Public Health & Community Dentistry PDF

12/09/2024 PUBLIC HEALTH & COMMUNITY DENTISTRY 1 DENTAL PUBLIC HEALTH The goal of the dental profession is to protect and preserve the oral health of the public. Each dentist, dental hygienist, dental assistant, an...

12/09/2024 PUBLIC HEALTH & COMMUNITY DENTISTRY 1 DENTAL PUBLIC HEALTH The goal of the dental profession is to protect and preserve the oral health of the public. Each dentist, dental hygienist, dental assistant, and dental laboratory technician is a member of a team of health care workers combating diseases that jeopardize the health of the public. As with any good team, each member has an important role to play for the team to be successful. 2 1  12/09/2024 PUBLIC HEALTH - HISTORY England (1777) milkmaid - cowpox Dr. Jenner collaborated with other providers to study the relationship and establish the scientific principle of immunization that eventually resulted in eliminating smallpox. 3 PUBLIC HEALTH - HISTORY In 1798, the United States passed an act that provided for the relief of sick and disabled seamen, which established a federal network of hospitals for the care of merchant seamen, the precursor of US Public Health Service, which was initiated in 1902. 4 2  12/09/2024 PUBLIC HEALTH - HISTORY John Snow 5 PUBLIC HEALTH - HISTORY Identification of a polluted public water well as the source of an 1854 cholera outbreak in London Dr John Snow used a logical, epidemiological approach to study the outbreak. By studying the geographical relation of the sick to a water pump, he was able to help control the outbreak. 6 3  12/09/2024 PUBLIC HEALTH - HISTORY The Parisian court dentist Désirabode may have been the first one, in 1843, who considered caries prevention, even mentioning fluoride compounds. Systematic administration of fluorides as an agent against caries began in the 20th century. 7 PUBLIC HEALTH - HISTORY First significant recording of public health measures in the USA: South Carolina 1967 A water measure was enacted to prevent diseases caused by water supplies 8 4  12/09/2024 WHAT IS PUBLIC HEALTH? “Public Health is a coalition of professions united by their shared mission” (Institute of Medicine of the National Academy of Sciences) 9 WHAT IS PUBLIC HEALTH? “coalition of professions” the achievement of better public health requires more than the participation of the various health professions. It includes contributions from engineers, educators, statisticians, political scientists, policy analysts, and administrators, among many others. Individuals and groups banding together to achieve a common goal “shared mission” fulfilling society’s interest in assuring conditions in which people can be healthy. 10 5  12/09/2024 HEALTH 11 12 6  12/09/2024 HEALTH “The health, body and mind is so fundamental to the good life that if we believe men have any personal rights at all as human beings, then they have absolute moral right to such measure of good health as society alone is able to give them” (Aristotle) 13 HEALTH “Free from pain or disease” (traditional dictionary definition) “A state of complete physical, mental and social well-being and not merely absence of infirmity” (WHO, 1948). 14 7  12/09/2024 HEALTH 15 HEALTH “Complete and lasting freedom from disease is but a dream remembered from imaginings of a Garden of Eden designed for the welfare of man” (René Dubos) 16 8  12/09/2024 WHO HEALTH DEFINITION For the first time, health is defined as a positive condition and not just the absence of infirmity. Health is considered a human right. The influences of economic and social environments are also considered. The maintenance of Health status is society’s responsibility (not just health professionals) 17 PUBLIC HEALTH 18 9  12/09/2024 PUBLIC HEALTH “The science and art of preventing disease, prolonging life, and promoting physical and mental efficiency through organized community effort for the sanitation of the environment, the control of communicable infection, the education of the individuals in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery to insure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birth right of health and longevity” (Winslow, 1920) 19 PUBLIC HEALTH Public health now can be thought of as being concerned with four broad areas: Lifestyle and behaviour Human biology The environment The organization of health programs and systems 20 10  12/09/2024 PUBLIC HEALTH Determines the health status of the community. Identifies populations potentially affected or at risk for a particular problem through the use of epidemiologic methodology. Plans, implements, and evaluates the appropriate interventions. 21 PUBLIC HEALTH Two themes determine public health practice: 1. The scientific knowledge regarding the causes and control of disease 2. The belief of the public that the disease can be controlled and that doing so is a public responsibility 22 11  12/09/2024 PUBLIC HEALTH Ten Great Public Health Achievements -- United States, 1900-1999 (Centers of Disease Control and prevention) Vaccination Motor-vehicle safety Safer workplaces Control of infectious diseases Decline in deaths from coronary heart disease and stroke Safer and healthier foods Healthier mothers and babies Family planning Fluoridation of drinking water Recognition of tobacco use as a health hazard 23 PUBLIC HEALTH 24 12  12/09/2024 PUBLIC HEALTH - HISTORY Since 1900 the average life expectancy of persons in the USA has increased by more than 30 years, with 25 of those years (83%) being attributed to advances in public health. 25 DENTAL PUBLIC HEALTH/ COMMUNITY DENTISTRY 26 13  12/09/2024 DENTAL PUBLIC HEALTH The ADA has recognized dental public health as one of nine specialties of dentistry 27 DENTAL PUBLIC HEALTH “The science and art of preventing and controlling dental disease and promoting dental health through organized community effort. It is that form of dental practice that serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with research and the application of the findings of research, with the administration of programs of dental care for groups, and with the prevention and control of dental disease through a community approach” (American Board of Dental Public Health) 28 14  12/09/2024 DENTAL PUBLIC HEALTH A better understood explanation of dental public health may be best achieved by giving specific examples. Dental public health is: less tooth decay because of fluoridated water and school fluoride programs less periodontal disease because of public education programs greater access to high-quality early diagnosis and treatment of dental disease because of dental care delivery programs and research less tooth damage among athletes because of mouthguard programs less oral cancer because of tobacco cessation and cancer screening programs. 29 DENTAL PUBLIC HEALTH 30 15  12/09/2024 DENTAL PUBLIC HEALTH/ COMMUNITY DENTISTRY 31 PREVENTION “The prescription comes too late when the disease has gained strength by long delays” (Ovid, 43 BC – 17 AD) 32 16  12/09/2024 PREVENTION Primary prevention: seeks to avoid the occurrence of an illness or injury by preventing exposure to risk factors (discourage teenagers from smoking or vaping, vaccines, dental hygiene). Secondary prevention: attempts to minimize the severity of the illness or the damage because of an injury-causing event once it has occurred (screening programs to detect cancer early, use of fluoride to remineralize tooth surfaces that have been demineralized). Tertiary prevention: attempts to limit the disability resulting from an injury or disease (Prosthetics). 33 PREVENTIVE DENTISTRY 34 17  12/09/2024 PREVENTIVE DENTISTRY Preventive dentistry is a philosophy and a practice method which encompass all dentistry specialties. Its aim is to establish and maintain the patient’s oral health. 35 PREVENTIVE DENTISTRY Part of Community dentistry. It is developed in the dental practices. It includes five types of interventions: Vaccines Chemoprophylaxis (fluoride) Screening: Early diagnosis and treatment Use of physical barriers (fissure sealants) Oral health/health education 36 18  12/09/2024 ORAL HEALTH IN PRIMARY CARE “All people, everywhere, shall have access to a skilled, motivated and facilitated health worker within a robust health system” (United Nations Millennium Declaration Goal Statement) 37 PRIMARY HEALTH CARE “Essential healthcare based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain […]. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process[…]” (WHO definition) 38 19  12/09/2024 PRIMARY HEALTH CARE The WHO suggested the following criteria for judging good quality primary health care: General (patients have not been pre-selected according to their medical condition) Continuous (the same physician cares for same patient over time) Comprehensive (covers all conditions) Coordinated and Collaborative (doctors are linked to other sources of care and are the case-managers for that patient) Family-oriented (ideally, patient and other family members treated by same health care team) Community-oriented (responds to health needs of the community). 39 ORAL HEALTH IN PRIMARY CARE Community dentistry needs to be completely integrated in Primary Health System to be fully developed It represents the first contact between the population and the National Health Service. 40 20  12/09/2024 STRATEGIES FOR ORAL DISEASE PREVENTION AND HEALTH PROMOTION 41 STRATEGIES FOR ORAL DISEASE PREVENTION AND HEALTH PROMOTION Oral diseases are the most common of the chronic diseases and are important public health problems because of their prevalence, their impact on individuals and society, and the expense of their treatment. 42 21  12/09/2024 STRATEGIES FOR ORAL DISEASE PREVENTION AND HEALTH PROMOTION In some countries, oral diseases are one of the most expensive diseases to treat Treating caries, estimated at US$ 3513 per 1000 children, would exceed the total health budget for children of most low-income countries. The situation for adults in developing countries is worse, as they suffer from the accumulation of untreated oral diseases. There are few efficient dental care systems to cope with their problems, and where there are, the cost is beyond most people’s means 43 POPULATION STRATEGY The Population Health Approach focuses on improving health status through actions directed toward the health of an entire population, or sub-population, rather than individuals. 44 22  12/09/2024 HIGH RISK STRATEGY Aim to identify individuals or groups who are likely to have an increased incidence of a disease, based on the presence of modifiable risk factors known to be causal for the disease, or characteristics of individuals or groups that are associated with a higher incidence of disease. Once identified, interventions are targeted to these individuals or groups to modify their risk of illness or disease. 45 HIGH RISK STRATEGY High risk strategy should be applied when there is an identifiable minority with high risk of illness. It should be applied in populations with low incidence and prevalence of caries. High risk strategy necessary requirements: 1. The occurrence of the pathology must be low to justify the efforts to identify susceptible individuals. 2. Sensitive and simple methods available to identify susceptible individuals 3. Effective and simple measurements to help susceptible individuals 46 23  12/09/2024 HIGH RISK VS POPULATION APPROACH 47 HIGH RISK VS POPULATION APPROACH 48 24  12/09/2024 COMMON RISK FACTOR APPROACH This approach assumes that the chronic, non- communicable diseases such as obesity, heart disease, stroke, cancer, diabetes, mental illness, and dental disease share similar risk factors. Poor hygiene, tobacco use, stress, trauma, are factors linked to the development of several chronic conditions including oral diseases. Action towards common risks improves a range of chronic diseases. A cost-effective approach 49 COMMON RISK FACTOR APPROACH Individual behaviors are influenced by a range of social and psychological factors and are rarely changed by good advice alone. Dental professionals should work with a holistic approach with other medical and non-medical professionals to achieve positive oral health outcomes among children. A coordinated consistent message between different health promotion providers will improve health outcomes across a broad range of non- communicable diseases. 50 25  12/09/2024 COMMON RISK FACTOR APPROACH A health promotion approach targeted towards those with greater need aims to assist individuals and communities to provide a supportive environment to improve health behaviors. To deliver this policy, organizations, communities and legislation may be required to address the broader determinants of oral health. Behaviors are influenced by political, psychological and social factors therefore require involvement by key stakeholders such as policy makers who can influence change to sustain the heath promotion. 51 ANY QUESTIONS? 52 26  12/09/2024 BIBLIOGRAPHY Jong’s Community Dental Health Hamagea H, Lamothe L, Couturier Y, Esfandiari S, Voyer R, Charbonneau A, Emami E. From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care. BMC Oral Health (2018) 18: 23 Harris NO, Garcia-Godoy F and Nathe CN. Primary Preventive Dentistry, 8th Edition. Upper Saddle River. 2013 (page 6) Odontología Preventiva y odontología comunitaria (2002) Rafael Rioboo. https://www.healthknowledge.org.uk/public-health-textbook/research-methods/1c-health-care- evaluation-health-care-assessment/epidemiological-basis-pstrategies http://www.who.int/bulletin/volumes/83/9/editorial30905html/en/ Oral Health Prevention Strategy for children and Young people in Surrey (coord. Helen Adkinson). Nielsen Nathe C. Dental Public Health & Research. Contemporary Practice for the Dental Hygienist (2017) 4th edition. Cuenca Salas E y Baca García P (coord.) Odontología preventiva y comunitaria. Principios, métodos y aplicaciones. 4ª Edición (2013) 53 27