Community Dental Health and Research Principles

Primary prevention

Prevents disease before it occurs

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Ex. sealants and water fluoridation

Examples of primary prevention

Fl for prevention
Health education and promotion

Secondary prevention

Routine Tx to terminate the disease process or restore tissues to as normal as possible; RESTORATIVE CARE (i.e., periodontal debridement, sealants for incipient caries)

Tertiary prevention

Replacement of lost tissues through rehabilitation- disease has done its damage (i.e., crowns, partials)

Example of tertiary prevention

Implants

Dental Hygiene Tx/Process of Care

Assessment, diagnosis, planning, implementation, Evaluation, and documentation by RDH (ADPIED)

Last step in DH process of care (ADPIE\____)

Documentation by RDH

Optimal Fl level in drinking water is

0.7 ppm

Xylitol

Inhibits bacteria's ability to metabolize sugar. In other words, antibacterial effect against decay causing bacteria

5 Dimensional health model

Physical (food, TB, floss)
Intellectual/mental (knowledge)
Emotional (trust)
Social (interaction w ppl)
Spiritual (values, morals)

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PIE...So Scrumptious

Maslow Hierarchy of Needs

LOWEST TO HIGHEST:
Physiological, Safety, Love & belonging, Self esteem, Self actualization needs

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Pumpkin Spice Latte...So Scrumptious

T or F: In Maslow Hierarchy of Needs, one must meet lower level need before the next higher need can be met

True

Theory of Stages of Learning

LOW TO HIGH:

Unawareness

Awareness

Self interest

Involvement

Action

Habit

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Unicorns Are So Incredible And Happy

DH Process of care: Planning

Developing a lesson plan

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Develop a goal and several objectives

Goal

Broad statement about the expected outcome when project is complete

Objectives

Specific and observable actions that the learner can preform; steps to achieve the goal of a program

The\_____for your program is set FIRST...then you develop measurable\______

Goal, Objectives

Summative evaluation

Evaluation of program after implementation

Formative evaluation

Internal evaluation of the program during planning

Dental Examinations Classifications

Type 1 Complete Exam
Type 2 Limited Exam
Type 3 Inspection
Type 4 Screening

Type 1- Complete Exam

Preformed if Tx is planned
Mouth mirror, explorer, adequate illumination, thorough rads, study models, and other tests needed
Least used in community health

Type 2- Limited Exam

Preformed if Tx is planned
Mouth mirror, explorer, adequate illumination
Posterior bitewing radiographs and select periapicals

Type 3- Inspection

Mouth mirror, explorer, adequate illumination
*Most common in community health*

Type 4- Screening

Tongue depressor and available illumination
Least valid exam; largest number of errors

Similar dental exam classifications\________; if it uses a \_________it's\___________

Type 3 & Type 4; tongue depressor; Type 4

Cumulative index

All past & present evidence of condition

Most common site for oral cancers

Tongue

Cancer screenings should be performed at

Every dental exam

Oral Hygiene Indices

Patient Hygiene Performance (PHP)
Plaque Index (PI)
Oral Hygiene Index (OHI)
Volpe-Manhold (VMI)

Patient Hygiene Performance (PHP)

Reversible


Uses disclosing solution


Assess performance in removing plaque and debris after toothbrushing instructions

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0 Plaque absent 1 Plaque present

Plaque Index (PI)

Reversible


Uses probe to assess plaque


Assess THICKNESS of plaque at the gingival margin

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Code 0: No Plaque

Code 1: Thin Plaque

Code 2: Moderate Plaque

Code 3: Severe Plaque

Oral Hygiene Index (OHI)

Reversible


Used to measure oral hygiene status
Observable DEBRIS (PLAQUE) and CALCULUS

(DI-S) (CI-S)

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GOOD FAIR POOR

Volpe-Manhold (VMI)

Reversible


Used to test for plaque control and calculus inhibition


Measures supra gingival calculus formation following prophylaxis

Gingivitis Indices

Gingival Index (GI)
Gingival Bleeding Index (GBI)
Sulcular Bleeding Index (SBI)
Eastman Interdental Bleeding Index

Gingival Index (GI)

Reversible
Uses probe
Based on severity of inflammation and location
Determines prevalence and severity of gingivitis in groups

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Use four surfaces on six indicator teeth

0= Normal gingiva

1= Mild inflammation (No Bleeding)

2= Moderate inflammation (Bleeding)

3= Severe inflammation, ulcerated tissue with tendency toward spontaneous bleeding

Gingival Bleeding Index (GBI)

Reversible
Uses unwaxed floss
Check for bleeding and delayed bleeding- gingival inflammation

0- No bleeding
1- Bleeding

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Bleeding or No bleeding

Sulcular Bleeding Index (SBI)

Reversible
Uses probe
Designed to detect early symptoms of gingivitis

Wait 30 sec after probing

Eastman Interdental Bleeding Index (EIBI)

Reversible
Uses wooden interdental cleaner
Assess papillary bleeding - indicates inflammation

0- No bleeding 1- Bleeding

Periodontal Indices

Periodontal Index (PI)
Periodontal Disease Index (PDI)
Periodontal Screening & Recording (PSR)
Community Periodontal Index of Treatment of Needs (CPITN)

Periodontal Index (PI)

Irreversible
Clinical exam alone or with radiographs
Each tooth scored based on condition of surrounding tissue
Does not measure loss of attachment - question of validity

0= Healthy 1= Bleeding 2= Calculus 3= shallow pockets 4= Deep pockets CPITN (COMMUNITY PERIODONTAL INDEX OF TREATMENT NEEDS) MOST IMPORTANT

Periodontal Disease Index (PDI)

Irreversible
Modified version of PI- using Ramjord's teeth (only 6 teeth
Measures the prevalence and severity of perio. disease
Measures both reversible (gingival) and irreversible (attachment loss) of perio. disease
3, 8, 14, 19, 24, 30

Periodontal Screening & Recording (PSR)

- Classifies perio. Tx needs quickly and efficiently
- Preliminary screening tool to determine need for full-mouth perio. assessment
-Requires use of special probe

Community Periodontal Index of Treatment of Needs (CPITN)

Developed by World Health Organization (WHO)
Determines perio. needs rather than perio. status
Requires use of special probe

Measures pockets, bleeding and dental biofilm retention factors (also measures calculus)

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RECORED THE HIGHSET READING IN THE SEXTANT

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Code 0: No bleeding No calculus No Defective margin

Code 1: Bleeding No calculus No Defective margin

Code 2: Bleeding and calculus No Defective margin

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(See pt treatment needs)

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Dental Caries Indices

Caries Management by Risk Assessment (CAMBRA)
Decayed, Missing, Filled Teeth/Decayed, Missing, Filled Surfaces (DMFT/DMFS)
decayed, need for extraction, filled teeth (deft)
Root Caries Index (RCI)

Caries Management by Risk Assessment (CAMBRA)

Method of identifying the cause of disease through the assessment of risk factors

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Individualized for each pt

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Risk factors must be individually managed through behavioral, chemical or minimally invasive procedures

Decayed, Missing, Filled Teeth/Decayed, Missing, Filled Surfaces (DMFT/DMFS)

No third molars, therefore 28 teeth are counted

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Irreversible

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Used to Measure PAST & PRESENT caries of PERMANENT DENTITION

decayed, need for extraction, filled teeth (deft)

20 teeth are counted

Irreversible

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Measures observable caries experience in primary teeth

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Does not take into account teeth that have been extracted/exfoliated due to PAST caries experience

Root Caries Index (RCI)

Irreversible

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Assess the extent of root caries experience

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Only takes into account areas of root exposure

Dean's Index of Fluorosis

Irreversible

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Rates fluorosis within a population

INcidence rate

How many NEW cases are seen in a population (i.e., water coming into the bathtub)

Prevalence

Total number of cases at a given time; ALL EXISTING (i.e., standing water in the bathtub)

Null hypothesis

Stated as a negative outcome
i.e., there's no statistically significant difference between...

Research hypothesis

Stated as a positive outcome
i.e., there's a statistically significant difference between...

A\_____is a representative subset of a population

Sample

\______sample is most accurate

Large

Random sample

Every subject is selected independently and randomly
Reduces chances of bias

Systematic sample

Select every "nth" to participate

Convenience sample

Group is already together and convenient
Easy for evaluator
Creates bias

Retrospective research design

Investigates possible causes of disease
Uses medical records

Longitudinal research design

A group is observed over a long period of time

Experimental research design

Most familiar type of research
Known as CLINICAL TRIAL
Investigates cause and effect
Manipulation of variables
Can be conducted as a double blind study

Control group

What stays constant in the study- often receives placebo (no Tx)

Independent variable

Variable that is being manipulated

Dependent variable

Outcome that is being studied

Double-blind study

Neither the researcher nor the participants know who is in the control group (placebo) and who is in the group receiving the Tx (independent variable)

Quasi-experimental research design

Experimental study that does not have a control group
Unethical

Pilot study research design

A small version of a study. A trial run to test it for the long term study

Institutional Review Board (IRB)

Reviews the ethical implications of research study
Ensures safety

Interval scale

All characteristics of ordinal scale, PLUS equal distance between units of measurement

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No absolute zero point- so number can be negative i.e., temp.

Ratio scale

All characteristics of interval scale, PLUS has absolute zero point

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Can apply all arithmetic i.e., money, height

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Between two numbers NO DENOMINATOR (BOTTAM NUMBER)

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Ex- 3:2 men will have something out of 3:2 women

Normal distribution (Gaussian distribution)

Bell-shaped curve; symmetrical and unimodal
*Mean, median, and mode are equal*

Skewed distribution

Distribution of scores asymmetrical; curve distorted

Positively skewed

Curve shifted to left; more scores in lower range

Negativley skewed

Curve shifted to right; more scores in higher range

Measures of Dispersion

How much variation is present in a group of data

Standard deviation

Square root of the variance
*Most common/useful measure of dispersion*

Inferential statistics

Can generalize from a sample to a larger group of subjects

Correlation Co-efficient Value (r-value)

Shows strength of relationship between two variables

Correlation

Relationship/association between the variables

Correlation Co-efficient value
Signified by r-value:
ranges from -1 to +1
closer r is to 1\_______ the relationship
closer r is to 0\_______ the relationship

Stronger, weaker

Direct relationship between two variables
As value of x increases, value of y increases; same with decrease
r\= +1, shows\_________

Positive correlation

Inverse relationship between two variables
As value x increases, value of y decreases; vice versa
r\= -1, shows\_________

Negative correlation

INTRA-examiner reliability

Consistent performance by the same investigator when using a data collection instrument.


i.e., your probing depths being consistent each time you collect data

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One person

INTER-examiner reliability

Consistent performance by the different investigators when using the same data collection instrument.

i.e., probe depths being consistent amongst a group of examiners

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More than one person

Epidemiology

The study of patterns and determinants of health and disease conditions in defined populations

\_______is multifactorial

Disease

Endemic

Disease occurring frequently and at a predictable rate in a specific location or population'

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WILL ALWAYS BE THERE BUT LOW AND CONSTANT

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EX: Malaria in many African countries Chicken pox in North America

EPidemic

Occurrence of disease in excess of normal in a community/region

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Usually occurring Unexpectedly and spreading raPidly in large numbers. aka "outbreak"

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STAYS IN ONE AREA such as a community and region

Pandemic

An epidemic in which the disease my cross international borders to affect several countries

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Spread worldwide

Morbidity

Extent of disease/injury in a defined population

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HOW SICK ARE YOU

Disease rate

Expression of disease in a population in a given period of time

Causality

An exposure results in a particular outcome- cause and effect

Risk

The probability that a specified event will occur

Risk factor

Modifiable attribute

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Identified with longitudinal studies (over time) i.e., smoking and perio. relationship

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CAUSALLY ASSOCIATED WITH THE DISEASE (SMOKING LEADS TO PERIODONTAL DISEASE)

Risk indicator

Modifiable attribute

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Suspected risk, but not confirmed with longitudinal studies

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NOT CAUALLY ASSOCIATED WITH THE DISEASE (STRESS, OSTEOPOROSIS MAY INFLUENCE PERIODONTAL DISEASE)

Risk marker

Non-modifiable attribute
(Age, gender, race, SES, etc)
QUANTITATIVE ASSOCIATION WITH DISEASE

Fluoride Preventive Strategies

Fluoride supplements, varnishes, toothpaste

Dental sealant

Prevent pit and fissure caries
Place as soon as possible after eruption

Alternative Restorative Treatment (ART)

Sealing a tooth after removing demineralized tooth surfaces manually

nutritional counseling

Diet is a major etiologic factor in dental caries