caries symposium 5 - population level Flashcards
what is epidemiology
study of the distribution and determinants of diseases in populations
- distribution = burden
- determinants = cause or risk factors
- population = groups of individuals geographic/area/community
what is descriptive epidemiology
- describes the problem
- trends/ prevalence
analytical epidemiology
- analyses the problem
- risk factors
- social determinants
what are the 3 factors that cause caries
- time = years, seasonal, time of day, generation
- place = regional, global, communities
- person = age, gender, medical history
how do you describe disease in a populations
- counts = number of people affected by a particular condition at particular time and area
- prevalence = proportion of population with a disease an any given point (point prevalence) or period (period prevalence)
- incidence = number of new cases of a disease in a defined population over a defined period of time (rate)
- standardised data = number of new cases of a disease in a defined population over a defined period of time
what is point prevalence
proportion (%) of population with a disease at any given point
what is period prevalence
proportion of population with a disease at any given period
what is descriptive epidemiology of the oral health
- it is estimated that 3.5 billion people worldwide have oral diseases
- caries of the permanent teeth is the most prevalent
- globally, 2.4 billion adults suffer from caries and 486 million children in primary teeth
how do you measure/record caries
- DMFT/dmft = upper case for permanent teeth, lower case of primary
- ICDAS = international caries detection and assessment system, restorative and caries status scores, looks at enamel and dentine level of decay
- significant caries index = take into account skewed distribution of caries in population
what percentage of 5 year olds in Scotland have a score of 7 dmft
10th of population
what are the caries detection stages
- extensive decay
- moderate decay
- initial decay
- very early decay
what is extensive decay
lesions into the pulp (D3)
what is moderate decay
- clinically detectable lesions in dentine
- clinically detachable cavities limited to enamel
what is initial decay
clinically detectable enamel lesions with intact surfaces
what is very early decay
- small lesions detectable only with additional diagnostic aids
- sub-clinical initial lésions in a dynamic state of progression/regression (a lot of decay is this)
what are some global surveys used
- WHO database
- US has CDC
what are some UK surveys used
- adult dental health survey
- child dental health surveys
- BASCD surveys
- NDIP surveys
why is the amount of caries in developing countries increasing
due to a growing consumption of sugar
- opposite happens in developed countries as they have effective public health measures
what is the main thing that has driven improvements in oral health
fluoride toothpaste
what four things make up the traditional biomedical model of caries
- plaque microorganisms
- substrate
- time
- tooth
(if only two or three of these occur don’t get caries, only get caries if all 4 occur)
what are the strategies for preventing caries in a population
- high risk individual approach (clinical risk assessment)
- targeted population approach (targeting on areas of deprivation/communities)
- whole population approach (universal e.g. NHS)
what are the strategies for delivering fluoride
- toothpaste
- water fluoridation
- community fluoride schemes
what are the main risk factors of caries
- diet
- hygiene
- tobacco
what are the 3 sections of circumstances and risks of oral health inequalities
- upstream actions
- midstream actions
- downstream actions
what are upstream actions
- socioeconomic and political context (structure and systems)
- policies put in place (macroeconomic, social and welfare, food, education and health system)
what are midstream actions
- community context
- community workforce, schools, nurseries , environment
what are downstream actions
- behaviour and biological factors = age, biofilm, diet
- psychosocial factors = stress
- health services = quality of care
what are health improvement approaches
- theory based
- evidence based
- common risk factor approach
- community engagement
- multi-agency working
what are the child smile guidelines
- importance of fluoride
- register child with dentist = as early as possible, and attend regularly
- standard risk of caries = all children
- enhanced risk children = SIMD of 1-3, and daft experience
what are some integrated programmes with child smile
- supervised brushing
- FVA (fluoride varnish application) in nursery and schools
who gets fluoride varnish
- 2-5 year olds
- for children from 2 year olds apply varnish 2 times a year
what is oral health improvement advice
- demonstrate and observe hands-on brushing instruction
- tailored advice on diet and nutrition
- have an action plan
