Protean aspects of preventive dentistry

Abstract

Prevention of disease has many as­ pects and represents the highest calling of the health professions. Elimination of pain and suffering is the goal of practitioners of the heal­ ing arts, and preventive methods should dominate efforts to achieve this goal. Restorative and corrective surgical procedures should ultimate­ ly be historical reminders of man’s lack of knowledge as he attempted to understand disease processes. The practice of dentistry was founded on the treatment of two of the most common human ailments— dental caries and periodontal dis­ ease. Dentists are to be commended for their past and present efforts to curtail these diseases by preventive measures. Through years of educa­ tional effort, they have convinced many people of the value of oral hy­ giene, periodic professional exam­ ination, and treatment to prevent serious oral disease. Universal ac­ ceptance of these services is a con­ tinuing goal. The dentist’s responsibility must include the prevention of ailments other than dental caries and perio­ dontal disease. Periodicdental exam­ ination may reveal oral signs that are the earliest manifestations of dis­ eases affecting other organs and sys­ tems. Early treatment of many of these diseases may prevent pain and suffering, impoverishing expense of protracted treatment, or early death. Increasing numbers of dentists are routinely performing screening tests on all patients to fulfill their respon­ sibility to diagnose any disease that may influence dental treatment or produce changes in oral tissues. A hematologic examination, urinalysis, and blood pressure reading are some of the necessary components of a complete preventive dentistry pro­ gram. The use of intraoral mouthguards and face masks by athletes is an out­ standing example of how simple methods can prevent serious dental pain and disability. Mouthguards pre­ vent injuries not only to oral tissues but can prevent neurologic disorders such as concussion, and peripheral nerve dysfunction resulting from in­ jury to cervical vertebrae. Automobile accidents usually pro­ duce oral and facial injuries. Many of these can be prevented by the use of restraining seat belts and shoulder harnesses. Dentists must be active supporters of campaigns to promote the use of these safety devices. Some of the fatal diseases within the dentist’s realm of responsibility are oral malignancies. Most oral can­ cer can be cured if it is detected and treated when the primary lesion is small. Unfortunately, the death rate as a result of oral cancer remains high. Good preventive dentistry prac­ tice must include an awareness of the incidence of oral cancer, the ability to recognize primary lesions, and skill in performing the procedures necessary to detect and diagnose oral cancer. In addition, dentists must participate in educational and massscreening programs to increase pub­ lic awareness of the cancer problem. Tobacco is a cause of both oral cancer and cardiovascular disease, and it contributes to the pathogene­ sis of non-neoplastic disease of the periodontium. A dentist must advise his patients about the hazards of us­ ing tobacco and actively campaign to curtail its use by the general public. Many valuable preventive proce­ dures are practiced that are not given the same recognition as the proce­ dures used for plaque control. Interceptive orthodontic treatment may prevent disfiguring or disabling mal­ occlusion. Severe xerostomia and its complications may be prevented by shielding salivary glands that lie in the path of a therapeutic beam of radiation. Fatal or crippling bacter­ emia may be prevented by using an antiseptic lavage to cleanse perio­ dontal tissues before oral surgery. This list of examples can be extended merely by applying the true meaning of prevention to all aspects of en­ lightened dental practice. Preventive dentistry has many as­ pects. The ubiquity of dental caries and periodontal infection demands most of the time devoted to preven­ tive measures. This should not ob­ scure the realization that the practice of dentistry must include the preven­ tion of all conditions that either affect oral tissues or influence dental treat­ ment.