ヘルスサイエンス・ヘルスケア

Volume 9，No.1（2009）

A Proposal of Health Intervention
Types in Adult Dental Patients

Yoriko Matsuoka, Kakuhiro Fukai

Abstract ：I t has been indicated that the declining oral functions can change for the worse on the multifaceted elements such as nutritional intake, activities of daily living, aspiration pneumonia, and mortality. Moreover, oral diseases and systemic ones have been clarified their deeply links with eachother. On the basis of these facts, it would be effective provision of health instruction, if dental professionals classify the types of health intervention and focus on the contents of appropriate supports with individual needs in advance. The purpose of this article is to reconstruct health interventions for adult dental patients based on the classification of Dulmen et al. (2007). As a result, it
can be classified six types of intervention: educational, cognitive, affective, behavioral, technicalintervention, and others (environmental intervention). The classification of health instruction would
be needed, based on the concrete indices and assessments.
Key words : oral health promotion, types of health intervention, classification, oral functions, common riskapproach
1. Introduction

ing oral functions is tooth loss mainly caused by

Oral functions are not only to retain one’s life

dental caries and periodontal diseases. It has been

through respiration or eating meals including mas-demonstrated that tooth loss impacts nutritional

tication, swallowing, taste, supporting digestion.

intake, activities of daily living, and of mortality

Those are inevitable for comfortable social life

lately, when one is unable to keep suitable masti-

such as communication, aesthetic aspect, and facial

cation and occlusion due to the declining oral func-expression. The representative element of declin-tions1-5） . Moreover, it has been also reported
deeply relationships between oral and systemic【著者連絡先】〒341-0003 埼⽟県三郷市彦成 3-86
深井⻭科医院・深井保健科学研究所
松岡順⼦
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E-mail： yorikom@wg8.so-net.ne.jp

diseases6-8）. It would be needed oral health instruction for adults based on the interrelationships
between oral and systemic diseases as well as theprevention of oral diseases such as dental caries
and periodontitis. It seems to be effective to classify and to focus on the contents of dental profes̶ 33 ̶A Proposal of Health Intervention Types in Adult Dental Patientssional supports for health instruction matchingwere 2.31 times as more as suffering metabolic

individual needs in dental settings.

.
syndrome compared with unaffected individuals15）

This article aims at the reconstruction of profes-

Fast eating as well as Caloric intake enhances obe-

sional health interventions as to the supportive ele-sity. It would be able to approach common risks

ments for adult dental patients based on the classi-

between oral health and life-style illnesses16）.

fication of Dulmen et al.9）.
2 − 2. Respiratory infection: pneumonia
2. Oral health promotion programs

Aspiration pneumonia is linked to mortality in

In daily dental clinics, health professionals sup-elderly people. If the elderly recover their health,port patients to be in good health by themselves

it is often unavoidable to decline the activities ofand help them to improve behavior of daily livings

daily living which causes to be bedridden leading

caused oral diseases through oral health interven-high incidence of silent aspiration17-18）. Aspiration

tion. Concretely, it is related to mainly three kinds

pneumonia causes mixed infection with oral anaer-of behavior: oral hygiene behavior, dental visit

obic bacteria such as periodontal bacteria19-20）. To

behavior, and food intake behavior. In adults, oral

prevent aspiration pneumonia, it will need tocondition will be significantly changing due to therestore reflexes of swallowing and coughing toonset of periodontitis and tooth loss. To prevent

normal. It has been reported that one of the bestoral diseases and to improve oral health through-way to improve those reflexes is stimulation ofout their lives, it would be needed to find the risks

oral hygiene and oral functional training throughof oral diseases in early stages and to improve oral

oral exercise without instruments21-22）. In elderly

health behavior according to individual risks .

people, oral function and oral hygiene are deeply10）

associated with the systemic condition. To main2 − 1. Common risk approachtain and improve oral function to normal is to keep

There are several common risk factors between

oral health as well as to prevent aspiration, malnu-

oral diseases and life-style related ones. Fortrition, dehydration. Those are connected with sys-instance, type 2 diabetes mellitus mainly caused

temic health and life expectancy.

one’s life-style such as overeating, insufficient
exercise, and obesity which is worsen periodontal

2 − 3. Functional tooth number and mortality

disease. Inversely, periodontal disease accelerates

To maintain oral good functions is to avoid tooth

worsening diabetes mellitus and diabetic complica-

loss preventing oral diseases and to retain appro-tions such as heart attack, angina, and stroke11-12）.

priate mastication and occlusion. This is associated

Periodontal treatments diminish TNF-α and IL-6

with systemic good health. It is demonstrated thatof cytokine stemmed from inflammatory gums

functional tooth number is correlated with mortali-

and improves tooth movement. Those result inty, and tooth loss enhances the risk of death byimprovement of glycemic control and dietary

heart disease among men aged 40-89 yrs3）.

habits.

Besides, it is indicated that females aged 40 orBesides, diet-induced obesity has been linked

more with dentures show significantly higher mor-

to worsen diabetes mellitus and periodontal

tality rate that those without dentures (p<0.05) 4）.

disease13-14）. According to D’
Aiuto et al. (2008), theFunctional tooth retention and restoration of oral

subjects aged 45 or older with severe periodontitis

function after dental treatments would be one of̶ 34 ̶

ヘルスサイエンス・ヘルスケア

the factors concerning to individual life expectan-

Volume 9，No.1（2009）tion behavior on oral health.
Concretely,“educational intervention”includes

cy.

providing oral health information based on the sci3. Health interventions and health behavior

entific evidence such as etiology and prophylaxis

As to the methods of health instruction, one ofof oral diseases, effects of plaque removal andthe classifications of health interventions is Pre-treatments, negative effects, and risks of treat-cede Proceed Model developed by Green andment break.“ Cognitive intervention” is associat-

Kreuter. . In this model, behavior factors are clas-

ed with reconstructing cognitive bias of one’s

sified as follows: predisposing, reinforcing, enabling,

behavior and condition. For instance, it is a caseand environment.

that one does not notice the facts, instead of pre-23）

Fukai. (2005) indicates that to categorize charac-senting gingival inflammation, dental plaque, chew-terization and demand of adults for a dental check-ing preference, fast eating, and unbalanced diet.

up in advance is effective to provide appropriate“ Affective intervention” is related to encourage-

health education and health learning meeting thement, comfortable experience, perceived improve-

individual needs10）. Concerning the classification ofment, and relieving anxiety. This is a case that one

oral health instruction, four types of interventions

feels refresh in one’s mouth through professionalcan be proposed: (1) advisement and counseling

tooth cleaning; one perceives improvement of gin-type; (2) providing health information and support-

gival bleeding.“Behavioral intervention”is to sup-ing awareness type; (3) environmental and follow-

port patients’ actual health behavior by way ofup support type; (4) health skill type.

concrete goal setting and to follow them up. For

van Dulmen et al. (2007) reviewed 38 systematicinstance, it refers to self-monitoring for implemen-reviews concerning to patient adherence for med-tation of fluoride mouth rinsing on a calendar; toical treatments published during 15 years fromsend a notice letter of next dental check-up; to set

1990 to 2005 . They suggested that the effective

a self goal for proper sweet intake through dietary9）interventions were found in four theoretical

records.“Technical intervention”means technicalapproaches: technical, behavioral, educational, andinstruction and concrete supports. That is, regard-affective intervention.

ing oral hygiene, it contains the following elements:
instrumental usage, choice, keeping, exchange

4. Health intervention types in dental adultinterval; dental visit frequency and duration; prop-patients

er number of chewing strokes and mouthful vol-In dental health, clinical interventions for adultume to prevent or improve fast eating and obesity.

dental patients are classified based on the catego-“ Others (environmental intervention) are mainly

rization of Dulmen et al. this time. As a result, it

associated with the environmental factors toshows Table 1 following six points: (1) educational

improve or prevent patients’ health behavior. Itintervention, (2) cognitive intervention, (3) affective

includes occupational environment as to timeintervention, (4) behavioral intervention, (5) techni-restriction; family cooperation for proper sweet

cal intervention, (6) others (environmental interven-intake; emergency acceptance on a holiday, hometion). Oral health instruction includes following

dental care in case of visiting difficulty, to secure

behavior: oral hygiene behavior, dental visit behav-

parking areas, and to keep dental rooms andior, food intake behavior, and systemic risk reduc-instruments clean.

̶ 35 ̶

Table 1 A classification and types of oral health intervention in adults

A Proposal of Health Intervention Types in Adult Dental Patients̶ 36 ̶

ヘルスサイエンス・ヘルスケア

5. Conclusion
It would be effective approach that dental professionals support individual adult patients focusing on the classified health instruction in advancewithin a clinical time limit. Moreover, dental healthproviders tend to regard the results of clinicalindices such as CPI and DMFT as importance toassess oral health condition. To support patients’improvement of health behavior, it is neededhealth instruction based on the subjective assessment to promote self-awareness. From thesepoints, it is assumed that the classification ofhealth instruction would be required, based on theconcrete indices and assessments, applicable indental clinics easily.
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