Health Promotion and Disease Prevention
Health promotion questions test your ability to move patients from information to behavior change. You should understand the levels of prevention - primary (preventing disease before it occurs, e.g., fluoride, sealants, education), secondary (early detection, e.g., screening, prophy, early caries management), and tertiary (limiting disability, e.g., periodontal maintenance, restorations) - and be able to classify interventions correctly. Know the major behavior-change models: the Health Belief Model (perceived susceptibility, severity, benefits, barriers, self-efficacy, cue to action), the Transtheoretical (Stages of Change) Model (precontemplation, contemplation, preparation, action, maintenance, and sometimes termination/relapse), and Motivational Interviewing (open-ended questions, affirmations, reflective listening, summarizing - the OARS skills). Understand risk factors and risk assessment for caries and periodontal disease, including diet (fermentable carbohydrates, frequency), fluoride exposure, tobacco, diabetes, xerostomia, and oral hygiene behaviors. Know the evidence base for fluoride (systemic vs. topical), sealants, and chemotherapeutic agents such as chlorhexidine and xylitol.
Traps: misclassifying an intervention's prevention level; assuming education alone changes behavior; labeling a patient "noncompliant" rather than assessing readiness; and confusing the Health Belief Model with the Stages of Change. Questions often reward matching the intervention to the patient's stage - giving a full action plan to a precontemplator is wrong.
Rule of thumb: assess readiness before educating; for precontemplators, build rapport and raise awareness rather than prescribe action.
Worked example: A patient says, "I know I should floss, but I just don't." That is contemplation, not action. Use reflective listening and explore barriers rather than immediately assigning a flossing schedule.