PUBLIC HEALTH DENTISTRY INTRODUCTION The Dental Public

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 Ø 1840 - Term ‘Public Health’ Ø 1848 - Public Health act in England

DEFINITIONS Ø Health [WHO] : A state of complete physical , mental and social well being and not merely the absence of disease or infirmity.

Ø Public Health [Winslow] : The art and science of preventing disease , prolonging life and promoting physical and mental efficiency through organized community efforts.

Ø 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 Ø Ø 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 Ø The water line demarcation between apparent and inapparent disease. Ø Ø 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 on health implies a sound mind, in sound body, in a sound family, in sound environment. effect a a

CHANGING CONCEPTS IN PUBLIC HEALTH Ø Disease control phase aimed at the control of man’s physical environment eg: Water supply , sewage disposal, etc Ø 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

Ø Social Engineering phase [1960 – 1980] Social and behavioral aspects of disease and health given priority ”risk factors” as determinants of diseases came into existence Ø 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 q q Minimize / eradicate the disease of health problem and its consequences. Minimize the chances of its occurrence in future

Objective q q q 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 q q q 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 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 is well informed about that they participate in that the community the programme and 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 and oral clinical examination Analysis of available health 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 Community consent and co Participation -operation Service provider Dentist alone, sometimes with an assistant Health team professionals and para professionals, community volunteers

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 sittings Continuing care, Self care Funding Generally by the patient Generally by Governme nt or Local authorities

SERVICES PROVIDED THROUGH PUBLIC HEALTH DENTISTRY Ø Ø Ø Ø 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.