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57 Cards in this Set
- Front
- Back
Define "dental public health" |
A non clinical speciality of dentistry Assess health needs Improve health of populations |
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What are the aims of dental public health |
Review dental issues in populations Prevent disease and promote health through organised community efforts Highlight range of factors influencing oral health, find the most effective way to prevent and treat |
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What are the five aspects of dental public health |
Leadership and Expertise Oral Health Surveillance Policy Development Community Based Prevention Maintain Dental Safety Net |
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Describe Leadership and Expertise |
Find the causes of oral health problems and social determinants of health. Preventative. Promote health of all. Encourage partnership with flexible solutions and advocate community participation in oral health. OH is a silent epidemic, the most preventable non-communicable disease |
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Describe Oral Health Surveillance |
Collect epidemiological data, interpret it and find trends to assess oral health needs. |
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Describe Policy Development |
OH often overlooked, only receives backwash effect. DPH wants a common risk factor approach in an integrated health policy. Upstream/macro - legislation e.g. smoking Downstream/micro - brushing guidelines Dental access is now an indicator of health. |
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Describe Community Based Prevention and Health Promotion |
Variation between different regions, e.g. 5YO caries is 20% is SE but 35% in NW. Understand social determinants of health and their impact. Work with local authorities to develop OH programs on a community level. |
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Describe the Maintenance of the Dental Safety Net |
"the sum of individuals and organisations, both public and private involved in delivering OH services to people who for reasons of poverty, culture, language, health status, geography and/or education are unable to secure them on their own". Inverse Care Law - poor gain less than rich Local councils now have more of a role. |
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What are the three models of health? |
Social Biomedical WHO (Ottawa) |
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Describe the social model of health |
Health is based on the whole individual, the combination of biological, social, psychosocial and environmental factors. Takes a holistic approach; patient is self-reliant and takes a more preventative approach. Practitioner is a helper not a healer. |
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Describe the biomedical model of health |
Human body is a machine that can be fixed through medical intervention. The practitioner is the expert with the aim to diagnose and to treat, with the patient being passive. Focus is biological with the main purpose being to cure. |
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Describe the WHO model of health |
"a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" |
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What is the advantage of the WHO model |
It does not see health as being a negative concept. Also recognises physical, psychological and social domains. |
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What is the disadvantage of the WHO model |
Interprets health as a duty to self, relies on a process of medicalisation - reliance on check-ups and medicine |
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Describe the OTTAWA charter |
Outlined the principles for health promotion. "Health promotion is the process of enabling people to increase control over and to improve their health" |
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What are the three strategies described in the OTTAWA charter |
Advocacy - create the essential conditions for health Enable - all people to achieve their full health potential Mediate - between different interests in society in the pursuit of health |
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Why do we measure health? |
By studying the factors that influence health, we can reduce negative factors and promote positive factors to develop practical solutions to promote health and identify any unmet health needs (capacity to benefit from an intervention) |
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Define "health status" |
"a description or measurement of the health of and individual or population at a specific point in time against identifiable standards using health indicators as a reference". (life expectancy, mortality, morbidity) |
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Define life expectancy |
average number of years of life remaining to a person of a specific age |
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Define mortality |
number of deaths in a population at a given time divided by the number of the people in a population, multiplied by 1000 |
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Define mobidity |
number of non fatal outcomes in a population at a given time divided by the number of the people in a population, multiplied by 1000 |
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Prevalence |
The percentage of the population with the disease right now Number of cases of a disease in a population at a specific time divided by number of people at risk multiplied by 1000 |
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Incidence |
Number of new cases of a disease Number of new cases in a population at a specific time, divided by number of people at risk, multiplied by 1000 |
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Describe different types of information gained |
Demographic - age, sex, population, geography Social - deprivation, employment, housing Health need - distribution of indicators of an intervention Mortality - death according to person/place Morbidity - health or illness of population Health service use - diagnosis, intervention, procedures |
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What are the examples and advantages of quantitative health data |
Summary measure / rates can makes inferences about population health status |
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Why do we interpret health data |
Determine health inequalities, variations between groups e.g. ethnicity, sex, age |
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Describe a behaviourist approach to health inequalities |
Behaviour and lifestyle explain health differences, but ignores the fact that behaviour is shaped by social context. Assumes free choice of lifestyle and blames the individual for their health |
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Describe a social determinant approach to health |
Recognises that "distribution of power, income, goods and services, as-well as immediate circumstances of peoples lives e.g. healthcare, education and their work, leisure, home and community impact on their health" |
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Describe a health need and their three different statuses |
capacity to benefit from intervention, aims to improve health benefits for all Met - current standard of care is appropriate Unmet - gaps in current services or information Overmet - over use of services, e.g. antibiotics |
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Describe the four ways to identify health needs |
Normative - defined objectively by professional Felt - subjectively important to the individual Expressed - felt need expressed e.g. protest Comparative - comparing similar groups |
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What are the effects of poor oral health? What is it's relationship with general health? |
Physical and psychological impacts can affect daily life such as pain, diet, socialise and speech impacts. Oral health is an indicator for general health, with a bi-directional and complex relationship. Oral health should be person-centred. |
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Describe Cohen and Jago's findings |
Clinical measures play a role in measuring oral health, but could be improved if socio-dental indicators were included such as lifestyle and access to care. Positive impact on oral health policy. |
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Describe Locker's findings |
Locker developed a new model for measuring oral health, moving away from a biomedical model to one which measured impact on everyday function. |
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Describe Locker's model of oral health |
Disease - periodontitis Impairment - tooth loss Discomfort/limitations - speaking/eating limits Disability - reduced daily function, embarassed Handicap - not getting job interview |
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Describe the Department of Health's definition of Oral Health |
"standards of health of oral tissues which enables an individual to perform daily activities without discomfort or embarrassment, which contribute to overall well-being. |
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What did Locker help develop? |
Oral-Health Related Quality of Life Measures He decided that QoL is concerned to the degree by which someone enjoys the important possibilities of life. OHRQoL |
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What did Sheiham and Watt recognise? |
That oral health and general health are shaped by similar issues and called for a common risk factor approach or coordination. By integrating the two and assessing oral needs in socio dental ways, health plans greatly enhance OH and GH. |
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How is oral health measured |
Using both clinical and OHRQoL measures |
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Describe clinical indicies |
Clinical measures involve scoring patients on indices to show prevalence of a disease. e.g. DMFT, Helkimo, CPITN They are measured on certain criteria |
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Describe criteria for clinical indicies |
Simple - easy to understand and use Objective - clear categories, easy to respond Valid - does it measure what it intends to Reliable - can it replicate results Reproducible - will it give same results if condition being assessed hasn't changed Quantifiable - can be statistically analysed Sensitive - able to detect small changes Acceptable - not painful or demeaning, appropriate use of time and ethical |
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Describe DMFT |
Index for measuring prevalence and severity of dental caries in a population. It has three measures. |
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What are the three measures of DMFT, what can the scores range from |
Treatment - (M+F)/DMF x 100 Care - F/DMF x 100 Restorative - F/(D+F) x 100 Scores range from 0 to 32 |
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Describe the DMFT brackets |
Very low - below 1.2 Low - 1.2 - 2.6 Moderate - 2.6 - 4.4 High - 4.4 + |
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What are the advantages of clinical measures |
Compare OH of different groups, measure prevalence, incidence |
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What are disadvantages of clinical measures |
Measures disease, not health. Indices only offer end point, no insight onto how oral health impacts social well-being. |
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What are the advantages of OHRQoL measures |
Poor oral health can reduce social contact, induce depression, reduce appetite. Psycho-social focus, patient designed |
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What are disadvantages of OHRQoL measures |
Not widely used, focused on specific groups, subjective, less likely to be used clinically. |
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Describe Oral Health Literacy |
The degree to which individuals have the capacity to obtain, process and understand basic oral health information and services needed to make appropriate health decisions. Low OHL is associated with poor OH status. |
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Describe epidemiology |
The study of occurance and distribution of health related states or events in specific population including the study of determinants inducing such states, and the application of knowledge to control health problems. |
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What are the aims of epidemiology? |
Aetiology Occurrence Progress Intervention Evaluate Repeat |
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Epidemiology step 1 |
Aetiology - person (age, gender), place (rural, urban), time (annual, daily). Does a relationship exist between events and outcomes? Are these factors causal, enabling, contributing or preventative? Causal association = risk factor Non-causal association = risk indicator |
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Epidemiology step 2 |
Occurance - three measures: Risk of incidence - probability a person will develop disease over time period Incidence rate - rate at which new event occurs in a population Prevalence - a measure of disease occurance |
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Epidemiology step 3 |
Progress - three types of epidemiology: Observable - observe effects of exposure, investigator not in control Experimental - investigator in control of exposure, control and research groups Analytical - systematic assessment of relationships and hypothesis |
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Epidemiology step 4 |
Intervention - are existing protocols cost effective, are they inclusive of patient perspective? e.g. Fluoridation, reduced tooth decay 30% |
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Epidemiology step 5 |
Evaluate - identify modifiable factors that can impact on disease occurrence, such as policy development |
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Describe Oral Epidemiology |
The "study of distribution and determinants of oral health related states or events in a specified population, and the application of this study to control oral health problems". Can measure scale of disease, find trends, susceptible groups, causes, impacts on society and highlight preventable measures. Sources include WHO, PHE, BASCD |
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Statistics |
4 billion people have untreated OH problems 75% of the world have no access to a dentist Dental treatment costs 5-10% of health budget 10-15% of adults have severe periodontitis 54% of adults have gingivitis 70% of 5 year old's are caries free 86% of 65+ year old's have 21 functional teeth |