caries symposium 5 - population level

Question 1

what is epidemiology

Answer 1

study of the distribution and determinants of diseases in populations

• distribution = burden
• determinants = cause or risk factors
• population = groups of individuals geographic/area/community

Question 2

what is descriptive epidemiology

Answer 2

• describes the problem

- trends/ prevalence

Question 3

analytical epidemiology

Answer 3

• analyses the problem
• risk factors
• social determinants

Question 4

what are the 3 factors that cause caries

Answer 4

• time = years, seasonal, time of day, generation
• place = regional, global, communities
• person = age, gender, medical history

Question 5

how do you describe disease in a populations

Answer 5

• 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

Question 6

what is point prevalence

Answer 6

proportion (%) of population with a disease at any given point

Question 7

what is period prevalence

Answer 7

proportion of population with a disease at any given period

Question 8

what is descriptive epidemiology of the oral health

Answer 8

• 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

Question 9

how do you measure/record caries

Answer 9

• 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

Question 10

what percentage of 5 year olds in Scotland have a score of 7 dmft

Answer 10

10th of population

Question 11

what are the caries detection stages

Answer 11

• extensive decay
• moderate decay
• initial decay
• very early decay

Question 12

what is extensive decay

Answer 12

lesions into the pulp (D3)

Question 13

what is moderate decay

Answer 13

• clinically detectable lesions in dentine

- clinically detachable cavities limited to enamel

Question 14

what is initial decay

Answer 14

clinically detectable enamel lesions with intact surfaces

Question 15

what is very early decay

Answer 15

• 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)

Question 16

what are some global surveys used

Answer 16

• WHO database

- US has CDC

Question 17

what are some UK surveys used

Answer 17

• adult dental health survey
• child dental health surveys
• BASCD surveys
• NDIP surveys

Question 18

why is the amount of caries in developing countries increasing

Answer 18

due to a growing consumption of sugar

- opposite happens in developed countries as they have effective public health measures

Question 19

what is the main thing that has driven improvements in oral health

Answer 19

fluoride toothpaste

Question 20

what four things make up the traditional biomedical model of caries

Answer 20

• plaque microorganisms
• substrate
• time
• tooth
  (if only two or three of these occur don’t get caries, only get caries if all 4 occur)

Question 21

what are the strategies for preventing caries in a population

Answer 21

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

Question 22

what are the strategies for delivering fluoride

Answer 22

• toothpaste
• water fluoridation
• community fluoride schemes

Question 23

what are the main risk factors of caries

Answer 23

• diet
• hygiene
• tobacco

Question 24

what are the 3 sections of circumstances and risks of oral health inequalities

Answer 24

• upstream actions
• midstream actions
• downstream actions

Question 25

what are upstream actions

Answer 25

• socioeconomic and political context (structure and systems)
• policies put in place (macroeconomic, social and welfare, food, education and health system)

Question 26

what are midstream actions

Answer 26

• community context

- community workforce, schools, nurseries , environment

Question 27

what are downstream actions

Answer 27

• behaviour and biological factors = age, biofilm, diet
• psychosocial factors = stress
• health services = quality of care

Question 28

what are health improvement approaches

Answer 28

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

Question 29

what are the child smile guidelines

Answer 29

• 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

Question 30

what are some integrated programmes with child smile

Answer 30

• supervised brushing

- FVA (fluoride varnish application) in nursery and schools

Question 31

who gets fluoride varnish

Answer 31

• 2-5 year olds

- for children from 2 year olds apply varnish 2 times a year

Question 32

what is oral health improvement advice

Answer 32

• demonstrate and observe hands-on brushing instruction
• tailored advice on diet and nutrition
• have an action plan