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Dental Public HealthDental Public Health
Dental Public HealthDental Public Health
IntroductionIntroduction
Topics
Historical DevelopmentDental Care Delivery
in the United Statesaround the world
Financing Dental CareLegislative InitiativesEducation and PromotionTarget PopulationsLesson PlanProgram PlanningProgram Evaluation
Oral EpidemiologyResearch MethodsBiostatisticsEvaluation of Literature and ProductsCareers in the GovernmentEntreprenurial InitiativesBoard Review
The Prevention Movement
Dental Hygiene’s Relation to Dental Public Health
Historical Development
Dental Hygiene as Forerunner to the Prevention Movement
Dr. Alfred Fones Founder of Dental
Hygiene School and First Author of Dental Hygiene College Textbook
Historical Development Continued
• Practice Settings– Schools– Industry– Military– Hospitals
• Professional Organizations
Preventive ModalitiesPreventive Modalities
Dental Hygiene TreatmentDental Hygiene Treatment FluoridationFluoridation XylitolXylitol Dental SealantsDental Sealants Oral Cancer Exams and Tobacco Oral Cancer Exams and Tobacco
CessationCessation Nutritional CounselingNutritional Counseling Atraumatic Restorative Treatment (ART)Atraumatic Restorative Treatment (ART) Mass Education/MediaMass Education/Media
Dental Care DeliveryDental Care Delivery
In the United StatesIn the United States
Dental Care Delivery Dental Care Delivery
F E D E R A LD ep artm en ts o f th e
F ed era l G overn m en t
N O N G O V E R N M E N TP riva te P rac tice
In s titu tion s , S ch oo lsIn su ran ce-B ased M od e ls
S TA TED ep artm en ts o f S ta te
S ta te P rison sC om m u n ity C lin ics , S ch oo ls
V eh ic les o f D en ta l C arein th e U n ited S ta tes
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
Access to Care Restriction of dental
hygiene services Shortage of Medicaid
providers Financial Situations
Insurance Medicaid
Transportation
Factors Affecting Dental Factors Affecting Dental Health, ContinuedHealth, Continued
SES Relation to SES Relation to Dental HealthDental Health
Dental Hygiene Dental Hygiene SciencesSciences
Increase in the Increase in the Geriatric Geriatric PopulationsPopulations
MalpracticeMalpractice Insurance ChangesInsurance Changes
Federal InfluenceFederal InfluenceExecutive Branch System
Legislation Senate and House ofRepresentatives
Executive President andCabinet
Judicial Federal Court
Department of Health and Department of Health and Human ServicesHuman Services• Public Health Public Health
Service Operating Service Operating DivisionDivision
• Human Services Human Services Operating DivisionOperating Division
Public Health Service Public Health Service Operating DivisionOperating Division
National Institutes National Institutes of Healthof Health
Food and Drug Food and Drug AdministrationAdministration
Centers for Centers for Disease Control Disease Control and Preventionand Prevention
Agency for Toxic Agency for Toxic Substances and Substances and Disease RegistryDisease Registry
Indian Health ServicesIndian Health Services Health Resources and Health Resources and
Services Services AdministrationAdministration
Agency for Health Agency for Health Care Policy and Care Policy and ResearchResearch
Substance Abuse and Substance Abuse and Mental Health Services Mental Health Services AdministrationAdministration
Human Services Operating Division
Centers for Medicaid and Medicare
– Medicaid– Medicare
Administration for Children and Families
Administration on Aging
Public Health Service
PHS works toward improving and advancing the health of our nation.U.S. Surgeon GeneralDental Hygienists work as Public Health Officers.
Other Federal Other Federal DepartmentsDepartments
Influencing Dental CareInfluencing Dental Care
AgricultureAgriculture DefenseDefense EducationEducation JusticeJustice
LaborLabor StateState TreasuryTreasury Veteran’s AffairsVeteran’s Affairs United States United States
Peace Corps Peace Corps (which is an (which is an executive branch executive branch agency)agency)
Individual State InfluenceIndividual State Influence
State Dental State Dental DivisionsDivisions
MedicaidMedicaid S-CHIPSS-CHIPS PrisonsPrisons Tribal ClinicsTribal Clinics InstitutionsInstitutions Community ClinicsCommunity Clinics
Dental Health Care PersonnelDental Health Care Personnel
NeedNeed DemandDemand UtilizationUtilization SupplySupply Dental Hygiene Dental Hygiene
ShortagesShortages Dental Hygienist Dental Hygienist
to Dentist to Dentist Employment Employment Ratio = 1:2Ratio = 1:2
Dental FinanceDental Finance
Public and Private Public and Private
Funding of Dental CareFunding of Dental Care
Historical Funding of Dental Care
Patient’s Responsibility The Advent of Dental
Insurance Medicaid Coverage for
Dental Services Today’s Dental
Financing
Payment MethodsPayment Methods
Fee-for-ServiceFee-for-Service Capitation PlansCapitation Plans Encounter Fee PlansEncounter Fee Plans Barter SystemBarter System
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 feeIndemnity plans pay fee-for-service.Discounted coverage available and sliding scales for certain patients in certain clinics
Capitation MethodCapitation Method
Dental Managed CareDental Managed Care A certain amount is paid to a dental A certain amount is paid to a dental
practice for a certain number of practice for a certain number of patients. Payment is received patients. Payment is received whether treatment is provided or not.whether treatment is provided or not.
Many times employees will state that Many times employees will state that they are not paid for “cleanings” they are not paid for “cleanings” provided; however, this is not an provided; however, this is not an accurate statement.accurate statement.
Encounter and BarterEncounter and Barter
Encounters are for Encounters are for an arrangement an arrangement paid for each visit. paid for each visit.
Barter system is Barter system is used when the used when the dental provider dental provider negotiates negotiates payment by payment by exchanging goods exchanging goods and services.and services.
Insurance PlansInsurance Plans
Dental Service CorporationsDental Service Corporations Health Service CorporationsHealth Service Corporations Preferred Providers OrganizationsPreferred Providers Organizations Individual Practice AssociationsIndividual Practice Associations Capitation ProgramsCapitation Programs
Dental BillingDental Billing
Claim FormClaim Form ADA CDTADA CDT Payment PlansPayment Plans Dental Credit CardsDental Credit Cards Explanation of Explanation of
BenefitsBenefits
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• Local
Governments
Medicaid Title XIX State/Federal
Program Your State’s
Medicaid Program Other State’s
Medicaid Program
Dental Care DeliveryDental Care Delivery
Around the WorldAround the World
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 Health Policies• Lobbying Groups• International Dental
Organizations
International OverviewInternational Overview
Related Dental Related Dental ProfessionalsProfessionals
Regulation of Regulation of Dental HygienistsDental Hygienists
Independent Independent PracticePractice
Portability of Portability of LicensureLicensure
Future of Dental Future of Dental HygieneHygiene
Legislative Initiatives Legislative Initiatives Affecting Dental Hygiene Affecting Dental Hygiene
PracticePractice
In the United StatesIn the United States
Issues in the United States
Preceptorship/Alternative EducationOn-the-Job Training for Supragingival
ScalingRestrictive Supervision Laws Affecting
Access to CareAdvanced Dental Hygiene Practitioner
State Governments
Legislative Executive Judicial
Major Bodies of LawMajor Bodies of Law
Common LawCommon Law Statutory LawStatutory Law Constitutional Constitutional
LawLaw Administrative Administrative
LawLaw
Laws Pertaining to Dental Laws Pertaining to Dental HygieneHygiene
• State Dental Hygiene Practice Act, sometimes referred to as the statute
• Supervision Status
State Dental BoardState Dental Board
• Administrative LawAdministrative Law
• Governs Dental Hygienists and the Governs Dental Hygienists and the Practice of Dental HygienePractice of Dental Hygiene
• Rules and RegulationsRules and Regulations
• Self-RegulationSelf-Regulation
Supervision TypesSupervision Types
UnsupervisedUnsupervised
Independent PracticeIndependent Practice
Collaborative PracticeCollaborative Practice
General SupervisionGeneral Supervision
Indirect SupervisionIndirect Supervision
Direct SupervisionDirect Supervision
International OverviewInternational Overview
Related Dental Related Dental ProfessionalsProfessionals
Regulation of Regulation of Dental HygienistsDental Hygienists
Independent Independent PracticePractice
Portability of Portability of LicensureLicensure
Future of Dental Future of Dental HygieneHygiene
Dental HealthDental HealthDental HealthDental Health
Education and PromotionEducation and Promotion
Health Education Health Education PrinciplesPrinciples
Five Dimensional Five Dimensional Health ModelHealth Model– PhysicalPhysical– MentalMental– SocialSocial– SpiritualSpiritual– EmotionalEmotional
Dental Health EducationDental Health Education
Goal: to prevent Goal: to prevent dental diseases dental diseases utilizing appropriate utilizing appropriate dental health dental health interventionsinterventions
Health Education Health Education PrinciplesPrinciples
Health Education: the education of Health Education: the education of health behaviors that bring an individual health behaviors that bring an individual to a state of health awarenessto a state of health awareness
Health Promotion: the informing and Health Promotion: the informing and motivating of people to adopt health motivating of people to adopt health behaviorsbehaviors
Health Behavior: an action that helps Health Behavior: an action that helps prevent illness and promotes health for prevent illness and promotes health for a populationa population
Goals of Dental Health Education
Provide Effective Dental Health Education.
Change Values Aimed at Improving Health.
Healthy Behaviors
Stages of LearningStages of Learning
• Unawareness • Awareness • Self-Interest • Involvement • Action • Habit
Transtheoretical ModelTranstheoretical Model
PrecontemplationPrecontemplation ContemplationContemplation PreparationPreparation Maintenance Maintenance ActionAction
Theory of Reasoned ActionTheory of Reasoned Action
Attitude toward the behaviorAttitude toward the behavior Subjective normsSubjective norms Perceived behavioral controlPerceived behavioral control IntentionIntention BehaviorBehavior
Social Cognitive Theory
• Self-Efficacy Theory• Knowledge –
Behavior – Environment
Empowerment Models
• Participant Oriented• Social Environments
Motivation
• Motivation is the will of the individual to act.
Maslow’s Heirarchy of Needs
Self-Actualization Need for Self-Esteem Belongingness and
Love Safety Needs Physiological Needs
Behavioral Conditioning Classical
Conditioning Operant
Conditioning Modeling
Lesson PlanLesson Plan
DevelopmentDevelopment
Assessment PhaseAssessment Phase
Assess target populations’Assess target populations’ needsneeds interestsinterests abilitiesabilities
Assess resourcesAssess resources
Dental Hygiene Diagnosis
Formulate Findings from Assessment into a Diagnosis.
Prioritize Goals.
PlanningPlanning
Broad Goal Broad Goal FormulationFormulation
Specific Specific ObjectivesObjectives
Select Teaching Select Teaching Methods.Methods.
Implementation
Be Prepared. Effective Teacher
Characteristics
EvaluationEvaluation
• Qualitative MeasurementQualitative Measurement
• Quantitative MeasurementQuantitative Measurement
• Information Provided to Appropriate Information Provided to Appropriate PartiesParties
Target Target PopulationsPopulations
For the Practicing HygienistFor the Practicing Hygienist
Target PopulationsTarget Populations
A group of individuals with A group of individuals with similarities of some sort whether it be similarities of some sort whether it be
age, race, educational background, age, race, educational background, life situations, and/or health life situations, and/or health
conditionsconditions
Specific Target PopulationsSpecific Target Populations
Family CaregiversFamily Caregivers Health Care Health Care
WorkersWorkers Hospice WorkersHospice Workers Persons with Persons with
Medical Medical Conditions/Conditions/DiseasesDiseases
Developmentally Developmentally DisabledDisabled
Hearing ImpairedHearing Impaired
Visual Visual ImpairmentsImpairments
School TeachersSchool Teachers Social WorkersSocial Workers AgesAges
PrenatalPrenatal InfancyInfancy ChildrenChildren AdultsAdults Older AdultsOlder Adults
Cultural DiversityCultural Diversity
The social, ethnic, and The social, ethnic, and cultural elements that cultural elements that compose a person. compose a person.
Barriers to Dental Hygiene and Dental CareAge Language Habit
Culture No Finances Lack of Faith
Education Misunderstanding Fear
Transportation Values Safety
Illiteracy Attitudes Denial of Disease
No providers Invulnerability Convenience
Social Issues Education Levels Provider Conflicts
Program PlanningProgram PlanningProgram PlanningProgram Planning
For the Dental HygienistFor the Dental Hygienist
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• Mouthguard Programs• Dental Health Educational Programs• Tobacco Cessation Programs• Denture Identification Programs
Dental Public Health Dental Public Health ProgramsPrograms
► Healthy Smile Healthy Smile ProgramProgram
► Inner City Health Inner City Health Center Dental Center Dental ProgramProgram
► Soroptomist Dental Soroptomist Dental ProjectProject
► Matthew 25Matthew 25► Operation SmileOperation Smile
Dental Hygiene Program Dental Hygiene Program Planning ParadigmPlanning Paradigm
AssessmentAssessment Population’s dental needsPopulation’s dental needs DemographicsDemographics FacilityFacility PersonnelPersonnel Existing ResourcesExisting Resources FundingFunding
Dental Hygiene Program Dental Hygiene Program Planning Paradigm, ContinuedPlanning Paradigm, ContinuedDental Hygiene DiagnosisDental Hygiene Diagnosis Prioritization of needsPrioritization of needs Formulation of diagnosis to provide goals and Formulation of diagnosis to provide goals and
objectives for blueprintobjectives for blueprint
PlanningPlanning Methods to measure goalsMethods to measure goals BlueprintBlueprint Address constraints and alternatives.Address constraints and alternatives.
Dental Hygiene Program Dental Hygiene Program Planning Paradigm, ContinuedPlanning Paradigm, ContinuedImplementationImplementation Program will begin operation.Program will begin operation. Revision and changes identified and Revision and changes identified and
employedemployed
EvaluationEvaluation Measuring goalsMeasuring goals Qualitative and quantitative evaluationQualitative and quantitative evaluation Ongoing revisions employedOngoing revisions employed
Program EvaluationProgram Evaluation
Dental Public HealthDental Public Health
Program EvaluationProgram Evaluation
Program Planning Program Planning → Objectives→ Objectives Measurement of ObjectivesMeasurement of Objectives FormativeFormative SummativeSummative
Evaluation Techniques
Traditional Nonclinical Measurements Interviews Surveys
Clinical Methods Basic BSS Dental Indexes
Government’s EvaluationGovernment’s Evaluation
• Healthy People Healthy People 2010 Objectives 2010 Objectives and Evaluation and Evaluation MechanismsMechanisms
• NOHSSNOHSS
• Call to ActionCall to Action
Oral Epidemiology
• Study of Oral Diseases• Multifactorial Nature of Disease• Terminology
• Epidemic Prevalence• Endemic Incidence• Pandemic Etiology• Disease Rates Surveilance• Mortality Risk Factors• Morbidity Index
Oral Epidemiology ReportsOral Epidemiology Reports
Morbidity and Morbidity and Mortality (MMWR)Mortality (MMWR)
Healthy People Healthy People ReportsReports
Surgeon General’s Surgeon General’s ReportReport
Call to ActionCall to Action
Global Oral Data Global Oral Data BankBank
Epidemiology of Oral Diseases Epidemiology of Oral Diseases
Periodontal DiseasesPeriodontal Diseases
Tooth LossTooth Loss
Dental CariesDental Caries
Oral CancerOral Cancer
Cleft Lip/PalateCleft Lip/Palate
InjuryInjury
ToothachesToothaches
ResearchResearch
In Dental HygieneIn Dental Hygiene
Significance of Research Significance of Research to Dental Hygieneto Dental Hygiene
Dental public health is based Dental public health is based upon programs that have upon programs that have
demonstrated effectiveness in demonstrated effectiveness in achieving health for the achieving health for the
population.population.
Types of Research
Historical Descriptive
Survey Observational Case Studies Correlational
Epidemiological Longitudinal Cross-sectional
Retroactive Experimental
(Prospective) Quasi-experimental
Beginning Research
Research Question Does Brand X toothpaste whiten teeth?
Positive Hypothesis Brand X toothpaste does significantly
whiten teeth. Null Hypothesis
There is no statistically significant difference between Brand X and a placebo when comparing the whitening of teeth.
Research DesignResearch Design
Formulating a hypothesisFormulating a hypothesis Review of the literatureReview of the literature Methods and materialsMethods and materials Statistical evaluationStatistical evaluation
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
Informed ConsentInformed Consent
Informed Consent is part of Informed Consent is part of examining the ethics of the research examining the ethics of the research project as a whole.project as a whole.
Dental ResearchDental Research
BiostatisticsBiostatistics
Categorizing Data• Discrete or Continuous
– Nominal– Ordinal– Interval– Ratio
Descriptive Statistics
Measures of Central Tendency Mean Median Mode
Measures of Dispersion Range Variance Standard Deviation
The Normal Distribution
Gaussian Distribution Bell-Shaped Curve Skewed Data
Graphing DataGraphing Data
Frequency Frequency Distribution TableDistribution Table
Grouped Frequency Grouped Frequency TableTable
Bar GraphBar Graph HistogramHistogram PolygonPolygon 0
10
20
30
40
50
60
70
80
90
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
East
West
North
Correlation Correlation
Coefficients Positive Correlation Negative
Correlation Strong Correlation
Correlation
Pearson Product Movement Correlation Coefficient
Spearman Rank-Order Correlation Coefficient
Statistical Decision MakingStatistical Decision Making
►ProbabilityProbability►Type I ErrorType I Error►Type II ErrorType II Error►Degrees of FreedomDegrees of Freedom
Inferential StatisticsInferential Statistics
Parametric Inferential StatisticsParametric Inferential Statistics Student t-testStudent t-test Analysis of VarianceAnalysis of Variance
Nonparametric Inferential StatisticsNonparametric Inferential Statistics Chi Square TestChi Square Test Other Nonparametric TestsOther Nonparametric Tests
Interpretation of DataInterpretation of Data
Statistical Statistical SignificanceSignificance
Clinical Clinical SignificanceSignificance
Research ResultsResearch Results
Validity: Results of the study can Validity: Results of the study can be inferred to the general be inferred to the general population.population.
Reliability: The study was Reliability: The study was conducted in a controlled manner conducted in a controlled manner and if repeated would lend the and if repeated would lend the same results; thus, the study is same results; thus, the study is reproducible.reproducible.
Evaluation ofEvaluation of
Scientific Literature and Scientific Literature and Dental ProductsDental Products
Regulation of Dental Care Regulation of Dental Care ProductsProducts
Food and Drug Food and Drug AdministrationAdministration
American Dental American Dental Association Seal Association Seal of Acceptanceof Acceptance
Dental Hygienist’s Role
Critical consumer Patient education Awareness of
advertising techniques
Evaluation of Scientific Literature Introduction Purpose Research Design Sample Selection
Product Usage Examiners Statistical
Significance Results
Careers in
Dental Public Health
Positions for the RDHPositions for the RDH
U.S. PHSU.S. PHS VA HospitalsVA Hospitals Federal PrisonsFederal Prisons Military Base Military Base
ClinicsClinics Other Agencies Other Agencies
United States RDH United States RDH Positions Positions
Commissioned Commissioned Officer PositionsOfficer Positions
Civil Service Civil Service PositionsPositions
National Health National Health Service CorpsService Corps
Other OptionsOther Options
Independent ContractorIndependent Contractor Employee of Dental Staffing AgencyEmployee of Dental Staffing Agency Student OpportunitiesStudent Opportunities
COSTEPCOSTEP
Strategies for Creating Strategies for Creating Dental Hygiene PositionsDental Hygiene Positions
In Dental Public Health In Dental Public Health SettingsSettings
PopulationsPopulations
HomeboundHomeboundInstitutionalizedInstitutionalizedPopulations with DisabilitiesPopulations with DisabilitiesRural Area ResidentsRural Area ResidentsPopulation with Dental PhobiasPopulation with Dental PhobiasPopulations faced with Language or Populations faced with Language or Cultural BarriersCultural BarriersPatients without FinancingPatients without Financing
Proposed Plan for ActionProposed Plan for Action
Dental Hygiene Program Planning ParadigmDental Hygiene Program Planning Paradigm AssessmentAssessment Dental Hygiene DiagnosisDental Hygiene Diagnosis PlanningPlanning Implementation Implementation EvaluationEvaluation
Practice Management Issues
Patient tracking Appointment scheduling Practice promotion Collection of fees
Proposal Development Proposal Development and Presentationand Presentation
Introduction Introduction Significance of Significance of
PositionPosition Blueprint of the Blueprint of the
Operational Operational ProgramProgram
ConclusionConclusion ContractsContracts Teaching Strategies Teaching Strategies
Dental Public HealthDental Public Health
Review Review
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: Dental Public Health: Contemporary Practice Contemporary Practice
for the Dental Hygienist:for the Dental Hygienist:
““The Dental Hygienist is the The Dental Hygienist is the Premier Dental Public Health Premier Dental Public Health
Provider. “Provider. “