Health Promotion Sessions 1 and 2

What is Public Health (CDC Foundation definition)?

The science of protecting and improving the health of entire populations (from local neighborhoods to whole countries) through promoting healthy lifestyles, researching disease/injury prevention, and detecting/preventing/responding to infectious disease.

What is Dental Public Health (ADA definition)?

The part of dentistry providing leadership in population-based dentistry, oral health surveillance, policy development, community-based prevention/health promotion, and maintaining the dental safety net — it treats the community as the patient, not the individual.

What is the "change in focus" progression in dental public health?

Procedures → People → Populations → Programs → Policy.

What are Social Determinants of Health (SDOH)?

The conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks (Healthy People 2020).

What are the 5 major SDOH categories highlighted in lecture?

Education, Economic Stability, Neighborhood/Physical Environment, Health Care System, and Food/Community & Social Context.

What does the Fisher-Owens (2007) multi-level conceptual model add to oral health thinking?

It expands oral health beyond individual-level factors to include family and community levels of influence, across 5 domains: genetic/biological, social environment, physical environment, health behaviors, and dental/medical care.

What is the Keyes Diagram (1963)?

A model showing dental caries as the product of 3 overlapping circles — Host (tooth), Microflora (bacteria), and Substrate (diet) — all converging simultaneously; Time is often added as a 4th necessary factor.

What does the Fisher-Owens (2007) diagram structure look like?

Nested rings, with genetic/biological factors at the center (individual), surrounded by expanding layers for family and community, with the 5 determinant domains (biology, social environment, physical environment, health behaviors, dental/medical care) cutting across all levels.

What is Health Promotion (VicHealth definition)?

The process of enabling people to increase control over and improve their health; it engages populations in everyday life and focuses on community factors that support wellbeing rather than targeting only at-risk individuals.

What are the 3 levels at which Health Promotion can operate?

Individual level, community level, and state/federal level.

What are examples of Health Promotion activities?

Communication, education, and advocacy for policy/systemic/organizational change (e.g., Folic Acid campaign, Know Your Lemons, The Truth Campaign, community water fluoridation).

What is Prevention (WHO framing)?

Population- and individual-based interventions aiming to minimize the burden of disease and associated risk factors.

What is Primary Prevention?

Actions aimed at avoiding the manifestation of a disease before it occurs.

What is Secondary Prevention?

Early detection of disease when detection improves the chances of a positive health outcome.

What is Tertiary Prevention (per the Upstream-Downstream analogy)?

The "rescue team" — intervention after harm/disease has already occurred, aimed at reducing further damage or disability.

In the Upstream-Downstream walking-safety analogy, what does each level represent?

Health promotion = media campaign on walking safely; Primary prevention = warning sign; Secondary prevention = net before the rapids; Tertiary prevention = rescue team.

What is the core conceptual difference between Health Promotion and Prevention?

Health promotion increases/maintains "health capacity" (like charging your phone battery); prevention slows the loss of health capacity (like closing apps to save battery) — prevention does not add capacity, it just reduces its loss.

How do you distinguish whether a targeted activity is Health Promotion or Prevention?

Check if it targets a high-risk population/behavior specifically — generalized/widespread programs (e.g., Let's Move!) are Health Promotion, while programs targeting high-risk groups (e.g., needle exchange for IV drug users) are Prevention.

What is a "Cue to Action" in the Health Belief Model?

An event, person, or thing that triggers a person to change health behavior (e.g., advice from others, a family member's illness, social media, or internal cues like chest pain or fatigue).

What are common challenges to implementing Health Promotion and Prevention programs?

Gathering sufficient evidence, translating evidence into effective communication, identifying sustainable interventions, expanding from individual to community/policy level, and building community trust.

What is the "Social Contract" (general definition used in lecture)?

An implicit agreement among members of society to cooperate for social benefit, sometimes sacrificing individual freedom for state protection (theorized by Hobbes, Locke, Rousseau).

What does society expect from medicine under the social contract (Cruess 2006)?

Competence, altruistic service, morality/integrity, accountability, transparency, objective advice, and promotion of the public good.

What does medicine expect from society under the social contract (Cruess 2006)?

Trust, autonomy, self-regulation, a value-driven and adequately funded health care system, participation in public policy, shared responsibility for health, and both financial and non-financial rewards.

What percentage of surgically repaired caries lesions relapse within 2 years (per lecture)?

Up to 66% relapse within 2 years, illustrating that surgical repair alone doesn't address the underlying disease process.

What is the key takeaway about surgical repair and dental caries?

Dental caries is largely unaffected by surgical repair — filling a cavity removes decayed tissue but does not treat the underlying disease (diet/bacteria/behavior) driving future caries.

What is the difference between a "dental cavity" and "dental caries"?

A dental cavity is the physical hole/cavitation in the tooth (a sign); dental caries is the underlying disease process that causes it.

List the defining characteristics of dental caries as a disease process.

Chronic, transmissible, progressive, diet-dependent, fluoride-mediated, reversible (to a point), consequential, and largely unaffected by surgical repair.

What is Epidemiology?

The study of the prevalence and spread of disease — who gets it, how many get it, and how they're getting it.

According to NHANES (2011–2016), what percentage of US adults (20–64) have caries experience?

91% of adults 20–64 have had dental caries in their permanent teeth.

According to NHANES, what percentage of US adults (20–64) have untreated decay?

27% have untreated decay.

Which populations show more untreated decay per NHANES data?

Black and Hispanic adults, younger adults, and those with lower income/less education.

How did mean number of affected teeth change between 1999–2004 and 2011–2016?

It decreased from 8.2 to 7.4, mainly due to fewer filled teeth rather than any change in untreated decay.

What are the 3 Primary Etiological Factors of dental caries?

Cariogenic bacteria, fermentable carbohydrate diet, and a susceptible tooth (plus time as a factor).

What is a Biofilm?

A community of microorganisms growing on a surface that expresses properties not seen in the same organisms grown individually.

What is Dental Plaque?

A biofilm that forms naturally on the tooth surface, consisting of a mixed community of microbes embedded in an extracellular matrix of bacterial and salivary polymers.

What are the most common cariogenic bacterial species in dental plaque?

Streptococcus mutans (mutans streptococci) and Lactobacillus rhamnosus (lactobacilli).

What are the 3 domains assessed in Caries Risk Assessment?

Biological (bacterial load, development), Environmental (carbohydrate/diet, saliva/buffering capacity), and Behavioral (fluoride exposure, home care, dental home).

What is the Cariogram?

A computer program that generates a graphical, weighted-algorithm picture of overall caries risk based mainly on biological input factors, and suggests preventive/treatment strategies; pro: comprehensive; con: costly/time-consuming due to salivary microbiological testing.

What is the AAPD Caries-Risk Assessment Tool (CAT)?

A one-page, age-based form assessing biologic/behavioral factors, protective factors, and clinical findings, with separate versions for ages 0–5 and 6+ and for dental vs non-dental professionals.

What is the ADA Caries-Risk Assessment Tool (CAT)?

A one-page questionnaire rating patient risk as low/medium/high using factors like fluoride exposure, diet, caries experience of family, dental home, and visible plaque.

What is a shared limitation of CAT, CAMBRA, and Cariogram tools?

They are point-in-time assessments that have not been clinically validated as predictive of future caries incidence.

What is CAMBRA?

Caries Management by Risk Assessment — for infants/toddlers, combines parent/caregiver interview, child exam, risk-level assignment, and bacterial cultures if indicated, with preventive recommendations based on risk.

What is the "Caries Balance" concept (Featherstone 2008)?

Dental caries results from a continuum of repeated demineralization/remineralization cycles; whether caries progresses, reverses, or stays balanced depends on the interplay of pathological vs. protective factors.

What is remineralization?

The natural repair process for non-cavitated lesions, relying on calcium and phosphate ions (assisted by fluoride) to rebuild a new surface on existing crystal remnants.

What is the Stephan Curve?

A plot of dental plaque pH over time showing the fall and subsequent rise in pH after plaque is exposed to fermentable carbohydrates.

What is the "critical pH" and why is 5.5 accepted as its value?

The pH below which enamel demineralizes; 5.5 is accepted because below this the oral environment is no longer saturated with enamel minerals.

What is the resting pH of dental plaque, and how quickly/how long does it take to fall and recover after sucrose exposure?

Resting pH is 6.5–7.0; it can fall below 5.5 within 2–5 minutes of sucrose exposure, with a slow recovery of 30–60 minutes.

Why does frequency of sugar exposure matter more than total sugar amount for caries risk?

Each exposure triggers a new demineralization dip on the Stephan Curve; frequent exposures keep plaque pH below the critical threshold for longer, tipping the caries balance toward net mineral loss.