Public Health and

Dental Public Health

Public health

 Definedas: “The art and science of preventing disease,

prolonging life and promoting physical and mental efficiency,
through organized community efforts; for the sanitation of the
environment, the control of communicable infections, the
education of the individual in the personal hygiene,
Dental public health

 Dental public health is defined as “the science and art of

preventing and controlling dental diseases and
promoting dental health through organized
community efforts.
 specialty of dentistry that deals with the
prevention of oral disease and promotion of oral
health.
Characteristics of Public Health
Method
Group responsibility or Team work.
• Public health method depend team work this is due to
partially of people efficient handling of large groups of
people and partly that many processes involved in
prevention are better applied through team work.
Working together as an efficient and
harmonious medical team makes for
excellent quality of care for patients and
an enjoyable experience for all.
Characteristics of Public Health Method
CONT…
• Prevention.
(It is a major objective because it is ethical, involves
team work and is cost effective).
• Prevention can better performed through mass
population through public health
Characteristics cont…
• Counteracting medical indigence.

• Dealing with multifactorial problem

(using the science of epidemiology
and biostatistical methods).
• Which helps in arithmetic
measurements of a disease in large
population
• Deals with healthy or apparently healthy people
as well as the sick.

•
Health Education and adaptation of public
health programs to the community.
Functions of Public Health Dentist

1. Conduct health education programs to create awareness among

people.

2. Educating and motivating an individual or community to utilize

rendered dental services.

3. To organize dental camps and delivering dental services for the

needy like people in rural areas, orphanages, mentally/physically
compromised children, etc.
4. Conducting school dental health programs and providing
preventive dental care to the school children like topical
fluoride applications, pit and fissure sealants.

5. Conducting dental treatment camps and providing

treatments like extractions, oral prophylaxis, fluoride
applications, simple restorations, ART, etc. in schools or
in community for general public.

6. Updating the knowledge of people regarding new dental

preventive methods and procedures
8. Conducting surveys to collect baseline data,
know the nature and extent of the diseases in the
community and plan programs accordingly, to
decrease the incidence of the diseases.

9. Conducting dental public health activities and

field experiences for dental students .
Procedural Steps in Dental Public
Health
1. Survey:

 Surveys are methods for collection of

data, analyzing and evaluating them in
order to determine the amount of
disease problems in a community and
also to identify cases that have not been
identified
2. Analysis:

 Itis necessary to arrange or organize the data

collected from the survey in such a way that
meaningful figures are obtained.

 Analysiscan be done manually or using

computers.
3. Program planning:

 The objective is to design the plan so that it is

accepted by the community and in which they are
interested in, which is comprehensive and cheaper.

 It has to be ensured that the community is well

informed about the program so that they participate
in all the steps involved.
4. Program operation:

 A public health team, which constitutes of

professionals in various disciplines, has to be
employed for executing the program.

 Example:
 Water fluoridation, which includes a team of
dentists, engineers, chemists, water works
department, public health authorities
5. Financing:

 Financing in public health program is usually

through the government or by the local or state
authorities.

 Before planning a program, public health personnel

should identify the source of funds.
6 . Program appraisal:

 Final step in any public health program where effectiveness

of the program is assessed.
 Evaluation: A systematic method for collecting, analyzing,
and using data to examine the effectiveness and efficiency
of programs and, as importantly, to contribute to
continuous program improvement.
 Program: Any set of related activities undertaken to achieve
an intended outcome; any organized public health action.
PROGRAM EVALUTION….

• Program evaluation can include any or a variety of at

different types of evaluation, such as for needs
assessments, accreditation, cost/benefit analysis,
effectiveness, efficiency, formative, summative, goal-
based, process, outcomes, etc
Tools of Dental Public Health

1. Epidemiology:

 Epi = upon, demos = people, logos = science.

Is defined as “the study of the distribution and determinants of health
related states and events.
 the study of the determinants, occurrence, and distribution of
health and disease in a defined population.
 Infection is the replication of organisms in host tissue, which
may cause disease
2. Biostatistics:

 Is a branch of statistics concerned with mathematical facts and data

relating to the biological events.

 It involves compiling, analyzing, tabulating and representing the data in the

mathematical or graphical manner.
 Is the study of data analysis and statistical reasoning applied practically to
medicine and public health.
 It is a fundamental discipline at the core of modern health data science,
and underpins most key public health research disciplines such as
epidemiology and health services research
ROLE OF BIOSTATIC…FOR
CLINICAL
3. Social sciences:

 It includes sociology, cultural anthropology,

social psychology, economics and political
science.

 Social scientists are the persons, who play an

important role in understanding the group
behavior and are necessary to match effort and
effect.
4. Preventive dentistry: Preventive dentistry is the area of
dentistry that focuses on those procedures and life
practices that help people to prevent the beginning or
progression of oral disease.
• It includes at-home dental care performed by patients, as
well as dental care and education by professional dental
staff in the office or clinic

Prevention is better then cure, so prevent the

disease before it starts.
Preventive dentistry….

 Preventive dentistry includes two aspects of dental care, both performed to help
patients avoid dental disease or to catch it in its early, more treatable stages.
 In part, it is the oral hygiene care performed by the patient at home.
 Preventive dentistry also encompasses what is done by the dental staff in their
offices to help patients maintain healthy teeth and gums.
Preventive cont…
 In either case, the objective is to stop the development of oral
disease or to find it at an early stage.
 Dental health professionals most often look for early signs of
periodontal disease, dental decay, and other changes in the soft
tissue of the mouth that could lead to oral cancer.
Preventive..cont…
 Preventive care in a dental office includes prophylaxis, or
the cleaning of the teeth, which removes accumulations
of calculus.
 Dental prophylaxis is a cleaning procedure performed to
thoroughly clean the teeth. Prophylaxis is an important
dental treatment for halting the progression of
periodontal disease and gingivitis.
 It includes examination of the teeth and soft tissue, using
visual and tactile exams, radiographic examination, such
as x rays, and oral cancer screening.
prophylaxis doesn't just mean preventing disease. It can
also mean preventing the disease from getting worse or
preventing over-treatment.
Preventive cont…

 Newer techniques to diagnose periodontal or gum

disease include computerized measurement devices
that measure the bacterial content in the mouth.
 Sometimes, dentists prescribe medications to help
prevent dental disease.
 These include anti-inflammatory mouthwashes to
prevent periodontal problems
Preventive cont..

 Dental health professionals also look for malocclusions and might refer patients to
a dental specialist, such as an orthodontist, to correct a patient's bad bite.
 Experts state that children should be evaluated by an orthodontist by age seven.
 A serial extraction is the planned extraction of teeth in a strategic sequence in
order to guide the erupting permanent teeth into a more ideal position.
Different levels of prevention are

1. Primary prevention:

 Health promotion and Specific protection is protecting the

oral cavity from disease before it occurs.
 Relies on controlling exposure to the causes of caries
infection, including modifying unhealthy behavior and
increasing disease resistance.

 Water fluoridation, plaque control, immunization.

Secondary prevention:
 Defined as “ action which halts the progress of disease at
its incipient stage and prevents complications”.
 Disease is in its initial stages,includes Early diagnosis and
prompt treatment (simple restorations, scaling).
 are Fluoride use on incipient caries, dental restorations,
periodontal debridement, root canal treatments, serial
extraction, fixed and removable appliances, installation of
caps and crowns.
3. Tertiary prevention:
 Tertiary prevention includes all measures for oral rehabilitation. This
includes the treatment of periodontal diseases, the replacement of lost
teeth (dentures, implants), and the complex treatment of oral cancer.

 Mostly disease is in advanced stage which

includes disability limitation
 Such as
 Extractions
 Rehabilitation
 Removable or fixed prosthesis
 Implants
 Maxillofacial prosthesis.
Health and Disease
“Health is a state of complete physical,
mental and social well-being and not
merely an absence of disease or
infirmity” given by WHO in 1948.
Health is multidimensional there are a
number of indicators which may be
classified as
1. Mortality indicators.
2. Morbidity indicators.
3. Disability rates.
4. Nutritional status indicators.
5. Health care delivery indicators.
6. Utilization rates.
7. Indicators of social and mental health.
8. Environmental indicators.
9. Socio-economic indicators.
10. Health policy indicators.
11. Indicators of quality of life
 The most important determinants of health are
1. Heredity: Some biological and genetic factors affect
specific populations more than others.
2. Environment:Exposure to toxic chemicals can lead to
chronic and often irreversible health conditions such as
neurodevelopment problems, and congenital defects
and diseases associated with endocrine disruption;
3. Lifestyle:
4. socio-economic conditions
5. health and family services and other factors.
Epidemiological Triad
 This encompasses a broader concept of disease
causation.
 It includes factors like the agent, the host and the
environment.
 These factors should interact over a period of time
for the disease to occur.
 The epidemiologic triangle is a model for explaining the
organism causing the disease and the conditions that
allow it to reproduce and spread.
Agent

 The disease agent is defined as a substance living

or non-living, tangible or intangible, the excessive
presence or relative lack of which may initiate a
disease process.
Agent Classified as:
 Biological agents
 These are living agents of disease—viruses, fungi,
bacteria, protozoa.
Agent cont….

Nutrient agents
 Any excess or deficiency in the intake of
proteins, fats, carbohydrate, vitamins,
minerals and water.
 Physical agents
 Exposure to excess heat, cold, humidity, pressure,
radiation, electricity sound.
Agent cont..

 Chemical agents
 Endogenous- some of the chemicals may be produced in
the body as a result of derangement of function, e.g. urea
(uremia), serum bilirubin (jaundice), ketones (ketosis),
uric acid (gout).
Exogenous- agents arising outside of
human host, allergens, metals, fumes,
dust, gases
 Mechanical agents
 Exposure to chronic friction and other mechanical
forces may result in crushing, tearing, sprains,
dislocation and even death.
Agent cont…

 Social agents

 Poverty, abuse of drugs, unhealthy lifestyles, social

isolation.
Host
1.Demographic characteristics
…e.g. age, sex, ethnicity, residence, occupation, etc.

It has been found that certain chronic diseases such

as diabetes, hyperthyroidism and obesity are
strikingly more common in women than men and
diseases such as lung cancer and coronary heart
diseases are less frequent in women.
2.Biological…..e.g. genetic, biochemical,
immunological, physiological, etc.

3.Social and economic factors.

4.Life style….e.g. nutrition, personality traits, habits,

alcohol, exercice, etc.
Environment

1. Physical environment:

 It is applied to non-living things and

physical factors (air, water, soil,
housing, etc.)
2.Biological environment:

The living things are the viruses and

other microbial agents, insects, rodents,
animals and plants .
3.Psychosocial environment:

 Itincludes a complex of psychosocial factors

which are defined as those factors affecting
personal health,
Risk Factor

 When the disease agent is not firmly identified, the

etiology of a disease is generally discussed in terms of risk
factors
 Determinant is a variable associated with an increased risk
of disease or infection.
 Examples of Risk Factors

1. Dental caries : Sugar, malocclusion, poor oral hygiene, xerostomia.

2. Periodontal disease: Plaque, calculus, overhanging restorations.
3. Oral cancer: Tobacco, alcohol, virus, iron deficiency.
4. Heart disease: Obesity, smoking, blood-pressure, elevated serum
cholesterol.
Mortality (Death)

Mortality indicators represent the

traditional measures of health status.

They are probably the most often used

indirect indicators of health.
Morbidity
Morbidity is defined as any departure,
subjective or objective, from a state of
physiological well being.

 According to Dorland, it is the condition of

being diseased or morbid.
 Morbidity refers to an illness or disease. Mortality
refers to death.
 Both are used by scientists to determine health
statistics like disease incidence and all-cause
mortality rates.
Tooth Mortality

It is the number of teeth lost divided by total

number of the teeth present
Spectrum of Disease

 It is a graphical representation of variations in the manifestations of disease.

Preventive dentistry : It is the procedure
employed in practice of dentistry and
community dental health program which
prevent occurrence of oral disease and oral
abnormalities
The methods of caries control can be
studied under the following 3 types:
1. Chemical measures

2. Nutritional measures

3. Mechanical measures.
Chemical Measures

A vast number of chemical substances have

been proposed for the purpose of controlling
caries
These chemicals include

• Substances which alter the tooth surface or tooth

structure: Fluoride, silver nitrate, zinc chloride and
potassium ferocyanide

• Substances which interfere with carbohydrate

degradation through enzymatic alteration such as
Vitamin K, sarcoside
Nutritional Measures

This can be achieved by doing

alteration in the diet of the individual
which is best described through Diet
Counseling
Diet Counseling for Dental Caries

• Increase use of fibrous foods (cleansing and protective

foods)
• Restrict the carbohydrate diet to 30–50% of total calorie
requirement
• Select soluble form of carbohydrate that clears from the
mouth easily
• Avoid excessive use of sugar .

 Eliminateeating sticky food, if not completely then as

much as possible
Mechanical Measures
The control of dental caries by mechanical
measures refers to procedures specifically
designed for removal of plaque from tooth
surfaces.