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Dental Public Health Dental Public Health

Dental Public Health Introduction Dental Public Health Introduction

Topics Historical Development Dental Care Delivery in the United States around the world Financing Topics Historical Development Dental Care Delivery in the United States around the world Financing Dental Care Legislative Initiatives Education and Promotion Target Populations Lesson Plan Program Planning Program Evaluation Oral Epidemiology Research Methods Biostatistics Evaluation of Literature and Products Careers in the Government Entreprenurial Initiatives Board Review

The Prevention Movement Dental Hygiene’s Relation to Dental Public Health The Prevention Movement Dental Hygiene’s Relation to Dental Public Health

Historical Development Dental Hygiene as Forerunner to the Prevention Movement l Dr. Alfred Fones Historical Development Dental Hygiene as Forerunner to the Prevention Movement l Dr. Alfred Fones l Founder of Dental Hygiene School and First Author of Dental Hygiene College Textbook l

Historical Development Continued • Practice Settings – – Schools Industry Military Hospitals • Professional Historical Development Continued • Practice Settings – – Schools Industry Military Hospitals • Professional Organizations

Preventive Modalities n n n n Dental Hygiene Treatment Fluoridation Xylitol Dental Sealants Oral Preventive Modalities n n n n Dental Hygiene Treatment Fluoridation Xylitol Dental Sealants Oral Cancer Exams and Tobacco Cessation Nutritional Counseling Atraumatic Restorative Treatment (ART) Mass Education/Media

Dental Care Delivery In the United States Dental Care Delivery In the United States

Dental Care Delivery Dental Care Delivery

Dental Public Health The oral health care and education, with an emphasis on the Dental Public Health The oral health care and education, with an emphasis on the utilization of dental hygiene sciences, delivered to a target population

Factors Affecting Dental Health l Access to Care ¡ ¡ ¡ Restriction of dental Factors Affecting Dental Health l Access to Care ¡ ¡ ¡ Restriction of dental hygiene services Shortage of Medicaid providers Financial Situations l l ¡ Insurance Medicaid Transportation

Factors Affecting Dental Health, Continued n n n SES Relation to Dental Health Dental Factors Affecting Dental Health, Continued n n n SES Relation to Dental Health Dental Hygiene Sciences Increase in the Geriatric Populations Malpractice Insurance Changes

Federal Influence Federal Influence

Department of Health and Human Services • Public Health Service • Operating Division Human Department of Health and Human Services • Public Health Service • Operating Division Human Services Operating Division

Public Health Service Operating Division n n National Institutes of Health Food and Drug Public Health Service Operating Division n n National Institutes of Health Food and Drug Administration Centers for Disease Control and Prevention Agency for Toxic Substances and Disease Registry n n Indian Health Services Health Resources and Services Administration Agency for Health Care Policy and Research Substance Abuse and Mental Health Services Administration

Human Services Operating Division l Centers for Medicaid and Medicare – – Medicaid Medicare Human Services Operating Division l Centers for Medicaid and Medicare – – Medicaid Medicare l l Administration for Children and Families Administration on Aging

Public Health Service PHS works toward improving and advancing the health of our nation. Public Health Service PHS works toward improving and advancing the health of our nation. U. S. Surgeon General Dental Hygienists work as Public Health Officers.

Other Federal Departments Influencing Dental Care n n Agriculture Defense Education Justice n n Other Federal Departments Influencing Dental Care n n Agriculture Defense Education Justice n n n Labor State Treasury Veteran’s Affairs United States Peace Corps (which is an executive branch agency)

Individual State Influence n n n n State Dental Divisions Medicaid S-CHIPS Prisons Tribal Individual State Influence n n n n State Dental Divisions Medicaid S-CHIPS Prisons Tribal Clinics Institutions Community Clinics

Dental Health Care Personnel n n n Need Demand Utilization Supply Dental Hygiene Shortages Dental Health Care Personnel n n n Need Demand Utilization Supply Dental Hygiene Shortages Dental Hygienist to Dentist Employment Ratio = 1: 2

Dental Finance Public and Private Funding of Dental Care Dental Finance Public and Private Funding of Dental Care

Historical Funding of Dental Care l l Patient’s Responsibility The Advent of Dental Insurance Historical Funding of Dental Care l l Patient’s Responsibility The Advent of Dental Insurance Medicaid Coverage for Dental Services Today’s Dental Financing

Payment Methods Fee-for-Service n Capitation Plans n Encounter Fee Plans n Barter System n Payment Methods Fee-for-Service n Capitation Plans n Encounter Fee Plans n Barter System n

Fee-for-Service A dental practice sets a fee, and a patient and/or third party pays Fee-for-Service A dental practice sets a fee, and a patient and/or third party pays for the fee. UCR: usual, customary and reasonable fee Indemnity plans pay fee-for-service. Discounted coverage available and sliding scales for certain patients in certain clinics

Capitation Method n n n Dental Managed Care A certain amount is paid to Capitation Method n n n Dental Managed Care A certain amount is paid to a dental practice for a certain number of patients. Payment is received whether treatment is provided or not. Many times employees will state that they are not paid for “cleanings” provided; however, this is not an accurate statement.

Encounter and Barter n n Encounters are for an arrangement paid for each visit. Encounter and Barter n n Encounters are for an arrangement paid for each visit. Barter system is used when the dental provider negotiates payment by exchanging goods and services.

Insurance Plans Dental Service Corporations n Health Service Corporations n Preferred Providers Organizations n Insurance Plans Dental Service Corporations n Health Service Corporations n Preferred Providers Organizations n Individual Practice Associations n Capitation Programs n

Dental Billing § § § Claim Form ADA CDT Payment Plans Dental Credit Cards Dental Billing § § § Claim Form ADA CDT Payment Plans Dental Credit Cards Explanation of Benefits

Government Role • • • Research Disease Prevention Disease Control Program Planning and Operation Government Role • • • Research Disease Prevention Disease Control Program Planning and Operation Funding for the Education of Dental Professionals • Regulation

Government’s Role • U. S. PHS • Federal Block Grants • State Governments • Government’s Role • U. S. PHS • Federal Block Grants • State Governments • Local Governments

Medicaid n n Title XIX State/Federal Program Your State’s Medicaid Program Other State’s Medicaid Medicaid n n Title XIX State/Federal Program Your State’s Medicaid Program Other State’s Medicaid Program

Dental Care Delivery Around the World Dental Care Delivery Around the World

International Dental Health Care • Dental Diseases • Historical Perspective • Demographics and the International Dental Health Care • Dental Diseases • Historical Perspective • Demographics and the Dental Hygienist • Global Education of the Dental Hygienist • The Role of the Dental Hygienist • Access to Care in Other Countries

International Dental Health Care, Continued • Dental Public Health Programs and Campaigns • Oral International Dental Health Care, Continued • Dental Public Health Programs and Campaigns • Oral Health Policies • Lobbying Groups • International Dental Organizations

International Overview n n n Related Dental Professionals Regulation of Dental Hygienists Independent Practice International Overview n n n Related Dental Professionals Regulation of Dental Hygienists Independent Practice n n Portability of Licensure Future of Dental Hygiene

Legislative Initiatives Affecting Dental Hygiene Practice In the United States Legislative Initiatives Affecting Dental Hygiene Practice In the United States

Issues in the United States l Preceptorship/Alternative Education l On-the-Job Training for Supragingival Scaling Issues in the United States l Preceptorship/Alternative Education l On-the-Job Training for Supragingival Scaling l Restrictive Supervision Laws Affecting Access to Care l Advanced Dental Hygiene Practitioner

State Governments n n n Legislative Executive Judicial State Governments n n n Legislative Executive Judicial

Major Bodies of Law n n Common Law Statutory Law Constitutional Law Administrative Law Major Bodies of Law n n Common Law Statutory Law Constitutional Law Administrative Law

Laws Pertaining to Dental Hygiene • State Dental Hygiene Practice Act, sometimes referred to Laws Pertaining to Dental Hygiene • State Dental Hygiene Practice Act, sometimes referred to as the statute • Supervision Status

State Dental Board • Administrative Law • Governs Dental Hygienists and the Practice of State Dental Board • Administrative Law • Governs Dental Hygienists and the Practice of Dental Hygiene • Rules and Regulations • Self-Regulation

Supervision Types Unsupervised Independent Practice Collaborative Practice General Supervision Indirect Supervision Direct Supervision Supervision Types Unsupervised Independent Practice Collaborative Practice General Supervision Indirect Supervision Direct Supervision

International Overview n n n Related Dental Professionals Regulation of Dental Hygienists Independent Practice International Overview n n n Related Dental Professionals Regulation of Dental Hygienists Independent Practice n n Portability of Licensure Future of Dental Hygiene

Dental Health Education and Promotion Dental Health Education and Promotion

Health Education Principles n Five Dimensional Health Model – – – Physical Mental Social Health Education Principles n Five Dimensional Health Model – – – Physical Mental Social Spiritual Emotional

Dental Health Education Goal: to prevent dental diseases utilizing appropriate dental health interventions Dental Health Education Goal: to prevent dental diseases utilizing appropriate dental health interventions

Health Education Principles n n n Health Education: the education of health behaviors that Health Education Principles n n n Health Education: the education of health behaviors that bring an individual to a state of health awareness Health Promotion: the informing and motivating of people to adopt health behaviors Health Behavior: an action that helps prevent illness and promotes health for a population

Goals of Dental Health Education l Provide Effective Dental Health Education. l Change Values Goals of Dental Health Education l Provide Effective Dental Health Education. l Change Values Aimed at Improving Health. l Healthy Behaviors

Stages of Learning • • • Unawareness Awareness Self-Interest Involvement Action Habit Stages of Learning • • • Unawareness Awareness Self-Interest Involvement Action Habit

Transtheoretical Model n n n Precontemplation Contemplation Preparation Maintenance Action Transtheoretical Model n n n Precontemplation Contemplation Preparation Maintenance Action

Theory of Reasoned Action Attitude toward the behavior n Subjective norms n Perceived behavioral Theory of Reasoned Action Attitude toward the behavior n Subjective norms n Perceived behavioral control n Intention n Behavior n

Social Cognitive Theory • Self-Efficacy Theory • Knowledge – Behavior – Environment Social Cognitive Theory • Self-Efficacy Theory • Knowledge – Behavior – Environment

Empowerment Models • Participant Oriented • Social Environments Empowerment Models • Participant Oriented • Social Environments

Motivation • Motivation is the will of the individual to act. Motivation • Motivation is the will of the individual to act.

Maslow’s Heirarchy of Needs n n n Self-Actualization Need for Self-Esteem Belongingness and Love Maslow’s Heirarchy of Needs n n n Self-Actualization Need for Self-Esteem Belongingness and Love Safety Needs Physiological Needs

Behavioral Conditioning n n n Classical Conditioning Operant Conditioning Modeling Behavioral Conditioning n n n Classical Conditioning Operant Conditioning Modeling

Lesson Plan Development Lesson Plan Development

Assessment Phase n Assess target populations’ needs l interests l abilities l n Assess Assessment Phase n Assess target populations’ needs l interests l abilities l n Assess resources

Dental Hygiene Diagnosis Formulate Findings from Assessment into a Diagnosis. Prioritize Goals. Dental Hygiene Diagnosis Formulate Findings from Assessment into a Diagnosis. Prioritize Goals.

Planning n n n Broad Goal Formulation Specific Objectives Select Teaching Methods. Planning n n n Broad Goal Formulation Specific Objectives Select Teaching Methods.

Implementation l l Be Prepared. Effective Teacher Characteristics Implementation l l Be Prepared. Effective Teacher Characteristics

Evaluation • Qualitative Measurement • Quantitative Measurement • Information Provided to Appropriate Parties Evaluation • Qualitative Measurement • Quantitative Measurement • Information Provided to Appropriate Parties

Target Populations For the Practicing Hygienist Target Populations For the Practicing Hygienist

Target Populations A group of individuals with similarities of some sort whether it be Target Populations A group of individuals with similarities of some sort whether it be age, race, educational background, life situations, and/or health conditions

Specific Target Populations n n n Family Caregivers Health Care Workers Hospice Workers Persons Specific Target Populations n n n Family Caregivers Health Care Workers Hospice Workers Persons with Medical Conditions/ Diseases Developmentally Disabled Hearing Impaired n n Visual Impairments School Teachers Social Workers Ages l l l Prenatal Infancy Children Adults Older Adults

Cultural Diversity The social, ethnic, and cultural elements that compose a person. Cultural Diversity The social, ethnic, and cultural elements that compose a person.

Barriers to Dental Hygiene and Dental Care Barriers to Dental Hygiene and Dental Care

Program Planning For the Dental Hygienist Program Planning For the Dental Hygienist

What is a dental public health program? Educational, clinical, and referral services to a What is a dental public health program? Educational, clinical, and referral services to a target population

Preventive Programs • • School Fluoride Mouthrinse Programs School Dental Sealant Programs Xylitol Programs Preventive Programs • • School Fluoride Mouthrinse Programs School Dental Sealant Programs Xylitol Programs Mouthguard Programs Dental Health Educational Programs Tobacco Cessation Programs Denture Identification Programs

Dental Public Health Programs ► Healthy Smile Program ► Inner City Health Center Dental Dental Public Health Programs ► Healthy Smile Program ► Inner City Health Center Dental Program ► Soroptomist Dental Project ► Matthew 25 ► Operation Smile

Dental Hygiene Program Planning Paradigm n Assessment Population’s dental needs n Demographics n Facility Dental Hygiene Program Planning Paradigm n Assessment Population’s dental needs n Demographics n Facility n Personnel n Existing Resources n Funding n

Dental Hygiene Program Planning Paradigm, Continued Dental Hygiene Diagnosis n n Prioritization of needs Dental Hygiene Program Planning Paradigm, Continued Dental Hygiene Diagnosis n n Prioritization of needs Formulation of diagnosis to provide goals and objectives for blueprint Planning n n n Methods to measure goals Blueprint Address constraints and alternatives.

Dental Hygiene Program Planning Paradigm, Continued Implementation n n Program will begin operation. Revision Dental Hygiene Program Planning Paradigm, Continued Implementation n n Program will begin operation. Revision and changes identified and employed Evaluation n Measuring goals Qualitative and quantitative evaluation Ongoing revisions employed

Program Evaluation Dental Public Health Program Evaluation Dental Public Health

Program Evaluation Program Planning → Objectives n Measurement of Objectives n Formative n Summative Program Evaluation Program Planning → Objectives n Measurement of Objectives n Formative n Summative n

Evaluation Techniques n Traditional Nonclinical Measurements q q n Interviews Surveys Clinical Methods q Evaluation Techniques n Traditional Nonclinical Measurements q q n Interviews Surveys Clinical Methods q q q Basic BSS Dental Indexes

Government’s Evaluation • Healthy People 2010 • • Objectives and Evaluation Mechanisms NOHSS Call Government’s Evaluation • Healthy People 2010 • • Objectives and Evaluation Mechanisms NOHSS Call to Action

Oral Epidemiology • Study of Oral Diseases • Multifactorial Nature of Disease • Terminology Oral Epidemiology • Study of Oral Diseases • Multifactorial Nature of Disease • Terminology • • • Epidemic Endemic Pandemic Disease Rates Mortality Morbidity Prevalence Incidence Etiology Surveilance Risk Factors Index

Oral Epidemiology Reports Morbidity and Mortality (MMWR) Healthy People Reports Surgeon General’s Report Call Oral Epidemiology Reports Morbidity and Mortality (MMWR) Healthy People Reports Surgeon General’s Report Call to Action Global Oral Data Bank

Epidemiology of Oral Diseases Periodontal Diseases Tooth Loss Dental Caries Oral Cancer Cleft Lip/Palate Epidemiology of Oral Diseases Periodontal Diseases Tooth Loss Dental Caries Oral Cancer Cleft Lip/Palate Injury Toothaches

Research In Dental Hygiene Research In Dental Hygiene

Significance of Research to Dental Hygiene Dental public health is based upon programs that Significance of Research to Dental Hygiene Dental public health is based upon programs that have demonstrated effectiveness in achieving health for the population.

Types of Research n n Historical Descriptive q q Survey Observational Case Studies Correlational Types of Research n n Historical Descriptive q q Survey Observational Case Studies Correlational n Epidemiological q q n n n Longitudinal Cross-sectional Retroactive Experimental (Prospective) Quasi-experimental

Beginning Research n Research Question n n Positive Hypothesis n n Does Brand X Beginning Research n Research Question n n Positive Hypothesis n n Does Brand X toothpaste whiten teeth? Brand X toothpaste does significantly whiten teeth. Null Hypothesis n There is no statistically significant difference between Brand X and a placebo when comparing the whitening of teeth.

Research Design Formulating a hypothesis n Review of the literature n Methods and materials Research Design Formulating a hypothesis n Review of the literature n Methods and materials n Statistical evaluation n

Experimental Approaches • • Two group pretest/post-test designs Time series Post-test only Solomon three Experimental Approaches • • Two group pretest/post-test designs Time series Post-test only Solomon three and four group Factorial Placebos Control groups

Sampling Techniques Randomization Systematic Convenience Stratifying Sampling Techniques Randomization Systematic Convenience Stratifying

Informed Consent n Informed Consent is part of examining the ethics of the research Informed Consent n Informed Consent is part of examining the ethics of the research project as a whole.

Dental Research Biostatistics Dental Research Biostatistics

Categorizing Data • Discrete or Continuous – – Nominal Ordinal Interval Ratio Categorizing Data • Discrete or Continuous – – Nominal Ordinal Interval Ratio

Descriptive Statistics o Measures of Central Tendency n n n o Mean Median Mode Descriptive Statistics o Measures of Central Tendency n n n o Mean Median Mode Measures of Dispersion n Range Variance Standard Deviation

The Normal Distribution n Gaussian Distribution Bell-Shaped Curve Skewed Data The Normal Distribution n Gaussian Distribution Bell-Shaped Curve Skewed Data

Graphing Data n n n Frequency Distribution Table Grouped Frequency Table Bar Graph Histogram Graphing Data n n n Frequency Distribution Table Grouped Frequency Table Bar Graph Histogram Polygon

Correlation o o Correlation Coefficients Positive Correlation Negative Correlation Strong Correlation Correlation o o Correlation Coefficients Positive Correlation Negative Correlation Strong Correlation

Correlation l l Pearson Product Movement Correlation Coefficient Spearman Rank-Order Correlation Coefficient Correlation l l Pearson Product Movement Correlation Coefficient Spearman Rank-Order Correlation Coefficient

Statistical Decision Making ► Probability ► Type I Error ► Type II Error ► Statistical Decision Making ► Probability ► Type I Error ► Type II Error ► Degrees of Freedom

Inferential Statistics n Parametric Inferential Statistics Student t-test n Analysis of Variance n n Inferential Statistics n Parametric Inferential Statistics Student t-test n Analysis of Variance n n Nonparametric Inferential Statistics Chi Square Test n Other Nonparametric Tests n

Interpretation of Data n n Statistical Significance Clinical Significance Interpretation of Data n n Statistical Significance Clinical Significance

Research Results Validity: Results of the study can be inferred to the general population. Research Results Validity: Results of the study can be inferred to the general population. n Reliability: The study was conducted in a controlled manner and if repeated would lend the same results; thus, the study is reproducible. n

Evaluation of Scientific Literature and Dental Products Evaluation of Scientific Literature and Dental Products

Regulation of Dental Care Products n n Food and Drug Administration American Dental Association Regulation of Dental Care Products n n Food and Drug Administration American Dental Association Seal of Acceptance

Dental Hygienist’s Role Critical consumer l Patient education l Awareness of advertising techniques l Dental Hygienist’s Role Critical consumer l Patient education l Awareness of advertising techniques l

Evaluation of Scientific Literature o o Introduction Purpose Research Design Sample Selection o o Evaluation of Scientific Literature o o Introduction Purpose Research Design Sample Selection o o Product Usage Examiners Statistical Significance Results

Careers in Dental Public Health Careers in Dental Public Health

Positions for the RDH n n n U. S. PHS VA Hospitals Federal Prisons Positions for the RDH n n n U. S. PHS VA Hospitals Federal Prisons Military Base Clinics Other Agencies

United States RDH Positions n n n Commissioned Officer Positions Civil Service Positions National United States RDH Positions n n n Commissioned Officer Positions Civil Service Positions National Health Service Corps

Other Options n n n Independent Contractor Employee of Dental Staffing Agency Student Opportunities Other Options n n n Independent Contractor Employee of Dental Staffing Agency Student Opportunities n COSTEP

Strategies for Creating Dental Hygiene Positions In Dental Public Health Settings Strategies for Creating Dental Hygiene Positions In Dental Public Health Settings

Populations Homebound Institutionalized Populations with Disabilities Rural Area Residents Population with Dental Phobias Populations Populations Homebound Institutionalized Populations with Disabilities Rural Area Residents Population with Dental Phobias Populations faced with Language or Cultural Barriers Patients without Financing

Proposed Plan for Action n Dental Hygiene Program Planning Paradigm n n n Assessment Proposed Plan for Action n Dental Hygiene Program Planning Paradigm n n n Assessment Dental Hygiene Diagnosis Planning Implementation Evaluation

Practice Management Issues l l Patient tracking Appointment scheduling Practice promotion Collection of fees Practice Management Issues l l Patient tracking Appointment scheduling Practice promotion Collection of fees

Proposal Development and Presentation n n n Introduction Significance of Position Blueprint of the Proposal Development and Presentation n n n Introduction Significance of Position Blueprint of the Operational Program Conclusion Contracts Teaching Strategies

Dental Public Health Review Dental Public Health Review

Community Health/Research Principles Promoting health and preventing disease within groups Participating in community programs Community Health/Research Principles Promoting health and preventing disease within groups Participating in community programs Analyzing scientific information, utilizing statistical concepts, and applying research results

Dental Public Health: Contemporary Practice for the Dental Hygienist: “The Dental Hygienist is the Dental Public Health: Contemporary Practice for the Dental Hygienist: “The Dental Hygienist is the Premier Dental Public Health Provider. “