Dental Public Health - Epidemiology & Prevention of Oral Diseases

• what is the oral health strategy?


  shift from downstream victim blaming - to - upstream (more preventative)

  
  

  (need a sensible combination of the 3)
• Give Examples of health promotion intervention from the three levels of public health interventions

  •Upstream ( whole population approach)

  - water fluoridation

  - sugar taxation

  - smoking banning

  - increasing availability of affordable healthy food.

  
  

  • Downstream/ Midstream (high risk approach)

  - health education ( eg : supervised tooth brushing in schools)

  - preventive intervention (eg: providing fluoride varnish for the patients)
• what are the three levels of public health interventions to

  improve health of the population and which is best to use?

  1) Downstream

  Treatments, prevention, and health education for those experiencing some disease and disability

  -consumes most of the resources, encompasses a small segment of the population

  
  

  2) Mid-stream

  Preventive interventions targeting populations at risk of adverse health outcomes.

  
  

  3) Upstream

  healthy public policy interventions which include governmental, institutional, and organizational actions directed at entire populations that require adequate support through tax structures, legal constraints, and reimbursement mechanisms for health promotion and primary prevention

  
  

  -----> It is best to use a sensible combination of the three
• what is Health promotion?

  Health promotion is the process of enabling people and communities to increase control over their health and its determinants.

  
  

  - the aim is to change the range of options available to

  people and to make health-promoting choices easier and/or to diminish health damaging options by making them more

  difficult to choose
• what is the common risk factors approach?

  There are common, rather than specific, risk factors that affect a wide range of chronic conditions, including oral health.

  
  

  so, promoting general health by controlling a small number of risk factors may have a major impact on a large number of diseases at a lower cost, greater efficiency and effectiveness than disease specific approaches
• what is the theory of general susceptibility?

  specific groups of the population are more vulnerable

  to a very broad array of diseases.
• why is Periodontal disease a social disease?

  caused psychosocial factors (social factors and individual thought and behaviour)

  
  

  - the psychosocial factors lead to changes in oral habitat, changes in the behavioural responses of the patient (poor hygiene & smoking) and changes in the patients responses to the environment (stress)
• periodontal disease levels are higher in?


  • Boys than girls, males than females

  • Older than younger

  • Less educated than higher educated

  • Poorer than richer

  • Unskilled than skilled

  • Rural than urban

  • Certain ethnic groups
• what are the main changes and patterns in dental caries levels?


  -A dramatic decline in the prevalence (proportion of a particular population found to be affected by a medical condition at a specific time) and severity of dental

  caries.

  
  

  - Levels in most industrialised countries around 1.0 to 1.5 at

  12 years of age.

  
  

  -Lower caries incidence in children and adolescents.

  
  

  - More common among the least affluent ( rich) , least educated.

  
  

  -In England, more common among Asian children - mainly due to diet

  
  

  -Most people have no or low caries cavities and a small

  percent have higher levels.

  
  

  -Most lesions (injury/damage) are now pit and fissure lesions, smooth surfaces relatively infrequently affected.

  Progression of early lesions are less frequent and much

  slower.

  The lesions are smaller, and cavitation occurs at a later stage

  of the disease

  
  

  -Most caries now occur in adults instead of in children

  
  

  - we have an aging population and roots caries have become more common.
• what's the link between deprivation ( lack of basic necessities in society) and dmft?

  increased deprivation = increased dmft
• what is dmft?

  decayed, missing, filled teeth
• history of Epidemiology: what did Wade Hampton Frost find?

  observed that TB patients were more vulnerable to a very

  broad array of disease
• history of Epidemiology: what is the Black Report?

  In 1980, the UK Department of Health and Social Security published the Report of the Working Group on Inequalities in Health (Black Report).

  
  

  - It links health inequality to economic inequality

  ------> lower socioeconomic position & worse standard of living = morelikelyy to have disease
• what is used to show correlation between water fluoride levels & severity of fluorosis

  Dean's Fluorosis Index
• history of Epidemiology: what did Frederick McKay do?

  • Frederick McKay: noticed brown stains ( mottled enamel/ fluorosis) on the teeth of patients and linked this to the water supply. He also realised that people with mottled enamel had fewer cavities.

  
  

  In 1931, fluoride in the water supply was identified and via Dean's Fluorosis index, we can see that there is a correlation between the level of fluoride in the water and the severity of mottled enamel( fluorosis).

  
  

  
  

  more fluoride in water = less cavities
• history of Epidemiology: what did john snow do?


  • John Snow: discovered that cholera was transmitted by contaminated water (1855) and that the distribution of cholera cases in London was linked to water supply companies
• How do we assess and report the distribution of oral diseases in the population?

  Identified using oral health surveillance:

  -clinical survey (eg, Adult Dental Health Survey)

  -screening (eg, cancer screening).
• why do we need to understand the epidemiology of oral diseases?


  • To inform public health policies, planning, and allocation of resources.

  • To identify changing patterns in the diseases distribution.

  • To help identify risk factors at the population level

  • To assess impact of health promotion activities ( eg: sugar taxation on levels of caries or obesity or banning of tobacco usage on periodontal disease or cancer)

  • To assess impact of health care policies ( eg: the new NHS contract that encourages the use of more preventative services)
• Definition of Oral Epidemiology


  The study of the distribution of oral diseases in

  the population

  - identifying the factors that decisively affect the outcome of oral conditions (determinants) and the risk factors at the population level.