Advertisement

Public Health Ansätze zur Förderung der Zahngesundheit

  • Aubrey Sheiham
Article
  • 90 Downloads

Abstract

Zahnerkrankungen sind die häufigsten chronischen Erkrankungen, und der Mund ist der in der Behandlung teuerste Teil des Körpers in Dentschland. Da diese Erkrankungen trotz vorhandener wissenschaftlich-epidemiologischer Basis zu deren Prävention noch immer weit verbreitet sind, werden alternative Ansätze unter Verwendung von Public-Health-Prinzipien benötigt. Die Wurzeln des Problems liegen in der Dominanz des restaurativen Ansatzes, der nicht evidenz-basiert ist, und in einem ideologischen Glauben an die risikoorientierte Strategie mit ineffektiver individueller Zahngesundheitserziehung. Anstelle dieser Vorgehensweisen solite ein Public-Health-orientierter populationsbasierter Ansatz unter Nutzung des Konzeptes allgemeiner Risiken und von Prinzipien der Gesundheitsförderung verwendet werden. Gesundheitsförderung verändert die Lebensbedingungen so, dass die gesunden Handlungsmöglichkeiten die einfacheren werden und die ungesunden schwieriger umzusetzen sind. Die meisten chronischen Krankheiten haben die gleichen Ursachen und in Gruppen einzuordnende Risikofaktoren. Menschen mit einer ungesunden Ernährung trinken und rauchen häufig auch stark, leben risikoreicher und haben weniger körperliche Aktivität. Alie diese Risikofaktoren sind auch mit Zahnerkrankungen assoziiert. Die Unterteilung des Körpers in einzelne Bereiche ist irrational. Menschen haben nicht ein spezielles Zahngesundheitsverhalten, das vom allgemeinen Gesundheitsverhalten getrennt werden kann. Um das Verhalten zu verändern, muss die Umwelt verändert werden. Dieses erfordert gesetzliche, finanzpolitische und ökonomische Interventionen. Dental Public Health solite in andere Public Health-Ansätze integriert werden.

Schlüsselwörter

Dental Public Health Strategic allgemeines Risiko gesamte Population Gesundheitsförderung 

Public health approaches to promoting dental health

Abstract

Dental diseases are the most common chronic diseases and the mouth is the most expensive part of the body to treat in Germany. The persistence of high levels of dental diseases despite the availability of a scientific epidemiological basis for preventing them suggests that alternative approaches using public health principles are needed. The dominance of the restorative approach, which is not based upon evidence, and an ideological belief in the high-risk strategy using ineffective individualised dental health education, lies at the root of the problem. Instead, a public health ‘directed population based approach’ using the concept of common risk, and health promotion principles, is advocated. Health promotion alters the environment so that healthier choices are the easier choices and unhealthy ones, more difficult. The causes of most chronic diseases are common to a number of them and the risks are grouped. People who have a poorer diet, smoke and drink excessively and take more risks and less exercise. All those risk factors are associated with dental diseases. Compartmentalising the body is irrational. People do not have dental health behaviours separate from general health behaviours. To change behaviours, change the environment. That requires legal, fiscal and economic interventions. Dental public health should be integrated with other public health approaches.

Keywords

dental public health strategy common risk whole population health promotion 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Brown, L. (1994). Research in dental health education and health promotion: a review of the literature. Health Educ Quart, 21, 83–102.Google Scholar
  2. Department of Health and Social Security. (1986). Report of the Committee of Enquiry Into Unnecessary Dental Treatment. London: HMSO. p. 58–59.Google Scholar
  3. Elderton, R.J. (1977). The quality of amalgam restorations. In Allred H.A.. (ed). Series of monographs in the assessment of the quality of dental care, p 45–79. London: London Hospital Medical College.Google Scholar
  4. Grabauskas, V. (1987). Integrated programme for community health in noncommunicable disease (Interhealth). In: Leparski E, (ed). The prevention of non-communicable diseases: experiences and prospects, p. 285–310. Copenhagen: World Health Organization Regional Office for Europe.Google Scholar
  5. Green, L./Kreuter, M.( 1990). Health promotion as a public health strategy for the 1990s. Ann Rev Pubi Health, 11, 319–334.CrossRefGoogle Scholar
  6. Heners, M. (2000). Dentistry as a scientific discipline. In: Evidence-Based Dentistry. Evidenz-basierte Medizin in der Zahn-, Mund- und Kieferheilkunde. Eds Winfried Walthur/ Wolfgang Micheelis), p 34–40. Köln München: Deutscher Zahnärtzte Verlag DÄV-Hanser.Google Scholar
  7. Kay, L./Locker, D. (1996). Is dental health education effective? A systematic review of current evidence. Community Dent Oral Epidemiol, 24, 231–235.PubMedCrossRefGoogle Scholar
  8. Kohlmeier, L./Kroke, A./Pötzsch, J./Kohlmeier, M./Marin, K. (1993). Ernährungsabhängige Krankheiten und ihre Kosten. Baden-Baden: Nomos Verlagsgesellschaft, 327–328.Google Scholar
  9. Marthaler, T.M./O’Mullane, D.M.O./Vrbic, V. (1996). The Prevalence of Dental Caries in Europe 1990-1995. Caries Res, 30, 237–255.PubMedCrossRefGoogle Scholar
  10. Mautsch, W. (1995). Oral health in a multisectoral approach. In: Promoting Oral Health in Deprived Communities.(Eds. W. Mautsch and A Sheiham), p. 267–282. Berlin: Deutsche Stiftung fur Internationale Entwickling.Google Scholar
  11. McKeown, T. (1979). The Role of Medicine medicine dream, mirage or nemesis? Oxford: Basil Blackwell.Google Scholar
  12. Milio, N. (1986). Promoting health through public policy. Ottawa: Canadian Public Health Association, 1984, 11.Google Scholar
  13. Moyses, S.T. (2000). The impact of health promotion policies in schools on oral health in Curitiba, Brazil. PhD Thesis. London: University College London.Google Scholar
  14. Multiple Risk Factor Intervention Trial Research Group. (1982). Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results. J Am Med Assoc, 248, 1465–76.CrossRefGoogle Scholar
  15. Nadanovsky, P./Sheiham, A. (1995). The relative contribution of dental services to the changes in caries levels of 12 year-old children in 18 industrialized countries in the 1970s and early 1980s. Community Dent Oral Epidemiol, 23, 231–239.CrossRefGoogle Scholar
  16. Nadanovsky, P./Sheiham, A. (1994). The relative contribution of dental services to the changes and geographical variations in caries status of 5- and 12-year-old children in England and Wales in the 1980s. Community Dental Health, 11, 215–223.PubMedGoogle Scholar
  17. Pickerill, H.P. (1923). The prevention of dental caries and oral sepsis, 3rd edition, London: Bailliere Tindall and Cox.Google Scholar
  18. Reich, E. (2000). Evidence-based dentistry in caries therapy. In: Evidence-Based Dentistry. Evidenz-basierte Medizin in der Zahn-, Mund- und Kieferheilkunde. Eds Winfried Walthur/ Wolfgang Micheelis, p. 171 - 185. Köln München: Deutscher Zahnärtzte Verlag DÄV-Hanser.Google Scholar
  19. Richards, D. (2000). Use of best evidence in making decisions: a challenge for the scientist and practitioner. In: Evidence-Based Dentistry. Evidenz-basierte Medizin in der Zahn, Mund- und Kieferheilkunde. Eds Winfried Walthur/ Wolfgang Micheelis, p 53–63. Köln München: Deutscher Zahnärtzte Verlag DÄV-Hanser.Google Scholar
  20. Rodrigues, C./Watt, R./Sheiham, A. (1999). The effects of dietary guidelines on sugar intake in 3 year olds attending nurseries. Health Promotion International 14, 329–335.CrossRefGoogle Scholar
  21. Rose, G. (1993). The Strategy of Preventive Medicine, Oxford University Press.Google Scholar
  22. Schiffner, U./Reich, E. (1999a): Karies/Füllungen bei den Jugendlichen. In: Micheelis, W.; Reich, E.; Institut der Deutschen Zahnärzte (ed.): Dritte Deutsche Mundgesundheitsstudie (DMS III). Ergebnisse, Trends und Problemanalysen auf der Grundlage bevölkerungsreprasentativer Stichproben in Deutschland 1997, p. 206. Köln,Google Scholar
  23. Schiffner U./Reich, E. (1999b). Karies/Füllungen bei den Erwachsenen. In: Micheelis, W.; Reich, E.; Institut der Deutschen Zahnärzte (ed.): Dritte Deutsche Mundgesundheitsstudie (DMS III). Ergebnisse, Trends und Problemanalysen auf der Grundlage bevölkerungsrepräsentativer Stichproben in Deutschland 1997. p. 250. Köln.Google Scholar
  24. Schneider, M./Beckmann, M./Biene-Dietrich./Gabanyi, M./Hofmann U./Köse A./Mill D./Späth B. (1998). Augsburg: Gesundheitssysteme im internationalen Vergleich. Eigenverlag. p. 142-143.Google Scholar
  25. Schou, L./Wight, C. (1994). Does dental health education affect inequalities in dental health? Community Dent Health, 11, 97–100.PubMedGoogle Scholar
  26. Sheiham, A. (1997). The impact of dental treatment on the incidence of dental caries in children and adults. Community Dent & Oral Epidemiol, 25, 104–12.CrossRefGoogle Scholar
  27. Sheiham A. (1996). Oral Health Policy and Prevention. In: The Prevention of Oral Disease. Ed. J.J. Murray, Third Edition, Oxford: Oxford University Press, p.234–249.Google Scholar
  28. Sheiham, A. (1995). Assessment of the role of Western dentistry. In: In: Promoting Oral Health in Deprived Communities.(Eds. W. Mautsch and A Sheiham), p.l19- 136. Berlin: Deutsche Stiftung fur Internationale Entwickling.Google Scholar
  29. Sheiham, A. (1991). Public health aspects of periodontal diseases in Europe. J Clinical Periodontol, 18, 362–369.CrossRefGoogle Scholar
  30. Sheiham, A./Joffe, M. (1992). Public dental health strategies for identifying and controlling dental caries in high and low risk populations. In: Johnson NW ed. Risk Markers for Oral Diseases. Volume 1. Dental Caries: Markers of High and Low Risk Groups and Individuals, p. 445–81. Cambridge: Cambridge University Press.Google Scholar
  31. Sheiham, A./Watt, R.W. (2000). The Common Risk Factor Approach: a rational approach for promoting oral health. Community Dent & Oral Epidemiol In pressGoogle Scholar
  32. Smedley, B.D./Syme, S.L. (2000). Promoting Health. Intervention strategies from social and behavioral research. Washington, DC: National Academic Press.Google Scholar
  33. Sprod, A./Anderson, R. (1996). Treasure E. Effective oral health promotion. Literature Review. Cardiff: Health Promotion Wales.Google Scholar
  34. Watt, R.G./Daly, B./Fuller, S. (1996). Strengthening oral health promotion in the commissioning process. Manchester: Eden Bianchi Press.Google Scholar
  35. Watt, R./Fuller, S. (1999). Oral health promotion—opportunity knocks! Br Dent J, 186, 3–6.PubMedCrossRefGoogle Scholar
  36. Watt, R.G./Sheiham A. (1999). Inequalities in oral health: A review of the evidence and recommendations for action. Br Dent J, 187, 6–12.PubMedCrossRefGoogle Scholar
  37. World Health Organization. (1984). Health Promotion. A discussion document on the concept and principles. Copenhagen: World Health Organization Regional Office.Google Scholar
  38. World Health Organization. (1998). Health Promoting Schools; a healthy setting for living, learning and working. Geneva: World Health Organization.Google Scholar
  39. World Health Organization. (1986). The Ottawa Charter for Health Promotion. Health Promotion 1. iii-v. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer-Verlag 2001

Authors and Affiliations

  1. 1.Department of Epidemiology and Public Health University College LondonMedical SchoolLondon

Personalised recommendations