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BDS3 > PHEBD > Flashcards

PHEBD Flashcards

1
Q

What are 4 main determinants of oral health (oral health related behaviours)?

A
  • Oral Hygiene
  • Diet
  • Smoking
  • Alcohol consumption
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2
Q

How would you give healthy eating advice to a patient following the common-risk factor approach?

A
  • Explain how the diet impacts both general as well as oral health
  • Ask Px to complete a diet sheet for next appointment
  • Start by asking Px what they think, what changes are feasible
  • Start with small changes/substitutes (easier to maintain)
  • Review on next appointment and give praise
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3
Q

What are the 5 Principles of the Ottawa Charter and give 2 examples of each?

A
  1. Building Health Public Policies (Legislative, Fiscal measures and Taxation) - Sugar Tax or Changes in Legislations
  2. Creating Supportive Environments - Water fluoridation and Health Promoting Schools (e.g. with Targetted supervised toothbrishing and Fluoridated milk supplies)
  3. Strengthening Community Action - “Community Health Champions” or School/Community Food Cooperatives
  4. Developing Personal Skills - Dental Education to general population or OH training for wider professional workforce (3 too)
  5. Re-orientating heath care services to prevention of illness and promotion of health - Delivering better OH toolkit, Targetted F Varnish/FS applications or Increased accessability of Dental Services
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4
Q

What are 5 common risk factors?

A
  • Smoking
  • Diet
  • Stress
  • Hygiene
  • Alcohol
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5
Q

What were the 3 main components of Scotland’s 2006 ChildSmile scheme?

What is the main 2 priniciple’s in the Ottawa Charter addressed?

Is this an up/mid/down -stream approach?

A

[Early Intervension - Starting at birth]

  1. CORE PROGRAMME - Universal daily toothbrushing in nursaries and Targetted daily brushing in schools
  2. TARGETTED PROGRAMME - F Vanish programme
  3. UNIVERSAL PROGRAMME - All new born children

Creating Supportive Environments and Re-orienttative health services to prevention

Mid/Down-stream

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6
Q

What are 5 arguements FOR Water Fluoridation?

A
  • Fluoride has been proven to reduce tooth decay (in areas of high flouridation, there are reduced incidences of decay)
  • Reduced cost to NHS (e.g. tooth extractions which are a main reason for child hospital admission)
  • Universal approach - Helps to benefit everyone (including those in low socioeconomic area)
  • Most cost effective dental public policy (estimated less than 50p per person per year)
  • Water supplies are well regulated (excellent safety)
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7
Q

OH Promoting schools are created based on:

PRACTICE, ENVIRONMENT & PARTNERSHIP

Outline some aspects of these

A

PRACTICE - OH Education of staff and students

ENVIRONMENT - Safe building/playground (prevent injury), Safe water supplies and No smoking

PARNTERSHIPS - Work closely with OH service providers and create networks with other HPS

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8
Q

What is meant by Ottawa Charter Principle 3?

How can this be carried out? (4)

Give 2 practical examples in the context of Oral Health Promotion…

A

Strengthening Community Action (Mid-stream Approach) = Giving communities a “voice” and encouraging them to take ownership and action in achieving goals

  • Mobilise existing community assets (don’t presume they know nothing!)
  • Improve access to resources
  • “Community Health Champions”
  • Develop partnerships with Local Authorities/Services
  • E.g.*
  • Community Health Champions or School/Community Food Cooperatives*
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9
Q

What is meant by a “Health Promoting School”?

What prinicple of the Ottawa Charter does this address?

Is it an Upstream, Midstream or Downstream approach?

(Big Exam Q)

A

Schools that strengthen their capacity as a healthy setting for living, learning and working. Presence of and strengthening of health promotion and education in schools leads to an improved health of students, staff, families and community.

Ottawa Charter: Creating Supportive Environments

Downstream/Midstream

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10
Q

How would you carry out SDM with a patient?

(5 steps & 3 Talk Model)

A

3 TALK MODEL

  1. Team Talk - Ensuring Px is aware you are there to support them, answer any questions and guide where necessary (Px will not be abandoned!)
  2. Option Talk - Discussing alternatives using risk communcations (e.g. numbers and visual aids)
  3. Decision Talk - Informed preferences and preference-made decisions
  • Introduce options to the patient - Have they heard of any of these? Brief description
  • Introduce Option Grid - Ask if they’d like to go through it together or read it alone in own tim e
  • Ask Px whats most important to then (FELT NEEDS) - E.g. Cost, Risks (Highlight this)
  • Discuss comparisons and invite any Qs
  • Encourage Px to take home, re-read and return with their decision (no decisions need to be made at initial appt)
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11
Q

What is meant by “Oral Health”?

A

A state of being free from mouth or facial pain, cancers, infections, periodontal disease, decay or tooth loss and any other oral diseases which would limit an individuals capacity to smile, speak, masticate and their psychosocial wellbeing

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12
Q

Dentures are the most common means of tooth replacement in the UK - Why? (2)

A
  • Cheaper
  • More accessable (e.g. on NHS)
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13
Q

Rates of coronal decay are falling (46% 1998 to 18% 2009) - Why? (5)

A
  1. Better access to dental treatment
  2. Increased dental education
  3. Improved treatment alternatives and prevention measures
  4. Increased fluoridated water access
  5. Other government initiatives: Healthy Eating campaigns etc
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14
Q

Rates of edentulism are falling (28% in 1978 to 6% in 2009) - Why? (5)

A
  1. Better access to dental treatment
  2. Improved attitudes and treatment principles (e.g. minimally invasive)
  3. Increased dental education
  4. More alternative options
  5. Fluoridated toothpaste (1970’s)
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15
Q

What is the “Chain of Risk Model”?

(Think: Gateway drug)

A

A sequence of linked exposures that raise disease risk because one bad experience or exposure tends to lead to another

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16
Q

Adults from routine/manual (lower socioeconomic) bakgrounds less likely to report being given OH advice - Why? (4)

A
  1. Reduced dental attendance - Seen more likely to attend in pain
  2. Reduced dental education (dentists having less time to spend with Px in NHS)
  3. Attitudes: Px doesn’t care OR dentist doesn’t give advice as thinks Px wont care
  4. Language/Cultural barriers
17
Q

What do you understand by Up-stream, Mid-stream and Down-stream Approaches to Health Promotion?

How does each relay to a prinicple of the Ottawa Charter?

A

UPSTREAM APPROACH
(OC1: Building Public Policies)
Legislative & Fiscal Measures
Including: Sugar Tax, Smoking Ban and Water Fluoridation (2)

⇒

MIDSTREAM APPROACH
(OC3: Strengthening Community Action)
Including: Community Health Champions & School/Community Food Cooperatives

⇒

DOWNSTREAM APPROACH
(OC5: Re-orientation of Health Services towards Prevention)
Including: Targetted F Varnish/FS application, Delivering better OH toolkit and Increased dental access

18
Q

What is meant by a Non-Communicable Disease?

Name 4…

A

Chronic diseases resulting from a combination of environmental and genetic factors, which cannot be passed on from person to person

  • Heart Disease
  • Diabetes
  • Cancer
  • Respiratory Disease (e.g. Asthma)

N.B. Obesity is NOT a Non-Communcable Disease…

19
Q

What is “Life course epidemiology”?

What 2 conclusions have been drawn from these types of studies?

A

Study into the long-term effects of physical/social exposures (e.g. at birth, childhood, adolescence) on later adult life

  1. There is an accumulation of risk over time - Therefore LIFE COURSE APPROACH of EARLY INTERVENTION
  2. Environmental exposures (e.g. malnutrition) at critial periods of development may have an impact on the development of chronic diseases in later life
20
Q

What is meant by “Health”?

A

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (weakness)

(WHO Definition)

21
Q

What is meant by “Oral Health Promotion”?

What 3 things/models can we follow to bring about mass change?

A

ORAL HEALTH PROMOTION = The process of enabling individuals and communities to increase control of the determinants of health and thereby improve their health

  1. The Ottawa Charter for Health Promotion (5)
  2. The Common-Risk Factor Approach
  3. Life Course Approach (early intervention)
22
Q

What is meant by health inequalities?

What is the main cause of this variation (in which we must address)?

A

Health Inequalities = Differences in health status or the distribution of health determinants (e.g. socioeconomic, cultural or environmental, including education, employment, living and working conditions) between different population groups

Main predictor of varience = SOCIAL DETERMINANTS (the conditions in which people are born into and raised - including: Culture, Social Norms, Education)

23
Q

What is the Tower Hamlet “SUGARSMART” Campaign?

What principle of the Ottawa Charter does it address?

Is is an up/mid/down -stream approach?

A

Raising public awareness on sugar content of food/drink, Making nutritional information more clear, Increasing physical activity and Reviewing School Menu’s

OTTAWA CHARTER: Creating Supportive Environments

Down/Mid-stream

24
Q

What is meant by the “Common Risk Factor Approach”?

How can this be implemented for Oral Health?

Name 2 government Common Risk Factor approaches…

A

A method used to create cross-disciplinary health promotion programmes based on the premise that many non-communicable diseases (e.g. cancer, heart disease, diabetes or chronic respiratory disease) share common risk factors (e.g. diet/obesity, smoking, alcohol, stress).

Following this, we aim to create a collaborative approach (vs. disease specific) with wide-spread effects by targetting shared risk factors (in OH these include: diet, smoking, hygiene, alcohol, stress and trauma)

  1. Government taxations (e.g. sugar tax)
  2. Health promoting schools
25
Q

What are 5 arguments AGAINST Water Fluoridation?

A
  • Unethical - Mass medication
  • Dose cannot be controlled/individualised between ages and quantity ingested
  • Fluorosis (mottling of teeth)
  • Fluoride can be obtained by other means (E.g. Toothpastes or Topical varnishes)
  • Systemic Risks - Kidney failure, GIT issues
26
Q

What is a decision aid?

How does it support the patient? (4)

A

Means of facilitating communication with the patient so that they can best make informed consent (e.g. use of Option Grids in multiple treatment options)
Usually include:

  • Multiple Options and layman explainations of what they are
  • Success Rates
  • Side Effects (and their prevalences)
  • Cost and Lifetime
  • Time
  • POI
  • Graphical/Visual Aids

How does it support the patient?

  • Informing them of all relevant information (informed consent)
  • Provides information in more condensed manner (e.g. visual aids or easy comparison tables)
  • Provides most up-to-date Evidenced-based comparisons (information the patient might not be able to obtain themselves)
  • Opens conversation through SDM so patient can voice factors most important to them and discuss with the dentist
27
Q

What are the 3 main strategies to tackling health inequalities through health promotion? (AEM)

A
  1. Advocate - Improve social/enviornmental/political conditions
  2. Enable - Make available to all people (universal)
  3. Mediate - Coordinated action with local authorities, volunteers, media and government
28
Q

In SDM, how should you best communcate risks?

A
  1. Numbers
  • Absolute numbers (vs. “3 times more likely with Type A)
  • Numbers with consistently common denominators
  1. Positive AND Negative Outcomes
  2. Visual Aids
  • Pie Chart
  • Paling Palette

(avoid descriptive/qualitative terms such as “low risk” - vague and subjective)

29
Q

What were the 5 goals of the Primary Health Care Approach (WHO, 2003 - recommended to tackle health inequalities)?

(HINT: Lots of Reforms…)

From these, what are the 4 principles?

A
  1. Reduce social inequalities (→ Equity in access to care)
  2. Health Service Reform - Around public needs (→ Prevention and Promotion)
  3. Public Policy Reform - Health integration into all sectors (→ Mulit-sectorial Approach)
  4. Leadership Reform
  5. Increase Stakeholder Participation (→ Community Participation)
30
Q

Public water fluoridation is an example of:

  1. What principle in the Ottowa Charter?
  2. Up-stream/Mid-stream/Down-stream approach?
A
  1. Creating Supportive Environments
  2. Up-stream
31
Q

What is meant by Shared Decision Making?

What is the most important thing to bear in mind?

A

A coversational and evidence-based approach where clinicians and patients discuss multiple treatment options (3 talk model) with best available evidence

Most Important factor = What matters most to the patient (“FELT” NEEDS)

32
Q

What are the 4 main types of “Needs”?

(Nana Can’t Find Eggs)

Define and give ways you would measure/identify these…

A
  1. NORMATIVE - Defined by professionals (e.g. the dentist) using assessment (BPE/Radiograph)
  2. COMPARATIVE - Comparing one group to another (Variations in dental attendance by age)
  3. FELT - What Px percieves as important (Talking to Px during history)
  4. EXPRESSED - Arise when FELT needs are turned into action (Dental attendance)
33
Q

What can be used to mass-assess patients Oral Health Demand?

A

OHIP (Oral Health Impact Profile)

Questionnaire covering 7 domains (OHIP-14 is shortened version with only 2 Q’s per domain)

Includes: Functional Limitations, Physical Pain and Physical/Social/Psychological Disability

34
Q

What are the 5 Principles of the Ottawa Charter?

A
  1. Building Healthy Public Policies
  2. Creating Supportive Environments
  3. Strenghtening Community Action
  4. Developing Personal Skills
  5. Re-orienting health care services towards prevention of illness and promotion of health
35
Q

Adults from routine/manual (lower socioeconomic) backgrounds are more likely to only visit when in pain - Why? (3)

A
  • Reduced access to dental care (COST)
  • Attitudes: Lack of caring or do not understand importance of prevention before pain
  • Mistrust in dentists
36
Q

Why did only 9% of patients recieve smoking cessation advice from the dental team? (4)

A
  1. Lack of cessation training
  2. Lack of time in appointment (NHS)
  3. Language/Cultural barriers
  4. Access - Px doesnt see dentist regularly!
37
Q

What is the difference between

  1. Disease?
  2. Illness?

(Define both)

A
  1. DISEASE = A named pathological entity as diagnosed by clinical signs and symptoms (for example cancer or caries)
  2. ILLNESS = How a person feels when unwell and its effects on their every day lives
38
Q

Social determinants are best assessors of oral health inequalities - What are 4 examples of this from the ADHS 2009?

A

Low socioeconomic households more likely to:

  1. Experience caries
  2. Smoke
  3. Only visit dentist if in pain
  4. Not have recieved any advice on cleaning

BDS3 (7 decks)

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