DPH & BS Flashcards
Define public health
it’s the science and practice of preventing oral diseases, promoting oral health and improving the quality of life through the organised efforts of society.
List a range of sciences and disciplines of dental public health
Epidemiology Health promotion Medical statistics Sociology and psychology Health economics Health services management & planning Evidence based practice Demography
What are the main determinant of health
Age, gender, genetics
Lifestyle factors
Social and community networks
Living and working conditions - (agriculture & food production, education, work environment, unemployment, water & sanitation, health care services, housing)
Socioeconomic, cultural and environmental conditions
Define Epidemiology
The study of the distribution of diseases or health outcomes within a population
Define Screening
An examination of people without pain to classify them as likely or unlikely to have disease or health condition
What is Prevalence
The number of cases of a disease in a given population at a designated time
What is Incidence
The number of new cases of a disease in a population within a specific time
Define Health Education
A communication activity which provides the individual, family, & community with information & skills which gives them the knowledge to make informed decisions
Properties of an ideal epidemiology index
Simple - easily applied
Objective - clear & unambiguous
Valid - measures what its intended to do
Reliable - consistently even at different times
Quantifiable - amendable to statistical analysis
Sensitive - detect small shifts
Acceptable - accepted by subject (people)
Barriers to Dental Care
Service based barriers
Economic barriers
Psychological barriers
5 A’s of Access to Dental Care (Penchansky & Thomas 1981)
Availability Accessibility Affordability Acceptability Accommodation
What are Service based barriers
availability to service accessibility to service (location/disable friendly) registration appointment systems environment of surgery level of service provided accommodation (opening times/waiting time) Affordability (direct/indirect cost)
What are Economic barriers
cost of check up/regular attendance might not be possible
cost of potential treatment might be prohibitive
patient concern about unknown cost
time away from work - reduce income
travel cost to surgery
What are Psychological barriers
perceived need treatment need but no pain experienced perception of value for money perception of available local NHS anxiety or fear
What are the three stages of prevention
Primary - preventing a person getting a health outcome or disease (vaccinations)
Secondary - after the disease has occurred but before the person notices symptoms, it helps to find diseases early (screening)
Tertiary - person already has symptoms of disease, to prevent damage or pain (dietary advice to manage disease & prevent complications)
What is the Ottawa Charter (WHO 1986)
Its a guidance document on health promotion by the WHO
What are the priority areas for Health promotion by Ottawa Charter
Built healthy public policy Create supportive environments Strengthen community action Develop personal skills Re-orient health services
Define equality
creating a fairer society where everyone can participate and have same opportunities to fulfil everyone potential
Define diversity
recognising everyone is different and respecting and valuing their difference.
Bradshaw (1972) Taxonomy of Need
Normative Need Felt Need Expressed Need Comparative Need (Hidden Need)
What is Normative Need
defined by healthcare professionals based on an assessment against an agreed set of criteria
What is Felt Need
defined by what people perceived as being important (what they really want)
What is Expressed Need
defined as felt need but expressed in words or action (this becomes demand)
What is Comparative Need
defined as needs that when compared with similar individuals are considered lacking with regards to services or resources
What is Hidden Need
this is normative need which is not expressed, it doesn’t come to the attention of the dental service. (ref: clinical iceberg)
What treatment choices can enable DCPs to provide patients with information
Evidence based research
Clinical governance process
Self Audit
How do health problems develop?
infections
toxic chemicals
genetics
lifestyle/behaviours (smoking, diet, alcohol, drugs)
accidents
social factors ( poverty, lack of education, medical care, poor sanitation)
What are the advantages and disadvantages of UK National Surveys
Advantages
- comparable data
- all age groups surveyed
- provides information of all major oral conditions
Disadvantages
- only once every 10 years
- data only available for large regions
- lack of local data for planning
What factors are linked to differences in dental health
poverty levels
ethnic/cultural groups
access to dental services
What are risk indicators
poverty and ethnicity are indicators for untreated decay and identifying groups at risk
What is a risk factor
the cause of the difference, i.e. areas with no fluoridation of water, has availability to fluoride toothpaste but the lacks of daily use from early age leads to caries
What are the advantages and disadvantages of the dmft index
Advantages
- measures caries experience
- easy to use
- use world wide
Disadvantages
- diagnostic criteria can be different between countries and through time
- assumes all extractions due to caries
- assumes all fillings due to caries
- decay component includes arrested, dentinal and pulpal involvement caries and filled teeth with caries
- its irreversible
What are the uses of epidemiology
describe ageing processes
identify cause of disease
test theories for control of disease
providing information to planning health services
What are the types of epidemiology studies
Descriptive - describes patterns not cause ( in other words - describes the prevalence & incidence of disease or disorders) (BASCD & ADH surveys)
Analytical - establishes cause and effects through studies such as observational (which are case controlled/cohort) and experimental (Randomised Controlled studies)
What is a case controlled study
its an observational study which observes and collects information from present to past
What is a cohort study
its an observational study which observes and collects information from present and compare it to data collected over a period of time (i.e. in a years time)
What is a randomised controlled trail
its an experimental study which intervenes to make changes and observes outcome.
Causation & Association criteria
Sir Austin Bradford Hill’s criteria:
- strength of association
- dose related
- consistency of association
- correct with respect to time
- specificity of association
- biologically plausible
- reversibility
Define Anxiety
A feeling of unease or nervousness about something about to happen
Define Fear
a biological response to threat such as danger, pain or harm
Define Phobia
an irrational fear of something
What are the effects of dental anxiety
Physiological and Somatic sensations
- breathlessness, palpitations, sweating, dry throat, muscle tension
Cognitive Features
- poor concentration, poor recall of events, imagining the worst, hypervigilance
Behavioural Reactions
- avoidance (cancelling or DNA or asking for all treatment at one visit)
- late for appointments
- breathing deeply
What can cause dental anxiety
previous experience other family members experience lack of control fear of unknown anxious personality
How can anxiety be assessed
through physiological assessment
behavioural observation - children & adult
self-report - ask patient, or through questionnaires (modified dental anxiety scale, modified child dental anxiety scale, children’s dental fear picture test)
What non-pharmacological techniques are available to manage anxiety
having good communication skills welcoming dental environment treatment planning being prepared enhancing control acclimatisation tell show do distraction positive reinforcement modelling voice control relaxation timing of appointments systemic desensitisation hypnosis showing empathy
Why is it important to recognise and manage anxiety
can affect future anxiety, especially childhood experiences
creates a barrier to accessing services
creates a barrier to communication
to ensure pain control
Define health psychology
study of the mind and behaviours in health and illness
What are the types of models used in behavioural science
mathematical model - system using maths and language (nature verse science)
mental model - explanation of someone’s thought process of how something works in reality
psychological model - theoretical representation that stimulates mind or social processes.
What is the most effective model in health behaviour
Transtheoretical model which specifies when a patient is ready to change behaviour by identifying stages that precede behaviour change
What are the stages of the transtheoretical model
1) Precontemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance
6) Relapse
What is Maslow’s Hierarchy of Needs
its a motivational theory that encourages achievement of certain needs, covering:
- self actualisation (creative, acceptance, need to exceed)
- self-esteem ( confidence, achievement, respect of others, unique)
- love & belonging (friendship, family, intimacy, connections)
- safety & security (health, employment, property, family and social ability)
- physiological needs (breathing, food, water, shelter, clothing, sleep)
What is communication
a process where information, meanings and feelings are shared through verbal & non-verbal messages
What are the main factors of communication
environment (sounds, smell, sight, feelings)
non-verbal communication (appearance, touch proximity, body language)
verbal communication (vocabulary, meaning, paralanguage, perceived meanings)
written communication
listening
What can good communication skills lead to
better diagnosis & understanding of patients problems reduce patient anxiety greater patient satisfaction reduce patient complaints increase commitment to advice given
What are the three phases during a dental consultation
Introductory - greeting, preliminary chat & explanation
Intervention - carrying out treatment
Closing - summary of treatment, health education and dismissal
What techniques can be use to improve communication skills
learn to listen be aware of patients emotions empathise encourage think before you speak
What are the advantages and disadvantages of water fluoridation
Advantages
- benefits everyone
- cheap
- up to 40% reduction in caries over lifetime
- 15% of water fluoridated in UK
- caries increases after fluoride removed from water
- safe, cost effective, consistent, good population coverage, compliance not needed, low risk of overdose
Disadvantages
- mass medication
- takes away freedom of choice
- requires complex infrastructure
List the methods of fluoride delivery
Water fluoridation topical fluoride application fluoride toothpaste fluoride tables/drops fluoride salt fluoride milk fluoride in fruit juices
Define barriers to dental care
a circumstance, perception or behaviour which prevents a person from gaining access to dental care
a) What information can be use to determine local need
b) How are these carried out
a) Using local surveys, such as BASCD, Adult Dental Health surveys and National surveys
b) through school screening, population count, dmft index, identifying the area (what is the deprivation, is the water fluoridated), using Townsend & Jarman (aka Carr-Hill formula) deprivation index.
