16: Strategies for Oral Health Promotion and Disease Prevention and Control

Strategies for Oral Health Promotion and Disease Prevention and Control

M. Anjum Shah and the publisher acknowledge the past contributions of Mary Catherine Dean and Jacquelyn L. Fried to this chapter.

The promotion of oral health and the prevention of oral diseases and disease progression are the focus of dental hygiene practice. As an educator and provider of preventive and therapeutic services, the dental hygienist must use evidence-based strategies and interventions that support prevention-oriented health care. Because the success of preventive oral health programs depends on the client’s self-care behaviors, the dental hygienist must ensure client adherence to appropriate self-care regimens. This chapter focuses on the dental hygienist’s role as a facilitator of client oral health behaviors and as a provider of educational services for health promotion and oral disease prevention and control.

Oral Health Education

Basic Concepts

Initiation and progression of dental diseases depend on the interaction of host, agent, and environmental factors; thus, prevention and control of these diseases require attention to all primary and modifying factors in each category

Dental caries and the inflammatory periodontal diseases are complex disease states that require the colonization by specific pathogenic bacteria in dental plaque biofilm; none will occur in the absence of pathogenic bacteria in biofilm; thus, the control of plaque biofilm is essential in any oral disease prevention program

In dentistry, the emphasis is to prevent disease, maintain oral health, and halt disease progression

Effective preventive programs identify active disease and assess disease risk; clients at high risk for dental caries, periodontal disease, and oral lesions require multiple preventive strategies applied frequently and aggressively (see the sections on “Periodontal disease risk factors” in Chapter 14 and “Caries risk factors” in Chapter 15; see also Table 15-6)

The prevention of oral diseases requires the participation of clients with adequate knowledge of the disease process and personal level of risk, sufficiently developed skills in implementing oral care procedures, and the motivation to practice preventive behaviors over time to decrease the level of risk

Many strategies can facilitate changes in the health behaviors of clients; a grasp of the basic concepts underlying educational, motivational, and behavioral theory is necessary to understand the variables influencing a person’s oral health beliefs, attitudes, values, and behaviors

Educating clients in effective oral care practices follows the process-of-care model

Appointment Sequencing

Instructions for the control of dental plaque biofilm are given to the client before any treatment is instituted

Biofilm control instructions should be given to the client throughout dental and dental hygiene care

Stages in Making a Commitment to a New Behavior

Learning-Ladder or Decision-Making Continuum

One approach to mastering the behavior of dental plaque biofilm control is based on the concept that humans learn in a series of sequential steps, referred to as the learning-ladder continuum or the decision-making continuum2

The dental hygienist first determines the client’s entry level on the ladder and then plans for the client’s moving up the steps in sequence

Steps in the process

Trans-theoretical Model3

Learning Domains

To be considered successful, disease-control education must result in behavioral changes; once a client’s learning needs have been assessed, a plan for teaching and learning can be designed

Three domains of learning have been classified in a hierarchy and are used to specify the learning objectives:

Instructional Principles

See Table 19-14 for dental management considerations with clients who have special needs.

Effective teaching involves the direction and facilitation of learning to help make positive changes in a person’s behaviors

To maximize learning, the following principles apply to the design of an educational plan:

Visual aids enhance verbal instructions

Human Behavior Principles



Motivation theories—locus of control


Prevention-Oriented Health Models

Health Belief Model

Based on the concept that one’s beliefs direct behavior; the model is used to explain and predict health behaviors and acceptance of health recommendations; the emphasis is on the perceived world of a client, which may differ from objective reality


Cues to action—once these beliefs have been accepted, the client will act on them, when necessary; the stronger the beliefs, the greater is the potential that appropriate action will occur

Maslow’s Hierarchy of Needs

Theory about human nature that is used to explain the motivational process; Maslow suggested that inner forces (needs) drive a person to action; he classified needs in a pyramid according to their importance to the client, his or her ability to motivate self, and the importance placed on the needs being satisfied; only when a client’s lower needs are met will the client become concerned about higher-level needs; once the needs have been met, they no longer function as motivators (Figure 16-1)

Hierarchy of needs

1. Physiologic—survival needs are the most powerful and must be met before any others; include the components necessary for body homeostasis, such as food, water, oxygen, sleep, temperature regulation, and sex

2. Security and safety—these needs are required for protection against physical or psychological damage and are more cognitive than physiologic in nature; include shelter, a job for economic self-sufficiency, and a well-organized and stable environment

3. Social—once the physiologic and security needs have been met, then the needs for love and social belonging become prime motivators; include belonging to a group and having the chance to give and receive friendship and love

4. Esteem or ego—of the two categories of needs that exist at this level, one involves feelings of worth, such as competence, achievement, mastery, and independence; the other involves gaining the esteem of others and triggers learning and the desire to acquire status, power, and higher-level skills

5. Self-actualization or self-realization—these needs drive the client to reach the very top of his or her field; based on positive actions toward development, growth, and self-enhancement

Application—assessment of a client’s level of needs may aid in the identification of motivational factors that can be targeted for enhancing behavior change

Factors Influencing Client Adherence to Preventive Regimen

Client–clinician interaction

Client’s support systems

Complexity of therapy

Prevention Principles for Children

Proactive counseling of parents about anticipated developmental changes in their children

Information provided to parents or caregivers in appropriate-sized “bites” on the basis of the developmental milestone anticipated in their children

Guidance is based on the rationale that people are ready to apply information that is most relevant to them and their children

Box 16-1 provides suggestions for obtaining compliance from pediatric clients

Box 16-1

Tips for Dental Hygienists Working with Children

When a child visits your practice, your priority is to create a positive dental experience. The child is more important than his or her teeth. Incorporating the ideas from this fact sheet as you interact with children will help them become both comfortable and compliant.

Make the reception area a friendly, colorful place. Include toys, games, and videos. Books about visiting a dental office and a doll dressed as an oral health care provider will help children discuss any fears they may have

Each staff member should greet the child by name in a friendly and welcoming manner. Bend down or squat so that you are at the level of the child’s head, and listen to what he or she has to say

The treatment room should be decorated in a way that is visually assessable and appealing to children. Show the child the instruments you will be using and explain how they are used. Make everything that looks unfamiliar look friendly. For example, you might draw friendly faces on the masks used for demonstration; or, as some practitioners like to, call the suction instrument “Mr. Thirsty.” Demonstrate the buttons on the chair and how the chair moves up and down, but do not put the chair back if doing so makes the child nervous

Allow the parent into the treatment area if the child so desires, especially for the first visit. Both you and the room will look less frightening with a familiar person present

Explain exactly what you are going to do during the appointment. Use age-appropriate terms to explain why it is important that teeth be kept healthy

Turn the appointment into a game. For example, count eyes, ears, and fingers before moving on to counting teeth. Always give the child a choice of flavors. Write down preferences so that you will have all of the child’s favorites ready for the next visit. If the light shines in the child’s eyes, produce a pair of sunglasses and say how “cool” he or she looks.

Use a new toothbrush during the brushing lesson. Apply fluoride varnish. Let the child know that you are in control with a fast solution to every problem.

Praise the good, but do not criticize the bad. A child may take “these teeth don’t look so good” very personally and feel that he or she has done something wrong. Concentrate on teaching the right way to take care of teeth

Do not use tricks or lies; keep your promises. If you say “Just let me do one more thing,” do just one more thing and then let the child go. If the child will not cooperate, try again another day

When the visit is over, let the child pick a treat from a “treasure box.” Praise good behavior, and let the child give the parent(s) the “good news” about his or her teeth

Snap a picture of the child’s sparkling smile and create a gallery of photos in the office. Seeing his or her own picture is something a child looks forward to at the next appointment

Modified from American Dental Hygienists’ Association: Tips for dental hygienists working with kids [members only section, requires registration and password].

Dental Plaque Biofilm Detection

General Considerations

Because dental plaque biofilm is relatively invisible and tooth surfaces are not easily accessed, teaching clients dental disease-control skills can be challenging

Agents that make biofilm visible supragingivally can enhance the teaching–learning process by:

The presence of subgingival plaque biofilm cannot be demonstrated by using disclosing agents

The plan for disease-control education should include establishing the associations among the presence of plaque, clinical signs of disease such as bleeding, the presence of risk factors, and possible links to systemic disease

Subgingival biofilm detection by the client is best managed when the client has an understanding of the gingival sulcus (or pocket) and of the clinical changes that occur with ineffective plaque biofilm removal

Disclosing Agents

Application Methods for Disclosing Agents

Solutions are applied with a cotton swab; the tablets are chewed and swished; the client is instructed to rinse and expectorate; single-unit doses are available

The agents do not stain biofilm-free tooth surfaces unless roughness (i.e., decalcification, pitting) is present


Mechanical Plaque Biofilm Control on Facial, Lingual, and Occlusal Tooth Surfaces

Basic Concepts

Microbial population of dental plaque biofilm contributes to the initiation of dental caries and periodontal diseases

Mechanical disruption of organized plaque biofilm colonies, both supragingivally and subgingivally, is effective and widely used to prevent and control dental diseases

Toothbrushing—most widely used and effective means of controlling plaque biofilm on the facial, lingual, and occlusal surfaces of teeth

Toothbrushes are available in many shapes, sizes, and textures; new designs based on in vivo and in vitro studies, manufacturers’ claims of superior biofilm control, and consumer appeal are being marketed

The selection of the type of toothbrush should be based on the client’s needs, oral characteristics, and preferences

Special attention to subgingival plaque biofilm control in areas >3 mm is essential; toothbrushes are generally ineffective in depths >3 mm and in furca; additional tools must be selected

Toothbrushes should be replaced after 2 to 3 months of use and when filaments become bent or splayed

Clients who are immunosuppressed, debilitated, or diagnosed with a known infection and those about to undergo surgery should disinfect their toothbrushes or use disposable ones

Manual Toothbrushes


1. Parts include the handle, head, and shank; the head, or the working end, holds clusters of bristles (tufts) in a pattern

2. Design variables

3. Bristle characteristics

Desirable characteristics of toothbrushes

Factors in toothbrush selection and recommendations

Soft, multiple-tufted brushes are generally recommended on the basis of their usefulness in both supragingival and subgingival plaque disruption with minimal likelihood of trauma to soft and hard tissues; many toothbrushes have received the American Dental Association (ADA) Seal of Acceptance, the Canadian Dental Association (CDA) Seal of Recognition, or both4

Manual Toothbrushing Methods

Although the Bass (sulcular) method is widely recognized as being the most effective and most often recommended, it is helpful to know all the major methods. The method selected should disrupt both supragingival and subgingival plaque biofilm to the extent possible. The issue of gingival stimulation is of less importance than plaque control. Although a horizontal scrub technique is often used, it is not recommended because of potential trauma to hard and soft tissues.

In all of the following methods, the handle is placed parallel to the occlusal plane for posterior (facial and lingual) and anterior facial surfaces and parallel to the long axis of the tooth (using the toe of the brush) for anterior lingual surfaces. Occlusal surfaces are cleaned with a scrubbing motion.

Bass or sulcular brushing method

Stillman’s method

Roll method

Charters’ method

Fones (circular) method

Combination methods

Leonard (vertical) method

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Jan 1, 2015 | Posted by in Dental Hygiene | Comments Off on 16: Strategies for Oral Health Promotion and Disease Prevention and Control

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