Dental Public Health

Question 1

What criteria should be fullfilled for a new screening programme?

Answer 1

• The condition shoud be an important health problem
• Natural history of disease should be understood
• Disease must have a recognisable latent or early symptommatic stage
• Suitable test for examination
• Test should be acceptable
• Evidence that programme is effective in reducing morbidity/mortality
• Benefits should outweigh harm
• Opportunity cost should be economically balanced
• Adequate staffing and facilities for diagnosis and treatment
• There should be an accepted treatment
• Agreed policy on who to treat

Question 2

What is the evidence for screening school children in the UK?

Answer 2

Programme is ineffective in reducing levels of active caries or increasing dental attendence in population under study

Question 3

What does the term sensitivity refer to?

Answer 3

Sensitivity identifies the proportion of individuals who truly DO have the disease AND are given a positive test result

I find it helpful to remember: sensiTivity = sensitive to the Truth (i.e. do have disease + do have positive result)

Question 4

What does the term specificity refer to?

Answer 4

Specificity identifies the proportion of individuals who truly DO NOT have the disease AND were given the correct negative test result

I find it helpful to remember: specificity = speciFies the False (i.e. do not have disease and do not have positive test result

Question 5

What is the relationship between sensitivity and specificity?

Question 6

What are the 5 elements of the WHO Ottowa Charter?

Answer 6

1. Building healthy public policy
2. Creating sipportive environments
3. Strengthening community action
4. Developing personal skills
5. Reorientating health services

Question 7

Give an oral health example of 1. Building healthy public policy

Answer 7

Fluoridation of water

Question 8

Give an oral health example of 2. Creating supportive environments:

Answer 8

Smoking policies

Question 9

Give an oral health eamples of 3. strengthening community action

Answer 9

Smoking cessation support groups

Question 10

Give an oral health example of 4. developing personal skills

Answer 10

Oral health educaton

Question 11

Give an oral health example of 5. Reorientating health services

Answer 11

Primary Healthcare approach = prevention rather than treatment (i.e. fluoride varnishes)

Question 12

What is a strategy?

Answer 12

A plan for obtaining a specific goal or result

Question 13

What info do you need to write a strategy?

Answer 13

• Socio-demographic profile of population
• Existing service provision
• Disease levels
• Public concerns

Question 14

Give an example of a national strategy for oral health:

Answer 14

Fluoride toothpastes, smoking, water fluoridation

Question 15

How do you know if a strategy has worked?

Answer 15

Reassessment

(if no change in need then can look at why this may be and adapt the approach/scrap it)

Question 16

What are the characteristics of a healthy diet?

Question 17

How has the consumption of sugar changed in the UK over time?

Answer 17

• Gradual decline in packet sugars since the peak in 1950s/60s
• Increase in hidden sugars (i.e. diet food that removes fat but puts in extra sugar or the sugar put into processed food)

Question 18

What studies have been done to link sugar with caries?

Answer 18

Experimental:

• Vipenholm 1954 = patients at the vipenholm mental hospital were fed large amounts of sweets for 2 years, different groups were given sweets between mealtimes, at mealtimes, different amounts and types
• Turku 1975 = medical and dental students chewed sucrose and xylitol ocntaining chewing gum for 1 yr

Observational:

• Tristan da Cunna 1968 = groups eating low amounts of sugar (hopewood house 1963, hereditary fructose intolerance, dentists children, war time diets) and groups eating high amounts of sugar (sugar cane chewers, workers in sweet factories, children taking sugar based medicines)

Question 19

What could be done to reduce sugar consumption?

Answer 19

1. Creating supportive environments
   * Removing vending machines from schools, remove sweets from checkouts, minimum nutritional requirements for school meals, free milk and fruit in schools (especially in areas of deprivation)
2. Building healthy public policy
   * Food labelling, reduced sugar in processed foods, advertising bans, sugar tax
3. Strengthening community action
   * Cookery clbd, food co-operatives
4. Developing personal skills
   * Health education about sugars in foods and soft drinks, educate parents not to add sugar/honey/whiskey to bottle feeds or dip dummies into sugary drinks
5. Reorientating health service
   * Sugar free medicines, dental disease prevrntion

Question 20

Define water fluoridation:

Answer 20

The controlled addition of a fluoride compound to a public water supply in order to bring the fluoride concentration up to a level that effectively prevents dental decay (1ppm = 1mg/L)

Question 21

Describe the distribution of water fluoridation in the UK:

Answer 21

Only 10% of the UK (mainly the West Midlands and North East) receives fluoridated water.

Areas with very high tooth decay rates which need fluoridation include the North West, Merseyside, Yorkshire, Scotland, Wales, and Northern Ireland and some socially deprived communities in the South (e.g. Inner London).

Question 22

What is the evidence of the benefit of water fluoridation for oral health?

Answer 22

• Water fluoridation increases the proportion of children without tooth decay by 15%
• Children in fluoridated areas have an average of 2.25 fewer teeth affected by decay

Question 23

What arguments are used by groups who oppose water fluoridation?

Answer 23

• Fluorosis - major concern & over-estimate the effect, consider it to be the first sign of fluoride poisoning = quote non scientific reserch about areas that are naturally fluoridated (higher conc.)
• Civil liberty concerns - mass medication, violates human rights and contravenes european convention on human rights
• Environmental concerns - uses waste product fluoride from fertiliser industry (may contain impurities such as arsenic), considers fluoride in the water as dumping toxic waste, considers it would threatent the organic food industry

Question 24

The water industry act 2003 changed the legislation regarding water fluoridation. Describe the changes to the act and the impact this will have on future fluoridation schemes:

Answer 24

Companies are now compelled to fluoridate water if requested to do so by relevant authorities

= less opposition (i.e. no financial opposition by water companies) to fluoridation = more likely to happen across the country and in the areas most in need

Question 25

What is dental health education?

Answer 25

Any educationl activity which aims to achieve a dental health goal

Question 26

What is the evidence for the benefit of Dental Health Education for changing behaviour?

Answer 26

= the only way we can instigate change (long-term)

Domains of learning:

Cognitive - aquisition of facts

Affective - attitudes and beliefs

Behavioural - skills and actions

Question 27

What Dental Health Education should we give our patients?

Answer 27

Oral hygiene instruction

Question 28

At population level what is one of the main disadvantages of the Dental Health Education approach?

Answer 28

The most effective place to deliver the education is in a dental surgery but this only reaches attenders and not those most at need