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. “