Prevalence and Prevention in Population Flashcards
What is epidemiology?
the study of the distribution and determinants of diseases in populations
What is distribution?
burden of the disease
What are determinants?
cause or risk factors of the disease
What is population?
groups of individuals geographic/ area/ community/ community of interest (ages, minorities, races)
What are the epidemiology principles?
time
place
person
What are demographics influenced by?
births
deaths
ages
gender
migration
What are counts?
no.of people affected by a particular condition (at a particular time, and area)
What is prevalence?
is the proportion (%) of population with a disease at any given point (point prevalence) or period (period prevalence in time)
i.e 10% of the population are affected
What is incidence?
is the number of new cases of a disease in a defined population over a defined period of time (rate)
i.e. 10 per 100,00 per annum are affected
What is the standardised data?
takes into account population age-structure
i.e. older population = more cancer
What is the most common oral disease?
caries
How are caries recorded/measured (methods)?
- DMF/dmfIndex
– no. of decayed, missing, filled teeth (or surfaces DMFS/dmfs) - ICDAS
– International Caries Detection and Assessment System – Restorative status and Caries status scores - Significant Caries Index
– takes into account skewed distribution of caries in population
What system is most effective for enamel caries?
ICDAS
What are D3 classifications of decay?
obvious decay such as lesions into the pulp or clinicaly detectable lesions in dentine
seen by the naked eye
What has been the main driver of improvement since the 1970s?
flouoride toothpaste
What was missing from the traditional biomedical model of caries causation?
effect of fluoride
diet (not just “substrate”)
What are the approaches for preventing caries in populations?
- High risk individual approach (clinical risk assessment)
- Targeted population approach (targeting on areas of deprivation / communities)
- Whole population approach (universal ie / eg. a founding principle of the NHS)
What is proportionate universalism?
proportionate targeting = greater change in gradient > +ve health outcome
What are the strategies for delivery of fluoride?
- Toothpaste
- Water fluoridation
- Community fluoride schemes
– NICE National Institute Guidelines on oral health improvement https://www.nice.org.uk/guidance/ph55
What are strategies for diet improvement?
- Links with obesity
- Actions to reduce sugar
- Local community / school
- Industry (sugar substitutes, reformulation, labelling)
- SUGAR TAX !!
What is a common risk factor approach?
factors such as diet, stress, hygiene, tobacco, alcohol and physcial activity
can cause a range of diseases
i.e they are a common risk factor
What are methods of health improvement approaches?
- Theory-based
- Evidence-based
- Common risk factor approach
- Community engagement
- Multi-agency working
- Proportionate universalism
What are the evidence based clinical guidelines?
Importance of fluoride
Register child with a dentist as early as possible (regular
attendance)
Standard risk
* All children
Enhanced risk
* SIMD 1-3 (scottish index of multiple deprivation)
* Decay experience dmft
What does the childsmile integrated programme consist of?
supervised toothbrushing (targeted school universal)
FVA in nursery and school (targeted)
practice and community (targeted universal)
What is the upstream to downstream approach?
upstream (healthy public policy)
>
downstream (health education and clinical prevention)
What did childsmile incorporate in the NHS primary care payment system 2011?
Ø Oral health improvement advice
- Demonstrate and observe hands-on brushing instruction
-Tailored advice on diet and nutrition
- Action plan
ØFluoride varnish [2-5 years]
- For children from 2 years, apply
varnish 2 x per year
- [additional 2 x per year in
nursery / primary schools]
Who is involved in childsmile practice and community?
health visitor/ nurse
dental health support worker
primary care dental practice
non-dental local community/third sector organisations
What are the general childsmile approaches and are they upstream, midstream or downstream?
influencing public health policy at national level -upstream/mid
oral health training for wider workforce- midstream
supervised tooth brushing in nursery and school - midstream
universal and targeted provision of toothbrushes and toothpaste - down/mid
targeted community based fluroide varnish programmes - mid/down
integration of oral health into targeted home visits by health workers - mid/down
signposting with community initiatives - mid/down
What were outcomes for childsmile?
reduction in DMFT in children
