To develop, adopt and encourage pro-active programs to progressively develop oral health care world-wide.
To provide a comprehensive information and communication system for making relevant information available to members, the media and governments.
The aim of public health is to enhance the health of population. The study of the oral health in the community will require an appreciation of other disciplines like:
Sociology and psychology, Epidemiology,
Health economics, Health promotion, Health education,
Health service organizational methods Medical statistics.
TOOLS OF DENTAL PUBLIC HEALTH
1. Epidemiology 2. Biostatistics 3. Social sciences 4. Principles of administration 5. Preventive dentistry 1. Epidemiology
Defined as ‘the study of the distribution and determinants of health related states or events in specified populations and the application of this study to control health problems’. [Last 1988]
Uses
1. Concerned with course and outcome [natural history] of disease in individuals and groups.
2. Causation of disease.
3. Used to describe the health status of the population group
4. Helps in evaluating effectiveness and efficiency of health services [intervention]
2. Biostatistics
It is the method of collection, organizing, analyzing, tabulating and interpretation of datas related to living organisms and human beings.
Uses
1. To test whether the difference between two populations, regarding a particular attribute is real or a chance occurrence.
2. To define normalcy.
3. To study the association between two or more attribute in the same population.
4. To evaluate the efficacy of vaccines by controlled studies.
5. To evaluate the progress of public health programs.
6. To define and measure the extent of morbidity and mortality in the community.
3. Social Science
It includes sociology, cultural anthropology and psychology. Sociology is the study of human groups. Sociology is not concerned with behavior unique to individuals but patterned human relationship.
4. Principles of administration
Sound administration is essential for the success of any public health program whether on the national, intermediate or the local level.
Administration is defined as “the art and science of guidance, leadership, and control of the efforts of a group of individuals towards some common goal”.
Management is the operational part of administration. It is defined as: “It is a set of interactive processes through which the utilization of resources results in the accomplishment of organization objectives.” It is a “conversion mechanism”.
It is through “management” that the objectives of the health care organization are achieved by gathering and positioning of resources.
Elements of Administration: Planning Organization Staffing Directing Coordinating Reporting Budgeting Supervising Evaluation 5. Preventive dentistry
Prevention is defined as “actions aimed at eradicating, eliminating or minimizing the impact of diseases and disability. The concept of prevention is best defined in the context of levels, traditionally called, primary, secondary and tertiary prevention”.
PROCEDURAL STEPS IN DENTAL PUBLIC HEALTH
1. Survey 2. Analysis
3. Program planning
4. Ethics and planning approval 5. Program operation
6. Financing
7. Program appraisal
Stages of Clinical and Public Health Practice
1. Examination/survey
A clinical dentist carries out a thorough and careful examination on the 1st visit of the patient which includes
N
Table 9.3: Differences between personal/private practitioner and community health dentist
Private Community health dentist
1. Works more or less alone 1. Works in a team
2. Focus on individual patient 2. Focus is on community
3. Independent decision maker regarding line of treatment 3. Decision taken by governing body or advisory council 4. Higher take home pay but less fringe benefits 4. Salaried with fringe benefits like pension plan etc. 5. Priorties of individual care may be coincidentally 5. Goals are socially determined, and seeks to minimize
related to social goals. Private care seeks to maximize the the chance of worst outcome chance of best possible outcome
6. Patient consent and cooperation required 6. Requires community participation
7. Intervention includes appropriate dental procedure 7. Promotive and preventive measures at individual and community levels are carried out
8. Payment for treatment by individual 8. Funding by government authorities 9. Emphasis on curative and restorative care 9. Emphasis on promotive and preventive care
a history and clinical assessment. This helps in future treatment planning for patient. Survey is 1st step in public
health practice. It means clinical assessment of the extent and severity of disease in a population. Here the public health dentist examines the population to assess the oral health problem unlike a single patient by clinical dentist. 2. Diagnosis/analysis
A clinical dentist makes a diagnosis of the problem based on the examination. In public health the information collected by survey is analyzed. The analysis of data is done to make the obtained data more meaningful. Statistician and computers aid in compilation of data. 3. Treatment planning/program planning
Treatment planning includes both dentist and patient participation. Dentist’s professional judgment of treatment, patient interest in treatment and cost factor etc. are involved. The patient may accept the treatment in full or partially or may reject it completely.
In program planning similarly the people may accept the ideal program with enthusiasm or may reject it or accept only a part of it. The decision reflects the community’s relative value solving the particular health problem.
4. Informed consent/ethics and planning approval
Informed consent of the patient is taken before starting any treatment. Patient is explained all aspect of treatment planned. Similarly all ethical clearance and approval from all the concerned persons and authorities is taken before implementing a public health program.
5. Treatment/program operation
After taking consent the treatment schedule is arranged. Complex treatment may require services of various specialists for different procedures, which is coordinated by the primary dentist.
Similarly once a community public health program has been adopted, a varied group of discipline which constitutes a public health team may be utilized for execution of the program.
6. Payment/finance
Payment for treatment in a clinical setup is informed to the patient and mode of payment acceptable to both the dentist and patient is arranged.
Funds for community public health program are arranged by local, state or federal grants. The public health professional is expected to know how to secure and manage the funds. Local or voluntary organization may also contribute towards the program. Differences have been shown in the following Table 9.3.
7. Evaluation/program appraisal
Patient is evaluated by the dentist regularly during the course of treatment. Recording of initial condition helps to compare with later observations.
Similarly data collected in initial surveys serves as a baseline against which effectiveness of an oral health program can be evaluated or assessed. Public health team is accountable to the community for a periodic appraisal of their program.
Role of a Public Health Dentist
A public health dentist can play a role in community or field based programs like:
Dental public health professionals work with the school- based fluoride mouth rinse program.
Suggestion and guidance on Community and school water fluoridation program.
Classroom-based education for elementary school children on dental health, plaque awareness, and tobacco use prevention.
Community oral health education and prevention initiatives in partnership with private dentists and other health care groups.
Spit Tobacco Education Program activities
Community dental sealant, dental screening, early childhood caries, and baby bottle tooth decay education programs.
Prevent abuse and neglect through Dental Awareness program.