Use of Epidemiology in Planning and Delivery of Dental Care

• Concepts of need:

  • Normative need
  • Professionally defined - our take on what is clinically necessary
  • Assessment against agreed criteria - eg IOTN (Index of Orthodontic Treatment Need)
  • Felt/perceived need - subjective - what people feel is important
  • Expressed need
  • Arises from perceived need
  • Eg pt requesting tooth whitening
  • Expressed as words of action =  "demands"
  • Comparative need - individual/group compared with another individual/group in terms of health/services/resources
• Oral health inequalities = "differences in oral health which are avoidable, unnecessary, unjust and unfair"
• The Commissioning Cycle:

  • Patients and public at the heart of everything
  • Strategic planning is 1st thing you need to do
  • Need to assess health needs of population first because if we don't then we can't design the dental practice to ensure that they meet the needs
  • Procuring services is next
  • Buying correct dental contract and practice size for the population, with the correct amount of UDAs (units of dental activity)
  • Monitoring and evaluation is final part
  • Need to find out whether the service is meeting the needs of the population (patient feedback & looking at UDAs)

  
• Applications of epidemiology - oral health needs assessment:

  • To describe the oral health needs and oral healthcare needs of a population
  • Who has needs?
  • What are their needs?
  • To what extent are these needs met?
  • Broader socio-dental approach - professional vs lay perspectives?
  • Highlights priorities/inequalities/gaps
  • To identify key issues to inform local commissioning decisions
• Service design and redesign:

  • What are the needs of the population?
  • Have the needs of the population changed?
  • Does the proposed service meet those needs?
  • Guidance?
• Service evaluation and review:

  • Has the population changed?
  • Have the needs of the population changed?
  • Does the service meet those needs?
  • New guidance?
  • Are there any gaps in service - geography/type/amount?
• Tackling inequalities:

  • Individual level - education, empowerment
  • Public health measures
  • Targeted - fluoride varnish, supervised tooth brushing, toothbrush and paste packs
  • Population measures - water fluoridation, toothbrush and paste packs
• Vulnerable groups:

  • Experience significant oral health problems
  • Vulnerable adults living in the community have difficulty accessing dental services
  • Limited amount of information is available regarding the views and experiences of local children, young people, and vulnerable adult groups regarding NHS dental services
  • Examples:
  • Live in a disadvantaged area/from a lower socioeconomic group
  • Physical/mental disabilities
  • Mental health problems
  • Older & frail
  • Socially isolated/excluded
  • Homeless/frequently move
  • Smoke or misuse substances (including alcohol)
  • Poor diet
• Oral health - homeless people - poorer dental health than the general population:

  • Higher prevalence of caries and periodontal disease
  • Increased risk of untreated dental disease
  • Treatment focused on extractions - multiple missing teeth
  • Higher risk of oral cancer - higher prevalence of smoking and alcohol consumption