Page 16
candidosis (Reibel 2003). In a population study in Canada, it has been shown that current smokers are less likely to visit a dentist, more likely to report sensitivity in tooth, tooth ache in previous month, orofacial pain and social limitations due to teeth (Millar and Locker 2007). Strong association between smoking and periodontitis is well documented (Sheiham and Nicolau 2005). Bergström (2004) reported a 5-20-fold higher risk of destructive periodontal disease among smokers than non-smokers. Oral Health Care – Prosthodontics, Periodontology, Biology, Research and Systemic Conditions 210 From the public health point of view, it is essential to consider the whole of the causal chain when assessing health risks. This consideration will also facilitate adopting appropriate policies and strategies for disease prevention. Regarding oral health, in addition to the efforts for modifying the risk behaviours in individual level such as oral hygiene practices, in a broader context, considering socio-environmental factors and the characteristics of available oral health services are needed for effective planning on disease prevention and treatment (Petersen 2005a). A detailed understanding of the factors influencing health –determinants of health– is crucial for effective delivery of health services. Achievement of sustainable improvements in the health of population depends on addressing the underlying causes of disease in a society (Daly et al. 2002, Watt 2007). Assessment of risks to health and focussing on them has a key role in preventing diseases (WHO 2002). Risk assessment in dental public health, however, has still a limited scope; the emphasis mostly being on behavioural risk factors rather than on socio-environmental factors in oral diseases (Petersen 2005a). Oral diseases have some risk factors shared with several chronic diseases, thus adopting a common risk factor approach, aimed at reducing risk factors of a large number of diseases, is suggested for the effective prevention of oral diseases through general health promotion (Sheiham and Watt 2000). 4. Dental caries management For many years, almost from the beginning of 20th century, caries management has been dealt with tooth restoration as a cure for dental caries and at that time it was considered an improvement in the dental care compared to the previous treatment –tooth extraction (Selwits et al. 2007). New understanding about caries initiation and progression indicated that there are potentials for prevention of dental caries (Daly et al. 2002). Based on this understanding, in some regions like Scandinavia, a preventive approach has been adopted for control of dental caries since many years ago (Heidmann et al. 1987). It should be considered that dental caries is among a group of chronic diseases that are largely preventable by avoiding its risk factors and much more improvements are expected if public health programs established appropriately. (Fejerskov 2004, The Liverpool Declaration 2005). 4.1 Traditional restorative treatment Traditionally, dental profession has focused on pain relief by restoring damaged teeth or tooth extraction (Kidd and Fejerskov 2003, Anusavice 2005). For many years dental caries in its early or late stages have been treated identically. Early surgical intervention and placement of restoration will, however, result into earlier introduction of teeth in the restoration life cycle (Elderton 1990), which makes the tooth survival time shorter (Anusavice 2005). Therefore, filling damaged tooth with a restoration should not be considered as real treatment since it does not aim at eliminating the fundamental cause of caries i.e. dental plaque (Elderton 1996). Disease control in dental caries concerns