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Common Risk Factor Approach

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Dr. Ankit Mohapatra

The document discusses the common risk factor approach (CRFA) to promoting oral health, highlighting its significance in addressing non-communicable diseases (NCDs) and improving overall health outcomes. It emphasizes the integration of oral health promotion into broader health initiatives by addressing social determinants and modifiable risk factors like diet, tobacco, and alcohol use. The conclusion calls for the dental profession to adopt this integrated approach to reduce morbidity from chronic diseases and incidence of oral diseases.

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COMMON RISK FACTOR APPROACH: A RATIONAL BASIS FOR PROMOTING ORAL HEALTH Dr. Ankit Mohapatra Department Of Public Health Dentistry 1
2
CONTENTS • Introduction • History • Risk Factors • Levels of Prevention • Upstream and Downstream Approach • Oral Health and General Health 3
4 • Common Risk Factors • Rationale for Promoting Oral Health • CRFA application in Indian scenario • Conclusion
INTRODUCTION • The World Health Professional Alliance (WHPA) acclaimed that “the global epidemic of non-communicable diseases (NCDs) has become a significant threat to human health and development and unless urgently addressed, the burden of NCDs would continue its dramatic increase”. 5 20082014
6
• Oral diseases, including dental caries, periodontal disease and oral cancer, are neglected but important to NCDs with a significant burden on overall health. • It is well known and established that oral diseases significantly affect quality of life and its associated healthcare expenditure has a catastrophic effect on the public health budgets. 7
HISTORY • Until the 1950s • Mid twentieth century • Shifting of focus • Framingham Heart Study 8
DETERMINANTS OF HEALTH • Health is an amalgamation of many factors. • The Dahlgren and Whitehead's model (1991) depicted a core of individuals grouped together with some of the non- modifiable risk factors for disease such as age, gender and heredity. 9 Bambra C, Gibson M, Sowden A, et al. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health 2010;64:284e29.
RISK FACTORS • “Any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury.” 10 World Health Organization. (2014). Risk factors. Accessed Jan 23, 2018
IMPACT OF SOCIAL DETERMINANTS ON RISK FACTORS • In dentistry, most health promotion is addressed at an individual level in hopes of changing individual lifestyle factors. • For health promotion, including dental health promotion, to have a more far-reaching affect it should be directed at the wider sphere of determinants, such as the social and community networks. 11
LEVELS OF PREVENTION Tertiary Secondary Primary 12
UPSTREAM AND DOWNSTREAM APPROACH 13McKinlay 1979
ORAL HEALTH & GENERAL HEALTH CONNECTION • Traditionally medicine and dentistry have been seen as fields unrelated to each other. • Medicine and dentistry are studied in different schools and have separate professional associations but both professions are related by human anatomy. 14
• “Oral health promotion and oral disease prevention should embrace what is termed ‘the common risk factor approach,’ leading to the integration of oral health promotion into broader health promotion.” 15 Petersen PE, Kwan S. Evaluation of community-based oral health promotion and oral disease prevention-WHO recommendations for improved evidence in public health practice. Community Dent Health. p.1. 2004 Dec; 21(4 Suppl):319-329. Accessed Jan 23, 2018.
COMMON RISK FACTORS 16
SMOKING/TOBACCO • Tobacco use is the leading preventable cause of disease, disability and death. • For every person who dies from a smoking-related disease, about 30 more people experience at least one serious illness from smoking. 17
ORAL HEALTH • Stained Teeth, • Reduction Of Taste, • Periodontal Disease, • Oral Cancer, • Decreased Wound Healing • Decrease In The Body’s Immune Response To Infection • Reduced Salivary Flow Rate GENERAL HEALTH • Vascular Stenosis • Lung Cancer • Cardiovascular diseases • Chronic Obstructive Pulmonary Disease • Smoking During Pregnancy Causes Pre mature delivery • Sudden Infant Death Syndrome 18
• Smoking as a modifiable risk factor for both periodontal disease and coronary heart disease is well documented. • A study (2017) reported a positive association between apical periodontitis and cardiovascular disease. 19 Berlin-Broner Y, Febbraio M, Levin L. Association between apical periodontitis and cardiovascular diseases: a systematic review of the literature. International Endodontic Journal. 50, 847–859, 2017.
ALCOHOL • Alcohol is considered as one of the independent modifiable risk factors for periodontitis. • Excessive intake of alcohol is also a risk factor for NCDs. 20
• Alcoholism- Failure to fulfill major role obligations at work, school, or home, continued drinking even in situations where it is physically hazardous, recurrent alcohol–related legal problems and continued drinking despite persistent or recurrent social or interpersonal problems it may cause. 21 Gmel G, Rehm J. Harmful Alcohol Use. National Institute on Alcohol Abuse and Alcoholism.
ORAL HEALTH • Periodontal Disease • Dental Caries • Precancerous Lesions. • Negatively Effects Blood Clotting Factors. GENERAL HEALTH • Cirrhosis of Liver • Hypertension • CVD • Digestive problems. • Depression • Anxiety 22
• A systematic review (2014) reported that episodic and chronic heavy drinking do not provide any beneficial effect on IHD. 23 Michael Roerecke and Jürgen Rehm . Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers. BMC Medicine.201412:182
• Nutritional deficiencies associated with heavy drinking can lower the body’s natural ability to use antioxidants to prevent the formation of cancer. 24 The Oral Cancer Foundation. The Alcohol Connection. Accessed Jan 19, 2018.
DIET • Unhealthy diets are those that have increased fat, sugar and sodium and are low in the intake of fruit and vegetables. • A statement by AHA reports a strong evidence supporting the association of added sugars with increased cardiovascular disease risk through increased energy intake, increased adiposity, and dyslipidemia. 25 Miriam B. Vos et al. Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association. 2017;135:e1017-e1034
• Eating Large Amounts Of Processed Or Fast Food • Eating Larger Portions • Sugary Drinks • Carbohydrates 26
ORAL HEALTH • Dental caries • Periodontal disease GENERAL HEALTH • Obesity • Cancer • CVD • Diabetes • Hypertension 27
• A study (2011) reported that overweight students, the frequent consumption of fatty foods and infrequent consumption of vegetables were associated with an increased risk of periodontitis. • In underweight and normal-weight students, eating habits had little effect on the periodontal condition. 28 Takaaki Tomofuji et al. Relationships Between Eating Habits and Periodontal Condition in University Students. J Periodontol 2011;82(12):1642-1649
• Fat – Body require right kind of fat, mainly monounsaturated and polyunsaturated fatty acids and very limited amounts of saturated fats. • Too much saturated fat may elevate blood cholesterol thereby increasing the risk for CVDs as well as some cancers. 29
• A study (2001) reported that a reduction or modification of dietary fat intake results in reductions in cardiovascular events. 30 Hooper Lee, Summerbell Carolyn D, Higgins Julian P T, Thompson Rachel L, Capps Nigel E, SmithGeorge Davey et al. Dietary fat intake and prevention of cardiovascular disease: systematic review BMJ 2001; 322 :757
SUGAR • There is convincing evidence, collectively from human intervention studies, epidemiological studies, animal studies and experimental studies, for an association between the amount and frequency of free sugars intake and dental caries. 31
• Body uses carbohydrates to make glucose. • Glucose is converted from glycogen stored in the liver and muscles. • When released into the bloodstream, it provides energy for the cells. • Insulin from the pancreas helps control the amount of glucose in the body. 32
• More glucose in the body, the more insulin is released into the bloodstream. • A consistently elevated glucose level puts individuals at risk for insulin resistant type 2 diabetes and CVD. 33 American Nutrition Association. Nutrition Digest. 2010;36(4).
STRESS/CONTROL • Depression is a highly prevalent risk factor for incident coronary heart disease (CHD) and for cardiovascular morbidity and mortality in patients with established CHD. • The link between psychologic stress and atherosclerosis may be both direct, via damage to the inner layer of the artery. 34
ORAL HEALTH • Poor Oral Hygiene • Periodontal Disease • Dental Caries • Reduced Salivary Flow • Bruxism • ANUG • Reduced Immune Response 35
36
HYGIENE • Oral biofilm begins with the formation of the pellicle and ends with the complex formation of mature biofilm. • Study reports that host response to pathogenic organisms contained in oral biofilm may be a risk factor for the four major NCDs, cancer, CVDs, respiratory diseases and diabetes 37 National Institute Of Dental And Craniofacial Research. Part Three: What Is The Relationship Between Oral Health And General Well- being? Accessed Jan 25, 2018.
38 • Lack of oral hygiene encourages bacterial build-up and biofilm plaque formation, and can also increase certain species of pathogenic bacteria associated with more severe forms of periodontal diseases. American Academy of Periodontology statement on Risk Assessment. J Periodontol. 2008;2:202.
39 • Further poor OH increases the risk of periodontitis by approximately two- to five-fold compared with good OH. Oral care habits, including regular brushing and regular dental visits can decrease the risk of periodontitis. Lertpimonchai A et al. The association between oral hygiene and periodontitis: a systematic review and meta-analysis. Int Dent J.2017; 67: 332–343
• Poor oral hygiene has been recognized as a possible risk factor for oral and pharyngeal cancer. • Study (2013) reported that inadequate oral health is correlated with oral human papillomavirus (HPV) infection. • Findings showed HPV infection was 55% higher among those self-reporting poor to fair oral health. 40 Science Daily. American Association for Cancer Research (AACR). Poor oral health linked to cancer-causing oral HPV infection. August 21, 2013. Accessed Jan 25, 2018.
• Inflammatory mediators, the cytokines interleukin-1 beta (IL-1), interleukin-6 beta (IL-6) and tumor necrosis factor (TNF), are produced by a broad range of cells and can enter circulating blood, attach to the atheromatous plaque in the arteries, and be a factor in clot formation. 41 Leishman SJ, Do HL, Ford PJ. Cardiovascular Disease And The Role Of Oral Bacteria. J Oral Microbiol. 2010; 2:10.
• Protective mechanisms of the lungs usually prevent colonization of inhaled oral pathogens. • Two most common types of pneumonia are community- acquired pneumonia (CAP) and nosocomial, also known as hospital-acquired pneumonia. 42
• COPD is a pulmonary disease affecting airflow. • People with COPD often have compromised protective systems in their lungs making it difficult to eliminate inhaled oral pathogens. 43 Stoller JK: Acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 2002;346:988-994.
PHYSICAL EXCERSISE 44 • Physical activity has shown to have a protective relationship with several chronic diseases. Mohammad S et al. Increased physical activity reduces prevalence of periodontitis. Journal of Dentistry. 2005;33,(9): 703-710
45 • A systematic review (2010) reported a positive association for obesity in the development of periodontal disease. • There was a greater mean clinical attachment loss among obese individuals, a higher mean body mass index (BMI) among periodontal patients, and a trend of increasing odds of prevalent periodontal disease with increasing BMI.* Benjamin W. Chaffee and Scott J. Weston. Association Between Chronic Periodontal Disease and Obesity: A Systematic Review and Meta-Analysis. J Periodontol.2010;81(12):1708-1724
INJURIES • Facial injury is most prevalent among young men from socially deprived areas and the involvement of alcohol serves to significantly widen the inequalities gap in this group of patients. • Facial trauma in females has a very strong association with domestic abuse and alcohol consumption by the perpetrator in particular is often a factor in these cases 46 Conway DI, McMahon AD,, Graham L et al. The Scar on the Face of Scotland: Deprivation and Alcohol Related Facial Injuries in Scotland. Journal of Trauma. 2010;68:644–649.
• It has now become clear that the causative or risk factors in oral disease are often the same as those implicated in the major general diseases. RATIONALE FOR PROMOTING ORAL HEALTH 47 THE NORTH KERELIA PROJECT (1972) COMMUNITY ACTION AGAINST RISK FACTOR ADVICE FOR AVOIDANCE MRFIT 1982 INTENSIVE INTERVENTION FOR RISK FACTORS MEDICAL EXAMINATION
The Multiple Risk Factor Intervention Trial- • Lifestyle approach (changing the behaviours) But Social And Cultural Environment 48 By integrating oral health into strategies for promoting general health and by assessing oral needs in socio-dental ways, thus leading to an improvement in quality of life.
OBESITY CANCERS HEART DISEASES RESPIRATORY DISEASE DENTAL CARIES PERIODONTAL DISEASE TRAUMA DIET ¤ STRESS ¤ CONTROL ¤ HYGIENE ¤ ¤ TOBACCO ¤ ALCOHOL ¤ EXERSISE ¤ INJURIES POLITICAL PHYSICAL SOCIAL Modified from Sheiham and Watt,2000
CRFA APPLICATION IN INDIAN SCENARIO • Maternal and Child Health Services • School Health Services • ICDS • National Mental Health Programme • National Tobacco Control Programme • NPCDCS • Primary Health Care 50
• National Programme for Control and Treatment of Occupational Diseases • Mid Day Meal Programme • Ksheera Bhagya 51
52
CONCLUSION • For the most part, dental health promotion has been isolated from other health promotion initiatives. • The dental profession needs to adopt an integrated common risk factor approach with groups concerned about reducing NCDs. 53
• As Dental Public health professionals, we are in a position to couple with community stakeholders to address modifiable behavioral risk factors with appropriate health promotion information. • Taking this combined approach can greatly reduce the morbidity and mortality from chronic diseases and decrease the incidence of oral diseases. 54
55
EXERCISE • Which type of research study is the Framingham Heart Study? • Which type of prevention is directed at elimination of emergence of risk factors? • Which acute respiratory disease is associated with the inhalation of oral pathogens? 56 Longitudinal Study Primordial Prevention Hospital-acquired, Pneumonia.
REFERENCES • Carol Chapman. The Common Risk Factor Approach (CRFA) to Oral Health Promotion. http://se.dentalcare.com/en- us/home.aspx Assessed on Jan 23 2018. • C. Santhosh Kumar, Shweta Somasundara Y. Common risk factor approach: finding common ground for better health outcomes. International Journal of Contemporary Medical Research 2017;4(6):1367-1370. 57
• Abhinav Parakh et al. Strategies and Approaches in Oral Disease Prevention – A Common Risk Factor Approach. J Oral Dent Health. 2017;1(1):1-2 • Links between oral & general health. The Dental Health Foundation.https://www.dentalhealth.ie/dentalhealth/causes/general.ht ml. Assessed on Jan 24 2018 • Petersen, P. E. (2003), The World Oral Health Report 2003: continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme. Community Dentistry and Oral Epidemiology, 31: 3–24. 58
• Sheiham A. Dietary effects on dental diseases. Public Health Nutrition 2001;4:569-91. • Bambra C, Gibson M, Sowden A, et al. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health 2010;64:284e29. • World Health Organization. (2014). Risk factors. Accessed Jan 23, 2018 59
• Global oral health data bank. Geneva: World Health Organization; 2004. • Global oral health data bank. Geneva: World Health Organization; 2014. • Berlin-Broner Y, Febbraio M, Levin L. Association between apical periodontitis and cardiovascular diseases: a systematic review of the literature. International Endodontic Journal. 50, 847–859, 2017. • Gmel G, Rehm J. Harmful Alcohol Use. National Institute on Alcohol Abuse and Alcoholism. 60
• Michael Roerecke and Jürgen Rehm . Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta- analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers. BMC Medicine.201412:182 • The Oral Cancer Foundation. The Alcohol Connection. Accessed Jan 19, 2018. • Miriam B. Vos et al. Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association. 2017;135:e1017-e1034 61
• Takaaki Tomofuji et al. Relationships Between Eating Habits and Periodontal Condition in University Students. J Periodontol 2011;82(12):1642-1649. • Hooper Lee, Summerbell Carolyn D, Higgins Julian P T, Thompson Rachel L, Capps Nigel E, SmithGeorge Davey et al. Dietary fat intake and prevention of cardiovascular disease: systematic review BMJ 2001; 322 :757 • American Nutrition Association. Nutrition Digest. 2010;36(4). 62
• National Institute Of Dental And Craniofacial Research. Part Three: What Is The Relationship Between Oral Health And General Well-being? Accessed Jan 25, 2018. • American Academy of Periodontology statement on Risk Assessment. J Periodontol. 2008;2:202. • Lertpimonchai A et al. The association between oral hygiene and periodontitis: a systematic review and meta-analysis. Int Dent J.2017; 67: 332–343 • Science Daily. American Association for Cancer Research (AACR). Poor oral health linked to cancer-causing oral HPV infection. August 21, 2013. Accessed Jan 25, 2018. 63
• Leishman SJ, Do HL, Ford PJ. Cardiovascular Disease And The Role Of Oral Bacteria. J Oral Microbiol. 2010; 2:10. • Stoller JK: Acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 2002;346:988-994. • Mohammad S et al. Increased physical activity reduces prevalence of periodontitis. Journal of Dentistry. 2005;33,(9): 703-710 • Benjamin W. Chaffee and Scott J. Weston. Association Between Chronic Periodontal Disease and Obesity: A Systematic Review and Meta-Analysis. J Periodontol.2010;81(12):1708-1724 64
• Conway DI, McMahon AD,, Graham L et al. The Scar on the Face of Scotland: Deprivation and Alcohol Related Facial Injuries in Scotland. Journal of Trauma. 2010;68:644–649. • Carranza, F., Newman, M. and Takei, H. Carranza's Clinical Periodontology. 10th ed. 2006. St. Louis, Mo.: Elsevier Saunders. • Park K. Textbook of Preventive and Social Medicine. 23rd Ed. 65
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Common Risk Factor Approach

  • 1. COMMON RISK FACTOR APPROACH: A RATIONAL BASIS FOR PROMOTING ORAL HEALTH Dr. Ankit Mohapatra Department Of Public Health Dentistry 1
  • 2. 2
  • 3. CONTENTS • Introduction • History • Risk Factors • Levels of Prevention • Upstream and Downstream Approach • Oral Health and General Health 3
  • 4. 4 • Common Risk Factors • Rationale for Promoting Oral Health • CRFA application in Indian scenario • Conclusion
  • 5. INTRODUCTION • The World Health Professional Alliance (WHPA) acclaimed that “the global epidemic of non-communicable diseases (NCDs) has become a significant threat to human health and development and unless urgently addressed, the burden of NCDs would continue its dramatic increase”. 5 20082014
  • 6. 6
  • 7. • Oral diseases, including dental caries, periodontal disease and oral cancer, are neglected but important to NCDs with a significant burden on overall health. • It is well known and established that oral diseases significantly affect quality of life and its associated healthcare expenditure has a catastrophic effect on the public health budgets. 7
  • 8. HISTORY • Until the 1950s • Mid twentieth century • Shifting of focus • Framingham Heart Study 8
  • 9. DETERMINANTS OF HEALTH • Health is an amalgamation of many factors. • The Dahlgren and Whitehead's model (1991) depicted a core of individuals grouped together with some of the non- modifiable risk factors for disease such as age, gender and heredity. 9 Bambra C, Gibson M, Sowden A, et al. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health 2010;64:284e29.
  • 10. RISK FACTORS • “Any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury.” 10 World Health Organization. (2014). Risk factors. Accessed Jan 23, 2018
  • 11. IMPACT OF SOCIAL DETERMINANTS ON RISK FACTORS • In dentistry, most health promotion is addressed at an individual level in hopes of changing individual lifestyle factors. • For health promotion, including dental health promotion, to have a more far-reaching affect it should be directed at the wider sphere of determinants, such as the social and community networks. 11
  • 13. UPSTREAM AND DOWNSTREAM APPROACH 13McKinlay 1979
  • 14. ORAL HEALTH & GENERAL HEALTH CONNECTION • Traditionally medicine and dentistry have been seen as fields unrelated to each other. • Medicine and dentistry are studied in different schools and have separate professional associations but both professions are related by human anatomy. 14
  • 15. • “Oral health promotion and oral disease prevention should embrace what is termed ‘the common risk factor approach,’ leading to the integration of oral health promotion into broader health promotion.” 15 Petersen PE, Kwan S. Evaluation of community-based oral health promotion and oral disease prevention-WHO recommendations for improved evidence in public health practice. Community Dent Health. p.1. 2004 Dec; 21(4 Suppl):319-329. Accessed Jan 23, 2018.
  • 17. SMOKING/TOBACCO • Tobacco use is the leading preventable cause of disease, disability and death. • For every person who dies from a smoking-related disease, about 30 more people experience at least one serious illness from smoking. 17
  • 18. ORAL HEALTH • Stained Teeth, • Reduction Of Taste, • Periodontal Disease, • Oral Cancer, • Decreased Wound Healing • Decrease In The Body’s Immune Response To Infection • Reduced Salivary Flow Rate GENERAL HEALTH • Vascular Stenosis • Lung Cancer • Cardiovascular diseases • Chronic Obstructive Pulmonary Disease • Smoking During Pregnancy Causes Pre mature delivery • Sudden Infant Death Syndrome 18
  • 19. • Smoking as a modifiable risk factor for both periodontal disease and coronary heart disease is well documented. • A study (2017) reported a positive association between apical periodontitis and cardiovascular disease. 19 Berlin-Broner Y, Febbraio M, Levin L. Association between apical periodontitis and cardiovascular diseases: a systematic review of the literature. International Endodontic Journal. 50, 847–859, 2017.
  • 20. ALCOHOL • Alcohol is considered as one of the independent modifiable risk factors for periodontitis. • Excessive intake of alcohol is also a risk factor for NCDs. 20
  • 21. • Alcoholism- Failure to fulfill major role obligations at work, school, or home, continued drinking even in situations where it is physically hazardous, recurrent alcohol–related legal problems and continued drinking despite persistent or recurrent social or interpersonal problems it may cause. 21 Gmel G, Rehm J. Harmful Alcohol Use. National Institute on Alcohol Abuse and Alcoholism.
  • 22. ORAL HEALTH • Periodontal Disease • Dental Caries • Precancerous Lesions. • Negatively Effects Blood Clotting Factors. GENERAL HEALTH • Cirrhosis of Liver • Hypertension • CVD • Digestive problems. • Depression • Anxiety 22
  • 23. • A systematic review (2014) reported that episodic and chronic heavy drinking do not provide any beneficial effect on IHD. 23 Michael Roerecke and Jürgen Rehm . Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers. BMC Medicine.201412:182
  • 24. • Nutritional deficiencies associated with heavy drinking can lower the body’s natural ability to use antioxidants to prevent the formation of cancer. 24 The Oral Cancer Foundation. The Alcohol Connection. Accessed Jan 19, 2018.
  • 25. DIET • Unhealthy diets are those that have increased fat, sugar and sodium and are low in the intake of fruit and vegetables. • A statement by AHA reports a strong evidence supporting the association of added sugars with increased cardiovascular disease risk through increased energy intake, increased adiposity, and dyslipidemia. 25 Miriam B. Vos et al. Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association. 2017;135:e1017-e1034
  • 26. • Eating Large Amounts Of Processed Or Fast Food • Eating Larger Portions • Sugary Drinks • Carbohydrates 26
  • 27. ORAL HEALTH • Dental caries • Periodontal disease GENERAL HEALTH • Obesity • Cancer • CVD • Diabetes • Hypertension 27
  • 28. • A study (2011) reported that overweight students, the frequent consumption of fatty foods and infrequent consumption of vegetables were associated with an increased risk of periodontitis. • In underweight and normal-weight students, eating habits had little effect on the periodontal condition. 28 Takaaki Tomofuji et al. Relationships Between Eating Habits and Periodontal Condition in University Students. J Periodontol 2011;82(12):1642-1649
  • 29. • Fat – Body require right kind of fat, mainly monounsaturated and polyunsaturated fatty acids and very limited amounts of saturated fats. • Too much saturated fat may elevate blood cholesterol thereby increasing the risk for CVDs as well as some cancers. 29
  • 30. • A study (2001) reported that a reduction or modification of dietary fat intake results in reductions in cardiovascular events. 30 Hooper Lee, Summerbell Carolyn D, Higgins Julian P T, Thompson Rachel L, Capps Nigel E, SmithGeorge Davey et al. Dietary fat intake and prevention of cardiovascular disease: systematic review BMJ 2001; 322 :757
  • 31. SUGAR • There is convincing evidence, collectively from human intervention studies, epidemiological studies, animal studies and experimental studies, for an association between the amount and frequency of free sugars intake and dental caries. 31
  • 32. • Body uses carbohydrates to make glucose. • Glucose is converted from glycogen stored in the liver and muscles. • When released into the bloodstream, it provides energy for the cells. • Insulin from the pancreas helps control the amount of glucose in the body. 32
  • 33. • More glucose in the body, the more insulin is released into the bloodstream. • A consistently elevated glucose level puts individuals at risk for insulin resistant type 2 diabetes and CVD. 33 American Nutrition Association. Nutrition Digest. 2010;36(4).
  • 34. STRESS/CONTROL • Depression is a highly prevalent risk factor for incident coronary heart disease (CHD) and for cardiovascular morbidity and mortality in patients with established CHD. • The link between psychologic stress and atherosclerosis may be both direct, via damage to the inner layer of the artery. 34
  • 35. ORAL HEALTH • Poor Oral Hygiene • Periodontal Disease • Dental Caries • Reduced Salivary Flow • Bruxism • ANUG • Reduced Immune Response 35
  • 36. 36
  • 37. HYGIENE • Oral biofilm begins with the formation of the pellicle and ends with the complex formation of mature biofilm. • Study reports that host response to pathogenic organisms contained in oral biofilm may be a risk factor for the four major NCDs, cancer, CVDs, respiratory diseases and diabetes 37 National Institute Of Dental And Craniofacial Research. Part Three: What Is The Relationship Between Oral Health And General Well- being? Accessed Jan 25, 2018.
  • 38. 38 • Lack of oral hygiene encourages bacterial build-up and biofilm plaque formation, and can also increase certain species of pathogenic bacteria associated with more severe forms of periodontal diseases. American Academy of Periodontology statement on Risk Assessment. J Periodontol. 2008;2:202.
  • 39. 39 • Further poor OH increases the risk of periodontitis by approximately two- to five-fold compared with good OH. Oral care habits, including regular brushing and regular dental visits can decrease the risk of periodontitis. Lertpimonchai A et al. The association between oral hygiene and periodontitis: a systematic review and meta-analysis. Int Dent J.2017; 67: 332–343
  • 40. • Poor oral hygiene has been recognized as a possible risk factor for oral and pharyngeal cancer. • Study (2013) reported that inadequate oral health is correlated with oral human papillomavirus (HPV) infection. • Findings showed HPV infection was 55% higher among those self-reporting poor to fair oral health. 40 Science Daily. American Association for Cancer Research (AACR). Poor oral health linked to cancer-causing oral HPV infection. August 21, 2013. Accessed Jan 25, 2018.
  • 41. • Inflammatory mediators, the cytokines interleukin-1 beta (IL-1), interleukin-6 beta (IL-6) and tumor necrosis factor (TNF), are produced by a broad range of cells and can enter circulating blood, attach to the atheromatous plaque in the arteries, and be a factor in clot formation. 41 Leishman SJ, Do HL, Ford PJ. Cardiovascular Disease And The Role Of Oral Bacteria. J Oral Microbiol. 2010; 2:10.
  • 42. • Protective mechanisms of the lungs usually prevent colonization of inhaled oral pathogens. • Two most common types of pneumonia are community- acquired pneumonia (CAP) and nosocomial, also known as hospital-acquired pneumonia. 42
  • 43. • COPD is a pulmonary disease affecting airflow. • People with COPD often have compromised protective systems in their lungs making it difficult to eliminate inhaled oral pathogens. 43 Stoller JK: Acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 2002;346:988-994.
  • 44. PHYSICAL EXCERSISE 44 • Physical activity has shown to have a protective relationship with several chronic diseases. Mohammad S et al. Increased physical activity reduces prevalence of periodontitis. Journal of Dentistry. 2005;33,(9): 703-710
  • 45. 45 • A systematic review (2010) reported a positive association for obesity in the development of periodontal disease. • There was a greater mean clinical attachment loss among obese individuals, a higher mean body mass index (BMI) among periodontal patients, and a trend of increasing odds of prevalent periodontal disease with increasing BMI.* Benjamin W. Chaffee and Scott J. Weston. Association Between Chronic Periodontal Disease and Obesity: A Systematic Review and Meta-Analysis. J Periodontol.2010;81(12):1708-1724
  • 46. INJURIES • Facial injury is most prevalent among young men from socially deprived areas and the involvement of alcohol serves to significantly widen the inequalities gap in this group of patients. • Facial trauma in females has a very strong association with domestic abuse and alcohol consumption by the perpetrator in particular is often a factor in these cases 46 Conway DI, McMahon AD,, Graham L et al. The Scar on the Face of Scotland: Deprivation and Alcohol Related Facial Injuries in Scotland. Journal of Trauma. 2010;68:644–649.
  • 47. • It has now become clear that the causative or risk factors in oral disease are often the same as those implicated in the major general diseases. RATIONALE FOR PROMOTING ORAL HEALTH 47 THE NORTH KERELIA PROJECT (1972) COMMUNITY ACTION AGAINST RISK FACTOR ADVICE FOR AVOIDANCE MRFIT 1982 INTENSIVE INTERVENTION FOR RISK FACTORS MEDICAL EXAMINATION
  • 48. The Multiple Risk Factor Intervention Trial- • Lifestyle approach (changing the behaviours) But Social And Cultural Environment 48 By integrating oral health into strategies for promoting general health and by assessing oral needs in socio-dental ways, thus leading to an improvement in quality of life.
  • 49. OBESITY CANCERS HEART DISEASES RESPIRATORY DISEASE DENTAL CARIES PERIODONTAL DISEASE TRAUMA DIET ¤ STRESS ¤ CONTROL ¤ HYGIENE ¤ ¤ TOBACCO ¤ ALCOHOL ¤ EXERSISE ¤ INJURIES POLITICAL PHYSICAL SOCIAL Modified from Sheiham and Watt,2000
  • 50. CRFA APPLICATION IN INDIAN SCENARIO • Maternal and Child Health Services • School Health Services • ICDS • National Mental Health Programme • National Tobacco Control Programme • NPCDCS • Primary Health Care 50
  • 51. • National Programme for Control and Treatment of Occupational Diseases • Mid Day Meal Programme • Ksheera Bhagya 51
  • 52. 52
  • 53. CONCLUSION • For the most part, dental health promotion has been isolated from other health promotion initiatives. • The dental profession needs to adopt an integrated common risk factor approach with groups concerned about reducing NCDs. 53
  • 54. • As Dental Public health professionals, we are in a position to couple with community stakeholders to address modifiable behavioral risk factors with appropriate health promotion information. • Taking this combined approach can greatly reduce the morbidity and mortality from chronic diseases and decrease the incidence of oral diseases. 54
  • 55. 55
  • 56. EXERCISE • Which type of research study is the Framingham Heart Study? • Which type of prevention is directed at elimination of emergence of risk factors? • Which acute respiratory disease is associated with the inhalation of oral pathogens? 56 Longitudinal Study Primordial Prevention Hospital-acquired, Pneumonia.
  • 57. REFERENCES • Carol Chapman. The Common Risk Factor Approach (CRFA) to Oral Health Promotion. http://se.dentalcare.com/en- us/home.aspx Assessed on Jan 23 2018. • C. Santhosh Kumar, Shweta Somasundara Y. Common risk factor approach: finding common ground for better health outcomes. International Journal of Contemporary Medical Research 2017;4(6):1367-1370. 57
  • 58. • Abhinav Parakh et al. Strategies and Approaches in Oral Disease Prevention – A Common Risk Factor Approach. J Oral Dent Health. 2017;1(1):1-2 • Links between oral & general health. The Dental Health Foundation.https://www.dentalhealth.ie/dentalhealth/causes/general.ht ml. Assessed on Jan 24 2018 • Petersen, P. E. (2003), The World Oral Health Report 2003: continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme. Community Dentistry and Oral Epidemiology, 31: 3–24. 58
  • 59. • Sheiham A. Dietary effects on dental diseases. Public Health Nutrition 2001;4:569-91. • Bambra C, Gibson M, Sowden A, et al. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health 2010;64:284e29. • World Health Organization. (2014). Risk factors. Accessed Jan 23, 2018 59
  • 60. • Global oral health data bank. Geneva: World Health Organization; 2004. • Global oral health data bank. Geneva: World Health Organization; 2014. • Berlin-Broner Y, Febbraio M, Levin L. Association between apical periodontitis and cardiovascular diseases: a systematic review of the literature. International Endodontic Journal. 50, 847–859, 2017. • Gmel G, Rehm J. Harmful Alcohol Use. National Institute on Alcohol Abuse and Alcoholism. 60
  • 61. • Michael Roerecke and Jürgen Rehm . Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta- analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers. BMC Medicine.201412:182 • The Oral Cancer Foundation. The Alcohol Connection. Accessed Jan 19, 2018. • Miriam B. Vos et al. Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association. 2017;135:e1017-e1034 61
  • 62. • Takaaki Tomofuji et al. Relationships Between Eating Habits and Periodontal Condition in University Students. J Periodontol 2011;82(12):1642-1649. • Hooper Lee, Summerbell Carolyn D, Higgins Julian P T, Thompson Rachel L, Capps Nigel E, SmithGeorge Davey et al. Dietary fat intake and prevention of cardiovascular disease: systematic review BMJ 2001; 322 :757 • American Nutrition Association. Nutrition Digest. 2010;36(4). 62
  • 63. • National Institute Of Dental And Craniofacial Research. Part Three: What Is The Relationship Between Oral Health And General Well-being? Accessed Jan 25, 2018. • American Academy of Periodontology statement on Risk Assessment. J Periodontol. 2008;2:202. • Lertpimonchai A et al. The association between oral hygiene and periodontitis: a systematic review and meta-analysis. Int Dent J.2017; 67: 332–343 • Science Daily. American Association for Cancer Research (AACR). Poor oral health linked to cancer-causing oral HPV infection. August 21, 2013. Accessed Jan 25, 2018. 63
  • 64. • Leishman SJ, Do HL, Ford PJ. Cardiovascular Disease And The Role Of Oral Bacteria. J Oral Microbiol. 2010; 2:10. • Stoller JK: Acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 2002;346:988-994. • Mohammad S et al. Increased physical activity reduces prevalence of periodontitis. Journal of Dentistry. 2005;33,(9): 703-710 • Benjamin W. Chaffee and Scott J. Weston. Association Between Chronic Periodontal Disease and Obesity: A Systematic Review and Meta-Analysis. J Periodontol.2010;81(12):1708-1724 64
  • 65. • Conway DI, McMahon AD,, Graham L et al. The Scar on the Face of Scotland: Deprivation and Alcohol Related Facial Injuries in Scotland. Journal of Trauma. 2010;68:644–649. • Carranza, F., Newman, M. and Takei, H. Carranza's Clinical Periodontology. 10th ed. 2006. St. Louis, Mo.: Elsevier Saunders. • Park K. Textbook of Preventive and Social Medicine. 23rd Ed. 65
  • 66. 66

Editor's Notes

  • #9: Until the 1950s, epidemiologic research concentrated on the eradication of infectious diseases. Mid twentieth century, with the emergence and utilization of vaccines and antibiotics, infectious diseases came under control and were replaced by an upsurge in chronic and degenerative diseases. Researchers were discovering a substantial increase in the number of men diagnosed with cardiovascular disease (CVD). This upsurge shifted the focus of epidemiologic studies to the little known etiologic factors related to emerging chronic and degenerative diseases. One of the most famous studies of the time, the Framingham Heart Study, was a longitudinal cohort study undertaken in Framingham, MA. It began in 1948 and continues today. This unique study examined the health determinants, also known as the risk factors, associated with chronic disease.
  • #12: Negetive behaviours arise from social environments