Transcript PUBLIC HEALTH DENTISTRY

PUBLIC HEALTH DENTISTRY
INTRODUCTION
The Dental Public Health field has
been expanding in scope and
complexity with more emphasis being
placed on the total dental care delivery
system and its impact on oral health
status.
HISTORY
 1840
- Term ‘Public Health’
 1848
- Public Health act in England
DEFINITIONS
 Health
[WHO] : A state of complete
physical , mental and social well being
and not merely the absence of disease
or infirmity.
 Public
Health [Winslow] : The art and
science of preventing disease ,
prolonging life and promoting physical
and mental efficiency through organized
community efforts.
 Dental
Public Health [The American Board
of Dental Public Health] : The science and
art of preventing and controlling dental
disease and promoting dental health
through organized community efforts.
ICEBERG PHENOMENON OF
DISEASE

Disease in a community may be compared with an iceberg.

Tip of iceberg  what the physician sees in the community [clinical cases]

The vast submerged  Hidden mass of disease
- latent
- Inapparent
- Presymptomatic
- undiagnosed
- carriers
The water line  demarcation between apparent and
inapparent disease.


portion of iceberg
In hypertension , diabetes , etc, unknown morbidity far exceeds known morbidity.
CONCEPTS OF HEALTH
1.
Biomedical concepts
2.
Ecological concepts
3.
Psychosocial concept
4.
Holistic concept
1. Biomedical concept
 absence of disease
 inadequate to solve major health
problems (malnutrition, chronic diseases,
accidents)
2.
Ecological concepts
 dynamic equilibrium between man
and his environment.
disease : maladjustment of the human
organism to environment.
3. Psychosocial concept
 health is influenced by social ,
psychological, cultural, economic and
political factors.
4. Holistic concept
all sectors of society have an effect
on health.
health implies a sound mind, in a
sound body, in a sound family, in a
sound environment.
CHANGING CONCEPTS IN
PUBLIC HEALTH

Disease control phase
 aimed at the control of man’s physical
environment
 eg: Water supply ,sewage disposal, etc

Health promotion phase
 mother and child health services
 school health services
 industrial health services
 mental health & rehabilitation services
2 movements were initiated
1.
Basic health services – primary health
centres, subcentres
2. Community development programme

Social Engineering phase [1960 – 1980]
Social and behavioral aspects of disease and
health given priority
”risk factors” as determinants of diseases came into
existence

Health for all phase [1981 – 2000]
Members of WHO pledged “Health for all by the
year 2000”
The organized application of local, state, national and
international resources permit all people to lead a
socially and economically productive life
CHARACTERISTICS OF AN
IDEAL PUBLIC HEALTH
MEASURE
1. Of proven efficacy in the reducton of
the targeted disease.
2. Medically and dentally safe.
3. Easily and efficiently implemented,
utilizing a relatively small amount of
materials, supplies and equipment.
4. Readily administered by non dental
personnel.
5. Readily available and accessible to
large numbers of individuals.
6. inexpensive, therefore affordable by the
majority.
7. Uncomplicated and easily learned by
the utilizers.
8. Administered with maximum
acceptance on the part of the patient.
TOOLS OF DENTAL PUBLIC
HEALTH
1. Epidemiology
- the branch of medical science dealing
with epidemics.
- the study of the distribution and
determinants of health related events in
population.
Aims


Minimize / eradicate the disease of health
problem and its consequences.
Minimize the chances of its occurrence in
future
Objective



to define the magnitude and occurrence of disease
conditions in man.
to identify the etiologic factors responsible for above
conditions.
to provide data necessary for planning, implementation and
evaluation of programmes for
- preventing
- controlling
- treating diseases
2. Biostatistics
- statistics is the science of competing,
classifying and tabulating numerical data
and expressing the results in a
mathematical / graphical form
- biostatistics is that branch of statistics
concerned with mathematical facts and
data relating to biological events.
uses






to define normally
to test whether the difference between two
populations, regarding a particular attribute is real
or a chance occurrence
to study the correlation or association between
two or more attributes in the same population
to evaluate the efficacy of vaccines, sera, etc, by
control studies
to evaluate achievements of public health
programmes
to fix priorities in piblic health programmes
3. Social Sciences
- usually include sociology
cultural anthropology
psychology
- social scientist become necessary when effort and
effect do not match each other and we want to
know why
- new health programmes prepared to aid public
health worker in planning, evaluation,
fluoridation,etc, in interest of dental profession
4. Principles of administration
organization :
deals with the structure of an agency
way people are arranged into working
groups within it
management :
handling of personnel and operations in
such a way that the work of agency gets
done
5. Preventing Dentistry
levels of prevention :
primary  health promotion
specific protection
[immunization, hygiene]
secondary  early diagnosis
prompt treatment
tertiary  disease control
Procedural steps in dental public
health
1. Survey
2. Analysis
3. Programme planning
4. Programme operation
5. Financing
6. Programme appraisal
1.
Survey
- based on chief complaint of the population
- surveys are methods for collection of data, analysing and
evaluating them in order to determine the amount of disease
problems in a community
- parameters included in survey :
 assessment of socioecoomic status of community
 nature of distribution of community
 resources available for elimination of problem
 attitudes of community towards health providers
2. Analysis
- to define characteristics of specific
health problems in the community
- electronic data processing medias
such as computers are resorted for
analysing data
3. Programme planning
- designed programme should be accepted
by the community and the people shold
show an interest in it.
- it has to be ensured that the community
is well informed about the programme and
that they participate in all steps involved
4. Programme operation
- a public health team constituting
professionals in various disciples
- employed for excecuting the programme
- eg : water fluoridation in a community with
higher prevalence of dental caries
5.
Financing
- through funds provided by the
governments / by local or state authorities
- public health personnel
 identify source for securing funds
 plan for the management of same
6.
Programme appraisal
- effectiveness of programme is assessed
- dimensions : efficiency
appropriateness
adequacy
possible side effects
SIMILARITIES BETWEEN
PERSONAL AND COMMUNITY
HEALTH CARE
PATIENT
COMMUNITY
1. Examination
1. Survey
2. Diagnosis
2. Analysis
3. Treatment planning
3. Programme planning
4. Treatment
4. Programme operation
5. Payment for service
5. Finance
6. Evaluation
6. Approval
DIFFERENCES BETWEEN
PRIVATE DENTAL PRACTICE
AND PUBLIC HEALTH
DENTISTRY
Characteristic
Target
Collection of
information
Private Dental
Practice
Individual
patient
Public Health
Dentistry
community or
group of
individuals
History taking
Analysis of
and oral clinical available health
examination
and morbidity
records
Differences…
Special
investigations
Conclusions
Radiography,
blood test,
biopsies,
exfoliative
cytology
Diagnosis
Epidemiological
surveys
Situational
analysis of oral
health status
and needs and
utilization of
services
Differences…
Remedial
Measures
Treatment plan
based on
diagnosis,
patients
attitudes and
affordability
Major emphasis Curative and
restorative care
Action plan
based on
demands,
available
resources and
priorities
Promotive and
preventive care
Differences…
Requirements
for success
Patient’s
consent and
co-operation
Service
provider
Dentist alone,
Health team
sometimes with professionals
an assistant
and para
professionals,
community
volunteers
Community
Participation
Differences…
Intervention
Appropriate
dental
procedure
Promotive and
preventive
measure at
individual and
community level
Supportive
Disciplines
Psychology
Sociology,
Social
psychology,
Education,
Epidemiology
and
Biostatistics
Differences…
Organization &
Management
Not relevant
Very relevant
Perspective
Immediate
Long term
Evaluation &
Results
Relief of
symptoms and
restoration of
function
Formal
programme
evaluation
Differences…
Aftercare
Recall, Further Continuing
sittings
care, Self care
Funding
Generally by
the patient
Generally by
Government or
Local
authorities
SERVICES PROVIDED
THROUGH PUBLIC HEALTH
DENTISTRY







Health education
Dental Health camps
Dental treatmentsExtraction
Oral prophylaxis
Flouride applications
Oral hygiene measure
School Health Programme
Application of Caries Preventive measures
Demonstration of dental preventive methods and
procedures to the community
Dental Public Health activities and field experiences for
dental students
CONCLUSION
Kindness, concern and love for
the art of healing earned Hippocrates the
immortal title of ‘The Father of Medicine’.
The dental profession has primary
responsibilitiy for the oral health care of
the public.