5 Prevalence and prevention at a population level

Question 1

What is epidemiology

Answer 1

the study of the distribution on determinants of diseases in populations

Question 2

What does distribution mean

Answer 2

burden

Question 3

What does determinants mean

Answer 3

cause or risk factor

Question 4

What does population mean

Answer 4

groups of individuals in geographic/ area/ community/ community of interest

Question 5

How do population pyramids help epidemiology

Answer 5

prediction of the current and future population demographics so can plan interventions in advance

Question 6

What does ‘counts’ mean when describing disease in populations

Answer 6

no. of people affected by a particular condition (at a particular time, and area)

Question 7

What does ‘prevalence’ mean when describing disease in populations

Answer 7

the proportion (%) of population with a disease at any given point (point prevalence) or period (period prevalence in time)

(something like caries, diabetes etc, wouldn’t do for cancer)

Question 8

What does ‘incidence’ mean when describing disease in populations

Answer 8

the number of new cases of a disease in a defined population over a defined period of time (rate)

(would do for cancer cause it’s more about the number of new cases)

Question 9

What does ‘standardised data’ mean when describing disease in populations

Answer 9

takes into account population age structure

Question 10

According to the Lancet GBD study (2016) at least how many people are affected with oral diseases worldwide

Answer 10

3.58 billion

Question 11

According to the Lancet GBD study (2016) caries of the permanent teeth is the xxx of all conditions asseessed

Answer 11

most prevalent

Question 12

According to the Lancet GBD study (2016) globally how many people suffer from caries of permanent teeth and how many children suffer from caries of primary teeth

Answer 12

2.4 billion permanent
486 million children

We only treat 10-15% of decayed teeth in children so lots of disease out there with inappropriate treatment

Question 13

How is caries measured/recorded

Answer 13

DMF/dmf index
- no. of decayed missing, filled teeth or surfaces

ICDAS
- international caries detection and assessment system

Significant caries index
- takes into account skewed distribution of caries in population

Question 14

What has been the main driver for reducing caries rates since the 1970s in britain

Answer 14

fluoride toothpaste

Question 15

How does someones SIMD quintile affect their risk of caries

Answer 15

lowest quintile at most risk (most deprived)

highest at least

Question 16

Draw the traditional biomedical model for caries

what’s missing from the model?

Answer 16

• susceptible tooth
• plaque microorganisms
• substrate (sugar)
• time

availability/concentration of fluoride

Question 17

What are 3 strategies for preventing caries in populations

Answer 17

• high risk individual approach (clinical risk assessment)
• targeted population approach (targeting on areas of deprivation/ communities)
• whole population approach (universal i.e/e.g. a founding principle of the NHS)

Question 18

Is it better to shift the whole population into a lower risk category or to shift high risk individuals into a lower category

Answer 18

shift the whole population (encouraging everyone to change) into a lower risk category (bell curve)

Question 19

Caries prevention is aimed to be delivered via a proportioniate universal approach, what does this mean

Answer 19

What do we do with every child?
What do we do with the highest risk?
Called ‘proportionate universalism’, combined universal and targeted

Question 20

What are strategies for delivery of fluoride

Answer 20

• toothpaste
• water fluoridation
• community fluoride schemes

Question 21

What is a more effective way of dealing with oral health inequalities

Answer 21

treating it via a multiple risk approach i.e. by reducing risk factors for one disease you are reducing risk factors for lots of diseases

need to take into account that elements of life are interlinked

socioeconomic and political (structure and systems)–> community context –> behaviour and biological, psychosocial, health services factors –> oral health outcomes and inequalities

Question 22

What are some common health improvement approaches

Answer 22

• theory based
• evidence based
• common risk factor approach
• community engagement
• multi agency working
• proportionate universalism

Question 23

What is meant by upstream interventions

Answer 23

Public health policy

Question 24

What is meant by downstream interventions

Answer 24

health education and clinical prevention

Question 25

What are the evidence based clinical guidelines (SDCEP, 2018) on prevention and management of dental caries in children

Answer 25

• importance of fluoride
• register child with a dentist (as early as possible or as soon as the first tooth appears)
• standard risk = all children
• enhanced risk = simd 1-3, decay experience dmft

Question 26

what are some of the childsmile integrated programmes

Answer 26

Supervised brushing - making sure that young children brush regularly with a fluoride toothpaste (universal at nursery)

FVA in nursery and school - preventive dental care delivered in the nursery and school setting by mobile clinical teams (targeted)

Practice and community - community support and oral health promotion and clinical caries prevention delivered by the dental team (targeted)

Question 27

How does childsmile run

Answer 27

lots of different stakeholders
upstream-downstream approach
childsmile incorporated in NHS primary care payment system in 2011
health visiters/public health nurses/ dental health support workers/ primary care dental practice/ non-dental local community/ third sector organisations and services