in the

manifestation of disease The sequence of events that occur in the human host from the time of contact with the etiologic agent up to the point of the ultimate outcome Extends from subclinical to the fatal, progression can be halted by preventive measures

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Iceberg of Disease

Health professionals observe only a part of the illness in the community , just as only the tip of the iceberg is visible above the surface of the water. The inapparent cases are important as they are equally potent in the nature of transmission and spread. Management procedures cannot be directed only to clinically apparent cases.

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Dept of Preventive and Community Dentistry PIDC

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Concepts of Public Health

Disease control phase (1880-1920)

Disease control phase was aimed at the control of mans physical environment Health promotional phase (1920-1960) Initiated as personal health services (mother and child health services, school health services, industrial health services Social engineering phase (1960-1980) A new factor risk factors as determinants of these disease came into existence with chronic diseases Health for all phase (1981-2000) The organized application of local state, national and international resources to achieve health for all
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PREVENTIVE DENTISTRY: It encompasses all the dental practices that affect oral health status at individual & community levels. LEVELS OF PREVENTION:

1.Primary 2.Secondary 3.Tertiary

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Goals
To promote health To preserve health To restore health Minimize suffering and distress
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PRIMARY PREVENTION:
Action taken prior to the onset of disease that eliminates the

possibility for the occurrence of the disease.

It is more than just preventing the disease and promoting health,

its a concept of positive health encouraging achievement & maintenance of acceptable levels of health. Enables every individual to lead a socially and economically productive life.
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ADVANTAGES:
Low cost Safe Comfortable Easy

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APPROACHES RECOMMENDED FOR PRIMARY PRIMORDIAL BY WHO PREVENTION PREVENTION:

Prevention of the emergence or developmental risk factors in countries or population groups in which they have not yet appeared. The major intervention is by individual and mass education. Example: Efforts directed towards encouraging balanced diet

POPULATION (MASS) STRATEGY: Directed at the whole population irrespective of individual risk levels so as to bring about behavioural and lifestyle changes. Example: Betterment of the average oral hygiene status of a population would decrease the incidence of dental disorders.

High-risk Strategy:

It aims to bring preventive care to individuals at special risk

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 MODES OF PRIMARY PREVENTION: Health promotion: It is the process of enabling people to increase control over, and to improve health. It is not directed against any particular disease, but it is intended to strengthen the host through a variety of interventions like: Health education Environmental modification Nutritional interventions Behavioral changes Life style adaptations
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 Specific protection:
Provision of conditions for normal mental and physical functioning of the human being individually and in the group. It includes the promotion of health, the prevention of sickness and curative and restorative medicine in all its aspects.

Example: Fluoride application and pit and fissure sealants for caries prevention.

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 SECONDARY PREVENTION:
Actions which arrest the progression of the disease at its early

stage & prevents further complications.

It is majorly based on early detection , diagnosis & adequate

treatment.
The earlier the disease is diagnosed and rectified, the better it is

from the point of view of prognosis and preventing further complications and long term disability.
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 ADVANTAGES:
Reduces high mortality & morbidity Interception of prognosis of the disease

DISADVANTAGES:
Expensive

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 TERTIARY PREVENTION:
All measures available to reduce and limit impairments &

disabilities. Its aim to minimize suffering & to promote patients rehabilitative capacity.

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 MODES OF TERTIARY INTERVENTION:

Disability limitation:

The objective is to prevent or halt the transition of the disease process form impairment to handicap.

Ex- loss of teeth,inability to talk.

Rehabilitation

It is the combined and coordinated use of medical, vocational, social and educational measures for training and retraining the individual to the highest level possible of functional ability.

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Preventive procedures
Parental counseling

prenatal postnatal

Caries control Space maintenance Exfoliation of deciduous teeth Treatment of abnormal frenal attachments Treatment of locked permanent first molars Abnormal oral musculature related habits

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Caries control procedures:

Diet and oral hygiene Maintenance

Regular Checkup
Fluoride applications Prophylactic odontomy

Pit and fissure sealants.

Restorative procedures like silver amalgam, Glass Ionomers,

Cermets, Stainless steel crown. Immunization

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Diet and Oral hygiene maintenance

Balanced diet

which contains varieties of food, in such quantity and proportion that the need for energy ,amino acids, vitamins, fats, carbohydrates and other nutrients is adequately met for maintaining health.
The cariogenic potential of food depends on many variables such as presence of fermentable sugar sucrose ability to be retained by teeth. ability to form acids. ability to dissolve enamel.
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 The solid foods containing sucrose are more cariogenic than liquid foods.

The frequency in time of ingestion of foods are also important. The sucrose containing food becomes more dangerous if it is eaten more frequent.
The patient should be aided in identification of those foods which are likely to cause oral diseases.

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The 3 to 6 yrs olds require parental assistance to achieve effective plaque removal.

Parents should be instructed to brush for the child at least once a day.
Bedtime is the ideal time to establish this routine because the salivary flow rate slows during sleep Additional brushings may be performed by the child.

Parents need to remain active in supervising the home care practices of 6-12 yrs old

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Regular check-up:
The parents should bring their child for his/her first dental visit early at least by the time the baby is 6 months of age.

Frequency of recall visits have to be decided according to the individual needs. Usually a 3 monthly recall checkup is advised to monitor oral hygiene status.
Half yearly visit to the dentist should be routine.

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Immunization
Immunization with Streptococcus mutans should induce an immune response which might prevent the dental caries in following ways : It will prevent ability of the microorganisms to colonize on to the tooth surfaces. It can alter the pattern of polysaccharide metabolism by the bacteria and thereby reduces adhering capacity on to the tooth surfaces. Oral administration or subcutaneous injection of killed Streptococcus mutans can induce the formation of specific IgA, IgG, IgM in the blood.

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PREVENTION IS ALWAYS BETTER THAN CURE

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