PMHP need to know

Question 1

what is the optimal dose of fluoride in drinking water?

Answer 1

1ppm
1mg/l

Question 2

name 2 foods and/or drinks other than water which are good natural sources of fluoride

Answer 2

• fluoridated salt
• fluoridated milk

Question 3

list 4 methods of topical fluoride application for an 8 year old

Answer 3

• fluoride varnish 22,600ppm at least 2x per year
• fluoride toothpaste 1500ppm
• fluoride tablets 1mg fluoride daily
• fluoride mouth rinse 225ppm

Question 4

how does topical fluoride help prevent caries?

Answer 4

• fluoride slows down development of decay by stopping demineralisation of dentine
• makes enmale more resistant to acid attack from plaque bacteria
• speeds up remineralisation
• can stop bacterial metabolism at high concentrations to produce less acid
• fluoride that enters the tooth produces fluoroxyapatite which makes the tooth much stronger once remineralisation occurs

Question 5

what daily dose of fluoride tablet would you give to a child…
* age 4 yeats
* high caries risk
* area with <0.3ppm fluoride in water supply

Answer 5

o.5mg/day

Question 6

what is the recommended maximum weekly alcohol intake?

Answer 6

• no more than 14 units per week
• should be spread evenly over 3+ days

Question 7

what acts regulate alcohol in Scotland?

Answer 7

• criminal justice and licensing act 2010
• alcohol etc. act 2010
• air weapons and liscensing act 2015

Question 8

what has reduced alcohol consumption in Scotland?

Answer 8

• minimum pricing
• ban on multi-drink promotions
• lower drink drive limits

Question 9

what are the chairside interventions that can be used to help somoene with an alcohol problem?

Answer 9

• 5As (ask, advise, assess, assist, arrange)
• 2as 1R (ask, advise, refer)

Question 10

describe what incidence means

Answer 10

• number of new disease cases developing over a specific period of time in a defined population
• obtained from longitudinal studies or derived from registers

Question 11

what is the incidence rate?

Answer 11

the number of new cases of a disease in a period/number of individuals in the population at risk

Question 12

define prevalence

Answer 12

the number of affected indivduals in a population at a given time
estimates are obtained from cross-sectional studies or derived from registers which can relate to attributes to absence or presence of disease

Question 13

what does SIMD stand for?

Answer 13

scottish index of multiple deprivation

Question 14

what is the SIMD?

Answer 14

an area based index which uses a range of data to decide which neighbourhoods are most deprived by ranking data such as education and employment in order of deprivation from 1-5/10

Question 15

what are the 7 factors of deprivation measured in the SIMD?

Answer 15

• employment status
• income
• health and care services
• geographic access to services
• crime
• housing, living and working conditions
• education, skiils and training

Question 16

what are the four key design elements of randomised control trials?

Answer 16

specification of participants
control/comparison groups
randomisation
blinding/masking

Question 17

name an advantage of randomised control trials

Answer 17

provide the strongest and most direct epidemiologic evidence for causality

Question 18

give disadvantages of randomised control trials

Answer 18

more difficult to design and conduct than oberservational studies
not suitable for all research questions
high costs
still some risk of bias

Question 19

what is a cross-sectional study?

Answer 19

observational study that analyses data collected from a population, or a representative subset, at a specific point in time

Question 20

what is a case-series report?

Answer 20

description of the medical history of one or more patients

Question 21

what is a case-control study?

Answer 21

people with a disease are matched to those without it and earlier exposure to different factors are compared

Question 22

what is a cohort study?

Answer 22

participants are recruited to a study and followed up over time. Exposures and diseases are measured prospectively

Question 23

what is a systematic review and meta analysis?

Answer 23

all the evidence for RCTs looking at effectiveness of a particular treatment are synthesised

Question 24

what are case-series reports used for?

Answer 24

hypothesis generation
to identify a new disease outcome

Question 25

what are the disadvantages of case series reports?

Answer 25

cannot demostrate valid statistical associations
lack of control group

Question 26

what are cross sectional studies used for?

Answer 26

estimating prevalence of a disease
to investigate potential risk factors

Question 27

what are the disadvantages of cross-sectional studies?

Answer 27

recall bias
causality
confounding factors

Question 28

what are case-control studies used for?

Answer 28

looking at potential causes of a disease

Question 29

what are the disadvantages of case-control studies?

Answer 29

confounding factors
recall/selection bias
time relationships (did exposure occur before disease)

Question 30

what are cohort studies used for?

Answer 30

estimating incidence of disease
investigating cause of disease
determining prognosis
timing and direction of events

Question 31

what are disadvantages of cohort studies?

Answer 31

controls are difficult to identify
confounding factors
blinding is difficult
need large samples for rare diseases
very expensive and time consuming

Question 32

what does a confidence interval do?

Answer 32

tells us the range of values that a true population treatment effect is likely to lie

Question 33

what does a confidence interval that overlaps the value of no difference between treatments indicate?

Answer 33

there is insufficient evidence for a difference. between the treatment and control group in the population

Question 34

what does it mean if the confidence interval overlaps 1?

Answer 34

there is insufficient evidence that there is a difference between the drug and the placebo

Question 35

what is the absolute risk difference?

Answer 35

the difference in risk between groups

Question 36

what is the value of no difference?

Answer 36

when there is no absolute risk difference

Question 37

what is the ‘number needed to treat’ (NNT)?

Answer 37

the number of patients you would need to treat to prevent one patient from developing the disease/condition/outcome

Question 38

what is the risk ratio?

Answer 38

number of events of interest/
total number of observations

Question 39

what is the odds ratio?

Answer 39

number of events of interest/
number without the event

Question 40

what does a P value less than 0.05 mean?

Answer 40

you reject the null hypothesis
your results are significantly significant

Question 41

what is the dosage of fluoride tablets given to children?

Answer 41

6 months- 3 years= 0.25mg/d
3-6 years= 0.5mg/d
6+years= 1mg/d

Question 42

what dosage of fluoride mouthwash would you prescribe to children?

Answer 42

225ppm
age 6+ only

Question 43

what are the symptoms of fluoride toxicty?

Answer 43

• nausea
• abdominal pain
• diarrhoea
• vomiting

Question 44

what are the general health effects of smoking?

Answer 44

• narrows arteries and increases atherosclerosis
• increased risk of stroke
• increased chest infections, COPD, bronchitis and lung cancer
• increased stomach ulcers and stomach cancer
• increased risk of CHD and heart attack
• can cause macular degeneration and peripheral vascular disease

Question 45

what are the oral health effects of smoking?

Answer 45

increased risk of oral cancer
increase in periodontal disease, alveolar bone loss, attachment losss, pocket formation
increased risk of dry socket after dental extractions
halitosis and xerostomia
staining of teeth and restorations
nicotine stomatitis

Question 46

what are recent health promotion approaches in Scotland that have reduced smoking?

Answer 46

• age of purchase went from 16 -18
• plain packaing onf tobacco with health warnings
• packets no longer visibly on sale
• no longer in vending machines
• public smoking ban in 2006

Question 47

what types of approaches can be used for smoking cessation in the dental practice?

Answer 47

5 As- ask, advise, assess, assist, arrange
ask, advise, refer

Question 48

what periodontal phenomenom is experienced by smokers when trying to quit?

Answer 48

rebound gingivitis due to increased vascularity