Community DH Flashcards
Cross-Sectional Study
snapshot of a population at any given time
Goal VS Objective
Goal: Outcome intended
Objective: Specific way of attaining outcome
SMART Goals
Specific
Measurable
Attainable
Relevant
Time-Based
- how to make an objective
Incidence VS Prevalence
Incidence: number of new cases in x time
Prevalence: All cases in x time
Acute disease - Incidence increases, prevalence decreases
Chronic disease - Incidence decreases, prevalence increases
Endemic
disease that occurs frequently and predictably in a population
eg. common flu
Epidemic
Unexpectedly large number of cases of disease in a particular population
Pandemic
Outbreak over a large geographical area - often worldwide
Morbidity rate
Disease rate
actual disease / # possible diseases
Mortality rate
actual deaths / #possible deaths
Deaths
Random Sampling
Every member of population has an equal chance of being selected
Lease Bias
Stratified Sampling
Population is divided into subgroups
ie. to sample all students in Canada, select 2 students from each school
Systematic Sampling
Selection of every Nth person on the list
Convenience Sampling
Selection based on convenience
ie. people that come to the grocery store today
Judgement Sampling
Selection based on familiarity with subject to researcher
Most amount of bias
Independant VS Dependant Variable
IV: Intervention of exp.
produces a response to DV
(x)
DV: outcome of experience
will change due to IV
(y)
PICO
Problem
Intervention
Comparison
Outcome
- formatting for a good question
EBDM
Evidence Based Decision Making
- does not replace clinical skills, judgement, or experience
Reliability
Same results can be reproduced
- Intraexaminer: same evaluator
- Interexaminer: Change evaluator
Validity
Research measures what its intended to
- sensitivity: identify presence of disease
- specificity: identify absence of disease
Correlation
Negative: x and y are inverted
Positive: x and y increase/decrease together
Correlation closer to 1 is stronger
- +/- 0.95 correlates more than +/- 0.02
T-Test
Compares 2 groups on variables of interest
eg. girls vs boys
ANOVA
Analysis of Variance
- compares 3+ groups for significance
Chi-Square Test
Measures difference between 2 or more qualitative data
P-Value
Probability Value
- measures whether results occur by chance when testing a hypothesis
P<0.5, results are significant
P = 0.5, occurred by change
P>0.5, results are insignificant
Skew
describes a curve thats non symmetrical
- Positive: scores gathered in lower range (Mean>Median>Mode)
- Negative: scores gathered in higher range (Mean
Standard Deviation
How much scores deviate from mean
Mean
Average
3,3,5,9,11,14,17,20,23
Mean = 11.67
Median
Middle number
3,3,5,9,11,14,17,20,23
Median = 11
Mode
Most frequent
3,3,5,9,11,14,17,20,23
Mode = 3
Range
Difference between the highest and lowest score
3,3,5,9,11,14,17,20,23
Range = 20
Dispersion
Spread of scores around the mean, median, and mode
Descriptive Statistics
observational, no manipulation
WHO is getting a disease WHERE and WHEN
Inferential Statistics
Data thats used to reach conclusions that extend beyond immediate data
- average score of 100 students is 80% therefore average of students in students in city is 80%
- making an inference based on data
Case Control Studies
use existing records to identify people with a certain problem
- compare exposure to risk factor
Case Reports
Detailed description of an event and patient profile
Cohort Studies
Any group of people who are linked and followed and observed over time
- no manipulation
Randomized Clinical Trials
Randomly assigns participants to experimental or control group
- gold standard for reliable evidence
- reduces population bias
- time and money intensive
Meta - Analysis
Highest statistical power
- comprehensive review of all relevant studies of a particular topic
- total subjects treated as one large population
Systematic Review
Comprehensive review of all relevant studies of a particular topic
- more reliable than individual studies
Evidence ranking in research
CRITICAL APPRAISAL
- Meta analysis
- Systematic review
EXPERIMENTAL
-RCC
OBSERVATIONAL
- cohort studies
- case series
- case reports
Descriptive/Observational Studies
Describes a situation without predictions, cause, or effect
No manipulation is used (ie. Average cholesterol levels in 40-60y/o)
Usually retrospective
Analytic Studies
Quantifies relationship between intervention and outcome
Uses a hypothesis
Prospective Study
Observe outcome over time
Longitudinal Study
Observed over a long period of time (often decades)
Retrospective Study
After an outcome is developed (applying past studies to current)
Experimental Study
Researchers manipulate exposure
control vs treatment group
RCT’s
Pre/Post test
Null vs Alternative Hypothesis
Null: H0 - try to reject
Alternative: H1/2 - will be observed effect
ie: The amount of caries in children increased from 2001 to 2010
H0: the amount of caries did not increase between 2001-2010
H1/2: The amount of caries did increase from 2001-2010
The null hypothesis is rejected
Learning Ladder Model
Unawareness: patient lacks correct information/ has incorrect information
Awareness: patient knows about problem but doesnt take action
Self-Interest: patient shows interest in taking action
Involvement: patient wants more knowledge and to participate
Action: patient forms new behaviours
Habit: patient has a changed lifestyle
Health Belief Model
Explain and Predict a patients actions
Perceived Susceptibility: believe their susceptible to condition
Perceived Severity: believe condition has serious actions
Perceived Benefits: taking action reduces susceptibility to condition
Perceived Barriers: believe cost outweighs benefits
Cue to Action: exposed to factor that prompts action
Self-Efficacy: confidence in their ability to perform an action
Learning Domain Model
Cognitive: knowledge, intellectual ability
Affective: interest, attitude, values
Psychomotor: motor skills, performance
Motivational Theories
Internal locus of control: patient believes they have control of their life
External locus of control: pt believes their decisions are controlled by the environment/fate
Hierarchy of Needs
Assessment
create community profile to serve as baseline
- population characteristics
- resources
- oral disease
- direct observation and interviewing (survey is best method)
Types of Oral Health Examinations (4)
Type 1: complete exam - mouth mirror, explorer, light, rads, tests, study models
Type 2: limited exam - mouth mirror, light, explorer, rads
Type 3: inspection - mouth mirror, explorer, light
Type 4: screening - tongue depressor and light
Steps in Community vs Private Practice
COMMUNITY PRIVATE PRACTICE
Survey ⇒ Assessment/Examination
Analysis ⇒ Diagnosis
Planning ⇒ Planning
Implementation ⇒ Implementation
Financing ⇒ Payment
Evaluation ⇒ Evaluation
(SAP (L)IFE)
Analysis Step
AKA Prioritization of needs
Normative Needs: amount of OH care to keep a community healthy
- use: proportion of a population who receives dental treatment in x time
Community Program Financial Aids
- Medicare
- CHIP
- COBRA
- Block Grant
- Line Item Grant
Medicare: 65+ y/o
CHIP: Children Health Insurance Program
COBRA: work benefits
Block Grant: given to use at users discretion
Line item grant: specifies where money goes
Planning
Choose activities/programs that were successful in the past
Implementation & Evaluation
formal (lecture) or informal (pamphlet) delivery
formal (tests) or informal (feedback) evaluation methods
must be continuous from beginning of program
were objectives met?
Community Water Fluoridation
most effective measure to prevent decay
- inexpensive
- concentration 0.7ppm
- food made with water is considered systemic intake of fluoride
School Water Fluoridation
fluoride concentration 4-5x higher than community water
limited success
best to start at younger age
parent consent required
School Fluoride Rinse Programs
not common
not cost effective
Rx 0.2% 60sec/day for 1 week
parent consent required
Fluoride Dentrifrice
3yo and above
<3yo - rice size
3-6yo - pea size
Fluoride Supplements
AGE <0.3ppm 0.3-0.6ppm
Birth-6mo NONE NONE
6mo-3yo. 0.25mg/day NONE
3yo-6yo 0.5mg/day 0.25mg/day
6yo-16yo 1.0mg/day 0.5mg/day
Fluoride Varnish
more effective than gels/foams
- high caries risk apply every 3mo
- moderate caries risk apply every 6mo
Simple Dental Indicies
measures presence/absence of a condition
Cumulative Dental Indices
measures all evidence of past occurances
Irreversible Dental Indicies
measures condition that cant be reversed (ie. periodontal disease)
Reversible Dental Indicies
Measures condition that can be reversed (ie. gingivitis)
Criteria of an ideal index (8)
Clarity - easy to understand
Simplicity - easy to apply
Objectify - not ambiguous
Validity - measures what its intended to
Reliability - measures consistently between subjects
Quantifiable - expressible in numbers
Sensitivity - detects small changes
Acceptability - not harmful to the subject
Primary Prevention
prevent onset, reverse/arrest disease
- fluoride, prophylaxis, vaccinations
Secondary Prevention
Terminate disease and restore function
- filling a cavity, periodontal screening
Tertiary Prevention
replace and rehabilitate lost tissue
- implants and bridges
4 Root Caries Risk Facors
- age
- gingival recession
- medications (xerostomia)
- lack of OSC
Sealant Programs
For Children *
most effective when placed within 6mo of eruption
5A’s Intervention Model
ie. Tobacco Cessation
Ask (about tobacco use)
Advise (all users to quit)
Assess (willingness to quit)
Assist (patient in quitting)
Arrange (follow-up contact)
Deans Fluorosis Index
- based on most severe score on 2+ teeth (whole dentition based on one score)
Normal (0): translucent, pale
Questionable (0.5): few white flecks
Very Mild (1): opaque, <25% of dentition affected
Mild (2): white opacities, <50% dentition affected
Moderate (3): brown stains
Severe (4): pitting and brown stains
Dental Caries Indicies
(Permanent Dentition)
DMFT: decayed, missing, filled teeth
DMFS: decayed, missing, filled surfaces
*M+F due to caries
Dental Caries Indicies
(Primary Dentition)
deft - decayed, extraction needed, filled teeth
defs - decayed, extraction needed, filled surfaces
dmft - decayed, missing, filled teeth
dmfs - decayed, missing, filled surfaces
dft - decayed, filled teeth
dfs - decayed, filled surfaces
Which teeth are not included in a Dental Caries Indicies?
- 3rd molars
- congenitally unerupted
- supernumerary
- teeth removed/restored NOT due to caries
Root Caries Index (RCI)
evaluates extent of root caries
calculated as a %
PSR
Periodontal Screening and Recording
Distractor on boards (;
Community Periodontal Index of Treatment Needs
(CPITN)
Determines need of status vs needs of disease
highest depth in each sextant is recorded
Code 0: healthy, no bleeding (recommend biofilm control)
Code 1: healthy, BOP (recommend biofilm control)
Code 2: healthy, BOP, calculus present (recommend biofilm control and calculus removal)
Code 3: pockets >3.5mm (recommend biofilm control, comprehensive periodontal assessment, and treatment counselling)
Code 4: pockets >5.5mm (recommend biofilm control, comprehensive periodontal assessment, treatment counselling, and non-surgical periodontal therapy)
Main problem with periodontal index?
Questionable validity
(CAL not included)
Periodontal Disease Index
(PDI)
measures gingivitis and periodontitis seperately
- rarely used anymore
- 6 teeth
- good for individual and group studies
Eastman Interdental Bleeding Index
uses wooden wedge interproximal for 15 sec
0: absence
1: presence
Sulcular Bleeding Index
(SBI)
Detects early gingival disease by probing
- 0: healthy, no BOP
- 1: Healthy, BOP
- 2: BOP, slight swelling
- 3: BOP, obvious swelling
- 4: heavy BOP, swelling, possible ulcerations
Gingival Bleeding Index
(GBI)
Assesses bleeding
insert floss under gingival margin for 30 sec
0: absence
1: presence
Gingival Index
Based on severity and extent of inflammation
0: normal gingiva
1: mild inflammation, mild BOP
2: moderate inflammation, BOP
3: severe inflammation, ulcerations
useful for individual and group studies
Plaque Index
(PlI)
measures thickness of plaque at gingival margin
0-3 on all or some teeth
useful for clinical studies
AKA: stillness and low plaque index
Volpe-Manhold Index
(VMI)
everyone receives treatment at same time
used to test and compare AGENTS for plaque control and calculus inhibition
measures supracalculus formation following prophylaxis
Oral Hygiene Index
(OHI)
measures presence of plaque and debris
6 teeth evaluated
not useful for individual evaluation
useful for small and large population studies
Patient Hygiene Performance
(PHP)
measures plaque after toothbrushing
uses disclosing solution on 6 teeth
useful for assessing groups rather than individuals
Plaque Free Scores
(PFS)
measures % of teeth with no plaque
entire dentition is disclosed
score of 100% is ideal
easy at home follow-up
Plaque Control Record
(PCR)
measures % of teeth with supra plaque
entire dentition is disclosed
lower percentage is better
useful for assessing individual performance and OSC
