Introduction to Preventive Dentistry and Public Health Lecture PDF

Introduction to Preventive Dentistry and Public Health Prof. Stier Objectives Define six roles of the dental hygienist in order to determine how they relate to community oral health practice. Interpret and explain in writing, the definition of health as stated by the World Health Organizatio...

Introduction to Preventive Dentistry and Public Health Prof. Stier Objectives Define six roles of the dental hygienist in order to determine how they relate to community oral health practice. Interpret and explain in writing, the definition of health as stated by the World Health Organization, public health (John Knutson) (C.E.A. Winslow) dental public health (American Board of Dental Public Health) Define the following Key terms: Primary, Secondary, & Tertiary prevention and provide specific examples of each. List the current public health preventive modalities practiced today Objectives Identify and discuss the parallels in methods and approach of public health dentistry with clinical dentistry. List two (2) criteria for Public Health problems. List the various political levels that maintain & support public health departments Outline the scope of traditional dental public health programs Explain the role of the government in public health solutions. Discuss the 10 greatest Public health Achievements of the 20th Century. Identify core functions of public health and the essential public health services. Let’s Being with a Brain Teaser… You have a fox, a chicken and a sack of grain. You must cross a river with only one of them at a time. If you leave the fox with the chicken he will eat it; if you leave the chicken with the grain he will eat it. How can you get all three across safely? Take the chicken over first. Go back and bring the grain next, but instead of leaving the chicken with the grain, come back with the chicken. Leave the chicken on the first side and take the fox with you. Leave it on the other side with the grain. Finally, go back over and get the chicken and bring it over. What is Dental Public Health? How would you describe your own health? Physical Health Mental Health Emotional Health Health Defined Webster’s Definition: The condition of being sound in body, mind, or spirit; especially: freedom from disease The overall condition of the body The World Health Organization’s (WHO) Definition: A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity Public Health Defined WHO’s Definition: “The effort to promote physical and mental health and prevent disease, injury, and disability at the population level” (may be delivered at the individual level even though it’s to benefit the public) John W. Knutson’s Definition (American Public Health Association): “Public health is people’s health” Institute of Medicine’s (IOM) Definition: “What we as a society do collectively to assure the conditions in which people can be healthy” Dental Public Health Defined A specialty (1 of 9) of dentistry recognized by the ADA American Board of Dental Public Health (ABDPH) Definition: “The science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice that serves the community as a patient rather than the individual. It is concerned with dental health education of the public, with applied dental research, and with the administration of group dental care programs, as well as the prevention and control of dental diseases on a community basis” Focuses on oral health care, education of a population, and dental hygiene sciences Goals of Public Health Prevent epidemics and the spread of disease Protect against environmental hazards Prevent injuries Promote and encourage healthy behaviors Respond to disasters and assist communities in recovery Ensure the quality and accessibility of health services Core Functions of Public Health Assessment Monitors health of communities to identify problems and priorities Policy Development Process by which decisions are made about problems Assurance Make certain that all have access to appropriate and cost-effective services to reach public health goals. Includes individual treatments as well as health promotion and disease prevention activities Serving all Functions Research for new insights and innovative solutions to health problems How Public Health Serves Monitor health status to identify community health problems Diagnose and investigate health problems and health hazards in the community Inform, educate, and empower people about health issues Mobilize community partnerships to identify and solve health problems Develop policies and plans that support individual and community health efforts How Public Health Serves Cont’d Enforce laws and regulations that protect health and ensure safety Link people to needed personal health services and ensure the provision of health care when otherwise unavailable Ensure a competent public health and personal health care workforce Evaluate effectiveness, accessibility, and quality of personal and population-based health services Research for new insights and innovative solutions to health problems Public Health Problem What constitutes something as a “public health problem?” Have to be selective to avoid reactive, inefficient, and ineffective responses to society’s health needs Criteria Used to Define a Public Health Problem A condition or situation that is a widespread actual or potential cause of morbidity or mortality A perception on the part of the public, the government, or public health authorities that the condition is a public health problem. This definition allows a broad interpretation of a PH problem in that, “widespread”, “potential” and “perception” can all be interpreted differently in different situations. Examples: Bioterrorism, West Nile Virus, Severe Acute Respiratory Syndrome (SARS), automobile safety, water purification and oral disease Others examples? 10 Great Public Health Achievements of the 20 Century th Vaccination Motor vehicle safety Workplace safety Control of infectious diseases Decline in deaths from coronary heart disease and stroke Safer and healthier food Healthier mothers and babies Family planning Community water fluoridation Recognition of tobacco as a hazard Public Health Solutions Seven Characteristics Not hazardous to life or function. Effective in reducing or preventing the targeted disease or condition. Easily and efficiently implemented Potency maintained for a substantial time period. Attainable regardless of socioeconomic status. Effective immediately upon application Inexpensive and within the means of the community. Public Health Solutions Cont’d Examples: Seatbelts Airbags Immunizations Fluoridation of Drinking Water Tobacco Cessation Programs All of these examples prevent injuries and mortality Polio Example Dental Disease as a Public Health Problem Universal problem that does not undergo remission if left untreated About 99% of adults have had tooth decay by the time they reach their early 40s About 60% of adults over age 75 have had root caries The extent and severity of dental caries warrant the need for treatment and prevention programs throughout the United States. Dental decay, if left untreated, continues to escalate and results in expensive surgical procedures. Therefore, it is important to focus on prevention of the disease. Factors Affecting Dental Public Health Current structure of dental care delivery Poor distribution of providers Individuals accessing care regularly Restrictive regulatory statutes Geographic, educational and cultural barriers Cost of care/dental insurance Malpractice Aging population Solutions Community water fluoridation is the perfect example of a dental public health solution to the problem of dental decay. Organized community efforts have brought fluoridated drinking water to more than 144 million people. Results show that there is a significant reduction in the amount of dental decay. Community Water Fluoridation Has proven to be safe. It is a cost-effective solution for reducing dental decay in children. It is easily implemented by adding fluoride to the water supply. It reaches all people regardless of socioeconomic status. It is effective immediately upon initiation. Costs far less than the financial burden of restorative treatment. It meets all the seven characteristics to be considered an effective solution to the problem of dental decay. More Prevention is Still Needed Dental disease, however, still exists as a public health problem of the 21st century. More community dental health education needs to be performed with the implementation of additional dental health promotion and prevention programs. More Prevention is Still Needed Cont’d The Surgeon General’s report on oral health emphasizes the need for these programs and addresses the importance of oral health to the general health of the public Dental disease is discussed as a dental public health problem of universal prevalence that can be alleviated, and even prevented, with future public health measures Dental professionals, both those employed in the field of public health and those employed in private practice, must work together to educate the community and to provide the necessary programs to treat and prevent further disease  Roles of a Dental Hygienist in Public Health Provides clinical care to population Creates initiatives for populations Conduct research in and lobbies to change laws to better health/disease and the care in underserved population utilization of the D.H. Supports public health efforts Educates/promotes oral through funding, research health issues to specific and products populations Develops and coordinates dental public health programs Evolution of Public Health Treating a population with a disease Controlling the disease Preventing the disease Prevention of Disease Enhances quality of life Deters illness/outbreaks Cost effective Different types of Prevention Primary Secondary Tertiary Primary Prevention Use of strategies and agents to halt the onset of disease, reverse its progress, or arrest it before treatment is needed Immunizations in children Use of fluoride to prevent tooth demineralization Prophylaxis Secondary Prevention Routine treatment methods to end disease process and restore tissues to as nearly as normal as possible (restorative care) Setting a broken arm so the bone can heal Dental fillings Periodontal therapy (SRP) Tertiary Prevention Replaces lost tissues Prosthetics to replace missing limbs Bridges Implants Grafts Private Practice vs. Public Health Practice Community or population is the “patient” Programs to treat dental disease can be conducted on a community (public health) or individual (private practice) level Both involve the process of care (assessment, dental hygiene diagnosis, planning, implementation, and evaluation) Private Practice vs. Public Health Practice Cont’d Community oral health practice extends the role of the dental hygienist in private practice to include the people of the community as a whole. The public health facility (e.g., hospital, community clinic, school, or agency), rather than the private dental office, becomes the environment in which the service of oral health care is provided. The patient’s dental examination parallels the community survey as a means of assessment of the situation or problem Private Practice vs. Public Health Practice Cont’d The treatment plan and the plan for the community are similar. Both include the many facets of preparation (determining various methods, strategies, and costs of choosing a plan that will work best for the patient or community) The treatment and the program operation occur during the actual implementation of the plan. Payment for dental services is equated with program funding. Various methods of payment are explored in both cases. Private Practice vs. Public Health Practice Cont’d Evaluation of the treatment is similar to the program appraisal and should occur during the implementation and at the end of the treatment or operation. This comparison should help the private practice hygienist become comfortable with the concepts of community program planning, implementation, and evaluation. Private Public Practice Health Patient who has Target Population – a group of presented for individuals who share common treatment characteristics and/or structure History and Survey to determine Examination nature and extent Diagnosis Analysis Treatment Program Planning Planning Treatment Program Operation Payment for Financing the services Operation Evaluation Evaluation The Government’s Role in Public Health Delivery of Dental Care in the U.S. Oral health is a major unmet need in this country. Untreated dental disease is more prevalent in individuals from lower-income households and ethnic minorities. Oral health is integral to total health and well-being. Providers: dental hygienists, dentists, dental assistants, denturists (in some states), expanded function dental personnel, and dental technicians Delivery of Dental Care in the U.S. Cont’d Dental Care Delivery in the United States involves private and government entities. Trends are suggesting more public funding for dental care. Mostly in private dental practices Impacted by many federal and state governmental entities Federal Organizations-HHS Department of Health and Human Services (HHS) Main governmental agency for health protection Provides services for those who can’t help themselves Works closely with state and local governments Secretary is appointed by U.S. president Federal Organizations-PHS U.S. Public Health Service (PHS) Improve and advance health U.S. Surgeon General directs the PHS Dental hygienists can work as a PHS commissioned officer Federal Organizations-NIH National Institutes of Health (NIH) Federal governments medical research institution Houses 27 different health institutes National Institute of Dental and Craniofacial Research focuses on oral health sciences Federal Organizations-FDA Food and Drug Administration (FDA) Established in 1906 Regulates dental materials, dental equipment, and over-the- counter dental care products Federal Organizations-CDC Centers for Disease Control and Prevention Health surveillance system Prevents and monitors outbreaks Promotes oral health prevention Controlling caries and periodontal disease Fluoride Sealant programs in schools Federal Organizations-CMS Centers for Medicare and Medicaid Services (CMS) Medicare Federal insurance program for senior citizens Generally does not cover dentistry May reimburse for dental treatment done in hospital (rare) Medicaid Funds dental care to the poor CHIP Insurance for poor children Pays better than Medicaid Federal Organizations Indian Health Service (IHS) Dental care for Native Americans Health Resources and Services Administration (HRSA) Provides resources for medically underserved populations Agency for Healthcare Research and Quality (AHRQ) Research on healthcare quality, costs, access to care, and treatment effectiveness Federal Organizations Administration on Aging (AOA) Responsible for enhancing and supporting the older population’s independence Provides dental education, and promotes community-based programs that provide dental services to older adults Administration of Children and Families (ACF) Head Start and Early Head Start Programs Provide educational, social, medical, dental, nutritional, and mental health services to low-income pregnant mothers and children up to age 5 Federal Organizations-Agencies and Departments that employ Dental Hygienists Departments: Department of Justice(DOJ) Department of Veterans Affairs (VA) Bureau of Labor Statistics Department of Agriculture: Women, Infant and Children Program (WIC) – nutrition focused. Department of Treasury: Tobacco labeling Department of Education Agencies: Federal Trade Commission (F T C) Peace Corps State Level Develop oral health programs within their state Usually include educational programs for children under 18 years of age. Restorative and emergency services are often included through community clinics. Screening and data collection for needs assessments are also conducted at this level. State Level Cont’d May appear to overlap with federal organizations Prisons Tribal dental clinics Federally Qualified Health Centers (FQHCs) State clinic but can qualify for benefits such as Medicaid The center must meet certain characteristic Underserved populations, sliding fee scale, comprehensive services, quality assurance program, board of directors Dental Workforce When considering dental public health needs must consider: Need Professional judgment of what services are required to achieve health Demand What or how much treatment is desired by the population Supply Amount of services available Utilization Number of services actually consumed “Call to Action” 2003 Surgeon General’s “Call to Action” to increase oral health providers In response, the ADHA recognized the need to create new types of dental providers Demand for Providers Dentists 2 will retire for every 1 new graduate Fewer dentists in rural areas Growing need as older adult population grows, and focus on dental health increases Dental Hygienists To meet demands, dentists will hire more dental hygienists Other Dental Providers Denturists Complete oral evaluations, and fabricate/fit removable dentures Only legal in a few states Dental Health Aide Therapist (DHAT) Alaska/tribal clinics (2-year program, no degree) Minnesota (Bachelor and Master programs for those who are already RDH’s) Restorative care in remote areas Under dentist supervision through teledentistry Proposed Dental Providers Advanced Dental Hygiene Practitioner (ADHP) Mid-level provider Master’s Degree Preventive/Restorative Treatment; Prescriptions No supervision needed Community Dental Health Coordinator (CDHC) OHI Coronal polishing Under dentist’s direct supervision Legislation Dental hygiene practice, and the advent of new providers, are enacted and enforced by individual states Federal government provides models for states to emulate Legislative Branch: Responsible for making laws, including those affecting licensing and practice of dental hygiene Executive Branch: Carries out and enforces the laws Judicial Branch Interprets/judges the laws How a Bill Becomes a Law Laws Regarding Dental Hygiene Practice Detail scope of practice Supervision Licensure Requirements Procedures for suspension and revocation of license Supervision of Dental Hygienists How does the supervision of dental hygienists impact dental public health? Questions?