PUBLIC HEALTH PUBLIC HEALTH DENTISTRYDENTISTRY

Dr shabeel pnDr shabeel pn

Royal dental collegeRoyal dental college

INTRODUCTIONINTRODUCTION

The Dental Public Health field has The Dental Public Health field has been expanding in scope and been expanding in scope and complexity with more emphasis being complexity with more emphasis being placed on the total dental care delivery placed on the total dental care delivery system and its impact on oral health system and its impact on oral health status.status.

HISTORYHISTORY

1840 - Term ‘Public Health’1840 - Term ‘Public Health’

1848 - Public Health act in England1848 - Public Health act in England

DEFINITIONSDEFINITIONS

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

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

Dental Public Health [The American Board Dental Public Health [The American Board of Dental Public Health]of Dental Public Health] : : The science and The science and art of preventing and controlling dental art of preventing and controlling dental disease and promoting dental health disease and promoting dental health through organized community efforts.through organized community efforts.

ICEBERG PHENOMENON OF ICEBERG PHENOMENON OF DISEASEDISEASE

Disease in a community may be compared with an iceberg.Disease in a community may be compared with an iceberg.

Tip of iceberg Tip of iceberg what the physician sees in the community [clinical cases] what the physician sees in the community [clinical cases]

The vast submerged The vast submerged Hidden mass of disease portion of iceberg Hidden mass of disease portion of iceberg - latent- latent - Inapparent- Inapparent - Presymptomatic- Presymptomatic - undiagnosed- undiagnosed - carriers- carriers The water line The water line demarcation between apparent and demarcation between apparent and inapparent disease.inapparent disease.

In hypertension , diabetes , etc, unknown morbidity far exceeds known morbidity.In hypertension , diabetes , etc, unknown morbidity far exceeds known morbidity.

CONCEPTS OF HEALTHCONCEPTS OF HEALTH

1.1. Biomedical conceptsBiomedical concepts

2.2. Ecological conceptsEcological concepts

3.3. Psychosocial conceptPsychosocial concept

4.4. Holistic conceptHolistic concept

1. 1. Biomedical conceptBiomedical concept

absence of diseaseabsence of disease

inadequate to solve major health inadequate to solve major health problems (malnutrition, chronic diseases, problems (malnutrition, chronic diseases, accidents)accidents)

2. 2. Ecological conceptsEcological concepts

dynamic equilibrium between man dynamic equilibrium between man and his environment.and his environment.

disease : maladjustment of the human disease : maladjustment of the human organism to environment.organism to environment.

3. 3. Psychosocial conceptPsychosocial concept

health is influenced by social , health is influenced by social , psychological, cultural, economic and psychological, cultural, economic and political factors.political factors.

4.4. Holistic conceptHolistic concept

all sectors of society have an effect all sectors of society have an effect on health.on health.

health implies a sound mind, in a health implies a sound mind, in a sound body, in a sound family, in a sound body, in a sound family, in a sound environment.sound environment.

CHANGING CONCEPTS IN CHANGING CONCEPTS IN PUBLIC HEALTHPUBLIC HEALTH

Disease control phaseDisease control phase aimed at the control of man’s physical aimed at the control of man’s physical

environmentenvironment eg: Water supply ,sewage disposal, etceg: Water supply ,sewage disposal, etc

Health promotion phaseHealth promotion phase mother and child health servicesmother and child health services school health servicesschool health services industrial health servicesindustrial health services mental health & rehabilitation servicesmental health & rehabilitation services

2 movements were initiated2 movements were initiated

1.1. Basic health services – primary health Basic health services – primary health centres, subcentrescentres, subcentres

2. Community development programme2. Community development programme

Social Engineering phase [1960 – 1980]Social Engineering phase [1960 – 1980] Social and behavioral aspects of disease and Social and behavioral aspects of disease and

health given priorityhealth given priority ””risk factors” as determinants of diseases came into risk factors” as determinants of diseases came into

existenceexistence

Health for all phase [1981 – 2000]Health for all phase [1981 – 2000] Members of WHO pledged “Health for all by the Members of WHO pledged “Health for all by the

year 2000”year 2000” The organized application of local, state, national and The organized application of local, state, national and

international resources permit all people to lead a international resources permit all people to lead a socially and economically productive lifesocially and economically productive life

CHARACTERISTICS OF AN CHARACTERISTICS OF AN IDEAL PUBLIC HEALTH IDEAL PUBLIC HEALTH

MEASUREMEASURE

1. Of proven efficacy in the reducton of 1. Of proven efficacy in the reducton of the targeted disease.the targeted disease.

2. Medically and dentally safe. 2. Medically and dentally safe.

3. Easily and efficiently implemented, 3. Easily and efficiently implemented, utilizing a relatively small amount of utilizing a relatively small amount of materials, supplies and equipment.materials, supplies and equipment.

4. Readily administered by non dental 4. Readily administered by non dental personnel.personnel.

5. Readily available and accessible to 5. Readily available and accessible to large numbers of individuals.large numbers of individuals.

6. inexpensive, therefore affordable by the 6. inexpensive, therefore affordable by the majority. majority.

7. Uncomplicated and easily learned by 7. Uncomplicated and easily learned by the utilizers.the utilizers.

8. Administered with maximum 8. Administered with maximum acceptance on the part of the patient.acceptance on the part of the patient.

TOOLS OF DENTAL PUBLIC TOOLS OF DENTAL PUBLIC HEALTHHEALTH

1. Epidemiology1. Epidemiology

- the branch of medical science dealing - the branch of medical science dealing with epidemics.with epidemics.

- the study of the distribution and - the study of the distribution and determinants of health related events in determinants of health related events in population.population.

AimsAims

Minimize / eradicate the disease of health Minimize / eradicate the disease of health problem and its consequences.problem and its consequences.

Minimize the chances of its occurrence in Minimize the chances of its occurrence in futurefuture

ObjectiveObjective

to define the magnitude and occurrence of disease to define the magnitude and occurrence of disease conditions in man.conditions in man.

to identify the etiologic factors responsible for above to identify the etiologic factors responsible for above conditions.conditions.

to provide data necessary for planning, implementation and to provide data necessary for planning, implementation and evaluation of programmes for evaluation of programmes for

- preventing- preventing - controlling- controlling - treating diseases- treating diseases

2. Biostatistics2. Biostatistics

- statistics is the science of competing, - statistics is the science of competing, classifying and tabulating numerical data classifying and tabulating numerical data and expressing the results in a and expressing the results in a mathematical / graphical formmathematical / graphical form

- biostatistics is that branch of statistics - biostatistics is that branch of statistics concerned with mathematical facts and concerned with mathematical facts and data relating to biological events.data relating to biological events.

usesuses

to define normallyto define normally to test whether the difference between two to test whether the difference between two

populations, regarding a particular attribute is real populations, regarding a particular attribute is real or a chance occurrenceor a chance occurrence

to study the correlation or association between to study the correlation or association between two or more attributes in the same populationtwo or more attributes in the same population

to evaluate the efficacy of vaccines, sera, etc, by to evaluate the efficacy of vaccines, sera, etc, by control studiescontrol studies

to evaluate achievements of public health to evaluate achievements of public health programmesprogrammes

to fix priorities in piblic health programmesto fix priorities in piblic health programmes

3. Social Sciences3. Social Sciences

- usually include - usually include sociologysociology cultural anthropologycultural anthropology psychologypsychology - social scientist become necessary when effort and - social scientist become necessary when effort and

effect do not match each other and we want to effect do not match each other and we want to know whyknow why

- new health programmes prepared to aid public - new health programmes prepared to aid public health worker in planning, evaluation, fluoridation,etc, health worker in planning, evaluation, fluoridation,etc, in interest of dental professionin interest of dental profession

4. Principles of administration4. Principles of administration

organization :organization : deals with the structure of an agencydeals with the structure of an agency way people are arranged into working way people are arranged into working

groups within itgroups within it

management :management : handling of personnel and operations in handling of personnel and operations in

such a way that the work of agency gets such a way that the work of agency gets donedone

5. Preventing Dentistry5. Preventing Dentistry

levels of prevention :levels of prevention : primary primary health promotion health promotion specific protection specific protection [immunization, hygiene][immunization, hygiene]

secondary secondary early diagnosis early diagnosis prompt treatmentprompt treatment

tertiary tertiary disease control disease control

Procedural steps in dental public Procedural steps in dental public healthhealth

1. Survey1. Survey

2. Analysis2. Analysis

3. Programme planning3. Programme planning

4. Programme operation4. Programme operation

5. Financing5. Financing

6. Programme appraisal6. Programme appraisal

1. Survey1. Survey - based on chief complaint of the population- based on chief complaint of the population

- surveys are methods for collection of data, analysing and - surveys are methods for collection of data, analysing and evaluating them in order to determine the amount of disease evaluating them in order to determine the amount of disease problems in a community problems in a community

- parameters included in survey :- parameters included in survey : assessment of socioecoomic status of communityassessment of socioecoomic status of community nature of distribution of communitynature of distribution of community resources available for elimination of problemresources available for elimination of problem attitudes of community towards health providersattitudes of community towards health providers

2. Analysis2. Analysis

- to define characteristics of specific - to define characteristics of specific health problems in the communityhealth problems in the community

- electronic data processing medias - electronic data processing medias such as computers are resorted for such as computers are resorted for analysing dataanalysing data

3. Programme planning3. Programme planning

- designed programme should be accepted - designed programme should be accepted by the community and the people shold by the community and the people shold show an interest in it.show an interest in it.

- it has to be ensured that the community - it has to be ensured that the community is well informed about the programme and is well informed about the programme and that they participate in all steps involvedthat they participate in all steps involved

4. Programme operation4. Programme operation

- a public health team constituting - a public health team constituting professionals in various disciplesprofessionals in various disciples

- employed for excecuting the programme- employed for excecuting the programme

- eg : water fluoridation in a community with - eg : water fluoridation in a community with higher prevalence of dental carieshigher prevalence of dental caries

5. Financing5. Financing

- through funds provided by the - through funds provided by the governments / by local or state authoritiesgovernments / by local or state authorities

- public health personnel - public health personnel

identify source for securing fundsidentify source for securing funds

plan for the management of sameplan for the management of same

6. Programme appraisal6. Programme appraisal

- effectiveness of programme is assessed- effectiveness of programme is assessed

- dimensions : efficiency- dimensions : efficiency

appropriatenessappropriateness

adequacyadequacy

possible side effectspossible side effects

SIMILARITIES BETWEEN SIMILARITIES BETWEEN PERSONAL AND COMMUNITY PERSONAL AND COMMUNITY

HEALTH CAREHEALTH CARE PATIENTPATIENT

1. Examination1. Examination

2. Diagnosis2. Diagnosis

3. Treatment planning3. Treatment planning

4. Treatment4. Treatment

5. Payment for service5. Payment for service

6. Evaluation6. Evaluation

COMMUNITYCOMMUNITY

1. Survey1. Survey

2. Analysis2. Analysis

3. Programme planning3. Programme planning

4. Programme operation4. Programme operation

5. Finance5. Finance

6. Approval6. Approval

DIFFERENCES BETWEEN DIFFERENCES BETWEEN PRIVATE DENTAL PRACTICE PRIVATE DENTAL PRACTICE

AND PUBLIC HEALTH AND PUBLIC HEALTH DENTISTRYDENTISTRY

CharacteristicCharacteristic Private Dental Private Dental PracticePractice

Public Health Public Health DentistryDentistry

TargetTarget Individual Individual patientpatient

community or community or group of group of individualsindividuals

Collection of Collection of informationinformation

History taking History taking and oral clinical and oral clinical examinationexamination

Analysis of Analysis of available health available health and morbidity and morbidity recordsrecords

Differences…Differences…

Special Special investigationsinvestigations

Radiography, Radiography, blood test, blood test, biopsies, biopsies, exfoliative exfoliative cytologycytology

Epidemiological Epidemiological surveyssurveys

ConclusionsConclusions DiagnosisDiagnosis Situational Situational analysis of oral analysis of oral health status health status and needs and and needs and utilization of utilization of servicesservices

Differences…Differences…

Remedial Remedial MeasuresMeasures

Treatment plan Treatment plan based on based on diagnosis, diagnosis, patients patients attitudes and attitudes and affordabilityaffordability

Action plan Action plan based on based on demands, demands, available available resources and resources and prioritiespriorities

Major emphasisMajor emphasis Curative and Curative and restorative carerestorative care

Promotive and Promotive and preventive carepreventive care

Differences…Differences…

Requirements Requirements for successfor success

Patient’s Patient’s consent and consent and co-operationco-operation

Community Community ParticipationParticipation

Service Service providerprovider

Dentist alone, Dentist alone, sometimes with sometimes with an assistantan assistant

Health team Health team professionals professionals and para and para professionals, professionals, community community volunteersvolunteers

Differences…Differences…

InterventionIntervention Appropriate Appropriate dental dental procedureprocedure

Promotive and Promotive and preventive preventive measure at measure at individual and individual and community levelcommunity level

Supportive Supportive DisciplinesDisciplines

PsychologyPsychology Sociology, Sociology, Social Social psychology, psychology, Education, Education, Epidemiology Epidemiology and and BiostatisticsBiostatistics

Differences…Differences…

Organization & Organization & ManagementManagement

Not relevantNot relevant Very relevantVery relevant

PerspectivePerspective ImmediateImmediate Long termLong term

Evaluation & Evaluation & ResultsResults

Relief of Relief of symptoms and symptoms and restoration of restoration of functionfunction

Formal Formal programme programme evaluationevaluation

Differences…Differences…

AftercareAftercare Recall, Further Recall, Further sittingssittings

Continuing Continuing care, Self carecare, Self care

FundingFunding Generally by Generally by the patientthe patient

Generally by Generally by Government or Government or Local Local authoritiesauthorities

SERVICES PROVIDED SERVICES PROVIDED THROUGH PUBLIC HEALTH THROUGH PUBLIC HEALTH

DENTISTRYDENTISTRY Health educationHealth education Dental Health camps Dental Health camps Dental treatmentsDental treatmentsExtractionExtraction Oral prophylaxisOral prophylaxis Flouride applicationsFlouride applications Oral hygiene measureOral hygiene measure School Health ProgrammeSchool Health Programme Application of Caries Preventive measuresApplication of Caries Preventive measures Demonstration of dental preventive methods and Demonstration of dental preventive methods and

procedures to the communityprocedures to the community Dental Public Health activities and field experiences for Dental Public Health activities and field experiences for

dental studentsdental students

CONCLUSIONCONCLUSION

Kindness, concern and love for Kindness, concern and love for the art of healing earned Hippocrates the the art of healing earned Hippocrates the immortal title of ‘The Father of Medicine’.immortal title of ‘The Father of Medicine’.

The dental profession has primary The dental profession has primary responsibilitiy for the oral health care of responsibilitiy for the oral health care of the public.the public.