PMHP need to know Flashcards
what is the optimal dose of fluoride in drinking water?
1ppm
1mg/l
name 2 foods and/or drinks other than water which are good natural sources of fluoride
- fluoridated salt
- fluoridated milk
list 4 methods of topical fluoride application for an 8 year old
- fluoride varnish 22,600ppm at least 2x per year
- fluoride toothpaste 1500ppm
- fluoride tablets 1mg fluoride daily
- fluoride mouth rinse 225ppm
how does topical fluoride help prevent caries?
- 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
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
o.5mg/day
what is the recommended maximum weekly alcohol intake?
- no more than 14 units per week
- should be spread evenly over 3+ days
what acts regulate alcohol in Scotland?
- criminal justice and licensing act 2010
- alcohol etc. act 2010
- air weapons and liscensing act 2015
what has reduced alcohol consumption in Scotland?
- minimum pricing
- ban on multi-drink promotions
- lower drink drive limits
what are the chairside interventions that can be used to help somoene with an alcohol problem?
- 5As (ask, advise, assess, assist, arrange)
- 2as 1R (ask, advise, refer)
describe what incidence means
- number of new disease cases developing over a specific period of time in a defined population
- obtained from longitudinal studies or derived from registers
what is the incidence rate?
the number of new cases of a disease in a period/number of individuals in the population at risk
define prevalence
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
what does SIMD stand for?
scottish index of multiple deprivation
what is the SIMD?
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
what are the 7 factors of deprivation measured in the SIMD?
- employment status
- income
- health and care services
- geographic access to services
- crime
- housing, living and working conditions
- education, skiils and training
what are the four key design elements of randomised control trials?
specification of participants
control/comparison groups
randomisation
blinding/masking
name an advantage of randomised control trials
provide the strongest and most direct epidemiologic evidence for causality
give disadvantages of randomised control trials
more difficult to design and conduct than oberservational studies
not suitable for all research questions
high costs
still some risk of bias
what is a cross-sectional study?
observational study that analyses data collected from a population, or a representative subset, at a specific point in time
what is a case-series report?
description of the medical history of one or more patients
what is a case-control study?
people with a disease are matched to those without it and earlier exposure to different factors are compared
what is a cohort study?
participants are recruited to a study and followed up over time. Exposures and diseases are measured prospectively
what is a systematic review and meta analysis?
all the evidence for RCTs looking at effectiveness of a particular treatment are synthesised
what are case-series reports used for?
hypothesis generation
to identify a new disease outcome
what are the disadvantages of case series reports?
cannot demostrate valid statistical associations
lack of control group
what are cross sectional studies used for?
estimating prevalence of a disease
to investigate potential risk factors
what are the disadvantages of cross-sectional studies?
recall bias
causality
confounding factors
what are case-control studies used for?
looking at potential causes of a disease
what are the disadvantages of case-control studies?
confounding factors
recall/selection bias
time relationships (did exposure occur before disease)
what are cohort studies used for?
estimating incidence of disease
investigating cause of disease
determining prognosis
timing and direction of events
what are disadvantages of cohort studies?
controls are difficult to identify
confounding factors
blinding is difficult
need large samples for rare diseases
very expensive and time consuming
what does a confidence interval do?
tells us the range of values that a true population treatment effect is likely to lie
what does a confidence interval that overlaps the value of no difference between treatments indicate?
there is insufficient evidence for a difference. between the treatment and control group in the population
what does it mean if the confidence interval overlaps 1?
there is insufficient evidence that there is a difference between the drug and the placebo
what is the absolute risk difference?
the difference in risk between groups
what is the value of no difference?
when there is no absolute risk difference
what is the ‘number needed to treat’ (NNT)?
the number of patients you would need to treat to prevent one patient from developing the disease/condition/outcome
what is the risk ratio?
number of events of interest/
total number of observations
what is the odds ratio?
number of events of interest/
number without the event
what does a P value less than 0.05 mean?
you reject the null hypothesis
your results are significantly significant
what is the dosage of fluoride tablets given to children?
6 months- 3 years= 0.25mg/d
3-6 years= 0.5mg/d
6+years= 1mg/d
what dosage of fluoride mouthwash would you prescribe to children?
225ppm
age 6+ only
what are the symptoms of fluoride toxicty?
- nausea
- abdominal pain
- diarrhoea
- vomiting
what are the general health effects of smoking?
- 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
what are the oral health effects of smoking?
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
what are recent health promotion approaches in Scotland that have reduced smoking?
- 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
what types of approaches can be used for smoking cessation in the dental practice?
5 As- ask, advise, assess, assist, arrange
ask, advise, refer
what periodontal phenomenom is experienced by smokers when trying to quit?
rebound gingivitis due to increased vascularity
what is a null hypothesis?
general statement suggesting that there is no statistical significance in a set of data
how do you calculate an odds ratio?
no. time x occurred/no. times x never occurred
DIVIDED BY
no. times y occurred/no. times y never occurred
give roles of epidemiology
to assess people’s risk of disease
to study the causes and determinants of disease
to develop preventive programmes
to evaluate interventions e.g.oral cancer screening
What are the forms of abuse that may be involved in domestic abuse?
Physical violence
Verbal abuse
Emotional abuse
Sexual abuse
Financial Abuse
What process should you follow to ask about the possibility of domestic abuse
AVDR
Ask - ask about abuse in a private setting
Validate - show you are concerned about them
Document - be specific and detailed, use patients own words and describe injuries in as much detail as possible
Refer - signpost to appropriate services
What are physical signs you may see in domestic abuse ?
repeated injuries
Bruises at different stages if healing
dental/maxillofacial injuries
facial bruising, strangle marks around the neck or fingertip bruising
TMJ problems
-Orofacial pain
What questions would you ask a patient who smokes?
what do they smoke?
How often do they smoke?
How long have they smoked for?
Have they ever tried to quit before?
What advice would you give to patients about vaping?
Explain there is not enough research to determine long term effects of vaping however they are considered safer than normal cigarettes
recommend research backed methods to quitting smoking (e.g. nicotine patches)
don’t use as an alternative to smoking - use as a method of quoting
try not to use in public or infront of children
What are the 5 A’s in smoking sessation?
Ask - about smoking
Advise
Assess
Assist
arrange follow up for patients
What is the shortened approach to smoking cessation ?
Ask - establish smoking status and record
Advise
Act - offer referal to local stop smoking services
What are services to refer to for smoking cessation
local stop smoking services
Local pharmacy
What periodontal issue might occur when patients stop smoking?
increased bleeding when brushing due to gingival blood flow increasing
give examples of primary study designs
randomised control trials
cohort studies
case-control studies
define dependence
a compulsive physiological and psychological need for a habit forming substance
what are evidenced based treatments to support quitting smoking
nicotine patches
champix
e cigarettes
what are local services that could be referred to for smoking cessation
local pharmacy
specialist services
what do you do if a patient decides now is not the right time to quit smoking
record the advice given in the notes
make a note to bring it up in the future
give leaflet to patient and let them know advice is available when they want it
what standards were developed to improve the reporting of RCT
consort - consolidated standards of reporting trials
what does a confidence interval do?
tells us the range of values that a true population treatment effect is likely to lie
how do you reduce bias in a study design?
randomising
double blinding
what advise do you give to a patient about e-cigarettes?
- reducing exposure to tobacco
- likely to be safer but evidence base is still developing
how is PICO used in study design?
population
intervention
comparison
outcome
define significance
a measure of the probability of the null hypothesis being true compared to the acceptable level of uncertainty regarding the true answer
