20

HEALTH PROMOTION
Chris Sproat

Background
The health of the UK population has improved dramatically over
the last century. The dominance of infectious disease has declined
and has been replaced by degenerative diseases, cancer and coronary heart disease. The health gap between the rich and poor has
increased.

The aims of the government

To reduce mortality rate

To reduce health inequalities
To tackle the determinants of ill health and health
inequalities.

Factors affecting health can be modiable or xed. The

modiable factors are divided into those under individual
control (lifestyle) and those requiring general legislation
(Table 20.1).

Priority areas for action

1.
2.
3.
4.
5.
6.

Reducing the number of people who smoke

Reducing obesity and improving diet and nutrition
Increasing exercise
Encouraging and supporting sensible drinking
Improving sexual health
Improving mental health.

The mechanism. Rather than attempting to control all

aspects of health the main thrust is to promote and support
healthy lifestyle choices through:
education to increase awareness of the benets of a
healthy lifestyle and the risks associated with less
healthy alternatives.
legislation to improve those factors not under
individual control, e.g. access to services, food
labelling, etc.

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Health promotion

Table 20.1
Factors affecting health.
Fixed

Modiable
Lifestyle

Social/
economic

Environment

Services

Sex
Smoking
Poverty
Housing
NHS
Genes Diet
Employment Water quality
Education
Age
Activity
Social
Air quality
Social
Alcohol
exclusion Social
services
Sexual
environment Transport
behaviour
Leisure
Illicit drugs

The role of dentists in health promotion is important.

It is related to the unique position dentists hold within
the health care system, having regular access to a large
cohort of the population not seen by other health care
professionals.
The majority of the priority areas for action have a direct
impact on oral health for which dentists take a lead role in
patient education.

Smoking

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Smoking causes the death of 120 000 people per year in the
UK, or 20% of all deaths, and it is preventable. One in 10
of those in the age group 1115 years smokes; this is the
age when most smokers begin the habit. The government
aim is to reduce the number of adults over 16 who smoke
from 26% (currently) to 21% or less by 2010. (See also
Fig. 20.1.)
Smoking has been implicated in over 50 disease processes; however, there are three common diseases that
smokers die from:
cancer
chronic obstructive lung disease
coronary heart disease.

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Cessation of smoking

20

40
Male cases
Female cases

Percentage

30
20
10
0

1619

2024

2534

3549
Age

5059

60 and
over

Fig. 20.1 Prevalence of smoking in the UK by age and sex

2002/2003. It can be seen that the prevalence of smoking is
greatest in those aged 2024. For the rst time, in the 1624 age
group, the prevalence of smoking is higher in females than in
males, which is a worrying trend for the future (from the Ofce of
National Statistics).

Unlike much of the rest of the body, where the effects of

smoking are often hidden, there are visible effects on the
oral cavity. A thorough dental examination should detect
most oral changes and facilitate the delivery of advice on
how to stop smoking as well as support along with early
treatment. (See also Fig. 20.2.)
Oral effects of smoking include:
1. Oral cancer and pre cancer, where smoking is the
leading cause
2. Periodontal disease
3. Delayed wound healing due to peripheral
vasoconstriction
4. Increased failure of dental implants
5. Halitosis
6. Poor aesthetics due to tooth staining.

Cessation of smoking
Two-thirds of smokers would like to give up but only 8%
are currently successful.
The dental team should follow the four-A approach,
with regular review of progress:

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Health promotion

Face
Skin damage
Mouth
Oral cancer
Periodontal disease

Lung
Lung cancer
COPD
Pneumonia

Brain
Stroke

Larynx
Laryngeal cancer

Heart
Coronary heart
disease

Stomach
Ulcers
Pancreas
Pancreatic
cancer

Bladder
Bladder cancer

Genitalia
Impotence

Legs
Peripheral vascular
disease

Fig. 20.2 Common smoking-related cancers and diseases. It can

be seen that smoking has harmful effects on most body systems.

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Obesity, diet and exercise

20

DENTAL RELEVANCE OF SMOKING

The duty of dentists as members of the NHS team is to advise

patients of the risks of smoking and to support those who want
to quit.
Smoking has serious oral consequences, not least being the
leading cause of oral cancer.

Ask about smoking habits and desire to quit.

Advise on the general and oral harmful effects of
smoking and the facilities available to aid cessation of
smoking.
Arrange to refer smokers to the local NHS stop
smoking service or other local services.
Assist by encouraging the cessation of smoking.

How to stop smoking

Set a quit date.

Throw away all cigarettes, ash trays, etc.
Consider; Zyban or nicotine replacement,
acupuncture, hypnosis, support groups, i.e. NHS stop
smoking clinic.
Enlist help and support of family and friends.
Change routine to avoid smoking environments.
Take exercise and care with your diet.
Treat yourself with the money you save.

Obesity, diet and exercise

Obesity is a huge problem in the UK which has trebled in
the last 20 years. Currently over half of the women and
nearly two-thirds of men are overweight.
The upward trend in obesity is due to changes in eating
patterns, with increased consumption of fast and prepacked food combined with a lack of exercise and sedentary life style.
Obesity is determined by the persons body mass index
(BMI) weight in kilograms/height in metres2 (kg/m 2)
BMI categories:
underweight
normal weight

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<18.5
18.524.9

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DENTAL RELEVANCE OF OBESITY

The risk of adverse events occurring during dental treatment is

increased by the associated medical conditions:
diabetes
heart disease
hypertension.
General anaesthetic should be avoided in obese patients.

overweight
obesity

2529.9
>30

Obesity may be secondary to endocrine and renal

problems but is usually due to eating in excess of
necessity.
High BMI is associated with type II diabetes, heart disease,
hypertension, depression, osteoarthritis and reduced life
expectancy.
Primary prevention is the most effective way to combat
the obesity, involving:
1. Raising public awareness of the causes and problems
of obesity
2. Facilitating healthy diet, e.g. improved food labelling
and school meals
3. Promoting physical exercise for all age groups
4. Improved access to services that support weight
loss.
1.
2.
3.
4.

Secondary prevention for those overweight includes:

Increased exercise
Dieting
Drug therapy
Surgery (only in extreme cases).

Sensible drinking

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Alcohol consumption is endemic in UK, with 90% of adults

admitting to drinking. Binge drinking accounts for greater
than 40% of alcohol consumption in males and 22% in
females.

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Sensible drinking strategies

20

60
Male cases
Female cases

50

Percentage

40
30
20
10
0

1624

2544

4564
Age

65 and
over

Fig. 20.3 Adults exceeding recommended daily limits on at least

1 day during the preceding week: 2003/2004. It can be seen that
harmful drinking is widespread and is commonest in the 1624
age group, decreasing with age (from the Ofce of National
Statistics).

Sensible drinking implies less than 4 units per day for

males and less than 3 units per day for females. (It is more
useful to look at daily rather than weekly consumption.)
(See also Fig. 20.3.)
Effects of harmful drinking (see Ch. 14: alcohol abuse
section).

Sensible drinking strategies

In addition to raising awareness of the harmful effects of
alcohol, including binge drinking, a voluntary social
responsibility scheme has been set up with producers and
suppliers. This aims to protect the young from alcohol
and will ask for a sensible approach to advertising by not
targeting the younger age group, tightened control on sale
of alcohol to those under 18, and improved labelling of
containers and bottles to increase public awareness of the
harmful effects of alcohol.
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DENTAL RELEVANCE OF ALCOHOL

An alcohol history should be taken from all patients who drink.

The average number of units per day should be recorded.
Patients should be made aware of the recommended safe
limits:
Male:

4 units/day (28 units/week)

Female:

3 units/day (21 units/week)

Alcohol can affect multiple organ systems (see psychiatry section) and increase the risk of adverse events
occurring during dental treatment.

Useful websites
www.quit.org.uk
www.dh.gov.uk

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