DEFINITION “Actions directed to preventing illness and promoting health to reduce the need for secondary or tertiary health care. Mosby’s Medical dictionary, 8th edition, 2009 “The action of stopping something from happening or arising”. Oxford English Dictionary. Lexico 2020 GOALS OF PREVENTION To promote health To preserve health To restore health when it is impaired To minimize suffering and distress Successful prevention depends upon: a knowledge of causation dynamics of transmission identification of risk factors and risk groups availability of prophylactic or early detection and treatment measures, LEVELS OF PREVENTION 1) Primordial Prevention 2) Primary Prevention 3) Secondary Prevention 4) Tertiary Prevention PRIMORDIAL PREVENTION It is the prevention of emergence or development of risk factors in countries or population groups in which they have not yet appeared. Main intervention is through individual and mass education. Eg: Efforts directed towards discouraging children from adopting harmful lifestyles. PRIMARY PREVENTION “Primary prevention can be defined as the action taken prior to the onset of disease, which removes the possibility that the disease will ever occur.” Intervention is in the pre- pathogenesis phase of a disease or health problem. The WHO has recommended the following approaches for the primary prevention of chronic diseases where the risk factors are established: – A) Population (mass) strategy B) High -risk strategy SECONDARY PREVENTION Definition “ An Action which halts the progress of a disease at its incipient stage and prevents complications.” Modes of intervention – Early Diagnosis and Specific treatment The health programmes initiated by governments are usually at the level of secondary prevention. Advantages: Important in reducing the high mortality and morbidity of certain diseases like hypertension, cancer cervix and breast cancer. Disadvantages: More expensive and less effective than primary prevention. Patient is already subjected to mental anguish, physical pain; TERTIARY PREVENTION It is defined as “all the measures available to reduce or limit impairments and disabilities, and to promote the patients adjustment to irremediable conditions”. It is the intervention in the late pathogenesis phase. Treatment, even in late stages of disease, may prevent sequelae and limit disability. Modes of Intervention - Disability limitation and Rehabilitation. MODES OF INTERVENTION “Intervention” can be defined as any attempt to intervene or interrupt the usual sequence in the development of disease in man. 5 modes of intervention 1. Health promotion 2. Specific protection 3. Early Diagnosis and treatment 4. Disability limitation 5.Rehabilitation CONCLUSION To initiate preventive measures it is not necessary to know everything about natural history of the disease. Main objective of preventive medicine - to intercept or oppose the “cause” and thereby the disease process

1. By
Dr. Lasya

2. CONTENTS
 Definition
 Goals of Prevention
 Levels of Prevention
 Modes of Intervention
 Levels of Prevention for Dental Caries
 Levels of Prevention for Periodontal Disease

3.  Levels of Prevention for Oral Cancer
 Levels of Prevention for Dento-facial Anomalies
 Conclusion
 References

4. DEFINITION
“Actions directed to preventing illness and promoting health to reduce the
need for secondary or tertiary health care.
Mosby’s Medical dictionary, 8th edition, 2009
“The action of stopping something from happening or arising”.
Oxford English Dictionary. Lexico 2020

5. GOALS OF PREVENTION
1. To promote health
2. To preserve health
3. To restore health when it is impaired
4. To minimize suffering and distress

6. • Successful prevention depends upon:
– a knowledge of causation
– dynamics of transmission
– identification of risk factors and risk groups
– availability of prophylactic or early detection and treatment
measures,

7. – an organization for applying these measures to appropriate persons
or groups and
– continuous evaluation and development of procedures applied

8. LEVELS OF PREVENTION
1) Primordial Prevention
2) Primary Prevention
3) Secondary Prevention
4) Tertiary Prevention

9. PRIMORDIAL PREVENTION
• It is the prevention of emergence or development of risk factors in
countries or population groups in which they have not yet appeared.
• Main intervention is through individual and mass education.
Eg: Efforts directed towards discouraging children from adopting
harmful lifestyles.

10. PRIMARY PREVENTION
• “Primary prevention can be defined as the action taken prior to the
onset of disease, which removes the possibility that the disease will
ever occur.”
• Intervention is in the pre- pathogenesis phase of a disease or health
problem.

11. • It includes the concept of "positive health", a concept that encourages
achievement and maintenance of "an acceptable level of health that will
enable every individual to lead a socially and economically productive
life
• Modes of intervention – Health Promotion and Specific Protection

12. • The WHO has recommended the following approaches for the
primary prevention of chronic diseases where the risk factors are
established: –
A) Population (mass) strategy
B) High -risk strategy

13. Population (mass) strategy
“Population strategy" is directed at the whole population irrespective of
individual risk levels to bring about socio-economic, behavioral and
lifestyle changes.
Eg: A small reduction in the average oral hygiene of a population would
produce a large reduction in the incidence of dental caries

14. High-risk strategy
• The high-risk strategy aims to bring preventive care to individuals at
special risk.
• This requires detection of individuals at high risk by the optimum use of
clinical methods.

15. Advantages
1. Low cost
2. Safe
3. The individual is not yet exposed to pain and suffering

16. SECONDARY PREVENTION
Definition
“ An Action which halts the progress of a disease at its incipient stage and
prevents complications.”
• Modes of intervention – Early Diagnosis and Specific treatment
• The health programmes initiated by governments are usually at the level
of secondary prevention.

17. Advantages:
• Important in reducing the high mortality and morbidity of certain
diseases like hypertension, cancer cervix and breast cancer.
Disadvantages:
• More expensive and less effective than primary prevention.
• Patient is already subjected to mental anguish, physical pain; and
community to loss of productivity.

18. TERTIARY PREVENTION
• It is defined as “all the measures available to reduce or limit impairments
and disabilities, and to promote the patients adjustment to irremediable
conditions”.
• It is the intervention in the late pathogenesis phase.
• Treatment, even in late stages of disease, may prevent sequelae and limit
disability.
• Modes of Intervention - Disability limitation and Rehabilitation.

20. MODES OF INTERVENTION
• “Intervention” can be defined as any attempt to intervene or interrupt
the usual sequence in the development of disease in man.

21. • 5 modes of intervention
1) Health promotion
2) Specific protection
3) Early Diagnosis and treatment
4) Disability limitation
5) Rehabilitation

22. Health Promotion
• “It is the process of enabling people to increase control over, and to
improve health”.
• It is not directed against any particular disease, but is intended to
strengthen the host through a variety of interventions like

23. 1) Health education
2) Environmental Modification
3) Nutritional Intervention
4) Life Style and Behavioural Changes

24. 1) Health education
• Cost – effective intervention
• A large number of diseases could be prevented with little or no medical
intervention if people were adequately informed about them and if they
were encouraged to take necessary precautions in time.

25. • WHO’s constitution states that “the extension to all people of the
benefits of medical, psychological and related knowledge is essential to
the fullest attainment of health”.
• Targets – general public, patients, priority groups, health providers,
community leaders and decision makers.

26. 2) Environmental modifications
• Provision of safe water
• Installation of sanitary latrines
• Control of insects & rodents
• Improvement of housing

27. 3) Nutritional interventions
• Food distribution and nutrition improvement of vulnerable groups
• Child feeding programmes
• Food fortification
• Nutrition education

28. 4) Lifestyle and behavioural changes
• The action of prevention in this case, is one of individual and
community responsibility for health, the physician and in fact each
health worker acting as an educator than a therapist.

29. Specific protection
• Interventions aimed at specific protection
1. Immunization
2. Use of specific nutrients
3. Chemoprophylaxis
4. Protection against occupational hazards, accidents, carcinogens

30. 5. Avoidance of allergens
6. The control of specific hazards in the general environment eg: air
pollution, noise control
7. Control of consumer product quality and safety of foods, drugs,
cosmetics

31. Health protection
• Defined as "the provision of conditions for normal mental and physical
functioning of the human being individually and in the group. It
includes promotion of health, prevention of sickness and curative and
restorative medicine in all its aspects."
• Health protection covers a much wider field of health activities than
specific protection.

32. Early diagnosis and Treatment
• As per WHO Expert Committee early detection of health impairment is
"the detection of disturbances of homeostatic and compensatory
mechanism while biochemical, morphological, and functional changes
are still reversible."
• Early detection and treatment are the main interventions of disease
control.

33. • Earlier a disease is diagnosed and treated the better it is from the point
of view of prognosis and preventing the occurrence of further cases
(secondary cases) or any long-term disability.

34. Mass treatment
• Used in the control of certain diseases viz. yaws, pinta, bejel, trachoma
and filaria.
• Rationale- the existence of at least 4-5 cases of latent infection for each
clinical case of active disease in the community.
• Mass treatment is a critical factor in the interruption of disease
transmission – latent infection

35.  It includes: depends upon Nature of Disease & Incidence of Disease.
1) Juvenile Mass Treatment
2) Selective Mass Treatment
3) Total Mass Treatment

36. Disability limitation
• Objective - To prevent or halt the transition of the disease process from
impairment to handicap.
Concept of disability
• The sequence of events leading to disability & handicap have been stated
as follows:
Disease Impairment Disability Handicap

37. Impairment: Defined as “any loss or abnormality of psychological,
physiological or anatomical structure or function”.
Eg: loss of foot, defective vision, mental retardation, loss of teeth
Disability: Defined as “ any restriction or lack of ability to perform an
activity in the manner or within the range considered normal for a human
being”.
Eg: inability to talk or pronounce certain words clearly

38. Handicap: Defined as “a disadvantage for a given individual, resulting
from an impairment or a disability, that limits or prevents the fulfillment of
a role that is normal for that individual.
Eg: the teacher loses his job and becomes unemployed.

39. Disability prevention
• It relates to all levels of prevention
1. Reducing the occurrence of impairment viz. immunization against
polio (primary prevention)
2. Disability limitation by appropriate treatment (secondary prevention)
3. Preventing the transition of disability into handicap (tertiary
prevention)

40. Rehabilitation
• Rehabilitation is “ the combined and coordinated use of medical, social,
educational, and vocational measures for training and retraining the
individual to the highest possible level of functional ability.”
• It includes all measures-aimed at reducing the impact of disabling and
handicapping conditions and at enabling the disabled and handicapped
to achieve social integration
• Requires cooperation from different sections of society.

42. Type of rehabilitation Action Example
Medical rehabilitation Restoration of function Provision of dentures
Psychological
rehabilitation
Restoration of personal
dignity and confidence
Educating and motivating
the person to use the
denture effectively
Vocational rehabilitation Restoration of the
capacity to earn a
livelihood
Getting a job again
Social rehabilitation Restoration of the
family and social
relationship
The person is now ready
to fulfill the role required
of him by his family and
society.

43. Levels of Prevention for Dental Caries

44. Primary Prevention

46. Secondary Prevention

47. Tertiary Prevention

49. Levels of Prevention for Periodontal Disease

50. Primary Prevention

51. Secondary Prevention

52. Tertiary Prevention

53. Levels of Prevention for Oral cancer

54. Primary Prevention

55. Secondary Prevention

56. Tertiary Prevention

57. Levels of Prevention for Dento-facial Anomalies

58. Primary Prevention

59. Secondary Prevention

60. Tertiary Prevention

61. CONCLUSION
• To initiate preventive measures it is not necessary to know everything
about the natural history of the disease. Often times, removal or
elimination of a single known essential cause may be sufficient to
prevent a disease.
• The main objective of preventive medicine is to intercept or oppose the
“cause” and thereby the disease process.

62. REFERENCES
1. Park K. Park’s textbook of Preventive and Social Medicine. 25th
edition. India. Bhanot publishers.
2. Hiremath SS. Textbook of Public Health Dentistry. 3rd Edition. New
Delhi: Elsevier; 2016.
3. Peter S. Essentials of Preventive and Community Dentistry. 6th edition
Arya publishers; 2017