The World Health Organization defines health education (1) as a combination of learning opportunities to facilitate voluntary change of behavior that lead to an improvement of salud.La health promotion is any combination of education, organizational , economic and environmental factors that support the behaviors that lead to improved health, and empowers individuals to take advantage of the measures and preventive services. Both education and promotion, they complement and are necessary in programs to prevent oral diseases.
Models of health education
Until now the dominant model of health has been the "medical model". In terms of health education is to provide information on the etiology of the disease and instructed on how people should behave (2). This approach has been criticized because:
* It assumes that ordinary people believe that "experts know best."
* It involves the imposition of medical value to patients.
* You can induce feelings of guilt if the patient chooses not to follow the regime prescribed by the professional.
* Assumes that the individual is the primary cause of the disease, without considering the environment.
* Assumes that individuals are free to choose healthy lifestyles, forgetting that it is conditioned by economic and social factors.
This approach to health education was defined as "blaming the victim" because the people blame their own state of health or illness, when in fact they are victims of their circumstances (3).
A second model is the "psychological model" in which the dental health education considers the expectations and experiences, the standards group and the process of socialization. Health education based on this model of beliefs and feelings about themselves and their potential for health, and employs techniques that would be necessary for behavior change (2).
In a third model, called "Socio-Environmental Model", the purpose of health education is to change the environment to facilitate the choice of healthier lifestyles (2.3).
These three models are not mutually exclusive, and all are appropriate in certain circumstances (2).
Target Groups
All the procedures available to prevent oral health education components. The education of target groups, such as policy makers, food industry managers, staff responsible for providing health care-especially primary care professionals, employees of schools, health programs and participating in school and agency representatives State regulators from advertising, should be an integral part of any regulatory or legislative intervention of the Public Health services (4.5).
Similarly, to focus resources and allow the information disseminated is specific, education for the dental health of the population should be targeted especially to pregnant women and children and adolescents (6). Because of its importance, we refer primarily to the dental health education in school.
It is in the school where the largest and most homogeneous group that should be devoted to health education. Children not only have the most developed cognitive capacities, but also are at an age when they are eager to acquire new skills, when it finally, there is a greater risk for developing dental problems. Therefore, despite the existing evidence on the effectiveness of educational programs for school dental health is equivocal in nature, it is very important to continue to implement and improve. Since various prevention programs, such as water fluoridation, the use of topical fluorides, application of sealants and oral hygiene measures have great potential to reduce dental disease should be intensified efforts to increase its dissemination, especially among children who can benefit most from them (7).
Determinants of health behavior
The traditional educational techniques, as described in the medical model, they fail when they seek to attitudes towards dental health of children in healthy habits, because the relationship between knowledge and behavior can not be assumed to be linear (8). A child may not understand or can not be prepared to learn a concept at the intellectual level, but can be trained to understand basic form of manipulation of sensory-motor or perceptual experience. Thus, actual knowledge, understood as information translated into behavior, which can not be obtained until the activity has occurred (9).
Similarly the knowledge that they are temporary and the action or activity, behavior, in this case the desired behavior in terms of oral health are related to several factors. Of these socioeconomic factors are important in determining the behavioral health of children from low socio-economic classes tend to have poorer oral health and poorer dietary habits that children from higher socioeconomic classes (9) .
Also the beliefs of the family or peer groups are very powerful determinants, and it is unlikely that a child adopts a new mode of behavior against them. The positive health behaviors can be instilled, especially to 5 years, by acting as role models for parents. Since, by changes in family structure over the past 40 years, is less likely that parents can participate effectively in health programs, it is necessary to develop other alternatives for their participation (10).
Attitudes in adolescents, as well as shaped by the family, are influenced by the values and norms of peer groups (friends, fellow students, etc). It has been shown that behavior can be modified using the group's leaders as role models (9.11).
Other determinants of health behavior are:
* Personality and individual socio-cultural influences: in addition to the characteristics of each subject's personality, concern for the overall appearance and facial attractiveness are powerful motivating factors for taking and maintaining oral preventive practices, especially among teenagers (10, 12).
* Influence of the campaigns: while the media themselves can provide information, it is unusual for campaigns to motivate positive behavior change, because the audience plays an active role in the selection of stimuli and the filtering of messages to through their values and personal attitudes (10.13). However, it is easier to induce or reinforce negative behavior. For example has been that television advertising of sweets, biscuits and pre-sweetened cereals, the most advertised during children's programming schedule, as snacks to eat between meals, has encouraged this practice dental negative (10).
* Political and economic influence: Although manufacturers of baby preparations are informed of the consequences of sweetening, sugar is still a common additive in prepared baby foods. Often sugar is added equally to medicines. Another factor is advertising allegedly hidden in the teaching material provided by food manufacturers to schools, which often seeks to enhance the consumption of sugar products (10). Pamphlets, advertisements and books for schools are often poorly informed, wrong or unhelpful. Phrases such as "sugar is the purest food you can buy", "Sugar gives you energy," are misleading (14). The reduction in the availability of foods with high sugar content in schools can help children other alternative to choose healthy foods, but this approach has serious limitations (10).
Principles to consider in a dental health education program
At the time of planning an educational program on oral health should take into account a number of important points (1,4,7,8,15,16):
* Adoption of a flexible approach and use of routines, philosophies and existing staff.
* Integration of the educational program in dental health education programs for health and general compatibility with the local culture, the educational system and social goals.
* Use of secure messages scientifically, internally consistent and compatible with other messages and practical realities of the lives of the subjects.
* Design of programs to the specific needs of population subgroups at greatest risk.
* Inclusion of much activity and participation of the subject.
* Take into account the influence of "important people" such as family, group leaders, neighbors, etc.. to achieve a change in behavior of the subjects.
* Avoid "blaming the victim" or the hard teaching emphasis. Including development of individual responsibility and choice in activities that compromise health.
* Selection of an appropriate educational material for each type of audience.
* Periodic review of programs of dental health education by an advisory committee.
* Coordination between school personnel and health staff.
* Integration of health education in the dental school curriculum, without making additional demands on teachers.
The message
Actors involved in health education for dental health, often have provided information complicated, contradictory and even erroneous. The current consensus included the following points (5.17):
1. Reduce both the quantity and frequency of intake of foods and drinks containing sugar.
2. Clean teeth and gums thoroughly every day with a fluoridated paste. The brush is the only way to remove plaque that should be recommended in terms of public health and prevent periodontal disease. Brushing regularly will not prevent tooth decay, but the use of fluoride toothpaste can provide an obvious benefit.
3. Awareness of the importance of water fluoridation and other methods that contribute to systemic fluoride.
4. Regular visits to the dentist.
Assessment
The final measure of the impact of a health education program is to detect whether an individual or group is or is not free of dental disease (CAOD or percentage of subjects found free of caries). The intermediate tests that could guide the educator must involve the clinic in the act of removing plaque by brushing by the patient (18). The amounts of plaque varies with each patient and its successful removal is also variable. These factors must be considered good when the patients evaluated their own efforts or if it makes another person (19).
Other techniques for the assessment of dental health education programs such as the technique of choice of snacks or food to eat between meals "have been used successfully in pre-school (8).
An evaluation should look not only the result but also the process. (20). The data analysis process can result in program modifications that would otherwise remain unidentified.
Conclusion
Several studies have shown that dental health programs based on the classical model of education for health or medical model does not translate into lasting change in the hygiene of patients.
There are other factors that determine the behavior and should be taken into account: socio-economic factors, influence of significant individuals in the subject's life, socio-cultural influences, advertising, political influences and environment that surrounds the individual.
Information to the public and dental health education can be effective if taken together socio-economic measures that promote oral health to enable the individual to acquire a healthier lifestyle.
