Public health approaches for health

Question 1

Definition of dental public health (1)

Answer 1

“the science and art of preventing oral diseases, promoting oral health and improving quality of life through the organised efforts of society”

Question 2

There are a number of distinctions from DPH and individual patient care (5)

Answer 2

Serves the community rather than an individual patient
Is concerned with the public as individuals & as a whole
Applies dental research to community settings
Focuses on the causes of the causes of disease
Administers group dental care programs

Question 3

Criteria that must be met to be considered a public health problem (4)

Answer 3

Must be widespread or serious
Severe consequences to community & individuals
Costs to community and to individuals are great
Effective methods available to prevent, alleviate or cure

Question 4

Different perspectives of periodontal diseases (6)

Answer 4

Gingivitis & periodontitis are not same disease
Gingivitis is common - doesn’t inevitably lead to periodontitis
<10% of people get severe periodontitis
Gingivitis seldom causes discomfort or loss of function
If the burst theories are true its hard to distinguish periodontitis from its legacy
-i.e., you cannot distinguish who has got periodontitis from those who have had periodontitis.
-it’s hard to diagnose periodontitis
Periodontitis is not the major cause of tooth loss

Question 5

Aetiological factors for periodontal diseases (4)

Answer 5

Plaque
Dental restorations and prostheses
Tobacco
Stress

Question 6

‘ARMPITS’ for dental health (1)

Answer 6

Retention throughout life of a functional, aesthetic, natural dentition of not less than 20 teeth and not requiring recourse to a prosthesis

Question 7

Possible public health approaches for periodontal diseases (5)

Answer 7

Health education
Chemotherapeutic approaches
Screening
Dental treatment
Health promotion

Question 8

Health education (7)

Answer 8

Repeated systematic reviews show small, short-lived effect on oral hygiene from Dental Health Education
At population level is relatively ineffective & very expensive
Knowledge, Attitude, Behaviour (KAB) model now discredited
Individuals constrained in ability to change behaviour
But people already make effort to clean teeth
80 - 90% brush twice daily
Incorporate personal hygiene & grooming into socialisation

Question 9

Chemotherapeutic approaches (1)

Answer 9

No real place for entire populations

Question 10

Screening for early diagnosis and treatment (4)

Answer 10

Screening is not justified
No valid methods to assess risk
Seems to be gradient of greater risk rather than cut off point
Treatment is expensive and not very effective

Question 11

Clinical treatment for periodontal diseases (5)

Answer 11

At best only moderately effective for individuals
Removal of calculus not shown to improve progression of periodontitis
Professional cleaning at 3-6 month intervals not significant improvement
Benefit for an entire population attenuated by low attendance, sub-optimal Rx etc
Cost for entire population is huge

Question 12

Periontal health promotion based on principles of the Ottowa Charter (5)

Answer 12

Create supportive environments
-better washrooms at work
-socialisation re grooming
-fiscal to make OH aids cheaper
Healthy public policies
-improve standards of living
-tobacco use
Strengthen community action
-educate community leaders
-diverse community wide approaches integreated into general HP
Develop personal skills
-refusal skills
Reorientate health services
-referral to Stop Smoking Services
-less plaque retentive restorations/ dentures

Question 13

Dental trauma stats (1)

Answer 13

Experienced by up to 23% of children

Question 14

Risk factors dental trauma (7)

Answer 14

Orthodontic problems
Contact sports
Violence
Deprivation – crowding
Falls
Traffic and bike accidents
Poor environment

Question 15

Assault stats (3)

Answer 15

Inversely correlated with price of alcohol!
Seasonal
North West/South East split

Question 16

Public health approaches for trauma based on principles of the Ottowa Charter (5)

Answer 16

Create supportive environments
-soft surfaces in play areas
-socialisation re antisocial behaviour
-CCTV for early detection/ fast response
Healthy public policies
-mouth-guards for sports
Strengthen community action
-anti social behaviour programmes
-move fast food outlets
Develop personal skills
-socialisation
-alcohol education
Reorientate health services
-organisation of dental services

Question 17

Oral cancer stats (4)

Answer 17

In UK approx. 12,000 new cases of H&N cancer per year, 3% of all cancers
Sex difference and interaction with social class
Ethnic differences related to tobacco use
No marked improvements in cure rates for years though Rx improves QoL in interim

Question 18

Risk factors for oral cancer (6)

Answer 18

Tobacco
Alcohol
Premalignant lesions
Sunlight
Trauma
Human Papilloma Virus

Question 19

Public health approaches for cancer based on the principles of the Ottowa charter (5)

Answer 19

Create supportive environments
-fiscal action vs tovacco and alcohol
-restrict tobacco use in public places
-use of sun-block
Healthy public policies
-improve standards of living
Strengthen community action
-action against tobacco use
-educate community leaders
Develop personal skills
-diverse community wide approaches integrated into general HP
-alcohol and smoking education
Reorientate health services
-early diagnosis