DPH Approaches to Oral Disease

Question 1

Define dental public health

Answer 1

The science and art of preventing oral diseases, promoting oral health and improving quality of life through the organised efforts of society

Question 2

What does dental public health do?

Answer 2

Serves community rather than individual patient
Is concerned with the public as individuals and as a whole
Applies dental research to community settings
Focuses on the causes of the causes of dental disease
Administers group dental care programs

Question 3

List the criteria that makes a disease a public health problem

Answer 3

Must be widespread or serious
Severe consequences to community and individuals
Costs to community and to individs are great
Effective methods available to prevent, alleviate or cure

Question 4

If dental public health were to act, what must there be?

Answer 4

Strong evidence supporting need for action, feasibility and effectiveness
Good public support and acceptability
Good professional support
Economic benefits

Question 5

Periodontitis vs gingivitis?

Answer 5

Gingivitis and periodontitis are not the same
Gingivitis is common - seldom causes discomfort or loss of function
<10% of people get severe perio
Perio is not a major cause of tooth loss

Question 6

Aetiological factors for PD?

Answer 6

Plaque
Dental restorations and prostheses
Tobacco
Stress

Question 7

What makes periodontal disease a public health problem?

Answer 7

Widespread/serious
Severe consequences to community and individuals
Costs to community and to individs
Effective prevention, alleviation or cure

Question 8

How can we act against PD?

Answer 8

Have goals which are:
Appropriate
Realistic
Measurable
Positive
Important

Question 9

Aims for dental health?

Answer 9

Retention throughout life of a functional, aesthetic, natural dentition of not less than 20 teeth and not requiring recourse to a prosthesis - WHO 1982

Plaque free mouth = unrealistic

Achieve a level of plaque compatible with a rate of disease that will maintain an acceptable dentition for life

Question 10

Possible public health approaches for PD?

Answer 10

Health education
Chemotherapeutic approaches - no real place for entire populations
Screening
Dental treatment
Health promotion

Question 11

Health education?

Answer 11

Ineffective and expensive
80-90% brush 2x daily
Incorporate personal hygiene and grooming into socialisation

Question 12

Screening for early diagnosis and tx?

Answer 12

Screening is not justified
No valid methods to assess risk
Seems to be gradient of greater risk rather than cut off point
Treatment is expensive and not very effective

Question 13

Clinical treatment for PD?

Answer 13

At best only moderately effective for individuals
Removal of calculus not shown to improve progression of periodontitis
Professional cleaning at 3-6 month intervals not significant improvement
Benefit for an entire population attenuated by low attendance, sub-optimal Rx etc
Cost for entire population is huge

Question 14

Periodontal health promotion?

Answer 14

Create supportive environments
- Better washrooms at work

Healthy public policies

• Improve standards of living
• Tobacco use

Strengthen community action
- Educate community leaders

Develop personal skills

Reorientate health services - referral to stop smoking services, less plaque retentive features

Question 15

Dental trauma risk factors?

Answer 15

Orthodontic problems
Contact sports
Violence
Deprivation – crowding
Falls
Traffic and bike accidents
Poor environment

Question 16

What percentage of children experience dental trauma?

Answer 16

23%

Question 17

Public health approaches to trauma?

Answer 17

Supportive environments - soft surfaces in play areas, CCTV for early detection

Healthy public policies - mouthguards for sports

Strengthen community action - move fast food restaurants

Develop personal skills - alcohol education

Question 18

Oral cancer statistics?

Answer 18

In UK approx. 12,000 new cases of H&N cancer per year, 3% of all cancers
Sex difference and interaction with social class
Ethnic differences related to tobacco use
No marked improvements in cure rates for years though Rx improves QoL in interim

Question 19

Risk factors for oral cancer?

Answer 19

Tobacco
Alcohol
Premalignant lesions
Sunlight
Trauma
Human Papilloma Virus

Question 20

Public health approaches for oral cancer?

Answer 20

Create supportive environment - restrict tobacco use in public, use SPF

Healthy public policies - improve standards of living

Strengthen community action - Action against tobacco use

Develop personal skills
- Alcohol and smoking education

Reorientate health services - early diagnosis