9. Oral health prevention. Primary prevention.

Oral Health Prevention. Primary Prevention

• Oral health prevention = measures aimed at preventing oral diseases, detecting them early, and reducing their consequences.
• The two most common oral diseases are:
• Dental caries
• Periodontal diseases
• WHO distinguishes three levels of prevention:
• Primary prevention – prevents disease before it occurs.
• Secondary prevention – early diagnosis and treatment.
• Tertiary prevention – prevents complications and restores function.
• Important epidemiological fact:
• In 1969 WHO studies showed a very high prevalence of dental caries worldwide.
• Countries that introduced fluoridated water and active preventive programmes later reduced DMF values dramatically.
• By 1993 many Western European countries had DMF values of only 2.7– 4.4, while Scandinavian countries achieved around 0.2–0.6.
• Famous conclusion: “Every tooth decay can be prevented.”

Primary Prevention

• Primary prevention aims to stop disease before clinical signs appear by controlling risk factors.
• Main goals:
• Prevent dental caries.
• Prevent periodontal disease.
• Maintain healthy oral tissues.
• Promote lifelong oral health.
• Prevention should begin as early as possible.
• The foundations of permanent teeth begin developing during fetal life and continue throughout childhood.
• Organisational Principles of Primary Prevention

1. Increasing resistance of dental tissues

• Rational nutrition for pregnant women, nursing mothers and children.
• Adequate intake of calcium, phosphorus and vitamins.
• Optimal fluoride intake.
• Use of remineralising agents to strengthen enamel.

2. Reduction of local risk factors

• Stimulation of natural self-cleansing mechanisms.
• Use of antimicrobial agents.
• Reduction of low-molecular carbohydrates (sugars).
• Effective oral hygiene education.
• Application of fissure sealants.
• Prevention and correction of dento-maxillary abnormalities.
• Replacement of faulty restorations.
• Early treatment of proximal caries.

Fluoride Prevention

• Fluoride is the most important anti-caries factor.
• Actions of fluoride:
• Increases enamel resistance to acids.
• Promotes remineralisation.
• Forms acid-resistant fluorapatite.
• Inhibits bacterial metabolism and plaque formation.
• Has a positive effect on periodontal tissues.
• Sources of fluoride:
• Fluoridated drinking water.
• Fluoridated salt and milk.
• Mineral water.
• Fluoride tablets.
• Toothpaste, gels, varnishes and mouth rinses.
• Important fact:
• Optimal fluoride concentration in drinking water is approximately 1.2–1.4 mg/L.
• Excessive fluoride intake may cause Dental fluorosis, Yellow-brown discoloration, Defects of permanent tooth crowns
• Nutritional Prevention
• Proper nutrition is essential for normal tooth development and mineralisation.
• Recommendations:
• Reduce frequency of sugar consumption.
• Avoid sticky carbohydrates between meals.
• Encourage balanced intake of proteins, fats, carbohydrates, vitamins and minerals.
• Promote healthy eating habits from childhood.
• Food influences oral health in two ways:
• Endogenous effect – nutrients incorporated into developing tissues.
• Exogenous effect – consistency, pH and composition affect teeth directly.

Oral Hygiene