1 The Basisc of Hygiene in Dentistry: Assoc. Prof. Jindřich Fiala • •Dept. of Public Health C:\WINDOWS\Profiles\tom\Plocha\LOGOSUPP.PCX •Prevention (types, goals, methods). • •Preventable risk factors in cardiovascular and oncologic diseases. 2 n n 3 Subject scope nThe basic general principles and methods of health protection nNon-infectious factors affecting health (environmental, occupational, nutritional and other lifestyle factors…) n n nInfectious factors (infectious epidemiology) 4 Exam questions (topics) nA) Hygiene and preventive medicine – 15 questions n n nB) Epidemiology of infectious disease – 22 questions nFor the exam, every student picks randomly one A-question and one B-question 5 n n E:\000000000\Angl.zubaři\Beze jména.jpg 6 n n E:\000000000\Angl.zubaři\Beze jména 2.jpg 7 n n E:\000000000\Angl.zubaři\Beze jména 3.jpg 8 n n E:\000000000\Angl.zubaři\Beze jména 4.jpg 9 Why? n 10 5 Reasons for teaching Hygiene and Preventive Medicine in Dentistry: 1.Prevention works also in dentistry 2.Oral health is greatly influenced by factors like nutrition, smoking, hygiene, infections….) 3.Oral health is closely connected with main diseases and their risk factors 4.Occupational hygiene (physical and chemical factors): risks both for medical staff and patients 5.Infections (respiratory, parenteral): risks both for medical staff and patients n 11 Determinants of health Hereditary dispositions (genotype) Health External influences (including lifestyle) 12 On what depends, how healthy we are Inherited dispositions Health Environment (air pollution, water quality, noise, chemicals, etc.) (up to 5 %) Health Care (quality, availability, effectiveness) up to 20% Lifestyle factors (70%) Time (age) Socioeconomic factors 13 Health determinants Genetic basis Risk factors •The result depends on the balance •ILLNESS - HEALTH? Protective factors 14 Progress of individual health– different combinations of genetics ans lifestyle Time, age Health Disease Serious illness, death Youth Excellent health (condition) Elderly Excellent genotype + very healthy lifestyle Excellet genotype + very unhealthy lifestyle Bad genotype + healthy lifestyle Bad genotype + unhealthy lifestyle 15 15 Health protection and promotion 1)Protection against harmful external influences 2)Health promotion a)Environmental (physical, chemical, biological) b)Harms mediated by bad lifestyle a)Healthy lifestyle b)Medical promotion of imunity 16 Hygiene, preventive medicine, epidemiology Hygiene: nEnvironment and its impact on health (living conditions, work…) Preventive medicine: nHealth protection, disease prevention, health promotion Epidemiology: nStudy of the distribution and determinants of diseases 17 TYPES OF PREVENTION Principle: Prevention levels Primary •Secondary •Prevent the origin of ilness – by eliminating the causes of disease and/or by promoting the resistence •Early diagnosis of disorder, interruption of the development of the disease before the symptomatic stage •Terciary •Reduce the progression of disease, prevent new attacs of disease Kotulán: Introduction 18 Levels of prevention a) primary, b) secondary, c) tertiary l a. Primary prevention is the prevention of disease or injury. Primary prevention activities can be directed at individuals or at the environment. (1) Health education: encouraging people to develop good health habits (nutrition, exercise), to avoid harmful substances (alcohol, tobacco, drug abuse) and harmful circumstances (driving while intoxicated) and to use specific protective measures (e.g., immunizations, condom use). (2) Environmental modification can decrease injuries from falls, fires, or automobile accidents. Environmental sanitation is used to provide an adequate sewage system, safe drinking water, clean air, and environment free of toxic substances. Kotulán: Introduction 19 b. Secondary prevention l is the early detection and prompt treatment of disease. (1) Screening programs are used to detect diseases in early preclinical stages, when effective therapy may either cure the disease or limit its progression (e.g., neonatal detection of phenylketonuria, the Pap test to detect in situ carcinoma of the cervix, glaucoma testing). (2) Primary medical care is the predominant form of secondary prevention. Most health expenses are spent on, and most health care personnel are employed in, primary care. c. Tertiary prevention is the limitation of disability and the rehabilitation from disease. It emphasizes a person’s remaining abilities and attempts to restore the person to as normal a life as possible. 20 20 2 strategies in prevention: nPopulation approach nIndividual approach (also „high risk strategy“) 21 What belongs to primary prevention nVaccination nOccupational hygiene nEnvironmental hygiene (air, water, noise, radiaton…) nCommon hygiene (transmission of infections) nFood safety nLifestyle: nNo-Smoking nHealthy diet nPhysical activity 22 What belongs to secondary prevention nScreening, preventive check-ups with the aim of early diagnosis 23 Cardiovascular diseases – epidemiology, risk factors (etiology), prevention • 24 Mortality structure Cardio-vascular 52% Cancer 26% Injuries 7% Other 6% Respiratory 5% Digestive 4% 25 AHD0501-01-07-001 •Severe pain by myocardial infarction 26 nMyocardial infarction nStroke Clinical consequences of atherosclerosis: Atherosclerosis = Cardiovascular dieseases Common denominator, and the principal cause of the main cardiovascular diseases 27 Development of atheroslerosis in type ( it takes40-50 years) AHD1004-01-031 28 Causes of atherosclerosis Lifestyle factors § Diet - rich in saturated fats, cholesterol and energy § Smoking § Physical inactivity § Alcohol – high consumption § High blood Cholesterol § High Blood Pressure § Overweight, obesity § Trombogenic factors Main modifiable risk factors § Diabetes, elevated blood sugar (Modifiable directly (Modifiable undirectly, secondarily) Physiologic characteristics 29 Smoking nThe single most important risk factor for cardiovascular diseases (and cancer) n Basicaly very easy modifiability n Harms even in the smallest dose 30 Prevention of cardiovascular diseases by diet § People should be able to choose healthy foods and compose healthy diet for lowering the risk of atherosclerosis 31 Food, diet and the risk of atherosceloris – what matters: § Fats – mainly their composition § Too much energy § Protective substances (phytochemicals) nSaturated FA (animal fat in meat, milk fat, coconut…) nUnsaturated FA (in plant oils, fish) - MUFA – Mono Unsaturated - PUFA – Poly Unsaturated FA - „Trans“ fatty acids (in cheap pastries etc.) § Cholesterol in food (but this is not the most important factor) (different types of fatty acids): 32 Diet for prevention of CVD: § Diet must be varied § Energy intake to maintain BMI in the range 18.5 - 25 nFruits and vegetables nWholegrain cereals and breads nLow-fat dairy products § Promote the consuption of following foods: § Fish and omega-3 FA especially protect against CVD § Fats: nFats should acount for 25-35% of energy intake nSaturated – up to 7% of total energy intake nDietary cholesterol < 200mg / day nSaturated fats should be replaced by carbohydrates and MUFA+PUFA The effect of physical activity on cardiovascular risk factors Lifestyle factors § Diet - rich in saturated fats, cholesterol and energy § Smoking § Physical inactivity § Alcohol – high consumption Physiologic characteristics § High blood Cholesterol § High Blood Pressure § Overweight, obesity § Trombogenic factors § Diabetes, Glucose intolerance § Low cardiorespiratory fitness 34 Recommendations of physical activity nPractice physical activity on regular basis: Preferably daily Frequency: (how often) Length - duration: (of 1 session) >30 minutes Intensity: Moderate to Vigorous (60-80 % of max. HF) Type of activity: Endurance, aerobic •Max.HF (Heart Frequency) = 220 - age 35 Blood cholesterol nTotal cholesterol (TC) nLDL-cholesterol (LDL-C) nHDL-cholesterol (HDL-C) < 5 mmol/l, by hi-risk < 4,5 mmol < 3 mmol/l, by hi-risk < 2,5 mmol > 1 mmol/l (the higher, the better) 36 Body weight, fatness BMI 18,5 - 25 Weight [kg] / (Height)2 [m] nMaintan the balance between energy intake a output to keep Underweight Normal weight Overweight Obesity < 18,5 18,5 - 25 25 - 30 > 30 37 Blood pressure < 120 Systolic Diastolic Category < 80 120 - 129 80 - 84 85 - 89 > 90 130 - 139 > 140 Optimal Normal High normal Hypertension 38 Cancer • Incidence and mortality according to cancer sites C:\Users\jfiala\Desktop\VÝUKA\Rakovina - příprava, mustry\výskyt nádorů.jpg 40 Main risk factors • Causes of cancer Cancer Causes 41 obr Anand et al. (2008) 42 Attributive part of overall cancer mortality 0 5 10 15 20 25 30 35 40 % Smoking Diet 30 % Alcohol Infections Radiation (including Sun) Occupational exposures Chemical pollution and residuals 35 % 5 % Modifiable factors cause 90-95 % of all cancers! Cancer causes Physical inactivity 5 % 43 C:\Users\jfiala\Desktop\VÝUKA\15 - výuka podzim 2015\příčiny rakoviny - obrázky\Beze jména.jpg 44 Smoking and cancer risk nThe most important single cause of cancer (It causes approx. 30% of all cancer deaths) nThere are approx. 60 proved human carcinogens in cigarette smoke (!!!) nCigarettes classified as Carcinogen class I (=proved human carcinogen) nProvably causes cancer of 19 sites (!!!) And normally, freely being sold ?????? Kouření a rakovina 45 C:\Users\jfiala\Desktop\VÝUKA\15 - výuka podzim 2015\příčiny rakoviny - obrázky\cances caused by smoking.jpg Cancer sites with evidence of carcinogenity of smoking (Secretan 2009) 46 1.Mouth 2.Oropharynx 3.Nasopharynx 4.Hypopharynx 5.Oesophagus 6.Stomach 7.Colorectum 8.Liver 9.Packreas 10.Nasal cavity and paranasal sinuses 11.Larynx 12.Lung 13.Cervix uteri 14.Ovarium 15.Bladder 16.Kidney 17.Ureter 18.Bone marrow (myeloid leukemia) 19.Breast (limited evidence) Infekce 47 C:\Users\jfiala\Desktop\VÝUKA\15 - výuka podzim 2015\příčiny rakoviny - obrázky\infekce 2b.jpg Infekce 48 C:\Users\jfiala\Desktop\VÝUKA\15 - výuka podzim 2015\příčiny rakoviny - obrázky\kůže.jpg Diet and the risk of cancer •49 50 • Summary I – dietary factors with CONVINCING evidence of effect on cancer risk: C:\Users\jfiala\Desktop\VÝUKA\09 - výuka podzim 2012\Angl.zubaři\summary I - convincing.jpg 51 • Summary II – dietary factors with PROBABLE evidence: C:\Users\jfiala\Desktop\VÝUKA\09 - výuka podzim 2012\Angl.zubaři\summary II - probable.jpg 52 • C:\Users\jfiala\Desktop\VÝUKA\14 - výuka jaro 2015\Cz - medici\Rakovina - příprava\01 - common cancers.jpg And what is without any substantial effect on cancer risk (both adverse or favourable: 53 n„E-numbers“ in food nPesticide and other chemicals residuals in food nArtificial sweeteners nGreen tea, black tea nCoffee nSuplemments, pills againts cancer (vitamin etc.) nOrganic food (no other effect on cancer than normal foods) n n C:\Users\jfiala\Desktop\VÝUKA\Rakovina - příprava, mustry\mustry tabulek pro powerpoint -angl\physical activity.jpg Physical activity C:\Users\jfiala\Desktop\VÝUKA\15 - výuka podzim 2015\příčiny rakoviny - obrázky\obezta a pohyb.jpg 56 • C:\Users\jfiala\Desktop\VÝUKA\14 - výuka jaro 2015\Cz - medici\Rakovina - příprava\50 % can be prevented.jpg