COMMUNITY DENTAL HEALTH

1
COMMUNITY DENTAL HEALTH

• Algonquin College
• Janet Ladas

2
HISTORY OF PUBLIC HEALTH

• 1867 - British North American Act - Colonies
  came together to control disease
• 1870 - Ontario Public Health Act - Disease
  based
• 1875 - The English Public Health Act
  (Britain) - Provinces modeled after this
  Act - People demanded treatment

3
HISTORY OF PUBLIC HEALTH

• 1974 - Lalonde Report A New
  Perspective on Health
• of Canadians
• - Focus on health promotion
• 1983 - Ontario Health Protection and
  Promotion Act - Legislates all Ontario
  Health Departments and Health Care and
  Social Service care providers
• - Prevention through organization and
  delivery of public health programs and
  services

4
HISTORY OF PUBLIC HEALTH

• 1986 - Two landmark documents that
  affected Ontario health policies
• - 1.Achieving Health For All A Framework
  for Health Promotion
• 2.The Ottawa Charter on Health
  Promotion
• 1987 - Three important Ontario reports
  released by John Evans, Robert Spasoff and
  Steve Podborski - further impacted on health
  promotion policies
• - lead to formation of Premiers Health
  Council

5
HISTORY OF PUBLIC HEALTH

• 1993 - December 31 Proclamation of
• The Regulated Health Professionals Act

6
CRITERIA FOR PUBLIC HEALTH DECISIONS

• Disease or other threat to health is widespread
• Knowledge exists on how to prevent or cure the
  condition
• Such knowledge is not being applied
• W.H.O. DEFINITION OF HEALTH
• A state of complete physical / mental and social
  well-being and not merely the absence of disease

7
CORE FUNCTIONS OF PUBLIC HEALTH(Applied to
D.I.S. and Screening)

• ASSESSMENT
• Data analysis
• Statistics on dental health status/needs
• POLICY DEVELOPMENT
• Evidence-based decision making
• Set goals and objectives
• More children and youth have healthy teeth and
  gums and fewer have dental caries (M.O.H.)

8
CORE FUNCTIONS OF PUBLIC HEALTH(Applied to
D.I.S. and Screening)

• ASSURANCE OF SERVICES
• Provide services - Municipality
• Provide funding - Province
• Cost verses results
• Assure access to care (funding)
• Intense follow-up to assure care

9
COMMUNITY PREVENTION PROGRAMS

• PREVENTION PRIMARY GOAL
• PRIMARY PREVENTION
• - most effective
• - prevents disease before it occurs
  fluoridization / immunization, diet,
  physical activity

10
COMMUNITY PREVENTION PROGRAMS

• PREVENTION PRIMARY GOAL
• SECONDARY PREVENTION
• - treats disease after it occurs
• - promptly
• - reduce prevalence
• - shorten duration
• - screening / referrals
• - early accurate diagnosis

11
COMMUNITY PREVENTION PROGRAMS

• PREVENTION PRIMARY GOAL
• TERTIARY PREVENTION
• - limits or rehabilitates a disability from
  disease e.g. - prostheses provided
• - reduce complications
• COMMUNITY PREVENTION PROGRAMS USED ONLY WHEN
  SHOWN TO BE EFFECTIVE BY WELL-DESIGNED CLINICAL
  STUDIES AND EVIDENCE-BASED RESEARCH

12
WORLD HEALTH ORGANIZATION

• Est. April 7/48 World Health Day
• ACTIVITIES Global Based (200 Countries)
• Maintains Global Oral Data Bank
• Collects information and develops methods for
  that collection (indices)
• Monitors oral disease changes
• Develops and tests epidemiological methods

13
WORLD HEALTH ORGANIZATION

• ACTIVITIES
• Maintains Country Profile development
  (information on oral disease and services,
  tobacco use, sugar consumption,
  fluoride/fluoridization)
• Implements and evaluates community preventive
  programs (affordable oral care)
• Public education / health promotion

14
WORLD HEALTH ORGANIZATION

• ACTIVITIES
• Advocacy and legislation promotion
• Information dissemination
• (41 W.H.O. centers worldwide)

15
WORLD HEALTH ORGANIZATION

• YEAR 2000 GOALS
• By the age of
• 5-6 - 50 should be caries free
• 12 - DMFT should be less than 3
• 18 - 85 should have retained all their
  teeth
• 34-44 - a 50 reduction in the number of
  persons with no teeth
• 65 plus - a 25 reduction in the number of
  persons with fewer than 20 teeth
• W.H.O. is currently developing a new set of
  global goals for 2010

16
DENTAL PUBLIC HEALTH PEOPLES HEALTH

• Science and art of preventing and controlling
  dental disease on a community basis (not
  individual)
• Promotes dental health through organized
  community efforts
• Educates the public using applied dental research
  (evidence-based)
• Develops resources
• Funded by government

17
WHAT DENTAL PUBLIC HEALTH IS NOT

• Welfare Dentistry
• Just conducting surveys
• Just fluoridation
• Independent practice
• Provider of last resort

18
TEN GREAT PUBLIC HEALTH ACHIEVEMENTS

• 1. Control of infectious diseases
• 2. Decline in death from heart disease and stroke
• 3. Family planning
• 4. Water Fluoridization
• 5. Healthier mothers and babies

19
TEN GREAT PUBLIC HEALTH ACHIEVEMENTS

• 6. Motor vehicle safety
• 7. Recognition of tobacco health hazards
• 8. Safer and healthier foods
• 9. Safer workplaces
• 10. Vaccination

20
CURRENT DENTAL PUBLIC HEALTH PRACTICE

1. Water Fluoridization
2. Prevention of oral cancer
3. Reduction of dental problems
4. Education
5. Nutrition
6. Injury Prevention
7. Research and development

21
1. WATER FLUORIDIZATION

• 1901-08 Dr. Fredrick McKay observed Colorado
  Brown Stain
• (Motteling and brown opacities of the teeth
  less caries)
• 1920 Common link shared water source
  water analysis showed nothing
• 1925 McKay advised using water from outside
  source resulted in less motteling

22
1. WATER FLUORIDIZATION

• 1930 Improved water analysis method showed
  correlation between increased fluoride
  resulted in more motteling then termed
  Dental Fluorosis
• 1931 Dr. H. Trendley Dean
• Goal to define the minimal level of
  fluoride to inhibit caries without Fluorosis
• - developed Fluorosis index
• Result caries rate down at F. Level up to
  1.0 p.p.m.

23
2. PREVENTION OF ORAL CANCERW.H.O. A GLOBAL
CONCERN

• TOBACCO CESSATION
• How to reduce oral cancer
• Train health care workers to look for early signs
• Education of the public advertising (causes and
  signs)
• Involve other educators (teachers)
• Public policy taxes / bans
• Individual counselling
• Prevention / cessation programs
• Social acceptance changes

24
3. REDUCTION OF DENTAL PROBLEMS

• PREVENTIVE MEASURES
• Sealants effective but underused
• Fluoride variety of sources
• Prophylaxis improved access to care
• Government funded programs
• C.I.N.O.T. / D.I.S.

25
4. EDUCATION

• Information / Promotion
• - Dental Health Month
• - Dental Health Week
• - School dental curriculum
• - Dental Associations
• (To name a few)

26
5. NUTRITION

• Canada Food Guide
• School food policies
• Food labeling

27
INJURY PREVENTION

• SEAT BELTS
• SPORTS EQUIPMENT (MOUTHGUARDS)
• BIKE HELMETS

28
7. RESEARCH AND DEVELOPMENT

• EPIDEMIOLOGY study of disease and health in
  populations
• - caries control
• - periodontal disease
• - monitor disease trends
• - collected data analysis and dissemination

29
PREVENTIVE PROPERTIES OF FLUORIDE

• CLASSICAL EPIDEMIOLOGICAL STUDY SIX PRINCIPALS
• 1.Studied groups not individuals Colorado
  Springs Community
• 2.Examined well and ill people long term
  residents more affected
• 3.Looked at relative prevalence surrounding areas
  studied

30
PREVENTIVE PROPERTIES OF FLUORIDE

• CLASSICAL EPIDEMIOLOGICAL STUDY SIX PRINCIPALS
• 4.Broad goal established, e.g. association
  between prevalence of fluorosis or caries and
  fluoridated and non-fluoridated areas
• 5.Required 2 demonstrations
• - association itself is dependable and
  predictable from population to population
• - other factors could not be responsible

31
PREVENTIVE PROPERTIES OF FLUORIDE

• CLASSICAL EPIDEMIOLOGICAL STUDY SIX PRINCIPALS
• 6.Support for association between fluoride and
  dental health is gained through additional
  studies
• FINAL CONCLUSION
• Water can be fluoridated to optimal level to
  reduce caries without increasing fluorosis

32
MINISTRY OF HEALTH PROGRAMCHILDREN IN NEED OF
TREATMENTC.I.N.O.T.

• Dental Screening Program 3 Hygienists
• High/Moderate Risk Elementary Schools
• - screening of selected students and data
  recording
• - intensive follow-ups and referrals
• - take home notice
• - phone contact/consultation
• - follow up school screening
• - provision of preventive services
• - exam, prophylaxis, sealants, fluorides

33
MINISTRY OF HEALTH PROGRAMCHILDREN IN NEED OF
TREATMENTC.I.N.O.T.

• Dental Screening Program 3 Hygienists
• High/Moderate Risk Elementary Schools
• - Dental Health Education and Promotion
• - clients, caregivers, school staff
• - resource person
• - for students / caregivers
• - in the community
• - for other health care providers
• Year 2000 - 60 schools screened
• - 1500 CINOT referrals
• - 480 clinic services

34
TERMINOLOGY

• EPIDEMIOLOGY
• THE STUDY OF THE AMOUNT, DISTRIBUTION,
  DETERMINANTS AND CONTROL OF DISEASES AND HEALTH
  CONDITIONS AMONG GIVEN POPULATIONS.
• ENDEMIC
• A RELATIVELY LOW, BUT CONSTANT LEVEL OF
  OCCURRENCE OF A DISEASE OR HEALTH CONDITION IN A
  POPULATION.

35
TERMINOLOGY

• EPIDEMIC
• A DISEASE OR CONDITION CCURRING AMONG MANY
  INDIVIDUALS IN A COMMUNITY OR REGION AT THE SAME
  TIME AND USUALLY SPREADING RAPIDLY. OFTEN CALLED
  AN OUTBREAK OF DISEASE. WIDESPREAD OUTBREAKS
  ACROSS A REGION OR CONTINENT MAY BE TERMED
  PANDEMIC IN EXTENT.
• DISEASE RATES
• THE NUMBER OF CASES OR DEATHS AMONG A POPULATION
  OR TARGET GROUP DURING A GIVEN TIME PERIOD,
  EXPRESSED AS A RATIO. RATES ARE OFTEN
  STATISTICALLY ADJUSTED TO MAKE VALID
  COMPARISONS ACROSS DIFFERENT POPULATIONS OR TO
  DETECT TRENDS WITHIN THE SAME POPULATION.

36
TERMINOLOGY

• MORTALITY
• THE RATIO OF THE NUMBER OF DEATHS FROM A GIVEN
  DISEASE OR HEALTH PROBLEM TO THE TOTAL NUMBER OF
  CASES REPORTED.
• MORBIDITY
• THE RATIO OF SICK (AFFECTED) INDIVIDUALS TO
  WELL INDIVIDUALS IN A COMMUNITY. IT OFTEN
  MEASURES THE LEVEL OF NONFATAL HEALTH
  CONSEQUENCES (SEVERITY) OF A DISEASE OR CONDITION.

37
TERMINOLOGY

• PREVALENCE
• A NUMERICAL EXPRESSION OF THE NUMBER OF ALL
  EXISTING CASES OF A DISEASE OR PROBLEM IN A
  POPULATION MEASURED AT A GIVEN POINT OR PERIOD OF
  TIME.
• CASE RATE
• FREQUENCY OF OCCURRENCE OF A CONDITION
• INCIDENCE
• THE NUMBER OF NEW CASES OF A DISEASE IN A
  POPULATION OVER A GIVEN PERIOD OF TIME.

38
TERMINOLOGY

• ETIOLOGY
• THE THEORY OF CAUSATION FOR A DISEASE OR
  CONDITION.
• RISK FACTORS
• CHARACTERISTICS OF AN INDIVIDUAL OR POPULATION,
  WHICH MAY INCREASE THE LIKELIHOOD OF EXPERIENCING
  A GIVEN HEALTH PROBLEM (E.G., AGE, GENDER,
  EDUCATIONAL LEVEL, SOCIOECONOMIC STATUS).

39
TERMINOLOGY

• INDEX
• A STANDARDIZED METHOD USED TO DESCRIBE THE
  STATUS OF AN INDIVIDUAL OR GROUP WITH RESPECT TO
  A GIVEN CONDITION. INDEXES USUALLY INVOLVE A
  GRADUATED SCALE FOR MEASURING THE EXTENT OF THE
  HEALTH PROBLEM.
• SURVEILLANCE
• METHODS OR SYSTEMS USED TO MONITOR DISEASE AND
  MORBIDITY INA POPULATION PERIODICALLY OR ON AN
  ONGOING BASIS. IT IS AN IMPORTANT FUNCTION OF THE
  CENTERS FOR DISEASE CONTROL (CDC) AND HEALTH
  DEPARTMENTS, ETC.