Ppd - Dental Public Health

Front 1

Define "dental public health"

Back 1

A non clinical speciality of dentistry

Assess health needs

Improve health of populations

Front 2

What are the aims of dental public health

Back 2

Review dental issues in populations

Prevent disease and promote health through organised community efforts

Highlight range of factors influencing oral health, find the most effective way to prevent and treat

Front 3

What are the five aspects of dental public health

Back 3

Leadership and Expertise

Oral Health Surveillance

Policy Development

Community Based Prevention

Maintain Dental Safety Net

Front 4

Describe Leadership and Expertise

Back 4

Find the causes of oral health problems and social determinants of health. Preventative. Promote health of all. Encourage partnership with flexible solutions and advocate community participation in oral health.

OH is a silent epidemic, the most preventable non-communicable disease

Front 5

Describe Oral Health Surveillance

Back 5

Collect epidemiological data, interpret it and find trends to assess oral health needs.

Front 6

Describe Policy Development

Back 6

OH often overlooked, only receives backwash effect. DPH wants a common risk factor approach in an integrated health policy.

Upstream/macro - legislation e.g. smoking

Downstream/micro - brushing guidelines

Dental access is now an indicator of health.

Front 7

Describe Community Based Prevention and Health Promotion

Back 7

Variation between different regions, e.g. 5YO caries is 20% is SE but 35% in NW.

Understand social determinants of health and their impact.

Work with local authorities to develop OH programs on a community level.

Front 8

Describe the Maintenance of the Dental Safety Net

Back 8

"the sum of individuals and organisations, both public and private involved in delivering OH services to people who for reasons of poverty, culture, language, health status, geography and/or education are unable to secure them on their own".

Inverse Care Law - poor gain less than rich

Local councils now have more of a role.

Front 9

What are the three models of health?

Back 9

Social

Biomedical

WHO (Ottawa)

Front 10

Describe the social model of health

Back 10

Health is based on the whole individual, the combination of biological, social, psychosocial and environmental factors. Takes a holistic approach; patient is self-reliant and takes a more preventative approach. Practitioner is a helper not a healer.

Front 11

Describe the biomedical model of health

Back 11

Human body is a machine that can be fixed through medical intervention. The practitioner is the expert with the aim to diagnose and to treat, with the patient being passive. Focus is biological with the main purpose being to cure.

Front 12

Describe the WHO model of health

Back 12

"a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"

Front 13

What is the advantage of the WHO model

Back 13

It does not see health as being a negative concept. Also recognises physical, psychological and social domains.

Front 14

What is the disadvantage of the WHO model

Back 14

Interprets health as a duty to self, relies on a process of medicalisation - reliance on check-ups and medicine

Front 15

Describe the OTTAWA charter

Back 15

Outlined the principles for health promotion.

"Health promotion is the process of enabling people to increase control over and to improve their health"

Front 16

What are the three strategies described in the OTTAWA charter

Back 16

Advocacy - create the essential conditions for health

Enable - all people to achieve their full health potential

Mediate - between different interests in society in the pursuit of health

Front 17

Why do we measure health?

Back 17

By studying the factors that influence health, we can reduce negative factors and promote positive factors to develop practical solutions to promote health and identify any unmet health needs (capacity to benefit from an intervention)

Front 18

Define "health status"

Back 18

"a description or measurement of the health of and individual or population at a specific point in time against identifiable standards using health indicators as a reference".

(life expectancy, mortality, morbidity)

Front 19

Define life expectancy

Back 19

average number of years of life remaining to a person of a specific age

Front 20

Define mortality

Back 20

number of deaths in a population at a given time divided by the number of the people in a population, multiplied by 1000

Front 21

Define mobidity

Back 21

number of non fatal outcomes in a population at a given time divided by the number of the people in a population, multiplied by 1000

Front 22

Prevalence

Back 22

The percentage of the population with the disease right now

Number of cases of a disease in a population at a specific time divided by number of people at risk multiplied by 1000

Front 23

Incidence

Back 23

Number of new cases of a disease

Number of new cases in a population at a specific time, divided by number of people at risk, multiplied by 1000

Front 24

Describe different types of information gained

Back 24

Demographic - age, sex, population, geography

Social - deprivation, employment, housing

Health need - distribution of indicators of an intervention

Mortality - death according to person/place

Morbidity - health or illness of population

Health service use - diagnosis, intervention, procedures

Front 25

What are the examples and advantages of quantitative health data

Back 25

Summary measure / rates

can makes inferences about population health status

Front 26

Why do we interpret health data

Back 26

Determine health inequalities, variations between groups e.g. ethnicity, sex, age

Front 27

Describe a behaviourist approach to health inequalities

Back 27

Behaviour and lifestyle explain health differences, but ignores the fact that behaviour is shaped by social context. Assumes free choice of lifestyle and blames the individual for their health

Front 28

Describe a social determinant approach to health

Back 28

Recognises that "distribution of power, income, goods and services, as-well as immediate circumstances of peoples lives e.g. healthcare, education and their work, leisure, home and community impact on their health"

Front 29

Describe a health need and their three different statuses

Back 29

capacity to benefit from intervention, aims to improve health benefits for all

Met - current standard of care is appropriate

Unmet - gaps in current services or information

Overmet - over use of services, e.g. antibiotics

Front 30

Describe the four ways to identify health needs

Back 30

Normative - defined objectively by professional

Felt - subjectively important to the individual

Expressed - felt need expressed e.g. protest

Comparative - comparing similar groups

Front 31

What are the effects of poor oral health? What is it's relationship with general health?

Back 31

Physical and psychological impacts can affect daily life such as pain, diet, socialise and speech impacts.

Oral health is an indicator for general health, with a bi-directional and complex relationship. Oral health should be person-centred.

Front 32

Describe Cohen and Jago's findings

Back 32

Clinical measures play a role in measuring oral health, but could be improved if socio-dental indicators were included such as lifestyle and access to care.

Positive impact on oral health policy.

Front 33

Describe Locker's findings

Back 33

Locker developed a new model for measuring oral health, moving away from a biomedical model to one which measured impact on everyday function.

Front 34

Describe Locker's model of oral health

Back 34

Disease - periodontitis

Impairment - tooth loss

Discomfort/limitations - speaking/eating limits

Disability - reduced daily function, embarassed

Handicap - not getting job interview

Front 35

Describe the Department of Health's definition of Oral Health

Back 35

"standards of health of oral tissues which enables an individual to perform daily activities without discomfort or embarrassment, which contribute to overall well-being.

Front 36

What did Locker help develop?

Back 36

Oral-Health Related Quality of Life Measures

He decided that QoL is concerned to the degree by which someone enjoys the important possibilities of life.

OHRQoL

Front 37

What did Sheiham and Watt recognise?

Back 37

That oral health and general health are shaped by similar issues and called for a common risk factor approach or coordination. By integrating the two and assessing oral needs in socio dental ways, health plans greatly enhance OH and GH.

Front 38

How is oral health measured

Back 38

Using both clinical and OHRQoL measures

Front 39

Describe clinical indicies

Back 39

Clinical measures involve scoring patients on indices to show prevalence of a disease.

e.g. DMFT, Helkimo, CPITN

They are measured on certain criteria

Front 40

Describe criteria for clinical indicies

Back 40

Simple - easy to understand and use

Objective - clear categories, easy to respond

Valid - does it measure what it intends to

Reliable - can it replicate results

Reproducible - will it give same results if condition being assessed hasn't changed

Quantifiable - can be statistically analysed

Sensitive - able to detect small changes

Acceptable - not painful or demeaning, appropriate use of time and ethical

Front 41

Describe DMFT

Back 41

Index for measuring prevalence and severity of dental caries in a population. It has three measures.

Front 42

What are the three measures of DMFT, what can the scores range from

Back 42

Treatment - (M+F)/DMF x 100

Care - F/DMF x 100

Restorative - F/(D+F) x 100

Scores range from 0 to 32

Front 43

Describe the DMFT brackets

Back 43

Very low - below 1.2

Low - 1.2 - 2.6

Moderate - 2.6 - 4.4

High - 4.4 +

Front 44

What are the advantages of clinical measures

Back 44

Compare OH of different groups, measure prevalence, incidence

Front 45

What are disadvantages of clinical measures

Back 45

Measures disease, not health. Indices only offer end point, no insight onto how oral health impacts social well-being.

Front 46

What are the advantages of OHRQoL measures

Back 46

Poor oral health can reduce social contact, induce depression, reduce appetite.

Psycho-social focus, patient designed

Front 47

What are disadvantages of OHRQoL measures

Back 47

Not widely used, focused on specific groups, subjective, less likely to be used clinically.

Front 48

Describe Oral Health Literacy

Back 48

The degree to which individuals have the capacity to obtain, process and understand basic oral health information and services needed to make appropriate health decisions.

Low OHL is associated with poor OH status.

Front 49

Describe epidemiology

Back 49

The study of occurance and distribution of health related states or events in specific population including the study of determinants inducing such states, and the application of knowledge to control health problems.

Front 50

What are the aims of epidemiology?

Back 50

Aetiology

Occurrence

Progress

Intervention

Evaluate

Repeat

Front 51

Epidemiology step 1

Back 51

Aetiology - person (age, gender), place (rural, urban), time (annual, daily). Does a relationship exist between events and outcomes? Are these factors causal, enabling, contributing or preventative?

Causal association = risk factor

Non-causal association = risk indicator

Front 52

Epidemiology step 2

Back 52

Occurance - three measures:

Risk of incidence - probability a person will develop disease over time period

Incidence rate - rate at which new event occurs in a population

Prevalence - a measure of disease occurance

Front 53

Epidemiology step 3

Back 53

Progress - three types of epidemiology:

Observable - observe effects of exposure, investigator not in control

Experimental - investigator in control of exposure, control and research groups

Analytical - systematic assessment of relationships and hypothesis

Front 54

Epidemiology step 4

Back 54

Intervention - are existing protocols cost effective, are they inclusive of patient perspective?

e.g. Fluoridation, reduced tooth decay 30%

Front 55

Epidemiology step 5

Back 55

Evaluate - identify modifiable factors that can impact on disease occurrence, such as policy development

Front 56

Describe Oral Epidemiology

Back 56

The "study of distribution and determinants of oral health related states or events in a specified population, and the application of this study to control oral health problems". Can measure scale of disease, find trends, susceptible groups, causes, impacts on society and highlight preventable measures.

Sources include WHO, PHE, BASCD

Front 57

Statistics

Back 57

4 billion people have untreated OH problems

75% of the world have no access to a dentist

Dental treatment costs 5-10% of health budget

10-15% of adults have severe periodontitis

54% of adults have gingivitis

70% of 5 year old's are caries free

86% of 65+ year old's have 21 functional teeth