health promotion Flashcards
what is the role of epidemiology?
measure amount, distribution and natural history of disease
study causes and determinants of disease
assess peoples risk if disease
assess healthcare needs
develop prevention programmes
define prevalence
number of disease cases in a population at a given time
how is prevalence calculated?
number of affected individuals/total number of persons in population
define incidence
number of new disease cases developing over a specific period of time in a defined population
how do you calculate incidence?
rate = number of new cases of disease in a period/number of individuals in the population at risk
which studies can obtain prevalence?
cross sectional
which studies obtain incidence?
longitudinal
what are the properties of an ideal index?
clear unambiguous
objective not subjective
reproducible
indicate treatment need
correspond with clinically important stages of disease
not time consuming
what is the d3mft index?
decay into dentine missing and filled teeth
which teeth are scored for dmft in patients 6+?
c d e teeth
what are the limitations of the DMFT/dmft index?
teeth are extracted for reasons other than caries
can’t see inter proximal
FS or restoration?
what do the components of DMF show?
D - indicates treatment need
F - indicates treatment provision
M - indicates treatment failure
what is the difference between systemic and topical effects of fluoride?
systemic is pre eruptive incorporation of fluoride during tooth development
topical is post eruptive involvement in demineralisation/remineralisation
is systemic or topical fluoride the main source of fluoride?
topical
how does fluoride prevent caries?
promotes remineralisation
forms fluoro-appetite which is less susceptible to demineralisation
what are the two oral reservoirs of fluoride?
mineral deposits CaF2 in saliva
biologically/bacterially bound calcium-fluoride
what are community based examples of fluoride therapy?
water
school based brushing
varnish
give an advantage and a disadvantage of fluoridated salt
ad- provides element of choice and effect is comparable to water fluoridation
dis- risk of CV disease
what re the advantages of fluoridated milk?
natural healthy drink
rich in nutrients
targeted at those who need it most
what are the disadvantages of fluoridated milk?
distribution delayed until nursery
not all children drink milk
shelf life/cost
limited evidence of effectiveness
what are the benefits of fluoridated mouth rinse?
available for home use
reduces caries by around 30%
good compliance
what is the fluoride concentration of duraphat varnish?
22600ppmF
sustained contact of varnish on teeth allows what?
precipitation of calcium fluoride
progressive release of fluoride
what factors determine the antiquaries activity of fluoride toothpaste?
fluoride concentration
frequency of application
rinsing behaviors
when brushing happens
what is optimal brushing key points?
twice daily
1450ppmF toothpaste
don’t rinse
what are the disadvantages of fluoride toothpaste?
ingestion risk - acute or chronic toxicity
acute - rare
chronic - fluorosis
increased risk of enamel fluorosis
how much fluoride do young peoplee need to swallow to risk fluorosis?
0.1mgF/kg body weight
how can you reduce fluorosis risk in young children while maximising anti-caries benefit?
keep toothpaste out of reach of young children
brush twice daily - evening and one other time
supervise brushing
use small amount - pea of toothpaste
discourage swallowing
encourage spitting
use lower F formula if low caries risk
what are the principles of Childsmile nursery and school?
targeted to priority nurseries and schools based on SIMD - Scottish index multiple deprivation
6 monthly F varnish in nursery and primary
describe the Childsmile tooth brushing programme
oral health pack given at least 6 times by age of 5 starting 1st year of life
all nursery schools invited to participate in daily supervised brushing
primary schools in most deprived area invited to participate in daily supervised toothbrushing p1 and p2
list some targeted approaches of Childsmile
additional home support via DHSW
p1 and p2 supervised toothbrushing targeted to the 20% highest need primary schools
what is community water fluoridation?
the adjustment of natural fluoride content of a community water supply to achieve caries prevention while minimising fluorosis risk
what quantity fluoride is added to water?
0.5-1.2ppm depending on climate
what sources of fluoride are added to water?
hydrofluorosilicic acid or
hexafluosilicic acid or
sodium fluorosilicate or
sodium silicofluoride
what is the mean natural fluoride content in water?
0.1mgF/l
what legislation is in oplace related to water fluoridation in Scotland?
water (fluoridation) act 1985
what are the barriers to water fluoridation?
objections/acceptability
moral
political barriers
geographical barriers
financial barriers
what are the effects of water fluoridation on dmft and DMFT?
35% reduction in mean dmft
26% reduction in mean DMFT
also 15% more children caries free
what is absolute risk in epidemiology?
incidence rate of disease amongst people exposed to agent
what is attributable risk?
difference between incidence rates in exposed and non-exposed groups - represents the risk attributable to factor being investigated
what is a cohort study?
people exposed and not exposed to risk factors are exposed over a period of time to measure frequency of disease occurrence
what are the two main types of analytic observational studies?
cohort
case-control
what is a case-control study?
compare individuals with disease (cases) with those without disease (control) and trace back to assess risk factors
which is the more robust study between case-control and cohort?
cohort
