Board Review DH227 Community Oral Health Lisa Mayo, RDH, BSDH Concorde Career College.

Board Review DH227Community Oral Health

Lisa Mayo, RDH, BSDHConcorde Career College

Public Health in US

• Public Health– Prevents epidemics and the spread of disease– Protects against environmental hazards– Prevents injuries– Promotes and encourages healthy behaviors– Responds to disasters and assists communities in

recovery– Assures the quality and accessibility of health

services

Public Health in US

• Essential Public Health Services– Monitor health status to identify community health

problems– Diagnose and investigate health problems and health

hazards in the community– Inform, educate, and empower people about health

issues– Mobilize community partnerships to identify and solve

health problems– Develop policies and plans that support individual and

community health efforts

Public Health in US

• Essential Public Health Services– Enforce laws and regulations that protect health

and ensure safety– Links people to needed personal health services

and assure the provision of health care when otherwise unavailable

– Assure a competent public health and personal health care workforce

– Evaluate effectiveness, accessibility, and quality of personal and population-based health services

Public Health in US

General Public Health

• WHO: World Health Organization• Public Health: 1920– The science and art of preventing disease,

prolonging life and promoting physical health and efficiency through organized community efforts

– Criteria for Public Hl Problem1. The disease or other threat to health is widespread2. The disease is one that can be prevented, alleviated

or cured3. Such knowledge is not being applied

Public Health

• Characteristic of a Public Hl Measure1. Not hazardous to life or function2. Effective in reducing or preventing the targeted

disease or condition3. Easily and efficiently implemented4. Potency maintained for a substantial time period5. Attainable regardless of socioeconomic status,

education or income6. Effective immediately on application7. Costs are inexpensive and within the means of the

community

What is Dental Public Health

• Concern for and activity directed toward the improvement and promotion of the dental health of the population as a whole

• Form of dental practice that serves the community as the patient instead of the individual

Board Alert – Know This!PRIVATE PRACTICE DENTAL PUBLIC HEALTH

1 practitioner Team

1 patient Group

Dental Office Health Center

Hl Hx & Exam Survey & Needs Assessment

Exam Survey

Diagnosis Data Analysis

Treatment Plan Program Plan

Case Presentation Selling Program

Treatment Program Implementation/Operation

Fee Payment Budget/Financing/Funding

Patient Evaluation Program Evaluation/Appraisal

Board Question

The Department of Health and Human Services is a branch of which level of government?

a. Stateb. Localc. Federald. International

Community Hl Programs

• Collect needs Assessment data• Planning steps:

1. Analyze data2. Rank needs (prioritize)3. Identify goals4. Develop objectives (performance, condition, criteria)5. Identify resources/make budget6. Plan activities7. Implement plan8. Evaluate (on-going)

Question

The first step in establishing a community dental health program is to:a. Identify community needsb. Appoint consumer advocates to the planning committeec. Identify current dental health programsd. Determine dental manpower in the community

Question

Which of the following demonstrated the most effective and efficient of a community hygienist’s time?a. Conducting regular oral cancer screeningsb. Rendering oral prophy’s and topical fluoride treatmentsc. Delivering dental health instruction to elementary schoold. Organizing teachers to implement a school- based program involving self-application of topical fluoride

4 Government Levels of Community Dental Health

1. International2. Federal3. State4. Local


1. International– Coordinates programs for underdeveloped nations and gather

epidemiological data for comparisons across nations– Develops means to summarize tx needs of international

populations utilizing minimal equipment– WHO

2. Federal– Acts on oral health problems of national significance– Primarily within the jurisdiction of the Dept of Hl and Human

Services (DDHS)– Board Alert! DDHS published Healthy People 2010– Ex: CDC, Health Resources and Services Admin, National

Institute of Health, NIDRC, Agency for Healthcare Research and Quality


3. State– Provides consultation services to local health dept,

directly administers some programs4. Local– Directly administers county and city programs,

initiates dental health legislative measures (ex: Fluoridation)

Epidemiology

• Science of the measurement of the circumstances under which a disease (or health problem) occurs among groups of people

• Study of the occurrence and distribution of disease (patterns)

• Multi-factioral: involves the host, agent and/or environment

• Relates factors affecting health and disease in population to factors in the environment

Epidemiology

• Terms of related concepts1. Epidemic: occurrence of a group of illnesses of similar

nature clearly in excel of the normal expectancy and derived from a common source

2. Endemic: the usual levels of a disease that is found within a certain population; continuing problem: fluorosis

3. Pandemic: a disease affecting the majority of the population or a large region or one which is epidemic at the same time in many parts of the world

4. Mortality: # of deaths in a population5. Morbidity: amt of diseases or illness in a population

Epidemiology Research

1. Descriptive Rsrch-Describes the sample group and includes interpretation of data to evaluate a current event/situation-Incidence: # NEW cases of disease w/in a population OVER A PERIOC OF TIME (Ratio)-Prevalence: # of persons in a population affected by a condition at any one time (% ratio)


2. Analytic Rsrch-Determined the cause of disease, or if a causal relationship exists between a factor-Prospective Cohort Study: planned before data is collected – over along period of time to see who develops the disease-Retrospective Study: study using data collected in the past – after study is over-Case Control Study: comparing one population that has the disease with one that does not


3. Experimental Rsrch-Demonstrates cause and effects-Tests hypotheses (predict relationships among variable)-Experimental design-Use of sample to allow for generalization-Can allow for interference if study is deemed to be valid and reliable-Interference: generalizing from a sample to the general population of interest

Epidemiology

• Studies usually reports findings in terms of either PREVALENCE or INCIDENCE of disease (Board Alert!)– Prevalence: refers to the estimated population of people

who are managing a disease at any given time– Incidence: refers to the annual diagnosis rate or the

number of new cases of a particular disease diagnosed each year

– These 2 stats can differ: a short-lived disease like flu can have high annual incidence but low prevalence while a life-long disease like diabetes has a low annual incidence but high prevalence

Uses for Epidemiology

Board Alert – know this list!• Collecting data to describe normal biological processes• Understanding the natural hx of a disease process• Measuring the distribution o a disease in a given population• Id determinant of disease• Testing hypotheses for prevention and control of a disease

through studies• Planning and evaluating health care services

Indices of Epidemiology

• Key is to know the acronyms and what they are measuring such as perio, caries, etc…

• Another key = if you get a case that gives you numbers. Remember that the smaller the #, the less amount of disease. Ex: Measuring decay if the number is 1 then this means low levels of decay

• Dental Index: mathematical description of a disease or condition based on carefully determined criteria under specific circumstances

IndexBoard Alert!Characteristic of ideal index

SimpleUtility: clear, simple, objectiveValid: measures what is intended to be measuredReliable: measures consistently at different times,

reproducibility, stability of measurementClearSensitive: to shifts in disease in either directionQuantifiable: amenable to statistical analysisObjectiveAcceptable: to subjects involved

Index

• Validity and Reliability– An index is valid when it accurately measures what was

intended to be measured– An index is reliable when it consistently gives same results each

time• Calibration is a method of standardizing examiners,

increases reliability, decreases variation in assessing and recording observations of a study– Blind: when either subjects or raters, but not both, are unaware

of subject placement into experimental grps– Double Blind: when both raters and subjects are unaware of

which tx the subject is receiving

Index

• General Categories1. Reversible: measured conditions that can be

resolved or reversed (Gingivitis)2. Irreversible: measures cumulative conditions

that CANNOT be resolved (Caries & Perio)3. Simple: measures the presence or absence of a

disease4. Cumulative: measures all evidence of a condition

(past & present)

Irreversible Index

• Dental Caries: Irreversible– DMFT: Decayed, missing, filled teeth surfaces. Do

NOT include 3rd molars, unerupted, congenitally missing, primary tooth retained w/ perm successor erupted, teeth restored for reasons other than dental caries such as trauma, teeth removed for reasons other than caries

– DEF, DF, DMF: Indicates teeth to be extracted due to decay (lower case letters would indicate primary teeth)

– RCI (Root Caries): Requires recession!!!

Irreversible Index• CAMBRA

– Caries management by risk assessment – Id the cause of disease through the assessment of risk factors for

each indv patient and then managing those risk factors through behavioral, chemical and minimally invasive procedures

– Risk assessment grounded in the use of a CARIES RSK ASSESSMENT FORM

– Separate form for pedo patients– Based on answers = divide into low, mod, high, extreme risk– Sealants are recommended for indv at moderate or higher risk

levels– Frequency of recall caries exams and BWX increase risk level

increases– Salivary testing is optimal for low-risk and mod-risk indv

Gingivitis Index

• GI (gingival Index)– Reversible– Based on severity versus extent of inflammation– Can be used in individuals or study participants

• SBI (Sulcular Bleeding Index)– Reversible– Detects EARLY signs of gingivitis– Useful in short-term trials

Periodontal Index• PDI (Periodontal Disease Index)

– Irreversible & reversible (measures gingivitis separately)– Developed by Ramfjord

• PI (Periodontal Index)– Irreversible– Developed by Russel– Looks at surrounding tissue, Questionable for validity (no CAL)

• PSR (Periodontal Screening and Recording)– Rapidly assesses perio health– Required a special probe, useful as a preliminary screening technique

and for use in large populations• CPITN (Community Periodontal Index of Treatment Needs)

– Developed by WHO– Determines periodontal NEEDS versus periodontal STATUS requires

special probe

OHI Index: on Last Year’s Boards!• OHI-S (Simplified Oral Hygiene Index)

– Reversible– Measures oral hygiene status by assessing sub-&-supra plaque and calculus– Better for group vs individual assessment

• PII (Plaque Index)– Reversible– Developed by Silness and Loe– Used in conjunction with the Gingival Index– Scores plaque according to its thickness at the gingival margin

• PHP (Patient Hygiene Performance)– Reversible– Measures plaque after toothbrushing

• VMI (Volpe-Manhold Index)– Reversible– Used to test agents for plaque control and calculus inhibitions, measures supra

calculus formation following a prophy

Index

A lot of Index-style questions appear in the case study section

Know which index should be used for each case

Board Question

All the following are characteristics of an ideal index EXCEPT one.

a. Validb. Reliablec. Complexd. Objective

Summary of Current Diseases Trends

• Dental Caries– Age: root caries increase with increase age– Gender: females higher– Race/Socioeconomic Status: Hispanics, African-Americans

higher• Periodontal Disease

– Not as well understood as dental caries, but knowledge of disease and accuracy of measurement increasing

– Prevalence of severe gingivitis 7-15% worldwide– Age, gender, race/socioeconomic status: only increase age

equals increase risk perio


• Tooth Loss– Caries principle cause tooth loss at almost all ages with the

exception of the oldest age groups (over 60)– Edentulouism decreasing in US– Gender: females more– Race: slightly higher among whites

• Oral Cancer– Life and death implications– Most persistent environmental risk factor is tobacco use– Also related to alcohol, HPV– Age: young and old– Gender: twice as much in males, females starting to gain with

HPV


• Utilization of Dental Services– Diminishing number young people– Increased # persons living in poverty– Patterns• Age: peak ages: late teens, adults, more elderly due to

tooth retention• Gender: more women but both increasing• Race/Socioeconomic Status: high SES = greater use

Question

One method to decrease variation in assessing and recording observation when conducting a study is to:a. Use a more sensitive index instead of the simple

onesb. Have examiners eval common subjects, compare

results and come to an agreementc. Have examiners take more time in scoring subjectsd. Increase the number of examinerse. Rotate the number of examiners

Answer

One method to decrease variation in assessing and recording observation when conducting a study is to:a. Use a more sensitive index instead of the simple

onesb. Have examiners eval common subjects, compare

results and come to an agreementc. Have examiners take more time in scoring subjectsd. Increase the number of examinerse. Rotate the number of examiners

Question

Epidemiological studies of dental caries suggest all trends except:a. Caries occur where there is gingival recessionb. Males have higher DFM scores than femalesc. Caries experience increases steadily with aged. Females have higher DFM scores than malese. Overall caries rates are declining

Answer

Epidemiological studies of dental caries suggest all trends except:a. Caries occur where there is gingival recessionb. Males have higher DFM scores than femalesc. Caries experience increases steadily with aged. Females have higher DFM scores than malese. Overall caries rates are declining

Question

The def index is designed to determinea. Decayed, missing and filled primary teethb. Decayed, missing, and filled permanent teethc. Decayed, indicated for extraction due to decay and filled primary teethd. Decayed, erupted and filled primary teeth

Answer

The def index is designed to determinea. Decayed, missing and filled primary teethb. Decayed, missing, and filled permanent teethc. Decayed, indicated for extraction due to decay and filled primary teethd. Decayed, erupted and filled primary teeth

Question

The amount of untreated dental caries in a population at a given point in time is the caries:a. Indexb. Incidencec. Incrementd. Prevalencee. Morbidity rate

Answer

The amount of untreated dental caries in a population at a given point in time is the caries:a. Indexb. Incidencec. Incrementd. Prevalencee. Morbidity rate

Question

Which of the following is characteristic of stratified sampling?a. Each subject has an equal chance of being selectedb. Every nth subject is chosen from a representative samplec. Subjects are randomly chosen from a previously subdivided populationd. Subjects are randomly chosen from individuals

with special characteristics

Answer

Which of the following is characteristic of stratified sampling?a. Each subject has an equal chance of being selectedb. Every nth subject is chosen from a representative samplec. Subjects are randomly chosen from a previously subdivided populationd. Subjects are randomly chosen from individuals

with special characteristics

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Community Dental Health Programs

• Steps in developing a community program1. Assessment: First step is to conduct NEEDS

ASSESSMENT (Board Alert!)2. Planning3. Implementing4. Evaluation

Needs Assessment• Reason: define extent & severity of problem, id cause, provide a

profile of the community, collects baseline data• Board Alert – know which method works best for the target

population – analyze time, costs and community constraints• Ways to conduct needs assessment

– Direct observation– Interview– Questionnaire– Survey (BEST choice for large groups)– Epidemiological surveys (rsrch based)– Records, documents, charts (time consuming)

Needs Assessment Considerations

1. Access to Care Issues1. Needs: type of care available (office accepting Medicaide

pt in a town of 65,000)2. Demand: type of care desired (whitening vs restorative

procedures)3. Utilization: actual use of services available by the public 4. Barriers: obstacles which interfere with care to be

provided or received (lack of funding for low cost dental services)

Needs Assessment Considerations

2. Ways to Observe Needs– Through eyes of the PLANNER• Real needs based on health issues• Objective

– Through eyes of the TARGET POPULATION• Perceived needs or wants, opinion, subjective• Ex: the study participants want wht vs rest procedures

Needs Assessment Considerations3. Population Profile

– Gathers info about target population– Info included

1.# indv who will be part of program2.Geographic distribution of the target population3.Rate of growth in the community4.Degree of urbanization5.Ethnic & language profile6.Nutritional status7.Standard of living8.Amt & type of community services and utilities9.Profile of school system10.Gen health profile

Needs Assessment Examination Methods

• Type I: Comp exam using mirror, explorer, lighting, x-rays, study models, diagnostic tests, percussion, pulp vitality tests, transillumination, lab tests

• Type II: limited exam using mirror, explorer, lighting, limited x-rays. Useful when program may include dental tx for individuals and when time/money permit

BOARD ALERT!!

Needs Assessment Examination Methods

• Type III: Exam using mirror & lighting only. Adv: OHI basis, establishing rapport and planning motivational strategy, baseline info on dental needs of a group. Disadv: need for complete assessment overlooked, no value unless follow-up occurs

• Type IV: Exam using tongue depressor & lighting only. Id glaring needs for assessment in program planning

Type III & IV are most common method used in dental public health and in developing countriesBOARD ALERT!!

2. Planning Community Program• Systematic approach involving:

– Collection of Preliminary Info• Funding: Medicare, Medicaid, COBRA, Black grants, Line item

grants– Establishment of Priorities: rank problems– Determine Goals/Objectives

• Goals: broad-based statement of desired outcome• Objectives: must be measurable

– Consulting/Coordinating Activities• Facility, manpower, plan of action

– Drafting a Plan• Lesson plan, implementation strategy

3. Implementing

• Principles of Learning– Motivational factors, learning only progresses as far as

learner wants– External motivation or Internal motivation

• Principles of Teaching– Teach way skills are to be used, id learner needs,

establish goals/objectives, design learning strategies based on objectives, plan an evaluation, info delivery• Formal Delivery: lecture, demonstration, discussion• Informal Delivery: brochures, pamphlets, billboards

3. Implementing

• Principles of Learning– Motivational factors, learning only progresses as far as

learner wants– External motivation or Internal motivation

• Principles of Teaching– Teach way skills are to be used, id learner needs, establish

goals/objectives, design learning strategies based on objectives, plan an evaluation, info delivery• Formal Delivery: lecture, demonstration, discussion• Informal Delivery: brochures, pamphlets, billboards

3. Implementation• Stages of Learning (BOARD ALERT!)

1. Unawareness: learner has incomplete or inaccurate info

2. Awareness: correct info is given but it does not have personal meaning for learner

3. Self-Interest: learner personalizes info4. Involvement: old ideas replaced by new ones, learner

is motivated to act5. Action: learner tests new concept based on perceived

needs6. Habit: learner begins to experience gratification and

self-satisfaction, behavior is modified at this stage

4 Evaluation

• Also called program appraisal• Provides info for future program revisions• Analyses whether or not goals & objectives were met• May be formal or informal• Must be continuous from the beginning of the

program• Dependent from baseline data from needs

assessment

Board Question

The first step in implementing a community health program is

a. Selection of a venueb. Recruitment of volunteersc. Conduction of a needs assessmentd. Determination of goals and objectives

Community Dental Health ProgramsFluoride

• Fluoridation Programs – 1part to 1 million parts water: range = 0.7-1.2ppm

• Depends on mean daily temperature• Warmer = lower

– 17-40% reduction cost– Compounds used

1. Na silicofluoride (solid)2. Na fluoride (solid)3. Hydrofluosilic acid (liquid)

• School Water Fluoridation (next slide)• Fluoride Drops• Pit and Fissure Seals

Community Dental Health ProgramsFluoride

• School Water Fluoridation– Fluoridated 4.5x the optimal concentration

recommended for the community– Reduce caries by 25%

• F Drops– 0.125, 0.25, 0.50mg– Tablets: 0.50 and 1.0mg, oral rinse 1mg/15ml– Antifluoridationists are most successful at local

levels rather than state or national

Community Dental Health ProgramsHealth Education Pgrms

• Is the provision of health information to people that they apply in everyday living; a process with intellectual, psychological and social dimensions relating to activities that increase the ability of people to make informed decisions affecting their personal, family and community well being

• Cognitive vs Behavioral Learning• Special Needs Populations: elderly, disabled, medically

compromised, indigent

Community Dental Health ProgramsTx Pgrms

• Limit services• Target populations • Consider Resources/Money/Facilities• Demand – Effective Demand is the desire for care and the

ability to obtain it– Potential Demand is the desire for care and the

inability to obtain it

Community Dental Health ProgramsFinancing Pgrms

• Medicare, Medicaid• Local, county state, federal• Private foundations, organizations,

corporations• Fee for service, third party plans• Managed care

Question

Which of the following should be considered in planning learning activities for dental health education?

a. Content to be learnedb. Previous dental health knowledgec. Developmental levels of the groupd. Environment in which learning will take

placee. All the above

Answer

Which of the following should be considered in planning learning activities for dental health education?

a. Content to be learnedb. Previous dental health knowledgec. Developmental levels of the groupd. Environment in which learning will take

placee. All the above

Question

Select the first step of the following to formulate a dental program aimed at an underserved community

a. Assess the needs of the community and develop program goals

b. Establish priorities for dental health problems of the community

c. Analyze factors that interfere with dental health care in the community

d. Select strategies to meet dental needs of the community

e. Evaluate effectiveness of the community dental health program

Answer

Select the first step of the following to formulate a dental program aimed at an underserved community

a. Assess the needs of the community and develop program goals

b. Establish priorities for dental health problems of the community

c. Analyze factors that interfere with dental health care in the community

d. Select strategies to meet dental needs of the community

e. Evaluate effectiveness of the community dental health program

Question

In evaluation, both reliability and validity are important considerations. If an author states that his data are reliable, that means the date:

a. Would be reproductiveb. Would relate positively to an outside criterionc. Were obtained in an honest mannerd. Can be generalized to a larger populatione. Were collected by 1 personf. All the above

Answer

In evaluation, both reliability and validity are important considerations. If an author states that his data are reliable, that means the date:

a. Would be reproductiveb. Would relate positively to an outside

criterionc. Were obtained in an honest mannerd. Can be generalized to a larger populatione. Were collected by 1 personf. All the above

Question

Select the first step in correct order for the following research steps.

a. Data collectionb. Conclusionc. Hypothesisd. Problem identificatione. Analysis and interpretation

Answer

Select the first step in correct order for the following research steps.

a. Data collectionb. Conclusionc. Hypothesisd. Problem identificatione. Analysis and interpretation

Question

In developing a community profile, the information gathered does all the following except:

a. Is only necessary for large dental health programs

b. Is limited to geographic boundaries, population size and demographic datac. Is useful when working wit large or small

communitiesd. Provides a comprehensive overview of the communitye. Is a crucial step in the planning process for many reason

Answer

In developing a community profile, the information gathered does all the following except:

a. Is only necessary for large dental health programs

b. Is limited to geographic boundaries, population size and demographic datac. Is useful when working wit large or small

communitiesd. Provides a comprehensive overview of the communitye. Is a crucial step in the planning process for many reason

Question

In a nonfluoridated community, which preventive dental health program would have the maximum cost benefit for the control of caries in elementary school children?

a. Dental health education programb. Fluoride mouth rinse programc. Restorative care programd. Parent-teacher education programe. Pit and fissure sealant program

Answer

In a nonfluoridated community, which preventive dental health program would have the maximum cost benefit for the control of caries in elementary school children?

a. Dental health education programb. Fluoride mouth rinse programc. Restorative care programd. Parent-teacher education programe. Pit and fissure sealant program

Question

The most effective way to provide oral hygiene instruction in a nursing home

a. Hand out pamphlets to residentsb. Train the nurses/caregiversc. Teach the nursing home residentsd. Send written material to the

administrator

Answer

The most effective way to provide oral hygiene instruction in a nursing home

a. Hand out pamphlets to residentsb. Train the nurses/caregiversc. Teach the nursing home residentsd. Send written material to the

administrator

Preventing & Controlling Disease

• Oropharyngeal Cancer: HPV, alcohol, tobacco• ADHA Smoking Cessation Initiative: refer to

Wilkins/Darby• Craniofacial Birth Defects: cleft lips/palate, prenatal

care• Facial injury or trauma: mouthguards

Board Review DH227 Community Oral Health Lisa Mayo, RDH, BSDH Concorde Career College.

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Transcript of Board Review DH227 Community Oral Health Lisa Mayo, RDH, BSDH Concorde Career College.