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Year 3 PPD > Dentist In Society Year 3 > Flashcards

Dentist In Society Year 3 Flashcards

1
Q

What does power mean in dentistry? (3)

A
  • ability to ensure that a particular point of view prevails in a disputed situation
  • capacity that someone acts in certain way
  • ability to stifle opposition in particular perspective
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2
Q

3 contributing factors of dentist-patient relationship

A
  • environment of dental clinic
  • dental consultation (physical, emotional, social)
  • professional status of dentistry
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3
Q

aspects of physical powerlessness in dental consultation

A
  • mouth is v sensitive
  • ortho-facial pain in debilitating
  • difficult to communicate
  • physically lower than dentist, and horizontal
  • dentist controls movement (via chair)
  • treatment focussed on mouth
  • noisy atmosphere
  • not easy to hear/ reply to instructions/ prompts
  • within intimate zone
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4
Q

3 aspects of physical/emotional powerlessness in dental consultation

A

3:

  • people’s hands in your mouth is INVASIVE
  • intimate v personal space
  • requires trust
  • dentist looks alien with mask etc
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5
Q

4 levels of proximity for physical powerlessness

A
  • public (over 3.6m, when addressing big group)
  • social (2 arm lengths away, people you don’t know well)
  • personal (1 handshake away, friends)
  • intimate (2 fists away, emotionally close people)
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6
Q

how is power rational?

A

constructed through patterns of social relations that are reproduced through processes of socialisation

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7
Q

3 aspects of social powerlessness

A

3:
-professional role of dentist –> legitimacy and authority in consultation
(like a child being told off eg you should brush more)
-dentist can diagnose / undertakes clinical exam
-dentists decide and prescribe treatment

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8
Q

Explain paternalistic communication model

A 
Dentists get 'locked in' to role and control consultation with little input from patient.
Dentist (6):
-initiates, leads consultation
-asks direct questions
-limits amount/type of info to pt
-deflects answers 
-offers diagnosis and treatment

Pt (4):

  • explains symptoms
  • listens to instructions/ info
  • asks qs
  • consents to tx
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9
Q

Why does a dentist need to know about power?

A

3:

  • helps dentist be more aware of ways patient thinks about dental visits
  • better dentist-patient relationship
  • helps empower patient
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10
Q

a. 2 ways in which dentists represent authority

b. what is clinical autonomy?

A

a. -cultural authority: specialist knowledge on certain subjects, accepted by the state
- medical authority: having scientific knowledge to be able to describe and define health and illness and make decisions based on professional judgement and specialist knowledge. INCLUDING language (jargon) used

b. clinical autonomy: freedom of clinicians to make decisions based on their professional judgement and specialist knowledge

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11
Q

L2, SCREENING AND ORAL HEALTH

9 purposes/advantages of screening

A

9:

  • detect disease at pre-symptomatic stage, interrupt natural history of disease
  • detect individuals vulnerable to disease
  • enable informed reproductive choices
  • protect public health
  • prevention rather than cure
  • reduce morbidity and mortality
  • reduce cost (of healthcare and to economy-less days off work etc)
  • less radical treatment
  • reassurance for those deemed healthy
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12
Q

draw the natural history and interventions flowchart

A

induction (ind) —> promotion —-> expression
initiation aetiology –>ini. pathology—> clinical detection —> outcome

screening intervention —> traditional intervention

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13
Q

when is screening intervention active?

A

induction

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14
Q

define screening

A

rapidly applied tests on a large scale –> identifying unrecognised conditions

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15
Q

is screening diagnostic?

A

normally, no (requires follow up investigations and treatment)

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16
Q

3 types of screening

A
  • selective screening (single disease in limited population eg miners, multi-phasic- antenatal examinations)
  • mass screening (single disease in large population eg breast cancer, multi-phasic- routine check ups for women)
  • opportunistic
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17
Q

main aim/of selective screening

A

convert at-risk groups to low risk by behaviour modification or intervention

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18
Q

11 principles of screening. who are they by

A

set by UK NATIONAL SCREENING COMMITTEE CRITERIA

  • condition should be important health problem
  • natural history understood
  • recognisable latent or early symptomatic stage
  • suitable test for examination
  • test should be acceptable
  • evidence that program reduces morbidity/ mortality
  • benefits should outweigh harm
  • opportunity cost should be economically balanced
  • adequate staffing and facilities for diagnosis and treatment
  • should be an accepted treatment
  • agreed policy on who to treat
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19
Q

4 factors making a disease suitable for screening

A
  • early therapy gives better results than late therapy (or no point screening early)
  • condition has slow but progressive natural history
  • prevalence is high
  • disease has major effects
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20
Q

4 stages of screening

A
  • identification of at-risk group
  • application of screening test
  • application of appropriate diagnostic tests
  • treatment of those with +ve results
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21
Q

define sensitivity

A

probability that the test will be positive if disease is truly present (SEE TABLE)

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22
Q

define specificity

A

probability that the test will be negative if the disease is truly absent

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23
Q

how does screening link in with sensitivity and specificity?

A

screening is most effective for diseases which have screening tests with high sensitivity and specificity, so resources are not wasted on healthy individuals or diseases with known high prevalence

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24
Q

explain predictive values of a test

A

both about the prediction being correct.
positive predictive value: has disease when screening was positive
negative predictive value: does not have disease when screening was negative

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25
Q

how has screening for caries in schools changed over the years?

A

3 times in school career until 2006, then deemed ineffective
now some school visits in at risk areas in England and Wales
Scotland has national inspection program, combining screening and epidemiology

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26
Q

is there screening for oral cancer? why?

so how is oral cancer screened for?

A

no. value of screening test unclear
- not cost effective
- low prevalence
- not clear how you would identify high risk groups
- what frequency
- how would you evaluate effectiveness
- -> opportunistic screening carried out eg during check ups

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27
Q

L3 HEALTH PROMOTION

5 factors influencing health

A
  • human biology
  • physical environment
  • social environment
  • behaviour/lifestyle
  • health services
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28
Q

draw flowchart to socioenvironmental approach to health

A

(see lecture slide)
risk conditions (poverty, low status, dangerous stressful work, discrimination, poor housing, poor access to healthy food)
–> physiology (hypertension, obesity etc) and behaviour (smoking, exercise)
–> psychosocial (isolation, self-esteem, lack of control)
all –> oral health

BUT more complex than this: behaviour is a social and psychological product and is locked in to routines. also limited by physcial env/opportunites to make choices

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29
Q

3 examples of how inequalities affect health (black report)

A

-at every stage of life those in lower social classes have higher death rates
-children born in to lower social classes have lower birth weights and shorter stature
-all major diseases affect lower social classes more than higher ones
BLACK REPORT 1982

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30
Q

explain how behaviours are influenced by environment/ social class

A

behaviour locked in to routines, they are a social product
but behaviour also a psychological product
ie social AND physical environments provide OR restrict options of behaviour eg education of healthy food, but may not be able to afford it. also influenced by those around them

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31
Q

2 most common oral diseases

A

caries, periodontal disease

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32
Q

what % of schoolchildren worldwide have decay?

A

60-90%

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33
Q

what % of middle-aged adults have severe periodontal disease?

A

5-20%

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34
Q

incidence of cleft lip

A

1\500 to 700 births

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35
Q

what % of HIV positive people have oral fungal, bacterial or viral infections

A

40-50%

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36
Q

what % of public health expenditure relates to oral health in high income countries?

A

5-10%

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37
Q

what did Nancy Milio say can be done to improve health of populations?

A

make the healthy choices the easy (and cheaper) choices

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38
Q

define health promotion and give its aims 3

A

process of enabling people to increase control over and improve their health

  • focus on tackling determinants of health by
  • working in partnership with agencies and sectors in
  • strategic approach to promote population health
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39
Q

a. principles of health promotion (4)

b. 4 roles of HCPs in health promotion

A

a. -involves population as a whole
- directed towards action on determinants
- effective and concrete public participation
- not a medical service (but often involves HCPs for enablement, mediation, advocacy, education)

b. enablement, mediation, advocacy, education

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40
Q

5 approaches to health promotion

draw diagram (see lecture)

A
  • prevention
  • behaviour change
  • education
  • empowerment
  • social change
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41
Q

draw approaches to health promotion diagram

A

see handout or camera roll (16/9/15)

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42
Q

explain prevention

A

reduce disease levels by prevention, eg fissure sealant. doesnt address underlying causes

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43
Q

explain behaviour change

A

individuals take responsibility.
one to one advice and mass media campaigns
increasing knowledge does not always lead to change in behaviour –> education is a seperate point

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44
Q

explain education

A

provides knowledge (as does behaviour change) AND skills and attitude to make choices. does NOT persuade change in behaviour

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45
Q

explain empowerment

A

community-led encouragement from the bottom up

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46
Q

what type of health promotion are smoking intervention groups

A

education

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47
Q

explain social change

A

physical, social, economic environment

political arena eg fluoridation

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48
Q

difference between health promotion and health education

A

health promotion: umbrella term, including health promotion and education. concerned with empowerment (help people to help themselves). leads to public health policies
health education is about increasing health knowledge and skills only

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49
Q

why is an evidence base important in health promotion

A

need evidence for interventions because they all have cost

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50
Q

what is the opportunity cost

A

benefit of intervention compared to its cost

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51
Q

how is cost effectiveness measured

A

per QALY: quality of life adjusted years

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52
Q

explain/ draw common risk factor approach

A

see handout. diet, hygiene,smoking, alcohol, stress

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53
Q

is lack of fluoride a common risk factor ? why?

A

no. no serious health risks without fluoride

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54
Q

5 strategic elements of Ottawa charter

A
  • building healthy public policy
  • creating supportive environments
  • strengthening community action
  • developing personal skills
  • reorienting health services
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55
Q

explain building healthy public policy. inc 3 types

A

-encourage policy makers in organisations/ governments to place health on their agenda
-identify/ remove obstacles to healthy policies so these become the easier choices
1-health impact assessments (transport, income, agriculture, energy)
2-legislation and regulation (seat belts, smoking, fluoridation, food labelling, reducing sugar in processed foods,-advertising bans for unhealthy foods)
3-fiscal policies (taxes, subsidies on food, tobacco, alcohol)

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56
Q

explain creating supportive environments, 3 areas

A

-create living and working conditions that are safe, stimulating, satisfying, enjoyable
-encourage communities to care for each other
-encourage communities to take responsibility for conservation of natural resources
1-wider environment (access to healthy foods, no sweets on checkout)
2-working and social environments (food and smoking policies, exercise facilities, health and safety, no vending machines in school,milk in schools)
3-home (facilities)

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57
Q

explain strengthening community action

A 
community action to:
-set priorities
-make decisions
-plan local strategies
-implement plans
eg in food co-ops, farmers markets, cookery clubs, smoking cessation support groups
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58
Q

explain developing personal skills

A

-support of personal and social development
-provision of information and health education, eg not dipping dummies in sugar
-development of individual skills
eg knowledge attitudes behaviours (KAB), coping strategies, self-esteem, self-efficacy, empowerment

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59
Q

explain reorienting health services

A

-encourage health professional to look beyond clinical and curative services
-ensure health services are aimed at pursuit of health rather than only cure of illness (prevention over cure and health as more than just absence of illness)
eg sugar free medicine

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60
Q

explain primary healthcare approach (PHCA) 3

A

from treatment to prevention
from institutions to community
addressing the inverse care law

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61
Q

4 roles of health professionals in reorienting health services

A

advocacy
mediation
education
enablement

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62
Q

problems with health promotion

A
  • long intervals between preventive strategy and measurable improvements
  • time consuming (community consultation, health education, altering public policies)
  • often politically controversial
  • need to be rigorously evaluated
  • politicians like to put emphasis on personal lifestyle choices (so individual rather than government is responsible)
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63
Q

example of when health promotion has been effective and how

A

smoking: 10% price rise —> 1% reduction in smoking
banning advertising has reduced consumption

(but tobacco growing subsidised in some countries)

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64
Q

5 dilemmas for health promotion

A
  • healthism
  • victim blaming
  • inaccessibility of information
  • appropriation of health promotion by specialist groups
  • evaluation and effectiveness
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65
Q

CHILD DEVELOPMENT LECTURE

why, most often, are children referred to dental hospital?

A

behaviour (fear, temprament)

NOT complex dental problems

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66
Q

examples of how to persuade children to treatment

A
  • forced choice option
  • bribery
  • imagination (eg pretend chair is rocket)
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67
Q

types of development (in children) 4

A
  • physical development (body structure)
  • motor development
  • cognitive development
  • social development
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68
Q

what gene contributes to cleft

A

IRF6

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69
Q

influences on child development

A

nature (genetics, eg tooth development)
nurture (deprived v enriched. sensitive periods in development eg language should be picked up by 2yo)
interaction eg smoking during pregnancy

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70
Q

order of motor development

A
  • support head
  • rollover
  • sit
  • crawl
  • stand
  • walk

does not necessarily happen at same age, but order is usually the same

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71
Q

stages of cognitive development

A
  1. sensory-motor (0-2yo. knowledge through movement and sensation, eg object permanence)
    POCOFO
  2. pre-operational stage (2-7yo. language development, role play, egocentrism)
  3. concrete operational stage (7-11 yo. logical thinking, conversation)
  4. formal operational stage (12yo- adulthood. deductive reasoning, understanding abstract ideas)
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72
Q

stages of language development

A 
3 months- cooing
4 months- babbling
12 months- 1st word
18 months- 20 words, single utterance
24 months- 250 words, 2 word utterance
30 months 500 words, 3+ utterance
STAGE NOT AGE
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73
Q

development of fearful reactions

A
  • 7-10 months stranger anxiety (declines in intensity over 2nd yr, may never subside completely eg stranger danger)
  • separation anxiety (crying, clingy, withdrawn. usually becomes less frequent/ intense throughout pre-school period)
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74
Q

overcoming stranger anxiety in dental surgery 5

A
  • keep carers close at hand
  • social referencing (positive tone of voice)
  • make setting more familiar (toys, posters, colours. allow time to become comfortable)
  • don’t be intrusive
  • look ‘normal’- no white coats, paeds scrubs
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75
Q

explain 2 types of conditioning

A

classical conditioning: A learning process by which a subject comes to respond in a specific way to a previously neutral stimulus after the subject repeatedly encounters the neutral stimulus together with another stimulus that already elicits the response (eg Pavlov’s dogs, salivate on ringing of bell)
operant conditioning: type of learning where behavior is controlled by consequences. Key concepts in operant conditioning are positive reinforcement, negative reinforcement, positive punishment and negative punishment.

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76
Q

what is social learning

A

learning by watching what others do

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77
Q

behaviour associated with dental anxiety/ fear 6

A

-moving hands (30%)
-hands over mouth (24%)
-crying loudly (21%)
-shaking legs (18%)
moving body left and right (18%)
moving legs up and down (15%)
WATCH VIDEO

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78
Q

how to use learning schedules to influence child behaviour at the dentist

A
  • observational learning
  • ignore negative behaviour
  • time between response and reinforcement important
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79
Q

ADHD: % and describe

A

5-10% of children
inattention, hyperactivity, impulsivity
most common behavioural disorder, more common in boys
respond less, poor oral health

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80
Q

other behavioural disorders %

A

learning difficulties 1-2%

autistic spectrum 1%

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81
Q

how to adapt dentistry to children

A
  • clear goals for each visit (reward good behaviour, work at appropriate speed. maybe some appointments for familiarisation)
  • forced choice (closed questions eg would you like to get on chair from left or right)
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82
Q

behaviour management techniques 5PARCD

A

5:

  • reinforcement (verbal, stickers etc)
  • desensitisation (tell-show-do, modelling, distraction, euphemisms)
  • communication (stop signals, non-verbal communication eg hand holding)
  • aversion (voice control. used to use restraint/ hand over mouth)
  • pharmacology (sedation)
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83
Q

how to measure pain in children

A

children do not always report pain; only 48% 4yo with caries recorded pain. so other ways to measure pain:
-variations in cognitive ability (perception, understanding, memory)

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84
Q

define child abuse

A

when adult harms person under 18

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85
Q

% of child abuse in UK

A

7% serious physical neglect
6% neglect
6% emotional and sexual abuse

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86
Q

what did Piaget theorise about pain perception in children

A
  • at pre-operational stage: pain is global, a phenomenom
  • operational/ concrete: understanding improves over time
  • formal operational: understand what hurts, why and how much
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87
Q

how is dentistry relevant to social development

A

peer relationships:

-teeth and appearance affect popularity, bullying

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88
Q

who are commonly ‘abusers’

what % of young people suffer abuse?

A

2:

  • those with stronger physiological reactions to all social signals
  • those who were themselves abused/ neglected

7% serious physical abuse
6% neglect/emotional/sexual abuse

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89
Q

characteristics of children who are often abused

A 
defiant
unresponsive
hyperactive
irritable
unwell
look different
90
Q

what to do if we suspect child abuse

A
  • speak to supervisor
  • assess likelihood of harm
  • (usually) explain to child/parent
  • discuss with appropriate colleague
  • refer to social services, back up in writing within 48 hours
91
Q

5 mental health problems that impact dentistry

what should be considered if a patient has schizophrenia

A

scizophrenia, OCD, bipolar, eating disorders, pica

  • side effects of medication: xerostomia, hypersalivation
  • increased alchohol/ tobacco use, poor diet
92
Q

what should be considered if a patient has OCD

A

associated with high levels of dental anxiety

often bruxists

93
Q

what should be considered if a patient has bipolar disorder

A

often have poor OH, calculus, periodontal disease, caries, xerostomia

94
Q

what should be considered if a patient has an eating disorder

A
  • erosion (esp bulimia)
  • parotid gland hypertrophy
  • saliva flow
  • different gag reflex
  • oral mucosal lesions
95
Q

what is pica and why is it relevant to dentistry

A

Persistent Intake of non-nutritive substances (eating non food items eg paper, clay, metal). associated with learning difficulties
trauma to soft tissue/ tooth wear

96
Q

Frankl behaviour rating scale

A

1: definitely negative. refusal of treatment, crying, fearful
2: negative. reluctant to accept treatment, unco-operative, sullen, withdrawn
3: positive. acceptance of treatment, willing to comply with reservation but follows direction
4: definitely positive. good rapport, interested in dental procedures, laughing, enjoy situation

97
Q

PAIN AND DENTISTRY LECTURE

how does pain effect economy

A

5.2 million work days lost

98
Q

what % of dentate adults in England currently have toothache

A

9%

99
Q

examples of ways pain perception varies in different groups of people

A
  • more pain perception in those from routine/ manual occupations
  • more pain perception in younger people
  • more pain in anxious people
100
Q

3 dimensions of pain. explain each

A
  1. sensation (how much it hurts)- threatening context, accompanied by desire to reduce pain or escape
  2. affect (mood)- unpleasant emotions, distress/fear. feeling about long-term implications of pain (anger, depression, anger etc) and impact on life (routine, sleep, work)
  3. cognitive: evaluation, eg how to help pain by whats happened in the past
101
Q

what changes occur in the brain during pain

A

increased alpha brain waves
decreased delta brain waves
deactivated cortex (thinking part of brain)
deactivated limbic system (emotion)

102
Q

link between personality and pain

A

intensity of pain not affected
neurotic pt reports as more unpleasant, considers secondary impact eg sleep loss

pessimists more likely to have chronic pain, low pain tolerance and poor coping

103
Q

is there clear link between magnitude of injury and pain experienced?

A

no

104
Q

explain gate control theory of pain

A

automatic reflex: pain sensation and dorsal horn,eg moving hand from painful stimulus
excitatory pathway opens gate to brain and cortex –> pain perception, thought
inhibitory pathway prevents this pathway activating

105
Q

explain phantom pain

A

when limbs amputated, excitatory/ inhibitory pathways not destroyed so brain pathways still activated even when stimulus not there

106
Q

STRATEGIES FOR ORAL HEALTH LECTURE

define strategy

A

plan for obtaining specific goal or result

107
Q

4 functions of planning

A
  • guides choices so best decisions made
  • maximises results with limited resources
  • proactive rather than reactive decision
  • can set priorities
108
Q

explain 3 principles of strategy design

A

aim: what you want to achieve
objective: steps taken to achieve aim
data collection: identify/ understand problem, possible solutions, evaluation and feedback

109
Q

6 steps of McCarthy rational planning cycle

A

AODRIE

  1. assessment of need
  2. options
  3. decisions of policy
  4. available resources
  5. implementation
  6. evaluation
110
Q

4 areas of information needs for planning

A

SPED

  1. socio-demographic population profile (how need varies with age, ethnicity, deprivation, mobility)
  2. disease levels (trends, epidemiological data, disease distribution)
  3. public concerns (population priorities, views of services, demands
  4. existing service provision (cost, location, access, range)
111
Q

define a need for medical care

A

when individual has illness or disability for which there is an effective and acceptable treatment or cure

112
Q

3 descriptors of a need

A
  1. subjective: professional judgement varies
  2. dynamic: new technologies, drugs, information
  3. relative eg weight of fluoridation
113
Q

what is a needs assessment

A

evidence-based approach to commissioning and planning health services using objective and valid methods

114
Q

define 3 components of healthcare economics needs assessment

A

wants: individuals subjective assessment
demands: willingness to pay
needs: professional judgement about capacity to benefit

115
Q

3 components of pain and examples of each

A
  • sensory (discrimination of type and location of pain, perception) eg pulsing, throbbing
  • affective (motivation. emotional feeling about pain) eg tiring, sickening
  • cognitive (evaluation, past experiences) eg annoying, miserable
116
Q

what physiological measurements of pain are there and issues with this

A

inc cortisol, HR, respiration sweating

117
Q

2 self-report measures of measuring pain

A
  1. visual analogue scales:

2. pain questionnaires

118
Q

most common pain descriptors for dentistry:

  1. sensory
  2. affective
  3. evaluative
A
  1. sensory: throbbing
  2. affective: sickening
  3. evaluative: annoying
119
Q

which component of pain should pain relief target and why

A

affective. it is the most long-lasting

120
Q

examples of why/how pain relief varies between groups

A
  • ethnic differences: prescription drugs/prayer more common with black people compared to talking to neighbours with hispanic people
  • analgesia given more readily to extroverts and women
121
Q

why is looking at facial expression to tell pain good/bad

A
  • eyes tell the most

- people change their expression when they know theyre being watched

122
Q

why is it important to detect pain early in children

A
  • prevents invasive treatment or GA
  • reduce likelihood of dental anxiety
  • reduce impact on family life
123
Q

how to tell pain in young children

A

(may not vocalise pain and cannot use physiological measures)
-sleep loss
-negative behaviour
-crying, movement, muscle tension, facial expression
-eat less, refuse to eat nice foods
48% of 4yo with caries had reported pain

124
Q

how to alleviate pain: sensory

A

by DISCRIMINATION of type/location/intensity of pain

  • drugs, prevent neural pain pathways
  • placebo effect: 35% effective, due to endorphin relief
125
Q

how to alleviate pain: affective

A

MOTIVATION
promote neutral interpretation by:
a. distraction- visualisation is best. also radios, optimistic re-interpretation (eg pain is a sign of recovery)

b. enhancing control- stop signals

126
Q

how to alleviate pain: cognitive

what influences success of hypnosis

A
  • alter expectations, eg by avoiding emotive words
  • hypnosis (dependent on personality) increases calm and well-being, effective up to 12 months
  • outcome expectancies (more likely to work if they believe it)
  • perceived control over pain
  • imagery vividness (also part of distraction?)
127
Q

why do a needs assessment? 9

A
  • facilitates planning and commissioning
  • health care inflation (due to pay increase etc)
  • advances in medical care
  • changing demographics
  • limited resources
  • inequalities in health
  • inverse care law
  • consumerism and accountability
  • competing priorities
128
Q

how to evaluate solutions to health problems

A
  • evaluate possible interventions
  • evidence base
  • critical analysis/ level of evidence
  • systematic review/ meta analysis
  • funding and resources available
129
Q

how to evaluate oral health strategies

2 main aims of oral health strategies

A

DURING strategy implementation

  • does it work
  • is it acceptable to people
  • is it reaching people it’s meant to reach
  • how are resources being used
  • has problem been solved- is it time to stop?
  1. improve oral health
  2. ensure access to high quality NHS dental services
130
Q

3 target groups in strategic approach to oral health

A
  1. whole population- aim to lower average level of risk in population
  2. high risk- identify people at high risk through screening and offer prevention/ treatment
  3. targeted population- identify communities at higher risk –> use whole population strategies in targeted groups
131
Q

how whole population approach works and example of when it has been used in oral health strategies

A

reduce risk factors to whole population, eg fluoride for whole population

132
Q

advantages of whole population strategies 5

A
  • tackles underlying health determinants
  • avoids victim-blaming
  • enables healthy choices to be made
  • benefits whole society
  • it works! eg seatbelts, fluoridation, fluoride toothpaste, smoking
133
Q

disadvantages of whole population strategies 6

A
  • long timescale
  • powerful vested interests (eg toothpaste companies?)
  • mobilising action (forming alliances, lobbying and gaining support)
  • adverse effects (eg sugar producers)
  • issues of individual free choice
  • ‘prevention paradox’
134
Q

explain prevention paradox

A

majority of cases come from low-risk group, because it is so much bigger than the high-risk group
–> whole population has to change behaviour/ be treated for the sake of few individuals

135
Q

examples of high risk strategies

A

hep B vaccination for dental students, mammograms for women under 50 with strong family history

136
Q

advantages of high risk strategy 3

A
  • cost-effective use of resources
  • intervention appropriate to individual
  • readily accommodated within ethos and organisation of medical care
137
Q

disadvantages of high risk strategy 4

A
  • medicalizes prevention
  • non-selected individuals are still at some risk- where is line drawn between high and low risk? low risk miss out
  • contribution to overall control of disease may be small
  • poor ability to predict future of individuals
138
Q

positives and negatives of targeted population strategy and example

A

+: reduces inequalities, often cost effective, various types of interventions (environmental, clinical, skills)
-: not all at risk are in target group and vice versa –> no free choice

eg fluoride toothbrushing scheme in selected schools

139
Q

compare the level of use of each type of strategy

A
  • whole population: national, international
  • targeted population: local high need communities, integrated with whole population strategy (aims to level high risk groups with population)
  • high risk: local groups, integrated with targeted strategies
140
Q

explain the common risk factor approach

A

recognition that many diseases share risk factors (eg smoking, drinking –> heart problems, cancer, oral disease, diabetes)
–> direct action to common risks and underlying social determinants (housing, education, employment etc)
this is an example of PARTNERSHIP WORKING

141
Q

3 WHO oral health action areas

A
  1. diet, nutrition and oral health: malnourishment/ dietary excess
  2. oral health and fluorides: optimal fluoride level in water
  3. tobacco and oral health: tobacco use has risen in some groups eg young people and women
142
Q

what does ‘choosing better oral health’ include 5

A
  • current level of oral health
  • causes of poor oral health
  • roles and responsibilities for improving oral health
  • key areas of action
  • workforce requirements
143
Q

aims of ‘choosing better oral health’ 2

A
  • reduce prevalence of oral disease

- reduce oral health inequalities across all age groups in England

144
Q

how is progress of this measured

A
  • improvements in oral health of population

- increased delivery of high quality preventive dental services

145
Q

what is the ‘Delivering Better Oral Health Guide’?

A

evidence-based toolkit. guidance for practitioners and advice to patients

146
Q

DIET AND ORAL HEALTH LECTURE

compare inequalities in food types between high and low incomes

A

high income: more fish, fruit, vitamin C

low income: more calories,sat fat, sodium

147
Q

what % of diet should come from

a. total fat
b. sat fats
c. total carbohydrate
d. free sugars
e. trans fats
f. protein

A

what % of diet should come from
a. total fat: 15-30%
b. sat fats:
LOOK AT LECTURE

148
Q

recommended amount per day of

a. cholesterol
b. sodium
c. fruit/veg

A

recommended amount per day of

a. cholesterol: 400g.day

149
Q

recommended BMI

A

21-23kg\m2 (population)
18.5-24.9 kg/m2 (individual)
avoid weight gain of 5kg as adult

150
Q

recommended physical activity

A

1 hour/day on most days, inc moderate activity eg walking

151
Q

caries: what factors
a. increase risk
b. probably decrease risk
c. possibly decrease risk
d. decrease risk

A

what factors
a. increase risk: free sugars, freq of sugar intake
b. probably decrease risk: hard cheese, sugar free gum
c. possibly decrease risk: xylitol, milk, fibre
d. decrease risk: fluoride
of

152
Q

what factors
a. probably increase risk
c. possibly decrease risk
of dental erosion

A

what factors
a. probably increase risk: soft drinks, fruit juice

c. possibly decrease risk: hard cheese, fluoride
of dental erosion

153
Q

what factors
a. increase risk
b. decrease risk
of enamel defects

of

A

what factors
a. increase risk: excess fluoride (–> fluorosis), hypocalcaemia

b. decrease risk: vitamin D
of enamel defects

of

154
Q 
what factors
a.  increase risk
b. decrease risk
c. insufficient evidence
of periodontal disease
of
A

what factors
a. increase risk: vitamin c deficiency

b. decrease risk: good OH
c. insufficient evidence: sucrose, antioxidants, vit E
of periodontal disease
of

155
Q

classification of sugars

A

total –> intrinsic (in cell structure eg whole fruit), extrinsic
extrinsic –> milk, non-milk (inc processed hidden sugars)

156
Q

how has sugar consumption changed in UK since 1900s?

A

peaked post war

now less overall but inc hidden sugar due to less fat in foods

157
Q

how sugar consumption varies in developed/ non-developed countries

A

more in developed countries

158
Q

evidence for sugar and general health

A

no evidence of link between sugar consumption –> cancer, coronary heart disease, diabetes
BUT inc energy intake –> obesity –> diabetes, CHD, some cancers, resp disease etc

159
Q

examples of evidence for sugar and caries

A

a lot!!

  • animal studies: freq, conc, type of sugar
  • lab studies: plaque pH, test tube experiments, enamel slab experiments
  • experimental studies: Vipeholm (mental hospital patients given different conc/freq of sugar). Turku (students chewed sucrose v xylitol gum for a year)
  • observational studies: Tristan da Cunha (compared low sugar groups eg dentists children, wartime diets with high sugar groups eg sweet factory workers, children on sugar-coated medicine)
160
Q

strengths and weaknesses of evidence for relationship between sugar and caries

A

strength: strong body of evidence; all studies came to same conclusion
weakness: type of evidence weak; no double blind RCTs, ethical issues with Vipeholm

161
Q

compare experiments/findings of Streebny and Woodward/Walker

A

Streebny: 47 countries, positive correlation between sugar consumption and DMFT
Woodward/Walker: >90 countries, positive correlation between sugar consumption and DMFT. BUT no correlation in industrialised countries (due to education, fluoridation etc)

162
Q

WRITTEN COMMUNICATION LECTURE

3 types of response writing should provoke in the reader

A

cognitively
behaviourly
emotionally

163
Q

2 ility s the reader needs to understand writing

A
  • readability (40 different measures, EG legibility, legal, care with units, no abbreviations)
  • comprehensibility (lexical items, syntax, communicative effectiveness
164
Q

5 examples of when dentists use written communication

A
  • prescriptions (drugs/lab)
  • documentation (notes, consent forms)
  • referrals
  • patient info leaflets
  • reports
  • essays
165
Q

what should you ensure when writing clear prescriptions 7

A 
unambiguous, clear
be careful with units
no abbreviations
approved name
legal
care with IVS
weight/BSA dosing
166
Q

what info should be included in documentation (notes) 3

A
  • informed consent
  • treatment, alternatives, risks, complications
  • complaints policy- how, who, when
167
Q

6 audit categories

A
  • diagnosis and management
  • examinations and tests
  • corrections, abbreviations
  • legible, dated
  • identification
  • front sheet
168
Q

what are the most important audit categories and what % met standards

A

diagnosis 75%

medical history 67%

169
Q

give examples of audit areas that did not meet standards

A
  • documented leaflets
  • corrections signed and dated
  • legible
  • signature/name stamp
  • next of kin
  • allergies
170
Q

what to include in paediatric referral letters for GA 8

A
  • referrers full details
  • GMPs full details
  • medical history
  • dental history
  • reason for referral
  • justification for GA
  • radiographs
  • treatment plan
171
Q

what to include in urgent referral letter 6

A
  • pt details
  • urgency of referral
  • about problem
  • medical and dental history
  • pt understanding of referral
172
Q

advantages of educational resources (PIL) 6

disadvantages of PILs 6

A
  • improve pt understanding of condition and treatment options
  • increase involvement in care-awareness, prep for procedures
  • encourage adherence/skills/behaviour change
  • reduce anxiety and stress
  • increase satisfaction with care
  • can be referred to after event/consultation
  • ves
  • public ignores them
  • difficult to understand
  • poor readability
  • pt does not retain info –> poor adherence and tx choice
  • inaccurate
  • out of date
173
Q

define functionally illiterate and % of UK who are

A

would not pass English GCSE (reading level younger than 11)

16% of UK population (5 million)

174
Q

when to use leaflets and why

A

use as ‘gift’ alongside what was discussed

pts want info but ignore printed literature, may find it confusing

175
Q

4 examples of purpose of leaflets

A
  • improve awareness/ understanding
  • prepare for procedures
  • facilitate informed decisions/ reasoning/ patient involvement
  • encourage behaviours/ patient skills eg how to brush teeth, diet
176
Q

how to ensure information in leaflets is understandable

A
  • ensure info is concise, specific
  • risks, benefits and alternatives
  • figures not values
  • diagrams
  • target audience (age group, social class etc)
177
Q

how to ensure information enables reasoning (deliberation and decision making)

A
  • rating scales to rank treatment options
  • tick boxes to record feelings
  • free text space to note concerns, questions, priorities
178
Q

how to provide written info for people who don’t read much

A 
OBVIOUS:
short words/ sentences
legible font
interest of reader most important 
avoid unnecessary capitals/bold/italics
179
Q

what does SMOG stand for and how to calculate it

A

Simple Measure of Gobbledygook

divide number of sentences in sample in to 30 and multiply by number of words longer than 3 letters

180
Q

FLUORIDE AND FLUORIDATION

F- conc of sea water

A

1.3PPM

181
Q

ideal fluoride conc

history of fluoride

A

1ppm

thought to have effect on enamel since 1930s. water first fluoridated in Grand Rapids in 1945 –> levels of decay halved

182
Q

is F- detectable in water in high conc?

A

only by scientific monitoring equipment (tasteless, odourless

183
Q

mechanism of action of fluoride

A

fluorapatite crystals replace hydroxyl crystals in enamels

184
Q

why is fluorapatite desirable?

A

stronger, less likely to be demineralised by acid

185
Q

pre and post-eruptive effects of fluoride

A

pre-eruptive: enamel less susceptible to effects of acid

post-eruptive: interferes with metabolism of plaque-forming bacteria, enhanced remineralisation of enamel

186
Q

is fluoride given pre or post eruption and why?

A

post eruption
effects more important and too risky pre-eruption: children may swallow toothpaste, take too many tablets at once –> fluoride toxicity with >5mg/kg

187
Q

methods of individual fluoride delivery, +/- of each 5

A
  • toothpaste: simple, effective, free choice BUT risk of OD, toothbrushes expensive
  • gels: 21% effective (systematic review), free choice BUT taste bad, risk of OD if swallowed
  • tablets/drops: effective (40-50% caries reduction), free choice BUT compliance, OD risk
  • mouthrinses: 26% effective, free choice BUT compliance/ability, OD risk
  • fluoride varnish (2-4 times/yr): 46 or 33% effective, free choice BUT compliance, access (in surgery/community setting)
188
Q

3 methods of population fluoride delivery

what has been done to aid fluoride toothpaste use in UK 2

A
  • water
  • milk
  • salt
  • toothbrush/toothpaste distribution schemes to high risk children
  • supervised brushing schemes in schools/nurseries with fluoride toothpaste (BUT only on days childs attends, needs home support)
189
Q

pros and cons of fluoridated milk

A

+: safe, effective (? inconclusive evidence)

-: only when kids in school (not weekends, holidays), requires consent, untested in community settings

190
Q

pros and cons of fluoridated salt

A

+: effective (as much as water), free choice

-: conflicts with general health message about reducing salt intake

191
Q

dose of salt fluoridation

A

250ppm

192
Q

in what country has salt fluoridation been effective in reducing caries?

A

Jamaica

193
Q

define water fluoridation

evidence for water fluoridation

A

controlled addition of a fluoride compound to a public water supply in order to bring the fluoride conc up to a level that effectively prevents dental decay

  • increases proportion of children without tooth decay by 15%
  • children in areas of fluoridation have 2.25 fewer carious teeth
  • no association with bone fracture/ cancer BUT aesthetic fluorosis= 12.5
194
Q

what is fluorosis and when/where will it most likely occur

A

excessive fluoride uptake during tooth development –> mottled enamel
18-36 months risk age, maxillary central incisors
3% in fluoridated area –> don’t use fluoride toothpaste

195
Q

what % of UK has optimum fluoride level and where

A

10%

West Midlands, North East england

196
Q

in which countries is fluoridation common/rare

A

common: ROI 71%, USA 61%, NZ 64%, australia 60%
rare: Japan
(5. 7% worldwide)

197
Q

how is water fluoridation ruled in UK

A

1985 water fluoridation act
1991 Water Industry Act: no obligation to fluoridate
2003: 5 -must fluoridate if requested to do so by relevant authorities eg council
-local public consultation to be organised through Strategic \health authority SHA
-indemnity for water companies to be arranged by Secretary of State for Health
-relevant authority to meet reasonable capital and operating costs
-review of dental health every 4 years

198
Q

examples of bodies against fluoridation

A

Green party
national pure water association
soil association
campaign for fluoride free water in Ireland

199
Q

compare pro and anti lobby of adverse health effects of fluoridation

public opinion on fluoridation (2 surveys)

A

pro-lobby (evidence based): fluorosis bad but rare at 1ppm. no effect on general health
anti-lobby (not scientific): overestimates fluorosis, uses bad evidence

-omnibus survey 2003: 2000 interviews with random adults across Britain. 43% think water already fluoridated
67% think it should be added if it reduces decay
-Southampton city PCT survey 2008: overall more in favour although 2/3 knew nothing about it and half expressed no opinion

200
Q

compare pro and anti lobby of environmental effects of fluoridation

A

pro: Washington state review 2002 says no negative impact on environment. trace amounts of arsenic not traceable at 1ppm
anti: F- is waste product from fertilisation (toxic waste), contains impurities eg arsenic, bad for organic food industry

201
Q

compare pro and anti lobby of effects on civil liberties of fluoridation

A

pro: F- present naturally in water, common good more important than personal preference eg seat belts, can choose bottled water
anti: mass medication, against (european) human rights

202
Q

details of 2003 amendment to Water Industry Act 2003

A

local public consultation to be organised through SHA

  • indemnity for water companies to be organised by Secretary for State of Health
  • relevant authority to meet reasonable capital and operating costs
  • review of dental health every 4 years
203
Q

PREVENTION IN PRACTICE

difference between health education and health promotion

A

education: any educational activity which aims to achieve a healthy goal
health promotion: process of enabling people to increase control over and to improve their health

204
Q

which 2 approaches to oral health promotion does prevention in practice cover?

3 domains of learning in order

A
  • behaviour change (DHE, one to one advice)
  • prevention (led by HCPs)
  • cognitive: acquisition of facts
  • affective: attitudes and beliefs
  • behavioural: skills and actions
205
Q

explain health locus of control and 3 levels

A

the extent to which individuals believe their health is influenced by their own behaviour or by others
3:
-high internal locus of control: believe health influenced by own action
-high powerful others: believe in the influence of important people on outcomes
-high chance: believe health is down to chance

206
Q

describe the health belief model

A

individual does their own cost/benefit analysis when considering behaviour change ie how much change will benefit them. needs a cue or trigger eg people not wanting MMR vaccine

207
Q

5 steps in stages of change (transtheoretical model)

A
  1. precontemplation (no awareness)
  2. contemplation (aware, motivated, confident in ability to change)
  3. preparation (negotiation)
  4. action (commit, 3-6 months)
  5. maintenance (problem solving)
    (6. relapse (coping strategies))
208
Q

goals of each stage of transtheoretical model

A
  1. precontempla: encourage CONSIDERATION of behaviour change
  2. contemplation: evaluation leading to DECISION to change
  3. preparation: action plan implemented
  4. action: successful action and establishment of change (6 months)
  5. maintenance: long-term ESTABLISHMENT of new behaviour
209
Q

examples of barriers preventing change 9

A
  • lack of opportunity (restricted access)
  • lack of resources (money)
  • lack of support (bad influences)
  • lack of knowledge
  • conflicting info
  • future rather than immediate consequences
  • no clear goals
  • put off by failure
210
Q

what criticisms are there of stages of change model? 3

A

too simplistic:

  • more of a continuum
  • does not account for socio-cultural norms eg if everyone else smokes
  • not included: current behaviour, quit attempts, intention to change
211
Q

implications of stages of health model for health professionals 6

A
  • may be several attempts before change succeeds
  • motivations may not be health related
  • behaviour determined by complex array of factors
  • support essential
  • information alone is not v useful
  • no evidence that using one approach more successful than another (eg education, encouragement etc)
212
Q

what did reviews of oral health education discover?

A

fluoride effective at reducing caries

BUT chairside and school dental health education not useful

213
Q

4As of smoking cessation

A

Ask
Advise
Assist
Arrange

214
Q

describe a brief intervention for smoking 7

A

5-10 mins

  • establish if they want to smoke
  • set a date to stop
  • review past experience
  • identify future problems
  • identify support from family and friends
  • plan what to do about alcohol
  • consider nicotine replacement therapy
215
Q

who is the facilitator in smoking cessation

A

the patient (smoker)

216
Q

barriers of smoking cessation at dentists

A

time and resources

217
Q

problems with fissure sealant as caries preventative measure in children

A

-access to high risk children: difficult to do out of dental surgery
-problems with consent and compliance
(BUT slow release of fluoride with GIC (not resin))

218
Q

why is chlorhexidine used?

A

reduce strep mutans –> prevent post op infection

no evidence for caries reduction

219
Q

why is xylitol used and how?

A

in chewing gum
–> mastication –> saliva flow, prevents caries
also has direct effect on s mutans

220
Q

REVISION LECTURE

main organisation for health promotion

A

WHO

221
Q

explain why/how toothbrushing technique is important and what has been done to improve it

A
  • brushing alone does not prevent caries- fluoride toothpaste should be used too
  • normal brushing leaves plaque in fissures and other stagnation areas
  • -> parental supervision advised under 7 years (proven less risk of decay)
  • spit not rinse
  • supervised brushing scheme in school and nursery
222
Q

low income peoples barriers to oral health (12)

A

stress and the enormous amount of time involved to
find a dental provider;
2. when a provider is available, he/she tends to be overwhelmed
with low-income patients, which leads to
difficulty to schedule a timely appointment;
3. the provider may have rules to accommodate lowincome
patients, leading to excessive wait times in the
office on the day of the appointment (eg, the patient
may have to wait until all private insurance or self-pay
patients are seen first);
4. inconvenient or unreliable transportation, or total lack
of access to transportation;
5. children may miss school because of dental appointment
restrictions or because of transportation difficulties;
6. school absence policies, which may discourage parents
from taking their children out of school to go to an
appointment;
7. difficulties in accessing information on dental care
coverage;
8. feelings of embarrassment and shame to ask for help;
9. competing demands for limited financial resources;
10. racial/ethnic discrimination;
11. language barrier; and
12. powerlessness in the dental office, having to endure
the prejudice of staff, and being reluctant to complain
about it for fear of being dismissed.

Year 3 PPD (1 decks)

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